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HomeMy WebLinkAbout09-2456ERIC S. WARREN, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -LAW DONNA M. WARREN, NO. D d `? SL CIVIL TERM Defendant IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in Court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case will proceed without you and a decree of divorce or annulment may be entered against you for any claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at Cumberland County Courthouse, Carlisle, Cumberland County, Pennsylvania, 17013. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 32 South Bedford Street Carlisle, Pennsylvania 17013 Phone: (717) 249-3166 or (800) 990-9108 ERIC S. WARREN, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -LAW DONNA M. WARREN, NO. O CIVIL TERM Defendant IN DIVORCE COMPLAINT IN DIVORCE NO FAULT 1. Plaintiff is Eric S. Warren, an adult individual currently residing at 920 North Calvert Street, Unit 1, Baltimore, Baltimore County, Maryland. 2. Defendant is Donna M. Warren, an adult individual currently residing at 102 Hollar Avenue, Shippensburg, Cumberland County, Pennsylvania. 3. Plaintiff is a bonafide resident of the Commonwealth of Pennsylvania and has been so for at least six months immediately previous to the filing of this Complaint, having only moved to Maryland on or about April 13, 2009. 4. Plaintiff and Defendant were married on March 25, 1996, in Franklin County, Pennsylvania. 5. There have been no other prior actions for divorce or annulment between the parties. 6. Neither the Plaintiff nor the Defendant are members of the United States Armed Forces or its Allies. 7. Plaintiff has been advised of the availability of counseling and the right to request that the Court require the parties to participate in counseling. Knowing this, Plaintiff does not desire that the Court require the parties to participate in counseling. 8. Plaintiff and Defendant are citizens of the United States of America. 9. The parties' marriage is irretrievably broken. 10. Plaintiff desires a divorce based upon the belief that the Defendant will, ninety (90) days from the date of service of this Complaint, consent to this divorce. WHEREFORE, Plaintiff requests your Honorable Court to enter a divorce pursuant to 23 P.S. Section 3301 (c) of the Domestic Relations Code. Respectfully submitted, ?_I n -?l& .". 1. Hannah Herman Snyder, E-squu irvA Attorney for Plaintiff GRIFFIE & ASSOCIATES 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 VERIFICATION I verify that the statements made in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsifications to authorities. DATE: rV ?? 7? .il ERIC S. WARREN, Plaintiff cj 17 Tit 2 9 A ii 2.0 `rgi q9 ?-sb d • I 3 3 Qom, ck-l 20a 7 .2 ;7 y9y/ r --1 Walker, Connor & Johnson, LLC 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 (717) 262-2187-Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Eric S. Warren, ) Civil Action - Law Plaintiff, ) vs. ) No. 09-2456 Donna M. Warren, ) Defendant, ) In Divorce a v.m. NOTICE TO PLEAD To: Plaintiff, Eric S. Warren: You are notified to file a written response to the attached Counterclaim within twenty (20) days from service hereof or a judgment may be entered against you. WALKER, CONNOR & JOHNSON, LLC By: artha B. Walker, Esquire ttorney I.D. #15989 47 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 Attorney for Defendant P" `, Walker, Connor & Johnson, LLC 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 (717) 262-2187-Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Eric S. Warren, ) Civil Action - Law Plaintiff, ) vs. ) No. 09-2456 Donna M. Warren, ) Defendant, ) In Divorce a v.m. COUNTERCLAIM The Defendant, Donna M. Warren, makes the following counterclaim against the Plaintiff, Eric S. Warren. COUNT ONE EQUITABLE DISTRIBUTION 1. Defendant incorporates by reference the allegations contained in Paragraphs 1-6, 8 and 9 inclusive of Plaintiff's Complaint, as fully as though set out at large herein. 2. The Plaintiff and Defendant own and possess various items of personal and real property which are subject to equitable distribution by this Court. WHEREFORE, Defendant requests an Order determining and disposing of existing property rights and interests between her and Plaintiff. COUNT TWO ALIMONY 3. Defendant incorporates by reference the allegations contained in Paragraphs 1-6, 8 and 9 inclusive of Plaintiff's Complaint, as fully as though set out at large herein. 4. The Defendant is without sufficient property to provide for her reasonable needs, and is unable to adequately support herself through her employment. 5. The Defendant cannot support and maintain herself in the style she was maintaining prior to the separation of the Plaintiff and Defendant without continued financial assistance from Plaintiff. 2 .- WHEREFORE, pursuant to Section 3701, et seq., of the Divorce Code, "Alimony", Plaintiff respectfully requests your Honorable Court to require the scheduling of a hearing to determine Plaintiff's entitlement to alimony, and if so, the amount. COUNT THREE ALIMONY PENDENTE LITE CONSEL FEES AND EXPENSES 6. Defendant incorporates by reference the allegations contained in Paragraphs 1-6, 8 and 9 inclusive of Plaintiff's Complaint, as fully as though set out at large herein. 7. The Plaintiff has refused to enter into any reasonable and fair Property and Separation Agreement and Defendant will incur substantial legal fees in that regard. 8. Furthermore, the resolution of the issues raised by this Counterclaim will require Defendant to incur considerable additional expenses and costs. 9. The Defendant is without sufficient means to adequately support herself and to meet the costs and expenses of this litigation and is unable to maintain herself during the pendency of this action. WHEREFORE, pursuant to Section 3702, et. seq., of the Divorce Code, "Alimony Pendente Lite, Counsel Fees and Expenses", Defendant respectfully requests your Honorable Court to require the scheduling of a hearing to determine Defendant's entitlement to alimony pendente lite, counsel fees and expenses, and if so, the amount. WALKER, CONNOR & JOHNSON, LLC By: 6. -, rqAAt? artha B. Walker, Esquire ttorney I.D. #15989 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 Attorney for Defendant 3 VERIFICATION I verify that the statements made in this document are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. DATE: ?h Vim. Do . Warren, Defendant OF THE F.FDTP? "NOTA Y 2009 APR 22 P I : 20 curve ?4. ; : i\fry 418. oo PA AT Y C'ty tSig 3 G Wmliq ERIC S. WARREN, V. IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA DONNA M. WARREN, Defendant CIVIL ACTION -LAW NO. b ? - :;i H 5 U CIVIL TERM IN DIVORCE ACCEPTANCE OF SERVICE I, Martha B. Walker, Esquire acknowledge that on a??l I received a Complaint in Divorce in the above captioned action and acknowledge that I am authorized to do so on behalf of the Defendant, Donna M. Warren. Date: Y/5/ /o 9 M a B. Walker, Esquire Attorney for Defendant Walker, Connor & Johnson, LLC 247 Lincoln Way East Chambersburg, PA 17201 OF THIE I' -'I- 213Cg APR 23 i'i'i ?? ? 5 WALKER, CONNOR & JOHNSON LLC 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 (717) 262-2187-Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Domestic Relations Section Donna M. Warren, ) Docket No: 09-2456 Plaintiff, ) VS. ) PACSES Case No: Eric S. Warren, ) Defendant, ) COMPLAINT FOR ALIMONY PENDENTE LITE 1. Plaintiff resides at 102 Hollar Avenue, Shippensburg, Cumberland County, Pennsylvania. Plaintiff's date of birth is March 30, 1964. 2. Defendant resides at 920 North Calvert Street, Unit 1, Baltimore, Baltimore County, Maryland. Defendant's date of birth is August 13, 1970. 3. (a) Plaintiff and Defendant were married on March 25, 1996 in Chambersburg, Franklin County, Pennsylvania. (b) Plaintiff and Defendant were separated in March, 2009. (c) On April 22, 2009, Plaintiff filed a Counterclaim to the divorce action docketed to # 09-2456. Said Complaint raised the issue of alimony pendente lite. A fee of $26.00 for said count of alimony pendente lite was paid on the aforementioned date. 4. Plaintiff and Defendant are the parents of the following child born of the marriage: Name Birthdate SSN Residence Georgia Hall Warren 05/26/2000 207-78-7004 With Plaintiff 5. Plaintiff seeks support for the following persons: Plaintiff, Donna M. Warren. 6. (a) Plaintiff is not receiving public assistance. (b) Plaintiff is receiving no additional income. 7. No previous Order has been entered against the Defendant in an action for the support of Plaintiff. 8. Plaintiff last received support from Defendant in the amount: Defendant recently assisted Plaintiff in the purchasing of new tires. Defendant also gave Plaintiff $100.00 approximately a week ago. WHEREFORE, Plaintiff requests that an Order be entered against the Defendant and in favor of Plaintiff for reasonable support and medical coverage. I verify that the statements made in this Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904, relating to unworn falsification to authorities. k)X4 mwv\-/ Date Donna M. Warren, Plaintiff Guidelines for child and spousal support and for alimony pendente lite have been prepared by the Court of Common Pleas and are available for inspection in the Office of the Domestic Relations Section, Chambersburg, Pennsylvania. 2 RL tom, t==trNc THE 2009 APR 27 P 12: 0 7 CoPy 4o Ito DONNA M. WARREN, THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 09-2456 CIVIL TERM ERIC S. WARREN, IN DIVORCE Defendant/Respondent : PACSES NO: 588110823 ORDER OF COURT AND NOW, this 28th day of April, 2009, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R. J. Shadday on May 21, 2009 at 9:00 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you. If you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Edgar B. Bayley, President Judge Copies mailed to: Petitioner Respondent Martha Walker, Esq. Hannah Herman-Snyder, Esq. Date of Order: April 28, 2009 Sh ay, L oordinator YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 F : PK 111 APY 2009 APR 29 Fill "`I; G?-) 5 } + WALKER, CONNOR & JOHNSON LLC 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 (717) 262-2187 - Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Eric S. Warren, ) Civil Action - Law Plaintiff, ) vs. ) No. 09-2456 Donna M. Warren, ) Defendant, ) In Divorce a v.m. ACCEPTANCE OF SERVICE I, Hannah Herman-Snyder, Esquire, attorney for Plaintiff in the above-captioned action, do acknowledge that I have received a true and attested copy of the Counterclaim and Notice to Plead filed in the above-captioned matter on April 22, 2009. I certify that I am authorized to accept service on behalf of Defendant. Date: 4 ,- &I - 19 Nla t, _? X *4m,, - d Hannah Herman-Snyder, Esquire Attorney for Plaintiff OF THE PROTHONOTARY 209 MAY -6 PM 2:46 CUMBEhA`6 COUNTY PEW-SYL.VA"A ' In the Court of Common Pleas of CumberLwd County, Pennsylvania Order Number ERIC S. WARREN vs. Plaintiff /Respondent PACSES Case Number 588110823 ) Docket Number 09-2456 CIVIL DONNA M. WARREN Defendant /petitioner ) Other State ID Number ORDER OF COURT ? Final 1R Interim ? Modified AND NOW, 21st Day of May 2009 based upon the Court's determination that the Payee's monthly net income is $ 2,714.33 and the Payor's monthly net income is $ 5,287.33 , it is hereby ordered that the Payor pay to the Pennsylvania State Collection and Disbursement Unit One Thousand One Hundred and xx/100 Dollars ($ 1,loo. oo ) a month payable Bi-weekly The effective date of the order is June 15, 2009 Arrears set at $ 0.00 as of May 21, 2009 as follows: first payment due are due in full IMMEDIATELY. All terms of this Order are subject to collection and/or enforcement by contempt proceedings, credit bureau reporting, tax refund offset certification, driver's license revocation, and the freeze and seize of financial assets. These enforcement/collection mechanisms will not be initiated as long as obligor does not owe overdue support. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all the means listed above. For the Support of: Name Donna Marie Warren Service Type Birth Date 03/30/64 Form OE-518 Rev-6 WA t EN V. WARREN PACSES Case Number: 588110823 The defendant owes a total of $ 1,100.00 per month payable Bi-weekly $ 1,100.00 for current support and $ 0.00 for arrears. The defendant must also pay fees/costs as indicated below. This order is allocated and monies are to be applied as follows: Frequency Codes: 1 =One Time M =Monthly Payment Amount / Frequency Debt Type Description $ 1,100.00'/ M SPO Beneficiary Donna M. Warren Said money to be turned over by the Pa SCDU to: Donna M. Warren Payments must be made by check or money order. All checks and money orders must be made payable to Pa SCDU and mailed to: Pa SCDU P.O. Box 69110 Harrisburg, Pa 17106-9110 Payments must include the defendant's PACKS Member Number or Social Security Number in order to be processed. Do not send cash by mail. Service Type Page 2 of 4 Form OE-518 Rev.6 Wnrkarin WARREN V. WARREN PACSES Case Number: 588110823 The monthly support obligation includes cash medical support in the amount of $250 annually for unreimbursed medical expenses incurred for each child and/or spouse. Unreimbursed medical expenses of the obligee or children that exceed $250 annually shall be allocated between the parties. The party seeking allocation of unreimbursed medical expenses must provide documentation of expenses to the other party no later than March 31 st of the year following the calendar year in which the final medical bill to be allocated was received. The unreimbursed medical expenses are to be paid as follows: 50 % by defendant and 50 % by plaintiff. ® Defendant ? Plaintiff ? Neither party to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the ? Plaintiff ? Defendant shall submit to the person having custody of the child(ren) written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of : 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. THIS ORDER INCLUDES AN ADDTIONAL SUM OF $559.00 PER MONTH FOR MORTGAGE CONTRIBUTION ON THE MARITAL Ham. THE PARTIES AGREE TO MAKE THIS ORDER EFFECTIVE JUNE 15, 2009 Service Type Page 3 of 4 Form OE-518 Rev.6 Worker ID M WARREN v. WARREN PACKS Case Number: 588110823 IMPORTANT LEGAL NOTICE PARTIES MUST WITHIN SEVEN DAYS INFORM THE DOMESTIC RELATIONS SECTION AND THE OTHER PARTIES, IN WRITING, OF ANY MATERIAL CHANGE IN CIRCUMSTANCES RELEVANT TO THE LEVEL OF SUPPORT OR THE ADMINISTRATION OF THE SUPPORT ORDER, INCLUDING, BUT NOT LIMITED TO, LOSS OR CHANGE OF INCOME OR EMPLOYMENT AND CHANGE OF PERSONAL ADDRESS OR CHANGE OF ADDRESS OF ANY CHILD RECEIVING SUPPORT. A PARTY WHO WILLFULLY FAILS TO REPORT A MATERIAL CHANGE IN CIRCUMSTANCES MAY BE ADJUDGED IN CONTEMPT OF COURT, AND MAY BE FINED OR IMPRISONED. PENNSYLVANIA LAW PROVIDES THAT ALL SUPPORT ORDERS SHALL BE REVIEWED AT LEAST ONCE EVERY THREE (3) YEARS IF SUCH REVIEW IS REQUESTED BY ONE OF THE PARTIES. IF YOU WISH TO REQUEST A REVIEW AND ADJUSTMENT OF YOUR ORDER, YOU MUST DO THE FOLLOWING: CALL YOUR ATTORNEY. AN UNREPRESENTED PERSON WHO WANTS TO MODIFY (ADJUST) A SUPPORT ORDER SHOULD CONTACT THE DOMESTIC RELATIONS SECTION. ALL CHARGING ORDERS FOR SPOUSAL SUPPORT AND ALIMONY PENDENTE LITE, INCLUDING UNALLOCATED ORDERS FOR CHILD AND SPOUSAL SUPPORT OR CHILD SUPPORT AND ALIMONY PENDENTE LITE, SHALL TERMINATE UPON DEATH OF THE PAYEE. A MANDATORY INCOME ATTACHMENT WILL ISSUE UNLESS THE DEFENDANT IS NOT IN ARREARS IN PAYMENT IN AN AMOUNT EQUAL TO OR GREATER THAN ONE MONTH'S SUPPORT OBLIGATION AND (1) THE COURT FINDS THAT THERE IS GOOD CAUSE NOT TO REQUIRE IMMEDIATE INCOME WITHHOLDING; OR (2) A WRITTEN AGREEMENT IS REACHED BETWEEN THE PARTIES WHICH PROVIDES FOR AN ALTERNATE ARRANGEMENT. UNPAID ARREARAGE BALANCES MAY BE REPORTED TO CREDIT AGENCIES. ON AND AFTER THE DATE IT IS DUE, EACH UNPAID SUPPORT PAYMENT SHALL CONSTITUTE, BY OPERATION OF LAW, A JUDGMENT AGAINST YOU, AS WELL AS A LIEN AGAINST REAL PROPERTY. IT IS FURTHER ORDERED that, upon payor's failure to comply with this order, payor may be arrested and brought before the Court for a Contempt hearing; payor's wages, salary, commissions, and/or income may be attached in accordance with law; this Order will be increased without further hearing by % a month until all arrearages are paid in full. Payor is responsible for court costs and fees. Copies delivered to parties -M 1 9009 ate Consented: Plaintiff Defendant MAY 2 11009 Date Plaintiffs Attorney Defenda ' Attorney HE C T• N 0? 119? Edgar B. Bayley, Judge Service Type Page 4 of 4 Form OE-518 Rev.6 ERIC S. WARRNE, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 09-2456 CIVIL TERM DONNA M. WARREN, IN DIVORCE Defendant/Petitioner PACSES Case No: 588110823 NOTICE OF RIGHT TO REQUEST A HEARING The parties are hereby advised that they have until June 10, 2009 to request a hearing do novo before the Court. File request in person at: Office of the Prothonotary 1 Courthouse Square Carlisle, PA 17013 Or mail to: Office of the Prothonotary 1 Courthouse Square Carlisle, PA 17013 CC363 ?IL?p??Li 4• - C' 9 V, ' L 2 F ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dirt. of CUMBERLAND Date of Order/Notice 06/15/09 Case Number (See Addendum for case summary) Employer/withholder's Federal EIN Number CITY OF ALEXANDRIA VA C/O PAYROLL OFFICE 301 KING ST ALEXANDRIA VA 22314-3211 166-48-9366 Employee/Obligor's Social Security Number 1321102126 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 688.00 per month in current child support $ o . oo per month in past-due child support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in current medical support $ 0.00 per month in past-due medical support $ 1, loo . oo per month in current spousal support $ o . oo per month in past-due spousal support $ o . o o per month for genetic test costs $ o . oo per month in other (specify) $ one-time lump sum payment for a total of $ 1,788.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 412.62 per weekly pay period. $ 894.00 per semimonthly pay period 825.23 (twice a month) $ per biweekly pay period (every two weeks) $ 1, 788. 00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIA Y NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: 649110827 354 S 2009 09-2456 CIVIL 0Original Order/Notice OAmended Order/Notice 0Terminate Order/Notice OOne-Time Lump Sum/Notice RE: WARREN, ERIC S. Employee/Obligor's Name (Last, First, MI) DRO: R.J. Shadday ` Form EN-028 Rev.5 Service Type M OMB No.: 097"154 Worker I D $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS I heck you are required to provide a opy of this form to your m loyee. If yo r employee orks in a state that is iferent from the state that issued this order, a copy must be provieedpto your employee even if tie box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 5460011030 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 13 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME: WARREN, ERIC S. EMPLOYEE'S CASE IDENTIFIER: 1321102126 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOU NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WARREN, ERIC S. PACSES Case Number 588110823 Plaintiff Name DONNA M. WARREN Docket Attachment Amount 09-2456 CIVIL$ 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 Service Type M Addendum OMB No.: 0970-0154 Form EN-028 Rev.5 Worker ID $IATT FILEQ-)4i"E 2009 JUN 16 Phi 3: 10 PZ-i Walker, Connor & Johnson, LLC 247 Lincoln Way East Chambersburg, PA 17201 (717) 262-2185 (717) 262-2187- Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Eric S. Warren, ) Civil Action - Law Plaintiff, ) vs. ) No. 09-2456 Donna M. Warren, ) Defendant, ) In Divorce a v.m. STIPULATION AND AGREEMENT FOR EXCLUSIVE POSSESSION AND CUSTODY NOW comes the Defendant, by her Attorney, Martha B. Walker, and alleges as follows: 1. Defendant, Donna M. Warren, hereinafter Wife, resides at 102 Hollar Avenue, Shippensburg, Cumberland County, Pennsylvania. 2. Plaintiff, Eric S. Warren, hereinafter Husband, resides at 902 N. Calvert Street, Unit #2, Baltimore, Baltimore County, Maryland 3. The parties were married on May 25, 1996. 4. The parties are parents of Georgia Hall Warren, born May 26, 2000, who resides at the marital home. Husband filed a divorce action on April 20, 2009. 6. Husband is represented by Hannah Herman-Snyder, Esquire. 7. The parties through counsel have now agreed to have the Court enter the following as an Order of Court: A. Donna M. Warren, (Wife), is awarded exclusive possession of 102 Hollar Avenue, Shippensburg, Cumberland County, Pennsylvania effective immediately. B. Eric S. Warren, (Husband), will not be permitted to maintain any residence in the marital home thereafter. C. Effective immediately Husband is hereby evicted and excluded from the marital residence and real estate located at 102 Hollar Avenue, Shippensburg, Cumberland County, Pennsylvania, and shall have no right to enter upon the property or residence at that location. D. Husband shall not enter the marital home unless expressly invited to do so by Wife; E. This Order of Court shall remain in effect pending further Order of Court or equitable distribution of the martial estate, whichever shall first occur. By the Court, J. The parties further agree that, in procuring this Agreement, there has been no fraud, concealment, overreaching, coercion, or other unfair dealing on the part of the other. IN WITNESS WHEREOF, the parties hereto intending to be legally bound by the terms and conditions of this Agreement, execute this Agreement by signing below. WITN SES: Doff a M. Warren ric S. Warren I verify that the statements made in this Stipulation and Agreement are true and correct, I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. r"1 ?Z Donna M. Warren I verify that the statements made in this Stipulation and Agreement are true and correct, I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. ric S. Warren ,,j Ti-ii- 1Nf-',tTA T 2009 !`la 2'-4 Pil 3 ?.rl 1a??? ? 'r,?f i Walker, Connor & Johnson, LLC JUN 15 2009 G! 247 Lincoln Way East Chambersburg, PA 17201 (717) 262-2185 (717) 262-2187- Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Eric S. Warren, ) Civil Action - Law Plaintiff, ) vs. ) No. 09-2456 Donna M. Warren, ) Defendant, ) In Divorce a v.m. ORDER OF COURT NOW this 26, day of 4u..- , 2009 upon consideration of the within Stipulation and Agreement, it is hereby ordered as follows: A. Donna M. Warren, (Wife), is awarded exclusive possession of 102 Hollar Avenue, Shippensburg, Cumberland County, Pennsylvania, effective immediately. B. Eric S. Warren, (Husband), will not be permitted to maintain any residence in the marital home thereafter. C. Effective immediately Husband is hereby evicted and excluded from the marital residence and real estate located at 102 Hollar Avenue, Shippensburg, Cumberland County, Pennsylvania, and shall have no right to enter upon the property or residence at that location. D. Husband shall not enter the marital home unless expressly invited to do so by Wife. E. This Order of Court shall remain in effect pending further Order of Court or equitable distribution of the martial estate, whichever shall first occur. 13 By the Court, OF THE PROTHONOTARY 2019 JUN 2b PM 2: 20 ? ? i_ U ?XUN7Y PENNSYLVANA ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 09-2456 CIVIL State Commonwealth of Pennsylvania 649110$27 OOriginal Order/Notice Co./City/Dist. of CUMBERLAND 354 S 2009 OAmended Order/Notice Date of Order/Notice 11/12/09 XU Terminate Order/Notice Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice RE: WARREN, ERIC S. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, Mp 166-48-9366 Employee/Obligor's Social Security Number CITY OF ALEXANDRIA VA 1321102126 C/O PAYROLL OFFICE Employee/Obligor's Case Identifier 3 O 1 KING ST (See Addendum for plaintiff names ALEXANDRIA VA 22314 -3221 associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ o. oo per month in current child support $ o . oo per month in past-due child support Arrears 7 2 weeks or greater? Qyes ®no $ o . oo per month in current medical support $ o . oo per month in past-due medical support $ o . oo per month in current spousal support $ o . oo per month in past-due spousal support $ o . oo per month for genetic test costs $ o. oo per month in other (specify) $ one-time lump sum payment for a total of $ 0 . oo per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: ~ o . oo Per weekly pay period. $ o . oo per semimonthly pay period (twice a month) $ o. oo per biweekly pay period (every two weeks) $ o. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Ptease 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 DEfENDAN ' A AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOC/ SECURI ~J!<~J%~T1~ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. f~ ~ ~ 1 BY THE COURT: DRO: R, J. Shadday Service Type M OMB No.: 0970-0154 Form EN-028 Rev.5 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS tf heck you are required, to provide a opy of this form to your, m loyee. If yo r employee works in a state thatkis ~ di~erent from the state that issued this or~er, a copy must be provi~edpto your emp~oyee even if the box is not chec ed. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee%bligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee%bligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 545oo1io3o THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : ~ THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: ~ EMPLOYEE'S/OBLIGOR'S NAME: WARREN, ERIC S . EMPLOYEE'S CASE IDENTIFIER: 1321102126 LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: DATE OF SEPARATION: FINAL PAYMENT AMOUNT NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee%bligortrom employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Ad (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: * NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respell to these items. t 1. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet www.childsupport.state.pa.us Page 2 of 2 Service Type M OMB No.: 0970-0154 Form EN-028 Rev.S Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WARREN, ERIC S . PACSES Case Number 588110823 PACSES Case Number 649110827 Plaintiff Name Plaintiff Name DONNA M. WARREN DONNA M. WARREN Docket Attachment Amount Docket Attachment Amount 09-2456 CIVIL$ 0.00 00354 S 2009 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB GEORGIA H. WARREN 05/2.6/00 PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB Service Type M Addendum OMB No.: 0970-0154 PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB Form EN-028 Rev.5 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State ~'ommonwealth of Pennsylvania Co./City/Dlst.Of CUMBERLAND Date of Order/Notice 11/12/09 Case Number (See Addendum for case summary) Employer/Withholder's federal EIN Number AIR METHODS CORPORATION* 7301 S PEORIA ST ENGLEWOOD CO 80112-4133 166-48-9366 Employee/Obligor's Social Security Number 1321102126 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 688.00 $ $ o.oo o.oo $ o.oo $ i,loo.oo $ o.oo $ o.oo $ o.oo for a total of $ per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) one-time lump sum payment 1, 788 . oo per month to be forwarded to payee below. You do not have to vary your pay cycle to be incompliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 412.62 per weekly pay period. $ 894 . oo per semimonthly pay period - - (twice a month) $ 825.23 per biweekly pay period (every two weeks) $ i, ~8s . oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT' AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCI SECURIT RDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. ~ "r \ _ BY THE COURT: v ~ Edgar >~. Bayley, Judge DRO: R.J. Shadday Service Type M ones No.: o9~aotsa Arrears 12 weeks or greateri' Qyes ®no 649110827 354 S 2009 09-2456 CIVIL OOriginal Order/Notice OAmended Order/Notice OTerminate Order/Notice QOne-Time Lump Sum/Notice RE: WARREN, ERIC S. Employee/Obligor's Name (Last, First, MI) Form EN-028 Rev.S Worker I D $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ~ If hecke~ you are required, to provide a opy of this form to your~eed to your lemo r employee works in,a state that is di~ferent from the state that issued this or~er, a copy must be prove p~oyee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee%bligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. a4o9iss93o THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : ~ THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: O EMPLOYEE'S/OBLIGOR'S NAME: WARREN, ERIC S . EMPLOYEE'S CASE IDENTIFIER: 1321102126 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT; NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligorfvom employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by Internet www.childsupport.state.pa.us Page 2 of 2 Service Type 1"t OMB No.:0970-0754 Form EN-028 Rev.5 Worker ID $IATT ADDENDUM Summary of_Cases on Attachment DefendandObligor: WARREN, ERIC S . PACSES Case Number 588110823 PACSES Case Number 649110827 Plaintiff Name Plaintiff Name DONNA M. WARREN DONNA M. WARREN Docket Attachment Amount Docket Attachment Amount 09-2456 CIVIL$ 1,100.00 00354 S 2009 $ 688.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB GEORGIA H. WARREN 05/26/00 PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB Service Type M PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount g o.oo Child(ren)'s Name(s): DOB Addendum OMB No.: 0970-0154 Form EN-028 Rev.S Worker I D $ IATT ,-~ i ~.-~~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIC S. WARREN, ) Order Number ?0 P y 40 Plaintiff/Petitioner ) ,., o PACSES Case No. 588110823 _ 3 C= n - DONNA M. WARREN )Docket Number 09-2456 CIVIL r -am ) Defendant/Respondent N ® a PETTION FOR MODIFICATION OF ALIMONY PENDENTE LITW AND NOW comes Eric S. Warren, by and through his attorney of record, Hannah Herman-Snyder, Esquire and the law firm of Griffie and Associates and avers as follows: 1. Petitioner is the above named Plaintiff, Eric S. Warren, an adult individual currently residing at 10 Burke Drive, Shippensburg, PA, 17257. 2. Respondent is the above Defendant, Donna M. Warren, an adult individual currently residing at 102 Hollar Avenue, Shippensburg, PA, 17257. 3. An Order for Alimony Pendente Lite was entered on May 21, 2009 on behalf of Respondent. 4. Due to a change in circumstances, including a change in income for both parties, Petitioner is requesting a modification of the current Alimony Pendente Lite Order. 5. Counsel for Respondent, Martha B. Walker, Esquire is being provided with notice of the filing of this Petition by first class mail, postage prepaid. 6. Prior involvement by the Court consists only of Judge Bayley signing the Alimony Pendente Lite Order of May 21, 2009. WHEREFORE, Petitioner requests this Honorable Court schedule a conference with the Cumberland County Domestic Relations Office to modify the current Alimony Pendente Lite Order. Respectfully Submitted, al&h.a n - dK%14jkA Hannah Herman-Snyder, Esquirt Attorney for Plaintiff/Petitioner GRIFFIE AND ASSOCIATES 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 VERIFICATION I verify that the statements made in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsifications to authorities. DATE: do? 6 ??--- ERIC S. WARREN IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIC S. WARREN, Plaintiff/Petitioner VS. DONNA M. WARREN Defendant/Respondent Order Number PACSES Case No. 588110823 Docket Number 09-2456 CIVIL CERTIFICATE OF SERVICE I, Hannah Herman-Snyder, Esquire, hereby certify that I did, the ? day of November, 2010, cause a copy of the Petition for Modification of Alimony Pendente Lite of Plaintiff, Eric S. Warren, to be served upon the Plaintiff to her attorney of record by at the following address: Martha B. Walker, Esquire 247 Lincoln Way East Chambersburg, PA 17201 DATE: I l - Na - to 1&AIJZ?."K - GLftiMbA Hannah Herman-Snyder, Es ire Attorney for Plaintiff/Petitioner GRIFFIE & ASSOCIATES 200 North Hanover Street Carlisle, PA 17013 (717)243-5551 (800) 347-5552 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania 649110827 Co./City/Dist. of CUMBERLAND 354 S 2009 Date of Order/Notice 11/22/10 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number AIR METHODS CORPORATION* 7301 S PEORIA ST ENGLEWOOD CO 80112-4133 166-48-9366 Employee/Obligor's Social Security Number 1321102126 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee'slobligor's income until further notice even if the Order/Notice is not issued by your State. $ 610.00 $ 0.00 $ 0.00 $ 0.00 $ 422.00 $ 0.00 $ 0.00 $ 0.00 for a total of $ per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) one-time lump sum payment Arrears 12 weeks or greater( 1,032.00 per month to be forwarded to payee below. 0y noq rillco Tn = r cn •c r t ? w = xp ?? 2 N 2 Q IR7 CO You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ ?3F3 1 per weekly pay period. $ 516.00 per semimonthly pay period (twice a month) $ 476-31 per biweekly pay period (every two weeks) $ 1, 032.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic Payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE D NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier SOCIA URITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Dom: R. J. Shadday Edward E. Guido, Judge Form EN-028 Rev.5 Service Type M OMBNo.:0970.0154 Worker ID $IATT 09-2456 CIVIL OOriginal Order/Notice OAmended Order/Notice 0Terminate Order/Notice QOne-Time Lump Sum/Notice RL WARREN, ERIC S. Employee/Obligor's Name (Last, First, MI) ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If kheck. you are required to provide gopy of this form to pourompto your lemo r employee works in a state that is di erent rom the state that issued this or er, a copy must be rovi eedd ployee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employeelobligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 8409158930 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME: WARREN, ERIC S. EMPLOYEE'S CASE IDENTIFIER: 1321102126 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT. NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelob(igor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev-5 Service Type M OMB No, 0970.0154 Worker ID $IATT Y 7 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WARREN, ERIC S. PACSES Case Number 588110823 Plaintiff Name DONNA M. WARREN Docket Attachment Amount 09-2456 CIVIL$ 422.00 Child(ren)'s Name(s): DOB Addendum Service Type M OMB No.: 0970-0154 PACSES Case Number 649110827 Plaintiff Name DONNA M. WARREN Docket Attachment Amount 00354 S 2009 $ 610.00 Child(ren)'s Name(s): DOB GEORGIA H. WARREN,... 05/26/00, Form EN-028 Rev.5 Worker ID $ IATT DONNA M. WARREN, Plaintiff/Petitioner VS. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 09-2456 CIVIL TERM c-? z? 2'v z A? =c3 y,c z -4 N d EV C4 ERIC S. WARREN, IN DIVORCE Defendant/Respondent PACSES CASE: 588110823 ORDER OF COURT N w 00 G1 r=r?? ?7Q sn C?-" =z D -C AND NOW, this 22nd day of November, 2010, based upon the Court's determination that the Petitioner's monthly net income/earning capacity is $ 4,033.69 and the Respondent's monthly net income/earning capacity is $ 3,623.09, it is hereby ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit Four Hundred Twenty-two and 00/100 Dollars ($ 422.00) per month payable bi-weekly as follows: $ 422.00 per month for Alimony Pendente Lite and $ 0.00 per month on arrears. First payment due: in accordance with Respondent's pay schedule. The effective date of the order is November 22, 2010. Arrears set at $ 290.77- as of November 22, 2010. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and, at its discretion, make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Donna M. Warren. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the Respondent's name with their PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. cc360 The monthly support obligation includes cash medical support in the amount of $250 annually for unreimbursed medical expenses incurred for each child and/or spouse. Unreimbursed medical expenses of the obligee or children that exceed $250 annually shall be allocated between the parties. The party seeking allocation of unreimbursed medical expenses must provide documentation of expenses to the other party no later than March 31 ' of the year following the calendar year in which the final medical bill to be allocated was received. The unreimbursed medical expenses are to be paid as follows: 0 % by Respondent and 100 % by Petitioner. [X] Respondent [] Petitioner [] Neither party to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the [] Petitioner [X] Respondent shall submit written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. Other conditions: This Order is for a mortgage contribution only pursuant to the Respondent having a child support obligation under PACSES #649110827 and the Pennsylvania State Guidelines. This Order shall become final twenty (20) after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Office of the Prothonotary for a hearing de novo before the Court. Consented: Petitioner Respondent Petitioner's Attorney Respondent's Attorney Mailed copies on: November 23, 2010 Petitioner Respondent Martha B. Walker, Esq. Hannah Herman Snyder, Esq. DRO: R.J. Shadday BY THE COURT Edward E. Guido, J. (6 <]Pee WALKER, CONNOR & SPANG, LLC 247 Lincoln Way East Chambersburg PA 17201 (717) 262-2185 (717) 262-2187-Fax IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Domestic Relations Section Donna M. Warren, Docket No: 09-2456 - Civil Term Plaintiff, vs. Eric S. Warren, Defendant, PACSES No. 588110823 Demand for Appeal Hearing (Alimony Pendente Lite) -y,ww 'o r-- CD C 1. i1 L7 i? G_? rv co F;7, cam, , --1.3 C] C:) C".) Plaintiff demands an appeal hearing to appeal the alimony pendente lite Order entered on November 22, 2010 for the following reasons: Plaintiff feels that Defendant voluntarily quit a higher-paying job. Plaintiff further believes that the Domestic Relations Section erred in using the income from Defendant's new lower-paying job. Date: /1-0 Signature of attorney, if any, for party: -> Notice to Counsel: Counsel whose signature appears above will be deemed to have entered an appearance in the matter and will be obligated to provide representation at the hearing absent leave of court to withdraw. (Revised 04/2009) M - A. A In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DONNA M. WARREN, ) Docket Number Plaintiff/Petitioner ) VS. ) PACSES Case Number ERIC S. WARREN, ) Other State ID Number Defendant/Respondent ) ORDER OF COURT 3VIL 91/PldlJ23 C-7 c rn 00 ern X= U)r-- ci; 2> You, Eric Scott Warren, of 10 Burke Drive, Shippensburg, Pennsylvania 17257-8128-10 are ordered to appear at the DOMESTIC RELATIONS hearing room, c/o Hearing Room, DOMESTIC RELATIONS OFFICE, 13 North Hanover Street, Carlisle, Pennsylvania 17013 on the 191" day of January, 2011, at 1:30 p.m. for a hearing. You are further required to bring to the hearing: C=- c? rri 1 rn 1. a true copy of your most recent Federal Income Tax Return, including W-2s, as filed, 2. your pay stubs for the preceding six (6) months, 3. the Income Statement and the appropriate Expense Statement, if required, attached to this order, completed as required by Rule 1910.11(c), 4. verification of child care expenses and, 5. proof of medical coverage which you may have, or may have available to you, 6. information relating to professional licenses, 7. other: C, y r- ror1n -Iu a- z° C) -n ?ri Cumberland County Bar Association 32 Bedford Street Carlisle, PA 17013-3302-32 (717) 249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 WARREN V. WARREN PACSES Case Number 588110823 If you fail to appear for the hearing or to bring the required documents, the court may issue a warrant for your arrest and/or enter an interim Support order. THE APPROPRIATE COURT OFFICER MAY ENTER AN ORDER AGAINST EITHER PARTY BASED UPON THE EVIDENCE PRESENTED WITHOUT REGARD TO WHICH PARTY INITIATED THE SUPPORT ACTION. BY THE COU i Date of Order: X3-1--j Edward uido, JUDGE YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE HEARING AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the Court, please contact our office at (717)240-6225. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled hearing. CM-509 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DONNA M. WARREN, ) Plaintiff/Petitioner ) vs. ) ERIC S. WARREN, ) Defendant/Respondent ) Docket Number ,CT L PACSES Case Number Other State ID Number ORDER OF COURT r'; 5.19110823 ~o Z c -.4 rnCo ;6rn r- :z © 4 CO You, Donna Marie Warren, of 102 Hollar Avenue, Shippensburg, Pennsylvania 17257-2134-02 are ordered to appear at the DOMESTIC RELATIONS hearing room, c/o Hearing Room, DOMESTIC RELATIONS OFFICE, 13 North Hanover Street, Carlisle, Pennsylvania 17013 on the 19`" day of January, 2011, at 1:30 p.m. for a hearing. You are further required to bring to the hearing: 1. a true copy of your most recent Federal Income Tax Return, including W-2s, as filed, 2. your pay stubs for the preceding six (6) months, 3. the Income Statement and the appropriate Expense Statement, if required, attached to this order, completed as required by Rule 1910.11(c), 4. verification of child care expenses and, 5. proof of medical coverage which you may have, or may have available to you, 6. information relating to professional licenses, 7. other: Cumberland County Bar Association 32 Bedford Street Carlisle, PA 17013-3302-32 (717) 249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 WARREN V. WARREN PACSES Case Number 588110823 If you fail to appear for the hearing or to bring the required documents, the court may issue a warrant for your arrest and/or enter an interim Support order. THE APPROPRIATE COURT OFFICER MAY ENTER AN ORDER AGAINST EITHER PARTY BASED UPON THE EVIDENCE PRESENTED WITHOUT REGARD TO WHICH PARTY INITIATED THE SUPPORT ACTION. BY THE COURT: Date of Order: A -1-1 O Edward o, JUDGE YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE HEARING AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the Court, please contact our office at (717)240-6225. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled hearing. CM-509 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State: Commonwealth of Pennsylvania lo4Q I ) L)$ :-7 Co./City/Dist. of: CUMBERLAND 35L- S a Boa Date of Order/Notice: 01 /28/11 Case Number (See A e?for case summary) EmployerAVithholder's Federal EIN Number AIR METHODS CORPORATION* 7301 S PEORIA ST ENGLEWOOD CO 80112-4133 RE: WARREN, ERIC S. ba- aL-5L, Clvl I O Original Order/Notice @ Amended Order/Notice O Terminate Order/Notice O One-Time Lump Sum/Notice Employee/Obligor's Name (Last, First, MI) 166-48-9366 Employee/0 igo s -Social Security -Nu-mber 1321102126 mp oyee igor s ase enti er (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania . By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued y your State. $ 637.00 per month in current child support , ., 03 = --? $ 0.00 per month in past-due child support 0 00 Arrears 12 weeks or greater? Zt yew . $ . per month in current medical support 0 00 z = rn 's . per month in past-due medical support $ $ 422.00 per month in current spousal support 0 0 . 0 per month in past-due spousal support ,-, $ $ 0.00 per month for genetic test costs ?- r ' 0.00 per month in other (specify) ;-r $ one-time lump sum payment - -' for a total of $ 1,059.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 144,57 per weekly pay period. $ 529.50 per semimonthly pay period SAS ?? (twice a month) $ per biweekly pay period (every two weeks) $ 1,059.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT' E AND THE PACSES MEMBER ID (shown above as the Emp/oyee/Obligor's Case /dentif SOCI SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. lop, BY THE COURT: Service Type M EawDJ,-d_ E. 8 °db, OMB No.: 0970-0154 Form EN-028 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If checked you are required to provide a copy of this form to your employee. If your employee works in a state that is different from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 8409158930 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: Q THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: Q EMPLOYEE'S/OBLIGOR'S NAME: WARREN, ERIC S. EMPLOYEE'S CASE IDENTIFIER: 1321102126 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: _ LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11 • Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.12a.us Service Type M OMB No.: 0970-0154 Page 2 of 2 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WARREN, ERIC S. PACSES Case Number 588110823 Plaintiff Name DONNA M. WARREN D cke Attachment Amount 09-2456 CIVIL $ 422.00 Child(ren)'s Name(s): DOB PACKS Case Number 649110827 Plaintiff Name DONNA M. WARREN Docket Attachment Amount 00354 S 2009 $ 637.00 Child(ren)'s Name(s): DOB GEORGIA H. WARREN 05/26/00 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Do ke Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT DONNA M. WARREN, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : DOMESTIC RELATIONS SECTION ERIC S. WARREN, PACSES NO. 649110827 Defendant DOCKET NO. 354 SUPPORT 2009 ERIC S. WARREN, IN THE COURT OF COMMON PLEA OF , c3 S? , ? Plaintiff/Respondent CUMBERLAND COUNTY, PENNSY?JAWA 'i MW V. DOMESTIC RELATIONS SECTI01' - -?; c„n r w c? DONNA M. WARREN, PACSES NO. 588110823 -n ss Defendant/Petitioner DOCKET NO. 09-2456 CIVIL ?c CD-n >C7_ `o 0 yr`' T ` INTERIM ORDER OF COURT AND NOW, this day of January, 2011, upon consideration of the Support Master's Report and Recommendation, a copy of which is attached hereto as Exhibit "A", it is ordered and decreed as follows: A. The Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit as support for his daughter, Georgia H. Warren, born May 26, 2000, the sum of $637.00 per month. B. The Defendant shall pay directly to the Plaintiff as support for said child a sum equal to 16% of the net income received by the Defendant from part-time employment within 10 days of receipt thereof. C. The Defendant shall provide health insurance coverage for the benefit of said child as is available to him through employment or other group coverage at a reasonable cost. D. The monthly support obligation includes cash medical support in the amount of $250.00 annually for unreimbursed medical expenses incurred for said child. Unreimbursed medical expenses of the child that exceed $250.00 annually shall be allocated between the parties. The party seeking allocation of unreimbursed medical expenses must provide documentation of expenses to the other party no later than March 31 Sc of the year following the calendar year in which the final medical bill to be allocated was received. The unreimbursed medical expenses are to be paid as follows: 48% by Defendant and 52% by Plaintiff. E. The Defendant shall pay directly to the Plaintiff a sum equal to 48% of the expenses incurred by the Plaintiff for childcare during the summer break from school. F. The effective date of this order is October 11, 2010. G. The interim order of alimony pendente lite entered November 22, 2010 is affirmed as a final order. IMPORTANT LEGAL NOTICE PARTIES MUST WITHIN SEVEN DAYS INFORM THE DOMESTIC RELATIONS SECTION AND THE OTHER PARTIES, IN WRITING, OF ANY MATERIAL CHANGE IN CIRCUMSTANCES RELEVANT TO THE LEVEL OF SUPPORT OR THE ADMINISTRATION OF THE SUPPORT ORDER, INCLUDING, BUT NOT LIMITED TO, LOSS OR CHANGE OF INCOME OR EMPLOYMENT AND CHANGE OF PERSONAL ADDRESS OR CHANGE OF ADDRESS OF ANY CHILD RECEIVING SUPPORT. A PARTY WHO WILLFULLY FAILS TO REPORT A MATERIAL CHANGE IN CIRCUMSTANCES MAY BE ADJUDGED IN CONTEMPT OF COURT, AND MAY BE FINED OR IMPRISONED. PENNSYLVANIA LAW PROVIDES THAT ALL SUPPORT ORDERS SHALL BE REVIEWED AT LEAST ONCE EVERY THREE (3) YEARS IF SUCH REVIEW IS REQUESTED BY ONE OF THE PARTIES. IF YOU WISH TO REQUEST A REVIEW AND ADJUSTMENT OF YOUR ORDER, YOU MUST DO THE FOLLOWING: CALL YOUR ATTORNEY. AN UNREPRESENTED PERSON WHO WANTS TO MODIFY (ADJUST) A SUPPORT ORDER SHOULD CONTACT THE DOMESTIC RELATIONS SECTION. ALL CHARGING ORDERS FOR SPOUSAL SUPPORT AND ALIMONY PENDENTE LITE, INCLUDING UNALLOCATED ORDERS FOR CHILD AND SPOUSAL SUPPORT OR CHILD SUPPORT AND ALIMONY PENDENTE LITE, SHALL TERMINATE UPON DEATH OF THE PAYEE. A MANDATORY INCOME ATTACHMENT WILL, ISSUE UNLESS THE DEFENDANT IS NOT IN ARREARS IN PAYMENT IN AN AMOUNT EQUAL TO OR GREATER THAN ONE MONTH'S SUPPORT OBLIGATION AND (1) THE COURT FINDS THAT THERE IS GOOD CAUSE NOT TO REQUIRE IMMEDIATE INCOME WITHHOLDING; OR (2) A WRITTEN AGREEMENT IS REACHED BETWEEN THE PARTIES WHICH PROVIDES FOR AN ALTERNATE ARRANGEMENT. UNPAID ARREARAGE BALANCES MAY BE REPORTED TO CREDIT AGENCIES. ON AND AFTER THE DATE IT IS DUE, EACH UNPAID SUPPORT PAYMENT SHALL CONSTITUTE, BY OPERATION OF LAW, A JUDGMENT AGAINST YOU, AS WELL AS A LIEN AGAINST REAL PROPERTY. IT IS FURTHER ORDERED THAT, UPON PAYOR'S FAILURE TO COMPLY WITH THIS ORDER, PAYOR MAY BE ARRESTED AND BROUGHT BEFORE THE COURT FOR A CONTEMPT HEARING; PAYOR'S WAGES, SALARY, COMMISSIONS, AND/OR INCOME MAY BE ATTACHED IN ACCORDANCE WITH LAW. PAYOR IS RESPONSIBLE FOR COURT COSTS AND FEES. The parties are hereby advised that they may file written exceptions to the Support Master's Report and Recommendation within twenty (20) days of this order. Exceptions shall conform with the requirements of Rule 1910.12(f), Pa. R.C.P. If written exceptions are filed by any party, the other party may file exceptions within twenty (20) days of the date of service of the original exceptions. If no exceptions are filed within twenty (20) days of this interim order, this order shall then constitute a final order. Cc: Donna M. Warren Eric S. Warren Martha B. Walker, Esquire For the Defendant/Petitioner Hannah Herman-Snyder, Esquire For the Plaintiff/Respondent DRO/rj s By the Court, DONNA M. WARREN, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. DOMESTIC RELATIONS SECTION ERIC S. WARREN, Defendant ERIC S. WARREN, Plaintiff/Respondent V. DONNA M. WARREN, Defendant/Petitioner PACSES NO. 649110827 DOCKET NO. 354 SUPPORT 2009 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DOMESTIC RELATIONS SECTION PACSES NO. 588110823 DOCKET NO. 09-2456 CIVIL SUPPORT MASTER'S REPORT AND RECOMMENDATION Following a hearing held before the undersigned Support Master on January 19, 2011, the following report and recommendation are made: FINDINGS OF FACT 1. The Wife is Donna M. Warren, who resides at 102 Hollar Avenue, Shippensburg, Pennsylvania. 2. The Husband is Eric S. Warren, who resides at 151 Roxbury Road, Newville, Pennsylvania. 3. The parties are married but live separate and apart. 4. The parties are the parents of Georgia H. Warren, a minor child born May 26, 2000. 5. By order dated May 21, 2009 the Husband's obligation for support of said child was set at $688.00 per month. 6. The parties are in the process of divorce. 7. By order dated May 21, 2009 the Husband's obligation for alimony pendente lite was set at $1,100.00 per month. 8. On October 11, 2010 the Husband filed a petition for modification of said child support order. 9. On November 22, 2010 the Husband filed a petition for modification of said alimony pendente lite order. EXHIBIT "A" 10. In May, 2009 the Husband was employed full-time as a paramedic for the City of Alexandria, Virginia and part-time as a paramedic for STAT MedEvac in Hagerstown, Maryland. 11. In May, 2009 the Husband had combined net monthly income of $5,287.00. 12. In November, 2009 the Husband's part-time employment ended due to a relocation of the employer. 13. In November, 2009 the Husband voluntarily terminated his employment with the City of Alexandria and accepted full-time employment with Air Methods Corporation in Hagerstown, Maryland. 14. The Husband had earned approximately $79,000.00 annually in the City of Alexandria. 15. The Husband earns approximately $60,271.00 annually working for Air Methods. 16. The Husband had a two and a half hour one-way commute to Alexandria, Virginia. 17. The Husband pays $160.15 bi-weekly for health insurance coverage on the family. 18. The Husband's tax filing status is married/separate. 19. Working closer to home permits the Husband to spend additional time with his daughter. 20. The Husband is in the process of obtaining part-time employment on an on-call basis with West Virginia University. 21. The Wife continues to be employed as a nurse by the Chambersburg Hospital. 22. Since the entry of the prior order the Wife's net monthly income has increased from $2,714.00 to $4,034.00. 23. The Wife pays approximately $60.00 per week for childcare of her daughter during the school year. 24. The child attends a private school at an annual cost of $2,550.00. 25. The Wife continues to reside in the marital residence. 26. The residence is encumbered by two mortgages with a combined monthly payment of $2,005.00. 27. The parties agree to share the undetermined childcare expenses for the summer in proportion to their net monthly incomes. 2 DISCUSSION A party seeking to modify a support order has the burden of demonstrating that a material and substantial change of circumstances has occurred since the entry of the order to justify a modification. Mackay v. Mackay, 984 A.2d 529 (Ila. Super. 2009). When the order was entered in May, 2009 the Defendant was working two jobs, a full-time position in Alexandria, Virginia and a part-time position in Hagerstown, Maryland. In late 2009 the part-time employer closed its operations in Hagerstown. At or about the same time the Defendant found employment as a paramedic with Air Methods Corp. in Hagerstown and voluntarily left his employment in Virginia.. During the period of time since the entry of the order the Plaintiff's income has increased considerably. A modification of the order is justified. The Defendant now earns approximately $60,271.00 annually as a paramedic for Air Methods Corp. The Plaintiff argues, however, that the Defendant should be imputed with an income equal to his prior income with the City of Alexandria which was approximately $79,000.00 annually because he voluntarily left that employment and accepted a job paying significantly less. In Grimes v. Grimes, 596 A.2d 240 (Pa. Super. 1991) the Superior Court set forth the burden an obligor who has voluntarily left employment and accepted new employment at a lesser income must meet in order to have a support order reduced. The Court held that the obligor must first show that the change of employment was not made for the purpose of avoiding a child or spousal support obligation, and secondly that the obligor has made efforts to mitigate the loss of income. There is no dispute that the Defendant's change of employment was not made for the purpose of avoiding his support obligation. The Defendant continued to pay the amount established in the May, 2009 order for nearly a year before filing his petition for modification. There clearly was no intent on his part to avoid his support obligation. The second hurdle involves his efforts to mitigate the reduction in his income. The Defendant accepted employment approximately two hours nearer to his home than the prior job in Alexandria, Virginia. This clearly is a savings in fuel and wear and tear on his vehicle. He testified that despite having a lower gross annual income at his new position, his actual cash flow available for support is nearly comparable to what: he had been earning because of the reduction in commuting expenses and union dues. He also testified that the change of employment allowed him more time to see his daughter. His employment in Hagerstown as a paramedic is comparable to the job he had in Virginia. Unfortunately the pay in Hagerstown does not meet the level of pay in the Metropolitan Washington D.C. Area. He is taking steps to supplement his current income with part-time employment with West Virginia University, although his part-time earnings are speculative at the present time. Considering all circumstances, in the opinion of this Master, the Defendant has met his burden as set forth in Grimes, and his actual earnings will be utilized to calculate the support obligation. 3 The Defendant has gross monthly income at his employment with Air Methods of $5,023.00. With a tax filing status of married/separate, he has net monthly income for support purposes of $3,691.00.' The Plaintiff has net monthly income of $4,034.00.2 With combined net monthly income of $7,725.00 the basic requirement for the support of one child is $1,214.00 per month.3 The Defendant's proportionate share of that amount is $580.00. After adjustments for private school tuition, health insurance coverage, and childcare expenses incurred during the school year, the Defendant's monthly child support obligation is $637.00.4 The Defendant has requested a downward adjustment for shared custody. After a careful review of the testimony, in the opinion of this Master the Defendant has not met his burden of establishing shared custody equal to 40% of the overnights as required by Pa. R.C.P. 1910.164(c). No adjustment is recommended. Because the Defendant's net monthly income, less his child support obligation, does not exceed the Plaintiff s net monthly income, an obligation for alimony pendente lite would not exist under the guidelines.s However, the parties agree that the Defendant's obligation for a mortgage adjustment under Pa. R.C.P. 1910.16-6(e) shall be treated as alimony pendente lite and not as an adjustment to the child support obligation. The obligation for that adjustment is $422.00 per month as set forth in the interim order entered November 22, 2010. That order will be affirmed as a final order. The parties agree that the Husband shall pay his proportionate share of any expenses for childcare during the summer directly to the Plaintiff. That will be made part of the order. Because the Defendant's future income from part-time employment is speculative, he will be ordered to pay 16% of any net income6 received from part-time employment shall be paid directly to the Plaintiff as child support. RECOMMENDATION A. The Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit as support for his daughter, Georgia H. Warren, born May 26, 2000, the sum of $637.00 per month. B. The Defendant shall pay directly to the Plaintiff as support for said child a sum equal to 16% of the net income received by the Defendant from part-time employment within 10 days of receipt thereof. C. The Defendant shall provide health insurance coverage for the benefit of said child as is available to him through employment or other group coverage at a reasonable cost. ' See Exhibit "A" for the tax deductions from gross income. z The parties stipulated to the Plaintiff's net monthly income. s See Pa. R.C.P. 1910.16-3. a See Exhibit "B" for the guideline calculation. 5 See Pa. R.C.P. 1910.16-4 (a). 6 "Net income" is gross income less federal, state and local income taxes, FICA payments, union dues, and non- voluntary retirement payments. See Pa. R.C.P. 1910.16-2(c)(1). 4 D. The monthly support obligation includes cash medical support in the amount of $250.00 annually for unreimbursed medical expenses incurred for said child. Unreimbursed medical expenses of the child that exceed $250.00 annually shall be allocated between the parties. The party seeking allocation of unreimbursed medical expenses must provide documentation of expenses to the other party no later than March 31St of the year following the calendar year in, which the final medical bill to be allocated was received. The unreimbursed medical expenses are to be paid as follows: 48% by Defendant and 52% by Plaintiff. E. The Defendant shall pay directly to the Plaintiff a sum equal to 48% of the expenses incurred by the Plaintiff for childcare during the summer break from school. F. The effective date of this order is October 11, 2010. G. The interim order of alimony pendente lite entered November 22, 2010 is affirmed as a final order. 2S Zo r Ite K Michael R. Rundle Support Master In the Court of Common Pleas of Cumberland County, Pennsylvania Tax Detail Report Plaintiff Name: Donna M. Warren Defendant Name: Eric S. Warren Docket Number: 354 S 2009 PACSES Case Number: 649110827 Other State ID Number: Tax Year: Current: 2010 Defendant Plaintiff 1. Tax Method 1040 ES Manual 2. Fling Status Married Filing Separately Single 3. Who Claims the Exemptions Obli gee 4. Number of Exemptions 1 1 5. Month) Taxable Income $5,022.60 $4,034.00 6. Deductions Method Standard Standard 7. Deduction Amount $475.00 $475.00 8. Exemption Amount $304.17 $304.17 9. Income MINUS Deductions and Exemptions $4,243.43 $3,254.83 10. Tax on Income $742.62 $495.47 11. Child Tax Credit - - 12. Manual Adjustments to Taxes - - 13. Federal Income Taxes $742.62 - 13 a. Earned Income Credit - - 14. State Income Taxes $154.19 - 15. FICA Payments $384.23 - 16. City Where Taxes Apply --Select-- --Select-- 17. Local Income Taxes $50.23 - TOTAL Taxes $1,331.27 - SupportCalc 2010-5-12 EXHIBIT "A" In the Court of Common Pleas of Cumberland County, Pennsylvania Support Guideline Worksheet (Revised May 12, 2010) Rule 1910 16-1 et seq _......_...._ ...._._. Defendant Name: Eric S. Warren Docket Number. 354 S 2009 PACSES Case Number: 649110827 Plaintiff Name: Donna M. Warren Other Case ID Number: Amounts on une 4 comoinea 6 Plus Child's Monthly Soc Sec Retirement or Disability Derivative Benefit. 7. Adjusted Combined Total Monthly Net Income _ .._....... 8 PRELIMINARY Child Support Obligation based on Adjusted Income (Line,7) 9. Less Child's Monthly Social Security Retirement or Disability Derivative Benefit Line 6) ( ) ..___ ..... ..... .__...... ..... . . 10. Basic Child Support Obligation -- ._ _ ___ . From Rule 1910.16-3 Basic Child Support Schedule (Table Rev. 512010) 11. Net Income as a Percentage of Combined Amount 12. Each Parent's MontShare of the Child Support Obligation 13 Adjustment for Shared Custody Rule 1910.16-4 (c) (# of overnights: ..._... 14. Adjustment for Child Care Expenses Rule 1910.16-6 (a) 15. Adjustment for Health Insurance Premiums Rule 1910.16-6 ._......- 16. Adjustment for Unreimbursed Medical Rule 1910.16-6 17 Adjustment for Additional Expenses Rule 191016-6 (d) ........ ........ . 18. Total Obligation with Adjustments Line 12 minus Line 13, plus Lines 14,15,16,17 19 Less Split Custody Counterclaim Rule 1910.16-4 (d) ............... .. .. .......... 20. Obligor's Support Obligation Line 18 minus Line 19, Prepared by: mrr 52.22 33.95 Summary Re S5. Adjusted Support Obligation Monthly: Weekly: Line 20 (or S1, if applicable) plus Line S2 and S3 minus S4 (if applicable) $637.25 ; $146.66 TAX INFORMATION Tax Method Filing Status Exemptions S6. Defendant 1040 ES Married Filing Separately 1 S7. Plaintiff Manual Single 1 Date $1,214.00 47.78 $580.05 $76.45 -$120.78 ....................... $101.53 $637.25 $637.25 1/21/2011 W S1. PACSES Multiple Family Adjustment S2. Spousal Support Award S3. Adjustment for Excess Mortgage Payments (If Applicable) - S4. Custodial Parent Spousal Support Obligation (if Applicable) (-) - S8. Total Support Amount if Deviating from Guidelines Calculation Monthly: Weekly: S9. Justification for Deviating from Guidelines Calculation and/or Other Case Comments: SupportCalc 2010-5-12 EXHIBIT "B" DONNA M. WARREN, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. DOMESTIC RELATIONS SECTION ERIC S. WARREN, PACSES NO. 649110827 Defendant DOCKET NO. 354 SUPPORT 2009 ERIC S. WARREN, : IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent : CUMBERLAND COUNTY, PENNSYLVANIA V. : DOMESTIC RELATIONS SECTION DONNA M. WARREN, PACSES NO. 588110823 Defendant/Petitioner DOCKET NO. 09-2456 CIVIL INDEX OF EXHIBITS Plaintiff s Exhibit No. 1 - Custody order Defendant's Exhibit No. 1 - Earnings statements ,-, r -;j rn nw Defendant's Exhibit No. 2 - 2009 federal tax return vjr- w :;Q ' Defendant s Exhibit No. 3 - 2009 W-2 ?a 3-n °rn Defendants Exhibit No. 4 - Custody calendar %n w co -? Defendant's Exhibit No. 5 - GMAC mortgage payments Defendant's Exhibit No. 6 - Orrstown Bank mortgage payments FILED-OFFICE 'A THE PROTHONOTARY 2011 APR 13 AM 9: 2 6 CUMBERLAND COUNT'Y PENNSYLVANIA ERIC S. WARREN, V. IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA DONNA M. WARREN, Defendant : CIVIL ACTION -LAW NO. 09-2456 CIVIL TERM IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under §3301 (c) of the Divorce Code was filed on April 20, 2009, and served April 21, 2009 on Defendant's counsel, Martha B. Walker. Esquire. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final Decree of Divorce after service of notice of intention to request entry of the decree. I VERIFY THAT THE STATEMENTS MADE IN THE FOREGOING 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: ERIC S. WARREN, Plaintiff O THELPROTHO! OTARY 2011 APR 13 AM 9: 26 CUMBERLAND COUNT)` PENNSYLVANIA ERIC S. WARREN, V. IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA DONNA M. WARREN, Defendant CIVIL ACTION -LAW NO. 09-2456 CIVIL TERM IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST THE ENTRY OF A DIVORCE DECREE UNDER §3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree in 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 THE FOREGOING 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. sue,.. DATE: ERIC S. WARREN, Plaintiff 1 ? ERIC S. WARREN, V. IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA DONNA M. WARREN, Defendant CIVIL ACTION - LAW NO. CIVIL TERM IN DIVORCE r. PROPERTY AND SEPARATION AGREEMENT c.;j c C:) BETWEEN T C:,% + rrI ERIC S. WARREN v, AND DONNA M. WARREN GRIFFIE AND ASSOCIATES 200 NORTH HANOVER STREET CARLISLE, PA 17013 THIS AGREEMENT, made this o?' day of 2011, by and between ERIC S. WARREN, of 151 Roxbury Road, Newville, Cumberland County, Pennsylvania, party of the first part, hereinafter referred to as "Husband, AND DONNA M. WARREN, of 102 Hollar Avenue, Shippensburg, Cumberland County, Pennsylvania, party of the second part, hereinafter referred to as "Wife," WITNESSETH: WHEREAS, the parties hereto are Husband and Wife, having been married on May 25, 1.996, in Franklin County, Pennsylvania. They are the parents of one child, namely Georgia Hall Warren, born May 26, 2000. WHEREAS, diverse unhappy differences, disputes and difficulties have arisen between the parties and it is the intention of Wife and Husband to live separate and apart, and the parties hereto are desirous of settling their respective financial rights and obligations as between each other including the settling of matters between them relating to the past, present and future support and/or maintenance of Wife by Husband and Husband by Wife. WHEREAS, the parties hereto wish finally and for all time to settle and determine their respective property and other rights growing out of their marital relation; wish to live separate and apart; and, wish to enter into this property and separation Agreement; WHEREAS, both and each of the parties hereto have been advised of their legal rights and the implications of this Agreement and the legal consequences which may and will ensue from the execution hereof; 2 WHEREAS, Wife acknowledges that she is thoroughly conversant with and knows accurately the size, degree, and extent of the estate and income of Husband, and Husband acknowledges that he is thoroughly conversant with and knows accurately the size, degree and extent of the estate and income of Wife; NOW, THEREFORE, in consideration of the mutual promises, covenants and undertakings hereinafter set forth which are hereby acknowledged by each of the parties hereto, Wife and Husband, each intending to be legally bound hereby, covenant and agree as follows: 1. ADVICE OF COUNSEL: The provisions of this Agreement and their legal effect have been fully explained to the parties by their respective counsel, Hannah Herman-Snyder, Esquire for Husband and Martha B. Walker, Esquire for Wife. The parties acknowledge that they have received independent legal advice from counsel of their selection and that they fully understand the facts and have been fully informed as to their legal rights and obligations and they acknowledge and accept that this Agreement is, in the circumstances, fair and equitable and that it is being entered into freely and voluntarily after having received such advice and with such knowledge and that execution of this Agreement is not the result of any duress or undue influence and that it is not the result of any collusion or improper or illegal agreement or agreements and the parties hereto state that he or she in the procurement and execution of this Agreement, has not been subjected to any fraud, concealment, overreaching, imposition, coercion, or other unfair dealing on the part of the other, or on the part of the other's counsel. 3 2. WARRANTY OF DISCLOSURE: The parties warrant and represent that they have made a full disclosure of all assets and their valuation prior to the execution of this Agreement. This disclosure was in the form of an informal exchange of information by the parties' attorneys and/or parties and this Agreement between the parties is based upon this disclosure. 3. MUTUAL RELEASE: Husband and Wife each do hereby mutually remise, release, quitclaim, and forever discharge the other and the estate of such other, for all times to come and for all purposes whatsoever, of and from any and all right, title and interest, or claims in or against the property (including income and gain from property hereafter accruing) of the other or against the estate of such other, of whatever nature and wheresoever situate, which he or she now has or at any time hereafter may have against such other, the estate of such other, or any part thereof, whether arising out of any former acts, contracts, engagements, or liabilities of such other as by way of dower or curtesy, or claims in the nature of dower or curtesy or widow's or widower's rights, family exemption, or similar allowance, or under the intestate laws, or the right to take against the spouse's Will; or the right to treat a lifetime conveyance by the other as testamentary, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any state, commonwealth or territory of the United States, or (c) any other country, or any rights which either party may have or at any time hereafter have for past, present, or future support or maintenance, alimony, alimony pendente lite, counsel fees, costs or expenses, whether arising as a result of the marital relation or otherwise, except and only except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any thereof. It is the intention of Husband and Wife to give to each other by execution of this Agreement a full, complete, and general release with respect to any and all property of any kind or nature, real or personal, not mixed, which the other now owns or may hereafter acquire, except and only except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any thereof. 4. PERSONAL RIGHTS AND SEPARATION: Wife and Husband may and shall, at all times hereafter, live separate and apart. They shall be free from any control, restraint, interference or authority, direct or indirect, by the other in all respects as if they were unmarried. They may reside at such place or places as they may select. Each may, for his or her separate use or benefit, conduct, carry on and engage, in any business, occupation, profession or employment which to him or her may seem advisable. Wife and Husband shall not molest, harass, disturb or malign each other or the respective families of each other nor compel or attempt to compel the other to cohabit or dwell by any means or in any manner whatsoever with him or her. 5. AGREEMENT NOT A BAR TO DIVORCE PROCEEDINGS. This Agreement shall not be considered to affect or bar the right of Wife or Husband to a limited or absolute divorce on lawful grounds if such grounds now exist or shall hereafter exist or to such defense as may be available to either party. This Agreement is not intended to condone and shall not be deemed to be a condonation on the part of either party hereto of any act or acts on the part of the other party which have occasioned the disputes or unhappy differences which have occurred prior to or which may occur subsequent to the date hereof. The parties intend to secure a mutual consent, no-fault divorce pursuant to the terms of Section 3301 (c) or (d) of the Divorce Code of 1980. 5 9. BANK ACCOUNTS: For the mutual promises and covenants contained in this Agreement, Husband and Wife hereby waive all right, title, claim or interest they may have to equitable distribution in their respective bank accounts, checking or savings, if any, and each party waives against the other any duty of accounting for disposition of any jointly held funds. 10. AFTER-ACQUIRED PERSONAL PROPERTY: Each of the parties shall hereafter own and enjoy, independently of any claim or right of the other, all items of personal property, tangible or intangible, hereafter acquired by him or her after the parties date of separation, with full power, in him or her to dispose of the same as fully and effectively, in all respects and for all purposes, as though he or she were unmarried.t 11. MOTOR VEHICLES The parties agree to the division of their motor vehicles, acquired during their marriage, as follows: A. The 1996 Toyota Tacoma currently titled in Husband's name alone shall be the sole and exclusive property of Husband from the date of execution of this Agreement forward. Wife hereby waives any right, title, claim and/or interest she has or may have in said vehicle and will execute any documents necessary to so waive her interest in the vehicle within fifteen (15) of being requested to do so by Husband or his legal representative. B. The parties acknowledge that they formerly owned a 1996 Prowler Camper which was titled in Husband's name alone, but that camper has been sold and neither party have any claim, one against the other, relative to ownership or possession of the camper nor relative to any proceeds received from the sale of the camper. C. The snowmobile currently titled in Husband's individual name shall remain the sole and exclusive property of Husband. Wife hereby waives any right, title, claim and/or interest she has or may have in said snow mobile. Wife shall sign over the title to said vehicle to Husband within ten (10) days of the date of this Agreement. D. The 2007 Saab 9-3 currently titled in the parties' names jointly shall become the sole and exclusive property of Husband. Wife hereby waives any rim, title, claim and/or interest she has or may have in said vehicle. Husband shall refinance said vehicle within thirty (30) days of the date of this Agreement and at that time, Wife shall sign over the title of said vehicle to Husband. E. The 2002 Ford Expedition currently titled in the parties' names jointly shall become the sole and exclusive property of Wife. Husband hereby waives any right, title, claim and/or interest he has or may have in said vehicle. Husband shall sign over the title to said vehicle to Wife within ten (10) days of the date of this Agreement. 12. PENSION, RETIREMENT, PROFIT SHARING INVESTMENTS: A. The parties recognize that Husband has a 457 Deferred Compensation Plan as a result of his employment with the City of Alexandria. For the mutual promises and covenants contained in this Agreement, Wife shall waive all right, title, claim and/or interest she has or may have in said Deferred Compensation Plan. 8 B. The parties recognize that Husband has a City of Alexandria Retirement Income Plan for DS and ERT and FNI as a result of his employment with the City of Alexandria. For the mutual promises and covenants contained in this Agreement, Wife waives all right, title, claim and/or and interest she has or may have in said retirement, except that Wife shall receive a rollover of $37,274.44 from said Retirement Income Plan pursuant to a Qualified Domestic Relations Order (QDRO), which shall be prepared by counsel for Husband within sixty (60) days of the date of this Agreement. C. The parties recognize that Husband has a pension with the Virginia Retirement System as a result of his employment with the State of Virginia. For the mutual promises and covenants contained in this Agreement, Wife waives all right, title, claim and/or interest she has or may have in said pension. D. The parties recognize that Husband has retirement funds invested in TIAA CREF For the mutual promises and covenants contained in this Agreement, Wife waives all right, title, claim and/or interest she has or may have in this retirement account. E. The parties recognize that Wife has a Retirement Savings Plan for Non-Union Employees as a result of her employment with the Chambersburg Hospital. For the mutual promises and covenants contained in this Agreement. Husband waives all right, title, claim and/or interest he has or may have in said Retirement Savings Plan. 9 F. The parties recognize that Wife has investments with Met Life. For the mutual promises and covenants contained in this Agreement, Husband waives all right, title, claim and/or interest he has or may have in said investments. G. The parties recognize that Wife has 453(b) plan as a result of her employment with Chambersburg Hospital. For the mutual promises and covenants contained in this Agreement, Husband waives all right, title, claim and/or interest he has or may have in said 403(b). 13. REAL ESTATE: The parties are joint owners of real estate located at 102 Hollar Avenue, Shippensburg, Cumberland County, Pennsylvania. Said property is owned in joint names as tenants by the entireties. Said property is encumbered with a mortgage due and owing to GMAC, Account Number 0425626413. Said property is further encumbered with a second mortgage due and owing to GMAC, Account Number 8686270683. From the time of execution of this Agreement forward, Wife shall be solely and exclusively responsible for both the first and second mortgages due and owing to GMAC Account Numbers 0425626413 and 8686270683, and will indemnify Husband and hold him harmless from and against any and all demands for payment or collection activity of any nature whatsoever. In addition, Wife shall list the real estate for sale no later than April 1, 2011. Until such time as the marital residence is sold, Wife shall be solely and exclusively responsible for any and all costs associated with the marital residence, including but not limited to the first and second mortgages, taxes, home owner's insurance, utilities, and she shall further be responsible for all costs associates with the sale of the real estate. At the time the marital residence is sold, she 10 shall retain all proceeds from the sale of the marital residence, and Husband shall execute a deed conveying his interest to the buyer of said real estate. Husband, from time of execution of this agreement forward has no interest in any proceeds from the marital residence that may come due at the sale of the marital residence. Upon execution of this Agreement, Husband shall make no claim of any nature whatsoever relative to any legal or equitable interest in the aforesaid real estate, with the understanding that he will remain on the deed for practical purposes only. Should any monies be necessary to prepare the real estate for sale or upon settlement to close on the sale of the real estate, Wife shall be solely and exclusively responsible for the same. Should Wife be unable to sell the real estate by January 1, 2012, she shall be obligated to refinance the encumbrances on the property in a manner that removes Husband's nwne as a debtor on both of the GMAC mortgages and Wife shall assure Husband that his name did not appears as a creditor or responsible party for any utilities or other expenses associated with maintenance of the aforesaid residence. 14. LIFE INSURANCE: Each party agrees that the other party shall have sole ownership and possession of any life insurance policies owned by the other, with the right to designate a beneficiary as each of the party sees fit for his/her respective policy. Each party agrees to sign any documents necessary to waive, relinquish, or transfer any rights on such policies to the respective party who presently owns such policies. 15. MARITAL DEBT: Each party hereby confirms they have not incurred any additional debt since separation that has in any way obligated the other party. Neither party will take any action to incur 11 additional debt of any nature whatsoever in the other party's name from the date of execution of this Agreement forward. The parties shall each retain any and all debt that is in his or her name respectively and indemnify the other and hold him/her harmless from and against any and all demands for payment or collection activity of any nature whatsoever. Specifically, Wife shall be responsible for her Kohl's, Capital One, and Advanta debts, and Husband shall be responsible for the Capital One debt. 16. DAUGHTER'S COLLEGE SAVINGS: Husband is the custodian for an UTMA account that he holds on behalf of the parties' daughter, Georgia, with MFS Investment Management. Upon Wife showing proof that she contributed to said account during the 2010 calendar year, Husband shall transfer the account such that Wife is the custodian. If Wife cannot show the same, Husband shall retain said account. 17. WARRANTY AS TO FUTURE OBLIGATIONS: Wife and Husband each covenant, warrant, represent and agree that each will now and at all times hereafter save harmless and keep the other indemnified from all debts, charges and liabilities incurred by the other after the execution date of this Agreement, except as may be otherwise specifically provided for by the terms of this Agreement and that neither of them shall hereafter incur any liability whatsoever for which the estate of the other may be liable. 12 18. ALIMONY, ALIMONY PENDENTE LITE, SPOUSAL SUPPORT AND MAINTENANCE: A. Husband hereby waives any right or claims of any nature whatsoever relative to alimony, alimony pendente lite, spousal support, spousal maintenance, counsel fees and expenses against Wife. B. Husband shall pay to Wife non-modifiable alimony in the amount of $441.42 a month, with the alimony obligation to begin on the first day of the first month following the entry of a Divorce Decree, with the alimony pendente lite, hereinafter "APL," obligation currently at PACSES Number 58811082)r ending upon the date the Divorce Decree is entered. The alimony obligation shall end upon the death of either party, wife's cohabitation with a member of the opposite sex, or Wife's remarriage. The alimony obligation shall also end if Wife obtains employment such that she has health insurance available through her employer. C. Husband shall be credited in his alimony for any amount of APL that is paid past the date of the Divorce Decree. Therefore, if APL is paid by the Domestic Relations Office to Wife after the date of the Divorce Decree, the amount shall be deducted from the first alimony payment. For example, if $200.00 is paid to Wife after the date of the Divorce Decree, Husband shall owe to Wife, for the first month, $221.42. D. Husband agrees to pay $441.42 a month, for one year (twelve months), from April 1, 2011, in place of the current APL obligation such that for every month that the APL obligation continues past April 1, 2011, that shall be a month subtracted 13 from the agreed upon twelve months of alimony. Therefore, by way of example, Anj if the divorce is not finalized by -¢M31, 2011, Wife shall receive one less "?- , V month of alimony and if the divorce is not finalized by14-130, 2011, Wife shall 7 receive two less months of alimony. The intention is to pay for twelve months of health insurance for Wife, whether by way of APL, from today's date, or by way of alimony after the divorce is final. 19. DIVORCE: Husband has commenced an action for divorce from Wife pursuant to Section 3301 (c) of the Pennsylvania Divorce Code by the filing of a Divorce Complaint. Each of the parties shall sign an Affidavit of Consent and Waiver of Notice of Intention to Request the Entry of a Divorce Decree at the same time of execution of this Agreement and shall provide the same to counsel for Husband. It is further agreed and understood that any Decree of Divorce issuing in this matter shall reflect the fact that Husband shall bear the cost of same in his individual capacity. A. Each of the parties agree that this Agreement represents a complete and final agreement as to their respective property rights which arose from the marital relation and therefore mutually waive any and all rights they may have under Section 3501 (Equitable Distribution) of the Pennsylvania Code, Act No. 1990- 206. B. This Agreement may be offered in evidence in the action for divorce and may be incorporated by reference in the decree to be granted therein. Notwithstanding such incorporation, this Agreement shall not be merged in the decree, but shall survive the same and shall be binding and conclusive on the parties for all time. 14 20. LEGAL FEES: In the review and preparation of this Agreement, each party shall bear his/her own legal fees. 21. REMEDY FOR BREACH: If either party breaches any provision of this Agreement, the other party shall have the right, at his or her election, either to sue for damages for such breach, in which event the breaching party shall be responsible for payment for reasonable legal fees and costs incurred by the other in enforcing their rights hereunder, or to seek such other remedies or relief as may be available to him or her. 22. EQUITABLE DISTRIBUTION: It is specifically understood and agreed that this Agreement constitutes an equitable distribution of property, both real and personal, which was legally and beneficially acquired by Husband and Wife or either of them during the marriage as contemplated by The Act of December 19, 1990 (P.L. No. 1240, No. 206) known as "The Divorce Code," 23 P.S. 3501 et seq. of the Commonwealth of Pennsylvania, and as amended. 23. SUMMARY OF EFFECT OF AGREEMENT: It is specifically understood and agreed by and between the parties hereto, and each party accepts the provisions herein made in lieu of and in full settlement and satisfaction of any and all of said parties' rights against the other for any past, present and future claims on account of support, maintenance, alimony, alimony pendente lite, counsel fees, costs and expenses, equitable distribution of marital property and any other claims of each party, including all claims raised by them in the divorce action pending between the parties. 15 24. TAX CONSEQUENCES: By this agreement, the parties have intended to effectuate and have equitably divided their marital property. The parties have determined that such equitable division conforms to a right and just standard with regard to the rights of each party. The division of existing marital property is not, except as may be otherwise expressly provided herein, intended by the parties to constitute in any way a sale or exchange of assets and the division is being effected without the introduction of outside funds of other property not constituting a part of the marital estate. 25. MUTUAL COOPERATION/DUTY TO EFFECTUATE AGREEMENT: Each party shall, at any time and from time to time hereafter, take any and all steps and execute, acknowledge, and deliver to the other party any and all further instruments and/or documents that the other party may reasonably require for the purpose of giving full force and effect to the provisions of this Agreement. 26. RECONCILIATION: The parties shall only effect a legal reconciliation which supersedes this agreement by their signed agreement containing a specific statement that they have reconciled and that this agreement shall be null and void; otherwise, this agreement shall remain in full force and effect. Further, the parties may attempt a reconciliation, which action, if not consummated by the aforesaid agreement, shall not affect in any way the legal effect or this agreement or cause any new marital rights or obligations to accrue. 16 27. SEVERABILITY: The parties agree that the separate obligations contained in this Agreement shall be deemed to be interdependent. If any term, clause, or provision of this Agreement shall be determined by a court of competent jurisdiction to be invalid or unenforceable, then the parties agree that the Agreement may be reviewed and renegotiated in order to fulfill as closely as possible the purpose of the invalid provision. Notwithstanding any release contained herein, the parties intend that they may reinstate any and all economic claims to the extent available under the Divorce Code of 1980. Further, any court of competent jurisdiction may, under the equitable provisions and purposes of the Divorce Code, reinstate any economic claim which was available at the time of the parties' separation or avoid any waiver herein contained to renegotiate or effectuate as nearly as possible the purpose of the unenforceable provision. 28. NO WAIVER OF DEFAULT: This Agreement shall remain in full force and effect unless and until terminated under and pursuant to the terms of this Agreement. The failure of either party to insist upon strict performance of any of the provisions of this Agreement shall in no way affect the right of such party hereafter to enforce the same, nor shall the waiver of any breach of any provision hereof be construed as a waiver of any subsequent default of the same or similar nature, nor shall it be construed as a waiver of strict performance of any other obligations herein. 29. INTEGRATION: This Agreement constitutes the entire understanding of the parties and supersedes any and all prior agreements and negotiations between them. There are no representations or warranties other than those expressly set forth herein. This Agreement shall survive integration by any court into any judgment for divorce and shall continue to have independent legal 17 significance as written contract separate from such judgment for divorce and may be enforced as an independent contract. 30. EFFECT OF DIVORCE DECREE: The parties agree that unless otherwise specifically provided herein, this Agreement shall continue in full force and effect after such time as a final decree in divorce may be entered with respect to the parties. 31. NOTICES: Any and all notices given hereunder shall be in writing and shall be sent registered mail, return receipt requested: A. To the Wife, at 102 Hollar Avenue, Shippensburg, Pennsylvania, 17257. B. To the Husband, at 151 Roxbury Road, Newville, Pennsylvania, 17241. 32. WAIVER OR MODIFICATION TO BE IN WRITING: No modification or waiver of any of the terms hereof shall be valid unless in writing and signed by both parties and no waiver of any breach hereof or default hereunder shall be deemed a waiver of any subsequent default of the same or similar nature. 33. CAPTIONS: The captions of this Agreement are inserted only as a matter of convenience and for reference and in no way define, limit or describe the scope and intent of this Agreement, nor in any way effect this Agreement. 1.8 34. AGREEMENT BINDING ON HEIRS: The Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors and assigns. 35. LAW OF PENNSYLVANIA APPLICABLE: This Agreement shall be construed in accordance with the laws of the Commonwealth of Pennsylvania. 36. SUBSEQUENTLY DISCOVERED PROPERTY PENALTY FOR NONDISCLOSURE: Should either of the parties subsequently discover the existence of any marital property not distributed by this Agreement, said property shall be divided in the same proportion as this Agreement's equitable distribution of marital property (50150). However, if the existence of said property was knowingly concealed or its value misrepresented by one of the parties, said property shall be transferred in its entirety to the non-concealing party and the concealing party shall pay all costs, fees, and attorney's fees occasioned by the failure to disclose its existence or true value. IN WITNESS WHEREOF, the parties have set their hands and seals to two counterparts of this Agreement, each of which shall constitute an original, the day and year first above written. Witness:' ?- (Seal) Eric S. Warren IUli?r al) Donna M. War?re'n? 19 COMMONWEALTH OF PENNSYLVANIA ) ) SS. COUNTY OF CUMBERLAND ) On this, the -),) 64-day of RZIAI-t , 2011, before me, a notary public, the undersigned officer, personally appeared Eric S. Warren, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. In Witness Whereof, I hereunto set my hand and notarial seal. Ho" FUNC - Com=soeou9N, CUMeERIAND COUNFIf My C0nMnissWn Expires Apr 17, 2011 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Notar ublic SS. On this, the Jr?ly day of , 2011, before me, a notary public, the undersigned officer, personally appeared Donna M. Warren, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. In Witness Whereof, I hereunto set my hand and notarial seal. Notary Notarial Seal StaoeyA. Shank Notary Public Chambersburg 8ot?s, Prankpn County My Commission Expires Jan. 12, 2012 Member. Penn7yi7-,, a A?,s,aciition of Nat. 20 FILED-OFFICE 14 TNT Pi QTN 0 17 2011 APR 25 AM 8: b "UMB PENNS YL?A OU s ,f, IA ERIC S. WARREN, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. DONNA M. WARREN, Defendant : CIVIL ACTION -LAW NO. 09-2456 CIVIL TERM IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST THE ENTRY OF A DIVORCE DECREE UNDER §3301(c) OF THE DIVORCE CODE 4. I consent to the entry of a final decree in divorce without notice. 5. 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. 6. 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 THE FOREGOING AFFIDAVIT ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS HEREIN ARE MADE SUBJECT TO THE PENALTIES OF 18 Pa.C.S. §4904 RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES. t DATE: DOKKA M. WARREN, Defendant FILED-OFFICE {'Er THE PROTHONOTA t` 2011 APR 25 AM 8: 40 C11 PEP NSYLVAN?' ANT5 ERIC S. WARREN, V. IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA DONNA M. WARREN, Defendant : CIVIL ACTION -LAW NO. 09-2456 CIVIL TERM IN DIVORCE AFFIDAVIT OF CONSENT 4. A Complaint in Divorce under §3301 (c) of the Divorce Code was filed on April 20, 2009, and served April 21, 2009 on Defendant's counsel, Martha B. Walker. Esquire. 5. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 6. 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 THE FOREGOING 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: DONNA M. WARREN, Defendant ERIC S. WARREN IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL DIVISION DONNA M. WARREN NO. 09-2456 CIVIL TERM PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Transmit the record, together with the following information, to the court for entry of a divorce decree: 1. Ground for divorce: rnco 3W Irretrievable breakdown under § (3301(c)) and § (3301(d)(1)) of the Divorce Code. ?r _e U1 (Strike out inapplicable section.) 2. Date and manner of service of the complaint: April 21, 2009 via Acceptance of Service. 3. Complete either paragraph (a) or (b). (a) Date of execution of the affidavit of consent required by § 3301(c) of the Divorce code: by plaintiffApril 12, 2011 ; by defendant April 5, 2011 (b) (1) Date of execution of the affidavit required by § 3301(d) of the Divorce Code: (2) Date of filing and service of the plaintiffs § 3301(d) affidavit upon the respondent opposing party: 4. Related claims pending: 5. Complete either (a) or (b) (a) Date and manner of service of the notice of intention to file praecipe to transmit record, a copy of which is attached: (b) Date plaintiff's Waiver of Notice was filed with the Prothonotary: April 25, 2011 Date defendant's Waiver of Notice was filed with the Prothonotary: April 25, 2011 s* 3 co .c- z? rn r- -0m uZ 2-1 C3_n Attorney f r Plainti fen nt IN THE COURT OF COMMON PLEAS OF ERIC S. WARREN CUMBERLAND COUNTY, PENNSYLVANIA V. DONNA M. WARREN NO. 09-2456 DIVORCE DECREE AND NOW, 2-1 1,011 it is ordered and decreed that ERIC S. WARREN , plaintiff, and DONNA M. WARREN bonds of matrimony. defendant, are divorced from the Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: (If no claims remain indicate "None.") None. The parties' Property and Separation Agreement, dated April 5, 2011, is incorporated herein, but not merged. By the Court, '41a9/?? - dst+. rnarw 40 chi. f WtrmaA - Sngdl w ERIC S. WARREN, Plaintiff/Respondent Vs. DONNA M. WARREN, Defendant/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 09-2456 CIVIL TERM IN DIVORCE PACSES Case No: 588110823 ORDER OF COURT .may ^T9 5 AND NOW to wit, this 3rd day of May, 2011, it is hereby Ordered that the Alimony Pendente Lite order is terminated, effective April 29, 2011, pursuant to the parties' Divorce Decree of April 29, 2011. The Alimony Pendente Lite account is closed with a credit of -$422.15 and will be liquidated by an agreement of the parties. This Order shall become final twenty (20) days after the mailing of the notices of the entry of the Order to the parties unless either party files a written demand with the Office of the Prothonotary for a hearing de novo before the Court. DRO: R.J. Shadday xc: Petitioner Respondent Martha B. Walker, Esq. Hannah Herman Snyder, Esq. Form OE-001 Service Type: M Worker: 21005 BY THE COURT: 1A ERIC S. WARREN, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -LAW DONNA M. WARREN, NO. 09-2456 CIVIL TERM Defendant IN DIVORCE QUALIFIED DOMESTIC RELATIONS ORDER AND NOW, this day of 2011, it is appearing to the Court that: 1. The parties to the Divorce Action. The parties to this action are Eric S. Warren ("Participant") and Donna M. Warren ("Alternate Payee"). 1.1 Participant's name, address, social security number and date of birth are as follows: ; _. Name: Eric S. Warren Cc .rn c U :n-_ -ra r- Address: 151 Roxbury Road -- c? (D Newville PA 17231 _, { t = cr rn , Soc. Sec. No.: xxx-xx-9366 c : CD Date of Birth: August 13, 1970 1.2 Alternate Payee's name, address, social security number and date of birth are as follows: Name: Donna M. Warren Address: 102 Hollar Avenue Shippensburg, PA 17257 Soc. Sec. No.: xxx-xx-7122 Date of Birth: March 30, 1964 The parties were divorced by Order of this Court (a copy attached hereto) on April 29, 2011. The Decree has not been amended. 2. Plan. This Order applies to the City of Alexandria Retirement Income Plan for Deputy Sheriffs & Emergency Rescue Technicians & Fire Marshalls Plan of Eric S. Warren. The administrator responsible for determining whether the Order constitutes a Qualified Domestic Relations Order as described below is the City of Alexandria, Attention Arthur Lynch, Jr., 301 King Street, Suite 1600, Alexandria, Virginia, 22314. 3. Interpretation and Construction of Order. 3.1 The parties intend this Order (the "Order") to constitute a "Qualified Domestic Relations Order," within the meaning of Section 414(p) of the Internal Revenue Code of 1986, as amended (the "Code") and Section 206(d)(3)(B) of the Employee Retirement Income Security Act of 1974, as amended, ("ERISA"). The provisions of this Order shall be administered and interpreted in conformity with Section 414(p) of the Code and Section 206(d)(3)(B) of ERISA. 3.2 Nothing in this order shall be construed to require the Plan to provide: 3.2.1 Any type or form of benefit, or any option, not otherwise provided under the Plan. 3.2.2 Benefits to Alternate Payee (as defined in Paragraph 4) in an amount that exceeds the amount of benefits that the Plan would be required to pay with respect to the Participant. 3.2.3 Benefits to Alternate Payee which are required to be paid to another alternate payee under another order previously determined to be a qualified domestic relations order. IT IS ORDERED, ADJUDGED, AND DECREED as follows: 4. Alternate Payee. This Order creates or recognizes the existence of the right of Alternate Payee (as hereinafter defined) to receive all or a portion of the benefits payable with respect to Participant under the Plan. For purposes of this Order, Alternate Payee is: X 4.1 Former Spouse 5. Amount of Distribution and Form of Distribution to the Alternate Payee. The distribution to Alternate Payee contemplated by this Order shall be made in the amount of $37,274.44 from the aforesaid City of Alexandria Retirement Income Plan for Deputy Sheriffs & Emergency Rescue Technicians & Fire Marshalls of Eric S. Warren. 6. Distribution Date. The distribution to Alternate Payee contemplated by this Order shall be made as soon as administratively practicable following the Company's determination that this Order is a Qualified Domestic Relations Order. 7. Death of Participant or Alternate Payee The death of Participant before all benefits to which Alternate Payee is entitled under this Order have been paid shall not affect the right of Alternate Payee to benefits from the Plan as described in this Order. Should Alternate Payee die before benefits have been distributed to her, Alternate Payee's designated beneficiary shall receive any and all benefits remaining to be paid, with her estate receiving any portion not designated specifically by her. 8. Continuing Jurisdiction. The Court shall retain jurisdiction to amend this Order for the purpose of carrying out the intent of the Parties as reflected in this Order and to establish or maintain the status of the Order as a Qualified Domestic Relations Order. Either party to this Order may apply to the court for such amendment. IT IS INTENDED that this Order shall qualify as a Qualified Domestic Relations Order under the Retirement Equity Act of 1984. The Court retains jurisdiction to amend this Order as might be necessary to establish or maintain its status as a Qualified Domestic Relations Order under the Retirement Equity Act of 1984. By the Court, i Hannak flermcm - 5Nder, EuL j?( o CONSENTED TO: Date:T ? 2 f Date: r19 // / Date: IO11 Date: d Eric S. Warren, Plaintiff 'fie---•; Donna M. Warren, Defendant Hannah Herman-Snyder, Esquir Attorney for Plaintiff o'+?.C __ ", 6 .' / MartB. Walker, Esquire Atto ey for Defendant I verify that the statements made in this Stipulation and Agreement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Date: &A?106 ! Eric S. Warren, Plaintiff I verify that the statements made in this Stipulation and Agreement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Date: ?%iq 1.3 bit Donna M. Warren, Defendant ERIC S. WARREN, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION -LAW DONNA M. WARREN, NO. 09-2456 CIVIL TERM Defendant IN DIVORCE STIPULATION AND AGREEMENT By and between, Eric S. Warren, Plaintiff, and Donna M. Warren, Defendant, WINESSETH: WHEREAS, the parties, intending to be legally bound and waiving their right to be present when this Agreement and Order are presented and signed by the Court, hereby stipulate and agree that the Court may enter the attached Order of Court. IN WITNESS WHEREOF, the parties, intending to be bound by the terms and conditions of this Agreement, execute this Agreement by signing below: S? Hannah Herman-Snyder, Esquir Attorney for Plaintiff i 4A? Mart a B. Walker, Esquire Atto ey for Defendant i 4kic S. Warren, Plaintiff Donna M. Warren, Defendant