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HomeMy WebLinkAbout01-1297WENDELL B. LEHMAN, Plaintiff CHERYL E. HINKLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2OOl- /5?7 CIVIL ACTION-LAW IN DIVORCE CIVIL TERM NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divome 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, GOUNSEL 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 ATTORNEY AT ONCE. IF YOU DO NOT HAVE AN ATTORNEY OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 Telephone: (717) 249-3166 WENDELL B. LEHMAN, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2001- / ~ ~ 7 CIVIL TERM CHERYL E. HINKLE, Defendant CIVIL ACTION-LAW IN DIVORCE COMPLAINT UNDER SECTIONS 3301(C) AND 3301(D) OF THE DIVORCE CODE 1. Plaintiff is Wendell B. Lehman, an adult individual who currently resides at 16 Camellia Lane, Waggaman, Louisiana 70094. 2. Defendant is Cheryl E. Hinkle, an adult individual who currently resides at 20 Carter Place, Carlisle, Cumberland County, Pennsylvania and is represented by Carol Lindsay, Esquire. 3. Defendant has been a bona fide resident 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 January 1, 1993 in Las Vegas, Nevada. There have been no prior actions of divorce or for annulment between the parties. 6. 7. The marriage is irretrievably broken. The Plaintiff has been advised of the availability of counseling and that he may have the right to request that the court require the parties to participate in Counseling. 8. Plaintiff requests the court to enter a decree of divorce. II NHEREFORE, the Plaintiff requests the court to enter a decree of divorce in favor of the Plaintiff and against the Defendant. Respectfully submitted, O'BRIEN, BARIC & SCHERER I.D.# 61974 17 West South Street Carlisle, PA 17013 (717) 249-6873 Attorney for Plaintiff, Wendell B. Lehman masodirldomesticldivorcellehman.com VERIFICATION verify that the statements made in this Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. Wendell B. Lehman Date: WENDELL B. LEHMAN, Plaintiff CHERYL E. HINKLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2001-1297 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE ACCEPTANCE OF SERVICE AND NOW, this )"~ day of March, 2001, I, Carol J. Lindsay, Esquire, attorney for Cheryl E. Hinkle, the Defendant above, hereby accept service of the Complaint filed in the above case pursuant to Pa. R.C.P. 1920.4(e) and acknowledge receipt of a true and attested copy of said Complaint, WENDELL B. LEHMAN, , Plaintiff CHERYL E. HINKLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2001-1297 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE DEFENDANT'S AFFIDAVIT OF CONSENT, ACCEPTANCE OF SERVICE AND WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF DIVORCE DECREE UNDER SECTION 3301(C) OF THE DIVORCE CODE 1. A complaint in divorce under Section 3301(C) of the Divorce Code was filed on March 7, 2001. 2. Carol J. Lindsay, Esquire, Attorney for the Defendant signed an Acceptance of Service form on March 13, 2001. 3. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of the filing of the Complaint. 4. I consent to the entry of a final decree in divorce without notice. 5. 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. 6. 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. 7. I have been advised of the availability of marriage counseling and understand that I may request that the court require counseling. I do not request that the court require counseling. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Date: JUf~ Z~ 2 200~ JUI~ ~ 12001 WENDELL B. LEHMAN, Plaintiff CHERYL E. HINKLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2001-1297 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE 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 1. A complaint in divorce under Section 3301 lC) of the Divorce Code was filed on March 7, 2001, 2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of the filing of the Complaint. 3. I consent to the entry of a final decree in divorce without notice. 4. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 5. I understand that I will not be divorced until a Divorce Decree is entered by the Court and that a copy of the Decree will be sent to me immediately after it is filed with the Prothonotary. 6. I have been advised of the availability of marriage counseling and understand that I may request that the court require counseling. I do not request that the court require counseling, I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorifies. Date: ~/--,'//~/ {/'~ ~ II'"B. L'ehman '///~'L/'~//~e' ~ ~ ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of Date of Order/Notice 12/07/01 Court/Case Number (See Addendum for case summary) (~ Odginal Order/Notice O Amended OrdedNotice O Terminate Order/Notice Employer/Withholder% Federal EIN Number ALTON OC}{SNER MEDICAL FOUNDATI Employe rANit hholde r's Name C/O PAYROLL DEPARTMENT Employe r/Wit hholde r's Address 1516 JEFFERSON HWY NEW ORLEANS LA 70121-2429 RE: LEHmaN, MENEELL B. Employee/Obligor's Name (Last, First, MI) 197-40-7208 Employee/Obiigor's Social Security Number 9769100885 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 abovemamed employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 606.64 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? (~)yes C) no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 606.64 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' 'oes not match the ordered support payment cycle, use the following to determine how much to $ 139.99 per weekly pay period. $ 279.99 per biweekly pay period (every two weeks). $ 303.32 per semimonthly pay period (twice a month). $ 606.64 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten ('~ ,ne date of this Order/Notice. Send payment within seven (7) working days of the paydate/date . You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the w~, your employee for the the allowable amount. The total withheld amount, and your fee, cannot exceed 55. ,ne 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, PA YMENTS 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 ~IAIL. Date of Order: Service Type M Form EN-028 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS [] If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priori~. 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.* Repolting the Paydate/Date of Withholding. You must m~,rt the paydate/date ofw;thho[ding when sending the payment The ~,ayclat~:iat~ of withholding is th~ date on which amount was withheld fi'om the en,ployec's wage~. 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 mom 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: 6778100]_6s EMPLOYEE'S/OBLIGOR'S NAME: LEHMAN, WENDELL B. EMPLOYEE'S CASE IDENTIFIER: 9769100885 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 am 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)l; 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: 5tote, 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 32O CARLISLE PA 17013 If yOU or your employee/obligor have any questions, contact WAGE A'FFACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (71 7) 240-6248 or by Internet @ Page 2 of 2 OM8 No.: 0970-0154 Form EN-028 Service Type M Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: LEHMAN, WENDELL B. PACSE$ Case Number 071104040 /~/~.~1~f Plaintiff Name F Docket Attachment Amount 01-1297 CIVIL $ 606.64 Child(mn)'s Name(s): DOB [Jif 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 $ o.oo Child(mn)'s Name(s): DOg i-hr checked, you are required to enroll the child(ren) identified above in any, health insurance coverage available through the employee s/obligor% employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.00 Child(ren)'s Name(s): DOB [] If checked, you are required to enroll the child(mn) identified above in any, health in, surance coverage available through the employee s/obligor s employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB [] If checked, you are required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSE$ Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOg []If checked, you are required to enroll the child(mn) 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 i ii [] If checked, you are required to enroll the child(ten) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum OM B No.: 0970-0154 Form EN-02§ Service Type M Worker ID $IATT OROl rJnOt ce to WITI4HOLD ncome eot su.eort State Commonwealth of Pennsylvania Co./CiW/Dist of CUMBERT'~ND Date of Order/Notice 01/14/0:~ Court/Case Number ('See Addendum/'or case summary) Employer/Withholder's Federal E[N Number WTNN DIXIE LOUISIANA INC ~mployerh/VJthholder's Name L~O BOX 1540 £mploye r/Withho(de r's Address FORT WORTH TX 76101-1540 (~ Original Order/Notice Amended Order/Notice O Terminate Order/Notice ) RE: LE~M3LN, WENDELL B. Employee/Obligor's Name (Last, First, MI) 197-40-7208 Employee/Obligor% Social Security Number 9769100885 Employee/Obli§or's Case Identifier (See Addendum for plaintiff names assodated 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 OrdedNotice to Withhold income for Support based upon an order for support from CUMBERIm, ND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the abovemamed employee's/obligor's income until further notice even if the OrdedNotice is not issued by your State. $ 606.64 per month in current support $ 0.0o per month in past-due support Arrears 12 weeks or greater? (~)yes O no $ 0.00 per month in medical support $ 0,00 per month for genetic test costs $ per month [n other (specify) for a total of $ 6 0 6.6~, 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 d"es not match the ordered support payment cycle, use the following to determine how much to withhold. $ 139.99 per weekly pay period. $ 279.99 per biweekly pay period (every two weeks). $ 303.32 per semimonthly pay period (twice a month). $ 606,64 per monthly pay period. REMITTANCE INFORMATION: YOU must begin withholding no later than the first pay period occurrin§ ten Order/Notice. Send payment within seven (7) working days of the paydate/, deduct a fee to defray the cost of withholding. Refer to the laws governing the allowable amount. The total withheld amount, and your fee, cannot exct (~)/~ ~'~ f this _..led to _. employee for the the employee's/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on w[ihholding, 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 1-877-676-95§0 for instructions. Make Remittance Payable to: PA SCDU Date of Order: JAN 1 5 2002 Service Type M 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 THI: COURT: J1~ll~l"~l,ll--ll~--JJM, No.:O~7oo,s4 Worker ID $IATT / ./~,,~.f_,.,.~ Expiration Date: 1~'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 Pay,Jate/Date of Withholdin§. You must lepor~ the paydateMate of withholding whee sending tile payment Tile payd,de/date of withholding is the date on wl~ich amount was withheld fi~m 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: 7204885730 EMPLOYEE'S/OBLIGOR'S NAME: LEHMAN, WENDELL ]3. EMPLOYEE'S CASE IDENTIFIER: 9769100885; 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)l; or 2) the amounts allowed by the State of the employee's/obJigor'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 Jaw 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 If you or your emp{oyee/obligor have any questions, contact WAGE ATI'ACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet ~ Service Type M Page 2 of 2 Form EN~028 WorkerlD $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: LE~r¢~, W~NDEnL B. PACSF~$ Case Number 071104040,/~/f1~/~'~.~,7 Plaintiff Name ' CHERYL E. HINK~E Docket Attachment Amount 01-1297 CIVIL $ 606.64 Chi[d(ren)'s Name(s): DOB i--Jif checked, you are required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB J~lf checked, you are required to enroll the child(mn) identified above in any, health i,nsurance coverage available through the employee s/obligor s employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB :...:'~ ~ : J~lf checked, you are required to enroll the child(ten) identified above in any heakh insurance coverage available through the employee's/obli§or's employment PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOI~ l-hr checked, you are required to enroll the child(ten) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB E]lf checked, you are required to enroll the child(mn) identified above ~n any, heakh insurance coverage available through the employee s/obligor's employment. PACSE$ Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB J~lf checked, you are required to enroll the chiid(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M Addendum Form EN-028 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT . State Commonwealth of Pennsylvania Date of Order/Noti~ 0~/31/02 ~ ~/~ CouWCase Number (S~ (~) Odginal Order/Nofice O Amended Order/Notice O Terminate Order/Notice Employer/VVithholder's Federal EIN Number WINN DIXIE LOGISTICS INC Employer/Wit hholde r's Name PO BOX B Em ployer/~VithhoJder'~ Address JACKSON-q'ILLE FL 32203-0297 RE: LEHMAN, WENDELL B. Employee/Obligor'$ Name (Last, First, MI) 197-40-7208 Employee/Obligor's Social Security Number 9769100885 EmployeeJObligor's Case identifier (See A~ndum for plaintiff names a~odate8 wi~ cases on attao~ment) 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. $ 606.64 per month in current support $ 100.00 per month in past~due support Arrears 12 weeks or greater? (~)yes O no $ o. o0 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 706.64 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: $ 163.07 per weekly pay period. $ 3:[6.14 per biweekly pay period (every two weeks). $ 353.32 per semimonthly pay period (twice a month). $ 706.64 per monthly pay period. REMITTANCE INFORMATION: - (~. '~ YOU must begin withholding no later than the first pay period occurring ten Order/Notice. Send payment within seven (7) working days of the paydz deduct a fee to defray the cost of withholding. Refer to the laws gover the allowable amount. The total withheld amount, and your fee, ca' ~,, %~'' aggregate disposable weekly earnings. For the purpose of the limita, ~, .~ needed (See #9 on pg. 2). \,,j If remitting by EFT/EDI, please call Pennsylvania State Collections and Disb~. Customer Service at 1-877-676-9580 for instructions. '*e of this entitled to oyee for the ,e's/obligor's ,¢ing information is ,CDU) Employer Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: FEB 1 2002 ~___ ~Z'>~.~ ~/,c~ ~. [~ ~' Form~:~-L~ Se~iceType M ~,~.~ OMBNo.:0970-0154 WorkerlD $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS [] If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of th 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 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.* Repo, ting the PaydateJDate of Withholding. You reu~t ~epo~t the paydate/date of withholding when sending the payme,,t. The pay~l~te/date of withholding i~ the date on which amount was ,,*ithheld fl~m the em~loyee'~ wa~s. 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/oblJgor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) S. 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. WlTHHOLDER'S ID: ~93652949o EMPLOYEE'S/OBLIGOR'S NAME: .LEHMAN, W~NDE.L.L ~,. EMPLOYEE'S CASE IDENTIFIER: 9"/69'1008~5 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)l; 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: ,~OMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 1 7013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (71 7) 240-6248 or by Internet Service Type Page 2 of 2 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: LElqSL~N, WENDELL B. PACSES Case Number 071104040,'/~/~.Q~//~/ Plaintiff Name / CHERYL E. HINKLE Docket Attachment Amount 01-1297 CIVIL$ 706.64 Child(ren)'s Name(s): DOB [-hf checked, you are required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSE$ C~se Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB :. r-Ill checked, you are required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Cbild(mn)'s Name(s): OOg r-Ill checked, you are required to enroll the child(mn) identified above in any, health i.n, surance coverage available through the employee s/obligor s employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB J--Ill checked, you are required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSE$ Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DO8 I-'-ilf checked, you are required to enroll the child(ten) identified above in any, health insurance coverage available through the employee s/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Childimn)'s Name(s): DOB I--Ill checked, you are required to enroll the child(mn) identified above in any health in, surance coverage available through the employee's/obligor s employment. Service Type M Addendum Form EN-028 Worker ID STATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Date of Order/Notice 0~/~2/02 ~ ~/~ Cou~C~e Number (See Addendum for case summary) C) Original Order/Notice C) Amended Order/Notice Q~ Terminate Order/Notice Employer/Withholder's Federal EIN Number WINN DIXIE LOGISTICS INC F m ploye r/~Vithholder's Name PO BOX B E m ploye r/Withholde r's Address JACKSONVILLE FL 32203-0297 ) RE: LEI{MAN, WENDELL B. I~mpJoyee/Obligor's Name (Last, First, Mi) 197-40-7208 £mp[oyee/Obligor's Social Security Number 9769100885 Employee/Obligor's Case Identifier (See Addendum for plaintiff names a~sociated with cases on allachment) 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 CUiV~ER~",TD County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0. 00 per month in past-due support Arrear~ "~eks or greater? C)yes (~) no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 0. O0 per month to be forwarded to payee ' You do not have to vary your pay cycle to be in compliance with thc the ordered support payment cycle, use the following to determine $ 0.00 per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ o. OD per semimonthly pay period (twice a month). $ o. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10~. g 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 cycle does not match 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: Service Type M OMBNO,:0970~0T$4 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice o~/1~/~ Cou~Cam Numar (S~ Addendum for case summary) Employer/~/ithhoJder's Federal EIN Number WINN DIXIE LOGISTICS INC Ernp]eyerANithhoJder's Name PO BOX B 5 mp~oyerANithho%der'$ Address JACKSONVILLE FL 32203-0297 (~) Original Order/Notice O Amended Order/Notice O Terminate Order/Notice ) RE: LEHM~, WEIN~DELL B. Employee/Obliger's Name (Last, First, MI) 19'/-40-'/208 Ernp~oyee/Obligor's Social 5ecuriW Number 9~6910088~ Employee/Obliger'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 CUMBERLA.ND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obliger's income until further notice even if the Order/Notice is not issued by your State. $ 606.64 per month in current support $ 100. O0 per month in past-due support Arrears 12 weeks or greater? (~)yes O no $ 0.00 per month in medical support $ o. GO per month for 8enetic test costs $ per month in other {specify) for a total of $ '706.6~, 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 $ 163. o? per week[,/pay period. $ 326.14 per biweekly pay period (every two weeks). $ 353,32 per semimonthly pay period (twice a month). $ 706.64 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) v Order/Notice. Send payment within seven (7) working days of the paydate/date ( o de, duct a fee to defray the cost of withholding. Refer to the laws governing the w___ the allowable amount. The total withheld amount, and your fee, cannot exceed 55% ofihe ~mployee's/obiigor'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 Date of Order: JUL ] 9 2002 Service Type ~ 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~Obliger's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY TH~ Form EN-028 Worker ID $IATT ADDITIONAL INFORMATION TO I~MPLOYERS AND OTHI~R 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 Payx~ate/Date of withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withh~olding 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/obJigor'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: 5936529490 EMPLOYEE'S/OBLIGOR'S NAME: LEHMAN, WEND]~LL B. EMPLOYEE'S CASE IDENTIFIER: 9769100885 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. rf 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 off 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U,S.C. § 1673 (b)l; 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 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 @ Service Type Page 2 of 2 Form EN-028 Worker ID SZATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: LEHIv~.N, WE1NTDET,L B. PACSES Case Number 0 ? 110404 O/~%~L Plaintiff Name CHERYL E. HINKLE Docket Attachment Amount 01-1297 CIVIL $ 706.64 Child(ren)'s Name(s): PACS£S Case Number Plaintiff Name DOB Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB F-hf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ~-hf checked, you are required to enroll the child(ten) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name .Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB []lf checked, you are requ red to enroll the child ten) identified above in any health nsurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name ..Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB [] If checked you are requ red 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 $ o.oo 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 empioyee'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. Service Type M Addendum Form EN-028 Worker ID $IATT ORDER/NOTICE I'O WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania /,~ ~27//6 ~"~:/~ Co./Ci~/Dist of Date of Order/Notice 08/o5/02 I~ Cou~Case Numar (See 4ddendum for case summary) Original Order/Notice Amended Order/Notice O Terminate Order/Notice EmployerA, Vithholder's Federal EIN Number LILJEBERG ENTERPRISES, INC E mp[oyerANithho[der's Name ET. 3 £mployerANith holder's Address 3900 VETERANS MEMORIAL BL METAIRIE LA 70002-5634 ) RE: LEHMAN, WEN-DELL B. Fmployee/Obligor's Name (Last, First, MI) 197-40-7208 Employee/Obligor's Social Security Number 9769100885 Employee/Obligor's Case Identifier (See Addendum for plaintiff names assoc/ated whit cases on attachment) Custodia) Parent's Name (Last, First, MI) ) See Addendum for dependent names and birth dates associated with cases on attachmenL ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from C~3E~...t.,.~'~ County, Commonwealth of Pennsylvania. By law, you am 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. $ 606.64 per month in current support $ 100.00 per month in past-due support Arrears 12 weeks or greater (~)yes C) no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 706.64 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: $ 163.07 per weekly pay period. $ 32.6,14per biweekly pay period (every two weeks). $ 353.32per semimonthly pay period (twice a month). $ 706.64 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 ]-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier)OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: Service Type ~ BY THE COURT: Form EN-028 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS [] If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of th 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 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 Paydat~/Date of Withholding. You must report the paydateJdate of withholding when sending the payment. The pay~lat~/date of withholding is tE, e date on which amount was withh~ld 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 lncome 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 employmenL 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: 9?40100].$6 EMPLOYEE'S/OBLIGOR'S NAME: LEHMAN, WENDELL B. EMPLOYEE'S CASE IDENTIFIER: 9769:].00885 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 slim 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 discipllnao/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)l; or 2) the amounts allowed by the State of the employee's/obligoffs principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandato~/ 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 If you or your employee/obligor have any questions, contact WAGE A'FI-ACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet @ Se~ice Type M Page 2 of 2 OM8 NO.: 0970-01 $4 Ex~)iration Date: 12/31/00 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: T.EHM~N, WENDELL PACSES Case Number Plaintiff Name CHERYL E o HINELE Docket Attachment Amount 01-1297 CIVIL $ 706.64 Child(ren)'s Name(s): DOB [] If checked, you a~e required to enroll the child(ten) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.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. PACS£5 Case Number Plaintiff Name Qocket Attachment Amount $ o.oo Child(mnYs Name(s): DOB [] If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB : ['~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 $ o.oo Child(ren)'s Name(s): DOB [] If checked, you are required to enroll the child(ten) identified above in any health insurance coverage available through the employee's,'oblJgor's employment. PACSES Case Number Plaintiff Name Docket Al~achment Amount $ 0.00 Child(ren)'s Name(s): DOB : : ~'-]lf checked, you are required to enroll the child(ten) identified above in any health insurance coverage available through the employee's/obligor's employment: Service Type M Addendum Form EN-028 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of ~,II~ER~I:) Date of Order/Notice 08102/02 Court/Case Number (See Addendum for case summary) Employer/Withholder's Foderal EIN Number WINN DIXIE LOGISTICS INC Employer/Withholder's Name PO EOX E Em pfoyer/Withhofder's Address JACKSONVILL~ FL 32203~0297 O Original Order/Notice C) Amended Order/Notice (~) Terminate Order/Notice ) RE: LE~I~i~N, WENDET,T, B. Employee/Obli§or's Name (Last, First, MI) 197-40-'7208 Employee/Obligor's Social Security Number 9769100885 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 assodated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERI,AND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? C) yes (~ no $ 0. o0 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 0. O0 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0. O0 per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydateJdate 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 aggre§ate 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-§77-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL, Date of Order: - Form EN-028 Worker iD $IATT Service Type M a ~. ~- _~, OM6 No.: O~O~S4 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/Da~e of withholding: You must report the paydate/date of withholding when sending theT~ayment. ~ paydate/date of withholding is the date on which amobnt was withhekl from the employee's wage~. You must comply with the law of the state of the employee's/obligor's prindpal place of employment with respect to the time periods within which you must implement the withholding order and forward the support paymeets. 4.* Employee/Ob figor with Multiple Support Holdings: W 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 O~ders~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: 5936529490 EMPLOYEE'S/OBLIGOR'S NAME: 'r,EHMAN, WEND~.r,L B. EMPLOYEE'S CASE IDENTIFIER: 9?69100885 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, conrad 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 Ad (t 5 U,S.C. § t 673 (b)l; 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 Jeff after making mandatory deductions such as: State, Federal, local taxes; 5ocial 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 Jaw of the state that issued this order with respect to these items. Requesting Agency: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P,O. BOX 32O CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-622,5 or by FAX at (717) 240-6248 or by Internet @ Service Type Page 2 of 2 Form EN-028 Worker ID $IATT . , ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania ~,/~/, ~O/ -/~-/7 C~/'///Z- Co./City/Dist. of COMBW, RLA.ND (~ '7//b~b~b Date of OrdedNotice 12/05/02 Tribunal/Case Number (See Addendum for case summary) RE: LEHMAN, WENDELL B. EmployerANithholder's Federal EIN Number LILJEBERG ENTERPRISES, INC FL 3 3900 VETERANS MEMORIAL BL METAIRIE LA 70002-5634 O Ori§inal Order/Notice O Amended Order/Notice (~) Terminate Order/Notice Employee/Obligor's Name (Last, First, MI) 197-40-7208 Employee/Obligor's Social Security Number 9?69100885 Emp[oyee/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. $ 0.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes (~) no $ 0.0o per month in medical support $ 0. oo per month for genetic test costs $ per month in other (specify) for a total of $ 0. O0 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ o. 00 per weekly pay period. $ o. 00 per biweekly pay period (every two weeks). $ o. oo per semimonthly pay period (twice a month). $ 0. 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 am entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-875-676-9580 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 MALL. Date of Order: F'EJ3 ~ 2003 Service Type BY THE 7~ OMi]No 0970.0154 Worker ID $IATT ADDITIONAl_ INFORMATION TO EMPl-OYERS AND OTHER WITHHOLDERS [] If f~hecke~ you are required to provide a gopy of this form to your ~,mpJoyee, If yogr employee works in a state that is different trom the state that issued this or(~er, a copy must be proviaed to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of th is order have priority, If them are Federal tax levies in effect please contact the requesting agency listed below. 3, Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/ob}igor. 4.* Reporting the Paydate/Date of Withholding. Youmus~ ~epor~e/da~exrf~n s~nd~ paymer, t,~ I~,old[~e date on which amount wag w~thheld 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. 5.* Employee/Obligor with Multiple Support Holdings: If there is mom 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 posslble. (See//-10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 9740100186 EMPLOYEE'S/OBLIGOR'S NAME: LE~'i~Lz~, WEITDELL B. EMPLOYEE'S CASE IDENTIFIER: 9'759100885 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State ]aw governs unless the obligor is employed in another State, in which case the raw of the State in which he or she is employed governs. 9. Anti~liscrimination: 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. 10.* Withholding Limits: You may not withhold mom than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (1 $ U.S.C. § 1673 (b) l; or 2) the amounts alrowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARl-ISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE A'UFACHMENT UNIT by telephone at (717) 240.6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 Form EN-028 Worker ID $IATT VVENDELL B. LEHMAN, Plaintiff CHERYL E. HINKLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2001-1297 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE CERTIFICATE OF SERVICE I, Michael A. Scherer, Esquire, attorney for the Plaintiff in the above-captioned divorce action, do hereby certify that I served a certified copy of the Complaint in Divorce to the Defendant, as per the attached U.S. Postal Service Certified Mail, return receipt card. O'BRIEN, BARIC & SCHERER BY 'M~.'~S~Esq u ire DATE: July 17, 2001 SENDER: i aleo ~ to receh,e the follow- [] Complete items 1 and/or 2 for additionel services, ing services (fo~ an extra fee): D Write ,Retum ReeW;*pf Requestsd' on t~e rneilpieoe be4ow the &rti~e number, U The Return Recei¢ vail ,h~w to whom the article wa, delbefed and the dar, ~..~- 3 Article Addressed to: '~ 4a. Anlcle Number l~,,~l~,e '~· ~ · '" 4b, Service Type ?.~dllel~l~ I~ll[ · ~e E3 Exprsss Mail ~[~lnsured ~__ ~ ~ E] Re~mRec.,ptforMerchandlse r~COD 5. Received By: (Pdnt Name) 8. Addrees~e s Ad(~'ess (Only if requested and '~~res$~rAg~ PS Forn~811 ~ December 1994 ~ 0259~-99.8-o223 Domestic Return Receipt ~ W. High stl~et Car~ PA. MARITAL SETTLEMENT AGREEMENT THIS Agreement made this ~.,_~. ~.¢,~ ~ day of //~/~,'~ ~_~ .~ 2000 by and between CHERYL E. HINKLE of 20 Carter Place, Carlisle, Cumberland County, Pennsylvania, hereinafter referred to as WIFE, and WENDELL B. LEHMAN, of ! '-~ ~o.. ~ ~ i I ~-~ LA. L,,.)o.~ ,'~ ~t,/, A , hereinafter referred to as HUSBAND, WITNESSETH: WHEREAS, the parties hereto are HUSBAND and WIFE, having been joined in marriage on January 1, 1993; and WHEREAS, the parties hereto executed an Ante-Nuptial Agreement on December 3'1, 1992 and an Addendum to the Ante-Nuptial Agreement on or about March 2, 2000, according to the terms of which Addendum, HUSBAND was to pay to WIFE $63,000.00, and according to which such obligation was secured by a Note and Mortgage on real estate owned by HUSBAND; and WHEREAS, HUSBAND desires to sell the real estate free of WIFE's lien and to pay WIFE, instead, alimony in the amount of $606.64 commencing January 1, 2001 until paid in full; and WHEREAS, the parties hereto are desirous of settling fully and finally their respective financial and property dghts and obligations as between each other, including, without limitation, the settling of all matters between them relating to the ownership of real and personal property, claims for spousal support, alimony, alimony pendente lite, counsel fees and costs, and in general, the settling of any and all claims and possible claims against the other or against their respective estates. NOW, THEREFORE, in consideration of these considerations, and the mutual promises and undertakings hereinafter set forth, and for other good and valuable consideration, receipt and sufficiency of which is hereby acknowledged by each of the parties hereto, HUSBAND and WIFE, each intending to 5e legally bound, hereby covenant and agree as follows: 1. Advice of Counsel: The parties hereto acknowledge that each has been notified of his or her right to consult with counsel of his or her choice, and have been provided a copy of this agreement with which to consult with counsel. WIFE is represented by Carol J. Lindsay, Esquire, and HUSBAND has been advised that he may be represented by counsel of his choice Each party acknowledges and accepts that this agreement is, in the cimumstances, fair and equitable, and that it is being entered into freely and voluntarily, after having received such advice and with such knowledge as each has sought from counsel, 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 improper or illegal agreement or agreements. 2. Divorce: If one or the other parties files a Complaint for Divorce, the parties agree to the entry of a Decree in Divorce. The parties will execute, 90 days after the service of the Complaint in Divorce, Affidavits of Consent and Waivers of Notice under Section 3301(c) of the Divome Code, consenting to the entry of a Decree in Divorce. 3. Personal Property: The parties acknowledge that they have equitably and satisfactorily divided all of their personal property, and that all personal property :~ PA shall be the sole and individual property of the party in whose possession it is as of the date of this agreement. The parties waive any interest they may have in any property in the possession of the other, including employment benefits, vehicles, bank accounts, investments or any other such property required by one or the other of them in the course of their marriage. 4. Real Property: WIFE is the owner of a home at 20 Carter Place, Carlisle, Cumberland County, Pennsylvania, which was purchased prior to the parties' marriage. Pursuant to the parties Ante-Nuptial Agreement, HUSBAND waives any claim he may have to an interest in WIFE's realty. 5. Aliroony: HUSBAND will pay to WIFE alimony in the amount of $606.64 commencing January 1, 2001 and on the first day of every month thereafter for 178 months. Said alimony payments shall survive the death of WIFE, the death of HUSBAND, the remarriage or cohabitation of WIFE and, in the event of WIFE's death, shall be payable to her estate. The parties acknowledge that they have from one another each other's Social Security Number. Alimony payments shall be deducted from HUSBAND's gross income for the purposes of filing federal income tax returns and includible in WIFE's gross income for the same purpose. The alimony payments set out herein shall be payable to the Office of Domestic Relations of Cumberland County or the Office of Domestic Relations of a county having jurisdiction over HUSBAND. Enforcement shall be by attachment or garnishment of HUSBAND's wages. 6. Marital Debt: The payment of alimony set out in Paragraph 5 above is in consideration of certain madtal debt which WIFE has assumed in its entirety. The SAR)IS $1tI~, FLOWER & LINDSAY 26 W, ~h ~lreet C. M4ble~ PA 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' martial assets and all other rights determined by this Agreement including alimony shall be subject to court determination the same as if this Agreement had never been entered into. 7. Statement of Address and Employment: HUSBAND certifies that his address and telephone number are as follows: HUSBAND further certifies that the name, address and telephone number of his employer is as follows: By these presence, HMSBAND provides to WIFE a release to obtain from his employer any and all information necessaw to the placement of a garnishment or aRachment of his income pursuant to the terms of Paragraph 5 above. IN WITNE88 WHEREOF, the paRies hereto have set their hands and seals the day and year first above written. Witness: fyi E. Hink~e/ WENDELL B. LEHMAN, IN THE COURT OF COMMON 'PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA CHERYL E. HINKLE, Defendant NO. 2001-1297 CIVIL TERM CIVIL ACTION-LAW IN DIVORCE PRAECIPE TO 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: Service upon the Defendant via certified mail-restricted delivery on March 10, 2001. 3. (Complete either paragraph (a) or (b).) (a) Date of execution of the affidavit of consent required under Section 3301(c) of the divorce code: by the plaintiffJune 11. 2001 , by the defendant June 21, 2001 (b) (1) Date of execution of the plaintiff's affidavit required by Section 330 l(d) of the divorce code N/A (2) Date of service of the plaintiff's affidavit upon the defendant N/A 4. Related claims pending NONE 5. Complete either (a) or (b) (a) Date and manner of service of the notice of intention to file praecipe to transmit record, a copy of which is attached: N/A (b) Date plaintiff's waiver of notice in Section 3301(c) divorce was filed with the Prothonotary: June 27, 2001 Date defendant's waiver of notice in Section 3301 (c) divorce was filed with the Prothonotary: June 27, 2001 Michael A. Esquire Attorney for Plaintiff, Wendell B. Lehman IN THE COURT Of COMMON PLEAS WENDELL B. LEHMAN, Plaintiff OFCUMBERLANDCOUNTY STATE Of ~. PENNA. NO. 2001-1297 CIVIL CHERYL E. VERSUS HINKLE, Defendant DECREE iN DIVORCE WENDELL B. LEHMAN DECREED THAT CHERYL E. HINKLE AND , 200 I, It IS ORDERED AND · PLAINTIFF, , DEFENDANT, ARE DIVORCED FROM THE BONDS OF MATRIMONY. THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD iN THIS ACTION FOR WHICH A FINAL ORDER }-lAS NOT YET BEEN ENTERED; THE MARITAL SETTLEMENT AGREEMENT SIGNED BY THE PARTIES ON NOVEMBER 20, 2000 IS INCORPORATED HEREIN AS A FINAL ORDER.