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Home My WebLink About99-01135,. ,I ,.,...., rs,. I ? !\41'191(i11i ?' 11 1 r ? - I' ? ?1 LI r` I1 {I S: t , 1 II r .. so ?ii ur , 1i IA rl / 1 ' '; 1 1 .I I, I t ,- li. .. I,,I y44 {i 1 1? i ,1 f it f f 11 1 1 I 1 : . F. , 1 r Ir I , i,I' N •I 1 I - , , a ?? _ it 1 li r 1 t , . n!far Y r II - _ L_ it 1'f , It l, I,,, r, rt ;ri ! .r r. it ` 1 t 115 .fail ) i. .. ... .5 ?y( . ' ?, Y: _,a ?.? H ,.`. ;n .Ir ,r, ? « yt• ?j . •. ,?. 1; ?: ,•, ?ti ,fin a ,A. ,1?, YC .?ry?1. ,a •, ?atq ??:+? IN THE COUNT OF COMMON PI„EA r 1 .1J 1..v 1...... 1111 ...111.. 1....1.1.111..11.1.1._. ..i .. .. 11 .. ...1.1 1.. 1, ...1.. .. 11111 ..1..1 .1. i. nv 'r tI ft votttoltohvy ?.•A; . •A:• .1:• •;1.' •N. •t1: lr, 1.6• •;1: .V. qc. t1. 1: -. ti1.• .L•... t/A .1.• •A: ?.1: ?.1:? ?.1;•. ;0: ti1,• •t1:• 1.1h ?bA t1'r d1r S1•.•. 0r C IYI r. tiNP COUNTY h STAT'G OF a??!? f NFNNA,' oflARGt? MAti'i'?Nr aft;, P?ainbit'f N la 35 Qivt 1..T" ..... l 1 99 \iil pall:, QfI11iYt MAtifizNt paPonctsnt . fd DECREE IN' DI V 0 R C E AND NOW, ,.....;,..,yl.. „44".7 it is ordered gild 1 .. p decreed ah risp Marlin, Jr, - ,, that ....1.....11 ........1('.11...11.111. 1111.111•. plalntlff, gild t 11 11.. I 111. 1- .a .Martin.. , 1 . ..... :,.1.., defendant, ? . are divorced from tho„bonds of matrimony. . Tha court retalns lurlsdlctlon of the foll'owing claims which have been ralsed of record In this action for whicho final order has not yet been enteredt W' r_• IN '1'i ii!. COUIt''I' (W COMMON PI'd:AN CUIVIRVI i•ANia COON'ITY, Pi NNNYI,VANIA ?'11Ah1,1''.N MAiI'I'IN, fit„ 1 CIVii, ACTION - i.AW itlnilttifl' 1 I ' ' vH, .Nn. 99.1135 Civil 'I'01.111" I CFIfiRYI, MAi TIN, I ACTION IN PIVOKCF PRA1141PI TO TRANSMIT HEC 0111) TO'1'i 13 PltO THONOTARYi '1'rn? HI it I u •o I 1 vnro n 1 ? unrc , Inputhur wllh tho I1?Aowin? inlormntion {n 11)11 coot{ (pi aptly of 11 dlu dooruo? I, dround all, ciivolvol h•rolrlovoltio hl•onkclown ulltlor wo-1.(0 01'1110 Ulvorpo Colo, 3, Ditto U11tl numnor ol'tho HerVloo of tlto colllplollm 12!lllvored by oortlflod mall XpfliCIY(q???ollvorv, rot _t?irn rf?flttoalocl: c1??lllstl 1999, 3, Uuto of o>toyCllinll ttf tho nliiclnvil regulrvd by §3301(cq nl'tho plvorPa Cndol 14-1)1(11111111) February za, i 999 Unto of filing nncl eervipo oflito piuin11A'N a171d4?vil roguitod by §3301(d) oratd 1)ivnl•oo CndWOn roapnndullh Vilodl Fobruilry26. 999, Served oft Pol'ultdiintl Mtn•uh 4,1999, 4, itololod oildniH pundint3lsia w, Unlo nttd Itlnnnor III, sorviou of Ito not loo of 1111011116p to AIQ prtloelpu to trimHnlIt rooord, it copy of wlllull IH atlgohech Nuvombur 15, 1999' vIn cortjJ plllil dltflr1111y RoHpootI1111y Subntitlodl . DOW V C/I &e4 tutu Adoom IHgtllro . Lb, No, 79465' 117 Sooth I (ouovor St, CarllHlo, Pit, 17013 Attornoy for I'lulhtiff I :? pty?? 4y,?y ??niIV:YW3?OPJ?M11.?lMfA2PM1?YA{tiJLSrf'r.VlA\Lii?Ju ilaaxlula? 1.. ..,...:. .... ?... .. . '. ,. I? -,.• ?...r•. -.nr.17r1n\?M(Y.fiVN1V ?1?`???Nn?{'1^^!^•^TT/1 ? NKIN ClA111FRIANI) COUNTY, 111iNNhYLrVANIA ('I1AR1,l?S MARTIN, dlt„ ; C'IVII A("PION I x111' I'Iul0ll11' vH, N0. 994115 ('Ivll Tornt KY1 MARTIN, ; ACTION IN I)IYc)IZcy; I)elu0dtul( ?11C? :IY?t Cheryl MIU'110, 1)ufu111llllu c/o Al{l?l'Iluy,1111110H Kayor I?L1 Kuyur & 13r1?w0 l r' 4 fitlat I,lhurty Ave. ; C-n1'11810, I'fb 17011 Ph1111liff, ChpilOS NIIIIIIII, 10101111.4 to 1110 wills Ihu ("'nm'I I110-111111uhod l'rtww'Ipu to'l'r011.4111I1 12ucol'II ull ul' 01101 I)VUUIIII) I i- 6, 1999, Iy;lltluHll11g (1101 0 1111111 flu0rvo III I)IYUrcp bu Colored, ItUHht7ulf11ll>' 8tlhllllllufh to Adallly, 1'..4i11111o I) No, 79,165 117 South 11111jovor SIB (:'nrll.4lu, hi, 17013 A'I°fORNFY P(Ilt l'I,r11N'I'IFI: . C{{Altl l7S MARTIN, 1?laintilr + plVl? ACTION LAW 1 + No, 99•I 135 pivll `i'Nrm PI-OiRYL MARTIN, + holbndnht 1 ACTION IN PlYolwl '1'0'1'1'113 PRO THONOTAitY1 Tr1411?111it 1110 roopl(1, ta001110r With Iho IbilowhIgIIIforllllllloll la li1P dlvoroo daor901 Co41rl faI' olttly of a 11 Orollnd fnr dlvoroal IrrotriMblo hrookdowi uador #UaW of tho Pivoroo Co(io,.. unto 411cI 111a11a01' of 1110 aorvioo at'tho.Campl4hlh list' st>??-tl?ilYQt¢dsa?LMtu?ah A?ctl.tlQsuLlWii1' ., 3 pate of oxootllhul of tho AMdlivll rog4111'o(I ay §3301((1) ol'lho olvar00 Coclol I3,?1 Inltllifft Iloi,run?ry a laaa Data of flH11p and sorvloo of lalva iho pl4lntlffd I ffl(illAt rogull'oclby §3301(d) of 11110 t'ao C0110 a11,rospondontl rllodl I o irulllW 16. 1929, Soryod an Dofoad4atl &1 (( d, Rolalod 01411118 pondingl igultst, 51 Dato 4ad ?tuut11ol' of sorvlvo of tho 11011100 of Ilttoaddil..to fiio pra0oipo to ir(lnamh 1'010 a oapy al'IVhl1t IN (ithlohodl I`IpYQ111U0r is 1999 vin vlif]ocl 111111110 AtfprU4y , ti09t)00111t111ySllbh te(h. U4101 1 iAnr .c,v JdEuiro i79405 17 Soulh.i-t411ovor St, Cl1r11810, p!1 17o 13 Alloraoy fbrl'I4i11till, IN Tliii COURT 01? (?OMMON 141.1340 CUM1113RLAND COUN'i'Y,1'13NN5YLVANIA QHAR1a13S MARTIN, JR„ I CIVII. ACTION - HAW 1'hdntip'. I ;,, ', va, I Nu, 99.113 0 civil''Fnn CF113 M MARTIN, , . ACTION IN AlVolkcl, Dofvncinnt I " erru?nv«or ? ttv>i r or rtrn Norl?r or ?Nrr,,rlr AND NOW, this pooolttbor 15, 1999, it ?anq Adolns, llagt4o, horoby oortily that ml Nuvomhor 15, 1999, it tlllo nlld uarroot copy ortha 1'lahttirr'a NO'I'ICR OF IN I'GNTION 410 RP,QURST 13N'I'RY OF DIVORCR DECREE was aunod, vla.oortiflod n liil, roturn I'ouvipt rogtieatod, addrossod tot Choryl Marlin, Dolbndanl c/o Attornuy'JoliloB Kayor' KayoC alld Drowil 4 L?o; Lihorty,Av9, COMSIO, Po, 17013 ItospooMMY Subndttodl Jot o Adnnta,l3squlro !, . . No, 79460 117 Small I Ionovor St, Cnrllalo, Ptl, 17013 . (717)245.1006 r. r. r. , r , I I N oomnlnlu tams 1, R nod 0, Mao PP(oplojo Ilum A If 11001dP1Pd 011vory IQ doulrod, I 'ry A. 1110091490 Oy (Ploolo P(inl Cloudy 11,,,ppln ?I i ' 1IMM??11?11°°?lrleq P. I M prlni your nonlo pn nddrooe on IN rPVor9n I 60 111111 ?W0 Pnrl rP111rI1 1110 oard 10 YPIh M AliPo111111P p0fd IP 11 19 p11hP n1UIIpI0P0, ' ' - 11 0, 6101101100 " .. P Aponl, x?/ ? /I ? Add(01602 I-? nurnl 10, P or on Iho front It Pnaa d ?aor oddroe9 dnloranl from Ilant l7 n No (Joo - p IB ' (? No 1, Arliclo Addmooo .lol , yfle, p it YfiFh nipr dallyory addroee noloWl ?ry y ?r 60rvlaa Type ,. arllllod Mall Q pxpross Mall hlQl Ilocolpl lot Moruhamllea r 4 " l L d C7 n 1. ( (1og ol rB o ll d M I r, naura o p 'A, hoeldolod Pollyory7 (L'¦Ira Pao) Q Yal '- ,. ,9, A111010NumDor(.opYWill Barv/colabcU • ,.. nq r P(rr1. QQ11, tly Roy I 10011101110 I '. .. llaq 1000I)l '. 109699,99•M'176 f1a IN11 11, LOUR IOI ,. ? NNYL,MANIA. CUM1I1dilANla COUNTY, illiN COMMON PIVAli CFIAIiI,l;li MAIi'1'IN„Ili„ t CIVII Ac-'Z'ION ' I,AW Pluhrilfl', ': i vH I No, 07- /1.?,, C>r;,, 4 T'", CIII RYI, MARTIN, ACTION IN I)IVORCI: ,, pulbndant ,. _ i , NO,:1C1C `I'O 111,N] LAdlZ.1K'14AIM R1(711TS ' .. Y??tl lurvo boon Nudd In Court Ifyoa Moll to dolbrni apulnNt tho olaintN Not forgt in tho following pnpoN, you nu1Nt tak0 prompt notion,. Ytnl In wtu•tiod that If'yoll Ihll to do NO, 1110 aaHO May prooaod wflltoul yoll luld It clooroo'of dlvoroo or mtlttilmo11t ratty bo ottlot'ad oool11Nt yell by tho . Cotu•t, A Juddmm?l may alNO ba anlar0d nfiulnNl yotf for'nny olhoP olnim or I'01I01'roguaNloil in 1WHO poporN by 1110 11111111111T, You ntoy loco n?onay or proporly or o11t0r rights important to you, inaludhtla ommody or visloillop of J+nur ohlldron, Whoro rho ground lilt' tho divoray IN Indignities or Irrotdovabl0 brookdown tic tho ilturrlano, you linty ragoaNt ntorrillgo upunsol I no, A list'of morrlago aounNolors la avoflabl0 at alto OMoo'of tho Prothonotary, Cuntborland County Courthotwo, IF YOU DO NOT FILI? A CLAIM FOR ALIMONY, DIVISION OF PItOI?IgVcY, LAWYFR'S 113138 AND IWIRNS138 13131OR13 A DIVORCE OR ANNUI,M13NT IS GRANTED, YOU MAY LOSE I'll I RICH IT TO CI,AIM TI IFM, YOU SI?OULD TAIU3'1'IIts PAI'1?R TO YOUR LAWYHR AT ONCK 111 YOU UO .; NOT IIAV17 A LAWYI31t Olt CANNOT APIORp ONI", C10'fo, Ott'I'I:II.xPI IONl3;'I'1113 OFFICE SET'POR'I'II 1113LOW TO MNII OUT WI II?Itl:? YOU CAN CIET I.,13QAL 1IC31.P, Cumberland County Ilar ANaoolallou 2 Wbutty Avonuu Corlislo, Po, 17013 (717) 249-3166 1 r, , - r. 'L n I' 1.r r, I i. - 1.r J IN T1,11i CCalJifT ol1 COMMON 111,I:M CI NOWRI,AM) COUNT'i't I'IINNNYI,V lNIA CIIARGIIN MARTIN, IR„ I CIVrli, ACTION : I,AW i'Ialntlit, I r I Vol No, 0 l/.3y' 4 CI II RYI, MARTINI i ACTION IN I)IWI(cl pptundatttI COIVIP.AINT IN DIV( R 1.'1'11(101111' I11'Chmqu11 morlin, dr„ 1111 adult IndIVl(1u01, who utlrrontly roaldga fit 324 North W011141 Slraol, Moffat I Ially, H6611nylvunht, 170051. 2, Rol'undunl IN Cllolyi MAf11111 all u(1ult individtlnl, ivha 01-Irr01111y I-Ps WON at 4400 I',hposant 1,1111 Rand, Apt I3, l lordollarp, l'viamylv11n10, 17110, 3, Hlnintlfftllld DOl'badaltl IIRVo bean baltll 11(10 1'avldu1118 aPtllo Co111111011Wo11111) for (it looNt 6 moalh11 l,nnlocllatoly provloas (0.010 Ming of(I)IN Complaint, 4, Tho I'IniOtlff and tho nafyltdant Woru awl-l-led on Nuplunlbur I S 1908 In 1-InrrlNlnlrg, Dauphin,cnunty, I'a0n11ylv?lniu; 5, Tharo havu bean no prior outlom of cllvorou or for annninlunl balWeolrthu flaftloN, h, plolntil'f 11011 boon adViHnd that 06116e01hlg IN availablordml that pltltlt(il'f play 1111va the right lq requool,tltnl tho court reilldro llta pnr(IoN to p01'dolPniu Ill commuling," 7. I'lnlntiffond Uolbnclonl have no 0111101.011 logothor, 8, IIlaiit(lmtalcl Dolbnclnnl aro both elllzun11 oftha United SlaJO8 of Amorloa, 9, Noltilor i'lnlntlll'or I)olbiiclnnt 111.0 It alembor oflho Armedrl oraod of tho U11110d Staloff orally of IN 1111108. 1 , l?? tl'hv ftlaintifi'nvw•a that Ihv ?{'oun{iH plt tYltivlt titiH {IVtI{tit iH hpHV{I {lrPl ({{) 1'Iul1 the marrin?v iH' Irrvtrivv{Ibly broken, ,. WFll3i?l?l??lt?, i'luintiff rvtluuHlH lltp ua{trt k! ?ntur n duvrvv In cllvarvv, I verily ihnt the atntuntPnlH ntnciu in thiH Coniploint nrv trtto oncl vnrruut, I undvrHt{lncl qult lhlav HtntvmonlH hvruln {!rv mltciu Hultlc?vt la ihv pvnH4lvei cif 111 Pn c,fi, oll"Illvution to mithoritiva, 0904 rvlntlitg to tmHworn . . chnriuH Mtu•tin? fir„ hlui?lti i ,.°- IZoHhoo(f)Illy H{IbltliltCd, No, 79465 17 Sot{tlt l ittt{ovvr SL Cln'IiHl?,1'0, 17013 (717) 245.8508 A'I•'1'ORN13Y FOR PLAINTIFF, ,,y75 1 : 41 ?c i i IN'1'111"? COtJit'1' Ah al1MMo N PIXAN .. CUM1111,10 AND COIJN'I'Y, PI?NN4yl,VANIA CHARbI?H MOTIM, R , I CIVIL, ACTION 1,AW 1'Itdntlfl' I Va, I Nn, , 99.1135 Clvll 'I'vrt11 I , CI1131M, MARTIN, I ACTION IN DIVORC(? I)ofbntlunt ,. I ?, AND NOW, Oils Moroh 8119(n, 1. Jgl1o AclnmN, I?ecllliro, horoby onrtlty 111t11 ph. Moroh A 1999, a U't1o Npd pol'fuol Fp11y nl'U1o'Nlaiatil' N N61100 iii 1)o11oad, COMPI,AIN'I' , and AhPII)AVI'I' Of, Sl3PAltA'I'ICN worn Norvod, vin opr11110d mall, rolln'n Noolpt ruduaNtod, addrossod tot Clioryl, Kay Merlin 44001'Itonsonl Hill Road, Alit 13 1,larrlnbm'e,,Ila, 17110 It6HpoolfIilly 81iU1111ltoch Jr?Rj l3Ngalre (1415 1iaflovol' Sly CarliNlo, Pa, 17011 (717)'245-8508 ATTORNEY FO" PLAINTIFF „ I 1 1 ??INpultl lama I nnd'ol7 It I nUlllllunnl wrvlrae ? I hlx( ? WI611 nl tu oulvn I116 1 M c OnIIl 1, ?Inms I m nnd.lIl Iolluwlltlf nPlit (lot till II Ihlnl will 11111110 and a ldws" an IhO lnvmu0 0f Ihls Inuit cu Illut Wit inn ma0n Ihla llxlrlt N(W f nad l0 llnl. ? Allar I I lie 101111 lO lhn land ul th0 nlulgtluca, al 1!11110 back 1161-41 ca'11ova 11111 r 1_I litI1110nnpp/n Ad(llnnn I I I Ian nil (I Wdln 'polum llOvolpf llaUlns10J-oil ilia ilia Ipipcu bnlaW lhu III ndu lannbol N 111111111d1n(11)nIIVPIY! M 111flO llplunl 11911"IN WIII allow la Wham Ino 1111100 will dnllyul l a m I Iaa 11111, ` IlOnyolu11. On1181111?nnllnnnlnr lal (611. I p. A''1lllrln Addronaud In, it Alllolo unlbnt Jx 01 -A *:?j `J? 411, Ilnrvlno lypn ' u.(L VVa ? 1\?1 ncl ?t 13 1-1 1*1"pnlnmtl, Calllllnd 1 I 4, 1 1 (-1 lixpttlan mall (-) Innis ad I-1 flolumRncolpl(orM2telinndisq'?(7CCf7 " t 1 Onto ul Pollvnty 6. loolvnd, By;. (1'11,11 Nruno) 1 11, Addrnnnun n Addittoo (Only 11 roqudalnd and loo la pnld) ' 6. S1p11 mci: (AddraaaaporApnnli ,. , ('8 I'utln 30111 I nnglnbnf 11114 10;169'1 otwu (,10111CN1?0 110111x11 I1p00117( I ! I r I 1 I ,. i - 11 1 ?i - ,. i? ,. i i _. _ .. _. ., y.. _ ? .. _ ?, 1 „.. ,? IN IIII'•('tlllltl c?h c'11?IMt1N p1.1, 1, _...,x..,...,..,, lt,'11lHRI,ANI) COUNTY, III`NNS)TVANIA 4'I Ir\Rkj.'S ?gAK'I'IN, dl?„ . ('IVII, A("Ph?N I AW NIt11ml1,1' 1. No, 09.11,15 ,0101 'I'ul'n1 ('I IMO 1. MARTINI I ACTION IN DIVOVI I laglun(11tt1 ' , -Ole 1 , 9S2N 1 S Ll?l? l l1iS LJ4(`J Ll?l_S)J?111? X213 t L? ? , TOT ('hurl) Mnrlln,,llulillchlnl ?? u? Gip Allornoy 1 mms I;IIyul' , K11yu1,,? Ilrowtl '' di$+1 a ill•?. 1 111~1 LIbuI'lyAvo, 1,;l i 1,a .I ?i CyI'll 1+Iu, Nlt, 17013 c All I'111n11ITi Ch111104 Mm,1111,11110"(14 to 1110 wlih thu C'1?ur1 thu AlIlwhu(1 Provulltu h? (!I'11115(t?111 Raord oil oI,11llul' 1)000111hu1, (, 1999, Ieclllu411116 thlil 1 1111111 (1001,00 111 hlvol'0u hu e111ured. I(usl,uull'ull?'suhmllledf" _ •1 Diller ? I t0 r\(11114, I:y?lulre ,. ,111 No, 7905 ,117 South I I11nuvur til, ('11-11~10, I'll, 17013 A'1TORNI-.Y'14)1t 11I,AIN'1'IFV CIiAR1,HP MARTIN, dli t CIVIL ACTION ? LAW I lalntiff 1 1. No, 99,i 1,15 civil'I'prm CI-I13RYL MARTIN, 1 ., Po?ndnnt I ACTION IN DIVORCE . 1 Ut;nr.Stt?r rn mRnhgn?lT t?1?12 ' 'l9-ll' NROTHONOTAItYI 1 ranenlit Lilo ropprd, loeothpr with 1119 following Infp divorce dpPrpol i•m011011 to the Court for patty of o l I 0I•01111d for dlvoropl h'r0p'IpvtlUlo Urpnlcdown tutdor,Ql(? oI'tllo nlv0roo Codo, 2? pata nl?d a1a111?Pr of t11P AprVIPp of the Ca11?p1t1lllt! I)011vorud l?v oert??, , 'CQStriot0d doliyorv r turn te0oi 1?-?lilslflt4sh11??ivurod ot??j??c?C ,, a Unto of ox0ou110t1 of the nM"'ll rptllliroc) UY §3301(d) of t11o pivol•PO Cociol, ,, ,?,L' 1'_1Ullldfll Itehrunrv A 1999 lapto of 0111) tCotoldo dsorvr oioePSpo of tndhe011 t,plulntlfl's 0 iYld11vit roquh'od Uy, §3301(4) of tho p ivoroU n 1'llech Iklxunrv ti 19 Sorvod oil apfontlhntt March 4. Rc c 4, Roloted cl111a1s poltclll1g;- lm. 5. Ditto n11cl tnnn11or of service 0f the 1101100 at,11110nlfoil to gtoprnooipo to Iransmlt 1,41, n Dopy of whioh Is nlglohoch Nc,vO,n ,pr 5 ?IN1111 Mill _0ortl(le(t mnil to Atto? ,. . Itospoett1111y SUbn led, Dow ATit?t; 'd ' s,1?sgtdr0 r, o179465 117 South I1tu1ov0r st, Corl1810, Ita, 17013 j nttornoy Ibr I'iai11litl' f. IN TI III 0(1101(`1'. O COMMON 111,1'?AS COM1311,RI,ANI) COUNTY,11I?NNhYINANIA CI IARI 18 MARTIN,,1K i clYtl, Ac'I'I()N r 1.,AW pl11lntiil' ? , vo I No. CHITY1, MARTIN, I ACTION IN DIVORC1? h?ibnchuri a AFFIDAVIT(He SEPARATION -,d4 ? -T1/ and Nva eontlnnod Io I Thu 1)[11.1 ION to thIN 1101 loll H0p11r11t0d oil #Ym,,Nf Ilvu Holm ot011nd Ilpllrt 1`01, it 110r1od oflit 101181 two z, Thu 11111rriepu IN Irrotl'lovlilly lrokun, '3,1 undur8tuuld (hit ? nl11y IoHp my,hi118 001100611118111iilloO, dlvi8ion orpropurly, Inwyol"N rou8 or gx11011803 if l do Ilol 01ni111 (11u111 buforo 11 dlvol'00 18 gl'11111ad; l verify tliilt IN 0lntunwnla mndu in 0118 0,11(uvit oro trllu 1111(1 aorroot, I 1111d0r8tend (11111 fulso H0Itu111u111H huru111111•u Imidu Hllliluot to IN ponallioH of I H 1116C,8, §49041 roltlthig. to tnmol'Il 01181110011011 to 1111thoritl6H, ?? churlo8 Marlin .Ir, I'Inl11tifl ail i. ,. ,, ?. ., ; ?,. , ,. :, ? _. CI IM 1,118 MARTIN 1It, IN 'I'I113 CQult'I OF COMMON 1114WH OF IIIAlllll?1' : CIJM1113ItL,ANp CUUN'I'Y, I"FNN8YI,VANIA ve. : CIYII., AC'T'ION , IA4V NO, 991115 CIV1?,'1'I3RM ' CI II?ItY1, MAIt'1'IN, , palt?nthutl ; IN1PIVOKCF 11 °' 1 'I'A'1'1113 plto'1'I1ANn11'ARYi .. PloloP P111or qly,ilppP11r111100 RH opullHol ol'ruoord Ibr 11101111nVU•UIg111PI1Pt1 P01,011tIi111t• Itop rulllllly H11b111111ot6 dent s Jr ICIi or, I???uIrP IAWI-ly l'olt A 131 I.Ibor1 AvogtlP Coq ll?lo, 11 17011 (717) 213.7922 co; JnIIU Ad11i118, 13IgUll'o r ,,;', ,, ,,` ?.r r??. CI1AlUX-4 MAIt'19N„Ilt,, IN'fl-IF C0IJK p ()P COMMON 11114A5 W, PlninllA' ('I1M111'IiI,ANI) COUNTY, PI:NNSYI,VANIA vN,' CIVlla ACTION I,AW NO. 09-1115 C'lVll"I'l?ItM CHI%Yl, MAKTIN, laefonat4htt IN PIVORCI? " !)b.l?U:NpAN9''S CRUN'I'ICIt-AhG'IgA1'.P!' UNI)!4!t hl.C'rlON 33111(11) O 9'llh; plV0140P, C011110, I. Clrook either (a) or (b). (cut do not oppose the entry of a divoroe doureo. (b)1 oppose the o111 1;y ol'it divorce duoroo 11001111 No (Chpok W,(II) or bnthh (I)'I'ItU pa1'tioN If) thitiaUtion have not IIVud Nuparolo find apart (ht' it perio(l of nr „ lend Iwo yolorN , 00 1,110 marriage IN not Irrolrievably broken. 2. Chock olthor (0) or (b). (a) I do not wish in nutko any oWh"H for cooilonlo rullef I uridumaind th01 I may lose 1'IB116 concorning alimony, c110Nlnn or properly, I0wYo1''H Was or oKpfaios IN do'not olninl Thom bol'ore a dlvna•oo IN granlod, '(b))l wish to Am coonho roliol' wliloh may Inolildo aliillony, dlykion of pl'opol IVr IIIWyur'N loon or.oKponsoN or other Important rights, understand that In nddhion to chooking. (G) above,, l must also Illo all of illy oaononle claims whh the Prothonotary In wrhltlg and sorw0 (heart oil the other party, II' I Iidl to do so bellarq the unto sot !ht'lh on the Nolloo of Inlollllotl In Itequost,.DIV01•00D"eroy, the dlvoreo duwvo may he entoreal withoul An-then delay. Vorhy that the inotomottts )node In'thk comilor•ollldavll ova tt'uo and Sea I undorelnml that 1111so sttlturnanis horohl are nmd0 suNocl to 1110 putlaltios ill' IN Pa, C.S. § 4190,1 t'olallog to titlswova IhINIllootion to authorities Dole' e Cher I Martin NO'PIO19l If you de not wish U? oppose the curry of it divorce docreo mid you do not Wish to i nike nuy' eialtn for econonile ralloi', yltu need not Me this enunimmaflldavil, ?,? ;?? ';'?` +.'' ,;.. ?',;,: ?,: ,; ,,,.,. ?;:,, IN THR COURT OF COMMON KRAa GuMRIEKANp COUNTY, PRNNaMANIA CHARI-Rs MARTIN, JR., Plaintiff C,IVII. ACTION - I•AW , , Vol No, OO.1130 01VII Term QHRRYh MARTIN, ACTION IN pIVoRGR prjfendant I TRIAGE 5 ETTLUMfiNXA kgMaNT TI118 AGRPPMPNT, made this 7 TI"li day of oe bn G ei,, logo, by and between, 0I1PRYt MARTIN, of Harrishuro, Pennsyylvanla, hereinafter referred to as vial,, and t?fiARl Pe MARTIN, JR,, of aarilsla; Pennsylvania, tiereinatter referred to no 111•IUBPAND", WITNEeer?THt WHPRPA6, Husband and Wife were lawfully married on se'piember le, lops, In Harrisburg, Pennsylvania, and; WHPRCAS, differences, disputes, and difficulties have Arleen between the par110a And it Is the Intention of Husband and Wife to live separate and Apart for the rest of their natural IIVea, end the parties desire to settle their respective financial property rights And oblloations As between each other, WHERPAB; ilia provisions of this Agreement and their legal effect have been fully explained to (he parties by their respective counsel, The Husband has employed and tied the benefit or counsel of Jane Adams, Esquire. as Ilse attorney, The Wife has ernplayed and had the benefit or counsel of James Ksyer, Coqulre, as liar attorney, Each party acknowledges that he or she ties received Independent least advice from counsel of his or liar seleollon and that eaal fully understands the foots and has been fully Informed as to hie or her legal rights and obllgatlona, an? each pony Acknowledges and accepts that this Agreement Is, under the oiroumstAnces, fair and equitable, and that It 1s being entered Into treaty and volufdarily after having received such advice and with such knowledge, and that execution of this Agreement Is not Ilia result of any duress or undue Influence, and that It 16 not ilia result of any collusion or Improper Ills al Agreement or agreements, In addition, eaoh party herato acknowledges that Ile or site lips been Yully advleed by Ilia or her respactive attorney of the Impact of 1110 Pehnoylvanla ptvorce node, whereby ilia ourt lies the right and duty to determine oil marital rights of Ilia parties Including divorce, alimony, allrnony pendente tile, equitable distribution of all martial property owned or possessed individually by Ilia other, counsel fees, and costs of lipgatlon, eaoh party hereto stilt deatrea to execute this Agreament, Acknowledge that the terms and conditions set forth hareln are fair, just, and equitable to'each of the parties and wolves tits or liar respective right to have the ooUrt of Commons Pleas of oumberland county or any other Court of competent jurisdiction make any detennlnotion or order affecting the respective party's tight to a divorce, alimony, alimony pendants lite. equitable dlatributlon of all inertial property, counsel fees, and costs of litigation, NOW THCHOoRn, Wife and Husband, each Intending to be legally bound, hereby covenant i and agree as follows; „ l Ki 1, OPPARATIDN, Thal Ilia p0rllos Intaild to mpintgin appnrale and pormpnonl domlalles and to live Apart from each other, It is Ilia Intention And purpose of this agreement to eel forth their respopllye rights and dliti0s While they continue to live apart tram earth other, Whereas A ocmpipinl in plyorpo was 11100, both parties will agreo to a No•Folt falVarco after Ilia Applicable ninety (00) day itine period lips run. The 130109 have pltar11PIN to dlVldo thpir nIAIdIlIolllpl property In A mprlner.whiph conforms to A ?ust 0110 ripl)t slendArrd, Willi due regard to the rights of each party It Is Ilia Intention of Ilia ppprlles that such (flvtpllon shell be final And forever determine their reapeplive rights, The division of pxisling martial property Is not Intended by tile parties to constitute In any wpy A sale or exchange of psspts, A, INTRRPRRRNAR, Further, Ilia porlas Aaron to continue Ilvinpp epparalely and apart from each 0ihar at any place or??ipces that hp or she may select, Neither ppArty shall horAss, annoy, InJura, threaten,. of Interfere with the 0tliar party In Any manner whatsoever, Gpph partyy may carry an And enpppe In any 0mploymanh pprcf0sslon, business arothar pcllVlly ae he or she may rlaem Advleabls for his or nor solo lisp Ando oner(, Neither party shell Interfere Willi the uses, ownership, enjoyment, or disposition of Any property now owned and not specified heroin or property hereafter Acquired by Ilia other, A, RUPRRQU13NT DIVORM The parties horohy acknowledge that I-Itisband lisp filed a" oamplalnt In Onmberend Count , claiming th01 Ilia marriage Is IrrafrloyAl broken tinder the no-feltilt lntitual consent revision of SeoAn 3301(0) of the Pennsylvania Divorce ode; Wife hereby oxpressos liar agre0manl that the rnprilage is.lrrelriewably broken and ox reases liar Intent to execute an and all offidavite or other documents necessary for the parties to obtain all Absolute divorce pursuant 10 Section ,1301(0 of the Divorce Cpde, The parties hereby waive all rights to raquost Court ordered counseling under the Divorce Ocde, It Is father specifically understood And Agreed by Ilia parties that ilia provisions,, of title Agreement relating to equilpbie distribution of properly of the parties Are accepted by each party ae a final settlement for all purposes whatsoever, as contemplated by Ilia Pennsylvania Divorce Oode, Should p decree, Judgment, or order of separation or 61vorce be obtained by either of Ills parties In this or any other slate, country or Jurisdiction, each of Ilia parties hereby consents end Parses that this Agreement and all of Its covenants shall not 00 affected In any way byy any such seporallan or divorce; and that nothing in any such deorea, juidgmarlt, order, or further modifloalicn or revision thereof shall ailer, amend, or vary anyy term of this Agreement, whether or not either or both of the parties shAll relnprry (it being understood by and between the parties hereto that this Agreement shall survive and shall not be merged Into any deorea; Judgment, or order of separation,) 11 Is specifically agreed, however, that a copy of title Agreement or Ilia substance of the provisions thereof, may be incorporated by reference Into any divorce, ludgmont, or dooree, Title Incorporation, however, shall not be regarded as a morger,11 being the spaplllp itlent of the parties to permit this Agreement to survive any judgment and to be forever blinding: and conclusive upon Ilia parties, 4. DATE OF RXROUTION, The "date of execution" or "execution dale" of this agreement shall be defined as Ilse dale upon which It Is executed by the parties If they have each'exeouled Ole Agreement on the same date, Otherwise, the "dote of execution" or "execution date" of this Agreement shall be defined as the date of execution by Ilia party last executing title Agreement, 8, DIMINUTION PATS, The transfer of property, funds, and/or documents provided for herein shall only take place an true' distribution dale" which shall be defined as Ilia date of execution of title Agreemsnl unless otnetwlee'speallled herein, I 6, WIF016 DRNTS, Wife represents and warrants to Husband that since the separation she Ilea not and In Ilia future she WIII not contract or Incur any debt or liability for which Husband or the estate might be responsible and shall Indemnify and save harmless Husband from any and all claims or demands made against him by reason of debts or obligations Incurred by her, 74 HUepANDIS DEBTS, Husband represents and warrants to Wife that since the separation he Iles not and in Ilse future he will not contract or Incur any debt or liability for which Wife or liar estate might i i „ be rpspanelhip and shall Indemnify and soya harmless Wife from any and all olakno or dpniands made aoelnet her by raaaon of debts or ohiloplipns Inclirrpd by him. P, M TNAI...kPARPr auhlool to Ilia provisionspf this Aoreampnll oaplt pArtylips {Pleased and dischargped, and by this Agreement does for himsolf or herself and hie or her'helre, legal c r pr 1) noontallV04, pxpautors, adminlalralcrs, and assigns, release and dlscharnna Ilia other oLand from all puees of aaIlan, ptolms, rlphis, or demands whatsoever, in law or equity, which sillier of {he partlPa savor had Pr now has Poolnet Ina 0lhor, except ally or all cause or Options of option for divorce and pxoopl any or all as ones pf action of hrppoh of any of ilia provisions of this Agreement, 0, pIV141ON OF PPRSpN4 PRPPPRTY, hlushand and Wife do hereby opknpwiedpe that Choy have previously divided their langlbie pereonol property Including, but without limitallpn, jewelry, clothes, furniture, furnishin?a, raps, ca?rppets, hPusphold equipment and appplloncep, latures, books, works of ar6. and other persona prapprly, Pxcepl as may othorwlop On provldpd In this Agreement, Wife agrapp that all of Ilia property of Husband or In hie possession ahall he the sole and saparale properly of Husl sndi and Husband agrees that all of the properly of Wife or in liar possession shall be the sole and separate property of Wife, The parties o hereby specllloplly wavier, relgose, renounce, and forever abpndpll whatever claim, If any, he or sho may hove with respect to Ilia above Items which aholl bagolne tie sole expenses, and seporala property at ,is other. 1p, PPNRION INTPRPeTe, I-Itrshand has a retirement account with the State Pnlployap, Retirement Priem through hie employment' Wife shall prepare a Oupllfied Pomeapo Ralallone Order (QPRQ) whloll will transfer to a separate account for her henef1114% of Ilia total vested Interest; whioh represpnto one half of Ilia Interest earned from the date of marrioge until Ilia date of separation This transfer shall On arranged no that Illlebond shall not Incur any tax consequences as a result of this transfer and will qualify as a transfer of a spousal Interest. 11, MOTOR VsHIOI.13% The parties phoil raisin possession of their respective vehialea, Titles to these vehicles have already heart transferred: Paoli party agrees to he solely responsible for Ills amounts presently due and owing against his or her respective aulompbpes, 12, ALIMONY PPNPHNTP I.ITP and I.POAI, FOPS, Paoli party hereby waives any rlghl to alimony pendants llte, and each party agrees to he responalhle for hie or her own legal fees and 13, AhIMONYo Hteband agrees to pay to wife an amount of $100,00 par,month Allmony, The parties will make arrangements to have these payments deducted from Husband's paycheck directly and paid through Domestic Relallons• The portion mutually agree that these payments shall be norn modifiable;' however, sold payments shall cease upon the death or remarriage of Wife, " 14, INOOMR TO RPTURNe, Husband and Wife represent to each other that to Ilia beat of their knowledge all tax returns and 00181' documents required to be filed with Ilia Internal Revenue service for calendar years logo through 1004 have been filed and that no notions lava been received from the .; Internal Revenue Service which remain unresolved, Paoli party further represents to Ilia other that to the best of his or her knowledge, the Information set forth In the joint lax return for these calendar years wea and remains accurate as relates IQ his or her sole Income and eaknowledges'lhal the other party rolled on such repreeentallons In signing those returns. Therefore, if anyy deficiency in federal, elate, or local Income taxes ie proposed, or any assessment of an such tax ie Inada against the other party by reason of hie or her having joined 41 the filing of ON federal, stale or local income lax relume, Husband and Wife shall Indemnify and hold list nrlasa the oilier against and from shy and all tax; Interest, penaltyI or expellee relating from any such tax deficiency, Including reasonable Counsel and accounting fees, and such tax, Interest; and penallles or expenses 811011 he paid solely and entirely by the reapponalbla party as determined to be allrlbUlable to that party On account of mlarepresen1a11on or (allure to disclose relevant Information of Income on Ina aforesaid joint returna. 10h WAIVRR OR MPPIPIPATIPN TO OR IN WRITIt?P, No nlortflopllon or walvor of any of Ilia r terms hereof phpll be valid unloon In willing and stoned by poll )prlips, and no Wolvor of any breuph Iteraol or dofoull harounder shall lie deanlnd a waiver of any suhsagllanl dafoillI of Ilia some or similar nature) 16, MUTUAL POPPORATION, Faoll party shell, at any time and from time to time horeallor, r Lake any and all plans and oxonule, opknowlpdgo, and deliver to the other port y any and all further (nolrumonls and/or dootmlpnls that the other party may roponnably inquire for file purpose of giving full torap pled ellool In Ilia proylolons of MIR Agroemanl 17, APKIAA49 I•AW, The Aoroomanl shall be conatrued In accordance with Ilia laws of the Oommanwoailh of Pannsylvanlp which are In offeol An of Ilia date of execution of this Agreement, 10, WAIVRR OF OI.AIMR APAINPT THR RISITATRs: Paopt as harsh) otherwise provldod, anon party may 010pase of 1115 or liar property In any way, and oaah part hereby wolves and rpllnqulahos any and all rights ha or she may new have or harapflar acquire, under ?he present or (uturo laws of any ?Uflodlallpn, to shore In (he property or the estate of the other so a result of Iha marital relallonshlll, nohldinp without limitation, dower, owlasy, 5lalutary allowance, Widow's Allowance, right to take Inloeloay, riohl to fake aganst the Will of Ina other, and right to act as administrator or,exeoulor of Ilia other's palale, and each Will, al Iha. request of Ina other, execute, ocknowledoe, and deliver any and all Instruments which may be necesssry or.adVtspbis to carry Into ellaal this mutual waiver and rollnqquialtmont of all such Interests, Hollis, and claims, This agreement shall be binding and ahall Insure ?Ite bpnotit to ilia parties horela and their respective hairs, executors, administrators; suocaosors, and assigns, 10, WARRANTY OF PIKI.OeURh, The parties warrant and represonl that they have made a full disclosure of all their assets and their vahlauon prior to the execution of thls Agreement, This disolosure was In the form of an Informal exchange or Information by the parties' Attorneys and this Agreement betWeen Ilia parties Is based lipon this disolosure, 20, INTOGRATION, This Agreement conatlhdes ilia entire underelanding of the noNeg. There are no repreaenlellons or warranties ollnpr, than those expressly set forth herein, 21, OTHRR POOUMRNTATION, Wife and Hr sbond covenant and agree that they will forthwith execute any and all written Instrumants, as5lgnmenla, releases, solisfaollono, deods, notes, or such other writings as may be necessary or desirable for the proper effectuation of this Agreement, 22, NO WAIVRR OF URFAULT, Thls Agroemenl shall remain 111 fill force and effect unless and until terminated under and pursuant to the terms of this Agreement, The failure of either porly to Insist upon strict performance of any of Ilia provisions of this Agreement shall In no way affect Iho right of such party hereafter to enforce ilia same, nor shall the waiver of any default or breach,of any provision hereof py construed as a Waiver of any subseglrent default or breach of ilia same or similar nature, flat shall It be construed as a waiver or strict performance of any otter obligations herein, j 28, eRVRRADILITY, If any. term, condition, ciaUne; or provision of this Agreement shall be I determined or dealared to be void or invalld Ip low or otherwise, then only that form, oondlllon, clause, or'. provisions shall bo strloken from this Agreol alit; and In all other reopeals, this Agreement ehsll be valid i and continue in full force, effect, and operallorr, Llkewlse„tlle failure of any party to meal Ilia or her 1 obllgallons Under any one or morn of'Ihe paragraphs herein, With the exception of the satisfaction of the conditions precedent, shall In no way avoid or alter the remaining obligations of Ilia parties, . 1. 1 Iq ORP PI1i' If either pparty IlraaohOo any provlslons of llilfl aoraerr . the other purlY shall have the rlpht, at his or her oloctlon, to flue for damaoos far suph hroach, or aae pillar ramtpadids or relief ad may he ovollahlo to him or her, and Ilia party hreaahinqq ihifl Contract allotlld he reopens 016 for payment .Rf leapt fees and coalfl Incurred by the other In onforolno tllplr rlohis undar thlfl aoropmant. IN WITNPt38 WIiPRrOl', the parllos have horounto flat their honda and ooplo the day and Year first shove Wr Ilan; WI'rNPPP, tnaes i RI.P8 MARTIN, OR. Palo; QHPRY ARK M TIW VVIIO(N v Dale: n n' r. n , OIARIX'S MARTIN, JR, I IN TI lit COU10' ni''COMMON PIA'AN. OF Illalntll'I' 1 VOMPFRI-ANP COUNTY, VItNNSYI.VANIA vH, i i CIVII, AVI'ION I,AW . I No, 99.1135 CIVII,119?ItM C110,RYI, MARTIN, i pufunllnnt IN PIVORC1 c> r o"cc I AND NOW, thk clay oC Ducomb01', 1999 It IH (1001'1:0(1 llwt41110 Sllpaldllml For 1110 1311U'y ol"ID011108110 R011111cp1N O do" 11m b0011 oxmil0(1 by 1110 1*1110H 11111110(1 abow shall b0 I111111o all orcl0f of, 1111H 0o111'l. '1'110 coral of 00111/111 Plum of G' 11111hu1'llalcl Cn11111y HIIIIII (11aIIIII011 ,1111'1'(11011011 hl this mott0P, Ily 1110 C011111 - I , " .. it iIoul J11111uN d. Kay0f, i?Hgllll'c M L A + f n??+?? /`T 1, J Ad C? h' . altu allta, Hga u MmIrm cclUit'' OF C t?MMPN 111-I?,A (al GI IARI,118 MARTIN„llt,. r IN TI Ill Plaintiff rCUMI1I*I,ANP COUNTY, I111NNSYI.VANIA v8, I IIAMII,Y PIVISION I NO, 919.1135 t'.IV11.'I'h1tM Cl-IFI 1+ MARTIN, ; hul'wttlnnl i IN PIVI)RC .I 81'111 11. '1'10 FOR'I'111 ENTRY OF IMOMES'10C BULATIONS OIII)r ll AND NOW, this CL i / 9ch t ..1 uN _..__ slay, o CNARIAtI9 MAR'T'IN, JR„ plidnllIT, and (11111M, MAR'T'IN, Rvl'unshint, Oil hu1'uhy ASrvu turd Stlpulntu u8 h?Ilowal ' r. " 1, ,. 'I'Itc Pluitiiil'1', CFIAItI.f?S MAIt'I'IN, ,IIt, , (huru,innll?r rufurrusl to Its "Muinhur„)18 11 mombul' of dto CPI11111oI1Woailh of ponneylvanill, Sintu limployuu'lt Itoth•unlunt hyNlolll (hvroinallur 21 SI31tS, 118 n orcnttlra of Ntllttlty, 14 controlled bytho Stale 13111pinyoo'N Itolhrooluo( . Coda, 71 pit. C,S, f1§ 5101.5956 ("ROO1'u111ctlt Cocio" ), 1 Momlwl•'N ditto of hh'th IN pccombol' 211, 1954,,md his soolnl Suctlrhy oMillbur Is 169- 414.6177, 41 'I'ho DOf'omlllnt, CIMIkYl, MAR'T'IN, (horulhallor rcihrrocl hl'tls "AItornwo 1'11ycu") GIs ll)o formur spotwo of Mumbcr, Ahcrrlut0 (lnyuu'N chic of birth IN 1'01mla •y 25, 1956.1111d hor 8001111 .I. Sau urity nurtlhur)8 209.46.1403, _ 5, MOl111101+N la8tJ clown 1111111ing cldsll'cNN 1,41 So I)oollyltirook Ito,ld, Lot 1132, CnrlTNlu, PA 17013 6, Altc1'11mc I'llyco'N corro11t mallIng oddroNN INI 4400 hhoomint 11111 !fond; I InrriNburg,. , IIAt 17110, It is the ruxpnllHihillly of Allurnnlo Pope it, Well it orrpnt 11111111110 tallliass nit flip with SliltS fit 1111,11111pH, 71 The nlilrltlil property oonlpollunt of Munlhpl°H'iutlrempnt benpllt utilll11 1 (1) the Clovprlurp hroplioll IntllIII111 d by (2) the M0111000 8 reth'0111011t buttullt till the 011'000vp dote of Mpnlbur"s rpllrpntvnt uq1p111111ud by lwlllp the Mpllbpl''n 1111111 Avprnpp nohu'y , nn 11m1/dtl/yy (ditto nl'HOpnratlt,ll) hlHlond nl'Ihu'Munlhpr's nptl,nl llnnl avprape HnlAry, (n) The covurturo Rroutlnn IN it frlwtlon wlllI A,voltlu WON than of eggnl to onp, •I'hp, Aumvratpr,IN the 111110unt of Mulltbur'o Hprvlpu' As (1pllltu(I by 13131M 1161, the pprloo gmv 11'11111 111111/dd/yy Note of pull-'illgo), to 1111I)AW/YY ((lAle of Hopnl•ntloll) , The t1o11n111hultor IN the lohll' Anlotlat of Member's survive,'nH dullnu(i by SFRS, nn the pfloullvu unto of Mplttbor's rbihnniuat, (b) flollrtoult ppluenl ( 14%) oftho morilol property componenl of Mumbo)'" rptlranlunt bullollt is to be ollocallud to the Altul•Ilnlu I6nyuo as her uqullnblo dhitriblltl?n pertloll cif tI11H nulrlpli 11HHet, , H, Mentbcr's ro'thonienl bonuflt Is dpllnud AH till nulnios paid to a1, alt bohnlf of Moatliiir by SERS, h)ulmilitg toly huAp Hlmt'lvlilichimils or Hohodulud or od line illut'ommH bill ott0111ding (110 ` diHmbility portion ormly climbility alutlllllcH paid to Moulbot• by Stilts or Ally dul'erred eotiipollmitioll bunofitH inld to Momb'ar by SERS, The ogtlitable dlHlrihlUlon portion cif tlio.marllnl properly, contponool of Meolbur's rotirenlool bu,lpllt} aN Hot I'al•lll In Paragraph Sevell (7)1:Hholl be payable to ,plterllllto pnyue and 8111111 oonlnlottuo 118 Heoll'ns 110iiji11IHIrlltlvely fooslbh6 on or about the dale the Member actually ontorH pay Htntog n11c1 SEWS approV0411001110.9110 Reintion" ordur hwnl'poroting , IhIH Stipulation Hod Agivemoot; Nyliluliuvor Is later, „ 9, Munlbor Ituruby nonlinalaN Alloraalo Payou is all 11-rovounblo buttollniary'lo lhu PKIP111 It(liltorngtu 1'ny9p1H 9gnilllbl0 (Ilsh'ihlllloll p(u•lion nl'M9n1b91°H 1.9111'pnlonf 110119111 hnr ally OVIIII111011911(8 poyahlp by SI?W. This nollilnntioll shill, hoooltlp offoullvo upon ijpprovol by 1110'' fiporobtl'y pf ilia ItoIrp}tlpllt Ilnni'll, or It iIt nnthnt'Itoo rpproophlolIva of tlhy IVlllosliy Ito III on Ordor Inporporolinp Oils Sllpulntion and Ati mmo, rl'ho hop up of Only danth bonollt rpinninint3 Or Ilia tllloutllion of Altpl-nnto hoyoo'H 9tlnihlblo (Hstribiillon portion ("lln(tulpo") ehnll 110 pnitl 111 Ilia 11a11a11p111I'lus 11111110(1 by M9111bur on Illp It1Ht Nonllmnhnl (1 f Ilon91191111'19H Form 1110(I With ilia 1tut11'ontun{ Itont'd,p}'Ior to Momhpr'H (1911111, '' n. If Ilia Inai Nonllnation n1'yunull9hu'19H.1?nrn1111ud by Momhur prior to Monlbaj°s (1011111(11) pl'u(bllas ally 11111)1'oY9d IaooloHdu Ralllllom OrOur inoorpornling titles Slipulmlon Hn(I Apruomont, anti (b) minion Alturnnto lloyoo (iH tl bopuff oiary, Ohont t) ilia forms ol'tho dc1111oHllo Rohidons Order Hhldl mono govorn Allornnto pgyou's Mhom orally donth bonolll, (z) for pnrjlom of pnyhtg ilia 11111nnoo vin ilia lost Norm mdlon of IiunopolnrluH Form Illud With ilia Rotironlonl Dowd prlin, In Monlbor'H doilth, nltorntltu llnyoo shall by troatod its It'Altornoto Pnyou proclu9u11sucl Mombor, No portion of 1119 Itnlanoa Hh 111 I.r)o pnytlblo to Allornnlo I'nyou'H uslntu b, In 0111Aon, Monlbur shall onaoulo mid clolivoc to Alturnnto hnyuo nn llnthoriza(loll, III it form accopltlblu to SHRS, whioh WIII nuthody SIMS to ruNnsu, to Marino Pnyoa all mlovahl 1111hr111nddo ooncorning lvlanlhup'H rutiromont noao11m Allornnto hnyuo shall doliver ilia nuthnrizatlon to HNtS which will allow ilia Allornnto . Ppyou to uhook dal Hho Us noon nod oontintlos to ho 'proporly 1lonll11nlod undur,his po1•ngl'ulill, % Tho lorln nmd 111110111118 of, Munlbor'H vallt'ontonl bunalTfs pnyabla tq,tllu Allornnto „ 11ayae alter SI'RS aplu'nvpS it I?anteSlle Itclallnns Arcler htellrpm'Inling this Hilpnlulinty tool Agreoment is dependent open whleh opilon(s) In (tn,e) soioclod by Member uptm rolh'ontopt Member and Alternate Payee exproasly npruo bill i Montbor only Select any t'elh,enlettt oplim 00,01-00 11Y SIRS under IN Rutironwnt Qnde m the the Momhur files an Applieatian Mr Iteliremeal Allowance with H 11, Alternate Payee may not oxoroso tiny right privilPPP or option nffured by Si RS 8,110 shall leant imllviclual tax forms in Mombor tmci Altuninto Paycu for amounts paid in coati; 11 In the avant ol: the clealh of ITS* Payee print' in rucuipl of all of hut' payments payable to hoe Trom HUR4under MW CNACV, any clualll boncfit or 1,00ro?nopt bullpill payable to Allarmito Payee by MORN Shall ruvert to Mombor, . 13, In no event Shull Alternate Payee have greater bunal is or rights other than ingwo willch are available to Menlbor, Alternate Ptiyee 14 not e11111lod to any benefit not otherwise provided by S11ItS, The Alternate Payee 18 only entitled to tiro speaino bonflilis offered by SriRS aH provided In this Order, All other rights, privtiugcs and opt1011H oftbrod by 811ZS not granted {o Alternato Payee by this Order are presorved for Member, 14, It Is spoolllually Intended laid agreed by the pdl'11e8 horoto that this Orelurl (0) DUDS lint rmtiwro Si RS to provide tiny type ol,1n011efit op any option, not oihorwtso provielud uncler lily Rellrolltont C'o(jel (l)) 1)(108 not regairo,fil?RS to provide Illercasad benefits (dotermined oil the hods of actuarlal villtlo) Unless Increased t1uncilis tire gold to Mambo bosoct upon cost of living or I Increases based on othor than netundul Woos, is, Ito parkas intend tact agroo Ibat,tbu terms of dins Hilpulathm and Agramtent shall ba approved, adolited and colored as it Domestic Relations Order. 10, The court ol,C0111l110n I'lona of Tnmlorloml Comity, 119misylvanla, 611fiil voiln ,In1,101ption If) fin1Pf1(I filly pontPHtio ItPlfitinna Order InOnrporfiting IhIH l tipulntion:}mcl AnrNPmunh. hllt only I'm the porpoHP of oHlnhlisillu 11 fir 111nInUdllinB It to fl P01110HOP RPlotiolla Or4131'i provided, howovor, lung no Hnoli,m1101dmenl Hhnll rogllirP 511RS to provlllP filly IypP of l'(lrm ill' 1011001, Or filly option lint atilerwiou provided by SIARS, nnf)1110101, provldPd that no Hl1Pli nm011dln911t 01' right 01'11113 Collrl 10 HO III11PIl(I Will IIIVRIi41atP 1111H P1(IHtlilg 01'dol',' 17, _ 1'Ipnn entry aH it PomPHllo RPI11d0nH Ordol if P01,111100 got )y o(' tile 0111PHI16 1101110011H Order a11ct fill" StIplllfltioll lald ABroomont imil ony 1fOnflfillt de1311111en1H Off111e HPI'vP(t llpoll shRS 11111nPCllatoly, 'file Pollloallo Rol14tlo11H order ahmll take offoot ImmodlotPly upon SIRS opprovol and 51'ItS Ig?pl'nV141,ef ally illlelldlnlt (InonI11e1ltH 1111(1 then Hhall vollndl) In offoot until 1111'Alor OI'd0l, of Court, IN WI'I'NI?SS W1-1111030I', the pm'IIeH 1101'0to lavo Not their hanclH 14110 HoflIN file Plato 1111(1 yoor al?ivo }vrlttua, dAM ' J, K ` I',hQi HER If, M1 J f? AI?AM' V s Q CfAltlR8 M, R'I'I , JR, ' i.. ?. _ .. ' li li n .. _ _ ? .. ?. IN'I'I I I? COURT' olr COMMON I'I.I?AH CI?M11i'ItI.ANp c'OUN'I'Y, IaI:NN?IYLVANIA CIIAit?i?SMAIZ'I'IN,,IR„ , I CIYII,ACTION ,I,AW , ItIllintll i, I v8i I I NII, 99.113ri CIViI'1'ul'IIl C1i4;RYL MARTIN, „' I I ACTION IN PIYORCh pufo11cI11i11 _ L . " M DAVIT OF S ERVICE OF 11111 , c OE INTEN.T 1?Y?.ICtsTUr?r^?n?nu, . ANn NOW, tlda lauuunlbur 151 1999, hoo Aclums,1' 11111'0, Iluruhy ccrtO (lint ' 011 NOVOInber 16,1999* it 1111u oncl uorrool unpy of the P1011111A)s NOTICE RIdQU48'r 13N11ky ply Immcl, DITIMI? woo so1•voc1, vlo uol•tiltod I»uA, rutom revolpl ' '. ruquu#Itod, oddrossed tctl , Chotyi Mortlo, pufonchntt O/o'A0111OY Almon Koyer Koyor and Brow4' 4 Fin at Liburly Ave; Corlisle, Pa, 17013 Rurypeetn111y S11bn1111ud1 .. ' (Jot e Aclnnls, Itsqulre " '?I, , No. 79405 1`/ ?3oulh IioltoverSt, ,. Ctir1181c,11o, 17013 (717)245-N508 i , „ . 14 Oomplolc Ilolun 1, 2, 4111(18, Also dolppIpto Ilon1111 hoalr0olod UollYory In doalrocl, A. IlurulVar) by (Pirrnsa Pdnl Clnmty) 1NlY IN11 11? ?I p u cry i 1 14141 • l 111 1'0111 Your droll roll nddmua on Ilia loyornn an lhul wo coil rollnn Ilia nerd in Your - - -- - o eglnnnnn -I M Allnoh thin cord to Ilia book ill Iho nlnllplono, or nn Ilia bolt II splmo plialiQe• Y G, '?!`- .,.t/?t lil?z. A A0Ion1 CI Mlrlmesvo_ " " ? -» -' ----'--'--- 1, Adlnla Addryanod lo. - P, In dollyory nhdlons dillarool Imm onto 17 II Y128, nnlm Uullvory nddrsos UalaW; ' l Yon rJ No -. , /?n(jr° ? ny nolylvo1Ylm /? arlnmd Mnll C) I.xprpnn Mail -? '- / l G Y > ?, u'Irnolelmnd m 11041to 110culpl for Morahnndal, i 0 C ) rl 111suml mall n , ),I , - / 7p 6e- M; U I. 1109lnulud nollyary'I (I'xlrn Ifio) ^' (l Yoe / d, Aillrla Numnor (Copy horn soryloo laboll 9ti11 I 18 t'oflll Ally 11)!1() Uomm?lln (!clan! Racal YI toP6e9•aU•A417a0 I .. I 31 41 IN THE COUK- 0j C.cmlMc?N,PI.I'.r1ti C -'Utt'1131aiLANI? COUN'1'111: NNtiYLVANIA CI1ARWis 1,1AIt'I'IN, JR„ CIV,II. ACTION • LA1Y . _ Plnintll'1' I Z vs. No, 99.1135 c;Iv11 '1'61-111 I c'IIfatl'1. MARTIN, _ ACTION IN PIVOWT,. 1?PI?'n<Iilllt (?SZLIL?1?l.LL(`11.141I?L!'i?.l?l? > > ? 1?I?I?IY.l131S.1.I?LVSd13C:1?.llls ?) I ? ?? a'S,2t Churyl t.91n tin, I ?PI'und0nt 11?}'I I, 91 ,. cio rluornuy Jnnlus Knyur "v"i Kgyuf &, III' ONYII {1-l d Insl Llburly Ave, C,IdIsIV, Pit, 17013 •? 1-a ?, PIntI1t11'l', ?'htll'lus N'1111-1111, 1111011t1s to lllu \N'Ith 1110 Cotll'I 1110 AIItIcIllgl PI',weip0 to 'I I'tlllyl11 1 Ruuord on (I )tlllur puoonlbur (11 1999, rugtlus(ing 111111 it 1111111 (Iuurouln I)ivol." by vnlcrud. Ituspuctl'ully suhmltlcll? ' Iyulu Adnnls, L,t?µltro I` y1). No, 70,165 117 South I lunovur St. Corllslu, Pa, 17013 r1'TTORNFY FOR PLAIN I'IPIr CHARM MARTIN, JN, 1 CIVII• ACTIQN n I.AW 1 , va, 1 No, 92,I13SAvll Torn}, CI IIIRY1. MARTIN, 1 ACTION IN DIVORCE; Dolbndan! t , PRArCIPP TO TRANSMIT RECORD To TI-113 PROTHONOTARYI Transmit tile rooord, together with the following 111farolotlon to the Collrt for onpy era 'r dlverao duoraol 1, Around for dlvorow Irratriovabie broakdowll tlndor §3.141(d) of tile I)Ivoroo C009, 2 Data and monoor of tllo service of the Complahltl Dollv__ed bTortlt %L aujL L 9tLk Wdj4gtLY94, ratum rooolpt-Muosted dollyorad otl MtL1L, 1999 3, Dato of enecntloa of tho oMdavlt rcgtdred by §3101(4) of tilo.Divoroy Codoi 4.iJti"fllm r.?rut,ry-2 ,_1222 Date of fllhlg and setvloo of tiro plaintiff's at71dovlt requirucl Uy §5301(4) of the Dlvoroo Code oil rospondotltt Plladt lthuiuty-26.1222, Sorvod o11 Defondowl March 4, 199% 4, Reiatod oialnls pondlilgi.Nm, 5, Date and mnnnor of service of the nonce of Itltentlon to Me praoolpe to transmit ?}rugoer"d, a copy. of tvhloh Is attoohodt Novombor 15, 1999,y1a cortlflod nil to Attarnoy jamem kayos „ It.ospac1MIIy Subn to di Dam j..'?'lx`? •a" ??'11u, 'd s, Lsquiro ' t; o, 79465 117 Sollth Harlow St, Curllslo, pn, 17013 Attornoy for ?>IelnHcf IN'I'lll? ctaUlt'I' (11? c?t?MMc?N I'I'IsAN ? , CUM1117,10 ANp C 0I1N'I'Y,1'I;NNNYI,VANIA CI IAKId?SMAK'I'IN,,IK„ t (:IVII,ACTION I-AW. vH, t No, ??9•(135 CIO Torn) QIIMM,' MAK'I'IN, I. ACTION IN PIVORCI laulundtiltt t olumpli AND NOW, thlH z2?,rL dny of 1999, nllurcon" durtlllull of 010 btlhlllglloll Hlgllud by 1110 h{IrIIQH, It Is 110why OKhlaltl?h (Ind, Ia13cRlil?h thnt thu Alimony pnynluntH nllryud de In Houtlon P of the Mnrrlneu Solllvmunt Ahruumunt Omit ho duOuetvd 11'0111 111lhlllff m pnyuhuuk Hruutly Iii lll Judd through DoI1104110 ItulnllnnH, 1110 M. A7-.9 9 aKg c > „> C r ,., 1 COMIIM ItII? ANIatCOON'I Y,1 I NNSYI,VANIA C1101,119 MARTIM dit„ CIV11, ACTION - I,AW Nlnlttlll'I' r vN t No, 99.1135 elvll'I'unn t CHERYla MAK'1'IN,' ACTION IN oIV61tC1? l?Nlundulµ t '?1!ULATION ,ANI? NOW, 11118 (lily of pec(?4vl62e 1999, tltu pnrllu8, CHART-A!S MARTIM 311„ I'Inintll'I; onclcl Il;1tYl; MAIt'rIN, hureil(ltntt, El?t ltttruhy Agroo and Stlptilnlu its rollowNl htttin11111 Chorlux Martin (herein011ur retbrrvd to ux hlttln1111") vurrently 1.081(le8 nt 5p 13onnybratlk R9tld, I.qt #32, Curiinle; t'n, 1701;11 2, Hltthttll'I'N (title (Wbirth IN Domill or 26, 19541, Intcl hIN ecwl tl Nvettrily nttmhor 18 169, , 4.617'7 3, plltMdfr 18 Rut•runtly'omployud by litu punnxylvttnln hupnrlmunl of'11•nn8porlttllon, 4, hufundnnl Cltotyl Marlin, (hurulnnilur rulbrrud In nN "I)ol'undnnt") ourrunlly roN11190 tit 44001'ItcaNow I IIIl ltoacl, I IIn'1'18burg, hit„ 17110, 51 huf'c?ulnltl'N duto al'bit'llt IN I'obl'ttitty 2S, 1956 an(I Itu,• Noola[Hoenrity number 18 209- 46.1403 6, I'ut•eiiont to llto obovu•onptlort9(I dlvorco nllttter, I'Itdiitll'I'tmd holbndnnt 011101 Off Into it Morringv Sulllul eat Agroomoltl,'in Dopy IN (tllttulted nx 110111111 A) Wltlolt watt Illod wltlt Iltu I'rothottotory oil NovomUur N, 1999, 7, A'Gunidlit In au?linn I? 1!1'1118 Mnrl'1i10 SuNlumwll Aaru8mwll,11?10c1'+rlllnunly", Hall III I 'hNN (101-0011 In pny,14fNlldllnl $1110,011 Porlmm1111 Alinnnly, I 11, N10i01(1'I'N0d P01u11d11111 ON11'0 lit Ilovu IWHO pl1y111Pn1H dodoolud ftnlll 1111NhN111114 puy01104 c1l?uutlY Iind lttndp tltrn001t himt08110 ItulntlnitH, `?, Thu porllp11 nllllunliy a0r00 lhlll 01080 voym00t811111111110 nnmi?uullllnhl?l howov0r, Nn cl 11NY1110111N NIIRII uuNHU lipoll thu dculh ter rullUlrrloup nl' P01,011(l1U1h IN WITNI' sS WI HiR110 ,1110 j)IR1100 hur0lo havo Not 111011' 11ROH Rod yook 1110 (1111 0,1111d, " YURI, iihcwu wrlllulh „ i 1t, 11,19Q. I1--., ., ',??'u ?/' ,f ///<Fi +1"(?r?? /?7•• ??.. `1?, ;?" CI 111M, MARII' N O V.- 14A H ADAMS, 118 CIIARIA MARTIN„Ilt, , P 'I t'I a? ,d l 0,04,4% 'jlt }I,t AS I 11,11} f}tl+J .. t Yid H i7, MIR' 1J ?44rf4tr.II IN '1'1-11= ootJ(q'l' o1. COMMON, , r 1 I-nl? OUMPFRI.ANI? COUN'T'Y, 1)1-vANIA CHARI.CB MARTIN, JR,, -I'Inlitti(t Ys. CHFRY( MARTIN, 17o(oltdttllt clVll- ACTIc)N'? I.AW . NU t)D - 1 1;111 olvll 'fe+rnt ACTION IN lalvoDcr MARRIAUE-aarrl.EmEN-T-Agi3FcmE.N.T. :i 1'hII6 Ac?li13I MGN1' ntuclu his z.' r h C.III:IiYI. MAIi'f IN, of Hill rlehtlrp Polillsyl nillu, hufulnallor r ulurruu/to as "WII'I'•", tInd ar?gli141213fIWOpiL MAft1'IN, IR., of corliolu, porlrtsylvania, Ilorolnaftor olurrocl to as 1IUSpANIY1t_ YYIUif;?ETlit -„ is WHERIFAS. hlusband artd Wife Were laWlully ntarrlod on Sut Ponnsyl . ?lum Ytinui, and; d; bor 16 190, in 1•I11rristAgg, , Wl-l( RrAS, dllfafarlces, dlSpules, and dllfloulllos have arlsua bo(Woan Iha p and II the 11 intenllon of Ilhsband and Wlfo to live separate and apart for Iha roll of litoll' natural IlveHos, e and ilia i opartiae desire (o'eolllo tholr reSpoollvo financial properly flgltlS and obllprtlions as bulWeon llodh other, VVHFR(AS, ilia provisions of this Agrooinont and their legal afloat have boult fully oxplalriod to the partlos by their respective cotmsol, The Fhlsband has employed and hind ilia benefil or codnsol of . Jane Adains,, Vsqulfe, tie ills attorney, 1.110 Wife 11 a omployed and had 1110 benefit or counsel of Jollies Kayar, [squlro, as liar ollorlloy, haclt party aaknoWlodpesahal ho or site tale roealvod indopondont legal advice from l;ounsel of his or liar solochon and Ifler 00011 fully und0rstonds Ilia furls illio ha0 boon fully Infutmod tie to Ills or liar legal rights and oblig0tlon0, tend 011011 party 0ekn0Wl0dU0S 0nd aceupls 11101 Ibis / rIjwemonl 1s, undar Ilia ciroumstancos, fair and equitable, and Ihal 11 IS boing e1110r'IJCI Inca flealy and voluntarily after hOViftp orolve(f Such advic0 end with such knoWledgo, and that exoeullon 01111IS Aproenlonl is nul Ilia ooull of any dums or unduo inlluunoo, and Ihul ll Is flat Ilia resell of any 0011u810n er impopor Illegal nuroemmil or agtounlonls, Ill addition, anon pwly limoto aoknoWlodgos that lie of She title been fully advised by Ills or liar Iaspocllve altornoy of (lie Impact gf,lhe ponnsylvtlnia Glyorce Coclo, whereby is Court has the right and duly to dolormino all marital rights of Ilia patties Inciuchhg divorce, alimony, allmony pendonlo Ilia, aqultabla distribution of all nlar(lal proporty oWnocl or p 8sesced mdiVidually by Ilia othor, counsel fees, and, costs of IIIlgatlon, oath party hardlo still desilus 10 uxoculo this Agroemefil, ockrlowledgo that Ilia toraie and coildlllone sot forlll haroin tire ialr, just. and oqultable to each of Ilia poll us and Walvos his or liar ruspoollve right to have 1110 court of color ons pleas of Cumbollond ouli of com respeCounty (ylytairght to a divorolu, allmorly,talln nitilto ally rlequ ilablo dlssir butioh of IalgmIlia propolly, counsel toes. and costs of litigallon, enial NOW •I'NpR131 ORE", Wile and Husband, each Intondlflp (e lie lugnlly bound, hcroby Covenant and agreo as fagoWS. hyp r?ppr{ Irani flop t pthP( II a Iha htPll foil find purpaae d lIP Rpri3pmarit to sa pfl l hpir rospapl o rlphls pnd du?lppa Whllp Ihay oananu6 lp IIYp flpprl Ira111 ep011 olhQpr Whpropp q COMPIP"ll In plyorpe wall Illpd, (>oth pprhpa WIII pgrPP IP A Na hptdl plvprpp aI1Pr Iha appllpflhlp villa?y (gP) ally 111110 period lips roll. T11p pprtlpa Ilflya al{pulplUCl Ill dlYlda'h Uir InIl1f1111olllAl propefly III n Illnfulor which California Ill A luPtflnd rl(r1?11t alandprd, Wlih dull rapprtl'la Iha r?ghl6 al aflah party. II la ihp In?enhan of tI1G larpaa ?hpl apch dIVIUIOq ehp11 b0 Ihlfll plld Iprpypf (la?e1111111e {IIUIr rpappp{IVp rIg111P Tltp (IIVI6lp11 f of px f )allies 1110 pI propartY la riot lnlPndpd by I I ha pnrllou 10 Pona111utp In Any way A onto Or axohAilgo of APPPIP• 111111140 olhpf At Any p pee of 1)10005 1hAltllafor ally nlpylsploplUNpII11Pr PArtylallil oo parojellyll nd Injure, from ofloll o Interfere wq the clhpr pprly In any manner whfl?6ppver. Fault pflriQ may parry tin and pnufloo'in Any use se pA ynd marq, prhPleesion, busllloaa of Other activity cis hp or ahe lilAy tlepm flavlHAO10 for Ilia or liar, aplp banP(Ih Willer POY 6111111 Inlorforo Willi Ilia uses, PWnpra1)lp, pnJaympnl, or dlapoPlllpn of Any Property flow OWnpd And (lot oppolfled Ilorahl or property 11oraRl{ar AogAlrpd m 1110 order. Complaint InFgl1imuppr and Coo my olalminThe 0 4hal Ihpo,mflrrlnpA la Irrotrlal Ably bIII roika j lidalr a fheifre joIRU1? mutual gonsont ppproy161011 Of Section 3301(0) of IhOration pnO ex p Ponnaylypnpla plVotoe Cotip. WlPl hprpby expresses go to alffidafvlls or olltgr doolttInlenrla'n ioesagryl(orgt1 11I0 Pnrti08 ?o Oblflhl an ps hor l op all under Intent t X00111 gAny ndi t)hof Ilia .. oo plyoro 011 o Code. 'flip Pflrllos hereby waive all right to roatlast court Ordered counseling of under this the Agreement eme t gdp, it Is furplpr eppcl(loglly understood And Agreed by Ihe,partles IhAt Ilia provisions rola 1hl0 Ill oqullAblo distribution q filial B of property of (lip partip6 arc accepted by each party pa Shoulda for cif ptirposc0 WllAlso0ver, As conlemplalOd by Ilia PenrlsylvAnla plvoroe Cocle, area, In this o alny Ot erfolgle, aolttiinltry or jurisdiction, egallrof (ho pprlllos herebybcalttaanjs gold agrees Ihalrihls Agreement And ply of ha covenants Shall not be affected In Any WAY byy any such sppflraliolt or divorce; and that nothing In flay 6001) decree, Judgment, order, or lurthor nlodlfl amend oflllon or reylalan (hereof ahpll 111Ip?, , d vary An yy form of tilts Agreement, Whether or not elthpr or both of Ilia parllee ahAll remarry (It being ununderstood by And between Ilia parties hereto IIIPI tills Aro r both of Ili aurvlve find shall not be rtlet,ad Into Any decree, Judgl» ant, or order of sopgrnllon.) It is speol(loplly agreed, however, that a copy of (Ills Agreement or ilia substance of Ilia provlsions,titpreof, may be Incorporated by,ieference Into any divorce, Judgment, or decree, Tills incorporation, howoyar, shall not be regArded as a merger, 11 being file specific Intent of Ilia parties to permit this Agreement to survive Any judgment And to bU,lorever binding and conclusive upon the pgrlles: Tho be defined q Ilia date upon Whlich R Is elxo jod by Ilia pnlrties It they have coal) executed Ilia Agree vent on file same dal0, 0111orwlse, Ilia "dale of expou1101t" br "px00upoq data" of tills Agreonleht shall he defined As Iha date of,axpctlficn by Ihp party Inal oxeouthlg tills Agreonlent 6, DISTRIDUT10N DATF, The transfer of property„ funds, ahdlor aooumonls provided for heroin shall only take piece on Ilia "dis?rlbulloil date" Which shall bo defined as the dole of exeaullon of tills Agreement unloas otherwise specified heroin. 6, WIFE'S DUOTS, Wife ropregelils and warrAnls to Husbandlllat since Ilia separnUon'eho has not and In the future she will not contract or Incur ally debt or liability for wliloh Husband or Ilia estate might be responsible and slinll Indemnify and save harmless Husband from oily and all claims of domands,made Against Ilhn by reason of dob?s br abligallone incurred by her, 7, HUSBAND'S DI•'DTS, Husband roprMoftls and warran16 (o Wife that since Ilia separation lie 11061101 And 111 Ilia fululp hp will not contract or Incur Lilly debt or 11nbillry for WltlOh Wllo or Itor estate mlghl ry rvraN?rraiaip•enNann?r?nnanpurypnwgavanprmrnaq°pytrra?ranrpnyanri'atl'pluunu ur qut111inga'Ij1FWu •,`??"""''"'?"? Against liar by rpASP1l of driblo oropllggllons Incuriad by 1111" A, MOW 1`149AW (3llpf ool to IIlp proylslons of 11119 Agroanlenl, onoll porgy lips rolpappti And OlsonarapO, And by tills A?p(opmPnl door for Illnlself or horoalf and Ilia or liar hobs, Ipgpl (Pprosontollyoe, exPaalors, ArlmhilAfralors, and assigns, relapse and rflacharp0 Ilia 61hor 01 plid from all opuses of potion, claims, (Ighls, or donionda wllPlupoyor, in low or eggity, which ollhor of Ilia poltos saver had or now ties Against Ilia olhor, except any or oil cotisu or eoliaos of gollon for divorce Arlo uxoopt (lily or all couaoa of Action of Oregon of oily of IIlO provisions of tills Agroannanl, g, PIYIPIPN OF PPR40NAl. PROPERTY, 11116band Anil Wife do hereby poknowledup thgl They hays proyloualy dlvidoo (hair tanglblu poreontl property Inaludino, bill willloul limggllon, jewelry, clothes, furnltura, furnishings, rugs; cprpplo, hottssholil equlprPanl and AI)plltmom, pictures, books, works of AM And!.opler.poruonal propa(ty. I:xcopl as may aflipiw1ap be prcylriso In Pilo Agroomant, VVI(o pgraoa gull rill of Ilia properly of Husband or Ill Ilia possession shall be Ilia solo And papprgip property of Hui;WO( And I•fusopnd pproes IhAI All of Ihp f roparty of Wife or In liar poaaopslon ghpll be the solo and,uoppralo properly of Wlfo, T1ls parties Ua hereby sppallleplly wavier, release, ronounce, And forever gpondon Whatever alAlnl, if ally, he or aho may have Willi respect to the Above Items whloh ahall become the sole and sapprglo property of Ilia olhor, 19, PEN01ON1NTERE8Tti, Husband lips a retirement account with Ilia Slate Employes' Retirement system 1hroOgh file amploymoM. Wile shall prepare a qualified Pomeallo Relations order PPRO) whip I will transfer to a separate aocolml for liar benefit 14% of Ilia total yesled Interest, which represents one list(of Ills Interest earned from file Ogle of rnprringo until file date of seporriton, This transfer alloy be arranged so 11101 Fluabard sllall not (hour any (ax consoquoncoe as a result of this transfer find will qualify as a transfer,of a_. spousal Interest, 11, MOTOR VfiHlol-PSI The parties shall retain possession of llioir respective yohloles, Titles to these yelieles have Already.bsan transferred, Cecil pprfy agrees to by solely responsible for the . amounts prossnty duo And owing Against Ilia or liar respective nulamobiles, 12, ALIMONY PPNPENTI! I.ITC and (.CQAI. FCE$, Cgoh party horaby waives oily right to alimony penoenle Ilia, slid soon party agrees to be. responsible for Ilia or her own legal foes and expenses, 13, ALIMONY, Husband agrees to pay to Wife on amount of $100,00 par month Alimony. The parties will make Arrangements to have these payments deducted from Husband's paycheck directly and "paid through Pomestlo Iielatlons.- The parties niglually agree that Illese payments shall be tom modl(lal)1%,liowever, sell paynienis shalt oonso upon (ha death or remarriage of Wife. 14, INOOMC TAX RETURNS, hfusbsnd And Wild represent to cacti pillar that to Ilia beat of tholr " knowledge all tax relurna and other documents required to be flied Willi the Internal Revenue Service for colander years 1080 through 1004 have been filed and (lint no nolloos hoya been received from Ilia Internal Revenue Seryloc which remain unrosolved, Cooh party further represents to the other that to the best of his or liar knowledge, the Information set forth In (Ile joint tax raturn for these calendar years was and.remalns accurate as lolates to Ills or her solo Income slid acknowledges that the otter porly railed on soon roprosenlatlons In signing Ihosa returns, Theraforo, If any deflolenoy In federal, stale, or local Income taxes Is proposed, or any Assessment of allyy such tax Is made against Ills other party b reason of Ills or liar having joined In the filing of J+oln( federal, stale or local income lax returns, Husband and Wife shall Indemnify and hold harmless Ilia outer against and from any and all lox, Intsrost, penalty, or expense relating from any such Inx deficloncy, Inoluding reasonable counsel and accounting foes, and such lax; Interest, and penalties or expenses shall be paid solely And entirely by the responsible party As determined Po be attributable to (hat party,on account of misrepresentation or falluio to disclose relevant information of income on (lie oforosald joint returns, )grin)) Ileraa(allall be VAhd'dlnl In wr)))ap a algnt3 p IhPfPqr 0lal" hrelllldprBhAlleee blllednd a 3.rdptryadata ill of Ilia aaq 116 or Ullllltlllar nplura. lot MUTU4 OPPpURATIPN, 4011 pgrly shall, At ally (lute And (roll) 111110 o time horealier, lake any and All steps and axaoulp, tlpkltowleflpa, and dpIIVAI to Illo"ollter pallyy any and all filrl11or inalrionenle and/or doollnjonle II1p1 Ilia olhor party olpy roull0n4bly regulro or (he purpose of gIvIltg lull (prep And effect to Ilia prgytelons of (Ills Agraonal% Oolnmonwe AP ptlPa innRy Pniq which Are in ONO Asrof 110 dalorof motil on of Ihls Agreemen 8 of the 1ti,, WAIVIPR OF PhAIMS AQAINHT THU PSTAT90: Vxcop 1 party may ale 080 of the or liar property In any way, and each party hpropy waives And Yrelin wishes oily ah and all rlghle to or one nlpy now flays or hereafter acquire, under ilia present or future )ewe of any Ilifledlcllon, to ahpre In Ilia properly or the estate of the other pp ncluding wilhou I Ilmllatlon, dower, curlasy, elAIWIory Alona??WldaW?s allalwatmi erllrrJ olt111altrlkellllttaslACy, rlehl o lake apAnal l eta WIII of the olhpr, and riphl to pal ae adminls{rater or okeoulor of pie apier'r! estate, And eagl) will,, a{ the reguea? of !ho o{Itor, exeaulp, aoknawledpe, and dellvor any And alllnslnlmanle which may be neopseary or adVlpablp o ogrry Into gl(ee) ihla mutual Waiver plul rellnqqulshmont of all eulan In{eresl8, riphle, And alalma, Thls Apresmonl shall bo bindlnq and shall Insure 111e 110111110 the parties Iterela and iltelr rpspeq{lye lialra, exeouore, arlntlAlslra{ors, auoaessore arld pssiprte. 1B, WARRANTY PP slap{ PaURH, Tfhe partlea warrant And represent )hat lhoy hays made a lull dlsalopUre of all their asmfeto And !heir it Van prior to Ilia execution of this Agreement. This diecioaure waa In ilia form of an Informal pxchanp6 or Intornlatlon by the parties' Attorneys mild this Agreemepl between the par l1 a 18 baser) upon 11118 dIsoloedrs, 20, INTSARATION, This Agreenionl conelilutes file entire understanding of ilia parties. There are no representations or warranties other Ilian those expressly set fq(th herein. 21. OTHRR OOOUMhNTATION, Wife and Husband covenant Anal Agree tits) They will IortitWA11 execute any And all written Iris{rUmonis, assignments, releases, saflsfaetions, deeds, notes, or such ollter writings as may he necessary or desirable (or the proper effocluAlion of this Agreen)enl, No WAI until lerminpled and rrar d Pura an lu to jre l Tills of thisiAgrolanient. Thp llallure of eilher party jo Inslej nd upon strict perfornhonce of any of the provisions of this Agroanient shall In no way affect Ilse right of such art reafter by construed go A Walver oflAny sp bsequent defahaar breaon of ihele mila wina of tiny li or slnillnr nature, not shall It be construed fie a Walver or strict perforniance of any other obligations tierelh. 23, SEVaRAHILITY. If ally torn), condition, clause, or provlslon o(nu)s Agreemont shall be delermined or declared to be void or invalid In low or ofitunvlse, then only that lernl, condition, clpuse, or provisions shall be strlaken (rolnthis Agtsonlenh slit In all other respects, this Agreerliertt shall be valid In f continue and ruainyfone oraioo anof tl a ration, s herrein, Mill the exception of the sallslfacllonpof the gbndlllona prboedenl, shall In no way avoid or alter the renla hill obligations of the parties. I all ona Illip ItaYP IhP flph A1?1118 Pf 1 or IQIepPtLpn `jo pNPGIo??IpR1aAP8 (pf oUFh ufo Fhf or ppok 1111 0Pure 11ppPdl pyp ohf fpllel Ae mAy qqa Q ono pld IP 111cl or her, qnd Iltp petty hrepahln0 Illlp a nlrgPl shotilo ue repponslhla (Pr paympnl Of logo( (ppe Arld 00914 InoOrrad by pia athof In PnIPrFlno Ihplr rights Order Ihlo ppraPnlont, IN WITN se WI1I RI (),Ilya partlpp haya hprggnte pat iholr hands (md ppalp the (JAY Pnd yoPf first AGoYP WfIIIPrI, WITN9as; IARI.fs MAfiTI R, ? iplpps - hale; $11sRY M IiTI Dale /Q ul '?? ?f . 111 1110 court of Pmnlllu?1 1110114 fi PIIn1111,1ihAMP PP11111y1 Pon mylvoille ?PPA14t.'i9'IP 11111+A i IpNlt Ii1CP 1 It1N Pofo IlllAllt NRltlpl CIIRItlIPt3 MARfXN AR MPl11i1P1'1h NUltlltol'i 7612100460 I'llviru 110101 All r9rllwpugllrncp 111,11 Ntclatlu 1110 A1r•Inhcr 111 NKU111cr1 1 ,. CoMMONWPAAx11 QV BA P/a PAYRO??A 'PPM"ONp PO pog 8006 NARR t1PURd VA 17108.0006-06 .. ORDER OF TTACUMBNm 9 INCOMhu 11nmulol [freak D_M;U,nf Mullinle Cages on Altnulmletu PA '41 U6u of t'Inlntlrf Nnmo .y ? ItOfhlLlli AIn?tUl4onuaiiuv. CIIRRYI, MPI{F1N d ?31 069101091 9@•1170 41711, 46,01 101-WORK 1 1'4'I'Al,A'I'INtIIA1!{NI'AMttUNI't @ 49,01 Tot CoMMONWPAATIll OF PA " Ptlrsuptlt to iho Ip1Vs of tito.Conttnoltwottith of PonnsylVpnip the Iltoomo of CNARLue MARTIN oR t efoudpnt obligor, SSN 16944-6177 off LOT 3t 60 aoNNxnliboK Ra, CARUSeUa, PA, 17013.4200-03 Is hereby nowhed to tho following oxiollt You pro diroolod to pay to (Ito Pa State Colloolloo tmd Dishorsomoot Unit tiro stun of 46,01 poi' DI-WORK from the Income Otte (ho dofoodant obligor; The allaohment Pnyntollt most be sort to the Pa Slnlo Collection and Disbtlrsomont Wit Within soVon businoss days of the dnla lllo rlofoadpot obligor is ppid,. CHLCKS SHOULD BB MAUL PAYA111,1310 PA SCDU AND SLN,r TOI P(3nttsyylvanip SCI]U 11,0, Uox 69112 1-larrisburg, Pa 17106-9112 Norm UN-028 .., 8urviuu TY110 M Worker 11) OXATT G?lAnFRa .MAi1??N Ail 11AP PS Moodier IVOalliorl 760 100464 AYMBNTS MUST INC!aUP13'?'1-IR P13 +13NPANTIS NAMI3 ANP THR PACSBS RMS> NP x'09 QYIAI?' 111MR1 VIVIRPR IN ORPHR'I'o all PROCPSSfiP, PC) Nar 9'llls offlor of AttopllinplllMfor atIpport,is llllllllllg IIpPl1 yell 1111111 fortlipf ilutloP 1111ci shell hove priority over oily ottnolllllpot, onoputioti, Sarnish111pot or WagP ottllpllllitint onclor stAlo of IPP41 law oxpopt one rplollug to 'A prior support order, You Inlisl ponnnpopp 1110 41140111110111 of (Ito dorondant obligor's hlpolllp As sooll a8 possiblp bet lip later tholl foortooll days from Itlo dA1P of the issllaapo of tills ordpr of Allooli)ilpot, Yea are nollflpd tnrthor thot purmlult to lows I, 't'ile dofotttlpul obligor lips boon notitlo(l lllnl oil order of Attaolnlloot for support would.. ho Issuod, Z "Willilti folluro to Comply with tills orclor nlny rosult In (1) year being acl,ludged In contempt of potirl find pomillittod to Jail or fh?pd by (lip poilrit (11) your I)ohlp'hold liable for Oily, atlloullt 1101 Withhold or witl)llold bill not forwarded to the Po1119@tio Rolntions SPotlolll And (111)-tlli0olinlont of yPar Alods or proporty, ,. 3, Thq attooliment of Income or the possibility thorpof as a basis, In whole or Ill part, for,tho discharge of pg' oolployoo or n?ly disciplinary Option pgninst or (101,4011011 of Oil olliployoo is, prohibited, Vlolallott may rostllt Ill (1) year boing acQu(jgocl Ill coatompt and conl?nitloct to jail or And by lllo court and (11) oil notion pgalast you by the omployoo for clNtuagos, 41, If thoro are In your employment ono or more additional oinployoos milloso 1110011108 Oro subject toall atlocholont of support, you niny colni'llto file attnchutonl I)AYtilonl8 into it i to the pn SCnU and eeparatoly Idonthy the portion atb•ibutablo to each single )0ymoot t obligor, S, You most notify the Domestic Roinllons Sootlol? or the Ila SCDU whoa the dofoWant obligor torlniantos onlploymont and provide the Section with the onlployoo's 1081 known addross and the ammo atilt address of the now omployor, If known, pogo 2 of 3 Mimi IIN•028 Sotvloo Typo M Worhor 11) $snTT 9N6RUUn leaRTX" pr:. PnrtsllS Myn11Uur NumhNrt 701a19046q 6, mhp moxlmi m nmoviat of illp olhlphltlpilt 6111111 Pot PBPopd so %v of d1p'o111plpypo'a 1101111polmp whiph is within the Ilmits spi In tho ConsRmpi, CrOll prolopiloo Apt, I.5 ,?,C, g1fi71, 71 Tho torm "IrlPollip° as cipfhlpd by law 111p1u(im Po111po11salloll for sorvlooa, I11Pilldhls, Iml ' flat liliallod to, WIlgps' solorlos" fops, Pont I)P11snlloll In k11c11 po11h11lssiplts and Shrill or " itpmat l11001m0 clorlvod from Imshlossl $111114 dorivod from dpollus 111 proportyl hiluffic ?rontsl r9YA111041 dlvidPndsl amu?Itipst hicorap fronl'llfo hlsura11po and onclowfnont PPrltraplal 1111 forms of rptiro111ontl poilsipost IrlPollip from disollorgo of IIic10h1od110ast dislfiblltlYP allitro of pnrhlorallip 8rozts looolllpl II100111P III rospopt of a (1000001111 111991110 from art Intorest III oil 0510to or trtllitt military roliromont bPnofltsl railroad Pmployniplit rotirompfll bvnofltsf sp9lnl aoollrity bo?ipfitst 10niporury mud-ppr11lprlont (1lanhillty benpfitst worker's optnpollsatloll l tuiomploylno?ll Pompollsolloht othor olitilloillonts to mollpy or 111111) su11i awards, without rog?lyd to soilroo, hloludbig lotlory wlnnlogsl 111991110 tax ' rofthldsl.Iasaronco oonipo11sotion or.sottlpnlonisl awards or vordictst Pact noy form of payment (1110,10 mill polloctablo by fill itldiv?dtlal regardloss of IN sotirco, NI?i?1. INSTRLlCT=9. 1, Employers may oloot to docluut tip to 2%r of IN attaphmont amount for thoir oosts, This m111o tint must flat bo dOdtlatod froth 1119 allatlhillp111r It must bo paid from 1110 oniployoo's not carnlligs aftor tho hloomo ottaclimenl cloductlon has boost mado, If you ohooso to mako paymcnis via on oloctroaip fonds trollsfor, contact 1110 I'll SCDIJ tam toyor CuNtoinar Sotylcu at 1.877.676.956 p 0, iiY'CUh COURT -? Data of Ordorl _l+obrttnry r,, 2000 d Wos, IUi)(iIL 111101 Itd ahndQny 1.uy 51 .rd r xu1 dofuttcinnl; hwoo3 .1 Porml:N-00 SO"WO Typo M P-1 M1) }• Worker ih 01ATT 111 11lP ?fllp'R PP ?=(I!l111ln11 II?Pna of PllhAll';RI,?NII Cnn1lty, NanlHVivlndh ? , 11qA Ith ' ; P N, IIAN(1Vh:?1 R?!??,?1!''?ilhil?l'2?1", Ai ? 1411?s, PAI 17nh1 Pol'ondml Nt1111P1 QNAilmm i1 mriwuN alt Molllhor ll) Nimil PfI '161200464 11Ivn+v110141 All rnrrvalannlvncv nil"l Inclloly Iha Alcodlvr II( Numhrr, ORDER OI A9' ACHMION' O[ UN r ? 03 M IuN'j' COMNIe.Nq?9'ION III.N r I TH 110hum of Break Dluwulf.ItMulffido Cuflyr nq AWu1?Uwtl PA ' i line ul .. IIInInllff.hldUllt _ .. ... t;ntiu rvw I?l?LLL4C '. [11Wchumm AmnulLLlJ+l??y (HItinyl. mol'TH on 91011197 99.1110 Olvtt, 1. na,ao 1HOHTII . 9'R'1'Ah A1`I'AI'11A1h:N'1' AMoPN'I'1 6 100, 00 Now, by Orclor of this c0url, Ilto Doporollool of Labor mcl hldllsh'y, 11Hrogtl of IA1on1p10ynlalll ConlpoROOllon potlollls and AAhwoocos MUCIIAI, Is huroby tllrnclod to ollooh Ilia lossol' of $ 23 , oil liar wook, or 60 '90, of Ilia Uiloolployolanl Componsnlloll baltoflls olhorwiso poyoblo In 1110 Rofondflol ciIMHO R, MAR'L'IN OR SOUbd Scetlrhy Nln11bur 169-44-6177 , Molllhur 11) Numbor 76121.00464 , RUCRA is ordore(I to ronllt ilia 0111011111 ollnelled to Ilia DopilrJoloill of 1111111110 Wolfoto MIMI PI1W shall forword ilia on1o1H11 racolved from nuCIIA to ilia Domostto Itol lllons Soolioll of lilts courl for s11pport and/or support orrollrogos, if ilia Uofo11(10110% utlempinymonl cnntpoosodoll bo11allls pro olloctlcd by nilolllor Conrt or Courts for support nod10t'sttpporl orroorogos, OI'W ploy roduco Ilia omounl otloulml under this Order 80 ihot ilia 101111 1111uUlllt olloollcll (IOUs Hilt oxceed ilia 1111101111111 anlolull s11blool to gnrolshnlonl pllrsllolll to IS U,S,C, § 167,3 (b)(2) olld 23 PA, C.S.A. § 4348 (g), This Order `8111111 Ila offeellvo upon recolpl of ilia nolica of ilia Order by 1110 RUCIIA and shall ramoin i0 offaol 1111111 ilia OUfalldlud's 011111101110111 to URumployntont compunsolloo holtofital minor Ilia ApplIvAdoil for - 1.10110flls (IO(ad LMNIO 27, 2004 In oxlml lslo(I, oxptro(I or dufarrcd, IIUCIIA shall comply with tills Orclor, iltlloss Ills anlooded or vscoled by subsaquum Ortlur of this Calm, „ All (plosllolls, chollongos or obllgollolls to lilts Order sl11dl Ile direcled to ilia Pomaslio Italollolls Soc(Ioll of lilts Court, 13Y'I'11H COURT / 0' b1110 of o1'darl _ ,IU?,_" 2QQl '37 17" form RN-530 Sorvlco'I'ypu M Worker II) *1ATT QRPFR/N(aTICF TA WITHI.10l•p INCOMF FOR SUPPORT binlp Cr11R111W1W4+alttl fit 1!1?luleY?caNla Q arlNln,rl c?,clor(Nnurn Cn,/f lY/(??5t, p( GUMeldltf Nu 0 Mqundnd fhdar/rynllrn hr11UU(QCfInC/Npllctl 00 as 0A ? ? Inn111ndlnPulnrlNutlro , 1'rlhunahCnsn Nulnhnr (See Adde(ldllul (or rasa wifunnry) (mplupur/yYllldmhlur'c I actor d CIN Nlllnbal Itl ihAIt'1'TN, GIIARI,Ide , R, l1R f pgduynR/C)Iglpnr'i Nun o (fasl Phst, Mll GGMMPNWWAA+PII OF PA l mil II?:Nrtbl yes al snrutllY Nunlln,r 0/0 PAY11011L oppltAllioNg 963a?Alr4GA A'f1PA011MWN11's RNAUANGII PNT't' 1 ngduyue/r,b 111w, r,rrn Idven(vi Po JIM 0006 (SoeAddendnnl(fit plahlll((narnol IIA1tRTH8tilip PA 17100-000x, ?t??'? ?' ' ??. ;+uarlaledlyllhrarc+nnannrhn,rnU $ gyp/ p/ pfj e' t.pslrxllnl p,unnt's N,Imu II nsL I'Irq, hlll See Addendom (or dePandanf names and h0h chi ' fes ns;nrlafpd IWNr wises nn atMrlunanL aRUI'R INFONMATIONr This Is an prifir/Notlre to Withhold hicomp for SUppoil hllsud ppon im order (or slq,porl front GOMIIPBLANP COnnIV, Com1110MVoallh of hilinhylymla, Ily low, YOU ern raquhecl to ?ludi,cl Illeso 01111 mints front III() Ilhavo•niunoil employee's/obligor's Invonlo 611111 Iseiled by your Slnlo, further nUtlco (v)n If Ihn prd(1r/Nnl1cn Is not $ _ a 00 por month Ili currant supprnl $ 0 , o(1por ipontlt In fills bdue support Armors 12 "ohs or grenlert O ph Q no $ n , no par 11100th In Mucllrpl support $ 0 no per nlanlll (or ff{{plpllc toll costs $ por montlt In ollior (spoclfy) for a lma n o, fill par mpnlh to be forwardad to payee below, Yall (In not havo to Vrlry yoIll• pay cycle In 1)n In romplhlnc,i'Whh Iltu support ordor, If YMa pay cycle daps ,at 11111tclt Ills ordered Puppotl'pnyilunll Q(:Ia, asp tha (of lowing to tfolormIno how milctt to WlNtlloldl $.--'ff-mliar wuoklyy pay llorlod, $ -o o0 per blWoekly ay porlod (oyory Iwo Wanks). $ o qp par 601111nfonthly piiyporlod QW(co a month), $ 0, o0 per monthly pay parlutL RWI TTANCG INI`QRMATION; Yoll Must 1)(18111 wllhholdlnN 110 Iptor than tho (Irsl pay porlod occurrhnA Ion (10) working (111 .9 altar the date of Iltls order/Nnllcn, Sand payment wllllht soven (7) working clays of Ilm paydale/date of wltIIIIoin8. Yoll'aro eltllll(Id to rludurl a foe to dn(rpY lit(1c?s? U(WlNtholdhUf, Rufar f1) the Ipws gnvprnlnl4 111e Wnrk stale U(ynUr enrydnynn for Ihn allowable u11tcnlnt; Tllo lofnl wlthhold amount, mid your foo, rnnnol oxcend 5M4. of the umployiii+'s/ ohllgor's oggrellato d1'spgsa1)le wookly oanlings, For Iho 1)urpUS(1u(.Iho IIIIIIIaNon on w11111toldloll, t11(1 folluwllln Infommilon Is Itae(I Ud (Soo 1110 nil pR. 2), if wiIII11N11f by 111,ADI, ploasncnll 1'nnnsylyn11la Slate Collectlnns and DIshursnnloiil liilll (SCOU) Eiiiploynr CUstomor 5olvlco at 1•1177.676.09110 for Ilist rucllolts, make Iteltllttaltce payable tot PA SCDQ Send check for Pennsylvallla SCDU, 11,0,11ax 69112, hlarrisburR, pa 1710(0112 IN ADDITION, PAYMENTS MUST INCLUDE THE UETENbANT'S NAME AND THE PACSES MEMBER Ib (shown above as 01e'61ployee/ObllNor's case )deall ler) ON SOCIAL SECURITY NU41HER IN ORDER TO ffE PHOCESSEp, DO NOT SEND CASH BY MAIL, IIY THE COLM I AUG 9 .t 2(144 ' Selvlrr, Tytiir M,. namwup,n,u r'nrm I:N•02e WwWrIU OTAT9' 1 J APPITION4 INFORMATION TA GWI)1•AYFMs ANP OTHER WITI11101448h " ?? Ifr It lrkka I Vm Ira r(H ?l?arl Ia 1 1 t, r1ll o 'r,pV o h s form la ndr q 111 lIt, loVYUO nnr , I 'i, lr am 110 o of <s nit slam) rile Is lllffo?ettl ?rnln Ild+ still{? Ihilt Issll?+[? ?I )i Is Ul, n rt+'11) Illltsl ba IYrnylr?at+ r?IZlp?ayaulpVtYnY(IYIU Is Ilal {'hlll'? Rtl, I, Wt),rppruclillu.I111+VaII1I11i11Y Ca1111111I1E o of Vviluinlly rarnNninxi Indlim tripes, lrlkally-mml Imslnassus, pml 1nd11n-awand 1) nesspt IpGllallan o reselyilRhh Illll choose 1l) iVllhhekl In nrcer(linice Will) this nulls, 2, Prlorlivi Will IIIioldlnµ rudder Oils priler/Nolirl hoc prior RY oval lily olhur IanaI procpee 1111 (111 r shill Illy Ilse scone Income Fndpral lax times In (worl bnfete rocelpt Ili Iltis order have prlurllY, I( Ihure• flu rooor,tl lox (avles In affect Ptuilsm conlilrt Ilia runansllnn ilnpllr y tided below, !, 011III1111111N PaYfnalllsl Y?ou (,dill combinl+ vyllhbald imlouolt (rant more 111111 (1111 onq,lr,yyee/ahlknor's Iacmnlo In a slanle p,lytppnl In m:odl then{{'Yl oil l{{m lgao ousllop ?Ylllthakllon Ylnl 1111161, hrmy(Vmr, gaparrIely (dentlfy lilt,) hu ponkoo a(lkle skittle pny111e iA(loyvi n1 Ihnt Is allrlbulnbin ill u1c11 L? Mqln It 1hullnydn 00vilt (011hb((ldill o Yen ololl ropotl lhp mydnla/dole m( wllliht,l(IIn11)vhell sending ilia p;tyaltlilt, Thn- pnY{tnle/d11at1(wlllthaltlln 1 Is 1110(111111 en Whicll 1ImMl)1 wig wllhhnld franrlhu um dnve()'s wi taus, Yau Inugl ('amply wtili Ihu Inwpf Iha 61n1o p(Iho amplnyua's (11 ,or's prinrlppl plnco,(if timpltlymenl )vhh r()specl la Ihu I?nul pr+rlada rvilhln which vouvtnlsl Inlplntnmq Ito Wllh ti(I n nrdnr n{ld toevlnl the suppull pfiyntenls, S,' limp ftyaplpllinmr svllli MIIIIIIIIe sit Illorl 1111Idlligoi If there Is more Mile one order/Nollce m Withheld lltrunle (or Supl)nrl tilginsl 11 um?oypa/ohlloor rim yell fire (mil 'ill to honer 111 soppull f1ltla0Nnticas (lilt, It, Fvdorll or Slate wllllhakdloll Ilnills, y611 olusl fallow Ilia 114 of Ilia slillo oleo Ilnyno's/nttllgnr's principal plasm of engdaymanl, You most honor rill Oulars possdbl e, Ilan Min buloW /Nullras to ilia trmalesFuxlunl ? h, Teriplimll(m Noll(Ipatlnlll You ol)isl lromi)lly no11(y Ill() Rmgmslinll Allom y when lilt) employee/ublknar IsIto longer wmklnN for yoo, I'Ialim provide Ills Infenl)nllen ro(p(aslF+I nod rahlm it (,(lily of Ih(s Order/Nogcii It, Iht) Agency llluoli(le(k hnlow, WITHHOLMICSlnl 23a17a2990 RMIIrkG?YRh'slpiikl4pft'S NAMP MAHTIN, 01 I1d:E1 a, acs RMfiLAYRk'S C SR IPFNTIRIRRI- 76121 HIM _ PATE Of SRIIARATIONI I•AST KNOWN HPMF APP?IIRSSI NRW RMPLOYRR's NAMRIAPPHPSSf 7, ?Illllp Still) J!gloplils( You moy Ito mqulmd to reporl amllvitUhol(l from Imop still) 1111y11)uals sprh'aI homilies, camntksslyns, er sovorailru pity, l( you Ihwo Ally questions ghoul 1111111) s11m pilyl l)nlls, conlilcl tile poeoq ar aulhorhy below, 11, LI1111111YI" I( you fail to W11111101 Income as ttm olilm/Nolice (11mcls,.yotl ero Ilakle for both Ilia amill elilml 411n nmd you should llnva withheld from Ihdompinypo%blitlor's Income and ether pumaRlus lief by 11tinnsylvmia 51110 law, Panlisylyanhi slalo law ltuyorns unless ilia obligor Is employed l1 al)nlllur Slniu, In Which case ilia law of 11111 Snide Ili Whlch lie or she Is employed governs, g. AntlKRscr1minallm a You ilia subin:l It, a fine delennined under Slate troy for discharging ell ohlpdnyoo/ohIlljol' from argtloyelapt, to(uslnn (o a nlifoy, or taking dlsciplhtery action lnninsl ally umployna/obllgorhocnuse of 11 supporl Wllidmldlrtg; I'annsylvao(A State 11w travelog umloss the ohilgar Is employed In mother sligo, Ill W11101 n1so ilia IayvSlf ilia State In lv11101 ha or slm,ls employedIlovorns, M., Wllllhell(IIIN Lhnllst You may licit Withhold more Ihno ilia Inner nit 1) Ihu an neolb ollrnvad by Iha Fedurll consumer Credit 1'rotucllon Ad 05 U.S.C. 140677 (1111 t or 2) ilia amolols allowed by the stele of ilia angdnyea's/ulillgar's prlnclpnl ptnce of employmnol Tito radurll ftndl applies la tilt) nggrogAlu dlsposlblo Weakly eandnils (AMI'L' ADWI: Is Ilm net Inenma left lifter making mandatory doducllons such list Stater Federal, lo(:at latest sochd so(urily laxagl aml Metllcem lazes, 11, AdtIIllmnAlln(1tt 'NQTCt If you or your agool tire served will) A copy, of this order Ili Ilia stolo {hat Issued Iha order, ynu are. In follow the low of Ilia stale Ihll Isstlusl 11116 order will) respect to these hoes, Kuhlillllell Ilyt If you or your (implo oil/obligor have any questions, QQ I'sTIC RIILp71?7LL5 il!dION milled MC11' ATTACIiMfNI UNII' 13_N I-IANOV'R S1 try telephone 11 J71 7) ',' -( S or, P.O, noX 320 by FAX fit (717) 2-00.02111 nr C6RI.ISI.1: I'A 17013 by'f11lernol wWw,g'ltllds11(?tnrt elnle jm us 5orylco 1Ypt+ M Pop 2 of 2 Fotill FN-0211 Mill NO .1 Wuuoiv.i Worker 111 ?TJ(7"P "ITF ARpt:R/NATIGk TO WITFllirakh INCPMk I'PR 50111108T ' ,. ?IRIA.?gllRti!}MtF?tl(.Qf.P.Il111lflyL?iRtr1, CJX PrlµlnalPrdudNnlllu ,. Cn,/C 1Y/Pishn aumupR1ANn • (JAntnntlntlnnldr/Npllia Pali) (if Qrdor/Nntlcp 09/24 04 Q IgnnlnnlaRnludNalica Trihunnl/Coin Numhnr (spp Addondlim (pr crisp summary) µ1'•i MAIt'1'1N, Ct(AIMUS R. tilt I?niPlaYurMlpdtaldur's i'odprnl f IN NlnaUur " Ihrtplriyuo/ppllHnr s Nalco (latl, fhrL MI) ' ", ?H?41?6177 Of1RIrI6J,p OltpYnI,pR 7prrCt' frt'Plpyno/0141µ0('s 51)(14150oldly Npntpal 111£1 1fARRxsRUpcl r'xKQ 7TI111Hn464 GAR111PPIP RA 17013-1618' Cngdnynu/0141µnrtC,itnlrnnllllr, (Sep Ali lenrdan (or 1441n(1(rn4111er arhnlwre ar+arialwliIlrhea Numnse'u4aI'll ??`' (:uslndin I'drupl's ( sl, fllsl, kl l ? r4y9 7 See Addendmn (or deppndeill namRs and dirfh dales assochtled ivllh cases oil allaclnnonG ORPFR INFORMATIOM Thls Is an Order/Nolico In Wlllthnld Inconto for Supporl hasod upon an order for snppon (ruin . C'vmB 4RW1NA county, ConlntnnwilaIll1 of I'minsylvanlp, py law, you are roglllred to deduct those amotmis from ilia ithova,nomed timployae'f/obllgor's htcomo imill flnther notice oyan If the Prder/Nollcp Is'nol Issltod by your state, $. 100.00 par month III current support $ _ ii, no per 111011111111 pasl•duo sUpporl Armors 14^.wneks or sroolarf Oyes Q, On $ g. on parlnonth In modlcal support $ a , Ulm month for gonollc last costs $ par month III othor (specify) fora Iola o $ 160, o0 par ImI1th to ho forworcled to payea holow, You din nol Imo to vary ynUr pay cycle to h1)111 complionco W1111 1110 slq)perl order, I( your pay cycle clogs not match the ordorad support payment cycle, llso the (ollowllle to detornllpa how mech to wltliltnldi $ 23 . o©por wooklyy pay pnrlod, $ 46 .it, par hlwookly my period (every two Wanks), $; ro , oo por sonllmanllily pay parlod (twice a ntnnlh), $ io . on par monthly pay period, RFMITTANCF IWORMATIONt „You Inlsl begin wllhholdtill n? I0lpr than Ilia first pay pnrlod occurring ton (10) workinn days after the (late of this Orclor/Nonce, Sold payment wlllllll sovnn (7) working days of ilia poycllle/date of wIlliholdlog. You are entitled to dnclucl a fee to defray Ilia cost of Wllliholdhlg, Refor to ilia laws govorninll Ilia Work state Of our orllployne for Ilia ollnwphlo amount, The total willihokl amount, 'and yoilr fee, cannot exceed 55% o4llle nlllployyapls/ obligor's aggregato disposable weekly oaraings, For Ilia purposo of tho limllallon oil withholding, lltn (allowlltg Informnllotl Is handed (Sao 1110 oll pll, 2). If romllllOo by FFT(FDI, please call 1'aitnsylvmtia Stale Collecllons gild Plsbursoment Unil (SCPU) I:nlployer CUslolnor Service it 1.117Y-670-9500 for Inslrectlons, Make kemlttime Paynblo tot PA SCDU sorld c{lock tot Po1111sylVallla SCtaUt P,O, poX ((91121 Narrlsburgt Pa 17106.9112 INAOOITION, PAY41ENTS MUST INCLUM THE OFFFNDANPS NAMCAN0 THE (ACSFS MEMOM 11) (sholvfr above as The Enlployee/obilitue's case Idepllfler) pR ,SOCIAL SWUp1,TY NUMBER IN ORDER TO Or PROCESstp, Oa NOT SEND CASH uY MAII, hY TI r COYItTI SE 2 Date of Ordert h o 200 Form l:N•0211 Service Type M OM11NO10e700 WorkorlU 01ATT JI APPITIONAF INFORMATION TQI FMPFAYFRIi ANP ATHFR WITIIHPIPFRIi pill?fi?fpitlr'(rnynlllip5l??ld`?lit?lr?aivl?l?aii?rcnlpI,,ilrsj,liiltl?rpijtlil+?Invrilri,piiliiyiYrtnif?tnl lkllttlii?liailni?isd, 1 We pppreclolo 11111 Ynllmiltry cm» lllonco of Federally .ioccipnidud ImllAn Irlbos, Ir11)a11vownetl Ilu5111116sas, onitirldlan•nwnPd hNSlmgsas Iocilled fill n 0lsprvgPml Idol Choose In Wllhhotd In Arrortlanco with this nollrt). 2, PrIorI1Y1 WllllholdlAo un(Ior this o4lor/Nollro has prtorlly oVur Any other In`ml process 1lndor Shit) law oµalnsl Ilia spmu InCnnlo, Fedolpl Ink I1tlVils III Pf(pe1 bn(ool mcollrt a( this ardor Imvo prlorlly, if stern eel federal klx Inylos ill effect pleaso cpnlocl Ilia m lloollog .. ARanry IIge11 nIoW 3, GoluhIRII18 P1IYIR011161 You Con Conithirl wllhhold amounts from more than ono onlployoo%tpµar's Inrnnlo In a shoslp paynivail It) ouch pliancy acltlositnp wlll!hnldloll. You nnlsl' hnwovt)r, sepormaly Idonll(y Ilia poolon oh lip sinµln poymanl Ihal Is aµrilosilblo In Port. innpluynv/ohllµnr, 11-0-Rapmdnµ lhailmadnte/Pntn a( WI111holdlnnr-Ycarmost renorl Ilia v Almon(wIlhholdInswhnnsondinµdhnpnYmonti Tlta- Iha om dnyonb woµes You mull comply with III 1Aw n(Illa. In Ihn heel porlods within whlcli yotl nulsl Inlplutopm Ilia w11 moaning oreormno larwm0 me sapped poynlanls 5,' Ftop?ayea/Ahlrr With Mldllplo l'gdlpnrl 11aIllIliRsl If them le moor than ono order/NillIca to Wpllhold'InroolI' (or support log inp't 11116 (!11111 oY1111/nhll ar Alit You ArP11nA o In honor 111 s(Ipptnl polar/Nollcos (Ilia In Foduml or 5ta11a W111111a1d11111 11111116, you lutist ticlw Ilia low a( Ito strop ofonl?dnyno's/nhllons's princilm platen o(omplaynlan6 Yo11 mull honor All orders/Nollcos to Ilia µrnlplosl extant posslhlo, (sea t110 bolow G, TPrmlimlhm Noti(Ivallnlll You Ilelsl )roloptly notify Ilia Rmlooslllul Agency Whon Ilia amployoo/ohllµor Is an lomte worklas (of yolL 11 Aso prnvklo Ilia In(ounro oll roquoslo(I and lotion a copy Willis ordor/Nollco to Ilia Aµnnry Idm lfied Imlow, yWyITHHOLMRIS IPM 20111377040 RMP64YRI!SIPRIIOORISNAMFI- MARTIN, 011ARTAS II, OR PATR OF SRPARATIONl 7, lllntp $11111 PAYlloollsl You may hit ragolrod to mparl and wlihliold from lump slim ppymanls such as Imitates, commissions; or SOYPmnre,tiny. If yell lowo any rtaa61lo116 ahnrll Jump stop paylllolos, contact Ilia parson) or,1mdlortty bolow, 0; G1rhllit4l If you (Ail to wllhhold Inrolne As Ilia OOWNIAlce directs, yoo ern Iloblo for Will Ilia pccunmllAtad amount you should havo withhold front the ampleyne/obllgor's Inromo rnd,othor pana111115 sn1 by paansylvonla state law, Ponnsylvenlo state low sovorns ltnloss Ilia obligor Is tooployed Is Another Iblle, In Which rasa Ilia law of the Stria In which in or she Is employed novotns, 0, Anthrllsnrhillnnllnm, Yep art) sublacl to p (Inn 1lalonminnd under Suite IOW (nr dlscharglnll en emplnyna/obligor from cipglloymt)nL mfusloll to mtploy, or Irking dlsclplloary Acllnn oflalrlst any om loyoo/ohllµnr bemuse 01a support wIthholdlnrl, Poonsylvanlo Steto low governs 0nlass Ilia obllnor Is tooployod In Another Stain, In which cast) Ilia low of Ilia 5111to In Which ho or 51111 Is alllployecl IlPVanis, 10,0 WRIIhaldhol I.dmdisl Ynti may nnl withhold mliro Ilion Ilia lessor nh 1) Ilia monuols allowed by Iho Fedoml Consumlor Credit Prolacllon Act 05 1-140, fi1Gy3 (b)11 or 2) Ilia amounts Allowed by Ilia State of Iho nmployon's/obltnor's ptlnclpa) pIACa of 11inplaylnal6 Tho Fedornl Ilmll Appllas in Ilia agµnolala dlsposMblo weekly nalnlmts (APWH. APWI: Is Ilia not Income loft rotor making loandalmy „ 6lndurllons such Asa Stolo, Fudaml, local West Social Securhy lexos) And hladlcarn loxes, II, A1ldllinnnl lnfpl 'NOTSC If you or your agoht ern salved WI111 A copy of I1115 order In IN stela that Issued Ilia orcdar, you Are to joltow Ilia law of that Blato that Issued hits orclar with rospecl to (Iilso hams, Submilled Hyl If You or your olllplo at)/ohllgor hovn tiny guesllons, DOWSTIC RLt.ATIONS SECTION rnnlncl WXCI: AITACI IMIiNT UNIT 13 N. HANOVER ST.. by (alophono tit (717) 240.6225 or P,O, R X 320 by FAX ill (L7) 240,6248 or MUSI.L• PA 17013 by 1111erm11 wWw,cltlhl5u11)ohMotn, m,Us Pogo 2 of 2 form FN-0211 StaYIcnTypo M Min No M70 1115.1 WorkorID ¢IATT ItImmiltv 'if cases fill tu" l]P(alldrlnl/?(illsnrl Mi11i4'?N1 011011p3 It, Pit UuM41 099}01997 1 IACSfS (asoNtnnhnr ' pi Ali {, ftn'T=N llulullff hlltuul 1 94 pi-Illyalllt1111pU91 -A9^>r}38 OIV>rNl' 400110 1 AlleChnuuu nmpyrld ?. p00 Chlld(ronl's Nnnlpls)I pgll Chlld(rnnl's Npma(sh pnn „ I. ! I. I Ij che{:Ilad, you Oro [arlrllfal to enroll Ilia Ch110(roll) If chacke(l yrnt ora llgr lrml to ollrpll Iha r'llll(I(rpll) I( Qn if ad a hive In ally Ida, h) InsllfallCa GaVaralr(1 nyanahlp II11o0811 Iha III11plnyaa'e/allllfl0r'6 alllplnylllami _ l ` I Ie11I(e(I ahnyp III ally 1t10 lh InsllrnnCa CgyprallP ayallalll(1 I?1rot19h Ilia mnplnyau s/nhll9pr's pntplnynt{utl, PACShS Case Niunbor VIAIntl(( Name: I'ACSLS Cusp Numhar J?I9lnllff NQ9lli P_UIM Alladuonnl Amount Ilnrknl Att1.hmal l Amriiml otoo ChIld(raN1s Nama(s)l poll Chlld(rall)'s Nam(?(s)I o, ao po9 ( If chocllall, you are (agtllfad to unroll 1110 child(roil) „ I a )ava n ally 1101 I 1 htsurollca covpnl9o avallnhlo I onllfl ' ? ? ' ? If chucl(0d, you are rall(J1Jed to enroll Iha Clllltl(ra ) IfIanllflarl o nlvo In any Ion I1h Insuraluo covura9o avaflallla nypo uprle lha,Pmp l I s/ohllear s antpl0ynu1nl+ 11roull I tl10 alnploypa's/nbll9nr's pnlplny111pnh I'ACS[S Canso Numbor I'ACSIiS Cn a Numhar Plaintiff Nanm , plnlntlff Nmno pnckut Attachment Ain I" c : e Allachmoul Aniounl $ 0.00 Chlld(rarl)'s Nnma(s)I Uoh $ p?pp Cllld(ranNs.Nomo(s)I pon (I( chucked, yotl am r iltllled to unroll ilia child9en) It onllf ed above IIn ally two IIII Insurmlco covor(19o ovallabla l If chocked, you nro tn(p+l+ad to noroll Iha cldld(ti?n) 4I10111$ pd above In any Ihpn 11 Insurance coverf. to nvallnbla I l throu9 l ilia omployoo s/oblt9or s amploymnnh llroug l Iha anlployeo's/ohllgat's pillploylllnnl, Addendum I'orill l:N•o2a SoivIveTypo M MINNna119T0aI r 54 Workor,lh #IAr'r' ORNO NOTICI TO WITi1NOI•A INCOMI rPH SuPI'ART 11 SInIP XmImatuVpgltlt if_It-4tpn0vanliL Q 060111ai aldei/Nollca i2p,?Plly/hlsl, of CUMnpRAANp 'O At11andm(Oidpr/Nollte, PPIP Pf f?rdlir/Nollco ..10/13/04 Tpnninple Flydar/NaIIFp Trlhunplfcoso Nlnnhar (spa Addorlollpt ter tasa spnlinmryl K ART:[ CHARLES It, alt I:ntplnyarlyy (IIIIOhIatV Nflotai rIN Ngmpat Gngdnypo/OpllµOr't Npmn 16atb flub MII eARi,THA>? CItRY€1ApR OPHIP I:mpnyoa/nullµnr'ospclnlserurayNpnthP? '?p 4 64 1.1.1 p IIARRTODUpp Pup ,I:r66ploye171p,Vppllµnr't Coo 15551'af _ oARiaTp4p BA 17P13-lplp (SppA11011(lomMr Pla6glffoamer F-IFri' ??99 "?? S a+raclatod Wish raroi oil erforlmleflo N`Jw-??s ?"?'/?r ?y 7 Cgftr>tIISIParanl't Nnmv (tdth Pltib hill " Soo Addontltijn for rlppvndom nomvs,nid blrfh dafos asserlafed W(h cases en nffachrnpn6 ORM INFORNIATIONr This Ifi an Order/Nollco to Withhold Income for Support hosed upon on ordar,for support from CUMPIRKANU county, colitInonweahll of l'nnnsylvonlo, Ry law, you ore required to deduct those atllPUllls from the al)ovo,nampd ompinyao's/oblIsor's Incetlul until furihor notice even If the ordar/Nntic:o Is not Issued by your State, $ o, on per month In currow stglporl $ a , oil par month hl pasl-chle support Arrears 12 weeks or nromor? Oyes t? no $ o. na per month In nlecllcml support $ o, On per month for llonotlc lest costs $ par month Ill other (specify) for a tote of $ o , oo per month In be forwarded to payee holow, you d0 not have to v,1ry your pay cycle to be In coolphllllce with Ilia support order, If your pay cycle does not match the ordered gupporl pmymanl cycle, use Iha foilowinn to dotonpino how much to withhaidl $ o , an per wank)yy pay period,, $ o; oo per biweekly hay par(od (every two weeks), $ o no par samlmanl tly pay period (twice a month), $ o, paper monthly pay period, „ REMITTANCE INFORMATION+ You Ilnttst benill withholding no later than ilia first pay period occurring tall (10) working clays after the dato of this Orclor/N, oWco, send Implant within soven (7) worklnn days of (ho paydote/dato of withholding, You ore entitled In cluclucl a fee to.dafray Iha cost of withholding, Refer to the laws ttovornlnp the work state of your employee for the allowable allloml, Thii'tntal withhold ,1ltloul% and your fee, cannot exceed 55% of the timpioyyno's/ obllgot's anerenate dispopablo weekly earnings, For tllo purpose of ilia limitation oil withholding, the following Information Is roodud'(Son 1110 an 1% 2), If remllling by CPT/Cpl, plea-go call Poll nsyivoniA State Collections end Dlshursorpent Unit (SCDU) Cnlployor Customer Service at 1.1177.676.05110 for lostrucllons, Make Remittance Payable tot PA SCDU Setld eliaek tot PennsYlvanla SCDU, PA pox 69112, Harrisburg, Pa 17106«9112 IN AUDITION, PAYMENTS MUST INCLUDE THE DETENE)ANT's NAME AND THE PACSES MEMBER ID (Sholvit ellove as file Enij)loycolobllNor's Case Idea {/tier) po 40CIAl SECURITY NUMBER IN ONVER.To RE PROCESSED, DO NOT SEND CASH BY MAIL, 'I /p Illy THE COURTI Date of Orders OCT 14 2004 b y G .?* GtJ • D , ? E • Porin CN-0211 Snrvlev Type M oamNo iunldaIs I Workar Ib' $xhTT rII WITIMAF INFORMATION TO FMPFpYFR4 ANP ATHI R WITI-IMPI M P (Ill?fflot: l ofln [)`ilia slri 1l`IIti1}(Isiv4l l ours I, o( US j(art ilb l)( Im lol`In )II It If r,nnllo a or s ?1 1 alalu II it ?'¢t I l Il G , re 1 mus b ac In e r w 1 > (I ill o 0, lt of al le I? nm I hulc h I, Wit appror•Inlu Ilia vnhmlary cons lh;mcnp(frdPrrllly al iloolev-d In01all Irlbus, IrIhily-awntsl buslilnssm, nett Ilnllulpawnild fills Ilussos Ifivole(I all a roaolvollen I?lal chposo ill willillold III occoldonvo wolf lhls nollca 2; PFIr rllYl Wlihholillno kinder It* Onler/Nolice uis IllI Illy oyar any ollnor lorlal prpcoss (odor Slate low noolnsl Ilia somp Incn11ol. Fedora lox Io Ias Ill of(orl hpfnru re(:nipl atolls Paler have priority, If (host are Foilen111 lax lovies in affect pleoca contact Ilia rngpnspnN altency listed Icolow, 31 Gngthllolns Polvolellln You ciit cpnlbine wllhheld onuoutls from more then Ono nmployop/ohlblnr's Incnrpo In it sloillo poyntpnl In epch monq requesting wohholrling You lelat, howayoo sillmo illy Iduntify Ilia perllon of the slmllp paylnont Ihill Is ellflhblalln (n noc11 flolployeO/ohllpor, d.+ Itepartln8 ilia 1'nvdnlN?ate'hf WIII111nIdIn?rYou moist romli the t1inyy(late/dote of wllliholding when sondins ilia paymon -flip pnydatn/dare of Wlllihnldingg Is ilia alma on WiyIT elpomoinl was withhold fmlirihmom lloyaa's wages Yep mast chpiply ivllh Ilse Ia1v of Ilia slain a(Ihn unlpl[)yup's/ohN!{nr'S liflorlpol plare of omploymow with rasped to the I me horlnds within which yen most Inlplenuan the williholding ordnr'an(I fnnvnrd the suppmi paymenis s,+ Pmployae/Ohllsnr wllh MnIN)da s?gtpall linldhnst I(Ihnra Is mono ih0u nna gr(Ipr/Nnllca IO Wllhhekl Innnno fnf 5upprnl al o nsl ' lids (1111ployou/ohlloor on( you ern unit Ile to honer algl suppnll (lrclor/Nollcas (Ilia In ferlomi or StnlIn WllllholdIng bolls Ynrl [Ili ?Ollow ilia low n( Ihn slate of killhIloyae's/ohllgof's principal plnco of anlployalual. Yo11 nuol hrnutr rdl Olrlots/Nollces to Ilia luealesfoxIval possiblo; (see 010 eolow) ci, Tprlninallon Nolificollom You must otiml111y nollfy Ilia Neg11aslinlt Agency whoa ilia orni loymyowlivir is na looom wotking for you, P asu,praylilo ilia In(onnollon (ogllusled and reblal o copy of Ihls Ardor/Nellco to ilia Agency Idtailltled Inalow, WITHIJOILOPN's IDI 201g377e40 ns M11IOYPP SIORIaON S NAMP MARTIN, Attrstti 130 11, 11H PMPLOYPPIS CASP IpPNTRIM 7612100464 • PATP OF FPPARATIONt i.AST KNOWN HOMP APPRP651 NPW PMI+hOYPR's NAMF/APPR58i _ . 7, hoop som Payllloolsi Yoo slay be re(Ildred to lelmo and wilhhold ((call lent) Spill paynlrlltls Stich of bellows, cal volsslons, or _ severance pay, If you hove any questions 11110111 11111111 sum paymunls, contact ilia poison or rlolhorlly below, 0. Ghh1111y1 I( you toll to withhold Income as Ilse Orator/Nollro directs, you rtra Iloilo for holh ilia accumulated ontaoltl you should Itnvo wllllhold from ilia entployoo/ohllgor'S Income and olhur pollellios set fly Ponrtsylvailla Slate law, Penllsylvnlllo State IoW iviyorlls mloss ilia oblleor Is omploye(I In onothor Stale, Ill Mitch case Ihn low of Iho State In which ho or she Is amployed governs, o, AIi1MIlscrhlllilallbro You are slibloct to a (Ino dalornillied under Slalo law for dischnrillnp nn ogiployeo/obligor (real enlploynuell, 'ra(uslall in cniiploy, or iaking cllsclpllrlory, action ogalnst oily oniployae/obligor bncanseof it suppnll wllhhol(IInII• Ponmylvnnla span low ilovet is till loss ilia ebllgar is onq) loyed In apolhar Sialo, In Which caso Mallow o(iho 9iataln which l l or she Is amployr'd Ilovkims, 1 o,' W11I11+nldlug 1.11111111 Yc l moy not withhold mono ilia[) tilt) lessor oh' 1) Ilul amaunls allowed by 1110 Fri(Inral ConsumOr CrodII Protndlon Act (15 U,S,C, § 1673 (IM I (ir 2) the anlnunts ailowa(I by ilia State of Ilia a[)gdoy0n's/oblloot's principal place of onplinylnkint. Tim Fedoml Ilmll oppllns to the polvol{ate dlsposabla wooldy aamings IApWI1 Al3WF Is ilia not Income left actor making mandatary daduCllons such ask Stale, Fedorol, local Woo Sacral Socially Ioxosl end Mndlcaro thxos, 11, Additional 111(of 'NbM If you or your ngolll are served with 11 copy of INS order In ilia state that Issued the orclor, you nro to follow ilia low of Ilia state that issued INS ardor with rospacl to theso Moms,' Slibinitled Nyt If you or your amplyCo/obllilor have tiny (IIuostloas, UOMeSTIC RELATIONS SECTION ccintecl WAQF A'il'ACI-IMI'.NT All' 13 N. I IANOV:R ST by todophon0 al (717) 240.6225 or 1',0, gOX 320 by FAX kit (7171 240.6240 or irM1,1511 PA 17013 by Internet WWW,chlldsuppon,slate,lia,us Page 2 of 2 Form IIN•0211 Service Typo M Ohio No,,e4fi(1l3.r Watkor 11) 01ATl, " ORI?FR/NPTICI TO WITIRIPPI INC6hff FOR &UPPORT &IR1Ptl141N1M1M#7G1IUW(kPlUl6yly?lglp. (D PflNlutl ?r11PrlNlitlfP ?n,IC?ly/hish of duMtllyLt?11?u .-- _ O nasapdarlardur/NPllra hnaur(?ardnr/Nnlicr+,ox x oti_ QlunnlnaluorlluNNPlIrP Cnan Nunlbor fSaa Ar rll anrfllnl liar C114a llnnrnaryl arI i'1'T O rn( T LES r;, art rngdoynrg1911dit+ltlor's [0daral I'IN Numbot Vinployo0/0101tior's Namn it ash I4a, MII NW1,t,a 2111)11}°TNW M11IiKGq'y0 eoo ARHwNAil.ttp YORK VA 17402-21x'7 14gpluynnK) d apr'r 2111 la 5dcurllY Nlan tur , 7G1?xAo4e4 I+mplnyPnhhllflur's fasn lc 111111 lnr ,?,•/,,f?9??lfsl?" r?lV,?r?,,,, ° {SVOArlrlandrunlnrplahlllffnanlPr '/ ,uroflafarl Will rarer ug 00401"10111) e-IPPO"S 0,6"9(0I4'9 7 custodial parnnPs Mnnm (I ilsl, rlnl hl 1 Soo Addarldllrn for dopplidonf flames and hlrllr )bites assorlafed fV10164m fill 1101101iriwr6 OWN INFORMA1ICK 'oils Is ;lllprdor/Nplico to Witliltrdfl Incomo for support hased upon an rtr(lnr for slip)Or( from OuMUWttlasNn cnunlY, Gnllmnnwnnlllt of nlnnunis front Iho ahnvo•nam0d Incnnto llnlll ?'urthor Ify Inw, you 0r0 ruqulrcul In dculucl Ihrtsu amplnyt+c+'s/0hlhtor's I'<nulsIvanht, nollco rayon If tho Ordor/Nollco Is nnl Isaood by ymir 511110, $ loo: 00 pormorlllllli'cllrrortsllpporl $ o, an por month ht pnsl-dUo support Arrnnffi 12 Wrtnks fir yrodlnrl QYos ® Ile $ o. go por month Irrcurronl and Pasl-doe madlral support $ . 0. no par fllonllt for gonnllc last costs $ _ por month III olhor (Spocify) for 111112 rT7$ _ xoo,oa Ppr nlnMh to ha fnrwardarl in paYCe holaw, You do 1191 hpvo to Vrtry Your pay cycle to b0 In cnntpllancn WIII1 fin etipptal orclor, If your pay cycle dnas not match Ilto orflorod support prlymonl cycle, tlsa tho followlnlt to dotorn)lrto how mach to wllhhnl(Il YM"hl In,y I,ujo)JI, $ 46 , in por bIwoo ly lay lmlod (ovary Iwo woelis), $ so , oo por somirront ily, pay period (IWlro it month), $ loo . 1111 por monthly pry porlcirl, REMITTANCE INFORMATION, You must 1x111111 Wllltholdlnlt nn later than Iho oral pay porloc) occurrlny (on (10) worklnN days aftor Ills dalo of Ills Ordor/Notlco, Sond paymont wlihln sovnn (7) worklnlS days of lho poydnto/dolo of wllhlipIdInB, You aro ontitlod to dodllct n foe to defray 1110 cost ofwlllllloldlnn, Itofor In the laws 116Vernhllt 1110 Warl( Slaln of Your omployoo (or lip allowablo amount, Tho total Wlthhnld amount, and your (oil) cannot oxrood 55% of tho enlployyno's/ ohll lor's otior0ynlo dIsposahlit wookly earn Ililts, For tho purposo of Iho• Ilmllalion on Wllhholdlnµ, Iho followlnli 1111arnlnllon is Iloodacl (See 419 on peen 21, „ N ralnllting by C VUX please cell I'onmylvanla Slalo Collortlons and I")Ishursannntl Ultll (50)11) limployor Custom or Sorvlco al 1.1177.06.95110 (or Ilist ruclIon%, Make ReIVII(tsince Payable for :PA SCDu Solid chock tot I'annsylvanla SCDU, P4O, pox 611112, HarrlshurRr 1'a 171064112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER 10 (shaim above as the Errlployee/Oblijor's Case lrfonfl_f19r) OR, SOCIAL SECURITY NUMIIER IN ORDER To OE PROCESSED, DO NOI' SEND CASH uY MAIL, 1!Y Ti : COUIITI 'r Dale of Orden Fenn I:N-020 SaIvlco typo m OAIONu10970 1) Wollforth E1ATT kk JJ yyAPPITIPNAIII I{NP {PHMATIP? yN TO F(MPI•PY1iR'rs )ANP PTHIPR `W(ITNHP4I•PiHb I' 1 J ~ (Ilf(Paflilllplrnlllal?l(il5tnl(?Idiljtj 16611?H1111111rlnfcfrlr111((1 11 I? 11111611hP Pliyhl{9?Ilfl?fitil.lllllhl(ly{ )III Plnlyl?ll hf 11141?IIIR116 Ill>jlGlll fKpll, I, Prlnrdlyl Wllliholdleo antler Ills deter/Nalire has prinrlly oyor oily (litter legal Pracu66 tattler slant law 1181111151 the settle Incmnu, 11 ednrill lox Ili lus In affect he(onl torolpt W this older baye priority If Illern rim fedorid hlx 111015 in 061c l please penlrirl 11111 naalpsilntl asPnry listed t,nlaw, ?nhdlbdn8 Pdylltullisr yyou c m cnnddne wllhhold nlaoilels (rent mere 111nn nap amply (alloblloer's Inconbr in a single payalnnl to 88th agoncy rogtu1sliq wllldlolf?Illg, You mast, Imam, sopougely IflollWy the poltion Mile sdnllle pnynrent I1101 Is nlhlhl(Inillu to each nalpleyao/o1111o4 3,1-90110tling the fnydnte/f?ito of Wllhholdinm You must mportahn ,n daie/0010 of withholding when sendinii the poymont, Tltn - pPVllPIMIPIo of wllhholdIn?trI Is the dam on-which ommunl was wllhhold (real the rim tlnynn's wnoasr Yea 1111!61 comply Will Ihn Iaw of 1110 sham Ili I al nmplnyao's/nbilgor's p(ImAlml place of aelploylnonl wills rospilcl to the I?em perlcxls wllliln Milch yell 1111151 hmldnnloat the yYlthheh11ra order and (arWllnl Ihn sp)lleq (,eyalonls, 'j,' slllploypp/Phllsor ivilh Mglllpio smglnri Ilnkdli'm6l i(IhOm Is more than ono ordar/Nnllco to WI111hold ltrnlnnm (or Stlppnr o Mast I Its allmioyau/nhiloor nor yell am immilo In henar rill sa ami Biller/Nollcas (Ilia Ini'ndoral or slate wlthhnidina Ilnllts, yoo latIst follow Ills to1yyy, of the slate o(umploye0's/nbliitor's principal pace of employment; You must honor oq Orders/Nnilcas in Ihu greahlst extent possil'I6, Isom N0 h01ow) 5r Tergdnailoll Nnti(Icailnm Yell must millplly notify the liaquo&Ilmt Agency when Ilia ounployeu/o1111gor Is Il longer walking for yotl, Ploasp prnvlde the Information rog11ested and roliam a copy of this order/Nolice to the Agency Idnnoflud holow, TIi4 FMI!?OYRfIPRLICIQN NO LONMII WORKS Will 2322611950 Of S PARATIONI r. 6, Wimp sent Pavilluntsl You play he re(pdmd to rpporl and withhold (real hemp seal paynlants secl as icami ls, comm(sslons or soyprenco pay, I(yoe II11yo any (11m5dells Ilhoel 1111111) sea paynanlls, conlricl the parson or enlhorlly bolow, 7. Llahllityl d you fill to wllhhold Income as 1110 ordar/Nnlicil dkerls, yell are 114111o for both the ac(:anmlated annum you should have WIII111old (mill the enlployou/mblhgor's Income jllld other 1)an0hlus sul lly t'ollasylyiIIIIa State law, Pollosylyanla Stmo law governs unloss .. the obligor Is omployad Ii alolber hilmo, In whlclt case the law of Ilia.Stato Ill Which ho'0r pile is maploye(I governs, Ill Amil-discrlmhlatlma You are snblucl to a (Imo tl01onpilned untlor Sinle law for dlsr-hniaing ill omployou/obligor (real omploymonl, rofuslnrl to amploy, or takingdlsciplinnry action o1winst oily anlpioyan/obt(aor because of n suppmll wllhhclldhls, peI1115yIV41mIl1 SI411a 19W governs un(oss the obligor Is employed In nnolhar Stale, In whlclt cnso the law o(IIIo'Slnlo In which ho or still Is omplnyod llaVorns, ').' Withholding WOW You early net wldlholcl more than Ilex Iessar rib 1) Ilia amounts allowed by the federal Constmn(0craclll Protection Ana (15 ILIAC, §1673 (i)l I or 2( Iho anlolnlls allowed bylhe Stale of lite ulllpleyeels/ohRgor's ptincipal place of naployalonl, The federal limit oppllos to the oggrattala (Ilspnsahla weakly Parnhtgs (AOWth AI)Wt Is the net Income loft after making mandolory dpducllons such Ilia Stall, federal, local (axes) Sel:lnl Socially laxesl and Medicare taxes, for Irlbal nalors, Yell Illay not wllllhakd more 1114111 the ollioll is allowed undo; the lay of ilia Issuing little, for What umployars who roca(yo a slato order, will may not wllhhold more IItOn the Illailialts Allowed miller Iho haw of the Oki Ihnl Issuat the order, 10. Addillonal Intel 'No7o1 If you or your agent are 6arvmcl Will a copy of IIIIS orcint In Ill" stnln that Issued the order, yel are to follow Iho law of the state Iltat Issued this eater with mspmct'to 111asm II0111S, 11.Sllbmllled pyt If you or yoer'omplo co/obllgar hnVo any dIunsHong, DOMESTIC Rua-A1'I„ S HCTION contact . WADI: ATTAChIMI:N1' X11' 13 N. I-IANQAR ST by telephone ill (717) 2,10.6225 or _ W. BOX 320 by FAX ill' 1717) 2,10-62,111 or CARLISLE PA 17013 by Internet WWW.chlldsupped,Slate,Ilil,us S(1tvlco Typo' M Pone 2 of 2 I:oml EN•020 64m No"Immalfd - Workut R) ¢IATT SluuttllCv AftDENIIUM U??Q1 PPfpndRnUphllsnrl MARmr.Nl , ai(Attt,ra 13, aR , PAC51:fi Cann Nunibef oA91p;aA'1 PACSI S Cakn Nunlhr I IOInIIff Nnmo L1ilU11l?Alllu a11RRY11'MhR'I'IN 111 nl;lpnlll g llil([I11I111 U(l W MEW 1lachallintAlliptuil Ip 9A•; A U;yIy I o, p0. a Cllikhfnll)'6 NIIIhII(s)t POR (sll 01110lfalll'fi N11ml FOR QIf chockod, you era iO(p'hnd to nllroll the cltlld(ron) Q I(r hacked, yrnl aril cgl l prl to mlrnll Illo cllll(hno) WoltOflad ahnyo In ally hna Ii Insurmico cavorago nyallahin (IROIIN I Iltp 0111p oyaa's/nhllgor's eniploylllenl, l I{{Innll(`m` illmva Ia any Swa Ifi hnllfancn cnyorauo pvalhlhlo IltrnuR 1 I In limp nyon's/nhllllor's omployninnl. PACHS Casa Nunl l l " PAC:SLS Cat umhpr Plalnllff Natm rlalnllff Nnnu nrtcknl 41W 1WlaRL4111f1UW' Ll111S41 Allachnionl Amount 1 0,00 $ 0,00 ChIld(mnPs Nanio(e)I pOp 4t ChIld(rpnps Namo(s)i poO i ?If chockod, you are eup la{I to Onroll Ill() Clilldhon) l f ? If chackpd, you era faql I eft to unroll Ilia chlld(ron) I{{Itllf of{abm rIIl ally haa l l Illslihalwo coverapa ayallahlo I{{loilt Iad ahoyo In ally Ilna?lfl Insurance covarallp oyallablo Ihicing I III() nlliployno's/ohllRpr's aRlldoycia"t. Ihrrnul l Ilia omployouls/ablluor's anlployRlolllr ' ' 'S c nslwuLu pACSF.5 Ntuillm I'Inlnllff Nnnlo 1 jR Wjff Namo 12SiL' q AIlitchlnanl Amount ]n n 4llochmanl Anrount n 1 ' o,no Chlld(rap)'s Nmnn(sh Wit 1 9,00 Chlld(to0s NOmelsp' FOR (?1If ellncked, you are wi ulte11 to enroll the r.ItlldUpnt I44Tnllf ad nhovo In Oily ho lllll Insurnocn Cevatnlle ayalhlbla l If cllackad, you ara 1111.` lied to onroll Ilia chlld(ron I{(oillif ed Obove IIl any lion Ili Insuranco covarago nya?lobla f IltlmlR l Ilia epll) oyop's/ohlllint's a11116Vmmll. (lvouflh Ilia omploynn's/obllRm's onlploynlmlL Addondum Farm 11N.Q20 solvlcn l'ypo M Walker IU yin'Pm osm a . uinunsl PRKH/W14 TP WIT111-IPHI INCPW FOR $UPI1pRT $Is11P L"1U11111I[IIIKPpIIh u( LPlllaylVAII14. 0 Prlltlnpl t?rdnt/Nnllrn C0.(1711Y(Iplhl, of, PUMHURI,ANI) 0 Aanmdudt)nlmMul4ii hilly of ?RIPr/N(Itlrp a3 Qa nli, ? 'IPnoµtela Pr{Inr/Nollfn' Casa Numhor (Sad Addvndom (or case simin?ery) 11011i1RVIN, MARIANO R, s7R r)nplnyal lrllhhald¢I'r ll`clural I:IN Ngnthm I!ntpinynn/glrlipw'1 NaanO (I ittb f11µ, hill' ibP-44-4177 frnpluyau/nUllpur'c social snr,(ullY NUna40i NW141413 NIjUItI'YNI MAIII(E1'0+ 7b1a1p04b4 bop WWII RP fhgdnyuo/nlalµnr'sCnb01don11(lut YORK 114 174051-21P7 ? , /999Er/ a^(!((?/? (SuaAdrlontfur6(wfl'0111lnvgw M444 06-9 M t' Pp'/p 7 . cpspsllal Parnnt'c Nanm II 111, f lol, hill sea AddendlnR (nr dopandnnt nr111104 and birth dow assoclafed ?vlflr roses nil ,ittach"Imt, ORI)FR INFQIVVIAVON; This Is on orclor/Nnllco to Wllllhold IncoimiI'm Support hosod Ppoll an ordor for s(Ippnrl from a9MppLAN0 Collnly, cnnlnumwo,rgh of I'unnnylvolilo" Ry law, Ynu oro roquIro(I to cloclllcl thoso lnlollhis from Iho lhovn•nomod ampllydo's/obligor's Income chill fcrihor nollco ovon If Ihn ardor/Nnllco Is not Ihtiood by your Slolo, $ o , oa por nlonlll In corront support a , On par Innl1l11 In pgsl d(iP sllppnrt Arroors 12 weeks or prolitui 'QYas ® no $ o . oo por month in corront and pust•dtlo nlodlcol sllppnrt $ Q. no par I111rl1h for gollallc lost costs $ por month in olhor (spocifyl . for ) loth o($ ii, oo par mmlth to ho f0 wilrdod to phyau Below, You clo Idol how, to vory yoor poy cyclo In ho In cnnlpliallco with lho suppnrl order, If your pay cyclo dons nol rpoich Ihn ordorml sunporl payment ryclo, Use Ihn (ollow1olt tmtfootrilillln Ilow 11nlc11 to wllhlloldl $ o , oo per wookly poy porlnll, ., $ . n , np por hlwnnkly (my liorlod (ovary two wanks), $. 0. na por snnllnlrrli 11y Pay porlod (Iwico,a 11101111)), $ o . an por monthly poY porlod, WIYUTTANcF IN1`QRNIA7l0NI Ynu most 1108111 wlihhnltllpg on Intor, then Iho first pay period occorring Inn (10) workllllt days oftor Ihn cfato of tills order/Nnllco, Solld puYlnml within sovolt (7) wnrkblx days of ilia paydolo/clote of whhholdIng, You am onlltled In cfodurl o foo to defray the cast of withholding, Rofer to the blws goy6ming Ilia work slate of your olnployea for ilia allowable a11101A111, 1'110 load withhold onlnunl, and your fan, control oxcoml 55% of Iho onlployea!s/ ol)Iigor's aNgrogolo (11sposnhle wookly aomings, For Ilia purpose of Iho IIn111nlloo on withholding, till) following Informolloll Is Ilneded ($an 119 oil pare 2), If runtitting by 11'T11:131, plouso call hannsylyallia stolo collocllons and plshursonionl Unh (SCPU) Employer CUelomor Sorvice of 1.1177.676.95110 ((If luslruc'dolls, +r Mnka Remittance Payable tot PA SCDU Sand chock tot I!ennsylvanla SCUU, (',0c Dux 69112, Harrisburg) I'a 17106.6112 IN ADDITION, PAYMENTS MUST INCLUIX THE DEFENbANT'S NAME ANb THE PAWS MEMI E'R Ib (sholvb above as (haEnlplayee/Obllllor's Cose trlentiNer) OR SOCIAL SECURITY NUMItER IN OkbER To RE PROCESSED, 00 NOT SEND CASH BY MAIL, / r + 1 xY THE 'CO/UItTI ; .. j Unto of ortlnrc dl cu [;` L C'Y 04Z-70( , J Form UN-020 survIco l'yp0 M 06+0 Nu.1 aVni isc Wetkor 113 OIATT , f APPITIONAF INFORMATION TO FMPFAYFR$ ANR OTHIPH WITHHAFlTFRs (? I hoc' (I oii orp if (alto( In u 1 I In 0 {:o 1 n h s form In m n ,In It a it nnglluy , nr s t t state sliest Is r?if(nrr,iil rn1?e ilia skill) Atoll ?ss(I? I i, lls f1aln' Yl c?1l,lllnlnl by 1rn?1(Y?x1levorlr 11 oy it ny;Yilgf tn?rn I? )III 1 Morllyl Wllhhpklhls Imipr this Ordor/Noun, hire lirinrlly nvpr any olltnr,lnrlill prnrnss unrlor slob low osoi sl Ilm,some Inrnnln, Fpthiral Ipx 111015 in efh0'1 bnfmn mrolpl of Ibis order hays priority, If Thom Mro Fpdnrtl lax lovt0s In offut'1 please c'niq;Ir1111n 0xpmslinll nsoncY Ilslod holow, 2."GmIII111dnN Peympnlst Yorl ran ronlhlne Ivllhhal(I amounts (rntll morn Ihnn non nntplo flo/oblisnr's Inconm In M slnN10 paymonl to npch psollc:y rocpmsllnll WI111holdlnn. You ntosl; llowpyar, MIl Mgoly Identify Ihp pollinn of ilia sinlik, pnymnm Ihnl Is nllrlhrgahlp In omit nmplnypo/oblhlor, `. ?+s Rppmm?s ilia 1'nYple/pain of Withhpld!n?1: Yrnrmlrst raponihn Myrlaln/rlnin of Wlllllmldlps whon snntllns ilia pnymnnt -The- " "111ripg Is 1110 doto nn Wlt rlrmmrrmt witswllhhn d (mm Illp ampmyna s wa@m, Yntl must rmpply Willi Iha law of tiro I AVdata/data n(Wllit Iff elate oflho ,,III) aa'sAIM llnr s princlpol Nolen of omployntonl with rpsp"cl to tho limn porlods Wllldn which yon most Illlplonlpnl 1110 Wllhllnld!nli oldur;Ind forwent Ili, surn,oll p0yntopls, It fmilloypo/0111111or Willi MRIIIpIo support Holdilll?sl 1(Ihorn is nmro Ilion ono odder/Nnllcn lo Withhold Income for 5llllpml 011011191 t Its ontplnyynn/ohllgor;ou yoll an, Inlablo In honor of suppnr(nrdpr/Nnllrns than In Vtolornl or Slato wllltholdlilli Hollis, Yo l1 Mill fellow ,,III toty n(Ihn slab of nmployeo's/nbllnor's prlnclpal phtcn of 0py11oYn1nn6 You must hrnlnroll Ordoo/Nnllrns la Iltp 14au11"sl nxltull '' pps4jlt1", (hot) 1111 lmltllvl g, Tormllmllon Nollfivoilom )'ml mrel )romplly notify Iho pngrrdslinrt Agonry When Iha onlploy""/obllrtor is no Innpar workhu4 for you, Plaasp provide the Information rorlunslcid mad minor it copy of Ihts Onim/Nolico In Iho Asoncy Identified below, THR RMPkoYFFIORL QQR NO I.QNQBR w08KS FO 27295119 0 FMPI OYRR'51ORLIQOIVS NAMkc m1a1?? ?A111 13, ,?p RMPI.OYh0 GASP 1pRNT'IFIM 7612100464 PATF OF SpPARATIONI I.ANT KNOWN HOMF AP TRPS51 NRW FMP6OYpRIS NAMFIAOprulisl r,, l mnP Nuln PAYldpllisl You may 110 requlaxi to repent oral wllhhold (tool lump sunl PAymmals such as bnnusns, I:nnunlsslmis or soyelonro pay, If, yon 110yo filly (lausppnq about III 1111) sum paymonls, ronloct Iho poison ar ntnlmrlly hniow, r 7, 6lahllllYl U you fall to wllhhold Inconlo as Ille Orclor/Nollco directs, you aria Ilahio for both Illy, ammot l0lod ammanl You shapld hove wllhhold from tho (implnynn/o1111gor's (nconai,1nd other pm ilo"s slit by vonosyly;mlp S(al" low, Ponnsylvanln S1,110 low sovnrntunlass ilia obligor Ismul loyed In nnothor Slat", In which pse 1112 low of Iho Slab In which hit or still Is employed Noyorns, R, Anlhllecrlmin0llom You are sublocl to If fill" iiolamtlned undor Slalo Imy for discho(IiIns nn omployo0/ohllgor (mm omploynionl, rofuslnn to employ, or lokhls tlhcll,lhmory action ollolosl ony ompinyoo/oldhllor bm'auso of a suppoil wllhltold!ml, Pmlltsylvanip SInlrl law Ilovoins illness the obllRor Is omployi,d In pnotlier State, In Which coso Jim lawn( tiro stale to which h0 or sho Is'amployed 110VWns, 0•' Wllhhold111s khtlhsl You only not withhold morn Ilusn ilia I"ssur ofi I) Ilia aloolails allowed bylho FOdoral Consunlor Cretin Pu,laclloll Ail 0 5 U,S,C,'p 1673 JIM l or 2) Iha amounls ,olloW"d by Iho State of II)a olliploye"'s/obllilor's prinripol place of 0anploymonl, Tho 110(lomi Ilnill opplios In Iho astposnto disposable wnukly camiings (ADWO, ADWI: Is tiro flat Incense lofl aflor mpklns oinittlalory de(itlcllens such 051 Maio, Fedoras, Incas taxed Social Secuilly laxosi and Medicare laxet, For tribal radars, you may alit wllhhold mnrti thatt the animals allowed render Iho low of Ilia Issuing Irlbn, rotIribAl mnployors Who rocelvo it s1fi1a nrdpr, you may not withhold mnro than litq amounts ellowed undor ihn law of Iho slain that Issued Iho ardor, 10, Addillon0l lmnl sNOTtl If you or your egorll Oro served with a copy of tills ordor In tau, slate drat Issued the order, you pro to follow Iho . IoW of tho slain Owl Issued this order with resper i to thoso Ilonls, duestlons, I I'Stthnllifed Ilyt If you or your iinlployyao/ohllgor 11"Y" (Illy 130MESTIC RI•LAT'IONS SFCl"ION contact WAgr ATTACHNI NT UNIT 13 N. HA OVER 51• by lulc,hlllnno al (717) 2,10.6223 or P,o, BOX 320 by PAX al (717) 240-6248 or CARLISLE PA17013 by filtered www'childstippnrt,sh In, taus Page 2 of 2 Form M,0211 SarvlceType M Mill N,,.,0unal14 Wotker'IU ¢IATT ,. .. „ _.. _... ..- -,r .. ?,.--.?. ... .. ., ., (1HIMINATICIF TO WITI11101•11 IKOhili FOR 50111190-lo Atlilu >rwmnantYs?41111urGPalulky[V11111a. p+?rgli,tlr?rar+r/Nollrir G+?GIIY/1)Isha( eh 1, ,2tyh QGV1P11107 QnmxiulnrlrndudNrtlro Ptilo of (.)rdur/Notlro 0l,olpnL.l, 99-1138 c1vTr; •----6 ? Q lrmolnalu(+glnNNnlirn (:as(' Nun111nr Wo Arlrloorfom for Fdip momiarrl I(I!i,ulFtn9'IN, enFlkl,w(J RiQtc frnplul'I+rAYIIhhuUlni's I I?dplid I IN Nu?++l'I'I ?_ rngdnymr/(?blllu+r'sNans+ (I list, r1ol, Nil) 168x44-6177 ,. 01 "ll MOM 4 1491111'M14j, Pngdoyrn/tlpllo n;y Sncllll &ucplily Nitail+nr 00 Box 166 LG1A160464 1'AAT NC11I1rI1 Poll 17061-111(19, 111111 roy /061111or's Clio IRVIIIl(wr (40 Addwnhrr6 (pr plahttlli n,lmpr aondalrrllvllh rn(pr nn alfnrhnrrn6 c'gstrxlln PdrPnt'f Nanm (1+ISL Hill toll T $oo Addorlrlnnl for 1111(i m and Mall rlal(+s assorlafod Will cisns fill afMrlunonL ORPfR INN-JRAb1TIOM •11116 Is an order/Nollrii In Wllhhold Income for slgiporl h11so(f upon Ito ordar for supporl (roil) LUMBOB14ANP collnly, collg orwiv illill of ponnnylvrutl 1, 11yy law, volt ore required if) dodurl Illoso mmlunis front Iho Ilhayti-nanuul entployeo's/ph illor's blcoillo until further notlco even if Ihn ordar/Nollce Is not Issun(I by your Slow, $ ino; an per molllh In cutranl support _ $ 0, 06 pur mnnlh In posl•due supper) Arroarit 12 wooks or ivvillor( 0yo5 nX m ' $ ? n, nn h(+(' Illulilh In carrell and pilsbdun nuullral sup?ulrl $ n no p(+r Innnlh for ga6ulic lest rests $ per month In olher (6pot1(y) fornla a >F loo, oo Por month t6 h6 filrwarilocl In payou holow, you Stn put have In very your pay cy(io to ho ill complkq)ra Willi 11111 support ordar, If your ply cycl6 dons ,ill match 111(+ orderod support paynuml cyclo, use Ille following to dolorntlna how much it) wllhholdl $° 23, on ppr w6(lklY pay purled, $ _ 46 . is par hltvookly IImy porlod lnvory Iwo Wooks), $ sn, 06 par solllinlonthly ply porlod (IWl(,n a nlnnth), $ . ino , 00 pot. monthly pay podod; RI:A1111ANCE INVORAIA11r)Nt You Most In+gln WIIh1u11(ing 110 lalnr Ihal) tho Will pity piiliod occordng till) (ip) workhigdays aflor Iho Belo of lhls order/Nolluo. Sand pnynnnlt wllhhl sovoll (7) working dives nf,lho paydileAlal(+ of wllhholdhi; l You ere on1111110 to . dedllcl a fill, to dl+froy tho cast of withholding, Refor to lholaws gevarning Iho work sloto of your orriliklyou for lllo allowahlmolviownt, Tho Wlal wIU111o1d amount agd yore feu, ('annul excoml 55°6, 0f Ill+milplnyno's/ohlIgor's +llittregeh+ dlspusilhlo wookly emnlims. for the porposo o0 ho IIn11u111on en Wllhholdllig, Ihn following Informallon Is 11op(Ie(I (yen 116 nit papa 2), 10 If rol"11111111 bykfT/COI, plahso cell I'pnnsylv,mla Slate cnllocllons aril I)Ishurselovill Unit (SCI* hoployor cuslb6wr SeIvIvo 111 1.1177.670-95110 for Inslroctinos, Make Ro1ltUtnnce Payable lot PA SCOU of Send check tot PoemiRylvania 9cDui Polo, Dox 69112, 111irrlsburg, 1'a 17106.9112 IN ADDITION, PAYMENTS MUST INCLUDE THE OEEENDANT'S NAME AND THE PACSES MCMGCR 10 (shown ,Sbove as (he Erliployi+blobl(gor's Caso Idoilli ler) OR SOCIAI SECURITY NUMBER IN ORDER, TO RE PROCESSED, no NOT SEND CASH BY MAIL; " IIY THE COURTI. , gala of OId(+rt ) ; s C..._. , /Z, d f? l ) -? J,; t011.1(3y_o.l.er, 1a?,/ Judge I)K)i ItI Shaddcay I one 1 N•0211 5111vlca1yp(i tool uhuur,,:uwunw+ ? Wotknr 10 OIATT P'l ( kk VAPPITIONAl. INFONMATION TAI Mill-OWNS ANIavOTi1FN WITI11101-114145 1 ll?(?iiPiflr?Inlijilllii5lfili?I11ii11?a?11?n?1irf(11,itill?iYi111111, l)1il?itIIIlii?t1111i?lYiitil>>fi?1ilIviyoY(Ini?q?ll?ll?ilSlliilri?Nitd, 1 , Prlnrllyl WIIIIIitddIIIit IIIitIIIr IIdF I I I has InI(itIly oyor any Ulhpr Ipeal process Uminr Mill( Imy ItHnhlsl 1110 sa1110 Inn-o01U. I'odowl wx (11 Job in ciffPCl hnfnn Iecnlpi of Ihlh oldor Iuwo prlurlly, I(Ihunl IIIOI'advwl wx luvlus III ld(uc I plnasn rnlllacl (Ilo 11)quUslh111 PH01lry IIbled I+nluw, 2, ?andflnlnH Paymunpr rnl Cd111'lllllldlle willhold imtopnls (rent Innm 1111111 onu nnq)luyue/nhhHot's htt oho In it slnllln payllwol lo otu' 1 1111111111:v Iurpn+stlnit wll 1hm11InH You mobl, how11v0l, sapaccnoly 11111111 Y 111,, p0glon u( Ihu slnllln pilytnpnl I11al Is a110IIIIIa1dU lo 111101 uugtlnynnlhbllt{1111, :I,s Hopodl(III 1110 Pay(Inl(i/1) aIit of 1vIlhltoldlnip Yot I mush rnpon Ihn nwdalf/dnln of wllhholdIim whorl snltiIIn it IN Imynnntt, '1110 priYditI(t/dal(, of wilhhnldbl I Is Utn dalo on whirls onounrwas wllhho+d from Iho (1111 tIoyooIt wends, Ynll 1101st cooglly wllh Ihu boy of Iho sltttn n( Ilto mnplnyon's/nhl?µor's prl11clpil I I IBPn of ontpinymuut w I I I I Inspnt'I to1lnl goat porl011s wllltlo which yoll musl Impli'lnnnl Iho Willi 1mi ordor did (onvanl the soppotl ptly11mltls, hs klitplnyuulphllµnr WI?II Mtdllplu slgglnrl Ihddingsl If Ikon) Is mom 111111) ono f 0pr/Nollcn to Wlllillo(d Incoino for tipppoll III4alnsl Ihls eini loyvu/ohlllfor arc you ant unable to 1111111111 III s1wimn ( )ydnr/Nollcos don in rodowl or SIa1o wilhhnldlnit 1111111s, you 1111151 Olow 11111 law of Iho slato of nioployows/obllHor's prlnrilm pliwo o(nngtloynunll. You must honor all c orders/Notlros to Ihu iltemosl axloot possihlo, (Sop Ali h0lolv) 5.1ormintillml Noll(Icalllnll You trust pluntpllµmtlify Ihu Ito(Ilmslllm AHmcy whoa Iho nmpIbyvu/ohhlror Is no IonHor working for you, Illooso praylda Iltu Illformalion rut uostm lint) mlunr o co I)y,it( this I Mlor/Noliro Ili Ihn Annecy IdoI11IHod holuwl, TI fMP1 OM/0111.10811 No tol%Inf Wcl?l 6l'O?I ' 2511130917(1 ,. C tLOVIVS/OIII.10011'6 NAME I?'lMAld'1 ] ?.1jRLrLf't1_li._s11? _ RMPkQYcc'S CANV IPf•NTICIkH1-?§3a3aelri+ PATE Of ekpANATIONI, J.AST KNOWN HOME AOPIPSl fW PMPI.OYI'•H'S NAMPAPPI(hsst (I, hilly 511111 1'0ylltuttlsl You Inay ho m(pllrod In roporl and svlthhold from Imoll sum payl0e111s such as hnnows, volnOdssloas, or s0ypmnro pay. If you havo tiny gnustlons ilboill I1111Ip som paymows, conwo Iho oprson or tndhprily below, 7, I•IIIIIIIIIYI If you (idl In Wllhhold Incoloo as Ihp r.lydlor/Nollr.n directs, You too Ilablu for holl) Iho wCUmulilled aomultl You shoold linyo Wlllllleld front Itlo vil+ployovAIIIHI1(If's blcople (Ind othor livoillllos het I)y Polmhylvoilla Stile Iilw. Pnnnsylviinip Slalo I11W Hov11rns Unless Ihd abUllnr Is ungdrryud in anulbor Slnlo, In whlrh case Out liw of lhu Slat(, in w bleb ht (it she is apudoyad Hoyorns, , 11, 'At111 rlhotlttll111lt1nnl Yoo III(, sublocl to it (loll dobootinad nndor Slillo law for disc'hn(Hinlt an omplopil/ob4Hor (rant untploymml, mfuslpll Inlanployror wklhH dlsclpllnmy ictIon alti(list any nnq)loyoo%bliltnl hnfililso of it support wIlllllolllllill. Pollmylva11(a Slalalow Hpy(,h)s Unless Ilnt obligor Is oloployp(l In nnather Stato, In wlllch "on,llin Idly I)( Iho Slab In which Jill or she Is umployod nov11r116, b, s WINIhnI(IIIIH HIIIIIX1 You may nol withhold morn than Iho Ipssnr oft I) Iho amnunls allowed by Iho I'ailmal cmisumor credit Proloclion Ant (15 U,S,C,.Ii I (Ij l (I)ll i or ?o Iho,ihnounls allowed Ivy lllo Slnto of the onmloyews/obllnctr's prhtclpal place of elliploymonf TltaPadural Ibnil applies to tiro igtHlnnalo dlsposablo wookly uamlims (AUW EL AOWI. Is lho net Income loft i(tot miklmi mahUntory tledocllolls soli) list Slalo, fedoml, locid laxosi Sovial Socutlly lixosl and Medican+taxes. For Itlbul otdors, yon lolly 1101 Wllllhold no)to than Iho amounts Idlowed u11tl(,r Iho Iaw, it( Ihu Issolnp Irlbe, For tribal employers who recolv0 }t still(, oidur, yoo frilly 1101 wllhhold mnro " 111,111 Ill(, i)Inoolith allolyod olillot Ihu k)W of 110 slalo Ibill Issliml the otdn6 In, Addldomillnfol__ 'NOT"iii 'I( you or Yom olvint mo sorvotl Willi a copy of this ordol' III Ihn slalo Ilml Issuod Iho ordm'i'yotl oro b> follow Ihn low of the Sli to Illnl Issuod this oidor with iospoci to thoso Items, 11,SIlhlithlod Ilyl If you or your oloployon/ohll lot IwVo nlty t uosllhlts, UOMESIIC HIJAT"IONS SIQ.IION coltldel 1yAQf A"1?ALFIMpNTI1?IT 13 N. I IANOVI:R S I_ _ by loloplono al (717) 2'10-6225 or L .O. IIOX 72(1 - by FAX id (ZL7121fL42eLtt_ or CART ISLI: VA1 70 1 by Inlnrnol www,chlIlls( nporGslalo,pn,its I'npo 2 of 2 I orm IiNd1211 SolvIca1ypo M rnmoq, a1Ir11uih.I Wo*or11U.. QIAT9'' ,I•. I?l , IiUUIULlCY_l11S?1flWtL1L11uilS!UIIIflUI ,. „ IauPuNrh1111?c?hIllM)rl MAIi'r'TNl CIIANPr?fl li. ITR . „ lu ? uUlrul n G A l o I u n 7 „ s CluulWt[ u L' lg l a ll ?[WU iru ? PIiu1 1 llN I m . L1 Au,uLiuult?ruuuld > > I t?I1W 11WW1111111lllllll 9n-11.x11 CIVT! lpn,nn p n,no Chlhllrull)'s Nnnln(s)I 11(11 , „r.hlldhonl's Nnnugsh pon 1(f.Ilvilvd, yell illy (1941 11ed III rllloll IhU rhlhl(Inll) lu I n ?I l C 1 0I hily I ll hl I(cllel:kod, yell mo IUlhlhed to onfllll Iho child(roll) d I T yn lcp IRI l il I 1141 I n d nVnr{114n ilYd n il nlll(n Idluvil Il Nly lunllh InfiUriloCO ccwnfrditty ilYnlldhlo I1S ? hlrnllll l IIIe Plllp oynp'shlhllger'b P111411ay1my11?. ,. Ihlool i lho omp oymi's/obllgnl's e11111IoyIlle111, - 1JACHS (;;ISn N1Wll[[ PACSCS Ciou Numbu UUIW(LNam( ('lalnli(( Ninon ! MiRllllipulAilloput Lv>;kul AlWduuuuWUMULW $1 0,00 $ n,on Ghlld(ron)'s Nanw(s)I pall Chlldbon)'s Nomo(sh poll k, You tyro tegl Yell In unroll Iho child(um) ?I I(cllnc Pd ? II checkmll You am rlgl Irud to (mall Ihu chlld(ron) Illnllll(led allow In ony Imn lh Insurance covorulta,IvillloI I lunli(Ind ilbrna In mly hoa III Insgrmlco covurnga aVallnhlo IllrnullI Illo unlployuu's/ebllpar's rmployolunl, 1?lrolrl I the oloployoo!s/obligor's omplnynlunl, (IAC,SIiS Chsn Nrnll[[l[„ „ IIACSFS C ', Numbor 1?alllllll Nilllltl 1J4k111111[alllt 11J[IlSill ?llU111W4ll11t1[t1llllW 1 c : I AlWS1u1W[U4lllLlllW $ 0100 - - cldkI tem)'s.Namo(sb 000 $ 0 00 Chihl(omYs NilllloMi '- l]QI! ??I(checkod, Yoh Tiro mq1JIc(ed lo'onrull Iho chIlll(rell) I l d t I nn I( chocked, You om n9p Trrod to mlroll Ilse chlld(ron) „ ii b h ?Ih I ll bl I.? ll( I 4 t111 e leillI I Insiroll o covofillpl avollnbin i o 111 ally ' ? ' an nsloanco covemiI e ( ovo n any nvn n e a 4( A l ' ' l t WI ' Ihfllllg l the nllli4opo s/01111(Ilr s oloployllmlll. s gnr s emp lo ooll) ope ) oymen . I I tooll1I I Addendum form FN,ozrl sorylrolypo m Workot11) OTAmm ORWRINATICk TA WITIMPI.P IKWIF FAR SUITORT 50119 GWNttWtllkt lkNt-lffitlgdY?Ydt111? 01594 (197 (atlllplnal(g11p1lNllllra (9,/Clly/Plst, of aRMnl:RLANn 09-}136 C fV?f,' 0 AimmilminrdadNiillnr, Nil' Of ofdor/Nelir'e 07/19/06 ? IIIIIIIINIIP(IIIIIIIINt111tP Pisa Nnhlbar (NPP Af IPfloorll for Case slnRnlarY? typpinyur/Wllltlluldar's rmlartl r.IN Nusrbol fnglluyua/rlhllµ n'+ IJlnsu Il,ul I lul, A111 Illgtloyup/rI I Ilm'+ smi,11 sureliq' NIIIII uu PURP MoWHR & UQUIPMN'l' J, PO Box 19P R.??4.. 'nr it imil C egr B{AII) GU ply 17an1 Oln9 ulnlJt111II11gr4cur I1 Np( fYvaAllrPondnsl(fit p14111f(ean1P1 " ooarlalad Will l alas loll alla0Aµlun0 iisll;d I'Fi7f; I - uua i - fli+C?III SOP Addifildnm for dupuildell Memos and h1r111 dahls asaarhlleft with r,uPS lilt rtllnrhmenh oRPVR INFORMATOM This Is an ordor/Nrillco In Withhold Inconur fnr'tilillpull hexed tlpelt en uder (Ili nullPnll from CVMnlVttl+ANn Cnonly, Glnlnlollwoitlh of IIn1111sylvdllinl Ily 111W, ylm i11P illldle(I III dellnr.l these Pnum tis front Ihe'nbove•neowd ampleyao'S/ctltligor's Income Imlll hillier nollce evon If 1110 01 dor/Nullco is not IsstIm by your Stab, $ _ o , oe par month in current support " $ o, all par month to p9S1•dua support Arroms I a wi'ehs or IUnninrf (dyes ,,Q no $ o. no por month In currant poll past•d{tn ntoedlcal supped $ a. on'harmotilh for t{nnnlic lnsl costs $ por m6tith In other (spoclfy) for a tote o $ P , pro par month to he forWOrdad In pnyuP holom You iin not havo to vary your pay cycle to lin jo cinplienco Willi Ilia suppnll order, If your Ally cycle (dolls 11 11 111ntch ilia ordered support pgn-iool cycle, list, the following to clolorolllte how much In WhI1hn1111 $ a, oo par weekly pay period, $ . o . on par biwookiy )fly i m lod (every Iwo weeks), $- a , no par sanilmortitly pity period (Twice it 111r)111111, $ o , o Tier monthly Plly period, RGMITTANCk' 1N1:0j lkIATloN, You must begin wllhholdlnji no litter than the first pity p6dod occoNllg Imi'(In) wolkhlg de's 11flor ilia (title of this order/Nollco, Sand peynlont wllhln seven (7) working days of the paydole/d11te of wlldlbolAnn, Yon lire eglillod to cleducl it fee (o defray ilia cost (if withholding, linfer.lo life laws govnlliiog the wolk dote of your employee for the, ailitwable amount, The total withheld iluemi, ail yore feo, cannel IN ved !151/1 of the runplooYvo's/ ebli {or's ??gtSmgillo disposable wankly ennilllgs, For the porpoise of the Itliilhnloli oil withholding, Ilse fnllow1111{ III?oYlllllllnll IN hooded (San 119 fill pogo 2). If o31111011111 by QT/iDI, please call 1'nnnsylvanle Stale Collections 111111 DIhIlursommit 111111 (SLIM) i'.ngllnyer Clislomor Sarvlc'o lit 1.977.67(-95110 for.Inslrucllans, u Make RomlttaitCn Payable tot PA.SCpU Solid Check tot NnnllsyWalila ScDut 1100, hex 691121 I Iarr'Ishorg, Ila 171116.9112 IN ADDITON, PAYMENTS MUST INCIUPI° Tllk' OEEENUANI'N NAMI' ANT) I NE I'ACNES AIEMNEN Ip (sh(Jwn above as Ilia Enlployeeloblhtor's Case lrlanN(Ior) ON NOCIAI. NtCIINI i1' NOM111'N IN ONI)I'N TO NE PROCESSED, po Nor SEND CASH n,Y MAII, " IIY I IIICMli I L Date of Orden -?'y.- . .lam ........ ..._?.y..... nnlrly c)tn1 a?1', i lodge MR01. Ii,J, Shnddny Form CNd12n Service Type M nnni,d avonri, Worker 10 91Ah'Ir APPITIONAF INFPRMATIAN TO FMPWYFRs ANp ATHFR WITHHOP)PHS Q Ifr Itnclk(rj1 rat am rarinlrnc` tc Ir 1 I`W ll a 1 Oil s lorl)1 Id our 111 110 tm I(yn Ir nmPlnVnq 1Yor s n able Iha Is c1I Irnlll Ilia slalt? Illnl )56 1lF'tl lips (lnII Fntt? It1Np1 hn IY(PIlluc' In ,41. PIr,,1,,r Pn nYrlil I(Irln IM I not ultuckudt 1; Prlnrhyi Withholding under Ills ()1dor1Nolca ills priorlty over illy other In !nl process midor Slate low floi*sl ilia samolnvOlno. " Pnclerol lax Was in effect hpfom mcelpl n(Ihls prsIm 111yo priority, If thorn are .oderal hx loylns In n((ecl ploaso contacl IIIp ro(lopslhlg, 0gonfy haled I)elow, „ 2, Coll)Illllhlg PAY111011101 You con cm»bllte whhheid mootnits (rhnl more 111111 (Ilia onmlovpp/n,ltllgor's Incnnlh In a single paylllanl In Poch Pooncy requPsiing W111111011110, You meal, littweyor, seporllely klontify the poulom of ilia single poynaall I11a1 Is ngrlhlltablo In earl alit ployrx/ohllgor, 3,t-Re%ltlinPilia iloydrte/PigoP(WilhhpldinppI You mcretmport the ??i?irYytlnla/rletn of vvllhllnllllna whomsonding thaP ymanh-The-- Pny?intp/limp of whhholdiliy Is (ha (Into on which amoonrwas withho ( fmmlllo nm )lnyra's wallos; 'You mosl comply with Ilia low WIN stole nr l 1a employee's/0111 gor's principal pliwo n('amploymoull with rospoct In the Dole picriods wllhllt wilcll you Inus1 lhlpleman11110 w111111114I g older mid (nnvmd Iha stl1)poltpoyntonls, A,1 Pmployee/Aldlgor wllll Mtllliplo Su (Marl Hultlln sr If Illom Is mom fhgii one Unlor/Nollcb (a Wllhhnhl Infonlo (or support 111 Mgsl fhls a11niloyee/ollloor irm you Ore unahln to honor kill sapporl Oulor/Nollcos (Ilia In rcxlorol or stale wllliholding Illnlfs, Yon (nusl ollmy the law of 11111 slioll c f ungdnynn's/pbllgor's principal plot o of engdoynm116 You most honor all Ordors/Nnllcas in Ilia iunatnsf axiom possll la, (Soil qa Im owl 5, Temdnation Nollfifolhoo You musl romplly nnli(y Ilia Rolleesling Agency when ilia entpklyae/obligor is no longer working for you. Illonso provido Iha Inforividaa rtinuPslml imd return it copy of This Ardor/Nollce to ilia Agency Idonliflud bolnw,, TI19 PMPI-OMIGHWOR NO IONICIGR WoN1?5 Paoli 2010309170 1 '1 P KOYPP'S/0111.M011'S NAMI! MT T I ARI,WH It, J11 PMPIOYPPIS GASP IpPNTIPIPRi 7siaio0asa _ PATP OF SPPARATIONI ,y, .,,,,,, lice. _ NPW PMI'POYPR'S NAMP/APPRIESSI 6, Gnlnp 511111 POylltnnlsl You limy be required in repoil kind Wlihhold (mm 1111111) skim Iloymunls such Its homilies, coilaaisslons, or savarlnco Ally, I(yau haya tray quosllnnd about lump sum pnymnnls, cnnlafi Iha parson nr onlhnrlly bnlaW, ' ?, 7, I.Iahllilyl If you (111 to wllllhold Income as Iha Ordor/Nollco dlracls, ygli ilia hablo for boll ilia arcnpnllolnd lnlmotl Yom should hlya. wgilllald front Iha elnployee/nblhtnr'sdnconlo Pad other I malllas sat by Patulsyfvnnla 511to low, Pannsylvlrtln Stilo law governs u11loss ilia obligor is m oployed in unnfllnr 5tmu, in whlch colic ilia low of ilia Slow in which lip or she Is anllileyed aovorns, P. A11111116cril111rlallool Yom nrn sublocl In a (Ilia dulannined undar Mato low for dlschlrghlg in omp(nydo/obligor front employmmtb reftl&ing to vinploy, or 141im dlsclplInilly lo-gull agallisl ally omployaa/obhger baclllse of a sallpPI( wolilloldlllg, POmisyly1111a Slalu Inw gaYofns rlllloss ilia obligor is cippleyed III anollior Sligo, Ili whk'h case ilia law of Ilia'Slato In which lkin or she is ounplayed govo,ins, q.1 Withholding 1.1111161 You may, lint wllkliold nlorolien ilia lesser oh l) Ilia nnlounls Plowed by ilia Federal Consuliar credll Protection Act (15 U0S4C, 4167:1 till I or 2) Ilia lunoulos allowo(I I)y Ilia Slalo o((ho omployoo's/obflgor's prindpal,place of omploynlal$ The Federal Ilntif oppllus to Ilia agivegntn (1isposohlo weakly namih)gs (APWP), AI)WI: Is ilia not locomo loft after maklmi mandatory doiltlcllons such psi Stile, Fellehtl, local loxasi Soclal'securlly I;lxosl and hledlclro taxes, For frlbll ordors, you may lint withhold morn Ilan ilia mnounls allowed Under the law of Iha Issullig Who, [lot IrQtal ontployors w1lo rnrulve 1 stole order, yell play mil wllilhold ninte ' then ilia ontoollis allowed under Iha low of ilia stab Iha1 Issued Iha order, kin. Addllimlal hi(o1 INOTEi If yore or, yoirt agonl nrn sowed with it copy of Ihls older Ili tho still(, flint Issuod the order, you are to follow the Inw of 1110 stale 11101 Issuncl this order Will respect to these Items, 11, Sol)III1110411vi If you of your oiilplo e1)/oUliyor hilve ally gilesllons, DOMC51IC It1 I.ATIONS SECTION conloc't WADI: A'I'1'AChIMI:NT UNIT 1,1 N LIA?NOWR ST by tolophono 0t (7] 7) 240-6225 or P.O. 110X 320 by FAX lit (717) 2410.62,16 or CARLISLE PA 17013 1 by Intomol wWW,cltlldsuppolLslillri;fl0,lls Pago 2 of 2 Form M-020 ServicuTypo )d o6mwl:u,voutsl Wok.4ID 0 IA'PT w Atalal;ldlaUM : ,, , „ ku(nu?arxuLS?lrar.w?.Attacholunl RPiWI1E11nI1C11lII?{nrl mAwr Ni otiAitidali It, 1111 I!A 585 G1sn Nlunhnr 069101AU7 LM R , p l I!ACb h-Colahlullllgl t!Irlhll?fl.IIIIIIIU „ o l IURY I 1" l-U&; ' Altadint ont r Ull l.lulliul I1a41111111111?111 llllll 99 1139 nxvxl?$ 0,po CI111{Ilrell!'s Nanu,(sh pl tll ` n ('IIIldllepl!s N1111U(hll I)OIi (?I(diockod, yoo me ?u11r+lred to unroll Iltn rhlklUonl 1 i i r l l l IS nnliflud it ,Oyu In my wo III Inpr011ce covanuto av111nldn lltrauat Iho amPlOyen's?nblh4oNs nrnplnymmd; Ii I i11( 11tIll i vi lI11111i1' ?ii ?i?if i InMiir ii?n l rwl? riijl i? iiViillO11le IlWnullI Illo moployv0 s/e1111llm's omploylllUOI1 MOB Clasp Nunmor I Af. 11 t! LtWJL[{lllldlUr , 1.IalllA(t.i`lallla I!lydllll(Il`11llIlU „ hncknl A 11as1uuunt m al ldullul AltaduwtuI Amount Chlid(ron)'s NOmv(s)l IX Al ChlldlrOnl'q NimmNI e, oo DOB— Q I( chocked, You Oro ia(llllfed to onmll lily c41Id(Imtl I1 If dim kad, you 0n1 tmp ilell to onroll Iha chll(I(ren IIanlljod o11ova III illy loll ll 1 111511NIMCO coveritun avOllnhln tftmUa t Iha amplOyua'syOhllnor's OmplOymolq, l ? I1Trltllf Nd ollowl n II Olty um III Insurllnco cove OpO 1Ya llhle IlnrnRl?11111, nngllnyoo's1o1111Rnr's umploynlOnl, MOB Casp Numbut „ ('n('51i5 l'us0 Nul„lu Ualullff Nmuu . Clululll(1?aulu undue Allah im lit A uututal Alla iMMI Amount $ 0,00 Childlrenl's N0lnnlsll I)ltll $ 0100 Chlldlr/nl's Naow(s)i UOh , I( dlechvd, you ow a0p'I ed to 0moll111e (hlhlbo 1 1001 i 1ifled ohoya In ally 1111011 InINI 1111,11 Novomg0 awdlahle I-P11(chvi ked, yon are IN IIIIrod Io Onrhll Iho rldlda I I IiII( 4l allow IIn (illy 1001111 I11511ra11CII1'INan111a AvO'LI)Ia 1rnlit 1Jhe anlp oyna's/ohlllplr's englloyuuu111 I?unurth Ihn angllOyau's/obllµar's e0mloyrltant. Addendum I11rItt 1iN•(12R ' Solvico lypn M nem, Worker Ih. tnmx el.uluoalsl 110I4HINOTIGI: To WITI IHPI-N INCOME I:68 S0141 0"T Mato ?4U11111WtkYpa(t(W11!WIIIdY?yAl1fA (D(molltulrndin/Nuptn cR,/Chy/Rlfih of clwl i3, o O59101097 (a nnnuulv,luldnNNolltn Dale n(Orifor/Nollco (7 17 Lri 99-1115 OTVTU Cahn N4lnlhor fSoP IdP11dN111 (fir fdSe sylllfilaryl O Irru+Iquln prylvr/NVato A( I'inplnyorAYllhhnlllach frdpml l'IN Nnlnls+l la) MAlf1+I:N, CIIA[tAWa it, It 1 nganyvc/t)Itllppr's Nua+p l(asl,l'hfh Ml) 1GB•41?6177 _ 0t1 p4711 ; rngaayvr/nl,llluu's Sul lal tint loll Nlgtlbnr M 1+AN0 TRUCK hpuli MuN t co Y , ;lu 110AI)WAY pit 761A16Q 6 cA1i11IpT+R VA viou-tio06 I:mplaynMOllllllprbt,l{ollnntlflsq Pup Alltivildf ll(orNldlrgl//narnvi ' assurlalvrl rvlflr rasar Nl alMrlmteno " Cusllx la I'ivanl's Nanq+ll,?n! rlnh MU Sae Addendmn for dopondonl i?antes and Will dates astorlalod rvlfh Vases on alhichglonb ORO'R IWORMeITPN+ Thlb Is rm ort.lnr/Nolico It) Wllhhnlrl Incnoln (or Support teased 11l)(111 an ordor for support from e0MU1a1111+ANR Connty, Conlnu,nweali l o(p(nnsylvtalla, Ily haw, Yoll are required to d(ducl those alnollnlh from the almo-narll(d (1111 plnyco's/ohlIllor's Inrrn»u Mild ftoihnr ni,llc( (Well If lilt, order/Nollco Is nol Issued by Yonr Slate, $ loo, eoper month In furronl supporl $ o, oo por month In pasbdu13 support Arrears 12 Weoks or $roatorl Oy(s Otto $ ii. oo l1 it Inonth In curr(nl and past-dun m13dlcal support $ o , oo par moltlll (or Henelle toll Posts $ por month In olhor (spti('Ify) for o tola n $ loo, no por monlh1o lip forwarded to pny(e h(low, you (to not have Ill vary your pay cycle to 1113 In contpliatlc o wlllt the soliporl order, If your pity cycle (tees llol 0i0tch the ordnlr+d support pnylnnnt cycle, uho Iho followlnn to dol(rollne how olnch to Whhheldl . $ as ` oo her weeklyy pny pnrlod, $ n fi; i s por blwookly pay pollod (ovely Iwo weeks), $ ^ so , ogpnr sonilmonlhly pay porlotl (twice it 111011111), $: ion . o por monthly pay period, RfkfITTANCE IWORAIATIONr yell order/Nollc?i. Son(ltpaymontlwhllln first lday ostof flip puydNuAfalo of Illill nlldlnnfttyou are britlNnd to deduct a fan to dnfrayIII( cost of wlthholdlnn, Rotor to Iho laws, governing the work slato of your employee for the illlowahlo amounl, lh( local withhold milmint, and your foo, calinot exceed 559/6Fof Iho enlployyoe's/ obllµor's aggr(galu dlsposablo weakly oarnlog.4. For the pulposo of the Illttll(Iloll oil WIIIlholdtng, the (oIInW1118I11(orlllatloll Ili I)l+13ded (See 099 on pen( 2), If reltlllllpg by frT/fDh pleltso call 11onnsylvanla filete Collocllons and plsbuls(moltt Unit (SCIaU) Employer Customer SelVlcn ill 1.1177.676.95110 (or Instructions, Make Reml(talice payable tot PA SCOU Send check tot Pennsylvania SCDU, p,o, Uox 691121 Harrlsllurltt pa 17100.9112 l IN A00106N, PAYMENTS MUST INCIUnt: THE IWENUANT'S NAME AND THE pACSES MAWR ID 4holvll Above as 010 En?pl(yee/pbllp(r's Casa IdeeR(Ier)OR SOCIAL ACURITY NUMBER IN ORDER To RE PROCESSED, Do NOT 4NU CASH BY MAl1, 111V TI-11i CO ItTs Dale of Onferl Dint R, ?, Hl)ttUUgy ! }1' en.ley O Ler j r. , t ,lodge form GNd120 . '...SelVlee Type. M IWO Nu.: 1!97011 x•1 Workerlb 01nmz, APPITIONAI. INFORMATION TO Chilli OYGRN ANp RTI1CR WIl'1I106pCRN Ir leekel nu 1 In l t 11w In 1 1 1 Ie a oft n(Ih S (nn n In ou e u llo eu, If o n' InlpIn I (nkS In t clan Illy ll IF ,Ilfr?nrm rrnYn Ihl) 6nl1!!! Itinn ?ssull!! )Ins nnlul,11111111 INS! III I?m?117VJ hl?'enr III )III) nn nytYl,Yr1?In Inik 14 nm l hn(? ty6 o I, Prl, rpyi Wllhholdlnµ under Offs Older/Nulls e li,ls pdodty over Im1' nlher ip till plofmss roller Sill lil{ MW oltnlnsl the'lame lnvoln i. Cadnl-11 fax loy(l)s In of ilo IlPfnro olrelpt of Ihls (mler hive Iollnµy, If IhPnl tml1'Pdprdl Ipx Ipyles In elfprl plot Sit rullh»'1 file tegllpsllnµ iµPncy llslml ht)low, . itmllhinhlN P11Ylllenlll fill c• of rehlhina W11111100 amnullls front more than one nmelnyee/(11)11µ(11's In(oiin) In a slnµlo payn»n11 to PflCt1 nllellcy millo lllip whlllltd(I11111. Yen mohi, Ilowilyol, biyU1G11e1y Identify life pnlllml n((ltp spittle pilvoloill that Is Illtrlllolnhle i(t each employee/ohl nor, :1,t lipp(1tlop I »)11,0110/0010 o(Wllhhghlingl yen most report Iho II)nyydae/date of wlthholdlon when sendina lho Imyment, Tile Paydal /ditto fist wllhhnk 1 Is !110 dale en 1'hlch nnlotull W115 Wilhheld )real Ihn 0111 lloyee's wages Yptl rllusl woolly Willi till) IIIW of lilt) slnln nr Iliv ontployools/ohllµnr s 110110pal 1) ovo of enfploymm?l WI(h Inspect In I In lane periods wlµlln which your n11is1 llnplnmmrl life wllllhuhllnµ rInler and (n{Wnol (hl) 6appoll pnynlulns, Ls Entplnypp/phllNorlvi h Molilplp S I gnarl HoldlnNsl If (hero is Isom than one order/Notlco In Withhold Invomp (or Soppntl onnlnsl 11116 f lilploype/ehllnPrtlof Yoh ar) olllll)?u ill humor ill snpporl nlrlor/Nollcas lhm In Federal (it State whllholdIng 11111116, yon must fellow I it, law of the shop of nnglhayuo's/n1)11aur's princlim office W ompl0ynaon, Yon moot hnnorall Colors/Noth•oa In (ht) ipeatosl extent pnsslble, (flee #0 below) k9 Torlnlimlloll Notiflcaliom Yen must lontplly notify the µrcjupFlingAga cY when Ihn cinplaynn/ehllgnr Is no Iramor working for you, I1?nase provide the In(ornlnt(on mnnosliul and roltim it cony of Oils order/Notice it) Ilse Agency Idenll(led below, -THE kMIll-O k 1001.lCpttNOI.ONQF„NMA IF MILL, EMPkd EE's YYlp111kIQAK'F NAM EMPEpYM11 C SE11)ENTIFIENI-- 26111100 a d?TE OF 6PPARATIONI EAST KNOWN HOME APPp2651 NEW EMPLOYER'S NAMEIAnpRESSi -- G, 6mllp shot PaYmelltat You cony 1)0 required to repoil and wllhhold (rims loop sum pilylnnnts shell 11s bonllsos, convolsslons, or beveranc0'pay, If yon have filly quost(om abot11 hoop stmt payalunls, confect (he poison or aolhorlty lm(ow, 7, IIahill1Y( I(yoo fall in wllhhold Invonin its the Older/Nogca (Iirec.ls, you are liable for holh file occumulaed amount yen Fhould Iloye wlllihoid (rem Ihp omployne/obllller's Illcomo poll olhor p611,11gus sill 1)y Ilonosylvn111a Sling law. Poollsylvaola State Iew Royouls onle6s Ilia obilnor is employed lit another Slam, In wttlch case the law of the State In Which Ito er she is ennployed governs, 11, AollKllicrhnlnatlnm You are slibiect In it fine digi rinhiml tinder Slate law ((it disdialghlg all employm)/gbbnor final olllplovinvnl, 1e4ashill to employ, or lokina disciplinary action agalllst ally eloploYee/nbllgnr hecanso of it supliirrf Whl'dtoldlon, Poollsylvellia Stele law - IIOVerlls notes$ file obligor I6 Qlllplnyell In llllothor Slate, Ill Willell cable 1110 111W of the Slilln fit Which he or silo is employed novenas, "U,l WI1111uddihN'Llllthst You may 110(wllllhold n1or01han Ills Insser o6'I) the alnounls allowed by 1110 Federal Cohslunur:Credil Protection Act (15 U,S,C, 41677 (1))11 er 2) (ho alnoumis allowed hY file Stelo of Ihn valpinyee's/ohIllror's pdncloal place of omployquenl, TIIp.FOCIenI 1111111 applles to tale eggmgao d(sposablo weekly millions (AUWC), AOWI! Is file nul htconlu tell after makintt mandrilmy deducll(ins such 1151 Slane; Federal, locallaxosl Social Security laxesl and MmIlcaro laxt)s, For Irlbal orders, you may net wilhllnld here Iltaii the mommas allowed under Ihb lase of the Isstnmi trifle,. For tribal employers who tocolvn a'state order, voo may not wlnhhold more gtnn II1n anlounns ollowed order the law e( Ill" slaw IliAl Issued file order, in, Ad11111nibil infal `NOTEI If you or your agent are swved with it copy of IIIIS orderln the sotto (flat (sslmd the order, you are to follow the .low of tilt Slato that Issued this ordut With respell In those alums, I1,Sgbmilletl Ilyl If ynu or ynir oloplnyy0u/obllllar hive ally gliestlolls, QMFSTIC RLI.A3I9N5 SFCIION contact ME A11ACHMIM'.. UNIT 1313N, -IANQVFR ST by telephone ill 1 ,240.6225 or 119 nnX 720 by FAX lit f7a 71 24 t.r,2A 1 or GAU15LE PA 17013 by Inlatltol www,cltlltfstlpport.stal(I'l)a,tls pogo 2 of 2 Form (:N-0211 Surylca Typo M osmem. ui,rauls) Worker IIX 01ATT AWlk,"ll?LM , „ >utuuu?cy.?(_?,iau>l.ru>.QU>vlµwtu4 lau(?Inrlanl?Allllµfirt MftR9'TN; ?IIAliII?,a It t OR „ 6U.CflNlhW aa0301aA'! A, . aUP 'f?`.>l&iLI111ulUl1l..' 1''.. . ItWI ullfLtf ?1 .. . altw W OB• h a{y?l $AlluFluum ?4iun?utl flaw, AIIavhmuuWuWUlul " ;. 0111(10111IN Niann(sh hPI $ I 1'hlidhanl's Ni111111(fi)I (? Oa pc?11 It I If clmc?ed, you fro CW I'll ml to oarall Iha cltll((lall) 1((10111$ 1 IpVa IIl 011Y III IIIII Insla,alcn cnvnrlan nY111 lbla If rhfa'kulh you lim l,qr lfred to aruoll Ilia chll(l(rpn) M 1 i (IIra41l11111a.(Illlploy(Ip'sAlhllpor'fi employlllpn6 ill, 11$ml 1llnVa ill mw luil I I Insumilco I:0ylms" pvp111111p III Folio 1 the olllployoos/flbho(Ir's olalllnyloval, .. ?: . ?' .a . - . 1'AC5G5 Cnso 141111111(1 Plaintiff Naha . -...,. .. IMUC.5 Cnsn Namlw plaintiff Nanln P-QL W clllac u Mal Amount $ 0 ) rula?1m1ii It Ainumll ,00 ChI1d(ran) s NimimMi oo(1 $ a oo Cldld(raN's Nanlo(s)i poll if chackoil, you ilia ?e(plIte(I to anmll Iha chlld(am) ({{ 0a11(In(I 1 myu III filly woIII klst a QIf chucklred, yilll am ttagi lIlr od ( n enroll Iho c ll( Wall) h lr llcn cnvontlle aWdllhlo lhrnualt Iltn nnlplnyne's/ohll8nr's ampl0ynwnL ' Idnnllfod l h ovo ht ;utY I In l ll l lasu [tn cpva6, a 0 o 0v111eb1 II1r0Ig1I1 the amployon's/OhlhSor's amploy6ionb plnlttllff Nmna j!hl[vlff Nand 0 Alladilmunt Alaounl „ 12amliff AllarhmanlAmount $ 0100 Chlld(ten)'s Name(s)i. I)ol) $ - 0100 Chlll(lna)'s Nomo(s)i Poll If rhocked, You hto aqt It)ad to oiltoll Ihn rhlldaan) nllf all abova a any Ilea ?IlI Insurance covaralia av1llollln Ihroali?t Ilia nmpI nyao's/ hll ' l , If chocked, you 00 ((ngldred to ant011 Ilia child (roll ) 1 Me 1111(I(d nlmvo III ally Ilonlth IIIsmnmco covempo avalIable o s emp liar oynum6 ( troual111111 entployeoVobllaor's employmun6 5ervlca 7"Yon,. M Addondum I'nrn11:N•02n I W11 N u,n7Yaln51 Wotkut 11) QIATT,. N ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 04/16/07 Case Number (See Addendum for case summary) 059101897 Q Original Order/Notice 99-1135 CIVIL O Amended Order/Notice O Terminate Order/Notice Employer/Withholder's Federal EIN Number CUMBERLAND TRUCK EQUIPMENT CO 25 ROADWAY DR CARLISLE PA 17013-8806 RE: MARTIN, CHARLES R. JR Employee/Obligor's Name (Last, First, MI) 169-44-6177 Employee/Obligor's Social Security Number 7612100464 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ o . go per month in current support $ o . oo per month in past-due support Arrears 12 weeks or greater? Dyes ® no $ 0.00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ 0.00 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: $ o. o o per weekly pay period. $ o . o0 per biweekly pay period (every two weeks). $ 0. 0g per semimonthly pay period (twice a month). $ 0. 0g per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Date of Order: o C J, esley Oler, Jr.., DRO: R.J. Shadday Service Type M OMB No.: 0970-0154 Judge Form EN-028 Rev. 1 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hhecked you are required to provide gopy of this form to your gulloyee. if yorr employee works in a state that is di the state that issued this or er, a copy must be prove ed to your employee even if the box is not checked. Brent from 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.* Repoiting tI je Paydate/Date of Withholding. You must report the paydate/date of withholding when sendinr t i ayrn nt. The pay datc-:/date of. wit! fl iold ing is tI ie date on wh icl i ai i ioui it was withheld from tl ie en iployee's wage5. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2324084290 EMPLOYEE'S/OBLIGOR'S NAME: MARTIN, CHARLES R. JR EMPLOYEE'S CASE IDENTIFIER: 7612100464 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: 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 Service Type M Page 2 of 2 OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker ID $IATT f 1 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: MARTIN, CHARLES R. JR PACSES Case Number 059101897 PACSES Case Number Plaintiff Name Plaintiff Name CHERYL MARTIN Docket Attachment Amount Docket Attachment Amount 99-1135 CIVIL$ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): F-1 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 DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): ? 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 DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type M Worker ID $IATT OMB No.: 0970-0154 C:p o ? q f ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania 059101897 Co./City/Dist. of CUMBERLAND 99-1135 CIVIL Date of Order/Notice 04/23/07 Case Number (See Addendum for case summary) EmployerM/ithholder's Federal EIN Number CLUGSTON AG AND TURF 3213 BLACK GAP RD CHAMBERSBURG PA 17201-9732 Employee/Obligor's Name (Last, First, MI) 169-44-6177 Employee/Obligor's Social Security Number 7612100464 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ loo . oo per month in current support $ o. oo per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in current and past-due medical support $ 0 . oo per month for genetic test costs $ 0.00 per month in other (specify) for a total of $ 100.00 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: $ 23.08per weekly pay period. $ 46.15per biweekly pay period (every two weeks). $ 50. oo per semimonthly pay period (twice a month). $ loo. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order- 4P C1 DRO: R.J. Shadday Service Type M O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: MARTIN, CHARLES R. JR BY THE COURT: I ,&- x J. sley Oler, ?? 4 Judge orm EN-028 Rev. OMBNo.:0970-0154 tA/nrkPr Ifs $IATT CIO Y, 12' 52 - 23 -. g L 6 G5•'5* 0.. r ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecked you are required to provide a copy of this form to your mployee. If your employee works in a state tha is di Brent from the state that issued this order, a copy must be provi?ed to your employee even if the box is not cheCKed. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one 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.* paydate/date of ' S. You must comply with the law of the ithhol-ng *s the -'ate on Milch amount was withheld ho... the ennplo y ee's ? age state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2516183760 EMPLOYEE'S/OBLIGOR'S NAME: MARTIN, CHARLES R. JR EMPLOYEE'S CASE IDENTIFIER: 7612100464 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 01; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11.Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker ID $IATT r ADDENDUM Summary of Cases on Attachment Defendant/Obligor: MARTIN, CHARLES R. JR PACKS Case Number 059101897 PACSES Case Number Plaintiff Name Plaintiff Name CHERYL MARTIN Docket Attachment Amount Docket Attachment Amount 99-1135 CIVIL$ 100.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type M Worker ID $IATT OMB No.: 0970.0154 O f a"Tr 71) yro i'-T .off 99-1135 CIVIL ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dirt. of CUMBERLAND Date of Order/Notice 03/28/08 Case Number (See Addendum for case summary) O Original Order/Notice Q Amended Order/Notice Q Terminate Order/Notice Employer/Withholder's Federal EIN Number VEND-MACK INC* C/O A-1 VENDING INC 308 14TH ST WINDBER PA 15963-1702 RE: MARTIN, CHARLES R. JR Employee/Obligor's Name (Last, First, MI) 169-44-6177 Employee/Obligor's Social Security Number 7612100464 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ loo . oo per month in current support $ 0 .0o per month in past-due support Arrears 12 weeks or greater? Qyes (9) no $ 0. oo per month in current and past-due medical support $ 0, 00 per month for genetic test costs $ 0.00 per month in other (specify) for a total of $ 10a . o o 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: $ 23.08.per weekly pay period. $ 46.15 per biweekly pay period (every two weeks). $ 50.00, per semimonthly pay period (twice a month). $ 100.00 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-#-cWn page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT- Date of Order: J. SLEY OLER, JUDGE DRO: R. J . SHADDAY Form EN-028 Rev. 1 154 Worker ID $IATT Service Type M OMB No.: 0970-0 100,x 12•+ 52• 23.08* 100• x 12-+ 26•a 4 6.15* ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? Ifghecke?l you are required to provide asopy of this form to your aloyee. If yoyr employee works in a state that is di B that issued this or er, a copy must be provi to your emp oyee even if the box is not checked. rent tram the state 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. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2510109410 EMPLOYEE'S/OBLIGOR'S NAME: MARTIN, CHARLES R. JR EMPLOYEE'S CASE IDENTIFIER: 7612100464 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act 0 5 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11.Submitted By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: MARTIN, CHARLES R. JR PACSES Case Number 059101897 Plaintiff Name CHERYL MARTIN Docket Attachment Amount 99-1135 CIVIL$ 101.00 Child(ren)'s Name(s): DOB ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type M OMB No.: 0970-0154 Worker ID $IATT , _ r--:7 -y _ ?. 4'.J ? '"7,^ ? } ? y ?t, .: ?' t "R" ?:: l e ??7 ?• j J C.r? K ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennelvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 04/01/08 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number LANDMARK EQUIPMENT 3213 BLACK GAP RD CHAMBERSBURG PA 17201-9732 059101897 99-1135 CIVIL O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: MARTIN, CHARLES R. JR Employee/Obligor's Name (Last, First, MI) 169-44-6177 Employee/Obligor's Social Security Number 7612100464 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0. oo per month in past-due support Arrears 12 weeks or greater? Dyes ® no $ 0.00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ 0.00 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 . o0 per weekly pay period. $ o . o o per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Date of Order: & , ` a J G J. ri? OLER, J X1, JUDGE DRO- R.J. SHADDAY Form EN-028 Rev. 1 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If ghecked you are required to prr vide aopy of this form to your m loyee. If yo r employee works in a state that is di Brent (from the state that issu this order, a copy must be providedpto your employee even if the box is not checed. 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 employeelobligor. 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. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2516183760 EMPLOYEE'S/OBLIGOR'S NAME: MARTIN CHARLES R. JR EMPLOYEE'S CASE IDENTIFIER: 7612100464 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 01; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: 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 Service Type M Page 2 of 2 Form EN-028 Rev. 1 Worker ID $IATT OMB No.: 0970-0154 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: MARTIN, CHARLES R. JR PACSES Case Number 059101897 PACSES Case Number Plaintiff Name Plaintiff Name CHERYL MARTIN Docket Attachment Amount Docket Attachment Amount 99-1135 CIVIL$ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type M Worker ID $IATT OMB No.: 0970-0154 f'? d ?°o ?+? ?a ? `? ,?. a. ? m ?. r ,? ? ' -.? fir ? '?? ?'.' ,_??. ? -v^' '= ?? ? ? ?(} ..,? ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 04/04/08 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number VEND-MACK INC* C/O A-1 VENDING INC 308 14TH ST WINDBER PA 15963-1702 99-1135 CIVIL O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: MARTIN, CHARLES R. JR Employee/Obligor's Name (Last, First, MI) 169-44-6177 Employee/Obligor's Social Security Number 7612100464 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ o . oo per month in current support $ 0. oo per month in past-due support Arrears 12 weeks or greater? Dyes ® no $ 0. oo per month in current and past-due medical support $ 0. oo per month for genetic test costs $ 0.00 per month in other (specify) for a total of $ o . 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: $ o. oo per weekly pay period. $ o, oo per biweekly pay period (every two weeks). $ o. oo per semimonthly pay period (twice a month). $ o. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Date of Order: a J. El& OLER R , JUDGE DRO: R.J. SHADDAY Form EN-028 Rev. 1 Service Type M OMB No,: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? Ifhecked you are required to provide aopy of this form to your m loyee. If your employee vyorks in a state that is di Brent rom the state that issued this o er, a copy must be provic?edpto 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 employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2510109410 EMPLOYEE'S/OBLIGOR'S NAME: MARTIN, CHARLES R. JR EMPLOYEE'S CASE IDENTIFIER: 7612100464 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: OMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Service Type M OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: MARTIN, CHARLES R. JR PACSES Case Number 059101897 PACSES Case Number Plaintiff Name Plaintiff Name CHERYL MARTIN Docket Attachment Amount Docket Attachment Amount 99-1135 CIVIL$ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. .. ...... .::::........... . : ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type M OMB No.: 0970-0154 Worker ID $IATT a -D - i m u 'r? " L 1J kf 7 Oct w . LL U- 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: CHARLES R. MARTIN JR Member ID Number: 7612100464 Please note: All correspondence must include the Member II) Number. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name CHERYL MARTIN PACSES Docket Case Number Number 059101897 99-1135 CIVIL Attachment Amount/Frequenc $ 100.00 MONTH TOTAL ATTACHMENT AMOUNT: $ 100.00 Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of $ 23.01 per week, or 50 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CHARLES R. MARTIN JR Social Security Number XXX-XX- 6177 , Member ID Number 7612100464 . OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673 (b)(2) and 23 Pa. C.S.A. § 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated NOVEMBER 2, 2 0 0 8 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: ^? o a DRO: R. J. SHADDAY J SLEY OLER, JUDGE Form EN-530 Rev.2 Service Type M Worker ID $ IATT r-o ?i t j. F? . t r ORDERMOTICE TO WITHHOLD INCOME FOR SUPPORT State: Commonwealth of Pennsylvania Co./City/Dist. of: CUMBERLAND Date of Order/Notice: 02/07/11 Case Number (See A en um for case summary) Employer/Withholder's Federal EIN Number LINDA D. FREY TRANSPORTATION 1 793 CRANES GAP RD CARLISLE PA 17013-9632 9q- 1155 0-1vi'1 @. Original Order/Notice Q Amended Order/Notice O Terminate Order/Notice O One-Time Lump Sum/Notice RE: MARTIN, CHARLES R. JR Employee/Obligor's Name (Last, First, MI) 169-446177 Employee/Obligors Social Securi71Tu-FI5e_r 7612100464 Employee/Obligors Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION. This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 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 $ 100.00 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 $ C?Vl nO?? -C o CD <<?' .. ?.. r"a ?„ Ja •- •-? 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: $ 23.08 per weekly pay period. $ 50.00 per semimonthly pay period (twice a month) $ 46.15 per biweekly pay period (every two weeks) $ 100.00 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 Emp/oyee/Obligor' Case IdenORCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BYMAIL. jr / / / BY THE COURT: Arrears 12 weeks or greater? 100.00 per month to be forwarded to payee below. oMe No.: 0970-0154 Form EN-028 Service Type M Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS 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. 2518743920 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: O EMPLOYEE'S/OBLIGOR'S NAME: MARTIN, CHARLES R. JR EMPLOYEE'S CASE IDENTIFIER: 7612100464 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: MARTIN, CHARLES R. JR PACKS Case Number 059101897 Plaintiff Name CHERYL MARTIN Docket Attachment Amount 99-1135 CIVIL $ 100.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name PACSES Case Number Plaintiff Name Dock Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Addendum Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT 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: CHARLES R. MARTIN JR Member ID Number: 7612100464 Please note: All correspondence must include the Member ID Number. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name CHERYL MARTIN PACSES Nub DoNumbe? Case. Number 059101897 99-1135 CIVIL W Attachment Am sA?Fi ±• _('R a ?n o 100.01 Io?ONTH , -'? ??. , % N ~! TOTAL ATTACHMENT AMOUNT: $ 100.00 Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of $ 23.01 per week, or 50%, of the Unemployment Compensation benefits otherwise payable to the Defendant, CHARLES R. MARTIN JR Social Security Number XXX-XX-6177, Member ID Number 7612100464. OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673 (b)(2) and 23 Pa. C.S.A. § 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated MARCH 6, 2011 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. Date of Order: 20II 2 L Service Type M Form EN-530 Worker ID $IATT BY THE COURT