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HomeMy WebLinkAbout04-0724Law Offices of Lee E. Oesterling & Associates, LLC 42 East Main Street Mechanicsburg, PA 17055 (717)-790-5400 IN THE COURT OF COMMON PLEAS OF THE 9' JUDICIAL DISTRICT CUMBERLAND COUNTY, PENNSYLVANIA KEVIN M. DANNER Plaintiff, : No. ON ?'12N ?u?C ?2_w? V. Civil Action - Divorce BARBARA S.ZEIGLER Defendant NOTICE TO DEFEND AND CLAIM OF RIGHTS YOU HAVE BEEN SUED IN COURT. I f y ou w ish t o d efend a gainst t he c laims s et forth in the following pages, you must take prompt action, You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the Court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 67? "W94?• f e y f?C bM ?ij i!!te t? ly Ap-n -0A.T? Y I NOTTCF, OF AVAU,ABIT,TTV OF COTTNSFS.TNG THE DIVORCE CODE OF PENNSYLVANIA REQUIRES THAT YOU BE NOTIFIED OF THE AVAILABILITY OF COUNSELING WHERE A DIVORCE IS SOUGHT UNDER ANY OF THE FOLLOWING GROUNDS: 23 Pa.C.S. § 3301(a)(6) - Indignities 23 Pa.C.S. § 3301(c) - Irretrievable Breakdown; Mutual Consent 23 Pa.C.S. § 3301(d) Irretrievable Breakdown; Two year separation where the court determines that there is a reasonable prospect of reconciliation A list of marriage counselors is available in the Office of the Prothonotary, Cumberland County Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania 17013. Telephone: (717) 240-6194. LEE E. & ASSOCJsATES, LLC 'Lee E. Oesterlm# 71 Attorney for Plaintiff 42 East Main Street Mechanicsburg, PA 17055 (717)790-5400 Law Offices of Lee E. Oesterling & Associates, LLC 42 East Main Street Mechanicsburg, PA 17055 (717)-790-5400 IN THE COURT OF COMMON PLEAS OF THE 9' JUDICIAL DISTRICT CUMBERLAND COUNTY, PENNSYLVANIA KEVIN M. DANNER Plaintiff, C to. No. b?-"!eZY Lr?L V. Civil Action - Divorce BARBARA S.ZEIGLER Defendant COMPLAINT UNDER SECTION 3301(C) OR 3301 (D) OF THE DIVORCE CODE 1. Plaintiff is Kevin M. Danner, an adult individual, sui juris, who currently resides at 6460 Wertzville Road, City of Enola, County of Cumberland, Commonwealth of Pennsylvania 17025. 2. Defendant is Barbara S. Zeigler, an adult individual, sui juris who currently resides at 129 Linda Drive, City of Mechanicsburg, County of Cumberland, Commonwealth of Pennsylvania 17050. 3. Plaintiff has been a bona fide resident of the Commonwealth of Pennsylvania for a period of more than six (6) months immediately preceding the filing of this complaint. 4. The parties were married on the 14's day of May 1998, County of Cumberland, Commonwealth of Pennsylvania. 5. Neither Plaintiff nor Defendant is in the military or naval service of the United States or its allies within the provisions of the Soldiers' and Sailors' Civil Relief Act of the Congress of 1940 and its amendments. 6. There have been no prior actions for divorce or annulment instituted by either of the parties in this or any other jurisdiction. 7. For purposes of § 3301(d) of the Divorce Code, the parties have been living separate and apart since on or about January 13, 2004. 8. The marriage is irretrievably broken. 9. 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. 10. Plaintiff intends to file an affidavit of consent after 90 days have elapsed from the date of service of the Complaint on the defendant and believes that defendant will also file such an affidavit. REQUEST FOR A NO-FAULT DIVORCE UNDER § 3301(c) OF THE DIVORCE CODE 11. The prior paragraphs of this Complaint are incorporated herein by reference thereto. 12. The marriage of the parties is irretrievably broken. WHEREFORE, Plaintiff respectfully requests the Court to enter a decree of divorce pursuant to § 3301(c) of the Divorce Code. PETITIONFOR EQUITABLE DIVISION, DISTRIBUTIONAND ASSIGNMENT OFMARITAL PROPERTY 13. The averments of paragraphs 1 through 12 of Count I are incorporated herein by direct reference thereto as if set forth verbatim. 14. The parties are the owners of various items of personal property and real property which qualify as marital property as defined in Section 401 of the 1980 Divorce Code. 15. Said marital property is subject to equitable division, distribution and assignment by this Court. WHEREFORE, Plaintiff prays that this Honorable Court: (a) equitably divide, distribute and assign all the parties' marital property; (b) enjoin Defendant from transferring or encumbering any marital property during the pendency of this action. LAW OFF ES OF E. OESTE ING & ASSOCIATES, LLC Lee E. Oesterling =. # 71 Attorney for Plaintiff 42 East Main Street Mechanicsburg, PA 17055 (717)790-5400 VRRTFICATION I verify that upon personal knowledge or information and belief that the statements made in this Complaint are true and correct, I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904, relating to unswom falsification to authorities. KEVINDANNER Date: r i7 ID C oz> Law Offices of Lee E. Oesterling, LLC 42 East Main Street Mechanicsburg, PA 17055 (717) 790-5400 IN THE COURT OF COMMON PLEAS OF THE 91:h JUDICIAL DISTRICT CUMBERLAND COUNTY, PENNSYLVANIA KEVIN M. DANNER Plaintiff, No. t14-724 rivilserm v. Civil Action - Divorce BARBARA S. ZEIGLER Defendant PRAECIPE TO REINSTATE / REISSUE COMPLAINT TO THE PROTHONOTARY: Kindly reinstate and mark reissued the Complaint in the above captioned matter in accordance with Pa.R.C.P. 401. Submitted, Lee E. Oesterling, Esquire Attorney for Plaintiff ID# 71320 N ?' p -- r Z7 :co- ?? f 'i • -n fil i, I =';] G ?: i_ _? --r; 3?, ' ?? = ? Cw.? .. ? T? f i i - I W '.z (Jt -? Law Offices of Lee E. Oesterling, LLC 42 East Main Street Mechanicsburg, PA 17055 (717) 790-5400 IN THE COURT OF CCOMMN PLEAS OMMON COUNT O THE 9 PENNSYLVANIA DISTRICT KEVIN M. DANNER Plaintiff, No--k4-J4 Term V. Civil Action - Divorce BARBARAS.ZEIGLER Defendant PRAECIPE TO REINSTATE / REISSUE COMPLAINT TO THE PROTHONOTARY: Kindly reinstate and mark reissued the Complaint in the above captioned matter in accordance with Pa.R.C.P. 401. Submitted, Lee E. Oesterling, Esquire Attorney for Plaintiff N O T11'1 i f b ; 7 . C_ GJ c=J rr: d: -• cn dry! a ICY -?: Law Offices of Lee E. Oesterling, LLC 42 East Main Street Mechanicsburg, PA 17055 (717) 790-5400 IN THE COURT OF COMMON PLEAS OF THE 9th JUDICIAL DISTRICT CUMBERLAND COUNTY, PENNSYLVANIA KEVIN M. DANNER Plaintiff, No. 04-724 Civ 1 Term V. Civil Action - Divorce BARBARA S. ZEIGLER Defendant PRAECIPE TO REINSTATE / REISSUE COMPLAINT TO THE PROTHONOTARY: Kindly reinstate and mark reissued the Complaint in the above captioned matter in accordance with Pa.R.C.P.401. Lee E. Oesterling"E? Attorney for Plaintiff -, ,.:, W:- ,. ,; - ' ` ; ; } r; _ -,- ' ^?= E'J { O +. ? ?? Law Offices of Lee E. Oesterling, LLC 42 East Main Street Mechanicsburg, PA 17055 (717) 790-5400 IN THE COURT OF COMMON PLEAS OF THE 9th JUDICIAL DISTRICT CUMBERLAND COUNTY, PENNSYLVANIA KEVIN M. DANNER Plaintiff, V. BARBARA S. ZEIGLER Defendant No. 04-724 Ceil Term Civil Action - Divorce I, Lee E. Oesterling, Esquire, a competent adult over the age of eighteen (18), say that I served the Complaint for Divorce in the above-mentioned action by personally handing a copy to the Defendant, Barbara S. Zeigler, at her place of residence at 129 Linda Drive, Mechanicsburg, Cumberland County, Pennsylvania ugust 17, 2004 and informed her of the contents of the document, in accordance with Pennsylvania Civil P edure Ru I930.4(a)(2)(i). Lee E. Oesterling, Esquire X71320 42 East Main Street Mechanicsburg, PA 17055 (717)790-5400 r•a n ?> c> ,. -„ -„ --? ?c -- ,, -, _.? --- _, '_ ?-' ?, -?4 ::? r,.? f N M. DANNER, : IN THE COURT OF COMMON PLEAS Plaintiff : OF CUMBERLAND COUNTY : PENNSYLVANIA VS. CIVIL ACTION SARA S. ZEIGLER, NO. 04-724 Defendant IN DIVORCE N O T I C E T O D E F E N D You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable reakdown of the marriage, you may request marriage counseling. A ist of marriage counselors is available in the office of the rnthonctarv at: Office of the Prothonotary Cumberland County Court House 1 Courthouse Square Carlisle, Pennsylvania 17013-3387 IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, ER IS FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE CE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE PA 17013 717-249-3166 M. DANNER, : IN THE COURT OF COMMON PLEAS Plaintiff : OF CUMBERLAND COUNTY : PENNSYLVANIA VS. : CIVIL ACTION RA S. ZEIGLER, : NO. 04-724 Defendant : IN DIVORCE ANSWER AND NOW COMES the Defendant, Barbara S. Zeigler, by and through attorneys, Dissinger and Dissinger, and files the following E?r and respectfully represents that: Admitted. ?. Admitted. 3. Admitted. 4. Admitted. 5. Admitted. 6. Admitted. 7. Denied. It is denied that the parties were separated on January 13, 2004. By way of further answer it is averred that the parties were separated on February 3, 2004. 8. Admitted. 9. Denied. Defendant is without sufficient knowledge to affirm or deny the allegation and therefore same is denied and proof demanded at time of hearing. 10. Denied. Defendant is without sufficient knowledge to affirm or deny the allegation and therefore same is denied and proof demanded at time of hearing. COUNT I Request for a No-Fault Divorce under 5 3301(c) of the Divorce Code 11. No response required. 12. Admitted. WHEREFORE, Defendant respectfully requests the court to enter a Decree in Divorce pursuant to § 3301.(c) of the Divorce Code. COUNT II Request for Equitable Division, Distribution and Assignment of Marital Property 13. No response required. 14. Admitted. 15. Admitted. WHEREFORE, Defendant prays this Honorable Court to equitably vide, distribute and assign all the parties' marital property. T, Plaintiff/Counter-Defendant is directed to answer the following counterclaim within twenty (20) days, or suffer possible default. COUNTERCLAIM AND NOW comes Barbara S. Zeigler, by and through her attorneys, (Dissinger and Dissinger, and avers as follows: COUNT I Request for Alimony Pendente Lite and Alimony under 3104, 3701, 3702 and 3704 of the Divorce Code I16. The prior paragraphs of this Answer are incorporated herein by reference thereto. 17. Defendant/Counter-Plaintiff is unable to sustain herself during the course of litigation. 18. Defendant/Counter-Plaintiff lacks sufficient property to rovide for her reasonable needs and is unable to sustain herself through appropriate employment. 19. Defendant/Counter-Plaintiff requests the Court to enter an award of alimony pendente lite until final hearing and thereupon to enter an order of alimony in her favor, pursuant to 3104, 3701, 3702 and 3704 of the Divorce Code. COUNT II Request for Counsel Fees, Costs and Expenses Under 3104 and 3502(a) of the Divorce Code ?0. The prior paragraphs of this Answer are incorporated herein by -eference thereto. 1. Defendant/Counter-Plaintiff has employed Mary A. Etter issinger, Esquire, of the law firm of Dissinger and Dissinger to represent her in this matrimonial cause. 22. Defendant/Counter-Plaintiff is unable to pay the necessary counsel fees, costs, and expenses and Plaintiff/Counter-Defendant is more than able to pay them. Reserving the right to apply to the Court for temporary counsel fees, costs and expenses, prior to final hearing, Defendant/ Counter-Plaintiff requests that, after final hearing, the Court order Plaintiff/Counter-Defendant, to pay Defendant/ Counter-Plaintiff's reasonable counsel fees, costs and expenses. WHEREFORE, Defendant/Counter-Plaintiff demands: That Plaintiff/Counter-Defendant's Complaint be dismissed. 1. That an order be entered distributing all of the property, real and personal, as the Court may deem equitable and just, plus costs; 2. That the Court enter an award of alimony pendente lite until final hearing and thereupon to enter an order of alimony in her favor, pursuant to 3104, 3701, 3702 and 3704 of the Divorce Code, and 3. That pursuant to 3104 and 3502(a) of the Divorce Code, the court enter an Order directing Plaintiff/Counter-Defendant to pay Defendant/Counter-Plaintiff's reasonable counsel fees, costs and expenses. Respectfully Submitted: DISSINGER AND DISSINGER ay: .tt? Mary A. Etter Dissinger Attorney for Defendant Supreme Court ID # 27736 28 North 32nd Street Camp Hill, PA 17011 717-975-2840 VERIFICATION I, Barbara S. Zeigler, verify that the statements made in the foregoing Answer and counterclaim 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. 4-2 Barbara S. Ze' er L&I :EVIN M. DANNER, IN THE COURT OF COMMON PLEAS Plaintiff : OF CUMBERLAND COUNTY PENNSYLVANIA VS. : CIVIL ACTION 3ARBARA S. ZEIGLER, NO. 04-724 Defendant IN DIVORCE CERTIFICATE OF :SERVICE I, Mary A. Etter Dissinger, do hereby certify that a copy of the foregoing Answer and Counterclaim has been duly served upon Lee E. Osterling, Esquire, attorney for Plaintiff, by depositing same in the United States Mail, postage prepaid, addressed as follows: Lee E. Osterling, Esquire Lee E. Oesterling & Associates, LLC 42 East Main Street Mechanicsburg, PA 17055 te: 6 I Mary A Etter issinge Attorney for Defendant ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of P nn ylvania XQOriginal order/Notice Co./City/Dirt. of CUMBERLAND O Amended Order/Notice Date of Order/Notice 10/22/04 O Terminate Order/Notice Tribunal/Case Number (See Addendum for case summary) RE: DANKER, KEVIN M. EmployeUWrthholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) HAMPDEN TOWNSHIP 230 S SPORTING HILL RD MECHANICSBURG PA 17050-3059 y5"d /0& d5? pzl- 7JV vc 166-46-2812 Employee/Obligor's Social Security Number 1931101390 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. $ 167.00 per month in current support $ 0. oo per month in past-due support Arrears 12 weeks or greater? Dyes (9) no $ o. oo per month in medical support $ o . o o per month for genetic test costs $ per month in other (specify) for a total of $ 167.00 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: $ 38.54 per weekly pay period. $ 77.08 per biweekly pay period (every two weeks). $ 83 5o per semimonthly pay period (twice a month). $ 167. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER /N ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: O C I rG BY THE CO T: W. Service Type M Form EN-028 OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS O dfi erentefrom the state that?issueo the orSJerpa of this form to your?mployee. If your employee works in a state that is copy must be provi e to your employee even if the box is not checked. 1: We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4. state of the employee's/obligor's principal place of employment with respect to the time per -wages- within You which t you comply with the la the the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 2360501360 EMPLOYEE'S/OBLIGOR'S NAME: DANNER KEVIN M. EMPLOYEE'S CASE IDENTIFIER: 1931101390 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. 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 h8 or she is employed governs. to.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: If you or your employee/obligor have an DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNTtions, 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.childsupportstate. pa us Service Type M Page 2 of 2 OMB No. 09]0-0154 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment DefendanUObligor: DANNER, KEVIN M. PACSES Case Number 850106854 Plaintiff Name BARBARA S. ZEIGLER Docket Attachment Amount 04-724 CIVIL $ 167.00 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 $ o.oo Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ?lf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum OMB No.: 0970-0154 Form EN-028 Worker ID $IATT ? -., r`? - r ; fl -i ?, t -.., f._, 4.. ' __ ] ? C_. _ ..'.? ?- __ ) Cf1 } ._' ?.. J r l •y ?_ P KEVIN M. DANNER, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 2004-724 CIVIL TERM BARBARA S. ZEIGLER, IN DIVORCE Defendant/Petitioner PACSES# 850106854 ORDER OF COURT AND NOW, this 22"d day of October, 2004, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $1,452.29 and Respondent's monthly net income/earning capacity is $1,870.35, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, 5167.00 per month payable bi-weekly as follows; $77.08 for alimony pendente lite and $0.00 on arrears. First payment due next pay date. Arrears set at $167.00 as of October 22, 2004. The effective date of the order is October 22, 2004. Respondent is to maintain medical insurance coverage on his spouse. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C..S'.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Barbara S. Zeigler. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. Unreimbursed medical expenses that exceed $250.00 annually are to be paid as follows: 0% by Respondent and 100% by Petitioner. The Petitioner is responsible to pay the first $250.00 annually in unreimbursed medical expenses. Respondent to provide medical insurance coverage. Within thirty (30) days after the entry of this Order, the Respondnet shall submit: to Petitioner written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at minimum, of. 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and E) five copies of any claim forms. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. DRO: R. J. Shadday BY THE COURT, Mailed copies on Petitioner 10-22-04: < Respondent Lee Oesterling, Esquire / Mary Dissi Dissinger, Esquire ? `f'e?/??? Kevin A. Hess J. _, -? N r7 cro 1 n C J ?.j ,? _.,? ? _,.. ca ?: `ri co ca T ??T -,m ?Q ?c? !:; ?? `'. c? ?.n t `n _?; 2 i l? - Jt? vs Case No. D 7 7q 1 Statement of Intention to Proceed To the Court: 11 1, intends to proceed with the above captioned matter. Print Name _°.L36ign Name G` Date: 01- C)q Attorney for Explanatory Comment The Supreme Court of Pennsylvania has promulgated new Rule of Civil Procedure 230.2 governing the termination of inactive cases and amended Rule of Judicial Administration 1901. Two aspects of the recommendation merit comment. I. Rule of civil Procedure New Rule of Civil Procedure 230.2 has been promulgated to govern the termination of inactive cases within the scope of the Pennsylvania Rules of Civil Procedure. The termination of these cases for inactivity was previously governed by Rule of Judicial Administration 1901 and local rules promulgated pursuant to it. New Rule 230.2 is tailored to the needs of civil actions. It provides a complete procedure and a uniform statewide practice, preempting local rules. This rule was promulgated in response to the decision of the Supreme Court in Shop v. Eagle, 551 Pa. 360,710 A.2d 1104 (1998) in which the court held that "prejudice to the defendant as a result of delay in prosecution is required before a case may be dismissed pursuant to local rules implementing Rule of Judicial Administration 1901." Rule of Judicial Administration 1901(b) has been amended to accommodate the new rule of civil procedure. The general policy of the prompt disposition of matters set forth in subdivision (a) of that rule continues to be applicable. II Inactive Cases The purpose of Rule 230.2 is to eliminate inactive cases from the judicial system. The process is initiated by the court. After giving notice of intent to terminate an action for inactivity, the course of the procedure is with the parties. If the parties do not wish to pursue the case, they will take no action and "the Prothonotary shall enter an order as of course terminating the matter with prejudice for failure to prosecute." If a party wishes to pursue the matter, he or she will file a notice of intention to proceed and the action shall continue. a. Where the action has been terminated If the action is terminated when a party believes that it should not have been terminated, that party may proceed under Rule230(d) for relief from the order of termination. An example of such an occurrence might be the termination of a viable action when the aggrieved party did not receive the notice of intent to terminate and thus did not timely file the notice of intention to proceed. The timing of the filing of the petition to reinstate the action is important. If the petition is filed within thirty days of the entry of the order of termination on the docket, subdivision (d)(2) provides that the court must grant the petition and reinstate the action. If the petition is filed later than the thirty-day period, subdivision (d)(3) requires that the plaintiff must make a show in to the court that the petition was promptly filed and that there is a reasonable explanation or legitimate excuse both for the failure to file the notice of intention to proceed prior to the entry of the order of termination on the docket and for the failure to file the petition within the thirty-day period under subdivision (d)(2). B. Where the action has not been terminated An action which has not been terminated but which continues upon the filing of a notice of intention to proceed may have been the subject of inordinate delay. In such an instance, the aggrieved party may pursue the remedy of a common law non pros which exits independently of termination under Rule 230.2. c'y ^? W' C) ` ' rj ° -?r _ a KEVIN M. DANNER, Plaintiff/Respondent VS. BARBARA S. ZEIGLER, Defendant/Petitioner : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : CIVIL ACTION : NO. 04-724 : IN DIVORCE PETITION TO INCREASE ALIMONY PENDENTE LITE AND NOW Comes Barbara S. Zeigler, Defendant/ Petitioner by and through her Attorneys Dissinger & Dissinger and requests the Court to increase alimony pendente lite and in support of this Petition avers as follows: 1. Petitioner's rate of pay has been reduced over the years such that she earns far less now than she did at the time the original alimony pendente lite order was entered. 2. It is believed that Plaintiff /Respondent, Kevin M. Danner, has received increases of approximately 10% per year in his hourly rate of pay since the entry of the support order and therefore he earns more than he did at the time the alimony pendente lite order was entered. 3. Petitioner is unable to sustain herself on the current amount of income and the $77.08 that Plaintiff/Respondent pays her bi- weekly pursuant to the current alimony pendente lite order which is attached hereto. Respectfully Submitted: DISSINGER AND DISSINGER By'' Mary A. Et,er Dissinger Attorney for Defendant /Petitioner Supreme Court I.D. #27736 28 North Thirty-Second Street Camp Hill, PA 17011 (717) 975-2840 VERIFICATION I, Barbara S. Zeigler, verify that the statements made in the foregoing document are true and correct. I understand that false jstatements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. arbara S. Zeig-lep-, /f)efAdant Petitioner KEVIN M. DANNER, Plaintiff/Respondent VS. BARBARA S. ZEIGLER, Defendant/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 2004-724 CIVIL TERM IN DIVORCE PACSES# 850106854 ORDER OF COURT AND NOW, this 22"d day of October, 2004, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $1,452.29 and Respondent's monthly net income/earning capacity is $1,870.35, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $167.00 per month payable bi-weekly as follows; $77.08 for alimony pendente lite and $0.00 on arrears. First payment due next pay date. Arrears set at $167.00 as of October 22, 2004. The effective date of the order is October 22, 2004. Respondent is to maintain medical insurance coverage on his spouse. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Barbara S. Zeigler. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. EXHIBIT A y Unreimbursed medical expenses that exceed $250.00 annually are to be paid as follows: 0% by Respondent and 100% by Petitioner. The Petitioner is responsible to pay the first $250.00 annually in unreimbursed medical expenses. Respondent to provide medical insurance coverage. Within thirty (30) days after the entry of this Order, the Respondnet shall submit to Petitioner written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at minimum, of. 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. DRO: R.1. Shadday Mailed copies on Petitioner 10-22-04: < Respondent Lee Oesterling, Esquire Mary Dissinger, Esquire BY THE COURT, Kevin A. Hess J. KEVIN M. DANNER, Plaintiff/Respondent VS. BARBARA S. ZEIGLER, Defendant/Petitioner : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : CIVIL ACTION : NO. 04-724 : IN DIVORCE CERTIFICATE OF SERVICE I hereby certify that on the date set forth below I served !a true and correct copy of the foregoing document upon the following attorneys, by First Class United States mail addressed as follows: Lee E. Oesterling, Esq. 42 East Main Street Mechanicsburg, PA 17055 AND Diane M. Dils, Esq. 1400 North Second Street Harrisburg, PA 17102 Date L ?. Mary A. Etter Dissinge Attorney at Law FILED U M OF THE PPnrr,NOTA€?Y 2009 APR - ! AM 10: 5 5 CLUK tXDUNTY PENNSYLVANIA CoPe1 Ta ?, v 6 KEVIN M. DANNER, THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 04-724 CIVIL TERM BARBARA S. ZEIGLER, IN DIVORCE Defendant/Petitioner : PACSES CASE NO: 850106854 ORDER OF COURT AND NOW, this 2nd day of April, 2009, a petition has been filed against you, Kevin M. Danner, 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 April 23, 2009 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 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 Mary A. Etter Dissinger, Esq. Lee Oesterling, Esq. Date of Order: April 2, 2009 ' R. J. S dday, onference Officer YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPR ENT 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 iH??ICE OF rtqE PP O', ,, NOTARY 2009 APR -2 PM 3, 10 NiiYLVA`H,b. KEVIN M. DANNER, Plaintiff/Respondent VS. BARBARA S. ZEIGLER, Defendant/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 04-724 CIVIL TERM IN DIVORCE PACSES CASE: 850106854 ORDER OF COURT AND NOW to wit, this 23rd day of April, 2009, it is hereby Ordered that the Order for Alimony Pendente Lite of October 22, 2004 remains in its entirety. This Order considers the length of the marriage, the length of separation and the date of the current order. The Petitioner's request for an increase in Alimony Pendente Lite is denied, without prejudice. This Order shall become final twenty (20) days after the mailing of the notice of the entry of the order to the parties unless either parry files a written demand with the Domestic Relations Section for a hearing de novo before the Court. BY THE COURT: * X4 Kev A. Hess, J. DRO: R.J. Shadday xc: Petitioner Respondent Diane M. Dils, Esq. Mary A. Etter Dissinger, Esq. Form OE-001 Service Type: M Worker: 21005 'OF THE € l'-? ? OT Y 2009 APR 23 PM : 0 r, uiYtCJ PENIN?i «.. - ?:.,i,A? TY _ { KEVIN M. DANNER, Plaintiff/Respondent VS. BARBARA S. ZEIGLER, Defendant/Petitioner : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA CIVIL ACTION NO. 04-724 IN DIVORCE NOTICE OF APPEAL AND REQUEST FOR HEARING DE NOVO AND NOW Comes Barbara S. Zeigler, Defendant /Petitioner by and through her Attorneys Dissinger & Dissinger and appeals from the order entered in this matter on April 23, 2009, and requests a hearing de novo. Respectfully Submitted: DISSINGER AND DISSINGER By Mary A. Et er issinger Attorney for Defendant /Petitioner Supreme Court I.D. #27736 28 North Thirty-Second Street Camp Hill, PA 17011 (717) 975-2840 . - - K KEVIN M. DANNER, Plaintiff/Respondent VS. BARBARA S. ZEIGLER, Defendant/Petitioner : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : CIVIL ACTION : NO. 04-724 : IN DIVORCE CERTIFICATE OF SERVICE I hereby certify that on the date set forth below I served a true and correct copy of the foregoing document upon the following attorneys, by First Class United States mail addressed as follows: Diane M. Dils, Esq. 1400 North Second Street Harrisburg, PA 17102 Dater ft Mary A. Etter Dissinger Attorney at Law 0 .. FILED-OFFICE OF THE PROTP MARY 2009 MAY I I AM I I : 33 ,j IN T, Y PENN'SYL ^:?' IA vy -/? L a In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION BARBARA S. ZEIGLER ) Docket Number 04-724 CIVIL Plaintiff ) VS. ) PACSES Case Number 850106854 KEVIN M. DANNER ) Defendant ) Other State ID Number ORDER OF COURT You, BARBARA S. ZEIGLER plaintiff/defendant of 129 LINDA DR, MECHANICSBURG, PA. 17050-1517-29 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 JUNE 9, 2009 at 1 0: 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: Form CM-509 Rev. 1 Service Type M Worker ID 21302 ZEIGLER v• DANKER PACSES Case Number: 850106854 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: ` 0 -0 100, 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. Page 2 of 2 Form CM-509 Rev. Service Type M Worker ID 21302 FLED-<; Or, TH?" 2009 Mil A Y 13 PI 3: i '1 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION BARBARA S. ZEIGLER ) Docket Number 04-724 CIVIL Plaintiff ) VS. ) PACSES Case Number 850106854 KEVIN M. DANNER ) Defendant ) Other State ID Number ORDER OF COURT You, KEVIN M. DANNER plaintiff/defendant of PO BOX 126, ENOLA, PA. 17025-0126-26 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 JUNE 9, 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. I Worker ID 21302 ZEIGLER v. DANNER PACSES Case Number: 850106854 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: 54x-ol 101 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. Page 2 of 2 Form CM-509 Rev. 1 Service Type M Worker ID 21302 ?f fir' r?",.•-,.::. ?:f-1,. ;;^y?' d ??? 2609 HAY 13 Pik 3: ; 1 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION BARBARA S. ZEIGLER ) Docket Number 04-724 CIVIL Plaintiff ) VS. ) PACSES Case Number 850106854 KEVIN M. DANNER ) Defendant ) Other State ID Number ORDER OF COURT - RESCHEDULE A HEARING You, BARBARA S. ZEIGLER 129 LINDA DR, MECHANICSBURG, PA. 17050-1517-29 are ordered to appear at DOMESTIC RELATIONS HEARING RM of C/O HEARING ROOM, DOMESTIC RELATIONS OFFICE, 13 NORTH HANOVER STREET, CARLISLE, PA. 17013 on the 17TH DAY OF JUNE, 2009 the prior hearing date of JUNE 9, 2 0 0 9 at 8: 3 OAM for a hearing. This date replaces 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-514 Rev. 1 Worker ID 21302 W 1%. ZEIGLER V. DANNER PACSES Case Number: 850106854 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 C URT: Date of Order: 5 )'? -U!) 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) 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. Page 2 of 2 Form CM-514 Rev. 1 Service Type M Worker ID 21302 4 TIC ' r?F J 14-11, In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION BARBARA S. ZEIGLER ) Docket Number 04-724 CIVIL Plaintiff ) VS. ) PACSES Case Number 850106854 KEVIN M. DANNER ) Defendant ) Other State ID Number ORDER OF COURT - RESCHEDULE A HEARING You, KEVIN M. DANNER of PO BOX 126, ENOLA, PA. 17025-0126-26 are ordered to appear at DOMESTIC RELATIONS HEARING RM CIO HEARING ROOM, DOMESTIC RELATIONS OFFICE, 13 NORTH HANOVER STREET, CARLISLE, PA. 17013 on the 17TH DAY OF JUNE, 2009 at 8:30AM for a hearing. This date replaces the prior hearing date of JUNE 9, 2009 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-514 Rev. 1 Worker ID 21302 W`, x ZEIGLER V. DANNER PACSES Case Number: 850106854 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- I ? _u`1 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) 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. Page 2 of 2 Form CM-514 Rev. 1 Service Type M Worker ID 21302 2009 MAY 19 Phi 3. 0 3 +4- t y KEVIN M. DANNER, : IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent : CUMBERLAND COUNTY, PENNSYLVANIA V. : DOMESTIC RELATIONS SECTION BARBARA S. ZEIGLER, : PACSES NO. 850106854 Defendant/Petitioner : DOCKET NO. 04-724 CIVIL INTERIM ORDER OF COURT AND NOW, this 1 st day of July, 2009, upon consideration of the Support Master's Report and Recommendation, a copy of which is attached hereto as Exhibit "A", it is ordered and decreed as follows: A. The Respondent shall pay to the Pennsylvania State Collection and Disbursement Unit as alimony pendente lite the sum of $400.00 per month. B. The Respondent shall continue to provide health insurance coverage for the benefit of the Wife as is available to him through employment or other group coverage at a reasonable cost. C. The effective date of this order is April 1, 2009. IMPORTANT LEGAL NOTICE PARTIES MUST WITHIN SEVEN DAYS INFORM THE DOMESTIC RELATIONS SECTION AND THE OTHER PARTIES, IN WRITING, OF ANY MATERIAL CHANGE IN CIRCUMSTANCES RELEVANT TO THE LEVEL OF SUPPORT OR THE ADMINISTRATION OF THE SUPPORT ORDER, INCLUDING, BUT NOT LIMITED TO, LOSS OR CHANGE OF INCOME OR EMPLOYMENT AND CHANGE OF PERSONAL ADDRESS OR CHANGE OF ADDRESS OF ANY CHILD RECEIVING SUPPORT. A PARTY WHO WILLFULLY FAILS TO REPORT A MATERIAL CHANGE IN CIRCUMSTANCES MAY BE ADJUDGED IN CONTEMPT OF COURT, AND MAY BE FINED OR IMPRISONED. PENNSYLVANIA LAW PROVIDES THAT ALL SUPPORT ORDERS SHALL BE REVIEWED AT LEAST ONCE EVERY THREE (3) YEARS IF SUCH REVIEW IS REQUESTED BY ONE OF THE PARTIES. IF YOU WISH TO REQUEST A REVIEW AND ADJUSTMENT OF YOUR ORDER, YOU MUST DO THE FOLLOWING: CALL YOUR ATTORNEY. AN UNREPRESENTED PERSON WHO WANTS TO MODIFY (ADJUST) A SUPPORT ORDER SHOULD CONTACT THE DOMESTIC RELATIONS SECTION. ALL CHARGING ORDERS FOR SPOUSAL SUPPORT AND ALIMONY PENDENTE LITE, INCLUDING UNALLOCATED ORDERS FOR CHILD AND SPOUSAL SUPPORT OR CHILD SUPPORT AND ALIMONY PENDENTE LITE, SHALL TERMINATE UPON DEATH OF THE PAYEE. A MANDATORY INCOME ATTACHMENT WILL ISSUE UNLESS THE DEFENDANT IS NOT IN ARREARS IN PAYMENT IN AN AMOUNT EQUAL TO OR GREATER THAN ONE MONTH'S SUPPORT OBLIGATION AND (1) THE COURT FINDS THAT THERE IS GOOD CAUSE NOT TO REQUIRE IMMEDIATE INCOME WITHHOLDING; OR (2) A WRITTEN AGREEMENT IS REACHED BETWEEN THE PARTIES WHICH PROVIDES FOR AN ALTERNATE ARRANGEMENT. UNPAID ARREARAGE BALANCES MAY BE REPORTED TO CREDIT AGENCIES. ON AND AFTER THE DATE IT IS DUE, EACH UNPAID SUPPORT PAYMENT SHALL CONSTITUTE, BY OPERATION OF LAW, A JUDGMENT AGAINST YOU, AS WELL AS A LIEN AGAINST REAL PROPERTY. IT IS FURTHER ORDERED THAT, UPON PAYOR'S FAILURE TO COMPLY WITH THIS ORDER, PAYOR MAY BE ARRESTED AND BROUGHT BEFORE THE COURT FOR A CONTEMPT HEARING; PAYOR'S WAGES, SALARY, COMMISSIONS, AND/OR INCOME MAY BE ATTACHED IN ACCORDANCE WITH LAW. PAYOR IS RESPONSIBLE FOR COURT COSTS AND FEES. The parties are hereby advised that they may file written exceptions to the Support Master's Report and Recommendation within twenty (20) days of this order. Exceptions shall conform with the requirements of Rule 1910.12(f), Pa. R.C.P. If written exceptions are filed by any party, the other party may file exceptions within twenty (20) days of the date of service of the original exceptions. If no exceptions are filed within twenty (20) days of this interim order, this order shall then constitute a final order. By the Court, Kevin A. Hess, J. Cc: Barbara S. Zeigler Kevin M. Danner Mary A. Dissinger, Esquire For the Defendant/Petitioner Diane M. Dils, Esquire For the Plaintiff/Respondent DRO KEVIN M. DANNER, : IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent : CUMBERLAND COUNTY, PENNSYLVANIA V. : DOMESTIC RELATIONS SECTION BARBARA S. ZEIGLER, : PACSES NO. 850106854 Defendant/Petitioner : DOCKET NO. 04-724 CIVIL SUPPORT MASTER'S REPORT AND RECOMMENDATION Following a hearing held before the undersigned Support Master on June 17, 2009, the following report and recommendation are made: FINDINGS OF FACT 1. The Petitioner is Barbara S. Zeigler, who resides at 129 Linda Drive, Mechanicsburg, Pennsylvania; she will hereafter be referred to as "the Wife." 2. The Respondent is Kevin M. Danner, who resides at 50 Bonnybrook Road, Carlisle, Pennsylvania, and whose mailing address is P.O. Box 126, Enola, Pennsylvania 17025; he will hereafter be referred to as "the Husband." 3. The parties were married on May 14, 1998. 4. The parties separated on or about February 3, 2004 when the Defendant moved from the marital residence. 5. On or about February 18, 2004 the Husband filed a complaint for divorce. 6. The Wife filed a claim for alimony pendente lite in the divorce action. 7. On October 22, 2004 an order was entered obligating the Husband to pay $167.00 per month as alimony pendente lite. 8. Neither party made any significant efforts to move the economic claims in the divorce action forward until the Husband retained new counsel in early 2009. 9. On April 1, 2009 the Wife filed a petition for modification of her award of alimony pendente lite. 10. In 2004 the Wife was employed by the Pennsylvania Department of Transportation earning approximately $10.62 per hour and had a net monthly income for support purposes of $1,452.00.1 ' See order entered October 22, 2004. EXHIBIT "A" 11. The Wife voluntarily left her position with PennDOT for medical reasons. 12. The Wife currently is employed by Carolina Logistic Services where she earns $8.82 per hour. 13. The Wife had gross earnings in 2008 of $16,963.00. 14. The Wife retired from the Commonwealth of Pennsylvania and in 2008 received pension benefits totaling $3,369.00. 15. The Wife's tax filing status is married/separate. 16. The Husband is employed by Hampden Township. 17. When the prior order was entered the Husband had net monthly income of $1,870.00.2 18. The Husband now has an hourly rate of pay of $17.40 for a 40 hour work week. 19. The Husband's tax filing status is married/separate. 20. The Wife continues to reside in the marital residence which is not encumbered by a mortgage. 21. The Wife pays annual real estate taxes on the residence of approximately $1,300.00. 22. The Husband provides health insurance coverage on the Wife through his employment at no monetary cost. DISCUSSION A party seeking to modify a support order has the burden of demonstrating that a material and substantial change of circumstances has occurred since the entry of the order to justify a modification. Soncini v. Soncini, 612 A.2d 998 (Pa. Super. 1992). An award of alimony pendente lite may be modified or vacated by a change in circumstances. Litmans v. Litmans, 673 A.2d 382 (Pa. Super. 1996). Although the Wife has changed employment and is now employed at a lower hourly rate of pay than she was in 2004, her gross earnings combined with her pension from her prior employment with the Commonwealth do not result in a significant change in her income. With gross earnings in 2008 of $16,963.00 and income from her pension of $3,369.00, her average gross monthly income is $1,694.00. Filing her federal income tax return as married/separate results in net monthly income for support purposes of $1,435.00.3 z See order entered October 22, 2004. s See Exhibit "A" for the tax deductions from gross income. 2 The Husband continues to be employed by Hampden Township. His hourly rate of pay has increased from 2004 to $17.40 per hour. This equates to a gross weekly income of $696.00, or $3,016.00 per month. Filing his federal income tax return as married/separate, the Husband has net monthly income for support purposes of $2,435.00.4 This is a significant change of circumstance since the entry of the order in 2004. With the net incomes as set forth above, the Husband's obligation for alimony pendente lite under the support guidelines is $400.00 per months The Husband has argued that his obligation to pay alimony pendente lite should be terminated, not increased. The basis for the argument was that the parties resided together for five years and nine months prior to the separation, and he has been paying alimony pendente lite for four years and eight months. He points to Pa. R.C.P. 1910.16-5(c) which provides that "[i]n determining the duration of an award for spousal support or alimony pendente lite, the trier of fact shall consider the period of time during which the parties lived together from the date of the marriage to the date of final separation." The Explanatory Comment to this rule states as follows: The primary purpose of these provisions is to prevent the unfairness that arises in a short term marriage when the obligor is required to pay support over a substantially longer period of time than the parties were married, and there is little or no opportunity for credit for these payments at the time of equitable distribution. In the present case, however, the Husband has not been paying alimony pendente lite for a period of time longer than the parties resided together after marriage. Secondly, there is significant marital property subject to equitable distribution in the form of the marital residence and the Husband's pension. In Belsky v. Belsky, 175 A.2d 348 (Pa. Super. 1962) the court held that an order for alimony pendente lite is intended to cover only the period of time that the case may with due diligence be prosecuted to a conclusion. In the present case neither party exercised due diligence for a period of five years following the filing of the complaint for divorce. In the opinion of this Master it would be improper to now punish the Wife when she has been no less diligent than her Husband in bringing the action to a conclusion. RECOMMENDATION A. The Respondent shall pay to the Pennsylvania State Collection and Disbursement Unit as alimony pendente lite the sum of $400.00 per month. B. The Respondent shall continue to provide health insurance coverage for the benefit of the Wife as is available to him through employment or other group coverage at a reasonable cost. a See Exhibit "A" for the tax deductions from gross income. 5 See Exhibit "B" for the calculation. C. The effective date of this order is April 1, 2009. Date N", CL Michael R. Rundle Support Master In the Court of Common Pleas of Cumberland County, Pennsylvania Tax Detail Report Plaintiff Name: Barbara S Zeigler Defendant Name: Kevin M. Danner Docket Number: 04-724 Civil PACSES Case Number: 850106854 Other State ID Number: Tax Year: Current: 2009 Defendant Plaintiff 1. Tax Method 1040 ES 1040 ES 2. Fling Status Married Filing Separately Married Filing Separately 3. Who Claims the Exemptions Obli gee 4. Number of Exemptions 1 1 5. Monthly Taxable Income $3,016.00 $1,694.40 6. Deductions Method 7. Deduction Amount $475.00 $475.00 8. Exemption Amount $291.67 $291.67 9. Income MINUS Deductions and Exemptions $2,249.33 $927.73 10. Tax on Income $224.93 $92.77 11. Child Tax Credit - - 12. Manual Adjustments to Taxes - - 13. Federal Income Taxes $224.93 $92.77 13 a. Earned Income Credit - - 14. State Income Taxes $95.31 $44.67 15. FICA Payments $230.72 $108.14 16. City Where Taxes Apply 17. Local Income Taxes $30.16 $14.14 TOTAL Taxes $581.12 $259.72 SupportCak 2009 EXHIBIT "A" In the Court of Common Pleas of Cumberland County, Pennsylvania Spousal Support Calculation Rule 1910.16 (PACSES FORMAT) Plaintiff Name: Barbara S Zeigler Defendant Name: Kevin M. Danner Docket Number: 04-724 Civil PACSES Case Number: 850106854 Other State ID Number: 1.Obligor's Monthly Net Income $2,434.88 2. Less All Other Support - 3. Less Obligee's Monthly Net Income $1,434.68 4. Difference $1,000.20 5. Less Child Support Obligation for Current Case - 6. Difference $1,000.20 7. Multiply b 30% or 40% 40.00% 8. Income Available for Spousal Support $400.08 9. Adjustment for Other Expenses - 10. AMOUNT OF MONTHLY SPOUSAL SUPPORT OR APL $400.08 Prepared b : mrr Date: 6/19/2009 SupportCak 2009 EXHIBIT "B" nLf u)-IjFlr!CE OF THE pRl7! H` NlOTAIQY 2009 JU -2 PP 3.22 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania 04"-IN C1\A OOriginal Order/Notice Co./City/Dist. of CUMBERLAND g50k0k0g 5LA OAmended Order/Notice Date of Order/Notice 07/01/09 OTerminate Order/Notice Case Number (See Addendum for case summary) QOne-Time Lump Sum/Notice RE: DANNER, KEVIN M. Employer/Withholder's Federal [IN Number Employee/Obligor's Name (Last, First, MI) 166-46-2812 Employee/Obligor's Social Security Number HAMPDEN TOWNSHIP 1931101390 230 S SPORTING HILL RD Employee/Obligor's Case Identifier MECHANICSBURG PA 17050-3212 (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current child support $ 0.00 per month in past-due child support Arrears 12 weeks or greater? ayes ® no $ 0.00 per month in current medical support $ 0.00 per month in past-due medical support $ 400.00 per month in current spousal support $ o. oo per month in past-due spousal support $ 0.00 per month for genetic test costs $ 0.00 per month in other (specify) $ one-time lump sum payment for a total of $ 400.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 92.5% per weekly pay period. $ 200.00 per semimonthly pay period (twice a month) $ 184.102 per biweekly pay period (every two weeks) $ 400.00 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 M VV THE D ENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obl? 's ale /dierOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MA BY THE COURT: JUL 0 6 2009 -177 ' Form EN-028 Rev.5 Service Type M OMB No, 0970.0154 Worker I D $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS El If heck you are required to provide a opy of this form to your mployee. If yoUr employee works in a state tha is di ferent rom the state that issued this or?er, a copy must be provi?ed to your employee even if the box is not cheCKed. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* 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. 2360501360 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : (] THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME:DANNER, KEVIN M. EMPLOYEE'S CASE IDENTIFIER: 1931101390 LAST KNOWN HOME ADDRESS: DATE OF SEPARATION: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 1 1. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 CARLISLE PA 17013 by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: DANNER, KEVIN M. PACSES Case Number 850106854 Plaintiff Name PACSES Case Number BARBARA S. ZEIGLER Plaintiff Name Docket Attachment Amount 04-724 CIVIL $ 400.00 Docket Attachment Amount Child(ren)'s Name(s): DOB $ 0.00 Child(ren)'s Name(s): PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Service Type M Addendum Form EN-028 Rev.5 OMB No.: 0970-0154 Worker ID $IATT FILET?-t;:1' nr I? y\r ? I''l? r y? ?? r''_).Ih 2009 JU -6 Pli 3: ? 4 I KEVIN M. DANNER, : IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent : CUMBERLAND COUNTY, PENNSYLVANIA V. : DOMESTIC RELATIONS SECTION BARBARA S. ZEIGLER, PACSES NO. 850106854 Defendant/Petitioner DOCKET NO. 04-724 CIVIL INDEX OF EXHIBITS Petitioner's 1 - Earnings statements Petitioner's 2 - Earning statement from Commonwealth Petitioner's 3 - 2008 tax return Petitioner's 4 -Social security summary Petitioner's 5 - Respondent's earnings statement Petitioner's 6 - Respondent's 2008 tax return Petitioner's 7 - Respondent's W-2's Petitioner's 8 - Respondent's 2003 earnings statement Respondent's 1 - Income and expense statement ::::::::::::;:.:.:;;::::::>::::::::::::::;;: ::.::::.::.::::.:::::...::: Earnin s Statement ? CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Period Beginning: 121`2112008 Period Ending: 12/27/2008 Pay Date: 01/02/2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Social Security Number: XXX-XX-0201 Earninue rate tours this partod year to dat• Regular Eamgs 8.8200 16.00 141 .12 141 .12 Other Benefits and Holiday Pay 8.8200 8.00 70.56 70.56 information this period total to dae• "??' :' ?1?b `w" '` 211 .68 Available Pto 0.00 y ' "' ' ' ' Float Ht Bal 8.00 Deductions Statuto __ ._ ._ _, _Federal- lt1 ome. Tax -15.83. Social Security Tax -12.79 Medicare Tax -2.99 PA State Income Tax -6.33 Silver Sprin Income Tax -4.12 PA SUI/SDI Tax -0.13 Other Dental Ins -5.47* Occ Priv Tax -1 .00 Primary Chkng -163.0121 15,.83.... -- 12.79 2.99 6.33 4.12 0.13 5.47 1.00 163.02 • Excluded from federal taxable wages Your federal taxable wages this period are $206.21 i a Q a °a N W{ al C C? w? - r eaooonov,rm _-. • CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 BARBARA S ZEIGLER Advice number: Pay date: ount number acc 0041846759 PETITION TR'S EXHIBI 00000010506 01 /02/2009 2313 8224 $163.02 NON-NEGOTIABLE 'rt!= 7illfaL`1.1t-yr r i n r J+ r i r rv-;: rl.viosni any-.v .. . J:1A11?P'1'frtR1i5S'?'?Pl':.S7Jrb..J?.....Il;, I=rl??;._idr':.,i„ tr:_ : ri? r11 J ::.1T :1i>! Ai•l . 'C CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA. N/A Earnings Statement ?> > Period Beginning: 12/28/2008 Period Ending: 01/03/2009 Pay Date: 01/09/2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Social Security Number: XXX-XX-0201 Eaminvis rata hours this period year to date Safety Bonus 143.97 143.97 Other Benefits and Regular Eamgs 317.52 Information this period total to date Holiday Pay 141.12 Available Pto 56,00 ..,;?:• >.:,,::'«x:•:?v::•.: 602.61 Float HI Bal 8.00 Deductions SLn.?.,.?-- __. Federal Income Tax -35.99 72.94 Social Security Tax -8.92 36.68 Medicare Tax -2.09 8.58 PA State Income Tax -4.42 18.16 Silver Sprin Income Tax -2.88 11.83 PA SUI/SDI Tax -0.08 0.36 Other Primary Chkng -89.59 441.12 Dental Ins 10.94 Occ Priv Tax 2.00 Your federal taxable wages this period are $143:97 t CMAM .. CAt QI{NA LOGISTIC SERVICES 8601 'piLGRIM COURT WINSTON-SALEM, . NC 27106 BARBARA S ZEIGLER VZO EL In N? ArMOs numb4t: Pay datt3' -9 account number 0041846759 % 000W020M 01/09,2009 2313 8224 $89.59 NON-NEGOTIABLE M - r r.ri wwzsdrr u.M.dAnl , :rr1:111:.: rh rtR.• rt: cu• ^, : rac-._s:. CIO? J .17 APL:.1Pla,l:9' •fJ 11.1ZIM, 4'/rl9M r,riar?i tjc4'rii5 EtIJrift uzhi31'IT. 'a Earnings Statement ?> > CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT ININSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal. 0 PA: N/A Social Security Number: XXX-XX-0201 Eamings rate hours this period Regular Eamgs 8.8200 20.00 176.40 Holiday Pay 5,8200 8.00 70.56 ' 9 W.". Deductions Statuto Federal Income Tax -21.12 Social Security Tax -14.97 Medicare Tax -3.50 PA State Income Tax -7.41 Silver Sprin Income Tax -4.83 PA SUI/SDI Tax -0.15 Other Dental Ins -5.47* Occ Priv Tax -1.00 Primary Chkng -188.51 Period Beginning: 12/28/2008 Period Ending: 01 103/2009 Pay Date: 01/09/2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 year to date to Other Benefits and 317.52 12 Information this period total to date 458.64 Available Pto 56.00 Float HI Bal 8.00 36.95 27.76 6.49 13.74 8.95 0.28 10.94 2.00 351.53 * Excluded from federal taxable wages Your federal taxable wages this period are $241.49 CARC?LINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 BARBARA S ZEIGLER 06 R P N4 AcIvic0 number: Pay datit: ik account number 0041846759 4 ? N s. E OQOOt)Q20879 , U1f09/?C009. , ' 2313 8224 $188.51 NON-NEGOTIABLE c i c 5c 2 it .nx?xrr,:rintr??V:cielrialMRPkrs.iil7 APb6 RJ'fJi•J a.: Jl.:'f:3rU7/6 63e t."tAI :, c;T i ,, k1.JL! ?1C SSA/s:IC153L"3«isll !6!?'Pf Wil-OA`l'1r1$,3;4!!!J'!r1 :31N F11 11f131Y id' CAROLINA LOGISTIC SERVICES 2801 PILGRIM COURT tMNSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Social Securer Number. )=-XC-0201 Earnings rata hours this period Regular Eamgs 8.8200 36.00 317.52 Pto Taken 8.8200 4.00 35.28 Holiday Pay Safety Bonus Ded"uc?ons Earnings Statement e Period Beginning: 01/04/2009 Period Ending: 01110,2009 Pay Date: 01/16,2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 year to data 635.04 Other Benefits and 35.28 Information this period total to data 141 12 Available Pto X52 , 00 143.97 Float HI Bat 8.00 955.41 Federal Income Tax -37.00 Social Security Tax -21.54 Medicare Tax -5.04 PA State Income Tax -10.66 Silver Sprin Income Tax -6.95 PA SUI/SDI Tax -0.21 Other Dental Ins -5.47* Occ Priv Tax -1.00 Primary Chkng -264.93 109.94 58.22 13.62 28.82 18.78 0.57 16.41 3.00 706.05 * Excluded from federal taxable wages Your federal taxable wages this period are $347.33 a 8 a n a t a t a C LL a LL S a LLQ F O?ODAOI,YO -- , :AF160NA. tQQI8Tf0 4EflWCES VQ1 P10RIM ' COUf? , VINe0N-SALEM., NC:27106 Advice number: Pay date. 0041846759 s '$ OQ?Ogk1b3. _01/1'6,2009 ... 2313 8224 $264.93 NON-NEGOTIABLE 19 rija!1i11G1 n.u. vJ:uwatrf S,t4 Tri= A-14 ra rJUL D Al Afl :lt ALS TU ` IE'P! WHVI UHEr;it]tJU'1F1 9flE)U iUSMAWL 0 CAROLINA LOGISTIC SERVICES 2801 PILGRIM COURT WINSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Social Security Number. XXX-XX-0201 Earnings rate hour's this period Regular Eamgs 8.8200 40.00 352.80 Holiday Pay Pto Taken Safety Bonus Deductions Stntut Federal Income Tax -37.00 Social Security Tax -21.53 Medicare Tax -5.03 PA State Income Tax -10.66 Silver Sprin Income Tax -6.95 PA SUI/SDI Tax -0.21 Other Dental Ins -5.47* Ooc Priv Tax -1.00 Primary Chkng -264.95 Earnings Statement Period Beginning: 01/11/2009 Period Ending: 01/17/2009 Pay Date: 01 /23x2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 year to dots Other (Benefits and 987.84 Information this period toot to dab 141.12 Available Pto 52.00 35.28 Float HI Be] 8.00 143.97 1,308.21 146.94 79.75 18.65 39.48 25.73 0.78 21.88 4.00 971.00 * Excluded from federal taxable wages Your federal taxable wages this period are $347.33 T f a ii I 0 c a 8 LL a LL a a LL F- 11 r CAA00NA L001STIC SERVICES '.2601 PILGRIM' COURT . WINSTON-SALEM,. NC 27106 9 ZEIGLER 140 Advice numb6r. Pay date: # account number 0041846759 01123/2009„ 2313 8224 $264.95 NON-NEGOTIABLE asp rKtl??o?tllatllPit'v:.elofMlflR?1lGMeict37h??yfi?:iiiJJ?fPJ.A11:._.?,"J?'.SE_?iFIb6'.'alet'+•RilrNzt?i?F3e?.?iis cal a .7ffr:.YL`l';?iP,l'?•iA"ae.',?.Jflh!A'Y'fEt??`f:?SFI?L`;4JC1Pslos?f?l?311:J?Ai,?•13dt?P:l?S'sld? CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Earnings Statement ?> > Period Beginning: 01 /18x2009 Period Ending: 01/24/2009 Pay Date: 01 /30/2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Social Security Number: XXX-XX-0201 Earnings rate hours this period Regular Earngs 8.8200 28.50 251.37 Pto Taken 8.8200 11.50 101.43 Holiday Pay Safety Bonus Deductions Statuto Federal Income Tax -37.00 Social Security Tax -21.54 Medicare Tax -5.04 PA State Income Tax -10.66 Silver Sprin Income Tax -6.95 PA SUI/SDI Tax -0.22 Other Dental Ins -5.47* Occ Priv Tax -1.00 Primary Chkng -264.92 :. year to date Other Benefits and 1,239.21 136.71 Information this period coat to date 141 12 Available Pto 40.50 143.97 Float HI Bal 8.00 1,661.01 183.94 101.29 23.69 50.14 32.68 1.00 27.35 5.00 1,235.92 * Excluded from federal taxable wages Your federal taxable wages this period are $347.33 0 1 0 0 c f U 0 u 7 0 U I- I CAROLINA LOGISTIC SERVICES ?Wi PIIrPRiM COURT WINSTON-SALEM, _NC 27106 BARBARA 8 ZEIGLER ciii 1? - Advice number: Pay date:' i account number 0041846759 00000050M 01 /30/2009 2313 8224 $264.92 NON-NEGOTIABLE 04/15/2009 10:42 3367701993 1. i Taxable Marital Status. Single ExemptiMMI 1110 Federal: 00 State. 00 hou tlda vniod Regular 0.920 24 00 : 221.60 Overthne PTO Takto s e t 1S1.1R Federal Wi?ho TAX 37.00- Social Security Ta 21.33- Medicare Tax 5.03- SDI Tax 0.21- PA Withholding To x 10.66- Silver Sprin W/ll Odder ax 6.95- LST PA ! 1.00. Qwkl 264.f)a- 'Pte Tx Dui . a? . *This deduction ucbs taxable gross. . i i Pay to the order of $ Zed i This Amount: INMAR PAYROLL PAGE 65/05 Eamings Statement Period Trading: 01/31/1009 Pay Date; 02/06/1009 Barbara S Zeigier 129 Unda Dr Mechanicsburg, PAS 17050 jp2ortmt Nobs 2.013.81 220.9a- 122.i2- 28.72- 1.21- 60.60- 39.63- PAWM check n mnbw 000605'!:3 Period Ending: 01191/9A09 Pay Date: 02/061M N4N-NEGQTIA,BL? (THIS IS NOT A CHECK) 04/15/2009 10:42 336 7701993 Taxable Marital Sa t is Single IS ! V d' 01Allow11 ' }federal: 00 Statc: 00 MAN t mds egjoO Regniar 6.620 32 Ovettiw 001 252.24 i Doductim Federal Witllhb 'tax 29.43- Socid Secntity Ta 17.16 - Medicare Tax 4.02- SDI Tax 0.17- PA Withholding T x e.50- Silver 3prin W/H ax s . s 4 - Ur-PA 1.00- Chcckl 233.99- 'Ptc Tx Dnt 6.47- ' This deduedon f?u, s taxable gross. INMAR PAYROLL PAGE 04/05 Earnings Statement Period Eadinc: 02/07=9 Pay Date. 02113/2009 Barbara S Zeigler 129 Linda Dr Me&anlcsburg, PA 17050 lit Nato 2.996.05 247.36- 137.11- 32.74- 1.31- 69.30- 4a.17- Payrob ebedr nueabw. 00070333 Period Ending: 02/0712009 Pay Date: 02/1312009 Pay to the order of This Amount: NON 10 -NEGOT. L,E ('T'HIS 19 NOT A CHECK) 04/15/2009 10:42 33 67701993 i Tax" Marian Status Single Fsxempdotu/Allowanc Federal; 00 Stu: 00 cave ehis Regular 9.820 40 no: as2.eo Overtime DadnMiow Federal Witltbold' tax 37.00- SocW Security Tau : 3 21.54- Medicare Tax 5.02- SDI Tax 0.21. PA Wit'hltolding Ti x 10.64- Silver Sprin W/H Odw aA 4.95- IX-PA 1.00- Cbtckl 764.94- 'PCe TX DM s 5.47- • M dedpotion uces taxable groan. i i ay to the t i i order of # w , A Thi nxm s . INMAR PAYROLL PAGE 03/05 Earnings Statement Period Ending: 02/24/2009 Pay Date: 02/2b/2009 Barba lm 5 Zeigler In Linda Dr Mechanicsburg, PA 17050 Import"t Notes 2,546.95 254.34- 161.$2- 37. 77- %.s9 79.96- 52.12- Payroll check npmiber: OOMJ8 Period Btkft: 02/14/2009 Pay Date: 02/20/2W9 NON-NEGOTI"LE (THIS IS NOT A CHECK ??ti:?:ii5 : ?,.....?. ?v: i,i:ji;i:.:.;::':;F.'SC •}?:;.:; ?•? ?•:'`.?i:v'•::?; 4 ?:?: CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT MNSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Social Security Number: XXX-XX-0201 Earnlnas rate hours this period Regular Eamgs 8.8200 23.00 202.86 Pto Taken 8.8200 9.00 79.38 Holiday Pay Safety Bonus Deduce e4u statuto Federal Income Tax -26.42 Social Security Tax -17.16 Medicare Tax -4.02 PA State Income Tax -8.50 Silver Sprin Income Tax -5.54 PA SUI/SDI Tax -0.17 Other Dental Ins -5.47* Occ Priv Tax -1.00 Primary Chkng -213.96 Earnings Statement ?> > Period Beginning: 02/15/2009 Period Ending: 02/21/2009 Pay Date: 02/27/2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 year to date 2,288.79 Other Benefits and 357.21 Information this period total to data 141.12 Available Pto 15.50 143.97 Float HI Bal 8.00 2,931.09 310.78 178.68 41.79 88.46 57.66 1.76 49.23 9.00 2,193.73 * Excluded from federal taxable wages Your federal taxable wages this period are $276.77 WIMM .. • n w . w . . .. w . LL cc LL OFJUALW. M: -.. ' 04/15/2009 10:42 3367701993 Taxable Marital Status: Single Exemptions/AHowance Federal: 00 Sure: 00 9ftybo rce t>>b Replar 9.920 32 00 Overduke PTO Takes - o 262.24 INMAR PAYROLL PAGE 02/05 Earnings Statement Period finding: 02/28/2009 Pay pate: 0 ffim 09 Barbara S Zeigler 129 Linda Dr Mechanicsburg, PA 17050 huporbw-t Not" 3,223.99 SmLstort? Federal Witbboldl g Tax Social Security T Medicare Tax 3DI Tax ' PA Withholding T Silver Sprin W/H tax I LST-PA Checkt 'MPre Tx D» t * This deduction 28.29- 21.S3- s.0a- 0.21- 10.66- 6.95- 1.00- 277.66- 5.A7- eiMIEW . 6u tmble gross. 339.07- 200.21- •6.02- 1.97- 99.12- 64.61- ftmD cheNt number. 001OWS Period Ending: 02/2812009 Pay Date: 0310612009 Pay to the order of This Au mett: NON-NEGOU"LE {THIS IS NOT A CHUCK) 04/15/2009 10:42 3367701993 Taxable Macias! Smu a: Single 8xetto?ftioas/Albwa Pcdeml: 00 Stag: 00 INMAR PAYROLL PAGE 01/05 Earnings Statement Period Ending: 031078009 Pay Date: 03/138009 Barbara S Zeigler 129 Linda Dr Mechanicsburg, PA 17050 Tmportnnt Notes Rcgtdar 6.920 23. 0 207.27 Overdtm PTO Taken s. o .10 Federal Wititho Thx 13.0 a - SocblSeCarhy Ta 15.25- 1?fedit&M Tax 3.57- TAX 0.1li- PA Widt6olding T 7.66- Silver son W/H Otbw sm 4.92- 1 LST-PA 1.00- Glteekl ! 20o.3e- *Pm Tx Ant 5.47- This deduction +?-.-s taxable gross. 7.535.26 3s2.15- .715.46- 50.39- 2.12- 106.67- 69.53- Payroll Check number. 00110520 Period Ending: 03/078009 Pay Date: 031138009 Pay to the order of This Amount: NON-NEGOTIABLE (THIS IS NOT A CHECK) i::: is i. ?•... '•i:• ?...i...; ...: i.;iN:: n'.: •::.::': •ii:: ;::•.:; :•.::r;•iii:.:yiiii:;;::>;!iii•i •:i':ii"?''<•::: CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Earnings Statement Period Beginning: 03/0112009 Period Ending: 03/07/2009 Pay Date: 0311312009 BARBARA S ZEIGLER 129 LINDA OR MECHANICSBURG, PA 17050 Social Security Number: XXX-XX-0201 Earninas rate hours this period year to data Regular Earngs 8.8200 23.50 207:27 2,778.30 Other Benefits and Pto Taken 8.8200 5.00 44.10 471 .87 information this period total to data Holiday Pay 141.12 Available Pao 2.50 Safety Bonus 143.97 Float HI Bal 8.00 ''t'{•:•?.?; ':}L<K;?:f;:i{ham`}' ':jt: .:.sss >.•..:>::::::> i.,:•>: h«:s> 3,535.26 Deductions Statutory - Federal Income Tax -13.08 352.15 Social Security Tax -15.25 215.46 Medicare Tax -3.57 50.39 PA State Income Tax -7.55 106.67 Silver Sprin Income Tax -4.92 69.53 PA SUI/SDI Tax -0.15 2.12 Other i Dental Ins -5.47* 60.17 Occ Priv Tax -1.00 11.00 Primary Chkng -200.38 2,667.77 0 * Excluded from federal taxable wages i Your federal taxable wages this period are $245.90 U 0 U 3 U F CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT W/NSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Social Security Number. XXX-XX-0201 Earninue raw tows this period Regular Eamgs 8.8200 34.50 304.29 Pto Taken 8.8200 2.50 22.05 Holiday Pay Safety Bonus Dsduationa Statuto Federal Income Tax -24.32 Social Security Tax -19.89 Medicare Tax -4.65 PA State Income Tax -9.85 Silver Sprin Income Tax -6.42 PA SUI/SDI Tax -0.20 Other Dental Ins -5.47* Occ Priv Tax -1.00 Primary Chkng -254.54 Earnings Statement Period Beginning: 03/0812009 Period Ending: 0311412009 Pay Date: 03/20/2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 year to date 3,082.59 Other Benefits and 493.92 Information this period total to date 141 12 Available Pto 0.00 143.97 Float HI Bal 8.00 3,861.60 376.47 235.35 55.04 116.52 75.95 2.32 65.64 12.00 2,922.31 * Excluded from federal taxable wages Your federal taxable wages this period are $320.87 c t I 0 ra W w X F Earnings Statement CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT tMNSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Period Beginning: 03/15/2009 Period Ending: 03/21/2009 Pay Date: 03/27/2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Social Security Number: XXX-XX-0201 Eaminas rats hours this period year to date Regular Eamgs 8.8200 24.00 211.68 3,294.27 Other Benefits and FI Holiday 8.8200 8.00 70.56 70.56 Information this period Available Pto Holiday Pay 141.12 Float HI Bal Pto Taken 493.92 Safety Bonus 143.97 a 4,143.84 Deductions Statuto Federal Income Tax -17.71 394.18 Social Security Tax -17.16 252.51 Medicare Tax -4.01 59.05 PA State Income Tax -8.50 125.02 Silver Sprin Income Tax -5.54 81.49 PA SUI/SDI Tax -0.17 2.49 Other Dental Ins -5.47* 71.11 Occ Pdv Tax -1.00 13.00 Primary Chkng -222.68 3,144.99 * Excluded from federal taxable wages Your federal taxable wages this period are $276.77 total to dot* 0.00 0.00 6 C u a u F 1 Earnings Statement CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Social Security Number: XXX-XX-0201 Esminas rata hours this period Regular Earngs 8.8200 40.00 352.80 Overtime Earng 13.2300 6.00 79.38 R Holiday Holiday Pay Pto Taken Safety Bonus Deductions statut Federal Income Tax -40.20 Social Security Tax -26.46 Medicare Tax -6.19 PA State Income Tax -13.10 Silver Sprin Income Tax -8.53 PA SUI/SDI Tax -0.26 Other Dental Ins -5.47* Occ Pdv Tax -1.00 Primary Chkng -330.97 year to date 3,647.07 79.38 70.56 141.12 493.92 143.97 A, 576. 02 434.38 278.97 65.24 138.12 90.02 2.75 76.58 14.00 3,475.96 * Excluded from federal taxable wages Your federal taxable wages this period are $426.71 c C c W a W X F_ H *=AM. W4 ' +CA04OUNA LOGISTIC" SERVICES Advios rtumher. 0900614051ti v 2601 PILGRIM COURT Pay date:% 04/03/2009 WINSTON-SALEM, NC7i06 Ds itsd to the.account of AV. aacoun Humber transit ABA amount BARBARA S ZEIGLER '- 0041846759 2313 8224 $330.97 IL 9: NON-N G TIABLE • Period Beginning: 03/22/2009 Period Ending: 03/28/2009 Pay Date: 04103/2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 J D Other Benefits and information this period total to dots Available Pto 0,00 Float HI Bal 0.00 ?" TFil?:l?itJ9tk`7.11:a?J?lbf3fBl;it.t?a:1PY:?fkiialil..L li. f?.i•Uil:.nti'.'.?N7bJ?:.?..^.iC..?% pl:"Jlz?;.l'f:6\j`1.Y,Pl?a'?tiF? ??!?h?'?1'kil::1`1 r.°sl.?.SiSIPIRit'llicl?'.3CtJ,??:t?:k?19F?k14!kuG+? Earnings Statement CAROLINA LOGISTIC SERVICES 21601 PILGRIM COURT IMNSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA. N/A Social Security Number. XXX-XX-0201 Earnings rate (hours this period Regular Eamgs 8.8200 38.00 335.16 Overtime Eamg R Holiday Holiday Pay Pto Taken Safety Bonus Deductions Statut Federal Income Tax -25.64 Social Security Tax -20.44 Medicare Tax -4.78 PA State Income Tax -10.12 Silver Sprin Income Tax -6.59 PA SUI/SDI Tax -0.20 Other . Dental Ins -5.47* Occ Priv Tax -1.00 Primary Chkng -260.92 year to date 3,982.23 79.38 70.56 141.12 493.92 143.97 4,91.1.1.3 460.02 299.41 70.02 148.24 96.61 2.95 Period Beginning: 03/29/2009 Period Ending: 04104/2009 Pay Date: 04/10/2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Other Benefits and Information this period teat to date Available Pto 0.00 Float HI Bal 0.00 82.05 15.00 3,736.88 Excluded from federal taxable wages Your federal taxable wages this period are $329.69 CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 BARBARA 8 ZEIGLER .0 V%O Advice numtier: Pay data. sw .. account number t 1%k ' .' ' 0041846759 Og0001.50948 04/10/2009 2313 8224 $260.92 NON-NEGOTIABLE t?d-"+!RDjI>?d?bll?l@?:YS'r a rj??±?;,Y:fr•?VI`l.:ail'?icJt".l,'..?,7:?"F?niLJ,.i;n,".1f1i'fiJ??:...ciw:.?? hJ?!J?1'l,:.YPl-1lPl!:i?? F,,!L1?`AY N'lH?fl:!3iJ??i411:1?k'.k?: ?P1J:libkS?fILF4Pl??Y,:i? Earnings Statement CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT tMNSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federate. 0 PA: N/A Period Beginning: 03/29/2009 Period Ending: 0410412009 Pay Date: 04/10/2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Social Security Number. M-XX-0201 Earnin s rata hours this perW year to data 9. Other Benefits and Safety Bonus 124.32 268.29 Information this period total to date Regular Earngs 3,982.23 Available Pto X0.00 Overtime Eamg 79.38 Float HI Bal 0.00 R Holiday 70.56 Holiday Pay 141.12 Pto Taken 493.92 -5, 035, gn Deductions Statutory Federal Income Tax - 31 .08 491.10 Social Security Tax -7.70 307.11 Medicare Tax -1.81 71.83 PA State Income Tax -3.82 152.06 Silver Sprin Income Tax -2.49 99.10 PA SUI/SDI Tax -0.07 3.02 Other Primary Chkng -77.35 3,814.23 Dental Ins 82.05 Occ Priv Tax 15.00 Your federal taxable wages this period are $124.32 CA10164NA i.QdIST1C SERVICES a60t iP)?.OR1M C,r.O?T W WON-SALEM, , NC 27106 BARBARA 8 ZEIGLER MA`5Vs N? y Advice numb6r. 000001gU94$ Pay date ' 04/10/2009 amount . mbyr transit ABA account nu- 0041846759 2313 8224 $77.35 NON-NEGOTIABLE FWINh,.6 ft o0 NjM -? 1R78NW+%iw.i1 i6 0wGI1A a W.-W a, rYMi,I a a a-zw'!* W ..jlI iiRi"s ?`P tiryA.f:.ilhi's f?'.r E R#SY jii"INf?yf?f]..+tlJlI,"J'.J,.11 t 16 `*,t Jj .^Y'_1I U !I ;FIJ.rkl,'ni- >s'' " J ;o :..:o..::..:... Earnings ..................... Statement CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Social Security Number: XXX-XX-0201 Earnings rate hours this period year to date Regular Earngs 8.8200 28.25 249.17 4,496.00 Overtime Earng 79.38 FI Holiday 70.56 Holiday Pay 141.12 Pto Taken 493.92 Safety Bonus 268.29 a s .. ?s3 $24:;1;,. 5,549.27 Deductions Statutory Federal Income Tax -12.75 518.91 Social Security Tax -15.11 338.29 Medicare Tax -3.54 79.12 PA State Income Tax -7.48 167.50 Silver Sprin Income Tax -4.87 109.15 PA SUI/SDI Tax -0.15 3.33 Other Dental Ins -5.47* 92.99 Occ Priv Tax -1.00 17.00 Primary Chkng -198.80 4,222.98 * Excluded from federal taxable wages Your federal taxable wages this period are $243.70 I CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 to the account of BARBARA S ZEIGLER Period Beginning: 04/12/2009 Period Ending: 04/18/2009 Pay Date: 04/24/2009 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Other Benefits and Information this period Available Pto Float HI Bal DarJ;? ;,-r'r V. VV 0.00 00000170509 04/24/2009 transit Advice number: Pay date account number 0041846759 2313 8224 $198.80 + o: NON-NEGOTIABLE "tit= prtIC,IiJI1L JDCUh12df rJL;1; ?LJ, F'7' i'i' r_ 1'l-,: rJJ:? die= AJLD -\r AN 41iJSiL? 70 `tl?h'J INH_E'1J r;H??,:1?'l?i Earnings Statement CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Social Security Number: XXX-XX-0201 Earnings rate hours this period Regular Earngs 8.8200 40.00 352.80 Overtime Earng FI Holiday Holiday Pay Pto Taken Safety Bonus Deductions Statuto Federal Income Tax -28.29 Social Security Tax -21.54 Medicare Tax -5.04 PA State Income Tax -10.66 Silver Sprin Income Tax -6.95 PA SUI/SDI Tax -0.21 Other Dental Ins -5.47* Occ Priv Tax -1.00 Primary Chkng -273.64 year to date 4,987.72 79.38 70.56 141.12 493.92 268.29 6.040.99 547.20 368.10 86.09 182.26 118.77 3.62 103.93 19.00 4,612.02 Advice number: Pay date- _. ::. 2 N Q t Q a C a 0 a 0 0 W M 0 * Excluded from federal taxable wages Your federal taxable wages this period are $347.33 Period Beginning: 04/26/2009 Period Ending: 05/02/2009 Pay Date: 05/08/2009 00000000504 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Other Benefits and Information this period Available Pto Float HI Bal W Q w w CAROLINA `LOGISTIC . SERVICES 2601 PILGRIM GOtJfiT WINSTON.-SALEM,, NC 27106 ,i ?. Deposited to the account of BARBARA S ZEIGLER c i " 00000190504' 05{08/2009 . -account number transit we. xxxxxx6759 xxxx xxxx ._._I ._ d_... 0.00 fif ,y amount $273.64 NON-NEGOTIABLE J t> :«>A xt!~#>[1€>3iA€kfl?f10051.....:.1.. Earnings Statement : : CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Social Security Number: XXX-XX-0201 Earnings rate hours this period Regular Earngs 8.8200 23.75 209.48 Overtime Earng FI Holiday Holiday Pay Pto Taken Safety Bonus Deductions Statuto Federal Income Tax -6.79 Social Security Tax -12.65 Medicare Tax -2.96 PA State Income Tax -6.26 Silver Sprin Income Tax -4.08 PA SUI/SDI Tax -0.13 Other Dental Ins -5.47* Occ Priv Tax -1.00 Primary Chkng -170.14 year to date 5,197.20 79.38 70.56 141.12 493.92 268.29 6,250.47 553.99 380.75 89.05 188.52 122.85 3.75 109.40 20.00 4,782.16 Period Beginning: 05/03/2009 Period Ending: 05/09/2009 Pay Date: 05/15/2009 00000000515 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Other Benefits and Information this period total to date Available Pto 0.00 Float HI Bal 0.00 Z Ir. ai U' C °I 0 0 N of * Excluded from federal taxable wages Your federal taxable wages this period are $204.01 w cc w M w. a w F 02000ADP, I. CAROLINA '1_OGISTIC SERVICES '2601 PILGRIM'COURT WINSTON-SALEM, NC 27106 Deposited to the account of BARBARA S ZEIGLER _ Advice number: 00000200515 Pay date: 05/15/2009 account number transit ABA xxxxxx6759 $170.14 NON-NEGOTIABLE »'<t> . ....:.........:....:......... ......... .................. .. . .. 72 :::1.:;, . :< .4: :i4Z.: 0 oxt t< Earnings Statement .1 ..................:........................................ CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Social Security Number: XXX-XX-0201 Earnings rate hours this period Regular Earngs 8.8200 30.25 266.81 Overtime Earng FI Holiday Holiday Pay Pto Taken Safety Bonus Deductions Statuto Federal Income Tax -15.39 Social Security Tax -16.20 Medicare Tax -3.78 PA State Income Tax -8.02 Silver Sprin Income Tax -5.23 PA SUI/SDI Tax -0.16 Other Dental Ins -5.47* Occ Priv Tax -1.00 Primary Chkng -211.56 year to date 5,464.01 79.38 70.56 141.12 493.92 268.29 6,517.28 569.38 396.95 92.83 196.54 128.08 3.91 114.87 21.00 4,993.72 Period Beginning: 05/10/2009 Period Ending: 05/16/2009 Pay Date: 05/22/2009 00000000501 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Other Benefits and Information this period total to date Available Pto 0.00 Float HI Bal 0.00 2 m t a U G a 0 a 0 0 N m M * Excluded from federal taxable wages Your federal taxable wages this period are $261.34 02000ADP, 1. W w 2 Cr w Deposited to the account of BARBARAS ZEIGLER _ Advice number: Pay date: account number` tri 00000210501; 05/22/2009 - xxxxxx6759 xxxx xxxx $211.56 NOWNEGOTIABLE CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Social Security Number: XXX-XX-0201 Earnings rate hours this period year to date Regular Earngs 8.8200 40.00 352.80 5,816.81 Overtime Earng 79.38 FI Holiday 70.56 Holiday Pay 141.12 Pto Taken 493.92 Safety Bonus 268.29 >3'AlI'& :><>>>>>>>>'<a 6,870.08 Deductions Statutory Federal Income Tax -28.29 597.67 Social Security Tax -21.53 418.48 Medicare Tax -5.04 97.87 PA State Income Tax -10.66 207.20 Silver Sprin Income Tax -6.95 135.03 PA SUI/SDI Tax -0.21 4.12 Other Dental Ins -5.47* 120.34 Occ Priv Tax -1.00 22.00 Primary Chkng -273.65 5,267.37 * Excluded from federal taxable wages Your federal taxable wages this period are $347.33 CAROLINA -LOGISTIC SERVICES 2601` PILGRIM 'C'OURT WINSTON-SALEM,, NC 27106 Deposited to the account of BARBARA S ZEIGLER Earnings Statement ?> > Period Beginning: 05/17/2009 Period Ending: 05/23/2009 Pay Date: 05/29/2009 00000000517 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Other Benefits and Information this period total to date Available Pto 0.00 Float HI Bal 0.00 ) J A L L I ?i`1J 8'7 i`1! Y Flphl DAF3;<-Ivr,r 1?'(U L7']rrlf it Af 3J 'f l>1' Advice number: 00000220517 Pay date: _ 05/29/2009 account number transit ABA amount xxxxxx6759 xxxx xxxx $273.65 NON-NEGOTIABLE z Q a ti c o: of al o? 0 N M1 @I wl CcI w w, G Earnings Statement CAROLINA LOGISTIC SERVICES 2601 PILGRIM COURT WINSTON-SALEM, NC 27106 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A Social Security Number: XXX-XX-0201 Earnings rate hours this period year to date Regular Earngs 8.8200 20.00 176.40 5,993.21 Overtime Earng 79.38 FI Holiday 70.56 Holiday Pay 141.12 Pto Taken 493.92 Safety Bonus 268.29 7,046.48 Deductions Statutory Federal Income Tax -3.29 600.96 Social Security Tax -10.60 429.08 Medicare Tax -2.48 100.35 PA State Income Tax -5.25 212.45 Silver Sprin Income Tax -3.42 138.45 PA SUI/SDI Tax -0.11 4.23 Other Dental Ins -5.47* 125.81 Occ Priv Tax -1.00 23.00 Primary Chkng -144.78 5,412.15 * Excluded from federal taxable wages Your federal taxable wages this period are $170.93 CAROLINA_ "LOGISTIC' SERVICES 2,501 PILGRIM COURT WINSTON-SALEM, NC 27106 Deposited to the account of a` BARBARA S ZEIGLER - Period Beginning: 05/24/2009 Period Ending: 05/30/2009 Pay Date: 06/05/2009 00000000519 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 J? a Other Benefits and Information this period total to date Available Pto 0.00 Float HI Bal 0.00 W rr w w H Advice number: 0©000250519 Pay date 06J05/2d09- account number transit ABA amount { xxxxxx6759 xxxx xxxx $144.78 NON-NEGOTIABLE j'p Earnings Statement ?> > Period Beginning: 05/31/2009 Period Ending: 06/06/2009 Pay Date: 06/12/2009 Taxable Marital Status: Single Exemptions/Allowances: Federal: 0 PA: N/A 00000000534 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Social Security Number: XXX-XX-0201 Earnings rate hours this period year to date Other Benefits and Regular Earngs 8.8200 30.00 264.60 6,257.81 Information this period total to date Overtime Earng 79.38 Available Pto 0.00 FI Holiday 70.56 Float HI Bal 0.00 Holiday Pay 141.12 Pto Taken 493.92 Safoty Bon= 268.20 4GQ 7,311.08 Deductions Statuto Federal Income Tax -15.06 616.02 Social Security Tax -16.07 445.15 z Medicare Tax -3.76 104.11 PA State Income Tax -7.96 220.41 Silver Sprin Income Tax -5.18 143.63 L PA SUI/SDI Tax -0.16 4.39 a Other V C a Dental Ins -5.47* 131.28 °a Occ Priv Tax -1.00 24.00 0 Primary Chkng -209.94 5,622.09 Cd 01 m ?I * Excluded from federal taxable wages Your federal taxable wages this period are $259.13 w W x - w E-i CAROUNA:LGGISTIC SERVICES 260.1 PILGRIM'C.OURT WINSTON-SALEM,, NC 27106 Advice number: Pay date. _ account number xxxxxx6759 00000240534 06/12/2009 BARBARA S ZEIGLER xxxx xxxx $209.94 NON-NEGOTIABLE Commonwealth of Pennsylvania 023314 EMPLOYEE. PAY STA,rEML'•NT Personnel No. 00013612 Transp ortation Period Ending 04/23/2004 Pay Date 05/07/2004 Barbara Zeigler Organizational Unit Name: TR Mtr Vhcls CDC Code: 0008888 129 Linda Drive B/U: Al Group: 03 Level: 01 Mechanicsburg, PA 17055 FWT Marital Status: S No. Exem ptions /Allowances: 00 GROSS EARNINGS YEAR TO DATE EARNINGS HOURS RATE AMOUNT NET PAY THIS PAY Differences from prev.per 9.64 MEMBERS 1ST FCU 6.04 TOTAL NET 6.04 DEDUCTIONS THIS PAY YTD Federal Withholding Tax 2.41 667.51 TX EE Social Security Tax 0.59 401.88 TX EE Medicare Tax 0.14 93.99 State Withholding-Pennsylvania 0.30 199.00 Local Wage Tax-Mechanicsburg Borough 0.16 110.19 TOTAL DEDUCTIONS 3.60 1,472.57 REIMBURSEMENTS THIS PAY YTD EMPLOYER PAID BENEFITS THIS PAY TX ER Social Security Tax TX ER Medicare Tax ER Wortcers Comp Benefit 0.59 0.14 0.18 TOTAL EARNINGS 9.64 SERVICE CREDIT 05 YR 00 PP SENIORITY INFORMATION Bargaining Unit Days: AFSCME AGREEMENT 935.67 • 5 TOTAL BENEFITS I? FWTTaxable Gross: 9.64 s PETITIONER'S EXHIBIT 617 -01 ?E 0.91 15.83 6.43 0.00 Accrual This PP 0.00 0.00 0.00 Absence Reported This PP 0.00 0.00 0.00 Adjustment 0.00 0.00 0.00 Quota This Stmnt 35.00 13.93 0.00 I n Department of the Treasury - Internal Revenue Service U. 1040 U.S. Individual Income Tax Retum 2008 Label L for to year Jan. /-Dec. 31, 2006. or other tax year begireting Is" Name Spouse's Name (if Joint Return) Home Add mmucrrna? BARBARA S ZEIGLER use the L IRS label. om«w+60. 01""WN 129 LINDA DRIVE Of M"* MECHANICSBURG PA 17050- IRS Use Only-Do not write or staple in this space. ,2006. ending 20 OMB No. 1545-0074 ty. State, and ZIP Code Your social security number 162-48-0201 Spouse's social security no. 166-46-2612 You mustertter • vour SSN(s) above. Presidential change your tax or refund. Election Campaign ? Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see instructions) ? You Spouse 1 Single 4 Head of household (with qualifying person). (See instructions.) Filing Status 2 Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent, enter Check only 3 Married filing separately. Enter spouse's SSN above this child's name here. ? one box. and full name here. ?kEV I N DANNER 6 Qualifying widow(er) with dependent child (see instructions) Exemptions so N Yourself. If someone can claim you as a dependent, do not check box 6a ................ Boxes checked on b Spouse ............................................. ..................................... 6a and 6b 1 c Dependents: (2) Dependent's (3) Dependent's relationship to 4 on 8of children If more (1) First name Last name social security no. you er(SbM&I -lived with you 0 than . did not pre wlln four d rear live so dvorw 1" 0 1 "= epen- ae . dents, Dependen u e i see W a v e instr. Add numbers ("? d Total number of exemptions claimed ....................................... ..................................... on lines above? 1 11 7 Wages, salaries, tips, etc. Attach Form(s) W-2 Income 7 Attach 8s Taxable interest. Attach Schedule B if required 8a Form(*) W-2 here. b Tax-exempt interest. Do not include on line 8a .......... 8b Also attach Forms 9a Ordinary dividends. Attach Schedule B if required ........ ............................-. on I M-R and tax 099- b Qualified dividends (see instructions) ........... . .......... 9b was withheld. 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) ........ 10 11 Alimony received .......................................... ................................ 11 12 Business income or (toss). Attach Schedule C or C-EZ .... ................................ 12 If you did not et W-2 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ? 13 g . see Instructions. 14 Other gains or (losses). Attach Form 4797 ............... . ................................ 14 16a IRA distributions .......... 154 b Taxable amount (see inst.) 16b 16a Pensions and annuities .... 1 164 1 b Taxable amount (see inst.) 16b 17 Rental real estate, royalties, partnerships. S corporations, trusts, etc. Attach Schedule E .... 17 18 Farm income or (loss). Attach Schedule F ................ ................................ 18 Enclose, but do not attach any 19 Unemployment compensation ......... . 19 , payment, Also, 20a Social security benefits I20a1 b Taxable amount (see inst.) 20b please use 21 Other income. List type and amount (see instr.) 21 Form 10404. 22 Add the amounts in the far right column for lines 7 through 21. This is your total income ? 22 23 Educator expenses (see instructions) ...................... 23 Adjusted 24 Certain business expenses of reservists. performing artists, Gross and fee-basis gov. officials. Attach Form 2106 or 2106-EZ 24 Income 25 Health savings account deduction. Attach Form 8889 ...... 26 26 Moving expenses. Attach Form 3903 ...................... 26 27 One-half of self-employment tax. Attach Schedule SE .... 27 28 Self-employed SEP, SIMPLE, and qualified plans ........ 28 29 Self-employed health insurance deduction (see intr.) ...... 29 30 Penalty on early withdrawal of savings .................... 30 31a Alimony paid b ReclpienrsSSN ? 31a 32 IRA deduction (see instructions) .......................... 32 33 Student loan interest deduction (see instructions) .......... 33 34 Tuition and fees deduction. Attach Form 8917 . ......... 34 35 Domestic production activities deduction. Attach Form 8903 35 36 Add lines 23 through 31a and 32 through 35 ............... ............................... 36 37 Subtract line 36 from line 22. This is your adjusted gross Income .................... ? 37 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. BCA Copy ftM form soaware ony. 2006 UNvemal Tax Systems, Inc. AU rights reserved. US1040Sf Rev f 16,963. (2008) _3 to ,-0, Vj? Form 1040 (2008) BARBARA S ZEIGLER 162-48-0201 Page 2 .... 38 Amount from line 37 (adjusted gross income) .................. 38 22,336. 39a Check You were born before Jan. 2, 1944. 8 Blind. Total boxes J Tax and If: Spouse was born before Jan. 2, 1944, Blind. checked ? 399 Credits b If your spouse itemizes on a separate return or you were a dual-status alien, Standard see Instructions and check here .......................................... ? 39b 8 Deduction C Chad if staid ird deduction lricndas real estate taxes or daster loss lase inso ...... ? 39C for - 40 itemized deductions (from Schedule A) oryour standard deduction (see left margin) ...... 40 5,450. e People who n h k d 41 Subtract line 40 from line 38 .............................................................. 41 16,886. y a e c ec box on lute 42 If line 38 is over $119,975, or you provided housing to a Midwestern displaced individual, 39s or 39b or see inst. Otherwise, multiply $3,500 by the total number of exemptions claimed on line 6d 42 3,500. who can be cl i d 43 Taxable Income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- ...... 43 13,386. - me as a a dependent, 44 Tax (see instructions). Check if any tax is from: a 11 Form(s) 8814 b 11 Form 4972 .. 44 1, TO 5 7 see intr. .................. . .. . . . 45 Alternative minimum tax (see instructions). Attach Form 6251 . ... 46 e All others: ...................................................... . . . . . • •. • • •. 46 Add lines 44 and 45 . 10, 46 , . Single or Married filin 47 Foreign tax credit. Attach Form 1116 if required .......... . 47 g separately, 48 Credit for child and dependent care exp. Attach Form 2441 48 - $5,450 49 Credit for the elderly or the disabled. Attach Schedule R . 49 Married filing 50 Education credits. Attach Form 8863 .................... 50 jointly or Qualifying 51 Retirement savings contributions credit. Attach Form 8880 .. 61 widow(er). 62 Child tax credit (see inst.). Attach Form 8901 if required 52 $10,900 6639 c ssos 6396 b 63 Credits from Form: a 53 Heed household. 54 Other credits from Form: a 3!100 b eeot c 8 8 8 64 $8.000 55 Add lines 47 through 54. These are your total credits ...... ................................ 65 56 Subtract line 55 from line 46. If line 55 is more than line 46, enter -0 .................. ? 56 1, 0 5 . 57 Self-employment tax. Attach Schedule SE ................................................ 57 Other 58 Unreported social security and Medicare tax from Form: a[] 4137 b 11 8919 .... 58 Taxes 59 Additional tax on IRAs. other qualified retirement plans, etc. Attach Form 5329 if required N 59 60 Additional taxes: a a AEIC payments b O Household employment taxes. Attach Sch. H 60 61 Add lines 56 through 60. This is your total tax ........................................ ? 61 62 Federal income tax withheld from Forms W-2 and 1099 ....-62 2,226. Payments 63 2008 estimated tax pymts and amt applied from 2007 return 63 64 a Earned Income credit (EIC) .............................. 64a If you have a b No N?COmbat ........ 64b attach Schedule 65 Excess social security and tier 1 RRTA tax withheld (a" ins) 65 q?c1S9,e EIC• 66 Additional child tax credit. Attach Form 8812 .............. 66 67 Amount paid with request for extension to file (see inst) .... 67 68 Credits from Form: a 112439 b114136 c 11eeot d11 aegis 68 69 First-time homebuyer credit. Attach Form 5405 69 70 Recovery rebate credit (see worksheet in the instructions) 70 300. 71 Add lines 62 through 70. These are your total payments .............................. ? 71 Refund 72 If Pule 71 is more than line 61, subtract line 61 from line 71. This is the amount you overpaid 72 Direct deposit? 73s Amount of line 72 you want refunded to you. If Form 8888 is attached, check here ? 11 73a see instructions ? b Rrx,m°Y`"'°oer B31382241 ? c Type. ® Checking 11 Savings and fill in 73b, 73c, and 73d, ? d P041846759 or Form 8888. 74 Amount a line 72 you wart applied to your 2009 estimated tax ? 74 Anwunt 75 Amount you owe. Subtract line 71 from line 61. For details on how to pay, see inst. ? 75 You Olive 76 Estimated tax penalty (see instructions) .... ................ I 76 2,526. Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. complies Via Designee Dagnee's phone aereonriavasai name ? no.. ?-- ?ww (pu4) No Sign Under penalties of penu(y. I dedwe Out i new examined this return and accompanying schedules and statements. and to the best of my krloaMdp and beret. they are tn,e, correct. and complete. DaGantion of prepuer (cheer than taxpayer) is based on ar information of which prepain r has any knowledip. Here Your signature Date Your occupation Daytime phone number Joint return? , ABORER 717-395-0539 Keep a copy / Spouse's signature. it a pint return. both must sign Date Spouse's occupation for Your Date Check if Preparers SSN or PTIN Paid Watuni s IF self-employed S25013108 Preparer's Fm's-(or EIN yours N Use Only wnp"w). address. Cod e and ZIP rxxi r Phone no. ZIP BCA copyright form software only. 2006 Universe! Tax Systems. inc. NI rights reserved Usi040s2 Rev 1 Form 04 (2008) fe, scctaab, ie e 8T1 Um at www agav/eft. Em loyoo otoronco Cop N?2 Wage and Tax Statement ? ? ? ? Cer" r - ber Cory ElplgrM centDoty ;210370/EG7 521800 A 1159 Eevplsyer's name, addess, and 21P Dods CAROLINA SUPPLY CHAIN SERVICES LLC 2601 PILGRIM CT WINSTON SALEM NC 27106 Batch #01664 1 ErsploviWa name, addrw•, and ZIP sods IARBARA S ZEIGLER 29 LINDA DR AECHANICSBURG,PA 17050 • FEP 10 number • s nun*w 162-48-0201 Wage, Ups, e0er solmp, Federal bl - tact witldeld 16963.44 1728.79 I Social security wages 4 Boatel "c uay im wiadnM 16963.44 1051.73 memeus wages and tips Medicare tax wkMwM 16963.44 245.97 eoslaf seaway *6 s Alovalod tips I Advance payment 1e DepasdaM can buniMs - 11 NorvqualMledpWe 150 laW 1 ao 14 Oliver ' i 10.34 SUI 1s FA Pima IM Wif ddt 16 Stab EmplloWs stile ID nor If atatt wages, tips, do. PA 9259 3541 16963.44 17 state Income tot weal wages, tim etc. 520.75 _ 16963.44 - - - - y is ri w w pro * " to WLoo.gt 399.34 YVS TB 2008 W-2 and EARNINGS SUMMARY AX This blue Earnings Summary section Is Included With your W2 to help daeortbe pordons In more detalL The reverse side includee general Information that you may also find helpful. 1. Thor foilowlno htformation reflects your final 2008 pa y stub plus any adtushmards submtned by Your employer. (cross Pay 17234.36 Sochi Security 1051.73 PA. State humne Tax 520.75 Tax Wkhheld Box 17 of W-2 Box 4 of W-2 Local Income Tax 339.34 Fed. Income 1728.79 Medicare Tax 245.97 Box led W-2 Tax Withheld Withheld sum m 10.34 Box 2 of W-2. Box 6 of W-2 Box % of W-2 2. Your Gross Pay was adjusted as follows to produce your W-2 Statement. Wages, Tips, other Sochd Security Medicare PA. State Wages, WSTB Compensation =1 s wages Tips, ? Local wages Box 1 of W-2 3 of w-2 Box s of w-2 8ox 1 b of W-2 Tips, Etc. Box 16 of W-: Oroas Pay 17,234.36 17,234.36 17,234.36 17, 234.36 17,234.' Less Other Cafe 125 270.92 270.92 270.92 270.92 270.f Reported W-2 Wages 16,963.44 16,963.44 16,963.44 16,963.44 16,963.4 3. Employes W-4 Proflie. To chaW! your Employee W-4 Proflie InforniaMon, Me a new W-4 with your payroll dep BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050 Social Security Number. 16246-0201 Tax" MariW Stales: SM(iLE Exemplims/Allowances: FEDERAL: 0 STATE: LOCAL: 0 o :Doe ?DV, enc. ------ F?a_.otxL,_nµno-'------------ PAYER'S name. street address, city, state, and ZIP code COMMONWEALTH OF PENNSYLVANIA STATE EMPLOYEES' RETIREMENT SYSTEM 30 NORTH THIRD ST STE 150 HARRISBURG, PA 17101.1716 PAYER'S Federal 1D number RECIPIENT'S ID number 231732438 1162-48-0201 RECIPIENT'S name, street address, city, state and ZIP code CORRECTED (if checked) 1 Grose distribution 2a Taxable amount yam,-TVV.f-v 2b Taxable amount not determined 4 Federal Income tax withheld $497.26 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050-1517 Form 1099-R 101010101011111111 1 Gross distribution ED CORRECTED (if checked) PAYER'S name, street address, city, state, and ZIP code COMMONWEALTH OF PENNSYLVANIA STATE EMPLOYEES' RETIREMENT SYSTEM 30 NORTH THIRD ST STE 150 HARRISBURG, PA 17101-1716 PAYER'S Federal ID cumber RECIPIENT'S ID number 231732438 1162-48-0201 RECIPIENTS name. street address, city, state and ZIP code 2a Taxable amount $2,486.28 2b Taxable amount not determined 4 Federal income tax withheld $497.26 OMB NO.1545.0119 2008 Form 1099-R Total distribution 5 Employee contributions Dist. Code(s) 9a Your total 1 Total employee contributions Medical Distributions From Pensions, Annuities, Retirement or Profit- Sharing Plans, IRAs, Insurance Contracts, etc. COPY C For Recipient's Records :t. This information is being furnished to the Internal Revenue Service. Department of the Treasury - Internal Revenue Service OMB NO.1545-0119 2008 I Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit- Sharing Plans, IRAs, Insurance Contracts, etc. Total distribution 5 Employee contributions code(s) 19a Your total dist. 1 % BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050-1517 9b COPY 2 File this copy with your state, city, or local income tax retum, when required. Form 1099-R Department of the Treasury - Internal Reverwe Service PAYER'S name, sheet address, city, state, and ZIP code COMMONWEALTH OF PENNSYLVANIA STATE EMPLOYEES' RETIREMENT SYSTEM 30 NORTH THIRD ST STE 150 HARRISBURG, PA 17101-1716 PAYER'S Federal ID number RECIPIENT'S ID number 231732438 1162-48-0201 RECIPIENT'S name, street address, city, state and ZIP code *************AUTO**3-DIGIT 170 BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050-1517 Form 1099-R U CORRECTED (if checked) 1 Gross distribution OMB No. 1545-0119 883.28 2008 2a Taxable amount Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit- Sharing Plans, IRAs, Insurance Contracts, etc. Total distribution COPY B 5 Employee contributions Report this Income on your federal tax return. If this form 7 Dist. code(s) 9a Your total cost. shows federal 2 ado Income tax withheld in box 4, 9b Total employee contributions attach this copy to your return. This information is being furnished to the Internal Revenue Service. 2b Taxable amount a not determined 4 Federal Income tax wlthhNd $0.00 Department of the Treasury - Inlemal Revenue Service CORRECTED (if checked) PAYER'S name, street address, city, state, and ZIP code 1 Gross distribution COMMONWEALTH OF PENNSYLVANIA $883.28 STATE EMPLOYEES' RETIREMENT SYSTEM 2a Taxable amount 30 NORTH THIRD ST STE 150 $883.28 HARRISBURG, PA 17101-1716 2b Taxable amount not determined C PAYER'S Federal ID number RECIPIENT'S ID number 4 Federal Income tax withheld 231732438 1 162-48-0201 1 $0.00 RECIPIENT'S name, street address, city, state and ZIP code BARBARA S ZEIGLER 129 LINDA DR MECHANICSBURG, PA 17050-1517 Form 1099-R 0 1 1111111111 IN11101 in OMB NO. 1545-0119 Distributions From Pensions, Annuities, 2008 R or Profit- ha e Plans, IRAs, S g Insurance Contracts, etc. Form 1o99-R Total distribution COPY C 5 Employee contributions For Recipients Records 7 Dist. code(s) 9a Your total dist. This information is 2 % being furnished to 9b Total employee contributions the Internal Revenue Service. Medical premium Department of the Treasury - Internal Revenue Service In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 FEBRUARY 10, 2009 Payee Name: BARBARA S. ZEIGLER Payor Name: KEVIN M. DANNER PACSES Member Number: 0931101394 PACSES Case Number: 850106854 Other State ID Number: Please note: All correspondence must include the PACSES Can Number. Statement of Yearly Payments for Individual Case BARBARA SUZETTE ZEIGLER 129 LINDA DR MECHANICSBURG PA 17050-1517 Dear BARBARA SUZETTE ZEIGLER Court records indicate that a total of $ 2,004.08 was disbursed during 2008 . Total disbursed for: Family Support (Spouse/Child[ren]) $ Child(ren) Support $ Spousal Support/Alimony Pendente Lite/Alimony $ Medical Support $ Fees $ Total Disbursed on All Obligations: Sincerely, ACCOUNTING OFFICE 0.00 0.00 2,004.08 0.00 0.00 2,004.08 Form FI-016 Service Type M Worker ID 21204 *** REC 2009134 144354 HEF716EO BJ84 CIPQYA6 PQA6 (F-BJ8 ) *** SEQY DTE:05/14/09 AN:162-48-0201 DOC:A35 UNIT:JPL PG: 001 MEF: QN: 162-48-0201 NA: B S ZEIGLE DB: 04/1957 SX: F AK: SMITH SUY24ARY FICA EARNINGS FOR YEARS REQUESTED YEAR EARNINGS YEAR EARNINGS YEAR. EARNINGS YEAR EARNINGS 1971 197.15 1981 10969.17 1991 2663.22 2000 16236.08 1972 91.50 1982 12604.50 1992 565.48 2001 11996.80 1973 398.40 1983 8234.31 1993 511.50 2002 7929.74 1974 240.94 1984 284.38 1994 .00 2003 14531.59 1975 2157.37 1985 2031.15 1995 .00 2004 7353.48 1976 2557.32 1986 3921.10 1996 361.71 2005 6617.61 1977 3522.29 1987 1724.48 1997 10455.98 2006 2709.66 1978 2452.39 1988 6549.85 1998 11812.46 2007 9495.57 1979 7706.93 1989 9668.13 1999 11661.83 2008 16963.44 1980 10380.93 1990 1378.12 SUMMARY MQGE EARNINGS FOR YEARS REQUESTED NO MQGE EARNINGS FOR YEARS REQUESTED REMARKS CLAIMS ACTIVITY -- SEE MBR ioCIAL SECURITY `.NISTRATION 200 S SPRING GARDEN STREET, SUITE 7ARLISLE, PA 17013 6-17-04 P9 q M co LO 6 ? 00rM CQ t: fV-Wr- ^ M ppp ? S 00?O' R O ? ?..= fVOO as 3 F Y VO??ND 3 , Vc?iv Y S `?'? «? a p aOM^ ? o o aa. ?vF ooa+ri QD_M?O Y A ozH m A ? es ? c F - . 12 A ? o y o ? v Y ` p 4ain7 .o C7? v, kn 00 00 00 o v1 O N M ?O f ?OONNl CT ?o ?o t,- C? 0?0 O, O Y Y1 OQ 00 %O C^ ?O 'D l'.: - "6 00 l-: O? M GQ7 gyp.- O? ??NQ1?_ vi o0 00 M -^o 0 PO-, "C O_ A •O C? I":'":O?lle: '":(7?pM000?R 6A "88r- C4 V4 V-1 C4 IT "a v v b v 10 E 2L a a a w aa. H V U U U (SuoU 00 o 0 C Y o !w??o ?Q?pFa, o?Cao.?W wW E?u?yH I U.-IOU p Gwwwu.C7 «$00000 00 C_ a \IR ?p o 00 0 > LCCTP- C)eh N .l? aN?efNM ?O U 'r o? al0"?NhNNN ? aA1 Y ?wu yF Q.w d V 7 7 7 u C O c?Ur41 F 9 Label (SW L Instruction A on papa 14.) 0 E UM the IRS L IabN. N Otherwise, E please print R or type. E Presidential Elscdon ClrnDaltn Department of the Treasury-Internal Revenue Service (oo? U.S. Individual Income Tax Return % For tits year Jan. 14)m 31, 2001, or other tax ym h III I p , 2004, f Your first name and Initial T last name H a Joint ritum. spouse's first name and Initial last cane Home address (number and street). It you have a P.O. box, ass page 14. IRS Use Oniy-Do not wrlb or mpb in this spa:* .20 ` OMB No. i"F W74 Your loom esouripr me nber 166;46;2812 Spouse's soolsl security number Apt. no. City, town or post office, state, and LP code. H you have a foreign address, we page 14. ENOLA, PA 17025 1 119 Single Filing Status 2 ? Monied filing jointly (even H only one had income) Check only 3 ? Married filing separately. Enter spouse's SSN above one box. and full name here. ? 6• Exemptions b c 11 more than four dependents, see page 17. You must enter your SSN(s) above. Checking a box below will not change your tax or refund. 0. 11 You I] soouse 4 LJ Need of household (with quid"V persanj. (See papa 15.) H the quddit person is a chid but not your dependent, enter this d1Od's bane hero. 111, 6 [3 Qualifying wkiow(er) with dependent child (see page 16) Yourself. H someone can calm you as a dependent, do not check box 6a . . . . . . . . . . . . . . . . . . . . . . . . . . . (1) first name Lad name (!) 0ipsndent's sodsl sourly number (3) Dwerxiorri's to relationship oar (4) for dill lox 1 1 ? on M and fib 1 No. of ohiWrerk on So w1w e lived wish you • dfd not In with you due to dvoros or separation feee p•9. 1d) riot e on Add rarrtbsrs on d Total number of exemptions claimed . . . . . . . . . . . . . . . laws shove ? 1 . . 7 Wages, salaries' tips, etc. Attach Form(a) W-2 . . . . . . . . . T 36317 Income . . 8• Taxable Interest. Attach Schedule B H required . . . . 8s Attach Form(s) b Tax-exempt Interest. Do not include on One 8a . . . W-2 here. Also 9e Ordinary dividends. Attach Schedule B if required . . . 9a attach Forms W-20 and b ouall ied dividends (see page 21) 91) 1099-A H tax 10 Taxable refunds, credits, or offsets of state and local income taxes (see page 22) 10 was Witititeid. 11 Alimony received . . . . . . . . . . . . . . . . . . 11 12 Business income or poss. Attach Schedule C or C-EZ . . . . . . . 12 13 Capital gain or (loss). Attach Schedule D If required. If not required, check here ? ? 13 H you did not 14 Other gains or posses). Attach Form 4797 . . . . . 14 get a W-2, 164 IRA distributions 150 . . . . . b Taxable amount (sea paps 23) 161) see page 21. 18a Pensions and annuities lea b Taxable amount (see pope 24) 16b Enclose, but do 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17 M attach, any 18 Farm Income or poss). Attach Schedule F 1s payment. Also, use F 19 Unemployment compensation 19 orm 1040-V. 20a Social security benefits , 1 20a 1 1 1 b Taxable amount (sae page 26) 20b 21 Other Income. List type and amount (see page 28) ................................... 21 22 Add the amounts in the far right column for lines 7 through 21. This is urtotel income ? 36317 23 Educator expenses (see page 28) 2,1 Adjusted Gross 24 Certain business expenses of reservists, performing artists, and fee-baste govemment of cial& Attach Form 2106 or 2106-E2 24 Income 25 Health savings account deduction. Attach Form 8889. . 28 26 Moving expenses. Attach Form 3903 . . . . . . 28 27 One-half of self-employment tax. Attach Schedule SE . . 27 28 Self-employed SEP, SIMPLE, and qualified plans . . . 29 29 Self-employed health Insurance deduction (sse page 29) 29 30 Penalty on early withdrawal of savings , 30 310 Alimony paid b Recipient's SSN ? 16 2; 4 8: 0 2 01 314 2002 32 IRA deduction (see page 30) . . . . . . 32 33 Student loan Interest deduction (see page 33) . . . . 33 34 Tuition and fees deduction. Attach Form 8917 . . . . 34 36 Domestic production activities deduction. Attach Form 8903 36 36 Add lines 23 through 31 a and 32 through 36 . . . . . . . . . . . . . 36 2002 37 Subtract line 36 from line 22. This is our usted gross kmxmw , ? .3 431-SJ For Disol wu% PrHacy Act and Paperwork Reduction Act Notioe, see page 88. Ca. No. 11 ?9 t c? t ??:?:Il:il? nA?,?ftrr, 6 6 -17- o9 Ir6 Form 1040 (2008) Paps 2 TAY sa A-.nt frnm Ilrr A7 /arllunfri nrnca incnmal 343151 . ??. . ____ .......- -. I--,--,-- a.- ...--...-, , . , , , , and 300 Check ( ? You were born before January 2, 1944. ? Blind. Tofal boxes Credits if: Sl ? Spouse was born before January 2, 1944, ? Blind. checked ? 39a I b ti yar spouse lumina on a separate ret m or you were a dud stahq slim, ses paps 34 and check hen ? 39b Standard c Check If standard deduction includes real estate taxes or disaster loss (sea page 34) ? 39c 40 5450 Deduction 40 Iternltted deduadons (from Schedule A) or your standard deduction (see left margin) f . 41 41 Subtract line 40 from line 38 P who . . . . . . . . . . . . . . . . . . chockedary 42 If Una 38 is over $119,975, or you provided housing to a Midwestern displaced individual, see box on One 42 3500 page 36 500 by the total number of examptkxns claimed on Nne 8d Otherwise multiply $3 39a, 39b, or . , , 39c or who 25365 enter -0- 43 If line 42 is more than line 41 43 Taxable Income Subtract line 42 from line 41 l c t d . , . Check If any tax Is from: a ? Form(s) 8814 b ? Forum 4972 M 3405 44 Tax (see page 36) a rnee as a dePendwIt . 3 Attach Form 6251 48 Alternative minimum tax (see page 39) we pap t . . . . • • • • • ' 45 3405 48 Add lines 44 and 45 ? e AN other: . . . . . . . . . . . . . . . . . Single or 47 Foreign tax credit. Attach Form 1116 if required . . . . 47 Married Maras filing ly, 48 Credit for child and dependent care expenses. Attach Form 2441 48 $5,450 49 Credit for the elderly or the disabled. Attach Schedule R . 49 Maimed filing 50 Education credits. Attach Form 8863 . . . . . . . . 50 lointly or ouawykv 81 Retirement savings contributions credit. Attach Form 8880 51 , widow( 52 Child tax credit (see page 42). Attach Form 8901 It required . 52 $10,900 53 Credits from Form: a ? 8398 b ? 8839 c ? 5695 Head 154 Other credits from Form: a ? 3000 b ? 8801 c ? 54 household, 000 $8 55 Add lines 47 through 54. These are your total credits . . . . . . . . . . . 66 0 , 66 Subtract line 55 from line 46. If line 55 Is more than line 46, enter -0- . . ? 56 3405 57 57 Sent-employment tax. Attach Schedule SE . . . . . Other 56 Unreported social security and Medicare tax from Form: a ? 4137 b ? 8919 56 Taxes N 89 Additional tax on IRAs other qualified retirement plane etc Attach Form 5329 If required . , , . 60 Additional taxes: a ? AEIC payments b ? Housstaki employment taxes. Attach Schedule H 00 61 Add lines 56 through W. This Is your total tax . ? 8 3405 Payments 62 Federal income tax withheld from Forms W-2 and 1099 , . 62 3990 63 2008 estimated tax payments and amount applied from 2007 return 63 I *L . If you have a ; 64s Earned Income credit (EIC) NO "a attach child b Nontaxable combat pay election 64b , Schedule J 66 Excess social security and tier 1 RRTA tax withheld (see page 61) 86 86 Additional child tax credit. Attach Form 8812 . . . , 66 . 67 Amount paid with request for extension to file (see page 61) 67 68 Credits from Form: a ? 2439 b ? 4136 c ? 8801 d ? 8885 68 89 First-time homebuyer credit. Attach Form 5405. . . . . N 70 Recovery rebate credit (see worksheet on pages 62 and 63). 70 71 Add lines 62 through 70. These are our total . ? 71 3 9 9 0 Refund 72 If line 71 is more than line 61, subtract line 61 from line 71. This is the amount you overpold 72 585 Direct deposit? 73a Amount of line 72 ou want refunded to you. M Form 8888 Is attached, check here ? ? 73a 585 See paps 63 ? b Routing number 2 3 1 3 8 2 2 4 111- o Type: ® Checift ? Sa*v and AN in 73b, 73c, and 78d, ? d Account number 2 1 8 2 5 3 5 7 0 4 or Form 8886. 74 Amount of line 72 want t0 r 2009 estimated tax ? 74 Oulu 75 AnxKmt you owe. Subtract line 71 from line 61. For details on how to pay, see page 65 ? 78 01 YOU QWS 76 Estimated tax parts" sae page 65 76 n.;,A D..,ti„ Do you want to allow another person to discuss this return with the IRS (see page 66)? ? Yes. Complete the following. ® No Designee Deslprwe's Phone PersonelldsntMention name ? no. ? I ) number (PIM ? Sign tinder penalties of perjury, I declare that I have examIrW this return ate aooornpw*W schedules and statements, end to the best of my knowlsdps and Here belief, OW are true, correct, end campbts. Decoration of prepaer (other than taxpayer) is bead on all i tortnetion of which rxeprar has any bawtsdps. Joint return? Your signature Date Your occupation Dfy8me phone number See pegs 15 LABOR L Keep for a copy Spouse's signature. tt a Joint Mm, both must sign. Date Spare's occupation your records. Paid s Date Check It s S SN or PnN SOW" ? SELF-PREPARED sere-employed ? ureparels's Fri sddnanew (or ; r?ployem EIN ,and-a2IP code Phone no ( 1 Form 1040 (2008) 4000000235 vmo rvo. inn-wuo vuNy r.+ IV vv r .vu -L., Ll l lillVy GC a, LVLrll1L '0A -tunl mployer identification number (EIN) 23-6050136 1 Wages, tips, other compensation 33260.27 2 Federal income tax withheld 3537.05 mptoyers name, address, and ZIP code Hampden Township 3 Social security wages 33280.27 4 Social security tax withheld 2063.35 230 S. Sporting Hill Rd. 5 Medicare wages and tips 33280.27 6 Medicare tax withheld 482.53 MECHANICSBURG, PA 17050 7 Social security tips 8 Allocated Ups 9 Advance EIC payment 10 Dependent care benefits 11 Nonqualified plans 12a Code mployee's social security number C 60.84 166-46-2812 12b Code 12c Code 12d Code mployes's name address and ZIP code Suff. , KEVIN M DANNER 13 Statutory employee 14 Other PAUC 29.88 P O Box 126 Enola, PA 17025 Retirement plan X Third-party sick pay State Employers state ID number PA 23-6050136 16 State wages, tips, etc. 33219.43 17 State income tax 1019.85 18 Local wages, tips, etc 33219.43 . 19 Local income tax 531.48 20 Locality name m W-2 Wage and Tax Statement 2006 Department of the Treasury - Internal Revenue Service 0000000235 OMB No. 1545-0008 Copy 2 To Be Filed With Employee's State, City, or Local Tax Return -mployer identification number (EIN) 23-6050136 1 Wages, tips, other compensation 33280.27 2 Federal income tax withheld 3537.05 -mployer's name, address, and ZIP code Hampden Township 3 Social security wages 33280.27 4 Social security tax withheld 2063.35 230 S. Sporting Hill Rd. 5 Medicare wages and tips 33280.27 6 Medicare tax withheld 482.53 MECHANICSBURG, PA 17050 7 Social security tips 8 Allocated Ups 9 Advance EIC payment 10 Dependent care benefits 11 Nonqualified plans 12a Code Employee's social security number C 60.84 166-46-2812 12b Code 12c Code 12d Code Employee's name, address and ZIP code Suff. KEVIN M DANNER 13 Statutory employee 14 Other PAUC 29.88 P O Box 126 Enola, PA 17025 Retirement plan X Third-party sick pay State Employers state ID number PA 23-6050136 16 State wages, Ups, etc. 33219.43 17 State income tax 1019.85 18 Local wages, tips, etc 33219.43 . 19 Local income tax 531.48 20 Localityname rm W-2 Wage and Tax Statement 2006 0000000235 1 OMB No. 1545'0008 Ayers name, address, and ZIP code Hampden Township 230 S. Sporting Hill Rd. MECHANICSBURG, PA 17050 Department of the Treasury - Internal Revenue Service spy C For EMPLOYEE'S RECORDS - This information is being furnished to the Internal Revenue Service. If you are required to file a lax urn, a negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it, 23-6050136 1 Wages, tips, other compensation 33280.27 2 Federal income tax withheld 3537.05 3 Social security wages 33280.27 4 Social security tax withheld 2063.35 5 Medicare wages and tips 33280.27 6 Medicare tax withheld 482.53 7 Social security lips 8 Allocated Ups 9 Advance Etc payment 10 Dependent care benefits 11 Nonqualified plans 12a Code C 60.84 166-46-2812 12b Code 12c Code 12d Code Employee's name, address and ZIP code Suff. 13 14 Other KEVIN M DANNER Statutory employee PAUC 29.88 P O Box 126 Enola, PA 17025 Retirement plan X Third-party sick pay i State Employers state ID nunnber 16 State wages, Ups, etc. 17 State income tax 18 Local wages, Ups, etc. 19 Local income tax 20 Locality name PA 23-6050136 33219.43 1019.85 33219.43 531.48 rm W-2 Wage and Tax Statement 2006 Department of the Treasury - Internal Revenue Service ks Q' O a Employee'ssocial security number 1 6666- -46-2812 OMBNo. 1545-0008 Copy 6 To Be Filed With Employee's FEDERAL Tax Return b Employer identification number (EIN) 23-6050136 1 Wages, lips, other compensation 35652.22 2 Federal income tax withheld 3945.34 c Employers name, address, and ZIP code Hampden Township 3 Social security wages 35652.22 4 Social security tax withheld 2210.44 230 S. Sporting Hill Rd. 5 Medicare wages and tips 35652.22 6 Medicare tax withheld 517.00 MECHANICSBURG, PA 17050 7 Social security tips 8 Allocated tips 9 Advance EIC payment 10 Dependent care benefits 11 Nonqualified plans 12a Code d Control number C 71.50 0000000245 12b Code 12c Code 12d Code e Employee's name, address and ZIP code Suit. KEVIN M DANNER 13 Statutory employee 14 Other LST 52.00 P O Box 126 Enola, PA 17025 Retirement plan X PAUC 32.02 Third-party sick pay 15 State Employers state ID number PA 23-6050136 16 State wages, tips. etc. 35580.72 17 State income tax 1092.33 18 Local wages, tips, etc 35580.72 . 19 Local income tax 569.33 20 Locality name orm W-2 Wage and Tax Statement 2007 Department of the Treasury - Internal Revenue Service a Employee's social security number 16666- -46-2812 OMB No. 1545-0008 Copy 2 To Be Filed With Employee's State, City, or Local Tax Return b Employer identification number (EIN) 23-6050136 1 Wages, tips, other compensation 35652.22 2 Federal income tax withheld 3945.34 c Employers name, address, and ZIP code Hampden Township 3 Social security wages 35652.22 4 Social security tax withheld 2210.44 230 S. Sporting Hill Rd. 5 Medicare wages and tips 35652.22 6 Medicare tax withheld 517.00 MECHANICSBURG, PA 17050 7 Social security tips 8 Allocated tips 9 Advance EIC payment 10 Dependent care benefits 11 Nonqualified plans 12a Code d Control number C 71.50 0000000245 12b Code 12c Code 12d Code e Employee's name, address and ZIP code Suff. KEVIN M DANNER 13 Statutory employee 14 Other LST 52 00 P O Box 126 Enola, PA 17025 Retirement plan X . PAUC 32.02 Third-party sick pay 15 Slate Employers state ID number PA 23-6050136 16 State wages, tips, etc. 35580.72 17 State income tax 1092.33 18 Local wages, tips, etc 35580.72 . 19 Local income tax 569.33 20 Locality name =orm W-2 Wage and Tax Statement 2007 Department of the Treasury - Internal Revenue Service a Employee's SSN 166-46-2812 OMB No. 1545-0008 Copy C For EMPLOYEE'S RECORDS - This information Is being furnished to the Internal Revenue Service. If you are re uired to file a lax return, a negligence penalty or other sanction may be imposed oyou if this Income is taxable and you (ail to report ft. q b Employer identification number (EfN) 23-6050136 1 Wages, tips, other compensation 35652.22 2 Federal income tax withheld 3945.34 c Employers name, address, and ZIP code Hampden Township 3 Social security wages 35652.22 4 Social security tax withheld 2210.44 230 S. Sporting Hill Rd. 5 Medicare wages and tips 35652.22 6 Medicare tax withheld 517.00 MECHANICSBURG, PA 17050 7 Social security tips 8 Allocated tips 9 Advance EIC payment 10 Dependent care benefits 11 Nonqualified plans 12a Code d Control number C 71.50 0000000245 12b Code 12c Code 12d Code e Employee's name, address and ZIP code Suff. KEVIN M DANNER 13 Statutory employee 14 Other LST 52 00 P O Box 126 Enola, PA 17025 Retirement plan X . PAUC 32.02 Third-party sick pay is state Employers state ID number PA 23-6050136 16 State wages, Nps, etc. 35580.72 17 State income tax 1092.33 18 Local wages, tips, etc. 35580.72 19 Local income tax 569.33 20 Locality name Form W-2 Wage and Tax Statement 2007 Department of the Treasury - Internal Revenue Service a Lmployee's SSN 1 OMB W 1545 0008 For EMPLOYEE'S RECORDS • This information is being tu n . v to the internal Ho . „ .. __ 166-4 6-2812 1 . return, negligence pen alty or other sanction may be e Imposed on if t e t it. you fail you if this income e Is la taxable and d you fail to report it. b Employer Identhication number (EIN) 1 Wages, bps, other compensation 2 Federal income tax withheld 23-6050136 36316.63 3990.40 c Employers name, address, arW0 3 Social security wages 4 Social security tax withheld Hampden Tottnship 36316.63 2251.66 . tax 230 S. Sporting Hill Ad. r 36316.63 526.64 Mechanicsburg, PA 17050 7 Social security tips 8 Allocated bps 9 Advance EIC payment 10 Dependent care benefits 11 Nonqualified plans 12a Cade C 149 6 d Control number .2 0000000260 12b Code t2c Code 12d Code e Em lo ee's name address and ZIP code Suff p , y . 13 14 Other XEVIN M DANNlR Statutory employee PAUC 21.70 P 0 Box 126 Retirement plan X LST 52.00 PA 17025 Xnola , Third-party sick pay is state Employer's state ID number 16 Suite wages, tlps, etc. 17 State income tax 18 local wages, tips, etc. 19 Local income tax 20 Locaety name PA 23-6050136 36166.67 1110.30 36166.67 579.71 Form W-2 Wage and Tax Statement 2008 Department of the Treasury - Internal Revenue Service EMPLOYEE SOCIAL SECURITY PERIOD ENDING EMPLOYEE NAME ID NUMBER DATE y%AKlXlvD L EARNINGS DEDUCTIONS LEAVE :SCRIPTION HOURS AMOUNT _ DESCRIPTION AMOUNT YEAR-TO-DATE DESCRIPTION USED LEAVE BALANCE •)C)u)° I.Yf)a '72.00 •792.00 ME 1) 1 1.°3.:.;4 382. '". :> i c k I.f-? av .0 .y.<) 50 :a er i (ne 2.::i0 41.25 •f' i ca . 90 J.6 34 , 36 vac::a -I- i on 83 00 'x'2 .00 vclca 1. 1x,)1'1 8„{){) X38.00 -f•c-d i M 1. 47.23 J.696. 82 I:yr.-)r<3C)-itta I. .0{ .50 1. cm a 9.21. 263 52 t11.1f fn . 1.8 .`.'i .::'.`.'i * u DC: C 00 1 C l . . I)e •(' 2 2, {){) ::5;3 7 .';){) CHECK DATE CHECK NO. _ NET PAY AMOUNT RRENT EARNINGS 25 921 CURRENT DEDUCTIONS 75 86 1 CURRENT 4"=? 9 ) EARNINGS - ^y,r °x nCi °xor.; YTD DEDUCTIONS . r } (?/-. I YTD 21 OW 32 PETITIONER'S EXHIBIT 6-f 7-d4 AC Arthur K. Dils, Esquire DILS AND DILS 1400 North Second Street Diane M. Dils, Esquire Harrisburg, PA 17102 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA BARBARA S. ZEIGLER Plaintiff vs. NO. 04-724 PACSES NO. 850106854 KEVIN M. DANNER Defendant INCOME AND EXPENSE STATEMENT UNDER Pa.R.C.P. 1920.31(a)(1) This Form Must Be Completed (If you are self-employed or if you are salaried by a business of which you are the 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 AND EXPENSE STATEMENT OF KEVIN M. DANNER I verify that the statements made in this Income and Expense Statement are true and correct. I understand that false statements herein are a subject to the penalf s of 18 Pa.C.S. § 4909 relating to unsworn falsification to authorities r Date: -412 Diane M. Dils Attorney for efendant INCOME: Employer: Hampden Townsh Address: City, State, ZIP Type of Work: Payroll Number: SEE PAYSTUB OF 6-2-09 ATTACHED Gross Pay per Pay Period: RESPONDENT'S! EXHIBI Arthur K. Dils, Esquire Diane M. Dils, Esquire DILS AND DILS 1400 North Second Street Harrisburg, PA 17102 ITEMIZED PAYROLL DEDUCTIONS: (Bi-Weekly) NAME AMOUNT Federal Withholding SEE $ - Social Security $ - Local Wage Tax ATTACHED $ - Occupational Tax $ - State Income Tax PAYSTUB $ - Misc. Tax $ - Retirement $ - Savings Bonds $ - Union $ - Life Insurance $ - Health Insurance $ - Medicare $ - Unemployment Tax $ - Disability Insurance $ - Other: $ - Misc. $ - Misc. $ - Misc. $ - Total Itemized Payroll Deductions $ - Gross Pay Per Pay Period $ - Net Income Per Pay: $ - OTHER INCOME: (Fill In Appropriate Column) WEEK MONTH YEAR Alimony $ - $ - $ - Interest $ - $ - $ - Dividends $ - $ - $ - Pension $ - $ - $ - Annuity $ - $ - $ - Social Security $ - $ - $ - Rents $ - $ - $ - Royalties $ - $ - $ - Expense Account $ - $ - $ - Gifts $ - $ - $ - Unemployment Compensation $ - $ - $ - Workmen's Compensation $ - $ - $ - Misc. Misc. Misc. TOTAL GROSS INCOME: $ - $ - $ - TOTAL TAXES: $ - $ - $ - TOTAL NET INCOME: $ - $ - $ - Arthur K. Dils, Esquire DILS AND DILS 1400 North Second Street Diane M. Dils, Esquire Harrisburg, PA 17102 EXPENSES (Fill In Appropriate Column) WEEK MONTH YEAR HOME Mortgage/Rent (LOT RENT) $ - $ 300.00 $ - Maintenance $ - $ - $ - Utilities $ - $ - $ - Electric $ - $ 30.00 $ - Gas $ - $ - $ - Oil (Average) $ - $ - $ 1,100.00 Telephone $ - $ 75.00 $ - Water $ - $ - $ - Sewer $ - $ - $ - Trash $ - $ - $ - Misc. $ - $ - $ - Misc. $ - $ - $ - EMPLOYMENT (Fill In Appropriate Column) WEEK MONTH YEAR Public Transportation $ - $ - $ - Lunch $ - $ 120.00 $ - Misc. $ - $ _ $ _ Misc. $ - $ - $ Misc. $ - $ - $ - TAXES (Fill In Appropriate Column) WEEK MONTH YEAR Real Estate $ - $ - $ - Personal Property $ - $ - $ - Income (Federal, State & Local) $ - $ - $ - Other $ - $ - $ - Other $ - $ - $ - Other $ - $ - $ - Other $ - $ - $ - INSURANCE (Fill In Appropriate Column) WEEK MONTH YEAR Homeowners $ - $ - $ - Automobile $ - $ 88.33 $ - Life $ - $ - $ - Accident $ - $ - $ - Health $ - $ - $ - Other $ - $ - $ - DILS AND DILS 1400 North Second Street Harrisburg, PA 17102 Arthur K. Dils, Esquire Diane M. Dils, Esquire AUTOMOBILE (Fill In Appropriate Column) WEEK MONTH YEAR Payments $ - $ - $ - Fuel $ - $ 350.00 $ - Repairs (Average) $ - $ - $ 150.00 Other $ - $ - $ - Other $ - $ - $ - Other $ - $ - $ - MEDICAL (Fill In Appropriate Column) WEEK MONTH YEAR Doctor $ - $ - $ 100.00 Dentist $ - $ - $ - Orthodontist $ - $ - $ - Hospital $ - $ - $ - Medicine $ - $ 15.00 $ - Special Needs (Glasses, Braces, $ - $ - $ - Orthopecic Needs) $ - $ - $ - Other $ - $ - $ - Other $ - $ - $ - Other $ - $ - $ - EDUCATION (Fill In Appropriate Column) WEEK MONTH YEAR Private School $ - $ - $ - Parochial School $ - $ - $ - College $ - $ - $ - Religious $ - $ - $ - Charter $ - $ - $ - Other $ - $ - $ - Other $ - $ - $ - Other $ - $ - $ - PERSONAL (Fill In Appropriate Column) WEEK MONTH YEAR Clothing $ - $ - $ 500.00 Food $ - $ 400.00 $ - Barber/Hairdresser $ - $ 12.00 $ - Other: $ - $ - $ - Other: $ - $ - $ - Other: $ - $ - $ - Other: $ - $ - $ - Arthur K. Dils, Esquire DILS AND DILS 1400 North Second Street Diane M. Dils, Esquire Harrisburg, PA 17102 CREDIT PAYMENTS (Fill In Appropriate Column) WEEK Credit Card Accounts $ - Mastercard Charge Accounts $ - Memberships $ - Other: $ - Other: $ - Other: $ - LOANS (Fill In Appropriate Column) WEEK Credit Union $ - Home Equity Loan $ - Personal Members 1st $ - Other Citifinancial $ - Other $ - Other $ - MISCELLANEOUS (Fill In Appropriate Column) WEEK Household Help $ - Child Care $ - Papers/Books/Magazines (Average) $ - Entertainment $ - Pay TV $ - Vacation $ - Gifts $ - Legal Fees $ - Charitable Contributions $ - Other Child Support $ - Alimony Payments $ - Savings $ - Other: $ - Other $ - Other $ - Other $ - TOTAL EXPENSES: MONTH YEAR $ 60.00 $ - MONTH YEAR $ 210.00 $ - $ 401.00 $ - MONTH YEAR $ •866- $ - $ gD -op $ee-ee $ - $ ace - oc $ - $ 4 A69-% $ - $ 20dO -d4 $ 2,141.33 $ 4,150.00 1 Arthur K. Dils, Esquire Diane M. Dils, Esquire DILS AND DILS 1400 North Second Street Harrisburg, PA 17102 PROPERTY OWNED: OWNERSHIP NAME DESCRIPTION VALUE HUSBAND WIFE JOINT Checking Acct. $ - Savings Acct. $ - Credit Union $ - Stocks/Bonds $ - Real Estate $ - Other $ - Other $ - Other $ - Other $ - Total $ - INSURANCE: COVERAGE POLICY NAME COMPANY NUMBER HUSBAND WIFE JOINT Hospital: Blue Cross Other Other Other POLICY Medical: COMPANY NUMBER HUSBAND WIFE JOINT Blue Shield Medicare Other Delta Dental X Other Davis Vision X Other Medical x OF T F , :F1 ?Y ' o CD d ° , < ? C D ?, o c PO 00 A 00 tr N O? U 0O O OO OOOOOy N? O O • s n 00 tl? w oo w o v, w -t ? ?O )O ?l w O J ?D ? ? ONN OA00N? ? O O OO?OOO,r. y y C) 0 d co ??yc?'p' o c'o oo`°a7,bd CD -, cc o y ? k is -o 00 0 0 1 a o 0 0 "0 7: "0 ll? 10 10 mC. il.. a It n a 0 0 ° b r. f]? V? N tl? O N N J -••-0o N S 'b A ?O ?O O? N O 57, 91 90 J •.• .r •• 00 (p OoJ000W OOO CNtj ?• AOcn J A OOOOAJ,. d. ?O y 0 V .1 .-. •-N ? N to N to N N '101 N NO W p ?°AA00NO 00 00 1,D ?-+.•O1-B O tnOA? -- w w O Aww?°••rp `p 0000 (D OO?ON 000 ??Cn Uw Jc OOOtJi 00 U O O 0 O A O? 00 A O? ? P+ ? G n d d 'f Da a O? A ? y z'' w d d ~? oom ., ., ??oo Aw 0 ? p p A 00 lA w O C O m 0007 _ p wAJA W N 0000 N NSA-'Om 0000000 NJOA W ?O O t9 0 c m V CO CO N G -i BARBARA S. ZEIGLER, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 04-724 CIVIL TERM KEVIN M. DANNER, IN DIVORCE Defendant/Petitioner PACSES CASE: 850106854 ORDER OF COURT AND NOW to wit, this 29th day of October, 2009, it is hereby Ordered that the Order for Alimony Pendente Lite is terminated, effective October 16, 2009, pursuant to the parties' Property Settlement Agreement of October 16, 2009. There is a remaining balance of $729.98 that is to be paid off at the rate of $400.00 per month with the existing wage garnishment. 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. BY THE COURT: Kevin ess,, J. DRO: R.J. Shadday xc: Petitioner Respondent Mary A. Etter-Dissinger, Esq. Diane M. Dils, Esq. Form OE-001 Service "Type: M Worker: 21005 Rte-OFFICE OF Tt ,, 1HO'( 2009 OCT 29 PM ': 34 CUM 4;i i a ? COUNTY PENNSYLVANIA ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 04-724 CIVIL State Commonwealth of Pennsylvania QOriginal Order/Notice Co./City/Dist. of CUMBERLAND OAmended Order/Notice Date of Order/Notice 10/29/09 (2 Terminate Order/Notice Case Number (See Addendum for case summary) QOne-Time Lump Sum/Notice Employer/Withholder's Federal EIN Number HAMPDEN TOWNSHIP 230 S SPORTING HILL RD MECHANICSBURG PA 17050-3212 RE:DANNER, KEVIN M. Employee/Obligor's Name (Last, First, MI) 166-46-2812 Employee/Obligor's Social Security Number 1931101390 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current child support $ 0.00 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 $ o . oo 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 $ o. 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: $ 0.00 per weekly pay period. $ o. oo per semimonthly pay period (twice a month) $ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. 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 FITS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. i BY THE COURT: ?• 0* Tl?-- T TT--.- DRO: R.J. Shadday Service Type M OMB No.: 0970-0154 Form EN-028 Rev.5 Worker 1 D $ IATT ri Ak ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If#hecketi you are required to provide aopy of this form to your mployee. If yoYr employee orks in a state that is di Brent rom the state that issued this o er, a copy must be provided to 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 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. 2360501360 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: F-J EMPLOYEE'S/OBLIGOR'S NAME:DANNER, KEVIN M. EMPLOYEE'S CASE IDENTIFIER: 1931101390 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 employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA 0 5 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST 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 T e M OMB No.: 0970-0154 YP Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: DANNER, KEVIN M. PACSES Case Number 850106854 PACSES Case Number Plaintiff Name Plaintiff Name BARBARA S. ZEIGLER Docket Attachment Amount Docket Attachment Amount 04-724 CIVIL $ 0.00 $ 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 OMS No.: 0970-0154 Worker ID $IATT OF THE P'k)i `-?r^,=t OTARY 2009 OCT 30 PM Z: 4 3 C4f.. =:aJ?Y KEVIN M. DANNER IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 04-724 BARBARA A. ZEIGLER CIVIL ACTION - LAW Defendant IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on February 18, 2004. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final Decree in Divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this Affidavit are true and correct. I understand that false statements made herein are made subject to the penalties of 18 Pa. C.S. §4904, relating to unsworn falsification to authorities. WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final Decree in Divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a Divorce Decree is entered by the Court and that a copy of the Decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Waiver 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,/z Kevin M. Danner, Plaintiff ,? __ - :. ?? ? ??. ?i'-fit/ KEVIN M. DANNER IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. : NO. 04-724 BARBARA,ZEIGLER CIVIL ACTION -LAW Defendant IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on February 18, 2004. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final Decree in Divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this Affidavit are true and correct. I understand that false statements made herein are made subject to the penalties of 18 Pa. C.S. §4904, relating to unsworn falsification to authorities. WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final Decree in Divorce without notice. 2. I -understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a Divorce Decree is entered by the Court and that a copy of the Decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Waiver 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: Barbara S. Zeigler, e enda r,. _,_, _ „ .._ , .::, • t r ?.? '? - .. r,l ?a r... ?tl V PROPERTY SETTLEMENT AGREEMENT THIS AGREEMENT is made this day of ??u r 2009, by and between: KEVIN M. DANNER, hereinafter referred to as Husband; --AND-- BARBARA S. ZEIGLER, hereinafter referred to as Wife; WITNESSETH: WHEREAS, Husband and Wife were lawfully married on May 14, 1998; and WHEREAS, there are no minor children born of the marriage. )6p'Q_ KMD ?Sz OAL WHEREAS, diverse unhappy marital difficulties have arisen between the parties causing them to believe that their marriage is irretrievably broken, as a result of which they have separated and now live separate and apart from one another, the parties being estranged due to such marital difficulties with no reasonable expectation of reconciliation; and the parties hereto are desirous of settling fully and finally their respective financial and property rights and obligations as between each other, including without limitation by specification: the settling of all matters between them relating to the ownership of real and personal property; and in general, the settling of any and all claims and possible claims by one against the other or against their respective estate, particularly those responsibilities and rights growing out of the marriage relationship. NOW THEREFORE, in consideration of the mutual promises, covenants and undertakings hereinafter set forth and for other good and valuable consideration, the 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: 1. SEPARATION It shall be lawful for each party, at all times hereafter, to live separate and apart from the other, at such place or places as he or she may, from time to time, choose or deem fit. Each party shall be free from interference, authority or contact by the other, as fully as if he or she were single and unmarried, except as may be N Initials K n Initial$S KMD BAZ necessary to carry out the provisions of this Agreement. Neither party shall molest the other or attempt to endeavor to molest the other, nor compel the other to cohabit with the other, or in any way harass or malign the other, nor in any way interfere with the peaceful existence, separate and apart from the other. Should a Decree, Judgment, or Order of separation or divorce be obtained by either of the parties in this or any other state, country or jurisdiction, each of the parties hereby consents and agrees that this Agreement and all of its covenants shall not be affected in any way by any such separation or divorce; and that nothing in any such Decree, Judgment, Order or further modification or revision thereof shall alter, amend or vary any term of this Agreement, whether or not either or both of the parties shall remarry, it being understood by and between the parties hereto, that this Agreement shall survive and shall not be merged into any Decree, Judgment, or Order of divorce or separation. It is specifically agreed however, that a copy of this Agreement or the substance of the provisions thereof, may be incorporated by reference into any Order of divorce, Judgment, or Decree. This incorporation, however, shall not be regarded as a merger, it being the specific intent of the parties to permit this Agreement to survive any Judgment and be forever binding and conclusive upon the parties. 2. EFFECTIVE DATE The effective date of this Agreement shall be the "date of execution" or "execution date", defined as the date upon which it is executed by the parties if M a Initials K" Initials`;?Sz- KMD BAZ they have each executed the Agreement on the same date. Otherwise, the "date of execution" or "execution date" of this Agreement shall be defined as the date of execution by the party last executing this Agreement. 3. MUTUAL RELEASES Husband and Wife do hereby mutually remise, release, quit-claim or forever discharge the other and estate of such other, for all time to come, and for all purposes whatsoever, from any and all rights, title and interest, or claims in or against the estate of such other, or whatever nature and wherever situate, which he or she now has or at any time hereafter may have against such other, the estate of such other or any part thereof, whether arising out of any former acts, contracts, engagements, or liabilities of such other or by way of dower or curtesy, of claims in the nature of dower or curtesy, or widow's or widower'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 or a surviving spouse to participate in a deceased spouse's estate, whether arising under the United States, or any other country; or any rights which either party may now have or at any time hereafter have for the past, present, or future support or maintenance, alimony, alimony pendente lite, counsel fees, costs or expenses, whether arising as a result of the marital relation or otherwise, except all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. a Initials ?Q InitialsJJ?Z KMD BAZ It is the intention of Husband and Wife to give to each other, by the execution of this Agreement, a full, complete and general release with respect to any and all property of any kind or nature, real, personal, or mixed, which the other now owns or may hereafter acquire, except, and only except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. 4. DISTRIBUTION DATE The transfer of property, funds and/or documents provided for herein shall only take place on the "distribution date" which shall be defined as the date of execution of the Divorce Decree, unless otherwise specified herein. 5. MUTUAL CONSENT/ADVICE OF COUNSEL Husband and Wife acknowledge and understand the terms and conditions of this Agreement, and Wife is represented by Mary A. Etter Dissinger, Esquire, and Husband is represented by Diane M. Dils, Esquire. Each party acknowledges that he or she has received or has been given an opportunity to receive independent advice from counsel of his or her selection and was fully informed as to his or her legal rights and obligations. Husband and Wife acknowledge that they fully understand the facts as to their legal rights and obligations under this Agreement. Husband and Wife acknowledge and accept that this Agreement is, under the circumstances, fair and equitable and that it is being entered into freely and voluntarily, and that the a Initials XAO InitialsS%-Z KMD BAZ execution of this Agreement is not the result of any collusion or improper or illegal agreement or agreements. 6. FINANCIAL DISCLOSURE The parties confirm that each has relied on the substantial accuracy of the financial disclosure of the other as an inducement to the execution of this Agreement. Notwithstanding the foregoing, the rights of either party to pursue a claim for equitable distribution, pursuant to the Pennsylvania Divorce Code, of any interest owed by the other party in an asset of any nature at any time prior to the date of execution of this Agreement that was not disclosed to the other party or his or her counsel prior to the date of the within Agreement is expressly reserved. In the event that either party, at any time hereafter, discovers such an undisclosed asset, the parties shall have the right to petition the Court of Common Pleas of Dauphin County to make equitable distribution of said asset. The non-disclosing party shall be responsible for payment of counsel fees, costs, or expenses incurred by the other party in seeking equitable distribution of said asset. 7. DEBTS AND OBLIGATIONS Husband represents and warrants to Wife that since 2004, he has not, and in the future he will not contract or incur any debt or liability for which Wife or her estate might be responsible and shall indemnify and save Wife harmless from any M a Initials K" InitialsB-S--Z KMD BAZ and all claims or demands made against her by reason of such debts or obligations incurred by him since the date of said separation, except as otherwise set forth herein. Wife represents and warrants to Husband that since 2004, she has not, and in the future she will not contract or incur any debt or liability for which Husband or his estate might be responsible and shall indemnify and save Husband harmless from any and all claims or demands made against him by reason of such debts or obligations incurred by her since the date of said separation, except as otherwise set forth herein. 8. REAL ESTATE Husband and Wife hereby acknowledge that they are the joint owners as tenants by the entireties of real estate located at 129 Linda Drive, Mechanicsburg, Cumberland County, Pennsylvania 17055. Wife hereto waives all of her right, title and interest in said real estate to Husband upon a lump sum payment of Fifty Thousand Dollars (50,000.00). Husband hereby agrees to pay to Wife the sum of Fifty Thousand Dollars ($50,000.00) representing Wife's agreed portion of the equity of the real estate. Wife hereby agrees that she will execute a Deed placing the real estate into Husband's name alone. Husband and Wife hereby acknowledge that Husband will immediately obtain financing utilizing the terms of this Property Settlement Agreement to a Initials AAO Initials V-) KMD BAZ obtain the Fifty Thousand Dollars ($50,000.00) for payment to Wife. Husband hereby acknowledges his agreement to pay to Wife said sum of Fifty Thousand Dollars ($50,000.00) within thirty (30) days of the execution of this Agreement. Wife hereby agrees that she will simultaneously with the execution of this Agreement execute a Deed placing the real estate into Husband's name alone which shall be held in escrow with Wife's attorney and said Deed shall be turned over directly to the mortgage/financing institution when requested, at the time of the closing of the financing for said payment of Fifty Thousand Dollars ($50,000.00) to Wife. Wife hereby agrees that she shall vacate the real estate within sixty (60) days after the receipt of Fifty Thousand Dollars ($50,000.00). Wife hereby acknowledges that she will vacate the real estate leaving it in the same condition as it is currently. Husband and Wife hereby agree that Husband may walk through the premises at or about the execution of this Agreement and again at the time that Wife vacates the premises. Husband hereby agrees that he will provide notification to Wife's attorney of his intended walk through of the real estate and it is hereby acknowledged that said walk through shall be coordinated with Wife's attorney, with Husband providing at least three (3) days advance notice. Husband and Wife hereby acknowledge that Wife has paid the county/township taxes for the real estate for the period of January through a Initials Initialsn-%z KMD BAZ December, 2009 and that Husband shall be responsible for the payment of the school tax for the period July 1, 2009 through June 30, 2010. Husband and Wife further acknowledge that Husband shall become the sole and separate owner of the trailer and the addition on the real estate and Wife hereby agrees that she shall execute the titles to the same and that said titles shall be retained by her attorney until payment of the Fifty Thousand Dollars ($50,000.00) is made to Wife. At that time, the titles to the trailer and the addition shall be turned over to Husband. 9. PERSONAL PROPERTY Husband and Wife hereby acknowledge that Wife has been residing in the real estate since 2004 and Husband hereby agrees that Wife shall retain all items of personal property, household furnishings that are in the real estate including two sheds and Wife shall remove all times at the time she vacates the real estate. Husband and Wife hereby agree that Husband shall retain all items of personalty in his possession. 10. PENSIONS/RETIREMENTS Husband and Wife hereby acknowledge that Wife has accumulated a pension through her employment with the Commonwealth of Pennsylvania and said retirement is in pay status currently. Husband hereby waives all of his right, title and interest which he has to the pension of Wife through the Commonwealth W a Initials 41" Initials '?>SZ KMD BAZ of Pennsylvania. Husband and Wife hereby acknowledge that Husband has accumulated a pension plan as a result of his employment with Hampden Township. Wife hereby waives all of her right, title and interest in said pension plan and agrees to execute any and all documents necessary. 11. SPOUSAL SUPPORT/ALIMONY PENDENTE LITE Husband and Wife hereby acknowledge that Husband is currently paying Alimony Pendente Lite through the Domestic Relations Office in the Court of Common Pleas of Cumberland County, said Order is Docketed to No. 04-724 Civil Term, PACSES No. 850106854. Husband and Wife hereby agree that said Alimony Pendente Lite Order shall be terminated upon execution of this Property Settlement Agreement. Husband and Wife hereby acknowledges that if Husband is unable to obtain the payment to Wife in the amount of Fifty Thousand Dollars ($50,000.00) as set forth in Paragraph 8 above within thirty (30) days of the execution of this agreement, that the Alimony Pendente Lite Order shall be reinstated until such time as said payment is received by Wife, and the real estate shall immediately be listed with a real estate agent at a sale price of One Hundred Eighty Five Thousand Dollars ($185,000.00) and upon sale, Wife shall receive one-half of the net proceeds from the sale of the residence. O a InitialsI<An Initials'Z KMD BAZ Wife hereby specifically waives all of her right, title and interest which she may, or may not have, as to Alimony, Counsel Fees, Costs and Expenses incidental to this divorce action. 12. WAIVER OF RIGHTS The parties hereto fully understand their rights under and pursuant to the Divorce Code, Act of 1980, No. 1980-26, as amended February 12, 1998, particularly the provisions for alimony pendente lite, spousal support, equitable distribution of marital property, attorneys fees, and expenses. Both parties agree that this Agreement shall conclusively provide for the distribution of property under the said law and the parties hereby waive, release and forever relinquish any further rights they may respectively have against the other for alimony, alimony pendente lite, spousal support, equitable distribution of marital property, attorneys fees, and expenses. 13. WAIVER OR MODIFICATION TO BE IN WRITING A modification or waiver of any of the terms of this Agreement shall be effective only if in writing, signed by both parties, and executed with the same formality as this Agreement. No waiver of any breach hereof or default hereunder shall be deemed a waiver of any subsequent default of the same or similar nature. r--i r-I a Initials ft1 Initial1?3 Sz KMD BAZ 14. MUTUAL COOPERATION Each party shall, at any time and from time to time hereafter, take any and all steps and execute, acknowledge and deliver to the other party, any and all future instruments and/or documents that the other party may reasonably require for that purpose of giving full force and effect to the provisions of the Agreement. 15. AGREEMENT BINDING ON HEIRS This Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective legatees, devises, heirs, executors, administrators, successors, and assigns in the interest of the parties. 16. BREACH If either party breaches any provision of this Agreement, the other party shall have the rights, at his or her election, to sue in law or in equity to enforce any rights and remedies which the party may have, and the party breaching this Agreement shall be responsible for payment of attorneys fees and all costs incurred by the other in enforcing his or her rights under this Agreement. 17. LAW OF PENNSYLVANIA APPLICABLE This Agreement shall be construed in accordance with the laws of the Commonwealth of Pennsylvania. N a Initials 9" Initials 'BS7- KMD BAZ 18. HEADINGS NOT PART OF AGREEMENT Any headings preceding the text of the several paragraphs/provisions and sub-paragraphs hereof, are inserted solely for convenience of reference and shall not constitute a part of this Agreement nor shall they affect its meaning, construction or effect. 19. DIVORCE The parties hereto acknowledge that their marriage is irretrievably broken. The parties further agree to execute the necessary Affidavits of Consent and Waiver of Counseling, and Waiver of Notice of Intent to Request Entry of Divorce Decree upon execution of this Property Settlement Agreement so that the divorce may become finalized. The parties further agree and acknowledge that this Property Settlement Agreement shall be incorporated into said Decree in Divorce; however, shall not merge therewith. Husband and Wife hereby agree that said Consents and Waiver of Counseling shall not be filed with the Court and the divorce shall not become finalized until Wife has received payment of Fifty Thousand Dollars ($50,000.00) as specifically set forth in Paragraph 8 herein. However, the parties hereto acknowledge that should said payment extend past the thirty (30) days and should the Consents and Waivers expire prior to finalization of the divorce pursuant to this Property Settlement Agreement, the parties hereto agree that they will cooperate and execute new Consents and Waivers and any and all necessary documents to finalize said divorce action upon payment of the Fifty M Thousand Dollars ($50,000.00) to Wife. Initials j5ep Initials KMD BAZ Wife hereby acknowledges that her health insurance will terminate upon finalization of the divorce, which is currently being held by Husband. 20. IRREVOCABILITY It is understood and agreed to by and between the respective parties thereto that the property division - distribution affected by the herein agreement is IRREVOCABLE and that such division - distribution shall not be affected by any change of circumstances of the respective parties OR by other statutory or judicial alternatives which may be available to the respective parties under prior, current, or future laws of the Commonwealth of Pennsylvania or any other jurisdiction. Except as provided herein, the parties hereby waive any respective rights to financial support and/or alimony and/or pension or future expectancies each may respectively have under prior, current, or future laws or case decisions. IN WITNESS WHEREOF, the parties hereto have set their hands and seals the day and year first above written. s KEVIN M. DANNER SEAL d., Witness BARBARA A. Z E r-I a Initials 6in Initials'a-sZ KMD BAZ KEVIN M. DANNER IN THE COURT OF COMMON PLEAS Plaintiff, : CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION vs. . BARBARA S. ZEIGLER Defendant NO. 04-724 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: ( X ) Irretrievably breakdown under Section ( X ) 3301(c) ) 3301 (d) of the Diver-ee Code v vvuv. Strike out inapplicable section) 2. Date and manner of service of the complaint: Certificate of Personal Service, August 17, 2004. 3. [Complete either Paragraph (a) or (b).] (a) Date of execution of Affidavit of Consent required by Section 3301(c) of the Divorce Code by Plaintiff, October 14, 2009; by Defendant, October 16, 2009 (b) (1) Date of execution of the affidavit required by Section 3301 (d) of the Divorce Code: N/A. (2) Date of filing and service of the Plaintiff's affidavit upon the respondent: N/A .I 4. Related claims pending: None. 5. Complete either (a) or (b) (a) Date and manner of service of the notice of intention to file praecipe to transmit record; N/A (b) Date of Plaintiff's Waiver of Notice in 3301(c) Divorce was filed with the Prothonotary: Simultaneously herewith Date Defendant's Waiver of Notice in 3301(c) divorce was filed with the Prothonotary: Simultaneously herewith Respectfuljy..s4mitted, Diane M. Di sAsquiKc 1400 N. Second Street Harrisburg, PA 17102 (717) 232-9724 I.D. No. 71873 Date: November 11, 2009 f WMAO-k-* Tte 13 KEVIN M. DANNER V. BARBARA S. ZEIGLER IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 04-724 CIVIL TERM DIVORCE DECREE AND NOW, Aley, t Y , zeo 1 , it is ordered and decreed that KEVIN M. DANNER plaintiff, and BARBARA S. ZEIGLER , 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.") It is further Ordered that the Property Settlement Agreement dated October 16, 2009 and attached hereto is incorporated herein by reference. By the Court, Atte ! J. 1-4- lKonotary R, t . ' W. KEVIN M. DANNER, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 04-724 CIVIL TERM BARBARA S. ZEIGLER, IN DIVORCE Defendant/Petitioner PACSES CASE: 850106854 ORDER OF COURT AND NOW to wit, this 20th day of January, 2009, it is hereby Ordered that the Plaintiff/Respondent has made a direct payment in the amount of $400.00 to the Defendant/Petitioner in order to liquidate the remaining balance as stated in the Order of Court dated October 29, 2009. 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: N [1 --4 u N C? Edward E. Guido, ? r `_. N -? DRO: R.J. Shadday xc: Petitioner Respondent Form OE-001 Service Type: M Worker: 21005