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HomeMy WebLinkAbout08-5427BETH A. WATSON IN THE COURT OF COMMOM PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW DIVORCE MICHAEL E. WATSON Defendant No. NOTICE YOU HAVE BEEN SUED IN COURT. If yu 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 in 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 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 Dauphin County, Front and Market Streets, Harrisburg, 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 Lawyer Referral Service 32 South Bedford Street Carlisle, Pa 17413 (717) 249-2663 Counseling. 10. Plaintiff avers the following grounds for divorce: a. the marriage is irretrievably broken, b. the parties consent to the divorce; or in the alternative c. the parties have lived separate and apart for a period of two (2) years. WHEREFORE, Plaintiff, BETH WATSON, prays for a divorce from the bonds of matrimony existing between Plaintiff and Defendant. COUNTI EQUITABLE DISTRIBUTION 11. The averments of paragraphs 1-10 are incorporated herein by reference as if fully set forth. 12. During the marriage the parties acquired marital property, assets and debts which Plaintiff requests the Court equitably distribute and assign. 13. Plaintiff and Defendant have agreed to distribution of marital assets as provided for in the Marital Settlement Agreement, attached hereto as Exhibit "A", as to an equitable division of said property and debt. WHEREFORE, Plaintiff, BETH WATSON, respectfully requests this Honorable Court to incorporate said Marital Settlement Agreement as an order of court pursuant to a Decree in Divorce. COUNT II SPOUSAL SUPPORT 14. The averments of paragraphs 1-13 are incorporated herein by reference as if fully set forth. 15. Plaintiff is without sufficient property to provide for her reasonable needs and the needs to which she has become accustomed as the spouse of Defendant. 16. Plaintiff is unable to support herself through appropriate employment and continue to be maintained in the station of life to which she has become accustomed as the spouse of Defendant. 17. The parties have agreed upon a figure and time period for said support and have included same in the Marital Settlement Agreement attached as Exhibit "All and ask this Honorable Court to adopt said Agreement as an Order of Court. WHEREFORE, Plaintiff BETH WATSON requests Your Honorable Court to enter an award of spousal support in favor of Plaintiff and against Defendant in such amount as is outlined in the Marital Settlement Agreement. WHEREFORE, Plaintiff, BETH WATSON, prays this Court: a. To enter a Decree in Divorce; and b. As to Count I, to equitably divide all marital property and debt in accordance with the Marital Settlement Agreement between Plaintiff and Defendant, and c. As to Count II, to award Spousal Support in accordance with the Marital Settlement Agreement between Plaintiff and Defendant; and d. To grant such further relief as the Court may deem equitable and just. Respectfully Submitted, Date: f 4r 875 Market Street, Suite 200 Lemoyne, PA 17043 (717)761-1274 phone (717)763-2094 fax Attorney for Plaintiff VERN ATMON I, Beth Watson, verify that the statements made in the foregoing COMPLAINT in DIVORCE are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 4904, relating to unworn falsification to authorities. Date ? P'*-? Beth Witson BETH WATSON : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V : CIVIL ACTION - LAW : DIVORCE MICHAEL E. WATSON : NO.. 0 Y - J 7 MARITAL SETTLEMENT AGREEMENT - &- day of THIS STIPULATION AND AGREEMENT entered into this ? September, 2008, by and between BETH WATSON, (hereinafter referred to as "Wife" ) and MICHAEL WATSON, (hereinafter referred to as "HUSBAND"). WHEREAS, Husband and Wife were married on March 13, 1998; and WHEREAS, Husband and Wife have lived in the same residence, but as two individuals separate and apart for more than 2 years; and WHEREAS, Wife has filed a Complaint in Divorce on September -, 2008, the parties desire to confirm their agreement relative to property distribution and execute a Marital Settlement Agreement to affect the same. NOW THEREFORE, in consideration of the mutual covenants, promises and agreements as hereinafter set forth: and intending to be legally bound, the parties hereto agree as follows: MARITAL HOME 1. Wife shall be permitted to remain living in the marital residence until her minor daughter graduates from High School. 2. The marital home will be refinanced into Husband's name only. The parties will each execute any and all documents necessary to affect this transfer of debt. Husband will assume any and all debt and obligation for the mortgage holding Wife harmless in any and all actions that may arise therefrom. 3. Husband shall make regular and complete payments on the mortgage for the period of time defined in paragraph #1. Should the house fall into forclosure, Husband shall be responsible for financing an apartment for Wife and her daughter until daughter graduates from High School. ?Xk 6,7- 4. The Deed to the marital home shall be transferred to Husband's name only. The arties will each execute any and all documents necessary to affect this transfer of title. 5. The contents of the home shall be divided by mutual agreement of the parties outside of this agreement and shall not be considered in this distribution agreement. VEHICLES 6. Title to the Windstar Van shall be transferred to Husband. There is no debt encumbering this vehicle. 7. Title to the Camry shall be transferred to Wife. Any and all debt associated with the vehicle shall be the sole responsibility of Wife. Wife shall hold Husband harmless of any and all debt or actions associated herewith. Husband shall execute any and all documents necessary to affect the transfer of title. SPOUSAL SUPPORT 8. Husband shall pay to Wife a sum of $150.00 per week in spousal support for a four year period commencing the date of the signing of this Agreement. Payment shall be made through and enforced by Domestic Relations Office of Cumberland County through wage attachment. Payment shall be made directly to Wife until an account is made active at Domestic Relations consistent with this Agreement. GENERAL TERMS 9. The terms and conditions of this Marital Settlement Agreement shall survive the entry of a Decree in Divorce. 10. Any permanent modification or waiver of the provisions of this Agreement must be in writing and shall be effective only if made in writing and executed with the formality of this Marital Settlement Agreement. 11. The parties acknowledge that they have read and understood the provisions of this Marital Settlement Agreement. The parties further acknowledge that in entering into this Marital Settlement Agreement, there has been no fraud, concealment, overreaching, coercion or other unfair dealings on the art of either party. 12. Husband acknowledges that he had the opportunity to consult with an attorney of his choice before entering into this Marital Settlement Agreement. Husband acknowledges that he understands his rights and agrees to all the terms and conditions included in this document. 13. Should either party violate the terms of this Agreement, that party shall be ordered to pay costs and reasonable attorney fees necessary to enforce the Agreement. IN WITNESS WHEREOF, the parties hereto intending to be legally bound by the terms herein, set forth their hands and seals the day and year above written. WITNESS: A L &I I ?" der l BETH 4ATN MICHAEL WATSON crx' ?' A. Q ?`. :El BETH WATSON : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V : CIVIL ACTION - LAW : DIVORCE MICHAEL E. WATSON :NO.. ACKNOWLEDGEMENT OF SERVICE I, MICHAEL WATSON, hereby acknowledge service of a copy of the Complaint in Divorce in the above captioned matter on September A , 2008. I hereby state that the above is a true and correct statem September, 2008 MICHAEL WATSON I W co (bl 1 ? W v`\-,f,? December 15, 2008 QC V)"er\®V\PjIIk lpw C\V ? ? L I, Beth A. Watson, do hereby agree to the changes set fbith in this document. In reference to Civil Action Law-Divorce #08-5427 filed in Cumberland County Court September 12, 2008 (copy attached). Spousal support was to begin when settlement/divorce was filed and garnished from Defendant's wages through Domestic Relations, PACSES # 028110518. Due to a recent pay cut in my husband's salary I am as ' g the courts to please change this order to reflect $100 payments a week for a total of years to begin January 2009. Any monies received prior to that will be returned to De ndant (Michael E. Watson) in cash with a signed receipt. There have been no transfers f money during this time. I am also requesting that all arrears be dropped as there the Courts and Domestic Relations. Thanking you in advance for your consideration. Beth A. Watson N Micahel E. Watson cc: Rickie Shadday APL Coordinator/Conference LccSHARON L WSW Notary V%dide G90RC0 mmiss cpNr? p? Z?, ZOl l a miscommunication between Officer QF-67/,?? 7 F- 5 k Mpwwr WOT+P A ait BETH WATSON, v. IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA MICHAEL E. WATSON, Defendant NO. 2008 - 5427 CIVIL ACTION - DIVORCE AFFIDAVIT OF CONSENT 1. A complaint in divorce under §3301(c) of the Divorce Code was filed on September 8, 2008. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of j5-Fa.C.S. §4904 relating to unsworn falsification to authorities. d'? Date/- MICHAEL E. WATSON k Ile ?. i_ rnr7 W Zjr ? ??V !?`? f J I BETH WATSON, v. IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA MICHAEL E. WATSON, Defendant NO. 2008 - 5427 CIVIL ACTION - DIVORCE AFFIDAVIT OF CONSENT 1. A conplaint in divorce under §3301(c) of the Divorce Code was filed on September 8, 2008. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Date: )q a O BETH WATSON ' r..? ? '? c ? ?... ""I.. .... '"C3? I,r 3 .r ? "r 7 ti,J - . ? ?' ?? ?? "? BETH WATSON, v. : IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA MICHAEL E. WATSON, Defendant NO. 2008 - 5427 CIVIL ACTION - DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER §3301(c) AND §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. 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: 1 a. I t)5? b-th ? W C?) - E WAT ON ref ? N C-o BETH WATSON, v. IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA MICHAEL E. WATSON, Defendant NO. 2008 - 5427 CIVIL ACTION - DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER §3301(c) AND §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. 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:/ 2_ ,-?rz,-77 MICHAEL E. WATSON ??'{ ? a?= ? -? ?? ? ?? ??, ?}a T ,;, rr; ` ?• BETH WATSON, v. IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008 - 5427 MICHAEL E. WATSON, Defendant To the Prothonotary: CIVIL ACTION - DIVORCE PRAECIPE TO TRANSMIT RECORD Transmit the record, together with the following information, to the court for entry of a decree: 1. Ground for divorce: irretrievable breakdown under §3301(c) of the Divorce Code. 2. Date and manner of service of the complaint: September 8, 2008 , Acknowledgement of Service (see attachment to Complaint) 3. Execution of the affidavit of consent required by §3301(c) of the Divorce Code were signed by Plaintiff Id 42 a G? r , by Defendant % ;7/6,P 4. All claims raised have been resolved by Marital Settlement Agreement. 5. (a)Waiver of Notice for Plaintiff was filed with the prothonotary on 034 A . (b) Waiver of Notice for Defendant was filed with the prothonotary on 3 C? Susan K. Pickfor , Esq. Attorney for Plaintiff 875 Market Street Suite 200 Lemoyne, PA 17043 717-761-5698 ID #43093 „t = , r ar: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA BETH WATSON V. MICHAEL E. WATSON DIVORCE DECREE AND NOW, 2f1 vv t3 2-3 _ oo `I , it is ordered and decreed that BETH WATSON , plaintiff, and MICHAEL E. WATSON , 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.") Incorporate terms of Marital Settlement Agreement filed with Complaint resolving a property and support issues. No. 2008-5427 By the Court, - ?? -;?, 11" ?al lovw i * '7k-7p vim' le, / In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Plaintiff Name BETH A. WATSON PACSES Docket Case Number Number 028110518 2008-5427 CIV TOTAL ATTACHMENT AMOUNT: ?? tv z Attachment AmourN0mueACv 433.33 MONTH / 433.33 = n't C)-71 a C"' Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of $ 99.73 per week, or 50%, of the Unemployment Compensation benefits otherwise payable to the Defendant, MICHAEL E. WATSON Social Security Number XXX-XX-5944, Member ID Number 3746102068. OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673 (b)(2) and 23 Pa. C.S.A. § 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated JANUARY 22, 2012 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: Defendant Name: MICHAEL E. WATSON c Member ID Number: 3746102068 --, z rat-r?°- Please note: All correspondence must include the Member ID Number. rnm -n .? =) m "O rn f" .c. <v -v =IC Financial Break Down of Multiple Cases on Attachment zo FEB 0 7 2012 Albert H. Maslarid JUDGE Form EN-530 Service Type M Worker ID $IATT ;,<??;' .ti's" . .' INCOME WITHHOLDING FOR SUPPORT U, X I i DS 1% Q ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) (?C7 G L?]"? CI V r I Q AMENDED IWO ?/ ?i J T uC Q ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT Q TERMINATION OF IWO Date: 04/06112 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO,(nust,¢e.regular on its. face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www acf hhs gov/programs/cse/newhire/employer/publication/publication htm - forms). If you receive this document from someone other than a. State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/TribefTerritory Commonwealth of Pennsylvania Remittance Identifier (include w/payment): 3746102068 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for ordeddocket lnformaiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) GRANITE TRANSPORTATION PO BOX 3819 YORK PA 17402-0135 RE: WATSON, MICHAEL E. Employee/Obligor's Name (Last, First, Middle) 167-78-5944 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) Employer/Income Withholder's FEIN 233049724 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www.acf.hhs.qoy/[)rograms/cse/newhir e/ employer/publication/oublication.htm -form . If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. 2330497240 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. $ 0.00 per month in current child support $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? $ 0.00 per month in current cash medical support $ 0.00 per month in past-due cash medical support $_ 433.33 per month in current spousal support $ 0.00 per month in past-due spousal support $ 0.00 per month in other (must specify) for a Total Amount to Withhold of $ 433.33 per month. 0 YeSD ::i& 6 tA)? t C: :Z --i rr > c-a 0 -" X wry; C.0 AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the OrderqRforr6tion. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: $ 100,00 per weekly pay period. $ 216.67 per semimonthly pay period (twice a month) $ _ Z66, Vh per biweekly pay period (every two weeks) $ 433.33 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10) working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), obtain withholding limitations, time requirements, and any allowable employer fees at http://www acf hhs gov/programs/cse/newhire/employer/contacts/ contact_map.htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No,: 0970-0154 Form EN-028 01/12 Service Type M Worker ID $IATT ? Return to Sender [Completed by Employer/income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official: Altled--ft . M4 d. 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 IdentiFer) 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•//www acf_hhg aoy r grams/cse/newhire/employer/contacts/contact_mao.htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal 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 01/12 Employer's Name: GRANITE TRANSPORTATION Employer FEIN: 233049724 Employee/Obligor's Name: WATSON MICHAEL E. 3746102068 CSE Agency Case Identifier: (See Addendum for as summary Order Identifier: (fee Addendum for order/docket information) Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: if this employee/obligor never worked for you or you no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 2330497240 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.oa.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) 40-6225, by fax at (717.)240-6248, by email or website at www.childsupport.state. 12a. us. IMPORTANT: The person completing this form is advised that the information may be shared with the employeelobligor. Service Type M OMB No.: 0970-0154 Page 3 of 3 Form EN-028 01/12 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WATSON, MICHAEL E. PACSES Case Number 028110518 Plaintiff Name BETH A. WATSON Docket Attachment Amount 2008-5427 CIV $ 433.33 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Dock t 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 PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Gnrm i=m-ngA n1 /1') INCOME WITHHOLDING FOR SUPPORT Dag ' o s/ S O ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT (IWO) O AMENDED IWO D G_ C?Z7 6 V il / O ONE-TIMEORDERMOTICE FOR LUMP SUM PAYMENT 0 ?1 Q TERMINATION OF IWO Date: 04/09/12 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO must be rggUlar gn,fts face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions hhttp: w acf hhs i i? rams/cse/newhiretem loyer/publication/publication htm - forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. state/ I noer I emtory commonwealth of Pennsylvania Remittance Identifier (include w/payment): 3746102068 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for ordeddocket Informalton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) YRC GLEN MOORE TRANSPORT 1711 SHEARER DR CARLISLE PA 17013-9663 Employer/Income Withholder's FEIN 232443760 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: WATSON, MICHAEL E. Employee/Obligor's Name (Last, First, Middle) 167-78-51944 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:gwww ca f hhs gov/aMrams/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. 2324437600 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 CUMBER LAND n , Commonwe alth of Pennsylvania (State/Tribe). You are required by law to deduct these am ounts t4Um&yee/ obligor's income until further notice. CID -a. $ 0.00 permonth in current child support f,-? -0 ? F % $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? O O ' $ 0.00 per month in current cash medical support $ 0.00 per month in past-due cash medical support C-, tea. $ 0.00 per month in current spousal support - $ 0.00 per month in past-due spousal support $ 0.00 per month in other (must specify) _Y for a Total Amount to Withhold of $ 0.00 per month. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period (twice a month) $ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is 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 5 of disposable income for all orders. If the employee/obligor's principal place of employment is not CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), obtain withholding limitations, time requirements, and any allowable employer fees at http://www acf hhs ov/ rograms/cse/newhire/emFoyer/contacts/ contact_map.htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970-0154 Form EN-028 01/12 Service Type M Worker ID $IATT ? Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to tha santler Signature of Judge/Issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official ,aAM,gAIllind Title of Judge/Issuing Official: Date of Signature: APR T?--; , } lr 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 eleMonic payment metbod 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 Employ*WObfigor'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: I4 :m.acf.hhs3.ggyLauMmma?cseing vhire/`em,pWericontactelma ictMV,hhtm 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/obligoes 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 forth currently in use. Form EN-028 01/12 Rarvina Tvna M Pacie 2 of 3 Worker ID $IATT Employer's Name: YRC GLEN MOORE TRANSPORT Employer FEIN: 232443760 Employee/Obligor's Name: WATSON, MICHAEL E. 3746102068 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/obli'gor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 2324437600 Q This person has never worked for this employer nor received periodic income. O This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known address: Last known phone number: Final Payment Date To SDU/Tribal Payee: Final Payment Amount: New Employer's Name: New Employer's Address: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.childsupport.state.pa.us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HA OVER ST. P.O. BOX 320-CARLISLE, PA 17013 (Issuer address). To EmRlloyee/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.childsuppgrt.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 $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WATSON, MICHAEL E. PACSES Case Number 028110518 PACSES Case UUmte Plaintiff Name Plaintiff Name BETH A. WATSON Docket Attachment Amount Docket Attachment punt 2008-5427 CIV $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB DOB PACSES Case Number Plaintiff Name Docket ant Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment A unt $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 01/12 SPrvirp Tvna M OM@No.:0970-0154 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) Q AMENDED IWO O ONE-TIMEORDERINOTICE FOR LUMP SUM PAYMENT O TERMINATION OF IWO ©a8� i'o SI? ;4)0 5"-- x1 C.�v Date: 01/01/15 ❑ Child Support Enforcement (CSE) Agency ® Court 0 Attorney ❑ Private Individual/Entity (Check One) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www.acf.hhs.gov/programs/cse/forms/OMB-0970-0154 instructions.pdf). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Tribe/Territory Commonwealth of Pennsylvania City/County/Dist./Tribe CUMBERLAND Private Individual/Entity Remittance Identifier (include w/payment): 3746102068 Order Identifier: (See Addendum for order/docket information) CSE Agency Case Identifier: (See Addendum for case summary) GRANITE TRANSPORTATION PO BOX 3819 YORK PA 17402-0135 Employer/income Withholders FEIN 233049724 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: WATSON, MICHAEL E. Employee/Obligor's Name (Last, First, Middle) 167-78-5944 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.acthhs.gov/programs/cse/forms/ OMB -0970-0154 instructions.odt). 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. 2330497240 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. 0.00 per month in current child support 0.00 per month in past -due child support - Arrears 12 weeks or greater? 0 yes Q?no � 3 (Dr— --1 Ic_; —0> crt --i c-: CO (-.:;.- AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Older, Information: If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: ' $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period (twice a month) $ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. $ 0.00 per month in current cash medical support $ 0.00 per month in past -due cash medical support $ 0.00 per month in current spousal support $ 0.00 per month in past -due spousal support $ 0.00 per month in other (must specify) for a Total Amount to Withhold of $ 0.00 per month. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact map. htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970-0154 Service Type M Form EN -028 11/13 Worker ID $IATT ❑ Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not • directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to '1,0 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: r. Date of Signature: JUDGF 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. 0 If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State -specific contact and withholding information can be found on the Federal Employer Services website located at: http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact map.htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past -due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti -discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date — 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN -028 11/13 Service Type M Page 2 of 3 Worker ID $IATT Employees Name: GRANITE TRANSPORTATION Employer FEIN: 233049724 Emp\nyee/Ob|igohallomo: WATSON, MICHAEL E. 3746102068 CSEAgnncyCuom|dnnUher(SweAdbendwm.fbroaseaumnnety) Order Identifier: fSee 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)(15U.S.O.1673b));or2)theamountoaUnwndbythaStatecvThheoftheemployee/ Nigohsphndpa|plaoeof employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, Iocal 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 5Y6'to5596and G596'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 Tribaorders, you may not withhotd more than the amounts aUowed under the Iaw of the issuing Tribe.For Tribal withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the Iaw 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 TribaI 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 Emptoyer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this 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: 2330497240 {J 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 foliowing information for (he employee/obligor: Termination date: Last known phone number: Last known address: Final PaymenDate To SDU/Tribat Payee: Final Payment Amount: New Employer's Name: New Employer's Address: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) byphone ad(717)24U-6235.byfax ed(T17)240-S248.byemail orwebsite at: vm*w.uhi|dmu000rLotsby.pous. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECT! N.13N.HANOVERST, P.O.BOX 32O.CARLISLE. PA. 17D18(Issuer oddnana). To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) byphone at(717)24O'G225.byfax ad(717)24O-S348.byemail orwebsite o<vm^wv.uhi/doupportstoha.pnuo. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. OMB No.: 0970-0154 Service Type M Page 3 of 3Worker ID $1ATT Form EN -028 11/13 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WATSON, MICHAEL E. PACSES Case Number 028110518 PACSES Case Number Plaintiff Name Plaintiff Name BETH A. WATSON Docket Attachment Amount Docket Attachment Amount 2008-5427 CIV $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): Service Type M DOB Addendum OMB No.: 0970-0154 Form EN -028 11/13 Worker ID $IATT