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HomeMy WebLinkAbout01-0762KRISTI J. CLARK, Plaintiff VS. STEVEN B. CLARK, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : No. O t- 7(,Z C"- Te,-- ACTION 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. Where 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 at the Office of the Prothonotary, Cumberland County Courthouse. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES AND EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO, OR TELEPHONE, THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pa. 17013 (717) 249-3166 KRISTI J. CLARK, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. No. 01-'76-1- STEVEN B. CLARK, ACTION IN DIVORCE Defendant COMPLAINT IN DIVORCE 1. Plaintiff is Kristi J. Clark, an individual sui juris, who has resided at 1873 Holly Pike, Carlisle, Cumberland County, Pennsylvania, since 1990. 2. Defendant is Steven B. Clark, an individual sui juris, who has resided at 25334 Beantree Court, Marina Valley, Ca., 92551, since June 1999. 3. Plaintiff has been a bona fide resident of the Commonwealth for at least 6 months immediately previous to the filing of this Complaint. 4. The Plaintiff and the Defendant were married on April 15, 1983 in Cleveland County, Oklahoma. 5. There have been no prior actions of divorce or for annulment between the parties. 6. Plaintiff has been advised that counseling is available and that plaintiff may have the right to request that the court require the parties to participate in counseling. Plaintiff and Defendant have two children together, namely, Joshua B. Clark, dob 6- 17-85, and Jordan S. Clark, dob 8-19-87. 8. Plaintiff and Defendant are both citizens of the United States of America. 9. Neither Plaintiff or Defendant are a member of the Armed Forces of the United States of any of its allies. 10. The Plaintiff avers that the grounds on which this action is based are: (a) That the marriage is irretrievably broken; and/or (b) That the Defendant has offered such indignities to the Plaintiff, the innocent and injured spouse, as to render her condition intolerable and life burdensome. WHEREFORE, Plaintiff requests the court to enter a decree in divorce. I verify that the statements made in this Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unworn falsification to authorities. Kristi J. Clark, izlai ff Date: A-7-v1 Respectfully submitted, an Adams, Esquire No. 79465 17 South Hanover St. Carlisle, Pa. 17013 (717) 245-8508 ATTORNEY FOR PLAINTIFF (" _, ?'_ J ! - _? ^:Y' t, •.. .? i ? fl ?. Ciy U C! W L 0 ? ? lu k O KRISTI J. CLARK, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. : No. STEVEN B. CLARK, ACTION IN DIVORCE Defendant AFFIDAVIT OF SEPARATION 1. The parties to this action separated on February 1999 and have continued to live separate and apart for a period of at least two years. 2. The marriage is irretrievably broken. 3. I understand that I may lose my rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unworn falsification to authorities. Date: / Ul & S\, C__?. Kristi J. Clark. Plai ff ? . vs. No. 01 - 762 Civil Term STEVEN B. CLARK, AC I ]ON IN DIVORCE Defendant AFFIDAVIT O F T THE NOTICE TO DEFEND. COMPLAINT, and AFFIDAX'Lf OF SEPARATION AND NOW, this February 21. 2001 _ I. Janc -Adams, Esquire, hereby certify that on February 17, 2001, a true and correct copy oI the NOTICE TO DEFEND, COMPLAINT, AND AFFIDAVIT OF SEPARA'I ION were scr\ed. via certified mail, restricted delivery, return receipt requested, addressed to: Steven B. Clark 25334 Beantree Court Marina Valley, CA 92551 DEFENDANT Respectfully Submitted: J e Adams, Esquire .D. No. 79465 117 South Hanover St. Carlisle, Pa. 17013 (717) 245-8508 ATTORNEY FOR PLAINTIFF JANE AWORN .117 SOUTH H CARLISLE., (717) IN H 11: COIL IZ )'OF COMMON PLEAS C U M B I: R LAND COUNTY, PENNSYLVANIA KRISTI J. CLARK, Plaintiff 'I Rt.. , -- n N a c m m -o a m d C O T C a m d a d a c m T v .J r _ n 1. V f ? .7 J C?? i 1 , KRISTI J. CLARK, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION -DIVORCE NO. 01-762 CIVIL TERM STEVEN B. CLARK, IN DIVORCE Defendant/Respondent DR# 30671 Paeses# 312103462 ORDER OF COURT AND NOW, this 22nd day of May, 2001, upon consideration of the attached Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shaddav on June]], 2001 at 9:00 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11® (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, George E. Hoffer, President Judge Mail copies on Petitioner 5-22-01 to: < Respondent Jane Adams, Esquire Lindsay Baird, Esquire f s Date of Order: May 22, 2001 y? R.J Shadday, Conference Officer YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 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 accomodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. . ., ;._ ,?. ?. ?, _. KRISTI J. CLARK, Plaintiff VS. STEVEN B. CLARK, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 01 - 762 Civil Term ACTION IN DIVORCE PETITION FOR ALIMONY PENDENTE LITE. AND NOW COMES, Plaintiff, Kristi J. Clark, by and through her Attorney, Jane Adams, Esquire, and respectfully represents that: 1. Plaintiff is Kristi A. Clark, an adult individual, who has resided at 401 Garland Drive, Carlisle, Pa. 17013 since February 27, 2001. 2. The Plaintiff's date of birth is February 11, 1958 and her social security number is: 185-38-5974. 3. Defendant is Steven B. Clark, an adult individual, who has resided at 25334 Beantree Court, Moreno Valley, CA, 92551 since June 1999. 4. Defendant's date of birth is January 26, 1956 and his social security number is: 441- 48-1720. 5. The Plaintiff and the Defendant were married on April 15, 1983 in Oklahoma. 6. Plaintiff has heretofore filed a complaint for divorce as of the above caption. 7. Plaintiff lacks sufficient property to provide for her reasonable means and is unable to support herself through appropriate employment. 8. Plaintiff requires reasonable support to adequately maintain herself in accordance with the standard of living established during the marriage. 9. The Defendant is financially able to provide for the reasonable needs of the Plaintiff. WHEREFORE, the Plaintiff requests that this Honorable Court enter an award of Alimony Pendente Lite until final hearing. Date: Respectfully submitted, r,an D. No. 79465 117 South Hanover St. Carlisle, Pa. 17013 (717) 245-8508 ATTORNEY FOR PLAINTIFF r, t 17 1r KRISTI J. CLARK, : IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. .. No. 01 - 762 Civil Term STEVEN B. CLARK, ACTION IN DIVORCE Defendant AFFIDAVIT OF SERVICE. AND NOW, this May 30, 2001, I, Jane Adams, Esquire, hereby certify that on or about May 12, 2001, a true and correct copy of the PLAINTIFF'S PETITION FOR ALIMONY PENDENTE LITE was served, via certified mail, return receipt requested, addressed to: Steven B. Clark 25334 Beantree Court Marina Valley, CA 92551 DEFENDANT AND Lindsay Baird 37 S. Hanover St. Carlisle, Pa. 17013 Respectfully Submitted: JanEsquire L65 117 South Hanover St. Carlisle, Pa. 17013 (717) 245-8508 ATTORNEY FOR PLAINTIFF m m XTN c Q N d ? x y E ° _ n ?+ V ?t z a> b m m ?v rD W N } O n m ? k u'j¢ U DDD T? ids & h?'? m 4 N Y N Y' ?, O 6 p U o r D? v Q L Q N N N X > n \ r o E ?Lk,VJ} c _ .D U U -b c m m m m - o y E£E??`- 8 o rn `q C U ° `, is 4 o E?.,?c v T M a ¦ °' ¢ 3 ?' ? '.r z c7 " V / II ((}} Q 4 ? 4 s s Q E 8 N O ?'b Q Q T Z ? Y A 5 `m E a M ? E ti m ? ? k c c a ?°¢? ro ?U d O k as z DOD w n a g d u o 3g a Z`N Va w? C d W U d¢ C ` V m e ? C aZ0xo M a E a . zi m o : v o E ? ° N « T N N N ? C y0 w + ' m ¢hN°,Eo€ N ? Y C'i m?mELm--? v E"? E m m a ? .d¢?3zm o ? E U V T m t" ? d EEc«.°m.o v ?, v ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT ??, 3a? a /993 State Commonwealth-of Pennsvlvania /?iS?S d7//d3G SS XO Original Order/Notice Co./City/Dist. of CUMBERLAND -/)/t d/aD 1 Q Amended Order/Notice Date of Order/Notice 05/28/02 O Terminate Order/Notice Court/Case Number (See Addendum for case summary) >°i'J`e £U -3/`-? /° 3 „36(o7/ )RE CLARK, STEVEN B. Employer/Withholder's Federal EIN Number ) Employee/Obligor's Name (Last, First, MI) ALLENBERRY INC ) 441-48-1720 Employer/Withholder's Name ) Employee/Obligor's Social Security Number PO BOX 7 ) 2901100703 Employer/Withholder's Address ) Employee/Obligor's Case Identifier BOILING SPRINGS PA 17007-0007 ) (See Addendum forplaintiff 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. $ 1, 507.56 per month in current support $ 173. o o per month in past-due support Arrears 12 weeks or greater? ® yes Q no $ 0.00 per month in medical support $ 0 , 00 per month for genetic test costs $ per month in other (specify) for a total of $ 1, 680.56 per month to be forwarded to oayee below. You do not have to vary your pay cycle to be in comphar - •r pay cycle does not match the ordered support payment cycle, use the following to $ 387.82 per weekly pay period. $ 775.64 per biweekly pay period (every two v - $ 840.28 per semimonthly pay period (twice a p e9? $ 1, 68 o. 56 per monthly pay period. J v REMITTANCE INFORMATION: You must begin withholding no later than the first pay pv, ___ b days after the date of this Order/Notice. Send payment within seven (7) working days of the payda-te/aar holding. 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 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 i needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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 PA CSES 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. BY THE COURT: Date of Order: MAY 2 9 2002 9EV11V40 6FESS Form EN-028 WOfkerlD $IATT Service Type M d:.?? , p?' ?'? ? OMB No.: 0910-m 54 MAY 2 9 2002 Expfratlor Date: 12/31/00 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this forth to your employee. i . 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 musPreport the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amow t-was withheld from the employee'swages: 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. WITHHOLDER'S ID: 2316842070 EMPLOYEE'S/OBLIGOR'S NAME: CLARK, STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any 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 (15 U.S.C. § 1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, federal, local taxes; Social Security taxes; and Medicare taxes. 10. *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. Requesting Agency: 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 Page 2 of 2 Form EN-028 oMe NO, 0910a154 WorkerlD $1ATT ExpiMdon Oars 12/3100 ADDENDUM Summary of Cases on Attachment Defendant/obligor: CLARK, STEVEN B. PACSES Case Number 271103055/-,:,/,w, Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 328 S 1993 $ 1,062.56 Child(ren)'s Name(s): DOB JOSHUA 8. CLARK 06/17/85 JORDAN S. CLARK 08/19/87 PACSES Case Number 312103462/0-'-/-71 Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 01-762 CIVIL $ 618.00 Child(ren)'s Name(s): DOB []if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. []if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Dlf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. [I If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. DIf checked, you are required to enroll the child(ren) ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT OMB No.: 09)0-0154 Expiration Date: 12131100 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT /, 3d s /99-3 State Commonwealth of Pennsylvania A K9, - o27// b -3 053 U Original Order/Notice Co./City/Dist. of CUMBERLAND /)/,I- 12/;Z0 g O Amended Order/Notice Date of Order/Notice 07/26/02 O Terminate Order/Notice Court/Case Number (See Addendum for case summary) 51,-,-v& ? C . Ole -7/ RE: CLARK, STEVEN B. Employer/Withholder's Federal EIN Number ) Employee/Obligor's Name (Last, First, MI) PENNFIELD FARMS > 441-48-1720 Employer/Withholder's Name ) Employee/Obligor's Social Security Number 2609 ROUTE 22 BOX 70 ) 2901100703 Employer/Withholder's Address ) Employee/Obligor's Case Identifier FREDERICKSBURG PA 17026-0070 ) (See Addendumforplaintiffnames associated with cases onattachment) 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. $ 1, 507.56 per month in current support $ 173. 00 per month in past-due support Arrears 12 weeks or greater? ®yes Q no $ o. oo per month in medical support $ 0 , 00 per month for genetic test costs $ per month in other (specify) for a total of $ 1, 680.56 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: $ 387.82 per weekly pay period. $ 775, 64 per biweekly pay period (every two weeks). $ 840, 28 per semimonthly pay period (twice a month). $ 1, 6s 0.56 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 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 pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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 Empfoyee/Obfigor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Date of Order: 9 20026 4 Form EN-028 Service Type M ao154 Worker ID $IATT Expiration Date 12/31/00 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* - Reporting the Paydate/Date of Withholding. You-must tport the paydate/date of withholding vben sending the-payment. The paydate/date of withholding is tfm- 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. WITHHOLDER'S ID: 2317372320 EMPLOYEE'S/OBLIGOR'S NAME: CLARK, STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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%b(igor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an 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 (15 U.S.C. §1673 01; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, federal, local taxes; Social Security taxes; and Medicare taxes. 10. *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. Requesting Agency: 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 Page 2 of 2 Form EN-028 OMB No.; 09/M154 Worker ID $1ATT Expiration Date: 12/37/W ADDENDUM Summary of Cases on Attachment Defendant/Obligor. CLARK, STEVEN B. PACSES Case Number 271103055/ Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 328 S 1993 $ 1,062..56. Child(ren)'s Name(s): DOB JOSHUA B. CLARK 06/.17/85 JORDAN S. CLA[RK08/19/87 PACKS Case Number 312103462 / 7U(o7/ Plaintiff Name C KRISTI J. CLARK Docket Attachment Amount 01-762 CIVIL $ 618.00 Child(ren)'s Name(s): DOB ?If checked, you are required to enroll the chi Wren) identified above in any health insurance coverage available through the employee's/obligor's employment. ?Ifchecked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ?If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT OMB No.: 0970-0154 Expiration Date 12131100 C: ??- , t _.? DR 30671 PACSES ID 312103462 KRISTI J. CLARK, Plaintiff/Petitioner Vs. STEVEN B. CLARK Defendant/Respondent : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : DOMESTIC RELATIONS SECTION : CIVIL ACTION - LAW NO. 01-762 CIVIL TERM ORDER OF COURT AND NOW, this 13th day of August, 2001, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $N/A per month and Respondent's monthly net income/earning capacity is $N/A per month, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $275.86 per month payable monthly as follows; $248.86 per month for alimony pendente lite and $27.00 per month on arrears. First payment due with respondent's first pay in September. Arrears set at $0.00 as of August 13, 2001. The effective date of the order is September 1, 2001. This order is based upon the parties' stipulation and agreement of August 9, 2001. Arrears on the Alimony Pendente Lite order are to be $1,667.94 on September 1, 2001 pursuant to the parties' agreement. 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 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: Kristi J. Clark. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed4c: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. Unreimbursed medical expenses that exceed $250.00 annually are to be paid 86% by the respondent and 14% by petitioner. The petitioner is responsible to pay the first $250.00 annually in unreimbursed medical expenses. Respondent to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the Respondent shall submit written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of. 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. DRO: R J. Shadday BY THE COURT, Mailed copies on Petitioner 8.14-01 to: < Respondent Jane Adams, Esquire Lindsay Baird, Esquire Kevin ess J. ?, ?' ,. Aug 07 01 03:19p FROM : 3ANE_ADAMS BRTRO LRW OFFICE FAH NO. : 7172458538 Aug. 07 2001 12755RM P3 IN TII$ COURT Of C(31~l{KI)N PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA KRISTI J. CLARK, Plaintiff VS. STEVEN 3. CLARK, Defendant DRS 30671 PACSES #312103462 and #2711103055. N?. Ol - 762 Civil Term ACFIMIN DIVORCE - STFPUL.A17ON AND AGREEMENT. AND NOW, this day of 4 , 2001, the patties, KRIS77 J. CLARK, Plaintiff, and STEVEN B. CLARK; Defendaot, do hereby Agree and Stipulate as follows: 1. Plaintiff', Kristi J. Clark, (hereinafter referred to as "Plaintiff') currently resides at 401 Garland Drive, Carlisle, Pa. 17013, belephor"umber (717) 249-3053, 2. Plaintiffs date of birth.is.FeWa y 11, 1958 and her seeialseaujity number is: 185-38- 5974. 3. Defendant, Steven B. Clark, (hereinafter referred to as "Defendant") currently resides at 25334 Beantree Court, Moreno Valley, CA, 92551, telephone number (909) 374-0631 4- Defendant's date of bitttr is ]aaaary26,1956 and his soeudsectuity number is: 441- 48-1720. 12 5. Deferadlimi'sdame llieem Aumbcris:,!/ 17 1?,3 fe2 717-243-8110 p.4 6. Defendant cwv l marks fools Foo&, Inc., 212-50 Box Springs Road, Suite Aug 08 01 11:00a BRIRD LRW OFFICE 717-243-8110 P.2 FROM : JPNe-ADPMS FAX NO. : 7172458538 Pug. 07 2001 11:54PM P2 207, Moreno Valley, California, 92557, telephone no. (909) 784-7282. 5. Plaintiff and Defendant are the parents of two minor children, namely, Joshua B. Clark, date of birth, 6-17-85, social security no. 160-66-7948 and Jordan S. Clark, date of birth, 8-19-87, social security no. 202-70.4475. 6_ Plaintiff filed a for spousal support and child support, under PACSES #2711103055 and an initial bearing was held on February 28, 2001. On or about April 30, 2001, a Petition for Alimony Pendente Liu (PACSES #312103462) was filed with the Court and served upon Defendant. Pursuant to these Petitions, the parties agree as follows: A_ The Defendan shall pay the amount of 51360.45 peg month in child support and $500.00 a month in alimony to the Plaintil -wilh modification addressed in section D. below. B. Payments will be deducted from Defeadarzfs paychePk and be forwarded to Plaintiff through PSECDU. C. This Agreement shall 1 ? effective immcdiatcly. D. Uporr execudon of this sgrew"t, Plaintiff shall1e fully responsible for all loan ptrymeau ducVwmtls lho cattplc's Ssu= Rodeo: Plaintiff shall retain possession of the vehicle. R Effective ScpscmW 1,1001; Defeadam's total stptpiort payment shall be reduced by the amount of the monthly payment on the jointly titled Isuzu Rodeo, ($251.14).- The amount of $251.14 shallcomimw ns he deducted from Defendant's checking account and forwarded to USAA, to satisfy the monthly payment duo on-dw couple's Isuza Rodeo DefeadwW4 total support payment shall be reduced until such time as the Istmr Rodeo is sold or the loan is paid in full, when the total support payment to Plaintiff shah again equal SI960.45. F. As of September 1, 2001, the amount of arrearago owed to Plaintiff shall equal: $8038.01. minus S1860:45.(the amount ofpa)OPent to be forwarded to Plaintiff by August 13, 2001) to equal $6177.56. 6. Defendant sSaH pay at least SI00.00 per mont4 towards any arrearages. 7. Unreimbwsed medical expenses are to be paid lA by the Defendant, and 14% by the Plaintiff. 8. Plaintiff, Kristi J. Clark, currently carries, and shall maintain medical coverage for the couple's minor children with the following medical plan: Blue Cross and Blue Shield, QBD185385974 in Plan 022656000. 9. Within thirty (30) days of Defendant's request, Plaintiff will provide written proof of medical coverage for the couple's two children. Proof of coverage shall consist, at a minimum of: 1) the name of the health care coverage provider(s); 2) 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. 10. Settlement proceeds in the amount of $18,672.69 from the sale of the couple's home are have been held in escrow. Pursuant to prior agreement of the parties, $2,500.00 of this amount was disbursed to Kristi J. Clark. The remaining proceeds equal $16,172.69. Pursuant to this Stipulation and Agreement, the remaining settlement proceeds have been disbursed as follows: $4,596.17 disbursed to Steven B. Clark. $288.00 to Jane Adams to cover attorney's fees for time spent on settlement. $11,288.69 disbursed to Kristi J. Clark. 11. Nothing in this agreement shall prevent the parties from requesting a modification of this agreement where there is a material change in the circumstances of the parties or the children, and this agreement shall not contractually obligate the Plaintiff or Defendant to pay an amount per month without regard to the circumstances of the parties or the children. Aug 07 01 03:19p BAIRD LAW OFFICE 717-243-8110 p.7 FROM : JANE-ADAMS FAH NO. : 7172458538 Aug. 07 2001 12:56AM % IN WITNESS WHEREOF, the parties hereto have set their hands and seals the date and year above written ICRI 3. CLK ESS d 4 Date: COMMONWEALTH OF PENNSYLVANIA }:ss COUNTY OF ) On this, the da /n /5U 2901, before " undersigned officer, personally appeared r'.?G4 known tome, (or satisfactorily proven) to be dte person whose name is-su6scjibed fhe within mstrumettt .aad 4nowledged that he/she executed the same for the purposes therein contained. IN WITNESS WHEREOF, 'I hcmunta set my hand and official seal. otary Public I my commission ?*v r'0"R.ZIfi? C; SEAL ! Je9k'it` ! FeIDv ?.° ? -- t3 'run R ; Ge t rrss? ?' c 5api. 0, 26u Aus 07 01 03:20p FROM : IARE_ADAMS BAIRD LAW OFFICE FRY, NO. : 7172458538 Aug. 07 2001 12:56W P7 WITNESS Date= COMMONW TH ? ISYLVANIA ) COUNTY ):ss On gusv the M dpf .2001. before m personallyaMem:ed A/r?,??to.i emdersignedofficer, ?Pe'sm whose =33C is subscn"bedito'the?wil?IrinC-icstrument, s?m*Pr0ven) to be executed the same for the purposcs therein co and ac"ledged that he/she ntaina IN WITNESS WHEREOF f?? av ial seal. c My commission expires: SEAL i 11IPEV.PCCMID COMMb 012140 717-243-8110 P.8 C. ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsvlvania ? / 3?k s? 13 /?f1C)x )_0, ,OS Co./City/Dirt. of CUMBERLAND l)? Date of Order/Notice 09/20/01 ??" Court/Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number PHILLIPS FOODS INC EmployerAVithholder's Name STE 207 Employer/Withholder's Address 21250 BOX SPRINGS RD MORENO VALLEY CA 92557-8712 ZIA-& 01-7(,-;1011116 /-'fhYSft 3-172IC?(lG? O Original OrderlNotice Amended Order/Notice O Terminate order/Notice )RE: CLARK, STEVEN B. Employee/Obligor's Name (Last, First, MI) > 441-48-1720 Employee/Obligor's Social Security Number 2901100703 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attadtmenO 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. $ 1, 609.31 per month in current support $ 100. 00 per month in past-due support Arrears 12 weeks or greater? Oyes Q no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 1, 709.31 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: $ 394. 46 per weekly pay period. $ 788. 91 per biweekly pay period (every two weeks). $ 854.66per semimonthly pay period (twice a month). $ 1.709.31 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 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 pg. 2), If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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 SYMAIL. BY THE COURT: Date of Order: SEP 2 1 2001 Service Type M NGSS 4* A4 OMB No. 0970-0154 Expiration Date. 12/31/00 J&Z)6C= Form EN-028 Worker ID $IATT u :,7 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee%bligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* - Reporting the Paydate/Date of Withholding. You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is tl,e date ?n 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/obligors 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. WITHHOLDER'S ID: 4414817200 EMPLOYEE'S/OBLIGOR'S NAME: CLARK, STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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 (15 U.S.C. §1673 MI; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *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. Requesting Agency: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact 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 Service Type M Page 2 of 2 Form EN-028 Worker ID $IATT OMB No.: 0970-0154 Expiration Date: 12131100 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CLARK, STEVEN B. PAGES Case Number / 2U? 27110305s Plaintiff Name f KRISTI J. CLARK Docket Attachment Amount 328 8 1993 $ 1,360.45 Child(ren)'s Name(s): DOB JOSHUA B. CLARK 06/17/85 JOADA)tlS. CLARK: 08/19/97 PAGES Case Number 312103462 / Plaintiff Name (( KRISTI J. CLARK Docket Attachment Amount 01-762 CIVIL $ 348.86 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(en) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT OMB No.: 0970-0154 Expiation Date: 12/31/00 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 2)6/z , _3,2 S /9S3 State Commonwealth of Pennsylvania ? 5 7/i03G'S3 0Original Order/Notice Co./City/Dist. of CUMBERLAND 021,xd9 1w; Q/ - 76'1 r!t/fl/e, 0 Amended Omer/Notice Date of Order/Notice 09/26/01 101/C?F5 Q Terminate Order/Notice Court/Case Number (See Addendum for case summary) 3/L 36&77 RE: CLARK, STEVEN B. Employer/Withholder's Federal EIN Number ) Employee/Obligor's Name (Last, First, MI) PHILLIPS FOODS INC ) 441-48-1720 Employer/Withholder's Name ) Employee/Obligor's Social Security Number STE 207 ) 2901100703 Employer/Withholder's Address ) Employee/Obligor's Case Identifier 21250 BOX SPRINGS RD ) (See Addendum for plaintiff names associated with cases on attachment) MORENO VALLEY CA 92557-8712 ) 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. $ 0. 00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in medical support $ 0, 00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0. oo per weekly pay period. $ 0. oo per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 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 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 pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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. BY THE COURT: Date of Order: 'P 2 7 2MI M a *???? Form Service Type M OMB N., 09100154 Worker ID ID $IATT ?xpin ion Date: 11131/00 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 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 employer'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. WITHHOLDER'S ID: 4414817200 EMPLOYEE'S/OBLIGOR'S NAME: CLARK, STEVEN S. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any 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 (15 U.S.C. § 1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *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. Requesting Agency: 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 a Page 2 of 2 OMB No.: 0970.0154 Expiation Date: 12/31/00 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CLARK, STEVEN B. PACSES Case Number 27110305Y??wgv Plaintiff Name KRI8T2 J. CLARK Docket Attachment Amount 328 8 1993 $ 0.00 Child(ren)'s Name(s): DOB JOSHUA B. CLARK 06/17/85 J'ORUAN?. CLATtTC:.: 0x/19/87 PACSES Case Number 31210346 /??? j? Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 01-762 CIVIL $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT OMB No.: 091p0154 Expiation natc 14131/00 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION KRISTI J. CLARK ) Docket Number 01-762 CIVIL Plaintiff ) vs. ) PACSES Case Number 312103462 /D30671 STEVEN B. CLARK ) Defendant ) Other State ID Number Order AND NOW to wit, this OCTOBER 10, 2001 it is hereby Ordered that: THE ORDER OF AUGUST 13, 2001 IS AMENDED IN THAT PLAINTIFF IS TO MAINTAIN MEDICAL INSURANCE FOR HERSELF. BY THE COURT: DRO: RT Sbadday xc; plaintiff defer0ant Jame Adams, Esquire Lindsay Baird, Esquire MMT11-, -11 w -/ of Ke Hess JUDGE Form OE-520 Service Type M Worker ID 21005 C; M Mi, - 2f lT' ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 10/15/01 Court/Case Number (See Addendum for case summary) 31 ?z l o 3 4t- ,a 01-`7(ca C, \) I O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice Employer/Withholder's Federal EIN Number HENRY'S SEAFOOD INC Employer/Withholder's Name PO BOX 164 Employer/Withholder's Address NRIGHTSVILLE PA 17368-0164 ???-? I RE: CLARK, STEVEN B. ,? 7 / I U 31"5 S Employee/Obligor's Name (Last, First, MI) nn > 441-48-1720 _5 Employee/Obligor's Social Security Number 2901100703 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. $ 1, 609.31 per month in current support $ 173. oo per month in past-due support Arrears 12 weeks or greater? ®yes Q no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 1, 782.31 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: $ 41].30 per weekly pay period. $ 822, 60 per biweekly pay period (every two weeks). $ 891- 16 per semimonthly pay period (twice a month). $ 1. 782.31 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 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 i needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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. BY THE COURT: Date of Order: OCT 1 6 2001 Form EN-028 Service Type (.t OMB No.: 0970-0154 Worker lD $IATT Expiration Date: IV31100 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 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 paydateMate of withholding when sending the payment. Thy paydate/Mate of withholding is the date on which amount was withheld fhon, the employec'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/Obligorwith 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. WITHHOLDER'S ID: 2324908340 EMPLOYEE'S/OBLIGOR'S NAME: CLARK, STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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 (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *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. Requesting Agency: JDOMESTIC 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 @ Page 2 of 2 OMB No.: 0970-0154 Expiration (ate: IV31/00 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CLARK, STEVEN B. PACSES Case Number 271103055 Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 328 8 1993 $ 1,433.45 Child(ren)'s Name(s): DOB JOSHUA B. CLARK 06/17/85 'ToPmAx l€3. CLARK 08/1010 PAGES Case Number 312103462 Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 01-762 CIVIL $ 348.86 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT OMB No.: 0970-0154 Expiation Date: 12/31/00 l? ? v /" IN) KRISTI J. CLARK, Plaintiff V. STEVEN B.. CLARK, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DOCKET NO. 328 S 1993 PACSES Case Number 271103055/21208 01-762 CIVIL (APL) PRAECIPE FOR ENTRY OF APPEARANCE To: Prothonotary Kindly enter my appearance on behalf of Steven B. Clark, Defendant, in the above matter. Dated: November 28, 2001 B (-IAYA1t Ct j ?37 ay D. air , Es`iiire uth Ha o er Street Carlisle, PA 17013 (717) 243-5732 (-? ?.. i ,` i_ 'C ORDER/NOTICE O WI HHOD INCOME FOR SUPPORT 3a? ? /??a State Commonwealth of Pennsylvania 077//0305 Co./City/DisL of CUMBERLAND Date of Order/Notice 12/17/01 ?„?£5 X103 (?(D/? Court/Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice )RE: CLARK, STEVEN B. Employee/Obligor's Name (Last, First, M0 HENRY'S SEAFOOD INC ) 441-48-1720 Employer/Withholder's Name ) Employee/Obligor's Social Security Number PO BOX 164 ) 2901100703 Employer/Withholder's Address ) Employee/Obligor's Case Identifier WRIGHTS VILLE PA 17368-0164 ) (See Addendum for plaintiff names associated wiM 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. $ 1, 860.45 per month in current support $ 173.00 per month in past-due support Arrears 12 weeks or greater? (9) Yes Q no $ 0.00 per month in medical support $ 0. 00 per month for genetic test costs $ per month in other (specify) for a total of $ 2, 033.45 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: $ 469.26 per weekly pay period. $ 938. 52 per biweekly pay period (every two weeks). $ 1, 016. 73 per semimonthly pay period (twice a month). $ 2, 033. 45 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 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 i needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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 Idendfier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Date of Order: Service Type m DEC 1 8 2001 jVMATILIM 12 If r7/ i??iA/ . NC-cs OMB No. 0970-0154 Expiation Date: 12/31/00 W JUNG Form EN-028 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 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 th. Pdydate/Date of Withholding. You must report the paydateMate ofwdhholding when sending the payment. The paydate/dale of withholding is the date on which amount was withheld from tho employe...', 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 emp(oyee'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. WITHHOLDER'S ID: 2324908340 EMPLOYEE'S/OBLIGOR'S NAME: CLARK, STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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. B, 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 (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10 '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. Requesting Agency: If you or your employee/obligor have any questions, pOMESTIC RELATIONS SECTION 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 Page 2 of 2 Form EN-028 Service Type M OMNNo.0970-0154 WorkerlD $IATT Expiration D41c 12/311(30 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CLARK, STEVEN B. PACSES Case Number 271103055/1/X F g Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 328 9 1993 $ 1,433.45 Child(ren)'s Name(s): DOB J081-111A H CLARK 06/17/85 Jo8'bA>;T.:i .C.T,XR tiB/19/87 PACSES Case Number 312103462/3667 ? Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 01-762 CIVIL $ 600.00 Child(ren)'s Name(s): DOB ? if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name ?if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ?If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT OMB No.: 0910-0154 Ecpinlion Dale: 12/31/00 C7 CD r) -o a T7 c-? ?G 1; tJ C c ? cn < DR 30671 PACSES ID 312103462 KRISTI J. CLARK, Plaintiff /Petitioner vs. STEVEN B.CLARK, Defendant /Respondent IN THE COURT OP COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DOMESTIC RELATIONS SECTION CIVIL ACTION - LAW NO. 01-762 CIVIL TERM ORDER OF COURT AND NOW, this 17"' day of December, 2001, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $N/A and 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, $600.00 per month payable monthly as follows; $500.00 for alimony pendente lite and $100.00 on arrears. First payment due next modified wage attached payment. Arrears set at $1,885.87 as of December 17, 2001. The effective date of the order is November 1, 2001. This order is based upon the fact that a loan for plaintiff's vehicle has been paid in full and is no longer an obligation for the defendant. 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 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: Kristi J. Clark. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the defendant's PAC SES Member Number or Social Security Number in order to be processed. Do not send cash by mail. c CD c? 'O ry C7 G C• rn ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT >1E 5,U,9 ,9 /,K-3 State Commonwealth of Pennsvlvania /-f)K,, f"f 37//U -S 0Original Order/Notice Co./City/Dist. of CUMBERLAND {mac R/ C9 l{{ Q Amended Order/Notice Date of Order/Notice 01/09/02 -?Isr Ol- Z,;z elmz_ O Terminate Order/Notic( Court/Case Number (See Addendum for case summary) a ? 3l'2110 £s? 2 "o&7/ )RE: CLARK, STEVEN B. Employer/Withholder's Federal EIN Number ) Employee/Obligor's Name (Last, First, MI) HENRY'S SEAFOOD INC Employer/Withholder's Name PO BOX 164 Employer/Withholder's Address WRIGHTSVILLE PA 17368-0164 441-48-1720 Employee/Obligor's Social Security Number 2901100703 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. $ 1, 507. 56 per month in current support $ 173.00 per month in past-due support Arrears 12 weeks or greater? Oyes O no $ 0.0o per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 1, 680.56 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: $ 387.82 per weekly pay period. $ 775.64 per biweekly pay period (every two weeks). $ 840.28 per semimonthly pay period (twice a month). $ 1. 680.56 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 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 i needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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/Obfigor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: JAN 10 2002 * W. Date of Order: ,(-EUf 14 f/?S? ?rc>b?e Form EN-028 Service Type M Mj1TT°r_1,8No.:0970-0154 WorkerlD $IATT / t? /()Expiration Date: 12131100 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 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 emp)oyee/obligor. 3.* Reporting the f aydate/Date of Withholding. You must report the paydate/date of withholding when sencling the payment. The paydateMate of withholding is the date on which amount was withheld fiom the employec'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. WITHHOLDER'S ID: 2324908340 EMPLOYEE'S/OBLIGOR'S NAME: CLARK, STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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 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 (15 U.S.C. §1673 MI; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *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. Requesting Agency: 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 Page 2 of 2 OMB No.: 0970-0154 Expiation Date: 17/31/00 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CLARK, STEVEN 8. PACSES Case Number 2 7110 3 0 5 5/,2/-qo r Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 328 8 1993 $ 1,062.56 Child(ren)'s Name(s): DOB JOSHUA H. CLARK D6/17/85 abfV6" S. CLARK 08'./19/87 PACSES Case Number 312103462/j Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 01-762 CIVIL $ 618.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? Ifchecked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's{obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment, through the employee's/obligor's employment. Addendum Form EN-028 Service Type 11 Worker ID $IATT OMB No.: 09)00154 Expiration Date 12131100 l ' r-, _ `.- ?? ?1 DR 30671 PACSES 312103462 KRISTI J. CLARK Plaintiff /Petitioner VS. STEVEN B. CLARK, Defendant /Respondent IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DOMESTIC RELATIONS SECTION CIVIL ACTION - LAW NO. 01-762 CIVIL TERM ORDER OF COURT AND NOW, this 9a' day of January, 2002, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $847.62 and Respondent's monthly net income/earning capacity is $3,562.91, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $618.00 per month payable weekly as follows; $119.54 for alimony pendente lite and $23.07 on arrears. First payment due with next modified wage attachment payment. Arrears set at $1,543.80 as of January 9, 2002. The effective date of the order is November 14, 2001. Defendant is to directly pay plaintiff forty two percent (42%) of any and all net bonuses within five days upon receipt of the bonus. Defendant is to send verification of said bonus and payment to the Domestic Relations Office within the same five days. 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 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: Kristi J. Clark. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. Unreimbursed medical expenses that exceed $250.00 annually are to be paid 81% by the respondent and 19% by petitioner. The petitioner is responsible to pay the first $250.00 annually in unreimbursed medical expenses. Petitioner to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the Petitioner 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, This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. DRO: R. J. Shadday Mailed copies on Petitioner 1-10-02 to: < Respondent Jane Adams, Esquire Lindsay Baird, Esquire BY THE COURT, A4 Kevin A. Hess J. C c ? ,_ ?f? , i _. ORDER/NOTI E TO WITHHOLD INCOME FOR SUPPORT My. g /993 State Commonwealth of Pennsylvania ?f) SFS 7//631)5 0Original Order/Notice Co./City/Dist. of CUMBERLAND Amended Order/Notice Date of Order/Notice 04/26/02 Terminate Order/Notice Court/CaseNumber (See Addendum for case summary) ???SFS 3//l3?Co? RE: CLARK, STEVEN B. Employer/Withholder's Federal FIN Number ) Employee/Obligor's Name (Last, First, MI) HENRY'S SEAFOOD INC ) 441-48-1720 EmployerMrithholder's Name ) Employee/Obligor's Social Security Number PO BOX 164 ) 2901100703 Employernroithholder's Address ) Employee/Obligor's Case Identifier WRIGHTS VILLE PA 17368-0164 ) (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. $ o. oo per month in current support $ 0. 00 per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0. oo per month in medical support $ o . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ o. oo per weekly pay period. $ o. oo per biweekly pay period (every two weeks). $ 0. oo per semimonthly pay period (twice a month). $ o. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the 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 i needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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. BY THE COURT: MAY 3 2002 ' -* xw/, Date of Order: KF I REV A, /f? SS --j-u /)&C Form EN-028 Service Type m .117. OMB No.: 0970,0154 Worker ID $IATT "An Expiration Dale: 12/31/00 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 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 ng the payment. The paydateJdate of withholding is the date on which amountwas-oai[hheld 6om 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. WITHHOLDER'S ID: 2324908340 EMPLOYEE'S/OBLIGOR'S NAME: CLARK, STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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 05 U.S.C, §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *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. Requesting Agency: ,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 (9 Page 2 of 2 Form EN-028 OMBN,097M54 Worker ID $IATT Expiration Date. 12/31/00 E' r i KRISTI J. CLARK, Plaintiff vs STEVEN B. CLARK, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 01-762 CIVIL TERM IN DIVORCE AFFIDAVIT OF CONSENT, ACCEPTANCE OF SERVICE AND WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF DIVORCE DECREE UNDER SECTION 3301(C) OF THE DIVORCE CODE 1. A complaint in divorce under Section 3301(C) of the Divorce Code was filed on February 7, 2001. 2. Defendant acknowledged receipt and accepted service of the Complaint on February 17, 2001. 3. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of the filing of the Complaint. 4. 1 consent to the entry of a final decree in divorce without notice. 5. 1 understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 6. 1 understand that I will not be divorced until a divorce Decree is entered by the Court and that a copy of the Decree will be sent to me immediately after it is filed with the Prothonotary. 7. 1 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 16 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. \? - v?- 0,)-" j(- Date: Krist% J. Clark, efendant G z M rT cn Le N i) { KRISTI J. CLARK, Plaintiff V. STEVEN B. CLARK, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 01-762 CIVIL TERM IN DIVORCE AFFIDAVIT OF CONSENT, ACCEPTANCE OF SERVICE AND WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF DIVORCE DECREE UNDER SECTION 3301(C) OF THE DIVORCE CODE 1. A complaint in divorce under Section 3301(C) of the Divorce Code was filed on February 7, 2001. 2. Defendant acknowledged receipt and accepted service of the Complaint on February 17. 2001. 3. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of the filing of the Complaint. 4. 1 consent to the entry of a final decree in divorce without notice. 5. 1 understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 6. 1 understand that I will not be divorced until a divorce Decree is entered by the Court and that a copy of the Decree will be sent to me immediately after it is filed with the Prothonotary. 7. 1 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 to authorities. Date: ?2-- Steven B. Clark, Defendant n G .?> [fl fTi aL' I? 7 .7? LC ?.J '?'tl Ln G PROPERTY SETTLEMENT AGREEMENT THIS IS AN AGREEMENT made this WAdday of November, 2002, by and between Steven B. Clark, of 101 West Main Street, Apartment 6, Mt. Joy, Lancaster County, Pennsylvania, (hereinafter referred to as Husband) and Kristi J. Clark, of 53 Brian Drive, Carlisle, Cumberland County, Pennsylvania, (hereinafter referred to as Wife). WHEREAS, Husband and Wife were married on April 15, 1982, in Cleveland County; Oklahoma, and WHEREAS, various differences have arisen between Husband and Wife, whereby they have been living separate and apart since February 8, 1999; and WHEREAS, the parties have agreed to maintain separate and permanent domiciles and to live apart from each other; and WHEREAS, the parties desire to enter into an amicable settlement to provide for all of the property rights of the parties and to dispose of the rights and obligations of each to the other in respect to support, maintenance, alimony, counsel fees, equitable distribution, and all other rights and obligations under the Divorce Code of 1980, as amended, and it is the intention and agreement of the parties that this Agreement be a full, complete and final settlement of all of those rights and obligations under said Divorce Code; and NOW, THEREFORE, for and in exchange of mutual considerations, and intending to be bound by the provisions hereof, the parties agree that their recitals form a part of this Agreement and waive any right to counseling under the Divorce Code of 1980, as amended, and right to counsel fees, costs, alimony, support, maintenance, and any other rights under the said Divorce Code not provided for herein and agree as follows: 1. SEPARATION. The parties agree that it shall be lawful for each party, at all times hereafter, to live separate and apart from the other, at such place or places as he or she may, from time-to-time, choose or deem fit. Each party shall be free from interference, authority or contact by the other, as fully as if he or she were single and unmarried, except as may be necessary to carry out the provisions of this Agreement and as may be necessary to exchange information that pertains to the parties' minor child. Neither party shall molest the other or attempt to endeavor to molest the other, nor compel the other to cohabit with the other, or in any way harass or malign the other, nor in any way interfere with the peaceful existence, separate and apart, from the other. 2. REAL ESTATE. Husband and Wife jointly owned the marital residence located at 1873 Holly Pike, Carlisle, Pennsylvania. The marital residence was sold, the mortgage obligation removed and the proceeds divided between the parties as mutually agreed. 3. AUTOMOBILES. Husband and Wife shall have as his or her sole and exclusive property, title to and possession of any vehicle in that party's name as of the signing of this Agreement. Each parry shall indemnify and hold the other harmless from and liability on any loan encumbering the vehicle, cost of repairs, maintenance, registration, insurance and/or inspection of the vehicle which each is has as his or her sole and exclusive property. 4. PERSONAL PROPERTY. The parties have divided or have agreed to a division of their personal property which includes bank accounts, certificates of deposit, life insurance policies, jewelry, clothing, furniture and other personal items. After the aforesaid division of the personal property is complete, any and all property in the possession of Husband shall be his sole and separate property. Any and all property in the possession of Wife shall be her sole and separate property. Each party forever renounces whatever claims he/she may have with respect to the property which the other is taking. Each party understands that he/she has no right or claim to any property acquired by the other after the signing of this Agreement. 5. PENSION/RETIREMENT PLANS. Wife hereby releases any and all claims or demands she may have on Husband's pension or retirement plans. Husband hereby releases any and all claims or demands he may have on Wife's pension or retirement plans. 6. DEBTS. The parties represent and warrant to each other that neither has incurred any other debts nor made any other contracts for which the other or his/her estate may be liable, from date of separation forward. Neither party shall contract nor incur any debt or liability for which the other or his/her property or estate might be responsible and agrees to indemnify the other from any claims made against the other because of debts/obligations not incurred by the other. 7. ALIMONY, ALIMONY PENDENTE LITE. Alimony paid by Husband to Wife is addressed in a January 9, 2002, Order of Court, docketed at No. 01-762 Civil Term, DR No. 30671, PACSES No. 312103462. Husband shall pay the current amount until June of 2006. 8. EFFECTIVE DATE. The effective date of this Agreement shall be the date of execution by the parties if they had each executed the Agreement on the same date. Otherwise, the execution date of this Agreement shall be defined as the date of execution by the party last executing this Agreement. 9. DIVORCE. A Complaint in Divorce, claiming that the marriage is irretrievably broken under the no-fault mutual consent provision of Section 33010 of the Pennsylvania Divorce Code, was filed on February 7, 2001 in the Court of Common Pleas for Cumberland County at Docket No. 01-762 Civil Term. Both parties agree to execute any and all affidavits or other documents necessary for the parties to obtain an absolute divorce pursuant to Sections 3301© of the Divorce Code including waiver of all rights to request Court ordered counseling. 10. INCORPORATION INTO DECREE. Should a decree, judgment or order of separation or divorce be obtained by either of the parties in this or any other state, country, or jurisdiction, each of the parties hereby consents and agrees that this Agreement and all of its covenants shall not be affected in any way by any such separation or divorce; and that nothing in any such decree, judgment, order or further modification and revision thereof shall alter, amend or vary any term of this Agreement, whether or not either or both of the parties shall remarry, it being understood by and between the parties hereto that this Agreement shall survive and shall not be merged into any decree, judgment, or order of divorce or separation. It is specifically agreed, however, that a copy of this Agreement or the substance of the provisions thereof, may be incorporated by reference into any divorce, judgment or its decree. This incorporation, however, shall not be regarded as a merger, it being the specific intent of the parties to permit this Agreement to survive any judgment and to be forever binding and conclusive upon the parties. 11. MUTUAL RELEASE. Husband and Wife do hereby mutually remise, release, quit claim or forever discharge the other and the estate of such other, for all time to come, and for all purposes whatsoever, from any and all rights, title and interest, or claims in or against the estate of such other, of whatever nature and wherever situate, which he or she now has or at anytime hereafter may have against such other, the estate of such other or any part thereof, whether arising out of any former acts, contracts, engagements or liabilities of such other or by way of dower or curtesy of claims in the nature of dower or curtesy, or widow's or widower's rights, family exemption or similar allowance or under the intestate laws; or the right to take against the spouse's will; or the right to treat a lifetime conveyance by the other as testamentary or all or other rights of the surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of Pennsylvania, any state, commonwealth or territory of the United States, or any other country or any right which either party may now have or at anytime hereafter have for past, present or future support or maintenance, alimony, alimony pendente lite, counsel fees, costs or expenses, whether arising as a result of the marital relation or otherwise, except and only except all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. It is the intention of Husband and Wife to give to each other by the execution of this Agreement a full, complete and general release with respect to any and all property of any kind or nature, real, personal or mixed, which the other now owns or may hereafter acquire, except and only except all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. 12. COUNSEL FEES. Each party individually covenants and agrees that he or she will individually assume the full and sole responsibility for legal expenses for his or her attorney and 3 court costs in connection with any divorce action which may be brought by either party and shall make no claim against the other for such costs or fees, except for $518.00 which Husband agrees to pay on behalf of Wife to Wife's attorney. 13. ADDITIONAL INSTRUMENTS. Each of the parties shall, from time-to-time, at the request of the other, execute, acknowledge and deliver to the other party any and all further instruments or documents that may be reasonable required to give full force and effect to the provisions of this Agreement. 14. MODIFICATION OR WAIVER. A modification or waiver of any of the provisions of this Agreement shall be effective only if made in writing and executed with the same formality as this Agreement. The failure of either party to insist upon the strict performance of any of the provisions of this Agreement shall not be construed as a waiver of any subsequent default of the same or similar nature. 15. ENTIRE AGREEMENT. This Agreement contains the entire understanding of the parties and there are no representations, warranties, covenants or undertakings other than those expressly set forth herein. 16. SEPARATE PARAGRAPHS. It is specifically understood and agreed by and between the parties thereto that each paragraph hereof shall be deemed to be a separate and independent agreement. 17. BREACH. If either party breaches any provision of this Agreement, the other party shall have the right, at his or her election, to sue for damages for such breach or seek such other remedies or relief as may be available to him or her and the party breaching this Agreement shall be responsible for payment of legal fees and costs incurred by the other in enforcing the rights under this Agreement, or in seeking such other remedies or relief as may be available to him or her. 18. CONTROLLING LAW. This Agreement shall be construed under the laws of the Commonwealth of Pennsylvania. 19. INVALIDITY OF PROVISIONS. If any term, condition, clause or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, then only that term, condition, clause or provision shall be stricken from this Agreement, and, in all other respects, this Agreement shall be valid and continue in full force, effect and operation. 20. BINDING NATURE. Except as otherwise set forth herein, this Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors and assigns. IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above written. WITNESS CC Steven B. Clark t7ikN . C)Ct.-JQ KrisfPJ. Clark ?, -.. -:;??? ?. ? m?,, -y ?. _ _ 'i-- ? I-? ??:" rv ,? ?. r c? a _ ?: "' ?? KRISTI J. CLARK, Plaintiff V. STEVEN B. CLARK, Defendant TO THE PROTHONOTARY: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA :NO. 01-762 CIVIL TERM :IN DIVORCE PRAECIPE TO TRANSMIT RECORD Transmit the record, together with the following information, to the Court for entry of a divorce decree: 1. Ground for Divorce: Irretrievable breakdown under Section 3301(C) of the Divorce Code. 2. Date and manner of service of the Complaint: February 17, 2001, Certified Mail 3. Date of execution of the Affidavit of Consent required by Section 3301(C) of the Divorce Code: By Plaintiff: November 18, 2002; by Defendant: November 19, 2002. 4. Related claims pending: None. 5. Date Plaintiff's Waiver of Notice in §3301(C) Divorce was filed with the Prothonotary: ii- A-?2 as Date Defendant's Waiver of Notice in §3301(C) Divorce was filed with the Prothonotary: 0? dsay Dare @?frd, Esquire \ Attorney for the Defendant CZD N i v i% c-a 2 71 u?c: tv r 1 ?. C .. -rn I IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNA. KRISTI J. CLARK, Plaintiff VERSUS STEVEN B. CLARK, Defendant AND NOW, DECREED THAT AND No. 2001-762 DECREE IN DIVORCE aa.?.,.rc. a c KRISTI J. CLARK 2.00z, IT IS ORDERED AND STEVEN B. CLARK ARE DIVORCED FROM THE BONDS OF MATRIMONY. , PLAINTIFF, ,DEFENDANT, THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT YET BEEN ENTERED; The property settlement agreement is incorporated but not merged into the decree. BY TH OURT: ?e ATT ST i. PROTHONOTARY ?' 7 /T-w` aa' of moo- 2z° // ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 02/03/05 Case Number (See Addendum for case summary) O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice Employer/Withholder's Federal EIN Number RE: CLARK, STEVEN B. Employee/Obligor's Name (Last, First, MI) 441-48-1720 Employee/Obligor's Social Security Number RITTER FOOD SERVICE / 77 2901100703 PO BOX 720 W9- S 19`./3 Employee/Obligor's Case Identifier MOUNT JOY PA 17552-0720 ?J,C)?iSfs Z7//0305)Jr (See Addendum for plaintiff names J associated with cases on attachment) ?2UU/-76pJ-' of v/L Custodial Parent's Name (Last, First, MI) AK& fS o?A?/??ayCv? See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ o. oo per month in current support $ o. oo per month in past-due support Arrears 12 weeks or greater? Dyes ® no $ o. 00 per month in current and past-due medical support $ o . 00 per month for genetic test costs $ per month in other (specify) 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: $ o, oo per weekly pay period. $ o . oo per biweekly pay period (every two weeks). $ o. oo per semimonthly pay period (twice a month). $ o. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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. BY THE COURT: Date of Order: FEB _ 4 2005 4. kEUlc/ . t-(ESS ?UIr?E Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? Ifgheckefd you are required to provide agopy of this form toyouremployee. If yoyr employee %rks in a state that is di erent rom the state that issued this o er, a co must be provi e to our em olee even if t e 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 employeelob(igor'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. polydatefdate 1 wit! holding rs the date Oil VVIlidl 6111VUlit W65-Withheld from . ee s wager. You must comply with the law of the 'IM 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. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 8593100023 EMPLOYEE'S/OBLIGOR'S NAME: CLARK. STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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 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 (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 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 amounts allowed under the law of the state that issued the order. 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. Submitted By. 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 L'17) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 OMB No, 0970-0154 Form EN-028 Worker ID $IATT ?.._a 1?} 1` ? (a` . t -??, 4J ttU. 1, .li} .. ^'? ?}f t : ,? .:. i a. -? {l. '1 r.? <, ?_ c?? ORDERINOTICE TO WITHHOLD INCOME FOR. SUPPORT State Commonwealth of Pennsylvania 0Original Order/Notice Co./City/Dist. Of CUMBERLAND O Amended Order/Notice Date of Order/Notice 11/29/04 O Terminate Order/Notice Tribunal/Case Number (See Addendum for case summary) RE: CLARK, STEVEN B. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) RITTER FOOD SERVICE'. 3'-S> z In-9 PO BOX 720 ?MMES A-7//,6305 MOUNT JOY PA 17552-0720 ,b d, 02001-7&a- v P?4es? s ???ia3 ?? a- 441-48-1720 Employee/Obligor's Social Security Number 2901100703 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. $ 1, 057.00 per month in current support $ 136.50 per month in past-due support Arrears 1.2 weeks or greater? (2) Yes Q no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 1,193.50 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: $ 275.42 per weekly pay period. $ 550.85 per biweekly pay period (every two weeks). $ 596.75 per semimonthly pay period (twice a month). $ 1, 193. 50 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten 00) 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 #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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. ; Y THE COURT: I/ - o Date of Order: NOV " 2004 Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecke? you are required to provide a copy of this form to your m loyee. If yor employee works in a state that is di ferent from the state that issued this order, a copy must be provi?edpto your emproyee even if the box is not cheCKed. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. 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. 3. 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. 4.* Reporting the Paydate/Date of Withholding. You must irport the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which arnount was withheld frorn the mss- 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. 5.* 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 #10 below) 6. 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. WITHHOLDER'S ID: 8593100023 EMPLOYEE'S/OBLIGOR'S NAME: CLARK, STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. 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. 8. 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. 9. Antidiscrimination: 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 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. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. 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. Submitted By: If you or your erriployee%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 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 Form EN-028 Worker ID $IATT OMB No.: 0970-0154 r anriet ADDENDUM Summary of Cases on Attachmeni, Defendant/Obligor: CLARK, STEVEN B. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the ernployee's/obligor's employment. PACKS Case Number Plaintiff Name ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the ernployee's/obligor's employment. OMB No.: 0970-0154 Addendum Form EN-028 Worker I D $ IATT r_:. -, c?x ? 5 r- .C y r" t . w. .. ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT + 2?- r State Commonwealth of Pennsylvania "111iG)cD5 0Original Order/Notice Co./City/Dist. of CUMBERLAND 3,TS S li Aq--5 O Amended Order/Notice Date of Order/Notice 08/05/05 O Terminate Order/Notice Case Number (See Addendum for case summary) RE: CLARK, STEVEN B. Employer/Withholder's Federal FIN Number ?l Employee/Obligor's Name (Last, First, MI) TWIN TAILS SEAFOOD CORPORATION 01--IL02 GVtL. 8236 NW 30TH TER DORAL FL 33122-1914 441-48-1720 Employee/Obligor's Social Security Number 2901100703 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. $ 1, 057.00 per month in current support $ 173.00 per month in past-due support Arrears 12 weeks or greater? (Dyes Q no $ 0.00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 1, 230.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 283.85 per weekly pay period. $ 567.69 per biweekly pay period (every two weeks). $ 615.00 per semimonthly pay period (twice a month). $ 1.230. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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. BYTW'EOURL:A, '/ Date of Order: AUK 0 8 2005 .lip ' Form EN-0 Service Type M OMBNo.:09J0ot3J Worker ID ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WWITHHOLDERS ? Ifgheckl you are required. to provide a Copy of t his form to your ulo your If emp yog employee works in a state that is di event rom the state that issued this o der, a co must be provided yee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* paydate/datzo f-oithholding is the date on whid, amount was withheld f.m. the employ :e`s wager. 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. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 6509551780 EMPLOYEE'S/OBLIGOR'S NAME: CLARK. STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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 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 (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 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 amounts allowed under the law of the state that issued the order. 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. Submitted By: 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 Service Type M Page 2 of 2 OMB No, 0970-0154 Form EN-028 Worker ID $ZATT ADDENDUM Summary of Cases on Attachment DefendanUObligor: CLARK, STEVEN B. PAGES Case Number 271103055 Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 328 S 1993 $ 612.00 Child(ren)'s Name(s): DOB JORDAN S. CLARK 08/19(87 PACSES Case Number 312103462 Plaintiff Name_ KRISTI J. CLARK Docket Attachment Amount 01-762 CIVIL $ 618.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ?If checked, you are required to enroll the child(ren} ? If checkedl, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT OMB No.: 09)0-0154 9m .?? r rn ? U ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 08/19/05 Case Number (See Addendum for case summary) O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice EmployerNVithholder's Federal [IN Number RE:CLARK, STEVEN B. Employee/Obligor's Name (Last, First, MI) 441-48-1720 Employee/Obligor's Social Security Number TWIN TAILS SEAFOOD CORPORATION 2901100703 8236 NW 30TH TER 3a& s i9Sy3 Employee/Obligor's Case Identifier DORAL FL 33122 -1914 2;7 ?? o3(Jj (See Addendum for plaintiff names associated with cases on attachment) ?/- %44- Of r/C Custodial Parent's Name (Last, First, MI) 3/a./0 3 y1631- 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. $ 518. 00 per month in current support $ 173. oo per month in past-due support Arrears 12 weeks or greater? (2) Yes Q no $ 0.00 per month in current and past-due medical support $ o . o o per month for genetic test costs $ per month in other (specify) for a total of $ 691.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 159.46 per weekly pay period. $ 318.92 per biweekly pay period (every two weeks). $ 345.50 per semimonthly pay period (twice a month). $ 691. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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 EmpfoyeefObfigor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. d6, _ THE CO Date of Order: AUG 2 2 20ff- ? KEViAJ'A. 1+{&S Form EN-028 Service Type M oMeNo-0970-0154 WorkerlD $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If Checked you are required, to provide a opy of this form to yourBmployee. If your employee works in a state that is different from the state that issued this orr?er, a copy must be provi tled 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.* nz TMI[g LIM payuian. I I IC . 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. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 6509551780 EMPLOYEE'S/OBLIGOR'S NAME: CLARK, STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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 (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 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 amounts allowed under the law of the state that issued the order. 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. Submitted By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact MIAGE ATTACHMENT UNIT 13 N HANOVER ST by telephone at X17) 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 Service Type M OMB No, 097"154 WorkerlD $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CLARK, STEVEN B. PACSES Case Number 271103055 Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 328 S 1993 $ 73.00 Child(ren)'s Name(s): DOB JORDAN S. CLARK 08/19/87 PACSES Case Number 312103462 Plaintiff Name_ KRISTI J. CLARK Docket Attachment Amount 01-762 CIVIL $ 618.00 Child(ren)'s Name(s): DOB Off checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB D If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Off checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. D If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ?If checked, you are required to enroll the child(ren) Dlf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $iATT OMB No. 0910-0154 ? c. ? ? o -n - - _" ? ? ci '_- m s v- ? r? r t ? r ?7 C7 r:. c 's- K ORDER(NOTICE TO WITHHOLD INCOME FOR SUPPORT O Original Order/Notice State Commonwealth of Pennsylvania Co./City/Dist, of CUMBERLAND O Amended Order/Notice Date of Order/Notice 08/24/05 O Terminate Order/Notice Case Number (See Addendum for case summary) RE: CLARK, STEVEN B . Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 441-48-1720 Employee/Obligor's Social Security Number TWIN TAILS SEAFOOD CORPORATION // ?g S 2901100703 ° 3a& 3 ' 8236 NW 30TH TER 6, s Case Identifier Employee/Obligor DORAL FL 33122-1914 ftgte. 471/0305'T' (See Addendum for plaintiff names associated with cases on attachment) /y L?/ -7`? l- t/ Custodial Parent's Name (Last, First, MI) PfiestS 31,1103V{ -V 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. $ 1, 057, oo per month in current support $ 173 .00 per month in past-due support Arrears 12 weeks or greater? 0 Yes Q no $ o. 00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 1, 230.00 per month to he 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: $ 283. 85 per weekly pay period. $ 567.69 per biweekly pay period (every two weeks). $ 615. oo per semimonthly pay period (twice a month). $ 1.230. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information i needed (See #9 on page 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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 Empioyee/Obfigor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND GffUiSfd Br')'V t.ol! ( 5 BY THE COUR L f Date of Order: AUG 2 5 2005 Service Type M r - kFVi?vq,?EU ? Form EN-028 oMSNO.: WD-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If thecke? you are required to provide a CCopy of this form to your mployee. If your employee works in a state that is different from the state that issued this oroer, a copy must be provi?ed 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. . 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 OrdedNotice 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. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 6509551780 EMPLOYEE'S/OBLIGOR'S NAME: CLARK. STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any 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 (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 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 amounts allowed under the law of the state that issued the order. 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. Submitted By: 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 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Service Type M oMBNo.:0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CLARK, STEVEN B. PACSES Case Number 271103055 Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 328 S 1993 $ 612.00 Child(ren)'s Name(s): DOB JORDAN S. CLARK 08/19/87 PACSES Case Number 312103462 Plaintiff Name KRISTI J. CLARK Docket Attachment Amount 01-762 CIVIL $ 618.00 Child(ren)'s Name(s): DOB ?if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee'sfobligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 E3 If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT OMB No: 0970-156 C7 ? Tp{ F7 Yi - W 1 ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. Of CUMBERLAND Date of Order/Notice 10/02/06 Case Number (See Addendum for case summary) Employer/Withholder's Federal FIN Number TWIN TAILS SEAFOOD CORPORATION 8325 NW 30TH TER DORAL FL 33122-1916 17//03055 3R2 s 93 RE: CLARK, STEVEN B. l I D34?0 Dl - 71,,? CIVIL O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice Employee/Obligor's Name (Last, First, MI) 441-48-1720 Employee/Obligor's Social Security Number 2901100703 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. $ o. oo per month in current support $ 618. oo per month in past-due support Arrears 12 weeks or greater? Oyes Q no $ o . oo per month in current and past-due medical support $ o . oo per month for genetic test costs $ per month in other (specify) for a total of $ 618.00 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: $ 142.62 per weekly pay period. $ 285.23 per biweekly pay period (every two weeks). $ 309. oo per semimonthly pay period (twice a month). $ 618. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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. Date of Order: 0CT 0 3 2005 BY THE COURT: Form EN-028 Rev. ' Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecked you are required to provide a copy of this form to your mployee. If yo r employee works in a state that is di4ferent from the state that issued this order, a copy must be provideed 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.* Reporth ig tI ie Paydatefflate of Withhol ding. YOU MUSt llepOrt the paydate/date of withholding when sending the payine. It. The - You must comply with the law of the paydate/date of wit! holding is the date on whic! , aniou, it was withheld irom the employee's 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. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 6509551780 EMPLOYEE'S/OBLIGOR'S NAME: CLARK STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any 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 (15 U.S.C. §1673 01; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 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 amounts allowed under the law of the state that issued the order. 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 t.Submitted By: 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 by FAX at (717) 240-6248 or CARLISLE PA 17.013 by internet www.chiIdsupport.state.pa.us Service Type M Page 2 of 2 Form EN-028 Rev. 1 Worker ID $IATT OMB No.: 0970-0154 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CLARK, STEVEN B. PACSES Case Number 312103462 PACSES Case Number Plaintiff Name Plaintiff Name KRISTI J. CLARK Docket Attachment Amount Docket Attachment Amount 01-762 CIVIL $ 618.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type M Worker ID $IATT OMB No.: 0970-0154 t? ? ? C . _ F?. , ?? k ? '} !l - '"t7 '. - . z } ?-i ?? ti r Y 1 . y? ..? ,?_ , ?r ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dirt. of CUMBERLAND Date of Order/Notice 04/24/07 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number TWIN TAILS SEAFOOD CORPORATION 8325 NW 30TH TER DORAL FL 33122-1916 441-48-1720 Employee/Obligor's Social Security Number 2901100703 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. $ o . go per month in current support $ o . 00 per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ o . 00 per month in current and past-due medical support $ 0 . oo per month for genetic test costs $ o . oo per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ o . o .Q per weekly pay period. $ _ o. oo per biweekly pay period (every two weeks). $ o. oo per semimonthly pay period (twice a month). $ o . oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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. BY THE COURT: Date of Order: APR 2 5 2007 DRO: R. J. Shadday Service Type m 312103462 O Original Order/Notice 01-762 CIVIL O Amended Order/Notice O Terminate Order/Notice RE: CLARK, STEVEN B. Employee/Obligor's Name (Last, First, MI) N A, U4-?, V M. L. Ebert, Jr., J ge Form EN- 28 Rev. 1 OMBNo.:0470-0154 \n/nrltpr In $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS loyee. If your employee works in a state that is ? If hecked you are required to provide a copy of this form to your em Nerent from the state that issued this order, a copy must be provideto 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 ofiWiti-N-10 HIM& You must report the -pay datei'date of withholding when sending the-paryment. The the You must comply with the law of the paydate,'date of withholding Is flie- date on vvll'c'- amount was withheld from I I employee's wages. 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. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 6509551780 EMPLOYEE'S/OBLIGOR'S NAME: CLARK, STEVEN B. EMPLOYEE'S CASE IDENTIFIER: 2901100703 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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 (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 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 amounts allowed under the law of the state that issued the order. 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. Submitted By: 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. 1 Worker I D $ IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: CLARK, STEVEN B. PACSES Case Number 312103462 PACSES Case Number Plaintiff Name Plaintiff Name KRISTI J. CLARK Docket Attachment Amount Docket Attachment Amount 01-762 CIVIL $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB EJ If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. 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 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) © If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type Iy Worker ID $IATT OMB No.: 0970-0154 - v Xi Vic" t? PACSES CASE NO. 312103462 KRISTI J. CLARK, IN THE COURT OF COMMON PLEAS OF PLAINTIFF CUMBERLAND COUNTY, PENNSYLVANIA V. DOMESTIC RELATION SECTION CIVIL ACTION - DIVORCE STEVEN B. CLARK, DEFENDANT DOCKET NO. 01-762 CIVIL ORDER OF COURT AND NOW, this 31st day of May 2007, the Court being informed by the Domestic Relations Section that all of the arrears have been paid in full, IT IS HEREBY ORDERED AND DIRECTED that the case be closed. This Order shall become final twenty days after the mailing of the notice of the entry of the order to the parties unless either party files a written demand with the Domestic Relations Section for a hearing de novo before the Court. BY THE COURT, N-L U4 M. L. Ebert, Jr., Judge DRO: R.J. Shadday xc: plaintiff and defendant Form OE-001 Service Type M Worker ID 21005 C .J G p nt t,a t[?