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HomeMy WebLinkAbout03-1739SCOTT LANE WELSH, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -LAW NO. ?3 - 7 POK CHA WELSH, Defendant IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS TO: Pok Cha Welsh 6256 Billingsgate Court Mechanicsburg, PA 17055 YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a Decree of Divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you. When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the office of the Prothonotary at the Cumberland County Courthouse, Courthouse Square, Carlisle, Pennsylvania. 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 249-3166 Document #: 2666461 SCOTT LANE WELSH, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -LAW POK CHA WELSH, : NO 0.3 - Defendant IN DIVORCE COMPLAINT IN DIVORCE 1. The Plaintiff, Scott Lane Welsh, is an adult individual currently residing at 16 West Main Street, Apartment 5, Mechanicsburg, PA 17055 with a mailing address of P. O. Box 1301, Mechanicsburg, Cumberland County, Pennsylvania 17050 2. The Defendant, Pok Cha Welsh, is an adult individual currently residing at 6256 Billingsgate Court, Mechanicsburg, Cumberland County, Pennsylvania 17050. 3. Plaintiff has been a bona fide resident of the Commonwealth for at least six months immediately prior to the filing of this Complaint. 4. Plaintiff and Defendant were married on September 26, 1985 in Seoul, Korea. 5. Neither Plaintiff nor Defendant is in the military or naval service of the United States or its allies within the provision of the Soldiers' and Sailors' Civil Relief Act of the Congress of 1940 and its amendments. 6. Plaintiffs Social Security number is 200-56-6530, and Defendant's Social Security number is 441-88-1845. 7. There have been no prior actions of divorce or for annulment between the parties. 8. Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the Court require the parties to participate in counseling. Document #: 2666461 VERIFICATION I, Scott Lane Welsh, hereby certify that the facts set forth in the foregoing Complaint in Divorce are true and correct to the best of my knowledge, information and belief, and that false statements herein are made subject to the penalties of 18 Pa. C.S.A. §4904 relating to unworn falsification to authorities. Date: a Lane Welsh Document #: 266646.1 t? 'S Cs+ s-, i i SCOTT LANE WELSH, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -LAW NO. 03-1739 03-1739 POK CHA WELSH, Defendant IN DIVORCE CERTIFICATE OF SERVICE I, Bruce J. Warshawsky, Esquire, counsel for Plaintiff, Scott Lane Welsh, hereby certify that a true and correct copy of the Complaint in Divorce was served by certified mail, return receipt requested, upon Defendant Pok Cha Welsh, on April 17, 2003. Attached hereto, marked as Exhibit "A", and incorporated herein by reference is the signed return receipt card for said service. METZGER, WICKERSHAM, KNAUSS & ERB, P.C. By Bruce J. Warshawsky, Esquire Attorney I.D. No. 58799 P.O. Box 5300 3211 North Front Street Harrisburg, PA 17110-0300 (717) 238-8187 Attorneys for Plaintiff Dated: May 5, 2003 I)nM--1 0. 2617167 1 ¦ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ¦ Print your name and address on the reverse so that we can return the card to you. ¦ Attach this card to the back of the mailpiece, or on the front if space permits. A. Signature X D4, r ? Agent ? Addressee B. Rece by (Pdnted Nam) C. Dat of Delivery D. 1 addre d' 1? r-1 Yes 1. Article Addressed to: If YES, enter delivery address below: ? No rf7 3. •Serv?e Type / /C 6 'Certified Mail ? Express Mail -7093 < ? Registered ? Return Receipt for Merchandise ? Insured Mail ? C.O.D.' I 4. Restricted Delivery? (Extra Fee) ? yes 2. Article Number ??ll //? ?q (? r? ! M /?j (Transfer from service labeo 700 0 /p ?Q C/ol? GE PS Form 3811; August 2991 Domestic Return Receipt 102595-02-M-1540 AtLST A rF I FGAL' 800-221-0510 n C _ CD Cn) n Z7 "Tl?? -? ?' N Jrr JUL 2 2 20N f IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA SCOTT LANE WELSH, Plaintiff VS. POK CHA WELSH, Defendant * NO. 03-1739 * * * CIVIL ACTION - LAW IN DIVORCE * * * * QUALIFIED DOMESTIC RELATIONS ORDER 1. IDENTIFYING INFORMATION 1. Scott Lane Welsh is a Participant in the Central Pennsylvania Teamsters Pension Fund Retirement Income Plan 1987. His address is 16 West Main Street, Apartment #5, Mechanicsburg, Pennsylvania 17055. His social security number is 200 56 6530. 2. The Alternate Payee is Pok Cha Welsh. Her address is 6256 Billingsgate Court, Mechanicsburg, Pennsylvania 17050. Her social security number is 441 88 1845. Her date of birth is May 14, 1963. 3. The parties were married on September 26, 1985, and they separated on April 7, 2003. The instant Qualified Domestic Relations Order relates to the equitable distribution of marital property pursuant to the Pennsylvania Divorce Code. II. METHOD OF DIVIDING PARTICIPANT'S BENEFITS 1. The plan shall pay to the Alternate Payee a portion of the Participant's vested accrued benefit under the Plan. (a) The Alternate Payee shall receive a benefit equal to 48.5% of the Participant's vested account balance as of March 31, 2003. 2. The Fund shall separately account for the benefits awarded in Paragraph 1 of this Section II as soon as administrable after this Order is determined to be a Qualified Domestic Relations Order. The Alternate Payee shall be credited with net income, loss or expense from the date set forth in 1(a). 3. The Alternate Payee may elect to receive payment from the Plan in any form in which benefits may be paid under the Plan to the Participant (other than in the form of a joint and survivor annuity). 4. The Alternate Payee may select a beneficiary to receive her benefits in the event the Alternate Payee should die prior to receiving all of her benefits by filing a beneficiary designation form with the Fund Office. In the event the Alternate Payee should die prior to receiving benefits, the Plan shall pay benefits to a beneficiary selected by the Alternate Payee on a beneficiary form provided by the Fund Office on request, or if no beneficiary is selected, to the Alternate Payee's estate. 5. The Alternate Payee may elect to receive payment from the Plan at the Participant's earliest retirement age, or, if earlier, at the earliest date permitted under the Plan. For purposes of this paragraph, the Participant's earliest retirement age means the earlier of (i) the date on which the Participant is entitled to a distribution under the Plan, or (ii) the later of (a) the date the Participant attains age 50 or (b) the earliest date on which the Participant could begin receiving benefits under the Plan if the Participated separated from service. III. OTHER PROVISIONS 1. This Order is intended to constitute a Qualified Domestic Relations Order within the meaning of section 414(p) of the Internal Revenue Code of 1986, as amended, and section 206(d) of the Employee Retirement Income Security Act of 1974, as amended, and shall be interpreted in I Vi s n^ g I :g s; LZ w ucz J,_,y no a manner consistent with such intention. 2. The Court shall retain jurisdiction to amend this Order to the extent necessary to establish or maintain its status as a Qualified Domestic Relations Order. 3. It is recognized that the Alternate Payee may elect to commence receiving benefits before the Participant retires. If the Alternate Payee so requests, the Participant will cooperate with the Alternate Payee in substantiating a documentation or information or application to the Fund and shall provide any to establish their eligibility for benefits. alL Pok Cha We sh, Defendant/Alternate Payee Andrew C. Spears, Esquire 4j radl Winnick, Esquire B oa n BY THE COURT: ?" 26 Zoo y SCOTT LANE WELSH, IN THE C01JRT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW V. NO. 03-1731) POK CHA WELSH, DIVORCE Defendant AFFIDAVIT OF CONSENT'. 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on April 16, 2003 and served upon Defendant on April 17, 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 Divorce. I verify that the statements made in this Affidavit are true and correct. I understand that any false statements herein are made subject to the penalties of 18 Pa.C.S., Section 4904, relating to unworn falsification to authorities. Dated: S / /0 6 ?J Pok Cha'Welsh 298083-1 ro C7 c (J --r I t T7 r h } A? i'V -G i; SCOTT LANE WELSH, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW V. NO. 03-17313 POK CHA WELSH, Defendant IN DIVORCE WAIVER OF NOTICE OF INTENTION TO RE_ Q_ VEST Al I--% nip' niVnRC1 I consent to the entry of a final decree of divorce vvithout notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyers' 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 any false statements herein are made subject to the penalties of 18 Pa.C.S., Section 4904, relating to unswom falsification to authorities. Dated: s - ? )dj _ Pok Cha Welsh 298083-1 51 1 T fl7 _ W 1ti: i SCOTT LANE WELSH, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -LAW NO. 03-1739 POK CHA WELSH, Defendant IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on April 16, 2003 and served upon Defendant on April 17, 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 Divorce. I verify that the statements made in this Affidavit are true and correct. I understand that any false statements herein are made subject to the penalties of 18 Pa.C.S., Section 4904, unworn falsification to authorities. Dated: W70 to 298083-1 SCOTT LANE WELSH, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -LAW NO. 03-1739 POK CHA WELSH, Defendant IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF DIVORCE UNDER SECTION 33`0 OF 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, lawyers' 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 any false statements herein are made subject to the penalties unworn falsification to authorities. Dated: 7 0 relating to 298083-1 ?.? i "" :.? r? -i7 _ ::??• ... :? . .. ::.:? . ? ; SCOTT LANE WELSH, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -LAW NO. 03-1739 POK CHA WELSH, Defendant IN DIVORCE PRAECIPE TO TRANSMIT RECORD TO THE PROTHONOTARY: Kindly transmit the record, together with the following information, to the Court for entry of a Divorce Decree: 1. Ground for divorce: Irretrievable breakdown under Section 3301(c) of the Divorce Code. 2. Date and manner of service of Complaint: A Complaint in Divorce was filed on April 16, 2003, and served on Defendant on April 17, 2003. 3. Complete either paragraph (a) or (b): (a) Date of execution of Plaintiff's and Defendant's Affidavits of Consent required by Section 3301(c) of the Divorce Code: Plaintiff: Executed August 7, 2004; filed August 20, 2004 herewith Defendant: Executed August 3, 2004; filed August 9, 2004 (b)(1) Date of execution of Plaintiffs Affidavit required by Section 3301(d) of the Divorce Code: NA 309960-1 (2) Date of filing and service of the Plaintiffs Affidavit upon the respondent: Filing: NA Service: NA 4. Complete the appropriate paragraphs: (a) Related claims pending: None (b) Claims withdrawn: None (c) Claims settled by agreement of the parties: All (d) State whether any written agreement is to be incorporated into the Divorce Decree: Marital Settlement Agreement, dated February 23, 2004 5. (a) Date and manner of service of the Notice of Intention to File Praecipe to Transmit Record, a copy of which is attached, if the Decree is to be entered under Section 3301(d)(1)(i) of the Divorce Code: Service: NA (b) Date Plaintiffs Waiver of Notice in §3301(c) Divorce was filed with the Prothonotary: August 20, 2004, herewith Date Defendant's Waiver of Notice in §3301(c) Divorce was filed with the Prothonotary: August 9, 2004 METZGER, WICKERSHAM, KNAUSS & ERB, P.C. By CA . ? Y Andrew C. Spears, Esquire Attorney I.D. No. 87737 P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 Attorneys for Plaintiff Dated: I • ?. Qom' 309960-/ SCOTT LANE WELSH, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -LAW NO. 03-1739 POK CHA WELSH, Defendant IN DIVORCE CERTIFICATE OF SERVICE AND NOW, this '11"y of 2004, 1, Andrew C. Spears, Esquire, of Metzger, Wickersham, Knauss & Erb, P.C., , attorneys for Plaintiff, Scott Lane Welsh, hereby certify that I served a copy of the Praecipe to Transmit Record this day by depositing the same in the United States mail, postage prepaid, at Harrisburg, Pennsylvania, addressed to: Bradley A. Winnick, Esquire The Wiley Group 130 West Church Street Suite 1000 Dillsburg, PA 17019 Attorneys for Defendant Pok Cha Welsh METZGER, WICKERSHAM, KNAUSS & ERB, P.C. By:U Q__ Andrew C. Spears 109960-/ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNA. SCOTT LANE WELSH No. 03 - 1739 VERSUS POK CHA WELSH DECREE IN DIVORCE AND NOW, iCJ.s b.X&-e t Leo Y , IT IS ORDERED AND DECREED THAT Scott Lane Welsh , PLAINTIFF, AND Pok Cha Welsh 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; Marital Settlement Agreement dated February 23, 2004 between the parties is incorporated but not merszed herein. BY THE COURT: ATTES J. PROTHONOTARY "'? ? ? '`?:?' '?°? moo- F- .6 ?. .... ,?1'V '.• •? ? ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 09/15/05 Case Number (See Addendum for case summary) EmployerAVithholder's Federal FIN Number ROADWAY EXPRESS INC* PO BOX 471 AKRON OH 44309-0471 200-56-6530 Employee/Obligor's Social Security Number 7606101304 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, Mn See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 2, 170.06 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ o. 00 per month in current and past-due medical support $ o . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 2,170.06 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: $ 500.78 per weekly pay period. $ 1. 001.57 per biweekly pay period (every two weeks). $ 1. 085.03 per semimonthly pay period (twice a month). $ 2.170.06 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 SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: SEP 1 G; C3 DRO: R.J. Shadday Service Type M 961107667 O Original Order/Notice 03-1739 CIVIL O Amended Order/Notice 964106268 O Terminate Order/Notice 253 S 2004 RE: WELSH, SCOTT L. Employee/Obligor's Name (Last, First, Mp BY THE COURT: I !??- /? 'LF, Kevin ess, Judge ,04 Form EN-028 OMB No.. 097M 54 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required. to provide a copy of this form to your Qmployee. If yo r employee works in a state that 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. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* pagdate/date of vithholdingis tire date rnr -the-employee's-wager. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 3404926700 EMPLOYEE'S/OBLIGOR'S NAME:- WELSH, SCOTT L. EMPLOYEE'S CASE IDENTIFIER: 7606101304 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. §1673 (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 (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; 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. 11. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M 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.chiIdsupport.state.pa.us Page 2 of 2 OMB No.'. 0970-0154 Form EN-028 Worker ID $1ATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WELSH, SCOTT L. PACSES Case Number 961107667 Plaintiff Name POK C. WELSH Docket Attachment Amount 03-1739 CIVIL$ 500.00 Child(reN's Name(s): DOB PACSES Case Number 964106268 Plaintiff Name POK C. WELSH Docket Attachment Amount 00253 S 2004 $ 1,670.06 Child(reN's Name(s): DOB JOSHUA A. WELSH 02/14/90 JESSICA K. WELSH. 06/29/88 ?lf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(reN's Name(s): DOB ?lf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(reN's Name(s): DOB ?If checked, you are required to enroll the child(ren) ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M OMB No. 097W1 SV Worker ID $IATT : n q ('] b ^{? (Jt 'T ?i:: ? f"`_E ? m -,.... -a _{ "° m ? ? ?=. -o a? z >?.; ? tT ? r tom; ? . ca ?+- ?-i cn w ? ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dirt. of CUMBERLAND Date of Order/Notice 09/19/05 Case Number (See Addendum for case summary) Employer/withholder's Federal FIN Number ROADWAY EXPRESS INC* PO BOX 471 AKRON OH 44309-0471 200-56-6530 Employee/Obligor's Social Security Number 7606101304 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1670.06 per month in current support $ o. oo per month in past-due support Arrears 12 weeks or greater? Dyes Q no $ 0. oo per month in current and past-due medical support $ 0 _ 00 per month for genetic test costs $ 1670.06 per month in other (specify) for a total of $ 1670.06 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: $ 385.40 per weekly pay period. $ 770.80 per biweekly pay period (every two weeks). $ 835.03 per semimonthly pay period (twice a month). $ 1670.06 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 SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND 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. S 1 9 2 I? Date of Order: Service Type m 961107667 03-1739 CIVIL 964106268 253 S 2004 O Original Order/Notice Q Amended Order/Notice O Terminate Order/Noticf RE: WELSH, SCOTT L. Employee/Obligor's Name (Last, First, M0 BY THE COURT: OMB No: 0970M 54 Form EN-028 Worker ID 21205 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ployee. If yo r employee works in a state that is ? If hecked you are required to provide a opy of this form to your, em difgferent from the state that issued this or?er, a copy must be provided to your employee even if the box is not checked. 1. Priority: Withholding under this order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* lrmmumg wncu JCnU IF ,gIF ,p yarF.,O1- I- You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 3404926700 EMPLOYEE'S/OBLIGOR'S NAME: WELSH SCOTT L. EMPLOYEE'S CASE IDENTIFIER: 7606101304 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 employeelobligor 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. §1673 (b)1; or 2) the amounts allowed by the State of the employee'slobligor's principal place of employment. The Federal limit applies to the 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. 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. I ].Submitted By: DOMESTIC RELATIONS SECTION 13 N HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M 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 OMB N .: 097"154 Form EN-028 Worker lD 21205 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WELSH, SCOTT L. PACSES Case Number 961107667 Plaintiff Name POK C. WELSH Docket Attachment Amount 03-1739 CIVIL$ 500.00 Child(ren)'s Name(s): DOB PACKS Case Number 964106268 Plaintiff Name POK C. WELSH Docket Attachment Amount 00253 S 2004 $ 1,170.06 Child(ren)'s Name(s): DOB JOSHUA A. WELSH 02/14/90 JESSiCA'.K. WELSH 06JZ9J88 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee'slobligor's employment. ?if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M oMS b: 0970o154 Worker ID 21205 O . ? ' .>>? 'J fTS nj? t IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA SCOTT LANE WELSH, Plaintiff VS. POK CHA WELSH, Defendant x x CIVIL ACTION - LAW IN DIVORCE x x NO. 03-1739 CIVIL TERM x x x STIPULATION FOR ENTRY OF ALIMONY ORDER AND NOW, this ac t" day of kp? Vic! 2005, Scott Lane Welsh of Mechanicsburg, Pennsylvania (hereinafter referred to as "Plaintiff'), and Pok Cha Welsh of Mechanicsburg, Pennsylvania (hereinafter referred to as "Defendant"), having reached an agreement for the entry of an Order for Alimony at the above-captioned docket, desire to legally obligate themselves to adhere to the terms of said Agreement: WHEREAS the parties were formerly Husband and Wife, having been married on September 26, 1985; and WHEREAS Plaintiff filed a Complaint in Divorce at the above-captioned docket on April 16, 2003; and WHEREAS the parties entered into a Marital Settlement Agreement, dated February 23, 2004; and WHEREAS Paragraph #22 of the Marital Settlement Agreement provided for Plaintiff to pay Defendant alimony in an amount, and subject to conditions, prescribed therein; and WHEREAS a Decree in Divorce was issued by The Honorable Kevin A. Hess on September 2, 2004, in which the Marital Settlement Agreement was incorporated but not merged therein. NOW THEREFORE, it is hereby agreed and stipulated by the parties as follows, all of which constitutes a complete and accurate reflection of the terms and conditions of the Marital Settlement Agreement: Plaintiff shall pay to Defendant the amount of $500.00 per month in alimony. 2. Said payments shall be made through the Cumberland County Court of Common Pleas Domestic Relations Section by direct payroll deduction. The payment of alimony shall be for an indefinite period, but shall terminate upon Defendant's cohabitation as that term is defined under the relevant Pennsylvania law. 4. Either party may seek to modify the amount of alimony by filing the appropriate petition with the Cumberland County Prothonotary. It is agreed that any modification to the award of alimony shall only be made upon a finding of a substantial change in circumstances of one or both parties. 6. It is agreed that, in the event a modification to the award of alimony is warranted pursuant to Paragraph #5 above, the alimony shall be modified according to the then applicable Pennsylvania guidelines for spousal support / alimony pendente lite. The herein Stipulation is agreed to by the parties in contemplation of the Stipulation for Support, dated July 18, 2005, entered at No. 253 S 2004, relating to the payment of child support between the parties. 8. It is the intention of the parties for the terms of this Stipulation to be adopted and entered as an Order of This Court, and that it shall be submitted to the Cumberland County Domestic Relations Section for collection and enforcement. co Lane elsh, Plaintiff DATE q? na r Melia re sm it . DATE IGdl . Winnick, Esquire o? - 9 A DA R/d (,A-5- DATE ???{i n C.. r ' ?`- ' -?r r ?.,1 ?? 2_ . ?? J r . ?. j -? ?i 4? S' In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Defendant Name: SCOTT L. WELSH Member ID Number: 7606101304 Please note: All correspondence must include the Member ID Number. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Flm mcial Break Down of Multiple Cases on Attachment PACSES Docket Plaintiff Name Case e Number Number Attachment Amount/Frequency POK C. WELSH 961107667 03-1739 CIVIL $ 500.00 /MONTH POK C. WELSH 964106268 00253 S 2004 $ 1,170.06 MONTH TOTAL ATTACHMENT AMOUNT: $ 1,670.06 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 3 a 4.3 4 per week, or 5 0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, SCOTT L. WELSH Social Security Number 2 0 0- 5 6- 6 5 3 0, Member ID Number 7606101304 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673 (b)(2) and 23 Pa. C.S.A. § 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated JANUARY 6, 2 0 0 8 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: ?'",;' 15 DRO: R. J. SHADDAY Service Type m ; 5:, - /4 ,/ KEVIN HESS, JUDGE Form EN-530 Worker ID $ IATT ?) ...? •°..?.r" '?- t -^i _.,? -r? ' -s^,+ -a'^ ; o ; -? ....? ..,. `X3 ?._.. °C In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: SCOTT L. WELSH Member ID Number: 7606101304 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multip le Cases on Attachment PACSES Docket Plaintiff Name Case Number Number Attachment Amount/Freouencv POK C. WELSH 961107667 03-1739 CIVIL $ 500.00 MONTH / / TOTAL ATTACHMENT AMOUNT: $ 500.00 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $115.07 per week, or 5 0.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, SCOTT L. WELSH Social Security NumberXXX-XX-6530 , Member ID Number 7606101304 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated JANUARY 6, 2 0 0 8 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: • `?[ JUDGE Form EN-034 Rev. l Service Type M Worker ID $ IATT r-ol 9 1 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Defendant Name: SCOTT L. WELSH Member ID Number: 7606101304 Please note: All correspondence must include the Member ID Number. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name POK C. WELSH PACSES Docket Case Number Number 961107667 03-1739 CIVIL Attachment AmoundFrequenc 500.00 /MONTH / / TOTAL ATTACHMENT AMOUNT: $ 500.00 Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of $ 115.07 per week, or 50 of the Unemployment Compensation benefits otherwise payable to the Defendant, SCOTT L. WELSH Social Security Number XXX-XX- 6530 , Member ID Number 7 6 0 61013 04 . OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673 (b)(2) and 23 Pa. C.S.A. § 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated JANUARY 6, 2 0 0 8 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: y 009 DRO: R. J. SHADDAY 71?1- /'51 X4 KEVIN ,pt.0' HESS, JUDGE Form EN-530 Rev.2 Service Type M Worker ID $ IATT OF THE P?:??PONOTARY 2009 SEP 14 PM 2: 2 7 08/10/2011 11:23 7172406248 CUMBERLANDCTVDRO PAGE 03/03 -?dq,- .-e 0 3- 17 3 q C; v-t I AUG 18 2011 CUMBERLAND COUNTY DOMESTIC RELATIONS Date of Application:__?- // Request for Support Record Search Name: -w,0 E L_ 5 0, c o T L (Last) (First) T {Mi) Address: 1 CiLO& A.0 -ST. Social Security Number: Q00 -- 51-0 (I S-3 0 D.O.B.: 12-?-- Domestic Relations Case Number if Known: 3 -- fr1r W, L Party Requesting information: F tJf U A GUAt2,qu-QEE j 1ryrE?,1ENLL,L (Print Name of Firm Name) T t?t,eitr4 raiu , c? -4 410 - toffs,- - %3 b 3 is 4aw fuo * ?'64 <t11 U?iZ2.G (Telephone Number) (Address) yzsr - X3/3 . q53 3- ??1 (Fax Number) (Signature) -Z - - A, Twenty Dollar ($20.00) Fee is Due per Social Security Number Make check or money order payable to. DRS/Lien Search INITIAL REQUEST Has no Record in Domestic Relations as of: Support Arrears as of End of Month Prior to Date of Application: Monthly Total Support Obligation. $SISap,p (Lien Coordinator) The Amount shown above is reflected in the Domestic Relations Section Cumberland County, Pennsylvania. Domestic Relations Case Number: `l 6 f d ©-) 6 6 Sibncsl: (Lien Search Coordinator} BRING-DOWN REQUEST Support Arrears- $ G ?t7 3 ?? (Date) D $ ?av 3 N '• . (Date) As Of. (Date) Signed: (Date) *** Lien Satisfisfaction Receipt Available Upon Request*** CC720 r? z °o -ern T> z ? t00(0 t0 1S0y C) C= In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: SCOTT L. WELSH ? ? -r! Member ID Number: N rTICO rn Please note: All correspondence must include the Member ID Number. _ Z Or- x ° ? CM .? 1 VACATE ATTACHMENT OF UNEMPLOYMENT B "FITS _ =C-5 Financial Break Down of Multiple Cases on Attachment PACSES Plaintiff Name Case Number Nu ombe Attachment Amount/Frequency POK C. WELSH 961107667 03-1739 CIVIL 500.00 MONTH TOTAL ATTACHMENT AMOUNT: $ 500.00 The prior Order of this Court directing the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), to attach $115.06 or 50% per week of the Unemployment Compensation benefits of SCOTT L. WELSH, Social Security Number XXX-XX-6530, Member ID Number 7606101304 is hereby vacated. This Order to Vacate shall be effective upon receipt of the notice of the Order by the Department and shall remain in effect until a further Order of the Court is filed. BY THE COURT Date of Order: JAN 0 6 2012 00-01 Ault H. Masland JUDGE Form EN-035 Service Type M Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT t `7 O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) Q AMENDED IWO G) V I Q ONE-TIMEORDERMOTICE FOR LUMP SUM PAYMENT Q TERMINATION OF IWO Date: 06/01/12 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO,must,be reguler on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www acf hhs gov/programs/cse/newhire/employer/publication/publication htm - forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Tribe/Territory Commonwealth of Pennsylvania Remittance Identifier (include w/payment): 7606101304 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for orderldocket informalton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) YRC WORLDWIDE` PO BOX 471 AKRON OH 44309-0471 Employer/Income Withholder's FEIN 340492670 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: WELSH, SCOTT L. Employee/Obligor's Name (Last, First, Middle) 200-56-6530 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www.acf.hhs,oov/prourams/cse/newhire / employer/publication/publication.htm - form . If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. 3404926700 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. $ 0.00 per month in current child support $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? O yes_; (),_no $ 0.00 per month in current cash medical support $ 0.00 per month in past-due cash medical support r, $ 0.00 per month in current spousal support ?- $ 0.00 per month in past-due spousal support $ 0.00 per month in other (must specify) for a Total Amount to Withhold of $ 0.00 per month. yea,. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with thF V?deFlhfor'rrlation. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period (twice a month) $ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. $ _ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten 10 working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55° of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www.acf.hhs.gov/procirams/cse/newhire/employer/contacts/contact map htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970-0154 Form EN-028 06/12 Service Type M Worker ID $IATT ? Return to Sender [Completed by Employer/Income Withholder). Payment must be directed to an SDU irl accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below), If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal law): 4? .?-,i? ,,.+?,,.,. _? _ Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. ? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: httQ•//www acf hhs gov/proarams/cse/newhire/employer/contacts/contacl mao htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Triballaw for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date - 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN-028 06/12 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: YRC WORLDWIDE` Employer FEIN: 340492670 Employee/Obligor's Name: WELSH, SCOTT L. 7606101304 CSE Agency Case Identifier: (See Addendum for case summary Order Identifier: (See Addendum for order/docket Information Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 3404926700 Q This person has never worked for this employer nor received periodic income. O This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known address: Last known phone number: Final Payment Date To SDU/Tribal Payee: New Employer's Name: Final Payment Amount: New Employer's Address: CONTACT INFORMATION: To Employer/income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www childsupDort. state. pa us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST. P.O. BOX 320, CARLISLE PA 17013 (Issuer address). To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at www.childsupportstate. pa us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. Service Type M OMB No.: 0970-0154 Page 3 of 3 Form EN-028 06/12 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WELSH, SCOTT L. PACSES Case Number 961107667 Plaintiff Name POK C. WELSH Docket Attachment Amount 03-1739 CIVIL $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Service Type M PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum OMB No.: 0970-0154 Form EN-028 06/12 Worker ID $IATT ^ . INCOME WITHHOLDING FOR SUPPORT /1L / /M~7L/ '7 `Y�p / ,D ORIGINAL INCOME WITHHOLDING onosaINonos FOR SUPPORT<xmo> « °M=°"="', " /�� _ /_~3� O ows�n�sonosnmonos�omuowpmv���vwsmr O TERMINATION opxwo Date: 0 Child Support Enforcement(CSE)Agency Court 171 Attorney 0 Private IndividuallEntity(Check One) NOTE:This IWO must be regular on its face.Under certain circumstances you must reject this IWO and return it to the sender(see IWO instructions http:/Lw\kw.acf.bhs.gov/Rro-grams/cse`/"newhire/employer/publication/publicati!2n.htm-form ). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Triberrerritory Commonwealth of Pennsylvania Remittance Identifier(include w/payment): 7606101304 CitylCounty/Dist.[Tribe CUMBERLAND Order Identifier: (See Addendum for orderldocket Informaiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) RE: WELSH,SCOTT L. YRC WORLDWIDE* ptoyee/Obligor's Name(Last,First,Middle) Sent Electronically Employee/Obligor's Social Security Number (See Addendum for plaintiff names DO NOT MAIL associated with cases on attachment) Custodial Party/Obligee's Name(East, First, Employer/Income Withholder's FEIN 340492670 NOTE:This IWO must be regular on its face. Under certain circumstances you must reject Child(ren)'s Name(s)(Last,First,Middle) Child(ren)'s Birth Date(s) this IWO and return it to the sender(see IWO instructions you receive this document from someone other than a State or Tribal CSIE agency or a Court,a copy of the underlying order must be allached. See Addendum for dependent names and birth dates associated with cases an attachment. ORDER INFORMATION: This document|o based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. o � 0.00 per month in current child support $ 0.00 per month |npast-due child support- Arrears 12weeks or greater? [}ys@ Z<@ 46 -+ rnco ::,. _c�n $ 0.00 per month in current cash medical support �crn $ Der �cr_ �,rn � � CI' $ 500,00 per month in current spousal support +C:, $ 0.00 per month in past-due spousal support -n $ o.00 Per month in other(must specify) C--�� for aTotal Amount to Withhold of$ ��r��n�' ��c AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be incompliance with the . If your pay cycle does not match the ordered payment cycle,withhold one of the following amount: $ 115.07 per weekly pay period. $ 250.00 per semimonthly pay period(twice amonth) $ 230.14 per biweekly pay period(every two weeks) o 500.00 per monthly pay period. $ Lump Sum Payment: Oo not stop any existing |VVO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten(10) working days after the date of . Send payment within working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor,withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (Gteta/Tribe), the employer can obtain withholding Umitmtiona, time requiremento, and any allowable employer fees nd htm for the emp\ovee/ob|igo/e principal place nfemployment. Document Tracking Identifier OMB No.:uomu`m ' Form EN-428D0/12 Service Type&; Worker /[) $}ATT Y ❑ Return to Sender[Completed by Employer/income Withholder]. Payment must be directed to an SDU in accordance with 42 USC§666(b)(5) and (b)(6)or Tribal Payee(see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal law): KEVIN A HESS Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: APRIL 12 2013 If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order,a copy of this IWO must be provided to the employee/obligor. ❑ If checked,the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law(23 PA C.S.§4374(b))requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit(PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER/D(shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: http://www acf hhs gov/programs/cse/newhire/employer/contacts/contact map htm Priority: Withholding for support has priority over any other legal process under State law against the same income(USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment.You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the"Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment.The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State(or Tribal law if applicable)of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date—05/31/2014.The OMB Expiration Date has no bearing on the termination date of the IWO;it identifies the version of the form currently in use. Form EN-428 06/12 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name Employer FEIN: E Name: WELSH,SCOTT L. 7606101304 CSE Agency Case|denUfier Order Identifier:(—See Addendum for orderldocket information Withholding Limits:You may not withhold more than the lesser of. 1)the amounts allowed by the Federal Consumer Credit Protection Act(CCPA)(15U.S.C. 1873(b)); or2)the amounts allowed by the State or Tribe cf the omp/oyee/ob|k]or'e principal place of employment(see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such me: State, Federal, local taxes; Social Security taxes; statutory pension contributions;and Medicare taxes.The Federal limit is 50%of the disposable income if the obligor is supporting another family and 60%of the disposable income if the obligor is not supporting another family. However,those limits increase 5Y6'0n55%and 859&-if the arrears are greater than 12 weeks. |f permitted by the State or Tribe,you may deduct a fee for administrative costs.The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders,you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employersfincome withholders who receive a State IWO,you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d)of the CCPA(15 U.S.C. 1673(b)). Depending upon applicable State or Tribal law,you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks?If the Order Information does not indicate that the arrears are greater than 12 weeks,then the Employer should calculate the COPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are no longer withholding income for this employee/obligor,an employer must promptly notify the CSE agency and/or the sender by retuming this form to the address listed in the Contact Information below: 3404926700 0 This person has never worked for this employer nor received periodic income. 0 This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: Final Payment Amount: New Employers Name: New Employer's Address: CONTACT INFORMATION: To-Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT(Issuer name) by phone at by fax at by email orwebsihaat: Send term ination/incomo status notice and other correspondence to: DOMESTIC RELATIONsq SECTION, 13 N. HANOVER ST. P.O. BOX 320.CARLISLE, PA. 17013(Issuer address). To Employee/Obligor: |f the employee/obligor has questions, contact WAGE ATTACHMENT UNIT(Issuer name) by phone at . by fax ot . by email nrwebniteat . IMPORTANT:The person completing this form is advised that the information may be shared With the employee/obligor. OMB mv.:oonm1n* Form EN-428O8/12 Service Type WY Page 3of3 Worker|Q$|ATT ADDENDUM Summary of Cases on.Attachment Defendant/Obligor: WELSH, SCOTT L. PACSES Case Number 961107667 PACSES Case Number Plaintiff Name Plaintiff Name POK C.WELSH Docket Attachment Amount Docket Attachment Amount 03-1739 CIVIL $ 500.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Doc et Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-428 06/12 Service Type M OMB No.:0970-0154 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT 0 ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT(IWO) 0 AMENDED IWO p3- ��3q CI V 1 0 ONE•TIMEORDERINOTICE FOR LUMP SUM PAYMENT 0. TERMINATION OF two Date: 04/16/13 ❑ Child Support Enforcement(CSE)Agency N Court ❑ Attorney ❑ Private Individual/Entity(Check One) NOTE:This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender(see IWO instructions bllp� w w,acf hhs gov/programs/cse/newhire/employer/publication/publication htm forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Tribell-eimtory Commonwealth of Pennsylvania Remittance Identifier(include w/payment): 7606101304 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket informaiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) RE: WELSH, SCOTT L. YRC WORLDWIDE' Employee/Obligor's Name(Last, First,Middle) 200-56-6530 Sent Electronically Employee/Obligor's Social Security Number D O NOT MAIL (see Addendum foxes on attachment) associated with cases on attachment) Custodial Party/Obligee's Name(Last, First, Middle) Employer/Income Withholder's FEIN 340492670 NOTE:This IWO must be regular on its face. Under certain circumstances you must reject Child(ren)'s Name(s)(Last, First, Middle) Child(ren)'s Birth Date(s) this IWO and return it to the sender(see IWO instructions httpi/wvr v acf hhs gov/programs/cse/newhire/ gmployer/publication/publication.htm-formo.If you receive this document from someone other than a State or Tribal CSE agency or a Court,a copy of the underlying order must be attached. 3404926700 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND Countv, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. $ 0.00 per month in current child support $ 0.00 per month in past-due child support- Arrears 12 weeks or greater? 0 yes nU $ 0.00 per month in current cash medical support $ 0.00 per month in past-due cash medical support for -0 b $ 0400 per month in current spousal support r 2 $ 0.00 permonth in past-due spousal support $ 0.00 per month in other(must specify) r—z v <3 for a Total Amount to Withhold of$ _� Z CD-,I 0.00 per month. o AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the�defobn. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount:-t cn � $ 0.00 per weekly pay period. $ 0.00 per semimonthly $ 0.00 per biweekly pay period eve two weeks $ 0.00 per monthly pay period (twice-5 month) (every ) y pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten 10 working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www acf hhs gov/programs/cse/newhire/employer/contacts/contact map htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.:0970-0154 Form EN-428 06/12 Service Type M Worker ID$IATT ❑ Return to Sender[Completed by Employer/Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5)and (b)(6) or Tribal Payee(see Payments to SDU below). If payment is not directed to an SDU(Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal law): KEVIN A HESS Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: APRIL 16 2013 If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order,a copy of this IWO must be provided to the employee/obligor. ❑ If checked,the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERWINCOME WITHHOLDERS Pennsylvania law(23 PA C.S. §4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit(PA SCDU) Employer Customer Service at 1.877.676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER/D(shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: http://www.acf.hhs.gov/programs/cse/newhire/emi)loyer/contacts/contact_maD htm Priority: Withholding for support has priority over any other legal process under State law against the same income(USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney,:or'Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by.a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State(or Tribal law if applicable)of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple'IWOs:If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or,Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Dale-0 513112 01 4.The OMB Expiration Date has no bearing on the termination date of the IWO;it identifies the version of the form currently in use. Form EN-428 06/12 Service Type M Page 2 of 3 Worker 10 $IATT Employers Name: YRC WORLDWIDE' Employer FEIN: 340492670 Employee/Obligor's Name: WELSH SCOTT L 7606101304 CSE Agency Case Identifier: Sge Ad endum for case summary} Order Identifier:(See Addendum for orderldocket InformatioW Withholding Limits:You may not withhold more than the lesser of: 1)the amounts allowed by the Federal Consumer Credit Protection Act(CCPA)(15 U.S.C, 1673(b));or 2)the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment(see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as:State, Federal,local taxes;Social Security taxes;statutory pension contributions;and Medicare taxes.The Federal limit is 50%of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However,those limits increase 5%-to 55%and 65%-if the arrears are greater than 12 weeks. If permitted by the State or Tribe,you may deduct a fee for administrative costs.The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders,you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO,you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d)of the CCPA(15 U.S.C. 1673(b)). Depending upon applicable State or Tribal law,you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks?If the Order Information does not indicate that the arrears are greater than 12 weeks,then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are no longer withholding Income for this employee/obligor,an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 3404926700 Q This person has never worked for this employer nor received periodic income. 0 This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: Final Payment Amount: New Employer's Name: New Employer's Address: CONTACT INFORMATION: To ErnolMrtlncpme Withholder: If you have any questions,contact WAGE ATTACHMENT UNIT(Issuer name) by phone at(717)240-6225, by fax at(717)240-6248, by email or website at:www.childsupDo .Stat .pa.us. Send termination/income status notice and other correspondence to:DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST, P O. BOX 320 CARLISLE, PA. 17013(Issuer address). To Employee/Obligor: If the employee/obligor has questions, contact k6 AGE ATTACHMENT UNIT(Issuer name) by phone at(717)240-6225, by fax at(717)240-6248, by email or website at www.childsupport state oa us. IMPORTANT:The person completing this form is advised that the information may be shared with the employeetobiigor. OMB No.:9970-6154 Form EN-42806/12 Service Type M Page 3 of 3 Worker ID$IATT 1L ADDENDUM Summary of Cases on Attachment Defendant/Obligor. WELSH, SCOTT L. PACSES Case Number 961107667 PACSES Case Number Plaintiff Name Plaintiff Name POK C.WELSH pocket Attachment Amount Docke Attachment Amount 03-1739 CIVIL $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount pocket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Dock t Attachment Amount Docke Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-428 06/12 Service Type M OMB No.:0970-0154 Worker ID $IATT