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HomeMy WebLinkAbout03-2866WAYNE SCOTT FORD, : IN THE COURT OF COMMON PLEAS PLAINTIFF : OF CUMBERLAND COUNTY, : PENNSYLVANIA VS. NO. 01 ? °Z?(CPj71L TERM GABRIELE SABINE FORD, : CIVIL ACTION -LAW DEFENDANT : ACTION FOR DIVORCE / CUSTODY NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment maybe entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Courthouse, One Courthouse Square, Carlisle, PA 17013-3387. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 32 South Bedford Street Carlisle PA 17013 (717) 249-3166 1-800-990-9108 WAYNE SCOTT FORD, : IN THE COURT OF COMMON PLEAS PLAINTIFF : OF CUMBERLAND COUNTY, : PENNSYLVANIA VS. NO.O3'0tv6CIVII, TERM GABRIELE SABINE FORD, CIVIL ACTION -LAW DEFENDANT ACTION FOR DIVORCE / CUSTODY COMPLAINT FOR NO-FAULT DIVORCE UNDER SECTION 3301(c) OF THE DIVORCE CODE AND NOW, comes the Plaintiff, WAYNE SCOTT FORD, by and through his counsel, Susan Kay Candiello, Esquire, of the Law Firm of Susan Kay Candiello, P.C., and makes the following consolidated complaint in divorce for divorce and custody. 1. Plaintiff is WAYNE SCOTT FORD, an adult individual, who resides at 816 York View, Grantham, Cumberland County, Pennsylvania, 17027. The Plaintiff has resided in Cumberland County for over one (1) year. 2. Defendant is GABRIELE SABINE FORD, an adult individual, who resides at 910 Hawthorne Avenue, Mechanicsburg, Cumberland County, Pennsylvania, 17055. 3. Plaintiff and Defendant have been bona fide residents in the Commonwealth for at least six (6) months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were lawfully married on October 11, 1988. 5. There have been no prior actions of divorce or for annulment between the parties except this Complaint filed for divorce. 6. The marriage is irretrievably broken. 7. Plaintiff has been advised of the availability of counseling and of the right to request that the court require the parties to participate in counseling. Plaintiff has chosen not to engage in, or to request any counseling. 8. Neither Plaintiff nor Defendant has ever been a member of the United States Military Services. 9. Plaintiff and Defendant have two (2) children. SASCHA BORIS FORD, born March 5, 1985, is the natural son of Defendant and was adopted by the Plaintiff during the marriage. BENEDIKT JOSEPH FORD, born on July 15, 1990, is the natural son of Plaintiff and Defendant. SASCHA BORIS FORD is not a minor and as such is not subject to any order of custody. COUNT I - REOUEST FOR NO-FAULT DIVORCE UNDER SECTION 3301(c) OF THE DIVORCE CODE 10. Paragraphs 1 through 9 of this Complaint are incorporated herein by reference thereto. 11. After ninety (90) days have elapsed from the date of filing of this Complaint, Plaintiff intends to file an Affidavit consenting to the divorce. Plaintiff believes Defendant may also file such an affidavit. WHEREFORE, if both parties file affidavits consenting to a divorce after ninety (90) days have elapsed from the date of filing of this Complaint, Plaintiff, WAYNE SCOTT FORD, respectfully requests the court to enter a Decree of Divorce pursuant to section 3301(c) of the Divorce Code. COUNT H - REOUEST FOR EOUITABLE DISTRIBUTION OF MARITAL PROPERTY UNDER SECTION 3502(a) OF THE DIVORCE CODE 12. Paragraphs 1 through 11 of this Complaint are incorporated herein by reference thereto. 13. The Plaintiff requests the Court to equitably divide, distribute or assign the marital property between the parties without regard to marital misconduct in such proportion as the Court deems just after consideration of all relevant factors. WHEREFORE, Plaintiff, WAYNE SCOTT FORD, respectfully requests the Court to enter an order of equitable distribution of marital property pursuant to Section 3502(a) of the Divorce Code. COUNT III - REOUEST FOR CONFIRMATION OF CUSTODY UNDER SECTIONS 3104(a)(2) and 3323(b) OF THE DIVORCE CODE 14. Paragraphs 1 through 13 of this Complaint are incorporated herein by reference thereto. 15. The parties are the parents of the following minor child who resides with the Defendant at this time: NAME AGE SEX DATE OF BIRTH BENEDIKT JOSEPH FORD 13 years Male July 15, 1990 16. During the past five (5) years the child has resided with the parties and at the addresses herein indicated: WITH WHOM ADDRESS FROM/ TO Defendant Plaintiff and Defendant 910 Hawthorne Avenue Mechanicsburg PA 910 Hawthorne Avenue Mechanicsburg, PA May 17, 2003 to Present 1998 to May 17, 2003 17. Plaintiff has not participated in any other litigation concerning the child in this or any other state. 18. There are no other proceedings pending involving custody of the child in this or any other state. 19. Plaintiff knows of no person not a party to these proceedings who has physical custody of the child or who claims to have custody, partial custody or visitation rights with respect to the child. 20. The best interests of the child will be served if Plaintiff and Defendant have Shared Legal Custody and Plaintiff has Primary Physical Custody of their son with Defendant having Partial Physical Custody of their son. WHEREFORE, Plaintiff, WAYNE SCOTT FORD, respectfully requests that, pursuant to Sections 3104(a)(2) and 3323(b) of the Divorce Code, the Court enter an order confirming Shared Legal Custody with Plaintiff, WAYNE SCOTT FORD, and Defendant, GABRIELE SABINE FORD, and Primary Physical Custody with Plaintiff, WAYNE SCOTT FORD, and Partial Physical Custody with Defendant, GABRIELE SABINE FORD, of the parties' minor child, BENEDIKT JOSEPH FORD. Respectfully submitted, LAW FIRM OF SUSAN KAY CANDIELLO, P.C. Dated: June J10, 2003 ct??c,`, `-0.1Z Susan Kay Cand' uire Counsel for Pla tiff PA I.D. # 64998 5021 East Trindle Road Suite 100 Mechanicsburg PA 17050 (717) 796-1930 VERIFICATION The undersigned hereby verifies that the facts averred in the foregoing document are true and correct to the best of his knowledge, information, and belief. This verification is made subject to the penalties of 18 Pa. C.S.A. §4904 relating to unsworn falsification to authorities. DATED: 6(P1/9 (p/Q ,?3 WAYN OTTFORD ?n ? cco WAYNE SCOTT FORD IN THE COURT OF COMMON PLEAS OF PLAINTIFF CUMBERLAND COUNTY. PENNSYLVANIA V. GABRIELE SABINE FORD DEFENDANT • 03-2866 CIVIL ACTION LAW IN CUSTODY ORDER OF COURT AND NOW, Monday, June 23, 2003 , upon consideration of the attached Complaint, it is hereby directed that parties and their respective counsel appear before Dawn S. Sunday, Esq. , the conciliator, at 39 West Main Street, Mechanicsburg, PA 17055 on Wednesday, July 16, 2003 at 3:30 PM for a Pre-Hearing Custody Conference. At such conference, an effort will be made to resolve the issues in dispute; or if this cannot be accomplished, to define and narrow the issues to be heard by the court, and to enter into a temporary order. All children age five or older may also be present at the conference. Failure to appear at the conference may provide grounds for entry of a temporary or permanent order. The court hereby directs the parties to furnish any and all existing Protection from Abuse orders, Special Relief orders, and Custody orders to the conciliator 48 hours prior to scheduled hearing. FOR THE COURT, By. /s/ Dawn S. Sunday, Esq. Custody Conciliator The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilites Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. YOU SHOULD TAKE THIS PAPER TO YOUR ATTORNEY AT ONCE. IF YOU DO NOT HAVE AN ATTORNEY OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 32 South Bedford Street Carlisle, Pennsylvania 17013 Telephone (717) 249-3166 VIIWA lSNN3d AiNnGl f7,-N`29VCO ? i :h wd ? ranr co Auvi f4 i'LSV C C7H1 70 3O :Y (J 7 Ii J WAYNE SCOTT FORD, PLAINTIFF VS. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, : PENNSYLVANIA NO. 03-2866 CIVIL TERM GABRIELE SABINE FORD, : CIVIL ACTION -LAW DEFENDANT : ACTION FOR DIVORCE / CUSTODY ACCEPTANCE OF SERVICE I, Barbara Sumple-Sullivan, Esquire, counsel for the Defendant in the above- captioned divorce/custody matter, accept service of the Complaint for No-Fault Divorce Under Section 3301(c) of the Divorce Code, and certify that I Dated: 7hA&. to do so. B ara umple-Sullivan, Esquire Counsel for De a tdcmt PA I.D. # 549 Bridge Street New Cumberland PA 17070-1931 (717) 774-1445 c s c_ " vu . -, . r? j_f - C; cn ;; ,. ?? _..? ? ?<<? J m?? ? ?/ .F Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 03-2866 GABRIELE SABINE FORD, CIVIL ACTION -LAW Defendant DIVORCE/CUSTODY ANSWER AND COUNTERCLAIM AND NOW, this 15'' day of October, 2003, comes Defendant, Gabriele Sabine Ford, by and through her attorney, Barbara Sumple-Sullivan, Esquire, and files this Answer and Counterclaim. In support thereof, it is averred as follows: Admitted. 2. Admitted. 3. Admitted. 4. Admitted. Admitted. 6. Denied. Plaintiffs vacating the house was not expected and Defendant does not believe the marriage is irretrievably broken. Denied. After reasonable investigation, Defendant is without knowledge to form an opinion as to the truth of the averment and said response is denied. Admitted. Admitted. COUNT I - REQUEST FOR NO-FAULT DIVORCE UNDER SECTION 3301(c) OF THE DIVORCE CODE 10. Defendant incorporates by reference the allegations of paragraphs 1 through 9 as if set forth herein by reference. 11. Denied. Paragraph 11 is denied. After reasonable investigation, Defendant is without knowledge as to the truth of the averment and, therefore, same is denied. COUNT H - REQUEST FOR EQUITABLE DISTRIBUTION OF MARITAL PROPERTY UNDER SECTION 3502(a) OF THE DIVORCE CODE 12. Defendant incorporates by reference the allegations of paragraphs 1 through 11 as if set forth herein by reference. 13. Admitted. WHEREFORE, Defendant requests the marital property and debt be equitably divided. COUNT III - REQUEST FOR CONFIRMATION OF CUSTODY UNDER SECTIONS 3104(A)(2) AND 3323(B) OF THE DIVORCE CODE 14. Defendant incorporates by reference her responses to paragraphs 1 through 13 as if set forth herein by reference. 2 15. Admitted. 16. Admitted. 17. Admitted. 18. Admitted. 19. Admitted 20. Admitted in part. Denied in part. It is admitted that the best interest of the child will be served by both Plaintiff and Defendant having shared legal custody. It is denied that the best interest of the child is to place primary physical custody with Plaintiff. Defendant has been the primary caretaker and she can provide the child with a stable, loving and structured environment. WHEREFORE, the Defendant requests the Court to grant shared legal and primary physical custody of the child with Defendant with partial rights of physical custody to Plaintiff. COUNTERCLAIM FOR PRIMARY CUSTODY 21. Paragraph's 1 through 20 of Defendant's Answer are incorporated herein by reference. 22. Petitioner is Gabriele Sabine Ford, an individual residing at 910 Hawthorne Avenue, Mechanicsburg, Cumberland County, Pennsylvania 17055. 23. Respondent is Wayne Scott Ford, an individual residing at 816 York View, Grantham, Cumberland County, Pennsylvania 17027. 24. Petitioner and Respondent are the natural parents of one minor (1) child, Benedikt 3 Joseph Ford (DOB: July 15, 1990). 25. Counterclaim Plaintiff believes it is in the best interest of the child to be in her primary custody because she has served as primary caretaker of the child and is better able to provide the care and stability for the child. Defendant is in a better position to set structure and rules for the child and still foster a good relationship with Plaintiff. Plaintiff has strained the child's relationship with Defendant. Defendant and the child are significantly bonded. COUNT IV SUPPORT, ALIMONY PENDENTE LITE AND ALIMONY 26. The averments in paragraphs 1 through 25, inclusive, of Defendant's Answer and Counterclaim are incorporated herein by reference thereto. 27. Defendant requires reasonable support to adequately sustain herself withthe standard of living established during the marriage. WHEREFORE, Plaintiff requests an award of Support, Alimony and Alimony Pendente Lite. WHEREFORE, Counterclaim Plaintiff requests this honorable court to grant her primary physical custody of the minor child with Counterclaim Defendant to have partial physical custody, 4 together with an award of Support, Alimony and Alimony Pendente Lite. Dated: October 15, 2003 3arbara Sumple-Sullivan, Esquire Attorney for Plaintiff 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. No. 32317 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 03-2866 GABRIELE SABINE FORD, CIVIL ACTION -LAW Defendant DIVORCE/CUSTODY VERIFICATION I, GABRIELE SABINE FORD, hereby certify that the facts set forth in the foregoing ANSWER AND COUNTERCLAIM are true and correct to the best of my knowledge, information and belief. I understand that any false statements made herein are subject to penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. Dated: 12003 SABINE FORD Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, Plaintiff V. GABRIELE SABINE FORD, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 03-2866 CIVIL ACTION - LAW DIVORCE/CUSTODY CERTIFICATE OF SERVICE I, Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served the foregoing Answer and Counterclaim, in the above-captioned matter upon the following individual by first class mail, postage prepaid, addressed as follows: Dated: October 15, 2003 Susan K. Candiello, Esquire 5021 East Trindle Road Suite 100 Mechanicsburg, PA 17050 $arbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070 Supreme Court I.D.: 32317 (717) 774-1445 _ l 0 ?e 1 a y .. ? 1 L WAYNE SCOTT VS. GABRIELLE SABINE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 03-2866 CIVIL ACTION LAW IN CUSTODY ORDER OF COURT AND NOW, consideration of the y1k day of 2003, upon Custody Conciliation Report, it is ordered and directed as follows: 1. The parties sha participate in a course of counseling with a professional to be selected by agreement. The purpose of the counseling shall be to assist the parties in improving communication and cooperation to enable them to effectively co-parent their Child, to address issues of concern to the parties with regard to the parenting arrangements, and to obtain recommendations. The parties shall equally share all costs of counseling which are not covered by insurance. 2. The parties shal obtain counseling for the Child with a professional to be selected by agreement. The purpose f the counseling shall be to assess the Child's needs and interests and to provide information and uidance regarding the parenting arrangements to the parents, as appropriate. The parties shall equally are all costs of the Child's counseling which are not covered by insurance. 3. The Mother shall obtain an alcohol assessment to evaluate concerns raised by the Father and shall provide the assessor nt results /recommendations to the Father through counsel. 4. Pending receipt y the parties of information and recommendations through the counseling process and further agree ent of the parties or Order of Court, the parties shall share having legal and physical custody of the C ild as follows: A. The p ies shall share having legal custody of Benedikt Joseph Ford, born July 15, 19 0 and shall consult with each other in making all major non-emergency decisions fecting the Child, including but not limited to all major medical, religious and educat onal decisions. Each party shall have equal access to information pertaining to the Chili , including, but not limited to, all medical and school related records and B. The F work (at weeks an have cusl weeks, ar pm or 4:z and from the Dartie is worxm C. For 1 from of shall hE regular her shall have physical custody of the Child every week from Tuesday after ther 4:00 pm or 4:45 pm) through Saturday at 4:00 pm during alternating through Friday before school during the interim weeks. The Mother shall dy of the Child every week from Saturday at 4:00 pm during alternating l from Friday after school during the interim weeks, through Tuesday at 4:00 pm, when the Father is off work. The Child shall continue to ride the bus to he Mother's residence on every school day unless otherwise agreed between The Father may have custody of the Child during periods when the Mother on weekends. iksgiving holiday in 2003, the Mother shall have custody of the Child of on Wednesday through Thanksgiving Day at 3:00 pm and the Father Ay from Thanksgiving Day at 3:00 pm through the end of the Father's period of custody. D. For the Christmas holiday in 2003, the Mother shall have custody of the Child from Christmas Eve through Christmas Day at 3:00 pm and the Father shall have custody from Christmas Day at 3:00 pm through the end of the Father's regular weekly period of custody. The parties shall share having custody of the Child during the remainder of the Christ as school break as arranged by agreement. 5. With the excep ion of emergencies, the parties shall contact each other by telephone only between the 9:30 pm and 10:00 pm on any evening to discuss issues concerning the Child as needed. Each party shall be available and willing to accept telephone calls from the other parent during this time period and all discussion shall be limited to issues regarding the Child. 6. Counsel for eit er party may contact the conciliator to schedule an additional custody conciliation conference, i necessary, after the parties have engaged in counseling and obtained guidance from the Child' counselor. 7. This Order is Conference. The parties mutual consent, the tern ;d pursuant to an agreement of the parties at a Custody Conciliation modify the provisions of this Order by mutual consent. In the absence of :his Order shall control. J. cc: Susan K. Candiello, Barbara Sumnle-Sul re - Counsel for Father Esquire - Counsel for Mother ,? ?!'M?nus??dun? h2 :pt ?V ?a- ?Or? EO ?einr?; ?:c?:,? 3a??c?-?iu?;?;,ri ? WAYNE SCOTT VS. GABRIELLE SABINE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 03-2866 CIVIL ACTION LAW IN CUSTODY IN PROCEDURE 191 1. The follows: NAME Benedikt Joseph Ford 2. A Conciliatior attendance: The Father, Mother, Gabriele Sabine 3. The parties Date IRDANCE WITH CUMBERLAND COUNTY RULE OF CIVIL the undersigned Custody Conciliator submits the following report: concerning the Child who is the subject of this litigation is as DATE OF BIRTH CURRENTLY IN CUSTODY OF July 15, 1990 Mother / Father Conference was held on October 28, 2003, with the following individuals in Wayne Scott Ford, with his counsel, Susan K. Candiello, Esquire, and the ,ord, with her counsel, Barbara Sumple-Sullivan, Esquire. to entry of an Order in the form as attached. Dawn S. Sunday, Esquire Custody Conciliator WAYNE SCOTT FORD, PLAINTIFF VS. GABRIELE SABINE FORD, DEFENDANT IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO.03-2866 CIVIL TERM CIVIL ACTION -LAW ACTION FOR, DIVORCE / CUSTODY STIPULATION FOR AGREED ORDER OF CUSTODY NOW THEREFORE, the parties, intending to be legally bound, agree as follows: Plaintiff is WAYNE SCOTT FORD (hereinafter sometimes referred to as "Father") who currently resides at 816 York View, Grantham, Cumberland County, Pennsylvania, 17027. Defendant is GABRIELE SABINE FORD (hereinafter sometimes referred to as "Mother") who currently resides at910 Hawthorne Avenue, Mechanicsburg, Cumberland County, Pennsylvania, 17055. BENEDIKT JOSEPH FORD, born on July 15, 1990, is the natural child of the Father, WAYNE SCOTT FORD, and the Mother, GABRIELE SA:BINE FORD, is the subject of this Stipulation for Agreed Order of Custody. It is Mother and Father's belief that it is in the best interests of their minor child to have a meaningful ongoing relationship with both their Mother and Father, provided the child is in a safe environment. WHEREFORE, Plaintiff, WAYNE SCOTT FORD, and Defendant, GABRIELE SABINE FORD, have entered into a mutual agreement regarding the custody of their child, BENEDIKT JOSEPH FORD, and respectfully request this Honorable Court to enter the following Order: W : 4 1. Plaintiff and Defendant shall share equally Legal Custody (as defined in 23 Pa.C.S.A. Section 5302) of their minor child, BENEDIKT JOSEPH FORD. 2. All decisions affecting their child's growth and development including, but not limited to: choice of camp, if any; choice of day care provider; medical and dental treatment; cr psychotherapy, psychoanalysis, or like treatment; decisions relating to actual or potential 3 litigation involving their child, directly or as beneficiary, other than custody litigation; education both secular and religious scholastic athletic pursuits and other extracurricular activitie Ikhall be considered major decisions and shall be made by Father and Mother, jointly, after discussion and consultation with each other and with a view towards obtaining and following a harmonious policy in their child's best interest. Neither Mother nor Father may make unilateral, arbitrary decisions in these areas. 3. Mother and Father agree to keep the other informed of the progress of their child's education and social adjustments. Mother and Father agree: not to impair the other's right to shared legal or physical custody of their child. Mother and Father agree to give support to the other in the role as parent and to take into account the consensus of the other for the physical and emotional well-being of their child. 4. While in the presence of their child, neither Mother nor Father shall make or permit any other person to make, any remarks or do anything ;which could in any way be construed as derogatory or uncomplimentary to the other parent. It shall be the express duty of each parent to uphold the other parent as one whom their child should respect and love. 5. It shall be the obligation of each parent to make their child available to the other in accordance with the physical custody schedule and to encourage their child to participate in the plan hereby agreed and ordered. 6. Each parent shall have the duty to notify the other of any event or activity that could reasonably be expected to be of significant concern to the other parent. 7. With regard to any emergency decisions which must be made, the parent with whom The child is physically residing at the time shall be permitted to make the decision necessitated by the emergency without consulting the other parent in advance. However, that parent shall inform the other of the emergency and consult with him or tier as soon as possible. If either parent should be unreachable at their office or residence, then that party shall provide the other party with the necessary information to facilitate notification of an emergency. Day-to-day decisions of a routine nature shall be the responsibility of the parent having physical custody at the time. 8. Mother and Father shall be entitled to complete and full information from any doctor, dentist, teacher or authority and have copies of any reports given to them as a parent. Such documents include, but are not limited to, medical reports, academic and school report cards, birth certificates, etc. Both parents may and are encouraged to attend school conferences and activities. Both Father and Mother's names shall be listed with the school as the parent to be contacted in the event of an emergency and to be notified regarding school events. 9. Neither Mother nor Father shall schedule activities or appointments for their child which would require their attendance or participation at said activity or appointment during a time when their child are scheduled to be in the physical custody of the other parent without that parent's express prior approval. 10. Mother shall have Primary Physical Custody and ]rather shall have Partial Physical Custody of their child, BENEDIKT JOSEPH FORD, according to the following schedule: / A. Father shall have the child on alternating weekends, beginning ??gqFriday K bh At1 W\ 0 yvh 0%*11 W ? Kf, uj q ° e> O h evening after school through (AL,? co rr. ?I?((e? r S. L?, Va,w5 i? b,ave; ?o Z ?t lnbFa $ 0-1 <C The (parties stall alternate the following holidays. ather shall lade-c ji have the odd numbered holidays and Mother the even numbered holidays in the even numbered years, to alternate annually thereafter: e 1) New Year's Eve and Day (this holiday shall be determined by the year in which the New Year's Eve occurs); 2) Memorial Day; 3) Independence Day (this day may be extended later in the evening to attend fireworks); 4) Labor Day. D. Easter: Mother and Father shall alternate: Easter with Father getting Schedule A in the even numbered years and Mother getting Schedule B in the even numbered years, to alternate annually thereafter. A. To begin Saturday evening before Easter Sunday at 6:00 p.m. through Easter Sunday at 1:00 p.m. B. To begin Easter Sunday at 1:00 p.m. through the Monday after Easter at 6:00 p.m. E. Thanksgiving Day: Mother and Father shall alternate Thanksgiving Day with Father getting schedule A in the even numbered years and Mother getting Schedule B in the even numbered years, to alternate annually thereafter. A. To begin Wednesday evening before Thanksgiving Day at 6:00 p.m. through Thanksgiving Day at 2,:00 p.m. B. To begin Thanksgiving Day at 2:00 p.m. through the Friday after Thanksgiving Day at 6:00 p.m. F. Christmas. Mother and Father shall alternate Christmas with Mother getting Schedule A in the even numbered years and Father getting Schedule B in the even numbered years, to alternate annually thereafter. A. To begin Christmas Eve at 6:00 p.m. through Christmas Day at 1:00 p.m. B. To begin Christmas Day at 1:00 p.m. through the day after Christmas at 6:00 p.m. G. Father shall have the child on Father's Day and Mother shall have the child with her on Mother's Day; H. Mother and Father shall each have the option of requesting one to two (1-2) non-consecutive weeks of vacation during the year with the child, providing a minimum of thirty (30) days' notice of the time requested to the other party. 1. All holidays, vacations, and specially designated times for visitation with their child shall supersede the regularly scheduled visitation. Holidays shall begin at 5:00 p.m. k the evening before the holiday and extend through 8:00 p.m. the day of the holiday, unless the parties agree to other times. 11. Mother and Father agree to share transportation equally, with the party beginning their period of visitation being responsible to get their child. 12. Mother and Father agree to be responsible for any ordinary everyday expenses which occur during their individual custody periods with their son. The parties agree to discuss sharing the costs of any extraordinary expenses for their child. 13. The parent with physical custody of their child agrees to keep the other parent fully aware and informed of any successes, difficulties, activities, emergencies, etc., in which their child has become involved. 14. The parties are encouraged to discuss and cooperate with each other when sharing and making requests for changes in periods of visitation. All permanent changes in periods of custody from those contained in this custody agreement shall be made in writing and signed by both parties. 15. The parties shall be free to mutually agree to alter and/or change the terms of this agreement. If the alteration and/or agreement is permanent and/or a change which will occur on numerous occasions, the parties agree the alteration and/or change shall be in writing and signed by both parties. WITNESS WITNESS W Q v u? C ) c l - c? -? N 0 jUN 1® 2004 WAYNE SCOTT FORD, : IN THE COURT OF COMMON PLEAS PLAINTIFF : OF CUMBERLAND COUNTY, : PENNSYLVANIA VS. NO.03-2866 CIVIL TERM GABRIELE SABINE FORD, : CIVIL ACTION -LAW DEFENDANT : ACTION FOR DIVORCE / CUSTODY ORDER OF COURT AND NOW, this ???day of 2004, upon consideration of the attached Stipulation for Agreed Order of Custody, Plaintiff, WAYNE SCOTT FORD, and Defendant, GABRIELE SABINE FORD, shall SHARE LEGAL CUSTODY and Defendant, GABRIELE SABINE FORD, shall have PRIMARY PHYSICAL CUSTODY and Plaintiff, WAYNE SCOTT FORD shall have PARTIAL PHYSICAL CUSTODY of the minor child, BENEDIKT JOSEPH FORD, in accordance with the language contained in the within Stipulation. BY CO T, 6. V J. r3 GS 1 L- F L'i 8 WV 81 la(?f h69Z A' J.Oi.ul LLOdd' ?Hi JO (% WAYNE SCOTT FORD, PLAINTIFF VS. GABRIELE SABINE FORD, DEFENDANT : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYLVANIA NO. 03-2866 CIVIL TERM : CIVIL ACTION- LAW : ACTION FOR DIVORCE / CUSTODY INCOME AND EXPENSE STATEMENT OF WAYNE SCOTT FORD Plaintiff, Wayne Scott Ford, files the following Income and Expense Statement and verifies the statements made herein are true and correct. Plaintiff understands any false . statements herein are made subject to the penalties of 18 Pa.C.S. §49 rel ' to unsrw. falsification to authorities. J ?? INCOME: V Employer: Pennsylvania State Police Address: 1800 Elmerton Avenue, Harrisburg, PA 17110 Type of Work: Information Technology Payroll Number: 508983 Pay Period: Biweekly Gross Pay Per Pay Period: $1 ,670.25 Itemized Payroll Deductions: Federal Withholding: 112.29 Social Security (FICA): 103.55 State Income Tax: 51.28 Local Income Tax: 28.39 Medicare: 24.22 Retirement: 104.39 Savings Bonds: Credit Union: Life Insurance: Health Insurance: Tax Deferred Comp: Fair Share Fee: 16.37 TOTAL: $ 1,229.76 OTHER INCOME (MONTHLY): Employment: Interest: Dividends: Disability Pensions: 463.00 Annuity: Federal Withholding: Savings Bonds: Life Insurance: Credit Union: Social Security: Rents: Royalties: Expense Account: Gifts: Unemployment Compensation: Workmen's Compensation: Support: (child) TOTAL MONTHLY INCOME: $ 2,922.52 EXPENSES (MONTHLY): HOME: Mortgage: Rent: $ 700.00 Utilities: Electric: Gas: Oil: Telephone: Water/Sewer/Garbage Cell Phone: 100.00 RENTAL: Water/Sewer/Garbage: EMPLOYMENT EXPENSES: Transportation: Lunches: 100.00 TAXES: School: Real Estate: Harrisburg City: Personal: Income: INSURANCE: Homeowners/Rental: Automobile: Life: Accident: Health: AUTOMOBILE: Payments: Fuel: Repairs: Maintenance: Licenses/Registration MEDICAL: Doctor: Dentist: Hospital: Medicine/Prescription Drugs: Counseling PERSONAL: Clothing: Food: Barber/Hairdresser: Laundry/Dry cleaning: Memberships: Bank Charges: Credit Card Payments: Support: AOL/Computer MISCELLANEOUS: Papers/Books/Magazines: Entertainment: Legal Fees: TOTAL EXPENSES: 10.00 98.00 14.00 386.00 100.00 20.00 30.00 4.00 15.00 30.00 10.00 50.00 100.00 300.00 40.00 1,351.08 24.00 24.00 100.00 $ 3,606.08 Total Monthly Income: Total Monthly Expenses: $ 2,922.52 $ 3,606.08 Total Monthly Shortfall $ 683.56 Dated: August _a 2004 Respectfully submitted, LAW FERM OF SUSAN KAY CANDIELLO, P.C. Counsel for P int j PA I.D. # 649 5021 East Trindle itoad Suite 100 Mechanicsburg, Pik 17050 (717) 796-1930 h.) _e?. t fll ? :: C1 T P. 1 _ . 1. . ? ??) f: ?._ T `i _ U WAYNE SCOTT FORD, PLAINTIFF VS. GABRIELE SABINE FORD, DEFENDANT : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYLVANIA : NO. 03-2866 CIVIL TERM : CIVIL ACTION -LAW : ACTION FOR DIVORCE / CUSTODY INVENTORY AND APPRAISE MENT FOR WAVNE SCOTT FORD Plaintiff, Wayne Scott Ford, files the following Inventory and Appraisement of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three (3) years. Plaintiff, Wayne Scott Ford verifies the statements made herein are true and correct. Plaintiff understands any false statements herein are made subject to the penalties of 18 Pa. C. S. §4904 relating to unsworn falsification to authorities. WA SCOTT . ORD ASSETS OF PARTIES Plaintiff marks on the list below those items applicable to the case at bar and itemizes the assets on the following pages. If an item has been appraised, a copy of the appraisal report is attached. (X) 1. Real property (X) 2. Motor vehicle(s), Boat (7) 3. Stocks, Bonds, Securities and Options ( ) 4. Certificates of deposit (3) 5. Checking accounts, cash (X) 6. Savings accounts, money market and saving certificates ( ) 7. Contents of safe deposit box(s) ( ) 8. Trusts (Xt 9. Life insurance policies, (indicated face value, cash surrender value and current beneficiaries) ( ) 10. Annuities ( ) 11. Gifts ( ) 12. Inheritance ( ) 13. Patents, Copyrights, Inventions and Royalties ( ) 14. Personal property outside the house ( ) 15. Businesses (list all owners, including the percentage of ownership, and officer/director positions held by a party with the company) ( ) 16. Employment termination benefits (severance pay, workman's compensation clai m/award) ( ) 17. Profit sharing plans ( ) 18. Pension plans (indicate employee contribution and date plan vests) (}) 19. Retirement plans, Individual Retirement Accounts (X) 20. Disability payments (Military) ( ) 21. Litigation claims (matured and unmatured) ( ) 22. MilitaryN.A. benefits ( ) 23. Education benefits ( ) 24. Debts due, including loans, mortgages held (7) 25. Household furnishings and personalty (include as a total category and attach itemized list if distribution of such assets is in dispute) ( ) 26. Other: Disability Settlement LIABIIdTIES OF PARTIEEi Plaintiff marks on the list below those items applicable to the case at bar and itemizes the liabilities on the following page: SECURED: (X) 1. Mortgages ( ) 2. Judgements ( ) 3. Liens ( ) 4. Other secured liabilities UNSECURED: ( ) 1. Credit card balances ( ) 2. Purchases ( ) 3. Loan payments ( ) 4. Notes payable ( ) 5. Other unsecured liabilities CONTINGENT OR DEFERRED: ( ) 1. Contracts or Agreements ( ) 2. Promissory notes ( ) 3. Lawsuits ( ) 4. Options (3) 5. Taxes (X) 6. Other contingent or deferred liabilities, Sascha's School Loans Respectfully submitted, Dated: August 2004 LAW FIRM OF SUSAN KAY CANDIELLO, P.C. Susan Kay Candiell Counsel for Plaint PA LD. # 64998 5021 East Trindle Road Suite 100 Mechanicsburg PA 17050 (717) 796-1930 cr> v -f ' - i CJ 0 0 N N j Q W a O U? O 0 U spa O? W O b N O z ?O 1 W C? Q z O? wA m a 9 10 O W O s 0 0 v w 0 ?I 2 2 x A Rf d d .Y 0 a .O a 0 w 0 a 3 0 W x 0 L N a w i 1 H U (ti ?Vq1 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, Plaintiff V. GABRIELE SABINE FORD, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 03-2866 CIVIL ACTION - LAW DIVORCE/CUSTODY AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 330l(c) of the Divorce Code was filed on June 18, 2003. 2. The marriage of the Plaintiff and Defendant is irretrievably broken. Ninety days have elapsed since the filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. 4. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 5. I verify that the statements made in this affidavit are true and correct. I understand that false statements are made subject to the penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. DATE. °C 7 ??? r?> c'> ? ? cn 7 .? __, -??= !.' i.,? (,;: j cr, Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, IN THE COURT OF COMMON PLEAS Plaintiff V. GABRIELE SABINE FORD, Defendant CUMBERLAND COUNTY, PENNSYLVANIA NO. 03-2866 CIVIL ACTION - LAW DIVORCE/CUSTODY AFFIDAVIT OF CONSENT A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on June 18, 2003. 2. The marriage of the Plaintiff and Defendant is irretrievably broken. Ninety days have elapsed since the filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. 4. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. I verify that the statements made in this affidavit are true and correct. I understand that false statements are made subject to the penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. DATE: J Ltl&zo COMMONWEALTH OF PENNSYLVANIA ) ) SS. COUNTY OF o/A ) Before me, the undersigned officer, a Notary Public in and for said Commonwealth and County, personally appeared WAYNE SCOTT FORD, who being duly affirmed according to law, deposes and says that the facts and matter set forth in the within and foregoing AFFIDAVIT OF CONSENT are true and correct to the best of his knowledge, information and belief. Affirmed and subscribed to before me this /W day of 12005. TARY PUBLIC My Commission Expires: (SEAL) COMMONWEALTH OF PENNSYLVANIA NotaAai Seal Et1oD. Wisner, Notary Pudic Caaa1Tapp.,YotkOw* [My Commission EVW May 24, 20118 Member, Pennsylvania Assoclat{on Of Notarlea ?.,? -? t'7 =i1 ..l -r. -? '";-- ?:<. -?. c? 7;?? -- -r1 ?.'?j _. [?' .- .. cS+ .?_ W Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, IN THE COURT OF COMMON PLEAS Plaintiff v. GABRIELE SABINE FORD, Defendant CUMBERLAND COUNTY, PENNSYLVANIA NO. 03-2866 CIVIL ACTION - LAW DIVORCE/CUSTODY WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER §3301(c) OF THE DIVORCE CODE I consent to the entry of a final decree of divorce without notice. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statement herein are made subject to the penalties of 18 Pa.C. S. §4904 relating to unsworn falsification to authorities. DATE: J? ?4 5 COMMONWEALTH OF PENNSYLVANIA ) ) SS. COUNTY OF NorZJL ) Before me, the undersigned officer, a Notary Public in and for said Commonwealth and County, personally appeared WAYNE SCOTT FORD, who being duly affirmed according to law, deposes and says that the facts and matter set forth in the within and foregoing WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER §3301(c) OF THE DIVORCE CODE are true and correct to the best of his knowledge, information and belief. A- Affirmed and subscribed to before me this /k Z day of OTARY PUBLIC My Commission Expires: (SEAL) COMMONWEALTH OF PENNSYLVANIA Nokvw sew EdcD. Witrlwr, Ndery Pl,tilc CertaRTwP•,YakOaeM [my ComlrieeMElpMeeMay24,2008 Member, Ponn"arrMa ABao0laHon Of WolarMre ?fjy , 2005. , C-1 -13 ?? r.n Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, Plaintiff V. GABRIELE SABINE FORD, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 03-2866 CIVIL ACTION - LAW DIVORCE/CUSTODY WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER §3301(c) OF THE DIVORCE CODE I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statement herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. DATE: ,?> {; > i ?_'' .? ,?T ?.o ;? _.. ,. r , --, u, ??' [?? `. MARITAL SETTLEMENT AGREEMENT 03 _ ;2pL THIS AGREEMENT, made thiQA day of Mot4 2005, by and between WAYNE S. FORD, hereinafter referred to as "HUSBAND", and GABRIELE S. FORD, hereinafter referred to as "WIFE". WITNESSETH, That: WHEREAS, the parties hereto are husband and wife, having been lawfully joined in marriage on October 11, 1988, in Newport, Perry County, Pennsylvania; WHEREAS, one (1) minor child exists of this marriage being Benedikt Joseph Ford, born July 15, 1990; WHEREAS, it is the intention of the parties to settle fully and finally their respective financial and property rights and obligations as between each other arising out of the marriage relationship or otherwise, including without limitation (1) the settling of all matters between them relating to the ownership of real and personal property; (2) the settling of all matters between them relating to the past, present and future support and/or maintenance of HUSBAND and WIFE; and (3) the settling of all matters between them relating to any and all rights, titles and interests, claims and possible claims in or against the estate of the other. NOW THEREFORE, with the foregoing recitals being hereinafter incorporated by reference and deemed an essential part hereof in consideration of the foregoing recitals, the mutual promises, covenants and undertakings herein set forth, and for good and valuable consideration, receipt of which is hereby acknowledged by each of the parties hereto, HUSBAND 511 212 00 5 and WIFE, each intending to be legally bound hereby, covenant and agree as follows: SECTION I GENERAL PROVISIONS 1. ADVICE OF COUNSEL HUSBAND and WIFE declare that they have each had a full and fair opportunity to obtain independent legal advice of counsel of their selection. WIFE has been independently represented by Barbara Sumple-Sullivan, Esquire. HUSBAND has been independently represented by Susan Kay Candiello, Esquire. However, HUSBAND is presently unrepresented by counsel. HUSBAND is cognizant of his right to legal representation and declares that he has chosen not to retain an attorney notwithstanding the fact that attorney for WIFE has told him that he has an absolute right to be represented by an attorney. HUSBAND has chosen instead to negotiate directly with counsel and/or with his WIFE. HUSBAND hereby acknowledges that he has done so willingly and he fully understands the facts and has been fully informed and understands that, had a Court decided this matter, he may have received more or less than is provided for in this Agreement. HUSBAND knowingly waives his rights, if any, to utilize the lack of his legal representation as a basis to attack the validity of this Agreement. Both parties further acknowledge and agree that each has fully disclosed their respective financial situations to the other, including their assets, liabilities and income. Each of the parties acknowledge and agree that, after having received such information and with such knowledge, this Agreement is fair, reasonable and equitable and that it is being entered into freely, voluntarily 5/12/2005 2 and in good faith and that the execution of this Agreement is not the result of any duress, undue influence, coercion, collusion and/or improper or illegal Agreement. 2. PERSONAL RIGHTS HUSBAND and WIFE may and shall, at all times hereafter, live separate and apart. Each shall be free from all control, restraint, interference or authority, direct or indirect, by the other in all respects as if she or he were unmarried, except as may be necessary to carry out the provisions of this Agreement. Each may reside at such place or places as she or he may select. Each may, for his or her separate use or benefit, conduct, carry on and engage in any business, occupation, profession or employment which to him or her may seem advisable. This provision shall not be taken, however, to be an admission on the part of either HUSBAND or WIFE of the lawfulness of the causes which led to, or resulted in, the continuation of their living apart. HUSBAND and WIFE shall not molest, harass, or malign the other or the respective families of each other, nor compel the other to cohabit or dwell in any manner with him or her, nor in any way interfere with the peaceful existence, separate from each other. 3. FINANCIAL DISCLOSURE The parties have fully disclosed to each other the extent of each otherOs income, assets, liabilities, holdings and estate. Each party warrants that the information provided has fully and accurately described the extent of his or her holdings. Each of the parties acknowledge that he or she is aware of his or her right to seek discovery including, but not limited to, written interrogatories, motions for document production, depositions, and other means of discovery 5 /1 21200 5 available through the Pennsylvania Rules of Civil Procedure. The parties acknowledge that they have had the right to have property fully appraised. Each party is fully satisfied that no additional information is necessary for the execution of this Agreement. 4. MUTUAL CONSENT DIVORCE The parties intend to secure a mutual consent, no fault divorce pursuant to the provisions of Section 3301(c) of the Divorce Code of 1980, as amended and will execute the documents necessary to effectuate a divorce under those provisions concurrently with the execution of this Agreement. The parties agree that the Affidavit of Consent and the Waivers of Notice shall be signed simultaneously with this Agreement. 5. SUBSEQUENT DIVORCE A decree in divorce, entered by the court of Cumberland County, shall not suspend, supersede or affect the terms of this Agreement. This Agreement, and the terms and conditions contained herein, as well as the enforcement of said terms and conditions, shall not be contingent upon the granting of a Divorce Decree to either party by the Court of Common Pleas of Cumberland County, Pennsylvania, or any other Court of competent jurisdiction. This Agreement shall remain in full force and effect even if the parties reconcile, cohabit as HUSBAND and WIFE, or attempt a reconciliation. This Agreement shall continue in full force and effect and there shall 5/12/2005 not be a modification or waiver of any of the terms hereof unless the parties, in a writing signed by both parties, execute a statement declaring this Agreement or any term of this Agreement to be null and void. Both parties hereto agree that this Agreement may be incorporated by reference but shall not be deemed merged into any judgment or decree for divorce obtained by either party. 6. OTHER DOCUMENTATION HUSBAND and WIFE covenant and agree that upon request of the other party, they will forthwith execute and deliver to the other party, any and all written instruments, assignments, releases, satisfactions, deeds, notes or such other writings as may be necessary or desirable for the proper effectuation of this Agreement. 7. MUTUAL RELEASES Except as otherwise expressly provided by this Agreement, A. Each party hereby absolutely and unconditionally releases and forever discharges the other and the estate of the other for all purposes from any and all rights and obligations which either may have or at any time hereafter have for past, present or future support or maintenance, alimony pendente lite, alimony, equitable distribution, counsel fees, costs, expenses and any other right or obligation, economic or otherwise, whether arising out of the marital relationship or otherwise, including all rights and benefits under the Pennsylvania Divorce Code of 1980, its supplements and amendments, as well as under any other law of any other jurisdiction, except and only except all rights, agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. Neither party shall have any obligation to the other not expressly set forth herein. B. Each party hereby absolutely and unconditionally releases and forever discharges the other and his or her heirs, executors, administrators, assigns, property and estate from any and all rights, claims, demands or obligations arising out of or by virtue of the marital relationship of the parties or otherwise, whether now existing or hereafter arising. The above release shall be effective regardless of whether such claims arise out of any former or future acts, contracts, engagements or liabilities or the other or by way of dower, curtesy, widow's rights, family exemption or similar allowance, or under the intestate laws, or the right to take against the 511 212 00 5 spouse's will, or the right to treat a lifetime conveyance by the other as testamentary, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of Pennsylvania, any state, commonwealth or territory or the United States, or any other country. It is expressly understood, however, that neither the provisions of this release nor the subsequent entry of a divorce decree are intended to defeat the right of either party to receive any insurance proceeds at the death of the other of which she or he is the named beneficiary (whether the beneficiary designation was made prior or subsequent to execution hereof), nor to defeat the right of either party to receive any legacy, bequest or residuary portion of the other's estate under his or her will, or to act as personal representative or executor if so named by the will of the other, whether such will was executed prior or subsequent to this Agreement. C. Except for any cause of action for divorce which either party may have or claim to have, and except for the obligations of the parties contained in this Agreement and such rights as are expressly reserved herein, each party gives to the other by the execution of this Agreement an absolute and unconditional release and discharge from all causes of action, claims, rights or demands whatsoever, in law or in equity, which either party ever had or now has against the other, 8. SUCCESSOR'S RIGHTS AND LIABILITIES This Agreement shall, except as otherwise provided herein, be binding upon and inure to the benefit of the parties hereto, their respective heirs, executors, administrators, successors or assigns. 9. SEVERABILITY If any provision in this Agreement is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the remaining provisions shall nevertheless continue in full force and effect without being impaired or invalidated in any way. 10. ENTIRE AGREEMENT HUSBAND and WIFE do hereby covenant and warrant that this Agreement contains all of the representations, promises and Agreements made by either of them to the other for the 5/12/2005 purposes set forth in the preamble hereinabove; that there are no claims, promises or representations not herein contained, either oral or written, which shall or may be charged or enforced or enforceable unless reduced to writing and signed by both of the parties hereto. 11. BINDING EFFECT OF AGREEMENTIWAIVER This Agreement shall remain in full force and effect unless and until terminated under and pursuant to the terms of this Agreement. The failure of either party to insist upon strict performance of the provisions of this Agreement shall not be construed as a waiver of any subsequent default of the same or similar nature, nor shall such failure be construed as a waiver of any other term, condition, clause or provision of this Agreement. 12. BREACH If either party breaches any provision of this Agreement, the other party shall have the right, at his or her election, to sue for damages for such breach or seek such other remedies or relief as may be available to him or her, and the party breaching this contract shall be responsible for payment of reasonable legal fees and costs incurred by the other in enforcing their rights under this Agreement. 13. CONTROLLING LAW This Agreement shall be construed and governed in accordance with the laws of the 5/12/2005 Commonwealth of Pennsylvania. SECTION H EQUITABLE DISTRIBUTION During the marriage, the parties have accumulated various assets and liabilities, the disposition of which is intended as follows: 1. ASSETS A. PERSONAL and HOUSEHOLD PROPERTY HUSBAND and WIFE do hereby acknowledge that they have heretofore divided the non- marital and marital personal and household property, including but without limitation, jewelry, clothes, furniture, and other assets. HUSBAND agrees that all assets in possession of WIFE shall be the sole and separate property of WIFE except the rocking chair (which shall be given to HUSBAND upon the condition it will be gifted to the parties' son, Benedikt Joseph Ford and not sold). WIFE agrees that all assets in possession of HUSBAND shall be the sole and separate property of HUSBAND. Each of the parties do hereby specifically waive, release, renounce and forever abandon whatever claims, if any, he or she may have with respect to any of the above said items which are the sole and separate property of the other. This document shall constitute a bill of sale for said sole property. B. REAL ESTATE The parties jointly own property at 910 Hawthorne Avenue, Mechanicsburg, Cumberland 5/12/2005 County, Pennsylvania. Said house is encumbered by a mortgage held by Sovereign Bank in the approximate amount of ONE HUNDRED THIRTY THOUSAND DOLLARS ($130,000.00). WIFE desires to maintain said home and reside therein. HUSBAND agrees to transfer all his rights, title and interest in the home to WIFE. HUSBAND agrees to execute a quitclaim deed at the time of signing this Agreement. WIFE agrees to be solely responsible for payment of the past, present and future principle, interest, penalties and costs related to the mortgage due and owing to Sovereign Bank and all other taxes, insurance, assessments or any other cost or expense related to the home. WIFE hereby agrees to indemnify and hold HUSBAND harmless from any and all liability as a result of non-payment of the mortgage or any other obligations as enumerated above associated with the real estate. HUSBAND and WIFE have each filed bankruptcy and HUSBAND has been totally discharged from all obligations related to the house, including his mortgage obligations. C. MOTOR VEHICLES The parties acknowledge that there were two marital vehicles acquired during the marriage, one being a 1995 Ford Aspire and a 2001 Volkswagen Jetta. The 1995 Ford Aspire is not encumbered and driven by WIFE. WIFE shall retain sole ownership and possession of said vehicle. HUSBAND agrees to transfer title of the vehicle to WIFE and hereby releases all claims to the vehicle. HUSBAND shall retain sole ownership and possession of the 2001 Volkswagen Jetta as his separate property. HUSBAND agrees that he shall be solely responsible for the repayment of the loan encumbering the 2001 Volkswagen Jetta. HUSBAND agrees to indemnify 5/12/2005 and hold WIFE harniless for any and all costs and expenses related to satisfaction of this loan obligation, including all costs, interest, losses incurred by WIFE, including reasonable counsel fees, to defend any such claims or to enforce this indemnification. D. FINANCIAL ASSETS The parties have previously divided all joint checking, savings and any other financial account to the satisfaction of both parties. Any and all other individual bank accounts shall remain in the possession of the individual it is titled to. E. PENSION. EMPLOYMENT AND RETIREMENT ACCOUNTS The parties have investments with Prudential Securities. These Accounts are No. 044- R42650-G9 and is titled in WIFE's name; and Account Nos. 044-R42668-G9, 044-R68063-G9 and Account No. 044-293161-G9 which are titled in HUSBAND's name. The parties agree all assets held by Prudential Securities be the sole and separate property of WIFE. HUSBAND waives all rights, title and interest in said accounts. Transfer of HUSBAND's accounts shall be transferred to WIFE so as to effectuate no loss of value. WIFE's counsel shall draft and enter as a court order a Qualified Domestic Relations Order (QDRO) as may be necessary to effectuate a full transfer to WIFE's name. All costs to draft and submit the QDRO shall be borne by HUSBAND. HUSBAND has certain pension benefits through the Commonwealth of Pennsylvania as a result of his current employment which had contributions as of date of separation of EIGHT THOUSAND DOLLARS ($8,000.00). WIFE waives any and all claims to said pension or 5/12/2005 10 employment benefits. HUSBAND also receives certain disability payments (V.A. Pension and Military Pension). WIFE waives any and all claims to said benefits, except as such may be used in the calculation of child support. F. INSURANCE Each party shall retain ownership of any life insurance policy in his or her name. HUSBAND agrees that he shall name WIFE as beneficiary of a life insurance policy of at least THIRTY THOUSAND DOLLARS ($30,000.00), as long as alimony is due and payable to her by HUSBAND. HUSBAND shall provide WIFE with annual proof of the existence of the policy and its current paid status. 2. DEBTS Each party represents that they have not contracted any debt or liability for the other for which the estate of the other party may be responsible or liable except as otherwise provided herein, and that except only for the rights arising out of this Agreement, neither party will hereafter incur any liability whatsoever for which the other party or the estate of the other party will be liable. Each party agrees to indemnify and hold harmless from and against all future obligations of every kind incurred by them, including those for necessities. The parties acknowledge that numerous marital debt exists, including but not limited to the following: Members 1 st Service Loan (JT) PSL-Credit Line/01 (3,506.26) 5/12/2005 11 America Online Visa (JT) $ (15,023.00) Account No. 4417 1284 9616 2403 Office Max (H) $ (315.65) Account No. 6011 6172 1017 1604 Sam's Club (H) $ (453.29) Account No. 77 1042 748749 1 Discover Card (H) $ (5,849.86) Account No. 6011 0023 2073 9683 Circuit City (H) $ (2,496.62) Account No. 1523 0034 6870 2717 Members 1 st Federal Credit Union Visa QT) $ (5,379.57) Account No. 4121 4499 9626 3773 Wife's Additional Account $ (3,000.00) Home Depot ?? Each party has filed for bankruptcy and these debts have been discharged incident to those proceedings. SECTION III CHILD SUPPORT AND ALIMONY 1. CHILD SUPPORT Child Support, health insurance and contribution to non-reimbursed medical expenses shall continue in accordance with the PACSES Case No. 365105884, Cumberland County Docket No. 545 1992. Each party acknowledges that this calculation is subject to modification upon petition by either party subject to the terms set forth below in paragraph 2. 5/12/2005 12 2. ALIMONY Upon entry of the Decree in Divorce, HUSBAND shall pay to WIFE the sum of FOUR HUNDRED SIXTY-EIGHT DOLLARS ($468.00) per month for sixty (60) months as alimony. This sum shall be due on or about the first day of each month. This amount shall not be modifiable in amount for any reason except for the death of either party. It is further agreed that payment of this sum shall not be includable in the income of WIFE or deducted from income of HUSBAND for calculation of child support for Benedikt. This sum shall be due and payable for a fixed term of sixty (60) months by HUSBAND. This term shall be non-modifiable. 3. COUNSEL FEES Each party will bear their legal costs and expenses. SECTION IV CONDITION PRECEDENT TO THE AGREEMENT'S EFFECTIVENESS The parties acknowledge that this Agreement shall become effective when actually signed by both parties. WITNESS WITNES 5/12/2005 13 COMMONWEALTH OF PENNSYLVANIA ) ) SS. COUNTY OF ) Before me, the undersigned officer, a Notary Public in and for said Commonwealth and County, personally appeared Wayne S. Ford, who being duly affirmed according to law, deposes and says that the facts and matter set forth in the within and foregoing Marital Settlement Agreement are true and correct to the best of his knowledge, information and belief. My commission expires: Affirmed and subscribed to before me this day of 12005. OTARY PUBLIC COMMONWEALTH OF PENNSYLVANIA Notarial Seal My commission expires: Edco.WWW,Nak"Pubic (SEAL) Canal TWP., York County My C mmmmon Expires May 24, 2008 Member, Pennsytvania Association Of Notarks COMMONWEALTH OF PENNSYLVANIA ) ) SS. COUNTY OF CUMBERLAND ) Before me, the undersigned officer, a Notary Public in and for said Commonwealth and County, personally appeared Gabriele S. Ford, who being duly affirmed according to law, deposes and says that the facts and matter set forth in the within and foregoing Marital Settlement Agreement are true and correct to the best of her knowledge, information and belief, Aff n ubscribed to before me thjs? 7 day of 2005. ZN60TATMBLIC (SEAL) NOtARbLL SEAL BARBARA SUMPLESUIWAN Notary Pt"o NEWCUMURL4W BOROUGH CUMBERWID COtNW Commow Nov 15, 2007 5/12/2005 14 r> r} (? _._ -, - i t., r,7 _. :- T ? '- 1; W G r.............. u,..? MARITAL SETTLEMENT AGREEMENT THIS AGREEMENT, made this day of MU , 2005, by and between WAYNE S. FORD, hereinafter referred to as "HUSBAND", and GABRIELE S. FORD, hereinafter referred to as "WIFE". WITNESSETH, That: WHEREAS, the parties hereto are husband and wife, having been lawfully joined in marriage on October 11, 1988, in Newport, Perry County, Pennsylvania; WHEREAS, one (1) minor child exists of this marriage being Benedikt Joseph Ford, born July 15,1990; WHEREAS, it is the intention of the parties to settle fully and finally their respective financial and property rights and obligations as between each other arising out of the marriage relationship or otherwise, including without limitation (1) the settling of all matters between them relating to the ownership of real and personal property; (2) the settling of all matters between them relating to the past, present and future support and/or maintenance of HUSBAND and WIFE; and (3) the settling of all matters between them relating to any and all rights, titles and interests, claims and possible claims in or against the estate of the other. NOW THEREFORE, with the foregoing recitals being hereinafter incorporated by reference and deemed an essential part hereof in consideration of the foregoing recitals, the mutual promises, covenants and undertakings herein set forth, and for good and valuable consideration, receipt of which is hereby acknowledged by each of the parties hereto, HUSBAND 5!1212005 and WIFE, each intending to be legally bound hereby, covenant and agree as follows: SECTION I GENERAL PROVISIONS 1. ADVICE OF COUNSEL HUSBAND and WIFE declare that they have each had a full and fair opportunity to obtain independent legal advice of counsel of their selection. WIFE has been independently represented by Barbara Sumple-Sullivan, Esquire. HUSBAND has been independently represented by Susan Kay Candiello, Esquire. However, HUSBAND is presently unrepresented by counsel. HUSBAND is cognizant of his right to legal representation and declares that he has chosen not to retain an attorney notwithstanding the fact that attorney for WIFE has told him that he has an absolute right to be represented by an attorney. HUSBAND has chosen instead to negotiate directly with counsel and/or with his WIFE. HUSBAND hereby acknowledges that he has done so willingly and he fully understands the facts and has been fully informed and understands that, had a Court decided this matter, he may have received more or less than is provided for in this Agreement. HUSBAND knowingly waives his rights, if any, to utilize the lack of his legal representation as a basis to attack the validity of this Agreement. Both parties further acknowledge and agree that each has fully disclosed their respective financial situations to the other, including their assets, liabilities and income. Each of the parties acknowledge and agree that, after having received such information and with such knowledge, this Agreement is fair, reasonable and equitable and that it is being entered into freely, voluntarily 5/12/2005 2 and in good faith and that the execution of this Agreement is not the result of any duress, undue influence, coercion, collusion and/or improper or illegal Agreement. 2. PERSONAL RIGHTS HUSBAND and WIFE may and shall, at all times hereafter, live separate and apart. Each shall be free from all control, restraint, interference or authority, direct or indirect, by the other in all respects as if she or he were unmarried, except as may be necessary to carry out the provisions of this Agreement. Each may reside at such place or places as she or he may select. Each may, for his or her separate use or benefit, conduct, carry on and engage in any business, occupation, profession or employment which to him or her may seem advisable. This provision shall not be taken, however, to be an admission on the part of either HUSBAND or WIFE of the lawfulness of the causes which led to, or resulted in, the continuation of their living apart. HUSBAND and WIFE shall not molest, harass, or malign the other or the respective families of each other, nor compel the other to cohabit or dwell in any manner with him or her, nor in any way interfere with the peaceful existence, separate from each other. 3. FINANCIAL DISCLOSURE The parties have fully disclosed to each other the extent of each otheros income, assets, liabilities, holdings and estate. Each party warrants that the information provided has fully and accurately described the extent of his or her holdings. Each of the parties acknowledge that he or she is aware of his or her right to seek discovery including, but not limited to, written interrogatories, motions for document production, depositions, and other means of discovery 5/12/2005 available through the Pennsylvania Rules of Civil Procedure. The parties acknowledge that they have had the right to have property fully appraised. Each party is fully satisfied that no additional information is necessary for the execution of this Agreement. 4. MUTUAL CONSENT DIVORCE The parties intend to secure a mutual consent, no fault divorce pursuant to the provisions of Section 3301(c) of the Divorce Code of 1980, as amended and will execute the documents necessary to effectuate a divorce under those provisions concurrently with the execution of this Agreement. The parties agree that the Affidavit of Consent and the Waivers of Notice shall be signed simultaneously with this Agreement. 5. SUBSEQUENT DIVORCE A decree in divorce, entered by the court of Cumberland County, shall not suspend, supersede or affect the terms of this Agreement. This Agreement, and the terms and conditions contained herein, as well as the enforcement of said terms and conditions, shall not be contingent upon the granting of a Divorce Decree to either party by the Court of Common Pleas of Cumberland County, Pennsylvania, or any other Court of competent jurisdiction. This Agreement shall remain in full force and effect even if the parties reconcile, cohabit as HUSBAND and WIFE, or attempt a reconciliation. This Agreement shall continue in full force and effect and there shall 5/12/2005 4 not be a modification or waiver of any of the terms hereof unless the parties, in a writing signed by both parties, execute a statement declaring this Agreement or any term of this Agreement to be null and void. Both parties hereto agree that this Agreement may be incorporated by reference but shall not be deemed merged into any judgment or decree for divorce obtained by either party. 6. OTHER DOCUMENTATION HUSBAND and WIFE covenant and agree that upon request of the other party, they will forthwith execute and deliver to the other party, any and all written instruments, assignments, releases, satisfactions, deeds, notes or such other writings as may be necessary or desirable for the proper effectuation of this Agreement. MUTUAL RELEASES Except as otherwise expressly provided by this Agreement, A. Each party hereby absolutely and unconditionally releases and forever discharges the other and the estate of the other for all purposes from any and all rights and obligations which either may have or at any time hereafter have for past, present or future support or maintenance, alimony pendente lite, alimony, equitable distribution, counsel fees, costs, expenses and any other right or obligation, economic or otherwise, whether arising out of the marital relationship or otherwise, including all rights and benefits under the Pennsylvania Divorce Code of 1980, its supplements and amendments, as well as under any other law of any other jurisdiction, except and only except all rights, agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. Neither party shall have any obligation to the other not expressly set forth herein. B. Each party hereby absolutely and unconditionally releases and forever discharges the other and his or her heirs, executors, administrators, assigns, property and estate from any and all rights, claims, demands or obligations arising out of or by virtue of the marital relationship of the parties or otherwise, whether now existing or hereafter arising. The above release shall be effective regardless of whether such claims arise out of any former or future acts, contracts, engagements or liabilities or the other or by way of dower, curtesy, widow's rights, family exemption or similar allowance, or under the intestate laws, or the right to take against the 5/12/2005 spouse's will, or the right to treat a lifetime conveyance by the other as testamentary, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of Pennsylvania, any state, commonwealth or territory or the United States, or any other country. It is expressly understood, however, that neither the provisions of this release nor the subsequent entry of a divorce decree are intended to defeat the right of either party to receive any insurance proceeds at the death of the other of which she or he is the named beneficiary (whether the beneficiary designation was made prior or subsequent to execution hereof), nor to defeat the right of either party to receive any legacy, bequest or residuary portion of the other's estate under his or her will, or to act as personal representative or executor if so named by the will of the other, whether such will was executed prior or subsequent to this Agreement. C. Except for any cause of action for divorce which either party may have or claim to have, and except for the obligations of the parties contained in this Agreement and such rights as are expressly reserved herein, each party gives to the other by the execution of this Agreement an absolute and unconditional release and discharge from all causes of action, claims, rights or demands whatsoever, in law or in equity, which either party ever had or now has against the other. 8. SUCCESSOR'S RIGHTS AND LIABILITIES This Agreement shall, except as otherwise provided herein, be binding upon and inure to the benefit of the parties hereto, their respective heirs, executors, administrators, successors or assigns. 9. SEVERABILITY If any provision in this Agreement is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the remaining provisions shall nevertheless continue in full force and effect without being impaired or invalidated in any way. 10. ENTIRE AGREEMENT HUSBAND and WIFE do hereby covenant and warrant that this Agreement contains all of the representations, promises and Agreements made by either of them to the other for the 5/12/2005 6 purposes set forth in the preamble hereinabove, that there are no claims, promises or representations not herein contained, either oral or written, which shall or may be charged or enforced or enforceable unless reduced to writing and signed by both of the parties hereto. 11. BINDING EFFECT OF AGREEMENT/WAIVER This Agreement shall remain in full force and effect unless and until terminated under and pursuant to the terms of this Agreement. The failure of either party to insist upon strict performance of the provisions of this Agreement shall not be construed as a waiver of any subsequent default of the same or similar nature, nor shall such failure be construed as a waiver of any other term, condition, clause or provision of this Agreement. 12. BREACH If either party breaches any provision of this Agreement, the other party shall have the right, at his or her election, to sue for damages for such breach or seek such other remedies or relief as may be available to him or her, and the party breaching this contract shall be responsible for payment of reasonable legal fees and costs incurred by the other in enforcing their rights under this Agreement. 13. CONTROLLING LAW This Agreement shall be construed and governed in accordance with the laws of the 5/12/2005 7 Commonwealth of Pennsylvania. SECTION II EQUTI'ABLE DISTRIBUTION During the marriage, the parties have accumulated various assets and liabilities, the disposition of which is intended as follows: 1. ASSETS A. PERSONAL and HOUSEHOLD PROPERTY HUSBAND and WIFE do hereby acknowledge that they have heretofore divided the non- marital and marital personal and household property, including but without limitation, jewelry, clothes, furniture, and other assets. HUSBAND agrees that all assets in possession of WIFE shall be the sole and separate property of WIFE except the rocking chair (which shall be given to HUSBAND upon the condition it will be gifted to the parties' son, Benedikt Joseph Ford and not sold). WIFE agrees that all assets in possession of HUSBAND shall be the sole and separate property of HUSBAND. Each of the parties do hereby specifically waive, release, renounce and forever abandon whatever claims, if any, he or she may have with respect to any of the above said items which are the sole and separate property of the other. This document shall constitute a bill of sale for said sole property. B. REAL ESTATE The parties jointly own property at 910 Hawthorne Avenue, Mechanicsburg, Cumberland 5/12/2005 County, Pennsylvania. Said house is encumbered by a mortgage held by Sovereign Bank in the approximate amount of ONE HUNDRED THIRTY THOUSAND DOLLARS ($130,000.00). WIFE desires to maintain said home and reside therein. HUSBAND agrees to transfer all his rights, title and interest in the home to WIFE. HUSBAND agrees to execute a quitclaim deed at the time of signing this Agreement. WIFE agrees to be solely responsible for payment of the past, present and future principle, interest, penalties and costs related to the mortgage due and owing to Sovereign Bank and all other taxes, insurance, assessments or any other cost or expense related to the home. WIFE hereby agrees to indemnify and hold HUSBAND harmless from any and all liability as a result of non-payment of the mortgage or any other obligations as enumerated above associated with the real estate. HUSBAND and WIFE have each filed bankruptcy and HUSBAND has been totally discharged from all obligations related to the house, including his mortgage obligations. C. MOTOR VEHICLES The parties acknowledge that there were two marital vehicles acquired during the marriage, one being a 1995 Ford Aspire and a 2001 Volkswagen Jetta. The 1995 Ford Aspire is not encumbered and driven by WIFE. WIFE shall retain sole ownership and possession of said vehicle. HUSBAND agrees to transfer title of the vehicle to WIFE and hereby releases all claims to the vehicle. HUSBAND shall retain sole ownership and possession of the 2001 Volkswagen Jetta as his separate property. HUSBAND agrees that he shall be solely responsible for the repayment of the loan encumbering the 2001 Volkswagen Jetta. HUSBAND agrees to indemnify 5/12/2005 9 and hold WIFE harmless for any and all costs and expenses related to satisfaction of this loan obligation, including all costs, interest, losses incurred by WIFE, including reasonable counsel fees, to defend any such claims or to enforce this indemnification. D. FINANCIAL ASSETS The parties have previously divided all joint checking, savings and any other financial account to the satisfaction of both parties. Any and all other individual bank accounts shall remain in the possession of the individual it is titled to. E. PENSION. EMPLOYMENT AND RETIREMENT ACCOUNTS The parties have investments with Prudential Securities. These Accounts are No. 044- R42650-G9 and is titled in WIFE's name; and Account Nos. 044-R42668-G9, 044-R68063-G9 and Account No. 044-293161-G9 which are titled in HUSBAND's name. The parties agree all assets held by Prudential Securities be the sole and separate property of WIFE. HUSBAND waives all rights, title and interest in said accounts. Transfer of HUSBAND's accounts shall be transferred to WIFE so as to effectuate no loss of value. WIFE's counsel shall draft and enter as a court order a Qualified Domestic Relations Order (QDRO) as may be necessary to effectuate a full transfer to WIFE's name. All costs to draft and submit the QDRO shall be borne by HUSBAND. HUSBAND has certain pension benefits through the Commonwealth of Pennsylvania as a result of his current employment which had contributions as of date of separation of EIGHT THOUSAND DOLLARS ($8,000.00). WIFE waives any and all claims to said pension or 5/12/2005 10 employment benefits. HUSBAND also receives certain disability payments (V.A. Pension and Military Pension). WIFE waives any and all claims to said benefits, except as such may be used in the calculation of child support. F. INSURANCE Each party shall retain ownership of any life insurance policy in his or her name. HUSBAND agrees that he shall name WIFE as beneficiary of a life insurance policy of at least THIRTY THOUSAND DOLLARS ($30,000.00), as long as alimony is due and payable to her by HUSBAND. HUSBAND shall provide WIFE with annual proof of the existence of the policy and its current paid status. 2. DEBTS Each party represents that they have not contracted any debt or liability for the other for which the estate of the other parry may be responsible or liable except as otherwise provided herein, and that except only for the rights arising out of this Agreement, neither party will hereafter incur any liability whatsoever for which the other party or the estate of the other party will be liable. Each party agrees to indemnify and hold harmless from and against all future obligations of every kind incurred by them, including those for necessities. The parties acknowledge that numerous marital debt exists, including but not limited to the following: Members 1st Service Loan (7T) PSL-Credit Line/01 (3,506.26) 5/12/2005 11 America Online Visa (7T) $ (15,023.00) Account No. 4417 1284 9616 2403 Office Max (H) $ (315.65) Account No. 6011 6172 1017 1604 Sam's Club (H) $ (453.29) Account No. 77 1042 748749 1 Discover Card (H) $ (5,849.86) Account No. 6011 0023 2073 9683 Circuit City (H) $ (2,496.62) Account No. 1523 0034 6870 2717 Members 1st Federal Credit Union Visa (ST) $ (5,379.57) Account No. 4121 4499 9626 3773 Wife's Additional Account $ (3,000.00) Home Depot ?? Each party has filed for bankruptcy and these debts have been discharged incident to those proceedings. SECTION III CHILD SUPPORT AND ALIMONY 1. CHILD SUPPORT Child Support, health insurance and contribution to non-reimbursed medical expenses shall continue in accordance with the PACSES Case No. 365105884, Cumberland County Docket No. 545 1992. Each party acknowledges that this calculation is subject to modification upon petition by either party subject to the terms set forth below in paragraph 2. 5/12/2005 12 2. ALIMONY Upon entry of the Decree in Divorce, HUSBAND shall pay to WIFE the sum of FOUR HUNDRED SIXTY-EIGHT DOLLARS ($468.00) per month for sixty (60) months as alimony. This sum shall be due on or about the first day of each month. This amount shall not be modifiable in amount for any reason except for the death of either party. It is further agreed that payment of this sum shall not be includable in the income of WIFE or deducted from income of HUSBAND for calculation of child support for Benedikt. This sum shall be due and payable for a fixed term of sixty (60) months by HUSBAND. This term shall be non-modifiable. 3. COUNSEL FEES Each party will bear their legal costs and expenses. SECTION IV 1. CONDITION PRECEDENT TO THE AGREEMENT'S EFFECTIVENESS The parties acknowledge that this Agreement shall become effective when actually signed by both parties. WITNESS &i WITNESS 5/12/2005 13 COMMONWEALTH OF PENNSYLVANIA ) ) SS. COUNTY OF ) Before me, the undersigned officer, a Notary Public in and for said Commonwealth and County, personally appeared Wayne S. Ford, who being duly affirmed according to law, deposes and says that the facts and matter set forth in the within and foregoing Marital Settlement Agreement are true and correct to the best of his knowledge, information and belief. Affirmed and subscribed to before me this /? day of 2005. 40TARY COMMONWEALTH OFPENNSYLV No?rfel Seel Eric M My commission expires. Caffol D. y (SEAL) wp. My Cor?n E,?ires Mey 21, 2006 Member, Pennsylvania Asaxletbn OI NolnNe COMMONWEALTH OF PENNSYLVANIA ) ) SS. COUNTY OF CUMBERLAND ) Before me, the undersigned officer, a Notary Public in and for said Commonwealth and County, personally appeared Gabriele S. Ford, who being duly affirmed according to law, deposes and says that the facts and matter set forth in the within and foregoing Marital Settlement Agreement are true and correct to the best of her knowledge, information and belief, e an subscribed to before me thisc `I day of 2005. OTARY PUBLIC My commission expires: (SEAL) No NL SEN SNOW SUMPIE-SUUNAN No" PUM NEWCUMEENLAW IoROUGH CUMBERlAW COUNtY ConwrMrlon Nw 15, 2007 5/12/2005 14 _l AE;- V? V WAYNE SCOTT FORD, Plaintiff VS. GABRIELLE SABINE FORD, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 03 - 2866 CIVIL IN DIVORCE ORDER OF COURT AND NOW, this 4/tj- day of 2005, the economic claims raised in the pro edings having been resolved in accordance with a marital settlement agreement dated May 24, 2005, the appointment of the Master is vacated and counsel can file a praecipe transmitting the record to the Court requesting a final decree in divorce. BY THE COURT, cc: Susan Kay Candiello Attorney for Plaintiff Barbara Sumple-Sullivan Attorney for Defendant A AA 41r 141j"ff Ge g o f P J. e? h,? L D 3 0.? 0 C.Mti. VNVA7 ASNN3d 2C :01 NV £- NAr S007 AbViQNC WQUd 3H1 d0 3OL-L40-t13113 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 WAYNE SCOTT FORD, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA V. NO: 2003 - 2866 CIVIL GABRIELE SABINE FORD, Defendant CIVIL ACTION - LAW IN DIVORCE PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Transmit the record, together with the following information, to the court for entry of a divorce decree: 1. Ground for divorce: Irretrievable breakdown under §3301(c) of the Divorce Code. 2. Date and manner of service of the complaint: Acceptance of Service on July 7, 2003. 3. Date of execution of the Affidavit of Consent required by § 3301(c) of the Divorce Code: by Plaintiff: May 16, 2005; by Defendant: May 24, 2005. 4. Related claims pending: All matters have been resolved pursuant to the Marital Settlement Agreement reached by the parties dated May 24, 2005 and incorporated, but not merged, into the Decree. See paragraph 5, page 4 of the Agreement. 5. Date Plaintiffs Waiver of Notice in §3301(c) Di, rce as filed with Prothonotary: May 31, 2005. Date Defendant's Waiver of Notice in §33 (c Divorce was filed with Prothonotary: May 31, 2005. Dated: May, 2005 / Barbara Sumple-Sullivan, Esquire fff?» 549 Bridge Street New Cumberland, PA 17070-1931 (717)-774-1445 Supreme Court ID #32317 Attorney for Defendant Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO: 2003 - 2866 CIVIL GABRIELE SABINE FORD, Defendant CIVIL ACTION -LAW IN DIVORCE CERTIFICATE OF SERVICE I, Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served a true and correct copy of the foregoing Plaintiffs Praecipe to Transmit Record, in the above-captioned matter upon the following individual by first class mail, postage prepaid, addressed as follows: Mr. Wayne S. Ford P.O. Box 226 Grantham, PA 17027 DATED: May 1 2005 i Barbara Sumple-Sulliva Esn Esq tiro e 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Supreme Court I.D. No. 32317 Attorney for Defendant r T ) Ct? G mm Una ?`? ? 'O C; ' n 7> C h? j4 IN THE COURT OF COMMON PLEAS WAYNE SCOTT FORD, OF CUMBERLAND COUNTY STATE OF y PENNA. F '? r Plaintiff VERSUS GABRIELE SABINE FORD, Defendant DECREE IN DIVORCE AND NOW, DECREED THAT AND 7L-? R WAYNE SCOTT FORD GABR= SABINE FORD ARE DIVORCED FROM THE BONDS OF MATRIMONY. PLAINTIFF, ,DEFENDANT, THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT YET BEEN ENTERED; All matters have been resolved Pursuant to the Marital Settlement Agreement reached by the parties dated May 24, 2005 and incorporated, but not merged, into the Decree. 2005 IT IS ORDERED AND ATTEST: J. • r PROTHONOTARY N 0. 2003 - 2866 4A' 137 r #V/ ? y r 3 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 09/12/05 Case Number (See Addendum for case summary) 136107440 03-2866 CIVIL O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice EmployerA'Vithholder's Federal EIN Number COMMONWEALTH OF PA C/O PAYROLL OPERATIONS ATTACHMENTS RESEARCH UNIT PO BOX 8006 HARRISBURG PA 17105-8006 RE: FORD, WAYNE S. Employee/Obligor's Name (Last, First, MI) 365105884 166-62-7533 545 S 92 Employee/Obligor's Social Security Number 8345101232 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. $ 968. 00 per month in current support $ o . oo per month in past-due support Arrears 12 weeks or greater? Q yes ® no $ o. 00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 968.00 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: $ 223 .38 per weekly pay period. $ 446.77 per biweekly pay period (every two weeks). $ 484. oo per semimonthly pay period (twice a month). $ 968. o0 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten 00) 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 i needed (See #9 on page 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S 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 E U Date of Order: SEP 1 3 2005 P• George E. Hoffer, P. Judge DRO: R.J. Shadday Form EN-028 Service Type M OM3 NO.:097(WI54 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 ofWithhokfing:-You niustreport-the-paydate/date-otwrthhohimg-when-senomgme-payrrrert --1ne-- paydate/date of withholding is the-date ortwhich -amount -was-withheM-from-the empfagee`swager. 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: 2321722990 EMPLOYEE'S/OBLIGOR'S NAME: FORD WAYNE S. EMPLOYEE'S CASE IDENTIFIER: 8345101232 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 fordischarging 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, 09)0-0154 Form EN-028 Worker ID SIATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FORD, WAYNE S. PACSES Case Number 136107440 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 03-2866 CIVIL$ 468.00 Child(ren)'s Name(s): DOB PACSES Case Number 365105884 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 545 S 1992 $ 500.00 Child(reN's Name(s): DOB BENEDIKT J. FORD 07/15/90 ? 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 ?lf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the childuren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT oma No, 0970 0154 .. ?., ?? - I., W ?? 1 ?,? - I -, '.1 i -r': ?'j-? . ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 63 _ , V&b O V I L State Commonwealth of Pennsylvania 3(p51 ()?? 0original Order/Notice Co./City/Dist. of CUMBERLAND 15 5 O Amended Order/Notice Date of Order/Notice 12/26/06 T O Terminate Order/Notice Case Number (See Addendum for case summary) RE: FORD, WAYNE S. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) BUREAU OF COMMONWEALTH C/O PAYROLL OPERATIONS ATTACHMENTS RESEARCH UNIT PO BOX 8006 HARRISBURG PA 17105-8006 166-62-7533 Employee/Obligor's Social Security Number 8345101232 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. $ 1, 015.00 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 $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 1, 015.00 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: $ 234.23 per weekly pay period. $ 468.46 per biweekly pay period (every two weeks). $ 507.50 per semimonthly pay period (twice a month). $ 1.015.00 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 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: DEC 2 6 2005 BY THE COURT: Form EN-028 Rev. Service Type M OMB No.: 0970-0154 Worker ID 21205 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecke? you are required to provide a opy of this form to your mployee. If your employee works in a state that is dierent from the state that issued this or er, 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.* pdyddte/date of withholding is t a ie date on which amount was withheld froin the employee's Yvar You must comply with the law of the ges. 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: 2321722990 EMPLOYEE'S/OBLIGOR'S NAME: FORD, WAYNE S. EMPLOYEE'S CASE IDENTIFIER: 8345101232 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. I i.Submitted By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev. 1 Service Type M OMBNo.:0970.0154 Worker ID 21205 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FORD, WAYNE S. PACKS Case Number 136107440 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 03-2866 CIVIL$ 468.00 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 365105884 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 545 S 1992 $ 547.00 Child(ren)'s Name(s): DOB BENEDIKT J. FORD 07/15/90 ? 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. Service Type M 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. Addendum OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker ID 21205 n ^? CD N ?i,l Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, Plaintiff V. GABRIELE SABINE FORD, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 03-2866 CIVIL ACTION -LAW CUSTODY MOTION TO WITHDRAW APPEARANCE 1. Petitioner is counsel for Defendant in the above captioned matter, Gabriele Sabine Ford. 2. Defendant is presently residing at 910 Hawthorne Avenue, Mechanicsburg, Cumberland County, Pennsylvania 17055., 3. Defendant has failed to cooperate with the requests of counsel. 4. Defendant has failed to make payment on her outstanding legal fees since June 1, 2006 and has an outstanding balance of One Thousand One Hundred Forty-Eight Dollars and 98/100 ($1,148.98) as of January 18, 2007. WHEREFORE, counsel for Defendant requests leave of court to withdraw representation on behalf of Gabriele Sabine Ford in the above-captioned matter. y su*itted, Dated: January 29, 2007 B& r?T'Slumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Supreme Court I.D. 32317 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 03-2866 GABRIELE SABINE FORD, CIVIL ACTION -LAW Defendant CUSTODY CERTIFICATE OF SERVICE I, BARBARA SUMPLE-SULLIVAN, ESQUIRE, do hereby certify that on this date I served a true and correct copy of the :Motion to Withdraw in the above-captioned matter upon the following individual(s) by United States first-class mail, postage prepaid, addressed as follows: Ms. Gabriele S. Ford 910 Hawthorne Avenue Mechanicsburg, PA 17055 DATE: January 29, 2007 Mr. Wayne S. Ford 480 Musser Road Shippensburg, PA 17257 Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 03-2866 GABRIELE SABINE FORD, Defendant CIVIL ACTION -LAW CUSTODY RULE AND NOW, this day of F4PW7? , 2007 on consideration of the Motion to Withdraw Appearance, a RULE is issued on Plaintiff and Defendant to show cause, if any, why the Court should not grant the relief requested. The Rule is returnable within y v days from the date of service hereof. J. ' a f JG ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania 3 jp j 1 U5-?4 Co./City/Dist. of CUMBERLAND 54 5 S Date of Order/Notice 02/21/07 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number BUREAU OF COMMONWEALTH C/O PAYROLL OPERATIONS ATTACHMENTS RESEARCH UNIT PO BOX 8006 HARRISBURG PA 17105-8006 166-62-7533 Employee/Obligor's Social Security Number 8345101232 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. $ 1, 046.00 per month in current support $ 0. 00 per month in past-due support Arrears 12 weeks or greater? Dyes 0 no $ 0.00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 1, 046.00 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: $ 241.3 8 per weekly pay period. $ 482.77 per biweekly pay period (every two weeks). $ 523, oo per semimonthly pay period (twice a month). $ 1.046. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten 00) 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: FEB 2 2 2007 rl CIVIL O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: FORD, WAYNE S. Employee/Obligor's Name (Last, First, MI) BY THE COURT: tx - L Form EN-028 Rev. ' Service Type M OMS No.: 097"154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If heckeff you are required to provide a?opy of this form to your?mployee. If yo?r employee works in a state that is di Brent TTrom the state that issueedd this o er, a copy must be provi eccii to your emp oyee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydateffiate of Withhomeling. You must report the paydate/date of withholding when sending the payment. The paydateldate of withholding is the date on which anivant was Withheld fron, 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: 2321722990 EMPLOYEE'S/OBLIGOR'S NAME: FORD WAYNE S EMPLOYEE'S CASE IDENTIFIER: 8345101232 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. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act 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 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 $IATT OMB No.: 0970-0154 ADDENDUM Summary of Cases on Attachment Defendant/Obligor. FORD, wAYNE s. PACSES Case Number 136107440 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 03-2866 CIVIL$ 468.00 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 365105884 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 545 S 1992 $ 578.00 Child(ren)'s Name(s): DOB BENEDIKT J. FORD 07/15/90 ? 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) ? 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 $zATT OMB No.: 09704)154 Barbara Sumple-Sullivan., Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA GABRIELE SABINE FORD, Defendant NO. 03-2866 CIVIL ACTION -LAW CUSTODY PETITION TO MAKE RULE ABSOLUTE Petitioner is counsel for Defendant, Barbara Sumple-Sullivan, Esquire. 2. Respondent is Defendant, Gabriele Sabine Ford. 3. Petitioner is requesting allowance to withdraw from the matter due to Respondent's failure to cooperate with the requests of counsel and failure to make payment on her outstanding legal fees since June 1, 2006. 4. On January 29, 2007, Petitioner filed a Motion to Withdraw her Appearance in this action. 5. On February 1, 2007, Judge Edward E. Guido issued a Rule returnable in Twenty (20) days upon Plaintiff and Defendant to show cause why the Motion to Withdraw Appearance should not be granted. 6. Said Rule was served upon Plaintiff and Defendant by letters dated February 2, 2007. True and correct copies of same are attached hereto as Exhibit A. 7. No timely answer or other response was filed to said Rule by Plaintiff or Defendant. 8. Petitioner requests that the Rule issued on February 2, 2007 be made absolute and Petitioner shall be allowed to withdraw from the matter. WHEREFORE, Petitioner requests the Rule be made absolute. DATE: February 23, 2007 f` Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 Exhibit A LAiv 0FFIcEs, BARBARA SU_1IPLE-SULLIVA-- 549 BRIDGE STREET '_?EW CUMBERLAND, PEN-- SIL-%:ANI_k 17070-1931 PHO\E (717) 774-1445 FAX (717) 774-70.59 February 2, 2007 Ms. Gabriele S. Ford 910 Hawthorne Avenue Mechanicsburg, PA 17055 Re: Rule to Show Cause Dear Gabb v: Enclosed constituting ser`rice on you is a Rule for your response. Please note your response is due within twenty (20) days. Barbara Sumple-Sullivan BSS/1h Enclosure Barbara SUmpie-Sullivan. Esquire Supreme Court r3?317 549 Bride Street ?vets- Cumberland. PA 17070 ('71-) 7-41-144'; WAYNE SCOTT FORD. Plaintiff V. GABRIELE S AI3PNE FORD, Defendant IN THE C'O'URT OF COMMON ` j5 CUMBERLAND COUNTY, PEA ti r V ti L-k : NO. 03-1866 CIVIL ACTION - LAW CUSTODY RULE AND NOW, this t day of ? 00 on eons ciera6on of the Motion to Withdraw Appearance, a RULE is issued o,,-.z Plaintiff and Defendant to show cause. it any, why the Court shculd not grant the relief requested. he Rule is returnable within days from the date of service- hereof. B17 THE COURT: J. E COPY FROM RECORu ind the SOW of said Carksie4 Pe. r LAiv OFFICES BARBARA, SUMPLIE-SULLIV N 549 BRII GY STREET NE,A' CUMBERLAND, PENNSYLVANIA 17070-1931 PHONE (717) 774-1445 FAX (717) 774-7659 February 2, 2007 Mr. 'Wayne S. Ford 480 .Masser Road Shippensburg, PA 1727 Re: Rule to Show Cause Dear Mr. Ford: Enclosed constituting service on you is a Rule for your response if aoI-i plan on contesting the motion of my wit?drawal. S: Barbara Suinple-Sullivan B S S,'Ih Enclosure Bar7ara Sumpte-Sulli-van. Esquire Supreme Court N3231 7 `149 B-dac 'Street New Cum"Derland_ PA 1707 0 (717 774-114 WAYNE SCOTT FORD. PN THE <7 0UR - F COMMON Pr ? '? S Plaintiff CUVIBER.LAtiD COUNTY. Pa---'\NS` "L ?ANLk v. : 'N, 0. 03-?856 GABRIE F SABlI E FORD. CIVIL ACTION - LA,' Defendant. CUSTOE,-Y RULE AND NO'W, this day of 007 on consider, von of tine Motion to Withdraw Appearance, a RULE is issued on Plaintiff and Dei=erld:-nt to sho«- cause.f any, why the Court should not grant the relief requested. f! 9"\ Tile Rule is returnable within' days from the date of ser-vic-e hereof. BY THE COURT: M y where®t„ -tere- unto set rq hanc nd the seat a said r. at Gwft, Pa. A? -7`77 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENN SYLVANIA • NO. 03-2866 GABRIELE SABINE FORD, CIVIL ACTION -LAW Defendant CUSTODY CERTIFICATE OF SERVICE I, BARBARk SUMPLE-SULLIVAN, ESQUIRE, do hereby certify that on -this date I served a true and correct copy of the Petition to Make Rule Absolute in the above-captioned matter upon the following individual(s) by United States first-class mail, postage prepaid, addressed as follows: Ms. Gabriele S. Ford 910 Hawthorne Avenue Mechanicsburg, PA 17055 DATE: February 23, 2007 Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 FEa:e2om ,eC/ Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 WAYNE SCOTT FORD, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. GABRIELE SABINE FORD, Defendant : NO. 03-2866 CIVIL ACTION -LAW CUSTODY ORDER AND NOW, this 4!?day of 1044.1 upon consideration of the Petition _ to Make Rule Absolute, said Petition is hereby GRANTED. It is further ORDERED and DECREED that Barbara Sumple-Sullivan, Esquire is withdrawn as counsel for Defendant, Gabriele Sabine Ford. BY THE COURT: J. Edward E. Guido ti rtiVI?I t? C i :I ! 14 I - NVW LOOZ 3A jo ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania 365105884 Co./City/Dist. of CUMBERLAND 545 S 92 Date of Order/Notice 01/09/08 Case Number (See Addendum for case summary) E m p loyer/With holder's Federal EIN Number BUREAU OF COMMONWEALTH* C/O WAGE ATTACHEMENT SECTION PO BOX 8006 HARRISBURG PA 17105-8006 136107440 03-2866 CIVIL O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: FORD, WAYNE S. Employee/Obligor's Name (Last, First, MI) 166-62-7533 Employee/Obligor's Social Security Number 8345101232 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. $ 996.00 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 $ 996.00 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: $ 229.85. per weekly pay period. $ 459.69.per biweekly pay period (every two weeks). $ 498.00 per semimonthly pay period (twice a month). $ 996. 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: JAN 10 2008 N -t ??4 ? M. L. EBERT, JR., JUDGE DRO: R.J. SHADDAY Form EN-028 Rev. 1 Service Type M OMB No.: 0970-0154 Worker I D $ IATT 0.0 0•* 9 9.6 , x 12- 52 0 229485* x q1?? 9960 12- + 26. 459•b9* -- ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecke? you are required, to provide a opy of this form to your m loyee. If yo r employee works in a state that is diferent from the state that issued this or?er, a copy must be provigedpto your emplyoyee 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 Wit -i old 11111 Ul IMNIL. lit: 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: 2321722990 EMPLOYEE'S/OBLIGOR'S NAME: FORD WAYNE S. EMPLOYEE'S CASE IDENTIFIER: 8345101232 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. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act 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 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 $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FORD, WAYNE S. PACSES Case Number 136107440 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 03-2866 CIVIL$ 468.00 Child(ren)'s Name(s): DOB PACSES Case Number 365105884 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 545 S 1992 $ 528.00 Child(ren)'s Name(s): DOB BENEDIKT J. FORD 07/15/90, ? 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. 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) EJ 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"? c.,.- gym. ..M rl C1°? o _l rt 03-2866 CIVIL ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania 365105884 Co./City/Dist. of CUMBERLAND 545 S 92 Date of Order/Notice 02/28/08 Case Number (See Addendum for case summary) E m ployer/With holder's Federal EIN Number BUREAU OF COMMONWEALTH* C/O WAGE ATTACHMENT SECTION PO BOX 8006 HARRISBURG PA 17105-8006 166-62-7533 Employee/Obligor's Social Security Number 8345101232 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. $ 1, 006. 00 per month in current support $ 1. 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 $ o . 00 per month for genetic test costs $ 0.00 per month in other (specify) for a total of $ 1, 007.00 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: $ 124.38 per weekly pay period. $ 248.77 per biweekly pay period (every two weeks). $ 503.50 per semimonthly pay period (twice a month). $ 1, 007. 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 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: FEB 2 9 2008 DRO: R. J. SHADDAY Service Type M O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: FORD, WAYNE S. Employee/Obligor's Name (Last, First, MI) h -t ?1-4 ? M.L. EBERT, JR., Form EN-028 Rev. 1 OMB No.: 0970.0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecketi you are required to provide copy of this form to your m loyee. If yo r employee %e in a state tha is di Brent rrom the state that issued this o er, a copy must be provi?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 Paydat&Bate of Withholding. You must report the paydate(date of withholding when sendinTs the payment. paydate/date of withholding is the date on which amount was Withheld fiorn the employee's . 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 employeelobligor 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: 2321722990 EMPLOYEE'S/OBLIGOR'S NAME: FORD, WAYNE S. EMPLOYEE'S CASE IDENTIFIER: 8345101232 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. I I.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 $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FORD, WAYNE S. PACKS Case Number 136107440 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 03-2866 CIVIL$ 468.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name PACSES Case Number 365105884 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 545 S 1992 $ 539.00 Child(ren)'s Name(s): DOB BENEDIKT J. FORD 07/15./90 ? 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 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) ? 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 OMB No.:0970-0154 $IATT t""? ra > f."a? s,, ? t -} -?'P ?, 03-2866 CIVIL ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania 365105884 O Original Order/Notice Co./City/Dist. of CUMBERLAND 545 S 92 O Amended Order/Notice Date of Order/Notice 03/26/08 O Terminate Order/Notice Case Number (See Addendum for case summary) RE: FORD, WAYNE S . EmployerNVithholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 166-62-7533 Employee/Obligor's Social Security Number BUREAU OF COMMONWEALTH* 8345101232 C/O WAGE ATTACHEMENT SECTION Employee/Obligor's Case Identifier PO BOX 8006 (See Addendum for plaintiff names HARRISBURG PA 17105-8006 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. $ 1, 007. oo per month in current support $ o. oo per month in past-due support Arrears 12 weeks or greater? Oyes 0 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 $ 1, 007.00 per month to be-To-rw--ar-ded to payee 595W. 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: $ 232.38 per weekly pay period. $ 464.77 per biweekly pay period (every two weeks). $ 503.50 per semimonthly pay period (twice a month). $ 1, 007. 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: MAR 2 6 200$ DRO: R.J. SHADDAY RT: BY THE COV _t QL4 M. L. EBERT, JR., JUDGE Form EN-028 Rev. Service Type M OMB No.: 0970-0154 Worker ID 21205 1 2 • `? .tx gyp tt,7 . X 26' 464'71* ,. ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecke? you are required to provide a copy of this form to your employee. If yo r employee works in a state that is di Brent 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 empioyee%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; 2321722990 EMPLOYEE'S/OBLIGOR'S NAME: FORD WAYNE S. EMPLOYEE'S CASE IDENTIFIER: 8345101232 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: DOMESTIC RELATIONS SECTION 13 N. HAN VER 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) 240-6225or 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 21205 ADDENDUM Summary of Cases on Attachment DefendanUObligor: FORD, WAYNE S. PACSES Case Number 136107440 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 03-2866 CIVIL$ 468.00 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'stobligor'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 365105884 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 545 S 1992 $ 539.00 Child(ren)'s Name(s): DOB BENEDIKT J. FORD 07/15/90 ?Ifchecked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee'slobligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? 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 Service Type M OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker ID 21205 r n ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 03-2866 CIVIL State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 04/06/09 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number BUREAU OF COMMONWEALTH* C/O WAGE ATTACHMENT SECTION PO BOX 8006 HARRISBURG PA 17105-8006 365105884 OOriginal Order/Notice 545 S 92 OAmended Order/Notice OTerminate Order/Notice OOne-Time Lump Sum/Notice RE: FORD, WAYNE S. Employee/Obligor's Name (Last, First, MI) 166-62-7533 Employee/Obligor's Social Security Number 8345101232 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 $ 0.00 $ 0.00 $ 0.00 $ 468.00 $ 0.00 $ 0.00 $ 0.00 per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) one-time lump sum payment for a total of $ 468.00 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: $ 108 -00 per weekly pay period. $ 234.00 per semimonthly pay period (twice a month) $-----.L6 - 00 per biweekly pay period (every two weeks) $ 468.00 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. 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 MEM8ER 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. DRO: R.J. Shadday Service Type M OMB No.: 0970-0154 Arrears 12 weeks or greater? O yes Q no M. L. Ebert, Jr., Judge Form EN-028 Rev. 4 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS 0 If 4hecked you are required to provide a copy of this form to your employee. If your employee works in a state that is di erent from the state that issued this order, a copy must be provide 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 possib.le. (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. 2321722990 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: O EMPLOYEE'S/OBLIGOR'S NAME: FORD, WAYNE S. EMPLOYEE'S CASE IDENTIFIER: 8345101232 LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: NEW EMPLOYER'S NAME/ADDR DATE OF SEPARATION: 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 employeelobligor 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 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at 717 240-6225 or P.O. BOX 320 CARLISLE PA 17013 by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev. 4 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FORD, WAYNE S. PACSES Case Number 136107440 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 03-2866 CIVIL$ 468.00 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 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev. 4 Service Type M OMB No.: 0970-0154 Worker ID $IATT FIL ED -f =riICE TARY 2009 APR -3 Ph 3: 04 CVV 0!T, ." ' ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 03-2866 CIVIL State Commonwealth of Pennsylvania OOriginal Order/Notice Co./City/Dirt. of CUMBERLAND OAmended Order/Notice Date of Order/Notice 08/03/09 XOTerminate Order/Notice Case Number (See Addendum for case summary) UOne-Time Lump Sum/Notice Employer/Withholder's Federal EIN Number BUREAU OF COMMONWEALTH* C/O WAGE ATTACHMENT SECTION PO BOX 8006 HARRISBURG PA 17105-8006 166-62-7533 Employee/Obligor's Social Security Number 8345101232 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'stobligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 $ $ 0.00 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ for a total of $ Arrears 12 weeks or greater? O yes 0 no 0 . 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: $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period (twice a month) $-------2 - 00 per biweekly pay period (every two weeks) $ o. 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. S 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: M. L. Ebert, Jr., JudgED per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) one-time lump sum payment RE: FORD, WAYNE S. Employee/Obligor's Name (Last, First, MI) DRO: R.J. Shadday Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker I D $ IATT d ? 5? ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If #heckep you are required, to per?vi lea opy of this form to yourswloyee. If yoyr employee %rks in a state that is di Brent rom the state that issu this o er, a copy must be provi to your employee even if t (e box is not checked 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* 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 employeetobligor 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. 2321722990 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: O EMPLOYEE'S/OBLIGOR'S NAME: FORD, WAYNE S. EMPLOYEE'S CASE IDENTIFIER: 8345101232 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT: 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 employeelobligor 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 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 CARLISLE PA 17013 by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/obligor: FORD, WAYNE S . PACKS Case Number 136107440 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 03-2866 CIVIL$ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Service Type M Addendum OMB No.: 0970-0154 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ..................... PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Form EN-028 Rev.5 Worker I D $ IATT AL G--t ICE - ,G , ARY M9 A G --ti lih 2: 1 J C Jti "y . ?, _'?, ice. ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 03-2866 CIVIL State Commonwealth of Pennsylvania OOriginal Order/Notice Co./City/Dist. of CUMBERLAND OAmended Order/Notice Date of Order/Notice 08/05/09 (Terminate Order/Notice Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice RE: FORD, WAYNE S. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 166-62-7533 Employee/Obligor's Social Security Number BUREAU OF COMMONWEALTH* 8345101232 C/O WAGE ATTACHMENT SECTION Employee/Obligor's Case Identifier PO BOX 8006 (See Addendum for plaintiff names HARRISBURG PA 17105-8006 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 $ o . oo per month in past-due child support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in current medical support $ o. oo per month in past-due medical support $ 468.00 per month in current spousal support $ o . oo per month in past-due spousal support $ 0.00 per month for genetic test costs $ o. oo per month in other (specify) $ one-time lump sum payment for a total of $ 468.00 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 suooort payment cycle, use the following to determine how much to withhold: $ 108.00.__ per weekly pay period. $ 234.00 per semimonthly pay period (twice a month) $ 216.00 per biweekly pay period (every two weeks) $ 468.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDE TO BE PROCESSED. DO NOT SEND CASH BY MAIL. r . BY THE COURT: M !T DRO: R.J. Shadday Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If hecke you are required to provide a opy of this form to your m loyee. If your employee %e in a state that is di erent frrom the state that issued this or?er, a copy must be provi?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 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. 2321722990 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME: FORD, WAYNE S. EMPLOYEE'S CASE IDENTIFIER: 8345101232 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT: 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 (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FORD, WAYNE S. PACSES Case Number 136107440 PACSES Case Number Plaintiff Name Plaintiff Name GABRIELE S. FORD Docket Attachment Amount Docket Attachment Amount 03-2866 CIVIL$ 468.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT f _ ? 7 I'{ ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 03-2866 CIVIL State Commonwealth of Pennsylvania OOriginal order/Notice CO./City/DiSt. Of Ct7PRBERLAND OAmended Order/Notice Date Of Order/Notice 08/09/10 OTerminate Order/Notice Case Number (See Addendum for case summary) QOne-Time Lump Sum/Notice RE: FORD, WAYNE S . Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, Mp 166-62-7533 Employee/Obligor's Social Security Number BUREAU OF COMMONWEALTH* 8345101232 C/O WAGE ATTACHMENT SECTION Employee/Obligor's Case Identifier PO BOX 8 0 0 6 (See Addendum for plaintiff names HARRISBURG PA 1710 5 - 8 0 0 6 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 cut~ERLAND 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 child support $ o.oo per month in past-due child .support Arrears 12 weeks or greaten' Dyes ~ o $ o. oo per month in current medical support ~ ..'~ _._ ~__, $ o.oo per month in past-due medical support __ ~ cs. _, $ o . oo per month in current spousal support ` .~T -T, $ o. oo per month in past-due spousal support `' C '~`'- $ o . oo per month for genetic test costs _ ~, d ~' $ o. oo per month in other (specify) ,,,~ $ one-time lump sum payment _ ,.. , ~j 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 incompliance 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 semimonthly pay period (twice a month) $ o . oo per biweekly pay period (every two weeks) $ o . oo per monthly pay period. BY THE COURT: ~ ~, 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 pavment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER 1N ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. ~ \ ~ DRO: R.J. Shadt3ay Service Type M M. L. Ebert, Jr. , Jlxige OMB No.: 0970-0154 Form E N-028 Rev.5 Worker I D $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ~ If ~heckesl you are n~quired, to pr ide a~opy of this form to your m loyee. If yorr employee yorks in a state that is di Brent firom the state that issued this o er, a copy must be provi~edpto your emp oyee 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%bligor'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%bligor. 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.* Empbyee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee%bligoranct 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%bligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2321722990 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : D THE EMPLOYEElOBLIGOR NO LONGER WORKS FOR: O EMPLOYEE'S/OBLIGOR'S NAME: FORD, WAYNE S . EMPLOYEE'S CASE IDENTIFIER: 8345101232 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT: 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%bligor'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. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee%bligorfrorn employment, refusing to employ, or taking disciplinary action against any employee%bligorbBcause 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 Ad (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 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.:0970-0154 Worker ID $IATT ~. ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FORD, wAnaE s . PACSES Case Number 136107440 Plaintiff Name GABRIELE S. FORD Docket Attachment Amount 03-2866 CIVIL$ O.Ob 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 $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev.5 Service Type ty OMB No.: 0970-0154 Worker I D $ IATT