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04-1079
OL.I - I cl7'f C toll. '[-€Ju, IN THE COURT OF COMMON PLEAS OF CAMERON COUNTY Fifty - Ninth Judicial District NO: 01- 6443 RECORDED: 10/09/01 BOOK: PAGE: 0 KIND: DIV DEBT: $ SURCHARGE: PRO: JCP FEE: SAT DATE: 0.00 10.00 40.50 5.00 / / <PLAINTIFF> 1 STAFFORD ROLAND D <DEFENDANT> 1 STAFFORD JODY M OCTOBER 9, 2001 - Plaintiff's Complaint in Divorce filed by CHARLES E. PETRIE, ESQ. SAME DATE: Certified copy of Complaint with endorsement thereon to plead to same, issued for service upon the defendant. Verification and Affidavit of Non-Military Service filed. NOVEMBER 13, 2001 - Praecipe to Enter Appearance and Certificate of Service filed on behalf of Defendant by MARCUS A. MCKNIGHT, III, ESQ.: AUGUST 23, 2002 - Motion to Transfer Venue filed by Charles E. Petrie, Esquire for Plaintiff. Entire file sent to Judge for review and Order. september 5, 2002 - ORDER TO TRANSFER CASE - AND NOW, this 4th day of September 2002, upon eonsideration of the within Motion to Transfer Venue, it is hereby ORDERED AND DECREED that the above divorce action is transferred to the Court of Common Pleas of the County of Cumberland. Pursuant to Pa. R.C.P. No. 213(f) the Prothonotary of the Court of Common Pleas of the County of Cameron is directed to immediately transfer the record together with a certified copy of the docket entries to the Prothonotary of the Court of Common Pleas of the County of Cumberland. BY THE COURT /s/ John H. Foradora, Specially Presiding. SEPTEMBER 5, 2002 - Certified copies sent to the Court of Common Pleas of Cumberland County, Charles E. Petrie, Esquire for Plaintiff and Marcus A. McKnight III, Esquire for Defendant. True and Correct Copy from the :.... of Cameron Co. ~~ JZf/n?//-h, ~w ~"~~ _ b{;;puW Pr~ ROLAND D. STAFFORD, Plaintiff 9/5/02 TRANSFERRED TO CUMBERLAND COUNTY. IN THE COURT OF COMMON PLEAS CAMERON COUNTY, PENNSYLVANIA CIVIL ACTION - LAW vs. NUMBER: 2001-6443 JODY M. STAFFORD, Defendant IN DIVORCE ORDER TO TRANSFER CASE AND NOW, this ~\j.\, day of 61:('// ,2002, upon consideration of the within Motion to Transfer Venue, it is hereby ORDERED and DECREED that the above divorce aetion is transferred to the Court of (J.UMR>w.ANO, Common Pleas of the County of D6.1:ll'hin. Pursuant to Pa.R.C.P. No. 213(f), the Prothonotary of the Court of Common Pleas of the County of Cameron is directed to immediately ~, ("~ .':-:-.:. ....., (.~ CJ J '41 transfer the record together with a certified copy of the docket entries to the Prothonqtary of the Court of Common Pleas of the County of (!vHb;:/VIr.I1) Dauphin. --. j'.' BY THE COURT: True and correct ~ frorr. the ,;,ds q. Cameron Co. 'dnna. (();t~~ Q.eput.y n.................' ~~cf~ :::JW(/{J!-LC( f'f?GS/llif'JtJ ROLAND D. STAFFORD, Plain tiff IN THE COURT OF COMMON PLEAS CAMERON COUNTY, PENNSYLVANIA CIVIL ACTION - LAW vs. NUMBER: 2001-6443 JODY M. STAFFORD, Defendant IN DIVORCE MOTION TO TRANSFER VENUE NOW COMES the Plaintiff, ROLAND D. STAFFORD, by and ..." ~::::: through his attorney, Charles E. Petrie, and respectfully represents :is '" o follows: c., w 1. That Plaintiff is ROLAND D. STAFFORD, who eurrently resides at 102 Fifth Street, New Cumberland, County of Cumberland, iv Pennsylvania. 2. That Defendant is JODY M. STAFFORD, who currently resides at an address unknown to Plaintiff, but who is represented by Marcus A_ McKnight, III, Esquire, 60 West Pomfret Street, Carlisle, Pennsylvania, 3, That at the time of the filing of the Complaint in Divorce, Plaintiff believed that the divorce matter would be resolved without the neeessity of a master's hearing, 4. That Defendant has indieated the need for a master's hearing to resolve the issue of equitable distribution. True and Correct Copy r'. ;'ed from the "ords of Cameron Co. ,na 9l4l//l) ~ffi?d/l./ CG,C' :N ProthonOtary 5. That Plaintiff is a resident of Cumberland County and Counsel for Plaintiff is a resident of Dauphin County. WHEREFORE, Plaintiff respectfully requests that Your Honorable Court enter an Order transferring venue to the Court of Common Pleas of Cumberland County, Pennsylvania, and directing that the Prothonotary of Cameron County transfer the ease file to the Prothonotary of Cumberland County. Respectfully submitted; & }(~AJ dJ Id-lw Charles E. Petrie 3528 Brisban Street Harrisburg, PA 17111 (717) 561-1939 Attorney for Plaintiff Trn6 and Correct Copy ';r,d from the . cis of Cameron Co. ,.,a. LfllI4l.41 ))2f/l?7/U{) ": 'hi ProthonOtary .....' <= C,;:. f'--.~ " ~.) w :'--, r....;. ROLAND D. STAFFORD, Plaintiff IN THE COURT OF COMMON PLEAS CAMERON COUNTY, PENNSYLVANIA CIVIL ACTION - LAW vs. NUMBER: 2001-6443 JODY M. STAFFORD, Defendant IN DIVORCE CERTIFICATE OF SERVICE ...., ._- I eertify that I sent a copy of the foregoing Motion to Transfer C'.' Venue to the Defendant's counsel, MARCUS A McKNIGHT, III, ESQUIRE, 1'\.~ w at 60 West Pomfret Street, Carlisle, Pennsylvania, 17013-3222, on August 21,2002, by U.S. First Class Mail, postage prepaid. I...., Respectfully Submitted, r!laJ(/;-l) Jl /1/-w Charles E. Petrie 3528 Brisban Street Harrisburg, PAl 7111 (717) 561-1939 Attorney for Plaintiff True and Correct Copy ,srttlied from the ""cords of Cameron Co. dnna. ~~)<;Z5~ 'i'AllP!Jty Pro\hoI'lOteUY vs, IN THE COURT OF COMMON PLEAS CAMERON COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NUatER: 2001 ~l.tri3 ROLAND D. STAFFORD, Plaintiff JODY M_ STAFFORD, Defendant IN DIVORCE 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 ease may proeeed without you and a decree of divorce or annulment may be entered against you. by C'" the eourt. A judgment may also be entered against you for any otJ:i.er ; "'; claim or relief requested in these papers by the plaintiff. You m~y lose g money or property or other rights important to you, including cU:st9dy or -,-c visitation of your children. , : - '"" , i I ~ ."7 When the ground for the divorce is indignities or irretrievabl~ . i<i breakdown of the marriage, you may request marriage counseli~g.1 Alist ;:, of marriage counselors is available in the Offiee of the Prothonotary, _ci LJ Cameron County Courthouse, Emporium, PA. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP, DAVID J. REED, PROTHONOTARY CAMERON COUNTY COURTHOUSE EMPORIUM, PA 15834 (814) 486-3355 Correct Copy \~j'Of{} tnA of CHmo~'on Co. (,8 Ql~sd/l?2d//~ . . .,., \:Ji'I"t\",')'\v:>t.ary > .. > .,d.~' ~," f-'~ vs. IN THE COURT OF COMMON PLEAS CAMERON COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NU~ER: 2001 ~tN 3 ROLAND D, STAFFORD, Plaintiff JODY M. STAFFORD, Defendant IN DIVORCE COMPLAINT UNDER SECTION 33011cl OF THE DIVORCE CODE 1. Plaintiff is ROLAND D, STAFFORD, who currently resides at 102 Fifth Street, New Cumberland, County of Cumberland, ..., ~) \C:;::,:) 2, C:J C) ---< i' I ,I '-0 Defendant is JODY M, STAFFORD, who eurrently re~ides a~, \ I r, I .,- Pennsylvania, since 1990. 102 Fifth Street, New Cumberland, County of Cumberland, 1'-.) Pennsylvania, since 1990. (~) W 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, The plaintiff and defendant were married on December 2, 1984, in Harrisburg, County of Dauphin, Pennsylvania. 5. There have been no prior actions of divorce or for annulment between the parties. 6. The marriage is irretrievably broken. True and Correct Copy ',''1rtified from the ""'cords of Cameron Co. .nna. ~4!.~) y:f,/TlUC/2/ "", f?i\)thonotary 7. Plaintiff has been advised that eounseling is available and that plaintiff may have the right to request that the eourt require the parties to participate in eounseling, 8, Neither party is a member of the Armed Forces of the United States of America or any of its Allies. 9. After ninety (90) days have elapsed from the date of service of this Complaint, plaintiff intends to file an Affidavit consenting to a ~ ~~ divoree. Plaintiff believes that defendant may also file such an affidaviC'i ; " --- ,{ C:) WHEREFORE, if both parties file affidavits eonsenting to J divore~ i, I t - \..~:> after ninety (90) days have elapsed from the date of service of this : I r. -" Complaint, plaintiff respectfully requests the Court to enter a deFee of:~~ ; I ..'J (,.,,) divorce pursuant to Section 3301 (c) of the Divorce Code. "..., ~J I verify that the statements made in this Complaint are true and correct. I,understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsifieation to authorities. r<\ ~ -- DATE:(A.--\..\-rL..l '1-00 I ~ \.~~ \. ROLAND D. STAFFORD, PLAINTIFF d.u-Lc~--> CHARLES E. PETRIE 3528 Brisban Street Harrisburg, PA 17111 (717) 561-1939 ATTORNEY FOR PLAINTIFF ~ .-J True and Correct Copy ,/~rtilied from the . cords of Cameron Co. "ma. ~ yf/l?V#7..J OOOuty ProthonOtary ROLAND D. STAFFORD, Plaintiff : IN THE COURT OF COMMON PLEAS : CAMERON COUNTY, PENNSYLVANIA : CIVIL ACTION - LAW vs. ; NU.R: 2001 ..-4> '-/ tf 3 JODY M. STAFFORD, Defendant : IN DIVORCE AFFIDAVIT OF NON-MILITARY SERVICE I, Plaintiff herein, do hereby depose and say that I am advised and believe that the above named Defendant is not presently in the active military serviee of the United States of America and I aver that the Defendant is not a member of the Army of the United States, United States Navy, the Marine Corps, or the Coast Guard, and is not an officer of the Public Health Service detailed by proper authority for duty with roe Army or Navy; nor is Defendant engaged in any military or NaVy'uriits ~; covered by the Soldiers and Sailors Civil Relief Act of 1940 and :. ~ designated therein as military service; nor has Defendant, to the! best 010 my knowledge, enlisted in the military serviee covered by this 'act.- , \ _ ~ -'3 ,-.... --. " _: , --,: , . This Affidavit is made under the provisions of the Soldit:;rs'artd Sailors Civil Relief Act of 1940. . ' I r,:;, ~ ~.) c.) (..J . ~Jn >-\_""7 I verify that the statements made in this Affidavit are true and correet. I understand that false statements herein are made subject to the penal~ies of 18 Pa.C.S. Seetion 4904, relating to unsworn falsification to authorities. O,\.,\-" qt)..C'X) \ DATE ~~ " ROLAND D. STAFFORD, PLAINTIFF .~ True and Correct Cop ~;ertifled from the Y .'Jcords of Cameron Co j. 8nna. . ~0~ i::l~ AuIllOl'l:' 'Y ~ LAW OFFICES .- IRWIN McKNIGHT & HUGHES ROGER B. IRWIN MARCUS A. McKNIGHT. III JAMES D. HUGHES REBECCA R. HUGHES MA./U( D. SCHWARTZ DOUGLAS G. MIllER WEST POMFRET PROFESSIONAL BUILDING 60 WEST POMFRET STREET CARLISLE, PENNSYLVANIA 77013-3222 1777) 249,2353 FAX 1717) 249-6354 E-MAIL: IMHLAW@SUPERNET.COM HAROLDS.IRWlN (1925-/977) HAROLDS.IRWlN, JR. (1954./986) IRWIN, IRWIN &JRW/N (1956-19l16) IRWIN, IRWIN & McKNIGHT (1986-1994) IRWIN. McKNIGHT & HUGHES (1994- ) November 7,2001 David J. Reed, Prothonotary Cameron County Courthouse Emporium, P A 17834 ......) Re: Stafford v. Stafford No. 2001-6443 Dear Sir or Madam: I am enclosing an original and four copies of the Praecipe to Enter Appearance in the above-captioned case. Please return the time-stamped copies to me in the self-addressed stamped envelope. If you have any questions, please do not hesitate to contact me. Thank you for your cooperation. Very truly yours, MAM/mln Ene\. cc: Ms. Jody Stafford True And Cowx,! r:,,!:'v fiOm the of Cameron Co. "3nna. 9Jt~Jf!~ t,,,'" '. "'"':'thonotary ROLAND D. STAFFORD, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CAMERON COUNTY, PENNSYLVANIA v. JODY M. STAFFORD, Defendant NO. 2001-6443 CIVIL ACTION - LAW IN DIVORCE CERTIFICATE OF SERVICE I, Marcus A. McKnight, III, Esquire, hereby certify that a copy of attached Praecipe to Enter Appearance was served upon the following by depositing a true and correct copy of the same in the United States mail, First Class, postage prepaid in Carlisle, Pennsylvania, on thfl date referenced below and addressed as follows: ,--) Charles E. Petrie, Esq. 3528 Brisban Street Harrisburg, P A 17111 -' IRWIN, McKNIGHT & HUGHES {vi;. By: Mar s A. MC~ ~squire 60 est Pomfret Street Carlisle, P A 17013 (717) 249-2353 Supreme Court LD. No. 25476 Date: November 7, 2001 TnJ€ and Correct Copy . ,,"filil:K) from the :.,..::;cyds of Cameron Co. '{-'enna. L#rLIt f?)>Zf~../ :i',o,'",;,l'! ProthonOtary ROLAND D. STAFFORD, Plaintiff v. JODY M. STAFFORD, Defendant : IN THE COURT OF COMMON PLEAS OF : CAMERON COUNTY, PENNSYLVANIA NO. 2001-6443 CIVIL ACTION - LAW IN DIVORCE PRAECIPE TO ENTER APPEARANCE To the Prothonotary: Please enter my appearance on behalf of the defendant, JODY M. STAFFORD, in the above captioned case. , True and Correct Copy '."",'\ilied from the : "cords of Cameron 00. ""anna. ~ J<!f~ 'f'>~U.t\f~ r'_~ Respectfully submitted, By: Marcus . Mc . h 60 West Pomfret S t Carlisle, Pennsylvania 17013 (717) 249-2353 Attorney for defendant Date November 7, 2001 '-' ,..~.) . ~ c:" f:) C_, ~ ~ - , 1- - ...0 .:..:.<.; 0 .- 1'0 ......... ~ d ,. ..t:: - GO "'\7 \) r _..- ~ --- ~ - ~ "-- , F .J) 1 I~ THE COURT OF COMMON PLE.~ OF CUMBERLAND COUNTY, PENNSYLVAJ.''lIA ROLAND D. STAFFORD, PLAINTIFF/RESPONDENT vs. JODY M. STAFFORD, DEFENDANT/PETITIONER NO. (")I...J - 1017' (1(JLI L~ JODY M. STAFFORD a master with respect to the ( X ) Divorce ( ) Annulment ( X ) Alimony ( X) Alimony Pendente XOTION FOR APPOTIlTXENT OF MASTER (R~X1xxx (Defendant), moves the court to appoint following claims: Lite ( X) ( ) (X) ( X ) Distribution of Property Support Counsel Fees Cos ts and E.."l:penses and in su~port or the mocion states: (1) Discovery is complete as to the claims(s) for which the appointment of a master is requested. (2) The defendant (has) ~) appeared in (by his attorney, MARCUS A. McKNIGHT, III (3) The staturory groundOs) for divorce (is) 3301 (c) (4) Delete the inapplicable paragraph(s): (a) The action is not contested. (b) Ari agreement has been reached with respect to the ALL THE ABOVE (c) The action is contested with respect to the following the action (lpJP""'''''''WlI~ ,Esquire) . me) following claims: claims : or fact. (5) The action (involves) (does not involve) comple~ issues of law (6) The hearing is .~ected to take (7) Additional info~tion, if any. (hamle;) (days). to the motion: Date: MAReH l2, 2004 -':) (Defendant) ORDER APPOINTING ~l~STER AND NOW ,19_, is appointed master with respect to the following claims: Esquire, By the Court: J '" ~_':l (':::.) -'.. -...: v. : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA ~7vIL ~~~ ~i1w (3'''L t-Fia..j IN DIVORCE ROLAND D. STAFFORD, Plaintiff /Respondent JODY M. STAFFORD, DefendanUPetitioner PETITION FOR ECONOMIC RELIEF AND NOW, this 12th day of March 2004, comes the Petitioner, lody M, Stafford, by her attorneys, IRWIN & McKNIGHT, and makes the following Petition for Economic Relief against the Respondent, Roland D. Stafford, as follows: 1. The Petitioner is lody M. Stafford who is the Defendant in a divorce action filed at in Cumberland County, Pennsylvania. Her address is 1105 Bridge Street, New Cumberland, Cumberland County, Pennsylvania 17070. 2, The Respondent is Roland D. Stafford who is the Plaintiff this divorce action. His address is 208 Hillcrest Drive, New Cumberland, Cumberland County, Pennsylvania 17070. 3. The petitioner seeks the following relief from the Court: a. Equitable distribution of the marital assets; b. Alimony pendente lite; c. Alimony; d. Costs and expenses; and e_ Counsel fees. WHEREFORE, the Petitioner, Jody M. Stafford, requests the relief set forth above. Respectfully submitted, IRWIN & McKNIGHT By: Marcus ~. Mc 60 West Pomfret treet Carlisle, PA 17013 717-249-2353 Supreme Court J.D. No: 25476 Attorney for the Defendant/Petitioner, Jody M. Stafford Date: March 12,2004 2 VERIFICATION The foregoing document is based upon information which has been gathered by counsel and myself in the preparation of this action. I have read the statements made in this document and they are true and correct to the best of my knowledge, information and belief. I understand that false statements herein made are subject to the penalties of 18 'Pa, C.S,A. Section 4904, relating to unsworn falsification to authorities_ i/IM~~ Date: MARCH 12, 2004 3 I''':' , \..L) ROLAND STAFFORD, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA VS. : NO: 04-1079 JODY STAFFORD, Defendant CIVIL ACTION-LAW : IN DIVORCE 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 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, One Courthouse Square, Carlisle, Pennsylvania 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYERS'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 32S0UlliBEDFORD CARUSLE, P A 17013 (717) 249-3166 OR (800)990-9108 ROLAND STAFFORD, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA vs. NO: 04-1079 JODY STAFFORD, Defendant CIVIL ACTION-LAW IN DIVORCE NOTICE OF AVAILABILITY OF COUNSELING TO THE WITHIN NAME[) DEFENDANT You have been named as a Defendant in a divorce proceeding filed in the Court of Common Pleas of Cumberland County. This notice is to advise you that in accordance with S3302 (c) or (d) of the Divorce Code, you may request that the court require you and your spouse to attend marriage COUnSE!ling prior to a divorce decree being handed down by the Court. A list of professional marriage counselors is available at the Cumberland County Courthouse, Cumberland County, Pennsylvania. You are advised that this list is kept as a convenience to you, and you are not bound to choose a counselor from the list. All necessary arrangements and the cost of counseling sessions are to be borne by you and your spouse. If you desire to pursue counseling, you must makE! your request for counseling within twenty (20) days of the date on which you receive this notice. Failure to do so will constitute a waiver of your right to request counseling. ROLAND STAFFORD, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA vs. JODY STAFFORD, Defendant NO: 04-1079 CIVIL ACTION-LAW IN DIVORCE AMENDED DIVORCE COMPLAINT 1. Plaintiff is Roland Stafford, an adult individual who currently resides at 208 Hillcrest Road, New Cumberland, Cumberland County, Pennsylvania. 2. Defendant is Jody Stafford, an adult individual who currently resides at 1105 Bridge Street, New Cumberland, Cumberland County, Pennsylvania. 3. The Plaintiff has been a bona fide resident(s) in the Commonwealth for at least six (6) months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on December 1, 1984 in Harrisburg, Dauphin County, Pennsylvania. 5. A prior action for divorce was filed in Cameron County, Pennsylvania at Docket Number 01-6443. The Divorce Complaint from Cameron County was transferred to Cumberland County on September 5, 2002. The Cumberland County Prothonotary received the complaint and assigned Docket Number 04-1079 on March 12, 2004. On the same date, a Petition for Economic Relief and Petition for Appointment of Master were filed. The Divorce Master currently has the file. 6. The Plaintiff in this action is not a member of thl9 Armed forces. 7. Plaintiff and Defendant are both citizens of the United States. 8. Plaintiff has been advised of the availability of marriage counseling and that he may have the right to request the court to require the parties to participate in such counseling. Being so advised, Plaintiff does not request that the court require the parties to participate in counseling prior to the divorce decree being handed down by the court. 9. The parties have been living separate and apart since October 26,2001. 10. The parties do not share any marital propelty and distribution of property is not an issue in this matter. 11. The parties are the natural parents of four (4) children, two of which are minors. 12. The parties have a current custody order dated June 28, 2004 at Docket Number 2001-5757 Cumberland County, Pennsylvania and custody is not at dispute in this matter. 13. The marriage between the Plaintiff and tht3 Defendant is irretrievably broken. WHEREFORE, the Plaintiff respectfully requests this Honorable Court to enter a Decree of Divorce. Respectfully submitted, Date: II)" of Abom & Kutulakis, L.L.P. Kffi7UO.ll, Kara W. Haggerty, E~ ire Attorney 1.0. No. 86914 36 South Hanover Street Carlisle, PA 17013 (717) 249-0900 Attorney for Plaintiff ROLAND STAFFORD, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA vs. NO: JODY STAFFORD, Defendant CIVIL ACTION-LAW IN DIVORCE VERI FICA TION I verify that the statements made in the foregoing Complaint in Divorce are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 94904, relating to unsworn falsification to authorities. I () I).. Q / :;"C')o-::( Date ~~~ J2-~~ Roland Stafford <2 ...,.:) ~ ~ ~ S'"' ~ > e -Off' mr-! rn~ Z ,.If"} .;.c. 7~.: I ~~ (f>; ,':'. - OJ ~", ;, ~:B '.t-:'" ,.' -0 ?in ~ go -0 ~ 5\f\ :;'C ~ ~ l" ~ c",J ;:.:: ROLAND STAFFORD, Plaintiff : IN THE COURT OF COMMON PLEAS CUMBERLAND COUN1Y, PA vs. NO: 04-1079 lODY STAFFORD, Defendant CIVIL ACTION-LAW IN DIVORCE AND NOW, this ACCEPTANCE OF SERVICE ~," day of /t)Hw.~ , 2004, I, Marcus McKnight, Esq., hereby certify that I did receive and accept service of the Complaint in Divorce in the above captioned matter on behalf of the Defendant, lody Stafford, and I further certify that I am authorized to do so. Respectfully submitted, ABOM & KUTULAKIS, L.L.P i-.'r- "" ?tow! . J ~LiL Mar s McKnighr, E~ Attorney for Defendant DATE (? ~~;: ~ = = .z:::- CJ Pl ,-) I ~ --f :r.1 I'll r=- -ocq ::rJ \T'- s:; ~-::) ~E. ..+1 O-C' ~~..~? ;(5' .1 >-l -..,.> ~XJ :.",~ ,') --,,",," ...I.. .;::- 00 ROLAND STAFFORD, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA vs. NO: 04-1079 lODY STAFFORD, Defendant CIVIL ACTION-LAW IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in divorce under ~3301(c) of the Divorce Code was filed on October 9, 2001. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. ~4904 relating to unsworn falsification to authorities. '~ ' '\ t - -- Date: \,0' \ f) i .AOO') CL..: .Y .-:? ROLAND STAFFORD " , \ '" <= 0 <= " en - -l " ::r.::"T: :=0 f"l1p.d I ~nrn -.J C'56 --~'l__". ~::J ~:~~~ N ~....-; N j;; cTJ CO -<; - ROLAND STAFFORD, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA vs. NO: 04-1079 lODY STAFFORD, Defendant CIVIL ACTION-LAW IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER $3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3, I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made 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: ~f"'\ S A(:)()S'C~ \ ,) ROLAND STAFFORD " '....,~') "', p ,-' '::' '" co ~ :.~: "'" (.::;:, Co.~ en ;c,. " ~J n "ii :r!~ nlf=;' """t)ri'l i3r.? "~~) f? (;Fr~: ::::J 7€ , -.J ROLAND STAFFORD, Plaintiff : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA vs. : NO: 04-1079 lODY STAFFORD, Defendant : CIVIL ACTION-LAW : IN DIVORCE ENTRY OF APPEARANCE Please enter the appearance of the undersigned as counsel for Plaintiff, Roland Stafford, in the above-captioned matter. Respectfully submitted, ABOM & KUTULAKIS, L.L.P '. , Kara W, Haggerty, Esq(1 e 36 South Hanover Stre Carlisle, Pennsylvania 17013 (717) 249-0900 Attorney for Plaintiff ill #86914 DATE 4/lq /00 r' c: r-.) C::' ........., :::::::;., ',::':) c:...n ~.) " .-.r." c-, ROLAND STAFFORD, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA VS. NO: 04-1079 JODY STAFFORD, Defendant CIVIL ACTION-LAW IN DIVORCE PETITION TO WITHDRAW APPEARANCE AS COUNSEL PURSUANT TO RULE l012(c) AND NOW, this 2.1 ~ of October 2005, comes Kara W. Haggerty, Esquire, counsel for the above captioned plaintiff who grant her leave to withdraw as counsel and in support thereof, avers the following: 1. On August 13, 2002 the Plaintiff entered into a written agreement with undersigned counsel wherein undersigned counsel agreed to enter his appearance and represent the Plaintiff in the above captioned divorce matter in exchange for the Plaintiffs agreement to pay undersigned counsel a set hourly rate for legal services in connection with the above captioned matter. The Plaintiff further agreed to pay the undersigned counsel a modest retainer from which the cost of the first several hours of legal services would be deducted. The Plaintiff paid that retainer_ 2. On November 1, 2004 the undersigned counsel filed an amended divorce complaint in the above captioned matter, 3, On April 13, 2005, opposing counsel stated that his client would not sign the consent for the divorce until the property and equitable division issues were handled, which were in front of the Divorce Master pursuant to a petition for economic relief that was filed by the Defendant in March of 2004. 4, On April 20, 2005, the undersigned counsel entered her appearance to represent the Plaintiff, 5. As of July 2005, the cost for undersigned counsel's legal services in connection with the above captioned matter exceeded the initial retainer and a bill was forwarded to the Defendant requesting payment of the outstanding balance for unpaid legal services and an additional modest retainer for continuing legal services, 6. In September 2005, undersigned counsel forwarded to the Plaintiff another letter stating requesting payment of the outstanding balance for unpaid legal services and an additional modest retainer for continuing legal services. 7. The undersigned counsel has attempted to cotnnlurucate with Plaintiff on a number of occasions regarding Plaintiff's payment of the outstanding bills and charges. However, despite numerous efforts, no response has been received by the undersigned counsel, and no fees have been paid. 8. On September 16, 2005, the undersigned counsel advised Plaintiff that if payment on the outstanding charges was not made or satisfactory arrangements agreed to, counsel would be forced to withdraw as Plaintiff's counseL 9. The Plaintiff refuses to pay for the legal services provided in connection with his divorce matter. 10. Legal services were provided since the Plaintiff retained the undersigned counsel, 11, Plaintiff has failed to fulfill obligations to the undersigned counsel regarding her services and has been given reasonable warning that the undersigned counsel will withdraw unless the obligation is fulfilled, and good cause therefore exists under Rule 1.16 (b)(4) of the Pennsylvania Rules of Professional Conduct for the undersigned counsel's withdrawal, 12. The coutinued representation of Plaintiff without payment of the undersigned counsel's fees, or the prospect of such payment, has resulted and will further result in an unreasonable financial burden on the undersigned counsel, and good cause exists therefore under Rule 1.16(b )(5) of the Pennsylvania Rules of Professional Conduct for the undersigned counsel's withdrawaL 13. Undersigned counsel remains willing and able to provide copies of all documents and other material contained in the Plaintiff's files. WHEREFORE, the undersigned counsel respectfully requests This Honorable Court to grant her Motion for Withdrawal of Appearance of Counsel, Respectfully submitted, ABOM & KUTULAKlS, LL.P. Date: 10 2--1/D5 K~, Kara W, H Attorney L , 8691 36 South Hanover Street Carlisle, PA 17013 (717) 249-0900 Petitioner VERIFICATION I, Kara W. Haggerty, Esquire, verify that the statements made in the foregoing Petition are true and correct, I understand that false statements herein are made subject to the penalties of 18 Pa,C.S, ~ 4904 relating to unsworn falsification to authorities. Respectfully submitted, ABOM & KUTULAKI5, LLP DATE 10 2J OS Kara W. Haggerty, Esq Attorney LD, No. 8691 36 S. Hanover Street Carlisle, P A 17013 (717) 249-0900 Petitioner CERTIFICATE OF SERVICE AND NOW, this l1 ~ of Octobcr 2005, I, Kara W. Haggerty, Esquirc, of Abom & Kutulakis, L.L.P, hereby certify that I did serve a true and correct copy of the foregoing Petition upon those listed below by depositing, or causing to be deposited, same in the United States Mail, First -class mail, postage prepaid addresscd to the following: Roland Stafford 208 Hilcrest Drive New Cumberland, P A 17070 Plaintiff Marcus A. McKnight, III Irwin McKnight & Hughes West Pomfret Professional Building 60 West Pomfret Street Carlisle, P A 17013 Deftndant's COUlIJel E. Robert Elicker 9 N. Hanover Street Carlisle, P A 17013 Divorce Master Respectfully submitted, AllOM & KUTULAKIS, LLP (!wwiJ . Ku:a W. Haggerty, Es 36 S, Hanover Street Carlisle, P A 17013 (717) 249-0900 Attorney LD. No. 86914 Petitioner ~..--...- ., ".(~ - <, :) ROLAND STAFFORD, Plaintiff vs, lODY STAFFORD, Defendant vi ;'~~ECEIVED nn .2 Q L005 ....'J. : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PA NO: 04-1079 CIVIL ACTION-LAW IN DIVORCE ORDER OF COURT AND NOW, this :3'" day of ~ , 20&, upon consideration of the verified Petition of Plaintiff's Counsel For Leave To Withdraw, it is hereby ORDERED and DECREED that said petition is GRAN1ED and that petitioner, Kara W. Haggerty, Esquire, and Abom & Kutulakis, liP, be permitted to withdraw as counsel of record for the plaintiff in the above matter. Distribution: ~a W. Haggerty, Esq, (:...Marcus A. McKnight, III, Esq, ~and Stafford 208 HiIcrest Drive New Cumberland, P A 17070 ~. Robert Elicker, Divorce Master BY THE COURT, J. V:f\ /r\:J..\S\i:,,!jd AlNn"-"'., ..',' ',,'",:,r~~'~~:f,!nJ 6S :L l,IV ~-!.ON ~OOZ Il";!'(\N,-,;.Ji(".1' "Hi:lO ^u J..VI v' ,.,..)....0 :il j::llj~C-G31\~ ROLAND D. STAFFORD, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 2004-1079 CIVIL ACTION - LAW IN DIVORCE JODY M. STAFFORD, Defendant DEFENDANT'S MARRIAGE COUNSELING AFFIDAVIT The defendant, being duly sworn according to law, deposes and says: 1. 1 have been advised of the availability of marriage counseling and understand that 1 may request that the court require that my spouse and I participate in counseling. 2. I understand that the court maintains a list of marriage counselors in the Prothonotary's Office. which list is available to me upon request. 3. Being so advised, I do not request that the court require that my spouse and I participate in counseling prior to a divorce decree being handed down. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein made are subject to the penalties of 18 Pa. CS. Section 4904 relating to unsworn falsification to authorities, Date: J -~Cf-6b ~ I1If1J JOm AFFORD . Defendant " ---) {--- C'" ROLAND D. STAFFORD, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 2004-1079 CIVIL ACTION. LAW IN DIVORCE JODY M. STAFFORD, Defendant DEFENDANT'S AFFIDAVIT OF CONSENT 1. A complaint in divorce under Section 3301(c) or 3301 (d) of the Divorce Code was filed on November I, 2004, 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of the filing of the complaint. 3. I consent to the entry of a final decree in divorce. 4. 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 made are subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. 7/J! FFORD Date: I - 0( C/_ Db (," ;-i C.' : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA ROLAND D. STAFFORD, Plaintiff v. NO. 2004-1079 CIVIL ACTION. LAW IN DIVORCE JODY M. STAFFORD, Defendant WAIVER OF NOTICE OF INTENTION TO REOUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE I. I consent to the entry of a final Decree of Divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3, I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein made are subject to the penalties of 18 Pa. C.S, Section 4904 relating to unsworn falsification to authorities. Date: / - J.. Lf - 0 0 ~ J1l.!fII JO STAFFORD Defend nt ,'1 ROLAND D. STAFFORD, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 04 - 1079 CIVIL JODY M. STAFFORD, Defendant IN DIVORCE ORDER OF COURT AND NOW, this ~ day of ~~ ' ........... 2006, the parties and counsel having entered into an agreement and stipulation resolving the economic issues on January 24, 2006, the date set for a Master's hearing, the agreement and stipulation having been transcribed, and subsequently signed by the parties and counsel, the appointment of the Master is vacated and counsel ean conclude the proceedings by the filing of a praecipe to transmit the record with the affidavits of consent of the parties so that a final decree in divorce can be entered. cc: ~land D. Stafford Plaintiff ~rcus A. MeKnight, III Attorney for Defendant BY THE ,.\)N,,\'('I1 \n\'~.'~ J\ I, '~',')" ~\~~O 1"'\ , _ ,c__ ','. ,~', ("'".\11.1(';..; N)"\\'.C;,' '.'" < ':iI" , S '.~ \~<:\ L<. ~~r ~~~l ur.I,C',:j'AJo:\O '~'r\i. :,0 ,,0' ~ ;~\~~\(r-Cl:'i'\\~ ..j....",.~. . ROLAND D. STAFFORD, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 04 - 1079 CIVIL JODY M. STAFFORD, Defendant IN DIVORCE THE MASTER: Today is Tuesday, January 24, 2006. This is the date set for a hearing in the above captioned divorce proceedings. Present in the hearing room are the Plaintiff, Roland D. Stafford, who is not represented by eounsel. Also present is the Defendant, Jody M. Stafford, who is represented by Marcus A. McKnight, III. This aetion was eommenced by the filing of eomplaint in divorce in Cameron County, Pennsylvania, on October 4, 2001. Said divorce aetion on motion to transfer venue was subsequently transferred based on said motion to Cumberland County, Pennsylvania. At the time of the filing of the original eomplaint, both parties resided in Cumberland County, Pennsylvania. Following the transfer of the aetion to Cumberland County, the Plaintiff filed an amended eomplaint in divorce on November 1, 2004. No eeonomic elaims were raised in the eomplaint. The eomplaint did aver grounds for divorce of irretrievable breakdown of the marriage. On March 12, 2004, the Defendant filed a 1 petition for economic relief raising economie claims of equitable distribution, alimony, alimony pendente lite, and counsel fees and expenses. Mr. Stafford signed and filed an affidavit of consent and a waiver of notiee of intention to request entry of divorce decree. The affidavit and waiver were signed on AprilS, 2005, and filed on April 7, 2005. The Defendant has provided the Master today with her affidavit of consent and waiver of notice of intention to request entry of divorce decree which will be filed today with the Prothonotary's office. Therefore the divorce can conclude under Section 3301(e) of the Domestic Relations Code. The parties were married on December 2, 1983, (incorreetly stated in the amended eomplaint as 1984) and separated on October 26, 2001. They are the natural parents of four children, two of whom are minors. The male ehild lives with Mr. Stafford and the female child lives with Mrs. Stafford. Wife is eurrently receiving as spousal support the sum of $98.00 per month paid through the Cumberland County Domestie Relations Offiee. The Master has been advised that the parties have reached an agreement with respect to the outstanding economic issues in the action. The agreement is going to be placed on the record in the presence of the parties and will 2 not be subject to any changes or modifieations exeept for correction of typographieal errors whieh may be made during the transeription. Therefore, when the parties leave the hearing room today they are bound by the substantive terms of the agreement. They are going to be asked to return later today to review the draft of the agreement for typographieal errors; eorreetions will be made as necessary, and then affix their signatures affirming the terms of the agreement as stated on the reeord. Even though the parties subsequently do not affirm the terms of the agreement by signing, they are nevertheless bound by the agreement when they leave the hearing room today. Upon receipt by the Master of the completed agreement, the Master will prepare an order vacating his appointment and Mr. MeKnight ean then prepare a praeeipe transmitting the record to the Court requesting a final deeree in divorce. Mr. MeKnight. MR. MeKNIGHT: Pursuant to today's diseussions and the information that has been exchanged by the parties, the following is the settlement that they have arrived at. 1. All personal property and other assets will be owned by the party who has possession of the respective asset. These inelude all automobiles, furniture, and other miscellaneous personal property that the parties have previously divided and distributed to themselves. 2. In addition, each party is responsible for their own 3 debt, and this is debt acquired in their own names, some of it pre-separation and some of it post-separation debt. Specifieally, the husband will be solely responsible for the Chase MasterCard, Diseover MasterCard, American General Loan, and his student loans. He will hold harmless wife from any elaims made by third parties against these debts from her although it is understood that her name was never on these particular loans and that they are in the sole name of husband. Likewise, wife will be solely responsible for any student loans or other MasterCards or debts that she has aequired since the separation and she will indemnify husband and he will in no way be responsible for any payment on any credit cards or loans that she has acquired after the separation. 3. The spousal support will end as of the date of the divoree decree; however, the Domestic Relations Office will be direeted to eollect the sum of $98.00 as alimony after the divorce until the month in whieh wife begins to receive the regular payments from husband's retirement paid through the United States Offiee of Personnel Management. The parties agree that this retirement which husband eurrently reeeives, which will be in the amount of $1,069.00 gross with a net monthly payment of $1,036.45, will be distributed 31% to the wife and the balanee to the husband. Husband has maintained that the amount of the retirement he receives has been redueed by the survivor annuity whieh is in the name of Jody M. Stafford. He will maintain Jody M. Stafford and the United States Offiee of Personnel Management is direeted to continue Jody M. Stafford as that survivor benefieiary of any annuity that would be payable upon Mr. Stafford's death to Jody M. Stafford as a survivor beneficiary. 4. Husband agrees to sign all doeuments neeessary to distribute of 31% of the monthly retirement to wife, and wife's attorney will prepare the necessary QDRO and submit it to the United States Offiee of Personnel Management, but husband agrees to eooperate with wife's eounsel in obtaining the information necessary to eomplete the QDRO and he agrees to sign it when it is ready. 5. Wife waives all claims for eosts and expenses and counsel fees. Husband hereby waives any elaims to costs and expenses also. 6. The alimony award will cease on the first day following the month that wife reeeives her first payment from husband's retirement fund and she waives all further alimony 4 after that date. 7. Except as herein otherwise provided, each party may dispose of his or her property in any way and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire under the present or future laws of any jurisdiction to share in the property or the estate of the other as a result of the marital relationship including without limitation, statutory allowance, widow's allowanee, right of intestacy, right to take against the will of the other, and right to aet as administrator or exeeutor in the other's estate. Each will at the request of the other execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interest, rights, and claims. THE MASTER: Mr. Stafford, you have heard the agreement as stated on the record? MR. STAFFORD: Yes. THE MASTER: And you are satisfied that that is the agreement to resolve all of the eeonomic claims in your divorce action? MR. STAFFORD: That will resolve the divoree action in my opinion, sir. THE MASTER: Do you have any questions about the agreement? MR. STAFFORD: No, sir. THE MASTER: You understand it? MR. STAFFORD: From my limited knowledge of law, yes, I understand it. THE MASTER: And you are going to come back today and review the draft of the agreement? 5 MR. STAFFORD: Yes, sir. THE MASTER: And then sign the agreement affirming the settlement, but you understand that if you do not sign, you are still bound by the agreement? MR. STAFFORD: I understand that, sir. MR. McKNIGHT: Jody, you've heard the terms of the agreement that we have just put on the record? MRS. STAFFORD: Yes. MR. McKNIGHT: Do you understand it? MRS. STAFFORD: Yes. MR. McKNIGHT: Are you in agreement with it? MRS. STAFFORD: Yes. MR. McKNIGHT: And you are satisfied that this resolves all of the issues that you've had over the years with your husband Roland Stafford? MRS. STAFFORD: Yes. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend to bind myself to the settlement as a eontract obligating myself to the terms of settlement and subjecting myself to 6 the methods and procedures of enforeement which may be imposed by law and in partieular Section 3105 of the Domestic Relations Code. WITNESS: DATE: \ h <{&cct:<~--;;2 - ...~~ Roland D. Stafford ~...... .). .Are, I 7 ROLAND D. STAFFORD, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. CIVIL ACTION - LAW 2004-1079 CIVIL TERM JODY M. STAFFORD, Defendant IN DIVORCE PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Transmit the record, together with the following information, to the court for entry of a divorce decree: 1. GroWld for Divorce: Irretrievable breakdown Wider Section 3301(c) of the Divorce Code. 2. Date and manner of service of complaint: A certified copy of the Complaint in Divorce was served upon Marcus A, McKnight, III, Esquire, counsel for the defendant, on November 29, 2004. His Acceptance of Service was filed on December I, 2004, 3. Complete either paragraph (a) or (b), (a) Date of execution of the affidavit of consent required by Section 3301(c) of the Divorce Code: by plaintiff: April 5, 2005; by defendant: January 24,2006. (b)(I) Date of execution of the affidavit required by Section 3301(d) of the Divorce Code: (b)(2) Date ofming and service of the plaintiff's affidavit upon the defendant: 4. Related claims pending: NONE. 5, Complete either (a) or (b). (a) Date and manner of service of the Notice ofIntention to file Praecipe to Transmit Record, a copy of which is attached: (b) Date plaintiff's Waiver of Notice in Section 3301(c) Divorce was filed with the Prothonotary: April 7, 2005, Date defendant's Waiver of Notice in Prothonotary: January 24, 2006. filed with the CDS A. Me HT, m, ESQUIRE r efendan c_, c.-~ c::;:) 0.... .." r'" 00 I o --n ::;:l -:- '"T" ftlf;; "l_1i n ~'.,O ':() ~\f;~ -,-,. :.0 -< <;;) c;> N ,.,+. :t::+i :+;:f. Of. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . + . . . + . . . . . . . + + + + + . + . + + . + + . . + + + + + + + + . + + + + . + . + . + . . . . ,+::+::+::f. . . + . + :t:~~:t:+.:+i:t::+;:t:+.+.:t: ~+.:t:+.:t:+.+.+.:t:+.+':f.+. +.:t:+.~,+:+.:t:+.+.~ + . + . . + + . + IN THE COURT OF COMMON PLEAS ROLAND D. STAFFORD, Plaintiff VERSUS JODY M. STAFFORD, Defendant AND NOW, DECREED THAT AND OF CUMBERLAND COUNTY STATE OF PENNA. No. 2004-1079 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE DECREE IN DIVORCE ~~'1- \ , 2006 , IT is ORDERED AND ROLAND D. STAFFORD , PLAINTIFF, JODY M. STAFFORD , DEFENDANT, ARE DIVORCED FROM THE BONDS OF MATRiMONY. THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE FINAL ORDER HAS NOT BEEN RAISED OF RECOfi.D~AT~..,S ACTION FOR WHICH A YET BEEN ENTERED; YV\;./"~ The Agreement dated January 24, 2006 and signed by the parties is hereby incorporated into this Divorce Decree, //) / A"EST, ~ ~ ( _~ PROTHONOTARY +. :t: +.:+: +. :f. +.:+; Of. +. Of.:+: +.:+::+: ~ '" Of.:+: Of. '" :+: '" 'to :+::+: "':+: 'to:+::+: 'f '" +. +:+: Of:+::+: '" 'f:+: . + . + . . + + . + . . + + . + + . . + . . + . . . . + + + . . . . + . . + . . . . + . . + . + J. + + . + + + + . . . + . . . + + + + + + + . + + + + + + + + + + + + . Of 'f +.:+::+:+ ,~-4-/.. ,l.Vv1 (-:";7, n:7w/ 77;U1:t, 0 /;,r;o :r r.r 1J' "" ," . r;z /1fi""" .?ill r'? 'V z. e , ' . 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 Member ID Number: 5339100878 ROLAND D. STAFFORD 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 Plaintiff Names JODY M. STAFFORD Case NSE b r N m et --fig. umber 935103980 04-1079 CIVIL TOTAL ATTACHMENT AMOUNT: Attachment Amo0SE I , ?Pn* 98.00 I TH"`- ? C- ?r r? ;"'rte i 7° p- x - -0 $ C_ > ?;rte ?V =J ;__ $ 98.00 # * - C 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 $ 22.55 per week, or 50%, of the Unemployment Compensation benefits otherwise payable to the Defendant, ROLAND D. STAFFORD Social Security Number XXX-XX-5115, Member ID Number 5339100878. 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 JUNE 5, 2011 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: JUN 14 2011 J , 1bP??'? 4- AJIGSIa?!C?. JUDGE Form EN-530 Service Type M Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State: Commonwealth of Pennsylvania Co./City/Dist. of: CUMBERLAND Date of Order/Notice: 07/06/11 Case Number (See A e?for case summary) Employer/Withholder's Federal EIN Number T W CONSULTANTS INC C/O PITTSBURGH OFFICE & RESER ONE CORP CENTER 5500 CORP DR STE 300 PITTSBURGH PA 15237 RE: STAFFORD, ROLAND D. U4-- 1b'7q CIVIL @ Original Order/Notice 0 Amended Order/Notice 0 Terminate Order/Notice 0 One-Time Lump Sum/Notice Employee/Obligor's Name (Last, First, MI) 169-44-5115 Employee/Obligors Social SecunI7177m5-er 5339100878 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current child support $ 0.00 per month in past-due child support $ 0.00 per month in current medical support $_ 0.00 per month in past-due medical support $ 98.00 per month in current spousal support $ 0.00 per month in past-due spousal support $ 0.00 per month for genetic test costs $ 0.00 per month in other (specify) $ one-time lump sum payment for a total of $ Arrears 12 weeks or greater? 98.00 per month to be forwarded to payee below. ;< C n '?a 4} Z7 © C7 -jc M 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: $ 22•bzper weekly pay period. $ 49.00 per semimonthly pay period (twice a month) $ 45.Z?; per biweekly pay period (every two weeks) $ 98.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANTS 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: OMB No.: 0970-0154 Form EN-028 Service Type M Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS F? If checked you are required to provide a copy of this form to your employee. If your employee works in a state that is different from the state that issued this order, a copy must be provided to your employee even if the box is not 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. 2513470520 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: O EMPLOYEE'S/OBLIGOR'S NAME: STAFFORD ROLAND D. EMPLOYEE'S CASE IDENTIFIER: 5339100878 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: _ FINAL PAYMENT AMOUNT: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www childsupoort state.pa.us OMB No, 0970-0154 Form EN-028 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: STAFFORD, ROLAND D. PACSES Case Number 93,5103980 PACKS Case Number Plaintiff Name Plaintiff Name JODY M. STAFFORD Docket Attachment Amount Docket Attachment Amount 04-1079 CIVIL $ 98.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB 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 Addendum Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT D4 - 107 q C I V I i State: Commonwealth of Pennsylvania Q Original Order/Notice Co./City/Dist. o : CUMBERLAND 0 Amended Order/Notice Date of Order/Notice: 07/15/11 Case Number (See A e?for case summary) O Terminate Order/Notice O One-Time Lump Sum/Notice RE: STAFFORD, ROLAND D. E m ployerfvVith holder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) THE MAGUIRE GROUP INC 169-44-5115 #1 mpoyee igors Social ecuri um er 33 COMMERCIAL ST 5339100878 FOXBORO MA 02035-2530 Employee/Obligors Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current child support $ 0.00 per month in past-due child support Arrears 12 weeks or greater? (dyes,,,,, Q cm $ 0.00 per month in current medical support $ 0.00 per month in past-due medical support -?? -n $ 0.00 per month in current spousal support =M rnI $ 0.00 per month in past-due spousal support Cn? ter"`" $ 0.00 per month for genetic test costs Co $ 0.00 per month in other (specify) `-, $ one-time lump sum payment 'c °. =c; for a total of $ 0.00 per month to be forwarded to payee below. - C..) it You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period (twice a month) $ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL S CURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. f' 1,. BY THE COURT: OMB No., 0970-0154 Form EN-028 Service Type M Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS F? If checked you are required to provide a copy of this form to your employee. If your employee works in a state that is different from the state that issued this order. a copy must be provided to your employee even if the box is not 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. 0503182110 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: O EMPLOYEE'S/OBLIGOR'S NAME: STAFFORD ROLAND D. EMPLOYEE'S CASE IDENTIFIER: 5339100878 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 - by Internet www childsu p port. state. pa. us OMB No-: 0970-0154 Form EN-028 0- ? 0 -f') VVnrkPr in 9',IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: STAFFORD, ROLAND D. PACSES Case Number 935103980 PACSES Case Number Plaintiff Name Plaintiff Name JODY M. STAFFORD Docket Attachment Amount Docket Attachment Amount 04-1079 CIVIL $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT 1J ` _ I 0_3q C IV) I O ORIGINAL INCOME WITHHOLDING ORDERMOTICE FOR SUPPORT (IWO) 0 AMENDEDIWO 0 ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT & TERMINATION OF IWO Date: 11/16/11 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO m*10e regutar on As. ace. 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 - 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): 5339100878 City/County/Dist./Thbe CUMBERLAND Order Identifier: (See Addendum for order/docket Informalton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) T W CONSULTANTS INC C/O PITTSBURGH OFFICE & RESER ONE CORP CENTER 5500 CORP DR STE 300 PITTSBURGH PA 15237 Employer/Income Withholder's FEIN Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: STAFFORD, ROLAND D. Employee/Obligor's Name (Last, First, Middle) 169-4d-5115 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 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 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 per month in current child support er c , $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? Q yes-Q? no- 0. 0O per month in current cash medical support rnm = F_q .. $ 0.00 per month in past-due cash medical support ?? < -uI-r, $ 0.00 per month in current spousal support -<> -J 7:0-Z) $ 0.00 per month in past-due spousal support <= ? ---I C:) $ 0.00 per month in other (must specify) C -y 4. =C) for a Total Amount to Withhold of $ 0.00 per month, y N (:D C AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Orr IA#?irmiWon. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: $ 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. $ 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/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 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. Signature of Judge/Issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official: AfbM H.. Masland Title of Judge/Issuing Official: Date of Signature: 'NOV 1 2GII 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: httpJ/www acf hhs aov/prourams/cse/newhire/employer/contacts/`contacl 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, 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 - 05131/2014. 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 Employer's Name: T W CONSULTANTS INC Employer FEIN: Employee/Obligor's Name: STAFFORD, ROLAND D. 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 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. 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 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 childsugport.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 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: STAFFORD, ROLAND D. PACSES Case Numbe Plaintiff Name JODY M. STAFFORD Docket Atta 04-1079 CIVIL $ Child(ren)'s Name(s): r 935103980 chment Amount 0.00 DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attac $ Child(ren)'s Name(s): hment Amount 0.00 DOB PACSES Case Number Plaintiff Name D4 kS a 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 c- CKI nno 4 , INCOME WITHHOLDING FOR SUPPORT n O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) I . L D g O Q AMENDED IWO _ I U / /1 /1) W) 1 O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT I [? 1 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 itslpce. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http:acf.hhs.dov/p?grams/cse/newhirelem foyer/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): 5339100878 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docketlnformaiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) T W CONSULTANTS INC C/O PITTSBURGH OFFICE & RESER ONE CORP CENTER 5500 CORP DR STE 300 PITTSBURGH PA 15237 Employer/Income Withholder's FEIN 251347052 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) 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/-pcQgrams/cse/newhire employer/publication/Dublication.htm - form . 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. 2513470520 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. t-, $ 0.00 per month in current child support $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? $ 0.00 per month in current cash medical support $ 0.00 per month in past-due cash medical support $ 98.00 per month in current spousal support $ 0.00 per month in past-due spousal support $ 0.00 per month in other (must specify) for a Total Amount to Withhold of $ 98.00 per month. O Ye nC; r W 01 - rorn C? r-2: o Z C:5 _n =CD y.C N .. _a 3> AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Or&er Ifi9brrriion. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: $ 22,Uper weekly pay period. $ 49.00 per semimonthly pay period (twice a month) $ 45.3 per biweekly pay period (every two weeks) $ 98.00 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 httl2://www.acf.hhs.aov/proarams/cse/newhire/employer/contacts/ contact map.htm for the employee/obligor's principal place of employment. Document Tracking Identifier RE: STAFFORD, ROLAND D. Employee/Obligor's Name (Last, First, Middle) 169-44-5115 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) 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 fha canrlar Of< Signature of Judge/Issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official: Ait lrtM. Maslanu Title of Judge/Issuing Official: Date of Signature: rr_n 1 A 2af- 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 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: htto•//www acf hhs aoy/Rrograms/cse/newhire/employer/contacts/contafA mao.htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(bx7)). 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 SOU,, 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 parry, court, or attorrr4r), 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 I#= 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 Dale - 05/31/2014. The OMB Expiration Date has no bearing on the termination dale 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: T W CONSULTANTS INC Employer FEIN: 251347052 Employee/Obligor's Name: STAFFORD, ROLAND D. 5339100878 CSE Agency Case Identifier: (See Addendum for case summary Order Identifier: (See Addendum for order/docket informatlon? 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 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: 2513470520 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 address: Final Payment Date To SDU/Tribal Payee: New Employer's Name: Last known phone number: Final Payment Amount: 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.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.childsupppn.state.12a.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 01112 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: STAFFORD, ROLAND D. PACSES Case Number 935103980 PACSES Case Number Plaintiff Name Plaintiff Name JODY M. STAFFORD Docket Attachment Amount Docket Attachment Am unt 04-1079 CIVIL $ 98.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): 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 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 INCOME WITHHOLDING FOR SUPPORT k Q, U (Q ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT(IWO) 04 U-7 9 CI'f I Q AMENDEDIWO 1 Q ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT Q TERMINATION OF IWO Date: 04/08/13 ❑ Child Support Enforeement(CSE)A jency ® 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 httD•//www acf hhsgov/2ro-Q rams/csetnewhirel 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. StatafTribe/Territory Commonwealth of Pennsylvania Remittance Identifier(include w/payment): 53391119878 City/County/Dist.lTribe CUMBERLAND Order Identifier (See Addendum far orderldociYet lnformoiton) Private individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) T W CONSULTANTS INC RE: STAFFORD ROLAND D. C/O PITTSBURGH OFFICE&RESER Employeet0bligor's Name(Last,First,Middle) ONE CORP CENTER 16944-5115 5500 CORP DR STE 300 Empioyee/Obligor's Social Security Number PITTSBURGH PA 15237 (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name(Last,First, Middle) Employer/income Withholder's FEIN 251347052 NOTE:This IWO must be regular on its face. Under certain circumstances you must reject Child(ren)'s Name(s)(Last,First,Middle) Child(renys Birth Date(s) this IWO and return it to the sender(see IWO instructions lip://www.acf.hhs.gQWoroarams/cse/newhire/ emRWA tllbkatIonb iica#ion.htm-formsi.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. 2513470520 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 QUMBERLAND County, Commonwealth of Pennsylvaniiaa (StatelTribe). You are required by law to deduct these amounts fror@he3gnpi6yee/ obligor's income until further notice. -c3 $ 0.00 per month in current child support 1-7 M v $ 0.00 per month in past-due child support-Arrears 12 weeks or greater? p y �J nom' -*�r P P PP 9 ' tin $ 0.00 per month in current cash medical support -<> v�3 " $ 0.00 per month in past-due cash medical support ` -1: ' $ 98.00 per month in current spousal support '" $ 0.00 per month in past-due spousal support $ 0.00 per month in other(must specify) for a Total Amount to Withhold of$ 98.00 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 following amount: $ 22.lo' per weekly Pay Period. $ 49.00 per semimonthly Pay Period(twice a month) $ 45.1-3 aer biweekly pay period(every two weeks) $ 98.00 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 within the 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 5WA 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.gpv/programs/eselnewhire/emiRoyer/contacts/contact map him for the employee/obligor's principal place of employment. Document Tracking identifier OMB No.:0970-0154 Form EN-028 06/12 Service Type M Worker ID$IATT ❑ Return to Sender[Completed by E linoornoMfithh er]. Payment must be directed to an SDU in accordance with 42 u$C" bX6)and(bXS)or Tribal Pam to SDU below).` if payment Is not directed to an SDU/Tr Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/lssuing Offta1(if required by State or Tribal law): . x Titles of Judflssu �� al: Print Name of J ing 60116161: Date of Signature: If the employee/ works in a StW or,for a Trite that is different from the State or Tribe that issued this order,a copy of this IWO must be provided to or. ❑ If checked,the employedinoome withholder must provide a copy of this form to the employeselobligor.. AOWnGNAL 114F TM FOR I M .+YSIR OME WIT11*40la. Pennsylvania l w,(23 PA C.S,$+1374 b))rowlim, re ace by an , if an-Moyer as aged to wow Mc " am� and + 15,60 n per m,or if an pier.has a h of two or more returned oh+ tMcs drew rtall.ttsr Pennsylvania Codeil#ons and Disbursement Urr (PA ` ] cu .A at i4tti"4lj� r instruiWons.PA PIPS 001V 4Z OOA 00 M � � tt►: PtA;WDU Send the&to. f�S � U, P @. 12, rZ PS 171 0112 IN ADA ! ��. 'T ( n as "..,. ., „. State-specific contact and withholding information can be found on the Federal Employer Services ito located at: fill Priority:Withholding for support has prir?rity over mil!, F� pic under 5terte law nst ale.sari income(� 42 § bX7)): If a F tai,Syr is 16 tto Conbini .P*yawmAJL*r When remitting payments to an SDU or Tilbal,CSIE agency,,you may combine wit.0,Wd sm unta from more tharl oft+e r r s Inarrke in ovVr4*VWih6rt.'you obligors portion ofthe payment. Payments To SDU:You must send child support payments p yable by income with0oAft.to this swoprift.SITU car to a Tribal CSE agency.if l "iWO Sou U4 010100sio to coal party,court,oN attoneay),you must�to box ab€wa a€'j t by a Court,Attorney,or Private Individuarintlty+and the r Jtary 1, IOU+ order Was issued by a Tribal CSE agency,you must follow the"Rem ps W Ia on FtlaIs form. Repotrdrq tluf"Pay Date: You must report the pay date when sending payment.The pay datwid th*(d on,whlch the amount was withheld from the employ+ obis 's .You eta *6 , tw if applicable)of the empioyee%obiigoes principal p 4 empWrhont no time perdods w whli h youa roust Implement the withholding and forward the support payments. Mu : if there is mores than one IWO against this end d you are unable to fully,honor � w d : Federal, State, or Tribal wed" 1 � � 4 ". . ! 'i°lt support before payment of an)r l .1�� S r5r Tr l; ot� s l place of employment to ditirrniri the app+ ooatlt method. Lump Sum Pmts:You may be required 4o noty a S or TI:C� noy"of upning.lu� paymnts to this employee/obligor such as bonuses, comrrtisslorrs,or severance pay. ctrtact` tder to det�itte If yod a relined to report and/or withhold lump sure payments. Liability: if you have any doubts;about the validity of this IWO con_t ttte Wider.if you fail to withhold income .. in me f the emptoyee/as i as�.IWO I y`. _ and any penalties set by Soft,or Tribal law/ rooec e. Anti-dlso Waj1en•You are sAect to a firmsdedsirrniaed under or Tribal,14aw for disc in g are orri selobil getr from employment,refusing to employ,or taking disira►ry action l sllrr. " lib #sti OMB Expiration Date-05/3112014.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 06/12 Service Type M Page 2 of 3 Worker ID$IATT ' Employers Name: Employer FEIN: Name: STAFFORD,ROLAND D. 5339100878 CSE Agency Case Identifier:Me Addendum for case summe Order Identifier: Withholding Limits:You may not withhold more then 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 baueo�Social Security taxes;statutory pension contributions;and Medicare taxes,The Federal limit|s 5096of 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. |f 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|mmxmmmdmn: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are 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: 2513470520 0 This person has never worked for this employer nor received periodic income. 0 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: Final Payment Amount: New Employer's Name: New Employees Address: CONTACT INFORMATION: |f you have any questions, contact W AGE ATTACHMENT UNIT(Issuer name) by phone at . by fax et . by email orwebm|hoat: . Send termination/income status notice and other correspondence to:DOMESTIC RELATIONS SECTION, 13 N. HANQyEIR ST. P.O. BOX 320, CARLISLE. PA, 17013(Issuer address). To EmplQyme/Obilgor: |f the employee/obligor has questions,contact WAGE ATTACHMENT UNIT(Issuer name) by phone at by fax at . by email orwwbs|bmmt IMPORTANT:The person completing this form is advised that the information may be shared with the employee/obligor. OMB wv'o9m*,m Form EN-0280@/12 ��N Service Type yN PmQo 3 of@ Worker|[)$|ATT STAFF'ORD, ROLAND D. PA SES Case NMMhK 936143980 PACES Case Ntt&*K pwwz JODY M.STAFFORD Chiid(ren)'s Name(s): DOB Chiid(ren)"s Nan*s): DOB E& M Cme � PACSES-. - Plaintiff Pia�fiff Mme Do Child(ren)'s Name(s): DOB Chiid(ren)"s Nan*s): DOB PACSES Case Number EAQfiU Cow tier Plaintiff Name - D ��AM [lt Dpcket $ttir1�9 dti Chiid(ren)'s Name(s): DOB Chiid(renys Name(s): 'DOB Addendum Form ENS 06/12 Service Type M OMB<W:0970-0154 Worker lD'$tATT INCOME WITHHOLDING FOR SUPPORT Q ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT(IWO) 1 �� O AMENDEDIWO Q ONE-TIMEORDERMOTICE FOR LUMP SUM PAYMENT c) TERMINATION OF IWO Date: 11/22113 ❑ Child Support Enforcement(CSE)Agency ® Court ❑ Attorney ❑ Private Individual/Entity(Check One) NOTE:This IWO mu;t be cegular,6n its1oco Under certain circumstances you must reject this IWO and return it to the sender(see IWO instructions htt '/g /www acf hhs gov/programs/cse/forms/OMB-0970-0154 instructions pdf). 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): 5339100878 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for orderldocket information) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) T W CONSULTANTS INC RE: STAFFORD,ROLAND D. C/O PITTSBURGH OFFICE & RESER Employee/Obligor's Name(Last,First,Middle) ONE CORP CENTER 169-445115 5500 CORP DR STE 300 Employee/Obligor's Social Security Number PITTSBURGH PA 15237 (see Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name(Last,First, Middle) Employer/Income Withholder's FEIN 251347052 NOTE:This IWO must be regular on its face. Under certain circumstances you must reject Child(ren)'s Name(s)(Last,First,Middle) Child(ren)'s Birth Date(s) this IWO and return it to the sender(see IWO instructions http://www.acf.hhs.aov/proarams/cse/f`orms/ OMB-0970-0154 instructions odfl.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. 2513470520 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, w $ 0.00 per month in current child support " _ $ 0.00 per month in past-due child support-Arrears 12 weeks or greater? O A (FLgo $ 0.00 per month in current cash medical support rrt $ 0.00 per month in past-due cash medical support rJ c3 $ 0.00 per month in current spousal support $ 0.00 per month in past-due spousal support -o $ 0.00 per month in other(must specify) .. y for a Total Amount to Withhold of$ 0.00 per month. " ry AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the"Qrd 'tnf6rination. If your pay cycle does not match the ordered payment cycle,withhold one of the following amount: $ 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. $ 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 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 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.aov/programs/cse/newhire/employer/contacts/contact mom. htm for the employee/obligor's principal place of employment, Document Tracking Identifier OMB No.:0970-0154 Form EN-02811/13 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. 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: NOV 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 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: hUp://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact 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,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. Fallow 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-428 11/13 Service Type M Page 2 of 3 Worker ID$IATT Employer's Name: T W CONSULTANTS INC Employer FEIN: 251347052 Employee/Obligor's Name: STAFFORD, ROLAND D. 5339100878 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 are 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: 2513470520 0 This person has never worked for this employer nor received periodic income. 0 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: 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 0717)240-6248, by email or website at:www.childsup op rt.state.pa.us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVERR ST P.O. BOX 320, CARLISLE. PA. 17013(Issuer address). To EmRloyee1Obiig9r: 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. OMB No.:0970.0154 Form EN-028 11/13 Service Type M Page 3 of 3 Worker ID$IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: STAFFORD, ROLAND D. PACSES Case Number 935103980 PACSES Case Number Plaintiff Name Plaintiff Name JODY M. STAFFORD Docket Attachment Amount Docket Attachment Amount 04-1079 CIVIL $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 11/13 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 Defendant Name: ROLAND D. STAFFORD Member ID Number: 5339100878 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 Pe Number Docket Attachment Amount/Fre Plaintiff Name Case Number N quency JODY M.STAFFORD 935103980 98.00 MONTH TOTAL ATTACHMENT AMOUNT: $ 98.00 fat, Now, by Order of this Court, the Department of Labor and Industry, Office of Unerr me4t Compensation Benefits (OUCB), is hereby directed to attach the lesser of$ 22.55 per wee4 ,_76r-50°,0'of the Unemployment Compensation benefits otherwise payable to the Defendant, €o? ROLAND D. STAFFORD Social Security Number XXX-XX-5115, Member ID Number 5339100878. 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 24, 2013 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: DEC U 3 Z313 G Albert H. Masland JUDGE Form EN-530 Service Type M 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: ROLAND D. STAFFORD Member ID Number: 5339100878 Fax: (717) 240-6248 Please note: All correspondence must include the Member ID Number. Zr— ORDER TO VACATE ATTACHMENT OF UNEMPLOYMENT BENEFZ Plaintiff Name JODY M. STAFFORD Financial Break Down of Multiple Cases on Attachment PACSES Docket Case Number Number 935103980 04-1079 CIVIL Attachment Amount/Frequency 98.00 / MONTH $ / / $ / TOTAL ATTACHMENT AMOUNT: $ 98.00 The prior Order of this Court directing the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), to attach $22.55 or 50% per week of the Unemployment Compensation benefits of ROLAND D. STAFFORD, Social Security Number XXX -XX -5115, Member ID Number 5339100878 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. Date of Order: JUN 0 3 2014 Service Type M BY THE COURT Form EN -035 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT 0 ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) Q AMENDED IWO O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT Q TERMINATION OF IWO q3s 1039 Fs() 04 — /DTI Gi v r I Date: 10/03/14 Child -Spool -1 Enforcement (CSE) Agenc �� `E] 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 rr....� instructionsM h- ttp://www.acf.hhs.gov/programs/cse/forms/OMB-0970-0154 instructions.pdf). 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 City/County/Dist./Tribe CUMBERLAND Private Individual/Entity Remittance Identifier (include w/payment): 5339100878 Order Identifier: (See Addendum for order/docket Information) CSE Agency Case Identifier: (See Addendum for case summary) CDR MAGUIRE INC FL 11 211 CONGRESS ST BOSTON MA 02110-2443 Employer/Income Withholders FEIN 050318211 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: STAFFORD, ROLAND D. Employee/Obligor's Name (Last, First, Middle) 169-44-5115 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.gov/programs/cse/forms/ OMB -0970-0154 instructions.pdf). 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. 0503182110 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 per month in current child support 0.00 per month in past -due child support - Arrears 12 weeks or greater? O yes j n42 :..y c- 0.00 per month in current cash medical support 0.00 per month in past -due cash medical support 98.00 per month in current spousal support 0.00 per month in past -due spousal support 0.00 per month in other (must specify) for a Total Amount to Withhold of $ 98.00 per month. AMOUNTS TO WITHHOLD: G You do not have to vary your pay cycle to be in compliance with the-order-Info/mat/on. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: $ 22,0„per weekly pay period. $ 49.00 per semimonthly pay period (twice $ 45.2 per biweekly pay period (every two weeks) $ 98.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. a month) REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the 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 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 map. htm for the employee/obligor's principal place of employment. Document Tracking Identifier Service Type M OMB No.: 0970-0154 Form EN -028 11/13 Worker ID $IATT [� Return tmSender [�omnol��dbwEmployer/Income mustbed�eu��toanSOUhl ^-'_'--.Withholder].Paymentp, accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments toGDU below). If payment is not directed to an SDUrrribal Payee or this IWO is not regular on its face, you must check this box and return the IWto the sender. Signature of Judge/Issuing Official (if requireby State or Tribal Iaw): Print Name of Judge/Issuing OfficiaI: Title of Judge/Issuing Officia Date of Sinatune: --OCT-0-61014 ��—e~_""� If the eworks in a State or for a Tribe that is different from tho Stateor Tribe that issued this ordea copy of this IWO must be provided to the Ej 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 caII 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 bheEmployee/Ob6gmr's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MA/1. State -specific contact and withholding information can be found on the Federal Employer Services website located at: http:0vwww.00f.hhu.gov/pmgnams/cae/nowhire/omp|oyentuntooto/contaot mop.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 paymeat. The pay date is the date on which the amount was withheld from the employee/obiigor's wages. You must comply with the Iaw of the State (or Tribal aw 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 |W0s:|fthere iomore than one |VVOagainst this employee/obligor andyounneunah|atofu|l/honoro|||VVOoduahn Federal, State, or Tribal withholding limits, you must honor all 1W0s to the greatest extent possible, givingiority to current support before payment of any past -due support. Follow the State or Tribal law/procedure of the employee/obligor's principal pface of ernployment 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 andlor withhold 1ump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender, It you fail to withhold income from the employee/obligors income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penafties set by State or Tribal Iaw/procedure. Anti -discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligorhnm employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date —����The OMB Expiration Date has no bearing on the termination date of the IWO;:identifies the version �the form currently muse. Form EN -028 11/13 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: CDR MAGUIRE INC Employer FEIN: 050318211 Employee/Obligor's Name: STAFFORD, ROLAND D. 5339100878 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 are 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: 0503182110 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: 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.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.childsupport.state.pa.us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor, OMB No.: 0970-0154 Service Type M Page 3 of 3 Form EN -028 11/13 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: STAFFORD, ROLAND D. PACSES Case Number 935103980 Plaintiff Name JODY M. STAFFORD Docket • Attachment Amount 04-1079 CIVIL $ 98.00 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 PACSES Case N mber Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount 0.00 0.00 Child(ren)s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount 0.00 Child(ren)s Name(s): DOB Service Type M Docket AttachmentAmount 0.00 Child(renys Name(s): DOB Addendum OMB No.: 0970-0154 Form EN -028 11/13 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 Defendant Name: ROLAND D. STAFFORD Member ID Number: 5339100878 Please note: All correspondence must include the Member ID Number. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Plaintiff Name JODY M. STAFFORD Financial Break Down of Multiple Cases on Attachment PACSES Docket Case Number Number 935103980 04-1079 CIVIL Attachment Amount/Freouency. 98.00 / MCI,TH G,a C3 TOTAL ATTACHMENT AMOUNT: $ 98.00 ' ?' 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 $ 22.55 per week, or 50%, of the Unemployment Compensation benefits otherwise payable to the Defendant, ROLAND D. STAFFORD Social Security Number XXX -XX -5115, Member ID Number 5339100878. 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 garnishrnent 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 DECEMBER 21, 2014 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. Date of Order: DEC 3 0 2014 Service Type M BY THE COURT Albert H. Masland JUDGE Form EN -530 Worker ID $IATT Wi•.