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HomeMy WebLinkAbout10-4079NANCY L. SMITH, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2010- %0 7 ?l CIVIL TERM C LAVERNE D. SMITH, CIVIL ACTION-LAW `-- ;? Defendant IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS rrj E3 J You have been sued in court. If you wish to defend against the claims?set 46th =< in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Court House, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, MARITAL PROPERTY, COUNSEL FEES OR EXPENSES BEFORE THE FINAL DECREE OF DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 32 South Bedford Street Carlisle, Pennsylvania 17013 (717) 249-3166 g 3 Sago ?.3?/. so Pti z /i4 ay3"G NANCY L. SMITH, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2010- CIVIL TERM LAVERNE D. SMITH, CIVIL ACTION-LAW Defendant IN DIVORCE DIVORCE COMPLAINT 1. Plaintiff is Nancy L. Smith, an adult individual who currently resides at 34 West Big Spring Avenue, Newville, Cumberland County, Pennsylvania 17241. 2. Defendant is LaVerne D. Smith, an adult individual who currently resides at 34 West Big Spring Avenue, Newville, Cumberland County, Pennsylvania 17241. 3. Plaintiff and Defendant have been bona fide residents in the Commonwealth of Pennsylvania for at least six months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on October 11, 1975 in Newville, Cumberland County, Pennsylvania. 5. There have been no prior actions of divorce or for annulment between the parties. 6. The marriage is irretrievably broken. 7. In the alternative, Defendant has offered such indignities to the Plaintiff as to make her life burdensome and condition intolerable. 8. The Plaintiff has been advised of the availability of counseling and that she may have the right to request that the court require the parties to participate in Counseling. WHEREFORE, the Plaintiff requests the court to enter a decree of divorce in favor of the Plaintiff and against the Defendant. COUNT II -EQUITABLE DISTRIBUTION 8. Plaintiff hereby incorporates by reference paragraphs 1 through 7 above. 9. The parties have acquired real estate, personal property, including automobiles, bank accounts and other items of miscellaneous property during the course of their marriage, some of which is marital property. WHEREFORE, Plaintiff respectfully requests this Honorable Court to enter a decree which effects an equitable distribution of marital property. Date: 6 IT/4 Respectfully submitted, BARIC SCHERER I&M4A, Mic el Scherer, Esquire I. D.# 61974 19 West South Street Carlisle, PA 17013 (717) 249-6873 Attorney for Plaintiff mas.d it/domestic/smith,nancy/divorcecom plaint.pld VERIFICATION I verify that the statements made in this Divorce Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. § 4904, relating to unsworn falsification to authorities. '-?az)tew Z?-? Date: Na L. Smith ~~~ ' ~~~ ~ d,~ ' ,~f~iir~~Y to r l aq ~ Y 2Qfu.liJfe 2$ fii~ III ~~PJI`~SY! ~,~ ~~;,q NANCY L. SMITH, Plaintiff v. LAVERNE D. SMITH, Defendant 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010-4079 CIVIL TERM CIVIL ACTION -LAW 1N DIVORCE PRAECIPE TO ENTER APPEARANCE TO THE PROTHONOTARY: Please enter the appearance of Keith O. Brenneman, Esquire on behalf of Defendant Laverne D. Smith in the above-captioned action. SNELBAKER & BRENNEMAN, P. C. Date: June 24, 2010 ~ "` ~ By: Keith O. Brenneman, Esquire 44 W. Main Street Mechanicsburg, PA 17055 (717) 697-8528 Attorneys for Defendant LAW OFFICES SNELBAKER 8C BRENNEMAN, P.C. CERTIFICATE OF SERVICE I, KEITH O. BRENNEMAN, ESQUIRE, hereby certify that I have, on the below date, caused a true and correct copy of the foregoing Praecipe for Entry of Appearance to be served upon the person and in the manner indicated below: FIRST CLASS MAIL, POSTAGE PREPAID, ADDRESSED AS FOLLOWS• Michael A. Scherer, Esquire Baric Scherer 19 West South Street Carlisle, PA 17013 SNELBAKER & BRENNEMAN, P. C. B ~~~~- Y• Keith O. Brenneman, Esquire 44 W. Main Street Mechanicsburg, PA 17055 (717) 697-8528 2 ~ / 20 ~ G Attorneys for Defendant Date: ~ uN~ Laverne D. Smith LAW OFFICES SNELBAKER 8C BRENNEMAN, F.C. NANCY L. SMITH, v. Plaintiff LAVERNE D. SMITH, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSIr~/AI~$A y NO. 2010-4079 CIVIL TERM ~~' . _. ~ ~ ~~ ~ CIVIL ACTION-LAW `'" , ~ ~' ~`j`~' IN DIVORCE `~~'` "~t`~ ~ ~+ ~ >r.r _ y , ,~,. ~ ~~ CERTIFICATE OF SERVICE ~`~~ -` I, Michael A. Scherer, Esquire, attorney for the Plaintiff in the above-captioned divorce action, do hereby certify that I served a certified copy of the Complaint in Divorce to the Defendant, as per the attached U.S. Postal Service Certified Mail, return receipt card. BARK SCHERER Michael A. Scherer, Esquire DATE: June 28, 2010 ^ Complete Rams 1, 2, -and 3. Also complete Item 4 if Restricted Delivery is desired. ^ Print your name and address on the reverse so that we can return the card to you. ^ Attach this card to the hack of the mailpiece, or on the front ff space permits. 1. Article Addressed to: L.~~~ ~ Sni~,rN~.• ``qq pp .v.11.~' p~ ~~ - Z `NQ1~N 1 i A. Signature ^ Ager>t B. Received by (Printed Name) ~ C. Date of Delivery D. Is delivery address d(if~ent from item 1 ? ^ Yes ~, enter delivery address bebw: ^ No ~._ ,~ 2z 8x iServlce Type Certtfled Mail ^ Express Mail "` S - Regletered ^ Return Receipt for Merchandise ^ Insured Mall ^ C.O.D. 4. Restricted Deliver)? (Exba Fee) Yes 2. Article Number 7 ~ p 9 2 8 2 0 ~ 0 ~ 2 210 3 1517 (transfer from service raaeu) PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 NANCY L. SMITH, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 2010-4079 CIVIL TERM LAVERNE D. SMITH, CIVIL ACTION-LAW Defendant IN DIVORCE ~ ^~~ t-~ <.-~ _. `~ PLAINTIFF'S PETITION FOR ALIMONY PENDENTE LITE '~~-~ '- AND NOW, comes Plaintiff, Nancy L. Smith, by and through her attoirney, 3 Michael A. Scherer, Esquire, and respectfully represents as follows: ~,, ,_ 1. Plaintiff, Nancy L. Smith, is an adult individual who is represented in this YC~Py `~ ~~ matter by Michael A. Scherer, Esquire. 2. Defendant, Laverne D. Smith, is an adult individual who is represented in this matter by Keith Brenneman, Esquire. 3. Plaintiff previously filed a divorce complaint to the above term and number which has been served upon defendant. 4. Plaintiff is incurring legal fees relative to this case and requires alimony pendente lite in Order to prosecute this action and to maintain herself during the pendency of this litigation. WHEREFORE, Plaintiff requests that the Court award her alimony pendente lite. Respectfully submitted, BARK SCHERER icha I .Scherer, Esquire I.D. # 61974 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 VERIFICATION I verify that the statements made in the foregoing Plaintiffs Petition For Alimony Pendente Lite are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. v `~ Michael A. Scherer, Esquire DATED: v ~I ~~ ~~ CERTIFICATE OF SERVICE I hereby certify that on August 11, 2010, I, Jennifer S. Lindsay, secretary at Baric Scherer, did serve a copy of the Plaintiff's Petition For Alimony Pendente Lite, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Keith O. Brenneman, Esquire Snelbaker & Brenneman, P.C. 44 West Main Street P.O. Box 318 Mechanicsburg, Pennsylvania 17055 Je ' e l n say NANCY L. SMITH, THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION -DIVORCE NO. 10-4079 CIVIL TERM LAVERNE D. SMITH, IN DIVORCE Defendant/Respondent PACSES NO: 878111762 ....: - r" ~' '; - - ... ORDER OF COURT - ~ ~ ~ ,~ r ~, ~. . AND NOW, this 1 lth day of August, 2010, upon consideration of the Petition for Alimony P~ndente ate ~ and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R J:. ~hadday on - August 3l. 2010 at 1:30 P.M. for a conference, at 13 N. Hanover St., Carlisle, PA ] 7013, after whictti~he ~~' conference officer may recommend that an Order for Alimony Pendente Lite be entered. ~~ - r YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed N (2) your pay stubs for the preceding six (6) months V~ (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you. If you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. Copies mailed to: Petitioner Respondent Michael A. Scherer, Esq. Keith O. Brenneman, Esq.. Date of Order: August 11, 2010 BY THE COURT, YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 NANCY L. SMITH, IN THE COURT OF COMMON PLEAS OF Plairtiff/Plaintiff CUMBERLAND COUNTY, PENNSYLVANI A • C ? =i VS. CIVIL ACTION - DIVORCE -OLD "r--n NO. 10-4079 CIVIL TERM c , ? LAVERNE D. SMITH, IN DIVORCE Defendant/Respondent PACSES CASE: 878111762 t ORDER OF COURT r AND NOW, this 31 st day of August, 2010, based upon the Court's determination that the Petitioner's monthly net income/earning capacity is $ 1.187.62 and the Respondent's monthly net income/earning capacity is $ 1,711.86, it is hereby ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit Two Hundred Thirty-one and 00/100 Dollars ($ 231.00) per month payable monthly as follows: $ 210.00 per month for Alimony Pendente Lite and $ 21.00 per month on arrears. First payment due on or before September 5, 2010. The effective date of the order is August 11, 2010. Arrears set at $ 144.99 as of August 31, 2010. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and, at its discretion, make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Nancy L. Smith. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the Respondent's name with their PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. cc360 N The monthly support obligation includes cash medical support in the amount of $250 annually for unreimbursed medical expenses incurred for each child and/or spouse. Unreimbursed medical expenses of the obligee or children that exceed $250 annually shall be allocated between the parties. The party seeking allocation of unreimbursed medical expenses must provide documentation of expenses to the other party no later than March 31" of the year following the calendar year in which the final medical bill to be allocated was received. The unreimbursed medical expenses are to be paid as follows: 0 % by Respondent and 100 °./o by Petitioner. [] Respondent [X] Petitioner [] Neither party to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the [X] Petitioner [] Respondent shall submit written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of: 1) the name of the health care coverage provider(s2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. Other conditions: This Order is based upon the premise that the Petitioner is to receive a gross amount of $1,233.00 per month, effective October, 2010, and made retroactive to May, 2010, from Social Security Disability. The Petitioner is to maintain her own medical insurance. This Order shall become final twenty (20) after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. Mailed copies on: SEP 0 2 201Q DRO: R. J. Shadday to: Petitioner Respondent Michael A. Scherer, Esq. Keith O. Brenneman. Esq. BY THE COURT, ,F /r ey Oler, Jr. i, J. ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 10-4079 CIVIL State Commonwealth -of Pennsylvania 0Original Order/Notice CO./City/Dist. of CUMBERLAND OAmended Order/Notice Date of Order/Notice 08/31/10 OTerminate Order/Notice Case Number (See Addendum for case summary) QOne-Time Lump Sum/Notice RE: SMITH, LAVERNE D. Employer/Withholder's Fede'al FIN Number Employee/Obligor's Name (Last, First, MI) 217-60-1933 Employee/Obligor's Social Security Number SOCIAL SECURITY ADMINISTRATION 3022102291 STE 1 Employee/Obligor's Case Identifier 200 S SPRING GARDEN ST (See Addendum for plaintiff names CARLISLE PA 17013-2578 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. $ 0.00 per month in current child support C =='? $ o. oo per month in past-due child support Arrears 12 weeks or greater? (?Jgd-i tno - $ 0.00 per month in current medical support 'ir- _T $ 0.00 per month in past-due medical support s '. w tl $ 210.00 per month in current spousal support ==' T} $ o. oo per month in past-due spousal support $ 0.00 per month for genetic test costs j-n $ o . oo per month in other (specify) T t? $ one-time lump sum payment r.> for a total of $ 210.00 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: $ 48.33 per weekly pay period. $ 105. 00 per semimonthly pay period (twice a month) $ 96. 66 per biweekly pay period (every two weeks) $ 210. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOC/AL URITY,UMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. / / f : 'ri BY THE COURT: J. wesie- Oler, Jr., Judge DRO: R. J. Sl-iadday Form EN-028 Rev.5 Service Type M OMB N°..0970-0154 Worker ID $oINC ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If checked you are required to provide a opy of this form to your. m loyee. If your employee works in a state that is different from the state that issued this or?er, a copy must be provi?edpto your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each 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. 8384100092 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: El EMPLOYEE'S/OBLIGOR'S NAME: SMITH, LAVERNE D. EMPLOYEE'S CASE IDENTIFIER: 3022102291 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT. NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 U); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left: after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60"/,. of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60"/" limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA 0 5 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 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 $OINC ADDENDUM Summary of Cases on Attachment Defendant/Obligor: SMITH, LAVERNE D. PACKS Case Number 87EI111762 Plaintiff Name NANCY L. SMITH Docket Attachment Amount 2010-4079 CIV$ 210.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev.5 Service Type M Worker ID $OINC OMB No.: 0970-0154 !_ ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 10-4079 CIVIL OOriginal Order/Notice State Commonwealth of Pennsylvania CO./City/DISt. Of CUMBERLAND OAmended Order/Notice Date Of Order/Notice 09/01/10 OTerminate Order/Notice Case Number (See Addendum for case summary) QOne-Time Lump Sum/Notice RE: SMITH, LAVERNE D. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, Mp 217-60-1933 Employee/Obligor's Social Security Number SOCIAL SECURITY ADMINISTRATION 3022102291 STE 1 Employee/Obligor's Case Identifier 2 0 0 S SPRING GARDEN ST (See Addendum for plaintiff names CARLISLE PA 17 013 - 2 5 7 8 associated with cases on attad-ment) Custodial Parent's Name (Last, First, Mp See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are require to deyluct~ese e amounts from the above-named employee's/obligor's income until further notice even if the Order/tic~+3 not issued by your State. -prS3 ~ era $ o. oo per month in current child support ~f~ ~ $ o . oo per month in past-due child support Arrears 12 weeks or greater ~~es -®nti ~ $ o. oo per month in current medical support r~"~~; -a $ o . oo per month in past-due medical support ~ ~> ~ ~r . $ 210.00 per month in current spousal support ~C, ~:'~ -a $ 21. oo per month in past-due spousal support ~ ~ $ o . oo per month for genetic test costs $ o . oo per month in other (specify) $ one-time lump sum payment for a total of $ 231. 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: $ 53 .16 Per weekly pay period. $ lls. 5o per semimonthly pay period (twice a month) $ 106 .32 per biweekly pay period (every two weeks) $ 231. 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. 5 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFEND T'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Iden 'fiery OR SO SEC ITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. L BY THE COURT: O~ J e ~ ~ ~ ~ ~ J. ~ ~y Oler, Jr., Judgs Form EN-028 Rev.5 SerFy~e JM Shadday OMB No.: 0970-0154 Worker I D $oINC ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ~ If heck you are required to pr vide a opy of this form to your m loyee. If yo r employee works in a state that is di~erent from the state that issuedthis order, a copy must be provideec~to your emp~oyee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee%bligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee%bligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respell to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee%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. s3s41ooo92 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : ~ THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: ~ EMPLOYEE'S/OBLIGOR'SNAME:SMITH, LAVERNE D. EMPLOYEE'S CASE IDENTIFIER: 3022102291 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%bligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee%bligorfmm 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 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 $oINC ADDENDUM Summary of Cases on Attachment Defendant/Obligor: SMITH, LAVERNE D. PACSES Case Number 878111762 Plaintiff Name NANCY L. SMITH Docket Attachment Amount 2010-4079 CIV$ 231.00 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 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 OMB No.: 0970-0154 Form EN-028 Rev.5 Worker ID $oINC NANCY L. SMITH, IN THE COURT OF COMMON PLF S Plaintiff CUMBERLAND COUNTY, PENI??V&NI IF:: V. NO. 2010-4079 CIVIL TERM ?; ?- - LAVERNE D. SMITH, Defendant IN DIVORCE T .<.=,. PLAINTIFF'S AFFIDAVIT OF CONSENT AND WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE A complaint in divorce under Section 3301(c) of the Divorce Code was filed on June 17, 2010. 2. Defendant received Divorce Complaint by certified mail on June 22, 2010. 3. The marriage of Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of the filing of the Complaint. 4. 1 consent to the entry of a final decree in divorce without notice. 5. 1 understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 6. 1 understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. 7. 1 have been advised of the availability of marriage counseling and understand that I may request that the court require counseling. I do not request that the court require counseling. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to unsworn falsification to authorities. Date: ?ne 10 12011 AS I ?s" Nancy L. rn x.511 l 1U 4 14 PM 3: `>_ UMBERLA'ND PI--'N,'SYs V ? I[" NANCY L. SMITH, Plaintiff V. LAVERNE D. SMITH, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010 - 4079 CIVIL TERM CIVIL ACTION -LAW IN DIVORCE DEFENDANT'S AFFIDAVIT OF CONSENT UNDER SECTION 3301(C) OF THE DIVORCE CODE 1. A complaint in divorce under Section 3301(c) of the Divorce Code was filed on June 17, 2010. 2. The marriage of the Plaintiff and the Defendant is irretrievably broken and ninety (90) days have elapsed from the date of the filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. 4. I verify that the statements made in this Affidavit are true and correct. I understand LAW OFFICES SNELBAKER& BRENNEMAN, P.C. that false statements herein are made subject to the penalties of 18 Pa. C. S. § 4904, relating to unsworn falsification to authorities. Date: ?1 r? ?'? 0201/' Laverne D. Smith , y, Fi •? f? -t t,.. ?10i i J11; 14 P 3- `'° "T1 t 1 Q d.? ''i ??? iJ b J w t ti e I P ENNSYLV,,? N,11% NANCY L. SMITH, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 2010 - 4079 CIVIL TERM LAVERNE D. SMITH, Defendant CIVIL ACTION - LAW IN DIVORCE DEFENDANT'S WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees, or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. 4. I verify that the statements made in this affidavit are true and correct. I understand LAW OFFICES SNELBAKER 8C BRENNEMAN, P.C. that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities. Date: G Laverne D. Smith NANCY L. SMITH, Plaintiff V. LAVERNE D. SMITH, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSY /ANA r 4 r i4l - NO. 2010- 4079 CIVIL TERM ?f3 `- ,_. CIVIL ACTION-LAW` IN DIVORCE - CA) ? j MARITAL SETTLEMENT AGREEMENT THIS AGREEMENT is made this /07 day of June, 2011, by and between Nancy L. Smith, of Carlisle, Cumberland County, Pennsylvania (hereinafter referred to as "Wife"), and Laverne D. Smith, of Newville, Cumberland County, Pennsylvania (hereinafter referred to as "Husband") RECITALS R.1: The Parties hereto are Husband and Wife, having been joined in marriage on October 11, 1975 in Newville, Pennsylvania; and, R.2: The parties have been living in separate residences since May, 2010; and, R.3: Differences have arisen between the parties, in consequence of which they intend to continue to live separate and apart; and, R.4: Wife filed a Complaint for Divorce in the Court of Common Pleas of Cumberland County in the Commonwealth of Pennsylvania, to above-captioned docket number on June 17, 2010; and, R.5: It is the desire and intention of the parties, to amicably adjust, compromise and settle all property rights, and all rights in, to or against the property or estate of the other, including property heretofore or subsequently acquired by either party, and to settle all disputes existing between them, including any claims or rights that they may have under the provisions of the Pennsylvania Divorce Code, as amended; and, R.6: Husband and Wife declare that each has had a full and fair opportunity to obtain independent legal advice of counsel of their selection. Wife has been independently represented by Michael A. Scherer, Esquire, who is her separate counsel. Husband has been independently represented by Keith Brenneman, Esquire, who is his separate counsel. NOW THEREFORE, with the aforementioned recitals being hereinafter incorporated by reference and deemed an essential part hereof and in consideration of the covenants and promises hereinafter to be mutually kept and performed by each party, as well as for other good and valuable consideration, receipt of which is hereby acknowledged, and the parties, intending to be legally bound, hereby agree as follows: 1. SEPARATION: It shall be lawful for each party at all times hereafter to live separate and apart from the other party at such place or places as he or she from time to time may choose or deem fit, free from any control, restraint or interference from the other. Neither party shall disparage or discredit the other in any way, nor in any way injure his or her reputation; nor shall either of them act or permit anyone else to act in any way which might tend to create any disaffection or disloyalty or disrespect between the members of the family of either party. 2 2. DIVORCE: The parties acknowledge that the marriage is irretrievably broken and that they will secure a mutual consent no-fault divorce decree in the above- captioned divorce action. Simultaneous with the execution of this Agreement, the parties shall execute the Affidavits of Consent and Waiver of Notice Forms necessary to finalize said divorce. Said Affidavits and Waivers shall be immediately filed with the Prothonotary's Office. If either party fails or refuses to execute and file the foregoing documents, 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. 3. REAL PROPERTY: The parties are owners as tenants by the entireties of real estate located at 34 W. Big Spring Avenue, Newville, Cumberland County, Pennsylvania. The marital residence recently appraised for $138,000.00. Husband shall pay Wife the sum of $69,000.00 representing Wife's share of the equity in the marital residence within thirty days of the date of this agreement. Simultaneous to the receipt of her funds, Wife shall sign a deed conveying all of her right, title and interest in the marital residence to Husband. At the time Husband pays Wife for her share of the equity in the marital residence, Husband shall pay Wife the additional sum of $2,000.00, representing Wife's share of the fair rental value of the real estate during the period of separation during which Husband occupied the real estate. 3 4. TANGIBLE PERSONAL PROPERTY: Wife shall retrieve the following items of personal property from the marital residence within thirty days of her receipt of her share of the equity in the marital residence: a. piano in marital residence; b. vanity table in garage; c. corner cupboard originating from Nancy's grandmother; d. walnut table; e. hope chest from Harvey family; f. Christmas items (half of them); g. Boxes in garage loaded by Husband with Wife's belongings. Aside from the foregoing, the parties have divided their tangible personal property upon a basis which as nearly as possible equitable divides such property between them and each party shall keep as their separate property the items currently in their respective possessions. Each party shall keep as their separate property the motor vehicle(s) they currently possess and use. 5. INTANGIBLE PERSONAL PROPERTY: Husband has an Individual Retirement Account (number xxxxxx6561) with Lincoln Financial Group, which shall be divided equally between the parties based upon the value as shown on the statement dated for the month of April, 2011. Husband shall cooperate with the transfer of funds from this account into Wife's name which shall occur through a rollover of the funds into an account in Wife's name alone. Wife shall be responsible to effectuate this rollover. 4 This paragraph shall constitute Husband's authorization and consent for Wife's counsel to communicate with the investment company or advisor to gather the information necessary to accomplish the rollover via a Qualified Domestic Relations Order or any other procedure required by the investment company. Husband has also accrued a 401 K plan from Tyco Corporation which shall be divided equally between the parties. Husband shall cooperate with the transfer of funds from this account into Wife's name which shall occur through a rollover of the funds into an account in Wife's name alone. Wife shall be responsible to effectuate this rollover. This paragraph shall constitute Husband's authorization and consent for Wife's counsel to communicate with the investment company or advisor to gather the information necessary to accomplish the rollover via a Qualified Domestic Relations Order or any other procedure required by the investment company. Aside from the foregoing, each party shall keep as their separate property any bank accounts or other investment accounts in their respective names. 6. ALIMONY: The parties waive any claim to alimony against each other. 7. DEBT: There is no marital debt or debt in the joint names of the parties. Any debt presently in Husband's name shall be his sole obligation to repay, and he shall indemnify Wife against any claims from creditors therefore. Any debt presently in Wife's name shall be her sole obligation to repay, and she shall indemnify Husband against any claims from creditors therefore. 8. AFTER-ACQUIRED PROPERTY: Each of the parties shall own and enjoy, independently of any claims or rights of the other, all real property and all items of 5 personal property, tangible or intangible, acquired during separation or hereafter, with full power to dispose of the same as fully and effectively as though he or she were unmarried. Any property so acquired shall be owned solely by that party and the other party shall have no claim to that property. 9. LIFE INSURANCE: To the extent that there is whole life insurance insuring either party, the party to whom the policy is titled shall keep the value of the policy as their separate property. 10. ATTORNEY'S FEES: Except as otherwise herein provided, each of the parties waives the right to receive a payment for counsel fees from the other, and each shall be responsible for his or her own counsel fees, costs and expenses, if such fees or expenses are incurred. 11. ADDITIONAL INSTRUMENTS: Except as otherwise herein provided, each of the parties shall from time to time, at the request of the other, execute, acknowledge and deliver to the other party, within ten (10) days of any request to do so, any and all further instruments that may be reasonably required to give full force and effect to the provisions of this Agreement. 12. COMPLETE DISCLOSURE: Each of the Parties hereto acknowledges they have disclosed all of their income to the Cumberland County Domestic Relations Office at the support conference held in this matter on August 31, 2010 and that their incomes have not materially changed since August 31, 2010. Husband's support obligation will end effective with the issuance of a Divorce Decree, and counsel, or the 6 parties, if necessary, shall notify the Domestic Relations Office immediately upon the issuance of a Divorce Decree. Each party has also disclosed all of their material assets. Wife warrants that she has no retirement accounts or investment accounts aside from any savings she may have accumulated during separation. Husband warrants that, aside from the retirement accounts listed herein, bank accounts at F&M Trust (#xx-xx494) and ACNB (account number xxx118) and any savings he has accumulated during separation, that he has no other investment accounts or substantial assets. The Parties do hereby acknowledge that there has been full and fair disclosure to the other of his or her respective income, assets and liabilities, whether such are held jointly, in the name of one party alone or in the name of one of the parties and another individual or individuals. The parties waive their right to conduct formal discovery under the Rules of Civil Procedure based upon the full disclosure of assets as set forth herein. 13. RELEASE of ALL CLAIMS: Except as otherwise provided herein, each Party releases and discharges completely and forever the other from any and all right, title, interest or claim of past, present or future support, division of property, including income of gain from property hereafter accruing, right of dower or curtesy, the right to act as administrator or executor of the estate of the other, the right to a distributive share of the other's estate, any right of exemption in the estate of the other, or any other property rights, benefits or privileges accruing to either party by virtue of their marriage relationship, or otherwise, whether the same are conferred by statutory or common law of the Commonwealth of Pennsylvania, or any other state, or of the statutory or 7 common law of the United States of America. Except as provided herein, the Parties specifically waive any and all rights that they may have to equitable distribution of marital property and/or alimony and counsel fees, except those counsel fees sought in the event of a breach of this Agreement, or any other marital rights as provided in the Pennsylvania Divorce Code, Act 26 of 1980 or any amendment thereto. Each party further releases the other from any and all claims or demands up to the date of execution hereof and any other claims either party could raise which arise from the marriage, contract or otherwise. 14. SEPARABILITY of PROVISIONS: If any term, condition, clause or provision of this agreement shall be determined or declared to be void or invalid in law or otherwise, then only that term, condition, clause or provision shall be stricken from this Agreement and in all other respects this agreement shall continue in full force, effect and operation. 15. GOVERNING LAW: All matters affecting the interpretation of this Agreement and the rights of the Parties hereto shall be governed by the laws of the Commonwealth of Pennsylvania. 16. INCORPORATION into DIVORCE DECREE: The Parties agree that 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. Upon entry of the Decree, the provisions of this Agreement may be incorporated by reference or in substance, but they shall not be deemed merged into such Decree. The Agreement shall survive any such Decree in Divorce, shall be independent thereof, and the Parties intend that all 8 obligations contained in this Agreement shall retain their contractual nature in any enforcement proceedings, whether enforcement is sought in an action on the contact itself at law or in equity, or in any enforcement action filed in a Divorce action. 17. BREACH: It is expressly stipulated that in the event that either party breaches any provision of this Agreement, he or she shall be responsible for any and all costs incurred to enforce the Agreement, including, but not limited to, court cost and counsel fees of the other party. In the event of breach, the other party shall have the right, at his or her election; to sue for damages for such breach or to seek such other and additional remedies as may be available to him or her. 18. ENTIRE UNDERSTANDING: This Agreement constitutes the entire understanding between the parties and there are no covenants, conditions, representations, or agreements, oral or written, of any nature whatsoever, other than those herein contained. 19. AGREEMENT BINDING on PARTIES and HEIRS: It is understood and agreed that not only the Parties hereto, but also their heirs, administrators, executors and assigns, shall be bound by all the terms, conditions and clauses of this Agreement. 9 IN WITNESS WHEREOF, the parties hereto, intending to be legally bound hereby, have hereunto set their hands and seals to this Agreement the day and year first above written. WITNESS: 41,4t, Michae ; . S herer, squire dI ( Nancy . Smith Keith O. Brenneman Q ? -' ;7? Laverne D. Smith 10 NANCY L. SMITH, Plaintiff Vs. LAVERNE D. SMITH, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION - LAW NO. 2010-4079 IN DIVORCE PRAECIPE TO TRANSMIT RECORD TO THE PROTHONOTARY: Transmit the record, together with the following information, divorce decree: -) f-..3 r7l : u = C= : L IMF , ; to the Court fofe ntry of a 1. Ground for divorce: irretrievable breakdown under Section 3301(c) of the Divorce Code. 2. Date and manner of service of the Complaint: Defendant received divorce complaint by certified mail on June 10, 2010. 3. (complete either paragraph (a) or (b).) A. Date of execution of the affidavit of consent required by Section 3301(c) of the Divorce Code: by Plaintiff on June 14, 2011; and Defendant on June 10, 2011. B. (1) date of execution of the Plaintiffs Affidavit required by Section 3301(d) of the Divorce Code: N/A (2) date of service of the Plaintiffs Affidavit upon the Defendant: N/A 4. Related claims pending: Parties Marital Settlement Agreement dated June 10, 2011 is incorporated but not merged herein as a final order of court.. 5. Indicate date and manner of service of the notice of intention to file praecipe to transmit record, and attach a copy of said notice under section 3301(d)(1)(i) of the Divorce Code: None served as the parties signed the Waiver of Notice. Defendant on June 10, 2011 and Plaintiff on June 10, 2011. Respectfully submitted, MichaAAerer, Esquire NANCY L. SMITH IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. LAVERNE D. SMITH No. 2010-4079 DIVORCE DECREE AND NOW, un c- Z it is ordered and decreed that NANCY L. SMITH , plaintiff, and LAVERNE D. SMITH , defendant, are divorced from the bonds of matrimony. Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: (If no claims remain indicate "None.") Parties Marital Settlement Agreement dated June 10, 2011 is incorporated but not merged herein as a final order of court. By the Court, ee jv ORDERMOTICE TO WITHHOLD INCOME FOR SUPPORT 10-4079 CIVIL State: Commonwealth of Pennsylvania C Original Order/Notice Co./City/Dist. o : CUMBERLAND C' Amended Order/Notice Date of Order/Notice: 09/07/11 Cl Terminate Order/Notice Case Number (See A e?for case summary) C One-Time Lump Sum/Notice RE: SMITH, LAVERNE D. Employer/Withholders Federal EIN Number Employee/Obligor's Name (Last, First, MI) 217-60-1933 SOCIAL SECURITY ADMINISTRATION mpoyee igors Social ecun y um er STE 1 3022102291 200 S SPRING GARDEN ST mpoyee igors ase en i 1er CARLISLE PA 17013-2578 (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. $ 0.00 per month in current child support $ 0.00 per month in past-due child support , Arrears 12 weeks or greater? C no $ 0.00 per month in current medical support c zn -?a a $ 0.00 per month in past-due medical support r" $ 0.00 per month in current spousal support err- $ 0.00 per month in past-due spousal support ?- t $ 0.00 per month for genetic test costs CD _rl $ 0.00 per month in other (specify) = r-, $ one-time lump sum payment tv ?r for a total of $ 0.00 per month to be forwarded to payee below. :r T You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period (twice a month) $ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shown above as the Employee/Obligor's rAl, se Identifier SOC/ SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH B BY THE COURT: _, I - ; .J i _ i f Wesley Oler,Xr., / OMB No.: 0970-0154 Form EN-028 Service Type M Worker ID $OINC ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS F? If checked you are required to provide a copy of this form to your employee. If your employee works in a state that is different from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* EmployeelObligor 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. 8384100092 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEEI01111II.IGOR NO LOWER° Nl ,$ FOR: O EMPLOYEE'S/OBLIGOR'S NAME: SMITH LAVERNE D. EMPLOYEE'S CASE IDENTIFIER: 3022102291 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: _ NEW EMPLOYER'S NAME/ADDRESS: FINAL PAYMENT AMOUNT: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: 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 childsuooort state pa us OMB No.'. 0970-0154 Form EN-028 Service Type M Page 2 of 2 Worker ID $OINC ADDENDUM Summary of Cases on Attachment Defendant/Obligor: SMITH, LAVERNE D. PACSES Case Numbe r 878111762 PACSES Case Number Plaintiff Name NANCY L. SMITH Plaintiff Name Docket Atta 2010-4079 CIV $ chment Amour 0 00 Docket Attachment Amount Child(ren)'s Name(s): . $ 0.00 DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name DDoc?k ..t Attac hment Amount $ 0.00 Docket Attachment Amount $ Child(ren)'s Name(s): 0.00 DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Nam Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Service Type M Addendum Form EN-028 OMB No.: 0970-0754 Worker ID $OINC In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION NANCY L. SMITH ) Docket Number: 2010-4079 CIV Plaintiff ) vs. ) PACSES Case Number: 878111 - LAVERNE D. SMITH ) ? *.. Defendant ) Other State ID Number. ; .t f J ..?, (Pr- Kam,. a zw.- "?"? 1 C-3 y Order i r *'3 ryw AND NOW to wit, this SEPTEMBER 8, 2011 it is hereby Ordered that: THE ALIMONY PENDENTE LITE ORDER IS TERMINATED, EFFECTIVE JUNE 24, 2011, PURSUANT TO THE PARTIES' DIVORCE DECREE OF JUNE 24, 2011. THE ABOVE CAPTIONED CASE IS CLOSED WITH A CREDIT OF $683.22. Form OE-520 02/11 Service Type M Worker ID 21205 BY THE COURT: