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HomeMy WebLinkAbout08-4863CD JEANNA B. COSTOPOULOS, ESQUIRE Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 Attorney for Plaintiff WILLIAM J. CALVERT, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. : No d$ - H8(v3 alyi 1 ler'M MARY M. CALVERT, CIVIL ACTION - AT LAW Defendant DIVORCE 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 at the Cumberland Courthouse, One Courthouse Square, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013-3308 (717) 249-3166 r ? JEANNE B. COSTOPOULOS, ESQUIRE Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 Attorney for Plaintiff WILLIAM J. CALVERT, Plaintiff vs. MARY M. CALVERT, Defendant THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No p ?_ y 8 (? 3 c ?:l?„? CIVIL ACTION - AT LAW DIVORCE AND NOW, comes the Plaintiff, William J. Calvert, by and through his attorney, Jeann6 B. Costopoulos, Esquire, and avers the following in support of this Complaint in Divorce: 1. Plaintiff, William J. Calvert, is an adult individual currently residing at 4227 Nantucket Drive, Mechanicsburg, Cumberland County, Pennsylvania, 17050. 2. Defendant, Mary M. Calvert, is an adult individual currently residing at 1117 Bridge Street (Front), New Cumberland, Cumberland County, Pennsylvania, 17070. 3. Plaintiff and Defendant have been bona fide residents of the Commonwealth of Pennsylvania for at least six months immediately prior to the filing of this Complaint. 4. Plaintiff and Defendant were married on October 8, 1977. 5. Plaintiff originally filed a divorce action in the 41 st Judicial District, Juniata County, Pennsylvania, which was dismissed several years ago due to inactivity. There have been no other prior actions of divorce or annulment between the parties. 6. The marriage is irretrievably broken. 7. The parties have been physically living separate and apart since March 8, 1997 and have not had marital relations since July of 1985. 8. Neither Plaintiff nor Defendant is in the military or naval service of the United States or its allies within the provisions of the Soldiers' and Sailors' Civil Relief Act of the Congress of 1940 and its amendments. 9. Plaintiff and Defendant are both citizens of the United States. 10. Plaintiff has been advised of the availability of marriage counseling and that he may have the right to request the Court to require the parties to participate in such counseling. Being so advised, Plaintiff does not request that the Court require the parties to participate in counseling prior to a Divorce Decree being handed down by the Court. 11. There are no dependent children from this marriage, the parties four (4) children have reached the age of majority. 12. This action is not collusive. WHEREFORE, Plaintiff, William J. Calvert, respectfully requests this Honorable Court grant him relief from the bonds of matrimony and order a Decree in Divorce. Respectfully Submitted: By: JEANN . COSTOPOULOS, ESQUIRE Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 ATTORNEY FOR PLAINTIFF Date: I, William J. Calvert, hereby verify and state that the facts set forth in the foregoing document are true and correct to the best of my information, knowledge and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. §4904 relating to unworn verification to authorities. Date: AMX/ William J. Calve 00 C7 Co < WILLIAM J. CALVERT, Plaintiff VS. MARY M. CALVERT, : THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA No 02- L18fo3 l??v?l lerM, : CIVIL ACTION - AT LAW DIVORCE Defendant =z.. ;__ tv NOTIr-E TO IF YOU WISH TO DENY ANY OF THE STATEMENTS SET FORTH IN THIS AFFIDAVIT, YOU MUST FILE A COUNTERAFFIDAVIT WITHIN STT DAL BE AFTER THIS AFFIDAVIT HAS BEEN SERVED ON YOU OR THE STA ADMITTED. . FF ` IT 1115 FR 4F('TION 3301 fd? OF TTY' T IVORCE C'ODF. 1. The parties to this action separated March 8, 1997 and have continued to live separate and apart for a period of at least two years. 2. The marriage is irretrievably broken. 3. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 4. I hereby verify that the statements made in this affidavit are true and correct. I understand that false statements are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Date: lv Awe Signature: ZWZil-liarn J. C rt C.L7 .. r c T?t-- -0IT C f y - f.., f? ri A JEANNE B. COSTOPOULOS, ESQUIRE Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 Attorney for Plaintiff WILLIAM J. CALVERT, Plaintiff THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. :No 084863 CIVIL TERM MARY M. CALVERT, CIVIL ACTION - AT LAW Defendant DIVORCE AFFIDAVIT OF SERVICE I, Jeanne B. Costopoulos, Esquire, verify that the Complaint in Divorce and Affidavit Under Section 3301(d) of the Divorce Code, both filed August 13, 2008, were both served upon the Defendant indicated above August 20, 2008, by first class, Certified Mail No. 7007 0710 0001 9994 5429, postage prepaid, return receipt requested, restricted delivery, pursuant to the requirements of Pa.R.C.P. § 1930.4. I verify that the statements made herein are true and correct and I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. By: JE E B. COSTOPOULOS, E RE Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 Attorney for Plaintiff Date: ¦ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ¦ Print your name and address on the reverse so that we can return the card to you. ¦ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: mat,, M Ca l v cr`k" 111-7 /V&i cct# hQrla??? P?9 /-7070 A. Received bye Pnnt Clearly) 18. -WO of D. Is delivery address Afferent from Item 1? ? Yes If YES, enter delivery address below: ? No 3. Service Type ,V'Certi ied Mail ? Express Mail ? Registered ? Return Receipt for Merchandise ? Insured Mail ? C.O.D. 4. Restricted Delivery? (Extra Fee) i9-Yes 2. Article Number 7007 0710 0001 9994 5429 (Transfer from service label) PS Form 3811, March 2x01 Domestic Return Receipt 102595-01-M-1424 C ?,,, `? .. ???. ?_ ---a ,,? .? ?- , rro _. c;? :,-- t? ?? 7s r :,? - .. U -? ? ? ?? ? WILLIAM J. CALVERT, Plaintiff VS. MARY M. CALVERT, Defendant : THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : No 08-4863 Civil Term : CIVIL, ACTION - AT LAW : DIVORCE COUNTER AFFIDAVIT UNDER SECTION 3301(d) OF THE DIVORCE CODE 1. Check either (a) or (b): [X (a) I do not oppose the entry of a divorce decree. ? (b) I oppose the entry of a divorce decree because: Check (i), (ii), or both: ? (i) The parties to this action have not lived separate and apart for a period of at least two years. ? (ii) The marriage is not irretrievably broken. 2. Check either (a) or (b): ? (a) I do not wish to make any claim for economic relief. I understand that I may lose rights concerning alimony, division of property, lawyer's fees, or expenses if I do not claim them before a divorce is granted. (b) I wish to claim economic relief which may include alimony, division of property, lawyer's fees, or expenses or other important rights. I hereby verify that the statements made in this Counter-affidavit are true and correct. I understand that false statements are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Date:_ Signature: Mary M, C ert Sworn to a4d subscribed to fore e this V g 2608. -dav -Rw, -#?o Notary Public COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL BETTY K. HOOVEN, Notary Public Lemoyne Boro., Cumberland County M Commission Expires May 27, 2009 .?., _r., "' f ??" -? `. . ??' 1r ..-K ". -? i f ` t? 7'1?' C. { .? ??? '? ?; ..I,.,. ...- JEANNE B. COSTOPOULOS, ESQUIRE Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 Attorney for Plaintiff WILLIAM J. CALVERT, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. MARY M. CALVERT, Defendant No 08-4863 CIVIL TERM CIVIL ACTION - AT LAW DIVORCE PETITION FOR APPOINTMENT OF DIVORCE MASTER AND NOW comes the Plaintiff, William J. Calvert, by and through his attorney, Jeanne B. Costopoulos, Esquire, and moves this Honorable Court to appoint a master with the respect to the following claims: Divorce In support of this motion, Plaintiff states; 1. Discovery is complete as to the claims for which the appointment of a master is requested. 2. The Defendant has appeared in the action, pro se. 3. The statutory grounds for the divorce are 3301(d) of the Divorce Code. 4. The action is contested with respect to the following claims: Unknown by Plaintiff. 5. This action does not involve complex issues of law or fact; and 6. The hearing is expected to take 1/2 day. Respectfully Submitted: Dated: ey? 'f By: JE B. COSTOPOULOS, E RE Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 Attorney for Plaintiff CERTIFICATE OF SERVICE I hereby certify that I am this day serving a copy of the Petition to the person and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of the same with the United States Post Office at Mechanicsburg, Pennsylvania, through first class mail, prepaid, and addressed as follows: Mary M. Calvert 1117 Bridge Street (Front) New Cumberland, PA 17070 By: JEA t B. COSTOPOULOS, DIRE Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 Attorney for Plaintiff A/4? Dated: (? to 07 WILLIAM J. CALVERT, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. : No 08-4863 CIVIL TERM MARY M. CALVERT, CIVIL ACTION - AT LAW Defendant DIVORCE ORDER APPOINTING DIVORCE MASTER AND NOW, this 15 day of , 2008, upon consideration of the attached Petition for Appointment of Divorce Master, it is hereby Ordered and Directed that 4&.;k Esquire, is appointed master with respect to the following claims: BY T OUR y ? ate, J. C"ll C3 E1.. `-" N t ; V ? WILLIAM J. CALVERT Plaintiff VS. MARY M. CALVERT Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 08-4863 CIVIL ACTION -LAW IN DIVORCE COUNTERCLAIMS TO DIVORCE COMPLAINT AND NOW, comes the Defendant, Mary M. Calvert, by and through her attorney, Mark K. Emery, Esquire, and files the following Counterclaims to Divorce Complaint and in support thereof avers as follows: COUNTI EQUITABLE DISTRIBUTION 1. During the marriage, Plaintiff and Defendant have acquired various items of marital property, both real and personal, which are subject to equitable distribution under the Divorce Code. 2. Defendant requests that this Honorable Court equitably distribute all marital property pursuant to the Divorce Code. WHEREFORE, Defendant Mary M. Calvert respectfully requests this Honorable Court equitably distribute all property, both real and personal, tangible and intangible, acquired by the parties during their marriage. 1 COUNT II ALIMONY PENDENTE LITE, SUPPORT, COUNSEL FEES, AND EXPENSES Paragraphs 1 and 2 are incorporated by reference as if fully set forth herein. 4. By reason of this action, Defendant has and will be put to considerable expense in the preparation of this case in the employment of counsel and the payment of costs. 5. Defendant is without sufficient funds to support herself and to meet the costs and expenses of this litigation and unable to appropriately maintain herself during the pendency of this action. 6. Defendant's income is not sufficient to provide for her reasonable needs and pay her attorneys' fees and the costs of this litigation. 7. Plaintiff has adequate earnings to provide support and alimony pendente lite for the Defendant and to pay her counsel fees, costs and expenses. WHEREFORE, Defendant Mary M. Calvert respectfully requests this Honorable Court compel the Plaintiff to pay Defendant alimony pendente lite, support, counsel fees, costs and expenses of this action. COUNT III ALIMONY 8. Paragraphs 1 through 7 are incorporated by reference as if fully set forth herein. 9. Defendant lacks sufficient property to provide for her reasonable needs. 10. Defendant is unable to sufficiently support herself through appropriate employment. 11. Plaintiff has sufficient income and assets to provide continuing support and to pay 2 alimony to the Defendant. 12. Plaintiff engaged in marital misconduct prior to the date of final separation. WHEREFORE, Defendant Mary M. Calvert respectfully requests this Honorable Court compel Plaintiff to pay alimony to Defendant. Respectfully submitted, LAW OFFICES OF MARK K. EMERY By: Mark K. Emery, Esquire Supreme Court I.D. No. 72787 410 North Second Street Harrisburg, PA 17101 (717) 238-9883 Attorney for the Defendant DATE: November 21, 2008 3 i VERIFICATION I, Mary M. Calvert, hereby verify that I have read the foregoing Counterclaims to Divorce Complaint and that the information contained therein is true and correct to the best of my knowledge, information and belief. I understand that false statements herein are subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Mary M. Ca ert DATE: //- / ?DD? CERTIFICATE OF SERVICE AND NOW, this 21 st day of November, 2008, I, Mark K. Emery, Esquire do hereby certify that I have served the foregoing Counterclaims to Divorce Complaint by mailing a true and correct copy via United States first class mail, addressed as follows: Jeanne B. Costopoulos, Esquire 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 LAW OFFICES OF MARK K. EMERY By: Mark K. Emery q w.._ ,x VN*i w WILLIAM J. CALVERT, Plaintiff VS. MARY M. CALVERT, Defendant THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : No 08-4863 CIVIL ACTION - AT LAW DIVORCE AMENDED AFFIDAVIT UNDER SECTION 3301(d) OF THE DIVORCE CODE 1. The parties to this action separated on April 15, 1995 and have continued to live separate and apart for a period of at least two years. 2. The marriage is irretrievably broken. 3. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 4. I hereby verify that the statements made in this affidavit are true and correct. I understand that false statements are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unworn falsification to authorities. Date: a -Q Signature: William J. Calpffi 2x99 CC t 2 2 WILLIAM J. CALVERT, Plaintiff VS. MARY M. CALVERT, Defendant : THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : No 08-4863 : CIVIL ACTION - AT LAW : DIVORCE PLAINTIFF'S AFFIDAVIT OF CONSENT UNDER SECTION 3301(c) OF THE DIVORCE CODE AND WAIVER OF COUNSELING 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on August 13, 2008. 2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of the filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. 4. 1 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 unworn falsification to authorities. Date: 10-/ "-q William J. .i ZC??I? (?.; t ?'.? ?= f : a ?,? _? ., mot,. WILLIAM J. CALVERT, Plaintiff VS. MARY M. CALVERT, Defendant THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No 08-4863 CIVIL ACTION - AT LAW DIVORCE PLAINTIFF'S WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree 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. 4. 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 unworn falsification to authorities. Date: William J. Calv w WILLIAM J. CALVERT, Plaintiff VS. MARY M. CALVERT, Defendant THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No 08-4863 CIVIL TERM CIVIL ACTION - AT LAW DIVORCE PRETRIAL STATEMENT OF PLAINTIFF, WILLIAM J. CALVERT AND NOW comes Plaintiff, William J. Calvert, by and through his attorney, Jeanne B. Costopoulos, Esquire, and files the following Pretrial Statement: 1. Marital Assets: The parties' only significant assets consist of railroad pension and retirement benefits as a result of Plaintiff's employment.. 2. Witnesses: Plaintiff does not intend at this time to call any witnesses other than himself. However, Plaintiff reserves the right to supplement his witness list with reasonable notice to Defendant. 3. Plaintiff intends to offer the following exhibits into evidence. a. Paystubs of Husband b. Husband's tax returns c. Conrail documents d. Norfolk Southern documents e. Railroad Retirement Board documents f. Fidelity documents g. Foreclosure on marital residence documents h. Wife's disability documents i. Husband's bankruptcy documents j. Support orders 4. Income of Plaintiff. See Income and Expense Statement of Plaintiff. 5. Expenses of Plaintiff. See Income and Expense Statement of Defendant. 6. Pension: Plaintiff has railroad benefits and is in the process of sending additional information to Defendant's counsel regarding same. 7. Defendant's claim for counsel fees should be denied. Plaintiff has been paying spousal support to Defendant since January 27, 2003 and there has been minimal litigation between the parties since that time. 8. Tangible personal property: All tangible personal property has been divided between the parties and each party shall retain the items currently in his or her possession. 9. Listing of marital debt: The marital residence was lost as a result of a bankruptcy filed by Defendant. No marital debt remains and neither party is seeking payment for marital debt paid post-separation. 10. Equitable Distribution: Defendant proposes a 50150 distribution of all pension and retirement benefits and that Conrad Seigel be retained to draft the necessary paperwork and that the cost be equally divided between the parties. 11. Alimony: Plaintiff believes Defendant's claim for alimony should be either denied or should be based on Defendant's full time earning capacity prior to her disability. Defendant's disability was caused by a third party after separation and compensation should be made by that party, not by Plaintiff. Defendant gambles and Plaintiff should not be responsible to support Defendant's gambling addiction. Respectfully Submitted: Dated: By: JE NE B. COSTOPOULOS, ESQUIRE Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 Attorney for Plaintiff CERTIFICATE OF SERVICE I hereby certify that I am this day serving a copy of the Petition to the person and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of the same with the United States Post Office at Mechanicsburg, Pennsylvania, through first class mail, prepaid, and addressed as follows: Mark K. Emery, Esquire 410 N. Second Street Harrisburg, PA 17101 By: JEA B. COSTOPOULOS, IRE Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 Attorney for Plaintiff Dated: ty X2 ?i FILED- F, CiCE 2009 NOV -S PM 12: 40 CU€Y1J`... - i.; MENNSYLVA!, IA WILLIAM J. CALVERT Plaintiff VS. MARY M. CALVERT Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 08-4863 CIVIL ACTION -LAW IN DIVORCE DEFENDANT'S AFFIDAVIT OF CONSENT AND WAIVER OF COUNSELING 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on August 13, 2008. 2. The marriage of the Plaintiff and Defendant is irretrievably broken, and ninety (90) days have elapsed from the date of both the filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of a notice of intention to request entry of the Decree. 4. I have been advised of the availability of marriage counseling, and understand that I may request that the Court require that my spouse and I participate in counseling. I further understand that the Court maintains a list of marriage counselors in the Prothonotary's Office, which list is available upon request. Being so advised, I do not request that the Court require that my spouse and I participate in counseling prior to a divorce decree being handed down by the Court. 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.A. Section 4904, relating to unsworn falsification to authorities. DATE: // G'9 Mary M. C vert Iv 7.7 7 WILLIAM J. CALVERT Plaintiff vs. MARY M. CALVERT Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 08-4863 CIVIL ACTION -LAW IN DIVORCE DEFENDANT'S WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER Q301(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 /'L -ee YY? Mary M. lvert MY WILLIAM J. CALVERT, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLN Abff A 9 VS. :No 08-4863 CIVIL TERM rn c ?n MARY M. CALVERT, : CIVIL ACTION - AT LAW N Defendant : DIVORCE 4 . µ . .xd . JOINT PETITION FOR BIFURCATION ' AND NOW, come the parties, William J. Calvert, by and through his attorney, Jeanne B. Costopoulos, Esquire, and Mary M. Calvert, by and through her attorney, Mark K. Emery, Plaintiff, and respectfully request this Honorable Court to bifurcate the above action and, in support thereof, aver as follows: 1. One of your Petitioners is the Plaintiff in the above Divorce action, William J. Calvert. 2. Your other Petitioner is the Defendant, Mary M. Calvert. 3. In the underlying Complaint for Divorce filed in 2008, it was alleged that the marriage was irretrievably broken. Both parties are prepared to file Affidavits of Consent and Waivers of Notice in order to proceed with the finalization of this Divorce, provided the Court grants this Joint Petition for Bifurcation. 4. Ancillary claims for Equitable Distribution, Alimony Pendente Lite, Attorneys' Fees, Costs, and Alimony remain pending. 5. Both of your Petitioners have agreed and therefore aver that all ancillary claims are preserved by the pleadings and that no prejudice will occur if the divorce is granted 1 prior to the adjudication of Petitioners' ancillary claims. 6. Your Petitioners, the Plaintiff and Defendant herein, have been separated in excess of two years. 7. Pursuant to the Divorce Code, 23 PA. C.S. §3101 et. seq., this Honorable Court is empowered to grant a Divorce and to reserve jurisdiction over the remaining ancillary issues. WHEREFORE your Petitioners, William C. Calvert, by and through his attorney, Jeannd B. Costopoulos, Esquire, and Mary M. Calver, by and through his attorney, Mark K. Emery, Esquire, respectfully pray this Honorable Court to: a. Order bifurcation in the Divorce Action; and b. Reserve jurisdiction over the remaining ancillary issues. William J. B. Costopoulos, Esquire Mary M. ClIvert f, Mark K. Emery, Esquir? Date Date Date 2 r . WILLIAM J. CALVERT, : THE COURT OF COMMON PLEA,%§F -j Plaintiff : CUMBERLAND COUNTY, PENN CIA VS. :No 08-4863 CIVIL TERM < x F 3 MARY M. CALVERT, : CIVIL ACTION - AT LAW Defendant : DIVORCE ``•' ' ORDER OF COURT AND NOW, this z 4' day of If JJI _.. , 2011, upon consideration of the attached Joint Petition for Bifurcation, it is hereby ORDERED and DECREED that the Divorce action filed by WILLIAM J. CALVERT, against MARY M. CALVERT, is hereby bifurcated and the parties may proceed to finalize the Divorce. This Court retains jurisdiction of any claims raised by the parties to this action for which a final Order has not yet been entered including, but not limited to, ancillary economic claims raised by either party. BY THE COURT: Distribution to: l ;o G Jeanne B. Costo ulos Esquire,. -I?i4#s? Po ? 5tfit?, Mechanicsburg, PA, 17055 Mark K. Emery, Esquire, 410 North Second Street, Harrisburg, PA 17101 Mid 000 ?1,4411 a0 D WILLIAM J. CALVERT, Plaintiff vs. MARY M. CALVERT, Defendant : THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA .No 084863 CIVIL TERM : CIVIL ACTION - AT LAW : DIVORCE PLAINTIFF'S WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301 ld) 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. 1 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. 4. 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. Dated: o?o11 Signature: G?/,l 7?? _ William alvest C = Co .rm C- te Z M- cnr" r -- P -orn ;?v te 0 cn o© r -- ? CD i C? WILLIAM J. CALVERT, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PEN NSY&VAW -n vs. No 08-4863 CIVIL TERM rcv Zrn a c ' rn 'ma- r= ro x= u 3> c rn o° MARY M. CALVERT, CIVIL ACTION - AT LAW "?_Z r --4C:) Defendant DIVORCE y° _ c)-n = 'C r o? DEFENDANT'S WAIVER OF NOTICE OF INTENTION x A TO REQUEST ENTRY OF A DIVORCE DECREE x UNDER SECTION 3301(d) 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. 4. 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 unworn falsification to authorities. Dated: Signature: Mary . Cafve"A s WILLIAM J. CALVERT, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. No 08-4863 n -a MARY M. CALVERT, MW CIVIL ACTION - AT LAW Z= a• :r- z -n v Defendant DIVORCE ?y N 3 PRAECIPE TO TRANSMIT RECORD v° 2q 3 oQ 2: To the Prothonotary: Please transmit the record, together with the following information, to the Court for entry of a divorce decree: 1. Ground for Divorce: Irretrievable breakdown under §3301(c) of the Divorce Code. 2. Date and Manner of Service of the Complaint: Service via first class, certified, restricted delivery mail, receipt no. 7007 0710 0001 9994 5429. 3. Date Plaintiff s Affidavit of Consent was signed and filed with the Prothontary: Signed October 19, 2009 and filed October 22, 2009. Date Defendant's Affidavit of Consent was both signed and filed with the Prothonotary: November 13, 2009. 4. Related claims pending: All economic claims are specifically preserved by joint petition for bifurcation filed June 21, 2011 and subsequent order granting bifurcation dated June 24, 2011. 5. Date Plaintiff s Waiver of Notice in Divorce was signed and filed with the Prothonotary: Signed October 19, 2011 and filed October 22, 2011. Date Defendant's Waiver of Notice in Divorce was both signed and filed with the Prothonotary: November 13, 2009. By: ` JEANNE . COSTOPOULOS, ESQUIRE Date: /e;70 // Attorney I.D. No. 68735 130 Gettysburg Pike, Suite C Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 ATTORNEY FOR PLAINTIFF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA WILLIAM J. CALVERT V. MARY M. CALVERT NO. 08-4863 DIVORCE DECREE AND NOW, . A h'• ,4.r 1) , it is ordered and decreed that WILLIAM J. CALVERT plaintiff, and MARY M. CALVERT 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.") Equitable distribution; Alimony Pendente Lite, Support, Counsel Fees, and Expenses; Alimony By the Court, , p? OS q-4-11. ee(4 JJoh ` P c ?? /Pct r- el ? WILLIAM J. CALVERT, Plaintiff Vs. MARY M. CALVERT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 08 - 4863 CIVIL IN DIVORCE ORDER OF COURT AND NOW, this 0 -*l day of 2012, the parties having previously been divorced by decree entered September 1, 2011, and the parties and counsel having entered into an agreement and stipulation resolving the economic issues on December 8, 2011, the date set for a Master's hearing, the agreement and stipulation having been transcribed and subsequently signed by the parties and counsel, the appointment of the Master is vacated. Pursuant to the agreement, counsel shall provide to the Court for signature an alimony order consistent with the terms of the agreement. BY THE COURT, v5x,00-F //.. Ke n A. Hess, P.J. -- r.j C cc: ?? Jeanne B. Costopoulos -?3 N `{ Attorney for Plaintiff =? M- - ? Mark K. Emery w Attorney for Defendant nccc? -a =C ) -71 L 4 WILLIAM J. CALVERT, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 08 - 4863 CIVIL MARY M. CALVERT, Defendant IN DIVORCE THE MASTER: Today is Thursday, December 8, 2011. This is the date set for a hearing in the above-captioned divorce proceedings. Present in the hearing room are the Plaintiff, William J. Calvert, and his counsel Jeanne B. Costopoulos, and the Defendant, Mary M. Calvert, and her counsel Mark K. Emery. This action was commenced by the filing of a divorce complaint on August 13, 2008, raising grounds for divorce of irretrievable breakdown of the marriage. The parties petitioned the Court to bifurcate the action and asking the Court to enter a decree in divorce. Judge Hess entered a decree on September 1, 2011. The decree did preserve claims of equitable distribution, alimony pendente lite, support, counsel fees and expenses, and alimony. We are here today to resolve the preserved economic issues and enter an agreement on the record. The Master has been advised that after considerable negotiations, the parties have reached an agreement with respect to all of the outstanding claims raised. The 1 agreement is going to be placed on the record in the presence of the parties. The agreement as placed on the record will be considered the substantive agreement of the parties, not subject to any changes or modifications except for correction of typographical errors which may be made during the transcription. Consequently, when the parties leave the hearing room today, they are bound by the terms of the agreement even though there is no signing of the agreement affirming the terms of settlement. The parties and counsel, however, are going to return later this morning to review the transcribed agreement, make any correction of typographical errors as necessary, and then affix their signatures affirming the terms of settlement as stated on the record. Upon receipt by the Master of a completed agreement, the Master will prepare an order vacating his appointment. The Master has indicated that with respect to the alimony claim, that he be provided an alimony order to attach to the order to vacate which will include a copy of the agreement so that the Court can enter an order separately with regard to the alimony agreement. It is also the Master's understanding that the payment of alimony will be made through the Cumberland County Domestic Relations Office and they will be provided, through counsel, a copy of the agreement and order of alimony. 2 The parties were married on October 8, 1977, and have been separated since April 15, 1995. The parties are the parents of four natural children, all of whom are emancipated. Ms. Costopoulos. MS. COSTOPOULOS: In full satisfaction of all claims against each other, the parties agree as follows: 1. Husband shall pay wife $4,000.00 cash on or before December 31, 2011. The payment shall be made to attorney Emery with a check payable to Mr. Emery as provided herein on or before December 31, 2011. 2. Effective on this date, December 8, 2011, husband shall pay wife non-modifiable alimony in the amount of $1,100.00 per month. Alimony will terminate upon the death of either party or wife's remarriage or co-habitation with a person of the opposite sex. Said payments will be made via a wage attachment through Domestic Relations through the Railroad Retirement Board. The parties agree that a separate alimony order will issue as provided in the comments of the Master. 3. All other claims, including claims for equitable distribution, counsel fees, alimony pendente litre and support are waived and withdrawn. 4. The parties agree that they will sign any documents necessary to effectuate the terms of this agreement. 5. All issues with respect to debt and distribution of property are resolved by the terms of this agreement which effectively withdraws all claims except for the alimony agreement as stated herein. MS. COSTOPOULOS: Mr. Calvert, did you hear the terms of this agreement as they were dictated on the record just now? MR. CALVERT: Yes, I did. 3 A MS. COSTOPOULOS: Do you fully understand the meaning of the agreement and the terms? MR. CALVERT: Yes, I do. MS. COSTOPOULOS: Do you, in fact., agree that -- are you satisfied with the agreement? MR. CALVERT: Yes, I am. THE MASTER: And you understand that this will be entered as an order of court with respect to the alimony issue? MR. MR. dictated by Ms. Co MS. MR. MS. MR. those terms? CALVERT: Yes, I do. EMERY: Mary, you've heard the terms as st.opoulos and Master Elicker? CALVERT: Yes. EMERY: You understood those terms? CALVERT: Yes. EMERY: And you are in agreement with MS. CALVERT: Yes, I am. MR. EMERY: There is nothing here today that would impact your ability to understand or consent to those terms? 4 l MS. CALVERT: No. THE MASTER: Thank you. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend to bind myself to the settlement as a contract obligating myself to the terms of settlement and subjecting myself to the methods and procedures of enforcement which may be imposed by law and in particular Section 3105 of the Domestic Relations Code. WITNESS: DATE: eanne B. Costopoulos William/. Calvert Attorney for Plaintiff / ar kK. Emery Mary M., alve t Attorney for D endant 5 2012FEB-7 P is PS JEANNE B. COSTOPOULOS, ESQUIRE Attorney I.D. No. 68735 130 Gettysburg Pike, Suite C Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 Attorney for Plaintiff WILLIAM J. CALVERT, Plaintiff vs. MARY M. CALVERT, Defendant ,UMBERLAND GOUNI ( PENNSYLVANIA THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No 08-4863 CIVIL TERM CIVIL ACTION - AT LAW DIVORCE STIPULATION FOR WAGE ATTACHMENT ORDER REGARDING ALIMONY AND NOW come the parties, Plaintiff, William J. Calvert, by and through his attorney, Jeann6 B. Costopoulos, Esquire and Defendant, Mary M. Calvert, by and through her attorney, Mark K. Emery, Esquire, and agree that the following provisions be incorporated into an order of court: Effective on December 8, 2011, Plaintiff shall pay Defendant alimony the sum of $1,100.00 per month in accordance with the terms of the parties' marital settlement agreement signed on December 8, 2011. Plaintiff shall be given credit for direct payments made to Defendant from December 8, 2011 and after. Said money to be collected by the Cumberland County Office of Domestic Relations through wage attachment by Railroad Retirement and turned over by the Pennsylvania Collection and Disbursement Unit to Mary M. Calvert. Plaintiff shall be responsible for any collection fees. The monthly alimony obligation does not include medical support. Unreimbursed medical expenses of Defendant shall be solely the responsibility of Defendant. Plaintiff shall not be required to provide health insurance coverage to Defendant. The parties hereby authorize the Court of Common Pleas of Cumberland County, Pennsylvania to immediately enter a wage attachment order of support against Plaintiff for payment of alimony pursuant to the terms of this agreement. Consented: L z/ -3i r William J. C t, Plaintiff *Mary . alvert, efendant Date Jeanne B. Costopoulos, Esquire Date Mark Emery, Esquire Date z WILLIAM J. CALVERT, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. :No 08-4863 CIVIL TERM MARY M. CALVERT, CIVIL ACTION - AT LAW rn Defendant DIVORCE 1 ORDER OF COURT - ~ - o AND NOW, this ?. 9 +t day of , 2012, up@-k- n' consideration of the parties' Stipulation for Wage Attachment Order regarding Alimony, it is hereby ordered as follows: Effective on December 8, 2011, Plaintiff shall pay Defendant alimony the sum of $1,100.00 per month in accordance with the terms of the parties' marital settlement agreement signed on December 8, 2011. Plaintiff shall be given credit for direct payments made to Defendant from December 8, 2011 and after. Said money to be collected by the Cumberland County Office of Domestic Relations through wage attachment by Railroad Retirement and turned over by the Pennsylvania Collection and Disbursement Unit to Mary M. Calvert. Plaintiff shall be responsible for any collection fees. The monthly alimony obligation does not include medical support. Unreimbursed medical expenses of Defendant shall be solely the responsibility of Defendant. Plaintiff shall not be required to provide health insurance coverage to Defendant. :Z,, COURT: 4 4, J. _1 Distribution to: Jeanne B. Costopoulos, Esquire, 130 Gettysburg Pike, Suite C, Mechanicsburg, PA, 17055 ? Mark K. Emery, Esquire, 410 North Second Street, Harrisburg, PA 17101 INCOME WITHHOLDING FOR SUPPORT O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) 1 a3U LL) -7 cj( j O AMENDED IWO -Z 00,5 S aUOIO O ONE-TIMEORDERMOTICE FOR LUMP SUM PAYMENT O TERMINATION OF IWO gg3_II-:D7S O!R - 48 b3 Clv Date: 02/21/12 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO must`tie r rar_on1sAce. 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. Staterrribe/Territory Commonwealth of Pennsylvania Remittance Identifier (include w/payment): 7636000235 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket Informafton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) RAILROAD RETIREMENT BOARD* C/O DEPUTY GENERAL COUNSEL 844 N RUSH ST BUREAU OF LAW CHICAGO IL 60611-1275 Employer/Income Withholder's FEIN 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 hStp:Hwww.acf.hhs.gov/procirams/cse/newhire/ employer/publication/publication.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. 2754100092 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 Countv, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts fro'Rth¢_*mp*ee/ obligor's income until further notice. -aX ;z --+ $ 0.00 per month in current child support xr?'q ryi-_ r, $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? O yl? b i? us -oc $ 0.00 per month in current cash medical support -< > fV c:t C7 $ 0.00 per month in past-due cash medical support r? =° $ 1,100.00 per month in current spousal support D c) z cs-r? $ 40.00 per month in past-due spousal support C:__ rQ o $ 0.00 per month in other (must specify) ---a ti} for a Total Amount to Withhold of $ 1,140.00 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: $_ 263,OSL per weekly pay period. $ 570.00 per semimonthly pay period (twice a month) $ 5ab . f per biweekly pay period (every two weeks) $ 1,140.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10 working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), obtain withholding limitations, time requirements, and any allowable employer fees at hftl2://www.acf.hhs.aov/programs/cse/newhire/employer/contacts/ contact map.htm for the employee/obligor's principal place of employment. Document Tracking Identifier RE: CALVERT, WILLIAM J. Employee/Obligor's Name (Last, First, Middle) 188-42-1997 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) OMB No.: 0970-0154 Form EN-028 01/12 Service Type M Worker ID $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 check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: r to f, 4 1-U I(. 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 Rayment 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 /dentifrer) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: hftp:ffwww.acf,hhs.gov/12maramsi.cse/newhire/`emi2loygr/contactstcontagA-map.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 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 01/12 Service Type M Page 2 of 3 Worker ID $OINC Employer's Name: RAILROAD RETIREMENT BOARD' Employer FEIN: Employee/Obligor's Name: CALVERT WILLIAM J. 7636000235 CSE Agency Case Identifier: (See Addendum for case summa rvl 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/obligors 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: 2754100092 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: New Employer's Name: New Employer's Address: Final Payment Amount: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.childsupport.state.pa.us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST. P.O. 320 CARLISLE PA 17013 (Issuer address). To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (17)_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: CALVERT, WILLIAM J. PACSES Case Number 143000750 Plaintiff Name MARY M. CALVERT Docket Attachment Amount 00325S 2006 $ 40.00 Child(ren)'s Name(s): DOB Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number 993113075 Plaintiff Name MARY M. CALVERT Docket Attachment Amount 08-4863 CIVIL $ 1,100.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docke Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSE$ Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 01112 Service Type M OMB No.: 0970-0154 Worker ID $OINC WILLIAM J. CALVERT, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 08-4863 CIVIL TERM R k MARY M. CALVERT, IN DIVORCE -vim - -; Defendant/Petitioner PACSES Case No: 993113075 a N u ORDER TO CREDIT ARREARS ?2r. •• = AND NOW to wit, this 24th day of February, 2012, it is hereby Ordered that Credit be given on the above captioned case in the amount of $1,855.93. There is an agreement of the parties to the credit. This credit is for direct payments. BY THE COURT: N i ?-" V M. L. Ebert, Jr., J. DRO: R.J. Shadday xc: Petitioner Respondent Mark K. Emery, Esq. Jeanne B. Costopoulos, Esq. Form OE-001 Service Type: M Worker: 21005 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION MARY M. CALVERT ) Docket Number: 08-4863 CIVIL Plaintiff ) vs. ) PACKS Case Number: 993113075 WILLIAM J. CALVERT ) Defendant ) Other State ID Number: G ORDER TO CREDIT ARREARS Fr ix7 M i AND NOW, on this 13TH DAY OF MARCH, 2012 IT IS HEREBY ORD D #Mt 6 credit be given on the above captioned case in the amount of $669.00. There C N C) O is not an agreement of the parties to the credit. This credit is for ® Direct Payments. ? Purchases made or services performed by the Defendant on behalf of the Plaintiff or children. ? Time children resided with the Defendant as agreed upon by parties, or addressed in a partial custody order for the following time periods: From to From to From to ? Other: Check # 2243 Plaintiff Defendant 13TH DAY OF MARCH, 2012 Date Service Type M Date Date BY THE COURT: ?14 M.1.._ftw, is JUDGE Form FI-002 Worker ID 21005 INCOME WITHHOLDING FOR SUPPORT *113 11 3D75 O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) Q AMENDED IWO I UOU ?5v OS - 4-? b 3 C)v i O ONE•TIMEORDERMOTICE FOR LUMP SUM PAYMENT r O TERMINATION OF IWO Date: 06/04112 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO must b¢ regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions htip•//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. otatei r[Det i erraory uommonweann or Pennsylvania Remittance Identifier (include w/payment): 7636000235 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for ordeNdocket informaiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) RAILROAD RETIREMENT BOARD* C/O DEPUTY GENERAL COUNSEL 844 N RUSH ST BUREAU OF LAW CHICAGO IL 60611-1275 Employer/Income Withholder's FEIN Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: CALVERT, WILLIAM J. Employee/Obligor's Name (Last, First, Middle) 188-42-1997 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.oov/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. 2754100092 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 v - $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? Q y4*;7?Q no $ 0.00 per month in current cash medical support { °% I $ 0.00 per month in past-due cash medical support $ 1,100.00 per month in current spousal support $ 100.00 per month in past-due spousal support - - c ?- $ 0.00 per month in other (must specify) t for a Total Amount to Withhold of $ 1,200.00 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: $ 276.16 per weekly pay period. $ 600.00 per semimonthly pay period (twice a month) $ 552.33 per biweekly pay period (every two weeks) $ 1,200.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten 10 working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www.acf.hhs.aov/programs/cse/newhire/employer/contacts/contact 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 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: M.L. ftW 4 Title of Judge/Issuing Official: Date of Signature: If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. ? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shown above as the EmployWObligor'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: hht p:llwww acf hhs gov/ pmgrams/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: RAILROAD RETIREMENT BOARD` Employer FEIN: Employee/Obligor's Name: CALVERT, WILLIAM J. 7636000235 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: 2754100092 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 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.childsupport.state . a 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 $OINC ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CALVERT, WILLIAM J. PACSES Case Number 143000750 Plaintiff Name MARY M. CALVERT Docket Attachment Amount 00325 S 2006 $ 100.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number 993113075 Plaintiff Name MARY M. CALVERT Docket Attachment Amount 08-4863 CIVIL $ 1,100.00 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 06/12 Service Type M OMB No.: 0970-0154 Worker ID $OINC INCOME WITHHOLDING FOR SUPPORT CI 3 11, 75 O ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT (IWO) O - Q AMENDED IWO Ug - ?O t //o CiV /, O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT O TERMINATION OF IWO Date: 8/03/12 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Chet One) NOTE: This IWO mustilbefeyalat or( i*Aface. Under certain circumstances you must reject this IWO and return it to the sender (s ee IWO instructions htt :// v/ r r ms/ /newhir m I r/ li i n/ li i n.h m - forms). If you receive this docu ent from someone other than a ate or Tribal CSE agency or a Court, a copy of the underlying order must be attached. StaterTriberrerritory Commonwealth of Pennsylvania Remittance Identifier (include w/payment): 763600 235 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket /nformelton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) RE: CALVERT WILLIAM J. RAILROAD RETIREMENT BOARD` C/O DEPUTY GENERAL COUNSEL Employee/Obligor's Name (Last, F irst, Middle) 844 N RUSH ST 188-42-1997 BUREAU OF LAW Employee/Obligor's Social Securi Number CHICAGO IL 60611-1275 (See Addendum for plaintiff net r;es associated with cases on attach ment) Custodial Party/Obligee's Name ( Last, First, Middle) Employer/income Withholder's FEIN Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) NOTE: This IWO must be regular o its face. Under certain circumstances you m st reject this IWO and return it to the sender (see IWO instructions h h n it ! empignoublication/publication.ht -form . If you receive this document from so eons other than a State or Tribal CSE agency r a Court, a copy of the underlying order must attached. 2754100092 See Addendum for deaendent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the err obligor's income until further notice. $ 0.00 permonth in current child support $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? p yes (@ nQ,,, $ 0.00 per month in current cash medical support C= C= -- $ 0.00 permonth in past-due cash medical support rq 00 330 $ 1,100.00 permonth in current spousal support ?-, $ 100.00 per month in past-due spousal support I $ 0.00 per month in other (must specify) for a Total Amount to Withhold of $ sm• 1,200.00 per month. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the er )RO If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: - $ 276.16 per weekly pay period. $ 600.00 per semimonthly pay period (twice $ 552.33 per biweekly pay period (every two weeks) $ 1,200.00 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 omi of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay d you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 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 require and any allowable employer fees at hfl2://www.acf.hhs.oov/programs/cse/newhire/employer/contacts/cont? htm for the employee/obligor's principal place of employment. Document Tracking Identifier a'alonth) If z of OMB No.: 0970-0154 Form EN-028 Service Type M Worker ID $OI ? Return to Sender (Completed by Employerdincome 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 U xv avx xuax . 4k Signature of Judge/Issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official: ji, Title of Judge/Issuing Official Date of Signature: AtFG 7'U- § 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 providea 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 MAjbod 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 TIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 109142, Hamburg, Pa 17106=9112 IN ADDITION, PAYNENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shower above as the Empjoyea/Oif NgWs Case Idendfler) OR SOCIAL SECURITY NUMSER IN ORDER TO BE PROCESSED. DO NOT SEND CASH 8Y MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: t?n D:/ .acf.hhs.goy/p=rams/ese/nowNre/employeri,contactW.contacA Mph 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/obiigor'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 Onto: 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 IWQs: 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 I WO, 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 youshould have withheld and any penalties set by State or Tribal law/procedure. Anti-dislcriminadon: 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 06/12 Service Type M Page 2 of 3 Worker ID $OINC Employer's Name: RAILROAD RETIREMENT BOARD- Employer FEIN: Employee/Obligor's Name: CALVERT, WILLIAM J. CSE Agency Case Identifier: (See Addendum for case summary Order Identifier: 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 li it is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not s pporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permittd by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit i dicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal em loyers/incon withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdic on in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S. . 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premium 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 yo 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: 27 4100092 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: 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.chiidsupportstate pa us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SE TION, 13 N. Hi P.O. BOX 320. CARLISLE. PA. 17013 (Issuer address). To Em loooyewDhhgor• If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at 717) 240_6, 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/ 2 Service Type M Page 3 of 3 Worker ID $OINC AND JM Suer? Of G?.° on Anachment DeWdartt/Obftar: CALVERT, WILLIAM J. PACSES Case Number 993113075 PACKS Case u be El ini? Plaintiff blame MARY M. CALVERT Docket AttW meet Amount 08-4863 CIVIL $ 1,200.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOES PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Attachment Amok Docke# Agagb 1'ient Amount $ 0.00 $ 0.00 ' Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACB0 m '' mbw Plaintiff Name Pia' tt-Jrt € -Name Docket Attachment Amount Docket Attachment mount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 06112 Service Type M OMB No.: 0970.0154 Worker ID $OINC INCOME WITHHOLDING FOR SUPPORT q /3075 0 ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT(IWO) @ AMENDED IWO 6)? Z� 3 covd 0 ONE-TIMEORDERINOTICE FOR LUMP SUM PAYMENT 0 TERMINATION OF IWO Date: 08/19113 ❑ Child Support Enforcement(CSE)Agency Z Court ❑ Attorney ❑ Private Individual/Entity(Check One) NOTEIThis IWO must4, e regyW�bnIs!f0ce. Under certain circumstances you must reject this IWO and return it to the sender(see IWO , , '7 instructions htt Jlvvvvv�.a: s I rams/cse/n ewh i re/employer/pub]i cation/qu bl i cation,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): 7636000235 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) RAILROAD RETIREMENT BOARD* RE: CALVERT,WILLIAM J. C/O DEPUTY GENERAL COUNSEL Employee/Obligor's Name(Last,First,Middle) 844 N RUSH ST 188-42-1997 BUREAU OF LAW Employee/Obligor's Social Security Number CHICAGO IL 60611-1275 (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 http://www.acf.hhs,aov/oroaram_sLose/newhire/ employerLpublir-ation/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. 2754100092 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 Coun 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 e;;- 4 $ 0.00 per month in current cash medical support $ 0.00 per month in past-due cash medical support 4SO C5 _V, $ 1,100.00 per month in current spousal support r.-J CZ) $ 0.00 per month in past-due spousal support $ om per month in other(must specify) cn! — for a Total Amount to Withhold of$ 1,1o0.00 per month. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the !gNe fbtiMation. If your pay cycle does not match the ordered payment cycle,withhold one of the following amount: ' $ 253.15 per weekly pay period. $ 550.00 per semimonthly pay period (twice a month) $ 506.30 per biweekly pay period(every two weeks) $ 1,100.00 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:Lwww.acf.hhs.ciov/programs/cse/newhire/employer/contacts/contact map htrn 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 check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal law): I Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: 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/ese/newhire/employer/contacts/contact map.ht Priority: Withholding for support has priority over any other legal process under State law against the same income(USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney),you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the"Remit payment to"instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment.The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State(or Tribal law if applicable)of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs,you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date—05131/2014.The OMB Expiration Date has no bearing on the termination date of the IWO;it identifies the version of the form currently in use. Form EN-028 06/12 Service Type M Page 2 of 3 Worker ID $OINC Employers Name: RAILROAD RETIREMENT BOARD* Employer FEIN: Employee/Obligor's Name: CALVERT,WILLIAM J. 7636000235 CSE Agency Case Identifier:(See Addendum for case surnma 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(4)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: 2754100092 0 This person has never worked for this employer nor received periodic income. 0 This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDLI/Tribal Payee: Final Payment Amount: New Employer's Name: New Employees 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.pe.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 Defendaht/Obligor: CALVERT, WILLIAM J. PACSES Case.Number 993113075 PACSES Case Number Plaintiff Name Plaintiff Name MARY M. CALVERT Docket Attachment Amount Docket Attachment Amount 08-4863 CIVIL $ 1,100.00 $ 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 Dogke t 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 LN-028 06/12 Service Type M OMS No.:0970-0154 Worker ID $OINC