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HomeMy WebLinkAbout08-4047V a GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 0 7 (tD l (?ttp f 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 32 SOUTH BEDFORD CARLISLE, PA 17013 (717) 249-3166 OR (800)990-9108 .. yQ?OM & NuTULAKIS Kara W. Haggerty, Esquire Attorney I.D. #: 86914 36 South Hanover Street Carlisle, PA 17013 (717) 249-0900 GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW IN DIVORCE COMPLAINT 1. Plaintiff is Glenn Foley, who currently resides at 313 Stonehedge Drive, Carlisle Cumberland County, Pennsylvania. 2. Defendant is Renee Foley, who currently resides at 313 Stonehedge Drive, Carlisle, Cumberland County, Pennsylvania. 3. The Plaintiff and Defendant have been bona fide residents 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 April 3, 1991 at McLean, Fairfax County, Virginia. COUNT I - DIVORCE 5. Paragraphs 1 through 4 of this Complaint are incorporated herein by reference as though set forth in full. 6. There have been no prior actions of divorce or for annulment between the parties. 7. Divorce is sought pursuant to the provisions of the Divorce Code, § 3301(c) and 3301(d), in that: a. The marriage is irretrievably broken. b. Plaintiff and Defendant have lived separate and apart since April 2008 and continue to do so. 8. Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the court require the parties to participate in such counseling. 9. The Plaintiff in this action is a member of the Armed forces. WHEREFORE, the Plaintiff requests the Court to enter a decree of Divorce. COUNT II - EQUITABLE DISTRIBUTION 10. Paragraphs 1 through 9 of this Complaint are incorporated herein by reference as though set forth in full. 11. Plaintiff and Defendant have acquired property, both real and personal, during their marriage from April 3, 1991, until April 2008, the date of their separation, which property is "marital property". 12. Plaintiff and Defendant may have owned, prior to marriage, property which has increased in value during the marriage and/or which has been exchanged for other property, which has increased in value during the marriage, all of which property is "marital property". 13. Plaintiff and Defendant have been unable to agree as to an equitable division of said property prior to the filing of this Complaint. WHEREFORE, the Plaintiff requests this Honorable Court to equitably divide all marital property. Respectfully submitted, ABOM&KUTULAKIS, L.L.P. DATE -l " ?" V V t?n? Kara W. Haggerty, Esq e ID No. 86914 36 South Hanover Street Carlisle, PA 17013 (717) 249-0900 Attorney for Plaintiff VERIFICATION I, Glenn Foley, verify that the statements made in this Divorce Complaint are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Date f/? o?I? 7 M ?r t OM CSC" &N ULAKIS Kara W. Haggerty, Esquire Attorney I.D. #: 86914 36 South Hanover Street Carlisle, PA 17013 (717) 249-0900 GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 08-4047 Civil Term CIVIL ACTION - LAW IN DIVORCE AFFIDAVIT OF SERVICE I, Kara W. Haggerty, Esquire, hereby certify that I did serve a true and correct copy of the Complaint under Section 3301(c) and (d) of the Divorce Code, upon the Defendant, by depositing, or causing to be deposited, same in the U.S. mail, certified, restricted delivery, postage prepaid, on Renee Foley, at Carlisle, Pennsylvania, addressed as follows: Renee Foley 313 Stonehedge Drive Carlisle, PA 17013 Return card acknowledging receipt on July 11, 2008 is attached as Exhibit "A". ABOM & KUTULAKi4 LLP Date: Kara W. Haggerty, E; 36 South Hanover Stj Carlisle, PA 17013 (717)249-0900 Attorney for Plaintiff I.D. No: 86914 I -'I- 0 Complete items 1, 2, and 3. Also complete item 4 if Restrieted Delivery is desired. 1 Print your name and address on the reverse so that we can return the card to you. ¦ Attach this card to the back of the maiipiece, or on the front if space permits. 1. Article Addressed to: re 0 Addressee ved by (Pdn Name C. Date of liv 8" !1 D. Is delivery address differen from item ? M"Yes If YES, enter delivery address below: 0 No 3. Service Type )Zbertified Mail 0 Express Mail C s Cd ?? / 7 V(? 0 Registered 0 Return Receipt for Merchandise 0 Insured Mail 0 C.O.D. 4. Restricted Delivel?MW a Fee) -%rxes 2. Article Number 7005 2570 0000 3804 3705 (Transfer from seMce /abeq PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 EXHIBIT `A" - c.-' r-- ? ? . wy. ,? , . ?` to t?h .<. e?? .r ?. P i_.. )? Lavery, Faherty, Young & Patterson, P.C. Todd C. Hough, Esquire Attorney 1. D. No. 91060 225 Market Street, Suite 304 P. O. Box 1245 Harrisburg, PA 17108-1245 Tel. 717-233-6633 Fax. 717-233-7003 E-mail., though@laverylaw.com Attorney for Defendant GLENN FOLEY, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 08-4047 - Civil Term V. RENEE FOLEY, 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 of 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 child. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary. 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. LAWYER REFERRAL SERVICE 32 S. Bedford Street Carlisle, Pennsylvania 17013 1-800-990-9108 Lavery, Faherty, Young & Patterson, P.C. Todd C. Hough, Esquire Attorney t D. No. 91060 225 Market Street Suite 304 P. O. Box 1245 Harrisburg, PA 17108-1245 Tel: 717-233-6633 Fax: 717-233-7003 E-mail., though@laverylaw.com Attorney for Defendant GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 08-4047 - Civil Term CIVIL ACTION - LAW IN DIVORCE ANSWER TO COMPLAINT IN DIVORCE AND COUNTERCLAIM AND NOW, comes the above-named Defendant, Renee Foley, by and through her attorney, Todd C. Hough, Esquire, and Answers the Complaint in Divorce with a Counterclaim as follows: 1. Paragraphs 1 through 4 are admitted. COUNT I -DIVORCE 5. Paragraphs 5 through 9 are admitted. COUNT II - EQUITABLE DISTRIBUTION 10. Paragraphs 10 through 13 are admitted. COUNT III - COUNTERCLAIM REQUEST FOR ALIMONY 14. Defendant's answers in Paragraphs 1 through 13 are incorporated herein by reference hereto as though set forth in full. 15. Defendant lacks sufficient property to provide for her reasonable needs. 16. Defendant is unable to sufficiently support herself through appropriate employment. 17. Plaintiff has sufficient income and assets to provide continuing support for Plaintiff. COUNT IV - COUNTERCLAIM ALIMONY PENDENTE LUTE COUNSEL FEES. EXPERT FEES AND COSTS 18 Defendant's claims in Paragraphs 14 through 17 are incorporated herein by reference hereto as though set forth in full. 19. By reason of this action, Defendant will be put to considerable expense in the preparation of her case, in the employment of counsel and the payment of costs. 20. Defendant is without sufficient funds to support herself and to meet the costs and expenses of this litigation and is unable to appropriately maintain herself during the pendency of this action. 21. Plaintiff has adequate earnings from his regular employment and business ventures to provide for the Defendant's support and to pay her counsel fees, costs, and expenses. WHEREFORE, the Defendant requests the Court to enter a decree: (a) Dissolving the marriage between the Plaintiff and Defendant; (b) Equitably distributing all property owned by the parties hereto; (c) Awarding the Defendant alimony; (d) Awarding the Defendant alimony pendente lite, counsel fees and costs including the cost of appraisals; and, (e) For such further relief as the Court may determine equitable and just. Res Date: r /' A, Todd-C. Hough, Esquire Attorney I.D. No. 91060 225 Market Street, Suite 304 P. O. Box 1245 Harrisburg, PA 17108-1245 Tel: 717-233-6633 Attorney for Defendant CERTIFICATE OF SERVICE I hereby certify that I am this day serving a true and correct copy of the attached Defendant's Answer to Complaint in Divorce and Counterclaims on the following individual by First Class U.S. Mail addressed as follows: Kara W. Haggerty, Esquire Abom & Kutulakis 36 South Hanover Street Carlisle, PA 17013 Attorney for Plaintiff Date: i? Todd C. Hough, Esquire Attorney I.D. No. 91060 225 Market Street, Suite 304 P. O. Box 1245 Harrisburg, PA 17108-1245 Tel: 717-233-6633 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of Cumberland County complies with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the Court, please contact our office. All arrangements must be made at least seventy-two (72) hours prior to any hearing or business before the Court. You must attend the scheduled conference or hearing. VERIFICATION Upon my personal knowledge or information and belief, I hereby verify that the facts averred in the foregoing Answer to Complaint in Divorce and Counterclaim are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein made are subject to the criminal penalties of 18 Pa. C. S. § 4904, relating to unswom falsification to authorities. Date: i Re a Foley 4 96 _: Lavery, Faherty, Young & Patterson, P.C. Todd C. Hough, Esquire Attorney I. D. No. 91060 225 Market Street, Suite 304 P. O. Box 1245 Harrisburg, PA 17108-1245 Tel: 717-233-6633 Fax: 717-233-7003 E-mail: though@laverylaw.com Attorney for Defendant GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 08-4047 - Civil Term CIVIL ACTION - LAW IN DIVORCE PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please enter my appearance as counsel for the above-named Defendant, Renee Foley. Date: f 11f /0 Tddd'C. Hough, Esquire Attorney I.D. No. 91060 225 Market Street, Suite 304 P. O. Box 1245 Harrisburg, PA 17108-1245 Tel: 717-233-6633 ('-) r-v `r-z t?; m sa. r? r GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant TO THE PROTHONOTAI Please withdraw n Renee Foley. Date: 3/71/a TO THE PROTHONOT Please enter my Foley. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 08-4047 - Civil Term CIVIL ACTION - LAW IN DIVORCE y appearance as counsel for the above-named Defendant, Respectfully submitted, To C. Hough, Esquire Attorney 1. D. No. 91060 rance as counsel for the above-named Defendant, Renee Respectfully submitted, Date: `117, Elizabeth ylor, Esquire Attorney I.D. No. 200139 D .r - ." GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant I, Amber L. South Praecipe for Withdrawal / indicated below: US Regular Mail Kara W. Haggerty, Esquir Abom & Kutulakis, L.L.P. 36 S. Hanover Street Carlisle, PA 17013 Attorney for Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 08-4047 CIVIL TERM IN DIVORCE CERTIFICATE OF SERVICE 1, hereby certify that I am on this day serving a copy of the of Appearance upon the person(s) and in the manner Amber L. Southard, Paralegal Date: :-rICE F T# 0 P 7" , NOTARY 2009 APR -9 PM I : 19 PEN'lsY1 WW Aom c& ' KTUr_nras Kara W. Haggerty, Esquire Attomey I.D. #: 86914 2 West High Street Carlisle, PA 17013 (717) 249-0900 GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA : NO. 08-4047 CIVIL ACTION - LAW IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in divorce under §3301(c) of the Divorce Code was filed on July 9, 2008. 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. Date: RE EE FOLEY FILED-OFFICE OF TH'c F^?T'`DNf'0TRRY 2069 NOV -3 °M 3: 58 OM & &U ULAKIS e Kara W. Haggerty, Esquire Attomey I.D. #: 86914 2 West High Street Carlisle, PA 17013 (717) 249-0900 GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 08-4047 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. 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: RE EE FOLEY RLED--i .FFICE ?? OF THE MO "ONOTARv 2009 NOV - 3 PM 3' 5 9 r i` UtY;_ Alom & LITLILAKIS Kara W. Haggerty, Esquire Attomey I.D. #: 86914 2 West High Street Carlisle, PA 17013 (717) 249-0900 GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA : NO. 08-4047 CIVIL ACTION - LAW IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in divorce under §3301(c) of the Divorce Code was filed on July 9, 2008. 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. Date: AID 1z GL N FOLE NOV 17 ; I '12, 41 ABOM & &uTUr_nicis Mara W. Haggerty, Esquire Attorney I.D. #: 86914 2 West High Street Carlisle, PA 17013 (717) 249-0900 GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA . NO. 08-4047 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: ZOO IZC-99 - J%t4? GGLkRN- FOL gry OF 74 A.. ABOM & I?uTUi.axis Kara W. Haggerty, Esquire Attorney I.D. #: 86914 2 West High Street Carlisle, PA 17013 (717) 249-0900 GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA . NO. 08-4047 Civil Term CIVIL ACTION - LAW IN DIVORCE THIS AGREEMENT, made this 10 day of ?Q?trnktr 2009, between GLENN FOLEY, (hereinafter referred to as "Husband', and RENEE FOLEY, (hereinafter referred to as "Wife"). WITNESSETH: WHEREAS, Husband and Wife were lawfully married on April 3, 1991 at McLean, Fairfax County, Virginia; WHEREAS, disputes and difficulties have arisen between the parties, and it is the present intention of Husband and Wife to live separate and apart, and the parties hereto are desirous of settling their respective financial and property rights and obligations as between each other, including without limitation by specification: the settling of all matters between them relating to the past, present, and future support and/or maintenance of Wife by Husband or Husband by Wife; the settling of all matters between them relating to-the equitable division of martial property; and, in general, the settling of any and all claims and possible claims by one against the other or against their respective estates ari sing out of the marriage; and WHEREAS, Husband and Wife declare that each has had a full and fair opportunity to obtain independent legal advice of counsel of his or her selection; that Husband has been represented by Kara W. Haggerty, Esquire, of Abom & Kutulakis, L.L.P., and that Wife has been represented by Elizabeth J. Saylor, Esquire, of the Law Offices of Peter Russo, P.C. The parties represent and warrant that they have fully disclosed to each other all assets of any 1 nature owned by each, all debts or obligations for which the other party may be liable in whole or part, and all sources and amounts of income. The parties acknowledge that they fully understand the facts, and they acknowledge and accept that this Agreement is, under the circumstances, fair and equitable, and that it is being entered into freely and voluntarily, with such knowledge and that execution of this Agreement is not the result of any duress or undue influence and that it is not the result of any improper or illegal agreement or agreements. NOW THEREFORE, in consideration of the premises and of the mutual promises, covenants and undertakings hereinafter set forth and for other good and valuable consideration, receipt of which is hereby acknowledged by each of the parties hereto, Husband and Wife, each intending to be legally bound hereby, covenant and agree as follows: 1. PERSONAL RIGHTS. It shall be lawful for each Husband and Wife at all times hereafter to live separate and apart from the other party at such place as he or she may from time to time choose or deem fit. The parties shall be free from any control, restraint, interference or authority, direct or indirect, by the other in all respects as fully as if they were unmarried, except as may be necessary to carry out the provisions of this Agreement. Husband and Wife shall not molest, harass, disturb or malign each other or the respective families of each other nor compel or attempt to compel the other to cohabit or dwell by any means in any manner whatsoever with him or her. The foregoing provision shall not be taken as an admission on the part of either party of the lawfulness or unlawfulness of the causes leading to their living apart. 2. MUTUAL RELEASE. Husband and Wife each do hereby mutually remise, release, quitclaim and forever discharge the other, for all time to come, and for all purposes whatsoever, of and from any and all rights, titles and interests, or claims in or against the property (including income and gains from property hereinafter accruing) of the other or against the estate of such other, of whatever nature and wheresoever situate, which he or she now has or at any time hereafter may have against such other, the estate of such other or any part thereof, whether arising out of any former act, contracts, engagements or liabilities of such other or by way of dower or curtesy; or claims in the nature of dower or curtesy or widow's or widower's rights, family exception or similar allowance, or under the intestate laws, or the right to take against the spouse's will; or the right to treat a lifetime conveyance by the other as testamentary, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the law of Pennsylvania, any state, commonwealth or territory of the United States, or any other country, or the right to act as personal representative of the estate of the other; or any rights which any party may now have or any time hereafter have for past, present, future support, maintenance, alimony, alimony pendente lite, counsel fees, costs or expenses, whether arising as a result of the marital relation; except all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or 2 for breach of any provision hereof. It is the intention of Husband and Wife to give to each other, by the execution of the Agreement, a full, complete and general release with respect to any and all property of any kind or nature, real, personal or mixed, which the other now owns or may hereafter acquire, except and only except all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision hereof. It is further specifically understood and agreed by and between the parties hereto that each accepts the provisions herein made by the other in lieu of and in full settlement and satisfaction of any and all of their rights against the other arising out of the marriage, or any past, present and future claims on account of support and maintenance; that it is specifically understood and agreed that the payments, transfers and other considerations herein recited so comprehend and discharge any and all such claims by each other against the other, and are, inter alia, in full settlement and satisfaction and in lieu of their past, present and future claims against the other in account of maintenance and support, and also alimony, alimony pendente lite, counsel fees, costs and expenses, as well as any and all claims to equitable distribution of property, both real and personal, and any other charge of any nature whatsoever pertaining to any divorce proceedings which may have been or may be instituted in any court in the Commonwealth of Pennsylvania or any other jurisdiction, including any other counsel fees arising in any manner whatsoever, except as may be incurred in connection with a breach of the Agreement as set forth hereinafter in paragraph 21. 3. RELEASE OF TESTAMENTARY CLAIMS. Except as provided for in this Agreement, each of the parties hereto shall have the right to dispose of his or her property by last will and testament or otherwise, and each of them agrees that the estate of the other, whether real, personal or mixed, shall be and belong to the person or persons who would have become entitled thereto as if the decedent had been the last to die. Except as set forth herein, this provision is intended to constitute a mutual waiver by the parties of any rights to take against each other's estate whatsoever, and is intended to confer third-party beneficiary rights upon the other heirs and beneficiaries of each. Either party may, however, make such provision for the other as he or she may desire in and by his or her last will and testament; and each of the parties further covenants and agrees that he or she will permit any will of the other to be probated and allowed administration; and that neither Husband nor Wife will claim against or contest the will and estate of the other except as necessary to enforce any breach by the decedent of any provision of this Agreement. Each of the parties hereby releases, relinquishes and waives any and all rights to act as personal representative of the other party's estate. Each of the parties hereto further covenants and agrees for himself and herself and his or her heirs, executors, administrators or assigns, for the purpose of enforcing any of the right relinquished under this Agreement. 3 4. FINANCIAL DISCLOSURE. The parties waive their rights to require the filing of financial statements by the other, although the parties have been advised by their respective attorneys that it is their legal right to have these disclosures made prior to entering into this Agreement. Without reliance upon financial disclosure, the parties are forever waiving their right to request or use that as a basis to overturn this Agreement or any part thereof. 5. INCOME TAX CONSIDERATIONS. The transfers of property pursuant to this Agreement are transfers between Husband and Wife incident to their divorce and as such are nontaxable, with no gain or loss recognized. The transferee's basis in the property shall be the adjusted basis of the transferor immediately before the transfer. The transfers herein are an equal division of marital property for full and adequate consideration and as such will not result in any gift tax liability. 6. PENSION, PROFIT-SHARING, RETIREMENT CREDIT UNION OR OTHER EMPLOYMENT-RELATED PLANS. The parties hereto expressly waive and relinquish any right, claim, title or interest in any pension, profit-sharing, retirement, credit union or other employment-related plans in which the other has any interest by virtue of his or her past or present employment, whether vested or unvested, matured or unmatured. Wife specifically waives any right or interest in Husband's retirement income from the United States military. 7. EQUITABLE DISTRIBUTION OF MARITAL PROPERTY. The parties have attempted to distribute their marital property in a manner which conforms to the criteria set forth in §3502 of the Pennsylvania Divorce Code and taking into account the following considerations: the length of marriage; the age, health, station, amount and sources of income, vocational skills, employability, estate, liabilities and needs of each of the parties; the contribution of each party to the education, training or increased earning power of the other party; the opportunity of each party for further acquisitions of capital assets and income; the sources of income of both parties, including but not limited to medical, retirement, insurance or other benefits; the contribution or dissipation of each party in the acquisition, preservation, depreciation or appreciation of the martial property, including the contribution of each spouse as a homemaker the value of the property set apart to each party; the standard of living of the parties established during the marriage; and the economic circumstances of each party at the time the division of the property is to become effective. The division of existing marital property is not intended by the parties to constitute in any way a sale or exchange of assets, and the division is being effected without the introduction of outside funds or other property not constituting martial property. The division of property under this Agreement shall be in full satisfaction of all marital rights of the parties. 4 a. DISTRIBUTION OF PERSONAL PROPERTY. The parties hereto mutually agree that they have effected a satisfactory division of the furniture, household furnishings, appliances, and other household personal property between them, and they mutually agree that each party shall from and after the date hereof be the sole and separate owner of all such tangible personal property presently in his or her possession, and this Agreement shall have the effect of an assignment or bill of sale from each party to the other from such property as may be in the individual possession of each of the parties hereto. The parties hereto have divided between themselves, to their mutual satisfaction, all items of tangible and intangible marital property. Neither party shall make any claim to any such items of marital property, or of the separate personal property of each party, which are now in the possession and/or under the control of the other. Should it become necessary, the parties each agree to sign, upon request, and titles or documents necessary to give effect to this paragraph. Property shall be deemed to be in the possession or under the control of either party if, in the case of tangible personal property, the item is physically in the possession or control of the party at the time of the signing of this Agreement and, in the case of intangible personal property, if any physical or written evidence of ownership, such as passbook, checkbook, policy or certificate of insurance or other similar writing is in the possession or control of the party. From and after the date of the signing of this Agreement, both parties shall have complete freedom of disposition as to their separate property and any property which is in their possession or control, pursuant to this Agreement, and may mortgage, sell, grant, convey, or otherwise encumber or dispose of such property, whether real or personal, whether such property was acquired before, during, or after marriage, and neither Husband nor Wife need join in, consent to, or acknowledge any deed, mortgage, or other instrument of the other pertaining to such disposition of property. b. MARITAL HOME. Husband and Wife mutually sold the marital residence situate at 313 Stonehedge Drive, Carlisle, Pennsylvania. The property was sold at a loss and the parties had to pay the sum of $18,842.40 at closing. Husband agrees to be solely financially responsible for the debt due as a result of the loss on the sale of the marital home. Husband shall indemnify and hold Wife and her property harmless from any and all liability, cost or expense, including attorney's fees, incurred in connection therewith. 8. DEBTS. Both Husband and Wife hereto covenant and agree that he or she has not in the past and will not at any time in the future incur or contract any debt, charge or 5 liability for which the other of them, their legal representatives, or their property or estate may become liable; and each of them further covenants at all times to keep the other free, defended, harmless and indemnified of and from all debts, charges and liabilities, including for any student loans hereafter or heretofore contracted by them, except as hereinafter provided. As of the date of separation, the parties had the following marital debt totaling $27,146.00: • Navy Federal Credit Union Visa - $9,907.88 • Navy Federal Credit Union loan - $9, 183.88 • USAA Federal Savings Bank loan - $8,054.24 Husband agrees to be solely financially responsible for the marital debt listed above. Husband shall indemnify and hold Wife and her property harmless from any and all liability cost or expense, including attorney's fees, incurred in connection. 9. COUNSEL FEES AND COSTS. Husband and Wife each agree to pay and be responsible for their own attorney's fees and costs incurred with respect to the negotiation of this property settlement agreement and the divorce proceedings related thereto. 10. ALIMONY ALIMONY PENDENTE LITE, AND EXPENSES. Husband agrees to pay and Wife agrees to accept as alimony the sum of $636.85 per month for a period of sixty (60) months from the date of the sale of the marital home (October 31, 2008). Said alimony shall be non modifiable and non terminable. 11. CUSTODY OF CHILDREN. Two children were born of this marriage, namely Jenna Foley and Daniel Foley. The parties shall have shared legal custody of the children. The parties agree that Wife shall have primary physical custody with Husband exercising partial physical custody at such times as the parties may agree. It is specifically acknowledged that Wife shall not unreasonably restrict any custodial time between Husband and the children. Husband shall be solely financially responsible for any transportation costs and expenses incurred to exercise custody of the children. 12. CHILD SUPPORT. Husband shall continue to pay child support for the support of the parties two minor children in the amounts currently specified by the Domestic Relations Section of Cumberland County ($679.32 and $679.33) until such time as either child graduates from high school or turns 18 years of age, whichever is later, which shall be non modifiable and non terminable. The parties specifically agree that 6 Wife shall claim the older child as a dependent for federal tax purposes each year, and Husband shall claim the younger child as a dependent for federal tax purposes each year. 13. LIFE INSURANCE. Husband shall maintain a life insurance policy, naming Wife as the beneficiary, in the amount of the outstanding alimony obligation. Husband reserves the right to change beneficiary amounts, so long as they are equal to or exceed the outstanding alimony obligation, and make other delegations at his discretion. Any time the life insurance policy is updated or changed, Husband shall provide to Wife a copy of said policy change. Husband agrees to maintain the children as beneficiaries of $100,000.00 each on the servicemembers' group life insurance policy he currently has in place until at least the youngest child attains the age of majority. 14. DIVORCE. A Complaint in divorce has been filed to No. 2008-4047 in the Court of Common Pleas of Cumberland County, Pennsylvania, and either party shall be free to proceed without further delay to secure the divorce. Both parties shall sign an affidavit evidencing their consent to the divorce, pursuant to §3301(c) of the Divorce Code. In the event, for whatever reason, either party fails or refuses to execute such affidavit upon the other party's timely request, that party shall indemnify, defend and hold the other harmless from any and all additional expenses, including actual counsel fees, resulting from any action brought to compel the refusing party to consent. Each party hereby agrees that a legal or equitable action may be brought to compel him or her to execute a consent form and that, absent some breach of this Agreement by the proceeding party, there shall be no defense to such action asserted. 15. BANKRUPTCY. The parties further warrant that they have not heretofore instituted any proceedings pursuant to the bankruptcy laws nor are there any such proceedings pending with respect to them that have been initiated by others. It is stipulated and agreed by the parties that the terms of this Agreement as they resolve the economic issues between the parties incidental to their divorce and the obligations of the parties to each other resulting therefrom shall not be dischargeable in bankruptcy, should either party file for protection under the Bankruptcy Code at any time after the date of execution of this Agreement. 16. RECONCILIATION. Notwithstanding reconciliation between the parties, this agreement shall continue to remain in full force and effect absent a writing signed by the parties stating that this Agreement is null and void. 17. INCORPORATION IN FINAL DIVORCE DECREE. The terms of this Agreement shall be incorporated but shall not merge in the final divorce decree between the parties. The terms shall be incorporated into the final divorce decree for 7 the purposes of enforcement only and any modification of the terms hereof shall be valid only if made in writing and signed by both of the parties. Any court having jurisdiction shall enforce the provision of this Agreement as if it were a Court Order. This Agreement shall survive in its entirety, resolving the spousal support, alimony, equitable distribution and other interests and rights of the parties under and pursuant to the Divorce Code of the Commonwealth of Pennsylvania, and no court asked to enforce or interpret this Agreement shall in any way change the terms of this Agreement. This Agreement may be enforced independently of any support order, divorce decree or judgment and its terms shall take precedence over same, remaining the primary obligation of each party. This Agreement shall remain in full force and effect regardless of any change in the marital status of the parties. It is warranted, covenanted and represented by Husband and Wife, each to the other, that this Agreement is lawful and enforceable, and this warranty, covenant and representation is made for the specific purpose of inducing the parties to execute the Agreement. 18. DATE OF EXECUTION. The "date of execution" or "execution date" of the Agreement shall be defined as the date upon which it is executed by the parties if they have each executed the Agreement on the same date. Otherwise, the "date of execution" or "execution date" of this Agreement shall be defined as the date of execution by the party last executing the Agreement. 19. FULL DISCLOSURE. Each party asserts that he or she has made or shall make a full and complete disclosure of all the real and personal property of whatsoever nature and whosesoever located belonging in any way to each of them, of all debts and encumbrances incurred in any manner whatsoever by each of them, and of all sources and amounts of income received or receivable by each party. 20. ENTIRE AGREEMENT. This Agreement contains the entire understanding of the parties, and there are no representations, warranties, covenants or undertakings other than those expressly set forth herein. 21. BREACH. If either party breaches any provision of this Agreement, the other party shall have the rights, at his or her election, either to pursue his or her rights in having the terms of this Agreement enforced as an Order of Court or to sue for specific performance or for damages for such breach, and the party breaching this Agreement shall be responsible for legal fees and costs incurred by the other in enforcing his or her rights under this Agreement. 22. PENNSYLVANIA LAW. The parties agree that the terms of this Agreement and any interpretation and/or enforcement thereof shall forever be governed by the Laws of the Commonwealth of Pennsylvania. 8 23. WAIVER OF MODIFICATION TO BE IN WRITING. No modification or waiver of any of the terms hereof shall be valid unless made in writing and signed by both of the parties. 24. ADDITIONAL INSTRUMENTS. Each of the parties shall from time to time, at the request of the other, execute, acknowledge, and deliver to the other party any and all further instruments, including Deeds and other real estate-related documents, titles, or other documents that may be reasonably required to give full force and effect to the provisions of this Agreement. 25. SEVERABILITY. If any term, condition, clause or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, then only that term, condition, clause or provision shall be stricken from this Agreement, and in all other respects this Agreement shall be valid and shall continue in full force, effect and operation. 26. WARRANTY. Husband and Wife again acknowledge that they have each read and understood this Agreement, and each warrants and represents that it is fair and equitable to each of them. 27. DESCRIPTIVE HEADINGS. The descriptive headings used herein are for convenience only. They shall have no effect whatsoever in determining the rights or obligations of the parties. IN WITNESS WHEREOF, and intending to be legally bound hereby, the parties hereto have hereunto set their hands and seals the day and year first above written. This Agreement is executed in duplicate, and each party hereto acknowledges receipt of a duly executed copy thereof. WITNESSES: G N FO Y RE EE FOLEY 9 i , 41 t STATE OF 1 it r h 1 N COUNTY OF Q S D SS. On this ? 04 'day of N ? V ? MA Q C 2009, before me, the undersigned officer, personally appeared GLENN FOLEY, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Agreement, and acknowledged that he executed the same for the purposes therein contained. See aA ? ac?ea? NOTARY PUBLIC COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF C om, a z r?C\ On this 9Z day of () C-A-0 1a4-r- , 2009, before me, the undersigned officer, personally appeared RENEE FOLEY, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Agreement, and acknowledged that she executed the same for the purposes therein contained. COMMONWEALTH OF PENNSYLVANIA ::: Seal My C mbMend County w Od 12. 20,, .a M,.:-, ?enrw*onla Assoclation et !4 --i3t;3s NNOT2?Rj PU LIC i 'v 10 ?b Ls??J y ACKNOWLEDGMENT State of California County of Fresno On November 10, 2009 before me, Agustin P Casarez, Notary Public personally appeared Glenn Foley, who proved to me on the basis of satisfactory evidence to be the person( whose name) is/ere- subscribed to the within instrument and acknowledged to me that he/s hey- executed the same in his/4erft eir authorized capacityo*, and that by his/ke A*eiif signature( on the instrument the personl)a'h or the entity upon behalf of which the person( acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Sign AQIIdW R CA MIEZ Cannibn N 1646113 P OWY AMC - caftmlo Fm Cw* corm =FO 13,'aslo (Seal) OF"4mw ZW NUV 17 PMfYr 42 ?' W* WQXW e ? Fr.Ailr +? r?rYrx?J Yt/14J0? t i ?: ,f.1 chi Rlf?l03 'A OM & LITLILAKIS Kara W. Haggerty, Esquire Attorney I.D. #: 86914 2 West High Street Carlisle, PA 17013 (717) 249-0900 GLENN FOLEY, Plaintiff V. RENEE FOLEY, Defendant To the Prothonotary: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 08-4047 CIVIL ACTION - LAW IN DIVORCE PRAECIPE TO TRANSMIT THE RECORD Transmit the record, together with the following information, to the court for entry of a divorce decree: 1. Ground(s) for Divorce: a. Irretrievable Breakdown under §3301(c) of the Divorce Code. 2. Date and manner of service of the Complaint: a. Service on Renee Foley by Certified/Registered Mail on July 11, 2008, as evidenced by Affidavit of Service filed on July 15, 2008. 3. Date of execution of the Affidavit of Consent required by §3301(c) of the Divorce Code: a. by Plaintiff November 10, 2009; by Defendant: October 26, 2009. 4. All economic claims previously raised have been settled by filing of the Marital Settlement Agreement dated November 10, 2009. ../ .R Date Waiver of Notice in §3301(c) Divorce was filed with the Prothonotary: a. by Plaintiff. November 17, 2009; by Defendant: November 3, 2009. Respectfully submitted, ABOM & KL7TUL "S, L.L.P DATE t i l ] log llu(tO [..??? Kara W. Haggerty, E q e Supreme Court ID # U 2 West High Street Carlisle, Pennsylvania 17013 (717) 249-0900 Attorney for Plaint of 4%mpw IN THE COURT OF COMMON PLEAS OF GLENN FOLEY CUMBERLAND COUNTY, PENNSYLVANIA V. RENEE FOLEY NO 08-4047 DIVORCE DECREE AND NOW, zy • , -7-?o?_, it is ordered and decreed that GLENN FOLEY plaintiff, and RENEE FOLEY , defendant, are divorced from the bonds of matrimony. Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: (If no claims remain indicate "None.") Marriage Settlement Agreement dated November 10, 2009. By the Court, 54 40 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 08-4047 CIVIL State Commonwealth of Pennsylvania 938110254 OOriginal Order/Notice Co./City/Dist. of CUMBERLAND 729 S 2008 @Amended Order/Notice Date of Order/Notice 03/01/10 OTerminateOrder/Notice Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice RE: FOLEY. GLENN L. Employer/Withholder's Federal EIN Number DFAS ARMY ACTIVE DUTY Sent Electronically DO NOT MAIL Employee/Obligor's Name (Last, First, MI) 231-82-6603 Employee/Obligor's Social Security Number 2701102020 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, Mp See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1,358.65 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 medical support o $ o.00 per month in past-due medical support $ 636.85 per month in current spousal support $ o. oo per month in past-due spousal support $ o . oo per month for genetic test costs $ o . oo per month in other (specify) $ one-time lump sum payment for a total of $ 1,995.50 per month to be forwarded to payee below. CN 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: $ 459.24 per weekly pay period. $ 997.75 per semimonthly pay period (twice a month). $ 918.48 per biweekly pay period (every two weeks). $ 1, 995.50 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic Payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: KEVIN A HESS Form EN-428 Rev.1 Service Type M OMS No.: 0970-0154 Worker ID $IATT 10 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If4heckefl you are required to provide gopy of this form to your m loyee. If yol? r employee works in a state that is di Brent rrom the state that issued this or er, a copy must be provi?edpto 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. 3599900000 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME:FOLEY, GLENN L. EMPLOYEE'S CASE IDENTIFIER: 2701102020 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 employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee'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 WALE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Service Type M OMB No.: 0970-0154 Form EN-428 Rev.1 Worker ID $IATT .1 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FOLEY, GLENN L. PACKS Case Number 604111492 Plaintiff Name RENEE G. FOLEY Docket Attachment Amount 08-4047 CIVIL$ 636.85 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 Service Type M Addendum OMB No.: 0970-0154 PACSES Case Number 938110254 Plaintiff Name RENEE G. FOLEY Docket Attachment Amount 00729 S 2008 $ 1,358.65 Child(ren)'s Name(s): DOB DANIEL G. FOLEY 09/28/91 J')rNKA M. F'OLEY 10/21/93. 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 Form EN-428 Rev.1 Worker ID $IATT GLENN L. FOLEY, Plaintiff/Respondent VS. RENEE G. FOLEY, Defendant/Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 08-4047 CIVIL TERM IN DIVORCE PACSES CASE: 604111492 ORDER OF COURT n c ^? a < lr cJ __"?l-t-, co ,,. -c h Ci AND NOW to wit, this 27th day of April, 2010, it is hereby Ordered that credit be given on the above captioned Alimony account in the amount of $636.85, pursuant to a direct payment made to the Defendant/Petitioner. BY THE COURT: esley Oler; r., J. DRO: R.J. Shadday xc: Petitioner Respondent Kara W. Haggerty, Esq. Form OE-001 Service Type: M Worker: 21005 ORDERMOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 06/29/10 Case Number (See Addendum for case summary) E m pl oyer/With holder's Federal EIN Number DFAS ARMY ACTIVE DUTY 938110254 729 S 2008 08-4047 CIVIL OOriginal Order/Notice (DAmended Order/Notice OTerminate Order/Notice QOne-Time Lump Sum/Notice RE: FOLEY, GLENN L. Employee/Obligor's Name (Last, First, MI) Sent Electronically DO NOT MAIL 231-82-6603 Employee/Obligor's Social Security Number 2701102020 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee'slobligor's income until further notice even if the Order/Notice is not issued by your State. _ $ 880.00 per month in current child support cam-- ° ' $ o. oo per month in past-due child support Arrears 12 weeks or greater? no $ 0.00 per month in current medical support $ o . oo per month in past-due medical support ' ` ca $ 636.85 per month in current spousal support $ O. Lo per month in past-due spousal support - + ; $ o . oo per month for genetic test costs c $ o. oo per month in other (specify) •• -+ $ one-time lump sum payment for a total of $ 1, 516.85 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 349.08 per weekly pay period. $ 758.43 per semimonthly pay period (twice a month). $ 698.17 per biweekly pay period (every two weeks). $ 1, 516.85 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. S 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: KEVIN A HESS Form EN-428 Rev.1 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS 1 heck you are required to pr vide a opy of this form to your m loyee. If yo r employee orks in a state that is ?i4erent from the state that issuff this order, a copy must be provisedpto your emproyee even if tie box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employeelobligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 3599900000 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME: FOLEY, GLENN L. EMPLOYEE'S CASE IDENTIFIER: 2701102020 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by Internet www.childsupport.state.pa.us Service Type M Page 2 of 2 OMB No.: 0970-0154 Form EN-428 Rev.1 Worker I D $ IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FOLEY, GLENN L. PACSES Case Number 604111492 Plaintiff Name RENEE G. FOLEY Docket Attachment Amount 08-4047 CIVIL$ 636.85 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 Service Type M Addendum OMB No.: 0970-0154 PACSES Case Number 938110254 Plaintiff Name RENEE G. FOLEY Docket Attachment Amount 00729 S 2008 $ 880.00 Child(ren)'s Name(s): DOB JENNA M. FOLEY 10/21/93 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Form EN-428 Rev.1 Worker I D $ IATT 4- ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 08-4047 CIVIL OOriginal Order/Notice State Sommonw Wth of Pennsylvania 938110254 Co./City/Dirt. of CUMBERLAND OAmended Order/Notice 729 S 2008 Date of Order/Notice 11/15/10 OTerminate Order/Notice Case Number (See Addendum for case summary) QOne-Time Lump Sum/Notice RE'. FOLEY, GLENN L. EmployerAAlithholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) DFAS ARMY ACTIVE DUTY Sent Electronically DO NOT MAIL 231-82-6603 Employee/Obligor's Social Security Number 2701102020 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee'slobligor's income until further notice even if the Order/Notice is not issued by your State. $ 438.00 per month in current child support $ o . oo per month in past-due child support Arrears 12 weeks or greater? Oyes, (&no , $ o . o o per month in current medical support $ o. oo per month in past-due medical support -; 7C , $ 636.85 per month in current spousal support " 1-71 $ o. oo per month in past-due spousal support $ o . o o per month for genetic test costs o' $ o . oo per month in other (specify) $ one-time lump sum payment for a total of $ 1,074.85 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not miikh the ordered support payment cycle, use the following to determine how much to withhold: $ 247.36 per weekly pay period. $ 537.43 per semimonthly pay period (twice a month). $ 494.73 per biweekly pay period (every two weeks). $ 1, 074.85 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. 9 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 HIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: KEVIN A HESS Form EN-428 Rev.1 DRO: R.J. Shadday OMB No.: 097M1 54 Worker ID Service Type m $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If heck you are required. to provide a opy of this form to your employee. If yoyr employee works in ,a state that is diferentrom 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 employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 3599900000 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: lZI EMPLOYEE'S/OBLIGOR'S NAME:FOLEY, GLENN L. EMPLOYEE'S CASE IDENTIFIER: 2701102020 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by Internet www.childsupport.state.pa.us Page 2 of 2 Form EN-428 Rev.1 Service Type M OMB No.: 0970-0154 Worker ID $TATT f ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FOLEY, GLENN L. PACSES Case Number 604111492 Plaintiff Name RENEE G. FOLEY Docket Attachment Amount 08-4047 CIVIL$ 636.85 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name PACSES Case Number 938110254 Plaintiff Name RENEE G. FOLEY Docket Attachment Amount 00729 S 2008 $ 438.00 Child(ren)'s Name(s): DOB JENNA M... FOLEY 1.0/21/93 PACSES Case Number 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 Plaintiff Name PACSES Case Number 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 Service Type M OMB No.: 0970-0154 Form EN-428 Rev.1 Worker ID $ IATT ORDERMOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania q 5l? I I D g J? Co./City/Dist. of CUMBERLAND Date of Order/Notice 01/31/11 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number Sent Electronically DO NOT MAIL 231-82-6603 Employee/Obligor's Social Security Number 2701102020 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 $ 0.00 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 $ 0.00 per month to be forwarded to payee below. O s 4 nQ., V :zrn rn ? ,)> Q ca C'? C4 ° M CD 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 SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: KEVIN A HESS Arrears 12 weeks or greater? U7,- 4 - D 1 + ? C i v i l Q Original Order/Notice O Amended Order/Notice Terminate Order/Notice O One-Time Lump Sum/Notice RE: FOLEY, GLENN L. Employee/Obligor's Name (Last, First, MI) OMB No.: 0970-0154 Form EN-428 Service Type M Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? 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. 3599900000 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: O EMPLOYEE'S/OBLIGOR'S NAME: FOLEY. GLENN L. EMPLOYEE'S CASE IDENTIFIER: 2701102020 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: NEW EMPLOYER'S NAME/ADDRESS: FINAL PAYMENT AMOUNT: 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 Service Type M If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us OMB No.: 0970-0154 Page 2 of 2 Form EN-428 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FOLEY, GLENN L. PACKS Case Number 604111492 Plaintiff Name RENEE G. FOLEY Docket Attachment Amount 08-4047 CIVIL $ 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 Docke Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Service Type M PACSES Case Number 938110254 Plaintiff Name RENEE G. FOLEY Docket Attachment Amount 00729 S2008 $ 0.00 Child(ren)'s Name(s): DOB JENNA M. FOLEY 10/21/93 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 OMB No.: 0970-0154 Form EN-428 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State: Commonwealth of Pennsylvania 938110254 Co./City/Dist. of: CUMBERLAND 729 S 2008 Date of Order/Notice: 08/15/11 Case Number (See A e?for case summary) Employer/V ithholder's Federal EIN Number HARLEY DAVIDSON OF BATON ROUGE 5853 SIEGEN LN BATON ROUGE LA 70809-4175 RE: FOLEY, GLENN L. 08-4047 CIVIL Q Original Order/Notice Q Amended Order/Notice Q Terminate Order/Notice 0 One-Time Lump Sum/Notice Employee/Obligor's Name (Last, First, MI) 231-82-6603 Employee/Obligors Social Security Number 2701102020 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 $ 0.00 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 $ 0.00 per month to be forwarded to payee below. -?? c = 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 Idery17r) // 70CIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BVMAfL. // BY THE COURT: 8 U-1 / 6 Oler, Jr., Judge Arrears 12 weeks or greater? oo CD OMB No.: 0970-0154 Form EN-028 Service Type M Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS n 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. 7209038660 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: O EMPLOYEE'S/OBLIGOR'S NAME: FOLEY, GLENN L. EMPLOYEE'S CASE IDENTIFIER: 2701102020 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: _ NEW EMPLOYER'S NAME/ADDRESS: FINAL PAYMENT AMOUNT: 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 wvvw.childsupport.state. pa.us OMB No.: 0970-0154 Form EN-028 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FOLEY, GLENN L. PACSES Case Number 604111492 Plaintiff Name RENEE G. FOLEY Docket Attachment Amount 08-4047 CIVIL $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number 938110254 Plaintiff Name RENEE G.FOLEY Do ke Attachment Amount 00729 S2008 $ 0.00 Child(ren)'s Name(s): DOB JENNA M. FOLEY 10/21/93 PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Numb r Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT (?! ?) l I 1 L I ?f Z O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) 0 (] 2 I 1 f V S - l? ?? C) I AMENDED IWO vl J ? r?U O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT ?'/ I ?t? O TERMINATION OF IWO Date: 05/24112 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://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. StatelTriberrerritory Commonwealth of Pennsylvania Remittance Identifier (include w/payment): 2701102020 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket Informalton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) DFAS C/O US MILITARY ANNUITANT PAY PO BOX 7131 LONDON KY 40742-7131 Employer/Income Withholder's FEIN Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: FOLEY, GLENN L. Employee/Obligor's Name (Last, First, Middle) 231-82-6603 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 htto://www.acf.hhs.oov/proarams/cse/-`newhire/ employer/publication/gublication.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. 2014100094 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 Countx, 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 Oho $ 0.00 per month in current cash medical support - -- $ 0.00 per month in past-due cash medical support " $ 636.85 permonth in current spousal support -^ $ 0.00 permonth in past-due spousal support s - ` $ o.oo per month in other (must specify) for a Total Amount to Withhold of $ 636.85 per month. - k' - o AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Cl ezznfo fati6k, I If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: - - $ 146.56 per weekly pay period. $ 318.42 per semimonthly pay pe riod (twice a month) $ 293.13 per biweekly pay period (every two weeks) $ 636.85 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 hftp://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/ contact_map.htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970-0154 Form EN-028 01/12 Service Type M Worker ID $OINC ? Return to Sender [Completed by Employerlincome 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 the box and return the O to the sender. !?? Signature of Judge/Issuing Official (if required by State or Tribal law): ""111111111bo Print Name of Judge/Issuing Official: Va v t n A Title of Judge/Issuing Official: ?,? Date of Signature: MAY 9 A 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 nonsufTicient 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 Employes/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: http•//www acf hhs gov/programs/ese/newhire/employer/contacts/contact mao 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 GSE 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 01/12 Service Type M Page 2 of 3 Worker ID $OINC Employer's Name: DFAS Employer FEIN: Employee/Obligor's Name: FOLEY, GLENN L. 2701102020 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: 2014100094 Q This person has never worked for this employer nor received periodic income. O This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: New Employer's Name: 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. childsu pport. 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. Service Type M OMB No.: 0970-0154 Page 3 of 3 Form EN-028 01/12 Worker ID $OINC ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FOLEY, GLENN L. PACSES Case Number 604111492 Plaintiff Name RENEE G. FOLEY Docket Attachment Amount 08-4047 CIVIL $ 636.85 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 Casi Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 01/12 Service Type M OMB No.: 0970-0154 Worker ID $OINC INCOME WITHHOLDING FOR SUPPORT DL Tql CI V I I ~ ?? ^ ? 112 p ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT 11WO) Date: 06101 O AMENDEDIWO p ONE-,nMEORDERINOTICE FOR LUMP SUM PAYMENT ? Attorney ? Private IndividuallEntity (Check One der (see IWO O TERMINATION OF IWO ® Court Agency ust reject this IWO f rmand return it to you receive th sndocument f om n Child Support Enforcement (CSE) This IWO must be regular on its face. Under wa certain circum fstances You m order must be attached. ng tion.htm - 27p1102o20 NOTE: www. cf.hh ovl r r ms/ eln (Court, a copy of under l, in structions h J ency o ment): someone other tha n a State or Tribal CSE ag Remittance Identifier d(include wdendum lpay order/ docket case summary) Commonwealth of Penns Ivania Order identifier: (See A for i se state/Tribe/TerntOry CSE Agency Case Identifier: (See Addendum for City/County/Dist./Tribe CUMBERLAND Private IndividuallEntity RE: FOLEY GLENN L. First, Middle) IrVigor's Name (Last, CACI ENTERPRISE 1100 N GLEBE RD ARLINGTON VA 22201-5798 Employerlincome Withholders FEIN 043786421 Child(ren)'s Birth Date(s) Child(ren)'s Name(s) (Last, First, Middle) Employee 231-82-6603 Number Employee/Obligor's Social Security (See Addendum for plaintiff names associated with cases on attachment) Custodial PartylObligee'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 mslcsel it I. h httD'1_ _ Ira m r ii t?onlo li anon htm If oth you receive this document from so oea Courtea than a Slate or Tribal CSE agency copy of the underlying order must be attached. 0437864210 r dependent names and birth dates associated with cases on attachment. See Addendum fo p ent is based on the support or withholding order from C MB p Unty INFORMATION: This docum by law to deduct these amounts from the mployee/ ORDER You are required om.Y,nr,wPalth of Pennsvly ni State/Tribe). obligor's income until further nofice. neater? s; n $ 0.00 per month in current child support O Ye past-due child suppo? -Arrears 12 weeks or g $ 0.00 per month ? i m y 0.00 per m n h in current cash medical support $ $ 0.00 per month in past-due cash medical support ` $ 636.85 permonth in current spousal support $ 0.00 per month in past-due spousal $ 0.00 per month in other (must specify) 636.85 per month. for a Total Amount to Withhold of $ You do not have to vary your pay cycle to be in compliance with the Order Information. AMOUNTS TO WITHHOLD: Yo payment cycle, withhold one of the following amount: (twice a month) If your pay cycle does not match the ordered $ 318.43 per semimonthly pay period $ 146.56 per weekly pay period. 636.85 per monthly pay period. $ 29 33.1.13 3 per biweekly pay period (every two weeks) $ existing IWO unless you receive a termination order. $ Lump Sum Payment: Do not stop any mm nwealth INFORMATION: If the employee/obligor's principal place of employment is within the withholding no later than the first pay period that occurs n 1 7 working days of the pay date REMITTANCE You must begin payment within v n . If of nsvlvania (State/Trte o Y to eelobligor, withhold up to 5° of w kin days after the date of this t Or of de support for any or all orders for this emp 1 ment is not within the you cannot withhold the full amouno eelobligor's principal place of emp Y disposable income for all orders. if t{ tomly, the employer can obtain withholding limitation co mec r /qui m Commonwealth of Pennsvlvani ( f.hh vl ro ram / s In whir ! m I and any allowable employer feesinc pal place of employment. principal htm for the employee/obligor's Document Tracking Identifier Form EN-028 06/12 OMB No.: 0970-0154 Worker ID $IATT RR ",urn to Sender [Completed by Employer/Income accord"+l ice with n 42 USC §866(b and Tribal Withholder]. Pa directec to an SDU/Tribal Payee or this IWO is not regular on its face Payment must be directed to an SDU in the sender. Yee (see Payments to SDU below). , you must check this box and returntthe IWp to is not Signature of Judge/Issuing Official (if required by Stat Print Name of Judge/Issuing Official: a or Tribal law); Title of Judge/Issuing Official: Date of Signature: ; t If the employee/obligor works in a State or for a Tribe that is different from the S must be provided to the employee/obligor. ? If checked, the employer/income withholder must provide a COPY State copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME VVITHHOL Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an DERS to withhold income from more than one em Da 1111F ptoyee and employs if an employer two or more returned checks due to nonsufficient funds, please call th s ordered 15 or more persons, or if an employer his the Pennsylvania State Coli FIPS has ad Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions, pq FIpS CODE 42 000 00 Send check to: Pennsylvania SCDU, P-0- 60112, IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME Harrisburg, urg, pa THE 17106-9112 the Emp/oyee/ObII9ors?Case Identifier) OR /D (shown above as PACSES MEMBER SOCIAL SECURITY SEND CASH BY MAIL NUMBER IN ORDER TO BE P State-specific contact and withholding information can be found on the Federal E ROCESSED. DO NOT 12s((?y(?rg Employer Services website located at: Priority: Withholding for support has priority over any other legal process under §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. State law against the same income (USC 42 Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you more than one employee/obligor's income in a single payment. You must, however, separate! i obligor's portion m the payment. Y may combine withheld amounts from Payments To SDU: You must send child support payments payable by income.. wi Y identify each. employee/ Tribal C is agency. If this I instructs you to send a party, court, or attorney) Payment to an enti thholding to the appropriate SDU or to a , you must check the box above and return this notice orthe than sender. EX Exception: If this by a Court, Attorney, or Private Individual/Entity and the initial order was entered before (e.g., Payable to the custodial issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on s IWO was sent Reporting the Pay Date: You must report the pay date when sending th January 1 1984 or the order was amount was withheld from the employee/obligor's wages. You must corn this form. applicable) of the employee/obligor's principal place of employment regarding Payment. The pay date to the date on which the he withholding and forward the support ?y with the law of the State (or Tribal law if payments. time periods within which ch you must implement AIAultiple IWOs; If there is more than one IWO against this employee/obligor and you ar ederat, State, or Tribal withholding limits, you must honor all tWOs to, the dera before payment of an support. y are unable to fully honor all lWOs due to rt any past-due Follow the State orTriba greatest ?vyfpcedu a of the employee/obligor'ss lace employment to determine the appropriate giving priority' current ump Sum allocation method. Payments: You may be required to notify a State or Tribal CSE a principal mployee%bli or such as bonuses, commissions ti severance 'port and/or withhold lump sum agency of upcoming lump sum payments to this payments. pay. Contact the sender to determine if you are required to ability: If you have any doubts about the validity of this IWO, contact the sender. If nployee/obligor's income as the IWO directs, you are liable for both the accumulated am... Y penalties set by State or Tribal law/procedure. You fail to withhold income from the amount you should have withheld and ti-discriminnaationn, fu Yoto employu are subject to a fine detemined under State or Trib plnt, resin, or taking disciplina al law for discharging an employee/ob!lgorfmm ry action against an employee/obligor because of this tWp, Expiration Date - 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWp; it identifies the ersion of the form currently in use. Service Type M Page 2 of 3 Form EN-028 06/12 Worker ID $IATT Employer's Name: CACI ENTERPRISE Employee/Obligor's Name: FOLEY, GLENN L. Employer FEIN: 043786421 1102020 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: 0437864210 O This person has never worked for this employer nor received periodic income. O This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: New Employer's Name: New Employer's Address: Final Payment Amount: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.childsupport.statepa.us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST. P.O. BOX 320, CARLISLE. PA. 17013 (Issuer address). To Em Ig_oyee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at www.childsupport.state. pa. us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. Service Type M OMB No.: 0970-0154 Page 3 of 3 Form EN-028 06/12 Worker ID $IATT A0_NQUM Defendant/Obligor: FOLEY, GLENN L. PACKS Case Number 604111492 PACSES Case umber Plaintiff Name Plaintiff Name RENEE G. FOLEY Docket Attac 08-4047 CIVIL $ hment Amount 636.85 Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACKS Case Number Plaintiff Name Plaintiff Name Docket Atta chment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Numbe Plaintiff Name r PACSES Case Number Plaintiff Name Docket Atta $ chment Amount 0.00 Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 06/12 Service Type M OMB No.: 0970-0154 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) O AMENDEDIWO O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT O TERMINATION OF IWO loG?} 11 t L?q2 Date: 06/01/12 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www.acf.hhs.gov/programs/cselnewhire/em looyer/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): 2701102020 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket lnformalton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) TIBER CREEK CONSULTING STE 400 12700 FAIR LAKES CIR FAIRFAX VA 22033-4905 Employer/Income Withholder's FEIN Child(ren)'s Name(s) (Last, First, Middle) RE: FOLEY, GLENN L. Employee/Obligor's Name (Last, First, Middle) 231-82-6603 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (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.ciov/DrDgrams/cse/newhire employer/publication/oublication.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. 7472100312 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 CUMBFRL AKD County, Comm onwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts fry thEbmpfoyee/ 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 y9 1__@ no ._.- $ 0.00 per month in current cash medical support $ 0.00 per month in past-due cash medical support - " $ 636.85 permonth in current spousal support $ 0.00 per month in past-due spousal support er ` . rv $ 0.00 per month in other (must specify) for a Total Amount to Withhold of $ 636.85 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: $ 146.E per weekly pay period. $ 318.43 per semimonthly pay period (twice a month) $ 293.13 per biweekly pay period (every two weeks) $ 636.85 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 n 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 htttp://www.acf.hhs.gov/proarams/cse/newhire/em foyer/contacts/contact map. htm 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 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. -.111111110, .41 Signature of Judge/Issuing Official (if required by State or Tribal law): 149 Allcz Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: .11 IN 0 A 2012 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 EMP"LOYERSIINCOME 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 IS 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' Idendfler) 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: htW://www.ad.hhs.aov/p_rQgrams/cselnewhire/emlZyer/contacts/contactmap htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO, OMB Expiration Date - 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN-028 06/12 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: TIBER CREEK CONSULTING Employer FEIN: Employee/Obligor's Name: FOLEY, GLENN L. 2701102020 CSE Agency Case Identifier: (See Addendum for case summary) Order Identifier: (See Addendum for order/docket information) Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you a no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 7472100312 Q This person has never worked for this employer nor received periodic income. Q This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known address: Last known phone number: Final Payment Date To SDU/Tribal Payee: Final Payment Amount: New Employer's Name: New Employer's Address: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www childsupportstate 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.childsupoort.state. pa. us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. Service Type M OMB No.: 0970-0154 Page 3 of 3 Form EN-028 06/12 Worker ID $IATT AMENDUM Sum aa of Cases on Attachment Defendant/Obtgor: FOLEY, GLENN L. PACSES Case Number 604111492 PACSES Case Number Plaintiff Name Plaintiff Name RENEE G. FOLEY Docket Attachment Amount Docket Attachment Amount 08-4047 CIVIL $ 636.85 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket $ 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 $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plain 'ff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 06/12 Service Type M OMB No.: 0970-0154 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT ?00" f?? O ORIGINAL INCOME WITHHOLDING ORDERMOTICE FOR SUPPORT (IWO) O AMENDEDIWO /l J' l /1 O ONE•TIMEORDER/NOTICE FOR LUMP SUM PAYMENT U8 - 4c / Civi I O TERMINATION OF IWO n-gym. ncimi,n ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One)` NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http'J/www acf hhs gov/p[Qgrami/csetnewhire/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. StatPrrriharr-itnn• -- - -- - ••?••-o•••o MUMILlance meminer (incwae w/payment): 2701102020 City/County/Dist./Tribe CUMBERLAND Order identifier: (See Addendum for order/docket Informalton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summarv) TIBER CREEK CONSULTING STE 400 12700 FAIR LAKES CIR FAIRFAX VA 22033-4905 Employer/Income Withholder's FEIN Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: FOLEY. GLENN L Employee/Obligor's Name (Last, First, Middle) 231-82-6603 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 aov/fir grams/cse/newhire/ e,mplQyer/publicatigjiZpublication.htm - forme. 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. 7472100312 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 unty, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from ti,' employee/ obligor's income until further notice. a- $ 0.00 per month in current child support . $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? Q y • fi4 N r r" $ 0.00 permonth in current cash medical support CO $ 0.00 permonth in past-due cash medical support <= .' $ 0.00 permonth in current spousal support $ 0.00 permonth in past-due spousal support tv $ 0.00 per month in other (must specify) for a Total Amount to Withhold of $ 0.00 per month. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the ordered payment cycle, withhold one of the 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 1 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 httl2://www acf hhs aov/programs/cse/newhire/em loygL/Contacts/contact maw htm 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 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): 1 Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: 2012 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 EMPLOYERSIINCOME 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 (shoran above as the Employee/O . or'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: /w• cf hhs aovlorog mslcse/newhiPa?emotoyer/contactstcontaet man.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/ob4igor because of this IWO. OMB Expiration Date - 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN-028 06/12 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: TIBER CREEK CONSULTING Employer FEIN: Employee/Obligor's Name: FOLEY, GLENN L. 2701102020 CSE Agency Case Identifier: (See Addendum for case ummar?r) Order Identifier: (See Addendum for order/do docket 1.+fQ1ZU V ' 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: 7472100312 O 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: New Employer's Address: Last known phone number: Final Payment Amount: CONTACT INFORMATION: To Emi2loyer/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 oa us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SFrTION, 13 N. HANOVER ST P,O. BOX 320, CARLISLE PA 17013 (Issuer address). To Em IZoyee/Obliggr: 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 childsugaort state a us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. OMB No.: 0970-0154 Form EN-028 06/12 Service Type M Page 3 of 3 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FOLEY, GLENN L. PACSES ase Number 604111492 Plaintiff Name RENEE G. FOLEY Docket AttanhmeMAmount 08-4047 CIVIL $ 0.00 Child(ren)'s Name(s): Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): PACSE5 QA% Number Plainiff Name Docket Attachment AmuM $ 0.00 DOB Child(ren)'s Name(s): DOB Docket Magh_ment Amount $ 0.00 Child(ren)'s Name(s): DOB DOB PACSES Case Number Plaintiff Name Docket A#UbmwttAAm_aunt $ 0.00 Child(ren)'s Name(s): DOB PACSES Caae,N M Ler Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Carina TvnP M Addendum OMB No.: 0970-0154 Form EN-028 06/12 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT LD4 1 14-(12 O ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT (IWO) dg ,(?? CI V 1 I Q AMENDEDIWO L?o 0 ONE-TIMEORDERINOTICE FOR LUMP SUM PAYMENT (.l TERMINATION OF IWO Date: 06/07/12 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO t'hust 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/cselnewhire/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/Triberrerritory Commonwealth of Pennsylvania Kemiuance wenrmer tmcwge wipaymnny: LrV ?vwsv City/County/Dist.R7ibe CUMBERLAND Order Identifier: (See Addendum for ordeddocket Informsiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) CACI ENTERPRISE 1100 N GLEBE RD ARLINGTON VA 22201-5798 RE: FOLEY GLENN L. Employee/Obligor's Name (Last, First, Middle) 231-82-6603 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) Employer/Income Withholder's FEIN 043786421 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 httn•//ww v acf hhs.gov/wsgrams/cse/newhire/ emplover/publication/oublication.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. 0437864210 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 Qt )MBERLAND Q? unty, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts f6,?n tt'W--employee/ obligor's income until further notice. r .? $ 0.00 per month in current child support $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? O Y r-O no $ 0.00 per month in current cash medical support $ 0.00 permonth in past-due cash medical support $ 0.00 permonth in current spousal support r J $ 0.00 permonth in past-due spousal support $ 0.00 per month in other (must specify) for a Total Amount to Withhold of $ 0.00 per month. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the ordered payment cycle, withhold one of the 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 n 1 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 555% 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/em looyer/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 06/12 Worker ID $IATT ? Return to Sender [Completed by Employerllncome 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 SOU 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: aon?axin Date of Signature: If IN 11 Q J4112 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 EMPLOYERSIINCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an SJ2gtr9nic pay=nt 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 nonsufliclent 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 0,00 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17105-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employes>AObfiW's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. 00 NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: hftg•//www acf hhs ov/2rQg=s/cse/newhir LmWoye to cts/contacA--ria 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 SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instruct 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 err>ployee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE:agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. _ Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date - 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN-028 06/12 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: CACI ENTERPRISE Employer FEIN: 043786421 Employee/Obligor's Name: FOLEY GLENN L. 2701102020 CSE Agency Case Identifier: (See Addendum for case surrimarvl Order Identifier: ($ee 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: 0437864210 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: New Employer's Name: New Employer's Address: Final Payment Amount: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at- www.childsupport, state, Da. 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 oa 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 06/12 Worker ID $IATT ADDENDUM Summary of CaM on Attachment Def9n4wWQ,bUqQr: FOLEY, GLENN L. PACSES Case Number 604111492 PACSES base Number Plaintiff Name Plaintiff Name RENEE G. FOLEY DockeS Docket Attachment Amount 08-4047 CIVIL $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): PACSES Case Number Plaintiff Name DockeS $ 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 ant Amount $ 0.00 Child(ren)'s Name(s): DOB Docket Attachment Am unt $ a.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 06/12 Service Type M OMB No.: 0970-0154 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT (P 0 4 1114612, O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT(IWO) J — q-7 C/v, l O AMENDED IWO / O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT Q TERMINATION OF IWO Date: 10101113 ❑ Child Support Enforcement(CSE)Agency El Court ❑ Attorney ❑ Private Individual/Entity(Check One) NOTE:This IWO mi.IgettegaulAoilfitScfaterOnder 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/Dublication.htm-forms). If you receive this document from someone other than a•'tate 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): 2701102020 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket informaiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) DFAS RE: FOLEY,GLENN L. C/O US MILITARY ANNUITANT PAY Employee/Obligor's Name(Last,First,Middle) PO BOX 7131 231-82-6603 LONDON KY 40742-7131 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name(Last,First, Middle) Employer/Income Withholders FEIN 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 htto://www.acf.hhs.gov(orograms(cse/newhire/ employer/publication/oublication.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. 2014100094 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? 0 yes O no $ 0.00 per month in current cash medical support Cw $ 0.00 per month in past-due cash medical support '1:3 uZ $ 0.00 per month in current spousal support .i $ 0.00 per month,in past-due spousal support z� ~'+ - / $ 0.00 per month in other(must specify) '11 ' for a Total Amount to Withhold of$ 0.00 per month. .r'-a 3}C) � ,D-1 AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with theZr lr�forma#Xgrt: If your pay cycle does not match the ordered payment cycle, withhold one of the following amount . _-�r" $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay per�' I (te a-n'ionth) $ 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.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 06/12 Service Type M Worker ID $OINC ❑ 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 chec 's box and return the IWO to the sender. • Signature of Judge/Issuing Official (if required by State or Tribal la . Print Name of Judge/Issuing Official: rl OR1as Title of Judge/Issuing Official: Date of Signature: OCT 0.1 me If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. ❑ If checked,the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law(23 PA C.S.§4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons,or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit(PA SCDU)Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID(shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: http://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. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments:You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO,contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date—05/31/2014.The OMB Expiration Date has no bearing on the termination date of the IWO;it identifies the version of the form currently in use Form EN-028 06/12 Service Type M Page 2 of 3 Worker ID $OINC Employer's Name: DFAS Employer FEIN: Employee/Obligor's Name: FOLEY, GLENN L. 2701102020 CSE Agency Case Identifier: (See Addendum for case summary) Order Identifier: (See Addendum for order/docket informations 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: 2014100094 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 Form EN-028 06/12 Service Type M Page 3 of 3 Worker ID $OINC ADDENDUM Summary of Cases on Attachment Defendant/Obligor: FOLEY, GLENN L. PACSES Case Number 604111492 PACSES Case Number Plaintiff Name Plaintiff Name RENEE G. FOLEY Docket Attachment Amount Docket Attachment Amount 08-4047 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 06/12 Service Type M OMBNo.:0970-0154 Worker ID $OINC GLENN L. FOLEY, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. • CIVIL ACTION -DIVORCE sonsmatoutift.ruissi RENEE G.FOLEY, IN DIVORCE Defendant/Petitioner PACSES Case No: 604111492 5:%490-‘, 7 0 ORDER OF COURT c (5' AND NOW to wit, on this 25th day of October, 2013, it is hereby Ordered that the Domestic Relations Section dismiss their interest in the above captioned Alimony matter as the obligation has been satisfied and there is no balance due the Petitioner. This Order shall become final twenty (20) days after the mailing of the notices of the entry of the Order to the parties unless either party files a written demand with the Office of the Prothonotary for a hearing de novo before the Court. - • ■ Thomas A. Placey, J. DRO: R.J. Shadday xc: Petitioner Respondent Form 0E-001 Service Type:M Worker:21005