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HomeMy WebLinkAbout03-5953E. RAELYNN GIPE, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff VS. CIVIL ACTION - DIVORCE NO. 2003 - SqU CIVIL TERM HARRY D. GIPE, IN DIVORCE Defendant NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the Court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Court House, Carlisle, Pennsylvania, 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYERS FEES OR EXPENSES BEFORE A DECREE OF DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 32 BEDFORD STREET CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 SAIDIS SHUFF, FLOWER & LINDSAY ATTORNEYS-AT-LAW 26 W. High Street Carlisle, PA SAIDIS, SHUFF, FLOWER & LINDSAY Attorneys for Plaintiff By: Esquire 26 West High Street Carlisle, PA 17013 (717) 243-6222 E. RAELYNN GIPE, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff VS. CIVIL ACTION - DIVORCE NO. 2003 - CIVIL TERM HARRY D. GIPE , IN DIVORCE Defendant COMPLAINT E. RAELYNN GIPE , Plaintiff, by attorneys, SAIDIS, SHUFF, FLOWER & LINDSAY, respectfully represents: 1. The Plaintiff is E. RAELYNN GIPE , who currently resides at 77 Mountain Street, Rear A. Mount Holly Springs, Cumberland County, Pennsylvania, where she has resided since June 2003. 2. The Defendant is HARRY D. GIPE , who currently resides at 21 Main Street, Newville, Cumberland County, Pennsylvania, where he has resided since September 1, 2003. 3. The Plaintiff and Defendant both have been bona fide residents in the Commonwealth of Pennsylvania for at least six months immediately prior to the filing of SAIDIS this Complaint. SHUFF, FLOWER & LINDSAY ArrowNTvs•Ar•uw 4. The Plaintiff and Defendant were married on January 5, 1989 at Smithville, 26 W. High Street Carlisle, PA Texas. 5. That there have been no prior actions of divorce or for annulment between the parties in this or in any other jurisdiction. 6. The Plaintiff avers that she is entitled to a divorce on the ground that the marriage is irretrievably broken and Plaintiff is proceeding under Sections 3301 (c) and/or (d) of the Divorce Code. 7. Plaintiff has been advised of the availability of marriage counseling and of the right to request that the Court require the parties to participate in marriage counseling, and does not request counseling. WHEREFORE, Plaintiff requests the Court to enter a decree of divorce. SAIDIS SNUFF, FLOWER & LINDSAY ATTOPM-AT•LAW 26 W. High Street Carlisle, PA Date: // I I -z j 07 SAIDIS, SHUFF, FLOWER & LINDSAY, P.C. Attorneys for Plaintiff By: / Carol J. ind ay, I D # 44693 26 West Hig tree Carlisle, PA 17013 (717) 243-6222 ?? E. RAELYNN GIPE, PLEAS OF Plaintiff VS. HARRY D. GIPE, IN THE COURT OF COMMON CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 2003 - CIVIL TERM IN DIVORCE Defendant VERIFICATION I, the undersigned, hereby verify that the statements made herein are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. E. Raelynn Gipe, Plaintiff Date: //° // -03 SAIDIS SHUFF, FLOWER & LINDSAY ATIORNEYS•AMAW 26 W. High Streei Carlisle, PA I d d r w c. s- H1hW.1W REV. W-0T COMMONWEALTH OF PENNSYLVANN DEPARTMENT OF HEALTH VITAL RECORDS RECORD OF STATE FILE NUMBER DDLINIY DIVORCE OR ANNULMENT STATE FILE DATE CUMBERLAND ® (CHECK ONE) ? HUSBAND 1. NAME (First) (MMMa) (Leaf) 2. DATE (MMa) (Dry) (YWW) Harry Dana Gipe BIRTH 09 12 89 3. RESIDENCE ShWWMR.D. City, Sm. wTop. County SMM 6. PLACE (SMM-FoMan Canby) 21 Main Street Newville Cumberland PENNSYLVANIA BIRTH Germany 5. NUMBER S. RACE 7. USUALOCCUPATION OFTHIS I WHITE Sped BLACK ° R` "' MARRIAGE I 0 j j DOCKWORKER WIFE e. MAIDEN NAME fte) (MMW) (Last) S. DATE (MMn) (ay) (Year) Hubbard Evelyn Raelynn Gipe BIRTH 10 12 1970 10. RESIDENCE SWWWaR.D. Ciy, Bas. a Top. C" SMM 11. PLACE (SMM a FOM2n CwnW 77 Mountain St. Rear A. Mt.Holly Springs Cumberland PENNSYLVANIA BIRTH Scottsbluff, N ebraska 12. NUMBER 3. RACE 14. USUAL OCCUPATION OF THIS WHITE BLACK OTHER (Specify) MARRIAGE One i? n n Nurse 15. PLACE OF (County) (SEW Or Forepn Country) 18. DATE OF (MMn) (Day) (YWa9 THIS MARRIAGE Smithville Bastrop THIS Texas MARRIAGE 01 05 1989 17A. NUMBER OF 78. NUMBER OF DEPENDENT 18. PLAINTIFF 19. DECREE GRANTED TO CHILDREN THIS CHILDREN UNDER 18. HUSBAND WIFE OTHER (Specify) HUSBAND WIFE OTHER (813ecity) MARRIAGE two ? ® ? ? ® ? 20. NUMBER OF HUSBAND WIFE SPUTCUSTODY OTHER(SwIfy) 21. LEGAL GROUNDS FOR CUSTODY ? ® 1 ? j?UIMEM (d) 33 °R OF ? ( 0 1 22. DATE OF DECREE (MMth) (Day) (YNF) 23. DATE REPORT SENT (Month) (Day) (Y-) I TO VITAL RECORDS 24. SIGNATURE OF TRANSCRIBING CLERK E. RAELYNN GIPE, Plaintiff VS. HARRY D. GIPE, Defendant law firm of SAIDIS, SHUFF, FLOWER & LINDSAY, Attorneys, hereby certify that I served the within Complaint in Divorce on the Defendant, HARRY D. GIPE by Certified Mail, Restricted Delivery, Addressee Only, Return Receipt Requested, (Article number 7003 1010 001 1200 4446) in Carlisle, Pennsylvania, addressed to: CERTIFICATE OF SERVICE AND now, this 15TH day of November, 2003, I, Carol J. Lindsay, Esquire, of the Harry D. Gipe 21 W. Main Street Newville, PA 17241 SAIDIS SHUFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA and proof thereof, the signed Return Receipt Card , is attached hereto. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 2003 - 5953 CIVIL TERM IN DIVORCE SAIDIS, SHUFF, FLOWER & LINDSAY, P.C. Attorneys fo4 Plaintiff , By: I D'# 44693 26 West High Street Carlisle, PA 17013 (717) 243-6222 re E. RAELYNN GIPE , Plaintiff VS. HARRY D. GIPE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 2003 - 559 s 3 CIVIL TERM IN DIVORCE PROOF OF SERVICE SAIDIS SHUFF, FLOWER & LINDSAY ATTORNEYS-AT-LAW 26 W. High Street Carlisle, PA E. RAELYNN GIPE, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff VS. CIVIL ACTION - DIVORCE NO. 2003 -5953 CIVIL TERM HARRY D. GIPE IN DIVORCE Defendant NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the Court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Court House, Carlisle, Pennsylvania, 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYERS FEES OR EXPENSES BEFORE A DECREE OF DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 32 BEDFORD STREET CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 SAIDIS SWIPE, FLOWER & LINDSAY ATTORNEYS•AT•IAW 26 W. High Street Carlisle, PA SAIDIS, SHUFF, FLOWER & LINDSAY Attorneys for Plaintiff By: ID# 44693 / 26 West gh Street Carlisle, PA 17013 (717) 243-6222 E. RAELYNN GIPE, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff Vs. CIVIL ACTION - DIVORCE NO. 2003 - 5953 CIVIL TERM HARRY D. GIPE IN DIVORCE Defendant AMENDED COMPLAINT E. RAELYNN GIPE, Plaintiff, by attorneys, SAIDIS, SHUFF, FLOWER & LINDSAY, respectfully represents: 1. The Plaintiff is E. RAELYNN GIPE , who currently resides at 77 Mountain Street, Rear A. Mount Holly Springs, Cumberland Conty, Pennsylvania, were she has resided since June 2003. 2. The Defendant is HARRY D. GIPE„ who currently resides at 21 Main Street, Newville, Cumberland County, Pennsylvania, where he has resided since September of 2003. 3. The Plaintiff and Defendant both have been bona fide residents in the SAIDIS SNUFF, FLOWER & LINDSAY 26 W. Nigh Street Carlisle, PA Commonwealth of Pennsylvania for at least six months immediately prior to the filing of this Complaint. 4. The Plaintiff and Defendant were married on January 5, 1989 at Smithville, Texas. 5. That there have been no prior actions of divorce or for annulment between the parties in this or in any other jurisdiction. 6. The Plaintiff avers that she is entitled to a divorce on the ground that the marriage is irretrievably broken and Plaintiff is proceeding under Sections 3301 (c) and/or (d) of the Divorce Code. 7. Plaintiff has been advised of the availability of marriage counseling and of the right to request that the Court require the parties to participate in marriage counseling, and does not request counseling. WHEREFORE, Plaintiff requests the Court to enter a decree of divorce. COUNT II - EQUITABLE DISTRIBUTION 8. The averments of Paragraph 1-7 are incorporated herein by reference as though set out in full. 9. The parties have, during their marriage, acquired certain property, both personal and real. WHEREFORE, Plaintiff prays this Honorable Court to equitably divide the parties' property. COUNT III - COUNSEL FEES AND COSTS 10. The averments in Paragraphs 1-9 are incorporated herein by reference as SAIDIS SNUFF, FLOWER & LINDSAY AnUMYS•AT•LAW 26 W. High Street Carlisle, PA though set out in full. 11. Plaintiff has incurred counsel fees and costs to prepare her case for trial which are beyond her ability to pay. WHEREFORE, Plaintiff prays this Honorable Court to order payment of her counsel fees and reimbursement of her costs. SAIDIS, SHUFF, FLOWER & LINDSAY, P.C. Attorneys for Plaintiff By: SAIDIS SHUFF, FLOWER & LINDSAY ATI'ORNEYS.AT•LAW 26 W. High Street Carlisle, PA 9 ee Carlisle, PA 17013 (717) 243-6222 Date: 2- Z -#- I D # 44693 26 West Hi E. RAELYNN GIPE, Plaintiff VS. HARRY D. GIPE Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 2003 - 5953 CIVIL TERM IN DIVORCE VERIFICATION I, E. Raelynn Gipe, the undersigned, hereby verify that the statements made herein are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. (f U? tl E.RAELYNN PE Date: -a4 SAIDIS SHUFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA r r C? r "`9. O ,-, -: ?, ,_ ?? _ 7 ;: E. RAELYNN GIPE, IN THE COURT OF COMMON PLEAS OF :CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff VS. :CIVIL ACTION - DIVORCE :NO. 2003 -5953 CIVIL TERM HARRY D. GIPE, :IN DIVORCE Defendant AFFIDAVIT UNDER S 3301(d) OF THE DIVORCE CODE 1. The Parties to this action separated on September of 2000 and continued to live separate and apart for a period of at least two years. 2. The marriage is irretrievably broken. 3. 1 understand that I may lose rights concerning alimony, division of lawyer's fees or expenses if I do not claim them before a divorce is granted. VERIFICATION I, E. Raelynn Gipe, the undersigned, hereby verify that the statements made SAIDIS SHOFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA are true and correct. I understand that false statements herein are made subject to penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. Date: ?r E. Rae ynn Gi e (' r.? .-.R i l?'-- .w -n " i C 1 i_: ', ? ? -? i U7 -_ E. RAELYNN GIPE, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff VS. CIVIL ACTION - DIVORCE NO. 2003 -5953 CIVIL TERM HARRY D. GIPE IN DIVORCE Defendant PETITION FOR ALIMONY NOW COMES E. Raelynn Gipe by and through her counsel Saidis, Shuff, Flower & Lindsay and Petitions this Honorable Court as follows: 1. The parties hereto were married on January 5, 1989 and separated on or about September 2000. 2. A Complaint in Divorce was filed on November 12, 2003. 3. Plaintiff is without resources sufficient to pay for her reasonable needs. WHEREFORE,` Plaintiff prays this Honorable Court to award to alimony in an amount sufficient to provide for reasonable needs, counsel fees and costs. SAIDIS, SHUFF, FLOWER & LINDSAY ATTORNEYS FOR PETITIONER/ BY: SAIDIS SHUFF, FLOWER & LINDSAY ATTORNEYS-AT-LAW 26 W. High Street Carlisle, PA Lindsay Gingrich Maclay, Esquire Supreme Court ID # 87954 Carol J. Lindsay, Esquire ID# 44693 26 West High Street Carlisle, PA 17013 (717) 2,43-6222 VERIFICATION I, the undersigned, hereby verify that the statements made herein are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. E. RAELYNN GIF'E 9-1z . )-?-C)q SAIDIS SHUFF, FLOWER & LINDSAY ATTORMYS•AT•LAW 26 W. High Street Carlisle, PA E. RAELYNN GIPE, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff Vs. CIVIL ACTION - DIVORCE NO. 2003 -59511 CIVIL TERM HARRY D. GIPE Defendant IN DIVORCE CERTIFICATE OF SERVICE I ND now, this _ his day of e t hLA 2004, I, Carol J. Lindsay, Esquire, of the law firm of SAIDIS, SHUFF, FLOWER & LINDSAY, Attorneys, hereby certify that I served the within Petitioner's Petition for Alimony this day by depositing same in the United States Mail, First Class, Postage Prepaid, in Carlisle, Pennsylvania, addressed to: Harry D. Gipe 21 West Main St. Newville, PA 17241 SAIDIS, SHUFF, FLOWER & LINDSAY Attorneys for Petitioner/Plaintiff SAIDIS SHUFF, FLOWER & LINDSAY By: J 110 Anny Pi r Secretary For Cai J. Lindsay 26 West High Street Carlisle:, PA 17013 (717) 243-6222 26 W. High Street Carlisle, PA co C7 ? -)w' 't1 J ll VVff.. t ; W i Ji x c,3 E. RAELYNN GIPE, Plaintiff VS. HARRY D. GIPE, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA :CIVIL ACTION - DIVORCE :NO.2003 -59531 CIVIL TERM :IN DIVORCE Defendant SAIDIS SHUFF, FLOWER & LINDSAY PLAINTIFF'S AFFIDAVIT OF CONSENT UNDER 53301(c) OF THE DIVORCE CODE AND WAIVER OF COUNSELING 1. A Complaint in Divorce under §3301 (c) of the Divorce Code was filed November 12, 2003. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. 3. 1 consent to the entry of a final Decree in Divorce: after service of notice of intention to request entry of the Decree. I verify that the statements made in this Affidavit are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to autthh?o`rri iities. cz? Date: 'a?'0/ '9J E. Raelynn Gipe PLAINTIFF'S WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 4 3301 (c) OF THE DIVORCE CODE 1. I consent to the entry of a final Decree of Divorce without notice. 2. 1 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. 1 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 to the best of my knowledge, information and belief. I understand) that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to authorities Date: % cf' E. Raelyrn Gipe 26 W. High Street Carlisle, PA n ra c? O m r. 0 D O `O' C2 rl) E. RAELYNN GIPE, Plaintiff VS. HARRY D. GIPE, Defendant :IN THE COURT OF COMMON PLEAS OF :CUMBERLAND COUNTY, PENNSYLVANIA :CIVIL ACTION - DIVORCE :NO. 2003 -5953 CIVIL TERM :IN DIVORCE DEFENDANT'S AFFIDAVIT OF CONSENT UNDER 53301(c) OF THE DIVORCE CODE AND WAIVER OF COUNSELING SAIDIS SHUFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA 3. A Complaint in Divorce under §3301 (c) of the Divorce Code was filed November 12, 2003. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. I consent to the entry of a final Decree in Divorce after service of notice of intention to request entry of the Decree. I verify that the statements made in this Affidavit are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to authonfi . Date: Z a ry D. Gip 1. 1 consent to the entry of a final Decree of Divorce without notice. 2. 1 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. 1 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 to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsif tion to authorities gyp' Date: 90 d '/ J _ 1 l/ 4rH D. ip J ? O -p i1: to =? m j IS i. E. RAELYNN GIPS, : IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. N0. 03 - 5953 CIVIL HARRY D. GIPS, Defendant IN DIVORCE ORDER OF COURT AND NOW, this o day of, 2004, the parties and counsel having entered into an agreement and stipulation resolving the economic issues on September 28, 2004, the date set for a Master's hearing, the agreement and stipulation having been transcribed, and subsequently signed by the parties and counsel, the appointment of the Master is vacated and counsel can conclude the proceedings by the filing of a praecipe to transmit the record with the affidavits of consent of the parties so that a final decree in divorce can be entered. BY THE COURT, G or E H f er, .J. cc: ol J. Lindsay Attorney for Plaintiff up-at ,,earry D. Gipe Defendant 47E, -,/a-oi -oV Ot, ?]SgB?Z 3A ?U E. RAELYNN GIPS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 03 - 5953 CIVIL HARRY D. GIPS, Defendant IN DIVORCE THE MASTER: Today is Tuesday, September 28, 2004. This is the date set for a hearing in the above captioned divorce proceedings. Present in the hearing room are the Plaintiff, E. Raelynn Gipe, and her counsel Carol J. Lindsay. Also present is the Defendant, Harry D. Gipe, who is not represented by counsel. A complaint in divorce was filed on November 12, 2003, raising grounds for divorce of irretrievable breakdown of the marriage. Although an affidavit under Section 3301(d) was previously filed averring a separation in excess of two years, the parties have provided the Master today with affidavits of consent and waivers of notice of intention to request entry of divorce decree so that the divorce can be concluded under Section 3301(c) of the Domestic Relations Code. The affidavits and waivers will be filed with the Prothonotary's office by the Master's office. On March 2, 2004, an amended complaint was filed by the Plaintiff raising the economic claims of equitable distribution and counsel fees and costs. 1 The Master has been advised that as part of the settlement, which Defendant is going to agreement the parties obligation to be paid however, attorney Lin with the Prothonotary the pleadings. the parties have reached, the be making payments of alimony. By are going to enter into an alimony by the Defendant to the Plaintiff; isay is going to file a petition today formally raising the alimony claim in An agreement is going to be placed on the record which in some respects will be left open to further review in the event of an issue arising regarding an IRS debt. The agreement will specifically indicate the circumstances in which the agreement can be revisited. However, the parties are going to resolve the equitable distribution claim with respect to the pension of husband and any other outstanding marital property issues. The decree in divorce will specifically state what issues are preserved in the event we need to come back to have further review of the IRS claims or wife's claim for counsel fees and costs. The agreement as placed on the record will be considered the substantive agreement of the parties not subject to any changes or modifications except for correction of typographical errors which may be made during the transcription. The agreement will be considered the 2 final agreement with respect to the matters addressed therein and when the parties leave the hearing room today they will be bound by the terms of the agreement even though they have not signed the agreement affirming the terms of settlement. However, the Master is going to ask the parties to return today at 2:00 p.m. to review the draft of the agreement and to sign affirming the terms of settlement. Thereafter, the Master will prepare an order vacating his appointment. Ms. Lindsay. MS. LINDSAY: The parties agree as follows: 1. Wife waives any claim she has for reimbursement for the value of a 1992 Ford truck which husband had as of the date of separation. 2. The parties agree to equally divide the balance in the Central Pennsylvania Teamsters Pension Fund in husband's name as of September 30, 2000, which amount is $87,204.05 and wife's share shall be segregated and held for her retirement benefit together with any income or loss thereon from September 30, 2000. Wife's counsel will prepare a QDRO for entry by the Court in order to accomplish the division. Within ten days of the date of mailing of the QDRO proposed to husband, he will sign and return the QDRO or have his counsel get in touch with counsel for wife to make any corrections that need to be made in the order so that it can be entered as an order of Court. 3. The parties acknowledge that they have outstanding tax obligations both to the Commonwealth of Pennsylvania and to the federal government. The parties have agreed that they owe the state $1,322.33. Wife will be solely responsible for the obligation for the payment of the Pennsylvania tax debt. The parties have further agreed that on account of federal taxes paid prior to this date, husband owes an amount to wife due to the fact that she paid more to the federal government in taxes than did he. In addition, husband has agreed to be responsible for a portion of wife's 3 attorney fees up to this hearing date. Therefore, husband will pay to wife as alimony through the office of Domestic Relations $100.00 per month for 30 months and such payment will be wage attached. That payment will total to wife $3,000.00 on account of the credits and payments which she is making as set out herein and will be taxable to wife and deductible to husband on his federal income tax return. 4. The parties have agreed to submit the outstanding balance owed to the IRS in the approximate amount of $9,801.12 to Tax Relief Associates, a group of attorneys in California who are presently representing wife in her attempt to obtain from the federal government an offer and compromise of the outstanding debt. Wife has paid the firm a flat fee retainer of $1,200.00. It is her understanding that there are no further attorney fees associated with this engagement. Wife will permit husband to join with her in the attempt to receive an offer and compromise from the IRS. If Tax Relief Associates Incorporated is successful in obtaining an offer and compromise which obligates the parties to pay at least $1,200.00 less than the amount presently due, $9,801.12, then husband, within 15 days of notice of the availability of the offer and compromise, will pay to wife $600.00 which represents one-half of the attorney fees associated to engage Tax Relief Associates Incorporated. In the event that Tax Relief Associates Incorporated cannot obtain at least a $1,200.00 reduction of the present amount due to the IRS, $9,801.12, wife will be solely responsible for the $1,200.00 retainer paid to those attorneys. 5. If Tax Relief Associates Incorporated is able to arrange an offer and compromise with the IRS, each party agrees to pay one-half of the offer and compromise amount within the time period set out by the offer and compromise. In the event that the Tax Relief Associates Incorporated is unable to make an offer and compromise, then the parties will equally share the outstanding tax due to the IRS and will enter into a payment plan within 45 days of the failure of the offer and compromise attempt to make the payments of their share directly to the IRS. 6. The parties will transmit the record and obtain a decree in divorce. However, the decree in divorce will reserve the issue of the amounts owed from this date at this time to the IRS. The parties shall not be permitted to revisit the amounts paid prior to this time to the IRS but in the event that the plan for payment of the IRS cannot be or is not successfully accomplished pursuant to the terms of this agreement, one or the other of them is permitted to 4 petition the Court for the Master to revisit this issue. The right to make such a request shall remain open for 18 months only. At that time, wife's request for attorney fees, additional to those incurred as to today, could be revisited in the event that such revisitation is appropriately given to the IRS issue only. 7. Previously the parties divided their household tangible personal property and the other debts that the parties had incurred during the marriage were discharged in the bankruptcy proceedings. 8. Each party is responsible for his or her debts incurred subsequent to the separation aside from whatever the parties acknowledge is due to the IRS. 9. The parties acknowledge that this agreement fully and finally settles all of the issues outstanding between them including their commitment to pay, each of them, one-half of the outstanding obligation to the IRS together with any interest or penalties assessed by the IRS on account of the 1997, 1998, and 1999 federal income taxes due and owing. The parties also acknowledge, however, that in the event that an unforeseen development occurs with regard to those taxes, that the offices of the Divorce Master and the Courts are available to them on that issue only. 10. 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, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the other, and right to act as administrator or executor in the other's estate. 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 interest, rights, and claims. THE MASTER: Mr. Gipe, have you been present during the statement of the agreement on the record? MR. GIPS: Yes. THE MASTER: Do you understand the agreement 5 as stated on the record? MR. GIPS: Yes. THE MASTER: Do you have any questions about it? MR. GIPE: No. THE MASTER: And you are agreeable to entering into this agreement to resolve all of the economic claims raised in this action with the understanding that there is still the possibility that we may have to come back to revisit an IRS issue? MR. GIPE: Yes. THE MASTER: And perhaps a counsel fees issue as well? MR. GIPE: Yes. THE MASTER: And you are satisfied to sign this agreement as it is prepared affirming the terms of settlement reached today? MR. GIPE: Yes. MS. LINDSAY: Raelynn, you've had an opportunity to listen as I dictated the terms of the agreement? MS. GIPE: Yes. MS. LINDSAY: And did you understand those terms? MS. GIPE: Yes. 6 MS. LINDSAY: And is this an agreement you wish to make? MS. GIPS: Yes. MS. LINDSAY: And you will be willing to return to the Master's office today to review the agreement as it has been taken down by the reporter and sign the agreement; is that correct? MS. GIPS: Yes. THE MASTER: And you both understand, however, that you are bound by this agreement even though you do not sign it later today when you leave this hearing room? The substantive terms of the agreement are in effect at this time. The purpose of coming back is to review the agreement for typographical errors and misstatements regarding perhaps a name of a vehicle or an account number or something like that. Do you understand that? MR. GIPS: Yes. MS. GIPS: Yes. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend to bind myself to the settlement as a contract obligating myself to the terms of settlement and subjecting myself to 7 the methods and procedures of enforcement which may be imposed by law and in particular Section 3105 of the Domestic Relations Code. WITNESS: DATE: Carol J. L'n say E. Raelynn Gipe Attorney or Plaintiff 9 4A H ry ipe E. RAELYNN GIPE, :IN THE COURT OF COMMON PLEAS OF :CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff VS. :CIVIL ACTION - DIVORCE :NO. 2003 -5953 CIVIL TERM HARRY D. GIPE, Defendant :IN DIVORCE DEFENDANT'S AFFIDAVIT OF CONSENT UNDER 43301(c) OF THE DIVORCE CODE AND WAIVER OF COUNSELING A Complaint in Divorce under §3301 (c) of the Divorce Code was filed November 12, 2003. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. 3. 1 consent to the entry of a final Decree in Divorce after service of notice of intention to request entry of the Decree. I verify that the statements made in this Affidavit are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to au?thoriti Date: / °2 6 V t/ aryD.Gip DEFENDANT'S WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 4 3301 (c) OF THE DIVORCE CODE 1. I consent to the entry of a final Decree of Divorce without notice. 2. 1 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. 1 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 to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsif tion to authorities SAIDIS SHUFF, FLOWER & LI & LINDSAY Date: // ATTOMYS•AT•LAW H rry D. ip 26 W. High Sheet Carlisle, PA N c = ?-. -?? =? _, ?> ?: -<, ?,; ., 'r,?, i ,? -_ '1 ?? ??Y-? , _ ' i t' -. E. RAELYNN GIPE, Vs. HARRY D. GIPE, Plaintiff Defendant :IN THE COURT OF COMMON PLEAS OF :CUMBERLAND COUNTY, PENNSYLVANIA :CIVIL ACTION - DIVORCE :NO.2003 -5953 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) 3301(d)(1) of the Divorce Code. (Strike out inapplicable section). 2. Date and manner of service of the complaint: Defendant was served via Certified Mail, Certificate of Service and Proof of Service filed with Prothonotary November 25, 2003 (copy enclosed) 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 the Plaintiff September .2?r, 2004;by the Defendant September Q_, 2004.. 4. Related claims pending: All matters resolved. The issue of payment of IRS debt is reserved for the Masters determination for 18 months pursuant to the parties aqreement of September 28, 2004. 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 3301(c) Divorce was filed with the Prothonotary: SeptemberSo 2004. Date Defendant's Waiver of Notice in 3301(c) Divorce was filed with the SAIDIS Prothonotary: September 004. SHUFF, FLOWER & LINDSAY ATrORNEYS•AT•LAW Ca in say, Esq 26 W. High Street Supreme Court Ip 44 3 Carlisle, PA Saidis, Shuff, Flo a Lindsay 26 West High Street Carlisle PA 17013 Phone: 717.243.6222 Attorney for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNA. E. RAELYNN GIPE Plaintiff N O. 2003-5953 VERSUS HARRY D. GIPE Defendant DECREE IN DIVORCE AND NOW, (?? ,Z_ -7A1/L? IT IS ORDERED AND DECREED THAT E. Raelynn Gipe PLAINTIFF, Harry D. Gipe AND 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; All matters resolved. The issue of payment of IRS debt is reserved for the Master's determination for 18 months pursuant to the parties agreement of September 28, 2004. BY T ATTEST: J. PROTHONOTARY 4?,' ? /&-Jr do G1 ,7i MAR 1 4 2005 tir E. RAELYNN GIPE, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff VS. CIVIL ACTION - DIVORCE NO. 2003 -5953 CIVIL TERM HARRY D. GIPE, Defendant IN DIVORCE QUALIFIED DOMESTIC RELATIONS ORDER AND NOW, this Z? day of , 2005, pursuant to an Agreement reached by the Parties on September 28, 2004 regarding the Equitable Distribution of Marital Property, specifically regarding the division of marital interest in the Central Pennsylvania Teamsters Retirement Income Plan 1987, it is hereby ordered and directed as follows: 1. Identifying Information 1. The Participant is: Harry D. Gipe r The Participant's social security number is: 165-64-0359 The Participant's address is: 21 West Main Street, Newville, Cumberland County, Pennsylvania, 17241 2. The Alternate Payee is: E. Raelynn Gipe The Alternate Payee's social security number is: 459-77-3360 The Alternate Payee's address is: 77 Mountain Street, Rear, Mount Holly Springs, Cumberland County, Pennsylvania, 17065 The Alternate Payee's date of birth is: October 12, 1970 3. The parties were married on January 5, 1989 and divorced on October 12, 2004. The parties have raised claims of equitable distribution of marital property pursuant to the Pennsylvania Divorce Code. 1 4. Participant enjoys a benefit in the Central Pennsylvania Teamsters Retirement Income Plan 1987, hereinafter, "the Plan". Method of Dividing Participant's Benefits 1. The Plan shall pay to the Alternate Payee a portion of the Participant's vested accrued balance under the Plan. The Alternate Payee shall receive a benefit equal to fifty percent (50%) of the Participant's vested account balance as of September 30, 2000. The Fund shall separately account for the benefits awarded in Paragraph 1 of this Section II as soon as administrable after this Order is determined to be a Qualified Domestic Relations Order. The Alternate Payee shall be credited with net income, loss or expense from the date set forth above, September 30, 2000. The Alternate Payee may elect to receive payment from the Plan in any form in which benefits may be paid under the Plan to the Participant (other than in the form of a joint and survivor annuity). The Alternate Payee may select a beneficiary to,receive her/his benefits in the event the Alternate Payee should die prior to receiving all of her/his benefits by filing a beneficiary designation form with the Fund Office. In the event the Alternate Payee should die prior to receiving benefits, the Plan shall pay benefits to a beneficiary selected by the Alternate Payee on a beneficiary form provided by the Fund office on request, or if no beneficiary is selected, to the Alternate Payee's estate. The Alternate Payee may elect to receive payment from the Plan at the Participant's earliest retirement age, or, if earlier, at the earliest date permitted under the Plan. For purposes of this paragraph, the Participant's earliest retirement age means the earlier of (i) the date on which the Participant is entitled to a distribution under the Plan, or (ii) the later of (a) the date the Participant attains age 50 or (b) the earliest date on which the Participant could begin receiving benefits under the Plan if the Participant separated from service. 't III. Other Provisions This Order is intended to constitute a qualified domestic relations order within the meaning of section 414(p) of the Internal Revenue Code of 1986, as amended and section 206(d) of the Employee Retirement Income Security Act of 1974, as amended, and shall be interpreted in a manner consistent with such intention. The Court shall retain jurisdiction to amend this Order to the extent necessary to establish or maintain its status as a qualified domestic relations order. 3. It is recognized that the Alternate Payee may elect to commence receiving benefits before the Participant retires. If the Alternate Payee so requests, the Participant will cooperate with the Alternate Payee in substantiating a claim or application to the Fund and shall provide any documentation or information reasonably necessary to establish their eligibility for benefits. Concurrence: Harry D. ipe 1- 03 E. Raely n Gipe I Fl- I" MAR 1 4 2005 yn E. RAELYNN GIPE, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff VS. CIVIL ACTION - DIVORCE NO. 2003 -5953 CIVIL TERM HARRY D. GIPE, Defendant IN DIVORCE QUALIFIED DOMESTIC RELATIONS ORDER AND NOW, this 'ZA_ day of Y L , 2005, pursuant to an Agreement reached by the Parties on September 28, 2004 regarding the Equitable Distribution of Marital Property, specifically regarding the division of marital interest in the Central Pennsylvania Teamsters Retirement Income Plan 1987, it is hereby ordered and directed as follows: 1. Identifying Information 1. The Participant is: Harry D. Gipe r The Participant's social security number is: 165-64-0359 The Participant's address is: 21 West Main Street, Newville, Cumberland County, Pennsylvania, 17241 2. The Alternate Payee is: E. Raelynn Gipe The Alternate Payee's social security number is: 459-77-3360 The Alternate Payee's address is: 77 Mountain Street, Rear, Mount Holly Springs, Cumberland County, Pennsylvania, 17065 The Alternate Payee's date of birth is: October 12, 1970 3. The parties were married on January 5, 1989 and divorced on October 12, 2004. The parties have raised claims of equitable distribution of marital property pursuant to the Pennsylvania Divorce Code. 4. Participant enjoys a benefit in the Central Pennsylvania Teamsters Retirement Income Plan 1987, hereinafter, "the Plan". Method of Dividing Participant's Benefits The Plan shall pay to the Alternate Payee a portion of the Participant's vested accrued balance under the Plan. The Alternate Payee shall receive a benefit equal to fifty percent (50%) of the Participant's vested account balance as of September 30, 2000. 2. The Fund shall separately account for the benefits awarded in Paragraph 1 of this Section II as soon as administrable after this Order is determined to be a Qualified Domestic Relations Order. The Alternate Payee shall be credited with net income, loss or expense from the date set forth above, September 30, 2000. The Alternate Payee may elect to receive payment from the Plan in any form in which benefits may be paid under the Plan to the Participant (other than in the form of a joint and survivor annuity). 4. The Alternate Payee may select a beneficiary to,receive her/his benefits in the event the Alternate Payee should die prior to receiving all of her/his benefits by filing a beneficiary designation form with the Fund Office. In the event the Alternate Payee should die prior to receiving benefits, the Plan shall pay benefits to a beneficiary selected by the Alternate Payee on a beneficiary form provided by the Fund office on request, or if no beneficiary is selected, to the Alternate Payee's estate. The Alternate Payee may elect to receive payment from the Plan at the Participant's earliest retirement age, or, if earlier, at the earliest date permitted under the Plan. For purposes of this paragraph, the Participant's earliest retirement age means the earlier of (i) the date on which the Participant is entitled to a distribution under the Plan, or (ii) the later of (a) the date the Participant attains age 50 or (b) the earliest date on which the Participant could begin receiving benefits under the Plan if the Participant separated from service. III. Other Provisions This Order is intended to constitute a qualified domestic relations order within the meaning of section 414(p) of the Internal Revenue Code of 1986, as amended and section 206(d) of the Employee Retirement Income Security Act of 1974, as amended, and shall be interpreted in a manner consistent with such intention. 2 -1 1 2. The Court shall retain jurisdiction to amend this Order to the extent necessary to establish or maintain its status as a qualified domestic relations order. It is recognized that the Alternate Payee may elect to commence receiving benefits before the Participant retires. If the Alternate Payee so requests, the Participant will cooperate with the Alternate Payee in substantiating a claim or application to the Fund and shall provide any documentation or information reasonably necessary to establish their eligibility for benefits. Concurrence: Har D. ipe r ?. E. Raely n Gipe pro ' In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Defendant Name: HARRY D. GIPE Member ID Nurnber: 6599100663 Fax: (717) 240-6248 Please note: AO correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multip le Cases on Attachment PACSES Docket Plaintiff Name Case e Number Number Attachment Amount/Frequency EVELYN R. GIPE 431102890 01046 S 2000 $ 839.00 /MONTH EVELYN R. GIPE 815107175 03-5953 CIVIL $ 350.00 MONTH $S / TOTAL ATTACHMENT AMOUNT: $ 1,189.00 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 $ 274.38 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, HARRY D. GIPE Social Security Number 165-64-0359 , Member ID Number 6599100663 . 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 arrearage, 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. § 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 AUGUST 1, 2004 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: APR 1 9 2005 GE Form EN-034 Service Type M Worker ID $IATT ?, ?.? _. , , <_ =: ?_; -- J?J fil-_ l:: ' T I `,) ?? ,.:'i. . ? J . ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dirt. of CUMBERLAND Date of Order/Notice 04/18/05 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: GIPE, HARRY D. Employee/Obligor's Name (Last, First, MI) ROADWAY EXPRESS INC*? ?D7? sb PO BOX 471 ?nifs ?,jl d 2„d ?? AKRON OH 44309-0471rr? ,*(/ .2003-5Y63 0116 Q'qm: F15107175- 165-64-0359 Employee/Obligor's Social Security Number 6599100663 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1, 014.00 per month in current support $ 175.00 per month in past-due support Arrears 12 weeks or greater? Oyes Q no $ 0. oo per month in current and past-due medical support $ o . oo per month for genetic test costs $ per month in other (specify) for a total of $ 1,189. oo 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: $ 274.38 per weekly pay period. $ 548.77 per biweekly pay period (every two weeks). $ 594.5o per semimonthly pay period (twice a month). $ 1,189. o0 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 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 Date of Order:-__?pR 1 9 2aQ5 ??Xo? G Y G? E Form EN 28 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecked you are required to provide a copy of this form to your -c loyee. If yo r employee works in a state that is di?ferent from the state that issued this order, a copy must be prow, ec?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. pdydate/ddte of withholding is the date on ohich amount Yvas vv thheld fun. the e ... ployee's waps. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 3404926700 EMPLOYEE'S/OBLIGOR'S NAME: GIPS, HARRY D. EMPLOYEE'S CASE IDENTIFIER: 6599100663 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M If you or your employeelobligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 OMB No.: 097MI 54 Form EN-028 Worker ID $TATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GIPS, HARRY D. PACSES Case Number 431102890 Plaintiff Name EVELYN R. GIPE Docket Attachment Amount 01046 S 2000 $ 839.00 Child(ren)'s Name(s): DOB DAYNA L. GIPE 08103189 DALLAS R. -:GIPS 05/04/93 PACSES Case Number 815107175 Plaintiff Name EVELYN R. GIPE Docket Attachment Amount 03-5953 CIVIL$ 350.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) 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 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Worker ID $IATT Service Type M OMB No.: 097P154 ? ,..> ,_. = ;, ??, _? =r _, r:,. ,;T: Ica c':'? -? - "" _ ? r ? ? ,? G, _.... H-77f?1 ? ?.?a-?- a ?? ORDER/NOTICE TO'WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 05/09/05 Case Number (See Addendum for case summary) O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: GIPE, HARRY D. EmployFUlNithholder's Federal EIN Number Employee/Obligor's Name (Last, First, Mb 165-64-0359 Employee/Obligor's Social Security Number ROADWAY EXPRESS INC* (O 7 /??'./t 6599100663 PO BOX 471 JJ ??Qs--?7V Employee/Obligor's Case Identifier AKRON OH 44309-0471 /?eS£ 5 (See Addendum for plaintiff names ..ZGYJ3-5'153 Cfiv/L associated with cases on attachment) Custodial Parent's Name (Last, First, M0 f? C'S? S V1,571U7/ 75- 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 amo{{? ots from the above-named employee's/obligor's income until further notice even if the Order/Notice is not ssuud by your State. $ 764.00 per month in current support $ 175.00 per month in past-due support Arrears 12 weeks or greater? ® yes Q no $ o. 00 per month in current and past-due medical support $ o . oo per month for genetic test costs $ per month in other (specify) for total of $ 939.00 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: $ 216.69 per weekly pay period. $ _t 433 38 per biweekly pay period (every two weeks). $ 469.50 per semimonthly pay period (twice a month). $T 939. 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 Oyler/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 aggded regate disposable 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 page 2)weekly earnings. For the purpose of the limitation on withholding, the following information is nIfe remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer a gate of Order: MAY ], ? ZdQJ? a ove as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO HE PROCESSED. O NOT SEND CASH BY MAIL. Service Type M BY THE CO 1 1.? Form EN-028 omie No. 0970,0154 WorkerlD $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If?hecked you are required to provide gopy of this form to yoursmAloyee. If your employee vorks in a state that is di erent from the state that issued this or er, a copy must be provi ed to your employee even if t e box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one 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. *-Reoortirte . You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 3404926700 EMPLOYEE'S/OBLIGOR'S NAME: GIPS. HARRY D. EMPLOYEE'S CASE IDENTIFIER: 6599100663 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of., 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional * NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 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 NO.; 0970-0154 Form EN-028 Worker ID $IATT r ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GIPE, HARRY D. PACSES Case Number 431102890 Plaintiff Name EVELYN R. GIPE Docket Attachment Amount 01046 S 2000 $ 839.00 Child(rem's Name(s): DOB DAYNA L. GIPE 08/03/89 DALLAS R. :GIPE 05/04/93 ? If checked, you are required to enroll the child(rem 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(rem'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 Childilrem's Name(s): PACSES Case Number 815107175 Plaintiff Name EVELYN R. GIPE Docket Attachment Amount 03-5953 CIVIL$ 100.00 DOB Child(rem'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 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. Addendum Service Type M OMB No.: 097"154 Form EN-028 Worker ID $IATT h) ? 1 ?) c-> 'Y i cn .? T .. ? C.. ?4:_. ?,: ?'1 `a C7 `_ ) ^` W In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: HARRY D. G2PE Member ID Number: 6599100663 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name EVELYN R. GIPE EVELYN R. GIPS PACSES Docket Case Number Number 431102890 01046 S 2000 815107175 03-5953 CIVIL TOTAL ATTACHMENT AMOUNT: Attachment Amount/Freauencv $ 839.00 /MONTH $$$ 100.00 MONTH S / / 939.00 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 $ 216.69 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, HARRY D. GIPE Social Security Number 165-64-0359 , Member ID Number 6599100663 . 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 arrearage, 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. § 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 AUGUST 1, 2004 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: MAY 1 Q 205 ?t>lc° B. Yd Y GE Form EN-034 Service Type M Worker ID $IATT - ?> > ? - o : , ?> -, -?, _. _? _,.. _, s," =? ; _ ,:- - r:a - W In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: HARRY D. GIPE Member ID Number: 6599100663 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multip le Cases on Attachment PACSES Docket Plaintiff Name Case Number Number Attachment Amount/Frequency EVELYN R. GIPE 431102690 01046 S 2000 $ 764.00 /MONTH EVELYN R. GTPE 815107175 03-5953 CIVIL $ 100.00 MONTH TOTAL ATTACHMENT AMOUNT: $ 864.00 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 $199.38 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, HARRY D. GIPE Social Security Number 165-64-0359 , Member ID Number 6599100663 . 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 arrearage, 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. § 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 AUGUST 12, 2001 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 2, 0 ???? Date of Order: SEP Service Type M J??- 051 f? BUDGE Form EN-034 Worker ID $IATT c cn 0 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 431102890 0 State Commonwealth of Pennsylvania original Order/Notice /Notice st. of CUMBERLAND 1046 S 2000 Q Amended Order/Notice Co./City/Di Date of Order/Notice 09/19/05 O Terminate Order/Notice Case Number (See Addendum for case summary) 815107175 03-SRJ59 CIVIL R£: GGIPE, HARRY D. Employer/Withholdei's Federal EIN Number Employee/Obligor's Name (Last, First, MI) ROADWAY EXPRESS INC* PO BOX 471 AKRON OH 44309-0471 165-64-0359 Employee/Obligor's Social Security Number 6599100663 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. $ 764. 00 per month in current support $ 100.00 per month in past-due support Arrears 12 weeks or greater? (S) yes Q no $ 0.00 per month in current and past-due medical support $ 0 . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 864.00 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: $ 199.38 per weekly pay period. $ 398.77 per biweekly pay period (every two weeks). $ 432. oo per semimonthly pay period (twice a month). $ 864 .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 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: SEP 2 0 2005 Form EN-028 Service Type M OWN,, 0970-01s4 WorkerlD $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If fhecked you are required to provide gopy of this form to your NT If yo r employee works in a state that is di ferent from the state that issued this or er, a copy must be provi?etl 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 thePagdate/Date-of-Withho{ding-Nou-mostreportthepaydate/date-efwithholding ndingthepaymentTEe- -is-the-date -on-whicharnom,i-waswithheld-from the-employee`s-wages- You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 3404926700 EMPLOYEE'S/OBLIGOR'S NAME: GIPS, HARRY D. EMPLOYEE'S CASE IDENTIFIER: 6599100663 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. I ].Submitted By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Service Type M OMB NO,: 0970-D154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GIPS, HARRY D. PACKS Case Number 431102890 Plaintiff Name EVELYN R. GIPS Docket Attachment Amount 01046 S 2000 $ 764.00 Child(ren)'s Name(s): DOB DAYNA L. GIPE 08/03/89 DALLAS R.GIPE 05/44/'.93 PACSES Case Number 815107175 Plaintiff Name EVELYN R. GIPE Docket Attachment Amount 03-5953 CIVIL$ 100.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(reN's Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(rern's Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M OMB No.: 09J0-0154 Worker ID $IATT ? ? ? u m 1` ? ? ? _J .. _ ? ? ?3 `, -n ??- ,_ ti ., ?. ??. ?} ? p 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: HARRY D. GIPE Member ID Number. 6599100663 Please note: All correspondence must include the Member ID Number. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Financial Break Down of Multi ple Cases on Attachment PACSES Docket Plaintiff Name Caw Number Number Attachment Amount/Frequency EVELYN R. GIPE 431102890 01046 S 2000 $ ) 764.00 /MONTH EVELYN R. GIPE 815107175 03-5953 CIVIL " $ 100.00 MONTH / TOTAL ATTACHMENT AMOUNT: S 864.00 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 $199.38 per week, or 55 of the Unemployment Compensation benefits otherwise payable to the Defendant, HARRY D. GIPE Social Security Number 165-64-0359 , Member ID Number 6599100663 . 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 9, 2005 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: QCT 18 2fr z Service Type M JUDGE Form EN-530 Worker ID $ IATT v a .? r? s.J CJ ., In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: HARRY D. GIPE Member ID Number: 6599100663 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multip le Cases on Attachment PACSES Docket Plaintiff Name Case Number Number Attachment Amount/Frequency EVELYN R. GIPE 431102890 01046 S 2000 $ 839.00 /MONTH EVELYN R. GIPE 815107175 03-5953 CIVIL $ 100.00 MONTH / S TOTAL ATTACHMENT AMOUNT: $ 939.00 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 $ 216.69 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, HARRY D. GIPE Social Security Number 165-64-0359 , Member ID Number 6599100663 . 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 arrearage, 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. § 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 9, 2005 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT DEC 2 7UU? * W, Date of Order: Kevin . Hess, JUDGE DRO: R.J. Shadday Form EN-034 Service Type M Worker ID $IATT ?^? n? C_ 0 _y ?? <?n 1 (-? i l ? ?. Y\} ?7 rT? l N ;r l:? t .% _.. . _...,., J v.J ` ;`?rr? .? o `i7 -:_ ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 12/21/05 Case Number (See Addendum for case summary) Employer/withholder's Federal FIN Number ROADWAY EXPRESS INC* PO BOX 471 AKRON OH 44309-0471 165-64-0359 Employee/Obligor's Social Security Number 6599100663 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. $ 764.00 per month in current support $ 175.00 per month in past-due support Arrears 12 weeks or greater? ®yes Q no $ a . oo per month in current and past-due medical support $ o . o o per month for genetic test costs $ per month in other (specify) for a total of $ 939. oo 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: $ 216.69 per weekly pay period. $ 433 .38 per biweekly pay period (every two weeks). $ 469.50 per semimonthly pay period (twice a month). $ 939. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If 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. P , n. r• Date of Order: JAN ?' ? Z4 W DROt R.J. Shadday Service Type M 431102890 OoriginalOrder/Notice 1046 S 2000 O Amended Order/Notice 815107175 O Terminate Order/Notice 03-5953 CIVIL RE GIPE, HARRY D. Employee/Obligor's Name (Last, First, MI) BY THE COUR Kev' A. Hess, Judge Form EN-028 OMB No : 09]0-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecked you are required to provide a copy of this form to your mployee. If your employee works in a state that is di erent from the state that issued this order, a copy must be provi ?ed to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. - 3.*-Reportingthef aydate/Date-of-Withholding-You must- reportthepaydate/date-of withholding wherrsendingthepayment Tire paydate/dat"fwithholding-isthedate -omrohich amountwas-withheld fn»mthe-employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 3404926700 EMPLOYEE'S/OBLIGOR'S NAME: GIPE HARRY D. EMPLOYEE'S CASE IDENTIFIER: 6599100663 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11.Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 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 No. 0970-0154 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GIPE, HARRY D. PACSES Case Number 431102890 Plaintiff Name EVELYN R. GIPE Docket Attachment Amount 01046 S 2000 $ 839.00 Child(ren)'s Name(s): DOB DAYNA L. GIPE 08/03/89 DALLAS R GIPE 05/04/93 ? 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) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M PACKS Case Number 815107175 Plaintiff Name EVELYN R. GIPE Docket Attachment Amount 03-5953 CIVIL$ 100.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum OMB No. 097"154 Form EN-028 WorkerlD $IATT In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Defendant Name: HARRY D. GIPE Member ID Number: 6599100663 PACSES Docket Case Number Number 431102890 01046 S 2000 $ 815107175 03-5953 CIVIL $ $ Please note: An correspondence most include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name EVELYN R. ANTHONY EVELYN R. ANTHONY Fax: (717) 240-6248 Attachment Amount/Freauencv 700.00 /MONTH 100.00 /MONTH / TOTAL ATTACHMENT AMOUNT: $ 800.00 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 $184.62 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, HARRY D. GIPS Social Security Number 165-64-0359 , Member ID Number 6599100663 . 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 arrearage, 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. § 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 9, 2005 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: Service Type M JUDGE Form EN-034 Worker ID $IATT ?. ,..? ,; :, .._, s;-. r:, .. ;?; ?.. E. RAELYNN GIPE, Plaintiff/Petitioner VS. HARRY D. GIPE, Defendant/Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 03-5953 CIVIL TERM IN DIVORCE PACSES Case No: 815107175 ORDER OF COURT AND NOW to wit, this 24th day of September 2007, it is hereby Ordered that the Cumberland County Domestic Relation Section dismissed their interest in the above captioned Alimony matter pursuant to an agreement of the parties that the credit from the child support obligation be applied to the Alimony arrears . There is no balance due the Petitioner. BY THE COURT: 04 k5 WK Hess, J. DRO: R.J. Shadday xc: Petitioner Respondent Form OE-001 Service Type: M Worker: 21005 tJ iA' ?'Tl r ? r n -?} R a 3 1 24 0 u =