HomeMy WebLinkAbout01-1014IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
DIANE O. RADCLIFF
3448 TRINDLE ROAD
CAMP HILL, PA 17011
(717) 737-0100
KATHRYN KNISELY,
Plaintiff
v.
EARL KNISELY, JR.,
Defendant
: NO.UI-JON
: CIVIL ACTION - LAW
: DIVORCE
NOTICE
YOU HAVE BEEN SUED IN COURT. If you wish to defend against the
claims set forth in the following pages, you must take prompt
action. You are warned that if you fail to do so, the case may
proceed without you and a decree of divorce or annulment may be
entered against you by the court. A judgment may also be entered
against you for any other claim or relief requested in these papers
by the Plaintiff. You may lose money or property or other rights
important to you, including custody or visitation of your children.
When the ground for divorce is indignities or irretrievable
breakdown of the marriage, you may request marriage counseling. A
list of marriage counselors is available in the office of the
Prothonotary at the Cumberland County Courthouse, Carlisle,
Pennsylvania.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY,
COUNSEL FEES OR EXPENSES BEFORE THE FINAL DECREE OF DIVORCE OR
ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
KATHRYN KNISELY,
Plaintiff
DIANE G. RADCLIFF
3448 TRINDLE ROAD
CAMP HILL, PA 17011
(717) 737-0100
V.
EARL L. KNISELY, JR.,
Defendant
NO. O / - /O/ / ?CuT,GUu
CIVIL ACTION - LAW
DIVORCE
COMPLAINT
AND NOW, this day of L& 200j, comes the
Plaintiff, KATHRYN KNISELY, by her attorney, IANE G. RADCLIFF,
ESQUIRE, and files this Complaint in Divorce of which the following
is a statement:
COUNT I: DIVORCE
1. The Plaintiff is KATHRYN KNISELY, an adult individual residing
at 999 Oak Lane, Apartment A, New Cumberland, PA 17070.
2. The Defendant is EARL KNISELY, JR., an adult individual
residing at 999 Oak Lane, Apartment A, New Cumberland, PA,
17070.
3. Plaintiff and/or Defendant have been bona fide residents of
the Commonwealth for at least six (6) months previous to the
filing of this Complaint.
4. Plaintiff and Defendant were married on April 17, 1999 at
Mechanicsburg, PA, Cumberland County.
5. There have been no prior actions of divorce or annulment
between the parties.
6. Plaintiff has been advised of the availability of counseling
and the right to request that the Court require the parties to
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participate in counseling.
7. The Defendant is not a member of the Armed Services of the
United States or any of its Allies.
8. The Plaintiff avers that the grounds on which the action is
based are:
That Defendant has offered such indignities to the person of
the Plaintiff, the innocent and injured spouse, as to render
her condition intolerable and life burdensome, and that this
action is not collusive.
DIANE G. RADCLIPP
3448 TRINDLE ROAD
CAMP HILL, PA 17011
(717) 737-0100
WHEREFORE, Plaintiff requests this Honorable Court to enter a
decree in divorce, divorcing the Plaintiff and Defendant.
COUNT II: EOUITABLE DISTRIBUTION
9. Paragraphs 1 through 8 are incorporated by reference hereto as
fully as though the same were set forth at length.
10. Plaintiff and Defendant have acquired property and debts, both
real and personal, during their marriage from April 17, 1999
to the date of separation, all of which is "marital property".
11. Plaintiff and/or Defendant have acquired, prior to the
marriage or subsequent thereto, "non-marital property" which
has increased in value since the date of marriage and/or
subsequent to its acquisition during the marriage, which
increase in value is "marital property".
12. Plaintiff and Defendant have been unable to agree as to an
equitable division of said property as of the date of the
filing of this Complaint.
-3-
WHEREFORE, Plaintiff requests this Honorable Court to
equitably divide all marital property and debts of the parties.
COUNT III: ALIMONY PENDENTE LITE, ALIMONY
13. Paragraphs 1 through 12 are incorporated by reference hereto
as fully as though the same were set forth at length.
14. Plaintiff lacks sufficient property to provide for herself
reasonable means and is unable to support herself through
appropriate employment.
15. Plaintiff requires reasonable support to adequately maintain
herself in accordance with the standard of living established
during the marriage.
WHEREFORE, Plaintiff requests this Honorable Court to enter an
award of alimony pendente lite until final hearing and hereafter
enter an award of alimony permanently thereafter.
COUNT IV: COUNSEL FEES
16. Paragraphs 1 through 15 are incorporated by reference hereto
as fully as though the same were set forth at length.
17. Plaintiff has employed Diane G. Radcliff, Esquire, as counsel
but is unable to pay the necessary and reasonable attorney's
fees for said counsel.
18. The Plaintiff is in need of hiring various experts to appraise
the parties' marital assets and does not have the funds to pay
the necessary and reasonable fees.
DIANE G. RADCLIFF
3448 TRINDLE ROAD
CAMP HILL, PA 17011
(717) 737-0100 -4-
WHEREFORE, Plaintiff requests this Honorable Court to enter an
award of interim counsel fees, costs and expenses and to order such
additional sums hereafter as may be deemed necessary and
appropriate and at final hearing to further award such additional
counsel fees, costs and expenses as are deemed necessary and
appropriate.
Respectfully submitted,
I NF r_ F, ESQUIR
448 Trin e Road
C PA 17011
Supreme Court ID #32112
Phone: (717) 737-0100
Fax: (717) 975-0697
Attorney for Plaintiff
DIANE G. RADCLIFF
3448 TRINDLE ROAD
CAMP HILL, PA 17011
(717) 737-0100 -5-
VERIFICATION
KATHRYN M. KNISLEY verifies that the statements made in this
Complaint are true and correct. KATHRYN M. KNISLEY understands that
false statements herein are made subject to the penalties of 18
Pa.C.S. Section 4904, relating to unsworn falsification to
authorities.
c
J THRYN/M. KISLEY
DIANE G. RADCLIFF
3448 TRINDLE ROAD
CAMP HILL, PA 17011
(717) 737-0100
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KATHRYN KNISELY,
Plaintiff
v
EARL KNISELY, JR.,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 01-1014 CIVIL TERM
CIVIL ACTION - LAW
IN DIVORCE
ACCUTIF 3CE i2E_5 ,RV1OF
I, EARL KNISELY, JR., the Defendant in the above captioned
action, hereby accept service of the Complaint in Divorce filed in
the above captioned matter on February 21, 2001.
Date: 2/26/01 ;? ?J
EARL KNISELY, JR. ({
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KATHRYN KNISELY,
Plaintiff
v
EARL KNISELY, JR.,
Defendant
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
NO. 01-1014 CIVIL TERM
: CIVIL ACTION - LAW
: IN DIVORCE
AFFIDAVIT OF CONSENT
DIANE G. RADCLIFF
3448 TRINDLE ROAD
CAMP HILL, PA 17011
(717) 737-0100
1. A Complaint in Divorce under Section 3301(c) of the Divorce
Code was filed on February 21, 2001.
2. The marriage of Plaintiff and Defendant is irretrievably
broken and ninety (90) days have elapsed from the date of
filing and service of the Complaint.
3. I consent to the entry of a final Decree in Divorce after
service of notice of intention to request entry of the decree.
I verify that the statements made in this Affidavit are true
and correct. I understand that false statements herein are made
subject to the penalties of 18 Pa. C.S. Section 4904 relating to
unsworn falsification to authorities.
Dated:
yyam?I.? ?Yl? f
THRYN ?1QVI
S LYNN
KATHRYN KNISELY,
Plaintiff
v
EARL KNISELY, JR.,
Defendant
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
NO. 01-1014 CIVIL TERM
: CIVIL ACTION - LAW
: IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REOUEST
ENTRY OF A DIVORCE DECREE. UNDER
SECTION 3301(c) OF THE DIVORCE CODE
1. I consent to the entry of a final decree in divorce without
notice.
2. I understand that I may lose rights concerning alimony,
division of property, lawyer's fees or expenses if I do not
claim them before a divorce is granted.
3. I understand that I will not be divorced until a divorce
decree is entered by the Court and that a copy of the decree
will be sent to me immediately after it is filed with the
Prothonotary.
DIANE G. RADCLIFF
3448 TRINDLE ROAD
CAMP HILL, PA 17011
(717) 737-0100
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.
Dated: 1111a/o/ 4H;R /4 YN IS Y
KATHRYN KNISELY,
Plaintiff
v
EARL KNISELY, JR.,
Defendant
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
NO. 01-1014 CIVIL TERM
: CIVIL ACTION - LAW
: IN DIVORCE
AFFIDAVIT OF CONSENT
DIANE G. RADCLIFF
3448 TRINDLE ROAD
CAMP HILL, PA 17011
(717(737-0100
1. A Complaint in Divorce under Section 3301(c) of the Divorce
Code was filed on February 21, 2001.
2. The marriage of Plaintiff and Defendant is irretrievably
broken and ninety (90) days have elapsed from the date of
filing and service of the Complaint.
3. I consent to the entry of a final Decree in Divorce after
service of notice of intention to request entry of the decree.
unsworn falsification to authorities.
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
Dated:
ARL KNISELY, JR. '?_
DIANE G. RADCLIFF
3448 TRINDLE ROAD
CAMP HILL, PA 17011
(717) 737-0100
KATHRYN KNISELY,
Plaintiff
v
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
NO. 01-1014 CIVIL TERM
EARL KNISELY, JR., : CIVIL ACTION - LAW
Defendant : IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DRCRRR UNDER
SECTION 3301(c) OF THE. DIVORCE CODE
1. I consent to the entry of a final decree in divorce without
notice.
2. I understand that I may lose rights concerning alimony,
division of property, lawyer's fees or expenses if I do not
claim them before a divorce is granted.
3. I understand that I will not be divorced until a divorce
decree is entered by the Court and that a copy of the decree
will be sent to me immediately after it is filed with the
Prothonotary.
unsworn falsification to authorities.
Dated: 111140) EARL K
NISEL ,
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
KATHRYN KNISELY,
Plaintiff
v
EARL KNISELY, JR.,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 01-1014 CIVIL TERM
CIVIL ACTION - LAW
IN DIVORCE
PRAECIPE OF TRANSMIT RECORD
To the Prothonotary:
Transmit the record, together with the following information, to the
court for entry of a divorce decree:
1. Ground for divorce:
Irretrievable breakdown under Section 3301 (c)of the Divorce Code.
2. Date and manner of service of the complaint:
A. Date: February 26, 2001
B. Manner: Personal Acceptance of Service
3. Date of execution of the affidavit of consent required by Section 3301
(c) of the Divorce Code:
a. Plaintiff: November 12, 2001
b. Defendant: November 12, 2001
QR
Date of execution of the Plaintiffs affidavit required by Section
3301(d) of the Divorce Code and date of service of the Plaintiff's 3301
(d) affidavit upon the Defendant:
a. Date of execution: n/a
b. Date of filing: n/a
c. Date of service: n/a
4. Related claims pending: No issues are pending. All issues have been
resolved pursuant to the Marriage Settlement Agreement between the
parties dated September 5, 2001 which Agreement is to be incorporated
into but not merged with the Divorce Decree.
5. Date and manner of service of the Notice of Intention to file Praecipe
to Transmit Record, a copy of which is attached, if the decree is to be
entered under Section 3301(d)(I)(i) of the Divorce Code:
a. Date of Service: n/a
b. Manner of Service: n/a
48
Date Waiver of Notice in Section 3301(c) Divorce was filed with the
Prothonotary:
a. Plaintiff's Waiver: November 13, 2001
b. Defendant's Waiver: November 13, 2001
1
DIANE G. CLIFF, ESQUIR
344 1 Road
m Hill, P 17011
Supreme urt ID # 32112
Phone: (717) 737-0100
Attorney for Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
KATHRYN KNISELY,
Plaintiff
V. NO. 01-1041
EARL KNISELY, JR.,: CIVIL ACTION - LAW
Defendant : DIVORCE
MARITAL AGREEMENT
BETWEEN
EARL L. KNISLEY,
AND
JR.
KATHRYN M. KNISLEY
TABLE OF CONTENTS
INTRODUCTION ............................................. 1
SECTION I
General Provisions ....................................... 3
SECTION II
Property Distribution Provisions ......................... 20
SECTION III
Alimony, Spousal Support, Child Custody, Child Support,
Health Insurance, Educational Expenses and Income Tax
Provisions ............................................... 33
SECTION IV
Closing Provisions and Execution ......................... 38
NOTARY ................................................... 40
MARITAL DISTRIBUTION SHEET ............................... 41
CUSTODY ORDER AND STIPULATION ............................ 43
INTRODUCTION
THIS AGREEMENT made this day of ,
2001, by and between KATHRYN M. KNISLEY ("Wife") of 6605 Salem Park
Circle, Mechanicsburg, PA 17050 and EARL L. KNISLEY, JR.
("Husband") of 999 Oak Lane, Apt. E, New Cumberland, PA 17070.
W I T N E S E T H:
WHEREAS, the parties hereto are husband and wife, having
been married on April 17, 1999 in Mechanicsburg, Pennsylvania and
separated on July 22, 2000.
WHEREAS, There were one (1) child born of this marriage:
Jacob Alexander Knisley, born December 31, 1998 (the "Child").
WHEREAS, diverse and unhappy differences, disputes and
difficulties have arisen between the parties and it is the
intention of Husband and Wife to live separate and apart for the
rest of their natural lives, and the parties hereto are desirous of
settling fully and finally their respective financial and property
rights and obligations as between each other including, without
limitation by specification: the settling of all matters between
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them relating to the ownership and equitable distribution of real
and personal property; the settling of all matters between them
relating to the past, present and future support, alimony and/or
maintenance of Wife by Husband or of Husband by Wife; and in
general, the settling of any and all claims and possible claims by
one against the other or against their respective estates.
NOW, THEREFORE, in consideration of the premises and
mutual promises, covenants and undertakings hereinafter set forth
and for other good and valuable consideration, receipt of which is
hereby acknowledged by each of the parties hereto, Wife and
Husband, each intending to be legally bound hereby, covenant and
agree as follows:
THIS SPACE INTENTIONALLY LEFT BLANK
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SECTION I
GFNFFAT- PROVTSTONS
1.01. INCORPORATION OF PRFAMBT.E
The recitals set forth in the Preamble of this Agreement are
incorporated herein and made a part hereof as if fully set forth in
the body of the Agreement.
1.02. AGREEMENT NOT A BAR TO DIVORCE PROCFFDINGS
This Agreement shall not be considered to affect or bar the
right of Husband and Wife to an absolute divorce on lawful grounds
if such grounds now exist or shall hereafter exist or to such
defense as may be available to either party. This Agreement is not
intended to condone and shall not be deemed to be condonation on
the part of either party hereto of any act or acts on the part of
the other party which have occasioned the disputes or unhappy
differences which have occurred or may occur subsequent to the date
hereof.
1.03. DIVORCE DECREE
The parties acknowledge that their marriage is irretrievably
broken and that they will secure a mutual consent no-fault divorce
decree in the above captioned divorce action. Upon the execution
of this Agreement, or as soon as possible under the terms of said
Divorce Code if said documents can not be signed upon the execution
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of this Agreement, the parties shall execute and file all documents
and papers, including affidavits of consent, necessary to finalize
said divorce. If either party fails or refuses to finalize said
divorce or execute and file the documents necessary to finalize the
divorce, said failure or refusal shall be considered a material
breach of this Agreement and shall entitle the other party at his
or her option to terminate this Agreement.
1.04. EFFECT OF DIVORCE DECREE
Unless otherwise specifically provided herein, this Agreement
shall continue in full force and effect after such time as a final
Decree in Divorce may be entered with respect to the parties.
1.05. AGREEMENT TO BE INCORPORATED IN DIVORCE DECRFF
The terms of this Agreement shall be incorporated into any
Divorce Decree which may be entered with respect to them.
1.06. NON-MERGER
This Agreement shall not merge with the Divorce Decree, but
rather, it shall continue to have independent contractual
significance and each party shall maintain their contractual
remedies as well as court remedies as the result of the aforesaid
incorporation or as otherwise provided by law or statute.
1.07. DATE OF RXFCUTION
The "date of execution", "execution date" or "date of this
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Agreement" shall be defined as the date of execution by the party
last executing this Agreement.
1.08. DISTRIBUTION DATE
The transfer of property, funds and/or documents provided for
herein shall only take place on the "distribution date" which shall
be defined as the date of execution of this Agreement unless
otherwise specified herein.
1.09. VOT.UNTARY EXECUTION AND FAIRNESS OF AGREEMENT
The parties acknowledge that each party has been advised of
his or her right to be advised by an attorney of his or her own
choosing prior to entering into this Agreement and both have had
the opportunity to have the provisions of this Agreement and their
legal effect have been fully explained to each of them. The
parties acknowledge that they have received independent legal
advice from counsel of their selection and that they fully
understand the facts and have been fully informed as to their legal
rights and obligations. They acknowledge and accept that this
Agreement is, under the circumstances, fair and equitable and that
it is being entered into freely and voluntarily after having
received such advice and with such knowledge, and that execution of
this Agreement is not the result of any duress or undue influence
and that it is not the result of any collusion or improper or
illegal agreement or agreements. The parties further acknowledge
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that each of them has entered into this Agreement with full
knowledge of the facts and full disclosure of their separate and
joint estates, and that each believes this Agreement to be
reasonable under the circumstances.
1.10. FINANCIAT• DISCLOSURE
The parties confirm that each has relied on the substantial
accuracy of the financial disclosure of the other, as an inducement
to the execution of this Agreement and each party acknowledges that
there has been a full and fair disclosure of the parties' marital
assets and debts and the parties' respective incomes, which has
been provided to each party. The parties further acknowledge that
the financial disclosure has included the disclosure of the marital
assets and debts set forth on the "Marital Distribution Sheet and
Settlement", attached hereto, marked Exhibit "A" and made a part
hereof, and that it is the parties' intent to distribute those
assets and debts in accordance with the distribution set forth
therein.
1.11. DISCT-OSURF AND WAIVER OF PROCMDURAT, RIGHTS
Each party understands that he or she has the right to obtain
from the other party a complete inventory or list of all of the
property that either or both parties own at this time or owned as
of the date of separation, and that each party has the right to
have all such property valued by means of appraisals or otherwise.
- 6 -
The parties further acknowledge that he or she has the right to
obtain from the other party an Income and Expenses Statement which
statement must set forth that party's income and monthly expenses
and is to have attached thereto copies of that party's last income
tax return and pay stubs for the last six months. In general, the
parties understand that they are entitled to a full and fair
disclosure of the income, assets and debts of the other party,
whether acquired during the marriage or otherwise before entering
into this Agreement. Both parties understand that they have the
right to have a court hold hearings and make decisions on the
matters covered by this Agreement. Both parties understand that a
court decision concerning the parties' respective rights and
obligations might be different from the provisions of this
Agreement.
Each party hereby acknowledges that this Agreement is fair and
equitable, that it adequately provides for his or her needs and is
in his or her best interests, and that the Agreement is not the
result of any fraud, duress, or undue influence exercised by either
party upon the other or by any other person or persons upon either
party.
Given said understanding and acknowledgment, both parties
hereby waive the following procedural rights:
a. Inventory: The right to obtain an inventory of all marital
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and separate property as defined by the Pennsylvania Divorce
Code.
b. Income and Fxpense Statement: The right to obtain an income
and expense statement of the other party as provided by the
Pennsylvania Divorce Code, except in instances where such an
income and expense statement is hereafter required to be filed
in any child support action or any other proceedings pursuant
to an order of court.
c. Discovery: The right to have any discovery as may be
permitted by the Rules of Civil Procedure, except discovery
arising out of a breach of this Agreement, out of any child
support action, or out of any other proceedings in which
discovery is specifically ordered by the court.
d. Determination of Marital and Non-Marital Property: The right
to have the court determine which property is marital and
which is non-marital, and equitably distribute between the
parties that property which the court determines to be
marital.
e. Other Rights and Remedies: The right to have the court decide
any other rights, remedies, privileges, or obligations covered
by this Agreement, including, but not limited to, possible
claims for divorce, spousal support, alimony, alimony pendente
lite (temporary alimony), counsel fees, costs and expenses.
- 8 -
1.12. BANKRUPTCY
The parties hereby agree that the provisions of this Agreement
shall not be dischargeable in bankruptcy and expressly agree to
reaffirm any and all obligations contained herein. In the event a
party files such bankruptcy and pursuant thereto obtains a
discharge of any obligations assumed hereunder, the other party
shall have the right to declare this Agreement to be null and void
and to terminate this Agreement in which event the division of the
parties' marital assets and all other rights determined by this
Agreement shall be subject to court determination the same as if
this Agreement had never been entered into.
1.13. SOCIAT• SECURITY BENEFITS
The parties agree that, subject to the rules and regulations
of the Social Security Administration, each of the parties shall
continue to be eligible for Social Security benefits to which he or
she would ordinarily be qualified as a party to a divorce after a
marriage of ten (10) years or more in duration, if the parties'
marriage is determined to be of ten (10) or more years in duration.
1.14. PFRSONAT. RIGHTS
Husband and Wife may and shall, at all times hereafter, live
separate and apart. They shall be free from any control,
restraint, interference or authority, direct or indirect, by the
other in all respects as fully as if they were unmarried. They may
- 9 -
reside at such place or places as they may select. Each may, for
his or her separate use or benefit, conduct, carry on and engage in
any business, occupation, profession or employment which to him or
her may seem advisable. Husband and Wife shall not molest, harass,
disturb or malign each other or the respective families of each
other nor compel or attempt to compel the other to cohabit or dwell
by any means or in any manner whatsoever with him or her.
1.15. MUTUAL REY-RASFS
Except as other wise expressly provided in this Agreement,
Husband and Wife each do hereby mutually remise, release, quitclaim
and forever discharge the other and the estate of such other, for
all time to come, and for all purposes whatsoever, of and from the
following:
a. Claims Against Property or Estate: Any and all right, title,
interest and/or claims in or against the other party, the
property (including income and gain from property hereafter
accruing) of the other or against the estate of such other, of
whatever nature and wheresoever situate, which he or she now
has or at any time hereafter may have against such other
party, the estate of such other party or the property of the
other party or any part thereof, whether arising out of any
former acts, contracts, engagements or liabilities of such
other.
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b. Dower, Curtsey, Widows Rights: Any and all rights and claims
of dower or curtsey, or claims in the nature of dower or
curtsey 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;
C. Life Time Conveyances: The right to treat a lifetime
conveyance by the other as testamentary, or all other rights
of a surviving spouse to participate in a deceased spouse's
estate, whether arising under the laws of (I) the Commonwealth
of Pennsylvania, (ii) State, Commonwealth or Territory of the
United States, or (iii) any other country;
d. Marital Rights: Any rights which either party may have or at
any time hereafter have for past, present or future support or
maintenance, alimony, alimony pendente lite, counsel fees,
equitable distribution, costs or expenses, whether arising as
a result of the marital relation or otherwise.
e. Breach Exception: The foregoing shall not apply to 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
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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 provisions thereof.
1.16. WAIVER OR MODIFICATION TO BF IN WRITING
No modification or waiver of any of the terms hereof shall be
valid unless in writing and signed by both parties and no waiver of
any breach hereof or default hereunder shall be deemed a waiver of
any subsequent default of the same or similar nature.
1.17. MUTUAT, COOPERATION
Each party shall, at any time and from time to time hereafter,
take any and all steps and execute, acknowledge and deliver to the
other party, any and all further instruments and/or document that
the other party may reasonably require for the purpose of giving
full force and effect to the provisions of this Agreement.
1.18. AGRFFMFNT BINDING ON HEIRS
This Agreement shall be binding and shall inure to the benefit
of the parties hereto and their respective heirs, executors,
administrators, successors and assigns.
1.19. INTEGRATION
This Agreement constitutes the entire understanding of the
parties and supersedes any and all prior agreements and
- 12 -
negotiations between them. There are no representations or
warranties other than those expressly set forth herein.
1.20. OTHER DOCUMENTATION
Wife and Husband covenant and agree that they will forthwith
(and within at least twenty (20) days after demand therefor),
execute any and all written instruments, assignments, releases,
satisfactions, deeds, notes, stock certificates, or such other
writings as may be necessary or desirable for the proper
effectuation of this Agreement, and/or as their respective counsel
shall mutually agree, should be so executed in order to carry out
fully and effectively the terms of this Agreement.
1.21. NO WAIVER OF DFFAUT-T
This Agreement shall remain in full force and effect unless
and until terminated under and pursuant to the terms of this
Agreement. The failure of either party to insist upon strict
performance of any of the provisions of this Agreement shall in no
way affect the right of such party hereafter to enforce the same,
nor shall the waiver of any subsequent default of the same or
similar nature, nor shall it be construed as a waiver of strict
performance of any other obligations herein.
1.22. BREACH
If for any reason either Husband or Wife fails to perform his
or her obligations owed to or for the benefit of the other party
- 13 -
and/or otherwise breaches the terms of this Agreement, then the
other party shall have the following rights and remedies, all of
which shall be deemed to be cumulative and not in the alternative,
unless said cumulative effect would have an inconsistent result or
would result in a windfall of the other party:
a. Specific Performance: The right to specific performance of
the terms of this Agreement, in which event the non-breaching
party shall be reimbursed for all reasonable attorney's fees
and costs incurred as the result of said breach and in
bringing the action for specific performance.
b. Damageg: The right to damages arising out of breach of the
terms of this Agreement, which damages shall include
reimbursement of all attorney's fees and costs incurred as the
result of the breach and in bringing the damage action.
c. Divorce Code Remedies: The right to all remedies set forth in
Section 3502(e) of the Pennsylvania Divorce Code, 23 PA.
C.S.A. 3502(e), and any additional rights and remedies that
may hereafter be enacted by virtue of the amendment of said
statute or replacement thereof by any other similar laws.
d. Other Remedies: Any other remedies provided for in law or in
equity.
1.23. r•AW OF PFNNSYT-VANIA APPT.ICAFtT.-P
This Agreement shall be construed in accordance with the laws
- 14 -
of the Commonwealth of Pennsylvania.
1.24. SWERABIT.ITY
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 remain valid and continue in full force, effect and
operation. Likewise, the failure of either party to meet his or
her obligations under this Agreement under any one or more of the
paragraphs hereunder, with the exception of the satisfaction of a
condition precedent, shall in no way avoid or alter the remaining
obligations of the parties.
1.25. HEADINGS NOT PART OF AGRFFMFNT
Any headings preceding the text of the several paragraphs and
subparagraphs hereof, are inserted solely for convenience of
reference and shall not constitute a part of this Agreement nor
shall they affect its meaning, construction or effect.
1.26. INCOME TAX MATTERS
With respect to income tax matters regarding the parties the
following shall apply:
a. Prior Returns: The parties have heretofore filed joint
federal and state returns. Both parties agree that in the
event any deficiency in federal, state or local income tax is
- is -
proposed, or any assessment of any such tax is made against
either of them, each will indemnify and hold harmless the
other from and against any loss or liability for any such tax
deficiency or assessment therewith. Such tax, interest,
penalty or expense shall be paid solely and entirely by the
individual who is finally determined to be the cause of the
misrepresentations or failure to disclose the nature and
extent of his or her separate income on the aforesaid joint
returns.
b. Current Returns: The parties shall file individual and
separate Federal and State Income tax returns for the calendar
year 2001 and hereafter.
1.27. PRESERVATION OF RECORDS
Each party will keep and preserve for a period of four (4)
years from the date of their divorce all financial records relating
to the marital estate, and each party will allow the other party
access to those records as may be reasonably necessary from time to
time.
1.28. MANNER OF GIVING NOTICE
Any notice required by this Agreement shall be sent to a party
at the address listed on page 1 above, or such other address as
that party may from time to time designate.
- 16 -
1.29. RFFRCT OF RNCONCIT.IATION
This Agreement shall remain in full force and effect even if
the parties reconcile, cohabit as Husband and Wife or otherwise, or
attempt a reconciliation. This Agreement shall continue in full
force and effect and there shall be no modification or waiver of
any of the terms hereof unless the parties, in writing, signed by
both parties, execute a statement declaring this Agreement or any
term of this Agreement to be null and void.
THIS SPACE INTENTIONALLY LEFT BLANK
- 17 -
SECTION II
PROPERTY DISTRIBUTION PROVTSTONS
2.01. FINAT. EQUITABT.E DISTRIBUTION OF PROPERTY
The parties agree that the division of all property and debts
set forth in this Agreement is equitable and in the event an action
in divorce has been or is hereafter commenced, both parties waive
and relinquish the right to divide and distribute their assets and
debts in any manner not consistent with the terms set forth herein
and further waive and relinquish the right to have the court
equitably divide and distribute their marital assets and debts. It
is further the intent, understanding and agreement of the parties
that this Agreement is a full, final, complete and equitable
property division.
2.02. AFTER-ACQUIRED PROPERTY
Each of the parties shall hereafter own and enjoy,
independently of any claim or right of the other, all property,
tangible or intangible, real, personal or mixed, acquired by him or
her, since July 22, 2000, the date of the parties' marital
separation, with full power in him or her to dispose of the same as
fully and effectively, in all respects and for all purposes, as
though he or she were unmarried and each party hereby waives,
releases, renounces and forever abandons any right, title, interest
- 18 -
and claim in and to said after acquired property of the other party
pursuant to the terms of this Paragraph.
2.03. WAIVER OF INHERITANCE
Each of the parties hereto does specifically waive, release,
renounce and forever abandon any right, title, interest and claim,
if any, either party may have in and to any inheritance of any kind
or nature whatsoever previously, or in the future, received by the
other party.
2.04. PERSONAT. PROPERTY
With respect to the tangible personal property of the parties
including, but without limitation with specific reference to,
jewelry, clothes, furniture, furnishings, rugs, carpets, household
equipment and appliances, tools, pictures, books, works of art and
other personal property ("the Personal Property"), the parties
agree as follows:
a. Division: Husband and Wife do hereby acknowledge that they
have previously divided the Personal Property. Hereafter Wife
agrees that all of the Personal Property in the possession of
Husband shall be the sole and separate property of Husband;
and Husband agrees that all of the Personal Property in the
possession of wife shall be the sole and separate property of
Wife.
b. Water: The parties do hereby specifically waive, release,
- 19 -
renounce and forever abandon whatever claims, if any, he or
she may have with respect to the Personal Property which shall
become the sole and separate property of the other.
2.05. V7.HICTMS, BOATS AND THE T,IKF
With respect to the vehicles, boats, snowmobiles, motorcycles
and the like owned by one or both of the parties, or the trade in
value thereof, identified and valued on Exhibit "A", incorporated
by reference hereto, ("the Vehicles") if the Vehicles have been
sold or traded in prior to the date of this Agreement, the parties
agree as follows:
a. Wife's Vehicles: 1992 Geo Prism and the Chevrolet Cavalier
(acquired by trade in of marital 1992 Geo Prism) shall be the
sole and separate property of Wife.
b. Husband's Vehicles: Any vehicle currently in Husband's sole
name or titled in Husband's name jointly with any third party
shall be the sole and separate property of Husband.
C. Identification: Identification of a Vehicle herein shall
include not only the vehicle, but also the sale or trade-in
value thereof if it had been sold or traded in prior to the
date of this Agreement.
d. Transfer of Titles: The titles to the Vehicles shall be
executed by the parties, if appropriate, for effectuating
transfer as herein provided on the date of execution of this
- 20 -
Agreement and said executed titles shall be delivered to the
proper party on the distribution date.
e. Title and Power of Attorney: For purposes of this Paragraph
the term "title" shall be deemed to include "power of
attorney" if the title to the Vehicle is unavailable due to
financing arrangements or otherwise.
f. Liens: In the event any Vehicle is subject to a lien or
encumbrance the party receiving the Vehicle as his or her
property shall take it subject to said lien and/or encumbrance
and shall be solely responsible therefor and said party
further agrees to indemnify, protect and save the other party
harmless from said lien or encumbrance.
g. Waiver: Each of the parties hereto does specifically waive,
release, renounce and forever abandon whatever right, title
and interest they may have in the Vehicles that shall become
the sole and separate property of the other party pursuant to
the terms of this Paragraph.
2.06. REAL ESTATE
The parties have no interest in any real estate, nor had any
during their marital relationship, and therefore no provision is
made in this agreement for any marital real estate.
Wife is the owner of a certain tract of improved real estate
known and numbered as 6605 Salem Park Circle, Mechanicsburg, PA
- 21 -
17050, which she acquired after the date of separation. Husband
hereby waives, releases and renounces any right, title, interest
and claim he may have in and to that real estate and acknowledges
that he has heretofore signed a waiver of any interest and claim in
and to that real estate, which waiver is incorporated by reference
and made a part of this Agreement the same as if the terms thereof
were set forth herein at length.
2.07. RETIREMENT AND PENSION PT•ANS
Neither Husband nor wife has any interest in any retirement
plan, whether through employment or established as an individual
retirement account.
If any such retirement plans exist, each of the parties does
specifically waive, release, renounce and forever abandon all of
their right, title, interest or claim, whatever it may be, in any
Pension Plan, Retirement Plan, IRA Account, Profit Sharing Plan,
401-K Plan, Keogh Plan, Stock Plan, Tax Deferred Savings Plan, any
employee benefit plan and/or other retirement type plans of the
other party, acquired after the date of separation, whether
acquired through said party's employment or otherwise, ("the
Retirement Plans"). Hereafter the Retirement Plans shall become
the sole and separate property of the party in whose name or
through whose employment said plan or account is held or carried.
Any interest that either party may have, or may heretofore
- 22 -
have had in or as the result of the Retirement Plans of the other
party, including rights or contingent rights in and to unvested
retirement benefits and/or by virtue of being a spouse,
beneficiary, contingent beneficiary or otherwise is hereby
extinguished, except as specifically herein provided, and the
parties shall hold his or her Retirement Plans free and clear from
any right or interest which the other party now has or may
heretofore have had therein or thereto.
If either party withdraws any sums from the Retirement Plans
distributed to him or her pursuant to the terms of this Paragraph,
that party shall be solely liable for any and all taxes and
penalties resulting from that withdrawal.
2.08. BANK ACCOUNTS/STOCK/TIFF INSURANCE
The parties acknowledge and agree that they have previously
divided to their mutual satisfaction all of their bank accounts,
certificates of deposit, bonds, shares of stock, investment plans
and life insurance cash value, identified and valued on Exhibit
"A", incorporated by reference hereto, ("the Accounts"). Hereafter
wife agrees that all the Accounts held in the name of Husband shall
become the sole and separate property of Husband; and Husband
agrees that all the Accounts held in the name of Wife shall become
the sole and separate property of Wife.
Each of the parties does specifically waive, release, renounce
- 23 -
and forever abandon whatever right, title, interest or claim, he or
she may have in the Accounts that are to become the sole and
separate property of the other pursuant to the terms hereof.
Any interest that either party may have in, or may heretofore
have had in or as the result of the existence of any Accounts by
virtue of being a beneficiary, contingent beneficiary or otherwise
is hereby extinguished, except as specifically herein provided, and
the parties shall hold such insurance free and clear from any right
or interest which the other party now has or may heretofore have
had therein or thereto.
2.09. TAX PROVISIONS
The parties believe and agree that the division of property
made to be made pursuant to the terms of this Agreement is a non-
taxable division of property between co-owners rather than a
taxable sale or exchange of such property. Each party promises not
to take any position with respect to the adjusted basis of the
property assigned to him or her or with respect to any other issue
which is inconsistent with the terms of this Paragraph on his or
her applicable federal or state income tax returns.
2.10. WIFE I S D'F•BTS
Wife represents and warrants to Husband that since the
parties' marital separation she has not contracted or incurred any
debt or liability for which Husband or his estate might be
- 24 -
responsible. Wife further represents and warrants to Husband that
she will not contract or incur any debt or liability after the
execution of this Agreement for which Husband or his estate might
be responsible. Wife shall indemnify and save Husband harmless
from any and all claims or demands made against him by reason of
debts or obligations incurred by her.
2.11. HUSBAND'S DEBTS
Husband represents and warrants to Wife that since the
parties' marital separation he has not contracted or incurred any
debt or liability for which Wife or her estate might be
responsible. Husband further represents and warrants to Wife that
he will not contract or incur any debt or liability after the
execution of this Agreement for which Wife or her estate might be
responsible. Husband shall indemnify and save Wife harmless from
any and all claims or demands made against her by reason of debts
or obligations incurred by him.
2.12. MARITAT• DEBT
During the course of the marriage, Husband and wife have
incurred certain bills and obligations and have amassed a variety
of debts, identified and valued on Exhibit "A", incorporated by
reference hereto ("the Marital Debts"), and it is hereby agreed,
without ascertaining for what purpose and to whose use each of the
Marital Debts were incurred, the parties agree as follows:
- 25 -
a. Wife's Debts: Wife shall be solely responsible for the
following bills and debts:
1. The debts and credit card accounts identified and valued
under the column marked "Wife" on Exhibit "A" attached
hereto and made a part hereof including:
Waypoint (Harris) Debt ($13,000.00)
Wife's Sally Mae Pre-marital ($17,000.00)
Student Loan
Joint Sears ($2,000.00)
JC Penney ($400.00)
Bon Ton ($700.00)
TOTAL ($33,100.00)
2. Any vehicle loan for Wife's Vehicles as required and set
forth herein.
3. Any and all taxes resulting from her withdrawal of funds
from her Retirement Plans set forth herein;
4. Any and all other debts, liabilities, obligations, loans,
credit card accounts, and the like incurred in Wife's
sole name, and not otherwise provided for herein.
b. Husband's Debts: Husband shall be solely responsible for the
following bills and debts:
1. The debts and credit card accounts identified and valued
under the column marked "Husband" on Exhibit "A" attached
hereto and made a part hereof including:
- 26 -
Providian ($900.00)
Capital 1 ($250.00)
Capital 1 Citi Financial ($3,400.00)
TOTALS ($4,550.00)
2. Any vehicle loan for Husband's Vehicles as required and
set forth herein.
3. Any and all taxes resulting from his withdrawal of funds
from his Retirement Plans set forth herein;
4. Any and all other debts, liabilities, obligations, loans,
credit card accounts, and the like incurred in Husband's
sole name and not otherwise provided for herein.
c. Indemnification: Each party agrees to hold the other harmless
from any and all liability which may arise from the aforesaid
bills which pursuant to the terms herein are not the
responsibility of the other party.
d. Cancellation of Joint Debts: Any joint debt shall be canceled
so that neither party can make any further charges thereunder,
and if said charges are made in violation of this Agreement,
then the party incurring said charge shall immediately repay
the same.
e. Non-Disclosed Liability: Any liability not disclosed in this
Agreement shall be the sole responsibility of the party who
has incurred or may hereafter incur it, and the party
- 27 -
incurring or having incurred said debt shall pay it as it
becomes due and payable.
f. No Further Joint Debt: From the date of this Agreement, each
party shall only use those credit card accounts or incur such
further obligations for which that party is individually and
solely liable and the parties shall cooperate in closing any
remaining accounts which provide for joint liability.
g. Refinance: In the event a party is assuming a liability for
which the parties are jointly liable, that party shall
refinance the same within sixty days of the date of this
Agreement so as to release the other party from any and all
liability thereunder.
2.13. INDEMNIFICATION
Any party assuming an obligation pursuant to the terms of this
Agreement shall indemnify, protect and hold the other party
harmless from and against all any and all liability thereunder,
including, but not limited to, any attorney's fees and costs
incurred by the other party as the result of defending against the
obligation and/or enforcing the provisions of this indemnification.
THE SPACE INTENTIONALLY LEFT BLANK
- 28 -
SECTION III
COUNSEL FEES, ALIMONY, SPOUSAL SUPPORT,
CHILD CUSTODY AND CHILD SUPPORT
3.01. WAIVER OF COUNSEL FEES
The parties hereto agree and do hereby waive any right and/or
claim each may have, both now and in the future, against the other
for counsel fees, costs and expenses.
3.02. AT,IMONY AND SUPPORT
With respect to alimony, alimony pendente lite, and spousal
support, the parties agree as follows:
a. A?imon : Husband shall pay Wife alimony in accordance with
the following terms and conditions:
1. Periodic. Monthly Payment Amount: The periodic monthly
payment amount shall be $150.00 per month.
2. Term: The term of payment is 90 months.
3. Commencement Date: The alimony payments shall begin on
the June 10, 2001.
4. Termination Date: The last alimony payment shall be made
on November 10, 2008.
5. Date of Payment.: The alimony payments shall be made on or
before the 10th day of each month.
6. Earlier Termination: The alimony shall terminate earlier
- 29 -
than the term herein provided upon and in the event of
the death of Husband.
7. No Tax Consequences: Despite the fact that the parties
have agreed that this is an alimony payment, the parties
acknowledged that they have fashioned the alimony amount
in such a fashion as to delete therefrom any tax
consequences or benefits to either party. Therefore, the
alimony shall not be reported by Wife as income on her
applicable income tax returns nor shall it be deductible
by Husband on his applicable income tax returns. For all
other purposes, however, excluding only income tax
treatment purposes, the payments shall be deemed to be a
periodic payment of alimony between Husband and Wife
associated with a dissolution of their marriage and
pursuant to a written marital agreement.
8. No Child Support Consequences: The parties further
acknowledge and agree that the alimony shall not be
considered as income to wife nor subtracted as income
from Husband for purposes of determining the amount of
child support due to be paid or received for the parties,
child, as such consideration would defeat the purpose for
which this alimony is intended.
9. No Court Modification: The alimony provisions set forth
- 30 -
in this Paragraph shall not be subject to modification by
the court or the parties absent mutual written agreement.
10. Payment: Husband shall pay the aforesaid alimony to and
through Domestic Relations Office of Cumberland County,
PA, pursuant to a court order to be entered for that
payment and Husband's wages shall be attached to guaranty
that payment. Pending that wage attachment, Husband shall
make the payments directly to Wife, who shall provide
Domestic Relations with a written statement of all
payments made by Husband directly to her so that he may
receive appropriate credit against the alimony order.
3.03. CUSTODY
With respect to the legal and physical custody, the parties
agree that concurrently with the execution of this Agreement they
will sign the Custody Stipulation attached hereto, marked Exhibit
"B" and made a part hereof. Upon the signing, the Stipulation
shall be delivered to Wife who shall secure the entry of the Court
Order attached thereto. Thereafter custody shall be governed by
the terms of that Order, as may be amended hereafter by agreement
of the parties or further order of the court.
3.03. HEAT-TH INSURANCE
The following shall apply regarding health insurance on the
parties and their child:
- 31 -
a. Health Insurance for Spouse: Any party carrying health
insurance on the other party shall continue to provide health
insurance coverage on the other party until the date of the
entry of the divorce decree. The party for whom that health
insurance is provided shall be entitled to elect Cobra
coverage under the other party's employment policy in
accordance with federal rules and regulations provided that he
or she shall be solely be responsible for the payment of the
costs therefor.
b. Health Insurance for Child: Any party carrying health
insurance on the child as the result of any order entered
through Domestic Relations shall provide such insurance
coverage for the child as determined by Domestic Relations.
C. Health Insurance Documentation: Any party having the
insurance coverage on the child or the other party shall be
required to provide the other party with all documentation
pertaining to the insurance including, but not limited to,
medical insurance cards, benefit booklets, claim submission
forms and all statements pertaining to the determination of
insurance coverage as to each claim made thereunder.
3.04. CHIT.D SUPPORT
The parties acknowledge that an order has been entered for
child support in the child support action docketed to Cumberland
- 32 -
County Domestic Relations Section Number 693-5-2000, Pacses Number
522102526. All matters regarding child support shall be governed
in orders entered in that support action and not by this Agreement.
THIS SPACE INTENTIONALLY LEFT BLANK
- 33 -
SECTION IV
CLOSING PROVISIONS AND EXECUTION
4.01: COUNTERPARTS:
This Agreement may be executed in counterparts, each of which
shall be deemed to be an original, but all of which shall
constitute one and the same agreement.
4.02: FACSIMILE SIGNATURE:
Each party agrees to accept and be bound by facsimile
signatures hereto.
BY SIGNING THIS AGREEMENT, EACH PARTY ACKNOWLEDGES HAVING
READ AND UNDERSTOOD THE ENTIRE AGREEMENT, AND EACH PARTY
ACKNOWLEDGES THAT THE PROVISIONS OF THIS AGREEMENT SHALL
BE AS BINDING UPON THE PARTIES AS IF THEY WERE ORDERED BY
THE COURT AFTER A FULL HEARING.
IN WITNESS WHEREOF, the parties hereto, intending to be
legally bound hereby, have signed sealed and acknowledged this
- 34 -
Agreement in various counterparts, each of which shall constitute
an original.
WITNESS:
( SEAL )
p'ier' ?I fI
THRYN M.KNDate:
(SEAL)
EARL L. KNISLEY, JR.
Date: ii/i211
- 35 -
COMMONWEALTH OF PENNSYLVANIA .
. SS.
COUNTY OF CUMBERLAND
On this the 2/Sr day of Aetr,,lst' , 2001, before me the
undersigned officer, personally appeared, KATHRYN M. KNISLEY, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within Agreement, and acknowledged that KATHRYN
M. KNISLEY executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and notarial seal.
NOTARY PUBLIC
My Commission Expires:
r nt3 jai i ? ?Ca :n. ,v t c 71V?
COMMONWEALTH OF PENNSYLVANIA t ?y r 5 i .:„rvo;i
SS. Member, Pennsyiaanla Asa=c tiun of Notaries
COUNTY OF CUMBERLAND
On this the /9N` day of 4JO&4ern /rv , 2001, before me the
undersigned officer, personally appeared, EARL L. KNISLEY, JR.,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within Agreement, and acknowledged that EARL
L. KNISLEY, JR. executed the same for the purposes therein
contained.
IN WITNESS WHEREOF, I have hereunto set my hand and notarial
seal.
.C?t?C.o«-elv ef° ?uxl? f
NOTARY PUBLIC
My Commission Expires:
j I!
C ,mi Hit B? , i f 1 Go lh/
14 GCO 1?IS ?.,,, t,_ f'li?
Mer b?r, r L?tiy i?la A ? '-n cI ? 1.,_„
- 36 -
KNISLEY V KNISLEY
Marital Distribution Sheet and Settlement
PREPARED: May 29, 2001
1. The parties will agree to the entry of a no-fault divorce
decree to be entered in the divorce action filed by Kathryn.
90 days from the date of the filing and service of the divorce
Complaint, each party will sign the required Affidavit of
consent and Waiver of Notice form to enable that decree to be
entered.
2. The parties assets and debts will be divided in accordance
with the following schedule:
DESCRIPTION VALUE DISTRIBUTION DISTRIBUTIO]
TO HUSBAND TO WIFE
Chevy Cavalier (used trade x
in of marital 1992 Geo
Prism)
Any Accounts Currently in Distribute
Wife's Name to Wife
Any Checking and Savings Distribute
Accounts Currently in to Husband
Husband's Name
Waypoint (Harris) Debt ($13,000.00) ($13,000.00;
Wife's Sally Mae Pre-marital Pre-marital To be paid
Student Loan by wife
Joint Sears ($2,000.00) ($2,000.00)
JC Penney ($400.00) ($400.00)
Bon Ton ($700.00) ($700.00)
Providian ($900.00) ($900.00)
Capital 1 ($250.00) ($250.00)
Capital 1 ($3,400.00) ($3,400.00)
TOTALS ($20,650.00) ($4,550.00) ($16,100.00)
3. Husband to pay Wife alimony at the rate of $150.00 per month
EXHIBIT "A"
MARITAL DISTRIBUTION SHEET
- 37 -
for ninety (90) months. This alimony is to be non-modifiable
and shall only terminate earlier in the event of the death of
Husband. While this payment is to be alimony, it is not to
have any tax consequences to wife nor husband. In other words
it will not be treated as taxable income to wife nor tax
deductible by Husband.
4. All other divorce claims are to be waived.
5. Child support will continue to be determined by Cumberland
County Domestic Relations.
6. Custody will be governed by the Stipulation and Order to be
entered in Cumberland County.
EXHIBIT "A"
MARITAL DISTRIBUTION SHEET
- 38 -
SOCIAL SECURITY INFORMATION SHEET
PURSUANT TO 23 Pa.C.S.A. SECTION 4304.1() (3) ALL DIVORCES MUST
INCLUDE THE PARTIES SOCIAL SECURITY NUMBERS.
PLEASE FILL IN THE APPROPRIATE INFORMATION AND RETURN TO THE
PROTHONOTARY'S OFFICE.
DATE
DOCKET NUMBER
PLAINTIFF'S NAME
PLAINTIFF'S SS #
DEFENDANT'S NAME
DEFENDANT'S SS#
November 12, 2001
01-1014 Civil Term
Kathryn Knisely
202-58-1444
Earl Knisely, Jr.
199-54-7379
r
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
STATE OF PENNA.
KATHRYN KNISELY,
Plaintiff
VERSUS
EARL KNSSELY, JR.,
Defendant
AND NOW,
DECREED THAT
AND
NO. 01-1014 CIVIL TERM
DECREE IN
DIVORCE
Nov?.,,cv ?Y `
KATHRYN KNTSFT.Y
EARL KNISELY, JR.
ARE DIVORCED FROM THE BONDS OF MATRIMONY.
2-06( , IT IS ORDERED AND
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;
No issues are outstanding. All issues have been resolved and settled
by the parties' Marriage Settlement Agreement dated November 12, 2001,
filarl of rernrrl nnri innnrpnraterl, hnt not mergad, intn this DecrPP.
BY THE COURT:
ATTEST' J.
1 97PROTHONOTARY
'?73
ORDER/NOTICE T WITHHOLD INCOME FOR SUPPORT
V, X93 ?-:)? 0original order/Notice
State Commonwealth of Pennsylvania /I )(7g5 Co./City/Dist. of CUMBERLAND /,e dd-M) / /? O Amended Order/Notice
Date of Order/Notice 03/04/02 ?{? ?Wl-ld'T ` /UILlb Terminate Order/Notice
Court/Case Number (See Addendum for case summary)
dX
)RE:RNISELY, EARL L. JR
Employer/Withholder's Federal EIN Number ) Employee/Obligor's Name (Last, First, MI)
DANTES RESTAURANT INC
Employer/Withholder's Name
> 199-54-7379
Employee/Obligor's Social Security Number
936 E COLLEGE AVE > 6414100590
Employer/Withholder's Address ) Employee/Obligor's Case Identifier
STATE COLLEGE PA 16801-6803 ) (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.
$ 504.00 per month in current support
$ 36. oo per month in past-due support Arrears 12 weeks or greater? (2) Yes Q no
$ 0.0o per month in medical support
$ o . 0o per month for genetic test costs
$ per month in other (specify)
for a total of $ 540. 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:
$ 124. 62 per weekly pay period.
$ 249.23 per biweekly pay period (every two weeks).
$ 270, oo per semimonthly pay period (twice a month).
$ 540, 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 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: MAR 4 200Z
row w?SLL`'j/ G J2iZ)6
i i4- Form EN-028
Service Type M 7 OMB No, 097" a Worker ID 21205
.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 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 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: 2512469430
EMPLOYEE'S/OBLIGOR'S NAME: KNISELY, EARL L. JR
EMPLOYEE'S CASE IDENTIFIER: 6414100590 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
OMB No. 0970-0154
Expiration Date: 12131/00
Form EN-028
Worker ID 21205
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: KNISELY, EARL L. JR
? 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.
PACKS Case Number 609104276 / 3/SL7
Plaintiff Name /
KATHRYN M. KNISELY
Docket Attachment Amount
01-1014 CIVIL$ 150.00
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 21205
OMB No.: 09>P0154
Expiration Date: 12/31100
(?, ?--.
?"- ,
nj
?,?
r;
ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT
State Commonwealth of Pennsylvania ; t)C'SF 5 x. /L'? S3? (S)Original Order/Notice
Co./City/Dist. of CUMBERLAND AR O Amended Order/Notice
Date of Order/Notice 05/14/02
Court/Case Number (See Addendum for case summary)
EmployerAVithholder's Federal EIN Number
GULLZFTYS CORP HEAD
Employer/Withholder's Name
138 MOSES THOMPSON LN
EmployerNJithholder's Address
STATE COLLEGE PA 16801-6840
?y Terminate Order/Notice
Jlq'/9
RE: KNISELY, EARL L. JR
Employee/Obligor's Name (Last, First, MI
199-54-7379
Employee/Obligor's Social Security Numl
6414100590
Employee/Obligor's Case Identifier
(See Addendum for plaintiff names assoc
Custodial Parent's Name (Last, First, MI)
J
I
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.
$ 504.00 per month in current support
$ 36. oo per month in past-due support Arrears 12 weeks or greater? Oyes 0 no
$ 0.00 per month in medical support
$ 0 . o0 per month for genetic test costs
$ per month in other (specify)
for a total of $ 540.00 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:
$ 124.62 per weekly pay period.
$ 249.23 per biweekly pay period (every two weeks).
$ 270, oo per semimonthly pay period (twice a month).
$ 540. 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 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:
.' %Z7
Date of Order:
Form EN-028
Service Type M OMBNo.:097M154 V WorkerlD $TATT
„_.. ?. 4n "anon 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-wherrsendmgthe payment. -The-
paydatcddate of withholding is the date or, which amount 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: 2388000107
EMPLOYEE'S/OBLIGOR'S NAME: YNISELY, EARL L. JR
EMPLOYEE'S CASE IDENTIFIER: 6414100590 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 0 5 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
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225
by FAX at (717) 240-6248 or
by Internet @
or
CARLISLE PA 17013
Service Type M
Page 2 of 2
OMB No, 0970-0154
Expiration Date: 12/3 VW
Form EN-028
Worker ID $IATT
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: KNISELY, EARL L. JR
PACSES Case Number 522102526
Plaintiff Name
KATHRYN M. KNISELY
Docket Attachment Amount
00693 S 2000 $ 390.00
Child(ren's Name(s): DOB
JACOB A. KNISELY 12/31/96
PACSES Case Number 60910427y3/V79
Plaintiff Name
KATHRYN M. KNISELY
Docket Attachment Amount
01-1014 CIVIL$ 150.00
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)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
?lf 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
?lf 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
Expiration Date: 12/71100
?= •7
?_. ;.? ,
?i; ? .?
?.,
t-
r n -_
SUPPORT
State Commonwealth of Pennsylvania AW9 FS ,/C
Co./City/Dist. of CUMBERLAND bfe 31y7
Date of Order/Notice 05/15/02 ,
Court/Case Number (See Addendum for case summary)
EmployedWithholder's Federal FIN Number
FIRST NATIONAL BANK
Employer/Withholder's Name
6704 CURTIS CT
EmployerM/ithholder's Address
GLEN BURNIE MD 21060-6406
O Original Order/Notice
?i //O Amended Order/Notice
Terminate Order/Notice
/peSf S 5'?-a/Dash
)RE: KNISELY, EARL L. JR
Employee/Obligor's Name (Last, First, MI)
> 199-54-7379
Employee/Obligor's Social Security Number
> 6414100590
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
$ o , o o per month in past-due support Arrears 12 weeks or greater? Oyes ® no
$ o. 00 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 deta-- 1w much to withhold:
$ o. oo per weekly pay period.
$ o. oo per biweekly pay peri,' "
$ 0.00 per semimonthly p.
$ o. o0 per monthly pay pe
REMITTANCE INFORMATION: c?
You must begin withholding no later tha U (10) working days after the date of this
Order/Notice. Send payment within sevc 'date of withholding. You are entitled to
deduct a fee to defray the cost of withholc --, erning the work state of your employee for the
the allowable amount. The total withheld . ur fee, cannot exceed 55% of the employee's/ obligor's
aggregate disposable weekly earnings. For _ 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 BY MAIL.
Date of Order:
Service Type M
M,,- 1 log
BY THE COURT:
Z o0 2- ?j? ???
g ?G- Oa
Form EN-028
OM0 NO, 0970-0154
Expiration Date: 12/31/00
Worker ID $IATT
I? n
t j :f`J iJ la Itgvl
i .u
A6 4i,
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
? If checked you are required to provide a copy of this form to your employee.
t. 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
paydateMateof withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support
against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must
follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest
extent possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for
you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below.
WITHHOLDER'S ID: 5203128400
EMPLOYEE'S/OBLIGOR'S NAME: KNISELY, EARL L. JR
EMPLOYEE'S CASE IDENTIFIER: 6414100590 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:
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.: 097MI 54 Worker lD $IATT
Expiration Dale: 12/31/00
In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
KATHRYN M. KNISELY ) Docket Number 01-1014 CIVIL
Plaintiff )
vs. ) PACSES Case Number 609104276
EARL L. KNISELY JR )
Defendant ) Other State ID Number
Order
AND NOW to wit, this JANUARY 5, 2007 it is hereby Ordered
that:
SHOULD THE DEFENDANT FALL IN ARREARS, PAYMENTS ARE TO BE INCREASED BY $1.50 PER
MONTH FOR PAYMENT ON SAID ARREARS.
BY THE COURT:
JUDGE
Form OE-520
Service Type M Worker ID 21205
r rz m
C
- W 8 177
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 01-1014 CIVIL
State Commonwealth of Pennsylvania 522102526 O Original Order/Notice
Co./City/Dirt. of CUMBERLAND 693 S 2000 O Amended Order/Notice
Date of Order/Notice 03/26/08 O Terminate Order/Notice
Case Number (See Addendum for case summary)
RE: KNISELY, EARL L. JR
Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI)
CEDAR CLIFF INN INC
1104 CARLISLE RD
CAMP HILL PA 17011-6203
199-54-7379
Employee/Obligor's Social Security Number
6414100590
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'sfobligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 504.00 per month in current support
$ 36.00 per month in past-due support Arrears 12 weeks or greater? Oyes Q no
$ 0.00 per month in current and past-due medical support
$ 0.00 per month for genetic test costs
$ 0.00 per month in other (specify)
for a total of $ 540.00 per month to be forwarded to payee a ow.
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:
$ 124.62 per weekly pay period.
$ 249.23 per biweekly pay period (every two weeks).
$ 270. oo per semimonthly pay period (twice a month).
$ 540. oo 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 #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: MAR 2 6 2008
EDWARD E. GUIDO, JUDGE
DRO: R.J. SHADDAY Form EN-028 Rev. 1
Service Type M OMB No.: 0970-0154 Worker ID 21205
_ ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
? If 4hecked you are required to provide a copy of this form to your @mployee. If yoyr employee works in a state that is
di Brent from the state that issued this order, a copy must be provided to your employee even if the box is not checked.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to
each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each
employee/obligor.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against
this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow
the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent
possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you.
Please provide the information requested and return a copy of this Order/Notice to the Agency identified below.
THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2318559840
EMPLOYEE'S/OBLIGOR'S NAME: KNISELY, EARL L. JR
EMPLOYEE'S CASE IDENTIFIER: 6414100590 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 WAGE ATTACHMENT UNIT
13 N. HANOVER ST by telephone at (717) 240-6225 or
P.O. BOX 320 by FAX at (717) 240-6248 or
CARLISLE PA 17013 by internet www.childsupport.state.pa.us
Page 2 of 2
Service Type M
OMB No,: 0970-0154
Form EN-028 Rev. 1
Worker ID 21205
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: KNISELY, EARL L. JR
PACSES Case Number 522102526
Plaintiff Name
KATHRYN M. KNISELY
Docket Attachment Amount
00693 S 2000 $ 390.00
Child(ren)'s Name(s): DOB
JACOB A. KNISELY 12/31/98
O 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 609104276
Plaintiff Name
KATHRYN M. KNISELY
Docket Attachment Amount
01-1014 CIVIL$ 150.00
Child(ren)'s Name(s): DOB
Olf 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
O 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
O 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
O 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
El 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.
Addendum Form EN-028 Rev. 1
Service Type M OMB No.: 0970-0154 Worker ID 21205
a
CIO
CTA
1
ORDER/0TICE TO WITHHOLD INCOME FOR SUPPORT
State Commonwealth of Pennsyly,
Co./City/Dist. of CUMBERLAND
Date of Order/Notice 04113/09
Case Number (See Addendum for
holder's Federal EIN Number
CEDAR CLIFF INN INC
1104 CARLISLE RD
CAMP HILL PA 17011-620:
199-54-7379
Employee/Obligor's Social Security Number
6414100590
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
01-1014 CIVIL
OOriginal Order/Notice
522102 @Amended Order/Notice
693 S 2000 OTerminate Order/Notice
summary) OOne-Time Lump Sum/Notice
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 Cou ty, 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 cu rrent child support
$ 0.00 per month in p t-due child support Arrears 12 weeks or greater? (g) yes O no
$ 0.00 per month in cu rent medical support
$ o . oo per month in p t-due medical support
$ o. oo per month in cu rent spousal support
$ 540.00 per month in p t-due spousal support
$ 0.00 per month for ge netic test costs
$ 0.00 per month in of er (specify)
$ one-time lump m payment
for a total of $ 540.00 per r onth to be forwarded to payee below.
You do not have to vary your pay cyc
the ordered support payment cycle, u
$ 124.62 , per weekly pay p.
$ 249.23 per biweekly pay
REMITTANCE INFORMATION: You
working days after the date of this Or(
withholding. You are entitled to dedt
state of your employee for the allowal
the employee's/ obligor's aggregate di
the following information is needed ('
If required by Pennsylvania law (23 P
Pennsylvania State Collections and D
for instructions. PA FIPS CODE 42 0(
Make Remittance Payable to: P
Send check to: Pennsylvania S(
IN ADDITION, PAYMENTS MUST IN
above as the Employee/Obligor's Cas4
DO NOT SEND CASH BY MAIL.
BY THE COURT:
DRO: R. J. Shadday
Service Type m
to be in compliance with the support order. If your pay cycle does not match
the following to determine how much to withhold:
iod. $ 270.00 per semimonthly pay period
(twice a month)
?riod (every two weeks) $ 540.00 per monthly pay period.
lust begin withholding no later than the first pay period occurring ten (10)
-r/Notice. Send payment within seven (7) working days of the paydate/date of
t a fee to defray the cost of withholding. Refer to the laws governing the work
e amount. The total withheld amount, and your fee, cannot exceed 55% of
Losable weekly earnings. For the purpose of the limitation on withholding,
e #9 on page 2).
? C.S. § 4374(b)) to remit by electronic payment method, please call
bursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580
1 00
\ SCDU
DU, P.O. Box 69112, Harrisburg, Pa 17106-9112
:LODE THE DEFENDANT'S NAME AND T CSES MEMBER ID (shown
Identifier) OR SOCIAL SECURITY /y,V R IN RDER TO BE PROCESSED.
OMB No.: 0970-0154
RE: KNISELY, EARL L. JR
Employee/Obligor's Name (Last, First, MI)
Edward E.
Judge
Form EN-028 Rev. 4
Worker I D $ IATT
?.w . ??
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
E] If 4 heck you are required. to rovide a opy of this form to your m loyee. If yo r employed works in a state that is
dierent from the state that issu this order, a copy must be provideedpto your emp?oyee even if the box is not checked.
1. Priority: Withholding under this Order/ Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt oft is 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 ust, however, separately identify the portion of the single payment that is attributable to each
employee/obligor.
3.* Reporting the Paydate/Date of Withho ing: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on ich 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 Omer/Notices due to Federal or State withholding limits, you must follow
the law of the state of employee's/obligor's p incipal place of employment. You must honor all Orders/Notices to the greatest extent
possible. (See #9 below)
5. Termination Notification: You must pro ptly notify the Requesting Agency when the employee/obligor is no longer working for you.
Please provide the information requested an return a copy of this Order/Notice to the Agency identified below. 2318559840
THE PERSON HAS NEVER WORKED FOR HIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0
EMPLOYEE'S/OBLIGOR'S NAME:!q!ISELY, EARL L. JR
EMPLOYEE'S CASE IDENTIFIER:
LAST KNOWN HOME ADDRESS:.
LAST KNOWN PHONE NUMBER:
NEW EMPLOYER'S NAME/ADDRE
4100590 DATE OF SEPARATION:
FINAL PAYMENT AMOUNT:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income a the Order/Notice directs, you are liable for both the accumulated amount you should have
withheld from the employeelobligor'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 line 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 (CCPA) (15 U.S.C. 1673 (b)); 0 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of
employment. Disposable income is the net i come left after making mandatory deductions such as: State, Federal, local taxes, Social
Security taxes, statutory pension contribution and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is
supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is
increased to 55% and that 60% limit is increa ed to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may
deduct a fee for administrative costs. The sup ort amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit usi g the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of
the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the
CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health
care premiums in determining disposable inc me and applying appropriate withholding limits.
10. Additional info:
*NOTE: If you or your agent are served with 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 ite s.
11. Send Termination Notice and
other correspondence to:
DOMESTIC RELATIONS SECTION
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by internet www.childsupport.state.pa.us
Page 2 of 2 Form EN-028 Rev. 4
Service Type M OMB No.: 0970-0154 Worker ID $IATT
ADDENDUM
Summary of Cases on Attachment
KNISELY, EARL L. JR
PACSES Case Number 609104276
Plaintiff Name
KATHRYN M. BEERS
Docket Attachment Amount
01-1014 CIVIL$ 540.00
Child(ren)'s Name(s):
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
Form EN-028 Rev. 4
Worker I D $ IATT
FILES
OF THE ;r?- -,D7
2009 APR 14 PM 3= 23
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
State Commonwealth of Pennsylvania
CO./City/DISt. Of CUMBERLAND
Date of Order/Notice o2/25/l0
Case Number (See Addendum for case summary)
Employer/Withholder's Federal EIN Number
CEDAR CLIFF INN INC
1104 CARLISLE RD
CAMP HILL PA 17011-6203
199-54-7379
Employee/Obligor's Social Security Number
6414100590
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
$ o.oo
$ o.oo
~ o.oo
$ 0.00
~ o.oo
$ o.oo
$ o.oo
per month in current child support
per month in past-due child support
per month in current medical support
per month in past-due medical support
per month in current spousal support
per month in past-due spousal support
per month for genetic test costs
per month in other (specify)
Arrears 12 weeks or greater?
one-time lump sum payment
for a total of $ 0.00 per month to be forwarded to payee below.
yes ~ no
C ~' , ,.
rt
~~
'~- t: ;~
- -r•
~. ~' -' ~~
;~~ .. _ .a
4~.
:~
~.1 ..
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:
$ o. oo per weekly pay period. $ o. oo per semimonthly pay period
(twice a month)
~ o . oo per biweekly pay period (every two weeks) $ o . oo per monthly pay period.
REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10)
working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of
withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work
state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of
the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding,
the following information is needed (See #9 on page 2).
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is
ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has
a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections
and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE
42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
/N ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAN CSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURIT ' MBER / RDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
BY THE COURT: ~.._
01-1014 CIVIL
OOriginal Order/Notice
OAmended Order/Notice
OTerminate Order/Notice
QOne-Time Lump Sum/Notice
RE: KNISELY, EARL L. JR
Employee/Obligor's Name (Last, First, Mp
DRO: R.J. Shadday Form EN-028 Rev.S
Service Type M OMB No.: 0970-0154 Worker I D $ IATT
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
~ If~heckefl you are required to provide a copy of this form to your m loyee. If yo r employee works in a state tha is
di Brent rTrom the state that issued this order, a copy must be provideedoto your emproyee even if the box is not chec~ed
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee%bligor's income in a single payment to
each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each
employee%bligor.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against
this employee%bligoravd you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow
the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent
possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee%bligor is no longer working for you.
Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2318559s4o
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: ~
EMPLOYEE'S/OBLIGOR'S NAME:KNISELY, EARL L. JR
EMPLOYEE'S CASE IDENTIFIER: 6414100590 DATE OF SEPARATION
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have
withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless
the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee%bligor from employment,
refusing to employ, or taking disciplinary action against any employee%bligor because of a support withholding. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of
employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social
Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is
supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is
increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may
deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of
the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the
CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health
care premiums in determining disposable income and applying appropriate withholding limits.
10. Additional info:
*NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state
that issued this order with respect to these items.
11. Send Termination Notice and
other correspondence to:
DOMESTIC RELATIONS SECTION
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by Internet www.childsupport.state.pa.us
Page 2 of 2 Form EN-028 Rev.5
Service Type M OMBNO.:0970-0154 Worker ID $IATT
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: KNISELY, EARL L. JR
PACSES Case Number 609104276 PACSES Case Number
Plaintiff Name Plaintiff Name
KATHRYN M. BEERS
Docket Attachment Amount Docket Attachment Amount
01-1014 CIVIL$ 0.00 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
Addendum Form EN-028 Rev.S
Service Type M OMBNo.:0970-0154 Worker ID $IATT
s
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 01-1014 CIVIL
State Commonwealth of Penn ylvania OOriginal Order/Notice
CO./City/Dlst. Of CUMBERLAND OAmended Order/Notice
Date of Order/Notice 02/25/10 OTerminate Order/Notice
Case Number (See Addendum for case summary)
QOne-Time Lump Sum/Notice
RE: KNISELY, EARL L. JR
Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, Mq
199-54-7379
Employee/Obligor's Social Security Number
SECOND CHANCE RESTAURANT 6414100590
138 MOSES THOMPSON LN Employee/Obligor's Case Identifier
STATE COLLEGE PA 16 8 O 1- 6 84 0 (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 child support
$ o . oo per month in past-due child support Arrears 12 weeks or greater? Qyes ~ no
$ o. oo per month in current medical support ZZ'~~ ~ .~
$ o . oo per month in past-due medical support ~~ ~
$ o. oo per month in current spousal support ~~+~ ~ =-i
$ s4o. oo per month in past-due spousal support -- ~ r~i7~
$ o. oo per month for genetic test costs `~ ~ -;~a
~_~ t_ ~~
$ o . oo per month in other (specify) -~ c ,
$ one-time lump sum payment ~; ~,,° ;;
.~
for a total of $ 540. oo per month to be forwarded to payee below. ~ ~:
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 124.62 per weekly pay period. $ 2~0. oo per semimonthly pay period
249.23 (twice a month)
$ per biweekly pay period (every two weeks) $ s4o.oo per monthly pay period.
REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10)
working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of
withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work
state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of
the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding,
the following information is needed (See #9 on page 2).
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic aavment method if an employer is
ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has
a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections
and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE
42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY BEI
DO NOT SEND CASH BY MAIL. ..,.s
BY THE COURT:
DRO: R.J. Shadday
Service Type M
OMB No.: 0970-0154
17106-9112
MEMBER /D (shown
~R TO BE PROCESSED.
Form EN-028 Rev.S
Worker I D $ IATT
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
If~hecketl you are required, to provide a copy of this form to your m loyee. If yo r employee works in a state that is
di Brent from the state that issued this order, a copy must be provi~edpto your emp~oyee even if the box is not checked.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to
each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each
employee%bligor.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against
this employee%bligoravd 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. 2712821980
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: D
EMPLOYEE'S/OBLIGOR'S NAME:KNISELY, EARL L. JR
EMPLOYEE'S CASE IDENTIFIER: 6414100590 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER:
FINAL PAYMENT AMOUNT:
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have
withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless
the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligorfrnm employment,
refusing to employ, or taking disciplinary action against any employee%bligor because of a support withholding. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed govems.
9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of
employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social
Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is
supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is
increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may
deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of
the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the
CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health
care premiums in determining disposable income and applying appropriate withholding limits.
10. Additional info:
*NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state
that issued this order with respect to these items.
11. Send Termination Notice and
other correspondence to:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by Internet www.childsupport.state.pa.us
Page 2 of 2
Service Type M OMB No.: 0970-0154
Form EN-028 Rev.5
Worker ID $IATT
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: xNISELY, EARL L. JR
PACSES Case Number 609104276 PACSES Case Number
Plaintiff Name Plaintiff Name
KATHRYN M. BEERS
Docket Attachment Amount Docket Attachment Amount
01-1014 CIVIL$ 540.00 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
Addendum Form EN-028 Rev.S
Service Type M OMBNO.:0970-0154 Worker ID $IATT
i ~
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 01-1014 CIVIL
State ..Commonwealth of Pennsylvania OOriginal Order/Notice
CO./City/Dist. of CID"IBERLAND OAmended Order/Notice
Date of Order/Notice 08/03/10 OTerminate Order/Notice
Case Number (See Addendum for case summary) Qone-Time Lump Sum/Notice
RE:KNISELY, EARL L. JR
EmployerM/ithholder's Federal EIN Number Employee/Obligor's Name (Last, First, Mp
199-54-7379
Employee/Obligor's Social Security Number
SECOND CHANCE RESTAURANT 6414100590
138 MOSES THOMPSON LN Employee/Obligor's Case Identifier
STATE COLLEGE PA 16 8 01- 6 8 4 0 (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 child support
$ o. oo per month in past-due child support Arrears 12 weeks or greateri+ Qyes ®no
$ o . oo per month in current medical support
$ o . oo per month in past-due medical support
$ o . o o per month i n current spousal support t`~ ~ ; -;
$ o . oo per month in past-due spousal support .-=~ ~ ~ '~'
$ o . oo per month for genetic test costs ~~' ~'' ~`~ -f-r
W v, ~~.~
$ o. oo per month in other (specify) ,;,-;,
$ one-time lump sum payment ~ p~. ~' ~ rT
for a total of $ 0.00 per month to be forwarded to payee below. - ~ ,~.
rr
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle s riot mat~Ft
the ordered support payment cycle, use the following to determine how much to withhold: -. G-~, ==<
$ o . oo Per weekly pay period. $ o . oo per semimonthly pay period
(twice a month)
$ o . oo per biweekly pay period (every two weeks) $ o . oo per monthly pay period.
REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10)
working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of
withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work
state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of
the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding,
the following information is needed (See #9 on page 2).
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic aayment method if an employer is
ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has
a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections
and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE
42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NiJa/A~~RDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL. ,~/
BY THE COURT:
Etivva~•d E .
DRO: R.J. Shadday
Service Type M
OMB NO.: 0970-0154
Form EN-028 Rev.S
Worker I D $ IATT
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
~ If ~heckes! you are required to provide a~opy of this form to your m loyee. If yoYr employee v~orks in a state that is
i Brent rom the state that issued this o er, a copy must be provideedpto your emp oyee 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 employee%bligor's income in a single payment to
each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each
employee%bligor.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against
this employee%bligoranct you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow
the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent
possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee%bligor is no longer working for you.
Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2712s2198o
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : ~ THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: D
EMPLOYEE'S/OBLIGOR'S NAME:IINISELY, EARL L. JR
EMPLOYEE'S CASE IDENTIFIER: 6414100590
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER:
DATE OF SEPARATION:
FINAL PAYMENT AMOUNT:
NEW EMPLOYER'S NAME/ADDRESS:
6. lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have
withheld from the employee%bligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless
the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Antiriiscrimination: You are subject to a fine determined under State law for discharging an employee%bligorfrorn employment,
refusing to employ, or taking disciplinary action against any employee%bligor because of a support withholding. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of
employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social
Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is
supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is
increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may
deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of
the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the
CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health
care premiums in determining disposable income and applying appropriate withholding limits.
10. Additional info:
* NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state
that issued this order with respect to these items.
11. Send Termination Notice and
other correspondence to:
DOMESTIC RELATIONS SECTION
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by Internet www.childsuyport.state.pa.us
Page 2 of 2 Form EN-028 Rev.5
Service Type M OMB No.: 0970.0154 Worker I D $ IATT
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: KNISELY, EARL L. JR
PACSES Case Number 609104276
Plaintiff Name
KATHRYN M. BEERS
Docket Attachment Amount
01-1014 CIVIL$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
Service Type M
Addendum
OMB No.: 0970-0154
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
__
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
Form EN-028 Rev.S
Worker ID $IATT