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Home My WebLink About08-2446 Angela L. Wert, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW IN DIVORCE Robert T. Wert, Sr., Defendant :NO. 08- -4,q I/& CIVIL TERM NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary, Cumberland County Courthouse, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, 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 County Bar Association 32 South Bedford Street Carlisle, Pennsylvania 17013 (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. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. Angela L. Wert, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW IN DIVORCE Robert T. Wert, Sr. Defendant :NO. 08- CIVIL TERM DIVORCE COMPLAINT The plaintiff, Angela L. Wert, by her attorneys, the Family Law Clinic, sets forth the following cause of action in divorce: COUNTI DIVORCE UNDER 23 Pa.C.S. %3301(c) AND 3301(d) OF THE DIVORCE CODE 1. Plaintiff is Angela L. Wert, who currently resides at 443 North Pitt Street Apt. 2, Carlisle, Cumberland County, PA 17013, since March, 2007 2. Defendant is Robert T. Wert, Sr., who currently resides at P. O. Box 138, Mertztown, Berks County, PA 19539, since September 2007. 3. Plaintiff has been a bona fide resident in the Commonwealth for at least six months immediately previous to the filing of this complaint. 4. Plaintiff and Defendant were married on February 12, 1999 in Reading, Berks County, Pennsylvania. 5. Plaintiff and Defendant have lived separate and apart since September, 2006. 6. There have been no prior actions for divorce or for annulment between the parties. 7. The marriage is irretrievably broken. 8. Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the court require the parties to participate in counseling. WHEREFORE, Plaintiff requests the court to enter a decree of divorce. COUNT II ALIMONY 9. Plaintiff repeats the realleges paragraphs one through eight as if fully set forth herein. 10. Plaintiff requires support to adequately maintain herself according to a reasonable standard of living. 11. Defendant is financially able to provide for his reasonable needs and the reasonable needs of Plaintiff WHEREFORE, Plaintiff requests the Court to enter an award of reasonable alimony, and such other relief as the Court deems just. COUNT III EQUITABLE DISTRIBUTION 12. Plaintiff repeats and realleges paragraphs one through eleven as if fully set forth herein. 13. Plaintiff and Defendant have acquired property during the marriage, including, but not limited to: a) Defendant's 401(k) account WHEREFORE, Plaintiff requests the Court to enter an award for equitable distribution of property, and such of other relief as the Court deems just. Respectfully Submitted, Date Afa-i-I 7 , 2,ooy lL/?Af? Fei Bao Certified Legal Intern MEGA RfESMEYER Supervising Attorney FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717) 243-2968 Fax: (717) 243-3639 VERIFICATION I verify that the statements made in the foregoing complaint are true and correct, to the best of my knowledge, information and belief. I understand making any false statement would subject me to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. Date Plaintiff U Angel L. Wert \\?? ?? ?; 7'-+ ? \? ??? f^: r?. fi 7` ?s ^.a ,_. ?.?, ? _..' _. ?:; ?? -? -_.? i_S'j FTt Vii' 1 ?' ?. ?_ ?? ??,\ { ?{ ,- .. .E _C ... °] Angela L. Wert : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW IN CUSTODY Robert T. Wert, Sr. Defendant NO. 08-2 / V6 CIVIL TERM PRAECIPE TO PROCEED IN FORMA PAUPERIS TO THE PROTHONOTARY: Kindly allow Angela L. Wert, Plaintiff, to proceed in forma pauperis. The Family Law Clinic, attorneys for the party proceeding in forma pauperis, certifies that we believe the party is unable to pay the costs and that we are providing free legal service to the party. Respectfully submitted, Date 00 a> _?/ Rq Fei Bao Certified Legal Intern ROB MT E. RAINS THOMAS M. PLACE ANNE MACDONALD-FOX LUCY JOHNSTON-WALSH MEGAN RIESMEYER Supervising Attorneys FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 717-243-2968 Angela L. Wert, Plaintiff V. Robert T. Wert, S Defendant I, Fei Bao, and correct copy of Box 138, Mertztov certified, restricted upon receipt by Ro green card. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION-LAW DIVORCE NO. 08 - 2446 CIVIL TERM CERTIFICATE OF SERVICE ertified Legal Intern, Family Law Clinic, hereby certify that I served a true the Divorce Complaint on Robert T. Wert, Sr., whose mailing address is P.O. i, PA 19539, by depositing a copy of the same in the United States mail, lelivery, return receipt requested, postage prepaid. Service was complete ert T. Wert, Sr., on the 21St day of April, 2008 as evidenced by the attached r 8? Fei Bao Certified Legal Int rn Meg er Ann4Maonald-Fox Supervising Attorney FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717) 243-2968 Fax: (717) 243-3639 i " ¦ Complete ite is 1, 2, and 3. Also complete item 4 if Rest cted Delivery is desired. ¦ Print your nary a and address on the reverse so that we ca return the card to you. ¦ Attach this car d to the back of the mailpiece, or on the front if space permits. 1. Article Address to: Robert Wes, Sr. d. M ert t wvl,> 1 P1 I ?t-3 A. Signature p X '1A \ W.S J*-- 13 Asp ? Addressee B,t?Received by (printed Name) C. a ofqelivery ot T Wca? s Q- ?? I / 08" D. Is delivery address different from Rem 1? ? Yes If YES, enter delivery address below: ? No 3. S,?ervice Type X Certified Mail ? Express Mail ? Registered V Return Receipt for Merchandise ? Insured Mail ? C.O.D. 4. Restricted Delivery? (Extra Fee) .Jts.Yes t 2. Article Number 7005 0390 0003 2632 6949 (Transfer from service label) PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 CJ ? C CT ° --t ?,. ?' f i' i rT'- ..._.. ? r-"r ..- r .{ ._ , -'C Angela L. Wert, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW IN DIVORCE Robert T. Wert, Sr., Defendant : NO. 08- 2446 CIVIL TERM PRAECIPE TO PROCEED IN FORMA PAUPERIS TO THE PROTHONOTARY: Kindly allow Angela L. Wert, Plaintiff, to proceed in forma pauperis. The Family Law Clinic, attorneys for the party proceeding in forma pauperis, certifies that we believe the party is unable to pay the costs and that we are providing free legal service to the party. Respectfully submitted, Date 2 O S Angel B ley Certified Legal Intern A ALD Supervisi g Attorney FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 717-243-2968 c; Angela L. Wert, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW IN DIVORCE Robert T. Wert, Sr., Defendant : NO. 08- 2446 CIVIL TERM NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary, Cumberland County Courthouse, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, 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 County Bar Association 32 South Bedford Street Carlisle, Pennsylvania 17013 (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. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. COUNTI DIVORCE UNDER 23 Pa.C.S. M3301(c) AND 3301(d) OF THE DIVORCE CODE Angela L. Wert, Plaintiff V. Robert T. Wert, Sr. Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW IN DIVORCE : NO. 08- 2446 CIVIL TERM AMENDED DIVORCE COMPLAINT WITH ALIMONY PENDENTE LITE COUNT The plaintiff, Angela L. Wert, by her attorneys, the Family Law Clinic, sets forth the following cause of action in divorce: 1. Plaintiff is Angela L. Wert, who currently resides at 443 North Pitt Street Apt. 2, Carlisle, Cumberland County, PA 17013, since March, 2007 2. Defendant is Robert T. Wert, Sr., who currently resides at P. O. Box 138, Mertztown, Berks County, PA 19539, since September 2007. 3. Plaintiff has been a bona fide resident in the Commonwealth for at least six months immediately previous to the filing of this complaint. 4. Plaintiff and Defendant were married on February 12, 1999 in Reading, Berks County, Pennsylvania. 5. Plaintiff and Defendant have lived separate and apart since September, 2006. 6. There have been no prior actions for divorce or for annulment between the parties. 7. The marriage is irretrievably broken. 8. Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the court require the parties to participate in counseling. WHEREFORE, Plaintiff requests the court to enter a decree of divorce. COUNT II ALIMONY 9. Plaintiff repeats the realleges paragraphs one through eight as if fully set forth herein. 10. Plaintiff requires support to adequately maintain herself according to a reasonable standard of living. 11. Defendant is financially able to provide for his reasonable needs and the reasonable needs of Plaintiff WHEREFORE, Plaintiff requests the Court to enter an award of reasonable alimony, and such other relief as the Court deems just. COUNT III ALIMONY PENDENTE LITE AND COSTS 12. Plaintiff repeats and realleges paragraphs one through eleven as if fully set forth herein. 13. Plaintiff requires support to adequately maintain herself according to a reasonable standard of living. 14. Plaintiff will also be at a disadvantage during this litigation due to the lack of financial resources. Plaintiff will be unable to pay for any expenses that might arise during litigation of this matter. 15. Defendant is financially able to provide for his reasonable needs and the reasonable needs of Plaintiff. WHEREFORE, Plaintiff requests the Court to order Defendant to pay a fair and reasonable sum of money in the form of Alimony Pendente Lite for the purpose of providing for the reasonable expenses that Plaintiff might incur during the pendency of this action and for her costs incurred in litigation this action. COUNT IV EQUITABLE DISTRIBUTION 16. Plaintiff repeats and realleges paragraphs one through fifteen as if fully set forth herein. 17. Plaintiff and Defendant have acquired property during the marriage, including, but not limited to: a) Defendant's 401(k) account WHEREFORE, Plaintiff requests the Court to enter an award for equitable distribution of property, and such of other relief as the Court deems just. Respectfully Submitted, Date J Z J /6(? z d -&, W i C?/ - Angel Bradley Certified Legal Intern 76 nald-Fox Supervising Attorney FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717) 243-2968 Fax: (717) 243-3639 VERIFICATION I verify that the statements made in the foregoing complaint are true and correct, to the best of my knowledge, information and belief. I understand making any false statement would subject me to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. Date E `? &k Plaintiff Angela /L Wert 0`k:: - { co r f13 "? ANGELA L. WERT, THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 08-2446 CIVIL TERM ROBERT T. WERT, IN DIVORCE Defendant/Respondent : PACSES CASE NO: 900110072 ORDER OF COURT AND NOW, this 2nd day of June, 2008, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R. J. Shadday on June 23, 2008 at 10:30 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you. If you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Edgar B. Bayley, President Judge Copies mailed to: Petitioner Respondent Anne MacDonald-Fox, Esq. Date of Order: June 2. 2008 R. J. Sha y, Conference Officer YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 ? f; ?': ? t'"') ` C13 ??i :.? 1.L? ?' ? ?? wy .?.! s ?.1 LL ? ._.y R;1 : c^,::+ .?. c :? U N 4 Angela L. Wert, Plaintiff V. Robert T. Wert, Sr., Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION-LAW DIVORCE NO. 08 - 2446 CIVIL TERM PACSES NO. REQUEST FOR HEARING ON ALIMONY PENDENTE LITE COUNT Angela L. Wert, Plaintiff in the above-captioned divorce action, requests a hearing on the alimony pendente lite count filed May 28, 2008. 1. An Amended Divorce Complaint with Alimony Pendente Lite count was filed on May 28, 2008. 2. Defendant, Robert T. Wert, Sr., was served with a copy of the Amended Divorce Complaint on May 28, 2008. 3. This matter is ready for scheduling before the Domestic Relations Section. Respectfully submitted, Date 2 /0? ?Lxj Ang&Bradley Certified Legal Intern ANNE ALD-FOX Supervising Attorney FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 Telephone: (717) 243-2968 Fax: (717) 243-3639 Lg ?J 3 p } 2 Angela L. Wert, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION-LAW DIVORCE Robert T. Wert, Sr., Defendant NO. 08 - 2446 CIVIL TERM CERTIFICATE OF SERVICE I, Angel Bradley, Certified Legal Intern, Family Law Clinic, hereby certify that I served a true and correct copy of the Amended Divorce Complaint With Alimony Pendente Lite Count on Robert T. Wert, Sr., by handing a copy of the same to Robert T. Wert, Sr. at the Domestic Relations Office at 13 North Hanover Street, Carlisle, Pennsylvania at approximately 10:45 a.m. on May 28, 2008. Ange radley Certified Legal Intern Anne ald-Fox Supervising Attorney FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717) 243-2968 Fax: (717) 243-3639 ra _ `..? .-^{ ,- ? ?? .-? ^ (1 ? +,+f ?? S `?-?? r•. `„. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff s? h Vs File No. IN DIVORCE Defendant NOTICE TO RESUME PRIOR SURNAME Notice is hereby given that the Plaintiff / defendant in the above matter, [select one by marking "x"] _>(" prior to the entry of a Final Decree in Divorce, or after the entry of a Final Decree in Divorce dated , hereby elects to resume the prior surname ogLac- e? , and gives this written notice avowing his / her intention purs t to the provisions of 54 P.S. 704. Date: Z OAada Signature Y-?3jAojz,..j Signature of name bei g resumed COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF Cu-,wbcrl?^. On the I (, day of Tc.A- e_ , 200g' before me, the Prothonotary or the notary public, personally appeared the above affiant known to me to be the person whose name is subscribed to the within document and acknowledged that he / she executed the foregoing for the purpose therein contained. In Witness Whereof, I have hereunto set my hand hereunto set my hand and official seal. Prothonotary or Notary Public NOTARIAL UK Y rPR OTMY, NOTARY WX CARLISU CU A D COUNIY CDWrHOW W COU NS810N 00ME8 MMMRY 4.8010 F:1 _n 7- M1; t? r P F r ? Q ro ? N 1 U' 4A . ? ?M ceA.+ J1 C K ,.. ANGELA L. WERT, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 08-2446 CIVIL TERM ROBERT T. WERT, IN DIVORCE Defendant/Respondent : PACSES Case No: 900110072 ORDER OF COURT AND NOW, this 23rd day of June 2008, based upon the Court's determination that the Petitioner's monthly net income/earning capacity is $ 1,015.85 and the Respondent's monthly net income/earning capacity is $ 2,238.56, it is hereby ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit Four Hundred Ten and 00/100 Dollars ($410.00) per month payable weekly as follows: $ 405.00 per month for Alimony Pendente Lite and $ 5.00 per month on arrears. First payment due: in accordance with Respondent's pay schedule. The effective date of the order is June 2, 2008. Arrears set at $ 386.14 as of June 23, 2008. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and, at its discretion, make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Angela L. Wert+. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the Respondent's name with their PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. cc360 r The monthly obligation includes cash medical obligation in the amount of $250 annually for unreimbursed medical expenses incurred for the spouse. Unreimbursed medical expenses of the oblige that exceed $250 annually shall be allocated between the parties. The party seeking allocation of unreimbursed medical expenses must provide documentation of expenses to the other party no later than March 31St of the year following the calendar year in which the final medical bill to be allocated was received. The unreimbursed medical expenses are to be paid as follows: 0% by the Respondent and 100% by the Petitioner. [X] Respondent [] Petitioner [] Neither party to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the [] Petitioner [X] Respondent shall submit to the other parry written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of: 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy o the benefits booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final twenty (20) after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. Consented: Petitioner Petitioner's Attorney Respondent Respondent's Attorney Mailed copies on: June 24, 2008 to: Petitioner BY THE COURT, Respondent Family Law Clinic N -. U-0,? M. L. Ebert, Jr., J. DRO: R.J. Shadday c1, { ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 06/23/08 Case Number (See Addendum for case summary) 900110072 OOriginal Order/Notice 08-2446 CIVIL OAmended Order/Notice 0Terminate Order/Notice (Done-Time Lump Sum/Notice Employer/Withholder's Federal EIN Number RE: WERT, ROBERT T. Employee/Obligor's Name (Last, First, MI) 203-52-4801 Employee/Obligor's Social Security Number NATIONAL FREIGHT INC* 4659101847 71 W PARK AVE Employee/Obligor's Case Identifier VINELAND NJ 08360-3508 (See Ad&ndum 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 $ o . oo per month in past-due child support Arrears 12 weeks or greater? Oyes ® no $ o . oo per month in current medical support $ o . oo per month in past-due medical support $ 405.00 per month in current spousal support $ o. oo per month in past-due spousal support $ 0.00 per month for genetic test costs $ o . oo per month in other (specify) $ one-time lump sum payment for a total of $ 405.00 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: $ 93.46 per weekly pay period. $ 202.50 per semimonthly pay period (twice a month) $ 1BL,22- per biweekly pay period (every two weeks) $ 405.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. $ 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: M.L. EBERT, JR., Service Type M OMe No.: 0970-0154 v JUDGE Form EN-028 Rev. 3 Worker I D $ IATT 405 *x 52•'? 93-46* ?vx 186?`?g?` ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS 0 Ig jhecke¢ you are required to g vide aopy of this form to yourloyee. If your employee vYorks in a state that is i Brent rom the state that i this o er, a b provismped to your employee even if th ssu copy must e e box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* 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. * Employeelobligor with Muhiple 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 employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2105869100 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME:WERT, ROBERT T. EMPLOYEE'S CASE IDENTIFIER: 4659101847 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS:. LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee%bligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact - WAGE ATTACHMENT UNIT 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev. 3 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WERT, ROBERT T. PACKS Case Number 900110072 Plaintiff Name ANGELA L. WERT Docket Attachment Amount 08-2446 CIVIL$ 405.00 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 0 if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 3 Service Type M OMB No.: 0970-0154 Worker ID $IATT N r 3';' 1 CX) ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 07/01/08 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number NATIONAL FREIGHT INC* 71 W PARK AVE VINELAND NJ 08360-3508 203-52-4801 Employee/Obligor's Social Security Number 4659101847 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ $ $ 0.00 0.00 0.00 $ 0.00 $ 405.00 $ 5.00 $ 0.00 $ 0.00 for a total of $ per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) one-time lump sum payment 410.00 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: $ 94.62 per weekly pay period. $ 205.00 per semimonthly pay period (twice a month) $ 189.23 per biweekly pay period (every two weeks) $ 410.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. S 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Service Type M OMB No.: 0970-0154 Arrears 12 weeks or greater? O yes (g) no OOriginal Order/Notice 900110072 @Amended Order/Notice 08-2446 CIVIL OTerminate Order/Notice (Done-Time Lump Sum/Notice RE:WERT, ROBERT T. Employee/Obligor's Name (Last, First, MI) L. EBERT, JR., F6rm EN-028 Rev. 3 Worker ID $IATT 410•x 12•+ 52? 94.62* 410• x 12 + 26•= 189.23* ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS UP eck you are required to pr vide a opy of this form to your mployee. If yo r employee orks in a state that is rent from the state that issuedthis order, a copy must be provi?ed to your employee even if tie 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 employeelobligor. 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. 2105869100 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME: WERT, ROBERT T. EMPLOYEE'S CASE IDENTIFIER: 4659101847 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee obligor from employment, refusing to employ, or taking disciplinary action against any 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) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee'slobligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev. 3 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WERT, ROBERT T. PACKS Case Number 900110072 Plaintiff Name ANGELA L. RHODES Docket Attachment Amount 08-2446 CIVIL$ 410.00 Child(ren)'s Name(s): DOB ® If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 3 Service Type M OMB No.: 0970-0154 Worker I D $ IATT C C) '.= c -TI t-n a 1 N Ty_ 10% ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 08-2446 CIVIL State Commonwealth of Pennsylvania OOriginal Order/Notice Co./City/Dist. of CUMBERLAND OAmended Order/Notice Date of Order/Notice 10/24/08 0Terminate Order/Notice Case Number (See Addendum for case summary) (Done-Time Lump Sum/Notice RE:WERT, ROBERT T. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 203-52-4801 Employee/Obligor's Social Security Number CARLISLE VENTURE GROUP, INC. 4659101847 PO BOX 1549 Employee/Obligor's Case Identifier MECHANICSBURG PA 17055-9049 (See Addendwn 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? Oyes ® no $ 0.00 per month in current medical support $ o. oo per month in past-due medical support $ 405.00 per month in current spousal support $ 5 . 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 $ 410.00 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: $ 94.62 per weekly pay period. $ 205.00 per semimonthly pay period 189:23. (twice a month) $ per biweekly pay period (every two weeks) $ 410.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. $ 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE (DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: / JUDGE DRO: R. J. SHADDAY Form EN-028 Rev. 4 Service Type M OMB No.: 0970-0154 Worker ID 21205 410=x 12= 52* 94.62* ?? 610=x 1 2= ? 26- 189.23 "k ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS I heck you are required, to pr idea opy of this form to your m {ogee. If yo r employee orks in a state that is giierent from the state that issuedthis order, a copy must be provideclpto your emproyee even if tie box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employeelobligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydateldate of withholding when sending the payment. The paydateldate 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 employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 0617584100 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : E3 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 13 EMPLOYEE'S/OBLIGOR'S NAME:WERT, ROBERT T. EMPLOYEE'S CASE IDENTIFIER: 4659101847 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT• NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. AntWiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. * Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsup"rt.state.pa.us Page 2 of 2 OMB No.: 0970-0154 Form EN-028 Rev. 4 Worker ID 21205 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WERT, ROBERT T. PACSES Case Number 900110072 Plaintiff Name ANGELA L. RHODES Docket Attachment Amount 08-2446 CIVIL$ 410.00 Child(ren)'s Name(s): DOB Addendum Service Type M OMB No.: 0970-0154 Form EN-028 Rev. 4 Worker ID 21205 0 rv -O c. - V C ) -n CO 4r,, ? -,am Irv.. -.. " t w.. - In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Defendant Name: ROBERT T. WERT Member ID Number: 4659101847 Please note: All correspondence must include the Member ID Number. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Financial Break Down of Multiple Cases on Attachment PACSES Docket Attachment Amount/Frequency Plaintiff Name Case e Number Number ANGELA L. RHODES 900110072 08-2446 CIVIL $ 410.00 MONTH TOTAL ATTACHMENT AMOUNT: $ 410.00 Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of $ 94.36 per week, or 50 of the Unemployment Compensation benefits otherwise payable to the Defendant, ROBERT T. WERT Social Security Number XXX-XX- 4801 , Member ID Number 4 6 5 910184 7 . OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673 (b)(2) and 23 Pa. C.S.A. § 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated NOVEMBER 8, 2009 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: NOV 17 2009 DRD: R.J. SHADDAY 1k t QV4 M. L. EBERT, JR. , JUDGE Form EN-530 Rev.2 Service Type M Worker ID $ IATT III f X 17 00 43 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pen=lvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 06/15/10 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number CARLISLE VENTURE GROUP, INC. PO BOX 1549 MECHANICSBURG PA 17055-9049 203-52-J801 Employee/Obligor's Social Security Number 465910147 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 $ $ 0.00 0.00 $ 0.00 $ 405.00 $ 5.00 $ 0.00 $ 0.00 per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) Arrears 12 weeks or greater? one-time lump sum payment 08-2446 CIVIL OOrigi nal Order/Notice OAmended Order/Notice OTerminate Order/Notice (Done-Time Lump Sum/Notice RE:WERT, ROBERT T. Employee/Obligor's Name (Last, First, MI) for a total of $ 410.00 per month to be forwarded to payee below. ® yes no 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: $ 94.62 per weekly pay period. $ 205.00 per semimonthly pay period (twice a month) $ 189.23 per biweekly pay period (every two weeks) $ 43.0.00 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 paydateldate 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 FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SO L SEC RITY NUMBS I ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: DRO: R. J. Shadday Service Type M • L • J.:IVC-3.l L , V L • , OMB No.: 0970-0154 Form EN-028 Rev.5 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If heck you are required to pr vide a opy of this form to your mployee. If yoYr employed orks in a state that is d& - .- rom the state that issued this o er, a copy must be provi, to your employee even if tie box is not chec ed. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employeelobligor. 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 employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 0617584100 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME:WERT, ROBERT T. EMPLOYEE'S CASE IDENTIFIER: 4659101847 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 (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker I D $ IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WERT, ROBERT T. PACSES Case Number 900110072 Plaintiff Name ANGELA L. RHODES Docket Attachment Amount 08-2446 CIVIL$ 410.00 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 Service Type M OMB No.: 0970.0154 PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Form EN-028 Rev.5 Worker ID $iATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT n- ?+4 C1v I I OOriginal Order/Notice State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND OAmended Order/Notice Date of Order/Notice 06/21/10 XOTerminate Order/Notice Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice RE: WERT, ROBERT T. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 203-52-41801 Employee/Obligor's Social Security Number NATIONAL FREIGHT INC* 4659101847 71 W PARK AVE Employee/Obligor's Case Identifier V INELAND NJ 08360-3508 (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 $ o . oo per month in past-due child support Arrears 12 weeks or greater? Dyes ® no $ 0.00 per month in current medical support $ 0.00 per month in past-due medical support $ o . oo per month in current spousal support o $ o . oo per month in past-due spousal support $ o . oo per month for genetic test costs r (C-5 ?. $ o. oo per month in other (specify) 1%a $ one-time lump sum payment for a total of $ 0.00 per month to be forwarded to payee below. `' . n1 You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycl oes4mot Bch the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period (twice a month) $ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment methA if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO E PROCESSED. DO NOT SEND CASH BY MAIL. t* BY THE COURT: Service Type M OMB No.: 0970-0154 Form EI1--028 Rev.5 Worker I D $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If heck you are required to provide a opy of this form to your m loyee. If yo employee works in a state that is diferent from the state that issued this order, a copy must be provit?edpto your emplr oyee 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. 2105869100 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 13 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME: WERT, ROBERT T. EMPLOYEE'S CASE IDENTIFIER: 4659101847 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the order information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by intemet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment DefendanVObligor: WERT, ROBERT T. PACSES Case Number 900110072 PACKS Case Number Plaintiff Name Plaintiff Name ANGELA L. RHODES Docket Attachment Amount Docket Attachment Amount 08-2446 CIVIL$ 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): PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): Service Type M DOB DOB Addendum OMB No.: 0970-0154 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Form EN-028 Rev.5 Worker ID $zATT INCOME WITHHOLDING FOR SUPPORT O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) O AMENDEDIWO O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT Q TERMINATION OF IWO `0 1/D072 Date: 01104/12 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions hfp://www acf hhs gov/programs/cse/newhire/employer/publication/publication htm - forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Tribe/Territory Commonwealth of Pennsylvania Remittance Identifier (include w/payment): 4659101847 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docketlnformalton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) CARLISLE VENTURE GROUP, INC. PO BOX 1549 MECHANICSBURG PA 17055-9049 Employer/Income Withholder's FEIN Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: WERT, ROBERT T. Employee/Obligor's Name (Last, First, Middle) 203-52-4801 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions employerloublication/publication.htm - forms/. If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND C ounty, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. $ 0.00 per month in current child support $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? Q yes Q no . $ 0000 per month in current cash medical support c ; ? $ 0.00 per month in past-due cash medical support 3 ;z --t $ 0000 per month in current spousal support MOD C _ $ 0.00 per month in past-due spousal support z -arn $ 0.00 per month in other (must specify) ?' t crt te o ? r - Z for a Total Amount to Withhold of $ 0.00 per month. o -v c s -n o > AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the r / fprma If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: z D o - $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay perietl (tv4be a: Onth) $ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10) working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), obtain withholding limitations, time requirements, and any allowable employer fees at http://www.acf.hhs.gov/proarams/cse/newhire/employer/contacts/ contact map.htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970-0154 Form EN-028 11/11 Service Type M Worker ID $IATT ? Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. N r, ^ % Signature of Judge/Issuing Official (if required by State or Tribal law): - -\ A Print Name of Judge/Issuing Official: -KL. it r't, Jr. Title of Judge/Issuing Official: Date of Signature: I a nl n 5 260 If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. ? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676.9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shown above as the EmployeeJObligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: hftp://?x^w^w acf hhs go_y_/programs./cse/newbire/employer/contacts/contac>vmap.htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date - 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN-028 11/11 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: CARLISLE VENTURE GROUP INC. Employer FEIN: Employee/Obligor's Name: WERT ROBERT T. CSE Agency Case Identifier: (See Addendum for case summary) Order Identifier: (See Addendum for order/docket information) 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/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit 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, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you a no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: Q This person has never worked for this employer nor received periodic income. Q This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known address: Last known phone number: Final Payment Date To SDU/Tribal Payee: Final Payment Amount: New Employer's Name: New Employer's Address: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.childsuaoort.statepa.us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST. P.O. BOX 320, CARLISLE. PA. 17013 (Issuer address). To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at www.childsupport.state.pa.us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. Service Type M OMB No.: 0970-0154 Page 3 of 3 Form EN-028 11/11 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WERT, ROBERT T. PACSES Case Number 900110072 PACSES Case Number Plaintiff Name Plaintiff Name ANGELA L. RHODES Docket Attachment Amount Docket Attachment mount 08-2446 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 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 11/11 Service Type M OMB No.: 0970-0154 Worker ID $IATT In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION ANGELA L. RHODES ) Docket Number: 08-2446 CIVIL Plaintiff ) vs. ) PACSES Case Number: 900110072 ROBERT T. WERT ) Defendant ) Other State ID Number: Order AND NOW to wit, this FEBRUARY 13, 2012 it is hereby Ordered that: The ordered on amount for payment on arrears is increased to $40.00 per month. BY THE COURT: `-) r-a ,r co z te r- r -- .` co C3 C3 ? --iQ ?p C.) Q -n f"t- -? C. V 1 Cz M.L. Ebert, Jr. JUDGE Form OE-520 02/11 Service Type M Worker ID 21205 INCOME WITHHOLDING FOR SUPPORT O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) ?}4L7 0-Wit Q AMENDED IWO ( 0 ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT . Q TERMINATION OF IWO Date: 02/13/12 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http•//wwtni'acf hhs govtbr'Mrams/cse/newhire/employer/publication/publication htm forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. zstate/ 1 nbe/ l ermory commonwealth of Pennsylvania Remittance Identifier (include w/payment): 4659101847 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for ordeddocket /nformalton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) JP MASCARO & SONS* 2650 AUDUBON RD AUDUBON PA 19403-2406 Employer/Income Withholder's FEIN 231721961 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: WERT, ROBERT T. Employee/Obligor's Name (Last, First, Middle) 203-52-4801 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www.acf.hhs.-Qov/programs/cWnewhire / employer/publicatignipublication.htm - forma. If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. 2317219610 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. $ 0.00 perm nth in current child support $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? Q yes rig '_*1 $ 0.00 per month in current cash medical support $ 0.00 per month in past-due cash medical support rJ7 rM $ 405.00 per month in current spousal support Zr co -vim '° $ 40.00 per month in past-due spousal support ?s* ? c-s. 7' $ 0.oo per month in other (must specify) <0 2d for a Total Amount to Withhold of $ 445.00 per month. Zp 3 X : AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the *erl4forr-9tion. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: --c co $ 102.70 per weekly pay period. $ 222.50 per semimonthly pay Y P Y Period (twice a month) $ 209,J9 per biweekl y pay period (every two weeks) $ 445.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10) working days after the date of this Order/Notice. Send payment within even 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), obtain withholding limitations, time requirements, and any allowable employer fees at http://www acf hhs gov/programs/cse/newhire/employer/contacts/ contact map.htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970-0154 Form EN-028 01/12 Service Type M Worker ID $IATT ? Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. i Signature of Judge/Issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: _ ?,... - . 4w•4 If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. ? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: http://ww r acf hhs gov/prQgramsicse/newhire/emi2loyer/corrtActs/contar4 map htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this iWO was sent by a Court, Attirney, do Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay gate: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld?frgm the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the empW- yee/obligor's principal place of employment regarding time periods within which you must implement the withholding and fo(%vard the support payments. Multiple iWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employeelobligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date - 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN-028 01/12 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: JP MASCARO & SONS* Employer FEIN: 231721961 Employee/Obligor's Name: WERT, ROBERT T. 4659101847 CSE Agency Case Identifier: (See Addendum for case summary) Order Identifier: (See Addendum for order /docket information) 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/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit 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, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you a no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 2317219610 Q This person has never worked for this employer nor received periodic income. O This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: New Employer's Name: New Employer's Address: Final Payment Amount: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.childsupport.state.pa.us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST. P.O. BOX 320, CARLISLE. PA. 17013 (Issuer address). To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at www.childsupportstate. a us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. OMB No.:0970-0154 Form EN-028 01/12 Service Type M Page 3 of 3 Worker ID $IATT AQ DUM Summary of Cash on Attachment Defendant/Obligor: WERT, ROBERT T. PACSES Case-Number 900110072 PACSES Case Number Plaintiff Name Plaintiff Name ANGELA L. RHODES Docket Attachment Amount Docket Attachment Amount 08-2446 CIVIL $ 445.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB 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 01/12 Service Type M OMB No.: 0970-0154 Worker ID $IATT In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Defendant Name: ROBERT T. WERT Member ID Number: 4659101847 Please note: All correspondence must include the Member ID Number. Fax: (717) N X, v •? C7 Z O ks ./ Co Financial Break Down of Multiple Cases on Attachment Plaintiff Name ANGELA L. RHODES PACSES Docket Case Number Number 900110072 08-2446 CIVIL TOTAL ATTACHMENT AMOUNT: $ 445.00 Attachment Amount/Frequency 445.00 1 MONTH -r? ra°, C3 "r? z C:)C?? - 4 .. r" Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of $102.41 per week, or 55.0%, of the Unemployment Compensation benefits otherwise payable to the Defendant, ROBERT T. WERT Social Security Number XXX-XX-4801, Member ID Number 4659101847. OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated NOVEMBER 8, 2009 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order. FEB 14 2012 ? ?`'? M.L awt 'A JUDGE Form EN-034 Service Type M Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT IWO Q AMENDEDIWO ~/d~ 1, Q ONE-TIMEORDERINOTICE FOR LUMP SUM PAYMENT ` x _ ~ `7"`y"~s- ~/ ~'l Q TERMINATION OF IWO ' Date' 1n/93N9 ^ Child Suppo~~t Enforcement (CSE) Agency ® Court ^ Attorney ^ Private Individual/Entity (Check One) NOTE: This IWO rnrt,9t be regUl~r dkt~~ face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions httD://vwyw.acf.hhs aav/programs/cse/newhire/emplover/publication/publication htm~ -forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. ~••~•~~ ~ ~~~~~ ~~,^,..'r ~~~~~,~~~~~w~a~~~~ ~~ ~C~~~~srwa~~m rtemtttance laenUfler (include w/payment): 4659101847 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendw» for order/docket informaiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) SOLID WASTE SERVICES 2650 AUDUBON RD AUDUBON PA 19403-2406 Employer,/Income Withholder's FEIN 231721961 Child(ren)'s Name,sl (Last, First. Middle) Child(ren)'s Birth Date(s) 2317219610 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBE•6~LAJ~4D C~.Intx, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct. these amounts-f~rc~i th emplgyee/ obligor's income until further notice. ~~ ~ x .~.~ ~rn c'~ ~~ $ _____0.00 per month in current child support ~~ ..~ ~ $_ __ 0.00 per month in past-due child support -Arrears 12 weeks or greater? Oy~3y'~,O ~~~, ~ $__ _!).00 per month in current cash medical support „--~ --tr $_ 0.00 per month in past-due cash medical support ~~" n• ~~ $_ 0.00 per month in current spousal support :~_c~-,~ 3 '~-- $ 0.00 per month in past-due spousal support :~~ ~ fir"' $_ 0.00 per month in other (must specify) --~ ~ '" - tT -=~, for a Total Amount to Withhold of $ 0.00 per month. AMOUNTS TO (WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the ordered payment cycle, withhold one of the fiollowing amount: $ 0.00 per weekly pay period. $ 0.00 per semimonthl $ _ 0.00 per biweekly pay period (every two weeks) $ 0.00 per month) y pay period (twice a month) y pay peric)d. $ ___ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Penn~lvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten 10 workino days after the date of this Order/Notice. Send payment within seven 7 lNOrking days of the pay date. If you cannot withhold the full amount of support for any or all orders i~or this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www.acf.hhs gov/programs/cse/newhire/employer/contacts/contact maD htm for the employee/obligor': principal place of employment. Document Tracking Identifier RE: WERT, ROBERT "l. Employee/Obligor's Name (Last, First, Middle) 203-52-4801 Employee/Obliggi~'s Social Security Number (See Addendum for plaintiff names associated with cases on atfachmenf) Custodial Party/Obligee's Name (Last, First, Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www acf hhs gov/programs/cse/newhire! employer/publication/publication htm - formal. If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. OMB No.: 0970-0154 Forn1 EN-028 06/12 Service Type M Worker ID $IATT ^ Return to Sender [Completed by Employer/Income Withholder). i-Aayrf~er~t ~nt,si. i1~ L:i€ec;t~c ... t ~ _ . accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below;.. €` p~v ~E~;r~~ ~ ' directed to an SDU/Tribal Payee or this IWO is not regular rare _~~ facie vf~~€ ~~7alxst check this `nox anr~ ~>t~_sr ~ isJ1,'~ € ., the sender. Signature of Judge/Issuing Official (if required by State or Trit~ai iaw' Print Name of Judge/Issuing Official _ _ _ _ _ _ __M.L. Eb@!"tF.jt' . __ Title of Judge/Issuing Official Date of Signature: _._ ~_ ~ _ . _ _ _ ~ i ~ `~ ;_' r If the employee/obligor works in a State or for a Tribe that is ciiffer~erit . €..°~~ ~ ~ .tz~~tru t,~°~ -tribe that issueaf t.l-~~s +~rc~ ~ ~ t~r;:; . • _ must be provided to the employeelobligor. ^ If checked, the employer/income withholder must pravid~_. ~ ~~ ~ ~, °rraE~iu}:o~:I°~;~~~t;~. ADDITIONAL INFORMATION FOR EMPLUYERStINCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance icy a€~ eie Ironic pavment me hoof. if aru earrpsoyer- €s orderer to withhold income from more than one employee and employs 15 or more persons. or if an errtployer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections ar~d Disbursement Unit (PA SCDU) Employer Customer Service at '1-877-676-9580 for instructions. PA FIPS C4pE 42 Ut1Us~? Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69°112, Harrisburg, Ira 17106-9112 1N ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT`S NAME AND THE PACSES MEMBER IU (shown ativs~e a the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER 1N ORDER TO BE PROCESSED. DO N0T SEND CASH BY MAIL. State-specific contact and withholding inforrnatior'~ c~ s ~~o t~~ur~U ~k;~ tt?f: r et3~r?i Employer ~~rycr~ v~. _ -~ '?e+, =~-- http~//www acf.hhs.goviprograms/cse/newhireiemploy_ericontacts/contact m~:htrr Priority: Withholding for support has priority over any oti~e€ «ega~ proses ~~r;cte :Mate iaw agaEns; ~;;~ ~~sox~r. ~ ~xre ~t ,~- ~;~: §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SL7U ;r s?"ibai CSE ager~c:y. you may ~;;umb~ne w~tt7t~eici ar~~~.€ ~t~ ;r_>:;~. more than one employee/obligor's income in a single payment. 'you must: however, separately identify each empioyee~~ obligor's portion of the payment, Payments To SDU: You must send child support payr~7ents payable ~+y rncaa7le withholding try Ina approp€~iate rc€~ Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU se cJ., payabik +c tn~. ~ ~s' party, court, or attorney}, you must check the box above and return this notice to the sender. Exception: If this IWC~ ~~;as r e by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1. '994 c}r the order ~..~r;. issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions an this form Reporting the Pay Date: You must report the pay date wne~r? :aer;dirig the payment. l"he pay date i~ the ;~ai~ _ b~ r~:c amount was withheld from the employee/obligor's wages. Ycu must comply with the law of the State Eor Tribal !aw ,! applicable) of the employee/obligor's principal place of employment regarding time periods within which k~0=.~ n~,is? irrt;ir the withholding and forward the support payments.. Multiple IWOs: If there is more than one IWO against this ewr~pioyeeiobiigor are~~ you are ur~~auic ,r~ ~ut~,t sou€~~~ ~f~ i~'`~s~ ~ ~L;~ :c: Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving pr~o~ety ~o z,a +us3• support before payment of any past-due support. Follow the State or Tribal law procedure of the employee/obligor's L€nr~€;it;~?! place of employment to determine the appropriate allocation method Lump Sum Payments: You may be required to notify a State or f riba? t~SE agency of upcoming usr~l, sum ~;ayrr~<,r employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine =.f y=oa,~ are requireC ~ report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this iv'J(:%. t ~€~taot €he sender. I yoz.a tali € ; ~;ithi roirr +r;;~~~~ ~ I;o x +,~~ employee/obligor's income as the IWO directs, you are liable for Loth the accumulated amount Vou should i ave withhel;.W, ar:,_' any penalties set by State or Tribal law/procedure __ _ _.. _ __ _ Anti-discrimination: You are subject to a fine determined under State or l-ribai iaw for dischargis'tg an er~t~,c yeelot~i~gc~r +s+-yrs. employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWC3 _ _ OMB Expiration Date-OS/31I2014. The OMB Expiratior Date !~a: o .._a,~.' - "`' ~~. - .' ~ ~_i'y v !_ C: 'J ~) Service Type M €~~~~ ~ ~ ~'~~"~~~~~ Employer's NamE;: SOLID WASTE SERVICES _ Employer FEIN: 231721.961 EmployeelObligor's Name: WE=RT, ROBERT T. 4659101847 CSE Agency Case Identifier: See Addendum for case summary) Order Identifier: !'See Addendum for orderJdocket information) 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)}; ar 2}the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is 'the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the cab{igor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 we::eks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the lirnit set by the lavv of the jurisdiction in which the employerlincomewlthholder is located or the maximum amount permiled under section 303(d) of the C:CP.A (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income .and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you a no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and!or the sender by returning this form to the addres:~ listed in the Contact Information below: 23~72~ssfo ~ This person has never worked for this employer nor received periodic income. ~ This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: New Employer's Name: Final Payment Amount: New Employer's Address: CONTACT INFORMATION: To Employerllncome Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (71740-6225, by fax at (717) 240-6248, by email or websute at: www.childsupport.state.pa.us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, ~ 3_N. HANOVER ST P.O. BOX, 320~CARLISLE. PA. 17013 (Issuer address). To EmployeelObligor If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (7171240-6225, by fax at (717) 240-6248, by email or website at www.childsupport.state.~a us. IMPORTANT: The person completing this form is advised that the information may be shared with the ernployee/obligor. OMB No.: 0970-0154 FOrrrl EN-028 06/12 Service Type M Page 3 of 3 Worker ID $IATT A_UC7~N17U11 Summate of Cases on Attachment. Defendant/Obligor: WERT. RGC~ER" PACSES Case Number 900110072 Plaintiff Name ANGELA L. RHODES Docket Attachment Amount 08-2446 CIVIL $ 0.00 Child(ren)'s Name(s): E)U PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Children}'s Name(s): ~::a ___ _ ~HLS[=5 ease ivumber f'iaintiff Nan~e~ ;: _i~intiff iv_ana~- PACSES Case Number Plaintiff Name D cke Attachment Amount $ 0.00 Child(ren)'s Names}: '~~~~aL; Service Type M ;~t~C~E~_~ase_iVUmbe -Main ~fil;_~Varr~ =.~tuet7cu, ,, >.. °~ , M: ANGELA L.RHODES, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY,PENNSYLVANIA VS. CIVIL ACTION-DIVORCE r m: NO. 08-2445 CIVIL TERM —+ ROBERT T. WERT, IN DIVORCE -0 :% Defendant/Respondent PACSES Case No: 900110072 � 7I C? 3 ORDER OF COURT ar AND NOW to wit,this 27th day of March, 2013, it is hereby Ordered that the Alimony Pendente Lite order is terminated, without prejudice, with no balance due, pursuant to no action on the divorce complaint since the filing of the divorce on April 16, 2008 and neither party residing in Cumberland County, Pennsylvania. This Order shall become final twenty (20) days after the mailing of the notices of the entry of the Order to the parties unless either party files a written demand with the Office of the Prothonotary for a hearing de novo before the Court. BY THE COURT: M. L. ert, r., 6J. DRO: R.J. Shadday xc: Petitioner Respondent Form OE-001 Service Type:M Worker:21005 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N.HANOVER ST,P.O.BOX 320,CARLISLE,PA.17013 7- Phone: (717)240-6225 Fax: 24 48 Defendant Name: ROBERT T. WERT Member ID Number: 4659101847 77 Please note:All correspondence must Include the Member ID Num NO __j ORDER TO VACATE ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiple Cases on Attachment PACSES Docket Plaintiff Nam Case Number Number Attachment Anj"nt/Fr,�pue" ANGELA L.RHODES 900110072 08-2446 CIVIL 44 WNTH% $ C— TOTAL ATTACHMENT AMOUNT: $ r The prior Order of this Court directing the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), to attach$102.41 or 50% per week of the Unemployment Compensation benefits of ROBERT T. WERT, Social Security Number XXX-XX-4801, Member ID Number 4659101847 is hereby vacated. This Order to Vacate shall be effective upon receipt of the notice of the Order by the Department and shall remain in effect until a further Order of the Court is filed. BY THE COURT Date of Order: KL,11694,Jr. JUDGE Form EN-035 Service Type M Worker ID$1ATT Angela L. Wert, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION - LAW : IN DIVORCE Robert Wert, Sr. • Defendant : NO. 08 - 2446 CIVIL TERM PRAECIPE TO WITHDRAW EQUITABLE DISTRIBUTION COUNT To The Prothonotary: Please withdraw without prejudice the equitable distribution count filed in the divorce at the above-captioned docket. Date: R./i 9 /3 ) , J 44 clitc) 4.6 Lau TiffaWLoBelio Certified Legal Intern Megan ' esmeyer, Esq. Supervising Attorney Community Law Clinic 371 West South Street Carlisle,PA 17013 (717) 243-2968 ,7,, c....., Fax: (717)241-3539 rn •-;-' ---:c -.,- Angela L. Wert, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION - LAW IN DIVORCE i Fr` c_- - Robert Wert, Sr. • Defendant : NO 08 - 2446 CIVIL TERM (7;3E-- NOTICE TO DEFENDANT If you wish to deny any of the allegations set forth in this affidavit, you must file a counter-affidavit within twenty days after this affidavit has been served on you or the statements will be admitted. PLAINTIFF'S AFFIDAVIT UNDER SECTION 3301(d) OF THE DIVORCE CODE 1. The parties to this action separated in September 2006, and have continued to live separate and apart for a period of at least 2 years. 2. The marriage is irretrievably broken. 3. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. Date Ange . Wert Plaintiff Angela L. Wert, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION - LAW : IN DIVORCE • Robert Wert, Sr. Defendant : NO. 08 - 2446 CIVIL TERM CERTIFICATE OF SERVICE I, Tiffany LoBello , Certified Legal Intern, Community Law Clinic,hereby certify that on '3/19/ 13 , 2013, I served Defendant, Robert Wert, Sr., a true and correct copy of the Notice to Defendant and Plaintiffs Affidavit Under Section 3301(d) of the divorce code, residing at P.O. Box 138, Mertztown, Pennsylvania 19539, by depositing a copy of the same in the United States mail, first class. Date: q / i3. G t1/ i-( 1 io, LoBe1l9 Certi ied Legal Intern Angela L. Wert, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION - LAW IN DIVORCE Robert Wert, Sr. Defendant NO. 08 - 2446 CIVIL TERM CERTIFICATE OF SERVICE 1, Tiffany LoBello , Certified Legal Intern, Community Law Clinic, hereby certify that on September 13, 2013, 1 will serve Defendant,Robert Wert, Sr., a true and correct copy of the Notice of Intention to Request Entry of 3301(d) Divorce Decree,residing at P.O. Box 138, Mertztown, Pennsylvania 19539,by depositing a copy of the same in the United States mail, first class. Q Date: rn LoBe o Certified Legal Intern W —AC) - Angela L. Wert, : IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION- LAW : IN DIVORCE • Robert Wert, Sr. Defendant : NO. 08 - 2446 CIVIL TERM NOTICE OF INTENTION TO REQUEST ENTRY OF 3301(d) DIVORCE DECREE TO: DEFENDANT You have been sued in an action for divorce. You have failed to answer the complaint or file a counter-affidavit to the Plaintiff's 3301(d) affidavit. Therefore, on or after October 2, 2013, the other party can request the court to enter a final decree in divorce. A counter-affidavit which you may file with the prothonotary of the court is attached to this notice. If you do not file with the prothonotary of the court an answer with your signature notarized or verified or a counter-affidavit by the above date,the court can enter a final decree in divorce. A counter Unless you have already filed with the court a written claim for economic relief, you must do so by the above date or the court may grant the divorce and you will lose forever the right to ask for economic relief. The filing of the form counter-affidavit alone does not protect your economic claims. 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. IF YOU CANNOT AFFORD 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 County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717) 249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 The Court 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. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. Angela L. Wert, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION - LAW : IN DIVORCE Robert Wert, Sr. Defendant : NO. 08 - 2446 CIVIL TERM DEFENDANT'S COUNTER-AFFIDAVIT UNDER 3301(d) OF THE DIVORCE CODE 1. Check either(a) or (b): () (a) I do not oppose the entry of a divorce decree. () (b) I oppose the entry of a divorce decree because (Check(i), (ii) or both): () (i) The parties to this action have not lived separate and apart for a period of at least two years. () (ii) The marriage is not irretrievably broken. 2. Check either(a) or (b): () (a) I do not wish to make any claims for economic relief. 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. () (b) I wish to claim economic relief which may include alimony, division of property, lawyer's fees or expenses or other important rights. I understand that in addition to checking (b) above, I must also file all of my economic claims with the prothonotary in writing and serve them on the other party. If I fail to do so before the date set forth on the Notice of Intention to Request Divorce Decree, the divorce decree may be entered without further delay. d I verify that the statements made in this counter-affidavit 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 Robert Wert, Sr. NOTICE IF YOU DO NOT WISH TO OPPOSE THE ENTRY OF A DIVORCE DECREE AND YOU DO NOT WISH TO MAKE ANY CLAIM FOR ECONOMIC RELIEF,YOU SHOULD NOT FILE THIS COUNTER-AFFIDAVIT. Angela L. Wert, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION - LAW : IN DIVORCE Robert Wert, Sr. • Defendant :NO. 08 - 2446 CIVIL TERM CERTIFICATE OF SERVICE I,Tiffany LoBello , Certified Legal Intern, Community Law Clinic, hereby certify that on September 13, 2013, I will serve Defendant, Robert Wert, Sr., a true and correct copy of the Notice of Intention to Request Entry.of 3301(d) Divorce Decree, residing at P.O. Box 138, Mertztown, Pennsylvania 19539, by depositing a copy of the same in the United States mail, first class. ..r . Date: /1 jtt r Tiff oBe o Certified Legal Intern Angela L. Wert, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION - LAW : IN DIVORCE nico Robert Wert, Sr. n, Defendant : NO 08 - 2446 CIVIL TERM c CD-; PRAECIPE TO TRANSMIT RECORD (-) = N) To the Prothonotary: - Transmit the record, together with the following information, to the court for entry of a divorce decree: 1. Ground for divorce: irretrievable breakdown and separation for two years under ' 3301(d) of the Divorce Code. 2. Date and manner of service of the complaint: service on Defendant by certified, restricted delivery, return receipt requested on May 21, 2008. 3. Complete either paragraph(a) or(b): (a) Date of execution of the affidavit of consent required by § 3301(c) of the Divorce Code: by Plaintiff N/A; by Defendant N/A. (b)(1) Date of execution of the affidavit required by § 3301(d) of the Divorce Code: July 31, 2013; (2) Date of filing and service of the plaintiffs affidavit upon the respondent: Filed on August 19, 2013 and served by first class mail on August 19, 2013. 4. Related claims pending: None. 5. Complete either(a) or (b): (a) Date and manner of service of the Notice of Intention to Request Entry of Divorce Decree, a copy of which is attached: Service by first class mail on September 13, 2013. (b) Date plaintiffs Waiver of Notice was filed with the Prothonotary: N/A. Date: / I3 k,�Ly.� !l 1 % f. IPg Bello Certi ied Legal Intern `Ld.I Meg. ' 'esmeyer Supervising Attorney Community Law Clinic 371 West South Street Carlisle, PA 17013 (717) 243-2968 Fax: (717)241-3539 : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA Angela L. Wert V. • Robert Wert, Sr. ; Na 08-2446 DIVORCE DECREE AND NOW, N 4• ` o.‘ 3%50111 x,013 , it is ordered and decreed that Angela L. Wert , plaintiff, and Robert Wed, Sr. , defendant, are divorced from the bonds of matrimony. Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: (If no claims remain indicate "None.") None. By the Court, 1 I 1 - Attest: J. , Prothonotary r /?./1 " / .4 Cet Ocpq rYQUEd oOC.31m0ni*f Law Otinie, Naha' arch Cagy m& ( I .4o datf ��IP� 0 .I Id •