Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
99-02865 (2)
P ? .r fJ I 11? lcj? CIO ?A IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNA. JOHN W. CONE, SR., Plaintiff VERSUS No. 99-2865 CIVIL TERM MARIAN G. CONE, Defendant DECREE IN DIVORCE IN DIVORCE AND NOW, -1 2002 , IT IS ORDERED AND DECREED THAT JOHN W. CONE, SR. PLAINTIFF, AND MARIAN G. CONE DEFENDANT, ARE DIVORCED FROM THE BONDS OF MATRIMONY. THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT YET BEEN ENTERED; V'kavj_•---. The Marriage Settlement Agreement dated January 14, 2002 and signed by _ the parties is hereby incorporated into this Decree, but not merged. J, BY THE COURT: ATTEST: n /1 - J• CIVIL ACTION LAW PROTHONOTARY 14? JOHN W. CONE, SR., Plaintiff V. MARIAN G. CONE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 99-2865 CIVIL TERM IN DIVORCE PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Transmit the record, together with the following information, to the court for entry of a divorce decree: 1. Ground for Divorce: Irretrievable breakdown under Section 3301(c) of the Divorce Code. 2. Date and manner of service of complaint: A certified copy of the Complaint in Divorce was served upon the defendant, Marian G. Cone, on May 13, 1999, by certified, restricted delivery mail, addressed to her at 56 Ridge Drive, Shermans Dale, Pennsylvania 17090, with Return Receipt Number Z 013 343 487. 3. Complete either paragraph (a) or (b). (a) Date of execution of the affidavit of consent required by Section 3301(c) of the Divorce Code: by plaintiff: January 21, 2002; by defendant: January 14, 2002. (b)(1) Date of execution of the affidavit required by Section 3301(d) of the Divorce Code: (b)(2) Date of filing and service of the plaintiffs affidavit upon the defendant: 4. Related claims pending: NONE. 5. Complete either (a) or (b). (a) Date and manner of service of the Notice of Intention to file Praecipe to Transmit Record, a copy of which is attached: (b) Date plaintiffs Waiver of Notice in Section 3301(c) Divorce was filed with the Prothonotary: February 12, 2002. Date defendant's Waiver of Notice in Section?301(c) Div a was filed with the Prothonotary: February 12, 2002. 7 3 A. fort ?? l.. .. .1 L:., ' t.J ?: L, C.) JOHN W. CONE, SR., IN THE COURT 01- COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA NO. 99. 2 8 6 e CIVIL TERM VS. CIVIL ACTION--LAW MARIAN G. CONE, Defendant IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the 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 in divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonatary at the Cumberland County Courthouse, High and Hanover Streets, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717) 249-3166 1 JOIIN W. CONE, SR., Plaintiff IN THE COURT OI'. COMMON PLEAS OP CUMBERLAND COUNTY, PENNSYLVANIA NO. 94. 2 F 4 s' CIVIL TERM V5. MARIAN G. CONE, Defendant CIVIL ACTION--LAW IN DIVORCE COMPLAINT IN DIVORCE 1. Plaintiff is JOHN W. CONE, SR., who currently resides at 1308 Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania. 2. Defendant is MARIAN G. CONE, who currently resides at 56 Ridge Drive, Shermans Dale, Pennsylvania. 3. Plaintiff and defendant have been bona fide residents in the Commonwealth for at least six months immediately previous to the filing of this Complaint. 4. The plaintiff and defendant were married on April 21, 1985 at Carlisle, Pennsylvania. 5. There have been no prior actions of divorce or for annulment between the parties. 6. The marriage is irretrievably broken. 7. Plaintiff has been advised that counseling is available and that plaintiff may have the right to require the parties to participate in counseling. 8. PlaintifTrcqucsts the court to enter a decree of divorce. Respectfully submitted, Jan2o-K. Jones, Esqu;file' Attorney for Plaintiff 7 Irvine Row Carlisle, PA 17013 (717) 240-0296 I verify that the statements made in this Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904, relating to unswom falsification to authorities. Cl H? r JOHN W. CONE, SR. f J?1 3 r Q 1 1r. '?n a O cr U a `° A JOHN W. CONE, SR. ; IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. :99-2865 CIVIL TERM MARIAN G. CONE Defendant : IN DIVORCE AND NOW, this 13th day of February, 2002, comes James K. Jones, Esquire, and certifies that he mailed a true and correct copy of the Divorce Complaint in the captioned matter to the defendant by certified mail, restricted delivery. Said return receipt is attached hereto indicating service was made on May 13, 1999. James&K Jones, Esquir 7 irvme Row Carlisle, PA 17013 (717) 240-0296 Cr 1<• V I% / a •? a an? o gems t and/or 2 for additional serAws. I also wish to receive the 'a :Compete Items 3, ee, "Alb. /?Iea??e?¢q?y???,-?, p{p?{?p?y, following services (for an :Pant your nenie end edtlreee on the ro w • ? ° e6/T'r++??• tide extra fee): can to yosuf. OY 0 ?d p? Attach thi •orm to the trend of the mail not 1. 0 Addressee's Address •? •? 1. :TThe Reettum Rocealpt wlu shhm to w om au a wee deivered end me date 2• Restricted Doll very delivered. Consult postmaster for fee. :. 3. Article Addressed to: 4a. Article Number /?,? ` 013 311a tI$? E `f?'lartOn G • Wtle 4b. Service Type t?o?1 ??n?? •• ? Registered X CeNAed I Cl ire tt-IIM?I l,gL)nIC': PR 13 ExpressNeil ? Insured W'., CC77TT AAAa d RetumPacelptfor Merchandise ? COD I?C?O 7. Date of Delivery ` ? 6. Received By: (Print Name) U. Addressee's Address (Only if requested and fee Is paid) n 6. Signature: (Addressee orAge/nfhO? PS Form 3811 December 1994 Domestic Retum Receipt' I ;1111 CJ 1? .1[I w .? JOHN W. CONE, SR., Plaintiff V. MARIAN G. CONE, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 99-2865 CIVIL TERM IN DIVORCE PLAINTIFF'S AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on May 11, 1999. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of the filing of the complaint. 3. I consent to the entry of a final decree in divorce. 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 herein made are subject to the penalties of 18 Pa. C. S. Section 4904 relating to unswom falsification to authorities. Date: sr o? 2002 1 <' ?4 ? ze -4-e- 0'7 ?/ JOHN W. CONE, SR. L ?- ::> ;?_. ?. ?_ - ?:? =.__ ?: ;`? ?.::? ;??; `>,? :: t? t_, JOHN W. CONE, SR., Plaintiff V. MARIAN G. CONE, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 99-2865 CIVIL TERM IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final Decree of Divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, 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 statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Date:, 2002 X4" z& -/- -JOHN W. CONE, SR. Plaintiff i'- ??: f - :i.,- --? ?° ?_ . ?.. <.I -- ? ?n '=? C ..: ?; ILLI L. ?=7 <? JOHN W. CONE, SR., Plaintiff V. MARIAN G. CONE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 99-2865 CIVIL TERM IN DIVORCE PLAINTIFF'S MARRIAGE COUNSELING AFFIDAVIT The plaintiff, being duly sworn according to law, deposes and says: 1. I have been advised of the availability of marriage counseling and understand that I may request that the court require that my spouse and I participate in counseling. 2. I understand that the court maintains a list of marriage counselors in the Prothonotary's Office, which list is available to me upon request. 3. Being so advised, I do not request that the court require that my spouse and I participate in counseling prior to a divorce decree being handed down. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Date: a , 2002 fzll/r ayf- w-X l? JOHN W. CONE, SR. ?' ?; _ ?. ?, -:] ? ., ' _._ ? .; , ... ; ; ; ; L:, ( l JOHN W. CONE, SR., Plaintiff V. : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 99-2865 CIVIL TERM MARIAN G. CONE, Defendant IN DIVORCE DEFENDANT'S AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on May 11, 1999. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of the filing of the complaint. 3. I consent to the entry of a final decree in divorce. 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 herein made are subject to the penalties of 18 Pa. C. S. Section 4904 relating to unswom falsification to authorities. Date: A"M / , 2002 MARIAN G. CONE c C .: - C= iJ JOHN W. CONE, SR., Plaintiff V. : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 99-2865 CIVIL TERM MARIAN G. CONE, Defendant IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final Decree of Divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, 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 statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Date: , 2002 `,%%? ^</ ? [mod we MARIAN G. CONE Defendant I .. I JOHN W. CONE, SR., Plaintiff V. MARIAN G. CONE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 99-2865 CIVIL TERM IN DIVORCE DEFENDANT'S MARRIAGE COUNSELING AFFIDAVIT The defendant, being duly sworn according to law, deposes and says: 1. I have been advised of the availability of marriage counseling and understand that I may request that the court require that my spouse and I participate in counseling. 2. I understand that the court maintains a list of marriage counselors in the Prothonotary's Office, which list is available to me upon request. 3. Being so advised, I do not request that the court require that my spouse and I participate in counseling prior to a divorce decree being handed down. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unworn falsification to authorities. Date: l,a„ ,2002 MARIAN G. CONE L_ MARRIAGE SETTLEMENT AGREEMENT 'N+h THIS AGREEMENT made this day of i4? arm . , 2002 by and between MARIAN G. CONE, (hereinafter referred to as " IFE") anJOHN W. CONE, SR., hereinafter referred to as "HUSBAND"). WITNESSETH: WHEREAS, HUSBAND and WIFE were lawfully married on April 22, 1985, in Cumberland County, Pennsylvania and separated on March 1, 1999. HUSBAND filed a Complaint in Divorce in Cumberland County, Pennsylvania, docketed at 99-2865 Civil Term on May 11, 1999. The parties hereto agree and covenant as follows: The parties intend to maintain separate and permanent domiciles and to live apart from each other. It is the intent and purpose of this Agreement to set forth the respective rights and duties of the parties while they continue to live apart from each other. 2. The parties have attempted to divide their matrimonial property in a manner which conforms to a just and right standard, with due regard to the rights of each party. It is the intent of the parties that such division shall be final and shall forever determine their respective rights. The division of existing marital property is not intended by the parties to constitute in any way a sale or exchange of assets. 3. Further, the parties agree to continue living separately and apart from the other at any place or places that he or she may select as they have heretofore been doing. Neither party shall molest, harass, annoy, injure, threaten or interfere with the other party in any matter whatsoever. Each party may carry on and engage in any employment, profession, business or other activity as he or she may deem advisable for his or her sole use and benefit. Neither party shall interfere with the uses, ownership, enjoyment or disposition of any property now owned and not specified herein or property hereafter acquired by the other, 4. The consideration for this contract and agreement is the mutual benefit to be obtained by both of the parties hereto and the covenants and agreements of each of the parties to the other. The adequacy of the consideration for all agreements herein contained is stipulated, confessed, and admitted by the parties, and the parties intend to be legally bound hereby. Each party to the Agreement acknowledges and declares that he or she, respectively: a. is represented by counsel of his or her own choosing; b. is fully and completely informed of the facts relating to the subject matter of this Agreement and of the rights and liabilities of the parties; c. enters into this Agreement voluntarily after receiving the advice of counsel; d. has given careful and mature thought to the making of this Agreement; e. has carefully read each provision of this Agreement; and f. fully and completely understands each provision of this Agreement, both as to the subject matter and legal effect. This Agreement shall become effective immediately as of the date of execution. 5. It is the purpose and intent of this Agreement to settle forever and completely the interest and obligations of the parties in all property that they own separately, and all property that would qualify as marital property under the Pennsylvania Divorce Code, Title 23, Section 401(e), and that is referred to in this Agreement as "Marital Property", as between themselves, their heirs and assigns. The parties have attempted to divide their Marital Property in a manner that conforms to a just and fair standard, with due regard to the rights of each Party. The division of existing Marital Property is not intended by the parties to constitute in any way a sale or exchange of assets, and the division is being effected without the introduction of outside funds or other property not constituting a part of the marital estate. It is the further purpose of this Agreement to settle forever and completely any obligation under the Pennsylvania Divorce Code relating to spousal support or alimony. 6. Each party represents and warrants that he or she has made a full and fair disclosure to the other of all of his or her property interests of any nature, including any mortgage, pledge, lien, charge, security interest, encumbrance, or restriction to which any property is subject. Each party further represents that ire or she has made a full and fair disclosure of all debts and obligations of any nature for which he or she is currently liable or may become liable. Each further represents and warrants that he or she has not made any gifts or transfers for inadequate consideration of Marital Property without the prior consent of the other. Each Party acknowledges that, to the extent desired, he or she has had access to all joint and separate State and Federal Tax Returns filed by or on behalf of either or both Parties during marriage. 3 7. REAL ESTATE: The parties do not own any real estate. 8. DEBTS: HUSBAND will be solely responsible for his own debts. WIFE will be solely responsible for her debts. HUSBAND will indemnify and hold harmless WIFE from all obligation related to his debts. WIFE will be solely responsible and will indemnify and hold harmless HUSBAND from any claim made against him related to her debts. 9. SPOUSAL SUPPORT: It is the mutual desire of the parties that HUSBAND will be required to pay Alimony in the amount of Four Hundred and no/100 ($400.00) Dollars per month to the WIFE for herself. WIFE will not provide any financial support or alimony pendente lite to the HUSBAND. The Alimony will be paid pursuant to the Cumberland County Office of Domestic Relations. Alimony shall terminate upon wife's death, remarriage, or cohabitation with a person of the opposite sex who is not a member of the wife's family within the degrees of consanguinity. 10. PERSONAL PROPERTY: The parties agree that the personal property shall be divided as follows: HUSBAND shall receive the following items: a. The personal property in his possession and the treadmill; b. His bank accounts; c. Any life insurance policy; d. His employee benefits; and c. The remainder of the escrow account at M&T Bank. 4 WIFE shall receive the following items: a. The personal property in her current possession; b. Her bank accounts; C. Any life insurance policy; d. Her employee benefits; and e. The sum of Twenty-Eight Thousand and no/100 ($28,000.00) Dollars from the escrow fund at M&T Bank. The WIFE hereby waives all right and title which she may have in any personal property of the HUSBAND. HUSBAND likewise waives any interest which he has in the personal property of the WIFE. Henceforth, each of the parties shall own, have and enjoy independently of any claim or right of the other party, all items of personal property of every kind, nature and description and wherever situated, which are then owned or held by or which may hereafter belong to the HUSBAND or WIFE with full power to the HUSBAND or the WIFE to dispose of same as fully and effectually, in all respects and for all purposes as if he or she were unmarried. & "e•C ' Each party agrees that neither will incur obligations, liens or liabilities on account of the other and that from the date of this Agreement, neither party shall contract or incur obligations, liens or any liability whatsoever on account of the other. 5 AUTOMOBILES: a. HUSBAND agrees to waive any and all interest which he may have in the automobiles in possession of the WIFE. b. WIFE agrees to waive any and all interest which she may have in the automobiles in possession of the HUSBAND. They each waive any claim which they have in any automobile owned by the other party. 12. INSURANCE EMPLOYEE AND MILITARY BENEFITS: The parties agree that any life insurance policies on the life of HUSBAND or WIFE or any other employee benefits, including but not limited to retirement, profit sharing or medical benefits of either party, shall be their own. WIFE waives all right, title and claim to HUSBAND'S employee benefits, and HUSBAND waives all right, title, and claim to any of WIFE'S employee benefits. WIFE will be maintained as a surviving spouse for all military retirement benefits of HUSBAND, unless HUSBAND remarries. 13. BENEFITS AND BANK ACCOUNTS: WIFE agrees to waive all right, title and interest which she may have in the savings or checking or any other bank accounts of the HUSBAND. The HUSBAND agrees to waive all interest which he has in the bank accounts of the WIFE. e 14. DIVORCE: The parties both agree to cooperate with each other in obtaining a final divorce of the marriage. It is agreed that the parties will execute and file the consents necessary to obtain the divorce. Any party who fails to cooperate with obtaining the Divorce shall pay all the costs and legal fees of the party who is seeking the divorce. 15. BREACH: If either party breaches any provisions of this Agreement, the other party should 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 will be responsible for payment of legal fees and costs incurred by the other in enforcing their rights under this Agreement. 16. ADDITIONAL INSTRUMENTS: Each of the parties shall from time to time, at the request of the other, execute, acknowledge and deliver to the other party any and all further instruments that may be reasonably required to give full force and effect to the provisions of this Agreement. 17. VOLUNTARY EXECUTION: The provisions of this Agreement and their legal effect have been fully explained to the parties by their respective counsel, and each party acknowledges that the Agreement is fair and equitable, and that it is being entered into voluntarily, and that it is not the result of any duress or undue influence. The provisions of this Agreement are fully understood by both parties and each party acknowledges that the Agreement is fair and equitable, that it is being entered into voluntarily, and that it is not the result of any duress or undue influence. 7 18. ENTIRE AGREEMENT: This Agreement contains the entire understanding of the parties and there are no representations, warranties, covenants or undertakings other than those expressly set forth herein. 19. APPLICABLE LAW: This Agreement shall be construed under the Laws of the Commonwealth of Pennsylvania. 20. PRIOR AGREEMENTS: It is understood and agreed that any and all property settlement agreements which may or have been executed prior to the date and time of this Agreement are null and void and of no effect. 21. PAYMENT OF COSTS AND LEGAL FEES: The parties agree to pay for their own costs and legal fees required to obtain and complete the divorce. 22. WAIVER OF CLAIMS AGAINST ESTATES: Except as herein otherwise provided, each party may dispose of his or her property in any way, and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire, under the present or future laws of any jurisdiction, to share in the property or the estate of the other as a result of the marital relationship, including without limitation, dower, courtesy, statutory allowance, widow's allowance, right to take in intestacy, right to take against the Will of the other, and right to act as administrator or executor of the other's estate, and each will, at the request of the other, execute, acknowledge and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interests, rights and claims. 8 IN WITNESS WHEREOF, the parties hereunto have set their hands and seals the day and year first above written. (SEAL) MARIAN G. CONE (SEAL) JOHN W. CONE, SR. 9 COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND PERSONALLY APPEARED BEFORE ME, this X4-1 day of U , 2002, a Notary Public, in and for the Commonwealth of Pennsylvania and C of Cumberland, MARIAN G. CONE, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Marriage Settlement Agreement, and acknowledges that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND PERSONALLY APPEARED BEFORE ME, this .-V`- day of (Ifil?Cu?t 2002, a Notary Public, in and for the Commonwealth of Pennsylvania and County of Cumberland, JOHN W. CONE, SR., known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Marriage Settlement Agreement, and acknowledges that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. ?? i n.eaRSrer__R NOT/IU,t SFX SMMW 3K5 a0A'1.C6PWEAD VW. NoTk7l PUBLX 1.lT HJLLY1111liERtA'61 Cp *" WY M-%X" EXPFCS AV it 121, - 10 DR 29019 PACSES ID 188101527 JOI-IN W. CONE, SR., Plaintiff/Respondent vs. MARIAN G. CONE, Dcfendan t /Petitioner IN T f IK COURTOr COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : DOMESTIC RELATIONS SECTION : CIVIL ACTION - LAW NO. 99-2863 CIVIL TERM ORDER OF COURT AND NOW, this 3rd day of November, 1999, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $747.34 per month and Respondent's monthly net income/earning capacity is $1,807.52 per month, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $670.00 a month payable weekly as follows; $149.60 per week for alimony pendente lite and $4.60 per week on arrears. First payment due November 5, 1999. Arrears set at $1,300.00 as of November 1, 1999. The effective date of the order is September 21, 1999. Husband is to maintain medical insurance coverage on wife. days. is to report his return to employment to the Domestic Relations Office within five This order is based upon an agreement of the parties and husband currently receiving disability insurance benefits. Failure to make each payment on time and in frill will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.S. 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with tilis Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to:. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 691 10 Harrisburg, PA 17106-9110 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. Unreimbursed medical expenses that exceed $250.00 annually are to be paid 0% by the respondent and 100% by petitioner. The plaintiff is responsible to pay the first $250.00 annually in unreimbursed medical expenses. Respondent to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the Respondent shall submit written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of. 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. Consented: Plaintiff/Petitioner Plaintiff/Petitioner's Attomey Defendant/Respondent Defendant/Respondent's Attorney DRO: R. J. Shadday BY THE COURT, Mailed w ics on t'etilloner -? 2 to: < Respondent Marcus McKnight, lll, L'squire - James Jones, Esquire / Edgar B. Bayley J. /? Si ILIP, -c. Ul- O: Id. U C G? ?l DR 29,019 PACSES ID 188101527 JOHN W. CONE, SR., Plaintiff/Respondent VS. MARIAN G. CONE, Defendant /Petitioner : IN'T'11C COURT Or COMMON PLEAS : C1JM13rRLAND COUN'T'Y, PENNSYLVANIA : DOMES'T'IC RELA'T'IONS SECTION : CIVIL. ACTION - LAW : NO. 99-2865 CIVIL'rf,RM ORDER OF COURT AND NOW, this 7'h day of December, 1999, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $747.34 per month and Respondent's monthly net income/earning capacity is $3,027.08 per month, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $920.00 a month payable weekly as follows; $211.74 per week, ($207.14 per week for alimony pendente lite and $4.60 per week on arrears). First payment due with next pay date. Arrears set at $271.67 as of December 7, 1999. The effective date of the order is November 22, 1999. This order is based upon an agreement of the parties through their attorneys Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Marian Cone. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. Unreimbursed medical expenses that exceed $250.00 annually are to be paid 0% by the respondent and 100% by petitioner. The plaintifTis responsible to pay the first $250.00 annually in unreimbursed medical expenses. Petitioner to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the Petitioner shall submit written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of. 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. DRO: R. J. Shadday BY THE COURT, Mailed copies on Petitioner to: < Respondent James Jones, Esquire Marcus McKnight, III, Esquire Edgar B. Bayley \ ), i c?? C V CUM1 ERLAND COUN N DOMEMc RELATIONS Date of Applicaniea t fi+? Sappert f?eeard 3n?e Nam Cone 'JJoohn W Addaess: 950 Walnut Bottom Road, Car(?lisle, PA t?t4 S0CW&MWWN=ber: 045-32-0291 D.O.D, 5126/41 Donlestle Ralatiop Casa Number if gnDMl 1 1015 2 7 pa? Requestigg Duncan & Hartman, P•C. 717-249-7780 1 ? Raw, Carlisle, Irvine e Row, Pa 17013 717-249-7800 MM traatsrt) A R'p DotLr (I;it?)I F ?'? pit Social S«®ri?yr Ria?ber kaio eLerh oa mmoaey order 0 toe DRSld,ies Sprat X nvrlrUL nQU= Has No Recw+d In Domestic Relations as of.- SuPPM Antears As of End of Month Pdoe to Date of Application: $) Yx vu Monthly Total Support Obligation: S%4?C: The Amount ahown above is re@ected in the Domestic Relations SeWon Office of Cumbesk?d C=tty, Penclsyhr hL )eod Domadc Relations Case Number: i?, (5, s i 1 fie` 1 r/ S :2 Signed: RRING-DOWN RF.Qu ST Supper Arrears: S As Of Signed: t°itQ) torraaaRuts?e QUoclo?fLk,? Coadhexor) (Dre) ***Lien Satisfied Receipt Available Upon Request*** S.? _ ' ,_ ` ?-: ,; ,:=? . , ?? ??:; ,;,_ =? _, ?, LIEN SATISFACTION Pacses#188101527 No. 99 CV 2865 DR# 29019 Name: John Cone Social Security Number: 045320291 Judgment Lien Satisfied as of February 27, 2001 Amount Paid $ 400.00 Signed: Qu?ie 7?1. cl J[?2 3-9-v1 ien Coordinator) (Dale) 119 S3 Jf C• ? ? U ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania- Co./City/Dist. of CUMBERLAND Date of Order/Notice 05/23/01 Court/Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number USF RED STAR Employer/Withholder's Name 24 WRIGHT AVE Employer/Withholder's Address AUBURN NY 13021-3128 r'?? lo( y;,) -7 OOriginal Onler/Notce')C, I 1 O Amended Outer/Notice O Terminate Order/Notice IRE: CONE, JOHN W. SR 1 Employee/Obligor's Name (Last, First, MI) I 045-32-0291 Employee/Obligor's Social Security Number 0244100333 Employee/Obligor's Case Identifier I (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. $ 900.00 per month in current support $ 20. oo per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ o, oo per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 920.00 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: $ 212.31 per weekly pay period. $ 424.52 per biweekly pay period (every two weeks). $ 46o. oo per semimonthly pay period (twice a month). $ 92o. 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 the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania Stale Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: 06/01/01 DRO: R.J. Shadday cc: defendant Service Type M BY THE COURT: J. Wesley Ol r,l Jr., '7 Form EN-028 OMB No.: aa10?015? [µ+iulim Dac 1241100 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS El If checked you are required to provide a copy of this form to your employee, I. 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.` -Reponingthe-Paydate/Date-of Withholding-You-must-report the-paydate/dateofwithholdingwhen-sending-the-payment-Tfte- paydate/dateofwithholding-is the datc-onwhich?mountwaswithheld-from-theemployee'swages-. 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 enhployee%obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 1504251000 EMPLOYEE'S/OBLIGOR'S NAME: CONE, JOHN W. SR EMPLOYEE'S CASE IDENTIFIER: 0244100333 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 the 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 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. 31673 MI; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: DOMESTIC RE(ATIONS SECTION 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 (()92134 7-6941 or by Internet Service Type M Page 2 of 2 oMa %o.: 097"154 1 yIi W ion DIM, 12)3t 'DO Form EN-028 Worker ID $iATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CONE, JOHN W. SR ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee'slobligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s); DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment, 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 die employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M OMp WO.: OOi P?OiH Worker ID $IATT fyrirtlion Dnc 11l1/00 e?j Li_ ? l J n 3 i? .. 7 ? ] cL i ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwth of ppnncyk-ni- 7 Co./City/DIsL of CUMBERLAND n Date of Order/Notice 07/19/01 be Court/Case Number (See Addendum for case summary) Employer/Withlwlder's Federal EIN Numlmr USF RED STAR Employer/Wllhholder's Name 34 WRIGHT AVE EmployerANilhholdrr's Ad(,nss AUBURN NY 13021-3118 )RE:CONE, JOHN W. SR O Original Onler/Notice O Amended Order/Notice. O Terminate Onler/Notice Employee/Obligor's Name (Last, First, Nut 045-32-0291 Employee/Obligor's Social Srcudty Numlxr 0244100333 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on atta(hment) 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. $ 900.00 per month in current support $ 0. oo per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ o.00 per month in medical support $ o . 00 per month for genetic test costs $ per month in other (specify) for a total of $ goo. 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: $ zo7.69 per weekly pay period. $ 41s. 3a per biweekly pay period (every two weeks). $ 450. oo per semimonthly pay period (twice a month). $ _ goo. 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 the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Colleaions 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 DRO: RJ Shadday BY THE COURT: xc: defendant y - Date of Order: July 2O, 20J1 Service Type M on+n Nu: oa; wn u lyd,niun Iw,'21", sley Oler, Jr. Form EN-028 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, 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 employeeJobligor's income in a single payment to each agency requesting withholding. You most, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.' -iteporting-the-Paydate/Date of Withholding-You-must reportthepaydate/dateofwithholdingwhensendingthepayment-Tfie- paydateMateofwithholding-isthrdatr. onwhichamountvvaswithheld-fmmthermployee'swages: You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments, 4.' Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) S. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 1504253.000 EMPLOYEE'S/OBLIGOR'S NAME: _ CONE. JOHN W. SR EMPLOYEE'S CASE IDENTIFIER: 0244100333 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%bligor 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. 10. 'NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: 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 ;r P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by Internet Q Page 2 of 2 Form EN-028 Service Type M Omit N„.:0nn-( ,,, WorkerlD $IATT r.n?ni„, uao-. ulnnui .01 1 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CONE, JOHN W. SR PACSES Case Number ] 9A1oI527/ _019 PACKS Case Number Plaintiff Name Plaintiff Name MARIAN O. CONE Docket Attachment Amount Docket Attachment Amount 99-2865 CIVIL$ 900.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): ?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. ? 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 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, PAGES 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. PAGES 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 ( her ked, you are required to enroll the child(ren) identified above in any health insurance coverage available. identified above in any health insurance (overage available through the employee's/ohligor s employment, through the employee's/obligor's employment. Addendum Form EN-028 Service Type m Worker ID $IATT l y`iulumlNrv 1:1 Wwl f?8 SJ c? n g . J Z Q?Q JOHN W. CONE, SR. Plaintiff V MARIAN G. CONE Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99-2865 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE CERTIFICATE PREREQUJSITF _Tg"ERyjCE OF A SURP0_F_.NA EURSUANT TO RuLF 4009.22 As a prerequisite to service of a subpoena for documents and things pursuant to rule 4009.22, Plaintiff John W. Cone, Sr. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least 20 days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) Defendants Counsel has waived the twenty day requirement, and 4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. Date: (T// 7 /G/ Attori<qrfor Plaintiff JOHN W. CONE, SR. : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V : NO. 99-2865 CIVIL TERM MARIAN G. CONE : CIVIL ACTION-LAW Defendant : IN DIVORCE John W. Cone, Sr. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If no objection is made the subpoena may be served. Date: 8l9 ?d/ Atto or Plaintiff JOHN W. CONE, SR. Plaintiff V MARIAN G. CONE Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99-2865 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE SUBPOENA TO PRODUCF, DOCUMFNTS OR THINGS FOR DIC OV .RY PURSUANT TOR E 4009.22 To: Support Services Members 1st Federal Credit Union Within twenty (20) days after service of this subpoena, you are ordered by the Court to produce the following documents or things: Statement for Marian G. Cone, social security number 206-32-0939 for account 43378 from March 1, 1998 through March 31, 1998 and January 1, 1998 through January 31, 1998 to James K. Jones, Esquire, 7 Irvine Row, Carlisle, PA 17013-3019. You may deliver or mail legible copies of the documents of produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by the subpoena within twenty (20) days after its service, the parties serving the subpoena may seek a Court Order compelling you to comply with it. This subpoena was issued at the request of the following person: James K. Jones, Esquire ID #39031 7 Irvine Row Carlisle, PA 17013 (717) 240-0296 Attorney for Plaintiff By the Court: Date: By: Prothonotary A8 S.1 ?: u: JOHN W. CONE, SR. Plaintiff V MARIAN G. CONE Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99-2865 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE As a prerequisite to service of a subpoena for documents and things pursuant to rule 4009.22, Plaintiff John W. Cone, Sr. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least 20 days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) Defendants Counsel has waived the twenty day requirement, and 4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. Date: /?/0/ Atto y for Plaintiff JOHN W. CONE, SR. Plaintiff V MARIAN G. CONE Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99-2865 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE John W. Cone, Sr. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If no objection is made the subpoena may be served. Date: Orb & rZ;;;= Atto or Plaintiff JOHN W. CONE, SR. Plaintiff V MARIAN G. CONE Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99-2865 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE To: Linda Wiles, Operations Mgr. Bank of Landisburg Within twenty (20) days after service of this subpoena, you are ordered by the Court to produce the following documents or things: Statement for Marian G. Cone, social security number 206-32-0939 for account 60302420 from February 1, 1998 through March 31, 1998 and to James K. Jones, Esquire, 7 Irvine Row, Carlisle, PA 17013-3019. You may deliver or mail legible copies of the documents of produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by the subpoena within twenty (20) days after its service, the parties serving the subpoena may seek a Court Order compelling you to comply with it. This subpoena was issued at the request of the following person: James K. Jones, Esquire ID #39031 7 Irvine Row Carlisle, PA 17013 (717) 240-0296 Attorney for Plaintiff By the Court: Date: By: Prothonotary M SJ r a) L ii V- ?J L ? (L l 1 JOHN W. CONE, SR., IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 99 - 2865 CIVIL TERM MARIAN G. CONE, IN DIVORCE Defendant/Petitioner DR# 29,019 Pacscs# 188101527 ORDER OF COURT AND NOW, this 7"' day of October, 1999, upon consideration of the attacbed Petition for Alimony Pendcutc Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shaddav on November 1. 1999 tit 9:00 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which (lie conference officer may recommend that an Order for Alimony Pendenle Lite be entered. YOU are further ordered to bring to the conference (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) [lie Income and Expense Statement attached to this order, completed as required by Rule 1910.1 In (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, [lie Court nlay issue a warrant for your arrest. BY THE COURT, George E. Hoffer, President Judge Mail copies on Petitioner 104-99 to: < Respondent Marcus McKnight. Esquire t James Jones. Esquire ?-??- Date of Order: October 7 1999 R. J. S idda.N. Conference Officer YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. 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 MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE. PENNSYLVANIA 17013 (717) 249-3166 i L. qF . 'lu':11 ?` i1i r?• 3f?C II gn PEI4INSfUlANA MARIAN G. CONE, Petitioner/Defendant V. JOHN WILLIAM CONE, SR., Respondent/Plaintiff CIVIL ACTION - LAW NO. 99-2865 CIVIL TERM IN DIVORCE PETITION FOR ALIMONY PENDENTE LITE AND NOW, comes Marian G. Cone, by and through her attorneys, IRWIN. MCKNIGHT & HUGHES, and petitions this Honorable Court as follows: The petitioner/defendant herein is Marian G. Cone who currently resides at 56 Ridge Drive, Shermans Dale, Pennsylvania 17090. : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA 2. The respondent/plaintiff herein is John William Cone, Sr. who currently resides at 1308 Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania 17013. 3. Petitioner and respondent were married on April 22. 1985, in Cumberland County, Pennsylvania and were separated on March 1, 1999. 4. The respondent tiled a divorce action at 99-2865 Civil Term in Cumberland County, Pennsylvania on May 11, 1999. 5. Petitioner is without the ability to cam income sufficient to meet her reasonable needs. WHEREFORE, petitioner, Marian G. Cone, respectfully requests that this Honorable Court order alimony pendente lite in an amount equal to the Pennsylvania State Support Guidelines. Respectfully submitted, IRWIN, MCKNIGHT & HUGHES By: ' 'I (/ y=_ i\Iarcus A. McKnig t, I I, Esquire 60 West Pomfret - cle Carlisle, PA 17013 Supreme Court I.D. No: 25476 (717) 249-2353 Attorney for the petitioner/defendant, Marian G. Cone Date: September 20, 1999 VI;R[FICATION The foregoing Petition for Alimony Pendente Lite is based upon information which has been gathered by counsel and myself in the preparation of this action. I have read the statements made in this document and they are true and correct to the best of my knowledge, information and belief. I understand that false statements herein made are subject to the penalties of 18 Pa. C.S.A. Section 4904, relating to unsworn falsification to authorities. MARIAN G. CONE Date: September 20, 1999 d CO y 0 1 ' __ ) (- G. CLL i u F: LLJ C/3 . i O m j LAW OFFICES TS£P 2 2 599 . „ .. v ? „Y y ? T . Y Y $ i ] . ,,,.-y f S i I p3 rv r I? 1 L. S fl' I.. i J / iil I / / I ' 0 r y ? i• '4 q .r F 4 s I^ «'? t 1 f 1 ! ??r ? StiY. a •. ' C.J ,` ON u z r r t? ml? W a PI V r?: 3 S T u ?r 1 ?t ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT b(f/, Q9- 2S'G-S ('/?/L J r original order/Notice State Commonwealth of Pennsylvania /5'('' Co./City/Dist. of CUMBERLAND Y ?C SAS /G/5') ? Q Amended Order/Notice Date of Order/Notice 02/19/02 OTerminateOrder/Notice Court/Case Number (See Addendum for case summary) Employer/Withholder's Federal LIN Number USF RED STAR Employer/Withholder's Name 34 WRIGHT AVE Employer/Withholder's Address AUBURN NY 13021-3118 I RE: CONE, JOHN W. SR 1 Employee/Obligor's Name (Last, First, MI) 045-32-0291 I Employee/Obligor's Social Security Number 1 0244100333 I Employee/Obligor's Case Identifier I (See Addendum for plaintiff names associated with cases on atrachm_en0 1 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. $ 400.00 per month in current support $ o. Ito per month in past-due support Arrears 12 weeks or greater? Q yes (9) no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) fora total of $ 400.00 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: $ 92.31 per weekly pay period. $ _ 184.62 per biweekly pay period (every two weeks). $ 2oo.oo per semimonthly pay period (twice a month). $ 400.ooper monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See 49 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, 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. FEB 2 0 2002 Service Type M -?-'7q'????MR Nn Ila)Illli} 02 I yr neon Oeir•. pn , form EN-028 WorkerlD $TATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a ropy of this form to your employee. 1. Priority: Withholding under (his Order/Node(- has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of Ili IN order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2, Combining Payments: You r,111 combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting widnholding. You must, however, wp;rawly identify pile portion of the single payment that is attributable to each employee/obligor. 3,' Reporting Ilse Paydnle/DNe of Withholding: You must report thepaydale/date of-withholding-when-sendingthepayment.-T-se- pnydille/dnte of wilhlnnlding I% flip dill(- on which mmnunt was withheld from the employee's-wager. You must comply with the law of the state of the employee's/obligor's principal place of pmploymenl with respect to the time periods within which you must implement the withholding order and forward fill, support payments. 4,' 1 mployet-A 1bIIg4 if with hill hit Ill' Support I 101d 1119%: If there is more than one Order/Notice to Withhold Income for Support 2µ,11n%1 this l,ngdoyeeluhl4tor and you afe unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow Ihl, law of Ihp state of onlpluyee's/obllgor's prlncipal place of employment. You must honor all Orders/Notices to the greatest extoll poWhIv Isle 119 bell"') S. Iennhnallon Nollliration: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you, Please pmvlde Ihn Infrtrnallon mqueswd and return a copy of this Order/Notice to the Agency identified below. Will 11 fill D(It's II): 1604251000 1M111OYII'S/0111IG(.llt'5NAMI.:, CONE, JOHN W. SR I MI11( )Ytl'S CASE IOI N111 I(R; 0244100333 DATE OF SEPARATION: I AS I KNOWN 1 WMI. ADDRI.SS: NI yN I Milt 0Yi R'S NAMI /ADDIUSS: 6. 1 until Suns Payments: You may be requlrel to report and withhold from pump sum payments such as bonuses, commissions, or sl,vomn(e pay. 11 you have,unY quesliuro about lump sure payments, contact the person or authority below. 7. I lability: 4 yon fall Ili withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have ssithhl,ld floor the l,uq:loyt-Nobllgor's income and other penalties set by Pennsylvania State paw. Pennsylvania State paw governs unless the obligor IS eng11nye1 in another State, in which case the law of the State in which he or she is employed governs. If. Anfl+hsrrfmin.Illun; You are sublecl to it fine determined under state law for discharging an employee/obligor from engdoynu'ul, infusing to employ, or Taking disciplinary action against any employee/obligor because of a support withholding. Penmylvantr Stapp Law Itrweuas unless the obligor is employed in another Slate, in which case the paw of the State in which he or she is enlpluylvl gnvollm q.' Withholding I imits: You may rot withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Pullet lion Al I (I 'I U.S.( . 41673 (fill; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. the 1(411.1.11 limit applies to the aggrvgaie disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory d(MI(II I(OnS 4(Il II JS: Slate, federal, local taxes; Social Security taxes; and Medicare taxes. ' NOI1: 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 slue that issued this order with respect to these items, Relrexting Agen(y: If you or your employee/obligor have any ' questions, )MI S11C Rf I Al IONS SECTION contact WAGE ATTACHMENT UNIT _ 1111. f1ANOVER 5T by telephone at (717) 240-6225 or 111Q, BOX 320 by FAX at (717) 240.6248 or CARLISI E IA 17013 by Internet @ _ Page 2 of 2 Form EN-028 5(-rviu' lyll(' M umX rro.u-+man s+ Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/obligor: CONE, JOHN W. SR PACKS Case Number 188101527 ,Zqo/n 7 PACSES Case Number Plaintiff Name Plaintiff Name MARIAN G. CONE Docket Attachment Amount Docket Attachment Amount 99-2865 CIVIL$ 400.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 DOB Child(ren)'s Name(s): DOB ?lf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ?lf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Chikhren)'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 healdh 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 1,.wam non.. n: i I W In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION JOHN W. CONE, SR., ) Docket Number 99-2865 CIVIL Plaintiff/Rspundent ) VS. ) PACSES Case Number 188101527 /D29019 MARIAN C. CONE, ) Defendant /Petitioner ) Other State ID Number ORDER AND NOW, to wit, on this 19TH DAY OF FEBRUARY, 2002 IT IS HEREBY ORDERED that the Alimony Pendente Litebe Q Vacated or QSuspended or ® Terminated without prejudice or Q Terminated and Vacated, effective JANUARY 21, 2001 , due to: THE PARTIES' MARRIAGE SETTLEMENT AGREEMENT EXECUTED ON JANUARY 21, 2002. THE CREDIT OF $1130.52 WILL BE DIRECTED TO THE ALIMONY ACCOUNT FROM THE ABOVE CAPTIONED ALIMONY PENDENTE LITE ACCOUNT. DRO: RJ Shadday xc: petitioner respondent Marcus McKnight, Esquire Janes Jones, Esquire ;v, c Service Type M BY THE COURT: a0viesley Oler Jr. v-l JUDGE Porte OE-505 Worker ID 21005 LLI CI ?' (.)![ L'1 f.:. L: I LD C7 .. L W1??.+ N m ll?l?L 1.-: cwt r;] CL C\j In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER Sr, P.O. BOX 320, CARLISLE, PA. 17013 Defendant Name: JOHN W. CONE SR Member ID Number: 0244100333 Please note: All correspondence must Include the Member ID Number. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name MARIAN 0. CONE PACSGS Docket Case Number Number 188101527 99-2865 CIVIL TOTAL ATTACHMENT AMOUNT: Attachment Amount/Freauenc $ 400.00 MONTH / $ 400.00 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 92.31 per week, or 50 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, JOHN W. CONE SR Social Security Number 045-32-0291 , Member ID Number 0244100333 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673 (b)(2) and 23 Pa. C.S.A. § 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated OCTOBER 5, 2003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: OCT 2 8 <fG3 v ] la.J Etc [ Sen ice Type 14 Q JUDGE Form EN-530 Worker ID $IATT e v o Z? 0 ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co,/City/Dist. of CUMBERLAND Date of Order/Notice 12/09/03 Tribunal/Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number CENTRAL PA TEAMSTERS PENSION PO BOX 15223 READING PA 19612-5223 O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: CONE, JOHN W. SR EmployeerObligor's Name (Last, First, MI) 045-32-0291 Employee/Obligor's Social Security Number 0244100333 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. $ 400. o0 per month in current support $ o. 00 per month in past-due support Arrears 12 weeks or greater? Oyes (9) no $ o. oo per month in medical support $ 0. 00 per month for genetic test costs $ per month in other (specify) for a total of $ 400.00 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: $ 92.31 per weekly pay period. $ 184.62 per biweekly pay period (every two weeks). $ 200, oo per semimonthly pay period (twice a month). $ 400. 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 #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, 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 71- For?n Date of Order. QE? i EN-07.8 Service Type M Os+e ho.. 0970184 Worker ID $OINC ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If,?heckefl you are required to pTvide gopy of this form to your m Ioyee. If yo r employer orks in a s ta t e tho` is event rom the stale that issue this or er, a copy must be proviseceto your empYoyee even if tXe box is not checked, 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employeetobl Igor. 4.*-Reportingthe-PaydatdBaWof%thholding. You-musHeportthe-paydate(dateofwithholdingwhen-sendingthe-Mment-The- paydateldatevfwithholdirtg-is-the-date-on which-amount-was-w thheld-from-theemployee'swages- You must comply with the law of the state of the employee's/obfigor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.• Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 0875100105 EMPLOYEE'S/OBLIGOR'SNAME: __ CONE, JOHN W. SR EMPLOYEE'S CASE IDENTIFIER: 0244100333 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law govems unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. 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 govems unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.' Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional 'NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.0, BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 2446225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 0n,9 u, IWOU 1E4 Form EN-928 WorkerlD $OINC ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CONE, JOHN W. SR ?entif identified above in any h alth nsuraance coveragle arvailable through the employee's/obligor's employment. ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. 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 ?i(checked, you are required to enroll the child(ren) identified above in any health insurance cove ige available through the employee's/obligor's employment. ?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) ? 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'slobligor's employment. through the employee's/obligor's employment. Service Type M Addendum Form EN-028 omxNO .uu7oaiu Worker ID $OINC 2 %- 65 D 1 LU C-j LLJ N u f ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth ofPennsylyania 0 original order/Notice Co./City/Dist. Of CUMBERLAND O Amended Order/Notice Date of Order/Notice 12/11/03 XQ Terminate Order/Notice Tribunal/Case Number (See Addendum for case Summary) RE: CONE, JOHN W. SR Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) USP RED STAR 34 WRIGHT AVE AUBURN NY 13021-3118 l?Nt?s?. /?os/o/5a? 045-32-0291 Employee/Obligor's Social Security Number 0244100333 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Qyes Q no $ o. oo per month in medical support $ o . oo per month for genetic test costs $ per month in other (specify) fora total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ ti, oo per weekly pay period. $ o. oo per biweekly pay period (every two weeks). $__ t? Uper semimonthly pay period (twice a month). $ 0, 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 #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER 1D (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 DateofOrder: Service Type M umnNn<04)e?n •;ic - form EN-028 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? IJ,fiheck, you are requirer to pr vile a opy of this form to your employee. If yoYr employeg orks in a state that is Brent rom the state that issuecPthis orr?er, a copy must be provided to your emp oyee even if I a box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below, 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employeelobligor. 4. - - --- - - e •, ,P I? V 0L= V„ w ,1L„ arnounrwaswnnnem-from-tnermployee's-wagesr 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 orderand forward the support payments. 5." Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligorand 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 #10 below) 6. 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. WITHHOLDER'S ID: 1504251000 EMPLOYEE'S/OBLIGOR'S NAME: CONE. JOHN W. SR EMPLOYEE'S CASE IDENTIFIER: 0244100333 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, ortaking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.' Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: 'NOTE: If you oryour agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: If you or your employeelobligor have any questions, AOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVFR ST by telephone at (717) 240-6225 or P O. BOX 320 by FAX at (7171 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 form EN-028 WorkerlD $IATT OMB N,1 114)IN1:54 w t. CD u_ ` v LLI Lt- O CGS ? CJ w JOHN W. CONE, SR., IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA NO. 99. 2 P 6 ao CIVIL TERM vs. CIVIL ACTION--LAW MARIAN G. CONE, Defendant IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the 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 in divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonatary at the Cumberland County Courthouse, High and Hanover Streets, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717) 249-3166 JOHN W. CONE, SR., IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA NO. 94 - 2 8 4 S? CIVIL TERM VS. CIVIL ACTION--LAW MARIAN G. CONE, Defendant IN DIVORCE COMPLAINT IN DIVORCE 1. Plaintiff is JOHN W. CONE, SR., who currently resides at 1308 Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania. 2. Defendant is MARIAN G. CONE, who currently resides at 56 Ridge Drive, Shermans Dale, Pennsylvania. 3. Plaintiff and defendant have been bona fide residents in the Commonwealth for at least six months immediately previous to the filing of this Complaint. 4. The plaintiff and defendant were married on April 21, 1985 at Carlisle, Pennsylvania. 5. There have been no prior actions of divorce or for annulment between the parties. 6. The marriage is irretrievably broken. 7. Plaintiff has been advised that counseling is available and that plaintiff may have the right to require the parties to participate in counseling. 8. Plaintiff requests the court to enter a decree of divorce. Respectfully submitted, J < Jones, Esq e Attorney for Plaintiff 7 Irvine Row Carlisle, PA 17013 (717) 240-0296 I verify that the statements made in this Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904, relating to unworn falsification to authorities. '-;O ??- JOHN W. CONE, SR. F O ? J c ZC? ::,4 y W m O N ?O C O J C G JOHN W. CONE, SR, IN THE COURT OF COMMON PLEAS OF PlaintifURespondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 99 - 2865 CIVIL TERM MARIAN G. CONE, IN DIVORCE Defendant/Petitioner DR# 29,019 Pacses# 188101527 ORDER OF COURT AND NOW, this 7s' day of October, 1999, upon consideration of the attached Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shaddav on November 1. 1999 at 9. 00 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, George E. Hoffer, President Judge Mail copies on Petitioner 16;7-99-to: < Respondent Marcus McKnight, Esquire James Jones, Esquire Date of Order: October 7. 1999 R. J. S dday, Conference Officer YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. 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 MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 MARIAN G. CONE, Petitioner/Defendant V. JOHN WILLIAM CONE, SR., Respondent/Plaintiff CIVIL ACTION - LAW NO. 99-2865 CIVIL TERM IN DIVORCE PETITION FOR ALIMONY PENDENTE LITE AND NOW, comes Marian G. Cone, by and through her attorneys, IRWIN, McKNIGHT & HUGHES, and petitions this Honorable Court as follows: The petitioner/defendant herein is Marian G. Cone who currently resides at 56 Ridge Drive, Shermans Dale, Pennsylvania 17090. : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA 2. The respondent/plaintiff herein is John William Cone, Sr. who currently resides at 1308 Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania 17013. 3. Petitioner and respondent were married on April 22, 1985, in Cumberland County, Pennsylvania and were separated on March 1, 1999. 4. The respondent filed a divorce action at 99-2865 Civil Term in Cumberland County, Pennsylvania on May 11, 1999. 5. Petitioner is without the ability to earn income sufficient to meet her reasonable needs. WHEREFORE, petitioner, Marian G. Cone, respectfully requests that this Honorable Court order alimony pendente lite in an amount equal to the Pennsylvania State Support Guidelines. Respectfully submitted, IRWIN, McKNIGHT & HUGHES By: Marcus .A. McKnig t, I, Esquire 60 West Pomfret Stre Carlisle, PA 17013 Supreme Court I.D. No: 25476 (717) 249-2353 Attorney for the petitioner/defendant, Marian G. Cone Date: September 20, 1999 2 VERIFICATION The foregoing Petition for Alimony Pendente Lite is based upon information which has been gathered by counsel and myself in the preparation of this action. I have read the statements made in this document and they are true and correct to the best of my knowledge, information and belief. I understand that false statements herein made are subject to the penalties of 18 Pa. C.S.A. Section 4904, relating to unworn falsification to authorities. MARIAN G. CONE Date: September 20, 1999 m C ¢ CL. W N W iu e : cn ? t C7 cn U DR 29019 JOHN W. CONE, SR. PACSES ID 188101527 , Plaintiff/Respondent IN THE COURT OURT OF COMMON PLEAS vs. COUNTY, pENNSYLVANIA MARIAN G. CONE, DOMESTIC RELATIONS SECTION CIVIL ACTION -LAW Defendant/petitioner NO. 99-2865 CIVIL TERM NO ORDER OF CO AND URT Petitioner's NOW, this 3 day of November, 1999, income/earnin monthly net income%arnin based u g capacity g capacity is $747.34 upon the Court's determination Pennsylvania State Coll is $1> 807.52 that Per month, it is hereby per month and Res $149.60 ection and Disbursement Unit, Y Ordered that the Respondent's pondent month] Per week for alimon $670.00 Y net November 5, 1999. Arr Y Pendente lite and a month payable weekl pay to the is September 21, 1999 ears set at $1,300.00 as $4.60 per week on weekly as follows. arr of November 1 1999. ears. First payment due effective date of the order Husband is to maintain medical insurance coverage on wife. The days. Husband is to report his return to employment to the Domestic Relations Office within five This order is based upon an agreement of the . Parties and husband currently receiving disability Failure to make each immediate collection b payment on time after dite by all of the me and in full will cause all arrears Further ecome subject to hearing, that the Respondent hams as provided by 23 pa Respondent in civil contempt of Court and willfully failed C 'S.§3703. P with this Ordet ''f the Court finds, limited to commitment of the Respondenttos discretion to comply make an appropriate Order, in ludin g eclare the but not Said prison for a period not to exceed six months. money to be turned money over by the PA SCDU to, order. All checks and money orders must be made Payments must be made by check or PA SCDU payable to PA SCDU and mailed to: P- 0- Box 69110 Harrisburg, PA 17106-9110 Abe Prot ssed include the defendant's PACSES 1. Member Do not send cash by mail Number or Social Security Number in order Unreimbursed medical expenses that exceed $250.00 annually are to be paid 0% by the respondent and 100% by petitioner. The plaintiff is responsible to pay the first $250.00 annually in unreimbursed medical expenses. Respondent to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the Respondent shall submit written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. Consented: Plaintiff/Petitioner Defendant/Respondent Plaintiff/Petitioner's Attorney Defendant/Respondent's Attorney DRO: R. J. Shadday BY THE COURT, Mailed copies on Petitioner //-9-q9 to: < Respondent Marcus McKnight, III, Esquire James Jones, Esquire Edgar B. Bayley J. L,JJ Co mow.. . _ T^a. . ? ? yC_ .? in d ^7 J DR 29,019 PACSES ID 188101527 JOHN W. CONE, SR., IN THE COURT OF COMMON PLEAS Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA Vs. DOMESTIC RELATIONS SECTION CIVIL ACTION - LAW MARIAN G. CONE, Defendant/Petitioner NO. 99-2865 CIVIL TERM ORDER OF COURT AND NOW, this 7a' day of December, 1999, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $747.34 per month and Respondent's monthly net income/earning capacity is $3,027.08 per month, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $920.00 a month payable weekly as follows; $211.74 per week, ($207.14 per week for alimony pendente lite and $4.60 per week on arrears). First payment due with next pay date. Arrears set at $271.67 as of December 7, 1999. The effective date of the order is November 22, 1999. This order is based upon an agreement of the parties through their attorneys Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S. § 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Marian Cone. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. Unreimbursed medical expenses that exceed $250.00 annually are to be paid 0% by the respondent and 100% by petitioner. The plaintiff is responsible to pay the first $250.00 annually in unreimbursed medical expenses. Petitioner to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the Petitioner shall submit written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. DRO: R. J. Shadday BY THE COURT, Mailed copies on Petitioner to: < Respondent James Jones, Esquire Marcus McKnight, Ill, Esquire Edgar B. Bayley J. w ?> ?.h ?- ?„ T.1 fx? ' '? ...5 1 PI (?, "T - _ 7 + Tl t??'. ?.? iTt ? ? - r ?.. .. ') ? ..._? \.? ? ?? Il t i t a ??1Dia ,c, pr CUMeRRLAND COU V DOMl1 MC MCLATIONS oaec ot'Appliwion Request fwRaeaN Sara Name Cone (?rJJoohn W Add?eas 95,0 Walnut Bottom Road, Carlisle, PA (MO ryTGaablr 045-32-0291 QQ5/26/41 Cam! Number if Kn'DMe 1 015 27 geld taronnaftA:- Duncan & Hartman, P. C. 717-249-7780 lwf? ?°wr?R?e 1 Irvine Roar, Carlisle, Pa 17013 (r?Mlreee IrisefM! t sal -? 717-249-7800 tt3z t? A Tea "br this) 'per S 8e40eigr Nuaebr MLb ri ak er mom ardor ArSW tK DR.gl U= Swab ? ? Ri?Qt1EST Has No Record In Domestic Relations as of. Support Arrears As of End of McoM Prior b Date of Matthly Total Support Obli c Apptieetion: $ Lf 0a. yp gWan: t_ /ul OO t aL The Amount shown above is reflected in the Domestic Relations Section 0810 of Cwmberlaed County. Pennsylvania. /ylerrrbrr Domestic Reietiore Can Nuteber: C,5 i s # ! 88 / G 15-2- Signed: 7 BRRYGDOWN MX=T Support Anzacs: S As Of: Sim: tD" (Direeepply DtR?odt.tee Coordkumr) (Doe) ***Lien Satisfied Receipt Available Upon Request*** m C 3 ? .17 LIEN SATISFACTION Pacses# 188101527 No. 99 CV 2865 DR# 29019 Name: John Cone Social Security Number: 045320291 Judgment Lien Satisfied as of Februarv 27, 2001 Amount Paid $ 400.00 Signed: ? - /;- -. cO , 9-9-y 1 yen Coordinator) (Date) a cr ? ? ?s ?; _>, N -?txi <?? -p ?-_? CjJ Q ? J ^?{ C ? r_ :J ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 05/23/01 Court/Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number USF RED STAR Employer/WithWder's Name 24 WRIGHT AVE Employer/Withholder's Address AUBURN NY 13021-3128 j ?/S 1 ° 1 XO Original Order/Notice ;290 O Amended Order/Notice O Terminate Order/Notice RE: CONE, JOHN W. SR Employee/Obligors Name (Last, First, MI) > 045-32-0291 Employee/Obbgor's Social Security Number > 0244100333 Employee/Obligor's Case Identifier (See Addendum for plaintiff names assodated 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. $ 900. 00 per month in current support $ 20. oo per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 920.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 23.2.31 per weekly pay period. $ 424.52 per biweekly pay period (every two weeks). $ 450, oo per semimonthly pay period (twice a month). $ 920. 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 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 pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER /D (shown above as the Employee/Obligor's Case Idendffer) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: 06/01/01 DRO: R.S. Shadday cc: defendant Service Type M BY THE COURT: J. Wesley 01 Jr.x Form EN-028 OM8 No.: 0970-0154 Worker ID $IATT Expi Mion Date: 11/31/00 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one 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.* 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. WITHHOLDER'S ID: 1504251000 EMPLOYEE'S/OBLIGOR'S NAME: CONE. JOHN W. SR EMPLOYEE'S CASE IDENTIFIER: 0244100333 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 ofa 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. 10. *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT P.O. BOX 320 by telephone at (717) 240-6225 or CARLISLE PA 17013 by FAX at (092) 347.6941 or by Internet Page 2 of 2 Form EN-028 Service Type M OMB No.: 0970-0134 WOrkerlD $IATT Expiation Da a 12131/00 ADDENDUM Summary of Cases on Attachment DefendanWbligor: coNE, JOHN W. SR PACSES Case Number 188101527 PACSES Case Number Plaintiff Name Plaintiff Name MARIAN G. CONE Docket Attachment Amount Docket AttachmentAmount 99-2865 CIVIL$ 920.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment mount $ 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 AttachmentAmount 8 0.00 Child(ren)'s Name(s): DOB r i d u u?? N (Dg J} tn ::rrn m0- ;?? o ,U ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania ref 574 JAS/D/s ? 7 Co./City/Dist. of CUMBERLAND s, - ??O/? Date of Order/Notice 07/19/01 x O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice Court/Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number USF RED STAR Employer/Withholder's Name 34 WRIGHT AVE Employer/Withholder's Address AUBURN NY 13021-3118 RE: CONE, JOHN W. SR Employee/Obligor's Name (Last, First, MI) 045-32-0291 Employee/Obligor's Social Security Number 0244100333 Employee/Obligor's Case Identifier (See Addendum for plaintiff names assodated 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. $ 900.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0, o0 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 900.00 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: $ 207.69 per weekly pay period. $ 415.38 per biweekly pay period (every two weeks). $ 450.00 per semimonthly pay period (twice a month). $ goo. 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 the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, 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: DRO: RI Stadday Q xc: defendant ?ffi / Date of Order: JUy 20, 2001 Form EN-028 Service Type M OMB No.: 097001 Worker ID $IATT Expiation Da e: 12131100 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 1504251000 EMPLOYEE'S/OBLIGOR'S NAME: CONE. JOHN W. SR EMPLOYEE'S CASE IDENTIFIER: 0244100333 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 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. 10. *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: 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 a Page 2 of 2 Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT Expiation Date 12/31/00 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CONE, JOHN N. SR PACSES Case Number Plaintiff Name Docket Attachment Amount g 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 g 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount g o.o Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount g 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. ..9. cn ? 4 - Q m a JOHN W. CONE, SR. : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V : NO. 99-2865 CIVIL TERM MARIAN G. CONE : CIVIL ACTION-LAW Defendant : IN DIVORCE As a prerequisite to service of a subpoena for documents and things pursuant to rule 4009.22, Plaintiff John W. Cone, Sr. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least 20 days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) Defendants Counsel has waived the twenty day requirement, and 4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. Date: g(/ 7 /(/ Atto for Plaintiff JOHN W. CONE, SR. : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V : NO. 99-2865 CIVIL TERM MARIAN G. CONE : CIVIL ACTION-LAW Defendant : IN DIVORCE John W. Cone, Sr. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If no objection is made the subpoena may be served. Date: r/1 Z& r,-2;: Atto or Plaintiff or? JOHN W. CONE, SR. : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V : NO. 99-2865 CIVIL TERM MARIAN G. CONE : CIVIL ACTION-LAW Defendant : IN DIVORCE To: Support Services Members 1 st Federal Credit Union Within twenty (20) days after service of this subpoena, you are ordered by the Court to produce the following documents or things: Statement for Marian G. Cone, social security number 206-32-0939 for account 43378 from March 1, 1998 through March 31, 1998 and January 1, 1998 through January 31, 1998 to James K. Jones, Esquire, 7 Irvine Row, Carlisle, PA 17013-3019. You may deliver or mail legible copies of the documents of produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by the subpoena within twenty (20) days after its service, the parties serving the subpoena may seek a Court Order compelling you to comply with it. This subpoena was issued at the request of the following person: James K. Jones, Esquire ID #39031 7 Irvine Row Carlisle, PA 17013 (717) 240-0296 Attorney for Plaintiff By the Court: Date: By: Prothonotary r a> c: u% z w`r -G Ljl. _ """ ,rte ?_ ? .712 (; ; J U JOHN W. CONE, SR. Plaintiff V MARIAN G. CONE Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99-2865 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE As a prerequisite to service of a subpoena for documents and things pursuant to rule 4009.22, Plaintiff John W. Cone, Sr. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least 20 days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) Defendants Counsel has waived the twenty day requirement, and 4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. Date: Atto y for Plaintiff JOHN W. CONE, SR. Plaintiff V MARIAN G. CONE Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99-2865 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE John W. Cone, Sr. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If no objection is made the subpoena may be served. Date: ?(9ley 0:_?: Attoi or Plaintiff JOHN W. CONE, SR. Plaintiff V MARIAN G. CONE Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99-2865 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE To: Linda Wiles, Operations Mgr. Bank of Landisburg Within twenty (20) days after service of this subpoena, you are ordered by the Court to produce the following documents or things: Statement for Marian G. Cone, social security number 206-32-0939 for account 60302420 from February 1, 1998 through March 31, 1998 and to James K. Jones, Esquire, 7 Irvine Row, Carlisle, PA 17013-3019. You may deliver or mail legible copies of the documents of produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by the subpoena within twenty (20) days after its service, the parties serving the subpoena may seek a Court Order compelling you to comply with it. This subpoena was issued at the request of the following person: James K. Jones, Esquire ID #39031 7 Irvine Row Carlisle, PA 17013 (717) 240-0296 Attorney for Plaintiff Date: By the Court: By: Prothonotary a? u: ?,_; c;,, - t ?_ ? ?;` `?T ?=;;' ? ? ?. ?.? - ;' „- r-- .... ' r ? 7 I O '` ? t_; U ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania OX Original Order/Notice Co./City/Dist. of CUMBERLAND O Amended Order/Notice Date of Order/Notice 12/09/03 O Terminate Order/Notice Tribunal/Case Number (See Addendum for case summary) RE: CONE, JOHN W. SR Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) CENTRAL PA TEAMSTERS PENSION PO BOX 15223 READING PA 19612-5223 045-32-0291 Employee/Obligor's Social Security Number 0244100333 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. $ 400.00 per month in current support $ o. oo per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0. oo per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 400.00 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: $ 92.31 per weekly pay period. $ 184.62 per biweekly pay period (every two weeks). $ 200, oo per semimonthly pay period (twice a month). $ 400, 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 #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, 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 COU T: Date of Order: DEC 1,033 ??SIEY d - '?I?GCt Form, EN-028 Service Type M OMS No.: 0970-0154 Worker lD $OINC ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If heckl you are required to pr vide a [[opy of this form to your employee. If yo r employee works in a state that is dif erent from the state that issued this o tler, a copy must be provided to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* paydateldate of withholding is the date Oil VVIliCh 3 110d It VV29 nithhe'd from the emplo?ee'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. 5.* 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 #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 0875100105 EMPLOYEE'S/OBLIGOR'S NAME: CONE, JOHN W. SR EMPLOYEE'S CASE IDENTIFIER: 0244100333 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. 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 employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: aOOMESTIC 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 Service Type M Page 2 of 2 OMB Na.: 0970-0154 Form EN-028 Worker ID $OINC ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CONE, JOHN W. SR 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 PACSES Case Number Plaintiff Name ? 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 H r ° o 7 c n1 ?7 -` - vm Co ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Q Original Order/Notice Co./City/Dist. of CUMBERLAND O Amended Order/Notice Date of Order/Notice 12/11/03 O Terminate Order/Notice Tribunal/Case Number (See Addendum for case summary) RE: CONE, JOHN W. SR Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) USF RED STAR 34 WRIGHT AVE AUBURN NY 13021-3118 JC?E / r ? r - ??los 61/ ?yc?s?s 7 045-32-0291 Employee/Obligor's Social Security Number 0244100333 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MO See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ o. oo per month in past-due support Arrears 1.2 weeks or greater? Dyes ® no $ 0.00 per month in medical support $ o . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ o. oo per weekly pay period. $ o. oo per biweekly pay period (every two weeks). $ o. oo per semimonthly pay period (twice a month). $ o. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, 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. THE CO T: is z? 03 ?l KTi ,r Date of Order: D? i 2, 1603 Form EN-028 Service Type M OMB No.: 0970-01 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? I .NhecW you are required to prQvide a opy of this form to your 0mployee. If your employee Yorks in a state that is i erent rom the state that issued this or?er, a copy must be provided to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one 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 employeelobligor. 4. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this 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 #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 1504251000 EMPLOYEE'S/OBLIGOR'S NAME: CONE, JOHN W. SR EMPLOYEE'S CASE IDENTIFIER: 0244100333 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. 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 employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act 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. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type N If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at f 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 Worker ID $IATT C- ° T i_I +f`_ ITi ni'Ti m FTii y TQ CO _ C. JOHN W. CONE, SR., IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY,PENNSYLVANIA VS. CIVIL ACTION-DIVORCE NO. "-2865 CIVIL TERM C-) MARIAN G.CONE, IN DIVORCE = Defendant/Petitioner PACSES Case No: 188101527 rnm 77 zrn rn-- C,nr- po -<> -j C) r-= --lc,; :x ORDER OF COURT AND NOW to wit,this 25th day of March, 2013, it is hereby Ordered that the Cumberland County Domestic Relations Section dismiss their interest in the above captioned Alimony matter,pursuant to the demise of the Respondent on March 15, 2013. There is no balance due the Petitioner. This Order shall become final twenty(20)days after the mailing of the notices of the entry of the Order to the parties unless either party files a written demand with the Office of the Prothonotary for a hearing de novo before the Court. Thom aY Al. Placey, J. DRO: R.J. Shadday xc: Petitioner Respondent Marcus A. McKnight, III, Esq. Form OE-001 Service Type:M Worker:21005 INCOME WITHHOLDING FOR SUPPORT 0 ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT(two) 0 AMENDED IWO 0 ONE.TIMEORDERMOTICE FOR LUMP SUM PAYMENT O TERMINATION OF IWO Date: 03/25/13 ❑ Child Support Enforcement(CSE)Agency CK Court ❑ Attorney ❑ Private Individual/Entity(Check One) NOTE:This IVVIDWAtba►i�OW40i face.Under certain circumstances you must reject this IWO and return it to the sender(see IWO instructions http:[M "Mat.hMs.goyl.prQgrams/cse/newhirelemployer/publication/publication,htm-forms). If you receive this document from someone other than a State or.Tribal CSE agency or a Court,a copy of the underlying order must be attached. State/Tribe/Territory Commonwealth of Pennsylvania Remittance Identifier(include w1payment): 0244100333 City/County/Dist.[Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket Informaiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) CENTRAL PA TEAMSTERS PENSION RE: CONE,JOHN W.SIR PO BOX 15223 Employee/Obligor's Name(Last,First,Middle) READING PA 19612-5223 045.32-0291 Employee/Obligors Social Security Number (See Addendum for plaintiff names associated with cases on attachment] Custodial Party/Obligee's Name(Last,First, Middle) Employer/Income Withholder's FEIN NOTE:This IWO must be regular on its face. Under certain circumstances you must reject Child(ren)'s Name(s)(Last,First,Middle) Child(ren)'s Birth Date(s) this IWO and return it to the sender(see IWO instructions htto:/ANww.ad.hhs,gg dp=ramak,Wnewhire empigyertpublicatioMwblication.htm-forms),if you receive this document from someone other than a State or Tribal CSE agency or a Court,a copy of the underlying order must be attached. 0875100105 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. $ 0.00 Per month in current child support $ 0.00 per month in past-due child support-Arrears 12 weeks or greater? Oyes -@d!M $ 0.00 per month in current cash medical support $ 0.00 per month in past-due cash medical support 0.00 perm n h in current spousal support $ 0.00 per month in past-due spousal support $ 0.00 per month in other(must specify) for a Total Amount to Withhold of$ 0.00 per month. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with tQ Or�(qr h1f ,orMation. If your pay cycle does not match the ordered payment cycle,withhold one of the following amount: $ 0.00 per weekly pay period. $ 0,00 per semimonthly pay period(twice a month) $ 0.00 per biweekly pay period(every two weeks) $ 0,00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10) working days after the date of this Order/Notice. Send payment within seven(7)working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at hftp://www.aef.hhs.gov/programs/cse/`newhire/employer/contacts/contact map. htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.:0970-0154 Form EN-028 06/12 Service Type M Worker ID$OINC ❑ Return to Sender[Completed by Ernployer-Anco e,Withholder). Payment must be directed to an SDU in accordance with 42 USC§666(b)(5)and (b)(6)or Tribal Payee(see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face,you must check this box and return the IWO to the sender. Signature of Judge/Issuing Official(if required by State or Tribal law): Print Name of Judge/Issuing Official: Title of Judge/issuing Official: Date of Signature: i If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order,a copy of this I WO must be provided to the employeetobligor. ❑ If checked,the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL.INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law(23 PA C.S.§4374(b))requires remittance by an aWr&_Q c aaymnt method if an employer is ordere to withhold income from more than one employee and empire IS or more persons,or If an employer has a history of two or more returned chucks due to nonsufficlont funds. Please call the Pennsylvania State Collertt Ions and Disbursement Unit(PA SCOU)Employer Customer Service at 1.877-676. 6a0 for instructions.PA TIPS CODE 42 890 40' 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 NEE AND THE PACSES URNISER ID(shown amo re as the Employee 1por's Case IidOW00)OR SOCIAL.SECURITY MASER IN ORDER TO BE PRESSED. 00 NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at Priority: Withholding for support has priority over any other legal process under State law against the same income(USC 42 §666(b)(7)). If a Federal taut levy is in effect,please notify.ther, tiler:" Combining Payments: When remitting payments to an SDU or Tribal CSE agency,you may combine withheld amounts from more than one employee/obligor's income in a single payment:You must,however,separately.identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. if this IWO instructs you to send a payment to an entity other than an SOU(e g.,pay to the custodial party, court, or attorney),you must check the box above and return this notice to the sender.Exception: if tgis 1WO was sent by a Court,Attorney,or Private Individual/Entity and the initial order was entered;before.January 1,'1994 or?the order was issued by a Tribal CSI`agency, you must follow the"Remit payment to"Inrsttructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment.The pay date is the date on whictr the amount was withheld from the employee/obligor's wages.You must comply with the law of the State(or Tribal law if applicable)of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments: Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all 1WOs due to Federal, State, or Tribal withholding limits,you must honor all IWOs to the greatest extent posmt�fe,.gtvtng priority to current support before payment of any past-due support, Follow the State or Ttlbal IaWproce€ture of the ernpfoy pbf c►r's principal place of employment to determine the appropriate allocation method. Lump Sum Payments:You may be required to notify a State or Tribal CSE agency of upcoming,lump sum payments to this employee/obligor such as bonuses, commissions,or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this 004 contact the sender. if you fail to withhold income from the employee/obligor's income as the IWO directs,you are liable for both the accumulated amount you should have withhel4and, any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employeelotiligor from employment, refusing to employ, or taking disciplinary action against an-a inpiloyoolobligor because this IWO. OMB Expiration Date—06/31/2014,The OMB Expiration Date has no bearing on the termination date of the IWO;it identifies the version of the form currently in use Form EN-028 06112 Service Type M Page 2 of 3 'Worker Iii $OINC ^ ` Employer's Name: Employer FEIN: Name: CONE,JOHN W.SR 0244100333 CSE Agency Case identifier: Order Identifier: Withholding Limits:You may not withhold more than the lesser of, 1)the amounts allowed by the Federal Consumer Credit Protection Ao (CCPA)(15U.G.C. 1G73(b));or2)theamountoa|hmvmdbythe8taboorThbenfthe empoyee/obigo/n principal place of employment(see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as:State, Federal, local taxes;Social Security taxes;statutory pension contributions;and Medicare taxes.The Federal limit iu5O%cf the disposable income if the obligor is supporting another family and 60%of the disposable income if the obligor ie not supporting another family. However,those limits increase 5%-to 55%and 65%-if the arrears are greater than 12 weeks. If permitted by the State o,Thhe.you may deduct a fee for administrative costs.The combined support amount and fee may not exceed the limit indicated in this section, For Tribal orders,you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO,you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d)of the CCPA(15 U.S.C. 1673(b)). Depending upon applicable State or Tribal law,you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks?If the Order Information does not indicate that the arrears are greater than 12 weeks,then the Employer should calculate the COPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are no longer withholding income for this employee/obligor,an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 0875100105 0 This person has never worked for this employer nor received pedodic income. 0 This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Teibal Payee: Final Payment Amount: New Employer's Name: New Employer's Address: CONTACT INFORMATION: To Employer/income Withholder: |?you have any questions,contact WAGE ATTACHMENT UNIT(issuer name) by phone ot . by fax nt . by email orwebsihaat: . Send termination/income status notice and other correspondence to:DOMESTIC RELATIQNS SECTION, 13 N, HANOVER ST, P.O. BOX 320. CARLISLE. PA. 17013(issuer address). To EmRlQyee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT(issuer name) by phone ot ` by fax ot . by email orweboibsot . IMPORTANT:The person completing this form is advised that the information may be shared with the employee/obligor. OMB w"'oomo,v^ Form EN-D28O8/12 Service Type M Page 3of3 Worker|D$ J|NC NN � AQQEIQUM Summarv_oCon':A#arbniW Qefendantf0bl rr: CONE, JOHN W. SR PACSES Case Nit 488109527 POSES QM Number PPlaiotiff Name Plaintiff blame MARIAN G.CONE Docket AttachMgC1L Aaloun DQr. A-ttachMt 99-2865 CIVIL $ 0.00 $ 0 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Numbe r PAC F.S Qaae Numbe r Plaintiff Name Plaintiff Name Docket AftachMgnt Amount D!2cft Attacft0VWl$m€�lt i $ 0.00 $ obo Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Caaa Numbe r PACSES Coe N.umber Plaintiff Name Plaintiff Name Docket Attachment Amount Docke Attachment Amour $ 0.00 $ O.OI Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 06112 Service Type M OMB No.:0970.0154 Worker ID $OINC