Loading...
HomeMy WebLinkAbout01-1501 FX - C",t ~, ,-. ;;_."'<'0 . . . . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNA. LOLETA C. MA'l'THEWS I Plaintiff No. 01-1501 CIVIL TERM VERSUS DAVID H. MATI'HEWS I Defendant DECREE IN DIVORCE ANO NOW'~ 9 ;J::. r: () ~ PM. ; ,~~ IT IS ORDERED AND . . . . . . . I:)ECREEp THAT LOLETA C. MA'I'THEWS , PLAtNTlFF, AND DAVID H. MATTHEWS , DEFENDANT, ARE DIVORCE;D FROM THE BONDS OF MATRIMONY. THE C;:O\JRT RETAtNS~URISDICTlON OF THE FOLLOWING CLAIMS WHtCH HAVE BEEN RAiSED OF RECORQ IN THtS ACTION FOR WHICH A FINAL, ORDER HAS NOT YET BEEN ENTERED; An order for pl.yment of alimony is to be entered contemporaneously with this Decree. . J. PROTHONOTARY . . . . ;'! ie . I'.', . I'; . + + . . . . + . + . . + . . . . + . . . + + + . . + . . . . . . . . . . . . . . . . . . . . . . . . ;'~~Mi;_iIIU~~Jtl!M~~~~~!Wi'Ml;;!~~;-~In,jMM ~ j "7>nv~ #P ~ 'P~ ~~ ~~ r;'Z~'~:Pl ? ~ ~<, It",' W:~Jfl;Rr~n~\"1!]JrJ """P""''''''''''''~_",,,,,,_w,.' ,~^~r.""" .' ,,'.~"'''''''~.,"' "~. , ,~ ,,~~~~"~ -I ~" ~ '_.,,,,,,_ ~(/- 1/ C'/ ['(1. /1- c:/ ~ ",' '~ "" - ~- II . ... LOLETA C. MATTHEWS, Plaintiff vs. ) ) ) ) ) ) ) ) ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID H. MATTHEWS, Defendant CIVIL ACTION - LAW NO. &/- /-5tJl i;J IN DIVORCE NOTICE TO DEfEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the foregoing pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree in divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at: Office of the Prothonotary Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 Telephone: (717) 249-3166 II ,,:! .. . .. LOLETA C. MATTHEWS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. 01- /:{Ol ~ /4AP- DAVID H. MATTHEWS, Defendant IN DIVORCE NOTICE OF AVAILABILITY OF COUNSELING TO THE WITHIN-NAMED DEFENDANT: You have been named as the Defendant in a Complaint in a divorce proceeding filed in the Court of Common Pleas of Cumberland County. This notice is to advise you that in accordance with Section 3302 (d) of the Divorce Code, you may request that the court require you and your spouse to attend marriage counseling prior to a divorce being handed down by the court. A list of professional marriage counselors is available at the Domestic Relations Office, 13 North Hanover Street, Carlisle, Pennsylvania. You are advised that this list is kept as a convenience to you and you are not bound to choose a counselor from this list. All necessary arrangements and the cost of counseling sessions are to be borne by you and your spouse. If you desire to pursue counseling, you must make your request for counseling within twenty days of the date on which you receive this notice. Failure to do so will constitute a waiver of your right to request counseling. " [ ,- , , ~: II ",,,,,,,- ... ... LOLETA C. MATTHEWS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW f)"'/~ NO. eJ/- ISO I L-W<-! DAVID H. MATTHEWS, Defendant IN DIVORCE COMPLAINT IN DIVORCE AND NOW comes the above-named Plaintiff, LOLETA C. MATTHEWS, by her attorney, Samuel L. Andes, and makes the following Complaint in Divorce: 1. The Plaintiff is LOLETA C. MATTHEWS, an adult individual who currently resides at 205 Cavalry Road in Carlisle, Cumberland County, Pennsylvania. 2. The Defendant is DAVID H. MATTHEWS, an adult individual who currently resides at 144 Amy Drive in Carlisle, Cumberland County, Pennsylvania. 3. Both the Plaintiff and Defendant have been bona fide residence of the Commonwealth of Pennsylvania for at least six months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on 26 November 1966 in Carlisle, Pennsylvania. 5. There have been no prior actions of divorce or annulment between the parties. 6. The marriage is irretrievably broken. 7. Plaintiff has been advised of the availability of marriage counseling and the Plaintiff may have the right to request that the Court require the parties to participate in counseling. "\ COUNT I IRRETRIEVABLE BREAKDOWN 8. The Plaintiff requests this Court to enter a Decree in Divorce. WHEREFORE, Plaintiff requests this Court to enter a Decree in Divorce pursuant to the Divorce Code of Pennsylvania. 11- ~., , [" . Ji' COUNT II EQUITABLE DISTRIBUTION 9. During the course of the marriage, the parties have acquired numerous items of property, both real and personal, which are held in joint names and in the individual names of each of the parties hereto. WHEREFORE, Plaintiff prays this Honorable Court, after requiring full disclosure by the Defendant, to equitably divide the property, both real and personal, owned by the parties hereto as martial property. COUNT III - ALIMONY 10. Plaintiff lacks sufficient property to provide for her reasonable needs in accordance with the standard of living of the parties established during the marriage. 11. Plaintiff is unable to support herself in accordance with the standard of living of the parties established during the marriage through appropriate employment. 12. The Defendant is employed and enjoys a substantial income from which he is able to contribute to the support and maintenance of the Plaintiff and pay her alimony in accordance with the Divorce Code of Pennsylvania. WHEREFORE, Plaintiff prays this Honorable Court to enter an Order awarding Plaintiff from Defendant permanent alimony in such sums as are reasonable and adequate to support and maintain Plaintiff in the station of life to which she has become accustomed during the marriage. COUNT IV ALIMONY PENDENTE LITE 13. Plaintiff is without sufficient income to support and maintain herself during the pendency of this action. 14. Defendant enjoys a substantial income and is well able to contribute to the support and maintenance of Plaintiff during the course of this action. WHEREFORE, Plaintiff prays this Honorable Court to order Defendant to pay her reasonable alimony pendente lite during the pendency of this action. II . ,,- ~' __L'~ - ... COUNT V - COVNSEL FEES AND EXPENSES 1 5. Plaintiff is without sufficient funds to retain counsel to represent her in this matter. 16. Without competent counsel,1 Plaintiff cannot adequately prosecute her claims I against Defendant and cannot adequatelv litigate her rights in this matter. 17. Defendant enjoys a substantial income and is well able to bear the expense of Plaintiff's attorney and the expense of this litigation. WHEREFORE, Plaintiff prays this Honorable Court to order Defendant to pay the legal fees and expenses incurred by Plaintiff in this litigation of this action. I verify that the statements made in this Complaint are true and correct. I understand that any false statements in this Complaint are subject to the penalties of 18 Pa. C.S. 4904 (unsworn falsification to authorities). Date:~200\ ~,t,C~~~ LAC. MATTHE . ,~ u I LAnde ' Attorney for Plaintiff Supreme Court ID # 17225 525 North 12th Street Lemoyne, Pa 17043 (717) 761-5361 II = - , ~ I I!J-"""~"; 'I ~' I ~ ~ . LOLETA C. MATTHEWS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW DAVID H. MATTHEWS, Defendant NO. tJ/- ~I ~ I I NOTICE TO DEFEND AND CLAIM RIGHTS IN DIVORCE You have been sued in court. If Y!lU wish to defend against the claims set forth in the foregoing pages, you must take prompt $ction. You are warned that if you fail to do so, the , case may proceed without you and a deqree in divorce or annulment may be entered against you by the court. A judgment may also I be entered against you for any other claim or relief requested in these papers by the Plaintif~. You may lose money or property or other rights important to you, including custody or vi~itation of your children. When the ground for the divorce i~ indignities or irretrievable breakdown of the marriage, you may request marriage cou~seling. A list of marriage counselors is available in the Office of the Prothonotary at: Office Of the Prothonotary Cumberlarld County Courthouse 1 Cqurthouse Square Carlisle, PA 17013 ! IF YOU DO NOT FILE A CLAIM FdR ALIMONY. DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCl: OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANV OF THEM. I YOU SHOULD TAKE THIS PAPER ITO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWVER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE vbu CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 Telephone: (717) 249-3166 I " " II 11 Ii I I II 1-. ~ll~~,_ 1 t LOLETA C. MATTHEWS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. DAVID H. MATTHEWS, Defendant IN DIVORCE NOTICE OF A V ~ILABILlTY OF COUNSELING TO THE WITHIN-NAMED DEFENDANT: You have been named as the Defeindant in a Complaint in a divorce proceeding filed in the Court of Common Pleas of Cumberland County. This notice is to advise you that in accordance with Section 3302 (d) of the Divorce Code, you may request that the court require you and your spouse to attend m;arriage counseling prior to a divorce being handed down by the court. A list of professional marriage counselors is available at the Domestic Relations Office, 13 North Hanover Street, Carlisle, Pennsylvania. You are advised that this list is kept as a convenience to you and you are not bound to choose a counselor from this list. All necessary arrangements and the cost of counseling sessions are to be borne by you and your spouse. If you desire to pursue counseling, you must make your request for counseling within twenty days of the date on which you receive this notice. Failure to do so will constitute a waiver of your right to request counselin;9. II ...... I,: '0" ~- '- "~'F~,;" LOLETA C. MATTHEWS, Plaintiff vs. ) ) } } } ) } ) ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. DAVID H. MATTHEWS, Defendant IN DIVORCE COMPLAINT IN DIVORCE AND NOW comes the above-named Plaintiff, LOLETA C. MATTHEWS, by her attorney, Samuel L, Andes, and makes the following Complaint in Divorce: 1. The Plaintiff is LOLETA C. MATTHEWS, an adult individual who currently resides at 205 Cavalry Roa.d in Carlisle, Cumberland County, Pennsylvania. 2. The Defendant is DAVID H. MATTHEWS, an adult individual who currently resides at 144 Amy Drive in Carlisle, Cumberland County, Pennsylvania. 3. Both the Plaintiff and Defendant have been bona fide residence of the Commonwealth of Pennsylvania for at least six months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on 26 November 1966 in Carlisle, Pennsylvania. 5. There have been no prior actions of divorce or annulment between the parties, 6. The marriage is irretrievably broken. 7. Plaintiff has been advised of the availability of marriage counseling and the Plaintiff may have the right to request that the Court require the parties to participate in counseling. COUNT I - IRRETRIEVABLE BREAKDOWN 8. The Plaintiff requests this Court to enter a Decree in Divorce. WHEREFORE, Plaintiff requests this Court to enter a Decree in Divorce pursuant to the Divorce Code of Pennsylvania. I I' ,I II .....~~"'-"-". . "' ,-"I ., j .~'''''''~,,_." .' COUNT" - EQUITABLE DISTRIBUTION , 9. During the course of the mar~iage, the parties have acquired numerous items of property, both real and personal, which C!re held in joint names and in the individual names of each of the parties hereto. WHEREFORE, Plaintiff prays this Honorable Court, after requiring full disclosure by the Defendant, to equitably divide the propenty, both real and personal, owned by the parties hereto as martial property. COU~T III - ALIMONY 10. Plaintiff lacks sufficient property to provide for her reasonable needs in accordance with the standard of living o~ the parties established during the marriage. 11 . Plaintiff is unable to support herself in accordance with the standard of living of I the parties established during the marria~e through appropriate employment. t i 12. The Defendant is employed and enjoys a substantial income from which he is able to contribute to the support and maintenance of the Plaintiff and pay her alimony in accordance with the Divorce Code of Pemnsylvania. WHEREFORE, Plaintiff prays this Honorable Court to enter an Order awarding Plaintiff from Defendant permanent alimony in such sums as are reasonable and adequate to support and maintain Plaintiff in the station of life to which she has become accustomed during the marriage. , COUNT IV - ALIMONY PENDENTE LITE 13:. Plaintiff is without sufficient lincome to support and maintain herself during the pendency of this action. 14. Defendant enjoys a substantial income and is well able to contribute to the support and maintenance of Plaintiff durihg the course of this action. WHEREFORE, Plaintiff prays this Honorable Court to order Defendant to pay her reasonable alimony pendente lite during the pendency of this action. Ii '~u.. ; - ~~" i. ". , , . 1 ~~, Ii.!li:...i,""'~" .' , I COUNT V - COltlNSEL FEES AND EXPENSES 1 5. Plaintiff is without sufficient funds to retain counsel to represent her in this matter. 16. Without competent counsel, Plaintiff cannot adequately prosecute her claims against Defendant and cannot adequately litigate her rights in this matter. 17. Defendant enjoys a substantial income and is well able to bear the expense of Plaintiff's attorney and the expense of this litigation. WIHEREFORE, Plaintiff prays this Honorable Court to order Defendant to pay the legal fees and expenses incurred by Plaintiff in this litigation of this action. J verify that the statements mape in this Complaint are true and correct. I understand that any false statements in this Complaint are subject to the penalties of 18 Pa. C.S. 4904 (unsworn falsification to authorities). Date: 3\ \31200 l , ~,\"('/~~~ LO A C. MATTHEW ~ ( . , ~I LAnde Attorney for Plaintiff Supreme Court 10 # 17225 525 North 1 2'h Street Lemoyne, Pa 17043 (717) 761-5361 fRUE COpy FROM RECORD tn Testimony whereof. I here unto set my hand ,md the seal of said Court at Carlisle. Pa ',;s_. 1< day of~ ..:2&&:"<",- - ~g-~~_... i :1 Ii ~~liIliil~'iIlMlful!~il1I~~'Ifl!~;i;tjj"";h~%>","M~.j;W)I:~L,-.",,,"--,-,.l,-"~, ~ "m ~;1 ,=" :fO~~,~ ;;~,E;;;~ ;~~ L ~ _ ,~"__~, '~'N~"" .~".. ,," __, ," __. ..J......, \ Sr\'M~d '1\r\~f\~. ) ~j \.,. ~ 'Ad~ \~h \\d \1S l\\li\{\~ " ,<<'A'fYc:'\'''\(.)~4Q.. 1.1""" '..!' 1(\ ::1"\ 'kl.I'l\VV 3\\1. ;:)v l~\l\~\\S ILi~~"'--'" ,,,._,.~""'"' ,_. . ~~. ""'j I o;j ~iliiiIlIIIlIII LOLETA C. MATTHEWS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. 01-1501 CIVIL TERM DAVID H. MATTHEWS, Defendant IN DIVORCE PRAECIPE TO THE PROTHONOTARY: Please reinstate the Complaint in the above matter. Date: 1 May 2001 S&AjJQJ) Attorney for Plaintiff Supreme Court 10 # 17225 525 North 12th Street Lemoyne, PA 17043 (717) 761-5361 II 'i~fiiJf--i"-~"--.:J~~..J.~J;W:W-1IiHl&w~~~~:IiG:!'@!@';':']nMitili-tt!lj,jji\iii!f{ilif;.a~~_lJ'" -,""L____ C~Li -"', "'~"" ",,""htJL, "'~,,,__"^,. - ,~-, _,~ _, ~ ,_ ~~m,_ Ij~< "^,"-"-< , , '~j i.:.... ' ~ ("; 0 C:::i C "i",\ s: :x -om :P' ~-:.;: :--:; rnrn -< Z::D I ,;'-:-1 ZC -. ~c!, S:-J CP. ,f:~ 1'.' ..;..c .L- ,:',(J ~G ~ ~_;". ..".t ZO ::r.:: ~;~~ J>~ '? --1 ~ 50 c;:i -< f:f ~._',.., "__.~'....,c ~.~ - "~ '~ "~_o-.- WL--'~~ . SHERIFF'S RETURN - NOT FOUND CASE NO: 2001-01501 P COMMONWEALTH OF PENNSYLVANIA , COUNTY OF CUMBERLAND MATTHEWS LOLETA C VS MATTHEWS DAVID H R. Thomas Kline ,Sheriff or Deputy Sheriff, who being duly sworn according to law, says, that he made a diligent search and inquiry for the within named defendant, DEFENDANT MATTHEWS DAVID H but was unable to locate Him in his bailiwick. He therefore returns the COMPLAINT - DIVORCE , NOT FOUND , as to the within named DEFENDANT , MATTHEWS DAVID H WRIT EXPIRED BEFORE SERVICE COULD BE MADE Sheriff's Costs: Docketing Service Affidavit Surcharge 18.00 3.10 .00 10.00 .00 31.10 ~~ R. Thomas Kline Sheriff of Cumberland County SAMUEL ANDES 05/11/2001 Sworn and subscribed to before me this ~ /f- day of ~ c:Lct;/ A.D. Q~.. 0 rn,$.~ I.falf. P 0 honotary I d_,~,~",_~~~d ",,- ~~ '-~ ., , ~ "~"'!;illl'l'M",,'~:1 SHERIFF'S RETURN - REGULAR CASE NO: 2001-01501 P , COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND MATTHEWS LOLETA C VS MATTHEWS DAVID H DAWN L. KELL , Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT - DIVORCE was served upon MATTHEWS DAVID H the DEFENDANT , at 0020:04 HOURS, on the 15th day of May at 144 AMY DRIVE , 2001 CARLISLE, PA 17013 by handing to DAVID H. MATTHEWS a true and attested copy of COMPLAINT - DIVORCE together with RIENSTATED WITH NOTICE and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 18.00 3.10 .00 10.00 .00 31.10 So Answers: ~~~~~l R. Thomas Kline 05/16/2001 SAMUEL ANDES Sworn and Subscribed to before BY:\)~~ M Deputy Sheriff me this <R.JJ....~ day of ~/'Q ;~.D.~ .d', ~ Ptothonotary ,-,,"= _. ~__L_ , ""~'-"IIII - '=.i.""".....~i!: ..', - . LOLETA C. MATTHEWS, Plai ntiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. DAVID H. MATTHEWS, Defendant CIVIL ACTION - LAW - IN DIVORCE NO. 01 - 1501 CIVIL TERM PRAECIPE TO WITHDRAW AND ENTER APPEARANCE TO THE PROTHONOTARY: Please withdraw my appearance for Defendant, David H. Matthews, in the above-referenced matter. Date: b" /"t.vJ 0 / By: . " Please enter my appearance for Defendant, David H. Matthews, in the above-referenced matter. Date{) , dd-' 0 \ Ja Adams, Esquire 117 South Hanover St ar isle, Pa. 17013 (717) 245-8508 1.0. No. 79465 '-~=""";"'-'-'''~~~'-''IiI\i~'' ., "ts...~ ::. ~c ...,,~ 1."" ~" -~~~~~~- ;",J oIlbi._",,~, ~- ~."~...k.""M~_ - ,_. =,"">~." ~ .,.,,'"~'~>-"' .,,'-'~.~",-.', "., ,,- ~,~ . o c: <- '"Qct nifr; ~5:~ -<;.-...::- <C~' ~~r-. i:C< ~ ~ t":) ~n ,.-. :z N r',) ',-~ ".~.~~' t~~! '~~C: -I'] , " ;,~~Ii~~: ~ :'j -< ~ J; CJ lw . ~~ ~ , I' LOLETA C. MATTHEWS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. 01-1501 CIVIL TERM DAVID H. MATTHEWS, Defendant IN DIVORCE PRAECIPE TO TRANSMIT RECORD TO 'THE PROTHONOTARY: Transmit the record, together with the following information, to the Court for entry of a divorce decree: 1, Grounds for Divorce: Irretrievable breakdown under Section 3301 (c). 2. Date and manner of service of the Complaint: Complaint served by the Sheriff on 15 May 2001 on Defendant. 3. Complete either Paragraph (a) or (b): (a) Date of execution of the Affidavit of Consent required by Section 3301 (c) of the Divorce Code: By Plaintiff: 1 December 2003 By Defendant: 11 November 2003 (b) (1) Date of execution of the Affidavit required by Section 3301 (d) of the Divorce Code: (2) Date of filing and service of the Plaintiff's Affidavit upon the Respondent: 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: (b) Date Plaintiff's Waiver of Notice in Section 3301 (c) Divorce was filed with the Prothonotary: Dated 1 December 2003. filed contemporaneously herewith. Date Defendant's Waiver of Notice. in Section 3301 (c) Divorce was filed with the Prothonotary: Dated 12 November 2003. filed contemporaneously herewith. Date: .3 :Df'c_ ;>:iYJ?> ~~ Attorney for Plaintiff II ~'~~~;lJil'il!M!<<li.J:il,-'~~Dll:;li1l!illiW~-'li~';'_:a>Offi.llj;f1i-'ld'l!1fulli1-ll~.~~_- '.' ~~~o \HT IT.!l!tAlUIflJlilJ! : ~_'i""""_',_~.__Y.. _ "_~,~,~ __~. 'h",,~ ,Co, ~_ .'O'.~' IIIiilL JllMl--.Ll ,'0 klial t (') c:::> ~ -o~ -~ ~ -.... -r .rFt1# 92~ C") com I ",.roO m- w ~~i t20 -0 g:!J ~o :::ll: ~.~ J;() ~ u c "" z #' ~ ~ Ul , ~ , LOLETA C. MATTHEWS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. 01-1501 CIVIL TERM DAVID H. MATTHEWS, Defendant IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301 ICI OF THE DIVORCE CODE 1. I consent to the entry of a final decree in divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees, or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Waiver are true and correct. I understand that false statements herein are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. 1/-J;2~():J- Date t;~~tJff~<~ DAVID . MA Tf EWS II :ili0..,,,,- -~~~~i;;1);i;;j~\"fiIgJ!.itIt;>'!iJitH!W,~~....l..:',:,,~,,~,,:,-"" I, _~ ~ ".:'!r .,~~ ~~ ". .c-,',.,;..-J.. "I~ . 0'- ->" '., " _>c,-,_,"," ,. """""X'" f ~ 0 0 c.> -n 0 --< -.;l"rn m -..- r:ng: " R\1J ~~ I '.fJ(T1, W ;00 ~ .' Si?, ,-- !;20 -0 XI ~c ::ll: c5:D -d W zf,? ;J:>c .. ~ ~ r ~ <J) '" ~.. J"..._~ , ~o , , ""~-' ^-.L 1 'fl~ -' - LOLETA C. MATTHEWS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. 01-1501 CIVIL TERM DAVID H. MATTHEWS, Defendant IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301 IC) OF THE DIVORCE CODE 1. I consent to the entry of a final decree in divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees, or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Waiver are true and correct. I understand that false statements herein are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. \g,-\-O'2> Date ~C'~~ E A C. MATTHEW I i " ~~~~~!M.i<jil1~~"~~.~'"--lli-.;;ll""'~!i~W~),;-"",,,,,__~di.t"'i'hcJWt,,,;;jWWiilifOcli',::;!ji~tV'",Jj-"~ljAir~'" '1iliflIII- "~~ ...-,-"...I"",,~~~~~ =;,,".. "," "',~ - - ,.". .~, ,"~, ""' .~ ,~~~ '-"-'-"~i",_ ~ ,'" ~. L~ -- t e 0 ~. ,'7- (,.;l ""- 0 ti -o~ r"'I mn C") -~;n Z::t' mr- Z~ I ~~ ~~ (.:> 0 "4," -0 ~:r4 ~C ::Il: 00 0 ~ 15m ;>c: ~ c:- ~ UI -< ~ .. \ LOLETA C. MATTHEWS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. 01-1501 CIVIL TERM DAVID H, MATTHEWS, Defendant IN DIVORCE JOINT MOTION FOR ENTRY OF ALIMONY ORDER AND NOW, this ,~ day of 17)€~J ,2003, come the above- named parties and their attorneys and jointly move this court to enter the attached Order for the Payment of Alimony to implement a provision of their Property Settlement Agreement made the same date as this Motion. ,,-, "~I! I:!i " " 'Ii \J~. ,GvJ 0 ~ ~ll.A~ Attorney for Plaintiff ~c~~ ta C. Matthews ;;] IJ' ~ David~ II ,-,~~~~~~iritit~m-AA~ll'.__a ,-~-'" " l.L,,~~,-,i,q-,.. __,,, ,>.,.."~""._"' ">' ~ r,. .=." , ~-~~ ,--I ;.J./ ..., . .,. ,"C'"'''' ";'" " , 'co""",..,,,,' ~,'"'L -4" ",C) ",0 0 c ~.*: ", s:: 0 ~;:J:n -otn ,.., !:2 P', ("') ::Xl ,Il-r z~ I -um 'c/) -c W :06 -<e OJ ~' -U ;:::5,.,-- ~c :x "';:tJ ~c5 '~'-,..n c w om :z; .. ~ :::< ~ ..., -< I (1j; - ~~ "'"" L - .J,' -..J':;,;,..., ~":, \ LOLETA C. MATTHEWS, Plaintiff vs. ) ) ) ) ) ) ) ) ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 01-1501 CIVIL TERM DAVID H. MATTHEWS, Defendant IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301 (cl of the Divorce Code was filed on 15 March 2001, reinstated on 2 May 2001, and served upon the Defendant within thirty days thereafter. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing of the complaint and the date of service of the complaint on the Defendant. 3. I consent to the entry of a final decree in' divorce either after service of a Notice of Intention to Request Entry of the Decree or upon filing of my Waiver of the Notice of Intention to Request Entry of the Decree. 4. I have been advised of the availability of marriage counseling and understand that the Court maintains a list of marriage counselors and that I may request the Court to require my spouse and I to participate in counseling and, being so advised, do not request that the Court require that my spouse and I participate in counseling prior to the divorce becoming final. I verify that the statements made in this Affidavit are true and correct and 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. \~-\ -O~ Date ,~Iii;:Itiii!IW~>I!~%mi!i!,""'-~;;;".'&;;~~Jffil~wiIll"-.4,L.~.-hif.d_,,%i7;'WlL'j',hg;lii~-'~t;@,:tlliiltl~~;' ., ~,^"-~ . _ ,_ _ "~" ,~",,~',_r,",.. , ~ _ , ~, e , " ~ ~' ~u."'.. '.~-j , (') 0 c: ~ ~ -os:' ~ ~fB :;j C") ffi:n 65~. I r- W .~~ ~.!, .;g. kC:-j ~() ~ :rJ ""'.:II :;>8 S:f Va ~ am .t:" ~ en -<: . 'C'-,I LOLETA C. MATTHEWS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. 01-1501 CIVIL TERM DAVID H. MATTHEWS, Defendant IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on 15 March 2001 and served upon the Defendant on or about 15 May 2001. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing of the complaint and the date of service of the complaint on the Defendant. 3. I consent to the entry of a final decree in divorce either after service of a Notice of Intention to Request Entry of the Decree or upon filing of my Waiver of the Notice of Intention to Request Entry of the Decree. 4. I have been advised of the availability of marriage counseling and understand that the Court maintains a list of marriage counselors and that I may request the Court to require my spouse and I to participate in counseling and, being so advised, do not request that the Court require that my spouse and I participate in counseling prior to the divorce becoming final. I verify that the statements made in this Affidavit are true and correct and 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. II. /2 ~o.3 Date /1 /7 ~~ff~;~ DAVID H. AT EWS II ~~"~llit&M~~~~~l.0>:if.:~~~~-~'~OO~'iii11fi:l dJ[),,_L__: : ^..l>rrnrU!l~ iM, nIl.LH__"~'" _=_" "'"'' . .". ,-- ,eif P Jli"'r~'" '''''liI'''- /.'". '" .~ ~ Cl ~ t\ W 0 --> ;:H~ fTl -r C"') t1~ :rJ Z --~ ~.~ t5.~ I W :.tJ ~ > a ;.<:::0 " 'J.!., jc ::II: "~:n 00 0 ct? Zm ~ 01' r:- ~ UJ -< ltvJ .. LOLETA C. MATTHEWS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs, CIVIL ACTION - LAW NO. 01-1501 CIVIL TERM DAVID H, MATTHEWS, Defendant IN DIVORCE ORDER FOR PAYMENT OF ALIMONY AND NOW, this 0'" day of ~- ~ ,2003, upon the joint motion of Plaintiff and Defendant,~mPlement a provision of their Property Settlement Agreement, we hereby order and decree as follows: 1. Defendant David H. Matthews shall pay to Plaintiff Loleta C. Matthews alimony as follows: A. The amount of alimony shall be $500.00 per month. The amount of alimony shall not be subject to modification except by the mutual written consent of both parties. B, The alimony shall be for an indefinite term and shall be terminated only by the Court of Common Pleas of Cumberland County upon the death of either party, Wife's remarriage or cohabitation with a man not her spouse, or a change in financial circumstances so great as to make the continuing payment of alimony unjustified. C. The payments made pursuant to this paragraph shall be treated by both parties as alimony whereby Husband deducts the payments from his income for tax purposes and Wife includes them in her income for tax purposes, D. The alimony payment shall be made through the Domestic Relations Office of Cumberland County which shall be authorized to collect and administer the alimony payments and Husband agrees that his wages shall be attached to enforce the alimony provisions of this agreement. The alimony payments due under this Order shall commence on the first day of the month following the entry of the final decree in divorce in this action, I BY THE COURT, Distribution: Samuel L Andes, Esquire (Attorney for Plaintiff) 526 North 12th Street, Lemoyne, PA 17043 J. . Jane Adams, Esquire (Attorney for Defendant) 36 South Pitt Street, Carlisle, PA 17013 II l~~~ilMi~~~ij~~ii\lil"6ffi!riR;'~jiHf-N{;;(W@ll;_,;i~"~H't:;'~,!j;~WiJf:' ',L_L_JLn" ;,..~, o:=!llll_~1 JIL~_~, ,-I~ :";,_~, ,'-'''-' ^""-'>' ~'o/_ ",."", ~_~"'"' ""~-,_ _ _. ~ '."'-'" I ,_ ,~,,;:;, ;, ], Vlf\!Vi\lJ..SNr--.8d I I ~Innr, nl, ',nUl"';N"'''' 1\.1..1',\ "...' ":H,, :':,,'_":~\,~! 10.) 0' :s \~d 0 I 33U CO '\J'''''''''~'; ,~, , "'" JO ^UV.l-\..'i'i~~,j-u.\JC:-'j '::;-11.. -J 3JljjQ-O:r1Jj 1';'\"- "'"', "~""~;~"C '- ' ,'" '.,,,,, ; -",:,L;G;",._" "".. ,,', .. ]l ~.; "~ ~"~ .~ ' - . , . . .'''-'-''00".. =w,~_ . .= "~~"'-><j;i , ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 01/21/04 Tribunal/Case Number (See Addendum for case summary) RE: MATHEWS, DAVID H. Employee/Obligor's Name (Last, First, MI) @Original Order/Notice o Amended Order/Notice o Terminate Order/Notice EmployerMlithholder's Federal EIN Number M ~/-/5{)1 {!lvlL Pf(eSZ$, .;,1.'/7/0(,,033 168-38-9740 Employee/Obligor's Social Security Number 7470001195 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) DANIEL COMPANY OF SPRINGFIELD 3725 W DIVISION ST SPRINGFIELD MO 65803-5675 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. $ SO 0 . 00 per month in cu rrent support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes <Xl 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 $ 500.00 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 t6 determine how much to withhold: $ J 15.38 per weekly pay period. I $ '-30.77 per biweekly pay period (every two weeks). $ '-50.00 per semimonthly pay period (twice J month). $ 500.00 per monthly pay period. REMITTANCE INFORMATION: I You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 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. c- (c '~H_, ro'-: r-- ';.:, ''-1;':;11.;;'''''',,, '"'~ ..1. ~{E. G. ~,eJ ,L,7ViXcf' Form EN-028 Worker ID $IATT Date of Order:JAM 2 2 2n8~ Service Type M OMS No.: 0970-0154 .< . l" , , i1 'eBi!!'1J-~; ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS D If.~hecked you are required to provide a copy of thiS form i() your el1'lPloyee. If your employee works in a state that is dltterent from the state that issued this order, a copy must be provided to your employee even ilthe 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. Ilthere 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 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. ' 4. * Repo,t:"g LI,e Payda~/Da.1x. of 'NitLLoldihg. You "lUst lepolt ti,e paydAlc'aate of ~vitlll,oldi"5 nI,e" !,(Jld:llg ti,e pay nlel Il. TI,l, p.,d_ie/date of ..ili,l.oldi"g is the date 0" ..hid, .,..MI,t..., ..itll,l,eld flOIO tl,e emplo,~e's ...gn You must comply with the law olthe 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, I 5. * 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 #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 infonnation requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S 10: 4310055790 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: MATHEWS, DAVID H. 7470001195 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fall 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. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* 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 olthe 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. 11, Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISI E PA 17013 by internet www.childsupport.state.pa.us Page ~ of 2 Form EN-028 Worker ID $IATT Service Type M OMB No.: 0970-0154 "O~ ,-, - ~ I . , l,.< " .d. . :&i:""J AD[)ENDUM Summary of Cases .on Attachment Defendant/Obligor: MATHEWS, DAVID H. PACSES Case Number 247106033 Plaintiff Name LOLETA C. MATTHEWS Docket Attachment Amount 01=15iil CIVIL $ 500.00 Child(ren)'s Name(s), DOB ::<?::::,:::::-::::::(/::\:\::::::::::.:)::,,:)/::):{,:(.::::;:,:::::=t\/:i\U:'iU/\:::}:,)::?n::::,:'::::'::,::::,.::('::'(-::':::\,:::;}:'::'::',:,,:,.:": ' o if checked, you are r~quir~d 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): DaB Dli~~:~~:;,~~~..~~'.';;~~i:~:~:~;~il:~~~~:ldi;:~~(".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 i3l~~~~~~~~,t~:;~;:~:i~~:~~~;;II;~~~~il~;;~~;).' identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M OMB No.: 097().()154 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s), DaB i , , bli~~~~~~~,;~~~;~:!~~;~~;~:~rollthe 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): 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. 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 ID $IATT ,:;~~t.mWl""..ih"~~-,"o1,""i!h,<~ilill;;;li&P:ii.\1i;M~l~trg",.k<~;il\'!l]lli:iI<hd,gl;"""-"ii.t",',~".j-""-'_~"" ';""'->:~_~[*'H;ii:r;,-~~ffililli.lW!:~~~~~m:~-i}r"'~1ll: ~~.~,~ "_. "'~ . () r-> 0 = :;;~ -n ---: :=1 -~ <- ?> r-:i-:.:O ;it--=. 'r- -om 1') -:JO N r, ) '=1r-> .,-,--- 'I V _,__r" ;;?(~ _'t::"* 6rn -\ ~~ r" -<- ,~.~. v,<.,,. "_~,_:, -".~, ,~-~--~ , -~-. '~'. ~ , . I - ~~ ~~.w ,,'~- , , ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of pennsylvania CoJCity/Dist of CUMBERLAND Date of Order/Notice 01/21/04 Tribunal/Case Number (See Addendum for case summary) o Original Order/Notice o Amended Order/Notice o Terminate Order/Notice EmployerlWithholder's Federal EIN Number RE: MATHEWS, DAVID H. Employee/Obligor's Name (Last, First, Mil 168-38-9740 Employee/Obligor's Social Security Number 7470001195 Employee/Obligor's Case Identifier (See Addendum for pJaintiH names associated with cases on attachment) Custodial Parent's Name (Last, First, Ml) PENMAC PERSONNEL SERVICES 447 SOUTH AVE SPRINGFIELD MO 65806-2132 INC b)J, ,;.zOO/ -/fJD/ ('{(J/C /f;r!r;;zs d-47/0~03 '3 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. $ $00.00 per month in current support $ 0 . 00 per month in past-due support Arrears 12 weeks or greater? 0 yes Q9 no $ 0.00 per month in medical support $ 0 . DOper month for genetic test costs $ permonth in other (specify) for a total of $ 500 . 00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compli1ance 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: $ 115. 38 per weekly pay period. I $ '-30.77 per biweekly pay period (every two jNeeks). $ 250.00 per semimonthly pay period (twice a month). $ ~oo. 00 per monthly pay period_ I REMITTANCE INFORMATION: I You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate!date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount The total withheld amount, and your fee, cannot exceed 55% of the employee's! obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 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 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. '~AII.J!:E~HE COURT: / - ;3;) {5l-( J< Form EN-028 Worker ID $IATT Date of Order: JAN 2 2 llJa~ Service Type M OMB No.: ;0970..01 54 ""'-' ~ ~~ .~'_~~~"~M d~~,.. , , .~" . "! ~"=..~ ....:....-~ - ~ ,- .,' :-J: , ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS D I(checked you are required to provide a (:opy of this form to your employee. If your employee works in a slate that is different from the state that issued this order, a copy must be provided to your employee even if the box is not checked, 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-<lwned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under Slate 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. 3. 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. 4.* ,~p6Il;,lg ti,l. PAyd~Date o(WitIIIIOldillg. You n,ust lepoltthe payJdl~ddte of nitl,l,oldil,g vvl,en se"d;"g ti,e payll.ellt. TI,e payda-teldate of vvitlll,Old;lIg;~ lLe dAte 151, vvl,id, ahlouht vvas vvitl,l,eld flfilflll,e elllpIQy!.c's vvages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5. * Employee/Obligor with 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 foliow the law of the state of employee's/obligor's principal place of employment You must honor all Orders/Notices to the gmatest 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 tothe Agency identified below. WITHHOLDER'S ID: 4316253880 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE II:lENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: MATHEWS. DAVID H. 7470001195 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fall 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 Slate law govems unless the obligor is employed in another Slate, in which case the law ofthe State in which he or she is employed governs, 9. Anti-discrimination: You are subject to a fine determined under Slate law for discharging an employee/obligor from employment, refusing to employ, or laking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania Slate law governs unless the obligor is employed in another State, in which case the law ofthe State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of, 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.5.c. ~1673 (b)l; or 2) the amounts allowed by the Slate of the employee's/obligor's principal place of employment The Federal limit applies to the aggregate disposable weekly eamings (AOWE). AOWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the slate that issued this order with respect to these' items, Submitted 8y: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLlSLF PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Worker ID $IATT Service Type M OMB No.: 0970.Q154 . . , , " '- _,--1' -;,. "q.~ ADDENDUM Summary of Cases on Attachment Defendant/Obligor: MATHEWS, DAVID H. PACSES Case Number 247106033 Plaintiff Name LOLETA C. MATTHEWS Docket Attachment Amount 01-1501 CIVIL $ 500.00 Child(ren)'s Name(s), DaB ..bl;~~~~~~~.~..;~~..~;~;;~~i;~~:~.~~.;;;I;~:~~il~i;~~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 D If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the empioyee's/obligors employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(mn)'s Name(s): DaB BI~~~~~~:d,;~~~;~;;~~;~~;~;~;~il:~~~~il~i~:~i\))i........... identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M QMB No.: 0970.-01 ~4 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DaB dl~~~:;.;~;;;;,~;~;;:;~~i;~:~~~;~;;;~:~~;I~;;~~i..i.............. identified above in any health insurance coverage available through the employee's/obtigor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DaB I 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): DOS D If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligors employment. Addendum Form EN-028 Worker ID $IATT t~~m..ti!liiIlilII4tt!M;I.'!'i%'_,;:",..@li'l_M~~i!iiiJMlt;k''''~l_;M!L''''"k~~i1;'<Hjg,~~i''lJ><iUcl;ti-j;!X..,,;;ri!~'O/j 1..- i 7 ','\1Ir~JiIJ" " e," ~_ ...~ ,~- ~, ilSiWllidj'NIllw:I'lIiiwJjJ ~ri_ '''~",~m1i~di'''' ~".,-,..,~~~"",,~...~ .-" ~~~ ; 0 '" = C) ~~ = -n -e- r;~ <- .-, ;!.:;<,~ :.C :;:- , ;.;0:= rn i--~ >' -;:,! rn ---" N :0- CJ r~; N C) ~ ~,-"! 0 ~ :--c :r-: .2 \5 0 C) 5>- c: .- ;;::c.:;, rli 2:- ::::~ -i :i:; -~ N -< ~ ,_,'C- '''-' ik1!r'!;: , " . ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of pennsylvania Co.lCity/Dist of CUMBERLAND Date of Order/Notice 01/23/04 Tribunal/Case Number (See Addendum for case summary) RE: MATTHEWS, DAVID H. Employee/Obligor's Name (Last, First, MI) @OriginaIOrder/Notice o Amended Order/Notice o Terminate Order/Notice EmployerMlithholder's Federal EIN Number )j/ c:MJtJl - /50/ (l r i/IL jJj(!SZS ();L7/{){olll 172-40-6979 Employee/Obligor's Social Security Number 7068100344 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (last, First, MI) CARLISLE TIRE & WHEEL PO BOX 99 CARLISLE PA 17013-0099 See Addendum for dependent names and birth dates associated 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. $ 500.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes <Xl 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 $ 500.00 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: $ 1 J 5 .38 per weekly pay period. $ 2~0. 77 per biweekly pay period (every two weeks). $ 250.00 per semimonthly pay period (twice a month). $ 500.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount The total withheld amount, and your fee, cannot exceed 55% of the employee's! obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the follOWing information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer SeNice 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: ../AN 2 6 2OM~ .. HE COURT: ~ E SeNice Type M OMB No.: 0970-0154 Form EN-028 Worker ID $IATT . ~~.l" '-'C.....,.....:., ~ ~' liN ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If.~hecked you are required to prpvide a ~opy of this form to your employee. Ifyo~remployee works in a state that is dilterenffrom the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. We appreciate th~ 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, If there 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 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 ~ach employee/obligor. 4.* Rl::po,LiI,g till:: F'AydatelDare of'NitLLoldihg. You iliUM lepolttl,e paydal~date of nitl,f,oldihg VVllel, s<chdih511le Pa.YIIIl::IIl. Till:: p'ydateldate of ..:tI,I,,,ld;,,g i. tl,~ date 010 ..1';<1, .,'lOUI.t.... ..itl,l,eld flolo th" "",ploy",', ..age.. You must comply with the law of the state of the employe~'s/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5,' Employee/Obligor with 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 oflhe state of employee's/obligor's principal place of empioyment. You must honor all Orders/Notices to the greatest extent possible. (See #1 0 b~low) 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 ID: 2322473100 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: MATTHEWS, DAVID H. 7068100344 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If yOU have any questions about lump sum payments, contact the person or authority below. 8. 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. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.' Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S,C ~ 1673 (b)1; or 2) the amounts allowed by the State of the employee's1obligor'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. 11. Additional Info: 'NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER 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 OMB No.: 0970-0154 , ~ , " , ~ l~' " " ""- ~- ADDENDUM Summary of Cases on Attachment Defendant/Obligor: MATTHEWS, DAVID H. PACSES Case Number 027106118 Plaintiff Name LOLETA C. MATTHEWS Docket Attachment Amount 01-1501 CV $ 500.00 Child(ren)'s Name(s): DaB .BI~~~;~~:~~~~;:~;~~~;;~~;~~~;~ii~~:~~iid;;;~;((........i 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): 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 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DaB E1;;~~;~~:d:{~~~~:;:~~;;~~~~~~;~;I;h;~~;~~i;:~;\. identified above in any health insurance coverage available through the employee's/obligor's employment Service Type M OMB No.: 097().{)154 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s), DaB tlli~~:~~:~:;~~.;~::~~;;~~;~:~;~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 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DaB o If checked, you are required to enrol/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 ,~~~"t:B:;;!H1k'..~ii,:~!;j,,:;;,w~~"''''~~!l~iM,,''-~''_j;',,")ik-'o-Jg''''''''_<J:i.;;;i=J:it':';I;d;'~i~,.Il!~;:ilW,;"",,,"1 ",';' "'V"ly,ilIlIIliftldilil:&lilil ""-~"'~-"iiOfiI I~~,,~~,~,,",~~"" ~ .ilii , g '" = 0 = -0 ;;:: .r;- um L. :r!." ~fn >- Z rn- -~ r- ~";' N "'OfTl ~~ .-:'0 -.J ~ -0 zO :x o:n $0 --;:;.(") C ':Y om z -~ :;! &- ~ ", "".'_k. >". -~ '..;;,~..-~", '''-'': ',;,- ~'&;,:;'~~ In the Court of Common Pleas of I CUMBERLAND County,Pennsylvanm DOMESTIC ,RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 I Defendant Name: PAVID H. MATTHEWS Member ID Number: 7068100344 I Please note: All correspondence must include the Member ID Number. I ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Financial Break Down of Multiole Cases on Attachment Plaintiff Name LOLETA C. lo1ATTHEWS PACSES Case Number 027106118 Docket Number 01-1501 CV Attachment Amount/FreQuencv $ I $ $ I $ 500.00 jMONTH ~ / ~ ~ / / TOTAL ATTACHMENT AMOUNT: $ 500.00 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $115.38 per week, or 50 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, DAVID H. MATTHEWS Social Security Number 172-40-6979 ,Member ID Number 7068100344 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U. S. C. ~ 1673 (b)(2) and 23 Pa. C.S.A. ~ 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated DECEMBER 1, 2002 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: JAN26. p. j, ~ b /O(8/~, ~[;S:JUDGE Form EN-530 Service Type M Worker ID $IATT ",iJ~.bIII~~~oo."';iI;<'~$,;'1ii'I~Ii<l\i!iiiM~i~,.jblm'ill<...:miJ<i.ffii,,.,,!,,",,';;':':m('~I~<ki.\\.""~~"~WOf,K~j;~ ~.- -~'~~~~lilt. "~,,~:J_'''~7=-, .~"t, '" t"_ _","'-~ J- "'". ~ ,^'.' ,". -~"^~'" ',- ~~~ ,-~.. ,~. - ^,' -~~, .. .".;....i..-... '" '.~-- ~ . ," ...,. (') ...., 0 = C = -n ;g: .- <- -l -0 CD :;::::n ~rn >- -L' Z mlTi tli~ l'.> :B$, ~G -.J Q. -0 ~:ii - :20 ::IC ~@ --.::0 )>C ~ Z -~ =<! z:- ~ - I> ~'"' " -I , - ~ ,,- . -,,'~ ~'~i , . . . .. ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of pennsylvania Co.lCity/Dist of CUMBERLAND Date of Order/Notice 01/23/04 Tribunal/Case Number (See Addendum for case summ~ry) o Original Order/Notice o Amended Order/Notice @ Terminate Order/Notice I \lJ ~/-/50/ {lrWL ..u:J / I IJkt>ZS d<f7/0!r>033 RE: MATHEWS, DAVID H. Employee/Obligor's Name (Last, First, MI) 168-38-9740 Employee/Obligor's Social Security Number 7470001195 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parenfs Name (Last, First, MI) EmployerlWithholder's Federal EIN Number PENMAC PERSONNEL SERVICES 447 SOUTH AVI;: SPRINGFIELD MO 65806-2132 INC 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 CUMBERLIUlD 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. $ 0 . Doper month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes <lD no $ 0.00 per month in medical support $ 0 . DOper month for genetic test costs $ per month in other (specify) for a total of$ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount The total withheld amount, and your fee, cannot exceed 55% of the employee'sf 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 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. MB.I',"",~~ THE CO T / .~}!. -0 if , r DateofOrder:~ (.,&!Jtip6 G, /'fJr~ p.. .1 " Service Type M OMB No.: 0970-0154 J>..€l3:. .;]Dbto C Form EN-028 Worker ID $IATT , . <~,~~ -. . .~~ " ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS D I(~hecked you are required to provide a copy o/this form to your employee. Ifyo~remployee works in a state that is dltterent from the state that issued this order, a copy must be provided to your employee even i/the 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 iegal process under Slate law against the same income. Federal lax levies in effect b~fore receipt of this order have priority. If there 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 employee/obligor's income in a single payment to each agency requesting Withholding. You must, however, separately identify the portion of the singie payment that is attributable to each employee/obligor. 4. * R.pOlti"g tl.. Pa,dalelOate of Witl ,I ,oldi"g. You n ,usllep",t tl ,e pa,date!date of "ithl ,old;"g "I ,e" .."dil '5 tl,o pa,l"el ,I. TI,e paydd~ddte of yy;tLI,old;l,g i& tile daffi O~I nl.kl. Al lIotll,t vvA3 vvitl.l.cld ~olll tile elllpk~yee/s YVdg~5. You must comply with the law of the state o/the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments, 5. * Empl!lyee/Obligor wilhMultiple Support Holdings: l/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 Federai or Slate withholding limits, you must follow the law o/the state of employee's/obligor's principal place of employment You must honor all Orders/Notices to the greatest extent possible. (See #1 (J 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 ID: 43H253880 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: MATHEWS, DAVID H. 7470001195 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay, If you have any questions about lump sum payments, contact the person or authority below. 8. 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 Slate, in which case the law of the Slate in which he or she is employed governs, 9. Anti-discrimination: Yo~ are subject to a fine determined under Slate law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any emplpyee/obligor because of a support withholding, Pennsylvania Slate law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* 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's/obligor's principal place of employment The Federal iimit applies to the aggregate disposable weekly earnings (ADWE). AOWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security IaXtS; and Medicare taxes. 11. Addilionallnfo: * 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. Submitted By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-624R or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Worker ID $IATT Service Type M OMS No.:10970-0154 '-~iIIolli'!-'l'l'li.1iId;i~-.rdi;.hi'''','i";,~lli;sf;\;l~;,:t;iilWr~t'''''$6J"I;jM3cl\""J~;;j",;~,,,;.;-:k:-,iub,'\:Uhi";];!'-B]t'SIM~~Ii~~~,~iul..g- .,_~,L ,,] " J ,<,~~,~~,~_~~~,.~ ,'n~___~" ,,__.,^~ _'v'''''' ","_, '.' ~'<_"p'""'__ ,."... __ .",_,,, ' ~" . ~. ,,^,.JU o c: s: -o'cP rnrn "7' :::t} ~- - Zc- ~Z '20 ~O ..-::0. J'"C ~ .1.0"'" b;; r , f'4 = = ...- <- :.:0- :;c: "" -' ~ ~,... i.'.~I:'.""" Q.. :C ~- '4 ~ -<.. "" 3 ~ ;- , .....~~~ .. . ~ "'. ~ '" -.'~, " i ":'k'~~1 ~ , , ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsvlvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 01/23/04 Tribunal/Case Number (See Addendum for case summary) RE:MATHEWS, DAVID H. Employee/Obligor's Name (Last, First, MI) o Original Order/Notice o Amended Order/Notice o Terminate Order/Notice EmployerlWithholder's Federal EIN Number 111 02f70/-/5O/ CrrJ/L fJ;Jf!r;[S .9'/7 / O&O~} 168-38-9740 Employee/Obligor's Social Security Number 7470001195 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) DANIEL COMPANY OF SPRINGFIELD 3725 W DIVISION ST SPRINGFIELD MO 65803-5675 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'sfobligor's income until further notice even if the Order/Notice is not issued by your State. $ 0 . 00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes @ no $ 0.00 per month in medical support $ 0 . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0 . 00 per weekly pay period. $ o. QO per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee'sf 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 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 BYMAIL. ~.' n :;JU:',J;..if' [/J' ~~~oq'If'i.4tIE COURT: Date of Order: JAN 2 6 2110'" A .;;V~ Form EN-028 Worker ID $IATT 0W Service Type M OMS No.: 097().{)154 . ~,,~'" ~- ~ ". :i .., , , ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS D If:~hecked you are required. to provi(le a copy of this form to your. employee. Ifyo~remployee works in,a state that is dilterent from the state that ISSUed thiS order, a copy must be prOVided to your employee even If the box IS not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, triballY-<lwned 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. If there 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 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. 4.' Repe"tll ,g II,e Pa,datelDate ofWitl,I,e,ldil ,g. Ye,b Inustlep6l1 d,e pa,d.le'date of "itl,l,oldi"g "I,,,,, sel,ding the pa,..,,,,,t. TI,,, paydateldate of vvitlll~t)ld;lIg ;5111~ dll~ 011 v~l,kL alllotll.t HaS vvitlII lI,dd f1oll. tile elllpIOy~~'5 vva:gl':3. You must comply with the law of the state of the employee'!;/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.' Employee/Obligor with 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 ofthe state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notilication: 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: 4310055790 EMPlOYEE'S/OBLlGOR'S NAME: EMPLOYEE;S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: MATHEWS. DAVID H. 7470001195 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhoid 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 iaw governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs, 10.' Withholding Limits: You may not withhold more than the lesser of: 1)1he 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'sJobligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). AOWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes: and Medicare taxes. 11. Additional Info: 'NOTE: If you or your 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. Submitted By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER 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-0l8 Worker ID $IATT Service Type M QMB No.: 0970.0154 ~~1<~;:;jjjl~~",-!!;m'iU''''''iI,0<I~Mi;;i<iil",,<!ii,jif6;1!!;f,1ili:U'''t;Li''','jdj-,::,._~_-.e'f_UZ" ,',i!l.h:o.i.','e";,[(~;,~;,"-,,--~;Imt.'W-~~Ili;_{I11fb;iW!;l;lU$m~j~~li!fJM~~W.i:Ntrl ' ..~ / Ii 2 ~ ~ ~ ~ -t ;v,~i <- I ~ ~'j~ N ..... ~ 31") '<;:- ..., ~g :J!; %tI1 ~ ~ c ~ ~ :;:- - "'~ ~" ." '1iliIIiil ,,' ' .. . 1 ~ LOLETA C. MATTHEWS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. DAVID H. MATTHEWS, Defendant CIVIL ACTION - LAW - IN DIVORCE NO. 01 - 1501 CIVIL TERM DOMESTIC RELATIONS ORDER This Order is intended to constitute a qualified Domestic Relations Order under section 206(d) of~e Employee Retirement Security Act of 1974, as amended, ("ERISA"), and section 414(p) of the Internal Revenue Code of 1986, as amended ("Code"). Section L Definitions. For purposes of this Order, the following terms when used with initial capital letters, shall have the following meanings: (a) Account - "Account" shall mean the participant's entire benefit in the Plan determined as of the division dine: r (b) Alternate Payee - "Alternate Payee" means the person who is to receive all or a portion of the Participant's Account as specified in this order. The name, current address, date of birth and social security number of the Alternate Payee are: Name: Prior name: Address: Date of birth: Social Sec. No: Loleta C. Matthews Loleta C. Koser 205 Calvary Road, Carlisle, Pa. 17013 , July 22, 1948 167-40-1065 '" ...~ (c) Division Date - "Division Date" means the date the Participant's Account will be valued for purposes of assigning a benefit to the Alternate Payee. The Division Date shall be October 3,2003. The Division Date is the Valuation Date coinciding with or immediately preceding the Date of this Order. (d) Participant - "Participant" means the person participating in the Plan whose benefit is to be divided under this order. The name, current address, date of birth, and social security number of the participant are: ~~, I ~ I ~ - ", , ~.' " < ",-", -"j, j Name: Address: Date of birth: Social Sec. No: David Matthews 1936 Sterretts Gap Ave. Carlisle, Pa. 17013 October 20, 1948 172-40-6979 (e) Plan - "Plan" means the Carlisle Corporation Employee Incentive Savings Plan. The Plan is a tax-qualified defined contribution plan sponsored by Carlisle Corporation. (t) Plan Administrator - "Plan Administrator" means: Carlisle Corporation 3925 Ballantyne Corporate Place, Snite 400 Charlotte, NC 28277 (g) Valuation Date - "Valuation Date" means any business day on which the New York Stock Exchange is open for trading. Section 2. Award to Alternate Payee. (a) Amount of Award. The division of Participant's benefits is pursuant to a marriage settlement agreement dated October 3, 2003, and filed with the Cumberland County Prothonotary under the above-captioned number. This order effectuates a division of marital property as provided by the marriage settlement agreement The Alternate Payee is hereby awarded: The sum of$11,700.00 of the Participant's vested Account as of the Division Date. If the participant's vested account consists of multiple sources (such as before tax salary deferrals, after-tax contributions, employer contributions, rollover contributions, or transfers from other plans), the Alternate Payee's awards shall be taken pro rata from each of them. Any basis in after-tax contributions shall be allocated between the Participant and the Alternate Payee based on the portion of the Account awarded to each. The Alternate Payee's award shall be subject to adjustment for any administrative fees and expenses to be deducted from it under the Plan's procedures. (b) Valuation Procedures for Dividing the Account. The value of the Participant's vested Account asofthe Division Date shall be determined under the Plan's valuation procedures, including any additions or subtractions to be made as of the Division Date under those procedures. Any contributions which have not been deposited in the Plan's -.'" c =~'Dj-Ji" ll,:"t ". trust fund by the Division Date shall be disregarded for purposes of this valuation. In determining the Alternate Payee's award under this order, the Participant's vested Account shall not be reduced by any outstanding loan to the Participant as of the Division Date. (In this case, an award to the Alternate Payee as ofthe Division Date shall not exceed 100% of the vested Account minus the value of any outstanding loan on the Division Date. (c) Time of Payment The Alternate Payee's award shall be paid to the Alternate Payee as soon as administratively feasible after the date on which the Plan Administrator's determination that this order constitutes a qualified domestic relations order becomes final. Cd) Form of Payment. The Alternate Payee's award shall be paid in a single lump sum cash distribution. The Alternate Payee must request payment of the lump sum pursuant to the Plan's distribution request procedures. (e) Investment of Award. Investment experience (Income, gains, losses, and expenses), if any, on the amount awarded to the Alternate Payee during the period between the Divisiqn Date and a Valuation Date determined by the Plan's Trustee which occurs a reasonable time prior to the date of the award is paid to the Alternate Payee shall be allocat~d to the Alternate Payee's award. The Alternate Payee's award shall be deemed to be iriitially invested pro rata in the investment options held in the account on the Division Date and shall be adjusted on a pro rata basis to reflect any changes in those investment options between the Division Date and the Valuation Date as of which the payment to the Alternate Payee is determined. Notwithstanding the foregoing, any loan outstanding to the Participant on or after the Division Date shall be allocated solely to the Participant, and payments of principal and interest on any such loan after the Division Date shall be allocated to the Participant's remaining benefit under the Plan. r- (f) Payment in the Event of Death. (1) If the Participant dies after this order is issued, the amount awarded to the Alternate Payee under this order shall be paid to the Alternate Payee as specified in this order; provided that this order is ultimately determined by the Plan Administrator to be a qualified domestic relations order. (2) If the Alternate Payee dies after this order is issued, but before receiving payment of the award, the amount awarded to the Alternate Payee under this order shall be paid to the legal representative of the Alternate Payee's estate; provided that the order is ultimately determined by the Plan Administrator to be a qualified domestic relations order. .;."""'~.~_~. .. I , ~,-~, ""'\i'pi (3) After this order is issued, the Alternate Payee shall not have any right or claim as surviving spouse, to any portion of the Participant's benefit under the Plan not specifically awarded to the Alternate Payee by this order. Section 3. No Additional Type or Form of Benefits. Nothing in this order shall be determined to require the Plan to provide any of the following: (a) Any type of form or benefits, or any option, not otherwise provided under the Plan. (b) Increased benefits over and above the benefits otherwise provided under the Plan. ( c) Payment of any benefits to the Alternate Payee which are required to be paid to an alternate payee under another order previously determined to be a qualified domestic relations order. Section 4. Taxes. The Alternate Payee shall be responsible for all taxes on the amounts awarded under this order. The Alternate Payee shall complete and sign any forms that may be required by the Plan Administrator relating to tax withholding, direct rollovers, or other matters in order to allow the payment provided under this order. Section 5. Continued jurisdiction. Because it is intended that this order be a qualified domestic relations order, the provisions hereof shall be administered and interpreted in conformity with ERISA and the Code. The court shall retain limited jurisdiction to amend this order only for the purpose of meeting any requirements to create, conform, and maintain this order as a qualified domestic relations order, and either party may apply this court for such an amendments. Section 6. Delivery of Order. Upon entry of this order, the Alternate Payee shall immediately deliver an officially certified copy of this order to the Plan Administrator at the address set forth above. Section 7. Change of Name or Address. If there is a change in the Alternate Payee's name or address, the Alternate Payee shall provide written notice of such change to the Plan Administrator at its address set forth above. ; I WHEREFORE, the parties, intending to be legally bound by the terms of this Stipulation and Agreement, do hereunto place their hands and seals: I f){J~~~~ David H. M tthews Defendant/Participant ~f~~ ole a C. Matthews Plaintiff/Alternate Payee Dat~~( am+ Date: Lfl, / {)'1 ~~~" ,.-. ~ -..'~ ~-~~ ~ el Andes, quire .-z 525 N. 12th St. P.O. Box 168 Lernoyne,Pa.17043 (717) 761-5361 Attorney for Alternate Payee - ~' t , ,. -8 ~'.' ';'_''''',,~J ",id e Adams, Esquire 3 S. Pitt St. arlisle, Pa. 17013 (717) 245-8508 Attorney for Participant ,J "},; day of WHEREFORE, it is hereby ORDERED and DECREED this ~; ( ,2004. By the Court, . ~U!!&IIt1li~b(j~~~~.~~;I!Il\i~W~f;I%ii5~~);[i~j",:Jjliijw'i>~if' >-~""I...-~ lZib!lilllliiillllllll 1~~ ,lQCJ.JfUm,~Tj_ -,- Vii\!'r;?\-1/Sr ,'[',J:~d )JJ\!r!C() .;' ;!:: _:::-;/'In:J C I .n 11j~ ~;I j ,t) :"11 S - HdV ~OOl """'l""'" "U"'''d -'Ill' JO AG v'j" -'I "'1 JI~iJ.;t; :'1'11 ~ ,""! ',V'-03'lIJ .....J.j.._v - -' ._,,""',',. ,_" _~ _,~,,',~",.~ _~"~,~>, '_N' ~- , tlI';ll':lj!j!_ail~~~:li:I!~'r~"'=- ~lIiIIii b ~ ,-- '>., . ~ "--" -. , '",-, .-"., _"0 ~_ . .. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNA. LOLETA C. MA'lTHEWS, Plaintiff No. 01-1501 CIVIL TERM . VER$US DAVID H. MA'lTHEWS, Defendant DECREE IN DIVORCE ANO NOW, , IT IS ORDERED AND OECREE;P THAT LOLETA C. MATI'HEWS , PLAINTIFF, ANP DAVID H. MATl'HE.WS , DEFENDANT, ARr;: D!VORCEQ FROM THE;: BONDS OF MATRIMONY. . THE CQ\..lRT RETAIN~ ,JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAtSEO OF REcORD IN THIS ACTION FOR WHtCH A FINAL ORDER HAS NOT YET BEEN ENTERED; An order for fClyment of alimony is to be entered contenporaneous.ly with this Decree. By THE COURT: ATTEST: J. PROTHONOTARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ^ - .~, .," ~ -" "' RECEIPT FOR PAYMENT ------------------- ------------------- Cumberland County Prothonotary's Office Carlisle, Pa 17013 MATTHEWS LOLETA C (VS) MATTHEWS DAVID H Case Number 2001-01501 Received of PD ATTY ANDES JEM Total Check/Other.. + Total Cash . . . . . . . .. + Change. . . . . . . . . . . .. - Receipt total.. .... 9.00 .00 .00 9.00 ~ " illill %L_ .;. 1illiiI!Iil"" Receipt Date Receipt Time Receipt No. Check No. 4892 '-"jij~_;' 12/04/2003 8:29:33 145162 Transaction Description ------------------------ Distribution Of Payment ---------------------------- DIVORCE DECREE Payment Amount 9.00 9.00 CUMBERLAND CO GENERAL FUND .- . -1 ~1-:' In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Defendant Name: DAVID H. MATTHEWS ~ernberIDNurnber: 7068100344 Please note: All correspondence must include the Member ID Nwnber. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name LOLETA C. MATTHEWS P ACSES Case Number 027106118 Docket Number 01-1501 CV Attachment AmountlFreauencv $ ! $ $ ! $ 500.00 IMONTH ~ I ~ ~ I I TOTAL ATTACHMENT AMOUNT: $ 500.00 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $115.38 per week, or 50 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, DAVID H. MATTHEWS Social Security Number 172-40-6979 ,Member 1D Nwnber 7068100344 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. ~ 1673 (b)(2) and 23 Pa. C.S.A. ~ 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated MAY 22, 2005 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: JUN - 7 2005 p. J . Ae€S . JUDGE ~)U..t: c. NO]C;CU, Service Type M Form EN-530 Worker 1D $IATT ,';.L".'-->itklL_~~~~Ii"~'-"li.fi,\~.~,m,,-~Ul!."ailmd,w,\.--."tiJiil;j,jiR!liiM. oJ [Of ~ " '"' c " ,. ' , ;,. _ _ ~. :~:" ~.' .c~ ('.'-i r} fe ci -~-~''-'-~'''1l!l-''~-~ -~ -", iii 0 ,.., ~ <=> c: <=> ~ en ~i c- -oee c::: ~iD ~ - t;;.~ 0 .:;.: :,~: !;2C ~-c; ~ ~:J:O ~Q z~ -~, \ S $'{;: CP. ~ ;;:- ~ ...J (5 Co ORDERMOTICE TO WITHHOLD INCOME FOR SUPPORT State: Commonwealth of Pennsylvania Co./City/Dist. of: CUMBERLAND Date of Order/Notice: 05/25/11 Case Number (See Addendum for case summary) Employer/Wthholder's Federal EIN Number CARLISLE TRANSPORATION PRODUCT 25 WINDHAM BLVD AIKEN SC 29805-9320 RE: MATTHEWS. DAVID H. D1- 15m CIVIL O Original Order/Notice O Amended Order/Notice 0 Terminate Order/Notice 0 One-Time Lump Sum/Notice Employee/Obligor's Name (Last, First, MI) 172-40-6979 mp oyee igo s Social SecunVWu_m_Fe_r 7068100344 mp oyee igor s ase enti er (See Addendum for plaintiff names associated with cases on attachmeno Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current child support $ 0.00 per month in past-due child support Arrears 12 weeks or greater? OL?bs ',?M rim $ 0.00 per month in current medical support , -- ---? ? a $ 0.00 per month in past-due medical support rr ) $ 0.00 per month in current spousal support -ter - $ 0.00 per month in past-due spousal support ?> Cn C $ 0.00 per month for genetic test costs r- -?r $ 0.00 per month in other (specify) >In =C $ one-time lump sum payment C:) C5 m for a total of $ 0.00 per month to be forwarded to payee below. "i t You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period (twice a month) $ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). 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 SO lAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BIT t BY THE COURT: Service Type M AA. L. E b er- f, _1 I', OMB No.: 0970-0154 Form EN-028 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS n If checked you are required to provide a copy of this form to your employee. If your employee works in a state that is different from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2322473100 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: Q EMPLOYEE'S/OBLIGOR'S NAME: MATTHEWS, DAVID H. EMPLOYEE'S CASE IDENTIFIER: 7068100344 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: NEW EMPLOYER'S NAME/ADDRESS: FINAL PAYMENT AMOUNT: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us OMB No.: 0970-0154 Page 2 of 2 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: MATTHEWS, DAVID H. PACSES Case Number 027106118 PACSES Case Number Plaintiff Name Plaintiff Name LOLETA C. MATTHEWS Docket Attachment Amount Do_ cke Attachment Amount 01-1501 CV $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): PACSES Ca Numb r Plaintiff Name Docket Attachment Amo unt $ 0.00 Child(ren)'s Name(s): Service Type M DOB PACKS 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 DOB Addendum OMB No.: 0970-0154 Form EN-028 Worker ID $IATT In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION LOLETA C. MATTHEWS Plaintiff vs. DAVID H. MATTHEWS Defendant Docket Number: 01-1501 CV PACSES Case Number: 027106118 Other State ID Number: = -.n Cc rTt PETITION FOR MODIFICATION OF AN EXISTING SUPPORT ORDER rV N ?v =R r?--T1 L/Y 1. The petition of DAVID HOWARD MATTHEWS respectfully represents that on DECEMBER 9, 2003, an Order of Court was entered for the support of LOLETA CATHERINE MATTHEWS A true and correct copy of the order is attached to this petition. Form OM-501 Service Type M Worker ID 21202 MATTHEWS v. MATTHEWS PACSES Case Number: 027106118 2. Petitioner is entitled to O increase O decrease O termination O reinstatement Vother of this Order because of the following material and substantial change(s) in circumstance: G? ,6j9 7 WHEREFORE, Petitioner requests that the Court modify the existing order for support. Petitioner Attorney for Petitioner I verify that the statements made in this complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities. 6 -zz-/11 Date Service Type M /' Petitioner Page 2 of 2 Form OM-501 Worker ID 21202 ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT DI - ) 5D I b11 t I State: Commonwealth of Pennsylvania Co./City Dist. o : CUMBERLAND Date of Order/Notice: 06/29/11 Case Number (See A en um for case summary) EmployerNVithholder's Federal EIN Number SOCIAL SECURITY ADMINISTRATION STE 1 200 S SPRING GARDEN ST CARLISLE PA 17013-2578 Original Order/Notice Q Amended Order/Notice Q Terminate Order/Notice O One-Time Lump Sum/Notice RE: MATTHEWS DAVID H. Employee/Obligor's Name (Last, First, MI) 172-40-6979 Employee/Obligor's Social Security Number 7068100344 mp oyee igor s ase enti ier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current child support $ 0.00 per month in past-due child support $ 0.00 per month in current medical support $ 0.00 per month in past-due medical support $ 500.00 per month in current spousal support $ 0.00 per month in past-due spousal support $ 0.00 per month for genetic test costs $ 0.00 per month in other (specify) $ one-time lump sum payment for a total of $ 500.00 per month to be forwarded to payee below. 0 yeV (i o rn- P -O -<> O CD. 4 © 4 -p ?O C") 0 = -- N CD m ,,t -C .g 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: $ 115.07 per weekly pay period. $ 250.00 per semimonthly pay period (twice a month) $ 230.14 per biweekly pay period (every two weeks) $ 500.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITYN MBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: L. Ebe?-kl J1r. IU J.u Arrears 12 weeks or greater? OMB No.: 0970-0154 Form EN-028 Service Type M Worker ID $OINC ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS D If checked you are required to provide a copy of this form to your employee. If your employee works in a state that is different from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies In effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency Identified below. 8384100092 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: Q EMPLOYEE'S/OBLIGOR'S NAME: MATTHEWS_, DAVID H. EMPLOYEE'S CASE IDENTIFIER: 7068100344 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT: NEW 6MPI 4&ER'*NAME/ADDRESS: 6. Lump-pum 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-tomithhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P. O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www childsupport state ga us Service Type M OMB No.: 0970-0154 Page 2 of 2 Form EN-028 Worker ID $OINC ADDENDUM Summary of Cases on Attachment Defendant/Obligor: MATTHEWS, DAVID H. PACKS Case Number 027106118 PACSES Case Number Plaintiff Name Plaintiff Name LOLETA C. MATTHEWS Docket Attachment Amount Docket Attachment Amount 01-1501 CV $ 500.00 $ 0.00 Child(ren)'s Name(s): DOB 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 PACKS 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 Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $OINC In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 246248 C? C C? -t rnw =-n Defendant Name: DAVID H. MATTHEWS n ;ov Member ID Number: 7068100344 t?-z ° -sca Please note: All correspondence must include the Member ID Number. n "0 N --4 ORDER TO VACATE ATTACHMENT OF UNEMPLOYMENT BENEFIS i° Financial Break Down of Multiple Cases on Attachment Plaintiff Name LOLETA C. MATTHEWS PACSES Docket Case Number N m r 027106118 01-1501 CV TOTAL ATTACHMENT AMOUNT: Attachment Amount/Frequency 500.00 MONTH $ 1 500.00 The prior Order of this Court directing the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), to attach $115.07 or 50% per week of the Unemployment Compensation benefits of DAVID H. MATTHEWS, Social Security Number XXX-XX-6979, Member ID Number 7068100344 is hereby vacated. This Order to Vacate shall be effective upon receipt of the notice of the Order by the Department and shall remain in effect until a further Order of the Court is filed. BY THE COURT Date of Order: JUN Z $ 209 JUDGE Form EN-035 Service Type M Worker ID 21205