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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
STATE OF
WENDELL B. LEHMAN,
PEN NA.
No. 2001-1297
CIVIL
Plaintiff
VERSUS
CHERYL E. HINKLE,
Defendant
ANDNOW,_A116U5..+ :::;t
WENDELL B. LEHMAN
.
DECREED THAT
AND
DECREE IN
DIVORCE
:J..OD I, IT is ORDERED AND
, PLAINTIFF,
CHERYL E. HINKLE
, 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;
.
.
THE MARITAL SETTLEMENT AGREEMENT SIGNED BY THE PARTIES ON
.
NOVEMBER 20, 2000 IS INCORPORATED HEREIN AS A FINAL ORDER.
.
.
.
By THE COURT:
1M-
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ROTHONOTARY
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WENDELL B. LEHMAN,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 2001- /~97
CIVIL ACTION-LAW
IN DIVORCE
CIVIL TERM
CHERYL E. HINKLE,
Defendant
NOTICE TO DEFEND AND CLAIM RIGHTS
You have been sued in court. If you wish to defend against the claims set forth
in the following pages, you must take prompt action. You are warned that if you fail to
do so, the case may proceed without you and a decree of divorce or annulment may be
entered against you by the court. A judgment may also be entered against you for any
other claim or relief requested in these papers by the Plaintiff. You may lose money or
property or other rights important to you, including custody or visitation of your children.
When the ground for 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 the Cumberland County Court House,
Carlisle, Pennsylvania.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, MARITAL PROPERTY,
COUNSEL FEES OR EXPENSES BEFORE THE FINAL DECREE OF DIVORCE OR
ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR ATTORNEY AT ONCE. IF YOU
DO NOT HAVE AN ATTORNEY OR CANNOT AFFORD ONE, GO TO OR
TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN
GET LEGAL HELP.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
Telephone: (717) 249-3166
II
WENDELL B. LEHMAN,
Plaintiff
v.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO.2001- / '"' CJ7 CIVIL TERM
CIVIL ACTION-LAW
IN DIVORCE
CHERYL E. HINKLE,
Defendant
COMPLAINT UNDER SECTIONS 3301(C)
AND 3301 (0) OF THE DIVORCE CODE
1. Plaintiff is Wendell B. Lehman, an adult individual who currently resides at
16 Camellia Lane, Waggaman, Louisiana 70094.
2. Defendant is Cheryl E. Hinkle, an adult individual who currently resides at
20 Carter Place, Carlisle, Cumberland County, Pennsylvania and is represented by
Carol Lindsay, Esquire.
3. Defendant has been a bona fide resident in 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 January 1, 1993 in Las
Vegas, Nevada.
5. There have been no prior actions of divorce or for annulment between the
parties.
6. The marriage is irretrievably broken.
7. The Plaintiff has been advised of the availability of counseling and that he
may have the right to request that the court require the parties to partiCipate in
Counseling.
8. Plaintiff requests the court to enter a decree of divorce.
I
!!
WHEREFORE, the Plaintiff requests the court to enter a decree of divorce in
favor of the Plaintiff and against the Defendant.
Respectfully submitted,
O'BRIEN, BARIC & SCHERER
:?44a~
Michael A. Scherer
1.0.# 61974
17 West South Street
Carlisle, PA 17013
(717) 249-6873
Attorney for Plaintiff,
Wendell B. Lehman
mas.dir/domestic/divorcellehman.com
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VERIFICATION
I verify that the statements made in this Complaint are true and correct.
understand that false statements herein are made subject to the penalties of 18 Pa.
C.S. S 4904, relating to unsworn falsification to authorities.
MAA~atf. ~I8V_
Wendell B. Lehman
Date: tJ/'/'I.t)/
il
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WENDEll B. lEHMAN,
Plaintiff
v.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2001-1297 CIVil TERM
CIVil ACTION-LAW
IN DIVORCE
CHERYL E. HINKLE,
Defendant
ACCEPTANCE OF SERVICE
AND NOW, this (3 day of March, 2001, I, Carol J. Lindsay, Esquire, attorney
for Cheryl E. Hinkle, the Defendant above, hereby accept service of the Complaint filed in
the above case pursuant to Pa. R.C.P. 1920.4(e) and acknowledge receipt of a true and
attested copy of said Complaint.
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WENDEll B. lEHMAN,
Plaintiff
v.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2001-1297 CIVil TERM
CHERYL E. HINKLE,
Defendant
CIVil ACTION-LAW
IN DIVORCE
DEFENDANT'S AFFIDAVIT OF CONSENT, ACCEPTANCE OF
SERVICE AND WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY
OF DIVORCE DECREE UNDER SECTION 3301fC) OF THE DIVORCE CODE
1. A complaint in divorce under Section 3301 (C) of the Divorce Code was
filed on March 7, 2001.
2. Carol J. Lindsay, Esquire, Attorney for the Defendant signed an
Acceptance of Service form on March 13, 2001.
3. The marriage of the Plaintiff and Defendant is irretrievably broken and
ninety days have elapsed from the date of the filing of the Complaint.
4. I consent to the entry of a final decree in divorce without notice.
5. 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.
6. 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.
7. I have been advised of the availability of marriage counseling and
understand that I may request that the court require counseling. I do not request that
the court require counseling.
I verify that the statements made in this affidavit are true and correct. I
understand that false statements herein are made subject to the penalties of 18
Pa.C.S. Section 4904 relating to unsworn falsification to authorities.
Date: ttl/YlfL-/f/) ;;aD/
:fi:I k~-
CI Cheryl E. Hinkle J1i w-enJ..(
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JUN 2 2 2001
JUN I 1 2001
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WENDELL B. LEHMAN,
Plaintiff
Ii II
'Ii, CHERYL E. HINKLE,
, . Defendant
v.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2001-1297 CIVIL TERM
CIVIL ACTION-LAW
IN DIVORCE
PLAINTIFF'S AFFIDAVIT OF CONSENT
AND WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY
OF DIVORCE DECREE UNDER SECTION 3301(Cl OF THE DIVORCE CODE
1. A complaint in divorce under Section 3301 (C) of the Divorce Code was
filed on March 7, 2001.
2. The marriage of the Plaintiff and Defendant is irretrievably broken and
ninety days have elapsed from the date of the filing of the Complaint.
3. I consent to the entry of a final decree in divorce without notice.
4. 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.
5. 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.
6. I have been advised of the availability of marriage counseling and
understand that I may request that the court require counseling. I do not request that
the court require counseling.
I verify that the statements made in this affidavit are true and, correct. I
understand that false statements herein are made subject to the penalties of 18
Pa.C.S. Section 4904 relating to unsworn falsification to authorities.
Date: Otll-tJ I
/4P.I,kWi ~
Wendell B. Lehman
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
l>I<.f. () I- /J. '17 (!.I(/f{..
State Commonwealth of Pennsvlvania IWe-<;ES 07//()t{DYD
CoJCity/Disl. of CUMBERLAND
Date of Order/Notice 12/07 /01 ~Je ~ / ,'1</
Court/Case Number (See Addendum for case summary)
@Original Order/Notice
o Amended Order/Notice
o Terminate Order/Notice
) RE: LEHMAN, WENDELL B.
) Employee/Obligor's Name (Last, First, MI)
)
)
)
)
)
)
)
197-40-7208
Employee/Obligor's Social Security Number
9769100885
Employee/Obligor's Case Identifier
(See Addendum for plaintiff names assodated with cases on attachment)
Custodial Parent's Name (last, First, MI)
EmployerlWithholder's Federal EIN Number
ALTON OCHSNER MEDICAL FOUNDATI
EmployerlWithholder's Name
C/O PAYROLL DEPARTMENT
EmployerlWithholder's Address
1516 JEFFERSON HWY
NEW ORLEANS LA 7D121-2429
See Addendum for dependent names and birth dates associated with cases on attachment,
ORDER INFORMA TION: This is an Order/Notice to Withhold Income for Support based upon an order for support
from 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.
$ 6D6. 64 per month in current support
$ D. OD per month in past-due support Arrears 12 weeks or greater? G9 yes 0 no
$ D. DO per month in medical support
$ O. DO per month for genetic test costs
$ per month in other (specify)
for a total of $ 606.64 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:
$ 13 9. 99 per weekly pay period.
$ 279.99 per biweekly pay period (every two weeks).
$ 303.32 per semimonthly pay period (twice a month).
$ 606.64 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
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 pg. 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, PA YMENTS MUST INCLUDE THE DEfENDANT'S NAME AND THE PACSES MEMBER 10 (shown
above as the Employee/Obligor'S Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
Service Type M
7"b~
Form EN-028 '
Worker 10 $IATT
Date of Order: DrCl 2 2091
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ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
D If checked you are required to provide a copy of this form to your employee.
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. * ~t-'ulting tllG Pa)dc1tb,![)ate of'NitLLoldil,g. '/utl J.ltIst lepolt tllG payJahddate of \l\>itl.J.oldillg vyl,ell selJdillg tl.~ paYIlIe;IIt. TLe
j..o1yJattldate of vvitlll,oIJ;J1/5 ;;, tile date Oil vyl,id, <:lIlIVUlIl m'H vyitl,lleld flOl1l tile; e;11It-'loyee's vyages. You must comply with the law of the
state of the employee'sJobligor'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,
WITHHOLDER'S ID: 6778100165
EMPLOYEE'S/OBLlGOR'S NAME: LEHMAN, WENDELL B.
EMPLOYEE'S CASE IDENTIFIER: 9769100885 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)l; 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.
10.
'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.
Requesting Agency:
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 (71 7) 240-6225 or
by FAX ai (717) 240-6248 or
by Internet @
Page 2 of 2
Form EN-028
Worker 10 $IATT
Service Type M
OMB No.: 0970-Q154
Expiration Date: 12/31100
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ADDENDUM
Summary of Cases on Attachment
PACSES Case Number
Plaintiff Name
CHERYL E. HINKLE
Docket Attachment Amount
01.=1297'CIVIL$ 606.64
Child(ren)'s Name(s):
Defendant/Obligor: LEHMAN, wi;:NOELL B.
0711.04040/31 :ltl'l PACSES Case Number
Plaintiff Name
DaB
Attachment Amount
$ 0.00
Child(ren)'s Name(s):
Docket
DaB
al;~~~~~~d:;;~~;~;~~~;;~~;~~~;~;I;~~~~il~(re~; /> .,... .,..'
identified above in any health insurance coverage available
through the employee's/obligor's employment.
[jl;ch~~~~~:;~~;r~;:~ui;~~;~:~r~ilthe 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):
DaB
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DaB
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.
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):
DaB
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DaB
t51;~~~~~~~:;~~~;~;:~~i;:~;~~~;~II;h~~~:I~i;~~;..'.. '.',..'. .,.. '.,..... . '
identified above 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.
Addendum
Form EN-028
Worker ID $IATT
Service Type M
OMBNo.:0970-0154
Expiration Date: 12131/00
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
1JJL 0/-/)..-17 {lIt/Ie.
~J4C~'(r:; 07//tWOYO
'b.e J I :J-t/y
@Original Order/Notice
o Amended Order/Notice
o Terminate Order/Notice
State Commonwealth of Pennsvlvania
Co./City/Dist of CUMBERLAND
Date of Order/Notice D1/14/D2
Court/Case Number (See Addendum for case summary)
) RE, LEHMAN, WENDELL B.
) Employee/Obligor's Name (Last, First, MI)
) 197 -40 -7208
) Employee/Obligor's Social Security Number
) 9769100885
) Employee/Obligor's Case Identifier
) (See Addendum for plaintiff names assodated with cases on attachment)
} Custodial Parent's Name (Last, First, MI)
)
EmployerlWithholder's Federal EIN Number
WINN DIXIE LOUISIANA INC
EmployerlWithholder's Name
PO BOX 1540
EmployerlWithholder's Address
FORT WORTH TX 76101-154D
See Addendum for dependent names and birth dates assodated with cases on attachment.
ORDER INFORMA nON: 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.
$ 606.64 per month in current support
$ O.DD per month in past-due support Arrears 12 weeks or greater? @yes 0 no
$ 0.00 per month in medical support
$ O. OD per month for genetic test costs
$ per month in other (specify)
for a total of $ 606.64 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:
$ 139.99 per weekly pay period.
$ 279.99 per biweekly pay period (every two weeks).
$ 303.32 per semimonthly pay period (twice a month).
$ 6D6. 64 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
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 pg. 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, 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:
Date of Order:
JAN 1 5 2002
vV l)t:,c
For EN-028
Worker ID $IATT
Service Type M
MBNo.:0970-0154
/ ~ I tJ _{):;. Expiration Date: 12/31/00
.- Ilili!iii!li'"" ~iil"r' >~-;.:,<
"
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o If checked you are required to provide a copy of this form to your employee,
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 ofthis order have priority. Ifthere Me Federai tax ievies 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. * Repoltil,g tll{. PAydatelDate ofV~';ll,l,oldil,g. You IlltBl,....,..,vlt tile paydalu'Jalt vf nitllllold;118 nl,c" :Jelldillg tile paYJllclll. Tile
pl.iydab.,/Jatb of nitl,l,oIJil,6;:J ll,e. date Oil nll;....L alJlvtlht nas nitLI,clJ hUII' tile elllployec':::I mJ.Oc:J. 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.
WITHHOLDER'S ID: 7204885730
EMPLOYEE'S/OBLlGOR'S NAME: LEHMAN, WENDELL B.
EMPLOYEE'S CASE IDENTIFIER: 9769100885 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 (1 S U.S.c. 91673 (b)l; 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 taxesi Social Security taxes; and Medicare taxes.
10,
'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.
Requesting Agency:
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 (71 7) 240-6225 or
by FAX at (7171 240-6248 or
by Internet @
Page 2 of 2
Form EN-028
Worker ID $IATT
Service Type M
OMB No.: 0970.0154
Expiration Date; 12/31/00
ADDENDUM
Summarvof Cases on Attachment
Defendant/Obligor: LEHMAN, wENDELL B.
PACSES Case Number 071104040 Iz.f;J!llf
Plaintiff Name I"
CHERYL E. HINKLE
Docket Attachment Amount
OJ.=1297'CIVIL$ 606.64
Child(ren)'s Name(s):
.
IP
DaB
Eri~~~~~~~~:;~~~;:';:~~;;:~;~:~;~,,;~:~~i,~i;:~;ii{/'"'"
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):
DaB
;EjI;;~~:~~~~:~~~':;:;:~~i;:~';~:~;~:I:~:~~il~~;~~;';".,"., ,',,',',," , '
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):
DaB
o 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.
Service Type M
-
k_' I,.
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~ III
" ""'....,gj;j<"
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name{s):
DaB
t1IJ.~~:~~~d:;~~~;:;:~~~;:~:;:~;~i:;~:~~:ldi;:~;'}"'""',""'"
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):
DaB
"dl;;'~~:~~:~:'~~:;;:;;~~i;:~;;:~;~II';~:~~il~i;:~;i'.';.;.',....' ,".',,',',','"
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):
DaB
o 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. ,
Addendum
Form EN-028
Worker 10 $IATT
OMB No.: 0970-0154
Expiration Date: 12131JOO
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
L>I(i-, 0lttJ1.-/;;./J 7 &r'lL
State Commonwealth of Pennsvlvania AvlA'rr:.C' 07// ()/ ~,,//;
Co./City/Dist. of CUMBERLAND r rTG;)L/.J /' '7' TV
Date of Order/Notice D1/31/02 7>e 3/ ~v
Court/Case Number (See Addendum for case summary)
o Original Order/Notice
o Amended Order/Notice
Q. Terminate Order/Notice
) RE: LEHMAN, WENDELL B.
) Employee/Obligors Name (Last, First, MI)
)
)
)
)
)
)
)
197-40-7208
Employee/Obligor's Social Security Number
9769100885
Employee/Obligor's Case Identifier
(See Addendum for plaintiff names associated with cases on attachment)
Custodial Parent's Name (last, First, Ml)
EmployerlWithholder's Federal EIN Number
WINN DIXIE LOGISTICS INC
EmployerM'ithholder's Name
PO BOX B
EmployerlWithholder's Address
JACKSONVILLE FL 32203-0297
See Addendum for dependent names and birth dates assodated with cases on attachment.
ORDER INFORMA TION: 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.
$ 6D6. 64 per month in current support
$ 100.00 per month in past-due support Arrears 12 weeks or greater? @yes 0 no
$ 0.00 per month in medical support
$ 0.00 per month for genetic test costs
$ per month in other (specify)
for a total of $ 706.64 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:
$ 163.07 per weekly pay period.
$ 326 14 per biweekly pay period (every two weeks).
$ 353.32 per semimonthly pay period (twice a month).
$ 7D6. 64 per monthly pay period.
REMITTANCE INFORMA TlON:
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
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 pg. 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, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
Date of Order: FES 1 2002
D&c
Form E -028
Worker ID $IATT
Service Type M
OMB No.: 0970-0154
~ _/ --0;;' Expiration Date: 12/31/00
-
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'''''''1"r Jd ' .I!.~;-~",,'i.
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t '.
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o If checked you are required to provide a copy of this form to your employee.
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. Ilthere 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.* RepOlt;116 tile PayJate!DatG or 'NitIILoIJ;..g. '(OU lilY'll lepolt tit.... ""ardale/date of yvitl.l,vIJihg nllell sehdil,g tile; paylllGIIt. Tile
pa.yJah::/daoc. of yy;t1.llold;115 ;;, tile date vI. yvl.id, altlOUht vvd5 yy;tl.l,eld n01l1 tile elllployee'5 vvdgc:;" 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 fOlWard 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 ofthis Order/Notice to the Agency identified below,
WITHHOLDER'S ID: 5936529490
EMPLOYEE'S/OBLlGOR'S NAME: LEHMAN , WENDELL B.
EMPLOYEE'S CASE IDENTIFIER: 9769100885 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,
B. 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 (ADWE). ADWE is the net income left after making mandatory
deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes.
10,
'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 resped to these items.
Requesting Agency:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
If you or your employee/obligor have any questions,
contad WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (7171 240-6248 or
by Internet @
Page 2 of 2
Form EN-028
Worker ID $IATT
Service Type M
OMB No.: 0970-0154
Expiration Date: 12/31/00
i
"' .. f&.~'fl.rtl!mW.u:':
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: LEHMAN, WENDELL B.
07110404oj.!J( ;J1j(/
PACSES Case Number
Plaintiff Name
CHERYL E. HINKLE
Docket Attachment Amount
01=12'97 CIVIL$ 706.64
Child(ren)'s Name(s):
DOB
dii~~~~~~~~.'~~.~'.;;~;~~~i;~~;~~~;~;I;~:~~il~(;~~i....'..i\\....
identified above in any health insurance coverage available
through the employee'slobligor's employment.
PACSES Case Number
Plaintiff Name
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.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
;Eili~~~~~~~~~~~:;~;~~~i;~~;~~~;~:I;~;~~il~;;~~;()\'}...,..'.
identified above in any health insurance coverage available
through the employee's/obligor's employment.
5eIVice Type M
PACSES Case Number
Plaintiff Name
Docket
Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
dii~~~~~~d~;~~:;~;:~~i;:~:;:~;~;lr:~~~~:ldi;~~)\..;.';;'....'.".""
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
:"::',':::','::",:"':::', ":",:""",:,.""::,,,",: ...:.,.,':...,.:...,.,.:..,.:..::..::..::....':'..,.,..';';'.""""";';':";";"";"',';"";"',"".';"..;",.;"..,,;..,.;.....
"""",.""""""",."""""".,.'.:."""."",;"";":",.,.;;.,..."..",.,;""",,,.,,..,.,.:,;":",;".;"...,..",.,."..",..;".'.",.;.,,,.,;.".;"..",....,..
........ .... .............................................................
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
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.
Addendum
Form EN-028
Worker ID $IATT
OMB No.: 0970.0154
Expiration Date: 12/31/00
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
'DU, ~/-/d97 C/Wt'.,
State Commonwealth of Pennsvlvania
Co./City/Dist. of CUMBERLAND jJ/9<!f5~> 07//aVo'/O
Date of Order/Notice 07/12/02 OR. di;2W
Court/Case Number (See Addendum for case summary)
o Original Order/Notice
0- Amended Order/Notice
CD Terminate Order/Notice
) RE: LEHMAN, WENDELL B.
) Employee/Obligor's Name (Last, First, MI)
) 197-40-7208
) Employee/Obligor's Social Security Number
) 9769100885
) Employee/Obligor's Case Identifier
) (See Addendum for plaintiff names associated with cases on attachment)
) Custodial Parent's Name (Last, First, MI)
)
Employer/Withholder's Federal EIN Number
WINN DIXIE LOGISTICS INC
Employer/WithhoJder's Name
PO BOX B
Employer/Withholder's Address
JACKSONVILLE FL 32203-0297
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's/obligor'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? Qyes @ no
$ 0.00 per month in 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 towithhold:
$ 0.00 per weekly pay period.
$ D. 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 firstpay 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
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 pg. 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, 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:
Service Type M
MAILED
7-i5 - 0;)- OM' No" 0970.o1S4
LAf'"anUn Date; 12/31/00
Date of Order:
cJUL 1 ill\lL\l
...~
~"'U"'"'r,:~~'_,
-
. .
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o If checked you are required to provide a copy of this form to your employee,
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,' ROPOII;"" the Pa,dm../Date of Witl,l,old;ng. YO" I"u,t 'epolt tl ,r pa,dat",'dale <>f ..ithholdil ,g ..1,0" ,endi, ,g the p.,' "e"t. TI,o
paydato'ddte uf yyitl.lloleJ;l.g is tl.e dare 011 v~I,.id"alflOIJI,t yy..U yyitl,l.e,ld NOll! tile elJ.pluyee's vvages. You must comply with the law of the
state ,ofthe 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 empklyment. You musthonor 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,
WITHHOLDER'S ID: 5936529490
EMPLOYEE'S/OBLlGOR'S NAME: LEHMAN. WENDELL B.
EMPLOYEE'S CASE IDENTIFIER: 9769100885 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 theState in which he or she is employed governs.
8. Anti-discriinination: You are subject to a fine determined under State law for discharging an employee/obligor from
employment, refusing toemploy, Or taking d1sciplinary 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 morelhan the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (15 U.s,c. 91673 (b)l; 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.
10,
'NOTE: If you or your agent are served with a Copy of this order in the state thatissued the order, you are to follow the
law of the 'state that issued this order with respect to these items.
Requesting Agency:
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) 24():'6248 or
by Internet @
Page 2 of 2
Form EN"028
Worker ID $IATT
Service Type M
OMB No.: 0970-0154
ExpiraUonDate: 12/31/00
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
M. .)o01-/;),c?7 r71J/;L.
State Commonwealth of Pennsylvania j)
Co./City/Dist.of CUMBERLAND rl4c.-C;f'.> tJ7ffO<jO,/D
Date of Order/Notice 07/18/02 01Z &-!~L(
Court/Case Number (See Addendum for case summary)
@original Order/Notice
o Amended Order/Notice
o Terminate Order/N~tice
) RE: LEHMAN, WENDELL B.
) Employee/Obligor's Name (last, First, MI)
) 197-40-7208
) Employee/Obligor's Social Security Number
) 9769100885
) Employee/Obligor's Case Identifier
) (See Addendum for plaintiff names associated with cases on attachment)
) Custodial Parent's Name (last, First, MI)
)
EmployerMlithholder's Federal EIN Number
WINN DIXIE LOGISTICS INC
Employer/Withholder's Name
PO BOX B
EmployerMlithholder's Address
JACKSONVILLE FL 32203-0297
See Addendum for dependent names and birth dafes associated with cases on attachment.
ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERL!UID County, Commonwealth of Pennsylvania. By law, you are required to deduct these
amounts from the above..named employee'sfobligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 606.64 per month in current support
$ 100.00 per month in past-due support Arrears 12 weeks or greater? (X)yes 0 no
$ 0..00 per month in medical support
$ 0 . 00 per month for genetic test costs
$ per month in other (specify)
for a total of $ 706.64 per'month to be for,warded 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:
$ 1,63.07 per weekly pay period.
$ 326.14 perbiweekly pay period (every two weeks).
$ 353.32 per semimonthly pay period (twice a month).
$ 106,. 64 per monthly pay period.
REMITTANCE INFORMA TlON:
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
de,duct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the
the allowable amount. The total withheld amount, and your fee, cannot exceed 55% ofthe employee'sf obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is
needed (See #9 on pg, :1).
If remitting by EH/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, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
Date of Order: JUL 1 9 2002
Form EN-028
Worker ID $IATT
Service Type M
r-"^~"'1L~D
~ :;",' ',~:,';:' .,' 'OMBNo.:097Q..0154
~~,~~ iisi Expiration Date; 12/31/00
, 7 ;Cj-O;}- ,
-
.
~~,
"" ~--
~-..
k.;cl
~ -
ADDITIONAL INFORMATION TO EMPLOYERS ANO OTHER WITHHOLDERS
D If checked you are required to provide a copy of this form to your employee.
1. Priority: Withholding under this Order/Notice has priority over any otherlegal 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.* Repoltil,g tll-:; PAydc\lefD~ of 'v'/;tl.l.old;, IS, )'au I..Ust lepolt the paydaLeldo.~ of y~itl,f'Oldil,g n[,~l, 3~lldijlg tile paylllellt. TIle
pa,date/date "f ;,itl,h'Jldi"g is d,e date "" "I,iel, a'""u"t "as "itl,l.dd I,,,,,, tl,e e,,'plo,ee's "ages, 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 fOiWard the support payments.
4. * Employee/Obligor with Multiple Support Holdings: If there is more than one Ord!lr/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 !l9below)
,
i,
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.
WITHHOLDER'S ID: 5936529490
EMPLOYEE'S/OBLlGOR'S NAME: LEHMAN , WENDELL B.
EMPLOYEE'S CASE IDENTIFIER: 9769100885 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-discrimihation: 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) th!l amounts allowed by th!l F!lderal Consumer Credit
Protedion Act (15 U.S.c. ~1673 (b)l; or 2) the amounts allowed by th!l 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.
10.
*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.
Requesting Agency:
DOMESTIC RtLA TIONS 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 @
Page 2 of 2
Form EN-028
Worker ID $IATT
Service Type M
QMB No.: 0970-0154
Expiration Djate: 12/31/00
.
-
.
-
-
. .
~
> ,. ,-. h~ . ~ '~~" 'I<~"'~.
AOOENDI:JM
Summary of Cases on Attachment
Defendant/Obligor: LEHMAN, WENDELL B.
071104040~~JOl~
PACSES Case Number
Plaintiff Name
CHERYL E. HINKLE
Docket Attachment Amount
01-1297 CIVIL $ 706.64
Child(ren)'s Name(s):
DOB
. Dlf~~:~~:~,~~uar~ reqUirjt~:~;~II:~:~~il~;;~~i>.Y ,'. ,"
identified above in any health insurance coverage available
through the employee's1obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
o 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.~~:~~:~,;~~;~..;:~~i;~;~;~~;I;~~..~~il~;;~~;..................,.. ...'.'.
identified above in any health insurance coverage available
through the employee's/obligor's employment.
Service Type M
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
.......... .
....... ...
.2J.I;~~~~k~~,;~~ are required to enroll the child(ren)' ..,......'.'
identified above in any health insurance coverage available
through the employee's/6bligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee'slobligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
o 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.
Addendum
Form EN-028
WorkerlD $IATT
0MB No.: 0970.0154
Expiration Date: 12/31/00
--
--',
, -
.,
-
'~M,~'
""',
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
/)~I cRCJCiI-/;;<.17 {?(I//G
State, Commonwealth of Pennsylvania //"'(!.<;f' /)71.,/6 dO ///)
CoJCity/Disl. of CUMBERLAND "T? 1/ '1'" 7"
Date of Order/Notice 08/05/02 ()i/C .3/ d? yc.;
Court/Case Number (See Addendum for case summary)
@OriginaIOrder/Notice
o 'Amended Order/Notice
o Termi~ate Order/Notice
) RE: LEHMAN, WENDELL B.
) Employee/Obligor's Name (Last, First, MI)
) 197-40-7208
) Employee/Obligor's Social Security Number
) 9769100885
) Employee/Obligor's Case Identifier
) (See Addendum for plaintiff names associated with cases on attachment)
) Custodial Parent's Name (Last, First, MI)
)
EmployerlWithholder's Federal EIN Number
LILJEBERG ENTERPRISES, INC
EmployerJ\Vjthholder's Name
FL 3
EmployerNvithholder's Address
3900 V!;:TERANS MEMORIAL BL
METAIRXE LA 70D02-5634
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'sfobligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 606.64 per month in current support
$ 100.00 per month in past-due support Arrears 12 weeks or greater? @yesO no
$ 0.00 per month in medical support
$ D . 00 per month for genetic test costs
$ per month in other (specify)
for a total of $ 706.64 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:
$ 163.07 per weekly pay period.
$ 326.14 per biweekly pay period (every two weeks}.
$ 353.32 per semimonthly pay period (twice a month).
$ 706.64 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
the allowable amount. The total withheld amount, arid your fee, cannot exceed 55% of the employee'sf obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is
needed (See #9 on pg. 2).
IT remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU)Employer
Customer Service at l-B77-676-9580 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 THtDEFfNDANT'S NAME AND THE PACSES MEMBER 10 (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:
AVO
6 2002
~~~~~~
Form EN-02B
Worker ID $IATT
Service Type M
~I!
- B No,: 0970-0154
"& -0)-- E";,,lioo 0:'" 12/31/00
~ '
Iti::H
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
D If checked you are required to provide a copy of this fonn to your employee.
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 paymentthat is attributable to
each employee/obligor.
3. * Rep,m;ng the Pa,datefDate of,"';(I.!.oldilog. '(OU I"d.llepolt tl ,e pa,dateM.t<; of ..itl,l,aldil,g ..I,elo .ending ll,e pa,n,el,t. TI,e
pa,datefdat<; of ..ill,l,aWilog is lI,e dolt on ..hieh .".ou"t.... ..ill,l,eld nOI" the elnplo,'e', ..ages. You must comply with the law of the
state of the employee'slobligor'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'slobligor's principal place of employment. You must honor all Orders/Notices to the greatest
extent possible. (See #9 below)
5. Tennination 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 ofthis OrderINotice to the Agency identified below.
WITHHOLDER'S ID: 9740100186
EMPLOYEE'S/OBLlGOR'S NAME: LEHMAN , WENDELL B.
EMPLOYEE'S CASE IDENTIFIER: 9769100885 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 sheis 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, ortaking 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 orshe is
employed governs.
9.* WithholdingLimits: You may not withhold morethan the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (15 U.s.c. !j1673 (b)l; or 2) the amounts allowed by the State of the empioyee'slobligor's principal place of employment.
The Federal limit applies to the aggregaie 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.
10.
*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.
Requesting Agency:
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 (71 7) 240-6225 or
by FAX at (717) 240-6248 or
by Internet @
Page 2 of 2
Form EN-028
Worker ID $IATT
Service Type M
OMB No.: 0970-0154
Expiration Qate: 12/31/00
I
.,1
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: LEHMAN, WENDELL B.
PACSES Case Number 071104040 0/ ;lyeV'
Plaintiff Name (-
C~ERYL E. ~INKLE
Docket Attachment Amount
01-1297 CIVIL$ 706.64
Child(ren)'s Name(s):
DOB
.al;~~:~~~:~~~..~.~:;:~~i~~~~:~;~II;~~~~ii~(;:~;'.i:::.'..'.'..'
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
..B;;~~:~~~;;~~;;:;~~~~~~~;:~;~il~~~.~~~I~~~~:................:......
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
B;;~~;~::;~:~;~;:~;;:;;:~;;;;;~;~~i~i;~~;:::..'...
identified above in any health insurance coverage available
through the employee's/obligor's employment.
Service Type M
'-
-.., "-" ,~" ^~~~.-
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
,'::" :\::;.::~<(:\:< ::':\ ::'((:<'::.:(./~ (:,:~:: :,',: :)'j);::,,: ;,.:;::/":';:E:)<.:"/::} ::;:) :~'fS{:.;;:/( /}.;:}/. ;.:;:;:/;\'.: ;:','::':'
tJ If checked, you are required to e~roU the child(ren)'
identified above in any health insurance coverage available
through the employee's1obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
Olf checked, you are required to enroU 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
. ..... .....'.....,.............'..
.............. "..
olf~;,;;;,k~:~~~;r~;,,;;~;;;;dt~~~;~;;;;,~~;,i1d(;;~; .,",,'.. ,,','," '
identified above in any health insurance coverage available
through the employee's/obligor's employment.
Addendum
Form EN-028
Worker ID $IATT
OMB No.: 097().()J54
Expiration Date: 12/31/00
';:;,:;
it
~~:JiJl4k~,"-",'~;-1~".1".;m'-'1:~!t;,j)jIXlwii,~~IM~"'li-""""';(\:.~" ;-,ri,;0_~','~f"li;' '''i~_;~;'f''J:'i;,"',i;,:,Mi~m.1if8lilfl~~:"i':;illMll<il!~iil&.~Jir;-.m- ~~;1l;;;ll!lli11'1S~!HlWlili;ii!l&hJj~',,"'~"" '.' , - '7.-"'-'
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-('" ,
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h'h',,,,,,,,,>
'.
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
State Commonwealth of pennsylvania Ok /. ~ 1- /,)J1? {} I"/L
Co./City/Dist. of CUMBERLAND P.4C')<L$ 07110l/Ciy(;
Date of Order/Notice 08/02/02 .LJft--. .Q(C),W
Court/Case Number (See Addendum for case summary)
o Original Order/Notice
0, Amended Order/Notice
@ Terminate OrderINotice
IRE: LEHMAN, WENDELL B.
) Employee/Obligor's Name (Last, First, Mil
)
)
I
I
I
I
)
197-40-7208
Employee/Obligor's Social Security Number
9769100885
Employee/Obligor's Case Identifier
(See Addendum for plaintiff names associated with cases on attachment)
Custodial Parent's Name (Last, First, MI)
EmployerMii\hholder's Federal EIN Number
WINN DIXIE LOGISTICS INC
EmployerlWithholder's Name
PO BOX I!
EmployerMiithholder's Address
JACKSONVILLE FL 322D3-0297
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's/obligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 0.00 per month in currentsupport
$ 0 . 00 per month in past-due support Arrears 12 weeks or greater? 0 yes @ no
$ D .OD per month in medical support
$ o. 00 per month for genetic test costs
$ per month in other (specify)
for a total of $ 0 .ooper 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 towithho,ld:
$ 0,.00 perweekly pay period.
$ 0.00 per biweekly pay period (every two weeks).
$ 0.00 per semimonthly pay period (twice a month).
$ O. OD 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
the allowable amount. The total withheld amount, and your fee, cannot exceed 55% o/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 pg. 2).
If remitting by EFT/EDI, please call PEmnsylvaniaState Collections and Disbursement Unit (SCDU) ~mployer
Customer Service at 1-877-676-9580 for instructions.
Make Remittance Payable to: pA SCDU
Send check to: PennsylvaniaSCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PA YMENTS MUSTlNCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Caselderitifier)OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
Service Type M
.~D b004/C /3_
~ -0-' _O~BNo.:0970-0154
5 ~c"O_" - Expiration Date: 12/31/00
,
Zlc"G
Form EN-028
Worker ID $IATT
AUO .) 2002
Date of Order:
-
-
-
.", -
,.
.
."~m_'::Si;
.1.
.
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
D If checked you are required to provide a copy of this form to your employee.
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. * Rep~lting the Pa,datelDate of Withl,oldj, ,g. YO" '"I:(,t "pM tl,E paydateldate of"ithl,,,ldilog,,I,cl1 ,endil,g toe pay' "elot. TI,e
paydateldate of "itoo"ld"ing i, toe date 61, "I,id, "1"O"I,t "a, "itl ,I ,eld flOn, tl,e en.ploy.,', "Age'. You m"ust comply with the law of the
state of the employee'slobligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the s~pport 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 OrderlNotices due to Federal orState withholding limits, you must
follow the law of the state of employee'slobligor's principal place of employment. You must honor all Orders/Notices totlie 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 infonnation requested and retum a copy of this Order/Notice to the Agency identified below.
WITHHOLDER'S 1.0: 5936529490
EMPLOYEE'S/OBLlGOR'S NAME: LEHMAN , WENDELL B.
EMPLOYEE'S CASE IDENTIFIER: 9769100885 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 iaw. Pennsylvania State law govems
unless the obligor is emploYed in anotherStaie, in which case the iaw of the State in which he or she is employed governs., '
8. Anti-discrimination: You are subject to a fine determined underState law for discharging an ernployee/obligor from'
employment, refusing to employ, or takingdisciplinary action against any employee/obligor because of a support withholding.
Pennsylvania State law govems unless the obligor is employed in another State, in which case the law of the State in which he or she is
employed govems.
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)l; 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,
10.
'NOTE: If you or your agent arese,rvedwith 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.
Requesting Agency:
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 (7171 240-6248 ' or
by Internet @
Page 20f 2
Form EN-028
Worker ID $IATT
Service Type M
OMB No.: 0970-0154
Expiration 9ate: 12/31/00
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State Commonwealth. of Pennsylvania
Co.lCity/Dist. of CUMBERLAND
Date of Order/Notice 12/05/02
Tribunal/Case Number (See Addendum for case summary)
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
iJ#, ~1 -/.).f7 all/t-
6 '1// ()I.fOl(O
o Original Order/~otice
o Amended Order/Notice
CD Terminate Order/Notice
.,.
LILJEBERG ENTERPRISES, INC
FL 3
3900 VETERANS MEMORIAL BL
METAIRIE LA 70002-5634
RE: LEHMAN, WENDELL B.
Employee/Obligor's Name {Last, First, Mil
197-40-7208
Employee/Obligor's Social Security Number
9769100885
Employee/Obligor's Case Identifier
(Spp Addpndum for plaintiff namps
associat@d with cases on attachmpnt)
Custodial Parent's Name (Last, First, MI)
EmployerlWithholder's Federal EIN Number
See Addendum for dependlmt 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 unti I further notice even if the Order/Notice is not
issued by your State.
$ 0 _ 00 per month in current support
$ 0 .ooper month in past-due support Arrears 12 weeks or greater? Oyes <Xl no
$ o. oopermonthin medical support
$ O. 00 per month for genetic test costs
$ per monthi n 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; () o 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 paydateJdate 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 S5%of theemployee's/ obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is
needed (See #10 on pg. 2),
If remittingby EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer
Customer S'ervice at 1-877-676-9580 for instructions.
Make Remittance Payable to:PA SCOU
Send check to; Pennsylvania SCOU, P.O. Box 69112, Harrisburg, Pa 17106.9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
Date of Order: ',' FEB
5 ZOOJ
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Form EN- 28
Worker ID $IATT
Service Type M r~~~~ii~~~~i~~~I~;Th~;~
,?'~l-_._.
OMB No.: 0970-0154
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ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
D If ~hecked you are required to prpvide a Copy olthis 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 ifthe box is not checked.
1, We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally.owned businesses, and Indian-owned
businesses located on a reservation that choose to withhold in accordance with this notice.
2. Priority: 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, rfthere are Federal tax levies in effect please contact the requesting
agency listed below.
3, Combining Payments: You can combine withheld amounts from more than one employe(1obligor'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,
4. * R-epOltil.lg tl r~ Pc.\ydAlc/Daoc of'v'/itlrl-161elillg. \'otllllust_lepOI1 ti,e paydc.\Lc/date of nitklr61dil,g nile" 5ellding ti,e. paylllellt. n,e
payda-telelate of nitlll,olclillg is tile 'elate 0" nl,id, "-"IOUllt nas nitl,l,eld (10111 tI,e emplOyee's nClgeS. You must comply with the law of the
state of the employee's/o[)ligor'sprincipal 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 Multiple Slipport 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 Statewithholding limits, you must follow
the I~w of the state Of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent
possible, (See #1 0 below)
6. 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.
WITHHOLDER'S JD: 9740100186
EMPLOYEE'S/OBLlGOR'S NAME:
EMPLOYEFSCASE IDENTIFIER:
LAST KNOWN HOME,ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
LEHMAN, WENDELL B.
9769100885 DATE OF SEPARATION:
7. Lump Sum payments: you may be required to report and withhold from lump sum payments such as bpnuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below,
8. Liability:, If you'fail to withhold income as the Order/Notice directs"you are liable for both the accumulated amount you shouJd 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/obligorfrom employment,
refusing to ernploy,ortakingdisciplinary 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. * Withholding Limits: You may notwithhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (15 U's,c. ~1673 (b)l: or 2) theamounts 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; Sodal Security taxes; and Medicare taxes.
11. Additional Info:
*NOTE:lf you or your agent ares,ervedwitha copy of this order in the state that issued the order, you are to follow the
law of the state that issued this oiLIer with respect to these items. '
Submitted By: If you or your employee/obligor have any questions,
DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT
13 N. HANOVFR ST by telephone at (717) 240-6225 or
P.O. BOX 320 by FAX at, (717) 240-6248 or
CARLISLE PA 17013 by internet www.childsupport.state.pa.us
Page 2 of 2
Form EN-028
Worker ID $IATT
Service Type M
OMBNo.:0970-0154
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WENDELL B. LEHMAN,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2001-1297 CIVIL TERM
v.
CHERYL E. HINKLE,
Defendant
CIVIL ACTION-LAW
IN DIVORCE
CERTIFICATE OF SERVICE
I, Michael A. Scherer, Esquire, attorney for the Plaintiff in the above-captioned
divorce action, do hereby certify that I served a certified copy of the Complaint in Divorce
to the Defendant, as per the attached U.S. Postal Service Certified Mail, return receipt
card.
O'BRIEN, BARIC & SCHERER
BY
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MicHael A. Scherer, Esquire
DATE: July 17, 2001
<;; SENDER:
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I also wish to receive the follow-
ing services (for an extra fee):
CI Complete items 1 andlor 2 for additional services,
Complete items 3, 4a, and 4b.. .
[J Print your name and address on the reverse of this form so that we can return this
card to you. .
o Attach this form 10 the front of the mail piece, or on the back If space does not
permi!. .
C Write ~Rstum Receipt Requested" on the mailpiece below the article number.
o The Return Receipt will show 10 whom the article was delivered and the date
delivered.
1. 0 Addressee's Address
2. JC. Restricted Delivery
4a. Article Number
1,.",,,,,, 'fMda600
4b. Service Type
o Registered
o Express Mail
o Return Recei;:>t for Merchandise
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SAlDIS
SHUffi.!!OWER
, &L1NvSAY
lUIUIINIm!oAI.lR.N
26 W, HIgh stroet
CaIils1e, PA
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MARITAL SETTLEMENT AGREEMENT
THIS Agreement made this r2.(11;(../ day of ~Vtl1fW../
/
2000 by and between CHERYL E. HINKLE of 20 Carter Place, Carlisle, Cumberland
County, Pennsylvania, hereinafter referred to as WIFE, and WENDELL B. LEHMAN,
of I Lo ~a.M of,1 \ 'L,,-- ~ .l.Ja.qqa.Il"o.tl /1\ , hereinafter referred to as HUSBAND,
WITNESSETH:
WHEREAS, the parties hereto are HUSBAND and WIFE, having been joined in
marriage on January 1, 1993; and
WHEREAS, the parties hereto executed an Ante-Nuptial Agreement on
December 31, 1992 and an Addendum to the Ante-Nuptial Agreement on or about
March 2, 2000, according to the terms 'Of which Addendum, HUSBAND was to pay to
WIFE $63,000.00, and according to which such obligation was secured by a Note and
Mortgage on real estate owned by HUSBAND; and
WHEREAS, HUSBAND desires to sell the real estate free of WIFE's lien and to
pay WIFE, instead, alimony in the amount of $606.64 commencing January 1, 2001
until paid in full; and
WHEREAS, the parties hereto are desirous of settling fully and finally their
respective financial and property rights and obligations as between each other,
including, without limitation, the settling of all matters between them relating to the
ownership of real and personal property, claims for spousal support, alimony, alimony
pendente lite, counsel fees and costs, and in general, the settling of any and all claims
and possible claims against the other or against their respective estates.
I
[:
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II
SAlOIS
SHUffi.!!OWER
, &.UNUSAY
.KI1OBflo",,,,,,,-,lAW
26W.Blgbsbeet
Carlis1e,PA
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NOW, THEREFORE, in consideration of these considerations, and the mutual
promises and undertakings hereinafter set forth, and for other good and valuable
consideration, receipt and sufficiency of which is hereby acknowledged by each of the
parties hereto, HUSBAND and WIFE, each intending to be legally bound, hereby
covenant and agree as follows:
1. Advice of Counsel: The parties hereto acknowledge that each has
been notified of his or her right to consult with counsel of his or her choice, and have
been provided a copy of this agreement with which to consult with counsel. WIFE is
represented by Carol J. Lindsay, Esquire, and HUSBAND has been advised that he
may be represented by counsel of his choice Each party acknowledges and accepts
that this agreement is, in the circumstances, fair and equitable, and that it is being
entered into freely and voluntarily, after having received such advice and with such
knowledge as each has sought from counsel, and that execution of this agreement is
not the result of any duress or undue influence, and that it is not the result of any
improper or illegal agreement or agreements.
2. Divorce: If one or the other parties files a Complaint for Divorce, the
parties agree to the entry of a Decree in Divorce. The parties will execute, 90 days
after the service of the Complaint in Divorce, Affidavits of Consent and Waivers of
Notice under Section 3301 (c) of the Divorce Code, consenting to the entry of a Decree
in Divorce.
3.
Personal Property: The parties acknowledge that they have equitably
and satisfactorily divided all of their personal property, and that all personal property
I,
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SAlOIS
SHllffi. !!-OWER
&UNIJSAY
,(f1llIINI!t'So.<<.IA'W
UW.ffigh_
Cerllslo,PA
shall be the sole and individual property of the party in whose possession it is as of the
date of this agreement. The parties waive any interest they may have in any property
in the possession of the other, including employment benefits, vehicles, bank
accounts, investments or any other such property required by one or the other of them
in the course of their marriage.
4. Real Property: WIFE is the owner of a home at 20 Carter Place,
Carlisle, Cumberland County, Pennsylvania, which was purchased prior to the parties'
marriage. Pursuant to the partie~ Ante-Nuptial Agreement, HUSBAND waives any
claim he may have to an interest in WIFE's realty.
5. Alimony: HUSBAND will pay to WIFE alimony in the amount of $606.64
commencing January 1, 2001 and on the first day of every month thereafter for 178
months. Said alimony payments shall survive the death of WIFE, the death of
HUSBAND, the remarriage or cohabitation of WIFE and, in the event of WIFE's death,
shall be payable to her estate. The parties acknowledge that they have from one
another each other's Social Security Number. Alimony payments shall be deducted
from HUSBAND's gross income for the purposes of filing federal income tax returns
and includible in WIFE's gross income for the same purpose.
The alimony payments set out herein shall be payable to the Office of
Domestic Relations of Cumberland County or the Office of Domestic Relations of a
county having jurisdiction over HUSBAND. Enforcement shall be by attachment or
garnishment of HUSBAND's wages.
6.
Marital Debt: The payment of alimony set out in Paragraph 5 above is
in consideration of certain marital debt which WIFE has assumed in its entirety. The
II
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SAIDIS
Sllt.Jffi~WER
, &UNVSAY
l'IiOIINIMloM.1AW
26 W. HIgh street
CarlisI.. PA
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~;' ,n .,-_ -"'~O~O"" -_"-0',~-;,_,~, ~;;..' V''''''-'"'"_''' <w--.-*-bf.d-.~"H")-'''~\;,'_"'''"''''~i\u''''''t~"0'_'" '_"""~' - _ '" -, " "-'!f,_'-"--1-~
parties hereby agree that the provisions of this Agreement shall not be dischargeable
in Bankruptcy and expressly agree to reaffirm any and all obligations contained herein.
In the event a party files such bankruptcy and pursuant thereto obtains a discharge of
any obligations assumed hereunder, the other party shall have the right to declare this
Agreement to be null and void and to terminate this Agreement in which event the
division of the parties' martial assets and all other rights determined by this Agreement
including alimony shall be subject to court determination the same as if this Agreement
had never been entered into.
7. Statement of Address and Employment: HUSBAND certifies that his
address and telephone number are as follows:
III ~ LA ~~a.I1fUI /1;1 7d:J9'1
SlYt --41~ -'ISFl-
HUSBAND further certifies that the name, address and telephone number of his
employer is as follows:
~ tJcLM-, Jndu,j ~ /51(, 'Jilluorn n,~
).1PAAI (J,.t _...~ L k -?-t:1/U ,f7;~- ~ 2. ~.17/tf
By these presence, HUSBAND provides to WIFE a release to obtain from his
employer any and all information necessary to the placement of a garnishment or
attachment of his income pursuant to the terms of Paragraph 5 above.
IN WITNESS WHEREOF, the parties hereto have set their hands and seals the
day and year first above written.
Witness:
~
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Che'Yl E. ~ -
~ ehm," (Se,'1
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I,
II
II
Jadl<lS
. ,
WENDELL B. LEHMAN,
Plaintiff
v.
IN THE COURT OF COMMON 'PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2001-1297 CIVIL TERM
CHERYL E. HINKLE,
Defendant
CIVIL ACTION-LAW
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) of the
divorce code.
2. Date and manner of service of the complaint: Service upon the Defendant
via certified mail-restricted delivery on March 10, 2001.
3. (Complete either paragraph (a) or (b).)
(a) Date of execution of the affidavit of consent required under Section 3301 (c)
of the divorce code: by the plaintiff June 11. 2001
by the defendant June 21. 2001
(b) (1) Date of execution ofthe plaintiffs affidavit required by Section 3301 (d)
of the divorce code N/A
(2) Date of service of the plaintiffs affidavit upon the defendant
N/A
4.
Related claims pending
NONE
5. Complete either (a) or (b)
(a) Date and manner of service of the notice of intention to file praecipe
to transmit record, a copy of which is attached: N/A
(b) Date plaintiffs waiver of notice in Section 3301 (c) divorce was filed
with the Prothonotary: June 27.2001
Date defendant's waiver of notice in Section 3301 (c) divorce was filed
with the Prothonotary: June 27.2001
MffifL
Michael A. cherer, Esquire
Attorney for Plaintiff, Wendell B. Lehman
Il
INCOME WITHHOLDING FOR SUPPORT
O ORIGINAL INCOME WITHHOLDING ORDERMOTICE FOR SUPPORT (IWO) l•
Q AMENDEDIWO
O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT
Q TERMINATION OF IWO Date: 04/02/12
? Child Support Enforcement (CSE) Agency ® 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 http•//www act 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/TribefTerritory Commonwealth of Pennsylvania Remittance Identifier (include w/payment): 97091UU505
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)
EAST JEFFERSON GENERAL HOSPITA
4200 HOUMA BLVD
M ETAI RI E LA 70006-2970
Employer/Income Withholder's FEIN 720692834
Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s)
RE: LEHMAN. WENDELL B
Employee/Obligor's Name (Last, First, Middle)
197-40-7208
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.gov/proarams/cse/"newhire
em to over/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.
7206928340
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
r r
$ 0.00 per month in past-due child support - Arrears 12 weeks or greater? 0 y[T
r t -'
$ 0.00 per month in current cash medical support
$ 0.00 per month in past-due cash medical support D c
$ 606.64 per month in current spousal support .?(ZD -J
=
$ 100.00 per month in past-due spousal support
$ 0.00 per month in other (must specify) r1Q
for a Total Amount to Withhold of $ 706.64 per month.i
AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information.
If your pay cycle does not match the ordered payment cycle, withhold one of the following amount:
$ Ito3,C77 per weekly pay period. $ 353.32 per semimonthly pay periol (twice a month)
$ 3 ac?. (5 per biweekly pay period (every two weeks) $ 706.64 per monthly pay period.
$ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination ooderZ °
r'°I"
REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is CUM A
Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first ham, r
occurs ten (10) working days after the date of this Order/Notice. Send payment within sev n 7 6i ci#te
pay date. If you cannot withhold the full amount of support for any or all orders for this employe OF:,4V!t *,Up
to 55% of disposable income for all orders. If the employee/obligor's principal place of employm4h In (5? t,.) C.,
CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), obtain withholding limitati_ , tb%e `
requirements, and any allowable employer fees at http://www.acf.hhs.gov/programs/cse/newhire/erhployer/c&tacts/
contact_map.htm for the employee/obligor's principal place of employment.
Document Tracking Identifier
OMB No.: 0970-0154 Form EN-028 01/12
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 t IWO to
the sender. vlt?_ n A
Signature of Judge/Issuing Official (if required by State or Tribal law):
Print Name of Judge/Issuing Official: I?'- at n A, _hAd a
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 /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:
fop://www.acf.hhs.gov/{rograms/cse/newhire/employer/contacts/contacl ma .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-028 01/12
Service Type M Page 2 of 3 Worker ID $IATT
Employer's Name: EAST JEFFERSON GENERAL HOSPITA Employer FEIN: 720692834
Employee/Obligor's Name: LEHMAN, WENDELL B. 9769100885
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: 7206928340
O 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 childsupport 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 childsupport state a 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 01/12
Worker ID $IATT
ADDENDUM
Summarv of Cases on Attachment
Defendant/Obligor: LEHMAN, WENDELL B.
PACSES Case Numbe r 071104040 PACSES Case Number
Plaintiff Name Plaintiff Name
CHERYL E. HINKLE
Docket Atta chment Amount Docket Attachment Amount
01-1297 CIVIL $ 706.64 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
PACSES Case Numbe r PACKS Case Number
Plaintiff Name Plaintiff Name
Docket Atta chment Amount Docket Attachment Amount
$ 0.00 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
PACSES Case Numbe r PACSES Case Number
Plaintiff Name Plaintiff Name
Docket Att achment Amount Docket Attachment Amount
$ 0.00 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
Addendum Form EN-028 01/12
Service Type M OMB No. 0970-0154 Worker ID $IATT
INCOME WITHHOLDING FOR SUPPORT on
O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO)
Q AMENDED IWO - q G ?)
O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT
O TERMINATION OF IWO
Date: 04/12112
? Child Support Enforcement (CSE) Agency ® 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 http•//www acf hhs gov/programs/cse/newhirelemployer/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.
ztatei i noer i emtory uommonweann of Hennsylvania Remittance Identifier (include w/payment): 9769100885
City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for orden'docket Informa/ton)
Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary)
EAST JEFFERSON GENERAL HOSPITA
4200 HOUMA BLVD
METAIRIE LA 70006-2970
Employer/Income Withholder's FEIN 720692834
Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s)
RE: LEHMAN, WENDELL B.
Employee/Obligor's Name (Last, First, Middle)
197-40-7208
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 I WO must be regular on its face.
Under certain circumstances you must reject
this IWO and return it to the sender (see IWO
instructions
htto://www.acf.hhs.aov/proarams/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.
7206928340
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.
Rr G._,
$ 0.00 per month in current child support
$ 0.00 per month in past-due child support - Arrears 12 weeks or greater? Q y4Ir, . 64
$ 0.00 per month in current cash medical support
$ 0.00 per month in past-due cash medical support
$ 606.64 per month in current spousal support
-;C
$ 0.00 per month in past-due spousal support
'?
$ 0.o0 per month in other (must specify)
> t: rv CD for a Total Amount to Withhold of $
606.64 per month.
k?
AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order lnformation.
If your pay cycle does not match the ordered payment cycle, withhold one of the following amount:
$ &.W per weekly pay period. $ 303.32 per semimonthly pay period (twice a month)
$ XZ, CD per biweekly pay period (every two weeks) $ 606.64 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 CUMBERLAND County,
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
CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), obtain withholding limitations, time
requirements, and any allowable employer fees at http://www.acf.hhs.oov/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-028 01/12
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
ine sender.
Signature of Judge/Issuing Official (if required by State or Tribal law):
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 /D (shown above as
the Employee/Obligor's Case /dentirrer) 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•/Iw w acf hhs oov/programs/cse/newhire/employer/contacts/contact man 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-028 01/12
Service Type M Page 2 of 3 Worker ID $IATT
Employer's Name: EAST JEFFERSON GENERAL HOSPITA Employer FEIN: 720692834
Employee/Obligor's Name: LEHMAN, WENDELL B. 9769100885
CSE Agency Case Identifier: (See Addendum for case summary) Order Identifier: (See Addendum for ordeddocket 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: 7206928340
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 address:
Last known phone number:
Final Payment Date To SDU/Tribal Payee:
New Employer's Name:
New Employer's Address:
Final Payment Amount:
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 childsuoport 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 chi Idsupport. state. Da. 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 01/12
Worker ID $IATT
ADDENDUM
Summate of Cases on Attachment
Defendant/Obligor: LEHMAN, WENDELL B.
PACSES Case Number 071104040
Plaintiff Name
CHERYL E. HINKLE
Docket Attachment Amount
01-1297 CIVIL $ 606.64
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 Tvi)e 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 01/12
Worker ID $IATT
INCOME WITHHOLDING FOR SUPPORT
O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO)
Q AMENDED IWO
O ONE-TIMEORDERMOTICE FOR LUMP SUM PAYMENT
Q TERMINATION OF IWO
14-0 Lki
I Iq9 -7 CIV I
Date: 04/20/12
? Child Support Enforcement (C:SE) Agency ® 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 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.
I I-Y . Ul rUrrWCa rr u rennsyrvarna _ rtemittance Identifier (include w/payment): 9769100885
City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket informaiton)
Private Individual/ ity _ CSE Agency Case Identifier: (See Addendum for case summary)
EAST JEFFERSON GENERAL HOSPITA
4200 HOUMA BLVD
METAIRIE LA 70006-2970
Employer/Income Withholder's FEIN 720692834
Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s)
7206928340
See Addendum for dependent names and birth dates associated with cases on
I' - }
ORDER INFORMATION: This document is ibased on the support or withholding order from Ct RCANQ County,
Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amouri%#6m the etxipiQyee/
obligor's income until further notice.
$ 0.00 per month in current chi'Id support
$ 0.00 per month in past-due child support - Arrears 12 weeks or greater? Q; r44 no
$ 0.00 per month in current cash medical support u"
$ 0.00 per month in past-due cash medical support _41
$ 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.
AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information.
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 (eve:ry 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 CUMBERLAND County,
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
CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), obtain withholding limitations, time
requirements, and any allowable employer fees at http://www.acf.hhs.gov/programs/cse/ne%vhire/employer/contacts/
contact map.htm for the employee/obligor's principal place of employment.
Document Tracking Identifier
RE: LEHMAN, WENDELL B.
Employee/Obligor's Name (Last, First, Middle)
197-40-7,208
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.govtr)rograms/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.
OMB No.: 0970-0154 Form EN-028 01/12
Service Type M Worker ID $IATT
-1i Return to Sender [Completed by Employer/income Withhoideri
? o
accordance with 42 USC §666(b)(5) and (b)(6' 0, - Payee (set f'aynle,r,ts ter SDhI Below t payment
directed to an SDU/Tribal Payee or this IWO is ?-i ,crier, ?h w : r1(. el!a the iUVO
the sender.
Signature of Judge/Issuing Official (if required by State or in tta! aw
Print Name of Judge/Issuing Official:
Title of Judge/Issuing Official:
x,
Date of Signature:
If the employee/obligor works in a State or for a Tribe that is different frorra trio Sta[t. „r Tribe that issuer this t!h s 1Vi C
must be provided to the employee/obligor.
? If checked, the employer/income withholder must providr f tnss form) !(.;h(- e:riployeelo l1gG
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 f-ederai Employer Services website located are.
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 w
Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodiai
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 implemens
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 t?,
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 surn payments to th r
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 front 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 fronn
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 f 1, ..-e rr, mv
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Service Type M ac :?r wrier its SIA
Employer's Name: EAST JEFFERSON GENERAL_HOSPITA _ Employer FEIN: 720692834
Employee/Obligor's Name: LEHMAN, WENDELL B. 9769100885
CSE Agency Case Identifier: (See Addendum for case mmarvl 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: 7206928340
O 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 L71. 7)_240-6225, by fax at 717 240-Ei248, by email or website at: www.childsupportstate.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 j71 T)_240-6225, by fax at 717 240-E3248, by email or website at www.childsupport state. pa. us.
IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor.
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Form EN-028 01/12
Worker ID $IATT
AUDENUUM
Summary._sT (,aces on_Attachmert
Defendant/Obligor: LEHMAN. VVivi } - L -.
PACSES Case Number 071104040 ySES Vase Number
Plaintiff Name iaintiff Name
CHERYL E. HINKLE
pocket Attachment Amount Deci?e Attachmen[ Amour=
01-1297 CIVIL $ 0.00 0.00
Child(ren)'s Name(s): DOB '.,,,hi1d(ren,,s'-, Name(s):
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): DOE C'hild(ren)'s Name(sj: )OB
- -- -- -------
PACSES Case Number PACSES Case Number
Plaintiff Name Plaintiff Name
Doc et Attachment Amount Docket Attachment Amount
$ 0.00 s 0.00
Child(ren)'s Name(s): DOES `hiid(rera)`s Name(s):
,Adclendurr? Form EN-028 (i
Service Type M = Worker ID $iA f