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Home My WebLink About03-1314 II II WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY , PENNSYLVANIA II vs. CIVIL ACTION - LAW NO. 03-13/4 DONALD W. CHESBRO, Defendant IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the foregoing pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree in divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at: Office of the Prothonotary Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 IF YOU DO NOT FILE A CLAIM FOR ALIMONY , DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 Telephone: (717) 249-3166 II WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. DONALD W. CHESBRO, Defendant IN DIVORCE NOTICE OF AVAILABILITY OF COUNSELING TO THE WITHIN-NAMED DEFENDANT: You have been named as the Defendant in a Complaint in a divorce proceeding filed in the Court of Common Pleas of Cumberland County. This notice is to advise you that in accordance with Section 3302 (d) of the Divorce Code, you may request that the court require you and your spouse to attend marriage counseling prior to a divorce being handed down by the court. A list of professional marriage counselors is available at the Domestic Relations Office, 13 North Hanover Street, Carlisle, Pennsylvania. You are advised that this list is kept as a convenience to you and you are not bound to choose a counselor from this list. All necessary arrangements and the cost of counseling sessions are to be borne by you and your spouse. If you desire to pursue counseling, you must make your request for counseling within twenty days of the date on which you receive this notice. Failure to do so will constitute a waiver of your right to request counseling. 1/ WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW DONALD W. CHESBRO, Defendant NO. IN DIVORCE COMPLAINT IN DIVORCE AND NOW comes the above-named Plaintiff, WENDY S. CHESBRO, by her attorney, Samuel L. Andes, and makes the following Complaint in Divorce: 1. The Plaintiff is WENDY S. CHESBRO, an adult individual who currently resides at 2704 Warren Way in Mechanicsburg, Cumberland County, Pennsylvania. 2. The Defendant is DONALD W. CHESBRO, an adult individual who currently resides at 906 West North Street in Carlisle, Cumberland County, Pennsylvania. 3. Both the Plaintiff and Defendant have been bona fide residents of the Commonwealth of Pennsylvania for at least six months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on 31 May 1995 in Arlington County, Virginia. 5. There have been no prior actions of divorce or annulment between the parties. 6. The marriage is irretrievably broken. 7. Plaintiff has been advised of the availability of marriage counseling and the Plaintiff may have the right to request that the Court require the parties to participate in counseling. COUNT I - IRRETRIEVABLE BREAKDOWN 8. The Plaintiff requests this Court to enter a Decree in Divorce. WHEREFORE, Plaintiff requests this Court to enter a Decree in Divorce pursuant to the Divorce Code of Pennsylvania. II COUNT II - EQUITABLE DISTRIBUTION 9. During the course of the marriage, the parties have acquired numerous items of property, both real and personal, which are held in joint names and in the individual names of each of the parties hereto. WHEREFORE, Plaintiff prays this Honorable Court, after requiring full disclosure by the Defendant, to equitably divide the property, both real and personal, owned by the parties hereto as martial property. COUNT III - ALIMONY 10. Plaintiff lacks sufficient property to provide for her reasonable needs in accordance with the standard of living of the parties established during the marriage. 11. Plaintiff is unable to support herself in accordance with the standard of living of the parties established during the marriage through appropriate employment. 1 2. The Defendant is employed and enjoys a substantial income from which he is able to contribute to the support and maintenance of the Plaintiff and pay her alimony in accordance with the Divorce Code of Pennsylvania. WHEREFORE, Plaintiff prays this Honorable Court to enter an Order awarding Plaintiff from Defendant permanent alimony in such sums as are reasonable and adequate to support and maintain Plaintiff in the station of life to which she has become accustomed during the marriage. COUNT IV - ALIMONY PENDENTE LITE 13. Plaintiff is without sufficient income to support and maintain herself during the pendency of this action. 14. Defendant enjoys a substantial income and is well able to contribute to the support and maintenance of Plaintiff during the course of this action. WHEREFORE, Plaintiff prays this Honorable Court to order Defendant to pay her reasonable alimony pendente lite during the pendency of this action. COUNT V - COUNSEL FEES AND EXPENSES 1 5. Plaintiff is without sufficient funds to retain counsel to represent her in this matter. 16. Without competent counsel, Plaintiff cannot adequately prosecute her claims against Defendant and cannot adequately litigate her rights in this matter. II 1 7. Defendant enjoys a substantial income and is well able to bear the expense of Plaintiff's attorney and the expense of this litigation. WHEREFORE, Plaintiff prays this Honorable Court to order Defendant to pay the legal fees and expenses incurred by Plaintiff in this litigation of this action. c~ Samuel L. And' . Attorney for Plaintiff Supreme Court ID # 17225 525 North 12th Street Lemoyne, Pa 17043 (717) 761-5361 " VERI FICA TION I verify that the statements made in this Complaint are true and correct. I understand that any false statements in this Com~laint are subject to the penalties of 18 Pa. C.S. 4904 (unsworn falsification to authoritiei). , J Date: ~ -(l-()~ ^ ~ i!:. '\\. " ~ ....c: VI ~ "tJ '( 0<) --0 ~ b -,... "x.--+- ~ ~ C9 V\ C \::l\.. '-... " ~" ~ d ~ ~"'\;) -' ' ,~ ~ ~ tf ~ c.,.., -- ' 9 ~ ,'>- => -;--- ~ ::.-) _A) .<.:." II WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY CIVIL ACTION - LAW vs. NO. 0 3 - 1.3 /'1 DONALD W. CHESBRO, Defendant IN DIVORCE MOTION AND NOW comes the above-named Plaintiff, by her attorney, Samuel L. Andes, and moves the court to schedule a Domestic Relations confl~rence and enter an order for Alimony Pendente Lite as claimed in her Divorce Complaint, a copy of which is attached hereto. Sa Attorney for Plaintiff Supreme Court ID # 17225 525 North 12th Street Lemoyne, Pa 17043 (717) 761-5361 WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW DONALD W, CHESBRO, Defendant NO. IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court, If you wish to defend against the claims set forth in the foregoing pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree in divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at: Office of the Prothonotary Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OH ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 Telephone: (717) 249-3'166 !' WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW DONALD W. CHESBRO, Defendant NO. IN DIVORCE NOTICE OF AVAILABILITY OF COUNSELING TO THE WITHIN-NAMED DEFENDANT: You have been named as the Defendant in a Complaint in a divorce proceeding filed in the Court of Common Pleas of Cumberland County. This notice is to advise you that in accordance with Section 3302 (d) of the Divorce Code, you may request that the court require you and your spouse to attend marriage counseling prior to a divorce being handed down by the court. A list of professional marriage counselors is available at the Domestic Relations Office, 13 North Hanover Street, Carlisle, Pennsylvania. You are advised that this list is kept as a convenience to you and you are not bound to choose a counselor from this list. All necessary arrangements and the cost of counseling sessions are to be borne by you and your spouse. If you desire to pursue counseling, you must make your request for counseling within twenty days of the date on which you receive this notice. Failure to do so will constitute a waiver of your right to request counseling. WENDY S. CHESBRO, ) IN THE COURT OF COMMON Plaintiff ) PLEAS OF CUMBERLAND ) COUNTY, PENNSYLVANIA ) vs. ) CIVIL ACTION - LAW ) ) NO. DONALD W. CHESBRO, ) Defendant ) IIN DIVORCE COMPLAINT IN DIVORCE AND NOW comes the above-named Plaintiff, WENDY S. CHESBRO, by her attorney, Samuel L. Andes, and makes the following Complaint in Divorce: 1. The Plaintiff is WENDY S. CHESBRO, an adult individual who currently resides at 2704 Warren Way in Mechanicsburg, Cumberland County, Pennsylvania. 2. The Defendant is DONALD W. CHESBRO, an adult individual who currently resides at 906 West North Street in Carlisle, Cumberland County, Pennsylvania. 3. Both the Plaintiff and Defendant have been bona fide residents of the Commonwealth of Pennsylvania for at least six months iimmediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on 31 May 1995 in Arlington County, Virginia. 5. There have been no prior actions of divorce or annulment between the parties. 6. The marriage is irretrievably broken. 7. Plaintiff has been advised of the availability of marriage counseling and the Plaintiff may have the right to request that the Court require the parties to participate in counseling. COUNT I - IRRETRIEVABLE BREAKDOWN 8. The Plaintiff requests this Court to enter a De!cree in Divorce. WHEREFORE, Plaintiff requests this Court to enter a Decree in Divorce pursuant to the Divorce Code of Pennsylvania. COUNT II - EQUITABLE DISTRIBUTION 9. During the course of the marriage, the partiE~s have acquired numerous items of property, both real and personal, which are held in joint names and in the individual names of each of the parties hereto. WHEREFORE, Plaintiff prays this Honorable Court, after requiring full disclosure by the Defendant, to equitably divide the property, both real and personal, owned by the parties hereto as martial property. COUNT III - ALIMONY 10. Plaintiff lacks sufficient property to provide for her reasonable needs in accordance with the standard of living of the parties established during the marriage. 11. Plaintiff is unable to support herself in accordance with the standard of living of the parties established during the marriage through appropriate employment. 12. The Defendant is employed and enjoys a substantial income from which he is able to contribute to the support and maintenance of thH Plaintiff and pay her alimony in accordance with the Divorce Code of Pennsylvania. WHEREFORE, Plaintiff prays this Honorable Court to enter an Order awarding Plaintiff from Defendant permanent alimony in such sums as are reasonable and adequate to support and maintain Plaintiff in the station of life to which she has become accustomed during the marriage. COUNT IV - ALIMONY PENDENTE LITE 13. Plaintiff is without sufficient income to support and maintain herself during the pendency of this action. 14. Defendant enjoys a substantial income and is well able to contribute to the support and maintenance of Plaintiff during the course of this action. WHEREFORE, Plaintiff prays this Honorable Court to order Defendant to pay her reasonable alimony pendente lite during the pendency of this action. COUNT V - COUNSEL FEES AND EXPENSES 15. Plaintiff is without sufficient funds to retain counsel to represent her in this matter. 16. Without competent counsel, Plaintiff cannot adequately prosecute her claims against Defendant and cannot adequately litigate her rights in this matter. 1 7. Defendant enjoys a substantial income and is well able to bear the expense of Plaintiff's attorney and the expense of this litigation. WHEREFORE, Plaintiff prays this Honorable Court to order Defendant to pay the legal fees and expenses incurred by Plaintiff in this litigation of this action. & Gmn Samuel L. ~~ Attorney for Plaintiff Supreme Court ID # 17225 525 North 12th Street Lemoyne, Pa 17043 (717) 761-5361 VERI FICA TION I verify that the statements made in this Complaint are true and correct. I understand that any false statements in this Com~laint are subject to the penalties of 1 8 Pac C.S. .:04 ((~SW_O~:faISification to ~Z~d . r '/(}S " Date: r::-J' ( -D ../ - L' E~D :. ~~BRj 11- F;; ) ! I lj (') ~~; :> , ,1 ...) I -.( 1,_ -< II IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA WENDY S. CHESBRO, Plaintiff CIVIL ACTION - LAW VS. NO. DONALD W. CHESBRO, Defendant IN DIVORCE DRS ATTACHMENT FOR APL PROCEEDINGS PETITIONER NAME WENDY S. CHESBRO ADDRESS 2704 WARREN WAY MECHANICSBURG, PA 17055 BIRTH DATE FEBHUARY 3, 1966 SOCIAL SECURITY NUMBER 174.-46-6193 HOME PHONE 763,-81 34 WORK PHONE 730.-7310 EMPLOYER NAME MICHAEL L. BANGS EMPLOYER ADDRESS 302 SOUTH 18TH STREET Camp Hill, PA 17011 JOB TITLE/POSITION LEGAL SECRETARY DA TE EMPLOYMENT COMMENCED 8-1-1985 GROSS PAY $2,Ei38.36 / MONTH NET PAY $1,701.92 / MONTH OTHER INCOME A TTORNEY'S NAME SAMUEL L. ANDES A TTORNEY'S ADDRESS 525 NORTH 12TH STREET LEMOYNE, PA 17043 A TTORNEY'S PHONE NUMBER 761-5361 II RESPONDENT NAME DONALD W. CHESBRO ADDRESS 906 WEST NORTH STREET CARLISLE, PA 17013 BIRTH DATE JUNE 22, 1961 SOCIAL SECURITY NUMBER 167-40-0698 HOME PHONE 240-2498 WORK PHONE 255..6464 EMPLOYER NAME CITY OF HARRISBURG EMPLOYER ADDRESS 123 WALNUT STREET HARRISBURG, PA JOB TITLE/POSITION FIREFIGHTER DA TE EMPLOYMENT COMMENCED 8/1989 GROSS PAY $58,769.00/ YEAR NET PAY $43,746.00/ YEAR OTHER INCOME A TTORNEY'S NAME A TTORNEY'S ADDRESS A TTORNEY'S PHONE NUMBER MARRIAGE INFORMATION DATE OF MARRIAGE MAY 31,1995 PLACE OF MARRIAGE ARLINGTON COUNTY, VIRGINIA DATE OF SEPARATION FEBRUARY 1, 2003 ADDRESS OF LAST MARITAL HOME 906 WEST NORTH STREET CARLISLE, PA 17013 DESCRIPTION OF DOCUMENT RAISING APL DIVOIRCE COMPLAINT CLAIM DA TE APL DOCUMENT FILED WENDY S. CHESBRO, Plaintiff : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA v. NO. 03-1314 CIVIL TERM DONALD W. CHESBRO, Defendant CIVIL ACTION - LAW IN DNORCE TO THE PROTHONOTARY: PRAECIPE TO ENTER APPEARANCES Kin~ly enter our appearances on behalf of the Defendant in the above- captioned matter. Respectfully submitted, ABOM & KuruLAKIs, L.L.P DATE 04- (05 f03 J~. Hc~6:zt= Kara W. Haggerty, " . e 8 South Hanover Street, Suite 204 Carlisle, Pennsylvania 17013 (717) 249-0900 Attorney for Defendant ID #86914 DATE 1/()/o~ ( I c Jason P. K akis, Esqwre 8 South anover Street, Suite 204 Carlisle, Pennsylvania 17013 (717) 249-0900 Attorney for Defendant ID #80411 (') c s: '"tJ D~' m[~; Z.i. Z[ ~:f' t;;.:C ~Cj "- (~l ~C: z: =< <:) u:> o -on ~; :;u I C..::- --0 ~...;;::.~. (-) n, N <n WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, P A v. NO. 03-1314 CNIL TERM DONALD W. CHESBRO, Defendant CNILACTION -LAW IN DIVORCE ACCEPTANCE OF SERVICE AND NOW, this 3RD day of April, 2003, I, Kara W. Haggerty, Esq., hereby certify that I did receive and accept service of the Complaint in Divorce in the above captioned matter on behalf of the Defendant, Donald Chesbro, and I further certify that I am authorized to do so. Respectfully submitted, MOM & KUTULAKIS, L.L.P DATE -'1!:1..J 0 l f 01. ~. (~4~ Kara W. Haggerty,s . e . 8 South Hanover Street, Suite 204 Carlisle, Pennsylvania 17013 (717) 249-0900 Attorney for Defendant ID #86914 (") c s:: -0 ell fT1 n, 2:-" ~~;, I"{"" ~ -, -=c ..;::(~, $:c ~ ... <::) w o 11 b "-0 ::0 I c." 'i2~; -":-"0 "~O . '~, j .~,~i~; -- "'rl ~~if f,1 -~; $ -< N .~ WENDY S. CHESBRO, PlaintiftlPetitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE DONALD W. CHESBRO, DefendantIRespondent NO. 2003-1314 CIVIL TERM IN DIVORCE Pacses# 150105377 ORDER OF COURT AND NOW, this 24th day of April, 2003, upon consideration of the attached Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shaddav onMav 16.2003 at 9:00 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 1910.11<<;) (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, George E. Hoffer, President Judge Mail copies on 4-24-03 to: Petitioner < Respondent Samuel Andes, Esquire --./1 ~ fJA i 7r /.:.W r . "~.,...,A..,,,;, '. p, ,. (' l' R. 1. Shadday, Conference Officer ' Date of Order: April 24. 20003 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 {)t:/Co '<~... .L: ...; >- 0:: i:!= I,U ~"? (J ~~: -"..- f , St,:'~': ~-j i ; C5 ...::t ~ :J~ Oz O~ ",:::S: '-,....J :!Fir.; ....JZ 0::,2: LultJ Q:) 0.. ~ .:.J o M ,.. Q: Uj N Cc; c... c:;;r 0') o WENDY S. CHESBRO, Plaintiff/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA VS. CIVIL ACTION - DIVORCE DONALD W. CHESBRO, Defendant/Respondent : NO. 2003-1314 CIVIL TERM IN DIVORCE Pacses# 150105377 ORDER OF COURT AND NOW, this 16th day of May, 2003, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $2,083.56 and Respondent's monthly net income/earning capacity is $3,373.99, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $226.00 per month payable bi-weekly as follows; $104.31 bi- weeklly for alimony pendente lite and $0.00 on arrears. First payment due on the first pay after June 6,2003. Arrears set at $0.00 as of May 16, 2003. The effective date of the order is June 6,2003. Respondent is to maintain medical insurance coverage on Petitioner. This order considers that Respondenat has a child support obligation and that the obligation will end on June 6,2003. This orde also considers that Respondent is making the mortgage payment on the marital home that is listed for sale and a sale has fallen through. Respondent is maintaining the utilities on this home for the sale. Respondnet has purchased another home on the basis that the marital home was sold. Respondent is to report to DRO immediately on the sale of the marital home and date oflast mortgage payment and the order will be modified to $516.00 per month. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.g 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the P A SCDU to: . Payments must be made by check or money order. All checks and money orders must be made payable to P A SCDU and mailed to: P A SCDU P.O. Box 69110 Harrisburg, P A 17106-9110 Payments must include the defendant's P ACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. VI!~.f'i,n;,SN\J3d '~~;",,..,,", '---',m;"';tlV 2S :.[ o Z /.";, ." " a,nv"i8- Unreimbursed medical expenses that exceed $250.00 annually are to be paid 0% by the respondent and 100% by petitioner. The petitioner is responsible to pay the first $250.00 annually in unreimbursed medical expenses. Respondent to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the Respondent shall submit written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of: 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy ofthe benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. DRO: R. 1. Shadday Mailed copies on May 19.2003 to; < Petitioner Respondent Samuel Andes. Esquire Jason Kutulakis. Esquire BY THE COURT, J' A. 4.. Kevin A. Hess J. ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsvlvania Co.lCityfDist of CUMBERLAND Dale of OrderfNolice 06/06/03 TribunalfCase Number (See Addendum for case summary) o Original Order/Notice @ Amended Order/Notice o Terminate Order/Notice Employer;W"ithholder's Federal EIN Number RE: CHESBRO, DONALD W. Employee/Obligor's Name (Last, First, M1) CITY OF HARRISBURG C/O PAYROLL OFFICE STE 406 10 N 2ND ST HARRISBURG PA 17101-1677 _- /We ~~ r ,. -..~ rL" - .. 11j"P//)~ 377 U/. /He~s. 7~ g /4'1'1 ~":lt>()(>o ,7 167-40-0698 Employee/Obligor's Social Security Number 6134000027 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 OrderfNolice 10 Wilhhold Income for Support based upon an order for support from CUMBERLAND Counly, Commonweallh of Pennsylvania, By law, you are required to deducI Ihese amounls from Ihe above-named employee'sfobligor's income unli I further nolice even if Ihe OrderfNolice is nol issued by your Slale. $ 905.00 per monlh in currenl support $ 0.00 per monlh in pasl-due support Arrears 12 weeks or grealer? Oyes @ no $ 0.00 per monlh in medical support $ 0.00 per monlh for genelic lesl cosls $ per monlh in olher (specify) for a total of $ 905.00 per month to be forwarded to payee below. You do nol have 10 vary your pay cycle 10 be in compliance wilh Ihe support order. If your pay cycle does nol malch Ihe ordered support paymenl cycle, use Ihe following 10 delermine how much 10 wilhhold: $ 208.85 per weekly pay period. $ 417,69 per biweekly pay period (every Iwo weeks), $ 452,50 per semimonlhly pay period (Iwice a monlh). $ 905.00 per monlhly pay period, REMITTANCE INFORMATION: You musl begin wilhholding no laler Ihan Ihe firsl pay period occurring len (10) working days after Ihe dale of Ihis OrderfNolice, Send paymenl wilhin seven (7) working days of Ihe paydaleldale of wilhholding, You are enlilled 10 deducI a fee 10 defray Ihe cosl of wilhholding, Refer 10 Ihe laws governing Ihe work slale of your employee for Ihe allowable amount The lolal wilhheld amounl, and your fee, cannol exceed 55% of Ihe employee'sf obligor's aggregale disposable weekly earnings, For Ihe purpose of Ihe limilalion on wilhholding, Ihe following informalion is needed (See #10 on pg, 2). If remitting by EFTfEDI, please call Pennsylvania Slale Colleclions and Disbursemenl Unil (SCDU) Employer Cuslomer Service al 1-877-676,9580 for inslruclions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identiiie,) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL',~r;;; ,:;,?~ 'l!'I.1l ~~~~) (.:,..l:i~'" ,\iA.&llL.tiit";"!11<~, BY THE COURT: " -9-()~ < . ",. Dale of Order: JUN 0 9 2003 ' ~ 1(t;",~.N~ 4.. ~IID(,/; Form EN-028 Worker ID $IATT Service Type M OMB No.: 0970-0154 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If !;hecked you are required to provide a ~opy of this form 10 your employee. If your employee works in,a state thai is ditterenffrom the state that issued this order, a copy must be provided to your employee even If the box IS not checked. 1. We appreciate the voluntary compliance of Federally recognizecllndian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice-. 2, Priorily: Wilhholding under Ihis Order/Nollce has prlorily over any olher legal process under Stale law against Ihe 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 lisled below, 3. Combining Payments: You can combine wilhheld amounls from more Ihan one employee/obligor's income In a single payment 10 each agency requesling wilhholding, You musI, however, separalely idenlily the portion of the single paymenl thai Is attributable to each employee/obligor, 4. * Rt!50ltillg ti,e P byda~/Date of \VitLl.oldi"g. YOu II lust ,epol1 ti,e paydatefdate of vvitLllOldillg vvll~" sel,d;"g tL(. parIIlO,t. TI.e paydate/Jare of n;tl,l,vld;hg;;:I tire d&te 01, nlrid. dll.OUllt vv3S vv;t1.I.eld flOIl. tire GlI.ployGe's nages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5,' Employee/Obligor with Mulliple Support Holdings: If Ihere is more Ihan one Order/Nollce to Withhold Income for Support against Ihis employee/obligor and you are unabie 10 honor all support Order/Notices due to Federal or Stale wilhholding limits, you must follow the law oflhe slale of employee's/obligor's principal place of employment. You musl honor all Orders/Notices 10 the grealesl exlenl possible, (See #10 below) 6. Terminalion Nolifiealion: You must promplly nollly Ihe Requesling Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S 10: 2360020100 EMPLOYEE'S/OBlIGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: CHESBRO, DONALD W. 6134000027 DATE OF SEPARATION: 7, Lump Sum Paymenls: You may be required 10 report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8, Liabilily: If you fail 10 wilhhold income as Ihe Order/Nolice directs, you are liable for bolh the accumulaled amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10,' Wilhholding Limits: You may not wllhhold more than Ihe lesser of: 1) Ihe amounts allowed by Ihe Federal Consumer Credll Prolection Act (15 U.s,C, 91673 (b)l; or 2) the amounls allowed by the State of Ihe employee's/obligor's principal place of employment. The Federallimil applies to Ihe aggregate disposable weekly earnings (ADWE). ADWE is Ihe net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11, Addilionallnfo: 'NOTE; If you or your agenl are served wilh a copy of Ihis order in Ihe slale Ihal issued Ihe order, you are 10 follow Ihe law of Ihe slale Ihal issued Ihis order wilh respecl 10 Ihese ilems. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARliSLE PA 17013 If you or your employee/obligor have any queslions, conlacl WAGE ATTACHMENT UNIT by lelephone al (717) 240-6225 or by FAX al (717) 240-6248 or by inlernel www.childsupportslale.pa.us Page 2 of 2 Form E N-028 Worker ID $IATT Service Type M OMB No.: 0970-0154 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CHESBRO, DONALD W. PACSES Case Number 150105377 Plaintiff Name WENDY S, CHESBRO Dockel Attachment Amount 03=1314 CIVIL $ 226,00 Child(ren)'s Name(s): DaB PACSES Case Number 492000037 Plaintiff Name TINA C. DONNELLY Docket Attachmenl Amounl 758894 $ 679,00 Child(ren)'s Name(s): DEVIN CHESBRO DAvIDClIllSBRO DaB 01/06/85 07/29/83 you are required 10 enroll Ihe chlld(ren) in any health insurance coverage available Ihe employee's/obligor's employment. you are required 10 enroll Ihe child(ren) in any health insurance coverage available employee's/obligor's employment. PACSES Case Number Plainliff Name PACSES Case Number Plainli!! Name Dockel Attachmenl Amounl $ 0.00 Child(ren)'s Name(s): DaB Dockel Attachmenl Amount $ 0.00 Child(ren)'s Name(s): DaB you are required to enroll the child(ren) above in any health insurance coverage available employee's/obligor's employment. you are required 10 enroll Ihe child(ren) in any health insurance coverage available employee's/obligor's employment. PACSES Case Number Plainliff Name PACSES Case Number Plaintiff Name ~ Attachmenl Amount $ 0.00 Child(ren)'s Name(s): DaB Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DaB you are required to enroll the child(ren) above in any health insurance coverage available employee's/obligor's employment. you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. Addendum Form EN-028 Worker ID $IATT Service Type M QMB No.: 097().()154 - (") 0 0 c: W 'T1 <' ~:_= .-< Ll n) " no ~-"'" , r- ~:; , ~ :;:: I -'OfTl ZC '~-7C::) co '- ID ! -. .:.:~ 0 r.:: '::~) " -Ti J; u.,.... !l~S L.. ) in j." L- ":1 :::> J:-... ;;;.J I D -< FEDERMAN AND PHELAN, LLP By: FRANK FEDERMAN, ESQ" Id. No. 12248 LAWRENCE T. PHELAN, ESQ., Id. No, 32227 FRANCIS S. HALLINAN, ESQ" Id, No, 62695 ONE PENN CENTER PLAZA, SUITE 1400 PHILADELPHIA, PA 19103 (215) 563-7000 A TIORNEY FOR PLAINTIFF WM SPECIALTY MORTGAGE, LLC 505 SOUTH MAIN STREET ORANGE, CA 92868 COURT OF COMMON PLEAS CIVIL DIVISION TERM Plainliff vs. NO. 03-1316 CIVIL DEBRA L. FARKAS 3360 SPRING ROAD CARLISLE, PA 17013 CUMBERLAND COUNTY RACHEL L. FARKAS 3360 SPRING ROAD CARLISLE, PA 17013 Defendant(s) CERTIFICATION OF SERVICE I hereby certifY a true and correct copy of Plaintiff's Amended Civil Action Complaint was served by regular and certified mail on Defendant's counsel on the date listed below: Christopher J. Keller, Esquire 101 South Market Street Mechanicsburg, PA 17055 DATE: &/.(//)] f ' t2J) J me R. Davey, Esquire Attorney for Plaintiff () C~, C G:> s:: ~:: -or;:' mrl-! .~ Z:T- :z: .- ::s CDe" 'D -<_: <,' r;: \~- "-j-, ~E .'jf -.-. .::--=:;: , -"oJ hS C " Z i'V 'C" :;! :D 'D -< ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsvlvania CoJCity/Dist. of CUMBERLAND Dale of Order/Nolice 06/12/03 Tribunal/Case Number (See Addendum for case summary) o Original Order/Notice @ Amended Order/Notice o Terminate Order/Notice EmployerlWithholder's Federal E1N Number RE, CHESBRO, DONALD W. Employee/Obligor's Name (Last, First, M1) CITY OF HARRISBURG C/O PAYROLL OFFICE STE 406 10 N 2ND ST HARRISBURG PA 17101-1677 i:>l! D!vo3 -131,/{l1f//L. j//le'i'i S /6' () 105377 167-40-0698 Employee/Obligor's Social Security Number 6134000027 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, Mil See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TlON: This is an Order/Nolice 10 Wilhhold Income for Support based upon an order for support from CUMBERLAND Counly, Commonweallh of Pennsylvania. By law, you are required 10 deducl Ihese amounls from Ihe above-named employee's/obligor's income unlil further nolice even if Ihe Order/Nolice is nol issued by your Slale. $ 226.00 per monlh in currenl support $ 0.00 per monlh in pasl-due support Arrears 12 weeks or grealer? Oyes @ no $ 0.00 per monlh in medical support $ 0.00 per monlh for genelic lesl cosls $ per monlh in olher (specify) for a total of $ 226.00 per month to be forwarded to payee below. You do nol have 10 vary your pay cycle 10 be in compliance wilh Ihe support order, If your pay cycle does nol malch Ihe ordered support paymenl cycle, use Ihe following 10 delermine how much 10 wilhhold: $ 52.15 per weekly pay period, $ 104.31 per biweekly pay period (every Iwo weeks), $ 113.00 per semimonlhly pay period (Iwice a monlh), $ 226.00 per monlhly pay period, REMITTANCE INFORMATION: You musl begin wilhholding no laler Ihan Ihe firsl pay period occurring len (10) working days after Ihe dale of Ihis Order/Nolice. Send paymenl wilhin seven (7) working days of Ihe paydale/dale of wilhholding, You are enlilled 10 deducI a fee 10 defray Ihe cosl of wilhholding. Refer 10 Ihe laws governing Ihe work slale of your employee for Ihe allowable amount. The lolal wilhheld amounl, and your fee, cannol exceed 55% of Ihe employee'sf obligor's aggregale disposable weekly earnings, For Ihe purpose of Ihe limilalion on wilhholding, Ihe following information is needed (See #10 on pg. 2), If remitting by EFT/EDI, please call Pennsylvania Slale Colleclions and Disbursemenl Unil (SCDU) Employer Cuslomer Service al 1-877-676-9580 for inslruclions, Make Remittance Payable to: PA seDU Send check to: Pennsylvania SeDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER 1D (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Dale of Order: JUN 1 3 2003 BY THE C/-. Kr=v/N .4.. N'cC;;f. ,;,4.. Service Type M OMB No,: 0970-0154 7V~&~ Form E N-028 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS D If r.hecked you are required 10 provide a r.opy of this form to your employee, If yo~r employee works in a slate thai is different from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1, We appreciate the volunlary compliance of Federally recognized Indian tribes, IriballY-<lwned businesses, and Indian-<lwned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency lisled below. 3. Combining Paymenls: You can combine wilhheld amounts from more Ihan one employee/obligor's income in a single payment to each agency requesting withholding, You musI, however, separately idenlify Ihe portion of the single payment Ihat is attribulable to each employee/obligor. 4. * Repoltihg tile F'aydatefDate of Witl,l,oldihg. You InUS! lepolt tile pay date/date of nitl,l,oldihg vvl,eh selldillg tile paylllellt. Tile payddl~/ddk v( nitl,l,oldillg is tile date 011 nhkL alllOtlht ~~a3 vwitl,l,eld flon. tllC <.:.lllploy"c'S nag.....:>. You must comply with the law of the slale of Ihe employee's/obligor's principal place of employment wilh respect 10 the time periods within which you must implement the withholding order and forward the support paymenls. 5,' Employee/Obligor wilh Mulliple Support Holdings: If Ihere is more Ihan one Order/Nolice to Withhold Income for Support againsl this employee/obligor and you are unable to honor all support Order/Notices due to Federal or Stale wilhholding limils, you musl follow the law of the state of employee's!obligor's principal place of employment You must honor all Orders/Notices to the greatest extent possible, (See #10 below) 6, Terminalion Nolificalion: You must promplly notify Ihe Requesling Agency when the employee/obligor is no longer working for you, Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 2360020100 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: CHESBRO, DONALD W. 6134000027 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liabilily: If you fail 10 withhold income as Ihe Order/Nolice direcls, you are liable for both Ihe accumulaled amount you should have withheld from Ihe employee/obligor's income and other penallies set by Pennsylvania Slate law. Pennsylvania Stale law governs unless the obligor is employed in another Slale, in which case the law of the Stale in which he or she is employed governs. 9. Anli-discriminalion: You are subject 10 a fine determined under Slate law for discharging an employee/obligor from employment, refusing to employ, or laking disciplinary aclion against any employee/obligor because of a support wilhholding. Pennsylvania Slate law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.' Wilhholding Limits: You may nol wilhhold more than Ihe lesser of: 1) the amounls allowed by the Federal Consumer Credit Prolection Act (15 U's,C 91673 (b)1; or 2) the amounts allowed by Ihe Slate of Ihe employee's/obligor's principal place of employment. The Federal limit applies to Ihe aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11, Additional Info: 'NOTE: If you or your agenl are served wilh a copy of Ihis order in Ihe stale Ihal issued Ihe order, you are 10 follow the law of Ihe slale Ihal issued Ihis order wilh respecl 10 Ihese ilems, Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any queslions, conlacl WAGE ATTACHMENT UNIT by lelephone al (717) 240-6225 or by FAX al (717) 240,6248 or by inlernel www.childsupport.slale.pa.us Page 2 of 2 Form E N-028 Worker ID $IATT Service Type M OMB No.: 0970-0154 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CHESBRO, DONALD W. PACSES Case Number 150105377 Plaintiff Name WENDY S, CHESBRO Dockel Attachment Amount 03=1314 CIVIL $ 226,00 Child(ren)'s Name(s): PACSES Case Number Plaintiff Name DOB Dockel Attachment Amount $ 0,00 Child(ren)'s Name(s): DOB you are required 10 enroll Ihe child(ren) in any health insurance coverage available Ihrough Ihe employee's/obligor's employment you are required to enroll Ihe child(ren) above in any health insurance coverage available employee's/obligor's employment. PACSES Case Number Plaintiff Name PACSES Case Number Plainliff Name Dockel Attachmenl Amounl $ 0.00 Child(ren)'s Name(s): DOB Docket Attachmenl Amount $ 0,00 Child(ren)'s Name(s): DOB you are required to enroll the child(ren) in any health insurance coverage available employee's1obiigor's employment you are required to enroll Ihe child(ren) in any health insurance coverage available employee's/obligor's employment PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name Dockel Attachment Amounl $ 0.00 Child(ren)'s Name(s): DOB Dockel Attachment Amounl $ 0.00 Chiid(ren)'s Name(s): DOB you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. Addendum Form E N-028 Worker ID $IATT Service Type M OMB No.: 0970-0154 .- 0 c) C) ~~ ",-, -n '- ,,l r! c::: ~; r: ..c:"_ ~:. U] c., r::: -,., ~ ~, ~ ~~) .P [ ':-! :;>: '., .'-1 :.n 51 -<: '-.1 -< WENDY S. CHESBRO, Plainliff/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE DONALD W. CHESBRO, Defendanl/Respondent : NO. 2003-1314 CIVIL TERM IN DIVORCE Pacses# 150105377 ORDER OF COURT AND NOW, thisl st day of August, 2003, based upon the Court's determinalion that Petilioner's monthly net income/earning capacity is $N/A and Respondent's monthly net income/earning capacity is $N/A, it is hereby Ordered Ihal the Respondent pay to the Pennsylvania Slate Collection and Disbursement Unit, $516.00 per month payable bi-weekly as follows; $238.15 for alimony pendenle lite and $0,00 on arrears, First paymenl due with next pay date. Arrears sel at $411,69 as of August 1,2003, The effective date oflhe order is August 1,2003, This order is based upon the lasl Order of Court on May 16, 2003 and the fact that the marital home has been sold and defendanl no longer has a mortgage payment on Ihe property.. Failure to make each payment on lime and in full will cause all aJTears to become subject 10 immediate collection by all of the means as provided by 23 Pa,C,S,g 3703. Further, iflhe Court finds, after hearing, that the Respondent has willfully failed 10 comply wilh this Order, it may declare Ihe Respondent in civil contempt of Court and its discrelion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not 10 exceed six months, Said money to be turned over by the P A SCDU to: Wendy S. Chesbro, Paymenls must be made by check or money order. All checks and money orders must be made payable to P A SCDU and mailed 10: PA SCDU P.O. Box 69110 Harrisburg, P A 17] 06-911 0 Payments musl include the defendant's P ACSES Member Number or Social Security Number in order to be processed. Do nol send cash by mail. Respondent to provide medical insurance coverage within thirty (30) days after the entry of Ihis order, This Order shall become final ten days after Ihe mailing of the notice of Ihe entry of Ihe Order to Ihe parties unless either party files a written demand with Ihe Prothonotary for a hearing de novo before the Court, DRO: R, J. Shadday Mailed copies on 8,4,03 to: < BY THE COURT, Petitioner Respondent Samuel Andes, Esquire Jason Kutulakis, Esquire 2' ;9- 4.- Kevin A. Hess J. . (") c::> 0 C W " s: ~ .-\ -0\1, Ml(t - "r '7- ;;;) ,;-ii~ "'- ,~'. Z,- I :,~Z en),' .c:~ -<.c , ) ~C- -r:o .~.-t :!",- :1: :~ -rl ,-- ~fi: ~ '~ ~-) ~? ~~~ <. "'" ..., Xl -<: -< "--. ,:- an nE! (::1 State Commonwealth of Pennsvlvania CoJCity/Dist. of CUMBERLAND Dale of Order/NOlice 08/01/03 Tribunal/Case Number (See Addendum for case summary) 1=010051'1 . 03-\3IY ~v,l o Original Order/Notice o Amended Order/Notice o Terminate Order/Notice ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT Employer/\tVithholder's Federal EIN Number CITY OF HARRISBURG C/O PAYROLL OFFICE STE 406 10 N 2ND ST HARRISBURG PA 17101-1677 RE, CHESBRO, DONALD W. Employee/Obligor's Name (last, First, MI) 167-40-0698 Employee/Obligor's Social Security Number 6134000027 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 INFORMA TlON: This is an Order/Noliee 10 Wilhhold Income for Support based upon an order for support from CUMBERLAND County, Commonweallh of Pennsylvania. By law, you are required 10 deducI Ihese amounts from Ihe above-named employee's/obligor's income unlil further nolice even if Ihe Order/NOlice is nol issued by your Slale, $ 516.00 per monlh in currenl support $ 0.00 per monlh in pasl-due support Arrears 12 weeks or grealer? Oyes @ no $ 0.00 per monlh in medical support $ 0 . 00 per monlh for genelic leSI cosls $ per monlh in olher (specify) for a Iota I of $ 516. 00 per month to be forwarded to payee below. You do nol have 10 vary your pay cycle 10 be in compliance wilh the support order. If your pay cycle does nOI malch Ihe ordered support paymenl cycle, use Ihe following 10 delermine how much 10 wilhhold: $ 119.08 per weekly pay period. $ 238.15 per biweekly pay period (every Iwo weeks). $ 258.00 per semimonlhly pay period (Iwice a monlh). $ 516.00 per monlhly pay period, REMITTANCE INFORMATION: You must be!lin wilhholding no later Ihan Ihe firsl pay period occurring len (10) working days after Ihe dale of Ihis Order/NOlice. Send paymenl wilhin seven (7) working days of Ihe paydale/dale of wilhholding. You are enlilled 10 deducI a fee 10 defray Ihe cosl of withholding. Refer 10 Ihe laws governing Ihe work slale of your employee for Ihe allowable amount. The lolal wilhheld amounl, and your fee, cannol exceed 55% of Ihe employee's/ obligor's aggregale disposable weekly earnings, For Ihe purpose of Ihe limilalion on wilhholding, Ihe following informalion is needed (See #10 on pg. 2), If remitting by EFT/EDI, please call Pennsylvania Slale Colleclions and Disbursemenl Unil (SCDU) Employer Cuslomer Service al 1,877,676-9580 for inslruclions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Dale of Order: u q)~ 2003 BY THE COURT: 7' /?~ Service Type M OMS No.: 097()..()154 Form EN,028 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If checked you are required to provide a copy of Ihis form 10 your employee, if your employee works in a slate thai is different from the state that issued this order, a copy must be provided to your employee even jf the box is not checked. 1. We appreciate the volunlary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reselVation that choose to withhold in accordance with this notice. 2. Priority: Withholding under Ihis Order/Notice has priority over any olher legal process under Stale law against the same income, Federai tax levies in effect before receipt of Ihis order have priority. If there are Federal lax levies in effect please contact the requesling agency listed below. 3. Combining Paymenls: You can combine wilhheld amounts from more than one empioyee/obligor's income in a single paymenl to each agency requesling wilhholding, You must, however, separalely identify the portion of the single payment Ihal is attribulable to each employee/obligor. 4. *=~~g ti': ~::~:~~~ ~;::'~~I~;;:~ .~~ :'~': J~~';~ tt,:~~~~~~: ~~;t~~,~I~~ :,1.", ""Ji"g H,e pa,J"ti,L Tl,e pa,JateAJ1ltc of "itJ,I,&/J;"g;, tl.e Jato c,,, "i,iLI, a",ouJ,j " itl,l. I' " ' c . You musl comply with Ihe law of the stale of the employee's/obligor's principal place of employment with respect 10 Ihe lime periods wllhin which you must implement the withholding order and forward Ihe support payments. 5. * Employee/Obligor wilh Mulliple Support Holdings: If there is more than one Order/Notice 10 Withhold Income for Support againsl Ihis employee/obligor and you are unable to honor all support Order/NOlices due 10 Federal or State wilhholding Iimils, you must follow Ihe law of Ihe stale of employee's/obligor's principal place of employment You musl honor all Orders/Nolices to Ihe grealest extenl possible, (See #1 0 below) 6. Terminalion Nolificalion: You musl promptly nolify the RequeSling Agency when Ihe employee/obligor is no longer working for you, Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 2360020100 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: CHESBRO, DONALD W. 6134000027 DATE OF SEPARATION: 7. Lump Sum Paymenls: You may be required to report and withhold from lump sum paymenls such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Uabilily: If you fail 10 withhold income as the Order/Nolice directs, you are liable for both the accumulaled amount you should have withheld from the employee/obligor's income and other penallies set by Pennsylvania Slate law, Pennsylvania Slale law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9, Anti-discriminalion: You are subject to a fine delermined under Stale law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action againsl any employee/obligor because of a support withholding. Pennsylvania Stale law governs unless the obligor is employed in another Stale, in which case the law of the Slale in which he or she is employed governs, 10, * Wilhholding Urnils: You may nol withhold more Ihan Ihe lesser of: 1) the amounls allowed by the Federal Consumer Credit Proteclion Act (15 U,S.c. 91673 (b)1; or 2) the amounts allowed by the Stale of Ihe employee's/obligor's principal place of employment The Federallimil applies 10 the aggregate disposable weekly earnings (ADWE), ADWE is the nel income left after making mandatory deductions such as: State, Federal, local taxesi Social Security taxes; and Medicare taxes. 11, Addilionallnfo: *NOTE: If you or your agenl are served wilh a copy of Ihis order in Ihe slale Ihal issued Ihe order, you are 10 follow Ihe law of Ihe slale Ihal issued Ihis order wilh res peel 10 Ihese ilems. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O, BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any queslions, conlacl WAGE ATTACHMENT UNIT by lelephone al (717) 240-6225 or by FAX al (717) 240-6248 or by inlernel www.childsupport.slale.pa.us Service Type M Page 2 of 2 Form EN-028 Worker ID $IATT OMBNo.:0970-0154 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CHESBRO, DONALD W. PACSES Case Number 150105377 Plainliff Name WENDY S, CHESBRO Docket Attachmenl Amount 03:rn4 CIVIL $ 516.00 Child(ren)'s Name(s): PACSES Case Number Plaintiff Name DOB Dockel Attachmenl Amounl $ 0.00 Child(ren)'s Name(s): DOB you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. you are required 10 enroll Ihe child(ren) in any health insurance coverage available employee's/obligor's employment. PACSES Case Number Plaintiff Name Dockel Attachment Amount $ 0.00 Child(ren)'s Name(s): PACSES Case Number Plainliff Name DOB Docket Attachmenl Amount $ 0.00 Child(ren)'s Name(s): DOB you are required to enroll Ihe child(ren) in any health insurance coverage available employee's/obligor's employment. you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. PACSES Case Number Plainliff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): PACSES Case Number Plaintiff Name DOB Dockel Attachment Amounl $ 0.00 Child(ren)'s Name(s): DOB you are required to enroll the Child(ren) in any health insurance coverage available employee's/obligor's employment. you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. Service Type M Addendum Form EN-028 Worker ID $IATT OMS No.; 0970-0154 (') ~~< "'"t_lh~ [nf: z., z; (f)" ~ c:=C .,;; "'';,./-- j;i ~._- ::;:: c:: '::~ VI n Ie. ci .' =;} a (..) Do (") -h ,'- c_ ::n I CF'> " ,.- "n r -(In, :~? "I C'J ,n, -r -- -Ii ,"h ~ ')rn ~h:! :b -< ~ <="' (JJ WENDY S. CHESBRO, Plaintiff : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA v. NO. 03-1314 CIVlL TERM DONALD W. CHESBRO, Defendant CIVIL ACTION - LAW IN DIVORCE DEFENDANT'S INCOME AND EXPENSE STATEMENT I, DONALD W. CHESBRO, 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 of 18 Pa.C.S. ~ 4904 relating to unsworn falsification to authorities. Date ct/J-li/o3 , I _Gb.-.t.l/l.A-~. L_ DONALD W. CHESBRO INCOME: Employer: Address: Type of Work: Payroll Number: City of Harrisburg 123 Walnut Street Harrisburg, PA 17101 Firefighter Pay Period: Biweekly Gross Pay per Pay Period: Itemized Payroll Deductions: Federal Withholding Social Security Local Wage Tax State Income Tax Retirement Savings Bonds Credit Union Life Insurance Health Insurance Other: Union Dues Support Net Pay per Pay Period: $'1,916.99 -$325.68 -$38.34 -$53.68 ..$115.95 -$35.68 -$26,34 -$238,15 $1,083.17 OTHER INCOME: Weekly Monthly Yearly Interest Dividends Pension Annuitly Social Security Rents Royalties Expense Account Gifts Unemployment Compensation Worker's Compensation Other: Total $0,00 $0.00 $0,00 EXPENSES: Home: Mortgage/Rent Maintenance Utilities: Electric Gas Oil Telephone Water Sewer Employment: Public Transportation Lunch Taxes: Real Estate (Escrowed) Personal Property Income Insurance: Homeowners (Escrowed) Automobile Life Accident Health Other Automobile: Payments Fuel Repairs Medical: Doctor: Dentisti Orthodontist Hospital Medicine Special Needs: Eye glasses Braces Orthopedic Devices Education: Private School Parochial School College Weekly Monthly Yearly 900.00 85.00 60.00 20.00 30.00 75.00 168.00 71.36 100.00 30.00 10.00 Religious Personal: Clothing Food Barber/Hairdresser Credit Payments Credit Card Charge Account Memberships Loans: Credit Union Other: 200,00 500.00 Miscellaneous: Household Help Child Care Subscriptions Entertainment Pay TV 60.00 Vacation Gifts Legal Fees 100,00 Charitable Contributions Child Support Payments Alimony Payments 516,00 Other: TOTAL EXPENSES: $0.00 $2,757.36 $168.00 PROPERTY OWNED: Description Value H W J C Checking Accounts PSECU $1,500.00 X Savings Accounts PSECU $400.00 X Credit Union Stocks/Bonds RealEstate Other TOTAL $1,900,00 INSURANCE: Hospital Blue Cross Other Medical Blue Shield Other Health/Accident Disability Income Dental Other Company No. H W . H = Husband; W = Wife; J = Joint; C = Child C (') !;;;: -rJ[;~j n1n'j 2~T' {f:,'~". eC-~; :eC .c:;... ..~. j>t., t:; , -, o W U) ", -0 W o o 'T' 'Tl F --,In _~:I 1..;; ',~6 ---"-I -,., ~](':--5 :5fn -I 3'i -< :~ -'" ::? (n WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, P A v. NO. 03-1314 CIVIL TERM DONALD W. CHESBRO, Defendant CIVIL ACTION - LAW IN DIVORCE INVENTORY OF DEFENDANT Defendant, Donald W. Chesbro, files the following inventory of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three years. I, Donald W. Chesbro, Defendant, verify that the statements made in this inventory are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa CS ~ 4904, relating to unsworn falsification to authorities. Date 9';J-,.03 _~/C./(/~ DONAID W. CHESBRO ASSETS OF THE PARTIES Defendant, Donald W. Chesbro, marks on the list below those items applicable to the case at bar and itemizes the assets on the following pages. (X) 1. Real Property (X) 2. Motor vehicles () 3. Stocks, bonds, securities and options () 4. Certificates of deposit () 5, Checking accounts, cash () 6. Savings accounts, money market and savings certificates ( ) 7, Contents of safe deposit boxes () 8. Trusts (X) 9. Life insurance policies (indicate face value, cash surrender value, and current beneficiaries) () 10. Annuities () 11. Gifts (X) 12. Inheritances ( ) 13. Patents, copyrights, inventions, royalties ( ) 14. Personal property outside the home () 15. Business (list all owners, including percentage of ownership, and officer/ director positions held by a party with company) () 16. Employment termination benefits--severance pay, worker's compensation claim/ award () 17. Profit sharing plans (X) 18. Pension plans (indicate employee contribution and date plan vests) (X) 19. Retirement plans, Individual Retirement Accounts () 20. Disability payments () 21. Litigation claims (matured and unmatured) ( ) 22. Military /V.A. benefits () 23. Education benefits () 24. Debts due, including loans, mortgages held () 25, Household furnishings and personalty (include as a total category and attach itemized list if distribution of such assets is in dispute) ( ) 26. Other MARlTALPROPERTY Defendant, Donald W, Chesbro, lists all marital property in which either or both spouses have a legal or equitable interest individually or with any other person as of the date this action was commenced: ITEM NUMBER 1 1 2 2 2 9 9 12 18/19 18/19 DESCRIPTION OF PROPERTY 906 W. North Street, Carlisle, P A Timeshare Great Vacations 1999 Grand Prix 2002 Chevy Suburban 2001 Gulf Stream Trailer $10,000 Life Insurance Policy $25,000 Life Insurance Policy $20,000 of inheritance went into the home Pension/Retirement plan Pension/Retirement plan NAMES OF ALL OWNERS Donald & Wendy Chesbro Donald & Wendy Chesbro Donald & Wendy Chesbro Donald & Wendy Chesbro Donald & Wendy Chesbro Donald Chesbro Wendy Chesbro Donald Chesbro Donald Chesbro Wendy Chesbro NON-MARITAL PROPERTY Defendant, Donald W. Chesbro lists all property in which a spouse has a legal or equitable interest which is claimed to be excluded from marital property: NONE PROPERTY TRANSFERRED Defendant, Donald W. Chesbro lists all property transferred in which a spouse has a legal or equitable interest: NONE LIABILITIES Defendant, Donald W. Chesbro lists all liabilities: NONE ,. ~, 0 C:J C) C ,,^1 -T1 ~..: (I') -ocr: "., .'1, [!] C. -u r- Z:L w In zr:-.. C) (I) '-_.' <::> ':':}() -< ~. ~C,-; ~"O ~J ~r- ... H ~() =-A: <;~~C5 .0 ~J ~'5m :i>C ::.., ~ .~. ::u (1\ -< WENDY S. CHESBRO, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, P A NO. 03-1314 CIVIL TERM DONALD W. CHESBRO, Defendant CIVIL ACTION - LAW IN DIVORCE PRETRIAL STATEMENT PURSUANT TO Pa.R.C.P. 1920.33 1. a. PLAINTIFF'S BACKGROUND Wendy S. Chesbro 2704 Warren Way Mechanicsburg, P A DOB: 2/3/67 Occupation: Paralegal Income: $32,000 Educational Background: Paralegal Del~ree b. DEFENDANT'S BACKGROUND Donald Chesbro 966 Pennsylvania Avenue Harrisburg, P A 17112 DOB: 6-22-61 Occupation: Harrisburg Fire Department Income: $49,841.74 Educational Background: c. Date of Marriage: May 31,1995 d. Place of marriage: Arlington County, VA e. Grounds for divorce: 3301 (c) Date of Separation: February 2, 2003 f. Issues for determination: Equitable distribution Counsel fees, costs, and expenses II. PERTINENT PROCEDURAL HISTORY Complaint in Divorce filed: March 26, 2003 Order for Appointment of Master: September 30, 2003 III. INVENTORY APPRAISAL a. Real Estate: 906 W. North Street Carlisle, PA 17013 Property sold. Proceeds held in escrow. Timeshare Great Vacations b. Motor Vehicles: 1999 Pontiac Grand Prix 2002 Chevy Suburban 2001 Gulf Stream Trailer c. Retirement / Pension: WIFE: Husband has waived entitlement to wife's pension. HUSBAND: Wife has waived entitlement to husband's pension. d. Personal Property: Division of personal property has not been addressed by the parties; however, it is anticipated that there are no outstanding issues regarding this matter. e. Debts: At this time, the parties have no outstanding marital debt. IV. WITNESS a. Lay: 1. Defendant 2. Plaintiff, as on cross Defendant reserves the right to identify additional witnesses, if necessary. V. EXHIBITS 1. Inventory. 2. Income and Expenses. 3. Appraisal report regarding trailer. Defendant reserves the right to identi~v additional exhibits. VI. INCOME INFORMATION See attached Income and Expense Statement of Defendant attached hereto as Exhibit 2. VII. EXPENSE INFORMATION See attached Income and Expense Statement of Defendant attached hereto as Exhibit 2. VII. PENSION VALUE See above. IX. PERSONALTY See above. X. HUSBAND'S PROPOSED ECONOMIC RESOLUTION 1. Husband proposes that the parties divide the proceeds from the sale of the marital residence equally, currently held in escrow, with each receiving 50%. 2. Husband proposes that the parties each retain their own retirement and/or pensions, savings and checking accounts, and insurance policies and each party waives the right to the other party's accounts. 3. Husband proposes that the Wife retain the 1999 Pontiac Grand Prix, that the Husband retain the 2002 Chevy Suburban and that each party is solely responsible for their own vehide, including insurance, maintenance and debt obligations on that vehicle. 4. Husband proposes that the Timeshare Vacation property in Hershey, Pennsylvania be transferred to Wife and will remain her sole and separate property. Date: 5. Husband proposes that the 2001 Gulf Stream Trailer be sold and the proceeds of the sale be divided equally, with each party receiving 50%. In the alternative, if Wife wishes to retain this Trailer, it shall be transferred to Wife and will remain her sole and separate property, with Husband receiving half the appraised value of the trailer according to Exhibit 3. Should the Wife wish to retain the Trailer and be unable to provide the Husband with half the appraised value, this amount shall be deducted from her share of the proceeds from the sale of the marital residence. 6. Any and all personal property has been divided and there are no outstanding issues regarding this matter. ?;/;t'j,t( I ( ~&L~ . Haggerty, squire Abo & Kutulakis, LLP 36 S uth Hanover Street Carlisle, P A 17013 Pa. ill No.: 86914 WENDY S, CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBEm,ANDCOUNTY,PA v. NO. 03-1314 CIVIL TERM DONALD W. CHESBRO, Defendant CML ACTION - LAW IN DIVORCE INVENTORY OF DEFENDANT Defendant, Donald W. Chesbro, files the following inventory of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three years. I, Donald W. Chesbro, Defendant, verify that the statements made in this inventory are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa CS ~ 4904, relating to unsworn falsification to authorities. Date ~,4-Jh3 _~//C./(/~ DONALD W. CHESBRO (") c:~ c: (...J :? ,....., iI~ ~~~~ r"rl z'!- ~.O Z' [' ,oJ S!,l,' a ~~ ;~ -'~ :i; E; Y.' ~ < <7\ o ~"fl ii~n ~-_:>(? , n~~ -/('':'::) ;~~j III ',. ~I ~D -< ASSETS OF THE PARTIES Defendant, Donald W. Chesbro, marks on the hst below those items applicable to the case at bar and itemizes the assets on the following pages. (X) 1. Real Property (X) 2. Motor vehicles () 3. Stocks, bonds, securities and options () 4. Certificates of deposit ( ) 5. Checking accounts, cash () 6. Savings accounts, money market and savings certificates () 7. Contents of safe deposit boxes () 8. Trusts (X) 9. life insurance policies (indicate face value, cash surrender value, and currentbenefiOnrie~ () 10. Annuities () 11. Gifts (X) 12. Inheritances ( ) 13. Patents, copyrights, inventions, royalties () 14, Personal property outside the home () 15. Business (list all owners, including percentage of ownership, and officer/director positions held by a party with company) () 16. Employment termination benefits..-severance pay, worker's compensation claim/award () 17. Profit sharing plans (X) 18. Pension plans (indicate employee contribution and date plan vests) (X) 19. Retirement plans, Individual Retirement Accounts () 20. Disability payments () 21. litigation claims (matured and unmatured) ( ) 22. Military /VA benefits () 23. Education benefits () 24. Debts due, including loans, mortgages held ( ) 25. Household furnishings and personalty (include as a total category and attach itemized list if distribution of such assets is in dispute) ( ) 26. Other MARITAL PROPERTY Defendant, Donald W. Chesbro, lists all marital property in which either or both spouses have a legal or equitable interest individually or with any other person as of the date this action was commenced: ITEM NUMBER 1 1 2 2 2 9 9 12 18/19 18/19 DESCRIPTION OF PROPERTY 906 W. North Street, Carlisle, PA Timeshare Great Vacations 1999 Grand Prix 2002 Chevy Suburban 2001 Gulf Stream Trailer $10,000 Life Insurance Policy $25,000 Life Insurance Policy $20,000 of inheritance went into the home Pension/Retirement plan Pension/Retirement plan NAMES OF ALL OWNERS Donald & Wendy Chesbro Donald & Wendy Chesbro Donald & Wendy Chesbro Donald & Wendy Chesbro Donald & Wendy Chesbro Donald Chesbro Wendy Chesbro Donald Chesbro Donald Chesbro Wendy Chesbro NON-MARITAL PROPERTY Defendant, Donald W. Chesbro lists all property in which a spouse has a legal or equitable interest which is claimed to be excluded from marital property: NONE PROPERTY TRANSFERRED Defendant, Donald W. Chesbro lists all property transferred in which a spouse has a legal or equitable interest: NONE LIABILITIES Defendant, Donald W. Chesbro lists all liabilities: NONE WENDY S, CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA v. NO, 03-1314 CIVIL TElUvI DONALD W. CHESBRO, Defendant CIVIL ACTION - LAW IN DIVORCE DEFENDANT'S INCOME AND EXPENSE STATEMENT I, DONALD W, CHESBRO, 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 of 18 Pa,C.S. ~ 4904 relating to unsworn falsification to authorities. Date 9,/..').-1(03 0--- f-lA-d--L DONALD W. CHESBRO o ~.~ \};;,:.; q;1 ~;'_ :~:C' ~?; . ~~'- Z"": :t't~ :O:J -, ;::) C,,'; :/) r"l -U G~ C) (-. Tl r..:? \;.,~() ~~} f1 ':''':~Ir-rl ;t> ,0 -< v -..,. (1'\ INCOME: Employer: Address: City of Harrisburg 123 Walnut Street Harrisburg, PA 17101 Firefighter Type of Work: Payroll Number: Pay Period: Biweekly Gross Pay per Pay Period: Itemized Payroll Deductions: Federal Withholding Social Security Local Wage Tax State Income Tax Retirement Savings Bonds Credit Union Life Insurance Health Insurance Other: Union Dues Support Net Pay per Pay Period: $1,916.99 -$325.68 -$38.34 -$53.68 -$115,95 -$35,68 -$26,34 -$238.15 $1,083.17 OTHER INCOME: Weekly Monthly Yearly Interest Dividends Pension Annuitly Social Security Rents Royalties Expense Account Gifts Unemployment Compensation Worker's Compensation Other: Total $0.00 $0.00 $0.00 EXPENSES: Home: Mortgage/Rent Maintenance Utilities: Electric Gas Oil Telephone Water Sewer Employment: Public Transportation Lunch Taxes: Real Estate (Escrowed) Personal Property Income Insurance: Homeowners (Escrowed) Automobile Life Accident Health Other Automobile: Payments Fuel Repairs Medical: Doctor: Dentisti Orthodontist Hospital Medicine Special Needs: Eye glasses Braces Orthopedic Devices Education: Private School Parochial School College Weekly Monthly 900.00 85.00 60.00 20.00 30.00 75.00 71.36 100.00 30.00 10.00 Yearly 168.00 Religious Personal: Clothing Food Sarber/Hairdresser Credit Payments Credit Card Charge Account Memberships Loans: Credit Union Other: 200.00 500.00 Miscellaneous: Household Help Child Care Subscriptions Entertainment Pay TV 60.00 Vacation Gifts Legal Fees 100.00 Charitable Contributions Child Support Payments Alimony Payments 516.00 Other: TOTAL EXPENSES: $0.00 $2,757.36 $168.00 PROPERTY OWNED: Description Value H W J C Checking Accounts PSECU $1,500.00 X Savings Accounts PSECU $400.00 X Credit Union Stocks/Bonds RealEstate Other TOTAL $1,900.00 INSURANCE: Hospital Blue Cross Other Medical Blue Shield Other Health/Accident Disability Income Dental Other Company No. H W . H = Husband; W = Wife; J = Joint; C = Child C 1"l1"'U..l.l"\.l"\.VPUUSC:IlUUIUt:S-\.Jt;::lU vmut:- ~JC1VCllrJlUl Vl'Ht:CI J.H1UCI~ NADAguides I~.- ~.~~I ""w@rffi _ i ~..lUJ ";'1 rree Vo'liclo Pnoing & Info'",oton www.NADAguides.com I ~\ppraisal Report TraveVFifth Wheel Trailers Consumer Edition Ju~ 10,2003 Recreation Vehicle Consumer Pricing 1986 to 2002 (,tl)LFSTREAM GULFSTREAM COACH INC 2001 INNSBRUCK SERIES Model: LengthlWldlh: Axles: Weight: Self-Contained: Low Retail: Average Retail: M-24RBD 25'x8' 2 4,485 YES $8,840 $10,650 Optional Equipment AIR CONDITIONING AND HEATING APPLIANCES 13,600 BTU CentraUDucted: Furnace (13,000-17,000 BTU): ENTERTAINMENT Microwave Oven: Water Heater 6 Gallon GaslElec. w/DSI: JACKS AND LEVELING SYSTEMS AMlFM Cassette Stereo: T.V. 13" Color: T.V. Antenna WlBooster: Scissor Stabilizer Jacks: MISCELLANEOUS OPTIONAL EQUIPMENT Auxiliary Battery (Each): Awning 17' -16' (Each): LPG Gas/Smoke Detector: Outside Shower: Power Roof Vent: Spare Tire and Carrier: Totals Total Low Retail: Total Averege Retail: Low: $450 Avg.: $590 Low: $100 Avg.: $130 Low: $135 Avg.: $180 Low: $180 Avg.: $240 Low: $75 Avg.: $105 Low: $135 Avg.: $180 !Cow: $50 Avg.: $80 !Cow: $135 Avg.: $180 Low: $45 Avg.: $60 Lbw: $460 Avg.: $605 Low: $60 Avg.: $80 l.ow: $70 Avg.: $90 l.ow: $105 Avg.: $140 l.ow: $85 Avg.: $115 $10,935 $13,425 ~ResearCh A New car 1$ Get An(llt/Jer Price -------- --- -------~---_.~._- low Retail Value - A low retail unit may have extensive wear and tear. BOd)' parts may have dents and blemishes. The buyer can exped to invest in cosmetic and/or mechanical worl(. This vehicle shoutd be in safe running order. Low retail vehicles usually are not found on dealer lots. Low reltailshould not be considered a trade~n value. http://www3.nadaguides.comNaluesIV Average Retail Value - An average, thOLrt glaring defects. Tires and glass rU~t:: 1 Vl '" I 30nC642F539&DID=3... 7110/2003 YiIUFICAnQjS 1, Domld W. Che3bro, verify that the SClltements made in the: foreaoing Pre-Trial Statem.:nt arc: U't1e and COtret;t. I wtdc:rstand the false: 5taltemcnts hereir.J are mille subjc:a to the penaltir.s of 18 Pa.C.s. S 4904 ~ to unsworn f;,1";';"",~0ll to audJorities. Date_ 6~i'f ( G'J JLb/~___ ~rJESB.R.O TOTRL P.0t CERTIFICATE OF SERVICE AND NOW, this 25th day of June, 2004, I, Kara W. Haggerty, Esquire, of ABOM & KUTULAKIS, LLP, hereby certify that I did serve a true and correct copy of the foregoing Defendant's Pre-Trial Statement by depositing, or causing to be deposited, same in the United States Mail, First-class mail, postage prepaid addressed to the following: Samuel L. Andes, Esquire 525 North Twelfth Street P. 0 Box 168 Lemoyne, PA 17043 Divorce Master 9 North Hanover Carlisle, PA 17013 Respectfully submitted, ABOM & KurULAKIS, LLP DATE 6P~,/ f { "= w. ,gg",y~..... 36 S. H over Street Carlisle, PA 17013 (717) 249-0900 ill No. 86914 Attorney for Plaintiff C) ....., <:'::C' '- C::) L c:: ....'-- 1'.' U1 -0 .. ::..;: C) j-n ....., =< 0 Of] ..... WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA v. NO. 03-1314 CIVIL TERM DONALD W. CHESBRO, Defendant CIVIL ACTION - LAW IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in divorce under 53301 (c) of the Divorce Code was filed on March 26, 2003 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. c.s. 54904 relating to unsworn falsification to authorities. Date: ~ IZ~/OS- g "-',"" ";:cr ';' , ~ ~ ~ ~=~ Ij', <;?, .-1...,., 4r: " ~, n~.}.~ :';')\..( ':?~~~ 'c") ~:) ".-..~ .,:';o:~ \ \ ' '"::;::, -J;) '.4 -,,;.;- ~;: - - U> - WENDY S. CHESBRO, Plaintiff IN THE COL'RT OF COMMON PLEAS CUMBERLAND COUNTY, PA v. NO. 03-1314 CIVIL TERM DONALD W. CHESBRO, Defendant CIVIL ACTION - LAW IN DIVORCE AFFIDAVIT OF CONSENT 2. A Complaint in divorce under ~3301 (c) of the Divorce Code was HIed on March 26, 2003. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in 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. Date: 8;;J'/ar , ~./~ DONALD W. CHESBRO -;?~~ ........,~ -:;..- /' " '* 1,-<'1 ,r,'\~. In\~') ,.-n ),-'1 C\.{~" C"hG. '"!( -:1 '-'" ..-- ~ 'V- ~ </ C) 'j, WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA v. NO. 03-1314 CIVIL TERM DONALD W. CHESBRO, Defendant CIVIL ACTION - LAW IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER ~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. ~4904 relating to unsworn falsification to authorities., Date: ~ h\O) C) f; ......, = = <.n o ..." ...... :J:-r M1 f~~ :gfT} C)y ,,_"Ie) ;?;~ :,;: :-'".1 .< :r.:-,~ c:: c:; N U1 ::r:::-", -',' 0) i7" WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA v. NO. 03-1314 CIVIL TERM DONALD W. CHESBRO, Defendant CIVIL ACTION - LAW IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER ~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! 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 ftled 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. ~4904 relating to unsworn falsification to authorities. Date: gPJM~ D~/~ DONALD W. CHESBRO n c ~. !~ ":s. ~"'-'. (1"\t ~ = "-'" o --n ..... ::c -1'1 fnp -om -"C) ;~:2f (;.~ --:-I:-n (,~C) .,~.m (::::!~ ~ ~.:iJ '< t=: G~j N cJl T.>> ,--. -- c..> - WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 03 - 1314 CIVIL DONALD W. CHESBRO, Defendant IN DIVORCE ORDER OF COURT AND NOW, this nA I day of &&~ 2005, the parties and counsel having entered into an agreement and stipulation resolving the economic issues on August 23, 2005, the date set for a four-party conference, the agreement and stipulation having been transcribed, and subsequently signed by the parties and counsel, 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 THE COURT, cc: ~muel L, Andes Attorney for Plaintiff . J. ~ara W. Haggerty ~ Attorney for Defendant :3 "':,' - 'It"',~ .: iJ L 0 :S !:ld S I JJO SDuZ Al:1VJ.C:i\jCj;3Hl .:10 :J~:~;~l(}{rnij WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 03 - 1314 CIVIL DONALD W. CHESBRO, Defendant IN DIVORCE THE MASTER: Today is Tuesday, August 23, 2005. This is the date we set to have a conference with counsel and the parties. Present are the Plaintiff, Wendy S. Chesbro, and her attorney Samuel L. Andes, and the Defendant, Donald W. Chesbro, and his attorney Kara W. Haggerty. The parties were married on May 31, 1995, and separated February 2, 2003. There were no children born of the marriage. The complaint in divorce was filed on March 26, 2003, raising grounds for divorce of irretrievable breakdown of the marriage and the economic claims of equitable distribution, alimony, alimony pendente lite and counsel fees and expenses. With respect to grounds for divorce, the parties are going to sign affidavits of consent and waivers of notice of intention to request entry of divorce decree. Those documents will be signed today and given to the Master to be filed with the Prothonotary's office. The divorce 1 will then be concluded under Section 3301(c) of the Domestic Relations Code. The Master has been advised that the parties have reached an agreement with respect to the outstanding economic issues. An 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 changes or modifications except for correction of typographical errors which may be made during the transcription. Following the transcription of the agreement, the agreement will be sent to counsel to review for typographical errors. After typographical errors have been corrected, if any, the agreement will be signed by the parties affirming the terms of settlement as stated on the record. However, if the parties do not sign the agreement they are nevertheless bound by the terms of the agreement when they leave the hearing room today. Upon receipt of a completed agreement by the Master, 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. Mr. Andes. MR. ANDES: The parties have agreed to resolve all of the economic issues in this case on the 2 following terms: 1. The 1999 Pontiac automobile and the 2001 Gulf Stream Innsbrook camper trailer will be transferred to wife, and the 2002 Chevrolet Suburban pick-up truck will be transferred to husband. The parties will make, execute, acknowledge and deliver the vehicle titles and such other documents as are necessary to complete these transfers promptly after the meeting this morning. 2. Husband is employed by the City of Harrisburg as a firefighter and as a result he has an account within the Pennsylvania Municipal Employees Retirement System and also a deferred compensation account. Wife is employed by the Law Offices of Michael Bangs and as a result has an account within that office's SEP-IRA account which is currently held with A,G. Edwards. Each of the parties waives any claim to or interest in those accounts currently held by the other and confirms each of the accounts to be the sole and separate property of the party in whose name they are now held. 3. Wife has a checking and other accounts at Members 1st Federal Credit Union and husband has certificates of deposit and checking and other accounts at the Pennsylvania State Employees Credit Union as well as an investment account with Linsco. Each of the parties waives any claim to or interest in the accounts held in the other party's name and confirms those accounts to be the sole and separate property of the party in whose name the accounts now stand. 4. Each of the parties has insurance on their lives, some policies of which were pre-marital and may have increased in value during the marriage. Each of the parties waives any claim to or interest in the policies of the insurance on the lives of the other or any policies of life insurance owned by the other and confirms those policies and their cash value to be the sole and separate property of whoever is the current owner of those policies. 5. The parties own a time-share unit at Great Vacation Resort in Hershey, Pennsylvania. They have agreed that they will transfer that time-share unit to husband's name alone and husband shall be free to sell it or dispose of it as he chooses. Wife shall, promptly upon presentation to her or her attorney, make, acknowledge, execute and deliver any documents necessary to transfer ownership of that time-share unit to husband's name alone. From and after today husband shall be responsible for 3 any debts or obligations arising out of his ownership of the unit and shall be solely entitled to any profits, distributions, or benefits arising out of the unit and he shall further indemnify and save wife harmless for any claims made against her arising out of his ownership or use of that unit from today forward. 6. During the marriage the parties owned a residence at 906 West North Street, Carlisle, Pennsylvania, which they sold in July of 2003 and from which they realized proceeds of sale of approximately $37,250.00. Those proceeds are currently held in escrow by their counsel. They will divide and distribute the funds held in escrow as follows: a) As soon as possible, after this morning's meeting, counsel for the parties will close the escrow account and distribute to each of the parties one-half of the balance in the account on the date it is closed. b) From husband's portion of the escrow account he shall transfer to wife the sum of $15,000.00. He hereby authorizes and directs counsel for both parties to deduct that sum from his share of the distribution from the escrow account and add it to the portion to be distributed to wife. Each of the parties will report as income and pay tax on one-half of any interest income generated by the escrow account during the time it was held in escrow by counsel for the parties. 7. Husband is currently obligated to pay alimony pendente lite to wife in an action entered through the Domestic Relations Office of Cumberland County. His obligation to pay that alimony pendente lite shall end on the later of 31 August 2005 or the date that the funds from the escrow account are distributed and wife receives her payment in accordance with this paragraph from the escrow account. After the termination of the alimony pendente lite in accordance with this paragraph, neither party shall have any further obligation to pay spousal support, alimony or alimony pendente lite to the other and each of the parties waives their right to seek or collect such payments from the other after the current alimony pendente lite order is terminated pursuant to this paragraph. 8. This agreement is intended to distribute and divide all of the marital assets of the parties. To the extent that either party has now in their possession household furnishings or other items of tangible personal property, the other party waives any claim to or interest in those 4 items and each of those items shall remain the sole and separate property of the party who now has possession of them. The parties have had explained to them the process of equitable distribution and their rights under the Pennsylvania divorce code to obtain further information about assets and to have the Court divide their assets, if necessary, through such process. Being aware of those rights and being aware of the assets, the parties have disclosed by each party to the other and each of the parties hereby waives and releases any further right to have the Court make equitable distribution of their marital property or to force the other party to provide further information about their financial assets or obligations. 9. Each of the parties waives and releases any claim against the other for counsel fees involved in this divorce action and the settlement of their financial and economic claims and, except in the event of breach of this agreement by the other party, each of the parties waives any right to seek or collect attorney fees from the other. 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. 11. This agreement shall be entered as a stipulation of the parties entered into the record in this case. In the event that it is at any time in the future entered as an order of Court, it shall be incorporated into such order but not merged into a final order or decree and the parties shall have the right to enforce it thereafter as a contract. Each of the parties reserves onto themselves all their rights under the laws of pennsylvania to enforce the terms and provisions of this agreement. 12. This agreement shall be interpreted and applied and enforced in accordance with the laws of and by the Courts of the Commonwealth of Pennsylvania. 5 13. There is no agreement between the parties relating to the economic issues in this divorce action or the divorce itself except as expressly set forth herein, and all prior agreement, understandings or undertakings between the parties relating to such economic matters and the divorce itself are merged into this agreement and shall no longer be separately enforced or valid. MR. ANDES: Ms. Chesbro, you heard that long-winded agreement that I dictated. You understand it? MS. CHESBRO: Yes. MR. ANDES: Do you have any questions about it? MS. CHESBRO: No. MR. ANDES: Do you understand that today, by entering into this agreement and expressing your assent to it on the record, that we are concluding all of these matters and that it will not be possible for us to change our mind and go back and try to change any of the terms and provisions of the agreement? MS. CHESBRO: Yes. MR. ANDES: Are you entering into this voluntarily and of your own free will? MS. CHESBRO: Yes. MR. ANDES: Do you have any questions about it? MS. CHESBRO: No. MR. ANDES: Are you satisfied that you 6 understand it? MS. CHESBRO: Yes. MS. HAGGERTY: Mr. Chesbro, have you heard the agreement as set forth on the record today? MR. CHESBRO: Yes. MS. HAGGERTY: Do you understand the terms of the agreement? MR. CHESBRO: Yes. MS. HAGGERTY: And you understand that it resolves all outstanding economic issues regarding your marriage and divorce? MS. CHESBRO: Yes. MS. HAGGERTY: Are you voluntarily and of your own free will entering into this agreement? MR. CHESBRO: Yes. MS. HAGGERTY: Do you have any other questions regarding the agreement? MR. CHESBRO: No. 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 7 imposed by law and in particular Section 3105 of the Domestic Relations Code. WITNESS: ~ Attorney for Plaintiff KMflJi). Kara W. Hagg Attorney for DATE: )4~Q) 10 Ol.'+O ~ 8 ~i~~ onald W. Chesbro In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION WENDY S. CHESBRO ) Docket Number 03-1314 CIVIL Plaintiff ) vs. ) PACSES Case Number 150105377 DONALD W. CHESBRO ) Defendant ) Other State ID Number ORDER AND NOW, to wit, on this 19TH DAY OF OCTOBER, 2005 IT IS HEREBY ORDERED that the support order in this case be 0 Vacated or o Suspended or <i)Terminated without prejudice or 0 Terminated and Vacated, effective OCTOBER 10, 2005 ,due to: THE PARTIES' AGREEMENT AS COMPLETED BEFORE THE DIVORCE MASTER ON AUGUST 23, 2005. PURSUANT TO THE AGREEMENT THERE IS NO BALANCE DUE. BY THE COURT: ~. ~ 4.. /' JUDGE Service Type M Form OE-504 Worker ID 21005 "' CJ c', ~~=? ,::J"\ ~ ::;0 fi'i \.'::' r>,? ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co.lCity/Dist. of CUMBERLAND Date of Order/Notice 10/19/05 Case Number (See Addendum for case summary) 150105377 03-1314 CIVIL o Original Order/Notice o Amended Order/Notice (8) Terminate Order/Notice CITY OF HARRISBURG C/O PAYROLL OFFICE STE 406 10 N 2ND ST HARRISBURG PA 17101-1677 RE: CHESBRO, DONALD W. Employee/Obligor's Name {last, First, Mil 167-40-069B Employee/Obligor's Social Security Number 6134000027 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (last, First, Mil EmployerM/ithholder's Federal EIN Number See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's1obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes @ no $ 0.00 per month in current and past-due medical support $ 0 . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 0,00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0 . 00 per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA seDU Send check to: Pennsylvania SeDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: ~. /? Ai Date of Order: OCT 1 I) 2005 Kevin Ju:lge Form E N-028 Worker ID $IATT DRO: R.J. Shadday Service Type M OMB No.: 0970-0154 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If !;hecked you are required to provide a copy of this form to your employee. If your employee works in a state that is ditterent from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. 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 th is 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. * Repo.t;"g t1u::; F' aydatefDale vf 'Iv';U.I.vIJ;llg. YOu Illu~ll1::'J.1Vll tile ()ciydatelddtt of yv;tLllvIJ;"5 vvLell 5elld;lIg lIu;:; f-laYlIltlll.-fhe-- l-'ayJah:/Jatt:: uf vv;t1.I.old;1I5 ;~ [II':::' Jete UII VVll;d. dlllUUllL YV<1::l vv;lIll,eld (I VII I ll,c t::'111f-'lvycc':. 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) S. 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. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2360020100 EMPLOYEE'S/OBLlGOR'S NAME: CHESBRO. DONALD W. EMPLOYEE'S CASE IDENTIFIER: 6134000027 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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 (15 U.s.c. 91673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings IADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxesi Social Security taxes; and Medicare taxes. 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 amounts allowed under the law of the state that issued the order. 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. II.Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Worker ID $IATT Service Type M OMS No.: 0970-0154 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CHESBRO, DONALD W. PACSES Case Number 150105377 Plaintiff Name WENDY S. CHESBRO Docket Attachment Amount 03-1314 CIVIL$ 0.00 Child(ren)'s Name(s): PACSES Case Number Plaintiff Name DOB Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB If you are required to enroll the child(ren) in any health insurance coverage available through the employee's/obligor's employment. D If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB If checked, you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. If checked, you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB D 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. you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. Addendum Form E N-028 Worker ID $IATT Service Type M OMB No.: 0970-0154 '" <-:::..l ,..j -,-1 f.;...t' r, :.r! 1"','. c) ( ,..~, r ," r:.,. vs. I ) I I I ) ) I ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA WENDY S. CHESBRO, Plaintiff CIVIL ACTION - LAW NO. 03-1314 CIVIL TERM DONALD W. CHESBRO, Defendant IN DIVORCE PRAECIPE TO TRANSMIT RECORD TO THE PROTHONOTARY: Transmit the record. together with the following information. to the Court for entry of a divorce decree: 1. Ground for Divorce: Irretrievable breakdown under Section 3301 (c). 2. Date and manner of service of the Complaint: Service acceoted by counsel of record on 3 Aoril 2003, (Acceotance of Service filed on 3 ADril 2003. 3, Complete either Paragraph (al or (bl: (a) Date of execution of the Affidavit of Consent required by Section 3301 (cl of the Divorce Code: by Plaintiff: 23 AUQust 2005 by Defendant: 23 AUQust 2005 (b) (11 Date of execution of the Affidavit required by Section 3301(d) of the Divorce Code: (21 Date of filing and service of the Plaintiff's Affidavit upon the Respondent: 4. Related claims pending: None 5. Complete either (al or (bl: (a) Date and manner of service of the Notice of Intention to File Praecipe to Transmit Record, a copy of which is attached: (bl Date Plaintiff's Waiver of Notice in Section 3301 (c) Divorce was filed with the Prothonotary: Dated 23 AUQust 2005. filed contemooraneously therewith by the Master. Date Defendant's Waiver of Notice in Section 3301 (c) Divorce was filed with the Prothonotary: dated 23 AUQust 2005, filed contemooraneously therewith by the Master Date:"2%'" D c..iobv~ ~~ &r-. 1'-. I t Sa"in L. Andes v Attorney for Plaintiff .' . . . , . . . . . , , , .. . . . . . . . . , , . , . , , . . , . . , . . , . , . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. , . . . . .. .. . .. .. .. .. .. .. . .. . .. .. .. .. .. . . .. . . . . . . . . .. ... ~~~~+.+.+.+.+.+.+. +. +.+.+.+.+.+.+.+.+.+.+.+.+.+.+++++++++++++~ .. . . . .. . .. .. .. . .. . . .. . .. . .. . . . .. .. . .. . . .. . . . . . . . . . .. .. . .. . .. . . . . .. . . . . . .. . .. . . . . . . . . . .. . .. . .. . . . . . . . .. . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . .. .. .. .. +++++++++++++++++++++++++ ++++++++++++ +++++++++++++++++ .. . ++. +.+ +.+.:+:+. +.+.:+; :+:+. ++.;+;:+:'l';Io;:+:+ IN THE COURT OF COMMON PLEAS OFCUMBERLANDCOUNTY STATE OF PENNA. WENDY S. CHESBRO, Plaintiff NO. 2003-1314 VERSUS DONALD W. CHESBRO, Defendant DECREE IN DIVORCE AND NOW, AJ.v~ WENDY S. CHESBRO ;.. 2005 IT IS ORDERED AND DECREED THAT _, PLAINTIFF, DONALD W. CHESBRO AND _, DEFENDANT, ARE DIVORCED FROM THE BONDS OF MATRIMONY. THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT YET BEEN ENTERED; NONE PROTHONOTARY ~ - .0-'_. +. :+::+:+:+:+. '+':+ Of :+: 'f"f J. /'A~ (J ,."'-; lP ,2> ~ ?"'t~ ~lr,p ~'4c? p7 " ... .. . 50' rc l( 51/ F-/I " WENDY S. CHESBRO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. 03-1314 CIVIL TERM DONALD W. CHESBRO, Defendant IN DIVORCE NOTICE TO RESUME PRIOR SURNAME NOTICE IS HEREBY GIVEN that WENDY S. CHESBRO, Plaintiff in the above matter, having been /~f granted a Final Decree in Divorce on the day of NO vemtl a? ,2005, hereby elects to resume the prior surname of WENDY K. STRAUB, and gives this written notice pursuant to the provisions of 54 P.S. 5704. DATE: /t/'f!o~ I W 1'1 / WENDY S. c'lt,i!l lVuJO If (' COMMONWEALTH OF PENNSYLVANIA 55.: COUNTY OF CUMBERLAND On the 'I fi, day of NO"~....&e.e.. ,2005, before me, the undersigned officer, personally appeared WENDY S. CHESBRO, known to me (or satisfactorily proven) to be the person whose name is signed to the within Notice to Resume Prior Surname and acknowledged that she executed the foregoing for the purpose therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. L"~~~ , Notary Public J~o EliIIL~_ III .... YIllE8Q ,::-.""".__ Y i::C''AM!s<- (, RO., CUlfeERl ~II.~ '..-'~XPIIlI'.S< I ........ co. -.:.::..~ 1. 200s -'- , ,...j ~ <i't. Q ~.. ~. y \~ "*' -=-. " ~ _,,~.;-u.':(i;J1 ~. ..,......-,,,- "''9.~'\''~.' \ . . -.1" .,~'" '.,' \",\, ~~:}') "tt.,", 0 ~ 0 ~~:,~ """ -',1 <If' ., - .-4 -..j ,--' ....-- :C...-n 0 ? - P""f:'" -dID I -"!,]CJ 'oj c:P H. \ ',., ',_:.),(:) .' 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