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Home My WebLink About09-7619 MICHAEL S. GEORGE, Plaintiff V. SHELLY A. GEORGE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2009 - "t' ,/'? CIVIL TERM CIVIL ACTION-LAW IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for 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 the Cumberland County Court House, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, MARITAL PROPERTY, COUNSEL FEES OR EXPENSES BEFORE THE FINAL DECREE OF DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. 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 (717) 249-3166 MICHAEL S. GEORGE, Plaintiff V. SHELLY A. GEORGE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2009 - -7 6 / q CIVIL TERM CIVIL ACTION-LAW IN DIVORCE DIVORCE COMPLAINT 1. Plaintiff is Michael S. George, an adult individual who currently resides at 23 Stamy Road, Newville, Cumberland County, Pennsylvania 17241. 2. Defendant is Shelly A. George, an adult individual who currently resides at 1200 Ponsettia Avenue, Orlando, Orange County, Florida 32804. 3. Plaintiff and Defendant have been bona fide residents in the Commonwealth of Pennsylvania for at least six months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on October 4, 1986 in Berlin, Worcester County, Maryland. 5. There have been no prior actions of divorce or for annulment between the parties. 6. The marriage is irretrievably broken. 7. The Plaintiff has been advised of the availability of counseling and that he may have the right to request that the court require the parties to participate in counseling. 8. Plaintiff requests the court to enter a decree of divorce. WHEREFORE, the Plaintiff requests the court to enter a decree of divorce in favor of the Plaintiff and against the Defendant. COUNT II -EQUITABLE DISTRIBUTION 9. Plaintiff hereby incorporates by reference paragraphs 1 through 8 above. 10. The parties have acquired real estate, personal property, including automobiles, bank accounts and other items of miscellaneous property during the course of their marriage, some of which is marital property. WHEREFORE, Plaintiff respectfully requests this Honorable Court to enter a decree which effects an equitable distribution of marital property. Respectfully submitted, O'BRIEN, BARIC & SCHERER Date: W"kA__.) Michael A. Scherer, Esquire I. D.# 61974 19 West South Street Carlisle, PA 17013 (717) 249-6873 Attorney for Plaintiff mas.d it/domestic/george/d ivorcecomplaint.pld 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: Z11310 Mic ael S. George .TY THE r !F Thy - OTARY 2009 VIN -4 I'd 3: 04 U? 1 r <?Vi'rj'i yt? 7338.5"C) 3 (ci.,s-O a3'awe MICHAEL S. GEORGE, Plaintiff V. SHELLEY A. GEORGE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2009 - 7619 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE PRAECIPE TO AMEND CAPTION TO THE PROTHONOTARY: Kindly amend the caption in this matter to reflect the correct spelling of the defendant's first name, which should appear as "Shelley." Respectfully submitted, O'BRIEN, B IC & SCHERER Michael A. Scherer, Esquire I.D. 61974 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 CERTIFICATE OF SERVICE I hereby certify that on November 25, 2009, I, Jennifer S. Lindsay, secretary at O'Brien, Baric & Scherer, did serve a copy of the Praecipe To Amend Caption, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Shelley A. George 1200 Ponsettia Avenue Orlando, Florida 32804 FILCO-3, I -,,tr"J w?/•'• ?f? OF E f pY i 2009 N.1.3' 25 Fr' i 3-. Gis ?;. It'll a_ " ?a I J k Fl~f"~~C ~~F ~~ ~~~ ~ ~°~l~nr Marianne E. Rudebusch, Esquire 4711 Locust Lane ~~ t ~ =5~ ~' ! 3 ~' ~'~ I ~ J 2 Harrisburg, PA 17109 717-657-0632 r ~v~: t~ '' ~ ,,r' it Id. No. 63522 Attorney for Defendant `ma'y ~ ~~ MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 2009-7619 SHELLEY A. GEORGE, :CIVIL ACTION -LAW Defendant IN DIVORCE DEFENDANT'S COMPLAINT FOR ALIMONY PENDENTE LITE UNDER SECTION 3702 OF THE DIVORCE CODE AND NOW, comes the Defendant, Shelley A. George, by and through her attorney, Marianne E. Rudebusch, Esquire, and respectfully files the following Complaint for APL and in support thereof avers as follows: 1. The Defendant, Shelley A. George, is an adult individual who temporarily resides at 1200 Poinsettia Avenue, Orlando, Florida, 32804. 2. The Plaintiff, Michael S. George, is an adult individual who resides at 23 Stamy Road, Newville, Cumberland County, Pennsylvania, 17241. 3. A Complaint in Divorce was filed by Plaintiff on November 4, 2009. (Exhibit A). 4. Plaintiff filed an Answer and Counterclaim to said Divorce Complaint on V January 20, 2010 (Exhibit B). 5. Defendant does not have sufficient funds to support herself during the pendency of this action. 6. Plaintiff is well able to pay support to Defendant. 7. Defendant requests this Court to grant her alimony pendente lite. Respectfully Submitted, Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, PA 17109 717-657-0632 Id. No. 63522 Dated: J J ~7 - ~ ~ 2 ATTORNEY VERIFICATION Undersigned counsel, Marianne E. Rudebusch, Esquire, hereby verifies and states that: 1. She is the attorney of record for Shelley A. George, Defendant. 2. She is authorized to make this verification on her behalf. 3. The facts set forth in the foregoing are true and correct to the best of her knowledge, information and belief. 4. This verification is made by counsel pursuant to Pa.R.C.P. Rule 1024(c). 5. She is aware that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to authorities. Dated: ~ = ~ 7 ' L D By: ~ eu,c. ~i-ea-~ Marianne E. Rudebusch, Esquire Attorney for Defendant EXHIBIT A • WINTER PARK Fax~407-615-9319 Nov 30 2009 933 P. 04 ~_._ ~~ MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS 0~ ~? Plaintiff CUMBERLAND COUNTY, PENNSY . '~ . AN ~ --~ ~~ t~~ , c3 . ; -n v. _y .. . NO. 2009 - ~(~~ CIVIL TL~IiJI ~~ ,~ r --~~ r ~ . , :~; SHELLY A. GEORGE, c ~~~ CIVIL ACTION-LAW ~ = t` Defendant IN DIVORCE ~~ c ~ ~~: ~`~ . a a r ~~ 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 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 the Cumberland County Court House, Carlisle, Pennsylvania. IF YOU DO NOT FILE A GLAIM FOR ALIMONY, MARITAL PROPERTY, COUNSEL FEES OR EXPENSES BEFORE THE FINAL DECREE OF DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. 1F 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 (717} 249-3166 TRUE CUPY FROIvI RRI In 1'~atimony ~~~her~of, E h~:e t!nto s~fi my end tk,a sanl of said Couri at %artisle, Pa. Thlf ,.. ~ of. ~.~;~... .,o~ .n Prothof at ry • WINTER Fax:407-615-9319 MICHAEL S. GEORGE, Plaintiff v. SHELLY A. GEORGE, Defendant Nov 30 2009 9:33 ~. _ P. 05 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2009 - CIVIL TERM CIVIL ACTION-LAW IN DIVORCE DIVORCE COMPLAINT 1. Plaintiff is Michael S. George, an adult individual who currently resides at 23 Starry Road, Newville, Cumberland County, Pennsylvania 17241. 2. Defendant is Shelly A. George, an adult individual who currently resides at 1200 Ponsettia Avenue, Orlando, Orange County, Florida 32804. 3. Plaintiff and Defendant have been bona fide residents in the Commonwealth of Pennsylvania for at least six months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on October 4, 1986 in Berlin, Worcester County, Maryland. 5. There have been no prior actions of divorce or for annulment between the parties. 6. The marriage is irretrievably broken. 7. The Plaintiff has been advised of the availability of counseling and that he may have the right to request that the court require the parties to participate in counseling. 8. Plaintiff requests the court to enter a decree of divorce. WHEREFORE, the Plaintiff requests the court to enter a decree of divorce in favor of the Plaintiff and against the Defendant. WINTER PARK ~x~407-615-9319 Nov 30 2009 934 P. 06 COUNT II -EQUITABLE DISTRIBUTION 9. Plaintiff hereby incorporates by reference paragraphs 1 through 8 above. 10. The parties have acquired real estate, personal property, including automobiles, bank accounts and other items of miscellaneous property during the course of their marriage, some of which is marital property. WHEREFORE, Plaintiff respectfully requests this Honorable Court to enter a decree which effects an equitable distribution of marital property. Respectfully submitted, O'BRIEN, BARK & SCHERER Date: ~ 1 ~ LI ' ° ~ ichael A. Scherer, Esquire I . D.# 61974 19 West South Street Carlisle, PA 17013 (717) 249-6873 Attorney for Plaintiff mas.dlr/gvmeattc/8.vrge/d Ivorcecvmplaint.ptd WINTER PARK x ~ 407-615-9319 Nov 30 2009 VERIFICATION 934 P. 07 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: r,/,,~.~ G~ J' ~~ ~~C~, f= ,~ -~-.'" Mic ael S. George WINTER PARK Fax~407-615-9319 ~... Nov 30 2009 934 ~~ P. 10 CERTIFICATE OF SEgyICE I hereby certify that on November 25, 2009, f, Jennifer S. Lindsay, secreta O'8rien, Baric & Scherer, did serve a copy of the Praecipe To Amend ry at class U.S. mail, postage prepaid, to the party listed below Caption, by first as follows: Shelley A. George 1200 Ponsettia Avenue Orlando, Florida 32804 EXHIBIT B ~.. f Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, PA 17109 717-657-0632 Id. No. 63522 Attorney for Defendant MICHAEL S. GEORGE, Plaintiff v. SHELLEY A. GEORGE, Defendant ~~ C') - t-a ,, ~_ c~ ..~ r_-' : ~ ~ - ~ + _~ ,~; ~~ .. ~i ~J (~ ~~ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 2009-7619 CIVIL ACTION -LAW IN DIVORCE DEFENDANT'S ANSWER TO PLAINTIFF'S DIVORCE COMPLAINT AND COUNTERCLAIM AND NOW, comes the Defendant, Shelley A. George, by and through her attorney, Marianne E. Rudebusch, Esquire, and respectfully files the following Answer to Divorce Complaint and Counterclaim and in support thereof avers as follows: 1. Admitted. 2. Admitted; however this is a temporary address and the Defendant is planning to return to the marital home at 23 Stamy Road, Newville, Cumberland County, Pennsylvania, 17241. 3. Admitted. 4. Admitted. 5. Admitted. ~~_. f 6. Denied. It is denied that the marriage is irretrievably broken. 7. Denied. The Defendant is without sufficient knowledge to form a belief as to the truth of this averment and therefore, it is denied. The Defendant desires counseling. 8. No answer required. COUNT II EQUITABLE DISTRIBUTION 9. No answer required. 10. Admitted. COUNTERCLAIM COUNT III CLAIM FOR ALIMONY UNDER SECTION 3701 OF THE DIVORCE CODE 11. Defendant hereby incorporates by reference all of the averments contained in paragraphs 1 through 10 of this Answer and Counterclaim. 12. Defendant does not have a sufficient source of income or earning capacity at the present time to maintain the standard of living enjoyed by the parties during their marriage. 13. Plaintiff does have a sufficient source of income and earning capacity to aid Defendant in maintaining the standard of living enjoyed by the parties during their marriage. 2 E ~- COUNT IV CLAIM FOR ALIMONY PENDENTE LITE UNDER SECTION 3702 OF THE DIVORCE CODE 14. Defendant hereby incorporates by reference all of the averments contained in paragraphs 1 through 13 of this Answer and Counterclaim. 15. Defendant does not have sufficient funds to support herself during the pendency of this action. 16. Plaintiff is well able to pay support to Defendant. 17. Defendant requests this Court to grant her alimony pendente lite. Respectfully Submitted, .1 '"-') l + ~ ~ ~ ~ ...vim.-~' t~: ~~ cal, lx-e:~,..Cl Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, PA 17109 717-657-0632 Id. No. 63522 Dated: 3 ~.~._. ATTORNEY VERIFICATION Undersigned counsel, Marianne E. Rudebusch, Esquire, hereby verifies and states that: 1. She is the attorney of record for Shelley A. George, Defendant. 2. She is authorized to make this verification on her behalf. 3. The facts set forth in the foregoing are true and correct to the best of her knowledge, information and belief. 4. This verification is made by counsel pursuant to Pa.R.C.P. Rule 1024(c). 5. She is aware that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to authorities. Dated: J- f ~-~f~ Marianne E. Rudebusch, Esquire Attorney for Defendant f...__ E MICHAEL S. GEORGE, Plaintiff v. SHELLEY A. GEORGE, Defendant ~_ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 2009-7619 CIVIL ACTION -LAW IN DIVORCE CERTIFICATE OF SERVICE ~~A~ AND NOW, this ~Y day of , 2010, I, Katherine A. Frey, Secretary to Marianne E. Rudebusch, Esquire, Attorney for the Defendant, hereby certify that a copy of the within document has been served, by depositing a copy of the same in the United States mail, first class, postage prepaid, delivery at Harrisburg, Pennsylvania, to the following addressee: Michael A. Scherer, Esquire 19 West South Street Carlisle, PA 17013 Attorney for Plaintiff By~ ` atherine A. Frey i i MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 2009-7619 SHELLEY A. GEORGE, :CIVIL ACTION -LAW Defendant IN DIVORCE CERTIFICATE OF SERVICE AND NOW, this f ~~ day of ~~'/~~ , 2010, I, Katherine A. Frey, Secretary to Marianne E. Rudebusch, Esquire, Attorney for the Defendant, hereby certify that a copy of the within document has been served, by depositing a copy of the same in the United States mail, first class, postage prepaid, delivery at Harrisburg, Pennsylvania, to the following addressee: Michael A. Scherer, Esquire 19 West South Street Carlisle, PA 17013 Attorney for Plaintiff By: Katherine A. Frey ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 09-7619 CIVIL State Commonwealt of Pennsylvania Co./City/Dist. of ~~ERLAND Date of Order/Notice oe/16/10 Case Number (See Addendum for case summary) O Original Order/Notice 550].11432 OAmended Order/Notice 54 S 2010 OTerminate Order/Notice QOne-Time lump Sum/Notice Employer/Withholder's Federal EIN Number BERKLEY CONTRACT PACKAGING 597 ALEXANDER SPRING RD STE A CARLISLE PA 17013-7637 RE: GEORGE, MICHAEL S. Employee/Obligor's Name (Last, First, MD aao-aa-9689 Employee/Obligor's Social Security Number 3301102230 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. $ aos.37 per month in current child support $ o . oo per month in past-due child support Arrears 12 weeks or greaten' Q yes ®no $ o . oo per month in current medical support ~ $ o . oo per month in past-due medical support ~=_7 ~ 0 ~~ $ 762.00 per month in current spousal support -_ `=' .,a $ o . oo per month in past-due spousal support ~ ; ;~, r_t $ o . oo per month for genetic test costs ~~ ~j` ~ ~' $ o . oo per month in other (specify) _ -..r ~ $ one-time lump sum payment for a total of $ 1, 567.37 per month to be forwarded to payee below. -_ r.:; - ~ ~~ You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle dais not~matc-h the ordered support payment cycle, use the following to determine how much to withhold: $ 361.70 Per weekly pay period. $ 7a3 . s9 per semimonthly pay period (twice a month) $ 723.40 per biweekly pay period (every two weeks) $ 1, 667.37 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 aavment 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 INCIUDE THE DEfENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDE TO BE PROCESSED. DO NOT SEND CASH BY MAIL. i BY THE COURT: ~ ; M. L. Ebert, Jr., Judge ~ DRO: R.J. Shadday Form EN-028 Rev.S Service Type M OMBNO.:0970-0754 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ~ If heck you are requirnd to provide a opy of this form to your m loyee. If yo r employee orks in a state that is di#erent from the state that issued this order, a copy must be provic~ec~to your empYoyee even if tie box is not checked 1. Prior'~ty: 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%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 respell to the time periods within which you must implement the withholding order and forward the support payments. 4. * Employee/Obligor with Muhiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee%bligor 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. 9000~3~160 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : D THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: O EMPLOYEE'S/OBLIGOR'S NAME: GEORGE, MICHAEL S . EMPLOYEE'S CASE IDENTIFIER: 3301102230 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT• NEW EMPLOYER'S NAMEIADDRESS: 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: tf 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%bligor'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%bligorfrorn employment, refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. t ~ . 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.S Service Type M OMB No.: 0970-0154 Worker I D $ IATT f • ADDENDUM Summary of Cases on Attachment DefendantlObligor: GEORGE, MICHAEL S . PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB Addendum Service Type M OMB No.: 0970-0154 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 09-7619 CIVIL State Commonwealth of Pennsylvania OOriginal Order/Notice Co./City/Dist. of CUMBERLAND 550111432 OAmended Order/Notice Date of Order/Notice 09/24/10 54 S 2010 OTerminate Order/Notice Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice RE: GEORGE, MICHAEL S. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) ALCOTT GROUP INC PO BOX 160 FARMINGDALE NY 11735-0160 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. $ 805.37 per month in current child support $ o.-- oo per month in past-due child support Arrears 12 weeks or greater? Oyes ® no $ o . oo per month in current medical support $ o, oo per month in past-due medical support $ 762.00 per month in current spousal support $ o . oo per month in past-due spousal support $ 0. go per month for genetic test costs f'o $ o. oo per month in other (specify) J?sr ' $ one-time lump sum payment =wC' for a total of $ 1,567.37 per month to be forwarded to payee below. c; You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle d5-6 np ma" the ordered support payment cycle, use the following to determine how much to withhold: $ 361 70 per weekly pay period. $ 783.69 per semimonthly pay period (twice a month) $ 723.40 per biweekly pay period (every two weeks) $ 1, 567.37 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. 220-82-9689 Employee/Obligor's Social Security Number 3301102230 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) BY THE COURT: M. L. Ebert, Jr., 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 If heckeO you are required to provide a copy of this form to your?mpI yee. If yoyr employee works in a state that is di Brent rtrom the state that issued this order, a copy must be provi edd to o 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. 2616384370 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : E3 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: E3 EMPLOYEE'S/OBLIGOR'S NAME: GEORGE, MICHAEL S. EMPLOYEE'S CASE IDENTIFIER: 3301102230 LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: NEW EMPLOYER'S NAME/ DATE OF SEPARATION: FINAL PAYMENT AMOUNT: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA 0 5 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.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM NDUM Summary of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S. PACSES Case Number 210111548 Plaintiff Name PACSES Case Number 550111432 SHELLEY A. GEORGE PHintlme Docket Attachment Amount SELLEY A. GEORGE 09-7619 CIVIL $-'762. 0o Docket Attachment Child(ren)'s Name(s): 00054 S 2010 $ 805.37 DOB Child(ren)'s Name(s): MICHAEL M. GEORGE PACSES Case Number Plainti__ ff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB DOB 12/18/93 PACSES Case Number Plaintiff Nam 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 Form EN-028 Rev.5 OMB No.: 0970-0154 Worker I D $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsyjvania Co./City/Dist. of CUMBERLAND Date of Order/Notice to/ol/lo Case Number (See Addendum for case summary) EmployerNVithholder's Federal EIN Number BERKLEY CONTRACT PACKAGING 597 ALEXANDER SPRING RD STE A CARLISLE PA 17013-7637 220-82-9689 Employee/Obligor's Social Security Number 3301102230 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, Mp See Addendum for dependent names and birth dates associated with cases on attachment ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 805.37 per month in current child support $ 43 .33 per month in past-due child support Arrears 12 weeks or greateri' Qyes ~ nom;, $ o . oo per month in current medical support ;~~' $ o. oo per month in past-due medical support -;-v'~ `~' n~-Y~ $ 762 . oo per month in current spousal support . ~ ~ '~ `~°~ $ o . oo per month in past-due spousal support "" ~' ~ -~'~, $ o.oo per month for genetic test costs ,~-,i>~ -.~ '=='~ ---c r~~ $ o. oo per month in other (specify) " -;~:~ ~~- ~~ $ one-time lump sum payment ~~~'~"~ ~ `~-n for a total of $ 1, 610.70 per month to be forwarded to payee below. "'~ ~;~ r~r~ =' _ c.a r~._ 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: $ .s71.70 per weekly pay period. $ 805.35 per semimonthly pay period (twice a month) $ 743.40 per biweekly pay period (every two weeks) $ 1, 610 • ~o 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 NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifi OR SOCIAL SECURITY N MBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. `'r ~\ a~ BY THE COURT: t` M. L. Ebert, Jr., Judge 09-7619 CIVIL OOriginal Order/Notice 550111432 OAmended Order/Notice 54 S 2010 OTerminateOrder/Notice QOne-Time Lump Sum/Notice RE: GEORGE, MICHAEL S. Employee/Obligor's Name (Last, First, Mq Form EN-028 Rev.5 Service Type M OMB No.: 0970.0154 Worker I D $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ~ If~heckefl you are required, to provide a~opy of this form to your~mployee. If yoYr employee works in a state that is di Brent from the state that issued this or er, a copy must be provi ell to your emp 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%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%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%bligoranct 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. 9000737150 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : ~ THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: ~ EMPLOYEE'S/OBLIGOR'S NAME:GEORGE, MICHAEL S. EMPLOYEE'S CASE IDENTIFIER: 3301102230 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%bligor'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%bligorfrorn 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 respell to these items. 1 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.5 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S . PACSES Case Number 210111548 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 09-7619 CIVIL$ 762.00 Child(ren)'s Name(s): DOB PACSES Case Number 550111432 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 00054 S 2010 $ 848.70 Child(ren)'s Name(s): DOB MICHAEL M. GEORGE 12/18/93 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 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 Addendum Form EN-028 Rev.S Service Type Iy OMB No.: 0970.0154 Worker I D $ IATT ~,,. ORDERlNOT1CE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania CO.ICIty/DtSt. Of CUMBERLAND Date of Order/Notice to/ol/lo Case Number (See Addendum for case summary) EmployedWithholder's Federal EIN Number ALCOTT GROUP INC PO BOX 160 FARMINGDALE NY 11735-0160 220-82-9689 Employee/Obligor's Social Security Number 3301102230 Employee/Obligor's Case Identifier (See Addendum for piaimiff 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'INotice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are req uired 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. .,~ ~ ~,~ $ 805.37 per month in current child support `_-~ ~ _, ~ $ 43.33 per month in past-due child support Arrears 12 weeks or greater? (~ n ~ , ~ ci ~'t--: $ o . oo per month in current medical support ' ---- ~~ G~ $ o . oo per month in past-due medical support ~;.n ~T- I o ~`~ $ ~6z . oo per month in current spousal support a, j.~.. `= ~ ' _,~.:,~; $ 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 c..t't -~-~ ~~ -'? for a total of $ i, 610.70 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: $ 371.70 Per weekly pay period. $ 805.35 per semimonthly pay period (twice a month) $ 743.40 per biweekly pay period (every two weeks) $ 1, 610. ~o 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°!0 of the employee'sf 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-b7b-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P,O. Box b9112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER 1D (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MA/L. , BY THE COURT: M. L. Ebert, Jr., Service Type M OMB No.: 0970.0154 09-7619 CIVIL OOriginal Order/Notice 550111432 OAmended Order/Notice 54 S 2.010 OTerminate Order/Notice QOne-Time Lump Sum/Notice RE: GEORGE, MICHAEL S . Employee/Obligor's Name (Last, First, Mp Form EN-028 Rev.S Worker ID $IATT r! ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ~ If ~hecke~ you are required to provide a~opy of this form to your m loyee. If yorr employee works in a state that is di Brent rom the state that issued this or er, a copy must be provideedpto your emp 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 paydateldate 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 respell 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%bligoranll 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. 26153s4370 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : ~ THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: D EMPLOYEE'S/OBLIGOR'S NAME: GEORGE, MICHAEL S . EMPLOYEE'S CASE IDENTIFIER: 3301102230 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. tf 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%bligor'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/obligorfrnm employment, refusing to employ, or taking disciplinary action against any employee%bligor 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. t 1. 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 CARLISLE PA 17013 by FAX at (717) 240-6248 or by Internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.S Service Type M OMB No.:0970-0754 Worker ID $IATT '~'~ r ADDENDUM Summary of Cases on Attachment DefendandObligor: GEORGE, MICHAEL S . PACSES Case Number 210111548 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 09-7619 CIVIL $ 762.00 Child(ren)'s Name(s): DOB PACSES Case Number 550111432 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 00054 S 2010 $ 848.70 Child(ren)'s Name(s): DOB MICHAEL M. GEORGE 12/.18/93 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 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 Addendum Form EN-028 Rev.S Service Type M OMBNO.:0970-0754 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 09-7619 CIVIL State Commonwealth of Pennsylvania 550111432 OOriginal Order/Notice Co./City/Dirt. of CUMBERLAND 54 S 2010 OAmended Order/Notice Date of Order/Notice 11/22/10 OTerminate Order/Notice Case Number (See Addendum for case summary) (Done-Time Lump Sum/Notice RE:GEORGE, MICHAEL S. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 220-82-9689 Employee/Obligor's Social Security Number ALCOTT GROUP INC 3301102230 PO BOX 160 Employee/Obligor's Case Identifier FARMINGDALE NY 11735-0160 (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, Ml) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current child support $ 0.00 per month in past-due child support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in current medical support c ? o $ o. oo per month in past-due medical support tea?. m --i $ 1,158.00 per month in current spousal support x? $ o. oo per month in past-due spousal support f?J Z= -C -,r- $ 0600 per month for genetic test costs ' (C yr rN p $ o. oo per month in other (specify) r--:x ..«?, $ one-time lump sum payment 3 for a total of $ 1, is8. o0 per month to be forwarded to payee below. z'` no --jrn -+ ca I> You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycletkes%t nigch the ordered support payment cycle, use the following to determine how much to withhold: $ 267-2-3 per weekly pay period. $ 579.00 per semimonthly pay period (twice a month) $_ 534,46 per biweekly pay period (every two weeks) $ 1,158.00 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 SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MA/t. N ? ?-" BY THE COURT: M. L. Ebert, Jr., Judge 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 If heckO you are required to provide a opy of this form to your m loyee. If yo r employee v?orks in a state that is dii erent from the state that issued this or?er, a copy must be provi?edpto your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employeelobligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2616384370 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: El EMPLOYEE'S/OBLIGOR'S NAME: GEORGE, MICHAEL S. EMPLOYEE'S CASE IDENTIFIER: 3301102230 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.*.Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 1 1. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. F,?-ANOVER 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.5 Worker ID $ IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Service Type M OMB No.: 0970-0154 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Form EN-028 Rev.5 Worker ID $IATT i ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania 550111432 Co./City/Dist. of CUMBERLAND 54 S 2010 Date of Order/Notice 11/22/10 Case Number (See Addendum for case summary) E mployer/With holder's Federal EIN Number BERKLEY CONTRACT PACKAGING 597 ALEXANDER SPRING RD STE A CARLISLE PA 17013-7637 09-7619 CIVIL OOriginal Order/Notice OAmended Order/Notice XOTerminate Order/Notice QOne-Time Lump Sum/Notice RE: GEORGE, MICHAEL S. Employee/Obligor's Name (Last, First, MI) 220-82-9689 Employee/Obligor's Social Security Number 3301102230 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. $ $ o . oo 0.00 per month in current child support per month in past-due child support Arrears 12 weeks or greater? Q@s nSR $ 0 00 per month in current medical support -OX n --I $ . 0.00 per month in past-due medical support Z ? o rn' $ o . oo per month in current spousal support f / v2iT "C -vim $ o . oo per month in past due spousal support G w pd $ 0.00 per month for genetic test costs ?p Y $ o. oo per month in other (specify) 3>? XCD 4. 4-q $ one-time lump sum payment rv rn v for a total of $ o. o o 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: $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period (twice a month) $ o . oo per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND 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. ft? _ BY THE COURT: ' IA L S, it M. L. EberC, Jr. , Jive Form EN-028 Rev.5 DRO: R.J. Shadday Service Type. M OMB No.: 097"154 Worker I D $ IATT 1 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If hecked you are required to prode %opy of this form to your employee. If yo?rr employee works in a state that is di Brent from the state that issued t is or er, 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. 9000737160 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 13 EMPLOYEE'S/OBLIGOR'S NAME:GEORGE, MICHAEL S. EMPLOYEE'S CASE IDENTIFIER: 3301102230 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. 1 1. 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 $IATT ` f ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S. PACSES Case Number 210111548 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 09-7619 CIVIL$ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Service Type M Addendum OMB No.: 0970-0154 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Form EN-028 Rev.5 Worker I D $ IATT MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 09-7619 CIVIL TERM SHELLEY A. GEORGE, IN DIVORCE c Defendant/Petitioner PACSES CASE: 210111548 _0= CO rn o r w ? CD ORDER OF COURT i o 2>Z N O? AND NOW, this 22nd day of November, 2010, based upon the Court's determina'tron fiat t?e Petitioner's monthly net income/earning capacity is $ 1,963.26 and the Respondent's monthly net income/earning capacity is $ 4,981.36, it is hereby ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit One Thousand One Hundred Fifty-eight and 00/100 Dollars ($ 1,158.00) per month payable weekly as follows: $ 1,158.00 per month for Alimony Pendente Lite and $ 0.00 per month on arrears. First payment due: in accordance with Responden t's pay schedule. The effective date of the order is November 1, 2010. Arrears set at $ 305.81 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: Shelley A. George. 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 considers that the parties' minor child is now living with the Respondent and this Order is based upon Pa. R.C.P. Rule 1910.16-4(e). This Order includes a mortgage contribution in the amount of $610.00 per month. The Respondent is to make a direct payment of 30% of any net bonus (minus taxes only) to the Petitioner within five (5) days upon receipt of said bonus with verification of the bonus amount. The Respondent is to report any and all bonus(es) received to the Domestic Relations Section, with verification of said bonus(es), within five (5) days upon receipt of the bonus(es). 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. Mailed copies on: November 23, BY THE COURT tw? -t M. L. Ebert, Jr., J. Petitioner Respondent Marianne E. Rudebusch, Esq. Michael A. Scherer, Esq. DRO: R.J. Shadday In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SHELLEY A. GEORGE vs. MICHAEL S. GEORGE ) Docket Number: 09-7619 CIVIL Plaintiff PACSES Case Number: 210111548 Defendant Other State ID Number: G Z?W ORDER OF COURT ?a y' n Legal proceedings have been brought against you 7°c? alleging you have willfully disobeyed an Order of Court. w -n ca .r' -0 Cn 1. If you wish to defend against the claim set forth in the following pages, you may, but are not required to, file in writing with the Court your defenses or objections. cif rrt r:.. :T3 C?.'.3 4 c) ?-n or; 2. You, MICHAEL S. GEORGE, Respondent, must appear in person in court on APRIL 7, 2011, at 1:30PM, in COURT ROOM 2 C/O CUMBERLAND CO COURTHOUSE, 4TH FLOOR, 1 COURTHOUSE SQUARE, CARLISLE, PA. 17013 IF YOU DO NOT APPEAR IN PERSON, THE COURT MAY ISSUE A WARRANT FOR YOUR ARREST AND YOU MAY BE COMMITTED TO JAIL. 3. If the Court finds that you have willfully failed to comply with its order you may be found to be in contempt of court and committed to jail, fined, or both. Form EN-528 Service Type M Worker ID 21600 GEORGE v. GEORGE PACSES Case Number: 210111548 YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE-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. CUMBERLAND CO BAR ASSOCIATION 32 S BEDFORD ST CARLISLE PA 17013-3302-32 (717) 249-3166 At the above scheduled proceeding, contempt may be dismissed, new and/or modified purge conditions may be imposed or incarceration recommended for the defendant. If the plaintiff fails to appear, the Court will proceed with the case and enter an appropriate order. The parties are to remain until dismissed by the Court. YOU ARE REQUIRED TO BRING: - Cash, credit card in your name, cashier/bank check or money order payable to DOMESTIC RELATIONS SECTION. Contact your local DRS before the hearing date to verify which of the payment methods listed above are accepted. - Most recent pay stubs for any and all employers. - Payroll address, phone #, fax # and contact person. - Proof of medical coverage. - Any other documentation relevant to your case and the issue of contempt as stated in the petition. AMERICANS WITH DISABILITIES ACT OF 1990 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. BY THE COURT: Date of Order: FE814 2091 JUDGE Form EN-528 Service Type M Page 2 of 2 Worker ID 21600 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SHELLEY A. GEORGE ) Docket Number: 09-7619 CIVIL vs. Plaintiff MICHAEL S. GEORGE PACSES Case Number: 210111548 Defendant ) Other State ID Number: PETITION FOR CONTEMPT - DEFENDANT TO THE HONORABLE, THE JUDGES OF SAID COURT: 1. Petitioner is CUMBERLAND County Domestic Relations Section. 2. Defendant is MICHAEL S. GEORGE who resides at: 12 KENNSINGTON CT, CARLISLE, PA. 17013-4813-12 3. On NOVEMBER 22, 2010 an order of support was entered by the Honorable Court directing Defendant to pay the sum of $1,158.00 per month plus $0.00 per month in arrears for the support of his/her dependent(s). 4. Defendant has failed to comply with the order as entered by the Court by failing to: ? pay as ordered. ? provide information which was ordered. ? appear as ordered. ® other: failure to report bonus and make payment from bonus. 5. The arrearages under the Order amount to $440.00 as of FEBRUARY 14, 2011. WHEREFORE, Petitioner prays that the Court issue an order directing the attendance of Defendant at a hearing of said Petition and hereafter to make an adjudication of contempt. I verify that the statements made in this Petition are true and correct to the best of my knowledge. I understand that false statements herein are made to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities. i FEBRUARY 14. 011 Derek R. Clapper. Es . i/ Date Signature Form EN-007 Service Type M Worker ID 21600 P, .S S In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SHELLEY A. GEORGE ) Docket Number: 09-7619 CIVIL Plaintiff ) vs. ) PACSES Case Number: 210111548 MICHAEL S. GEORGE ) Defendant ) Other State ID Number: PETITION FOR MODIFICATION r-? r` OF AN EXISTING SUPPORT ORDER c -n - -? M rn -? Cn 1. The petition of SHELLEY A. GEORGE respectfully represents that on y NOVEMBER 22, 2010, an Order of Court was entered for the support of SHELLEY A. GEORGE A true and correct copy of the order is attached to this petition. Service Type M Form OM-501 Worker ID 21205 4 GEORGE v. GEORGE PACSES Case Number: 210111548 2. Petitioner is entitled to O increase O decrease O termination O reinstatement O other of this Order because of the following material and substantial change(s) in circumstance: Please state your reason(s) for requesting a modification of your current APL order here: On o2 (y a ? r 1 /?Iacoth 6w (-wS --,en4 1A)tI-L i5 WHEREFORE, Petitioner requests that the Court modify the existing order for support. Petitio r.? A orney for Petitioner 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 ; 'Petitioner i" Form OM-501 Service Type M Page 2 of 2 Worker ID 21205 ORDERMOTICE TO WITHHOLD INCOME FOR SUPPORT State: Commonwealth of Pennsylvania 550111432 Co./City/Dist. of: CUMBERLAND 54 S 2010 Date of Order/Notice: 03/22/11 Case Number (See A e?for case summary) Employer/Withholder's Federal EIN Number ALCOTT GROUP INC PO BOX 160 FARMINGDALE NY 11735-0160 RE: GEORGE. MICHAEL S. 09-7619 CIVIL 0 Original Order/Notice Q Amended Order/Notice 0 Terminate Order/Notice 0 One-Time Lump Sum/Notice Employee/Obligor's Name (Last, First, MI) 220-82-9689 Employee/Obligor's Social Security Number 3301102230 Employee/Obligoes Case Identifier (See Addendum for plaintiff names associated with cases on attachmenQ 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. $ 824.00 per month in current child support C"5 X -° (=? n $ 82.00 per month in past-due child support Arrears 12 weeks or greater? 91ps j? nffi-n $ 0.00 per month in current medical support z:0 .or- $ 0.00 per month in past-due medical support ?? ? tv avp $ 539.00 per month in current spousal support t -z w --4c) $ 0.00 per month in past-due spousal support ? _0 ?-n $ 0.00 per month for genetic test costs _C z-- $ 0.00 per month in other (specify) (_ N CD $ one-time lump sum payment for a total of $ 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: $ :3,:3.47 per weekly pay period. $ 722.50 per semimonthly pay period (twice a month) $ 666 - 9.3 per biweekly pay period (every two weeks) $ 1,445.00 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 ase entif O SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CA Y 1L. BY THE COURT: M. L. Ebert, Jr., Judge 1,445.00 per month to be forwarded to payee below. DRO: R.J. Shadday OMB No.: 0970-0154 Form EN-028 Service Type M Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS n If checked you are required to provide a copy of this form to your employee. If your employee works in a state that is different from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2616384370 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: Q THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: Q EMPLOYEE'S/OBLIGOR'S NAME: GEORGE, MICHAEL S. EMPLOYEE'S CASE IDENTIFIER: 3301102230 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: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 CARLISLE PA 17013 by FAX at (717) 240-6248 or by internet www.childsul2port.state.pa.us OMB No.: 0970-0154 Form EN-028 Service Type M Page 2 of 2 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S. PACSES Case Number 210111548 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 09-7619 CIVIL $ 539.00 Child(ren)'s Name(s): DOB PACKS Case Number 550111432 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 00054 S 2010 $ 906.00 Child(ren)'s Name(s): DOB MICHAEL M. GEORGE 12/18/93 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVAIA? -°n VS. °w CIVIL ACTION - DIVORCE z? -' rr-- ISO o -,rln NO. 09-7619 CIVIL TERM ca ca °o SHELLEY A. GEORGE, IN DIVORCE X0 Z--"',z Defendant/Petitioner PACSES CASE: 210111548 A N cDc") m ORDER OF COURT ' -mac AND NOW, this 22nd day of March, 2011, based upon the Court's determination that the Petitioner's monthly net income/earning capacity is $ 2,112.33 and the Respondent's monthly net income/earning capacity is $ 4,732. 10, it is hereby ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit Five Hundred Ninety-three and 00/100 Dollars ($ 593.00) per month payable weekly as follows: $ 539.00 per month for Alimony Pendente Lite and $ 54.00 per month on arrears. First payment due in accordance with the Respondnet's pay schedule. The effective date of the order is February 15, 2011. Arrears set at $ -734.06 as of March 22, 2011. 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: Shelley A. George. 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 the spouse. Unreimbursed medical expenses of the spouse 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 [X] Petitioner [] Neither party to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the [X] 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 considers that the parties' minor child, Michael, is now residing with the Petitioner, his mother. 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. Mailed copies on: March 23, 2011 Petitioner Respondent Marianne E. Rudebusch, Esq. Michael A. Scherer, Esq. BY THE COURT N t ?" V M. L. Ebert, Jr., J. DRO: R.J. Shadday In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION MICHAEL S. GEORGE, ) Plaintiff/Respondent ) vs. ) SHELLEY A. GEORGE, ) Defendant/Petitioner ) Docket Number PACSES Case Number Other State ID Number 09-7619 CIVIL 210111548 ? N -ty3 rnrn a. ORDER OF COURT X M rte- ? ` ?ci You, SHELLEY A. GEORGE, of 23 Stamy Road, Newville, Pennsylvi _ rv 17013-4813 are ordered to appear at the DOMESTIC RELATIONS hearing roorff-c/? Hearing Room, DOMESTIC RELATIONS OFFICE, 13 North Hanover Street, Carlisle, Pennsylvania 17013 on the 5th of May, 2011, at 8:30 a.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: rn -0 a- Sp o? --?M George v. George PACSES Case Number 550111432 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: .3 - 31-- ? I -t ?? M. L. Ebert, Jr., 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. Cumberland County Bar Association 32 Bedford Street Carlisle, PA 17013-3302-32 (717) 249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 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 MICHAEL S. GEORGE, ) Docket Number 09-761.9 CIVIL Plaintiff/Respondent ) VS. ) PACSES Case Number 210111548 SHELLEY A. GEORGE, ) Other State ID Number Defendant/Petitioner ) c o rn Co IN. ORDER OF COURT ? X ? You, MICHAEL S. GEORGE, of 12 Kennsington Court, Carlisle, Penfig arna Z N 17013-4813 are ordered to appear at the DOMESTIC RELATIONS hearing roorr?, /o? Hearing Room, DOMESTIC RELATIONS OFFICE, 13 North Hanover Street, Carlisle, Pennsylvania 17013 on the 5th of May, 2011, at 8:30 a.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: 0- n a, o-n a? ..{ rn n -c yk George v. George PACSES Case Number 550111432 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: 3- 3 1 f i 'k t M. L. Ebert, Jr., 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. Cumberland County Bar Association 32 Bedford Street Carlisle, PA 17013-3302-32 (717) 249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 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 Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, PA 17109 717-657-0632 Id. No. 63522 Attorney for Defendant FILED-OFFICE Lit" THE PROTHONOTARY 2011 APR -5 PM 12: 30 CUMBERLAND COUNT' PENNSYLVANIA MICHAEL S. GEORGE, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 2009-7619 : PACSES NO. 210111548 and 550111432 and SHELLEY A. GEORGE, : 725112073 Defendant : IN DIVORCE AND SUPPORT PETITION FOR APPEAL OF APL ORDER AND NOW, comes the Defendant, Shelley A. George, hereinafter referred to as Wife, by and through her attorney, Marianne E. Rudebusch, Esquire, and respectfully files the following Petition for Appeal of APL Order and in support thereof, avers as follows: 1. A Complaint in Divorce was filed in the above action by Plaintiff, Michael S. George, hereinafter referred to as Husband, on 11/4/09. 2. Wife filed an Answer to Husband's Complaint in Divorce on 1/20/10, and a Complaint for Alimony Pendente Lite on 3/18/10. 3. A Support Order was issued on 3/22/11, under the above captioned PACSES numbers and Wife filed a request for a hearing de novo with the Domestic Relations Office of Cumberland County. 4. A hearing before the Support Master, Michael Rundle, Esquire, is scheduled for 515111 at 8:30 a.m. 5. Wife is requesting an appeal of the APL portion of the Support Order as well, and that the appeal be heard on the already scheduled date of 515111. WHEREFORE, Wife requests that her Petition for Appeal on the APL portion of the Support Order issued on 3/22/11, be scheduled with the support appeal already scheduled before Support Master Rundle on 515111. Respectfully Submitted, Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, PA 17109 717-657-0632 Id. No. 63522 Dated: 31- MICHAEL S. GEORGE, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2009-7619 SHELLEY A. GEORGE, : CIVIL ACTION -LAW Defendant : IN DIVORCE CERTIFICATE OF SERVICE 5t AND NOW, this J? day of , 2011, I, Katherine A. Frey, Secretary to Marianne E. Rudebusch, Esquire, Attorney for the Defendant, hereby certify that a copy of the within document has been served, by depositing a copy of the same in the United States mail, first class, postage prepaid, delivery at Harrisburg, Pennsylvania, to the following addressee: Michael A. Scherer, Esquire Michael R. Rundle, Esquire, Support Master 19 West South Street 9 North Hanover Street Carlisle, PA 17013 P.O. Box 320 Attorney for Plaintiff Carlisle, PA 17013 By: Katherine A. Frey 1 FILED-OFFICE Marianne E. Rudebusch, Esquire OF THE PROTHONOTARY 4711 Locust Lane 2011 APR -7 PM 2: 13 Harrisburg, PA 17109 717-657-0632 CUMBERLAND COUNTY Id. No. 63522 PENNSYLVANIA Attorney for Defendant MICHAEL S. GEORGE, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 2009-7619 : PACSES NO. 210111548 and 550111432 and SHELLEY A. GEORGE, : 725112073 Defendant : IN DIVORCE AND SUPPORT ORDER OF COURT -7/?_ AND NOW, this day of 2011, upon review of the attached Petition for Appeal of APL Order, it is hereby ORDERED that Wife's appeal of the APL Order entered with Domestic Relations on March 22, 2011 shall be heard during the already scheduled hearing before Support Master Rundle on May 5, 2011. BY THE COURT: Distribution: Marianne E. Rudebusch, Esquire, 4711 Locust Lane, Harrisburg, PA 17109 Michael A. Scherer, Esquire, 19 West South Street, Carlisle, PA 17013 Michael R. Rundle, Esquire, Support Master, 9 North Hanover Street, P.O. Box 320, Carlisle, PA 17013 MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 09-7619 CIVIL TERM SHELLEY A. GEORGE, IN DIVORCE Defendant PACSES CASE: 210111548 ORDER OF COURT AND NOW to wit, this 7th day of April, 2011, it is hereby Ordered that the case balance on the above captioned case be increased by the sum of $1502.40, pursuant to said sum being the amount due the Wife from the Husband's 2010 bonus as ordered in the November 22, 2010 Order of Court. 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 Michael A. Scherer, Esq. Marianne Rudebusch, Esq. Service Type: M BY THE COURT: 1k -t ?1? I M. L. Ebert, Jr., = 1 -07. r?rn < c:' ?C -4 cw ?v ern a CD o ? -rs MW CID -n ?Q -tm A Form OE-001 Worker: 21005 MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. C-) - NO. 2009 - 7619 CIVIL TERM --o= -- SHELLEY A. GEORGE, CIVIL ACTION-LAW Defendant IN DIVORCE ?> MOTION FOR APPOINTMENT OF MASTER Michael S. George moves the court to appoint a master withect to -p' Plaintiff , the following claims: (x) Divorce (x) Distribution of Property ( ) Annulment (x) Support (x) Alimony () Counsel Fees (x) Alimony Pendente Lite () Costs and Expenses and in support of the motion states: (1) Discovery is complete as to the claims for which the appointment of a master is requested. (2) The Defendant, Shelley A. George has appeared in the action by her attorney, Marianne E. Rudebusch, Esquire. (3) The statutory grounds for divorce are: 3301(c) (4) The action is contested with respect to the following claims: divorce, equitable distribution, support, alimony and alimony pendente lite. (5) The action does involve complex issues of law or fact. (6) The hearing is expected to take one (1) day. (7) Additional information, if any relevant to the motion: not applicable c DATE: J I 4 A // ichael A. S erer, Esquire ORDER APPOINTING MASTER AND NOW, this Ct?7 day of , 2011, E. Robert Elicker, III, Esquire is appointed master with respect to the ollowing claims: divorce, equit"le distribution, support, alimony and alimony pendente lite. (20F LS fnX4 ILt #4y M. I2x(r_?c4,__ s/&1lf aj ..... =C BY THE COURT , -- r ?? rn b ?.y ORDERMOTICE TO WITHHOLD INCOME FOR SUPPORT 09 - -7 Lo I (t C)va 1 State: Commonwealth of Pennsylvania Co./City/Dist. of: CUMBERLAND Date of Order/Notice: 06/02/11 Case Number (See A en um for case summary) Employer/Withholder's Federal EIN Number ALCOTT GROUP INC PO BOX 160 FARMINGDALE NY 11735-0160 -15U ) 4 3,2 O Original Order/Notice 54 S gU I C) 0. Amended Order/Notice 0 Terminate Order/Notice 0 One-Time Lump Sum/Notice RE: GEORGE, MICHAEL S. Employee/Obligor's Name (Last, First, MI) 220-82-9689 Employee/Obligor's Social Secun-71Vu_m_Fe_r 3301102230 mp oyee igo 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. $ 795.00 per month in current child support $ 0.00 per month in past-due child support $ 0.00 per month in current medical support $ 0.00 per month in past-due medical support $ 840.00 per month in current spousal support $ 84.00 per month in past-due spousal support $ 0.00 per month for genetic test costs $ 0.00 per month in other (specify) $ one-time lump sum payment for a total of $ 1,719.00 per month to be forwarded to payee below. c° C-) ( )Cps ? nW n_ r CID c..- ?_ ? " J c -v f-D-n M -=° 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: $ 396,'70 per weekly pay period. $ 859.50 per semimonthly pay period (twice a month) $ '793:39 per biweekly pay period (every two weeks) $ 1,719.00 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 1D (shown above as the Employee/Obligor's Case 1 entifi r) OR C L SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY . 1, BY THE COURT: ttt???........ Service Type M Arrears 12 weeks or greater? OMB No.: 0970-0154 Form EN-028 Worker ID 21205 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. 2616384370 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: O EMPLOYEE'S/OBLIGOR'S NAME: GEORGE, MICHAEL S. EMPLOYEE'S CASE IDENTIFIER: 3301102230 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: NEW EMPLOYER'S NAME/ADDRESS: FINAL PAYMENT AMOUNT: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us OMB No.: 0970-0154 Page 2of2 Form EN-028 Worker ID 21205 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S. PACKS Case Number 210111548 PACKS Case Number 550111432 Plaintiff Name Plaintiff Name SHELLEY A. GEORGE SHELLEY A. GEORGE Docket Attachment Amount Docket Attachment Amount 09-7619 CIVIL $ 924.00 00054 S 2010 $ 795.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB MICHAEL M. GEORGE 12/18193 PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID 21205 Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, PA 17109 717-657-0632 [d. No. 63522 Attorney for Defendant TILTD-OFFICE Or THE PROTHONOTARY 2011 JUN 20 AM 11: 47 CUMBERLAND COUNTY PENNSYLVANIA MICHAEL S. GEORGE, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2009-7619 SHELLEY A. GEORGE, : CIVIL ACTION -LAW Defendant : IN DIVORCE DEFENDANT'S INCOME AND EXPENSE STATEMENT UNDER RULE 1920.31 I hereby file the Statement of Income and Expenses required under Rule 1920.31 and verify that the information therein contained is true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. 4904, relating to unsworn falsification to authorities. ]Date: (D -- ( 7 - a 0 INCOME AND EXPENSE STATEMENT OF SHELLEY A. GEORGE Employer: Citizens Bank Address: 665 N. East Street, Carlisle, PA Type of Work: Banker Payroll Number: J031447 Pay Period (weekly, bi-weekly, etc): Weekly Gross Pay Per Pay Period: $583.48 Itemized Payroll Deductions: Federal Withholding -$65.61 Social Security -$22.84 Local Wage Tax -$1.00 State Income Tax -$22.14 Unemployment -$0.47 Medicare Tax -$7.89 Retirement (401 k) -$11.67 Savings Bonds Credit Union Life Insurance Health Insurance -$39.00 Pension Contribution Net Pay Per Pay Period: $412.86 Other Income: Monthly Interest - CD & Bonds Dividends Pension Annuity Social Security Yearly Rents Royalties Expense Account Unemployment Compensaion Workmen's Comp. Gifts Child Support Spousal Support/Alimony TOTAL HOME: Mortgage/Rent Maintenance & Lawn Hay Fields Utilities: Electric Gas Oil Sewer Telephone Cell Phone Water Dumpster EMPLOYMENT: Public Transportation $795.00 $9,540.00 $840.00 $10,080.00 $3,423.92 $41,087.07 EXPENSES Monthly Yearly $1,277.00 $15,324.00 $60.00 $720.00 $58.00 $700.00 $150.00 $1,800.00 $135.00 $1,620.00 $217.00 $2,604.00 $0.00 $25.00 $300.00 Lunch $0.00 TAXES: Real Estate $416.67 $5,000.04 Personal Property $0.00 INSURANCE: Homeowners $183.00 $2,196.00 Automobile(s) $67.00 $804.00 Life $50.00 $600.00 Accident Health Other AUTOMOBILES: Payments Fuel (all vehicles) $150.00 $1,800.00 Repairs $40.00 $480.00 MEDICAL: Doctor $85.00 $1,020.00 Dentist Orthodontist Hospital Medicine $40.00 $480.00 Special Needs (glasses $25.00 $300.00 braces, etc.) EDUCATION: Private School $0.00 Home School $45.00 $540.00 College Religious PERSONAL: Clothing $100.00 $1,200.00 Food $650.00 $7,800.00 Barber/Hair Dresser Credit Payments Credit Card $450.00 $5,400.00 Charge Accounts Memberships LOANS: Credit Union Line of Credit MISCELLANEOUS: Child Care/Babysitting Papers/Books/Magazines Entertainment Pay TV/Internet $85.00 $1,020.00 Vacation Gifts Legal Fees $100.00 $1,200.00 Charitable Contributions Child Support Alimony/Spousal Support Tax Preparation $25.00 $300.00 Animal Care $245.00 $2,940.00 TOTAL EXPENSES $4,678.67 $56,148.04 mnt ??ft_Q __ILA? Citizens Bank of Pennsylvania Pay Group: TIH-Citizens Bk of Penn Hourly EE Business Unit: USA01 2001 Market Street Pay Begin Date: 05/23/2011 Advice #: 000000005531617 Philadelphia, PA 19103 Pay End Date: 05/29/2011 Advice Date: 06/03/2011 TAX DATA: Federal PA State Shelley George Employee ID: J031447 Marital Status: Single n/a 23 Stamy Rd Department: 75714-Carisle Allowances: 0 0 Newville, PA 17241 Location: 665 North East Street, Carlisl Addl. Pct Job Title: Banker l Pay Rate: $14.188000 Hourly Addl. Amt HOURS AND EARNINGS TAXES - Current -- YTD - Description gajg Hours dim tigp? F.arnin g Description C urrent p Overtime 21.282000 0.75 15.96 16.75 376.03 Fed Withholdng 65.61 1,934.90 Regular 14.188000 40.00 567.52 837.25 11,794.92 Fed MED/EE 7.89 203.63 Holiday 0.00 15.00 210.00 Fed OASDl/EE 22.84 589.82 Prior Year PTO 0.00 30.00 420.00 PA Unempl EE 0.47 11.93 Scheduled PTO 0.00 40.50 568.97 PA Withholdng 16.70 431.13 Ex$ell - Traditional 0.00 1,543.10 PA Withholdng 5.44 140.41 PA LS Tax 1.00 22.00 TOTAL: 40.75 583.48 939.50 14,913.02 TOTAL: 119.95 3,333.82 BEFORE-TAX DEDUCTIONS AFTER-TAX DEDUCTIONS EMPLOYER PAID BENEFITS Description Current X]M Description Current YTQ Description Current ]M 401(k) 11.67 298.27 Child Life 0.40 2.40 LTD Before Tax 0.53 11.66 ROTH 401 K 11.67 298.27 Medical Plan 39.00 858.00 United Way 1.00 22.00 TOTAL: 51.20 1,167.93 TOTAL: 13.07 322.67 -TAXABLE TOTAL GROSS FED TAXABLE GROSS TOTAL TAXES TOTAL DEDUCTIONS NET PAY Current 583.48 532.28 119.95 64.27 399.26 YTD 14,913.02 13,745.09 3,333.82 1,490.60 10,088.60 YEAR-TO-DATE PAID TIME OFF SICK LEAVE NET PAY DISTRIBUTION Start Balance 0.0 0.0 Ac count Typ e Account Number Dep osit Amount + Earned 0.0 0.0 Advice #000000005531617 Checking 6225748419 $399.26 + Bought 0.0 0.0 Taken 0.0 0.0 Sold 0.0 0.0 + Adjustments 0.0 0.0 End Balance 0.0 0.0 TOTAL: $399.26 MESSAGE: For questions regarding your pay statement, please contact 866-472-8234 MICHAEL S. GEORGE, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 2009-7619 SHELLEY A. GEORGE, : CIVIL ACTION -LAW Defendant : IN DIVORCE CERTIFICATE OF SERVICE AND NOW, this day of , 2011, I, Katherine A. Frey, V_ tl Secretary to Marianne E. Rudebusch, Esquire, Attorney for the Defendant, hereby certify that a copy of the within document has been served, by depositing a copy of the same in the United States mail, first class, postage prepaid, delivery at Harrisburg, Pennsylvania, to the following addressee: Michael A. Scherer, Esquire 19 West South Street Carlisle, PA 17013 Attorney for Plaintiff By 4-AA therine A. Frey 0 Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, PA 17109 717-657-0632 Id. No. 63522 Attorney for Defendant MICHAEL S. GEORGE, Plaintiff V. SHELLEY A. GEORGE, Defendant OF TAE ?ROTNpN0 TARP 2111JUN20 AH11:47 CUMBERLAND COUNTY pENNS YLYANIA : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 2009-7619 : CIVIL ACTION -LAW : IN DIVORCE INVENTORY UNDER RULE 1920.33 Defendant, Shelley A. George, files the following inventory of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three years. Defendant verifies that the statements made in this inventory are true and correct. Plaintiff understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. i Date: ?- ([ By: S ley A. Ge r e ASSETS OF PARTIES DEFENDANT MARKS ON THE LIST BELOW THOSE ITEMS APPLICABLE TO THE CASE AT BAR AND ITEMIZES THE ASSETS ON THE FOLLOWING PAGES. (X) 1. Real Property (X) 2. Motor Vehicles () 3. Stocks, bonds, securities and options () 4. Certificates of Deposit (X) 5. Checking accounts, cash () 6. Savings accounts, money market and savings certificates () 7. Contents of safe deposit box(s) O 8. Trusts () 9. Life insurance policies (indicate face value, cash surrender value and current beneficiaries) () 10. Annuities () 11. Gifts () 12. Inheritances () 13. Patents, copyrights, inventions, royalties () 14. Personal property outside the home () 15. Businesses (list all owners, including percentage of ownership, and officer/director positions held by a party with company) () 16. Employment termination benefits - severance pay, worker's compensation claim/award () 17. Profit sharing plans () 18. Pension plans (indicate employee contribution and date plan vests) () 19. Retirement plans, Individual Retirement Accounts () 20. Disability payments () 21. Litigation claims (matured and unmatured) () 22. MilitaryN.A. benefits () 23. Education benefits (X) 24. Debts due, including loans, mortgages held (X) 25. Household furnishings and personalty (include as a total category and attach itemized list if distri- bution of such assets is in dispute) ( ) 26. Other MARITAL PROPERTY DEFENDANT LISTS ALL MARITAL PROPERTY IN WHICH EITHER OR BOTH SPOUSES HAVE A LEGAL OR EQUITABLE INTEREST INDIVIDUALLY OR WITH ANY OTHER PERSON AS OF THE DATE OF THE SEPARATION OF THE PARTIES: ITEM NUMBER DESCRIPTION OF PROPERTY 1 • 23 Stamy Road Newville, PA 17241 (House and land) 2• 2007 Mini Cooper 2• 2009 Kia Rio 5. Checking acct. w/ Metro No. 0833152713 NAMES OF ALL OWNERS Husband and Wife Husband Husband Husband NON-MARITAL PROPERTY DEFENDANT LISTS ALL PROPERTY IN WHICH A SPOUSE HAS A LEGAL OR EQUITABLE INTEREST WHICH IS CLAIMED TO BE EXCLUDED FROM MARITAL PROPERTY: ITEM NUMBER DESCRIPTION OF PROPERTY REASON FOR EXCLUSION None PROPERTY TRANSFERRED DEFENDANT LISTS ALL MARITAL PROPERTY IN WHICH EITHER OR BOTH SPOUSES HAD A LEGAL OR EQUITABLE INTEREST INDIVIDUALLY OR WITH ANY OTHER PERSON AND WHICH HAS BEEN TRANSFERRED WITHIN THE PRECEDING THREE YEARS: ITEM NUMBER DESCRIPTION DATE OF CONSIDER- OF PROPERTY TRANSFER ATION PERSON TO WHOM TRANSFERRED None LIABILITIES DEFENDANT LISTS ALL LIABILITIES OF EITHER OR BOTH SPOUSES ALONE OR WITH ANY PERSON AS OF THE DATE OF SEPARATION: ITEM NUMBER 26. 26. 26. 26. 26. 26. 26. DESCRIPTION OF PROPERTY Mortgage Credit Card Credit Card Credit Card Credit Card Credit Card Home repairs and maintenance NAMES OF ALL CREDITORS Wells Fargo Discover American Express Chase Bon Ton Bloomingdale's NAMES OF ALL DEBTORS Husband & Wife Husband & Wife Husband & Wife Husband & Wife Husband & Wife Husband & Wife Paid by Wife MICHAEL S. GEORGE, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 2009-7619 SHELLEY A. GEORGE, : CIVIL ACTION -LAW Defendant : IN DIVORCE CERTIFICATE OF SERVICE AND NOW, this day of , 2011, I, Katherine A. Frey, Secretary to Marianne E. Rudebusch, Esquire, Attorney for the Defendant, hereby certify that a copy of the within document has been served, by depositing a copy of the same in the United States mail, first class, postage prepaid, delivery at Harrisburg, Pennsylvania, to the following addressee: Michael A. Scherer, Esquire 19 West South Street Carlisle, PA 17013 Attorney for Plaintiff By: Katherine A. Frey In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SHELLEY A. GEORGE vs. MICHAEL S. GEORGE Plaintiff Defendant Docket Number: 09-7619 CIVIL ) PACKS Case Number: 210111548 Other State ID Number: PETITION FOR MODIFICATION OF AN EXISTING SUPPORT ORDER 4J M u r- -v -:w --n `?y 1. The petition of MICHAEL S. GEORGE respectfully represents that on MAY 9, 2011, an Order of Court was entered for the support of SHELLEY A. GEORGE A true and correct copy of the order is attached to this petition. Form OM-501 Service Type M Worker ID 21005 GEORGE v. GEORGE PACKS Case Number: 210111548 2. Petitioner is entitled to O increase `X decrease O termination O reinstatement O other of this Order because of the following material and substantial change(s) in circumstance: (Complete & file in the Prothonotary's Office) Al /i l i L S E 5 hi. 1 WHEREFORE, Petitioner requests that the Court modify the existing order for support. f Petitioner Attorney for Petitioner 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. Y z? Da a Petitioner Form OM-501 Service Type M Page 2 of 2 Worker ID 21005 MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 09-7619 CIVIL TERM s- _ SHELLEY A. GEORGE, IN DIVORCE Defendant PACSES CASE: 210111548 < -Z; - -' rNI) -. rr - ORDER OF COURT _i AND NOW, this I Ith day of August 2011, a petition has been filed against you, Shelley A. George, to modify an existing Alimony Pendente Lite Order. You are ordered to appear in person at the Domestic Relations Section, 13 North Hanover Street, Carlisle, Pennsylvania, on September 7, 2011, at 1:30 P.M. for a conference and to remain until dismissed by the Court. If you fail to appear as provided in this Order, an Order of Court may be entered against you. 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 the 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. Copies mailed to: Petitioner Respondent Marianne E. Rudebusch, Esq. Michael A. Scherer, Esq. Date of Order: August 11, 2011 BY THE COURT, 1k t ?" ? M. L. Ebert, Jr., Judge 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 32 S. BEDFORD ST. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 0 -- Z: °i M Marianne E. Rudebusch, Esquire 4711 Locust Lane --? rv E ==' Harrisburg, PA 17109 c-i _ - ' 717-657-0632 Id. No. 63522 = Attorney for Defendant --+ (-.) MICHAEL S. GEORGE, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 2009-7619 SHELLEY A. GEORGE, : CIVIL ACTION -LAW Defendant : IN DIVORCE DEFENDANT, SHELLEY A. GEORGE'S PRE-TRIAL STATEMENT AND NOW, comes the Defendant, Shelley A. George, by and through her attorney, Marianne E. Rudebusch, and files the following Pre-Trial Statement: 1. BACKGROUND Michael S. George and Shelley A. George, hereinafter referred to as Husband and Wife, were married on October 4, 1986 in Berlin, Maryland. There are two children to the marriage, Brianne George born on July 8, 1990 and Michael M. George born on December 18, 1993. Husband is age 47 and Wife is age 48. The parties separated on or about November 3, 2009, the date Husband filed a complaint in Divorce in the Court of Common Pleas of Cumberland County, docketed at 2009-7619. Wife filed an Answer and Counterclaim on January 19, 2010. Since the 1996 the parties and their two children have resided at 24 Stamy Road, Newville, PA. In January of 2009 Wife and the parties' son relocated temporarily to Florida to assist the parties' 18 year old daughter with health and emotional issues. The daughter was working as a dancer with a ballet company in Florida. Husband encouraged Wife to temporarily move to Florida to assist their daughter and regularly visited the family in Florida. Wife and children routinely returned to the marital residence for holidays and other visitations. Husband resided in the marital home until July 2010, when he moved from the home into a new house he had purchased. He lives there together with his paramour and her minor son from a previous relationship. Wife returned to the marital home from Florida with the parties' son on August 23, 2010 and they continue to live there. The home was in serious disrepair upon Wife's return and she spent $2,788.70 for the most necessary and pressing repairs. The parties' son, Michael M., suffered a serious head injury in 2006 which left him with neurological and cognitive deficits in addition to his ADD. He was unable to handle school work in a traditional setting and Wife home schooled him from the second grade to 2010. He is enrolled as a Senior at Big Springs High School for the 2011/2012 school year. For the majority of the marriage Wife was a stay at home mother because of her responsibilities for the farm which the family resided, as well as her son's educational needs. At the time of her move to Florida in 2009, she was working as a part time bank teller with 2 Commerce Bank (now Metro Bank). The move to Florida necessitated termination of Wife's employment with Commerce Bank, and she obtained employment in Florida with First National Bank of Florida. Upon her return to Pennsylvania in 2010 she obtained employment with Citizen's Bank and continues to work their presently. 2. LIST OF ASSETS As per Wife's Inventory and attached spreadsheet 3. NAME AND ADDRESS OF EXPERTS None at this time 4. NAME AND ADDRESS OF LAY WITNESSES A. Michael S. George (as if on cross) Husband will be questioned as to the values of the marital assets and liabilities and his relationship to Taleen Palmer prior to the date of seperation. B. Shelley A.George 24 Stamy Road Newville, PA Wife will testify as to the values of the marital assets and liabilities; husband's relationship to Taleen Palmer; reasons for her temporarily residing in Florida. C. Taleen Palmer 12 Kensington Court Carlisle, PA Ms. Palmer will be questioned as to her relationship with Michael George prior to the parties' date of separation. 3 D. Joel Stamy 404 Green Spring Road Newville, PA 17241 Mr. Stamy will testify as to the sale of the residence and the lot to the parties; his continued involvement with the lot adjacent to the residence; his knowledge of the purpose for which the residence was purchased by the parties. E. Rosalie Cirio 621 Cambridge Road Springfield, PA Mrs. Cirio will testify as to Wife's reasons for temporarily moving to Florida. 5. GROSS INCOME FROM ALL SOURCES Wife is a clerical worker at Citizen's Bank and earns $14.00 per hour. She receives $795.00 a month in child support for their son and $840.00 a month in APL for herself. Husband is employed by Berkely Contract Packaging at an annual salary of $80,000.00 plus yearly bonuses of up to $10,000.00. Husband and Wife both cover the minor son under their respective health insurances. 6. WIFE'S ESPENSES As per Wife's Income and Expense statement and attached spreadsheet. Wife alone has been making payments on all credit cards and is making the mortgage payments on the marital home in the amount of $1,277.00 per month. Additionally she is paying taxes and insurance on the property which amount to approximately $6,500.00 a year. The premium for the hazzard insurance on the residence is high because of it's designation as a "Bead and Breakfast." When Wife returned to PA in 2010, the mortgage was up to date 4 because both parties equally shared the monthly payments after husband moved from the house. The outstanding school and property taxes were approximately $4,000.00 for the fall of 2010. These taxes as well as the $800.00 taxes due in the Spring of 2011 remain unpaid. 7. VALUE OF PENSION AND RETIREMENT BENEFITS Because of her status as a "stay at home mother", Wife had very little participation in retirement plans. She had a 401(k) with Metro Bank, which she cashed in during 2010, when preparing to move back home to Pennsylvania from Florida. Her net proceeds after taxes and penalty were approximately $3,000.00. Her current employer offers a 401 (k) plan with a current balance of $220.59, all accumulated after the Date of Separation. 8. PERSONALTY Husband removed from the marital residence all items he wanted when he moved to his new home. 9. MARITAL DEBTS As per Wife's Inventory and attached spreadsheet Date of Separation balances on the credit cards totaled $16,587.12 and the current balance is $16,553.64. Husband had a Bank of America credit card with a balance of approximately $5,000.00. The debt was charged off. 5 Wife alone has made payments on the marital credit cards and since August 2010, on the mortgage on the marital home and the outstanding property and school taxes for the marital home. Wife has incurred veterinary and feeding costs for the jointly owned horses and Husband's 2 dogs in the amount of approximately $6,494.00 for the animals left behind at the farm by husband, when he moved from the home. Husband contributed $300.00 towards these costs for the dog, Madel. 10. PROPOSED RESOLUTION To Wife: 1. Marital Home located at 24 Stamy Road Newville, PA, subject to the encumbrances for the joint mortgage with Wells Fargo in the amount of $215,961.14 and all other liens attached to this property which arose after August 23, 2010. Wife shall refinance the joint mortgage in her name alone within 18 months from the date of issuance of a decree in divorce. Wife shall hold harmless and indemnify Husband for all responsibilities for this property. In the event that wife fails to re-finance the joint mortgage in her name alone withingl8 months from the date of issuance of a decree in divorce, the property shall be sold and all net proceeds shall go to wife. 2. All household goods and furnishing remaining in the marital residence including but not limited to farm equipment, tools and the like. 6 3. Vehicles a. 2006 Mini Cooper There are no encumbrances on this vehicle. b. 2004 Jeep Liberty Husband traded in this vehicle on a new car. C. 2009 Kia Rio The car is title in husband's name, however, it was a graduation gift to the parties' daughter and is in her possession. 4. Husband shall pay to Wife: a.. 50% or $8,293.56 of the balances at Date of Separation on the credit cards with Discover, American Express, Chase, Bonton and Bloomingdales for a total amount of $16,587.12; b. 50% or 2,000.00 of the funds he deposited into his own checking account # 0833152713 at Metro Bank on 11/3/09, the day prior to the filing of the Divorce Complaint on 11/4/09. C. 50% or $1,394.35 for the cost of repairs to the marital residence for a total amount of $2,788.70. d. Husband retained all funds from the income tax refund for 2010 in the amount of $1,820.75.50% or 910.37 shall be paid to Wife by Husband. e. 50% or 3,247.00 of the vet and feed bills for the animals he left behind when he vacated the marital residence in March 2010. 7 f. Husband shall reimburse Wife for the school and property taxes outstanding on the marital residence upon her return to the marital residence on 8/23/10 in the amount of $4,000.00. 5. Husband shall pay Wife alimony for 36 months following the issuance of a decree in divorce at the amount of the current APL order of $840.00 per month. To Husband: 1. Lot adjacent to the marital home which is unencumbered. Husband shall bear all cost associated with the transfer of this property to him including but not limited to surveys, subdividing, etc. There shall be a recorded easement benefitting 24 Stamy Road, upon the transfer of the lot to Husband or a sale of the lot by him. The net proceeds from the sale of the lot shall belong to Husband. Until the lot is sold Wife shall continue to be entitled to harvest the hay on the lot which serves as a source of food for the horses. The cost of harvesting the hay shall be borne by Wife. 2. 2004 Jeep Liberty 3. Two (2) Golden Retrievers registered to Husband. 4. All household goods and furnishings in Husband's possession. 8 Respectfully Submitted, Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, PA 17109 717-657-0632 Id. No. 63522 Dated: q" P ( I 7/5/2011 Assets and Liabilities 1. Real Estate and Mortgages Current Title Description Value HWJ _ 24 Stamy Road 365,000 J 1st Mort. (balance)...... 215,961 Monthly Payment ....... (principal plus interest)* Annual Interest Rate..... % (If blank, we use 4.8%) Who pays mortgage.... Q Shelley Q Michael Q 50/50. Or, lot 1 st Mort. (balance)..... . Monthly Payment ....... Annual Interest Rate.... . 75,000 J 0 i _ (principal plus interest)* % (If blank, we use 4.8%) Who pays mortgage.... Q Shelley QQ Michael Q 50/50. Or, % paid by Shelley % paid by Shelley (*) Mortgage payments will flow as an expense of the parties on the Affidavit and financial reports. Mortgage interest will be calculated and deducted automatically for tax purposes. 2. Investments, Checking Accounts, Etc. Current Title Description Value HWJ Certificate of Deposit 0 J Metro Checking 4,000 H 2009 income tax refund 1,821 3. Debts Current Monthly Title Description Balance Payment* HWJ Discover 9,642 W American Xpress 1,823 W Chase 3,944 W Bon Ton 563 W Bloomingdales 306 W Gap 275 W Bank of America 5,000 H (*) Monthly Payment will flow as an expense of the parties on the Affidavit and financial reports according to their payment percentages. Payment percentages are specified on the "more info" link for each debt. 4. Personal Items & Vehicles Current Title Description Value Asset Type HWJ 2007 Mini Cooper 9,450 Vehicle H 2009 Kia Rio Vehicle H 2004 Jeep Liberty H has info Vehicle H horses (2) Other J golden retrievers (2) Other H 5. IRA / 401 k Current Title IRA Description Value HWJ ? 401 (k) 221 W ? 401 (k) with Metro 3,000 W ? 6. Life Insurance 7. Business Law Office of Marianne E. Rudebusch Prepared by Ms. Marianne Rudebusch, JD (c) Family Law Software, Inc. v 13.02 71512011 1:17pm Shelley George & Michael George Page 1 7/5!2011 Jn the Court of Common Pleas of Cumberland County, Pennsylvania Shelley George ) Docket Number: 2009-7619 Plaintiff ) vs. ) PACSES Case Number. Michael George ) Defendant ) Other State ID Number: Please note: All correspondence must include the PACSES Case Number Inventory MARITAL ASSETS 1 2 3 4 5 6 7 8 9 10 11 12 Description of Properly Title Separation Current Marital Exhibit Value Value Equity (Val. Date) (Val. Date) 4 Stamy Road J 365,000 149,039 $365,000 less mortgage of $215,961 of J 75,000 75,000 ertificate of Deposit J 0 0 shed in by mutual consent Metro Checking H 4,000 4,000 #xxxx2713 009 income tax refund 1,821 1,821 007 Mini Cooper H 9,450 9,450 9 Kia Rio H 0 duation gift to daughter r 4 Jeep Liberty H H has info 0 ed in by husband es (2) o J 0 olden retrievers (2) H 0 01 (k) W 221 221 st separation 01 (k) with Metro W 3,000 3,000 shed in to pay bills and return to PA TOTALS Notes: (1) 401 (k) with Metro - net after taxes and penalty 0 458,492 242,531 est (1) Law Office of Mahe" E. Rudebusch Prepared by Ms. Marianne Rudebusch, JD (c) Family Law Software, Inc. v 13.02 7/5/2011 1:19pm Shelby George & Michael George Page 1 In the Court of Common Pleas of Cumberland County, Pennsylvania Shelley George ) Docket Number: 2009-7619 Plaintiff ) vs. ) PACSES Case Number: _ Michael George ) Defendant ) Other State ID Number: Please note: All correspondence must include the PACSES Case Number Inventory MARITAL LIABILITIES 1 2 3 4 5 6 7 7/5/2011 Description of Property Title Separation Current Marital Exhibit Value Value Debt (Val. Date) ver W 9 ,642 9,642 364 ican Xpress k W 1,823 1,823 009 e has W 3,944 3,944 5 onTon W 563 563 F 3 gdales W 306 306 9 9 751 ap W 275 275 ank of America H 5,000 5,000 TOTALS Notes: (1) Bank of America - debt was charged off Prepared By: Marianne Rudebusch Signature 0 21,553 21,553 Title: JD Date est (1) Law Office of Marianne E. Rudebusch Prepared by Ms. Marierm Rudebusch, JD (c) Family Law Software, Inc. v 1302 715r2o11 1:19pm Shelley George & Michael George Page 2 7/5/2011 -Marital Property Division Total of Marital Equity: Shelley $ 156,122 (69.2%) Michael $ 69,632 (30.8%) Marital Asset Line Items: Shelley's Michael's Total Marital % or $ Amount % or $ Amount Non-retirement Assets: Real Estate Equity: 24 Stamy Road lot Cash & Investments: Certificate of Deposit Metro Checking xxxx2713 2009 income tax refund 100 149,039 0 0 0 100 50 0 50 50 2,000 50 50 911 50 Personal Items: 2007 Mini Cooper 2009 Kia Rio 2004 Jeep Liberty horses (2) golden retrievers (2) Retirement Assets: IRAs and 401(k)s: 401 (k) 401 (k) with Metro Debts Shelley 9,450 Michael 0 0 149,039 75,000 75,000 910 1,821 0 9,450 _ 0 0 0 100 3,000 0 _ 221 0 3,000 Debt: Discover American Xpress Chase Bon Ton Bloomingdales Gap Bank of America 50 4,821 50 912 50 1,972 50 282 50 153 50 138 50 4,821 9,642 50 912 1,823 50 1,972 31944 50 282 563 50 153 306 50 138 275 5,000 Law Oft e of Marianne E. Rudebusch Prepared by Ms. Madenne Rudebusch, JD (c) Fan* Law Software, Inc. v 13.02 7/5/2011 1:20pm Shelley George & Micheal George Page 1 2006 MINI Cooper Hatchback 2D Trade In Values, Reviews - Kelley B... http://www.kbb.com/niini/cooper/2006-mini-cooper/hatchback-2d/?veh... o advertkement Home > Car Values > MINI > Cooper > 2006 > Style > Options > Hatchback 2D 2006 MINI Cooper Hatchback 2D Mileage: 80,000 change edit options change style why ads? 2006 MINI C Like r 1 Select Your Car 2 Tell Us Style / Options 3 See Blue Book value 4 j price values specs new car finder used cars for sale Tracle-In/Sell Values See Used Car Prim Trade-In Private Party Excellent Good Fair $10,175 $9,450 $8,200 Change condition Get a CARFAX Record Check Enter VIN (option/) go No VIN? No Problem! Get your New Car Price price your next car KBB Expert Suggestions Share Print My Recently Viewed My Saved Cars save Seller's Reso How much can I Use our monthly pa My KE I 1 of 4 7/5/2011 11:55 AM advertkement MICHAEL S. GEORGE, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 2009-7619 SHELLEY A. GEORGE, : CIVIL ACTION -LAW Defendant : IN DIVORCE CERTIFICATE OF SERVICE AND NOW, this day of , 2011, I, Katherine A. Frey, Secretary to Marianne E. Rudebusch, Esquire, Attorney for the Defendant, hereby certify that a copy of the within document has been served, by depositing a copy of the same in the United States mail, first class, postage prepaid, delivery at Harrisburg, Pennsylvania, to the following addressees: E. Robert Elicker, II, Esquire Office of the Divorce Master 9 North Hanover Street Carlisle, PA 17013 Michael A. Scherer, Esquire 19 West South Street Carlisle, PA 17013 Attorney for Plaintiff By: //1 19 Katherine A. Frey MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE • C7 C r,a c+ ;; i NO. 09-7619 CIVIL TERM - z SHELLEY A. GEORGE, IN DIVORCE -0 zm = rn Defendant/Petitioner PACSES Case No: 210111548 r r1 -<_" co c :> C) ORDER OF COURT rZ' ?f AND NOW to wit, this 8th day of September 2011, it is hereby Ordered that the Petition to Modify filed on August 8, 2011 in the above captioned matter is dismissed without prejudice due to there being no substantial change in either parties' income. 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. BY THE COURT: 1k M. L. Ebert, Jrt U?4A ? ., J. DRO: R.J. Shadday xc: Petitioner Respondent Michael A. Scherer, Esq. Marianne E. Rudebusch, Esq. Form OE-001 Service Type: M Worker: 21005 MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE • C= 09•107 C=) NO. 9944.7=IVIL TERM -r;:r N - SHELLEY A. GEORGE, IN DIVORCE :;Cm r Defendant/Petitioner PACSES Case No: 210111548 <> <C:) ORDER OF COURT =C: k N) C n AND NOW to wit, this 13th day of February, 2012, it is hereby Ordered that the Respondent is to make a direct payment of $1,624.26 to the Petitioner within 20 days from this date pursuant to the Support Master's order of May 9, 2011. The sum of $1,624.26 represents 30% of a net bonus that was received by the Respondent on or about December 16, 2011. Both parties are to report to the Domestic Relations Section that said sum has been paid. 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. BY THE COURT: N t ut:?? ? M. L. Ebert, Jr., J. DRO: R.J. Shadday xc: Petitioner Respondent Marianne E. Rudebusch, Esq. Michael A. Scherer, Esq. Form OE-001 Service Type: M Worker: 21005 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SHELLEY A. GEORGE ) Docket Number: 09-7619 CIVIL Plaintiff ) vs. PACSES Case Number: 210111548 MICHAEL S. GEORGE ) C= 'Tt Defendant ) Other State ID Number: mz ? ---i ? U)r - n c ORDER OF COURT *C-) c- 5c: w Legal proceedings have been brought against you alleging you have- rviliu lly disobeyed an Order of Court. 1. A critical issue in the contempt proceeding is your ability to pay and comply with the terms of the support order. If you wish to defend against the claims set forth in the attached Petition for Contempt, you may, but are not required to, file in writing with the Court your defenses or objections. 2. You, MICHAEL S. GEORGE, Respondent, must appear in person in court on MAY 31, 2012, at 1:30PM, in COURT ROOM 2 C/O CUMBERLAND CO COURTHOUSE, 4TH FLOOR, 1 COURTHOUSE SQUARE, CARLISLE, PA. 17013 IF YOU DO NOT APPEAR IN PERSON, THE COURT MAY ISSUE A WARRANT FOR YOUR ARREST AND YOU MAY BE COMMITTED TO JAIL. 3. If the Court finds that you have willfully failed to comply with its order you may be found to be in contempt of court and committed to jail, fined, or both. You will have the opportunity to disclose income, other financial information and any relevant personal information at the conference/hearing so that the Court can determine if you have an ability to pay. You may also tell the Court about any unusual expenses that may affect your income. Fill out the enclosed Income and Expense Statement form apd bring it with you. Form EN-528 10/11 Service Type M Worker ID 21600 GEORGE v. GEORGE PACSES Case Number: 210111548 At the above scheduled proceeding, the contempt may be dismissed, new and/or modified purge conditions may be imposed, or the judge may order you to go to jail. If the plaintiff fails to appear, the Court will proceed with the case and enter an appropriate order. The parties are to remain until dismissed by the Court. YOU ARE REQUIRED TO BRING: - The completed Income and Expense Statement form. - Cash, credit card in your name, cashier/bank check or money order payable to DOMESTIC RELATIONS SECTION. Contact your local DRS before the hearing date to verify which of the payment methods listedabove are accepted. - Most recent pay stub for any and all employers. - Payroll address, phone number, fax number and contact person. - Proof of medical coverage. - Any other documentation relevant to your case and the issue of contempt as stated in the petition. YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE/HEARING AND RESENT YOU. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FQRTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT H IG A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, TICS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFOR#AATION ABOUT A, $ THAT MAY OFFER LEGAL SERVICES TO ELIGMBLE PERMS AT A FEE OR NO FEE. CUMBERLAND CO BAR ASSOCIATION 32 S BEDFORD ST CARLISLE PA 17013-3302-32 (717) 249-3166 AMERICANS WITH Df$A".ltlES SGT OF 19 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. BY THE COURT: OR 1 4 2012 Date of Order: '* -t ?14 "A..Mwk 46 JUDGE Form EN-528 10/11 Service Type M Page 2 of 2 Worker ID 21600 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SHELLEY A. GEORGE ) Docket Number: 09-7619 CIVIL vs. Plaintiff MICHAEL S. GEORGE Defendant PACSES Case Number: 210111548 Other State ID Number: PETITION FOR CONTEMPT - DEFENDANT TO THE HONORABLE, THE JUDGES OF SAID COURT: c }? 1. Petitioner is CUMBERLAND County Domestic Relations Section. z 2. Defendant is MICHAEL S. GEORGE who resides at: - -'r- 12 KENNSINGTON CT, CARLISLE, PA. 17013-4813-12 C C 3. On MAY 9, 2011 an order of support was entered by the Honorable;zc: W yes . Court directing Defendant to pay the sum of $840.00 per month plus Z $84.00 per month in arrears for the support of his/her dependent(s). - =- 4. Defendant has failed to comply with the order as entered by the Court by failing to: ? pay as ordered. ? provide information which was ordered. ? appear as ordered. ® other: make 30% of net bonus payment to plaintiff. 5. The arrearages under the Order amount to $1,045.30 as of MARCH 14, 2012. WHEREFORE, Petitioner prays that the Court issue an order directing the attendance of Defendant at a hearing of said Petition and hereafter to make an adjudication of contempt. I verify that the statements made in this Petition are true and correct to the best of my knowledge. I understand that false statements herein are made to the penalties of 18 Pa. C.S. § 4904 relating to unsworn f ion to authorities. MARCH 14-2012 E$4• Date Signature - Form EN-007 03/11 Service Type M Worker ID 21600 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SHELLEY A. GEORGE ) Docket Number: 09-7619 CIVIL Plaintiff ) vs. ) PACSES Case Number: 210111548 MICHAEL S. GEORGE ) Defendant ) Other State ID Number: Order AND NOW to wit, this MARCH 20, 2012 it is hereby Ordered that: the contempt petition filed March 14, 2012 is dismissed. BY THE COURT: r ?< XC ) cr? :7 MARCH 20, 2012 Date JUDGE 1 - , +V* Form OE-001 Service Type M Worker ID 21600 INCOME WITHHOLDING FOR SUPPORT O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) 56D 1 I 143 =2-1 D I IIS W b O AMENDED IWO !? Sd 1() Q? - 110 i 9 CI V 1 O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT O TERMINATION OF IWO Date: 03/26/12 ? Child Support Enforcement (CSE) Agency M 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 htti)://www.acf.hhs.gov/programs/cse/newhire/employer/publication/i)ublication.htm - forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. States I abet I erntory commonwealth of Pennsylvania Remittance Identifier (include w/payment): 3301102230 City/County/Dist.rrribe CUMBERLAND Order Identifier: (See Addendum for order/docket informalton) Private Individual/Entity _ CSE Agency Case Identifier: (See Addendum for case summary) ALCOTT GROUP INC PO BOX 160 FARMINGDALE NY 11735-0160 Employer/Income Withholder's FEIN 261638437 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www.acf.hhs. gov/brog rams/cse/newhire/ employer/bublication/publication.htm - formo. 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. 2616384370 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts froii th Ip?rne ogee/ obligor's income until further notice. ^' $ 795.00 per month in current child support ' ' } $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? O yern gj) rj% $ 0.00 per month in current cash medical support CO -' $ 0.00 per month in past-due cash medical support , $ 840.00 per month in current spousal support $ 0.00 per month in past-due spousal support !?? $ 0.00 per month in other (must specify) r.a for a Total Amount to Withhold of $ 1,635.00 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: $ T7.3j per weekly pay period. $ 817.50 per semimonthly pay period (twice a month) $ 764,Ib??_per biweekly pay period (every two weeks) $ 1,635.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10) working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), obtain withholding limitations, time requirements, and any allowable employer fees at http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/ contact_map.htm for the employee/obligor's principal place of employment. Document Tracking Identifier RE: GEORGE, MICHAEL S Employee/Obligor's Name (Last, First, Middle) 220-82-9689 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) OMB No.: 0970-0154 Form EN-028 01/12 Service Type M Worker ID $IATT ? Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. ? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shown above as the Employee/Obligor's Case Identiffer) 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:Hwww.acf.hhs.gov/programs/cse/newhire/emFoyer/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 - 05/3112014. The OMB Expiration Date has no bearing on the termination date of the IWO, it identifies the version of the form currently in use. Form EN-028 01/12 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: ALCOTT GROUP INC Employee/Obligor's Name: GEORGE, MICHAEL S. CSE Agency Case Identifier: (See Addendum for case summary Employer FEIN: 261638437 3301102230 Order Identifier: (See Addendum for order/docket information) Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 2616384370 Q This person has never worked for this employer nor received periodic income. Q This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known address: Last known phone number: Final Payment Date To SDU/Tribal Payee: New Employer's Name: New Employer's Address: Final Payment Amount: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.childsupport.state.pa.us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST. P.O. BOX 320, CARLISLE. PA. 17013 (Issuer address). To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at www.childsupport.state.pa.us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. Service Type M OMB No.: 0970-0154 Page 3of3 Form EN-028 01112 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S. PACSES Case Number 210111548 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 09-7619 CIVIL $ 840.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number 550111432 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 00054 S 2010 $ 795.00 Child(ren)'s Name(s): DOB MICHAEL M. GEORGE 12/18/93 PACSES Case Number Plaintiff Name Do ke Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 01/12 Service Type M OMB No.: 0970-0154 Worker ID $IATT MICHAEL S. GEORGE, Plaintiff V. SHELLEY A. GEORGE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLMANIA e- C= NO. 2009 - 7619 CIVIL TERM' S' CIVIL ACTION-LAW CA) IN DIVORCE, -o r- MOTION FOR COUNSEL FEES AND NOW, comes Michael George, by and through his attorney, Michael A. Scherer, Esquire, and respectfully represents: 1. Wife raised a claim of marital misconduct in this matter. 2. A hearing was held on the marital misconduct allegation on February 16, 2012. 3. The essence of Wife's claim for marital misconduct was that Husband engaged in an extramarital affair during the parties' marriage prior to the date of separation. 4. At the hearing, Wife offered no proof of an affair, but merely identified a relationship Husband had with a co-worker. 5. Wife's actions in raising marital misconduct were designed to harass Husband and Husband's girlfriend, and to delay the resolution of this case. 6. Husband was forced to expend attorney's fees to defend the frivolous claims of Wife in raising marital misconduct. 7. Prior to the hearing, undersigned counsel warned Wife's counsel that there was absolutely no evidence of an affair between Husband and his co-worker, and that if Wife forced Husband to defend against the allegations, Husband would pursue a claim for counsel fees. Ra.so i?_ C4 1 ecI-4- is843 a'?a7aa,?? WHEREFORE, Husband respectfully requests that this Honorable Court award him counsel fees in connection with the frivolous, obdurate and vexatious claims advanced by Wife in this litigation. Respectfully submitted, BARIC SCHERER LLC DATE: 3- 2 6 ? r L- 4 s4zlt& Michae A. S herer, Esquire I. D. # 61974 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 Attorney for Plaintiff VERIFICATION The statements in the foregoing Motion for Counsel Fees are based upon information which has been assembled by my attorney in this litigation. The language of the statements is not my own. I have read the statements; and to the extent that they are based upon information which I have given to my counsel, they are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsifications to authorities. ?_ DATE: Michael S. Ge rge CERTIFICATE OF SERVICE I hereby certify that on ftQr 3D4' , 2012, I, Andrea M. Ramos, secretary at Baric Scherer LLC, did serve a copy of the Motion for Counsel Fees, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, Pennsylvania 17109 r Andrea M. amos Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, PA 17109 717-657-0632 Id. No. 63522 Attorney for Defendant MICHAEL S. GEORGE, Plaintiff V. SHELLEY A. GEORGE, Defendant f°?IJ?INf??I?i THE Z?i1 Z ?AY Ate UMI?ERLAPvD ODUN, ,{, pENNS YLVANIA : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA NO. 2009-7619 : CIVIL ACTION -LAW : IN DIVORCE DEFENDANT'S REVISED INCOME AND EXPENSE STATEMENT UNDER RULE 1920.31 I hereby file the Statement of Income and Expenses required under Rule 1920.31 and verify that the information therein contained is true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. 4904, relating to unworn falsification to authorities. Date: 3 Shelley A. #orge INCOME AND EXPENSE STATEMENT OF SHELLEY A. GEORGE Employer: Citizens Bank Address: 665 N. East Street, Carlisle, PA Type of Work: Banker Payroll Number: J031447 Pay Period (weekly, bi-weekly, etc): Weekly Gross Pay Per Pay Period: $583.48 Itemized Payroll Deductions: Federal Withholding -$65.61 Social Security -$22.84 Local Wage Tax -$1.00 State Income Tax -$22.14 Unemployment -$0.47 Medicare Tax -$7.89 Retirement (401 k) -$11.67 Savings Bonds Credit Union Life Insurance Health Insurance -$39.00 Pension Contribution Net Pay Per Pay Period: $412.86 Other Income: Monthly Yearly Interest - CD & Bonds Dividends Pension Annuity Social Security Rents Royalties I Expense Account Unemployment Compensaion Workmen's Comp. Gifts Child Support Spousal Support/Alimony TOTAL $795.00 $840.00 $3,423.92 EXPENSES HOME: Rent Mortgage/Rent Maintenance & Lawn Hay Fields Utilities: Electric Gas Oil Sewer Telephone Cell Phone Water (to be determined) Dumpster EMPLOYMENT: Public Transportation Lunch Monthly $875.00 $1,900.00 $60.00 $58.00 $150.00 $135.00 $217.00 $25.00 $9,540.00 $10,080.00 $41,087.07 Yearly $10,500.00 $22,800.00 $720.00 $700.00 $1,800.00 $1,620.00 $2,604.00 $300.00 $0.00 TAXES: Real Estate $416.67 $5,000.04 Personal Property $0.00 INSURANCE: Homeowners $160.00 $1,920.00 Automobile(s) $67.00 $804.00 Life $50.00 $600.00 Accident Health Other: Renters Insurance to be determined AUTOMOBILES: Payments Fuel (all vehicles) $150.00 $1,800.00 Repairs $40.00 $480.00 MEDICAL: Doctor . $85.00 $1,020.00 Dentist (parties son) $100.00 $1,200.00 Orthodontist Hospital Medicine $100.00 $1,200.00 Special Needs (glasses $25.00 $300.00 braces, etc.) EDUCATION: Private School Home School College Religious PERSONAL: Clothing $100.00 $1,200.00 Food $650.00 $7,800.00 Barber/Hair Dresser Credit Payments Credit Card $500.00 $6,000.00 Charge Accounts Memberships LOANS: Credit Union Line of Credit MISCELLANEOUS: Child Care/Babysitting Papers/Books/Magazines Entertainment Pay TV/Internet $85.00 $1,020.00 Vacation Gifts Legal Fees $500.00 $6,000.00 Charitable Contributions Child Support Alimony/Spousal Support Tax Preparation $25.00 $300.00 Animal Care $150.00 TOTAL EXPENSES $5,748.67 $77,688.04 MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 09-7619 CIVIL TERM ; SHELLEY A. GEORGE, IN DIVORCE Defendant/Petitioner PACSES CASE: 210111548 .: lr1 ?? ?- ORDER OF COURT AND NOW, this 17th day of May, 2012, based upon the Court's determination that the Petitioner's monthly net income/earning capacity is $ n/a and the Respondent's monthly net income/earning capacity is $ n/a, it is hereby ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit Five Hundred Seventy-eight and 00/100 Dollars ($ 578.00) per month payable bi-weekly as follows: $ 578.00 per month for Alimony Pendente Life and $ 0.00 of per month on arrears. The first payment due in accordance with the Respondent's pay schedule. The effective date of the order is February 1, 2012. Arrears set at $ 0.00 as of May 17, 2012. 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 is to be turned over by the PA SCDU for distribution and disbursement in accordance with Rule 1910.17(d). 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 the spouse. Unreimbursed medical expenses of the spouse 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 s` 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. 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 10% a month until all arrearages are paid in full. Payor is responsible for court costs and fees. Other conditions: This order is based upon an agreement of the parties, through their counsel, eliminating the additional sum for a mortgage contribution. Should the balance of this order exceed thirty days in arrears, an additional sum of 10% of the order will be added to liquidate any accumulated arrears. 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. Mailed copies on: May 17. 2012 BY THE COURT 'k -t M. L. Ebert Jr., J. xc: Petitioner Respondent Michael A. Scherer, Esq. Marianne E. Rudebusch, Esq. DRO: R.J. Shadday qL INCOME WITHHOLDING FOR SUPPORT ZI011154-9 U9-7b 19 Gvl I Date: 05/17/12 O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) ??? 1 1 ) , i `{ Q AMENDED IWO q 0 ONE-TIMEORDERMOTICE FOR LUMP SUM PAYMENT > ?] F\ 1 U 0 TERMINATION OF IWO a ill ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www act hhs gov/progrrams/cse/newhiretemployer/publication/publication htm - forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. Staterrriberretritory Commonwealth of Pennsylvania Remittance Identifier (include w/payment): 3301102230 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket informaiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) ALCOTT GROUP INC PO BOX 160 FARMINGDALE NY 11735-0160 Employer/Income Withholder's FEIN 261638437 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions httr)://www.acf.hhs gov/programs/cse/newhire/ emDoyer/publication/publication.htm - form . If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. 2616384370 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 CUMBERJ_AND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts fro thEMmployee/ obligor's income until further notice. gGZ; $ 795.00 per month in current child support a. ; $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? O Y11- Z) it?j $ 0.00 per month in current cash medical support ter:. ` $ 0.00 per month in past-due cash medical support 'r.. P-? $ 578.00 per month in current spousal support ?_-: $ 0.00 per month in past-due spousal support $ 0.00 per month in other (must specify) c. , for a Total Amount to Withhold of $ 1,373.00 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: $ 311 ,gS per weekly pay period. $ 686.50 per semimonthly pay period (twice a month) $-?,331Q per biweekly pay period (every two weeks) $ 1,373.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10) working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), obtain withholding limitations, time requirements, and any allowable employer fees at http://www act hhs gov/programs/cse/newhire/employer/contacts/ contact map.htm for the employee/obligor's principal place of employment. Document Tracking Identifier Service Type M OMB No.: 0970-0154 RE: GEORGE, MICHAEL S. Employee/Obligor's Name (Last, First, Middle) 220-82-9689 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) Form EN-028 01/12 Worker ID $IATT ? Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU 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): ' tR L st. t ? V Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: hi;_t 201 - - If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. ? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: hftp•//www acf hhs gov/pro.grams/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 WO, it identifies the version of the form currently in use. Form EN-028 01/12 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: ALCOTT GROUP INC Employer FEIN: 261638437 Employee/Obligor's Name: GEORGE, MICHAEL S. 3301102230 CSE Agency Case Identifier: (See Addendum for case summary) Order Identifier: (See Addendum for order/docket information) Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you a no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 2616384370 Q This person has never worked for this employer nor received periodic income. O This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known address: Final Payment Date To SDU/Tribal Payee: New Employer's Name: Last known phone number: Final Payment Amount: New Employer's Address: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.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. Service Type M OMB No.: 0970-0154 Page 3 of 3 Form EN-028 01/12 Worker ID $IATT ADDENDUM Summate of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S. PACSES Case Number 210111548 SHELLEY A. GEORGE c et Attachment Amount 09-7619 CIVIL $ 578.00 Child(ren)'s Name(s): DOB PACSES Case Number 550111432 Plaintiff Name SHELLEY A. GEORGE Deck t Attachment Amount 00054 S 2010 $ 795.00 Child(ren)'s Name(s): DOB MICHAEL M. GEORGE 12/18/93 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 01/12 Service Type M OMB No.: 0970-0154 Worker ID $IATT .. Cody tb `pvzo Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, PA 17109 717-657-0632 Id. No. 63522 Attorney for Defendant L CQUti! `, HNSYLV,- FIA MICHAEL S. GEORGE, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 2009-7619 : PACSES NO. 210111548 SHELLEY A. GEORGE, : CIVIL ACTION -LAW Defendant : IN DIVORCE PETITION TO MODIFY APL 1. Plaintiff resides at: 1160 Redwood Drive Carlisle, PA 17013 Cumberland County Plaintiff's Social Security Number is: 167-60-7783 Date of Birth: 2/15/63 2. Defendant resides at: 12 Kensington Court Carlisle, PA 17013 Cumberland County Date of Birth: 7/27/63 Defendant's Social Security Number is: 220-82-9689 3. (a) Plaintiff and Defendant were married on: 10/4/86 (b) Plaintiff and Defendant were separated in November 2009 (c) Plaintiff and Defendant were divorced on: N/A (d) Address of last marital domicile: 23 Stamy Road, Newville, PA 17241 4. Plaintiff and Defendant are the parents of or stand in loco parentis to the following child: Name Birth Date Agge Born of the Marriage Y=Yes, N=No Michael M. George 12/18/93 18 Y Residence: 1160 Redwood Drive Carlisle, PA 17013 5. Plaintiff seeks to modify the existing Order for APL dated May 9, 2011 effective June 7, 2012 when the parties child, Michael M. George, graduates high school. WHEREFORE, Plaintiff requests that the order dated May 9, 2011 be modified. I verify that the statements made in this Complaint are true and correct. I understand that false statements herein are made subject to penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, PA 17109 717-657-0632 Id. No. 63522 Attorney for Plaintiff Dated: ??-/? F 4 MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE r w, NO. 09-7619 CIVIL TERM -.ivcz; -? r.t.y l ( i - ..... SHELLEY A. GEORGE, IN DIVORCE ? E- Defendant/Petitioner PACSES CASE: 210111548 ? s- -L, ORDER OF COURT AND NOW, this 4th day of June, 2012, a petition has been filed against you, Michael S. George, to modify an existing Alimony Pendente Lite Order. You are ordered to appear in person at the Domestic Relations Section, 13 North Hanover Street, Carlisle, Pennsylvania, on June 25, 2012 at 9:00 A.M. for a conference and to remain until dismissed by the Court. If you fail to appear as provided in this Order, an Order of Court may be entered against you. 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 the Rule 910.11. (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you CC361 U The appropriate court officer may modify or terminate the existing order in any manner based upon the evidence presented. BY THE COURT, '?L4 Date of Order: June 4, 2012 M. L. Ebert, Jr., J e YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE 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. CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD ST. CARLISLE, PENNSYLVANIA 17013 (717)249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of 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:. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference. INCOME WITHHOLDING FOR SUPPORT ??10 1 S 4 g O ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT (IWO) q (? O AMENDED IWO `55 0111 q-?- ?1 I _ I -I ??V I O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT O TERMINATION OF IWO S Date: 06/08/12 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWOtust-baregularvn its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http•/. acf hhs gov/pe grams/ese/newhire/employer/publication/publication htm - forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Tnbe/Territory Commonwealth of Pennsylvania Remittance Identifier (include w/payment): 3301102230 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket /nformafton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) ALCOTT GROUP INC PO BOX 160 FARMINGDALE NY 11735-0160 Employer/Income Withholder's FEIN 261638437 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: GEORGE, MICHAEL S. Employee/Obligor's Name (Last, First, Middle) 220-82-9689 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions / hftp:/Iwww.acf.hhs.gov/`proarams/cse/newhire employer/publication/publication.htm - form . If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. 2616384370 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 CUMBIFRLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts fro- thC obligor's income until further notice. r- s'' -:r= -.; $ 0.00 per month in current child support $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? p y ;, O -me `; -- ` $ 0.00 permonth in current cash medical support r- _ - r y $ 0.00 per month in past-due cash medical support ` 2- $ 578.00 per month in current spousal support $ 0.00 permonth in past-due spousal support $ 0.00 per month in other (must specify) ` for a Total Amount to Withhold of $ 578.00 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: $ 133.39 per weekly pay period. $ 289.00 per semimonthly pay period (twice a month) $ 266:1-1 per biweekly pay period (every two weeks) $ 578.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs n 10 working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www.acf.hhs.gov/ roarams/cse/newhire/employer/contacts/contact map htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970-0154 Form EN-028 06/12 Service Type M Worker ID $IATT ? Return to Sender [Completed by Employer/income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. tt Signature of Judge/Issuing Official (if required by State or Tribal law): f Print Name of Judge/Issuing Official: MI.. ?. j Title of Judge/Issuing Official: Date of Signature: i If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this I WO must be provided to the employee/obligor. ? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERSANCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 1$ or more persons, or if an employer has a history of two or more returned checks due to nonsufftient funds. Pleasecall the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-6716-9590 for instructions. PA FIPS CODE 42 040 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 89112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: hhttn'//www acf hhs.oov/pSiqram,Wcse/newhice/employer/contacts/contaci man htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(bx7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU-or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SOU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date - 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN-028 06/12 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: ALCOTT GROUP INC Employer FEIN: 261638437 Employee/Obligor's Name: GEORGE MICHAEL S. 3301102230 CSE Agency Case Identifier: (See Addendum for case summary) Order Identifier: (See Addendum for order/docket Information) Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 2616384370 Q This person has never worked for this employer nor received periodic income. Q This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known address: Last known phone number: Final Payment Date To SDU/Tribal Payee: New Employer's Name: New Employer's Address: Final Payment Amount: CONTACT INFORMATION: To Em lQyer/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 childsupnortstate pa us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. Service Type M OMB No.: 0970-0154 Page 3 of 3 Form EN-028 06/12 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S. PACSES Case Number 210111548 PACSES Case Number Plaintiff Name Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount Docket Aftachmnt _Amount 09-7619 CIVIL $ 578.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): PACSES Case Number plaintiff ame Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docks Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB DOB PACSse Number Pontiff Name Do kc et Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB DOB Addendum Form EN-028 06/12 Service Type M OMB No.: 0970-0154 Worker ID $IATT MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 09-7619 CIVIL TERM SHELLEY A. GEORGE, IN DIVORCE Defendant/Petitioner PACSES CASE: 210111548 rT, 7 c.r; r ?v ORDER OF COURT CD r_-) AND NOW, this 25th day of June, 2012, based upon the Court's determination that the Petitioner's monthly net income/earning capacity is $ 2,439.76 and the Respondent's monthly net income/eaming capacity is $ 4,892.56, it is hereby ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit One Thousand Fifty-one and 00/100 Dollars ($1, 051.00) per month payable weekly as follows: $ 1,051.00 per month for Alimony Pendente Lite and $ 0.00 per month on arrears. The first payment due in accordance with the Respondent's pay schedule. The effective date of the order is June 7, 2012. Arrears set at $ -349.56 as of June 25, 2012. 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 is to be turned over by the PA SCDU for distribution and disbursement in accordance with Rule 1910.17(d). 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 the spouse. Unreimbursed medical expenses of the spouse 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. [] Respondent [X] Petitioner [] Neither party to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the [X] Petitioner [] 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. 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 0% a month until all arrearages are paid in full. Payor is responsible for court costs and fees. Other conditions: This order is based upon the Respondent no longer having a child support obligation since the child's emancipation on June 7, 2012. Should the balance of this order exceed thirty days in arrears, an additional sum of 10% of the order will be added to liquidate any accumulated arrears. 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. Mailed copies on: June 26, 2012 BY THE COURT M. L. Ebert, Jr., J. xc: Petitioner Respondent Marianne E. Rudebusch, Esq. Michael A. Scherer, Esq. DRO: R.J. Shadday INCOME WITHHOLDING FOR SUPPORT ((? 1 S g O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) Q AMENDED IWO (? - -7 lp j c l CI V I L_. O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT 0 TERMINATION OF IWO Date: 06/25119 ? Child Support. Enforcement (CSE) Agency 0 Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IV R q?t?¢t by oular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructio4hftp•t/uvu?(nr 5 . hs cov/ roc grams/cse/newhire/employer/publication/publication htm forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. ,o„nary ?,vnnnvnwearui ui r-ennswvania Remittance identifier (include w/payment): 3301102230 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket Informaiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) ALCOTT GROUP INC PO BOX 160 FARMINGDALE NY 11735-0160 Employer/Income Withholder's FEIN 261638437 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: _GEORGE, MICHAEL S. Employee/Obligor's Name (Last, First, Middle) 220-82-9689 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions hgp://www.acf. hhs.gov/mgrams/cse/newhire/ eMDloyer/publi=ion/`publication.htm - forma. 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. 2616384370 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION. This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. $ 0.00 per month in current child support $ 0.00 permonth in past-due child support - Arrears 12 weeks or greater? Q y*-« pry $ 0.00 per month in current cash medical support $ 0.00 per month in past-due cash medical support .0 $ _ 1,051.00 per month in current spousal support ; $ 0.00 per mop in past-due spousal support < $ 0.00 permonth in other (must specify)' 5 w. for a Total Amount to Withhold of $ 1,051.00 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: $ 842,54 per weekly pay period. $ 525.50 per semimonthly pa $ 485,013 per biweekly pay period (every two weeks) $ 1,051.00 per monthly pa y period (twice a month) y period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs n 10 working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www arf hhs gov/pe grams/cse/newhire/employer/contacts/contact maw htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970-0154 Form EN-028 06/12 Service Type M Worker ID $IATT ? Return to Sender [Completed by Employer/income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. D. =4 C i Signature of Judge/Issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official: filkilk, Title of Judge/Issuing Official: Date of Signature: If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. ? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERSIINCOMIE WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an eim=nic iay;Mnt mathod if an employer is ordered to withhold Income from more than one employee and employs 1$ or more persons, or if an employer has a history of two or more returned checks due to nonsuffficient funds. Please call the Pennsylvania State CoHections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CCU 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAI+'UENTS MUST INCLUDE THE DEPENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the EnWoy*W06ftoes Case Identiffe^) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: hftp•agM acf hhs aoylprogramaig alnewhire/employer/contactalcontact mara.htrn Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(bx7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fall 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 employeelobfigor from employment, refusing to employ, or taking disciplinary action against an emptoyee/obligor because of this IWO. OMB Expiration Date - 05/3112014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the forth currently in use. Form EN-028 06112 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: ALCOTT GROUP INC Employer FEIN: 261638437 Employee/Obligor's Name: GEORGE, MICHAEL S. 3301102230 CSE Agency Case Identifier: (See Addendum for case summary) Order Identifier: (See Addendum for order/docket Information) Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 2616384370 O This person has never worked for this employer nor received periodic income. O This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: New Employer's Name: Final Payment Amount: New Employer's Address: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.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.childsupportstate pa us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. OMB No.: 0970-0154 Form EN-028 06/12 Service Type M Page 3 of 3 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S. PACSES Case Number 210111548 PACSES Case Number Plaintiff Name Plaintiff--Name SHELLEY A. GEORGE ocket Attachment Amount DockS Attachment Amount 09-7619 CIVIL $ 1,051.00 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PA S Case Number Plaintiff Name Plaintiff Na A440MAM Docket $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name pk-W afsNeme Docket Attachment Amount Docket AttachniW Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 06/12 Service Type M OMS No.: 0970-0154 Worker ID $IATT M{CHAFE S. GEORGE IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVA IA v. NO. 2009-7619 CIVIL TERM ~~ a SHELLEY A. GEORGE, .: Defendant IN DIVORCE cn ~~ x c~ PLAINTIFF'S AFFIDAVIT QF CONSENT ~-ND ~ ~' WAWER OF Nt)TICE Of INTE1~Ti€X~! T4 RtEC~~T ENTIRY OIF~ ° DIVORCE i'~ECREE UNDER SECTION 3~1~C3 OF' THE DIYOi!~CE CODE 1. A complaint in divorce under Section 3301(C) of the Divorce Code was filed on November 4, 2009. 2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of the fining of the Complaint. 3. I consent to the entry of a final decree in divorce without notice. 4. I understand that I may lose rights couceming alimony, division of property, Lawyer's fees or expenses if I do not claim them before a divorce is granted. 5. 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 imrrtediately after it is filed with the Prothonotary. 6. I have been advised of the availability of marriage counseling and understand that I may request that the court require counseling. I do not request that the court require counseling. -~, 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 aut~ioritigs. RuC 02 2012 S:OORM RUDEHUSCHLRWOFFICE 7176571512 MtC`HAaL S. GiEORCE, : YN THE COVft'T OF COIN FLZA~S Ptili : CUMBERLAN21 COUNTY, P'1L~T~SYV `: . N -a a. ~ v. : NO. 2609-7619 ~ r°~t -_ : ~ ~ 9'MELLEY A. GEORGE, CIVII. ACTIt~3N -LAW ~~" cn ~~'' De~ttd~utt IN DIVORCE ~ ~ ~ ~ *' ~~ ~ ~~ .; _` OF CflNSE1VT -+ ~ =~'' ,.~ c,n ;- 1. A Compiaittt in Divorce under Section 3301(c) of the Divorce Code was fii«l an _ oar g 2. The marriage of PiaiAtlff and Defendant is irrctsiavably broi~cen anti ninety (90) days have elapsed from the date of Sling and service of the Complairn. 3. I consent to the entry of a final decree of divorce after sen-lce of Ncrtloe of I1tte~Eion to Rsquast Eastry of the Decree. I verify that the statemeata made in thin Affidavit are true and ccxroct. I undaratartd drat liaise statements heroin are nude subject ~ the penalties of 18 Pa.C.S.A. Section 4904 relating to unaworn falsification to authorit~e. Date: ~ ~ Shelly A. rQe 1 Ruh 02 2012 7:~2RM RUDEHUSCHLRWOFFICE 7176571512 MYC~AEL S. GEQ1tGE, IN TILE COURT QF COI1+lINON PLEAS :CUMBERLAND COUNTY, PENNBY'L"f~A~tIll ~~ v. : NO. 2tl!l9-7619 ~~; ~ . ~~ c~ SHE~.LEY A. GEORGE, : CIVIL ACTIOAfi • LAW ~ ~ u'+ 13eies~irot : IN DIVORCE ~ ~ c~ a ]fd~L~' o~ ~il~"~iL.'i'e ~~~ .~ ° 1, I consent to the entry of a Final Dtcroe of Divorce without notice. 2. I underatatttd that I may lose rights ao®cesn~g alimony, division of pro~paty, lawyer's Ease or expenses if I do not claim them before a divorcc is granted. 3. I understated that I will not be divorced until a divorce decree is asrtered by the Court and that a copy of the decree will be sent to nu irnttrodiately after it is filed with the Prothonotary. I vezify drat the statements made in this At~davit are true and co:rrec~. I utetand tit !!else sutements herein are made subject to the pesralti~s of 18 Pa. C.S. ~49t?4, relating to unsworn faleafication to authorities. ire: n' .3 //~~.~+ ~.w-p -,~; -,~ ,~ MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS OF' Plaintiff CUMBERLAND COUNTY, PENNSYL~N~ _::=: --,-- NO. 09 - 763-1 CIVIL ~ .. VS . ~~~ ~;~ ~ rrt ~ x~. -.; -~-~ -~ ~ ~ ~~ ' ` SHELLY A. GEORGE, u>r .._. '; ~ Defendant IN DIVORCE ~~ '`~ ~~' "C ~' ss ~ N NOTICE OF FILING OF MASTER' S REPORT ~'' ~ --t' " _~ ~ .M ,. - _., ~ - The report of the M aster has been filed this date and copies have been sent with this notice to counsel of record a d the parties. In accordance with P.R.C.P. 1920.55 within twenty (20) days after the mailing of this notice and report exceptions y be filed to the report by any party. If no exceptions are filed within the twenty (20) day period, the Court shall receive the report, and if approved, shall enter a final decr~e in accordance with the recommendations contained in the report. e~ ~~ Date: 8/17/12 E. Robert Flicker, II Divorce Master NOTE: If exceptions are filed, file the original with the Prothonotary and a copy with the Master's office. At that time, the party filing the exceptions should notify the court reporter in the Master's office so arrangements can be made for a transcript. Upon completion of the transcript and receipt of payment, the entire file will be returned to the Prothonotary's office for transmittal to the Court at time of argument on the exceptions. If no exceptions are filed, counsel shall prepare an order of Court consistent with the recommendations and provide a proposed order of Court to the Master. Counsel shall also prepare and provide with the proposed order of Court a praecipe* to the Prothonotary directing the Prothonotary to submit the case to the Court for final disposition. The Master will then transfer the file with the proposed order of Court and praecipe to the Prothonotary's Office for docketing and transmittal by the Prothonotary to the Court. * Form available in the Prothonotary's office and the Master's office. (NOT the praecipe to transmit the record form as set out in P.R.C.P. 1920.73(b).) MICHAEL S. GEORGE, Plaintiff vs. SHELLY A. GEORGE, Defendant L.~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW N0. 09 - 7619 CIVIL IN DIVORCE 1~1STER' S REPORT c~ ~, t`^.y.... 4::... "~ ~i, tV N ~ ~a~ (ISM i"" 7~ `J ~ ]~. ~~ p ~ -i C J a is»:7 Proceedings (February 16, 2012, and August 2, 2012) held before E. Robert Elicker, II, Divorce Master at 9 North Hanover Street, Carlisle, PA 17013 both days commencing at 9:00 a.m. li1PPE7~iRalNCES Michael A. Scherer Attorney for Plaintiff ~:. ~,~ ^ 1 f^'._ C'~ ` 3-~ -fir- .,.... ~-r-~ ~~~ ~~.; ~-> .4~i'± :'? :~ Marianne E. Rudebusch Attorney for Plaintiff • • PROCEDURAL HISTORY This action was commenced by the filing of a complaint in divorce on November 4, 2009, raising grounds for divorce of irretrievable breakdown of the marriage. The parties signed affidavits of consent and waivers of notice of intention to request entry of divorce decree on August 2, 2012; therefore, the divorce can proceed under Section 3301(c) of the Domestic Relations Code. The complaint raised a claim for equitable distribution. An answer and counterclaim were filed on January 20, 2010, by the Defendant wife raising economic claims of alimony and alimony pendente lite. On March 30, 2012, husband filed a claim for counsel fees arguing that because there was no evidence to support wife's claim of marital misconduct and because her allegations were frivolous, that he was put to the expense of defending a marital misconduct issue. The Master does not find that wife's allegations were without any degree of reasonableness and certainty not requiring an inquiry. The Master discussed the status of discovery with counsel, apre-hearing conference was set for October 14, 2011, followed by a hearing on the issue of marital misconduct on February 16, 2012, as the marital misconduct affected wife's alimony claim. Following that hearing, another conference was scheduled with no resolution and, therefore, a hearing on the issues remaining was scheduled for August 2, 2012. The Master issued a report and findings on the factor of marital misconduct following the hearing on February 16, 2012, which is made part of the record. At the time of the hearing on August 2, 2012, the Master determined that because of the status of the marital real estate at 23 Stamy Road, Newville, Cumberland County, • • Pennsylvania, the claim of equitable distribution was deferred for further adjudication pending the sale or foreclosure of the real estate. Also deferred were issues involving credit cazd debt and other credits and charges the parties have against each other relating to the real estate. The property is in foreclosure and the parties at this point have no idea what, if any, funds they will get out of a sale of the property or the foreclosure proceedings. The property is listed for sale but there has been no activity to date resulting in an offer to buy. Consequently, because the Master was aware that the parties have a number of offsetting azguments relating to credit card debts and other contributions for the maintenance and upkeep of the marital home, the Master decided to defer those matters to another hearing date after the house has been disposed of through foreclosure or sale at which time we will know if there aze any funds available for distribution. Consequently,-the claim for equitable distribution will be kept alive and pending. The Master then proceeded to take testimony on wife's alimony claim and the Master will render a report and recommendations relating to that claim at thus time. The Master also indicated that it is time that the parties conclude the divorce praceedings and, therefore, has indicated that the divorce can proceed to conclusion after the alimony issue has been resolved with the divorce decree specifically preserving the claim for equitable distribution. The Master proceeded to prepaze and file his report and recommendations on the alimony claim. 2 • • FINDINGS OF FACT 1. The parties were married on October 4, 1986, in Berlin, Maryland. The parties separated on or about November 3, 2009, the date of the filing of the divorce complaint in Cumberland County, Pennsylvania. 2. Husband is 48 yeazs of age and is employed by the Berkeley Contract Packaging Company, a subsidiary of the Alcott Group, Inc. with offices in the Cazlisle azea, Cumberland County, Pennsylvania. Husband's work involves packing procedures and design and production. Husband resides at 12 Kennsington Court, Cazlisle, Pennsylvania. 3. Wife is 49 yeazs of age and is employed at Citizens Bank of Pennsylvania at a local bank in Cazlisle, Pennsylvania. Wife resides at 1160 Redwood Drive, Carlisle, Pennsylvania. 4. According to a recent income review of the parties by the Cumberland County Domestic Relations Office, on June 25, 2012, it was determined that husband's net earnings monthly are $4,892.56 and wife's net earnings monthly aze $2,439.76. I 5. They aze the natural pazents of two children. The daughter is emancipated, not living with either of the pazents. The son has some health issues resulting from an accident which limit his abilities in some ways but he is working. Wife does provide occasional assistance to him with food and perhaps shelter at times. The son just recently went off the husband's support order as he graduated from high school; the daughter has been off the order for a couple of yeazs. 6. The parties both have a high school education and husband did have some night school training. 7. Wife has anauto-immune disease which affects her thyroid for which she has to take medication. Husband did not report any medical problems. 8. Husband is living with and essentially supporting a female friend and her small child. The child appazently gets child support from the father but it was not discussed in 1 There was testimony that husband received a bonus during the last year, and perhaps has received such a bonus other years, in the amount of approximately $8,000.00 to $9,000.00. The question azose as to how that bonus was treated as far as income and after counsel did a review and contacted the employer, it appears as if the bonus is used to pay for medical costs which, therefore, reduces the income impact of the bonus for tax purposes. It is for that reason, after reviewing the documents provided by husband's employer, that the Master is satisfied to use the findings of income that were developed and calculated by the Cumberland County Domestic Relations Office a few months previously. • • the testimony as to the amount. Husband testified that the female friend contributes up to $200.00 on a month on account of expenses. 9. Husband will benefit by the payment of alimony receiving a deduction against his income; wife will have a tax liability. 10. Currently wife receives alimony pendente lite in the amount of $1,051.00 per month. CONCLUSION OF LAW The parties signed affidavits of consent and waivers of notice of intention to request entry of divorce decree on August 2, 2012. The affidavits and waivers have been filed with the Prothonotary's office and the parties can, therefore, conclude the divorce under Section 3301(c) of the Domestic Relations Code. As the Master specifically noted in the opening remazks of his report, the claim for equitable distribution is going to be kept open for further adjudication based on factors which aze developing currently. Therefore, the divorce decree should note on the decree that the claim of equitable distribution has been preserved. ANALYSIS OF THE FACTORS UNDER SECTION 3701(b) OF THE DOMESTIC RELATIONS CODE 1. Based on the report of the Domestic Relations Office of June 25, 2012, the Master accepts the finding that wife's net earnings aze $2,439.76 and husband's net earnings aze $4,892.56, both monthly amounts. 2. Husband is 48 years of age and wife is 49 years of age. The wife has some health issue relating to her thyroid gland resulting from anauto-immune disease. Husband does not indicate that he has any health issues. 3. The sources of income of the parties aze related to the income that they earn at their place of employment which includes their medical and other benefits. 4 • 4. Neither party indicated an expectancy of any inheritance. 5. The parties have lived in a marital relationship for approximately 23 years up to the date of their sepazation in November 2009. They have been living in a state of separation for approximately three years. 6. Neither party has contributed in any significant way to the training or education of the other party. 7. Although neither party is serving as the custodian of a minor child, wife does assist on occasion with the expenses for the younger child who had been in an accident and who has some limited abilities as a result of the injuries. Husband indicated that he also helps the children as he is able. 8. The standazd of living of the parties established during the marriage would be considered modest. Although the parties did not specifically rate their standazd of living, based on the debt and expenses that the parties incurred for the children, it is reasonable to conclude that they had a modest lifestyle. 9. The parties aze high school graduates with some night school for husband. It is not expected that either of the parties aze going to continue their educational pursuits at this time. 10. There aze few assets to be distributed, if any, in this case and the parties both have liabilities on credit cazd debt. 11. Neither party brought any significant property to the marriage. 12. Wife did provide services as a homemaker while the children were being raised. 13. Wife is living on her income from her banking job. Husband has substantially more income through his position with the Berkeley Contract Packaging Company. Wife's needs have been supplemented throughout the course of the separation by husband paying to wife alimony pendente lite. He was also paying support for the children but that has now been terminated based on the age of the children. 14. A hearing was held on the marital misconduct issue. The Master's findings and report is attached relating to that issue. 15. No federal, state or local tax ramifications have been discussed relating to the alimony claim. Note, however, the Master's finding of fact No. 9. 16. Although wife does have an income, the payment to her of alimony will be able to assist her with her reasonable needs for a period of time. She does lack a significant amount of property to assist her in her standazd of living. 5 i ~ 17. Wife is capable of employment and is able to contribute to her own support; however, the payment of alimony to wife is necessary to assist in her expenses and for her needs. DISCUSSION ALIMONY Based on the findings of fact and analysis of the factors, the Master finds that the payment from husband to wife for alimony is necessary. Husband's position is that he should not pay wife any alimony because he has been paying alimony pendente lite for a period of years. He also believes that wife should be able to provide for her own needs without any assistance from him. Wife, on the other hand, indicates that she has expenses which are not able to be met by her income only and needs the assistance of some alimony contributions to be able to make her expenses. One of the facets of this case that is a bit troubling to the Master with regard to husband's attitude toward payment of alimony to his wife is that he is currently living with a younger woman who has a child to another man and for whom husband is apparently paying a substantial amount of expenses. Husband indicated that the person with whom he is living is contributing perhaps up to $200.00 per month which is hazdly significant in the context of the costs of providing for another adult and child in the household. Husband pays nearly $1,700.00 a month just for his housing in addition to making credit cazd payments, paying for utilities, automobile expenses, clothing and 6 • • food. Obviously, his expenses aze increased by the cost of having two additional people living with him in his household. Wife, on the other hand, has gone to work with a banking position that provides her essentially half of the net income as husband. She is working to provide for her own support in the best way that she can as well as providing emotional and other support occasionally for the parties' son who has suffered from an accident requiring special concern and caze. Although neither of the children live with wife, she does provide a place for the son to come to stay if he wishes to do so. Wife does not live extravagantly and is working to the best of her ability to provide for her own needs. The testimony of wife, contrary to husband's statement that he does not believe that wife should receive any alimony, is that she needs the alimony to be able to survive and meet her monthly needs. RECOMMENDATION ALIMONY The Master recommends that husband shall pay to wife monthly as alimony the sum of $800.00 for a period of five (5) yeazs. The alimony payments can be reviewed for modification or termination at the request of either party upon the showing of circumstances of a substantial and continuing nature pursuant to Section 3701(e) of the Domestic Relations Code. The payments of alimony shall begin upon the entry of a divorce decree at which time the alimony pendente lite payments will terminate. The alimony payments will continue from that point forwazd for a period of sixty months. 7 • ~~ COUNSEL FEES CLAIM RELATING TO THE MARITAL MISCONDUCT HEARING REQUESTED BY WIFE Although husband felt that the marital misconduct hearing was frivolous and, therefore, would require the payment of counsel fees for an unnecessary proceeding, nevertheless, the Master, after hearing, the testimony did not agree that wife's claim was "frivolous". Although the Master did not find that wife's testimony rose to the level of husband being engaged in a marital misconduct situation, as the Master has previously described in his memo, the Master did not find that wife's pursuit of the claim was onerous or without some merit for trial. Therefore, the parties will stand where they aze with regazd to their own counsel fees arising out of that portion of the hearing. RECOMMENDATION Husband's claim for counsel fees relating to the mazital misconduct hearing against wife is denied. Respectfully submitted, ~~u~~' E. Robert Elicker, II Divorce Master 8 • MICHAEL S. GEORGE, IN THE COURT OF COMMON PLEAS 0 Plaintiff CUMBERLAND COUNTY, PENNSYLVANI vs. N0. 09 - 7619 CIVIL SHELLY A. GEORGE, . Defendant IN DIVORCE MASTER FINDINGS Much of the testimony which was offered at the hearing on February 16, 2012, dealt with the marital disco between the parties. The parties related problems with finances and being separated because of the ballet interes of the daughter. As the Master pointed out, the issues that the parties testified about mostly related to the problems that led to a separation and will lead to the fin dissolution of the marriage. The issue that the Master understood was relatinc to the marital misconduct factor was husband's alleged relationship with a female friend, Taleen A. Palmer. The Master heard the testimony of Ms. Palmer and the parties, along with a witness who was present during a telephone conference wife had with husband when she was in New York City. After considering all of the testimony, the Master i satisfied that the relationship that was existing between Ms. Palmer and husband during the time the parties were married and living together (before the separation on November 4, 2009) was that of a relationship of a developin friendship and did not involve specific romantic or sexual context or contact. At or around the time of the separatio of the parties, Ms. Palmer testified that she was going through a break-up of a relationship that was important to her and that during that time she was not particularly interested in developing a new relationship with anyone. She had a child to the man that she thought she was going t be marrying and that relationship was headed to a break-up. After the parties separated, there is no doubt that husband and Ms. Palmer developed a relationship beyond simply a friendship through their working contact. But before the separation, wife apparently was aware of contact between husband and Ms. Palmer through the conversations that she had with husband about Ms. Palmer wanting to stop over on a weekend for a visit and also contact regarding a baby shower. The flowers that Ms. Palmer received, based on the evidence presented in exhibits, were sent after husband filed the divorce action. Before the separation, i~ did not appear that husband was attempting to hide the 1 existence of Ms. Palmer in his life. The Master does not believe that the relationshi between Ms. Palmer and husband, at the time the parties we e still in their marital relationship, was one that would ri e to a level of an extra-marital affair. The Master, after hearing all of the evidence, does not believe that Mr. George and Ms. Palmer were involved in any sexual relationship prior to the separation of the parties. And specifically, the Master does not find that the factor of marital misconduct will have any bearin on the amount of alimony or the term of the alimony that husband will be directed to pay to wife, assuming the fact support wife's alimony claim otherwise. 2 Eta-OFF1`r Marianne E. Rudebusch, Esquire ,, PRO(Ht t'J.fAri 4711 Locust Lane Harrisburg,PA 17109 2013 SEP 25 NI 1: 39 717-657-0632 Id.No. 63522 CUMBERLAND COUNTY Attorney for Defendant PENNSYLVANIA MICHAEL S. GEORGE, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 2009-7619 SHELLEY A. GEORGE, : CIVIL ACTION - LAW Defendant : IN DIVORCE PETITION TO WITHDRAW APPEARANCE AND NOW, comes Marianne E. Rudebusch, Esquire, attorney for the Defendant, Shelley A. George, and respectfully represents: 1. Petitioner is Marianne E.Rudebusch,Esquire,whose mailing address is 4711 Locust Lane, Harrisburg, Pennsylvania, 17109. 2. Defendant/Respondent is Shelley A. George, who resides at 1160 Redwood Drive, Carlisle, Pennsylvania, 17013. 3. Petitioner, Marianne E. Rudebusch, Esquire, was retained by Defendant/ Respondent on or about November 20,2009,to represent her in the above captioned divorce matter. 4. Petitioner asks to withdraw her appearance for Defendant because: a. There appears to be a serious failure to communicate between Defendant and Petitioner and Petitioner can no longer effectively represent Defendant. b. Defendant will not be prejudiced by having to obtain new legal counsel since this matter is not scheduled for any hearings at this time, which gives Defendant sufficient time to obtain new counsel. WHEREFORE, Petitioner respectfully requests that her appearance be withdrawn for Defendant and that she be removed from the docket as Defendant's attorney of record. Respectfully Submitted, baCklan, Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, PA 17109 (717) 657-0632 Id. No. 63522 Dated: (f-c-- 4- (3 2 MICHAEL S. GEORGE, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 2009-7619 SHELLEY A. GEORGE, : CIVIL ACTION - LAW Defendant : IN DIVORCE CERTIFICATE OF SERVICE AND NOW, this O , day of ,.- , 2013, I, Katherine A. Frey, Assistant to Marianne E. Rudebusch, Esquire, Attorney for the Defendant, hereby certify that a copy of the within document has been served, by depositing a copy of the same in the United States mail, first class, postage prepaid, delivery at Harrisburg, Pennsylvania,to the following addressees: Michael A. Scherer, Esquire Shelley A. George 19 West South Street 1160 Redwood Drive Carlisle, PA 17013 Carlisle, PA 17013 Attorney for Plaintiff Defendant By: Katherine A. Frey O t Marianne E. Rudebusch,Esquire ; HE Pi-tO p h o r ' } 4711 Locust Lane ! SEP Harrisburg,PA 17109 30 PE° 717-657-0632 f.",11`.e`��f�L,'4tt CLii ! Id.No. 63522 Attorney for Defendant �'ENNS YLVANIA MICHAEL S. GEORGE, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 2009-7619 SHELLEY A. GEORGE, : CIVIL ACTION - LAW Defendant : IN DIVORCE RULE TO SHOW CAUSE WHY PETITION TO WITHDRAW APPEARANCE SHOULD NOT BE GRANTED AND NOW,this 31) day of S LQ t ,2013, upon consideration of the attached Petition to Withdraw Appearance of Petitioner, Marianne E. Rudebusch, Esquire, a Rule is issued upon Defendant, Shelley A.George, and Michael A. Scherer, Esquire, attorney of record for Plaintiff, to show cause, if any, why the appearance of Marianne E. Rudebusch, Esquire, attorney for Defendant should not be withdrawn and Petitioner removed as attorney of record for Defendant. Rule Returnable r days from the date of service. BY THE COURT: J. _piatfibution: ' • yananne E. Rudebusch, Esq.,4711 Locust Lane,Hbg.,PA 17109 hael A. Scherer,Esq., Baric Scherer LLC., 19 West South Street, Carlisle, PA 17013-3432 ----• -Shelley A. George, 1160 Redwood Drive,Carlisle,PA 17013 ce;S6F.s /'UL L£rL csfr3 MICHAEL S. GEORGE, • IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. • NO. 2009-7619 CIVIL TERM • SHELLEY A. GEORGE, • CIVIL ACTION-LAW Defendant : IN DIVORCE PLAINTIFF'S ANSWER TO PETITION TO WITHDRAW APPEARANCE OF PETITIONER, MARIANNE RUDEBUSCH„ SQUIRE rrl( rri = 1. Admitted. (nL! 2. Admitted. , F=� ' 3. Admitted. '' :71` 4. Undersigned counsel does not oppose Attorney Rudebusch's request to withdraw her appearance in this matter. WHEREFORE, undersigned counsel is in concurrence with Attorney Rusebusch's request to withdraw her appearance in this matter. Respectfully submitted, BARIC I RER LLC Date: 0 (I/ ((3 Micha: I Scherer, Esquire 19 W-st South Street Carlisle, Pennsylvania 17013 (717) 249-6873 • CERTIFICATE OF SERVICE I hereby certify that on October 3 , 2013, I, Jennifer S. Lindsay, secretary at - Baric Scherer LLC, did serve a copy of the Plaintiffs Answer To Petition To Withdraw Appearance of Petitioner, Marianne Rudebusch, Esquire, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Marianne E. Rudebusch, Esquire 4711 Locust Lane Harrisburg, Pennsylvania 17109 JVI if: Lindsay/ E INCOME WITHHOLDING FOR SUPPORT Q ORIGINAL INCOME WITHHOLDING ORDER /NOTICE FOR SUPPORT (IWO) Q AMENDED IWO O ONE- TIMEORDERINOTICE FOR LUMP SUM PAYMENT Q TERMINATION OF IWO .IDI115 --7 09 -71p1q Con/ Date: 04/07/14 ❑ Child Support Enforcement (CSE) Agency ® Court ❑ Attorney ❑ Private Individual /Entity (Check One) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http: / /www.acf.hhs.gov /programs /cse /forms /OMB- 0970 -0154 instructions.pdf). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Tribe/Territory Commonwealth of Pennsylvania City /County /Dist./Tribe CUMBERLAND Private Individual /Entity Remittance Identifier (include w /payment): 3301102230 Order Identifier: (See Addendum for order /docket information) CSE Agency Case Identifier: (See Addendum for case summary) ALCOTT GROUP INC PO BOX 160 FARMINGDALE NY 11735-0160 Employer /Income Withholder's FEIN 261638437 Chiid(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: GEORGE, MICHAEL S. Employee /Obligor's Name (Last, First, Middle) 220 -82 -9689 Employee /Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party /Obligee's Name (Last, First, Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www.acf,hhs.gov/programs/cse/forms/ OMB - 0970 -0154 instructions,pdf). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. 2616384370 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania ( State/Tribe). You are required by law to deduct these amounts front e employee/ -p zr I O ye f % nib r— w obligor's income until further notice. $ 0.00 per month in current child support $ 0.00 per month in past -due child support - Arrears 12 weeks or greater? $ 0.00 per month in current cash medical support $ 0.00 per month in past -due cash medical support $ 0.00 per month in current spousal support $ 0.00 per month in past -due spousal support $ 0.00 per month in other (must specify) for a Total Amount to Withhold of $ 0.00 per month. 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 (10) working days after the date of this Order /Notice. Send payment within seven (7) working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee /obligor, withhold up to 55% of disposable income for all orders. If the employee /obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http: / /www.acf.hhs.gov/ programs /cse /newhire /employer /contacts /contact map. htm for the employee /obligor's principal place of employment. Document Tracking Identifier Service Type M OMB No.: 0970.0154 Form EN -028 11/13 Worker ID $IATT ❑ Return to Sender [Completed by Employer /Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge /Issuing Official (if required by State or Tribal law): Print Name of Judge /Issuing Official: Title of Judge /Issuing Official: Date of Signature: If the employee /obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee /obligor. ❑ If checked, the employer /income withholder must provide a copy of this form to the employee /obligor. ADDITIONAL INFORMATION FOR EMPLOYERS /INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1- 877 - 676 -9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106 -9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee /Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State - specific contact and withholding information can be found on the Federal Employer Services website located at: http: / /www.acf.hhs.gov/ programs /cse /newhire /employer /contacts /contact map.htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee /obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual /Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee /obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee /obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee /obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past -due support. Follow the State or Tribal law /procedure of the employee /obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee /obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and /or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee /obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law /procedure. Anti - discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee /obligor from employment, refusing to employ, or taking disciplinary action against an employee /obligor because of this IWO. OMB Expiration Date — 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN -028 11/13 Service Type M Page 2 of 3 Worker ID $IATT t t Employer's Name: ALCOTT GROUP INC Employer FEIN: 261638437 Employee /Obligor's Name: GEORGE, MICHAEL S. 3301102230 CSE Agency Case Identifier: (See Addendum for case summary) Order Identifier: (See Addendum for order /docket information) Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee /obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers /income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer /income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee /obligor never worked for you or you are no longer withholding income for this employee /obligor, an employer must promptly notify the CSE agency and /or the sender by returning this form to the address listed in the Contact Information below: 2616384370 Q This person has never worked for this employer nor received periodic income. Q This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee /obligor: Termination date: Last known 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.childsupoort.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 Service Type M Page 3 of 3 Form EN -028 11/13 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S. PACSES Case Number 210111548 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 09 -7619 CIVIL $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment 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 Docket Attachment 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 OMB No.: 0970 -0154 Form EN -028 11/13 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT Q ORIGINAL INCOME WITHHOLDING ORDER /NOTICE FOR SUPPORT (IWO) Q AMENDED IWO • ONE - TIMEORDER /NOTICE FOR LUMP SUM PAYMENT Q TERMINATIOIJ OF IWO 21a 0l- -ttolq GIVi Date: 04/18/14 ❑ Child Support Enforcement (CSE) Agency ® Court ❑ Attorney ❑ Private Individual /Entity (Check One) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http: / /www.acf.hhs.gov/ programs /cse /forms /OMB -0970 -0154 instructions.pdf). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Tribe/Territory Commonwealth of Pennsylvania City /County /Dist./Tribe CUMBERLAND Private Individual /Entity Remittance Identifier (include w /payment): 3301102230 Order Identifier: (See Addendum for order /docket information) CSE Agency Case Identifier: (See Addendum for case summary) BERKELEY CONTRACT PACKAGING LL 530 N MICHIGAN AVE KENILWORTH NJ 07033 -1023 Employer /Income Withholders FEIN 223678780 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: GEORGE, MICHAEL S. Employee /Obligor's Name (Last, First, Middle) 220 -82 -9689 Employee /Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party /Obligee's Name (Last, First, Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www.act hhs.gov/programs/cse/forms/ OMB - 0970 -0154 instructions mil) 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. 2236787800 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. $ 0.00 per month in current child support $ 0.00 per month in past -due child support - Arrears 12 weeks or greater? $ 0.00 per month in current cash medical support $ 0.00 per month in past -due cash medical support $ 800.00 per month in current spousal support $ 0.00 per month in past -due spousal support $ 0.00 per month in other (must specify) for a Total Amount to Withhold of $ 800.00 per month. c tno .,�. -< D r C CQ 2CD 1 AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Irrformation. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: $ 1 S.4,(02, per weekly pay period. $ 400.00 per semimonthly pay period (twice a month) $ Ztoq.2. q per biweekly pay period (every two weeks) $ 800.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee /obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10) working days after the date of this Order /Notice. Send payment within seven (7) working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee /obligor, withhold up to 55% of disposable income for all orders. If the employee /obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http: / /www.acf.hhs.gov/ programs /cse /newhire /employer /contacts /contact map. htm for the employee /obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970 -0154 Service Type M Form EN -028 11/13 Worker ID $IATT oto ❑ 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. _ s Signature of Judge /Issuing Official (if required by State or Tribal law): Print Name of Judge /Issuing Official: Title of Judge /Issuing Official: Date of Signature: `\- 21-kk-Q If the employee /obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee /obligor. ❑ If checked, the employer /income withholder must provide a copy of this form to the employee /obligor. ADDITIONAL INFORMATION FOR EMPLOYERS /INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1- 877 - 676 -9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106 -9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee /Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State - specific contact and withholding 'nformation can be found on the Federal Employer Services website located at: http: / /www.acf.hhs.gov/ programs /cse /newhire /employer /contacts /contact map.htm Priority: Withholding for support has priority Over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee /obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual /Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee /obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee /obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee /obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past -due support. Follow the State or Tribal law /procedure of the employee /obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee /obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and /or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee /obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law /procedure. Anti - discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee /obligor from employment, refusing to employ, or taking disciplinary action against an employee /obligor because of this IWO. OMB Expiration Date — 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN -028 11/13 Service Type M Page 2 of 3 Worker ID $IATT Emp|oye/oNamo: BERKELEY CONTRACT PACKAGING LL Emp|oyeek]b|ignralloma: GEORGE, MICHAEL S. CSE Agency Case Identifier: (See Addendum for case summary) Employer FEIN: 223678780 3301102230 Ordor|dnnUfioc(8meAddendun/fororden/docket/nformadon) 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 ofthe employee/obligor's principa place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, Iocal taxes; SociaI 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%'ho55% and 65% - if the arrears are greater than 12 weeks. If pemiitted 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 Empoyer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATU 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 Iisted in the Contact Information below: 2e36787e00 0 This person has never worked for this employer nor received periodic income. [) This person no Ionger works for this empoyer nor receives poriodic iricome. Please provide the foliowing information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDUfTribal Payee: Final Payment Amount: New Employer's Name: New Employers Address: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone ot(717)24O'G225.by fax at(717)%4O'G348.by email orwebsihe at: vmxmv.chUdeupport.ntate.po.uo. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST, P.O. BOX 320. CARLISLE. PA. 17O13 (Issuer oddnaam). ToEnployam/Ob||gor 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 vvwvv.childsupport.state.paus. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. OMB wu.o97o-0,u^ Service Type M Page 3 of 3 Form EN-028 11/13 Worker ID $1ATT ADDENDUM Summary of Gases on Attachment Defendant/Obligor: / GEORGE, MICHAEL S. PACSES Case Number 210111548 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 09-7619 CIVIL $ 800.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amo nt � 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 Docket Attachment Amount � 0.00 Child(renys 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 OMB No.: 0970-0154 Form EN-028 11/13 Worker |D$|AT-[ INCOME WITHHOLDING FOR SUPPORT O ORIGINAL INCOME WITHHOLDING ORDER /NOTICE FOR SUPPORT (IWO) O AMENDED IWO O ONE - TIMEORDER /NOTICE FOR LUMP SUM PAYMENT Q TERMINATION OF IWO / / /5Le D9 - 7219 C/ vi Date: 04/28/14 ❑ Child Support Enforcement (CSE) Agency ® Court ❑ Attorney ❑ Private Individual /Entity (Check One) NOTE: This NO must be regular on its fac)r'Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http: / /www.acf.hhs.gov /programs /cse /forms /OMB- 0970 -0154 instructions.pdf). If you receive this document from someone other than a State or Tribal CSE agency or,a Court, a copy of the underlying order must be attached. State/Tribe/Territory Commonwealth of Pennsylvania City /County /Dist./Tribe CUMBERLAND Private Individual /Entity Remittance Identifier (include w /payment): 3301102230 Order Identifier: (See Addendum for order /docket information) CSE Agency Case Identifier: (See Addendum for case summary) BERKELEY CONTRACT PACKAGING LL 530 N MICHIGAN AVE KENILWORTH NJ 07033 -1023 Employer /Income Withholders FEIN 223678780 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: GEORGE, MICHAEL S. Employee /Obligor's Name (Last, First, Middle) 220 -82 -9689 Employee /Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party /Obligee's Name (Last, First, Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and retum it to the sender (see IWO instructions htto://www.acf. hhs.gov/programs/cselforms/ OMB - 0970 -0154 instructions.pdt). 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. 2236787800 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. $ 0.00 per month in current child support $ 0.00 per month in past -due child support - Arrears 12 weeks or greater? $ 0.00 per month in current cash medical support ter - -up, cn $ 0.00 per month in past -due cash medical support < cL.- $ 0.00 per month in current spousal support co r- = ..r, $ 0.00 per month in past -due spousal support x'c- C °-� $ 0.00 per month in other (must specify) D ° ry c:� 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 (10) working days after the date of this Order /Notice. Send payment within seven (7) working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee /obligor, withhold up to 55% of disposable income for all orders. If the employee /obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http: / /www.acf.hhs.gov/ programs /cse /newhire /employer /contacts /contact map. htm for the employee /obligor's principal place of employment. 0 Document Tracking Identifier OMB No.: 0970 -0154 Service Type M Form EN -028 11/13 Worker ID $IATT ❑ Return to Sender [Completed by Employer /Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge /Issuing Official (if required by State or Tribal law): Print Name of Judge /Issuing Official: Title of Judge /Issuing Official: Date of Signature: APR 2 9 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. ❑ If checked, the employer /income withholder must provide a copy of this form to the employee /obligor. ADDITIONAL INFORMATION FOR EMPLOYERS /INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1- 877 - 676 -9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106 -9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee /Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State - specific contact and withholding information can be found on the Federal Employer Services website located at: http: / /www.acf.hhs.gov/ programs /cse /newhire /employer /contacts /contact map.htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee /obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual /Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee /obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee /obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee /obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past -due support. Follow the State or Tribal law /procedure of the employee /obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee /obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and /or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee /obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law /procedure. Anti- discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee /obligor from employment, refusing to employ, or taking disciplinary action against an employee /obligor because of this IWO. OMB Expiration Date — 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN -028 11/13 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: BERKELEY CONTRACT PACKAGING LL Employer FEIN: 223678780 Employee /Obligor's Name: GEORGE, MICHAEL S. 3301102230 CSE Agency Case Identifier: fSee Addendum for case summary) Order Identifier: (See Addendum for order /docket Information) Withholding-Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee /obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers /income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer /income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee /obligor never worked for you or you are no longer withholding income for this employee /obligor, an employer must promptly notify the CSE agency and /or the sender by returning this form to the address listed in the Contact Information below: 2236787800 Q This person has never worked for this employer nor received periodic income. O This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee /obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: Final Payment Amount: New Employer's Name: New Employer's Address: CONTACT INFORMATION: To Employer /Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240 -6225, by fax at (717) 240 -6248, by email or website at: www.childsupport.state.pa.us. Send termination /income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST, P.O. BOX 320. CARLISLE PA. 17013 (Issuer address). To Employee /Obligor: If the employee /obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240 -6225, by fax at (717) 240 -6248, by email or website at www.childsupport.state.pa.us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee /obligor. OMB No.: 0970 -0154 Service Type M Page 3 of 3 Form EN -028 11/13 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S. PACSES Case Number 210111548 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 09-7619 CIVIL $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount 0.00 Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount 0.00 Child(ren)'s Name(s): DOB Docket Attachment Amount 0.00 Child(ren)s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name pocket Attachment Amount 0.00 Child(ren)'s Name(s): DOB Service Type M Docket Attachment Amount 0.00 Child(ren)'s Name(s): DOB Addendum OMB No.: 0970-0154 Form EN-028 11/13 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) Q AMENDED IWO • ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT Q TERMINATION OF IWO °VDI 1(54-q Qq 7011 C►v►I Date: 05/06/14 ❑ Child Support Enforcement (CSE) Agency ® Court 0 Attorney 0 Private Individual/Entity (Check One) NOTE: This IWO must be regular.on,its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www.acf.hhs.gov/programs/cse/forms/OMB-0970-0154 instructions.pdf). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Tribe/Territory Commonwealth of Pennsylvania City/County/Dist./Tribe CUMBERLAND Private Individual/Entity Remittance Identifier (include w/payment): 3301102230 Order Identifier: (See Addendum for order/docket information) CSE Agency Case Identifier: (See Addendum for case summary) IMPACT FULFILLMENT SERVICES 1601 ANTHONY RD BURLINGTON NC 27215-8979 Employer/Income Withholders FEIN Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: GEORGE, MICHAEL S. Employee/Obligor's Name (Last, First, Middle) 220-82-9689 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www.acf.hhs.gov/programs/cse/forms/ OMB -0970-0154 instructions.pdf). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. 5531100336 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. t� ,..,, $ 0.00 per month in current child support 'IIZ ,r,. -_� $ 0.00 per month in past -due child support - Arrears 12 weeks or greater? 0 yes 2r3' noa /: -,_t $ 0.00 per month in current cash medical support cz� -< -ter $ 0.00 per month in past -due cash medical support -<D t , $ 800.00 per month in current spousal support �` V ' $ 0.00 per month in past -due spousal support D ' Q ;)--:-,--11' $ 0.00 per month in other (must specify) ,. ; -- for a Total Amount to Withhold of $ 800.00 •per month. cm -< c.n .=; AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Inform tion. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: $ 18442 per weekly pay period. $ 400.00 per semimonthly pay period (twice a month) $ 369,23 per biweekly pay period (every two weeks) $ 800.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact map. htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970-0154 Service Type M Form EN -028 11/13 Worker ID $IATT ❑ Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in { accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. �` Signature of Judge/Issuing Official (if required by State or Tribal law):f Print Name of Judge/Issuing Official: M.L. Ebett Jr. Title of Judge/Issuing Official: Date of Signature: rmAY 0 ( 2G14 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 DEFENDANTS 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. h hs.gov/programs/cse/newhi re/employer/contacts/contact_map, htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past -due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti -discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date — 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN -028 11/13 Service Type M Page 2 of 3 Worker ID $►ATT +� Employer's Name: IMPACT FULFILLMENT SERVICES Employer FEIN: Emp/oyeeK}bUQo/oNumn: GEORGE, MICHAEL S. 3301102220 CSE Agency Case Identifier: (See Addenclum for case summary) Order Identifier: (See Addendum for order/dockef 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 ofthe employee/obligors principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State tWa, you may not withhold morethan the Iesser of the limit set by the Iaw of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or 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 calcutate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUSf thifor you or you are no Ionger withholding income for this employee/obligor,anenployermuotpmmpVynoUfy<heCSEagenuyand/orthomandorby returning this form to the address listed in the Contact Information below: 5531100336 0 This person has never worked for this employer nor received periodic income. [J This person no Ionger works for this employer nor receives periodic income. Please provide the foliowing infomiation for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDUiTribaI Payee: Final Payment Amount: New Empoyer's Name: New Employer's Address: CONTACT INFORMATION: To Employer/lncome Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) byphone at(717)24O-823S.byfax ot(717)24O'G248.byemail cvwebsite at: vmww.oh|ldnupport.stoha.maus. 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 Service Type M Page 3 of 3Worker ID $1ATT Form EN -028 11/13 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: GEORGE, MICHAEL S. PACSES Case Number 210111548 Plaintiff Name SHELLEY A. GEORGE Docket Attachment Amount 09-7619 CIVIL $ 800.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Service Type M Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum OMB No.: 0970-0154 Form EN -028 11/13 Worker ID $IATT