HomeMy WebLinkAbout93-3494AS OF`Me?
sP
CASE# /9 13 - 3 y9 y c-r.1 4.,
HAS BEEN SCANNED.
ALL EARLIER
FILINGS TO THIS
CASE HAVE BEEN
MICROFILMED.
No, 3ggq cu q;3
CUMBERLAND COUNTY DOMESTIC RELATIONS
Date of Application: ?-' Request for Support Record Search
Name: M S 2A-'/ L' _
(Last) (First)
Address: r-T`r t e
Social Security Number: If IV ?Cg 9 8 L D.O.B.: y. /,lr-
Domestic Relations Case Number if Known: Zv 3 00 6 0 Z "t
Party Requesting Information: 6? yyJ???".?s G!??-%' ?/"
(?Pnnt Name o Firm Name)
?elep ne Number) (Address)
(-)I'll Sf YK4
-
(Fa Number) i )
A Twenty Dollar ($20.00) Fee is Due per Social Security Number
Make check or money order payable to: DRS/Lien Search
INITIAL REQUEST
Has no Record in Domestic Relations as of.
(Date)
Support Arrears as of End of Month Prior to Date of Ap rlication: $ Cr e d i l oP
Monthly Total Support Obligation: $ Soo • o?Zfrion
The Amount shown above is reflected in the Domestic Relations Section Office of
Cumberland County, Pennsylvania. m e m b tr --* q Sao o o oo a a.
Domestic Relations Case Number: P&CS is .4',7573 A 0 o 0 -2- _?
Signed: ZA"
67 (Lien Search Coordinator)
BRING-DOWN REQUEST
Support Arrears: $ As Of.
Signed:
(Lien Coordinator)
q )s /0 7
(Date)
(Date)
(Date)
* * * Lien Satisfisfaction Receipt Available Upon Request* * *
CC720
s-?
C
y5 E
3,
i 1
r
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 93-3494 CIVIL
State Commonwealth of Pennsylvania 071110750 0 Original Order/Notice
239 S 2009
Co./City/Dist. of CUMBERLAND OAmended Order/Notice
Date of Order/Notice 05/18/09 089109846 QTerminate Order/Notice
Case Number (See Addendum for case summary) 166 s 2008 00,e-Time Lump Sum/Notice
RE:MATTUS, PAUL A.
Employerlwithholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI)
194-58-9982
Employee/Obligor's Social Security Number
ALLSTATE INSURANCE COMPANY * 9800000022
HUMAN RESOURCE SVC CTR Employee/Obligor's Case Identifier
51 W HIGGINS RD STE 14 (See Addendum for plaintiff names
SOUTH BARRINGTON IL 60010-9300 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.
$
$
$ 910.00
50.00
0.00
$ 0.00
$ 500.00
$ _ 0.00
$ 0.00
$ 0.00
per month in current child support
per month in past-due child support
per month in current medical support
per month in past-due medical support
per month in current spousal support
per month in past-due spousal support
per month for genetic test costs
per month in other (specify)
one-time lump sum payment
for a total of $ 1,460.00 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:
$ 336.92 per weekly pay period. $ 730.00 per semimonthly pay period
(twice a month)
$ 673.85 per biweekly pay period (every two weeks) $ 1, 460.00 per monthly pay period.
REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10)
working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of
withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work
state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of
the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding,
the following information is needed (See #9 on page 2).
If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call
Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580
for instructions. PA FIPS CODE 42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
BY THE COURT:
DRO: R.J. Shadday
Service Type M
Arrears 12 weeks or greater? ® yes 0 no
OMB No.: 0970-0154
A. Hess, Judge
Form EN-028 Rev. 4
Worker ID $ IATT
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
If hecke? you are required to pro idea opy of this form to your loyee. If yo r employee orks in a state tha>kis
di#erent from the state that issued this order, a copy must be provi3mpto your employee even if tie box is not chec ed.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to
each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each
employee/obligor.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4. * Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against
this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow
the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent
possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you.
Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 1643100093
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: CI
EMPLOYEE'S/OBLIGOR'S NAME:MATTUS, PAUL A.
EMPLOYEE'S CASE IDENTIFIER: 9800000022 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT:
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have
withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless
the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment,
refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of
employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social
Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is
supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is
increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may
deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks : If the Order information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of
the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the
CCPA 0 5 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health
care premiums in determining disposable income and applying appropriate withholding limits.
10. Additional info:
*NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state
that issued this order with respect to these items.
11. Send Termination Notice and
other correspondence to:
DOMESTIC RELATIONS SECTION
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
13 N. HANOVER ST -- by telephone at (717) 240-6225 or
P.O. BOX 320 by FAX at (717) 240-6248 or
CARLISLE PA 17013
by internet www.childsupport.state.pa.us
Page 2 of 2 Form EN-028 Rev. 4
Service Type M oMBNo.:097"154 Worker ID $IATT
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: MATTUS, PAUL A.
PACSES Case Number
071110750
Plaintiff Name
SHARON S. JACOBY
Docket Attachment Amount
00239 S 2009 $ 720.00
Child(ren)'s Name(s):
DALTON J. MATTUS DOB
TRIS:TAN 3'. MATTUS 07/30/00
COLTON J. MATTUS 10/04/0;
05/24/98
PACSES Case Number 089109846
Plaintiff Name
CUMB RE LAND CO JUV PROB
Docket Attachment Amount
00166 S 2008 $ 240.00
Child(reN's Name(s):
AUSTIN JAMES MATTUS DOB
12/01/93
PACSES Case Number 253000027
Plaintiff Name
DENI- SE A. MATTUS
Docket Attachment Amount
3494 CV 93 $ 500.00
Child(ren)'s Name(s):
DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s):
DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s):
DOB
Service Type M Addendum Form EN-028 Rev. 4
OMB No, 0970-0154 Worker ID $IATT
FILED-C=F,!,177
2009 MAY 19 Pill 3: 03
071110750
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 239 S 2009
State Commonwealth; of Pennsylvania
CO./City/Dist. Of CUMBERLAND
Date of Order/Notice 10/14/10
Case Number (See Addendum for case summary)
Employer/1Nithholder's Fedelral EIN Number
ALLSTATE IN~URANCE COMPANY
HUMAN RESOU~CE SVC CTR
51 W HIGGIN RD STE TGA
SOUTH BARRII~TGTON IL 60010-9300
089109846
166 s 2008
253000027
93-3494 CIVIL
RE:MATTUS, PAUL A.
OOriginal Order/Notice
OAmended Order/Notice
OTerminate Order/Notice
QOne-Time Lump Sum/Notice
Employee/Obligor's Name (Last, First, Mq
194-58-9982
Employeel0bligor's Social Security Number
9800000022
Employee/Obligor's Case Identifier
(See Addendum for plaintiff names
associated with cases on attachment)
Custodial Parent's Name (Last, First, Mp
See Addejndum 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 CUMBERLPIND 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.
$ 9io. oo per month in current child support
$ 37 . oo per month in past-due child support Arrears 12 weeks or greater? ~~es
$ o.oo ~er month in current medical support ~~ ~, ---~~
$ o . oo er month in past-due medical support ~_ ~ ~-n---
$ soo. oo per month in current spousal support t.~~+ 'T~t i
$ o . oo per month in past-due spousal support ~~ -- ~®
$ o . oo der month for genetic test costs ~~ `~ ~~
~ c~ -rt
$ o. oo per month in other (specify) ° -a _
$ ane-time lump sum payment _~ ~~~- ~
2, -~~ ~ ~ ~
for a total of $ 1~, 447 . oo per month to be forwarded to payee below.
-.r
You do not have to vajry your pay cycle to be incompliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 333.93 pdr weekly pay period. $ 723.50 per semimonthly pay period
(twice a month)
$ 667.85 p$r biweekly pay period (every two weeks) $ 1, 447 • oo per monthly pay period.
REMITTANCE INFOl~MATION: You must begin withholding no later than the first pay period occurring ten (10)
working days after tht# date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of
withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work
state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of
the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding,
the following information is needed (See #9 on page 2).
Pennsylvania law (23i PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is
ordered to withhold ~ncome from more than one employee and employs 15 or more persons, or if an employer has
a history of two or mjore returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections
and Disbursement Ufiit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE
42 000 00
Make RemittancePayable to: PA SCDU
Send check to: P nnsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAY ENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employ a/Obligor's Case Ident'fier) OR SO AL SECURITY NUMBER !N ORDER TO BE PROCESSED.
DO NOT SEND CAS BY MAIL.
BY THE COURT: ~ ~ - p
J. slimy Olt ., ud
DRO: R. J . Shadday Form EN-028 Rev.5
Service Type M ones No.: o9~ao,sa Worker I D $ IATT
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
~ If ~hecked you are required. to provide a copy of this form to your~mployee. If yoYr employee works in a state that is
di Brent from the state that issued this order, a copy must be provi edd to your emp ogee even if the box is not checked
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to
each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each
employee/obligor.
3.* Reporting the Paydate/ ate of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholdin is the date on which amount was withheld from the employee's wages. You must comply with the law of the
state of the employee's/obli or's principal place of employment with respect to the time periods within which you must implement the
withholding order and forty rd 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%bligorsnd 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. i6431o0093
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : ~ THE EMPLOYEElOBLIGOR NO LONGER WORKS FOR: O
EMPLOYEE'S/OBLIGOR'S NAME:NIATTUS, PAUL A.
EMPLOYEE'S CASE IDENTIFIER: 9800000022 DATE OF SEPARAT
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT•
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have''any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to vv~ithhold 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%bligortrom employment,
refusing to employ, or takinig disciplinary action against any employee%bligorbBcause of a support withholding. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
9.* Withholding Limits: Ybu may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) (t 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of
employment. Disposable irycome is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social
Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is
supporting another family aid 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is
increased to 55% and that ~0% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may
deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of
the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the
CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health
care premiums in determiniing disposable income and applying appropriate withholding limits.
10. Additional info:
*NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state
that issued this order with respect to these items.
11. Send Termination N tice and
other correspondenc to:
DOMESTIC RELAT ONS SECTION
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by Internet www.childsupport.state.pa.us
Page 2 of 2
Service Type A'- OMB No.: 0970-0154
Form EN-028 Rev.S
Worker ID $IATT
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: MATTUS, PAUL A.
PACSES Case Number 071110750
Plaintiff Name
SHARON S. JACOBY
Docket Attachment Amount
00239 S 2009 $ 720.00
Child(ren)'s Name(s): DOB
DALTON J. MATTUS 07/30/00
TRISTAN ~J'. MA'~'2LtS 10/04/04
AUSTIN J. MATTUS 12/01/93
COLTON J. MATTUS 05f2'4/9$
PACSES Case Number 089109846
Plaintiff Name
CUMBERLAND CO JW PROB
Docket Attachment Amount
00166 S 2008 $ 227.00
Child(ren)'s Name(s): DOB
AUSTIN J. MATTUS 22/01/93
PACSES Case Number 253000027
Plaintiff Name
DENISE A. MATTUS
Docket Attachrpent Amount
3494 CV 93 $ 500.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachrhent Amount
$ o.oo
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
Addendum Form EN-028 Rev.5
Service Type M OMBNO.:0970-0754 Worker ID $IATT
ORDERMOTICE TO WITHHOLD INCOME FOR SUPPORT
b8'9 i U? S
State: Commonwealth of Pennsylvania ?(o? S ADC
Co./City/Dist. of: CUMBERLAND
Date of Order/Notice: 07/26/11 L,17/ U5 -3 (
Case Number (See A en um for case summary) 3?7 S'
Employer/Withholder's Federal EIN Number
ALLSTATE INSURANCE COMPANY
HUMAN RESOURCE SVC CTR
51 W HIGGINS RD STE TGA
SOUTH BARRINGTON IL 60010-9300
RE: MATTUS, PAUL A.
q1,15 - 30+ 111 1 /
O Original Order/Notice
Q Amended Order/Notice
O Terminate Order/Notice
O One-Time Lump Sum/Notice
Employee/Obligor's Name (Last, First, MI)
194-58-9982
mp oyee Igor s Social Securi-ty-N-um-5-er
9800000022
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.
$ 910.00 per month in current child support
$ 0.00 per month in past-due child support Arrears 12 weeks or greater? Q yes Q no
$ 0.00 per month in current medical support 4 ? .a 17,
$ 0.00 per month in past-due medical support - .....4
$ 500.00 per month in current spousal support r-nm c- :-
rn
$ 0.00 per month in past-due spousal support Y--
$ 0.00 per month for genetic test costs cnr- rv =?
-tf
$ 0.00 per month in other (specify) ---1
$_ one-time lump sum payment' -v r
["°
for a total of $ 1,410.00 per month to be forwarded to payee below.'
" cz
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle tl$es not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 2);2 per weekly pay period. $ 705.00 per semimonthly pay period
(twice a month)
$ LEO •77 per biweekly pay period (every two weeks) $ 1,410.00 per monthly pay period.
REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10)
working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of
withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work
state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of
the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding,
the following information is needed (See #9 on page 2).
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an
employer is ordered to withhold income from more than one employee and employs 15 or more persons, or
if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the
Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at
1-877-676-9580 for instructions. PA FIPS CODE 42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFEND T'S NAME AND THE PACSES MEMBER /D
(shown above as the Employee/Obligor's C4se Identifi r) OR SOLI SECURITY NUMBER IN ORDER TO BE
PROCESSED. DO NOT SEND CASH BYM IL./
BY THE COURT:
Service Type M
Vesley Oler, A, Judge
No.: 0970-0154
Form EN-028
Worker ID $IATT
C)/ I
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
F? If checked you are required to provide a copy of this form to your employee. If your employee works in a state that is
different from the state that issued this order, a copy must be provided to your employee even if the box is not checkec.
1. Priority: Withholding under this Order/Notic(.has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the
requesting agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment
to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to
each employee/obligor.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of
the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement
the withholding order and forward the support payments.
4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support
against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you
must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the
greatest extent possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for
you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 1643100093
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: O
EMPLOYEE'SIOBLIGOR'S NAME: MATTUS, PAUL A.
EMPLOYEE'S CASE IDENTIFIER: 9800000022 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER:
FINAL PAYMENT AMOUNT:
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should
have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding.
Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she
is employed governs.
9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place
of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes,
Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the
obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, that
50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State,
you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amour
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser
of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of
r
the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts pad f,
health care premiums in determining disposable income and applying appropriate withholding limits.
10. Additional info:
*NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the
state that issued this order with respect to these items.
11. Send Termination Notice and
other correspondence to:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by internet www childsupport state pa us
OMB No , 0970-0154
Form EN-028
l/ -L-r In GIDTT
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: MATTUS, PAULA.
PACSES Case Number 089109846 PACSES Case Number 253000027
Plaintiff Name Plaintiff Name
CUMBERLAND CO JUV PROB DENISE A. MATTUS
Docket Attachment Amount Docket Attachment Amount
00166 S 2008 $ 227.00 3494 CV 93 $ 500.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
AUSTIN J. MATTUS 12/01/93
PACSES Case Number 627105398
Plaintiff Name
PAMELA S. MATTUS
Docke Attachment Amount
00327S 2003 $ 683.00
Child(ren)'s Name(s): DOB
DALTON J. MATTUS 07/30/00
TRISTAN J. MATTUS 10/04/04
AUSTIN J. MATTUS 12/01/93
COLTON J. MATTUS 05/24/98
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
Addendum Form EN-028
Service Type M OMBNo:0970-0154 Worker ID $IATT
In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
DENISE A. MATTUS Docket Number: 3494 CV 93
Plaintiff
vs.
.
PACSES Case Number: 253000027
PAUL A. MATTUS n r
:1 c
Defendant Other State ID Number: =
--OX ..
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r-n CD
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Order _
C?
C=
AND NOW to wit, this SEPTEMBER 9, 2011 it is hereby Ordered t4:= CD "n
_., N)
THAT THE CUMBERLAND COUNTY DOMESTIC RELATIONS SECTION DISMISS THEIR INTER EST IN
THE ABOVE CAPTIONED ALIMONY MATTER, EFFECTIVE AUGUST 30, 2011, PURSUANT TO THE
DEMISE OF THE RESPONDENT ON AUGUST 30, 2011.
THE ALIMONY ACCOUNT IS CLOSED WITH A BALANCE OF $2,866.35 OWED TO THE
PETITIONER.
J
Form OE-520 02/11
Service Type M Worker ID 21205
BY THE COURT:
ORDERMOTICE TO WITHHOLD INCOME FOR SUPPORT
State: Commonwealth of Pennsylvania 089109846
166 s 2008
Co./City/Dist. of: CUMBERLAND
Date of Order/Notice: 09/08/11 627105398
Case Number (See A e?for case summary) 327 S 2003
Employer/Withholder's Federal EIN Number
ALLSTATE INSURANCE COMPANY
HUMAN RESOURCE SVC CTR
51 W HIGGINS RD STE TGA
SOUTH BARRINGTON IL 60010-9300
RE: MATTUS. PAUL A.
93-3494 CIVIL
O Original Order/Notice
Q Amended Order/Notice
(?) Terminate Order/Notice
O One-Time Lump Sum/Notice
Employee/Obligor's Name (Last, First, MI)
194-58-9982
mp oyee igor s Social Secur-if7lTu-m--S-er
9800000022
Employee/Obligors Case Identifier
(See Addendum for plaintiff names
associated with cases on attachment)
Custodial Parent's Name (Last, First, MI)
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts
from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your
State.
$ 0.00 per month in current child support
$ 0.00 per month in past-due child support Arrears 12 weeks or greater? 0 yes 9-no
$ 0.00 per month in current medical support
$ 0.00 per month in past-due medical support -cs3
$ 0.00 per month in current spousal support
r'"cT? rn ?r
$ 0.00 per month in past-due spousal support Z70 -fl 7-)0
$ 0.00 per month for genetic test costs ;o
$ 0.00 per month in other (specify)a
$ one-time lump sum payment C-)
yp tV __4
for a total of $ 0.00 per month to be forwarded to payee below. P"
rQ
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period
(twice a month)
$ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period.
REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10)
working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of
withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work
state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of
the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding,
the following information is needed (See #9 on page 2).
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an
employer is ordered to withhold income from more than one employee and employs 15 or more persons, or
if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the
Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at
1-877-676-9580 for instructions. PA FIPS CODE 42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID
(shown above as the Employee/Obligor's ase /dentin r ORS AL SECURITY NUMBER IN ORDER TO BE
PROCESSED. DO NOT SEND CAS Y A
7 J
BY THE COURT:/
J. V*sley Oler, Jr., Judge
OMB No.: 0970-0154 Form EN-028
Service Type M Worker ID $IATT
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
F-1 If checked you are required to provide a copy of this form to your employee. If your employee works in a state that is
different from the state that issued this order, a copy must be provided to your employee even if the box is not checked.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the
requesting agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment
to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to
each employee/obligor.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of
the state of the employee's/obligoes 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. 1643100093
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEE/OBLIGOR NO LON(WR WORKS FOR: O
EMPLOYEE'S/OBLIGOR'S NAME: MATTUS, PAUL A.
EMPLOYEE'S CASE IDENTIFIER: 9800000022 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER:
FINAL PAYMENT AMOUNT:
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should
have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding.
Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she
is employed governs.
9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place
of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes,
Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the
obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, that
50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State,
you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser
of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of
the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for
health care premiums in determining disposable income and applying appropriate withholding limits.
10. Additional Info:
*NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the
state that issued this order with respect to these items.
11. Send Termination Notice and
other correspondence to:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
If you or your employee/obligor have any questions
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by internet www.childsupport.state.pa.us
Service Type M
OMB No.: 0970-0154
Page 2 of 2
Form EN-028
Worker ID $IATT
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: MATTUS, PAUL A.
PACSES Case Number 089109846 PACSES Case Number 253000027
Plaintiff Name Plaintiff Name
CUMBERLAND CO JUV PROB DENISE A. MATTUS
Docket Attachment Amount Docket Attachment Amount
00166 S 2008 $ 0.00 3494 CV 93 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s):
AUSTIN J. MATTUS 12/01193
PACSES Case Number 627105398
Plaintiff Name
PAMELA S. MATTUS
Docket Attachment Amount
00327 S 2003 $ 0.00
Child(ren)'s Name(s):.
DALTON J. MATTUS
TRISTAN J. MATTUS
COLTON J. MATTUS
DOB
07/30/00
10/04/04
05/24/98
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):
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
DOB
DOB
Addendum Form EN-028
Service Type M OMB No : 0970-0154 Worker ID $IATT