HomeMy WebLinkAbout09-4035•
Thomas D. Gould, Esquire
I.D. # 36508
2 East Main Street
Shiremanstown, PA 17011
(717) 731-1461
THOMAS J. STALLSMITH,
PLAINTIFF
v.
ANNETTE M. CREMO,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 0q- 14o35 CiviiTerm
IN DIVORCE
NOTICE TO DEFEND AND CLAIM RIGHTS
YOU HAVE BEEN SUED IN COURT. If you wish to defend against
the claims set forth in the following pages, you must take prompt
action. You are warned that if you fail to do so, the case may
proceed without you and a decree of divorce or annulment may be
entered against you by the Court. A judgment may also be entered
against you for any other claim or relief requested in these papers
by the Plaintiff. You may lose money or property or other rights
important to you, including custody or visitation of your children.
When the ground for is indignities or irretrievable breakdown
of the marriage, you may request marriage counseling. A list of
marriage counselors is available in the Court Administrator's
Office, Third floor, Cumberland County Courthouse, Hanover and High
Streets, Carlisle, Pennsylvania.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY,
LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED,
YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER, 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.
Lawyer Referral Service
Cumberland County Bar Association
32 South Bedford Street
Carlisle, PA 17013
(717) 249-3166
1-800-990-9108
«.
THOMAS J. STALLSMITH,
PLAINTIFF
V.
ANNETTE M. CREMO,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 09- q6 3?
IN DIVORCE
COMPLAINT UNDER SECTION 3301(c) OR
3301(d) OF THE DIVORCE CODE IN DIVORCE
1. The Plaintiff is Thomas J. Stallsmith who currently
resides at 277 Stoner Road, Mechanicsburg, Cumberland County,
Pennsylvania 17055.
2. The Defendant is Annette M. Cremo who currently resides
at 1209 Redwood Hills Circle, Carlisle, Cumberland County,
Pennsylvania 17015.
3. The Plaintiff and Defendant have been bonafide residents
of the Commonwealth of Pennsylvania for at least six months
immediately prior to the filing of this Complaint.
4. The Plaintiff and Defendant were married on March 22,
1997 in Cumberland County, Pennsylvania.
5. There have been no prior actions of divorce or annulment
between the parties in this or any other jurisdiction.
6. The marriage is irretrievably broken.
7. The Defendant is not a member of the Armed Services of
the United States or any of its Allies.
8. The Plaintiff has been advised of the availability of
counseling and that Plaintiff may have the right to request that
the Court require the parties to participate in counseling.
9. Plaintiff requests the court to enter a decree of divorce.
-7 r,?,mw Z. ?yJma
Thomas D. Gould
Attorney for Plaintiff
I.D. # 36508
2 East Main Street
Shiremanstown, PA 17011
(717) 731-1461
VERIFICATION
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 unsworn
falsification to authorities.
Date: 6/) b 104
Thomas J. Stallsmith
NONCE OF AVAILABILITY OF COUNSELING
TO THE WITHIN-NAMED DEFENDANT:
You have been named as the Defendant in a Complaint in a
divorce proceeding filed in the Court of Common Pleas of Cumberland
County. This notice is to advise you that in accordance with
Section 3302(c) of the Divorce Code, you may request that the court
require you and your spouse to attend marriage counseling prior to
a divorce being handed down by the court. A list of professional
marriage counselors is available at the Domestic Relations Office,
13 North Hanover Street, Carlisle, Pennsylvania. You are advised
that this list is kept as a convenience to you and you are not
bound to choose a counselor from this list. All necessary
arrangements and the cost of counseling sessions are to be borne by
you and your spouse.
If you desire to pursue counseling, you must make your request
for counseling within twenty days of the date on which you receive
this notice. Failure to do so will constitute a waiver of your
right to request counseling.
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THOMAS J. STALLSMITH,
Plaintiff
VS.
ANNETTE M. CREMO,
Defendant
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: NO. 09-4035
: CIVIL ACTION - LAW
: IN DIVORCE
NOTICE OF INTENT TO SERVE A SUBPOENA
TO PRODUCE DOCUMENTS AND THINGS
FOR DISCOVERY PURSUANT TO RULE 400911
Respectfully Submitted,
Annette M. Cremo, Defendant, intends to serve a subpoena identical to the one that is
attached to this Notice. You have twenty (20) days from the date listed below in which to file of
record and serve upon the undersigned an objection to the subpoena. If no objection is made, the
subpoena may be served.
Date: 9 1 '3 /
LAW FIRM OF LINDA A. CLOTFELTER
Li da A. Clotfelter, Esquire
?jtorney
I.D. 72963
1 E. Trindle Road, Suite 100
Mechanicsburg, PA 17050
(717) 796-1930 telephone
(717) 796-1933 facsimile
Attorney for Defendant
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
THOMAS J. STALLSMITH,
Plaintiff . File No. 09 - 4035 CIVIL
vs.
ANNETTE M. CREMO,
Defendant
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR DISCOVERY PURSUANT TO RULE 4009.22
TO: BECTON DICKINSON & CO. at 1 Becton Drive, Mail Code 129, Franklin Lakes, NJ 07417-1880
(Name of Person or Entity)
Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the
following documents or things:
Employment records for Thomas J. Stallsmith, ss# xxx-xx-1099, including but not limited to a)
documentation of his compensation including monetary, in-kind and other benefits including dates
of bonuses from 1/2008 to the present, and gross and net bonus amounts. b) copies of detailed
monthly mobile telephone invoices including incoming and outgoing calls paid by the company on
behalf of Mr. Stallsmith from March 22, 1997 through August 31, 2009.
at Linda A. Clotfelter, Esquire 5021 E. Trindle Road, Suite 100, Mechanicsburg, PA 17050
(Address)
You may deliver or mail legible copies of the documents or produce things requested by this
subpoena, together with the certificate of compliance, to the party making this request at the address listed
above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the
things sought.
If you fail to produce the documents or things required by this subpoena within twenty (20) days
after its service, the party serving this subpoena may seek a court order compelling you to comply with it.
THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON:
NAME: LINDA A. CLOTFELTER
ADDRESS: _5021E. TRQJDLE ROAD, SUITE 100
MECHANICSBURG, PA 17050
TELEPHONE: (717)796-1930
SUPREME COURT ID # 72963
ATTORNEY FOR: DEFENDANT
Date:
Seal of the Court
BY THE COURT:
Prothonotary, Civil Division
Deputy
THOMAS J. STALLSMITH,
Plaintiff
VS.
ANNETTE M. CREMO,
Defendant
To: Becton Dickinson & Co.
Custodian of Records
1 Becton Drive
Mail Code 129
Franklin Lakes, NJ 07417-1880
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: NO. 09-4035
: CIVIL ACTION - LAW
: IN DIVORCE
NOTICE
You are required to complete the following Certificate of Compliance when producing
documents or things pursuant to the Subpoena.
CERTIFICATE OF COMPLIANCE WITH SUBPOENA
TO PRODUCE DOCUMENTS OR THINGS PURSUANT TO RULE 4009.23
I,
certify to the best of my knowledge, information
and belief that all documents or things required to be produced pursuant to this subpoena issued
on , 2011, have been produced.
Date:
Becton Dickinson & Co.
Custodian of Records
THOMAS J. STALLSMITH,
Plaintiff
VS.
ANNETTE M. CREMO,
Defendant
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
NO. 09-4035
CIVIL ACTION - LAW
IN DIVORCE
CERTIFICATE OF SERVICE
AND NOW this ?? th day of Ctp, 2011, the undersigned
hereby certifies that a true and correct copy of the foregoing NOTICE OF INTENT TO SERVE
SUBPOENA was served upon the opposing party by way of United States first class mail,
postage prepaid, addressed as follows:
Thomas D. Gould, Esquire
2 East Main Street
Shiremanstown, PA 17011
Respectfully Submitted,
LAW FIRM OF LINDA A. CLOTFELTER
.. ) ?
L A A. CLOTFELTER, ES(
omey I.D. 72963
021 E. Trindle Road, Suite 100
Mechanicsburg, PA 17050
(717) 796-1930 telephone
(717) 796-1933 facsimile
Attorney for Defendant
THOMAS J. STALLSMITH, IN THE COURT OF COMMON PLEAS OF
PLAINTIFF CUMBERLAND COUNTY, PENNSYQ/A99A
W,
V. . f
no -..1 iD
ANNETTE M. CREMO,
DEFENDANT NO. 09-4035 CIVIL ` `T' '
IN RE: PLAINTIFF'S MOTIONS TO COMPEL ANSWERS TO INTERROGATORIES
ORDER OF COURT
AND NOW, this 20th day of September, 2011, upon consideration of the Plaintiff's
Motion to Compel Answers to Interrogatories;
IT IS HEREBY ORDERED AND DIRECTED that:
1. Defendant shall provide the requested discovery on or before October 21,
2011;
2. Should the Defendants fail to provide the discovery pursuant to this Order a
hearing will be held on Tuesday, December 6, 2011, at 8:30 a.m. in Courtroom No. 2 of
the Cumberland County Courthouse, Carlisle, Pennsylvania, to determine if sanctions
should be imposed upon the Defendants to include payment of attorney's fees.
By the Court,
/Thomas D. Gould, Esquire
Attorney for Plaintiff
Linda Clotfelter, Esquire
Attorney for Defendant
M. L. Ebert, Jr., J.
Co
41.°11
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THOMAS J. STALLSMITH, : IN THE COURT OF COMMON PLEAS OF
Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA
C ? r :?
vs. : NO. 2009-4035 rrn -
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ANNETTE M. CREMO, : CIVIL ACTION - LAW w a
Defendant : IN DIVORCE
C? v c?-
ACCEPTANCE OF SERVICE
1, ANNETTE M. CREMO, Defendant in the above-captioned matter, hereby accept
service of the Divorce Complaint Under Section 3301(c) or 3301(d) of the Domestic Relations
Code on this date.
(0/
Date:
A?NkTE M. MO, Defendant
1 09 Re d Hill Circle
C isle. PA 17015
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FILED- Tc F; 01E
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MARITAL SETTLEMENT AGREEMENT-
CUM'DERLAND C"W- 7 Y rif THIS AGREEMENT, made this ?- day of e ?U'Yl i! ' '2011 by
and between THOMAS J. STALLSMITH (hereinafter referred to as Husband), and
ANNETTE M. CREMO (hereinafter referred to as Wife),
WHEREAS, Husband and Wife were married on March 22, 1997 in Cumberland County,
Pennsylvania; and
WHEREAS, one child was born of this marriage, Vanassa T. Stallsmith, born August 14,
1997; and
WHEREAS, diverse, unhappy differences, disputes and difficulties have arisen between
the parties and it is the intention of Husband and Wife to live separate and independent from
each other for the rest of their natural lives, and the parties hereto are desirous of settling fully
and finally their respective financial and property rights and obligations as between each other,
including without limitation by specification: the settling of all matters between them relating to
the ownership and equitable distribution of real and personal property; the settling of all matters
between them relating to past, present and future support and alimony; and in general, the
settling of any and all claims by one against the other or against their respective estates; and
NOW, THEREFORE, in consideration of the premises and of the mutual promises,
covenants and undertakings hereinafter set forth and for other good and valuable consideration.,
receipt of which is hereby acknowledged by each of the parties hereto, Husband and Wife, each
intending to be legally bound, hereby covenant and agree as follows:
1. Separation: It shall be lawful for each party at all times hereafter to live separate
and apart from the other party at such place as he or she may from time to time choose or deem
1
fit. The foregoing provision shall not be taken as an admission on the part of either party of the
lawfulness or unlawfulness of the causes leading to their living apart.
2. Interference: Each party shall be free from interference, authority, and contact by
the other, as fully as if he or she were single and unmarried, except as may be necessary to carry
out the provisions of this Agreement. Nothing in this paragraph shall prevent Husband and Wife
from having contact by their mutual agreement.
3. Subsequent Divorce: The parties acknowledge that Husband has filed a
Complaint in Divorce in Cumberland County, Pennsylvania, docketed to number 2009 - 4035
civil term, claiming that the marriage is irretrievably broken under the no-fault provision of
Section 3301(c) and (d) of the Pennsylvania Divorce Code. The parties hereby waive all rights to
request Court-ordered counseling under the Divorce Code. It is specifically understood and
agreed by the parties that the provisions of this Agreement as to equitable distribution of
property of the parties and alimony, accept as otherwise provided herein, are accepted by each
party as a final settlement for all purposes whatsoever, as contemplated by the Pennsylvania
Divorce Code.
Upon execution of this Agreement, Husband and Wife hereby consent and agree that this
Agreement and all of its covenants shall not be affected in any way by any such separation or
divorce; and that nothing in any future divorce decree, judgment, order or further modification or
revision thereof shall alter, amend or vary any term of this Agreement unless modified in writing
by both parties. It is specifically agreed that a copy of this Agreement will be incorporated by
reference, but not merged, into the Decree in Divorce. It is the specific intent of the parties to
permit this Agreement to survive any decree and to be forever binding and conclusive upon the
parties.
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Husband and Wife agree that each party shall execute an Affidavit of Consent and
Waiver of Notice concurrently with the execution of this Marital Settlement Agreement to be
utilized to obtain a divorce decree that incorporates the terms of this Agreement. Husband's
attorney, upon receipt of the signed documents, shall file them and any other necessary
documents to obtain a Decree in Divorce.
4. Date of Execution: The "date of execution" or "execution date" of this
Agreement shall be defined as the day upon which it is executed by the parties if they have each
executed the agreement on the same date. Otherwise, the "date of execution" or "execution date"
of this Agreement shall be defined as the date of execution by the party last executing this
Agreement.
5. Distribution Date: The transfer of property, funds and/or documents provided for
herein, shall only take place on the "distribution date" which shall be defined as specified herein.
6. 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 time to come, and
for all purposes whatsoever, of and from any and all rights, title and interests, 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 the other, the estate of such other or any part
thereof, whether arising out of any former acts, contracts, agreements or liabilities of such other
or by way of dower or curtesy, or claims in the nature of dower or curtesy or widow's or
widower's rights, family 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,
3
whether arising under the laws of (a) Pennsylvania, (b) any State, Commonwealth or territory of
the United States, or (c) any country, or any rights which either party may have or at any time
hereafter shall have for past, present or future support or maintenance, alimony, alimony
pendente lite, counsel fees, property division, costs or expenses, whether arising as a result of the
marital relations or otherwise, except all rights and obligation of whatsoever nature arising or
which may arise under this Agreement or for the breach of any provisions thereof. It is the
intention of Husband and Wife to give to each other by the execution of this Agreement a full,
complete and general release with respect to any and all property of any kind or nature, real,
personal or mixed, which the other now owns or may hereafter acquire, except and only except
all rights and agreements and obligations of whatsoever nature arising or which may arise under
this Agreement or for the breach of any provision thereof.
It is further agreed that this Agreement shall be and constitute a full and final resolution
of any and all claims which each of the parties may have against the other for equitable division
of property, alimony, counsel fees and expenses, alimony pendente lite or any other claims
pursuant to the Pennsylvania Divorce Code or the divorce laws of any other jurisdiction.
7. Advice of Counsel: The provisions of this Agreement and their legal effect have
been fully explained to Husband by his attorney, THOMAS D. GOULD, ESQUIRE, and to Wife
by her attorney, LINDA A. CLOTFELTER, ESQUIRE.
Husband and Wife acknowledge and accept that this Agreement is, in the circumstances,
fair and equitable and that it is being entered into freely and voluntarily 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.
8. Subsequent Reconciliation: The parties agree that the terms of this Agreement
4
shall not be affected in any way by their subsequent cohabitation or resumption of marital
relations, unless the parties specifically agree otherwise in writing.
9. Warranty as to & "tin Obligations: Each party represents that he or she has not
heretofore incurred or contracted for any debt or liability or obligation for which the estate of the
other party may be responsible or liable except as may be provided for in this Agreement. Each
party agrees to indemnify and hold the other party harmless for and against any and all such
debts, liabilities or obligations of every kind which may have heretofore been incurred by them,
including those for necessities, except for the obligation arising out of this Agreement.
10. Existing Debts: Husband and Wife acknowledge that the following is a complete
list of their debts:
(a) First mortgage secured by the marital residence located at 1209 Redwood Hills
Circle, Carlisle, Cumberland County, Pennsylvania in joint names with a balance of
approximately $203,022.00.
(b) A Home Equity Loan secured by the marital residence located at 1209 Redwood
Hills Circle, Carlisle, Cumberland County, Pennsylvania in joint names has been paid in full by
Wife.
(c) Penn State President's Club membership with a balance due of $10,600.00 as of
August 19, 2009.
(d) Marriott Vacation Club with a balance due of $32,589.00 as of August 29, 2011
payable in monthly installments of $686.02 as well as the annual fee of $3,800.00 that remains
outstanding.
(e) Disney Vacation Club maintenance fees of $164.89 per month remain
outstanding.
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(f) The parties acknowledge that there are no other joint marital debts.
11. Warranty as to Future Oblieations: Husband and Wife each covenant, warrant,
represent and agree that, with the exception of obligations set forth in this Agreement, neither of
them shall hereafter incur any liability whatsoever for which the estate of the other may be liable.
Each party shall indemnify and hold harmless the other party for and against any and 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.
12. Marital Residence and Other Real Property: The parties acknowledge that they
have utilized the real property located at 1209 Redwood Hills Circle, Carlisle, Cumberland
County, Pennsylvania (hereinafter "Marital Residence") as their marital residence.
Wife has made significant contributions of non-marital funds to the value of the Marital
Residence when purchased and in the form of significant renovations. Thus, it is specifically
agreed that Wife shall retain as her sole and separate property the Marital Residence and
Husband shall waive any and all rights he has in same and he shall remove himself from the
homeowners insurance policy.
Wife shall, within ninety (90) days of the date of execution of this Agreement, refinance
the first mortgage on the marital residence so as to remove Husband's name from the liens. It is
acknowledged by the parties that Wife has already paid in full the home equity loan previously
secured by the marital residence. Wife shall be solely and exclusively responsible for any and all
expenses associated with the marital home, including the mortgage, taxes, insurance and
maintenance. Wife further agrees to indemnify Husband and hold him harmless from any and all
liability for same.
Concurrently with the execution of this Agreement, both parties shall execute a deed
6
transferring the marital residence from both parties to Wife's name, alone. The deed shall be
held in escrow by Husband's attorney until such time as Wife obtains a mortgage.
Husband relinquishes any and all rights he may have in Wife's Barnesville, Pennsylvania
real estate.
The parties are the owners of a Disney and three Marriott time shares. Husband agrees to
transfer all of his rights and interests in the time shares to Wife. Due to the nature of the title to
those properties, Husband shall initiate the process for the title transfers. Both parties shall
cooperate fully in effectuating the transfers and the expenses related to the title transfers shall be
shared equally by the parties. In exchange, Wife agrees to be solely responsible for all expenses
related to the subsequent ownership of the time shares and shall indemnify Husband and hold
him harmless from any and all liability related to the time shares. Both parties shall, immediately
upon request, sign any and all documents necessary to effectuate the terms of this provision
regarding the time share real properties.
13. Personal Property: Husband and Wife agree that they have divided all of their
household personal property between themselves to their mutual satisfaction. Husband and Wife
waive their rights to have the personal property appraised. Husband has agreed to allow a few of
his families' heirlooms (black bed, marble top dresser, dough table, antique china cabinet, swivel
rocker, night stand, secretary and two mirrors) to remain at the former marital home for the
benefit of Vanessa. Husband maintains his right to possession of those items and may remove
them in the future upon fifteen (15) days written notice and written consent of Wife as to a time
mutually agreeable to both parties.
Husband shall transfer to Wife all of his right and interest in the liability known as the
Penn State President's Club membership. Due to the nature of the title of the liability, Husband
7
shall initiate the process for the transfer. Both parties shall cooperate fully in effectuating the
transfer and the expenses related to the transfer, if any, shall be Wife's responsibility. In
exchange, Wife agrees to be solely responsible for all expenses related to the subsequent liability
and shall indemnify Husband and hold him harmless from any and all liability related to same.
Both parties shall, immediately upon request, sign any and all documents necessary to effectuate
the terms of this provision regarding the time share real properties.
Neither party shall make any claim to any such item of marital property, or of the
separate personal property of either party, except as provided for in this Agreement. Should it
become necessary, the parties each agree to sign, upon request, any titles or documents necessary
to give effect to this paragraph.
14. Financial Accounts: The parties agree that they have equitably divided any joint
financial accounts. Husband agrees to transfer all of his right and title to the Wachovia account
to Wife. Husband and Wife agree to maintain their separate accounts and each waives any right
or interest they may have in the others.
It is further agreed that the account with Wachovia titled in Wife's name for the benefit
of Vanessa T. Stallsmith and funded by Wife's non-marital funds inherited by Wife shall remain
Wife's separate property.
It is also acknowledged by the parties that a certificate of deposit was established for the
benefit of Vanessa T. Stallsmith using Husband's inherited funds. Although neither party knows
of the location of the account, both parties expressly agree to cooperate fully in locating the asset
and that it shall be deemed to be Vanessa's property.
15. PensionlRetirencent Benefits: The parties acknowledge that Husband has a
pension plan known as the Becton, Dickinson and Company Retirement Plan, through his
8
employer which includes a premarital component. It is also acknowledged that Wife has a SEP
IRA and a Roth IRA through Wachovia Securities that were funded with non-marital funds
inherited by Wife.
Both parties acknowledge that they have shared with the other statements of the accounts
referenced herein. It is the parties' express intent to retain any pensions/retirements in his or her
own respective name and each hereby waives any and all rights in the other parties'
pension/retirement accounts.
16. Waiver of Benefciarv Designations: Unless otherwise specifically set forth in
this Agreement, each party hereto specifically waives any and all beneficiary rights and any and
all rights as a surviving spouse in and to any asset, benefit or like program carrying a beneficiary
designation which belongs to the other party under the terms of this Agreement. The parties by
the terms of this Agreement specifically waive the rights of spouse beneficiaries established by
federal or state statute including ERISA. Each party expressly states that it is his or her intention
to revoke by the terms of this Agreement any beneficiary designations naming the other party
which are in effect as of the date of execution of this Agreement. If the other party continues to
be named as beneficiary and no alternate beneficiary is otherwise designated, the beneficiary
shall be deemed to be the estate of the deceased party. Not withstanding the foregoing, however,
in the event that either party hereto specifically des'gnates the other party as a beneficiary after
the date of execution of this Agreement, then this waiver provision shall not bar that party from
qualifying as such beneficiary.
17. Motor Vehicles: The parties own one vehicle, a 1996 Ford Club Wagon. Husband
has transferred all of his right and interest to the vehicle to Wife and he shall remove himself
from the automobile insurance policy. Wife shall be responsible for all loans, insurance,
9
maintenance or other costs and expenses related to the vehicle. Wife shall indemnify and hold
Husband harmless for any liability related to the vehicle.
18. After Acquired Personal Property: Each of the parties shall hereafter own and
enjoy, independently of any claims or right of the other, all items of personal property, tangible
or intangible, hereafter acquired by him or her, 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.
19. Applicabilitv of Tax Law to Property Transfers: The parties hereby agree and
express their intent that any transfers of property pursuant to this Agreement shall be within the
scope and applicability of the Deficit Reduction Act of 1984 (herein the "Act"), specifically, the
provisions of said Act pertaining to transfers of property between spouses or former spouses.
The parties agree to sign and cause to be filed any elections or other documents required by the
Internal Revenue Service to render the Act applicable to the transfers set forth in this Agreement,
without recognition of gain on such transfer and subject to the carry-over basis provisions of said
Act.
20. Custody. Child Support and other Child-Related Issues: The parties agree that
the issues related to their daughter, Vanessa, shall be resolved as follows:
(a) Child Custody. The issues related to the custody of Vanessa are being addressed
in the Order of Court for Custody entered in a separate civil action docketed to
Cumberland County Civil Docket Number 09-8786.
(b) Child Support. The issues related to the child support of Vanessa are being
addressed in the Order of Court for Child Support entered in a separate civil action
docketed to Cumberland County Domestic Relations Section Docket Number 00556 S
2009 PACSES Case No. 300110986. It is specifically agreed that the child support
matter shall continue to be handled by the Domestic Relations Section and it is further
agreed that the Child Support Order shall be modified by agreement. The modified Child
Support Order to be effective as of the date of execution of this Agreement shall state that
10
the parties shall share equally all out-of-pocket medical expenses incurred for Vanessa T.
Stallsmith without the requirement that the expenses must exceed $250.00 per year.
(c) Educational Expenses. The parties agree to contribute equally to the expenses
associated with the undergraduate college or other post-high school education for their
daughter, Vanessa with each party's obligation being limited to the sum equal to fifty
percent (50%) of the cost of a Pennsylvania state university. Such expenses would
include without limitation, tuition, room and board, lab fees, miscellaneous student fees,
books and student supplies, however, the provisions here in acknowledging the parties
intent shall not in any manner confer third party beneficiary rights unto the child for the
payment of said expenses. If applicable, both parents shall be involved in and have input
into the choice of academic institution selected by the child. Further, the child will be
required to apply for and use all possible grants, scholarships, and work study programs
and any of their own income or assets before the parties are responsible to contribute to
his or her college expenses.
21. Bankruptcy or Reorganization Proceedings: In the event that either party
becomes a debtor in any bankruptcy or financial reorganization proceedings of any kind while
any obligations remain to be performed by that party for the benefit of the other party pursuant to
the provisions of this Agreement, the debtor spouse hereby waives, releases and relinquishes any
right to claim any exemption (whether granted under claim made pursuant hereto by the creditor-
spouse as set forth herein, including all attorney fees and costs incurred in the enforcement of
this paragraph or any other provision of this Agreement. No obligation created by this
Agreement shall be discharged or dischargeable, regardless of Federal or State law to the
contrary, and each party waives any and all right to assert that obligation hereunder is discharged
or dischargeable.
The parties mutually agree that in the event of bankruptcy or financial reorganization
proceedings by either party in the future, any monies to be paid to the other party, or to a third
party for the benefit of the other party, pursuant to the terms of this Agreement shall constitute
support and maintenance and shall not be discharged in bankruptcy.
11
22. Spousal Support, Alimony Pendente Lite. Alimony, and Counsel Fees, Costs
and Expenses:
a. Spousal Support and Alimony Pendente Lite - It is the intent of the parties that
the spousal support sum of Eight Hundred Thirty One Dollars ($831.00) per month shall
continue to be paid to Wife as spousal support until the parties' Divorce Decree is
entered, at which time the alimony payments from Husband to Wife shall commence.
b. Alimony - The parties expressly agree that beginning the first month following
the date of the divorce decree of the parties and continuing for a period of sixty (60)
months thereafter, Husband shall pay to Wife alimony in the amount of $450.00 per
month through the Domestic Relations Section. The alimony payment to Wife shall be
due and payable upon the same terms and/or frequency as the child support payment and
shall continue to be made without delay. The alimony shall terminate in the event of
either party's death, Wife's remarriage, or Wife's cohabitation. Cohabitation shall be
defined as Wife residing with a person of the opposite sex for more than two (2)
consecutive overnights.
C. Waiver of Alimony: Husband and Wife acknowledge that by this Agreement
they have respectively secured and maintained adequate funds to provide sufficient for
their comfort, maintenance and support. With the exception of the provisions herein
addressing Husband's alimony payments to Wife, the parties hereby waive, release and
give up any additional rights they may respectively have against the other for alimony.
d. Counsel Fees, Costs and Expenses: Each party shall be solely responsible for
the counsel fees, costs, and expenses incurred by him or her without contribution from
the other party.
23. Full Disclosure: Husband and Wife each acknowledge that he/she was advised
of his/her right to full and complete disclosure by the other of all assets in which the other party
has an interest. Each party had the opportunity to request information and receive copies of any
documents requested relevant to the content of this Agreement. Husband and Wife acknowledge
that she/he has been provided with any documents or information that she/he believes to be
important or material to decision-making regarding the content of this Agreement.
24. Disclosure and Waiver of Procedural Rights: Each party understands that he or
she has the right to obtain from the other party a complete inventory or list of all of the property
that either or both parties own at this time or owned as of the date of separation, and that each
12
party has the right to have all such property valued by means of appraisals or otherwise. Both
parties understand that they have the right to have the Court hold hearings and make decisions on
the matters covered by this Agreement. Both parties understand that a Court decision concerning
the parties' respective rights and obligations might be different from the provisions of this
Agreement. Both parties waive the following procedural rights:
(a) The right to obtain an Inventory and Appraisement of all marital and
separate property as defined by the Pennsylvania Divorce Code;
(b) The right to obtain an Income and Expense Statement of the other party as
provided by the Pennsylvania Divorce Code;
(c) The right to have the Court determine which property is marital and which
is non-marital and equitably distribute between the parties that property
which the Court determines to be marital;
(d) The right to have the Court decide any other rights, remedies, privileges,
or obligations covered by this Agreement, including but not limited to,
possible claims for divorce, spousal support, alimony, alimony pendente
lite, counsel fees, costs and expenses.
25. Health Insurance: The parties acknowledge that as of the date of the Divorce
Decree they each will provide their own health insurance coverage. Husband shall continue to
provide health insurance for Vanessa and the parties agree that any co-pays, deductibles, and
other unreimbursed medical expenses shall be shared equally as per Paragraph 20(b), above.
26. 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.
27. Mutual Cooperation: 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 a
reasonably require for the purpose of giving full force and effect to the provisions of this
13
Agreement.
28. Anolicable Law: This Agreement shall be construed in accordance with the laws
of the Commonwealth of Pennsylvania which are in effect as of the date of execution of this
Agreement.
29. Agreement Binding on Heirs: This Agreement shall be binding and shall inure to
the benefits of the parties hereto and their respective heirs, executors, administrators, successors
and assigns.
30. 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.
31. Other Documentation: Husband and Wife covenant and agree that they will
forthwith execute any and all written instruments, assignments, releases, satisfactions, deeds,
notes or such other writings as may be necessary or desirable for the proper effectuation of this
Agreement.
32. No Waiver on 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
default or breach of any provisions hereof be construed as a waiver of any subsequent default or
breach of the same or similar nature, nor shall it be construed as a waiver of strict performance of
any other obligations herein.
33. Severability: If any term, condition, clause or provision of this Agreement shall
be determined or declared to be void or invalid in law or otherwise, then only that term,
14
condition, clause or provision shall be stricken from this Agreement and in all other respects this
Agreement shall be valid and continue in full force, effect and operation. Likewise, the failure of
any party to meet his or her obligation under any one or more of the paragraphs herein, with the
exception of the satisfaction of the conditions precedent, shall in no way void or alter the
remaining obligations of the parties.
34. Enforcement of Agreement: If either party believes that the other party has
breached any provision of this Agreement, the parties agree to return to the Collaborative Law
Process or seek mediation to resolve the issue. If the parties are unable to resolve the issues
through the Collaborative Law Process or mediation, a party shall have the right at his or her
election; to sue for damages for such breach or seek such other remedies or relief as may be
available to him or her. The party breaching this contract shall be responsible for payment of
reasonable legal fees and costs incurred by the other in enforcing their rights under this
agreement.
35. Headings Not Part of Agreement: Any heading preceding the text of the several
paragraphs and subparagraphs hereof are inserted solely for convenience of reference and shall
not constitute a part of this Agreement nor shall they affect its meaning, construction or effect.
IN WITNESS WHEREOF, the parties hereto have set their hands and seals this day and
year first above written.
WITNESS
TNESS
15
l
THOMAS J. S LSMITH
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
On this ?' '4
day of %1tt7-e02d, h 2011, before me, the undersigned
officer, personally appeared ANNETTE M. CREMO, known to me (or satisfactorily proven) to
be the person whose name is subscribed to the within Agreement, and acknowledged that she
executed the same for the purposes therein contained.
Q01?ONWEALTH OF PEMSYLVAM
Unds A. Clotklter, Notary Public
Hltmpden Twp, Cumbedi k! County
commission expba June 21, 2014
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
On this ? day of S C, P T-.
2011, before me, the undersigned
officer, personally appeared THOMAS J. STALLSMITH, known to me (or satisfactorily
proven) to be the person whose name is subscribed to the within Agreement, and acknowledged
that he executed the same for the purposes therein contained.
COMMONWEALTH F PENNSYLVANIA
NOTARIAL SEAL
GINA LIBALDI, Notary Public
Camp Hill Boro, Cumberland County
My Commission Expires February 12, 2014
Notary Public
N tar4ublic
16
THOMAS J. STALLSMITH,
Plaintiff
VS.
ANNETTE M. CREMO,
Defendant
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 20094035 cn
= M
-0
-am
:CIVIL ACTION - LAW> °
IN DIVORCE { C -n
?• c, -y
Fi
c?
Y
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on
June 16, 2009.
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.
4. I understand that I may lose rights concerning alimony, division of property,
lawyer's fees and expenses if I do not claim them before a divorce is granted.
I verify that the statements made in this Affidavit are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to
unsworn falsification to authorities.
Date: /Z 11 1 1
THOMAS J. STALLSMITH, Plaintiff
THOMAS J. STALLSMITH,
Plaintiff
VS.
ANNETTE M. CREMO,
Defendant
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2009-4035
CIVIL ACTION - LAW
IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO
REQUEST ENTRY OF A DIVORCE DECREE
UNDER & 3301 (C) OF THE DIVORCE CODE
1.
2
I consent to the entry of a final decree of divorce without notice.
WM?
I understand that I may lose rights concerning alimony, division of property,
lawyer's fees or expenses if I do not claim them before a divorce is granted.
3. I understand that I will not be divorced until a divorce decree is entered by the
Court and that a copy of the decree will be sent to me immediately after it is filed with the
Prothonotary.
I verify that the statements made in this affidavit are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to
unworn falsification to authorities.
Date: 9' 2i f 1 l I ?- -f-A *
THOMAS J. STALLSMITH, Plaintiff
THOMAS J. STALLSMITH, : IN THE COURT OF COMMON PLEAS OF
Plaintiff : CUMBERLAND COUNTY, PENNSYL.VAA
VS. : NO. 2009-4035 :r m r` rl
-v
-u
. =;0
£1' m
ANNETTE M. CREMO : CIVIL ACTION - LAW
t C) S
Defendant : IN DIVORCE --"'
=- E'1
AFFIDAVIT OF CONSENT
A Complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on
June 16, 2009.
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.
4. I understand that I may lose rights concerning alimony, division of property,
lawyer's fees and expenses if I do not claim them before a divorce is granted.
I verify that the statements made in this Affidavit are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to
unsworn falsification to authorities.
Date: WC REMO, Defendant
THOMAS J. STALLSMITH, : IN THE COURT OF COMMON PLEAS OF
Plaintiff : CUMBERLAND COUNTY, PENNSYLVANI A
VS. : NO. 2009-4035 ..
MW
r M
ANNETTE M. CREMO,
: CIVIL ACTION - LAW
'
r- n
r
-b
?
,a
Defendant : IN DIVORCE W o
pry a ??.
WAIVER OF NOTICE OF INTENTION TO
REQUEST ENTRY OF A DIVORCE DECREE =.,
UNDER § 3301 (C) OF THE DIVORCE CODE
1. I consent to the entry of a final decree of divorce without notice.
2. I understand that I may lose rights concerning alimony, division of property,
lawyer's fees or expenses if I do not claim them before a divorce is granted.
3. I understand that I will not be divorced until a divorce decree is entered by the
Court and that a copy of the decree will be sent to me immediately after it is filed with the
Prothonotary.
I verify that the statements made in this affidavit are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to
unsworn falsification to authorities.
Date: C1 /2.--si t f
A E" M. CREMO, Defendant
THOMAS 1 STALLSMITH, : IN THE COURT OF COMMON P S -
Plaintiff : CUMBERLAND COUNTY, PEN1,V1 IAi,`r_°
VS. : NO. 2009-4035
ANNETTE M. CREMO, : CIVIL ACTION - LAW
Defendant : IN DIVORCE -
PRAECIPE TO TRANSMIT RECORD
TO THE PROTHONOTARY:
Kindly transmit the record, together with the following information, to the Court for entry of
a divorce decree:
1. The ground for divorce is irretrievable breakdown under Section 3301 (c) of the
Divorce Code.
2. The Complaint was filed on June 16, 2009.
3. Date and manner of Service of the Complaint: June 30, 2009, by Acceptance of
Service of Defendant as per the same filed on September 23, 2011.
4. The Plaintiff s Affidavit of Consent was executed by the Plaintiff on September 21,
2011 and filed on September 23, 2011. The Defendant's Affidavit of Consent was executed on
September 23, 2011, and filed on September 23, 2011.
5. Plaintiff executed a Waiver of Notice of Intention to Request Entry of a Divorce
Decree under 3301 (c) of the Divorce Code on September 21, 2011, and said waiver was filed on
September 23, 2011. Defendant executed a Waiver of Notice of Intention to Request Entry of a
Divorce Decree under 3301 (c) of the Divorce Code on September 23, 2011, and said waiver was
filed on September 23, 2011.
6. There are no related claims pending. The parties have resolved the economic issues
by written Marital Settlement Agreement dated September 23, 2011, which shall be incorporated, but
not merged into the parties' Divorce Decree per Paragraph 3 on Page 2 of the Agreement.
Respectfully submitted,
Date: J 1A0 !
LAW FIRM OF LINDA A. CLOTFELTER
y:
Li da A. Clotfelter, Esquire
torney I.D. No. 72963
5021 East Trindle Road, Suite 100
Mechanicsburg, PA 17050
(717) 796-1930 telephone
(717) 796-1933 facsimile
c
INCOME WITHHOLDING FOR SUPPORT
O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT(IWO) 3 ' I L1of 1.0 I 1
O AMENDED IWO
O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT Cis to S C-)9
(E) TERMINATION OF iWO ate: 11/22/13
❑ Child Support Enforcement(CSE)Agency N Court ❑ Attorney ❑ Private Individual/Entity(Check One)
NOTE:This IWO must be regular on its face.Under certain circumstances you must reject this IWO and return it to the sender(see IWO
instructions http://www.acf.hhs.aov/programs/cselforms/OMB-0970-0154 instructions Ddf). If you receive this document from someone
other than a State or Tribal CSE agency or a Court,a copy of the underlying order must be attached.
Staterrdbe/Territory Commonwealth of Pennsylvania Remittance Identifier(include w/payment): 8938102144
City/County/Dist.rrribe CUMBERLAND Order Identifier: (See Addendum for orderldocket information)
Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary)
RE: STALLSMITH,THOMAS J.
BECTON, DICKINSON AND COMPANY Employee/Obligor's Name(Last,First,Middle)
.,. ....�.....�.....,..,_....-.._..��..�,.,� 191-44-1099
Sent Electronically Employee/Obligor's Social Security Number
D O NOT MAIL � (See Addendum for plaintiff names
associated with cases on attachment)
Custodial Party/Obligee's Name(Last,First,
Middle)
Employer/Income Withholder's FEIN 220760120 NOTE:This IWO must be regular on its face.
Under certain circumstances you must reject
Child(ren)'s Name(s)(Last,First,Middle) Child(ren)'s Birth Date(s) this iWO and return it to the sender(see IWO
instructions
httl2://www.acf.hhs.00v/proarams/cse/forms
OMB-0970-0154 instructians.pt).If you
receive this document from someone other
than a State or Tribal CSE agency or a Court,a
copy of the underlying order must be attached.
2207601200
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMATION: This document is based on the support or withholding order from CUMB,EaAI Coui7y,
Commonwealth of Pennsylvania (StatetTribe). You are required by law to deduct these amounts Pgthe*mpinpee/
obligor's income until further notice.
$ 0.00 per month in current child support � �
s ci ,,;
$ 0.00 per month in past-due child support-Arrears 12 weeks or greater? O y ~', no - .y`•
$ 0.00 permonth in current cash medical support c-s '
ZZ
$ 0.00 per month in past-due cash medical support `-' -_'
$ 0,00 permonth in current spousal support
$ 0.00 per month in past-due spousal support
$ 0.00 per month in other(must specify)
for a Total Amount to Withhold of$ 0.00 per month.
AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information.
If your pay cycle does not match the ordered payment cycle, withhold one of the following amount:
$ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period(twice a month)
$ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period.
$ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.
REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth
of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (1 0)
working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If
you cannot withhold the full amount of support for any or all orders for this employee/obligor,withhold up to 55% of
disposable income for all orders. If the employee/obligor's principal place of employment is not within the
Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements,
and any allowable employer fees at http://www.acf.hhs.gov/procirams/cse/newhire/employer/contacts/contact map
htm for the employee/obligor's principal place of employment.
Document Tracking Identifier
OMB No.:0970-0154 Form EN-428 11/13
Service Type M Worker ID $IATT
* 3
❑ Return to Sender[Completed by Employer/Income Withholder]. Payment must be directed to an SDU in
accordance with 42 USC§666(b)(5)and (b)(6)or Tribal Payee(see Payments to SDU below). If payment is not
directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to
the sender.
Signature of Judge/Issuing Official (if required by State or Tribal law): KEVIN A HESS
Print Name of Judge/Issuing Official:
Title of Judge/Issuing Official:
Date of Signature: NOVEMBER 22 2013
if the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order,a copy of this IWO
must be provided to the employee/obligor.
❑ If checked,the employer/income withholder must provide a copy of this form to the employee/obligor.
ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS
Pennsylvania law(23 PA C.S.§4374(b))requires remittance by an electronic payment method if an employer is ordered
to withhold income from more than one employee and employs 15 or more persons,or if an employer has a history of
two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and
Disbursement Unit(PA SCDU)Employer Customer Service at 1-877-676-9580 for instructions.PA FIPS CODE 42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION,PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID(shown above as
the EmployeelObligor's Case Identifier)OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT
SEND CASH BY MAIL.
State-specific contact and withholding information can be found on the Federal Employer Services website located at:
httrr//www acf hhs aov/proarams/cse/newhire/employer/contacts/contact map.ht
Priority: Withholding for support has priority over any other legal process under State law against the same income(USC 42
§666(b)(7)). If a Federal tax levy is in effect, please notify the sender.
Combining Payments: When remitting payments to an SDU or Tribal CSE agency,you may combine withheld amounts from
more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/
obligor's portion of the payment.
Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a
Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU(e.g.,payable to the custodial
party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent
by a Court,Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was
issued by a Tribal CSE agency,you must follow the"Remit payment to"instructions on this form.
Reporting the Pay Date: You must report the pay date when sending the payment.The pay date is the date on which the
amount was withheld from the employee/obligor's wages.You must comply with the law of the State(or Tribal law if
applicable)of the employee/obligor's principal place of employment regarding time periods within which you must implement
the withholding and forward the support payments.
Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to
Federal, State,or Tribal withholding limits,you must honor all IWOs to the greatest extent possible,giving priority to current
support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal
place of employment to determine the appropriate allocation method.
Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this
employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to
report and/or withhold lump sum payments.
Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the
employee/obligor's income as the IWO directs,you are liable for both the accumulated amount you should have withheld and
any penalties set by State or Tribal law/procedure.
Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO.
OMB Expiration Date-05/31/2014.The OMB Expiration Date has no bearing on the termination date of the IWO;it identifies the version of the form currently in use.
Form EN-42811/13
Service Type M Page 2 of 3 Worker ID$IATT
Employer's Name: BECTON DICKINSON AND COMPANY Employer FEIN: 220760120
Employee/Obligor's Name: STALLSMITH THOMAS J. 8938102144
CSE Agency Case Identifier:(See Addendum for case summary) Order Identifier:(See Addendum for ordeddocket information)
Withholding Limits:You may not withhold more than the lesser of. 1)the amounts allowed by the Federal Consumer Credit Protection
Act(CCPA)(15 U.S.C. 1673(b));or 2)the amounts allowed by the State or Tribe of the employee/obligor's principal place of
employment(see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such
as:State, Federal, local taxes;Social Security taxes; statutory pension contributions; and Medicare taxes.The Federal limit is 50%of
the disposable income if the obligor is supporting another family and 60%of the disposable income if the obligor is not supporting
another family. However,those limits increase 5%-to 55%and 65%-if the arrears are greater than 12 weeks. If permitted by the State
or Tribe,you may deduct a fee for administrative costs.The combined support amount and fee may not exceed the limit indicated in
this section.
For Tribal orders,you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income
withholders who receive a State IWO,you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which
the employer/income withholder is located or the maximum amount permitted under section 303(d)of the CCPA(15 U.S.C. 1673(b)).
Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in
determining disposable income and applying appropriate withholding limits.
Arrears greater than 12 weeks?If the Order Information does not indicate that the arrears are greater than 12 weeks,then the
Employer should calculate the CCPA limit using the lower percentage.
Additional Information:
NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are
no longer withholding income for this employee/obligor,an employer must promptly notify the CSE agency and/or the sender by
retuming this form to the address listed in the Contact Information below: 2207601200
Q This person has never worked for this employer nor received periodic income.
0 This person no longer works for this employer nor receives periodic income.
Please provide the following information for the employee/obligor:
Termination date: Last known phone number:
Last known address:
Final Payment Date To SDU/Tribal Payee: Final Payment Amount:
New Employer's Name:
New Employer's Address:
CONTACT INFORMATION:
To Employer/income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT(issuer name)
by phone at(.717)240-6225, by fax at(717)240-6248, by email or website at:www.childsupport.state.pa.us.
Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST.
P.O. BOX 320,CARLISLE, PA. 17013(Issuer address).
To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT(Issuer name)
by phone at(717)240-6225, by fax at(.717)240-6248, by email or website at www.childsupport.state.pa.us.
IMPORTANT:The person completing this form is advised that the information may be shared with the employee/obligor.
OMB No.:0970-0154 Form EN-428 11/13
Service Type M Page 3 of 3 Worker ID$IATT
ADDENDUM
Summary of Cases on Attachment
Defendant/O bl Igor: STALLSMITH, THOMAS J.
PACSES Case Number 300110986 PACSES Case Number 619112796
Plaintiff Name Plaintiff Name
ANNETTE M. CREMO ANNETTE M. CREMO
Docket Attachment Amount Docket Attachment Amount
00556 S 2009 $ 0.00 09-4035 CIVIL $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
VANESSA T.STALLSMITH 08/14/97
PACSES Case Number PACSES Case Number
Plaintiff Name Plaintiff Name
Docke Attachment Amount Docket Attachment Amount
$ 0.00 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
PACSES Case Number PACSES Case Number
Plaintiff Name Plaintiff Name
Docket Attachment Amount Docket Attachment Amount
$ 0.00 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
Addendum Form EN-428 11/13
Service Type M OMB No.:0970-0154 Worker ID $IATT
In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
13 N.HANOVER ST,P.O.BOX 320,CARLISLE,PA.17013
Defendant Name: THOMAS J. STALLSMITH
Member ID Number: 8938102144
Please note:All correspondence must include the Member ID Number.
ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION,BNITS-,
f- ri
r r—
. C ) '�f
Financial Break Down of Multiple Cases on Attachment �,r)r— P?�..
PACSES Docket r—
Plaintiff Name Case Number Number Attachment Amc,VcrequEticy T
ANNETTE M.CREMO 300110986 00556 S 2009 785 ONii s TT
ANNETTE M.CREMO 619112796 09-4035 CIVIL 450. `MO -4r'
TOTAL ATTACHMENT AMOUNT: $ 1,235.00
Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment
Compensation Benefits (OUCB), is hereby directed to attach the lesser of$284.22 per week, or 50%, of
the Unemployment Compensation benefits otherwise payable to the Defendant,
THOMAS J. STALLSMITH Social Security Number XXX-XX-1099, Member ID Number 8938102144.
OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall
forward the amount received from OUCB to the Domestic Relations Section of this Court for support
and/or support arrearages.
If the Defendant's Unemployment Compensation benefits are attached by another Court or
Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so
that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to
15 U.S.C. § 1673 (b)(2)and 23 Pa. C.S.A. §4348 (g).
This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall
remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the
Application for Benefits dated DECEMBER 8, 2013 is exhausted, expired or deferred.
OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this
Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations
Section of this Court.
BY THE COURT -
\IINVA1ASNN]d
Date of Order: DEC 1 $k 2O a GNV1 Jj3 f3
:Z kid el 330 Edward E. Guido JUDGE
xf ( O M- .08d w Form EN-530
Service Type M Worker ID $IATT
INCOME WITHHOLDING FOR SUPPORT
6y ORIGINAL INCOME WIThHOLDING ORDERINOTICE FOR SUPPORT (IWO)
O AMswosoxwo
O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT
O TERMINATION OF IWO
09 -1-1-036 /!>NA
Date: 07/11/14
O Child Support EnforcemeE) Agency [8] Court 0 Attorney 0 Private Individual/Entity (Check One)
NOTE: This IWO must be regular on its faUnder certain circumstances ust reject this IWO and return it to the sender (see IWO
instructions htW://wwwecf.hhn rmo0MB-0970-01 cti.pdf).|fynureoeivethindocument from someone
other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached.
StatefTribefTerritory Commonwealth of Pennsylvania
CUMBERLAND
Private Individual/Entity
Remittance Identifier (include w/payment): 8938102144
Order Identifier: (See Addendum for order/docket information)
CSE Agency Case Identifier: (See Addendum for case summary)
BECTON, DICKINSON AND COMPANY
Sent Electronically
DO NOT MAIL
Employer/Income vMthholder'sFEIN 22O7OO12O
Child(ren)'s Name(s) (Last, First, Middle)
C»U (em)'xEUnhOate(s)
RE: STALLSMITH, THOMAS J.
Empoyee/ObIigors Name (Last, First, Middle)
191-44-1099
Employee/Obligors Social Security Number
(See Addendum for plaintiff names
assoclated with cases on attachment)
Custodial Party/Obligee's Name (Last, First,
Middle)
NOTE: This IWO must be regular on its face.
Under certain ci
(his IWO and rotum it to the sender (see IWO
instructions
OMB -0970-0154 instructions,p1). If you
receive this document from someone other
than a State or Tribal CSE agency or a Court, a
copy of the uriderlying order must be attached.
2207601200
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMATION: This document is based on the support or wthhoIding order from CUMBERLAND County,
Commonwealth of Pennsylvania (Statefrribe). You are required by law to deduct these amounts from the employee/
obligors income until further notice.
� 785.00 per month in current child support
�
0.00 per month in current cash medicasupport
0.00 per month in past -due cash medical support
450.00 per month in current spousal ..
s
0.00 per month in past -due spousasupport
� 0.00 per month in other (must specify) un'
fovaTota|AnmmuntbmWithhxld of $ 1.235.00 per month.
AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the
\fyour pay cycle does not match the ordered payment cycle, vvithhm|done ofthe foUowingomount�=`- t>z) `
� 284.22per weekly pay period. u 817.5Dper semimonthly pay per(bd(tvildaa;nonth)
� 568.44 per biweeky pay period (every two weeks) $ 1.335.0Oper monthly pay period.
Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.
REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth
of Pennsylvania /8tate/Tribe\, you must begin withholding no later than the first pay period that occurs ten (10)
working days after the date of this Order/Notice. Send payment within seven (7) working days of the pay date. If
you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of
disposable income for all orders. If the employee/obligors principal place of employment is not within the
Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding |imitaUono. time pequinaments,
and any allowable employer fees at http:/kmwvw.onf.hhu.gov/prognoms/cme/nevvhin*/emp|oyer/oontaotn/ountact_nap.
Ptrn for the employee/obligor's principal place of employment.
Document Tracking Identifier
Service Type M
OMB No.: 0970-0154
Form EN -428 11/13
Worker |OS|/\TT
❑ Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in
accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not
directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to
the sender.
Signature of Judge/Issuing Official (if required by State or Tribal law): KEVIN A HESS
Print Name of Judge/Issuing Official:
Title of Judge/Issuing Official:
Date of Signature: JULY 11, 2014
If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO
must be provided to the employee/obligor.
0 If checked, the employer/income withholder must provide a copy of this form to the employee/obligor.
ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered
to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of
two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and
Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as
the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT
SEND CASH BY MAIL.
State -specific contact and withholding information can be found on the Federal Employer Services website located at:
http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact mao htm
Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42
§666(b)(7)). If a Federal tax levy is in effect, please notify the sender.
Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from
more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/
Obligor's portion of the payment.
Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a
Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial
party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent
by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was
issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form.
Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the
arhount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if
applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement
the withholding and forward the support payments.
Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to
Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current
support before payment of any past -due support. Follow the State or Tribal law/procedure of the employee/obligor's principal
place of employment to determine the appropriate allocation method.
Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this
employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to
report and/or withhold lump sum payments.
Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the
employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and
any penalties set by State or Tribal law/procedure.
Anti -discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO.
OMB Expiration Date — 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO: it identifies the version of the form currently in use.
Form EN -428 11/13
Service Type M Page 2 of 3 Worker ID $IATT
Employer's Name: BECTON, DICKINSON AND COMPANY Employer FEIN: 220760120
Employee/Ob|igo/aNmmo: STALLSMJTH, THOMAS J.
8938102144
CSE Agency Case Identifier: (See Addendum for case summary) Order identifier: (See Addendum for order/docket information)
Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection
Act (CCPA)(15U.S.C.1073(b));or2)the amounts allowed bythe State nrTribe of the empoyee/obIigors principal pace of
employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such
as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of
the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting
another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State
or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in
this section.
For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribat
withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which
the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)).
Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in
determining disposable income and applying appropriate withholding Iimits.
Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the
Employer should calculate the CCPA limit using the lower percentage.
Additional Information:
NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If worked for you or you are
no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by
returning this form to the address listed in the Contact Information below: 2207601200
(] This person has never worked for this employer nor received periodic income.
[} This person no longer works for this employer nor recoives periodic income.
Please provide the foliowing information for the employee/obligor:
Termination date: Last known phone number:
Last known address:
Final PaymenDate To SDU/TribaI Payee: Final Payment Amount:
New Employer's Name:
New Employer's Address:
CONTACT INFORMATION:
To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name)
by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.ch.po.ms.
Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST
P.O. BOX 320. CARLISLE. PA. 17013 (Issuer address).
To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name)
by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at www.childsuoport.state.pa.us.
‘/IPORTANT: The person completing this form is advised that the information may be shared with the employee/obligOr.
Service Type M
OMB No.: 0970-0154
Page 3 of 3
Form EN -428 11/13
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: STALLSMITH, THOMAS J.
PACSES Case Number 300110986 PACSES Case Number 619112796
Plaintiff Name
ANNETTE M. CREMO
Plaintiff Name
ANNETTE M. CREMO
Docket Attachment Amount Docket Attachment Amount
00556 S 2009 $ 785.00 09-4035 CIVIL $ 450.00
Child(ren)'s Name(s):
VANESSA T. STALLSMITH
DOB Child(ren)'s Name(s): DOB
08/14/97
PACSES Case Number PACSES Case Number
Plaintiff Name Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
Service Type M
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
Addendum
OMB No.: 0970-0154
Form EN -428 11/13
Worker ID $IATT
A
INCOME WITHHOLDING FOR SUPPORT
O ORIGINAL INCOME WITHHOLOING ORDER/NOTICE FOR SUPPORT(IWO)��/l/l ///)C��/
�AMox�omm ~�- ''~ '-
��
- • oms�M�no��O�eF�mm=SUM ���r �57,
Cn TERMINATION OF IWO
24. /9 //279�
Date: 07v14/14
O Child Support Enforcement (CSE)*gency� ��� O��� O p��|nuw�o�m�(C����
NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO
instructions http:6/wxmvacf.hhs ,mu/OM8'0870-0154 instructions.pdf). If you receive this document from someone
other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached.
StaterTriberTerritory Commonwealth of Pennsylvania
CUMBERLAND
Private Individual/Entity
Remittance Identifier (include ~/payment): 8938102144
Order Identifier: (See Addendum for order/docket informaf!on)
CSE Agency Case Identifier: (See Addendum for case summary)
BECTON, DICKINSON AND COMPANY
Sent ��U��v=������^��%�UU��
~~^`-`~~^~-^^^`~~~^^�r
DO NOT MAIL
Employer/Income Withholder's FEIN 220760120
Child(em)'o Name(s) (Last, Fimt, Middle) ChiId(ren)s Birth Date(s)
RE: STALLSMITH, THOMAS J.
Employee/Obligor's Name (Last, First, Middle)
191'44`1099
Emp|oyoo*]b|igu/aSocial Security Number
(See Addendum for plaintiff names
associated with cases onattachment)
Custodial Party/Obligee's Name (Last, First,
NOTE: This IWO must be regular on its face.
Under certain circumstamust
this |wVand return xmthe sender (see /wu
instructions
mtp:8wmnwao[hhms/cue/forms/
oma'0970'015* instructions.pd. If you
receive this document from someone other
than a State or Tribal CSE agency or a Court, a
copy of (he underlying order must be attached.
2207601200
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County,
Commonwealth of Pennsylvania (State/Tribe). You are required by Iaw to deductthese amounts from -the employee/
-1o�C
rncn
=r1
[]ye=ci) Fii)no
rzz
o
n
o
—c
>
•�
obligors ncome until further notice.
�
0.00 per month in current child support
B
0.00 per month in past -due child support - Arrears 12 weeks or greater?
�
0.00 per month in current cash medical support
�
0.00 per month in past -due cash medical support
�
0.00 per month in current spousal support
Q
0.00 per month in past -due spousal support
�
0.00 per month in other (must specify)
for a Total Amount to Withhold of $ 0,00 per month.
r's.?
CPI
AMOUNTS TO WITHHOL.D: You do not have to vary your pay cycle to be in compiiance with the Order Information.
If your pay cycle does not match the ordered payment cycle, withhold one of the following amount:
�
0.00 per weekly pay period. 0.00 per semimonthiy pay period (twice a month)
� 0,00 per biweekly pay period (every two weeks) $ 0.00 per monthiy pay period.
�
Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.
REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the•Cnmmmnwea|th
of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10)
working days after the date of this Order/Notice. Send payment within seven (7) working days of the pay date. If
you cannot withhold the full amount of support for any or all orders for this employee/obiigor, withhold up to 55% of
disposabie income for all orders. If the employee/obiigor's principai piace of employment is not within the
Commonwealth of Pennsyivania (Stmte/Tribe), the employer can obtain withholding |imitotionm, time requiremants,
and any allowable employer fees at htto://wwxw.anf.hhu.gnv/prognamo/uaa/newhire/mmo|oyer/contactu/contont map.
h1Olfor the emp|oyem/ob|igor'sprincipal place mfemployment.
Document Tracking Identifier
OMB No.: 0970-0154
Service Type MWorker ID SIATT
Form EN -428 11/13
] Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in
accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not
directed to an SOU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to
the sender.
Signature of Judge/Issuing Official (if required by State or Tribal law): KEVIN A HESS
Print Name of Judge/Issuing Official:
Title of Judge/Issuing Official:
Date of Signature: JULY 14, 2014
If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this MO
must be provided to the employee/obligor.
0 If checked, the employer/income withholder must provide a copy of this form to the employee/obligor.
ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered
to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of
two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and
Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as
the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT
SEND CASH BY MAIL.
State -specific contact and withholding information can be found on the Federal Employer Services website located at:
http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact map.htm
Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42
§666(b)(7)). If a Federal tax levy is in effect, please notify the sender.
Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from
more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/
obligor's portion of the payment.
Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a
Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial
party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent
by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was
issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form.
Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the
amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if
applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement
the withholding and forward the support payments.
Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to
Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current
support before payment of any past -due support. Follow the State or Tribal law/procedure of the employee/obligor's principal
place of employment to determine the appropriate allocation method.
Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this
employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to
report and/or withhold lump sum payments.
Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the
employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and
any penalties set by State or Tribal law/procedure.
Anti -discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO.
OMB Expiration Date — 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use.
Form EN -428 11/13
Service Type M Page 2 of 3 Worker ID $IATT
Employer's Name: BECTON, DICKINSON AND COMPANY Employer FEIN: 220760120
Employee/Obligor's Name: STALLSMITH, THOMAS J. 8038102144
CSEAgencyCaoo|denb§oc(Saa4ddaadun`forraaesu/nnnary) Dndor|denUfier:(SeeAddendumfornrdeo/docketh*ymnnatimn)
Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection
Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of
employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such
as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of
the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting
another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State
or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in
this section.
For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income
withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the Iaw of the jurisdiction in which
the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA(15U.S.C.1U73(b)).
Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in
determining disposable income and applying appropriate withholding limits.
Arrears greater than 12 weeks? Ifthe Order Information does not indicate that the arrears are greater than 12 weeks, then the
Employer should calculate the CCPA timit using the lower percentage,
Additional Information:
NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUSIf this employee/obligor never worked for you or you are
no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by
returning this form to the address listed in the Contact Information below: 2207601200
{l This person has never worked for this employer nor received periodic income.
0 This person rio Ionger works for this employer nor receives periodic income.
Please provide the fotiowing inforrnation for the employeefobligor:
Termination date: Last known phone number:
Last known address:
Final Payment Date To SDU/Tribal Payee: Final PaymenAmount:
New Employer's Name:
New Employer's Address:
CONTACT INFORMATION:
To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name)
byphone ot(717)240-6225.byfax st(717)24O-G248.byemail n,website at: vm*w.uhi|dsupport.otaue.po.um.
Send termination/income status notice andandother correspondence to: DOMESTIC RELATtONS SECTION, 13 N. HANOVER ST,
P.O. BOX 320. CARLISLE, PA. 17013 (Issuer address).
To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name)
byphone od(717)240'S225.byfax ot(717)240'G248.byemail orwebsite atvwww.ohUdoupport.staha.po.uo.
IMPORTANT: The persocompleting this form is advisethat the iriformation may be shared with the employee/obligor.
OMB No.: 0970-0154
Service Type M Page 3of3Worker ID SIATT
Form EN -428 11/13
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: STALLSMITH, THOMAS J.
PACSES Case Number 300110986 PACSES Case Number 619112796
Plaintiff Name Plaintiff Name
ANNETTE M. CREMO ANNETTE M. CREMO
Docket Attachment Amount Docket Attachment Amount
00556 S 2009 $ 0.00 09-4035 CIVIL $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s):
VANESSA T. STALLSMITH 08/14/97
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
PACSES Case Number
Plaintiff Name
DocketAttachment Amount
$ 0.00
Child(ren)'s Name(s):
PACSES Case Number PACSES Case Number
Plaintiff Name Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
Service Type M
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
Addendum
OMS No.: 0970-0154
Form EN -428 11/13
Worker ID $IATT