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HomeMy WebLinkAbout08-1675WALKER, CONNOR & JOHNSON LLC 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 (717) 262-2187-Fax Diana M. Robertson, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff, ) ) ) Defendant, ) Civil Action - Law vs. Samuel C. Robertson, No. o$- 11.7'S' 0,V', -r In Divorce a v.m. NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in Court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment 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 other rights important to you, including custody or visitation of your children. When the ground for 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 of the Cumberland County Courthouse, First Floor, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM, YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABAOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Pennsylvania Bar Association Lawyer Referral Service 1-800-692-7375 (PA Only) or (717) 238-6715 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of Franklin County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangement must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Diana M. Robertson, ) Civil Action - Law Plaintiff, ) Samuel C. Robertson, ) Defendant, ) In Divorce a v.m. COMPLAINT UNDER SECTION 3301(a) OR 3301(c) OR 3301(d) OF THE DIVORCE CODE COUNT 1 DIVORCE 1. Plaintiff is Diana M. Robertson, a sui juris adult, who currently resides at 158 Springfield Road, Newville, Cumberland County, Pennsylvania, since March, 1996. 2. Defendant is Samuel C. Robertson, a sui juris adult, who currently resides at 158 Springfield Road, Newville, Franklin County, Pennsylvania. Defendant resided at this address from 1996 to March of 2006 when he moved out. Defendant then moved back to this address in January, 2008. 3. Plaintiff and Defendant have been bona fide residents in the Commonwealth for at least six months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on July 28, 1987 in Las Vegas, Clark County, Nevada. 5. There have been no prior actions of divorce or annulment of marriage between the parties except the action represented by this Complaint. 6. The marriage is irretrievable broken. 7. Neither the Plaintiff nor Defendant is a minor or incompetent. 8. Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the court require the parties to participate in counseling. 9. Plaintiff requests the court to enter a decree of divorce. 2 COUNT II DIVORCE 10. The allegations of Paragraphs 1 through 8 hereof are incorporated herein as fully as though set out at large. 11. In violation of his marriage vows and laws of the Commonwealth, the Defendant, Samuel C. Robertson, has offered such indignities to the person of the injured and innocent spouse, the Plaintiff, as to render her condition intolerable and life burdensome. WHEREFORE, Plaintiff respectfully requests your Honorable Court to enter a decree of divorce. COUNT III EQUITABLE DISTRIBUTION - SECTION 3502 12. The allegations of Paragraphs 1 through 8 hereof are incorporated herein as fully as though set out at large. 13. The parties have been unable to determine and equitably dispose of their respective rights and interests in the martial property. 14. Plaintiff will, within 60 days after service of this Complaint upon Defendant, cause to be filed an inventory and appraisement of all property owned or possessed at the time this Complaint is filed. WHEREFORE, Plaintiff requests your Honorable Court to equitably divide, distribute and assign the martial property pursuant to the provision of Section 3502 of the Divorce Code. COUNTYIV ALIMONY 15. The allegations of Paragraphs 1 through 8 hereof are incorporated herein as fully as though set at large. 16. The Plaintiff is without sufficient property to provide for her reasonable needs, and is unable to adequately support herself. 17. The Plaintiff cannot support and maintain herself in the style she was maintaining prior to the separation of the Plaintiff and Defendant without continued financial assistance from the Defendant. WHEREFORE, pursuant to Sections 3701, et seq., of the Divorce Code, "Alimony", Plaintiff respectfully requests your Honorable Court to order Defendant to file within 30 days of service of this Complaint upon Defendant, a complete income and expense statement and to 3 require the scheduling of a hearing to determine Plaintiff's entitlement to alimony, and if so, the amount. COUNT V ALIMONY PENDENTE LITE, COUNSEL FEES AND EXPENSES 18. The allegations of Paragraphs 1 through 8 hereof are incorporated herein as fully as though set out at large. 19. The resolution of the issues raised by this Complaint will require Plaintiff to incur considerable additional expenses and costs. 20. The Plaintiff is without sufficient means to adequately support herself and to meet the costs and expenses of this litigation and is unable to maintain herself during the pendency of this action. WHEREFORE, pursuant to Section 3702, et. Seq., of the Divorce Code, "Alimony Pendente Lite, Counsel Fees and Expenses", Plaintiff respectfully requests your Honorable Court to order Defendant to file within 30 days of service of this Complaint upon Defendant, a complete income and expense statement, and to require the scheduling of a hearing to determine Plaintiff's entitlement to alimony pendente lite, counsel fee and expenses, and if so, the amount. 4 VERIFICATION I verify that the statements made in this Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unworn falsification to authorities. DATE: 'J//I 0Y-1 Diana M. Robertson, Plaintiff WALKER, CONNOR & JOHNSON, LLC By: Martha B. Walker, Esquire Attorney I.D. # 15989 247 Lincoln Way East Chambersburg, PA 17201 (717) 262-2185 Attorney for Plaintiff f?. O ? J O 0 b W C ) r'' o -- n ni:m i C.?7 -r r WALKER, CONNOR & JOHNSON LLC 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 (717) 262-2187 - Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Diana M. Robertson, ) Civil Action - Law Plaintiff, ) vs. ) No. 08-1675 -Civil Term Samuel C. Robertson, ) Defendant, ) In Divorce a v.m. AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA COUNTY OF FRANKLIN SS: Martha B. Walker, Esquire, being duly sworn according to law, deposes and says that she is the attorney for the Plaintiff, Diana M. Robertson, in the above-captioned matter; that she did serve a true and attested copy of the Complaint in Divorce Under Section 3301(a) or 3301(c) or 3301(d) of the Divorce Code by mailing the same to Samuel C. Robertson, Defendant, by certified mail, restricted delivery, article number 7007 2560 0002 5855 5027 on March 24, 2008, to his mailing address of 158 Springfield Road, Newville, Pennsylvania 17241; that said certified mail article was delivered to Defendant, Samuel C. Robertson, on March 27, 2008, all as appears from the receipt for certified mail and the return receipt attached hereto. WALKER, CONNOR & JOHNSON, LLC COMMONWEALTH OF PENNSYLVANIA Notarial Seal Stacey A Shank, Notary Public Chambambag Boro, Franklin County My Commission E)pires Jan. 12, 2012 Member, Pennsylvania Association of Notaries Sworn to and subscribed before me By: this .51 day of , 2008. ,a /I , ZI Notary ublic Martha B. Walker, Esquire Attorney for Plaintiff Attorney I.D. #15989 247 Lincoln Way East Chambersburg, PA 17201 (717) 262-2185 Stacey A Member, Notary Public ?wldln County 2012 stocie4ion of Note r_ 1 0 pie. to ti C3 1 For delivery informatio n visit our webs ite at www.usps.comi, to i OFFI CIA g L U71' Ln to Postage $ Ln Certified Fee rU M Retum Receipt Fee (Endors ment R uir d Postmc Mere 0 e eq e ) 0 Restricted Delivery Fee (Endorsement Required) { ? , / D r O Lnn Total Postage & Fees r Sent r o a S ?rcJ 0 Street, Apt. No.; or PO Box No. __ ._•. --- !1 y ] r _ d 9,cqd, smre, 2/P+4 , ewv l1 t Pp i 7 a l v • CompbMe 1lerrta 1, 2, and S. Also complete Item 4 if Restricted Delivery Is desired. ¦ Print your name and address on the reverse so that we can return the card to you. ¦ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Sam ue1 CO. R-obeAlsM )5b Sortn? fold &4 (v,ewv%ll,e Pfq ??a41 - too- A, O Agent Wecel?*d by a? C ? Addrw t c I o taro (- ? Ke Y3vI1 1 M D. Is delivery address different from Item 1? ? Yes If YES, enter delivery address below: 0 No Type JIMWrMW Men ? Etquess Mall ? Registered 0 Retum Receipt for Merchanclea ? insured mail 0 C.O.D. 4. Restricted Denwery? (Extra Fee) 2. Article Number 7007 2560 0002 5855 5027 (Transfer from service tabso PS Form 3811, February 2004 Domsetic Rstum RecMpt roe M , Sro ; (7 h C. ?: c ?? ? t.XJ ? ?? r r; ?1 '' r r _ _ ?? .:? ?:, r :.? WALKER, CONNOR & JOHNSON LLC 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 (717) 262-2187 - Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Diana M. Robertson, Plaintiff, vs. Samuel C. Robertson, Defendant, Plaintiff resides at 158 Springfield Road, Newville, Cumberland County, Pennsylvania. Plaintiff's date of birth is December 1, 1949. COMPLAINT FOR ALIMONY PENDENTE LITE 1 2. 3. 4. 5. 6 7. Defendant resides at 158 Springfield Road, Newville, Cumberland County, Pennsylvania. Defendant's date of birth is September 15, 1950. (a) Plaintiff and Defendant were married on July 28, 1987 in Las Vegas, Clark County, Nevada. (b) Plaintiff and Defendant were separated on March 13, 2008. (c) Plaintiff filed a Complaint in Divorce on March 13, 2008. Said Complaint raised the issue of alimony pendente lite. A fee of $26.00 for said count of alimony pendente lite was paid on the aforementioned date. Docket No: 08-1675 PACSES Case No: Support Plaintiff and Defendant are the parents of the following children born of the marriage: Name Birthdate SSN Residence Plaintiff seeks support for the following persons: Plaintiff, Diana M. Robertson. (a) Plaintiff is not receiving public assistance. (b) Plaintiff is receiving no additional income. No previous Order has been entered against the Defendant in an action for the support of Plaintiff. 8. Plaintiff last received support from Defendant in the amount of on Walker, Connor & Johnson, LLC 247 Lincoln Way East Chambersburg, PA 17201 (717) 262-2185 (717) 262-2187- Fax WHEREFORE, Plaintiff requests that an Order be entered against the Defendant and in favor of Plaintiff for reasonable support and medical coverage. Guidelines for child and spousal support and for alimony pendente lite have been prepared by the Court of Common Pleas and are available for inspection in the Office of the Domestic Relations Section, Chambersburg, Pennsylvania. VERIFICATION I verify that the statements made in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904, relating to unsworn falsification to authorities. DATE: d Q rv MM ' ..? t_ C -? q DIANA M. ROBERTSON, Plaintiff/Petitioner VS. SAMUEL C. ROBERTSON, Defendant/Respondent THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 08-1675 CIVIL TERM IN DIVORCE PACSES CASE NO: 900110020 ORDER OF COURT AND NOW, this 12th day of May, 2008, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R. J. Shadday on June 12, 2008 at 9:00 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you. If you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Edgar B. Bayley, President Judge Copies mailed to: Petitioner Respondent Martha B. Walker, Esq. Date of Order: May 12, 2008 .a J. Sh day, Conference Officer YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 N ti ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 06/12/08 Case Number (See Addendum for case summary) E m ployer/With holder's Federal EIN Number 201-42-5012 Employee/Obligor's Social Security Number OOriginal Order/Notice 900110020 OAmended Order/Notice 08-1675 CIVIL OTerminate Order/Notice OOne-Time Lump Sum/Notice RE: ROBERTSON, SAMUEL C. Employee/Obligor's Name (Last, First, MI) CUMBERLAND VALLEY SCHOOL DISTR 2998101975 6746 CARLISLE PIKE Employee/Obligor's Case Identifier MECHANICSBURG PA 17050-1711 (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 1,445.00 $ 0.00 $ 0.00 $ 0.00 per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) Arrears 12 weeks or greater? O yes ® no one-time lump sum payment for a total of $ 1,445.00 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: $ 333.46 per weekly pay period. $ 722.50 per semimonthly pay period (twice a month) $ 666.92. per biweekly pay period (every two weeks) $ 1, 445.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. 3 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SE RITY NUMBEZIN RDER TO BE PROCESSED. /f 1. DO NOT SEND CASH BY MAIL. BY THE COURT: ' FMVIN A. HESS' Form E('mev. 3 Service Type M OMB No.: 0970-0154 Worker I D $ IATT 1,4 4 5 • x 52•? 353•6* 11445 • X 12•{ 26 666•g2* -1. ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS Me' e you are required to pr vide a opy of this form to your m loyee. If yo r employee works in a state that is r ck c' from the state that issuffthis orcfer, a copy must be provic?edpto your emplyoyee even if the box is not cheCKed 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employeelobl Igor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2360053240 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : El THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 13 EMPLOYEE'S/OBLIGOR'S NAME: ROBERTSON, SAMUEL C. EMPLOYEE'S CASE IDENTIFIER: 2998101975 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 CARLISLE PA 17013 by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev. 3 Service Type M OMB No.: 0970-0154 Worker I D $ IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: ROBERTSON, SAMUEL C. PACSES Case Number 900110020 PACSES Case Number Plaintiff Name Plaintiff Name DIANA M. ROBERTSON Docket Attachment Amount Docket Attachment Amount 08-1675 CIVIL $ 1,445.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ® If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ?if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. 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. 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) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 3 Service Type M OMB No.:0970-0154 Worker ID $IATT 0 ? -rf 7177 1 17 . - -?7 77 co 08-1675 CIVIL ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 06/19/08 Case Number (See Addendum for case summary) OOriginal Order/Notice OAmended Order/Notice (2 Terminate Order/Notice OOne-Time Lump Sum/Notice Employer/Withholder's Federal EIN Number CUMBERLAND VALLEY SCHOOL DISTR 6746 CARLISLE PIKE MECHANICSBURG PA 17050-1711 RE:ROBERTSON, SAMUEL C. Employee/Obligor's Name (Last, First, MI) 201-42-5012 Employee/Obligor's Social Security Number 2998101975 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ o . oo per month in current child support $ o . oo per month in past-due child support Arrears 12 weeks or greater? Dyes ®no $ 0.00 per month in current medical support $ 0.00 per month in past-due medical support $ 0.00 per month in current spousal support $ o. oo per month in past-due spousal support $ 0. oo per month for genetic test costs $ o . oo per month in other (specify) $ one-time lump sum payment for a total of $ o. o0 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0. 00 per semimonthly pay period (twice a month) $ o . 00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES 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: Z&VIN A. HESS, JUDGE Form EN-028 Rev. 3 Service Type M OMB No.: 097"154 Worker ID $IATT N ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS E] If hecke? you are required to provide a copy of this form to your. m loyee. if yo r employee orks in a state that is diferent from the state that issued this order, a copy must be provic?edpto your employee even if ttie box is not checked. 1. Priority: Withholding under this order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2360053240 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME: ROBERTSON, SAMUEL C. EMPLOYEE'S CASE IDENTIFIER: 2998101975 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev. 3 Service Type M OMB No.: 0970-0154 Worker I D $ IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: ROBERTSON, SAMUEL C. PACSES Case Number 900110020 Plaintiff Name DIANA M. ROBERTSON Docket Attachment Amount 08-1675 CIVIL$ 0.00 Child(ren)'s Name(s): DOB ® If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PAGES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) 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 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 3 Service Type M OMB No.: 0970-0154 Worker ID $IATT ?,,,? ?.? ?, ?_°? _ ~ ? t --{ ?. l '. t .... 1 'i ? ? ?1 i ??,' _ L _, ?-? ., ?a ., ..1 _ i? `.l? In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DIANA M. ROBERTSON ) Docket Number 08-1675 CIVIL Plaintiff ) VS. ) PACSES Case Number 900110020 SAMUEL C. ROBERTSON ) Defendant ) Other State ID Number ORDER TO CREDIT ARREARS AND NOW, on this 24TH DAY OF JUNE, 2008 IT IS HEREBY ORDERED that credit be given on the above captioned case in the amount of $ 666.92 There ® is 0 is not an agreement of the parties to the credit. This credit is for: ® Direct Payments. ? Purchases made or services performed by the Defendant on behalf of the Plaintiff or children. ? Time children resided with the Defendant as agreed upon by parties, or addressed in a partial custody order for the following time periods: From to From to From to ? Other: Plaintiff Defendant 24TH DAY OF JUNE, 2008 Date DRO: R. J. SHADDAY Service Type M Date Date BY THE COURT: KEvzly A. SS, JUDGE Form FI-002 Rev. I Worker ID 21005 C) ? ?. m t r ? CO Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 DIANA M. ROBERTSON, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -DIVORCE NO. 08-1675 CIVIL TERM PACSES No. 900110020 SAMUEL C. ROBERTSON, Defendant PETITION FOR MODIFICATION OF AN EXISTING ALIMONY PENDENTE LITE ORDER 1. Petitioner is Samuel C. Robertson (hereinafter referred to as "Defendant"), who currently resides at 158 Springfield Road, Newville, PA 17241. 2. Respondent is Diana M. Robertson (hereinafter referred to as "Plaintiff'), who currently resides at 158 Springfield Road, Newville, PA 17241. 3. There is an existing Alimony Pendente Lite Order which requires Defendant to pay One Thousand Four Hundred Forty-five Dollars ($1,445.00) per month payable bi-weekly. A true and correct copy of the Order dated June 12, 2008, is attached to this petition as Exhibit "A". 4. Petitioner, Samuel C. Robertson hereby requests a modification of the Alimony Pendente Lite Order entered on June 12, 2008. Since such time, the Plaintiff, Diana M. Robertson, has returned to work and has additional income. 1 • WHEREFORE, Defendant requests that the Court modify the existing Order for Alimony Pendente Lite. DATE: August 7, 2008 ffalf-bara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 Attorney on behalf of and Agent for Defendant, Samuel C. Robertson 2 EXHIBIT "A" DIANA M. ROBERTSON, Plaintiff/Petitioner VS. SAMUEL C. ROBERTSON, Defendant/Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 08-1675 CIVIL TERM IN DIVORCE PACSES Case No: 900110020 ORDER OF COURT AND NOW, this 12'h day of June 2008, based upon the Court's determination that the Petitioner's monthly net income/earning capacity is $ 0.00 and the Respondent's monthly net income/earning capacity is $ 3613.01, it is hereby ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit One Thousand FourHundred Forty-Five and 00/100 Dollars ($1,445.00) per month payable bi-weekly as follows: First payment due: in accordance with Respondent's pay schedule. The effective date of the order is June 1, 2008. Arrears set at $ 1,445.00 as of June 12, 2008. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and, at its discretion, make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Diana M. Robertson. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the Respondent's name with their PACKS Member Number or Social Security Number in order to be processed. Do not send cash by mail. cc360 The monthly obligation includes cash medical obligation in the amount of $250 annually for unreimbursed medical expenses incurred for the spouse. Unreimbursed medical expenses of the oblige that exceed $250 annually shall be allocated between the parties. The party seeking allocation of unreimbursed medical expenses must provide documentation of expenses to the other party no later than March 31St of the year following the calendar year in which the final medical bill to be allocated was received. The unreimbursed medical expenses are to be paid as follows: 76% by the Respondent and 24% by the Petitioner. [] Respondent [X] Petitioner [] Neither party to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the [] Petitioner [X] Respondent shall submit to the other party written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of. 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy o the benefits booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order is based upon an agreement between the parties, and residing in the same household The Petitioner is currently off work due to a medical leave. This Order shall become final twenty (20) after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. Consented: Petitioner Respondent Mailed copies on: June 12, 2008 to: Petitioner Respondent Barbara Sumple-Sullivan, Esq. Martha B. Walker, Esq. DRO: R.J. Shadday Petitioner's Attorney Respondent's Attorney BY THE COURT, Xin A. Hess, J. Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 DIANA M. ROBERTSON, IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -DIVORCE NO. 08-1675 CIVIL TERM PACSES No. 900110020 SAMUEL C. ROBERTSON, : Defendant : CERTIFICATE OF SERVICE I, BARBARA SUMPLE-SULLIVAN, ESQUIRE, do hereby certify that on this date, I served a true and correct copy of the Petition for Modification of an Existing Alimony Pendente Lite Order, in the above-captioned matter upon the following individual(s), by United States first- class mail, postage prepaid, addressed as follows: Martha B. Walker, Esquire Walker, Connor & Johnson, LLC 247 Lincoln Way East Chambersburg, PA 17201 DATE: August 7, 2008 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Defendant C na es car co ice[ cr, DIANA M. ROBERTSON, THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 08-1675 CIVIL TERM SAMUEL C. ROBERTSON., IN DIVORCE Defendant/Petitioner : PACSES CASE NO: 900110020 ORDER OF COURT AND NOW, this 8th day of August, 2008, a petition has been filed against you, Diana M. Robertson, to modify an existing Alimony Pendente Lite Order. You are ordered to appear in person at the Domestic Relations Section, 13 North Hanover Street, Carlisle, Pennsylvania, on September 18, 2008 at 10:30 A.M. for a conference and to remain until dismissed by the Court. If you fail to appear as provided in this Order, an Order of Court may be entered against you. You are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and ExpenseStatement attached to this order, completed as required by the Rule 1910.11. (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Edgar B. Bayley, President Judge Copies mailed to: Petitioner Respondent Barbara Sumple-Sullivan, Esq. Martha B. Walker, Esq. ,-t Date of Order: August 8, 2008 d' R. J. S day, Conference Officer YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 C7 o p 4 ? f q7 -74, rn W X DIANA M. ROBERTSON, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 08-1675 CIVIL TERM SAMUEL C. ROBERTSON, IN DIVORCE Defendant/Respondent : PACSES Case No: 900110020 ORDER OF COURT AND NOW, this 18th day of September 2008, based upon the Court's determination that the Petitioner's monthly net income/earning capacity is $ 521.33 and the Respondent's monthly net income/earning capacity is $ 2,959.66, it is hereby ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit One Thousand and 00/100 Dollars ($ 1,000.00) per month payable weekly as follows: $ 945.00 per month for Alimony Pendente Lite and $ 55.00 per month on arrears. First payment due: Octobert 1, 2008. The effective date of the order is August 1, 2008. Arrears set at $ 667.32 as of September 18, 2008. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and, at its discretion, make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Diana M. Robertson. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the Respondent's name with their PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. cc360 i i Respondent is to provide medical insurance coverage. This Order shall become final twenty (20) after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. Consented: Petitioner Respondent Mailed copies on: September 19, 2008 to: Petitioner Respondent Martha B. Walker, Esq. Barbara Sumple-Sullivan, Esq. Petitioner's Attorney Respondent's Attorney BY THE COURT, Ke A. Hess, J. DRO: R.J. Shadday C'7 ?°v-art C ? ? -? ttsn ?' ? ? -v r r ...? '% J ? 4,? "= J' ? ?: f."y. ?. ', ? 1 ?! ...? -s 1 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 DIANA M. ROBERTSON, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -DIVORCE NO. 08-1675 CIVIL TERM PACSES No. 900110020 SAMUEL C. ROBERTSON, Defendant APPEAL OF ORDER AND REQUEST FOR HEARING DE NOVO TO THE PROTHONOTARY: Please accept this as an Appeal of the Order dated September 18, 2008 and schedule the matter for De Novo Hearing before the Support Master. Respectfully Dated: September 26, 2008 Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Supreme Court No. 32317 Attorney for Defendant Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 DIANA M. ROBERTSON, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vi. CIVIL ACTION - DIVORCE NO. 08-1675 CIVIL TERM PACSES No. 900110020 SAMUEL C. ROBERTSON, Defendant CERTIFICATE OF SERVICE I, Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served a true and correct copy of the APPEAL OF ORDER AND REQUEST FOR HEARING DE NOVO, in the above-captioned matter upon the following individual, via United States first-class mail, postage prepaid, addressed as follows: Martha B. Walker, Esquire Walker, Connor & Johnson, LLC 247 Lincoln Way East Chambersburg, PA 17201 DATE: September 26, 2008 Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Defendant ---t r Cl ? T: N "t3 {1 A ? s 1 "%1 Barbara. Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 717 774-1445 DIANA M. ROBERTSON, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -DIVORCE NO. 08-1675 CIVIL TERM PACSES No. 900110020 SAMUEL C. ROBERTSON, Defendant APPEAL OF ORDER AND REQUEST FOR HEARING DE NOVO TO THE PROTHONOTARY: Please accept this as an Appeal of the Order dated September 18, 2008 and schedule the matter for De Novo Hearing before the Support Master. Dated: September 26, 2008 Respectfully Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Supreme Court No. 32317 Attorney for Defendant Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 717 774-1445 DIANA M. ROBERTSON, : IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vi. CIVIL ACTION -DIVORCE NO. 08-1675 CIVIL TERM PACSES No. 900110020 SAMUEL C. ROBERTSON, Defendant CERTIFICATE OF SERVICE I, Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served a true and correct copy of the APPEAL OF ORDER AND REQUEST FOR HEARING DE NOVO, in the above-captioned matter upon the following individual, via United States first-class mail, postage prepaid, addressed as follows: Martha B. Walker, Esquire Walker, Connor & Johnson, LLC 247 Lincoln Way East Chambersburg, PA 17201 DATE: September 26, 2008 ??_ " arbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Defendant Q O t .' Mr- ,1 (71 T-,, c.ta cry In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DIANA M. ROBERTSON ) Docket Number 08-1675 CIVIL Plaintiff ) VS. ) PACSES Case Number 900110020 SAMUEL C. ROBERTSON ) Defendant ) Other State ID Number ORDER OF COURT You, SAMUEL C. ROBERTSON plaintiff/defendant of PO BOX 724, NEW KINGSTOWN, PA. 17072-0724-24 are ordered to appear at DOMESTIC RELATIONS HEARING RM DOMESTIC RELATIONS OFC, 13 N HANOVER ST, CARLISLE, PA. 17013-3014-13 f7" ? before a hearing officer of the Domestic Relations Section, on the CX2 ° 96 -C 3F rn arnr rn -0 NOVEMBER 6, 2008 at 1: 3 0 PM fora hearing. >- w ?o `_ You are further required to bring to the hearing: n r z -? IV 1. -ro a true copy of your most recent Federal Income Tax Return, including W-2s, as f6c& tv 0 2. your pay stubs for the preceding six (6) months, 3. the Income Statement and the appropriate Expense Statement, if required, attached to this order, completed as required by Rule 1910.11 (c). 4. verification of child care expenses, and 5. proof of medical coverage which you may have, or may have available to you 6. information relating to professional licenses 7. other: Form CM-509 Rev. I Service Type M Worker ID 21302 ._ J Y a rr In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DIANA M. ROBERTSON ) Docket Number 08-1675 CIVIL Plaintiff ) VS. ) PACSES Case Number 900110020 SAMUEL C. ROBERTSON ) Defendant ) Other State ID Number ORDER OF COURT You, DIANA M. ROBERTSON plaintiff/defendant of 3306 DEERFIELD CMNS, SHIPPENSBURG, PA. 17257-8545-06 are ordered to appear at DOMESTIC RELATIONS HEARING RM DOMESTIC RELATIONS OFC, 13 N HANOVER ST, CARLISLE, PA. before a hearing officer of the Domestic Relations Section, on the NOVEMBER 6, 2008 at 1: 3 O PM for a hearing. You are further required to bring to the hearing: 17013-3011 o 3 q ? C° 3 '''? "ir*? = cn rn r a ? -o z rn -n r m z ? N -< z NO o 1. a true copy of your most recent Federal Income Tax Return, including W-2s, as filed, 2. your pay stubs for the preceding six (6) months, 3. the Income Statement and the appropriate Expense Statement, if required, attached to this order, completed as required by Rule 1910.11 (c). 4. verification of child care expenses, and 5. proof of medical coverage which you may have, or may have available to you 6. information relating to professional licenses 7. other: Service Type M Form CM-509 Rev. 1 Worker ID 21302 N ? _? -r? _ _ .?_ t --?^. _ ...?y ? ?, ."?x ?? ?? ? V* In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DIANA M. ROBERTSON Plaintiff VS. SAMUEL C. ROBERTSON Defendant Docket Number PACSES Case Number ) Other State ID Number ORDER OF COURT You, DIANA M. ROBERTSON 3306 DEERFIELD CMNS, SHIPPENSBURG, PA. 17257-8545-06 are ordered to appear at DOMESTIC RELATIONS HEARING RM 08-1675 CIVIL 900110020 plaintiff/defendant of DOMESTIC RELATIONS OFC, 13 N HANOVER ST, CARLISLE, PA. 17013-3014-13 before a hearing officer of the Domestic Relations Section, on the JANUARY 29, 2009 at 10: 3 OAM for a hearing. You are further required to bring to the hearing: 1. a true copy of your most recent Federal Income Tax Return, including W-2s, as filed, 2. your pay stubs for the preceding six (6) months, 3. the Income Statement and the appropriate Expense Statement, if required, attached to this order, completed as required by Rule 1910.11 (c). 4. verification of child care expenses, and 5. proof of medical coverage which you may have, or may have available to you 6. information relating to professional licenses 7. other: Service Type M Form CM-509 Rev. 1 Worker ID 23302 s ROBERTSON PACSES Case Number: 900110020 If you fail to appear for the conference/hearing or to bring the required documents, the court may issue a warrant for your arrest and/or enter an interim support order. If paternity is an issue, the court shall enter an order establishing paternity. THE APPROPRIATE COURT OFFICER MAY ENTER AN ORDER AGAINST EITHER PARTY BASED UPON THE EVIDENCE PRESENTED WITHOUT REGARD TO WHICH PARTY INITIATED THE SUPPORT ACTION. BY THE COURT: Date of Order: 1.Z - r-n v• ROBERTSON JUDGE YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE-HEARING AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. CUMBERLAND CO BAR ASSOCIATION 32 S BEDFORD ST CARLISLE PA 17013-3302-32 (717) 249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of CUMBERLAND County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office at: (717) 240-6225 . All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled hearing. Service Type M Page 2of2 Form CM-509 Rev. 1 Worker ID 21302 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DIANA M. ROBERTSON ) Docket Number 08-1675 CIVIL Plaintiff ) VS. ) PACSES Case Number 900110020 SAMUEL C. ROBERTSON ) Defendant ) Other State ID Number ORDER OF COURT You, SAMUEL C. ROBERTSON plaintiff/defendant of PO BOX 724, NEW KINGSTOWN, PA. 17072-0724-24 are ordered to appear at DOMESTIC RELATIONS HEARING RM DOMESTIC RELATIONS OFC, 13 N HANOVER ST, CARLISLE, PA. 17013-3014-13 before a hearing officer of the Domestic Relations Section, on the JANUARY 29, 2009 at 10:30AM for a hearing. You are further required to bring to the hearing: 1. a true copy of your most recent Federal Income Tax Return, including W-2s, as filed, 2. your pay stubs for the preceding six (6) months, 3. the Income Statement and the appropriate Expense Statement, if required, attached to this order, completed as required by Rule 1910.11 (c). 4. verification of child care expenses, and 5. proof of medical coverage which you may have, or may have available to you 6. information relating to professional licenses 7. other: Service Type M Form CM-509 Rev. 1 Worker ID 21302 -a ROBERTSON PACSES Case Number: 900110020 If you fail to appear for the conference/hearing or to bring the required documents, the court may issue a warrant for your arrest and/or enter an interim support order. If paternity is an issue, the court shall enter an order establishing paternity. THE APPROPRIATE COURT OFFICER MAY ENTER AN ORDER AGAINST EITHER PARTY BASED UPON THE EVIDENCE PRESENTED WITHOUT REGARD TO WHICH PARTY INITIATED THE SUPPORT ACTION. BY THE COURT: Date of Order: J Z - 8' - ox JUDGE YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE-HEARING AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. v• ROBERTSON CUMBERLAND CO BAR ASSOCIATION 32 S BEDFORD ST CARLISLE PA 17013-3302-32 (717) 249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of CUMBERL comply with the Americans with Disabilities Act of 1 facilities and reasonable accommodations available t( before the court, please contact our office at: (73-7) made at least 72 hours prior to any hearing or business scheduled hearing. Service Type M Page 2 of 2 kND County is required by law to 990. For information about accessible disabled individuals having business 240-6225 . All arrangements must be before the court. You must attend the Form CM-509 Rev. Worker ID 21302 - n ..ar ti } DIANA M. ROBERTSON Plaintiff Vs. SAMUEL C. ROBERTSON : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA Docket No. 08-1675 Defendant MOTION FOR APPOINTMENT OF MASTER Samuel C. Robertson (Mabdifi) (Defendant), moves the court to appoint a master with respect to the following claims: ( Divorce Distribution of Property () Annulment ( Support ( Alimony ( Counsel Fees ( Alimony Pendente Lite Costs and Expenses and in support of the motion states: (1) Discovery is complete as to the claims (s) for which the appointment of a master is requested. (2) The defendant (has) (hwmoot) appeared in the action mac) (by his attorney, Barbara Sumple-Sullivan , Esquire). (3) The Staturory ground (s) for divorce (is) (are) 3301(c) / 3301 "(d) (4) Delete the inapplicable paragraph(s): a. The action is not contested. b. An agreement has been reached with respect to the following claims: None. c. The action is contested with respect to the following claims: Distribution of Property, Support, Alimony, APL, Counsel Fees,. Costs (5) The action (jWM (does not involve) complex issues of law or fact and Expenses. (6) The hearing is expected to take One (1) Qg (days). (7) Additional information, if _? *evant to the motion: None. / IV / Date: / ..?N/! / Print Attorney Name ......... V13arbara Sumple-Sullivan, Esquire ORDER APPOINTING MASTER AND NOW, , 20 , Esquire is appointed master with respect to the following claims: By the Court: Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 DIANA M. ROBERTSON, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -DIVORCE NO. 08-1675 CIVIL TERM SAMUEL C. ROBERTSON, Defendant CERTIFICATE OF SERVICE I, BARBARA SUMPLE-SULLIVAN, ESQUIRE, do hereby certify that on this date, I served a true and correct copy of the Motion for Appointment of the Master, in the above- captioned matter upon the following individual(s), by United States first-class mail, postage prepaid, addressed as follows: Martha B. Walker, Esquire Walker, Connor & Johnson, LLC 247 Lincoln Way East Chambersburg, PA 17201 DATE: January 29, 2009 Barbara Sample-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Defendant DIANA M. ROBERTSON, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : DOMESTIC RELATIONS SECTION SAMUEL C. ROBERTSON, PACSES NO. 900110020 Defendant DOCKET NO. 08-1675 CIVIL ORDER OF COURT AND NOW, this 29th day of January, 2009, this matter having been scheduled for a hearing de novo before the Support Master on the Defendant's petition for modification of an existing alimony pendente lite order, and the parties having reached an agreement on all outstanding issues, upon recommendation of the Master it is ordered and decreed as follows: 1. Effective August 1, 2008 the Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit as alimony pendente lite the sum of $785.00 per month. 2. The Defendant shall continue to provide health insurance coverage for the benefit of the Plaintiff. By the Court, V15". * /,/ evin A. Hess, J. Cc: Diana M. Robertson Robertson Samuel C N . n ? -n F C- Martha B. Walker, Esquire For the Plaintiff a Barbara Sumple-Sullivan, Esquire 'vm For the Defendant cn J DRO ?..? ,=, -; ? c.._. -.i ,, z? g c,> ?? ?..?, r : ? , ?. eJan.28. 20096 4:14PM7172,22187 WCJ LAWOFFICE k J?n.26. 2009 3?34PM LA orsuaa BARBARA Si[JMPLE-STJ"IVAN it m mDM A'I'IOW New . PZNNIM .vANYA xzofo-sues PHONS 47717) 7 444AM VAX In" rra-Toss 7anumy 28, 2009 Michaol Rxwdle, Esquire Support mac ar 13 North Hanover Stmt P.O. Box 320 CarIkdo, PA 17013 Via fax and regalar mail Re: Dix= DL obftvm v. Sam4el C. Ytoberbon PAC995 Caeo No, 980110820 AeAd No. W1675 U ree)1 CvmkdW Qgjty No 5590 P•.16E 02/04 ho .5586 P. 3 ? o F= rrn .? n o '>m z? -< z L s? z N 0 Dear Mmtar Rundlo: T'he parties hsvo P=W an a=mmt in 9WI me t of the bearing scheduiod befom ynu mow. Pleaso wvisa ft Order of September 18, 2008 to provide an APL payment of $785.00 per month retroactive to the Amt 1, 2008, the date of ft Potidou for Modification. Mr. Robertson wM cout+mttu to pwvide health inmawe for Plaintiff. The heating LOmvri OW can be co mceled. Thank you for your eonsidexs&I - Sincerely yowl, A e&?aa-, Martha B. Walbr, Esquire Barbara Sumple-SuIllvan; Esquire HSM cc: W. Famual C, Robertson cc -?r3 cc. /dam ? 0 r C T FEB 0 2 2009 4 DIANA M. ROBERTSON Plaintiff Vs. SAMUEL C. ROBERTSON : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA Docket No. 08-1675 Defendant MOTION FOR APPOINTMENT OF MASTER Samuel C. Robertson ( (Defendant), moves the court to appoint a master with respect to the following claims: (lj Divorce Distribution of Property () Annulment Q Support ( Alimony ( Counsel Fees ( Alimony Pendente Lite ( Costs and Expenses and in support of the motion states: (1) Discovery is complete as to the claims (s) for which the appointment of a master is requested. (2) The defendant (has) (lumutt) appeared in the action 4=a&d*) (by his attorney, Barbara Sumple-Sullivan , Esquire). (3) The Staturory ground (s) for divorce (is) (are) 3301(c) / 3301(d) (4) Delete the inapplicable paragraph(s): a. The action is not contested. b. An agreement has been reached with respect to the following claims: None. c. The action is contested with respect to the following claims: Distribution of Property, Support, Alimony, APL, Counsel Fees,, Costs (5) The action (}tom (does not involve) complex issues of law or fact and uses. (6) The hearing is expected to take One (1) r (days). (7) Additional information, if Pzry) ant to the motion: None. / J Date: T Print Attorney Name ......... VBarbara Sumple-Sullivan, Esquire ORDER APPOINTING MASTER AND NOW, 20 Coq Tffi ej , E7 Esquire is appointed master with t to the following claims: a,o , :tvti? c r1Yk By the. ?_.. 1 J. I$ LAL11- N C6. J'd Q .o On J19 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 01/30/09 Case N u m ber (See Addendum for case summary) Employer/Withholder's Federal EIN Number PSERS C/O JANE SMITH PO BOX 125 HARRISBURG PA 17108-0125 201-42-5012 Employee/Obligor's Social Security Number 2998101975 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'slobligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current child support $ o.oo per month in past-due child support Arrears 12 weeks or greater? (yes ® no $ 0.00 per month in current medical support $ 0.00 per month in past-due medical support $ 785.00 per month in current spousal support $ o . oo per month in past-due spousal support $ 0.00 per month for genetic test costs $ o. oo per month in other (specify) $ one-time lump sum payment for a total of $ 785.00 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: $ 181.15 per weekly pay period. $ 392.50 per semimonthly pay period (twice a month) $ 362.31 per biweekly pay period (every two weeks) $ 785.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES 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: ;15- /% X 08-1675 CIVIL (Z)Original Order/Notice OAmended Order/Notice OTerminate Order/Notice QOne-Time Lump Sum/Notice RE: ROBERTSON, SAMUEL C. Employee/Obligor's Name (Last, First, MI) Kv6l.n A. Hess, Jugform EN-028 Rev. 4 DRO: R.J. Shadday Service Type M OMB No.: 097"154 Worker I D $OINC ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If heck you are required to provide a opy of this form to your m loyee. If yo r employee orks in a state tha is different from the state that issued this order, a copy must be provi?edpto your emproyee even if tie box is not checed. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 9127100234 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME: ROBERTSON, SAMUEL C. EMPLOYEE'S CASE IDENTIFIER: 2998101975 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: if you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by Internet www.childsupport.state.pa.us Service Type M Page 2 of 2 OMB No.: 0970.0154 Form EN-028 Rev. 4 Worker ID $OINC ADDENDUM Summary of Cases on Attachment Defendant/Obligor: ROBERTSON, SAMUEL C. PACSES Case Number 900110020 PACSES Case Number Plaintiff Name Plaintiff Name DIANA M. ROBERTSON Docket Attachment Amount Docket Attachment Amount 08-1675 CIVIL$ 785.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Service Type M OMB No.: 0970-0154 PACKS Case Number Plaintiff Name PACKS Case Number Plaintiff Name Form EN-028 Rev. 4 Worker ID $OZNC -rx ?i t5PA WALKER, CONNOR & JOHNSON, LLC 247 LINCOLN WAY EAST CHAMBERSBURG, PA 17201 (717)262-2185 (717) 262-2187 - Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DOMESTIC RELATIONS SECTION Diana M. Robertson, ) Order Number: Plaintiff, ) PACSES Case No: 900110020 vs. ) Docket No: 08-1675 Civil Samuel C. Robertson, ) Defendant, ) Support PETITION FOR MODIFICATION OF AN EXISTING SUPPORT ORDER 1. The Petition of Diana M. Robertson respectfully represents that on January 29, 2009 an Order of Court was entered for the support of. Plaintiff/Petitioner, Diana M. Robertson. A true and correct copy of the Order is attached to this Petition. 2. Petitioner is entitled to an increase of this Order because of the following material and substantial changes in circumstances: Plaintiff's/Petitioner's work hours have been decreased. WHEREFORE, Petitioner requests that the Court modify the existing Order for Support. Diane M. Robertson, Petitioner I verify that the statements made in this Petition 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. Date Diane M. Robertson, Petitioner 2 DIANA M. ROBERTSON, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : DOMESTIC RELATIONS SECTION SAMUEL C. ROBERTSON, PACSES NO. 900110020 Defendant DOCKET NO. 08-4675 CIVIL ORDER OF COURT AND NOW, this 29th day of January, 2009, this matter having been scheduled for a hearing de novo before the Support Master on the Defendant's petition for modification of an existing alimony pendente lite order, and the parties having reached an agreement on all outstanding issues, upon recommendation of the Master it is ordered and decreed as follows: 1. Effective August 1, 2008 the Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit as alimony pendente lite the sum of $785.00 per month. 2. The Defendant shall continue to provide health insurance coverage for the benefit of the Plaintiff. By the Court, V5, ' - evin A. Hess, J. Cc: Diana M. Robertson Samuel C. Robertson Martha B. Walker, Esquire For the Plaintiff Barbara Sumple-Sullivan, Esquire For the Defendant DRO r y:,? !73 DIANA M. ROBERTSON, Plaintiff/Petitioner VS. SAMUEL C. ROBERTSON, Defendant/Respondent THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 08-1675 CIVIL TERM IN DIVORCE PACSES CASE NO: 900110020 ORDER OF COURT AND NOW, this 30'' day of March, 2009, a petition has been filed against you, Samuel C. Robertson, to modify an existing Alimony Pendente Lite Order. You are ordered to appear in person at the Domestic Relations Section, 13 North Hanover Street, Carlisle, Pennsylvania, on May 5.2009 at 9:00 A.M. for a conference and to remain until dismissed by the Court. If you fail to appear as provided in this Order, an Order of Court may be entered against you. You are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by the Rule 1910.11. (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Edgar B. Bayley, President Judge Copies mailed to: Petitioner Respondent Martha B. Walker, Esq. Barbara Sumple-Sullivan, Esq. f Date of Order: March 30, 2009 J. Sh y, Cofiference Officer I/ YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESIN'T YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 t:"" -s ?%? ? '~ ? {-r ?` '- -- "?; , ?'' .;. .? ?? x g.»- WALKER, CONNOR & JOHNSON, LLC 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 (717) 262-2187 - Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Diana M. Robertson, ) Civil Action - Law Plaintiff, ) vs. ) No. 08-1675-Civil Term Samuel C. Robertson, ) Defendant, ) In Divorce a v.m. INCOME AND EXPENSE STATEMENTOF PLAINTIFF (Diana M. Robertson) • Plaintiff Name: Defendant Name: Docket Number: PACSES Case Number: Other State ID Number: Please note: all correspondence must include the PACSES Case Number Income and Expense Statement THIS FORM MUST BE FILLED OUT (If you are self-employed or if you are salaried by a business of which you are owner in whole or in part, you must also fill out the supplemental income statement which appears on the last page of this income and expense statement) INCOME STATEMENT OF: I verify that the statements made in this Income and Expense Statement are true and correct. I understand that false statements herein are subject to the criminal penalties of 18 PA C.S. §4004, relating to unworn fafication to authorities. ' C Date Name: INCOME: Employer: Curves of Shippensburg Address: 300 S. Fayette Street, Shippensburg, PA 17257 Type of Work Payroll No. Cir. Trainer Gross Pay Per Period$ 5, 34 . 13 Pay Period(wkly./by-wkly./etc. $5,349.13 y year yy Federal $15.00 Social Security $ 333.21 Local Wage $14.53 Withholding Tax State Income $165.00 Retirement $ Savings Bonds $ Tax Credit Union $ Life Ins. $ Health Ins. $ Other Deductions Local Tax: $88.69 (specify) Net Pay Per Pay Period $8.00 x 34 hrs. = 272.00 $235. x 26 = $6,110.00 ,'- 12 = $509. month Service Type M Income and Expense Statement = net 235.00 Form IN-008 Worker ID 28204 1 Income and Expense Statement PACSES Case Number: (FILL IN Appropriate Column) OTHER INCOME WEEK MONTH YEAR Interest $ $ 18.75 $ 225.00 Dividends 3.25 39.00 Pension Annuity Social Security Rents Royalties Expense Account Gifts Unemployment Compensation Workmen's Compensation IRS Refund 35.00 422.00 Other - APL 785.00 Other TOTALS $ $ $ TOTAL INCOME $ 842.00 month + 509 .-month = $1,351.00 (FILL IN Appropriate Column) EXPENSES: WEEK MONTH YEAR Home $ $ $ Mortgage/Rent 804.00 Maintenance Utilities Electric 80.00 Gas Oil Telephone 75.00 Clothing 100.00 Service Type M Form IN-008 Income and Expense Statement Worker ID 28204 Income and Expense Statement PACSES Case Number: (fill in Appropriate Column) EXPENSES WEEK MONTH YEAR Water Sewer Employment Public Transportation Lunch 86.00 Taxes Real Estate Personal Property 5.00 Income PA Tax 15.00 Local Tax 7.50 Insurance Homeowners 8.50 Automobile 33.50 Life Accident Health Other Automobile Payments Fuel 75.00 Repairs 85.00 Medical Doctor 20.00 Dentist 10.00 Orthodontist Hospital 100.00 Service Type M Form IN-008 Income and Expense Statement Worker ID 28204 Income and Expense Statement PACSES Case Number: (fill in Appropriate Column) EXPENSES WEEK MONTH YEAR Medicine 40.00 Special needs (glasses, braces, orthopedic devices) Education Private School Parochial School College Religious Personal 30.00 Clothing Food 400.00 Barber/Hairdresser 50.00 Credit Payments: Credit Card Charge Acct. 300.00 Memberships Loans Credit Union Miscellaneous Household help Child Care Papers/Books/Magazines 40.00 Entertainment Pay TV 104.00 Vacation Service Type M Form IN-008 Income and Expense Statement Worker ID 28204 Income and Expense Statement PACSES Case Number: EXPENSES (FILL IN APPROPRIATE Column) WEEK MONTH YEAR Gifts 35.00 Legal Fees 100.00 Charitable Contributions 20.00 Other child Support Alimony Payments Child Support Other TOTALS TOTAL EXPENSES $ $2,623.50 PROPERTY DESCRIPTION VALUE OWNERSHIP OWNED H W J Checking Accounts Savings Accounts Credit Union Stocks/Bonds Real Estate Other TOTAL INSURANCE COMPANY POLICY# Covera e* H W C Hospital Blue Cross Other Medical Blue Cross Other *H - Husband W - Wife C - Combined J - Joint Service Type M Form IN-008 Income and Expense Statement Worker ID 28204 FILE} OF *vr_ Pi'3')Tk )N00TAPY 2009 APR -6 Phi 2: 37 CU 4 . , ':; .?. : l id ?'? Pimh S` LVANA Walker, Connor & Johnson, LLC 247Lincoln Way East Chambersburg PA 17201 (717) 262-2185 (717) 262-2187 - Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Diana M. Robertson, ) Civil Action - Law Plaintiff, ) VS. ) No. 08-1675 -Civil Term Samuel C. Robertson, ) Defendant, ) In Divorce a v.m. INVENTORY OF PLAINTIFF Plaintiff files the following inventory of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three years. Plaintiff verifies that the statements made in this inventory are true and correct. Plaintiff understands that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unworn falsification to authorities. _.- Diana Robertson, Plaintiff Date of Marriage: Date of Separation: July 28, 1987 March 2008 ASSETS OF THE PARTIES Plaintiff marks on the list below those items applicable to the case at bar and itemizes the assets on the following pages. (X) 1. Real Property ( ) 2. Motor vehicles (X) 3. Stocks, bonds, securities and options ( ) 4. Certificate of deposit ( ) 5. Checking accounts, cash (X) 6. Savings accounts, money market and savings certificates ( ) 7. Contents of safe deposit boxes (X ) 8. Trusts ( ) 9. Life Insurance policies (indicate face value, cash surrender value and current beneficiaries) (X) 10. Annuities ( ) 11. Gifts ( ) 12. Inheritances ( ) 13. Patents, copyrights, inventions, royalties ( ) 14. Personal Property ( ) 15. Business (List all owners, including percentage of ownership, and officer/director positions held by a party with the company.) ( ) 16. Employment termination benefits - severance pay, workers' compensation claim/award ( ) 17. Profit sharing plans ( X) 18. Pension plan (indicate employee contribution and date plan vests) ( ) 19. Retirement plan, Individual Retirement Accounts. 2 ( ) 20. ( ) 21. ( ) 22. ( ) 23. ( ) 24. ( ) 25. ( ) 26. Disability payments Litigation Claims (matured or unmatured) Military / V.A. benefits Education benefits Debts due, including loans, mortgage held Household furnishings and personalty (include as total category and attach itemized list if distribution of such assets in dispute) Other 3 MARITAL PROPERTY Plaintiff lists all marital property in which either or both spouses have a legal or equitable interest individually or with any other person as of the date of this action was commenced: ITEM NO. DESCRIPTION OF PROPERTY NAME OF ALL OWNERS 1. Real Estate Husband & Wife 158 Springfield Road Newville, PA 17241 3. Sprint Stock Wife 3. Embarq Stock Wife 3. MetLife Stock Wife 3. Pioneer Funds Husband 6. Cornerstone Investments Husband & Wife #1336 -18 - Money Market Account 8. F & M Revocable Trust Husband & Wife 18. PSERS Lump Sum Husband 18. PSERS Annuity Husband 18. PSERS Annuity Survivor Benefit Wife 19. 100+ sick days accrued paid to Husband husband at retirement 20. $30,000 unaccounted Husband funds husband has 4 NON- MARITAL PROPERTY Plaintiff lists all property in which a spouse has a legal or equitable interest which is claimed to be excluded from marital property. ITEM NO. DESCRIPTION OF PROPERTY NAME OF ALL OWNERS PSERS Lump Sum (non-marital portion) Husband 2. PSERS Annuity Husband (non-marital portion) PROPERTY TRANSFERRED PERSON TO ITEM DESCRIPTION DATE OF WHOM NO. OF PROPERTY TRANSFER CONSIDERATION TRANSFERRED NONE LIABILITIES ITEM NO. 1, DESCRIPTION OF PROPERTY Mortgage 158 Springfield Road Newville, PA 17241 NAMES OF CREDITORS Countryside NAMES OF ALL DEBTORS Husband & Wife ()F 7 2009 APR -b M. L: 37 Cti?r?, ?:?P?? fY pr- DIANA M. ROBERTSON, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 08-1675 CIVIL TERM SAMUEL C. ROBERTSON, IN DIVORCE Defendant/Respondent : PACSES Case No: 900110020 ORDER OF COURT AND NOW, this 5th day of May 2009, based upon the Court's determination that the Petitioner's monthly net income/earning capacity is $ 153.33 and the Respondent's monthly net income/earning capacity is $ 2966.92, it is hereby ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit Nine Hundred Ninety and 00/100 Dollars ($ 990.00) per month payable monthly as follows: $ 990.00 per month for Alimony Pendente Lite and $ 0.00 per month on arrears. First payment due: in accordance with Respondent's pay schedule. The effective date of the order is March 27, 2009. Credit set at $ -48.93 as of May 5, 2009. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and, at its discretion, make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Diana M. Robertson. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the Respondent's name with their PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. cc360 ti The monthly support obligation includes cash medical support in the amount of $250 annually for unreimbursed medical expenses incurred for the obligee. Unreimbursed medical expenses of the obligee that exceed $250 annually shall be allocated between the parties. The party seeking allocation of unreimbursed medical expenses must provide documentation of expenses to the other no later than March 31" of the year following the calendar year in which the final medical bill to be allocated was received. The unreimbursed medical expenses are to be paid as follows: 0 % by the Respondent and 100% by the Petitioner. [X] Respondent [] Petitioner to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the [] Petitioner [X] Respondent shall submit written proof that the medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist of, at a minimum of: 1) the name of the health care coverage provide(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. The Order is based upon Petitioner's claim that she is limited to working five (5) hours per week. The Petitioner is to submit more detailed medical verification of her inability to work more hours. The Petitioner is to report to the Domestic Relations Section any changes in her income or change in circumstances, including her housing arrangements. This Order considers that the Respondent is in the marital home and is paying on the mortgage and escrow. This Order shall become final twenty (20) after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. Mailed copies on: May 5, 2009 to: Petitioner Respondent Martha B. Walker, Esq. Barbara Sumple-Sullivan, Esq. BY THE COURT, Kevn ess, J. DRO: R.J. Shadday -6 CUB' > , ,.? s,,, r? 15 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State -Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 05/05/09 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number PSERS C/O JANE SMITH PO BOX 125 HARRISBURG PA 17108-0125 Employee/Obligor's Name (Last, First, MI) 201-42-5012 Employee/Obligor's Social Security Number 2998101975 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 INFORMA71ON: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 990.00 $ 0.00 $ 0.00 $ 0.00 per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) Arrears 12 weeks or greater? 0 yes ® no one-time lump sum payment for a total of $ 990 . 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: $ 228.46 per weekly pay period. $ 495.00 per semimonthly pay period (twice a month) $ 456.92 per biweekly pay period (every two weeks) $ 990.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's ase Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY M BY THE COURT: MAy 0 6 2009 Service Type M KEVIN A. HESS, JUDGE OMB No.: 0970-0154 O Original Order/Notice 900110020 Amended Order/Notice 08-1675 CIVIL 0Terminate Order/Notice QOne-Time Lump Sum/Notice RE: ROBERTSON, SAMUEL C. Form EN-028 Rev. 4 Worker ID $OINC ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS EJ If hecked you are required to provide a copy of this form to your em loyee. If yo r employee works in a state that is diFerent from the state that issued this order, a copy must be providedpto 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 recgipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 9127100234 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : C] THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME: ROBERTSON, SAMUEL C. EMPLOYEE'S CASE IDENTIFIER: 2998101975 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65°k, if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA 0 5 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Service Type M OMB No.: 0970-0154 Form EN-028 Rev. 4 Worker ID $OINC I ADDENDUM Summary of Cases on Attachment Defendant/Obligor: ROBERTSON, SAMUEL C. PACSES Case Number 900110020 PACSES Case Number Plaintiff Name Plaintiff Name DIANA M. ROBERTSON Docket Attachment Amount Docket Attachment Amount 08-1675 CIVIL$ 990.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev. 4 Service Type M OMB No.: 0970-0154 Worker ID $oINC FILED-01 I:! 2009 MAY _6 P" 13. 10 17 1 0, Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 DIANA M. ROBERTSON, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : PACSES No. 900110020 SAMUEL C. ROBERTSON, CIVIL ACTION. 08-1675 Defendant IN DIVORCE APPEAL OF ORDER AND REQUEST FOR HEARING DE NOVO TO THE PROTHONOTARY: Please accept this as an Appeal of the Order dated May 5, 2009 and schedule the matter for De Novo Hearing before the Support Master. Dated: May 22, 2009 fi- R? Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Supreme Court No. 32317 Attorney for Defendant Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 DIANA M. ROBERTSON, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -DIVORCE NO. 08-1675 CIVIL TERM SAMUEL C. ROBERTSON, Defendant : PACSES No. 900110020 CERTIFICATE OF SERVICE I, Laura J. Edwards, Secretary to Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served a true and correct copy of the APPEAL OF ORDER AND REQUEST FOR HEARING DE NOVO, in the above-captioned matter upon the following individual(s), by United States first-class mail, postage prepaid, addressed as follows: Martha B. Walker, Esquire Walker, Connor & Johnson, LLC 247 Lincoln Way East Chambersburg, PA 17201 DATE: May 22, 2009 1 Laura 4SIe-Sullivan, , Secretary to BarbarEsquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 RLEE. 4! i" ?'._,L O T HP LyRr; "'ITAR Ji 21509 HAY 22 Pli 1: 26 1' ::I 3 ? L!r t ..-k In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DIANA M. ROBERTSON Plaintiff VS. SAMUEL C. ROBERTSON Defendant Docket Number ) PACSES Case Number ) Other State ID Number ORDER OF COURT You, SAMUEL C. ROBERTSON PO BOX 724, NEW KINGSTOWN, PA. 17072-0724-24 are ordered to appear at DOMESTIC RELATIONS HEARING RM 08-1675 CIVIL 900110020 plaintiff/defendant of CIO HEARING ROOM, DOMESTIC RELATIONS OFFICE, 13 NORTH HANOVER STREET, CARLISLE, PA. 17013 before a hearing officer of the Domestic Relations Section, on the JULY 22, 2009 at 8: 3 OAM for a hearing. You are further required to bring to the hearing: 1. a true copy of your most recent Federal Income Tax Return, including W-2s, as filed, 2. your pay stubs for the preceding six (6) months, 3. the Income Statement and the appropriate Expense Statement, if required, attached to this order, completed as required by Rule 1910.11 (c). 4. verification of child care expenses, and 5. proof of medical coverage which you may have, or may have available to you 6. information relating to professional licenses 7. other: Service Type M Form CM-509 Rev. 1 Worker ID 21302 ROBERTSON PACSES Case Number: 900110020 If you fail to appear for the conference/hearing or to bring the required documents, the court may issue a warrant for your arrest and/or enter an interim support order. If paternity is an issue, the court shall enter an order establishing paternity. THE APPROPRIATE COURT OFFICER MAY ENTER AN ORDER AGAINST EITHER PARTY BASED UPON THE EVIDENCE PRESENTED WITHOUT REGARD TO WHICH PARTY INITIATED THE SUPPORT ACTION. BY THE COURT: Date of Order: S-.), ?- c) JUDGE YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE-HEARING AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. v. ROBERTSON CUMBERLAND CO BAR ASSOCIATION 32 S BEDFORD ST CARLISLE PA 17013-3302-32 (717) 249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of CUMBERLAND County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office at: (717) 240-622-9 . All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled hearing. Service Type M Page 2 of 2 Form CM-509 Rev. Worker ID 21302 FILRI-' 2 t) 9 1-1 7 F In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DIANA M. ROBERTSON ) Docket Number 08-1675 CIVIL Plaintiff ) vs. ) PACSES Case Number 900110020 SAMUEL C. ROBERTSON ) Defendant ) Other State ID Number ORDER OF COURT You, DIANA M. ROBERTSON plaintiff/defendant of 3306 DEERFIELD CMNS, SHIPPENSBURG, PA. 17257-8545-06 are ordered to appear at DOMESTIC RELATIONS HEARING RM CIO HEARING ROOM, DOMESTIC RELATIONS OFFICE, 13 NORTH HANOVER STREET, CARLISLE, PA. 17013 before a hearing officer of the Domestic Relations Section, on the JULY 22, 2009 at 8: 3 0AM for a hearing. You are further required to bring to the hearing: 1. a true copy of your most recent Federal Income Tax Return, including W-2s, as filed, 2. your pay stubs for the preceding six (6) months, 3. the Income Statement and the appropriate Expense Statement, if required, attached to this order, completed as required by Rule 1910.11 (c). 4. verification of child care expenses, and 5. proof of medical coverage which you may have, or may have available to you 6. information relating to professional licenses 7. other: Service Type M Form CM-509 Rev. 1 Worker ID 21302 ROBERTSON PACSES Case Number: 900110020 If you fail to appear for the conference/hearing or to bring the required documents, the court may issue a warrant for your arrest and/or enter an interim support order. If paternity is an issue, the court shall enter an order establishing paternity. THE APPROPRIATE COURT OFFICER MAY ENTER AN ORDER AGAINST EITHER PARTY BASED UPON THE EVIDENCE PRESENTED WITHOUT REGARD TO WHICH PARTY INITIATED THE SUPPORT ACTION. BY THE COURT: Date of Order: . --j 6 - Ul JUDGE YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE-HEARING AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. v• ROBERTSON CUMBERLAND CO BAR ASSOCIATION 32 S BEDFORD ST CARLISLE PA 17013-3302-32 (717) 249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of CUMBERLAND County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office at: (717) 2 4 0 - 6 2 2 5 . All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled hearing. Service Type M Page 2 of 2 Form CM-509 Rev. I Worker ID 21302 'F T 7 F',; ci DIANA M. ROBERTSON, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : DOMESTIC RELATIONS SECTION SAMUEL C. ROBERTSON, PACSES NO. 900110020 Defendant DOCKET NO. 08-1675 CIVIL ORDER OF COURT AND NOW, this 17th day of September, 2009, this matter having been scheduled for a hearing de novo before the Support Master on the Wife's petition for an increase in alimony pendente lite, and the parties having reached an agreement on all outstanding issues, the request for hearing de novo before the Support Master is withdrawn. B 2e. Court, Cc: Diana M. Robertson Samuel C. Robertson Martha B. Walker, Esquire For the Plaintiff 14 Kevin A. Hess, J. Barbara Sumple-Sullivan, Esquire For the Defendant DRO FlI..L:l:o?l ; OF THE P;U .: 2009 SEA' 18 PH 2: 3 7 cUPA L-, L Walker, Connor & Johnson LLC 247Lincoln Way East Chambersburg PA 17201 (717) 262-2185 (717) 262-2187 - Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DIANA M. ROBERTSON, ) Civil Action - Law Plaintiff, ) VS. } No. 08-1675 -Civil Term SAMUEL C. ROBERTSON, ) Defendant, ) In Divorce a v.m. AFFIDAVIT OF CONSENT 1. A Complaint in Divorce Under Section 3301(c) of the Divorce Code was filed on March 13, 2008 2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of both the filing and service of the Complaint. 3. I consent to the entry of a final Decree of Divorce after service of notice of intention to request entry of the Decree. WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION ? 3301 (c) OF THE DIVORCE CODE I. I consent to the entry of a final Decree of Divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a Divorce Decree is entered by the Court and that a copy of the Decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made above are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. §4904, relating to unsworn falsification to authorities. Date:,/ le Samuel C. Robe son, D fenda t FILED- DFRCE .F THE €'w'.!7"")NIOTARY 2009 OC F# 2 PH i*- It 2 Walker, Connor A Johnson LLC 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 (717) 262-2187 - Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DIANA M. ROBERTSON, ) Civil Action - Law Plaintiff, ) VS. ) No. 08-1675 -Civil Term SAMUEL C. ROBERTSON, ) Defendant, ) In Divorce a v.m. AFFIDAVIT OF CONSENT 1. A Complaint in Divorce Under Section 3301(c) of the Divorce Code was filed on March 13, 2008 2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of both the filing and service of the Complaint. 3. I consent to the entry of a final Decree of Divorce after service of notice of intention to request entry of the Decree. WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION & 3301(c) OF THE DIVORCE CODE I . I consent to the entry of a final Decree of Divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a Divorce Decree is entered by the Court and that a copy of the Decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made above are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. §4904, relating to unworn falsification to authorities. i Date: qb,a lo q e&kAk? Diana M. Roberston, Plaintiff -?F THE PI r? 'ia th5fll??iil1 2009 GC T 15 Ph 2= 31 DIANA M. ROBERTSON, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 08 - 1675 CIVIL SAMUEL C. ROBERTSON, Defendant IN DIVORCE AND NOW, this ORDER OF COURT g6k day of 2009, the economic claims raised in the proceedings having been resolved in accordance with a marital settlement agreement dated September 15, 2009, the appointment of the Master is vacated and counsel can file a praecipe transmitting the record to the Court requesting a final decree in divorce. cc: ZMartha B. Walker Attorney for Plaintiff ? Barbara Sumple-Sullivan Attorney for Defendant ?d?ae?v9 BY THE C WICA1 Edgar B. Bayley, P.J. nL,ED-(.IF FiCE OF THE PPO--"-nNI TARY 2004OCT 28 FN 2: ?2 t i ?; COPY MARITAL SETTLEMENT AGREEMENT THIS AGREEMENT, made this )Ernday of September, 2009, by and between Diana M. Robertson, hereinafter referred to as "WIFE", and Samuel C. Robertson, hereinafter referred to as "HUSBAND". WITNESSETH, That: WHEREAS, the parties hereto are husband and wife, having been lawfully joined in marriage on July 28, 1987, in Las Vegas, Nevada; WHEREAS, there are no minor children were born of this marriage; WHEREAS, it is the intention of the parties to settle fully and finally their respective financial and property rights and obligations as between each other arising out of the marriage relationship or otherwise, including without limitation (1) the settling of all matters between them relating to the ownership of real and personal property; (2) the settling of all matters between them relating to the past, present and future support and/or maintenance of HUSBAND and WIFE; and (3) the settling of all matters between them relating to any and all rights, titles and interests, claims and possible claims in or against the estate of the other. NOW THEREFORE, with the foregoing recitals being hereinafter incorporated by reference and deemed an essential part hereof in consideration of the foregoing recitals, the mutual promises, covenants and undertakings herein set forth, and for good and valuable consideration, receipt of which is hereby acknowledged by each of the parties hereto, HUSBAND and WIFE, each intending to be legally bound hereby, covenant and agree as follows: e Final- 09/15109 -C- .; ?,.. , ? ,,,rt"ye;.fft ,F i ?,.? .. `.d` SECTION I GENERAL PROVISIONS 1. ADVICE OF COUNSEL HUSBAND and WIFE declare that they have each had a full and fair opportunity to obtain independent legal advice of counsel of their selection. WIFE has been independently represented by Martha B. Walker, Esquire. HUSBAND has been independently represented by Barbara Sumple-Sullivan, Esquire. Each party further declares that they are executing this Agreement freely and voluntarily, having obtained such knowledge and disclosure of their legal rights and obligations. Each party acknowledges that this Agreement is fair and equitable and is not the result of any fraud, coercion, duress, undue influence or collusion. Both parties further acknowledge and agree that each has fully disclosed their respective financial situations to the other, including their assets, liabilities and income. Each of the parties acknowledge and agree that, after having received such information and with such knowledge, this Agreement is fair, reasonable and equitable and that it is being entered into freely, voluntarily and in good faith and that the execution of this Agreement is not the result of any duress, undue influence, coercion, collusion and/or improper or illegal Agreement. 2. PERSONAL RIGHTS HUSBAND and WIFE may and shall, at all times hereafter, live separate and apart. Each shall be free from all control, restraint, interference or authority, direct or indirect, by the other in all respects as if she or he were unmarried, except as may be necessary to carry out the provisions Final- 09/15/09 2 f a of this Agreement. Each may reside at such place or places as she or he may select. Each may, for his or her separate use or benefit, conduct, carry on and engage in any business, occupation, profession or employment which to him or her may seem advisable. This provision shall not be taken, however, to be an admission on the part of either HUSBAND or WIFE of the lawfulness of the causes which led to, or resulted in, the continuation of their living apart. HUSBAND and WIFE shall not molest, harass, or malign the other or the respective families of each other, nor compel the other to cohabit or dwell in any manner with him or her, nor in any way interfere with the peaceful existence, separate from each other. 3. FINANCIAL DISCLOSURE The parties have fully disclosed to each other the extent of each other's income, assets, liabilities, holdings and estate. Each party warrants that the information provided has fully and accurately described the extent of his or her holdings. Each of the parties acknowledge that he or she is aware of his or her right to seek discovery including, but not limited to, written interrogatories, motions for document production, depositions, and other means of discovery available through the Pennsylvania Rules of Civil Procedure. The parties acknowledge that they have had the right to have property fully appraised. Each parry is fully satisfied that no additional information is necessary for the execution of this Agreement. 4. MUTUAL CONSENT DIVORCE The parties intend to secure a mutual consent, no fault divorce pursuant to the provisions of Section 3301(c) of the Divorce Code of 1980, as amended and will execute the documents Final- 09/15/09 necessary to effectuate a divorce under those provisions concurrently with the execution of this Agreement. The parties agree that the Affidavits of Consent and the Waivers of Notice shall be signed simultaneously with the execution of this Agreement. Counsel for WIFE shall immediately Praecipe the Court for entry of the Divorce Decree. 5. SUBSEQUENT DIVORCE A decree in divorce, entered by the court of Cumberland County, shall not suspend, supersede or affect the terms of this Agreement. This Agreement, and the terms and conditions contained herein, as well as the enforcement of said terms and conditions, shall not be contingent upon the granting of a Divorce Decree to either party by the Court of Common Pleas of Cumberland County, Pennsylvania, or any other Court of competent jurisdiction. This Agreement shall remain in full force and effect even if the parties reconcile, cohabit as HUSBAND and WIFE, or attempt a reconciliation. This Agreement shall continue in full force and effect and there shall not be a modification or waiver of any of the terms hereof unless the parties, in a writing signed by both parties, execute a statement declaring this Agreement or any term of this Agreement to be null and void. Both parties hereto agree that this Agreement shall be incorporated by reference but shall not be deemed merged into any judgment or decree for divorce obtained by either party. Final- 09/15/09 4 4< 6. OTHER DOCUMENTATION HUSBAND and WIFE covenant and agree that upon request of the other party, they will forthwith execute and deliver to the other parry, any and all written instruments, assignments, releases, satisfactions, deeds, notes or such other writings as may be necessary or desirable for the proper effectuation of this Agreement. 7. MUTUAL RELEASES Except as otherwise expressly provided by this Agreement, A. Each party hereby absolutely and unconditionally releases and forever discharges the other and the estate of the other for all purposes from any and all rights and obligations which either may have or at any time hereafter have for past, present or future support or maintenance, alimony pendente lite, alimony, equitable distribution, counsel fees, costs, expenses and any other right or obligation, economic or otherwise, whether arising out of the marital relationship or otherwise, including all rights and benefits under the Pennsylvania Divorce Code of 1980, its supplements and amendments, as well as under any other law of any other jurisdiction, except and only except all rights, agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. Neither party shall have any obligation to the other not expressly set forth herein. B. Each parry hereby absolutely and unconditionally releases and forever discharges the other and his or her heirs, executors, administrators, assigns, property and estate from any and all rights, claims, demands or obligations arising out of or by virtue of the marital relationship of the parties or otherwise, whether now existing or hereafter arising. The above release shall be effective regardless of whether such claims arise out of any former or future acts, contracts, engagements or liabilities or the other or by way of dower, curtesy, widow's rights, family exemption or similar allowance, or under the intestate laws, or the right to take against the spouse's will, or the right to treat a lifetime conveyance by the other as testamentary, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of Pennsylvania, any state, commonwealth or territory or the United States, or any other country. It is expressly understood, however, that neither the provisions of this release nor the subsequent entry of a divorce decree are intended to defeat the right of either party to receive any insurance proceeds at the death of the other of which she or he is the named beneficiary (whether the beneficiary designation was made prior or subsequent to execution hereof), nor to defeat the right of either party to receive any legacy, bequest or residuary portion of the other's estate under his or her will, or to act as personal representative or executor if so named by the will of the other, whether such will was executed prior or subsequent to this Agreement. Final- 09/15/09 C. Except for any cause of action for divorce which either party may have or claim to have, and except for the obligations of the parties contained in this Agreement and such rights as are expressly reserved herein, each party gives to the other by the execution of this Agreement an absolute and unconditional release and discharge from all causes of action, claims, rights or demands whatsoever, in law or in equity, which either party ever had or now has against the other. 8. SUCCESSOR'S RIGHTS AND LIABILITIES This Agreement shall, except as otherwise provided herein, be binding upon and inure to the benefit of the parties hereto, their respective heirs, executors, admini assigns. 9. SEVERABILITY If any provision in this Agreement is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the remaining provisions shall nevertheless continue in full force and effect without being impaired or invalidated in any way. 10. ENTIRE AGREEMENT HUSBAND and WIFE do hereby covenant and warrant that this Agreement contains all of the representations, promises and Agreements made by either of them to the other for the purposes set forth in the preamble hereinabove; that there are no claims, promises or representations not herein contained, either oral or written, which shall or may be charged or enforced or enforceable unless reduced to writing and signed by both of the parties hereto. Final- 09/15/09 6 C 9* 11. BINDING EFFECT OF AGREEMENTIWAIVER This Agreement shall remain in full force and effect unless and until terminated under and pursuant to the terms of this Agreement. The failure of either party to insist upon strict performance of the provisions of this Agreement shall not be construed as a waiver of any subsequent default of the same or similar nature, nor shall such failure be construed as a waiver of any other term, condition, clause or provision of this Agreement. 12. BREACH If either party breaches any provision of this Agreement, the other party shall have the right, at his or her election, to sue for damages for such breach or seek such other remedies or relief as may be available to him or her, and the party breaching this contract shall be responsible for payment of reasonable legal fees and costs incurred by the other in enforcing their rights under this Agreement. 13. CONTROLLING LAW This Agreement shall be construed and governed in accordance with the laws of the Commonwealth of Pennsylvania. 14. TAX RETURNS The parties agree that in the future if any penalties or interest or any liability for failure to Final- 09/15/09 7 Ale. declare income or the wrongful claiming of any deduction shall be assessed by the United States Internal Revenue Service or the Commonwealth of Pennsylvania, or any other state as a consequence of the parties' Federal and State income tax returns which were filed jointly by the parties, said tax, penalties or interest shall be the sole responsibility of the parry found to have improperly declared his or her income or improperly taken a deduction. The party responsible for the error shall suffer the consequences solely and hold the opposite parry harmless. Each parry agrees to hold the other party harmless from any penalty, interest or liability for such reason arising out of the filing or failure to file any past tax return. If the liability is the result of a simple computation error or an error not attributable to the intentional or grossly negligent conduct of either party, the parties shall share equally in all future tax liability or tax assessment, penalties and interest. SECTION II EQUITABLE DISTRIBUTION During the marriage, the parties have accumulated various assets and liabilities, the disposition of which is intended as follows: 1. ASSETS A. PERSONAL and HOUSEHOLD PROPERTY HUSBAND and WIFE do hereby acknowledge that they have heretofore divided the non- marital and marital personal and household property, including but without limitation, jewelry, clothes, furniture, and other assets. HUSBAND agrees that all assets in the present possession of WIFE shall be the sole and separate property of WIFE and, WIFE agrees that all assets in the Final-09/15/09 g _c? tp* present possession of HUSBAND shall be the sole and separate property of HUSBAND. Each of the parties do hereby specifically waive, release, renounce and forever abandon whatever claims, if any, he or she may have with respect to any of the above said items which are the sole and separate property of the other. This document shall constitute a bill of sale for said sole property. B. REAL ESTATE The parties jointly own property at 128 Springfield Road, Newville, PA 17241. Said house is encumbered by a mortgage held by Countrywide (Account No. 009870887) in the approximate amount of Sixty-Five Thousand Dollars ($65,000.00). HUSBAND desires to maintain said home and reside therein. WIFE agrees to convey her interest in the real estate to HUSBAND upon the condition that he refinances the existing mortgage debt and pays to WIFE the cash payment set forth in subparagraph G. below. HUSBAND shall have ninety (90) days to complete the refinance. HUSBAND shall be fully responsible for any past, present and future principal, interest, penalties and costs as well as any taxes, insurance and/or any debts associated with the real estate. WIFE agrees to execute a deed simultaneously with the execution of this Agreement wherein she assigns, conveys and transfers to HUSBAND all of his interest, rights and title in the marital residence. This deed shall be held in escrow by WIFE's counsel and recorded upon the event of HUSBAND's successful completion of the refinance. In the event that such refinance is not completed within ninety (90) days of the date of this agreement, the house shall be immediately listed for sale. Upon sale, all of the proceeds shall Final-09/15/09 9 (Z.-I 44?e be the sole property of HUSBAND after payment to WIFE of the sums set forth in subparagraph G. Pending the sale, HUSBAND shall have exclusive possession of the home and be solely responsible for any past, present and future principal, interest, penalties and mortgage costs as well as any taxes, insurance and/or any debts associated with the real estate. C. MOTOR VEHICLES The parties acquired two (2) vehicles during the marriage being a 1999 F-150 driven by HUSBAND and a 2001 Mercury Sable driven by WIFE. The parties agree that each party shall maintain as his or her sole or separate property the vehicle which he or she drives. Each party hereby waives, relinquishes and releases any claim in the vehicle which shall be the sole and separate property of the other. Neither of these vehicles are presently encumbered by any loan or lien. The titles were previously transferred to the respective owners. D. FINANCIAL ASSETSANVESTMENTS: The parties agree that the financial accounts existing at the time of separation are to be or were separated as follows: TO WIFE: 1) Cornerstone FCU Money Market (JT) - $9,178.00 distributed to WIFE Account No. 1336-18 2) Cornerstone FCU Checking (JT)- Account No. 1336-01 3) Cornerstone FCU Savings (JT)- Account No. 1336-07 Final-09/115/09 10 Closed and Distributed Closed and Distributed ,L-, - Y.- &, Ll- (9/24/2009) Leslie Garg ulo -Mail JPG „_ ,.pa T-QJj AND- l.) Cornerstone FCU Money i44arket (T)- $2,179.00 distributed to SB D and E Acmunt No. 1336-01 2) C omcast€ ni;-. CCU Savi W (If)- A:r t:t unt No. 71336-01 Any balauc c to be solely owned by HUSBAND . 3) Comcrsto= FGU C:hccksag (H?- Account No, 71:126-07 Any balanc i; to be oolelyr owned by HUSBAND e Additinnally, WIFE wtas the owner c l.n shares of stock at the time of warati€an, being: i Sprint Stock - 20 Sbatres 24 Met life S=k. 48 Sbatrus 3) Bttabarq Stack - ! She= WIFE shall rim-min thiea sl s of a as her sole and separate property. HUSBAND +.V aivas any and all olaainis to said slims orstock, E. 1 MN ANID R&TIRENIEN T Ac CQ?f: Prior to. ad dmophout the mar ,.HUSBAND accumulated certain rctir t benefits through his employment. Time benefits consisted of a Public' School Ernppleyces.Retireiaaent yste Pension, MBAND retired o ctivejurnc 0,.2t30S. In lightofHUSBAND's mployment prier to m arriaap, for purposes of detemihation, a sixty-four pi=eat (64%) cc vertore'fratcdQn shall be applied to all ofHUSBAND's PSERS bmiunts so as to deft e tltc taxi.tall; s fir ctiatribud on 1>etwrqn the parties. (Herei nafter =-Cxt: to as the "marital ::hare'' I) DIS'3'J l,t11ON or THE ht kRT'm S!°EA R OF HUSBAND P S EI~r: NMBUT[t: NS_ Upon distn-bution at the time of his retimnent:fixim PSERS, HUSBAND's paid in Fiaud-?4t15, 11 , n 2 ? 1 contributions were placed into an American Funds CB&T IRA Account (Account No. 00083335058). The parties agree that WIFE shall receive, as her sole and separate property, free of any and all rights, title, claim or interest of HUSBAND, by rollover from this account fifty-five percent (55%) of the existing "marital share" of the account. This share shall be defined and determined as fifty-five percent (55%) of a sum equal to sixty- four percent (64%) of the total account balance as of the date of distribution. HUSBAND shall receive, as his sole and separate property, free of any and all rights, title, claim or interest of WIFE, the remaining forty-five percent (45%) of the existing "marital share" of the account, as well as all remaining account balance which is attributable to HUSBAND's service while the parties were not married as his sole and separate property. Counsel for WIFE shall be responsible for preparing the documents necessary for the division of this benefit to rollover on a tax free basis from HUSBAND's account said sums into a qualified account for WIFE. WIFE shall indemnify and hold HUSBAND harmless from any tax liability he may incur as a result of an improper rollover of these funds to WIFE. II) DISTRIBUTION OF THE MARITAL SHARE OF HUSBAND'S PSERS ANNUITY. As a part of the divorce proceedings, the parties agreed to alter HUSBAND's annuity designation from a Maximum Single Life Annuity to a Joint and fifty percent (50%) survivor annuity for the benefit of WIFE pursuant to PSERS Option 3. The parties Final-09/15/09 12 (? a6 agree that WIFE shall receive fifty percent (50%) of the marital portion of HUSBAND's monthly pension, together with the applicable survivor annuity benefit. This marital share is defined as sixty-four percent (64%) of the entire benefit earned by HUSBAND. These interests shall be transferred to WIFE pursuant to a Domestic Relations Order or similar authorized distribution method without any tax consequences being incurred by HUSBAND. WIFE agrees to indemnify and hold HUSBAND harmless from any tax liability he may incur as a result of this transfer to WIFE. Counsel for WIFE shall be responsible for preparing the documents necessary for the division of this benefit and confirming preservation of WIFE's fifty percent (50%) of the survivor benefit attributable to the marital share of HUSBAND's annuity. WIFE waives any and all claims to all remaining benefits of HUSBAND through PSERS except as specifically assigned to her in this paragraph and HUSBAND shall have said benefits as his sole and separate property, free of any and all right, title, claim or interest of WIFE. HUSBAND's PSERS pension is in actual pay status presently and the amount of HUSBAND's monthly annuity has been being used for the calculation of monthly support for WIFE. Pending the actual implementation of the Domestic Relations Order and through PSERS and payment by PSERS of WIFE's share directly to WIFE, HUSBAND agrees that he shall continue to pay to WIFE the sum of Nine Hundred Ninety Dollars ($990.00) in monthly maintenance to WIFE until PSERS has implemented direct payment to WIFE. HUSBAND shall stop his direct payments to WIFE once he determines on a monthly basis whether the direct payment to WIFE has been initiated as Final-09/15/09 13 evidenced by same being reflected in a reduction of his monthly annuity payment. Once the implementation is accomplished, HUSBAND shall have no further obligation to pay to WIFE any sums except the alimony as set forth in Section III. below. In consideration of HUSBAND's continued payment of this sum to WIFE pending implementation of the Domestic Relations Order, WIFE waives any retroactive claim to her share of the PSERS annuity received by HUSBAND after the date of this Agreement to the date of implementation of the direct payments by PSERS to her. The parties acknowledge that the payment of Nine Hundred Ninety Dollars ($990.00) set forth in this paragraph will be taxable to WIFE for federal income tax purposes and deductible by HUSBAND. The parties further acknowledge that WIFE shall be responsible for all tax liability on her share of the PSERS retirement benefits received after the implementation of the Domestic Relations Order and that HUSBAND shall be responsible for all tax liability on his respective share of the PSERS retirement benefits he receives. III) DISTRIBUTION OF HUSBAND'S SEPARATE RETIREMENT ASSETS. HUSBAND is also the owner of Pioneer Funds 403(B) (Account Nos. 07501022947 and 6206356793), which funds were accumulated during the marriage. These Pioneer Fund accounts shall be divided between the parties with WIFE receiving as her sole and separate property, free of any and all right, title, claim or interest of HUSBAND, fifty-five Percent (55%) of the balance in the account on the date of distribution. This transfer shall be accomplished via tax free rollover into a qualified individual retirement account of WIFE. HUSBAND shall receive as his sole and separate Final-09/15/09 14 property, free of any and all right, title, claim or interest of WIFE, the remainder of the account. IV) WARRANTY BY WIFE ON PENSION BENEFITS. WIFE warrants that she has earned no retirement or other deferred employment benefits during the marriage. F. F&M TRUST: HUSBAND inherited certain funds during the marriage upon his Father's death in 1994. The inherited funds were placed into F&M Trust (Account No. 30751000) which was in the joint names of HUSBAND and WIFE. Certain distributions were made from this account after separation to both parties. Each party acknowledges that he or she has received an advanced distribution of Twenty Thousand Dollars ($20,000.00). Each party shall keep their advanced distribution from the Trust account as their sole and separate property and shall waive any claim to the advanced distribution received by the other party. WIFE shall receive a final distribution of Forty-five Percent (45%) of the balance of this F&M Trust account. The parties shall cooperate to complete this transfer within five (5) days of the date of execution of this Agreement. Upon distribution to WIFE of Forty-five Percent (45%) of the balance of the Trust, WIFE's name shall be removed from the account and HUSBAND shall retain the remainder as his sole and separate property. Final-09(15!09 15 y(c/ 9/24/2009 Leslie Gar Mai10001 JPG Page 1 Upon the refinance or mflc of The marital home as set forth in Section II.B, above, HUSBAND shall pay to WI s cash payment offforty-two Thousand SL%,rn Hundred Ninety Doll= ($42.79Mtl): 1. DEBTS Each party represents that they bavt not contracted any slit, or liability for the otbor for Which the agate of the other party 4 iy he resp A010 or llsl)le except as othtmise penvided hereiat, and that apt only for the rights arising out of this Agmement, neither party wilt lt+ at#tcr incur tmy la'abiltty what even for which die: other party or the cstsata of the other party will 1 liable. Each patty agoos to iiadcmnify and lanld.harmless from and trprtst: all future obliptions. of every kind ieaat d by them, in:rlud;'tag thou reir necessities, To the best refrypaardee.know] edge ttacparties:affiirrnnojointdebtsatismdatthc.:titaa,e of separation, oxeupt fbr dim. f aced obovu- SECTION iTtTu l.. ?i?LIl?vii «l?t'r ALJ.NI l'am' L EN'1 E- lT L 'Al lli RT i' t1 C7+PT AN :A ND Ct7tM L; S There is cwently In existence in he Co of Con-unon Kos Curelmrland. County, Pennsylvaniaa,D sticRelaationsDivis'ror,?DocketNo.0881675§PACE 08?1675,PACSESCI--ueNb. 900110020, an Orda7foralir€itmiy ndentelateintheatmoun of'KineHundredNinetyDolltars(S990,00)per-manth, l?itk9Wti.5AW 16 s%? payable to WIFE. There is an appeal pending presently on this Order filed by HUSBAND. Said appeal shall be withdrawn by HUSBAND and, in consideration of HUSBAND's obligation to continue to make the payment in accordance with Section II.E. above, the order shall terminate. Effective upon the entry of the Decree in Divorce, HUSBAND agrees to pay to WIFE the sum of Four Hundred Fifty Dollars ($450.00) per month as alimony. This payment shall be made on the 1" day of the I" month following the date of entry of the Decree in Divorce. The parties acknowledge that this sum shall be includable as income of WIFE and deductible from the income of HUSBAND for tax purposes. This alimony payment shall continue for a total payment period of seventy-two (72) months. The alimony payment shall be made through the Domestic Relations Office. HUSBAND's obligation to pay alimony shall be non-modifiable for any reason in amount and in duration. Said alimony shall only terminate earlier upon the first to occur of the following: (1) Death of HUSBAND; (2) Death of WIFE; or (3) WIFE's remarriage or cohabitation. WIFE shall be responsible for her own health insurance coverage effective upon the date of the parties' divorce decree and HUSBAND's obligation to provide coverage shall cease. This space intentionally left blank. Final-09/15/09 _?? 17 A&?4. SECTION V 1. CONDITION PRECEDENT TO THE AGREEMENT'S EFFECTIVENESS The parties acknowledge that this Agreement shall become effective when actually signed by both parties. A e', TNESS DIANA M. ROBE TSO WITNESS SAMUEL C. OBa TSON Final-09/15/09 18 ?( r A-4?? COMMONWEALTH OF PENNSYLVANIA ) ) SS. COUNTY OF ) Before me, the undersigned officer, a Notary Public in and for said Commonwealth and County, personally appeared Diana M. Robertson, who being duly affirmed according to law, deposes and says that the facts and matter set forth in the within and foregoing Marital Settlement Agreement are true and correct to the best of her knowledge, information and belief. Affirmed and subscribed to before me this as n d day of , 2009. NOTAPI PUBLIC COMMONWEALTH OF PENNSYLVANIA Notarial Seal My commission expires: SUMA Shank NotaryPubliic (SEAL) Chambemburg Boro, Fmntdln County oily Commission E)ir Jan. 12, 2012 Member, Pennsylvania Association of Notaries COMMONWEALTH OF PENNSYLVANIA ) ) SS. COUNTY OF CUMBERLAND ) Before me, the undersigned officer, a Notary Public in and for said Commonwealth and County, personally appeared Samuel C. Robertson, who being duly affirmed according to law, deposes and says that the facts and matter set forth in the within and foregoing Marital Settlement Agr?,eeg>tent are true and correct to the best of his knowledge, information and belief scribed to before me this /S da ocfJ ??2009. NOTARY PUBLIC My commission expires: COMMONWEALTH OF PENNSYLVANIA Notarial Seal Barbara Sumpie.&gtivan, Notary Public New Cumberland Boro, Cumberland County My Commission Expires. Nov. 15, 2011 r",g??......,?il Gf ie.......-., (SEAL) Final-09/15/09 19 Diana M. Robertson, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL DIVISION Samuel C. Robertson, Defendant NO. 08-1675 CIVIL TERM PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Transmit the record, together with the following information to the court for entry of a divorce decree: 1. Ground for divorce: Irretrievable breakdown under 3301 (c) 3fl X( HKOl EM (Strike out inapplicable section) 2. Date and manner of service of the complaint: March 27, 2008 - certified mail, restricted delivery. 3. Complete either paragraph (a) or (b). a. Date of execution of the affidavit of consent required by 3301 (c) of the Divorce code: byplaintiff September 22, 200?bydefendant October 9, 2009 b. (1) Date of execution of the affidavit required by 3301 (d) of the Divorce Code: N/A (2) Date of filing and service of the plaintiff's affidavit upon the respondent: N/A 4. Related claims pending: Resolved through private agreement 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: N/A b. Date of plaintiff's Waiver of Notice in 3301 (c) Divorce was filed with the Prothonotary: October 15, 2009 Date defendant's Waiver of Notice in 3301 (c) divorce was filed with the Prothonotary: October 12, 2009 ,.1./ /11ttomey for lainti fendant FILED -C,?FiCE OF THE 2009 NOV -3 PM 12: 12 -ry CUB 'i'LVAi I IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DIANA M. ROBERTSON, V. Plaintiff, : SAMUEL C. ROBERTSON, Defendant, NO. 08-1675 -Civil Term By the Court, DIVORCE DECREE AND NOW, N64-Ar , 260 , it is ordered and decreed that DIANA M. ROBERTSON , plaintiff, and SAMUEL C. ROBERTSON , defendant, are divorced from the bonds of matrimony. Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: > "None.")[ ,4(? 4 ,?i Atte J. Proth notary 1v 7 ro-& DIANA M. ROBERTSON, Plaintiff/Petitioner VS. SAMUEL C. ROBERTSON, Defendant/Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 08-1675 CIVIL TERM IN DIVORCE PACSES CASE: 900110020 ORDER OF COURT AND NOW to wit, this 4th day of December, 2009, it is hereby Ordered that the Order for Alimony Pendente Lite is terminated, effective November 16, 2009, pursuant to the parties' Marital Settlement Agreement of September 19, 2009 and Divorce Decree of November 16, 2009. There is a credit balance of $1,540.71 on the Alimony Pendente Lite account. The credit balance of $1,540.71 will be directed to the newly established Alimony account. This Order shall become final twenty (20) after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary's Office for a hearing de novo before the Court. BY THE COURT: X4 - V"r. * Ke ' A. Hess, J. DRO: R.J. Shadday xc: Petitioner Respondent Martha B. Walker, Esq. Barbara Sumple-Sullivan, Esq. Form OE-001 Service Type: M Worker: 21005 ? WADI goal IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Diana M. Robertson, Plaintiff, ) Defendant, ) Civil Action - Law V. Samuel C. Robertson, No. 08-1675 Civil In Divorce a v.m. STIPULATION AND AGREEMENT By and between, Diana M Robertson, Plaintiff, and Samuel C. Robertson, Defendant, WITNESSESTH: WHEREAS, the parties, intending to be legally bound and waiving their right to be present when this Agreement and Order are presented and signed by the Court, hereby stipulate and agree that the Court may enter the attached Order of Court. IN WITNESS WHEREOF, the parties, intending to be bound by the terms and conditions of this Agreement, execute this Agreement by signing below. M ha B. W r Es u're P m,i Attorney f& Ta Barbara Sumple-Sullivan, Esquire Attorney for Defendant c Diana M. Robertson, Plaintiff Samuel C. Robertson, Defend nt I verify that the statements made in this Stipulation and Agreement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Date: Diana M. Robertson I verify that the statements made in this Stipulation and Agreement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Date: l l d J C Samuel C. Roberts I verify that the statements made in this Stipulation and Agreement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Date: to a 9 / U f M ha B. Walker, Esquire Attorney for Plaintiff I verify that the statements made in this Stipulation and Agreement are true and correct. I understand that false statements herein are made subject to the pen? of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities?--ar-b-ara Date: l Z -- 2" - Sumple-Sullivan, Esquire Attorney for Defendant 6 DIANA M. ROBERTSON, Plaintiff, V. SAMUEL C. ROBERTSON, Defendant, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 08-1675 -Civil Term DIVORCE DECREE AND NOW, wPmhP? ?s 2009 , it is ordered and decreed that DIANA M. ROBERTSON SAMUEL C. ROBERTSON bonds of matrimony. plaintiff, and defendant, are divorced from the Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: W= ?r1 [ i? = g "None."X By the Court, Certified Copy Issued: November 17, 2009 Date Kevin A. Hess Attest: J. fa t) f\lm Proth otary RLEO--.:YFICE nn OF THE' „0" ?r"N"OTARY 2009 DEC 10 WHO: 2 w ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 12/04/09 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number ASERS C/O JANE SMITH PO BOX 125 HARRISBURG PA 17108-0125 201-42-5012 Employee/Obligor's Social Security Number 2998101975 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 $ $ 0.0o 0.00 $ 0.00 $ 450.00 $ 0.00 $ 0.00 $ 0.00 per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) Arrears 12 weeks or greater? Oyes Ono one-time lump sum payment for a total of $ 450.00 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: $ 103.85 ; per weekly pay period. $ 225.00 per semimonthly pay period (twice a month) $ 207.69 per biweekly pay period (every two weeks) $ 450.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY UMBER IN ORDE TO BE PROCESSED. DO NOT SEND CASH BY MAIL. A BY THE COURT: DRO: R. J. Shadday Service Type M OMB No.: 0970-0154 08-1675 CIVIL OOriginal Order/Notice @Amended Order/Notice O Terminate Order/Notice QOne-Time Lump Sum/Notice RE: ROBERTSON, SAMUEL C. Employee/Obligor's Name (Last, First, MI) A. Hess, Judge Form EN-028 Rev.5 Worker I D $oINC ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS El If gheckeLl you are required. to provide asopy of this form to your eem loyee. If yorr employee wo di Brks in a state that is rent firom the state that issued this or er, a copy must be providedpto your emp ogee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 9127100234 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : ED THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 13 EMPLOYEE'S/OBLIGOR'S NAME: ROBERTSON, SAMUEL C. EMPLOYEE'S CASE IDENTIFIER: 2998101975 DATE OF SEPARATION LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $oINC . I ADDENDUM Summary of Cases on Attachment Defendant/Obligor: ROBERTSON, SAMUEL C. PACSES Case Number 900110020 PACSES Case Number Plaintiff Name Plaintiff Name DIANA M. ROBERTSON Docket Attachment Amount Docket Attachment Amount 08-1675 CIVIL$ 450.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev.5 Service Type M OMB No.: 097"154 Worker ID $OZNC RLED-CffCE OF THE MTI-MT Y 2009 DEC -8 QM ! 1:02 cu I {_? jv3Y 0 ' WALKER, CONNOR & JOHNSON, LLC 247 Lincoln Way East DEC 10 20094 Chambersburg, PA 17201 (717) 262-2185 (717) 262-2187-Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Diana M. Robertson, ) Civil Action - Law Plaintiff, ) V. ) No. 08-1675 Civil Samuel C. Robertson, ) Defendant, ) In Divorce a v.m. QUALIFIED DOMESTIC RELATIONS ORDER AND NOW, this day of U4 y , 2009, it appearing to the Court that: 1. Parties to Divorce Action. The parties to this action are Samuel C. Robertson ("Participant") and Diana M. Robertson ("Alternate Payee"). 1.1. Participant's name, address, social security number and date of birth are as follows: Name: Samuel C. Robertson Address: 158 Springfield Road, Newville, PA 17241 Soc. Sec. No.: Participant's social security number will be provided when this Order is transmitted to the Administrator for processing Date of Birth: September 15, 1950 1 .2. Alternate Payee's name, address, social security number and date of birth are as follows: Name: Diana M. Robertson Address: 3306 Deerfield Commons, Shippensburg, PA 17257 Soc. Sec No.: Alternate Payee's social security number will be provided when this Order is transmitted to the Administrator for processing Date of Birth: December 1, 1949 1.3. The parties were divorced by Order of this Court (a copy attached hereto) on November 16, 2009. The Decree has not been amended. 2. Plan. This Order applies to the Pioneer Funds of Samuel C. Robertson, Account Nos. #07501022947 and #6206356793. The Administrator responsible for determining whether the Order constitutes a Qualified Domestic Relations Order, as described below, is American General Securities, Inc., c/o Barbara Bistline, 301 South Hanover Street, Carlisle, Pennsylvania 17013. 3. Interpretation and Construction of Order. 3.1. The parties intend this Order (the "Order") to constitute a "Qualified Domestic Relations Order", within the meaning of Section 414(p) of the Internal Revenue Code of 1986, as amended (the "Code") and Section 206(d)(3)(B) of the Employee Retirement Income Security Act of 1974, as amended, ("ERISA"). The provisions of this Order shall be administered and interpreted in conformity with Section 414(p) of the Code and Section 206(d)(3)(B) of ERISA. 3.2. Nothing in this Order shall be construed to require the Plan to provide: 3.2.1 Any type or form of benefit, or any option, not otherwise provided under the Plan. 3.2.2 Benefits to Alternate Payee (as defined in Paragraph 4) in an amount that exceeds the amount of benefits that the Plan would be required to pay with respect to the Participant. 3.2.3 Benefits to Alternate Payee which are required to be paid to another alternate payee under another order previously determined to be a qualified domestic relations order. IT IS ORDERED, ADJUDGED AND DECREED as follows: 4. Alternate Payee. This Order creates or recognizes the existence of the right of Alternate Payee (as hereinafter defined) to receive all or a portion of the benefits payable with respect to Participant under the Plan. For purposes of this Order, Alternate Payee is: X 4.1. Former Spouse. 5. Amount of Distribution and Form of Distribution to Alternate Payee. The distribution to Alternate Payee contemplated by this Order shall be made in the form of a transfer of fifty-five percent (55%) of the balance of the aforesaid accounts on the date of distribution from the aforesaid Individual Retirement Account of Samuel C. Robertson, Account Nos. #07501022947 and #6206356793 to the Individual Retirement Account FBO Diana M. Robertson, at F & M Bank, Account No. 68749400. 2 6. Distribution Date. The distribution to Alternate Payee contemplated by this Order shall be made as soon as administratively practicable following the Company's determination that this Order is a Qualified Domestic Relations Order. 7. Death of Participant or Alternate Payee. The death of Participant before all benefits to which Alternate Payee is entitled under this Order have been paid shall not affect the right of Alternate Payee to benefits from the Plan as described in this Order. Should Alternate Payee die before benefits have been distributed to her, Alternate Payee designates, her son, Matthew C. Wolfe, beneficiary of any and all benefits remaining to be paid. 8. Continuing Jurisdiction. The Court shall retain jurisdiction to amend this Order for the purpose of carrying out the intent of the Parties as reflected in this Order and to establish or maintain the status of the Order as a Qualified Domestic Relations Order. Either Party to this Order may apply to the Court for such amendment. IT IS INTENDED that this Order shall qualify as a Qualified Domestic Relations Order under the Retirement Equity Act of 1984. The Court retains jurisdiction to amend this Order as might be necessary to establish or maintain its status as a Qualified Domestic Relations Order under the Retirement Equity Act of 1984. By the Court, FILED-tit f"iCE: Or THEE PROT'.'-OTARY 2009 DEC 1 i PM 1: 22 LVAI CONSENTED TO: Date: /6 .? 0 9 Date: 1/4-7 /0 a Date: /D b-IZ.4 g Date: 12-,- Z eox-l Diana M. Robertson r Samuel C. R bertso Mafia B. W*er, Esquire $arbara Sumple-Sullivan, Esquire Attorney for Defendant RLED--c') k, 17 THE 2009 DEC 1 I PM 1: 2 2 Nei i- ;S WNA Martha B. Walker, Esquire WALKER, CONNOR & JOHONSON, LLC 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 ------------------------------------------------------------------ Diana M. Robertson IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL TERM Samuel C. Robertson NO. 08-01675 Defendant QUALIFIED DOMESTIC RELATIONS ORDER AND NOW, this day of , 20 , the parties, Diana M. Robertson, Plaintiff, and Samuel C. Robertson, Defendant, do hereby Agree and Stipulate as follows: 1. This Order relates to the provision of marital property rights to the Alternate Payee. 2. The Defendant, Samuel C. Robertson (hereinafter referred to as "Participant") has in effect the following Individual Retirement Account: CB&T Custodian IRA/Rollover for Samuel C. Robertson: Account Number 00083335058 3. Participant's date of birth and his Social Security number are found in the attached Addendum. 4. The Plaintiff, Diana M. Robertson (hereinafter referred to as "Alternate Payee") is the former spouse of Member. Alternate Payee's date of birth and her Social Security number are found in the attached Addendum. 5. Participant's last known mailing address is: 158 Springfield Road Newville, PA 17241 6. Alternate Payee's current mailing address is: 3306 Deerfield Commons Shippensburg, PA 17257 QDRO Page 2 7. To accommodate the marital property distribution between the parties IT IS ORDERED, ADJUDICATED AND DECREED AS FOLLOWS: a. A portion of the IRA with CB&T referenced in Paragraph 2 is marital property. b. That subject to the finalization of the divorce and the execution of the documents required by CB&T, the amount to be awarded to the Alternate Payee shall be determined as follows: 35.2% of the IRA account balance as of the date of distribution. The Alternate Payee's award shall be paid proportionately from all of the investment accounts. C. The amount designated in Paragraph 7(b) shall be paid directly into the following Individual Retirement Account: Individual Retirement Account with F&M Trust for Benefit of Diana M. Robertson - Account Number 687-49400 d. The parties are directed to timely submit to CB&T all documents that are required to finalize this Order. QDRO Page 3 8. This Court reserves jurisdiction to issue further orders as needed to execute this Order. Accepted and ordered this CONSENT TO ORDER: day of t?7 JAi ?4 Plain iff/Alternate Payee Date for Plaintiff/ Date Payee BY THE COURT Judge e- Attorney for Participant -77/ e r Date Date r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DIANA M. ROBERTSON V. SAMUEL C. ROBERTSON NO. 08-1675 CIVIL TERM DIVORCE DECREE AND NOW, NOVEMBER 16 2009 , it is ordered and decreed that DIANA M. ROBERTSON plaintiff, and SAMUEL C. ROBERTSON defendant, are divorced from the bonds of matrimony. Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: (If no claims remain indicate "None.") NONE Certified Copy Issued: DECEMBER 10, 2009 Date By the Court, KEVIN A. HESS Attest: CURTIS R. LONG J. Prothonota Martha B. Walker, Esquire WALKER, CONNOR & JOHNSON, LLC 247 Lincoln Way East ChambersburQ PA 17201 COURT OF COMMON PLEAS OF CUMBERLAND COUN'T'Y, PENNSYLVANIA Diana M. Robertson Plaintiff VS. Samuel C. Robertson Defendant CIVIL TERM NO. 08-01675 STIPULATION FOR THE ENTRY OF "DOMESTIC RELATIONS ORDER" AND NOW, this day of , the parties, Diana M. Robertson, Plaintiff and Samuel C. Robertson, Defendant, do hereby Agree and Stipulate as follows: 1. The Defendant, Samuel C. Robertson (hereinafter referred to as "Member") is a member of the Commonwealth of Pennsylvania, Public School Employees' Retirement System (hereinafter referred to as "PSERS"). 2. PSERS, as a creature of statue, is controlled by the Public School Employees' Retirement Code, 24 Pa. C.S. §§8101 et. seq. ("Retirement Code"). 3. Member's date of birth and Social Security number are disclosed in the attached Addendum. 4. The Plaintiff, Diana M. Robertson (hereinafter referred to as "Alternate Payee") is the former spouse of Member. Alternate Payee's date of birth and Social Security number are disclosed in the attached Addendum. 5. Member's last known mailing address is: 128 Springfield Road Newville, PA 17241 6. Alternate Payee's current mailing address is: 3306 Deerfield Commons Shippensburg, PA 17257 It is the responsibility of the Alternate Payee to keep a current mailing address on file with PSERS, at all times. 7. The Alternate Payee is entitled to a portion of the Member's benefits under PSERS as set forth below. PSERS is hereby directed to pay Alternate Payee's share directly to Alternate Payee. 8. The Member is currently receiving a monthly annuity for his lifetime pursuant to the terms of Option 3. Member waives his right to change his option selection by virtue of his divorce. 9. The Alternate Payee is awarded 32.0% of the Member's gross monthly annuity together with the Option 3 survivor annuity. The Alternate Payee shall receive 32.0% of any scheduled or ad hoc increase that is applied to Member's gross monthly annuity. 10. Payments to the Alternate Payee shall commence as soon as administratively feasible on or about the date PSERS approves a Domestic Relations Order incorporating this Stipulation and Agreement. 11. Payments shall continue to Alternate Payee for the remainder of the Member's lifetime. 12. If the Member dies before the Alternate Payee, the Alternate Payee shall be provided a survivor benefit in accordance with Option 3 elected by the Member upon his retirement. Member reaffirms his selection of Alternate Payee as his survivor annuitant and waives his right to select a new survivor annuitant by reason of his divorce from the Alternate Payee. 13. If the Alternate Payee dies before the Member, the Alternate Payee's share of the member's pension shall be paid to the Alternate Payee's estate. 14. Member shall execute and deliver to Alternate Payee an authorization, in a form acceptable to PSERS, which will authorize PSERS to release to Alternate Payee all relevant information concerning Member's retirement account. Alternate Payee shall deliver the authorization to PSERS which will allow the Alternate Payee to check that she has been and continues to be named as the survivor annuitant under Option 3. 15. Alternate Payee may not exercise any right, privilege or option offered by PSERS. PSERS shall issue individual tax forms to Member and Alternate Payee for amounts paid to each. 16. In no event shall Alternate Payee have greater benefits or rights other than those which are available to Member. Alternate Payee is not entitled to any benefits not otherwise provided by PSERS. The Alternate Payee is only entitled to the specific benefits offered by PSERS as provided in this Order. All other rights, privileges and options offered by PSERS not granted to Alternate Payee by this Order are preserved for Member. 17. It is specifically intended and agreed by the parties hereto that this Order: (a) Does not require PSERS to provide any type or form of benefit, or any option not otherwise provided under the Retirement Code; (b) Does not require PSERS to provide increased benefits (determined on the basis of actuarial value) unless increased benefits are paid to Member based upon cost of living or increases based on other than actuarial values. 18. The parties intend and agree that the terms of this Stipulation and Agreement shall be approved, adopted and entered as a Domestic Relations Order. 19. The Court of Common Pleas of Cumberland County, Pennsylvania, shall retain jurisdiction to amend any Domestic Relations Order incorporating this Stipulation and Agreement, but only for the purpose of establishing it or maintaining it as a Domestic Relations Order; provided, however, that no such amendment shall require PSERS to provide any type or form of benefit, or any option not otherwise provided by PSERS, and further provided that no such amendment or right of the Court to so amend will invalidate this existing Order. 20. Upon entry as a Domestic Relations Order, a certified copy of the Domestic Relations Order and this Stipulation and Agreement and any attendant documents shall be served upon PSERS immediately. The Domestic Relations Order shall take effect immediately upon PSERS approval and PSERS approval of any attendant documents and then shall remain in effect until further Order of the Court. WHEREFORE, the parties, intending to be legally bound by the terms of this Stipulation and Agreement, do hereunto place their hands and seals. BY THE COURT OA-? /D Alternate P yee _ C_„ da,JI Defendan embe k" C' Atto y for r DIANA M. ROBERTSON V. SAMUEL C. ROBERTSON IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO 08-1675 CIVIL TERM DIVORCE DECREE AND NOW, NOVEMBER 16 2009 , it is ordered and decreed that DIANA M. ROBERTSON plaintiff, and SAMUEL C. ROBERTSON , defendant, are divorced from the bonds of matrimony. Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: (if no claims remain indicate "None.") NONE By the Court, Certified Copy Issued: DECEMBER 10, 2009 Date KEVIN A. HESS Attest: J. CURTIS R. LONG /? Proth?o?n,/?ota of-- TI-r- r 2009 DEC 18 A'` v =, l l ?A I `d Martha B. Walker, Esquire WALKER, CONNOR & JOHONSON, LLC 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 DEC 2 1 2009 ---------------------------------------------------------------------------------------------- Diana M. Robertson IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL TERM Samuel C. Robertson NO. 08-01675 Defendant QUALIFIED DOMESTIC RELATIONS ORDER AND NOW, this t2" day of 20ct?, the parties, Diana M. Robertson, Plaintiff, and Samuel C. Robertson, Defendant, do hereby Agree and Stipulate as follows: 1. This Order relates to the provision of marital property rights to the Alternate Payee. 2. The Defendant, Samuel C. Robertson (hereinafter referred to as "Participant") has in effect the following Individual Retirement Account: CB&T Custodian IRA/Rollover for Samuel C. Robertson: Account Number 00083335058 3. Participant's date of birth and his Social Security number are found in the attached Addendum. 4. The Plaintiff, Diana M. Robertson (hereinafter referred to as "Alternate Payee") is the former spouse of Member. Alternate Payee's date of birth and her Social Security number are found in the attached Addendum. 5. Participant's last known mailing address is: 158 Springfield Road Newville, PA 17241 6. Alternate Payee's current mailing address is: 3306 Deerfield Commons Shippensburg, PA 17257 QDRO Page 2 7. To accommodate the marital property distribution between the parties IT IS ORDERED, ADJUDICATED AND DECREED AS FOLLOWS: a. A portion of the IRA with CB&T referenced in Paragraph 2 is marital property. b. That subject to the finalization of the divorce and the execution of the documents required by CB&T, the amount to be awarded to the Alternate Payee shall be determined as follows: 35.2% of the IRA account balance as of the date of distribution. The Alternate Payee's award shall be paid proportionately from all of the investment accounts. C. The amount designated in Paragraph 7(b) shall be paid directly into the following Individual Retirement Account: Individual Retirement Account with F&M Trust for Benefit of Diana M. Robertson - Account Number 687-49400 d. The parties are directed to timely submit to CB&T all documents that are required to finalize this Order. QDRO Page 3 8. This Court reserves jurisdiction to issue further orders as needed to execute this Order. Accepted and ordered this LZ`? day of 7?u,s..-vim' ?^-?• BY THE COURT . WAL Judge CONSENT TO ORDER: Plat if l ternate Payee Date Defend rti 'pant 'AeA y for Plaintiff/ Date Attorney for to Payee Participant Date 05 )a- .Date .?r _..? P4-Y R WALKER, CONNOR & JOHNSON LLC 247 Lincoln Way East DEC 312009 Chambersburg PA 17201 (717) 262-2185 (717) 262-2187 - Fax Diana M. Roberston, ) IN THE COURT OF COMMON PLEAS OF Plaintiff, ) CUMBERLAND COUNTY, PENNSYLVANIA vs. ) No. 08-1675 -CIVIL TERM Samuel C. Robertson, ) Defendant, ) In Divorce a v.m. ORDER OF COURT AND NOW, this day of 2010, the attached Stipulation and Agreement entered by the parties in the above-captioned case is incorporated, but not merged, into this Order of Court. BY THE COURT, i C, 2614 J N -4 P, J: 5 u 1 l If'\l ) ,,? r i F Id`ri G. r..t". I?Iirx orlov I ?rL M. t