HomeMy WebLinkAbout02-5040 NMORDERMOTICE TO WITHHOLD INCOME FOR SUPPORT IA - S D ?? Q t?? 7 U ' L
State: Commonwealth of Pennsylvania 733 i (] 4?S 4 Q Original Order/Notice
Co./City/Dist. of: CUMBERLAND Q Amended Order/Notice
Date of Order/Notice: 06113/11 (?) Terminate Order/Notice
Case Number (See A en um for case summary) O One-Time Lump Sum/Notice
Employer/Withholder's Federal EIN Number
LEMOYNE SLEEPER CO INC*
PO BOX 227
LEMOYNE PA 17043-0227
RE: LOWRY, ROBERT S.
Employee/Obligor's Name (Last, First, MI)
162-48-0922
Employee/Obligor's Social Secun-i71Tu_m_Fe_r
5402100251
mp oyee igor 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 child support
$ 0.00 per month in past-due child support Arrears 12 weeks or greater? p yes Q no
$ 0.00 per month in current medical support
$ 0.00 per month in past-due medical support o -?
$ 0.00 per month in current spousal support mom' C_
$ 0.00 per month in past-due spousal support -;z
$ 0.00 per month for genetic test costs
-? CM a
$ 0.00 per month in other (specify) f -- ,
$ one-time lump sum payment `-' ? r
x
for a total of $ 0.00 per month to be forwarded to payee below. T -
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle"do4s0nofA' atch
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 ID
(shown above as the Employee/Obligor's Case Identifi OR SO IAL SECURITY NUMBER IN ORDER TO BE
PROCESSED. DO NOT SEND CASH SYMAIL. ??
BY THE COURT:
J. V O(sley Oler,,*, Juclop
OMB No.: 0970-0154 Form EN-028
Service Type M Worker ID $IATT
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
n If checked you are required to provide a copy of this form to your employee. If your employee works in a state that is
different from the state that issued this order, a copy must be provided to your employee even if the box is not checked.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the
requesting agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment
to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to
each employee/obligor.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of
the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement
the withholding order and forward the support payments.
4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support
against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you
must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the
greatest extent possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for
you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2316394770
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: Q
EMPLOYEE'S/OBLIGOR'S NAME: LOWRY, ROBERT S.
EMPLOYEE'S CASE IDENTIFIER: 5402100251 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER: _
NEW EMPLOYER'S NAME/ADDRESS:
FINAL PAYMENT AMOUNT:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should
have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding.
Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she
is employed governs.
9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place
of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes,
Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the
obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, that
50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State,
you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser
of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of
the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for
health care premiums in determining disposable income and applying appropriate withholding limits.
10. Additional info:
*NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the
state that issued this order with respect to these items.
11. Send Termination Notice and
other correspondence to:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
Service Type M
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by internet www.childsupport.state.pa.us
OMB No.: 0970-0154
Page 2 of 2
Form EN-028
Worker ID $IATT
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: LOWRY, ROBERT S.
PACSES Case Number 248104975
Plaintiff Name
KAREN A. LOWRY
Docket Attachment Amount
02-5040 CIVIL $ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Do kke Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACKS Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
Service Type M
PACSES Case Number 733104854
Plaintiff Name
KAREN A. LOWRY
Docket Attachment Amount
00826 S 2002 $ 0.00
Child(ren)'s Name(s): DOB
CHRISTIAN NATHANIEL LOWRY 03/31/00
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACKS Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
i
'.?.ddeodum
OW1B No.: 0970-0154
Form EN-028
Worker ID $IATT
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT U? - 5D 4o Ll L r ?
State: Commonwealth of Pennsylvania 7 5 5 / 0 4 s3 54-
Co./City/Dist. of: CUMBERLAND Ya, t, ,s IW ?
Date of Order/Notice: 06/13/11
Case Number (See A e?for case summary)
Employer/Withholder's Federal EIN Number
ALLEN DISTRIBUTION'
PO BOX 62
PLAINFIELD PA 17081-0062
RE: LOWRY, ROBERT S
Qi Original Order/Notice
Q Amended Order/Notice
O Terminate Order/Notice
O One-Time Lump Sum/Notice
Employee/Obligor's Name (Last, First, MI)
162-48-0922
Employee/Obligor's Social Secur-ii71Tu_m_Fe_r
5402100251
mp oyes igor 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.
$ 798.00 per month in current child support
$ 0.00 per month in past-due child support Arrears 12 weeks or greater? yes Q no
$ 0.00 per month in current medical support
$ 0.00 per month in past-due medical support
$ 165.00 per month in current spousal support - 4
$ 35.00 per month in past-due spousal support C=
$ 0.00 per month for genetic test costs
$ 0.00 per month in other (specify) rn
$ one-time lump sum payment < -1-;
for a total of $ 998.00 per month to be forwarded to payee below. = r.)
v ..
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cyGT? do 's nobmatch
the ordered supoort payment cycle, use the following to determine how much to withhold:
$ a 3D,.? 1 per weekly pay period. $ 499.00 per semimonthly pay period
(twice a month)
$ 40. uA per biweekly pay period (every two weeks) $ 998.00 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 Case Identifier R SOCIAL SECURITY NUMBER IN ORDER TO BE
PROCESSED. DO NOT SEND CASH BYrMAIL.
BY THE COURT:
T
,?_, C_ 1 Ll
J. Wes[O Oler, Jr., Judge
OMB No.: 0970-0154
Service Type M
Form EN-028
Worker ID $IATT
I
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
? if checked you are required to provide a copy of this form to your employee. If your employee works in a state that is
different from the state that issued this order, a copy must be provided to your employee even if the box is not checked.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the
requesting agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment
to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to
each employee/obligor.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of
the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement
the withholding order and forward the support payments.
4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support
against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you
must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the
greatest extent possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for
you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2515764450
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: Q
EMPLOYEE'S/OBLIGOR'S NAME: LOWRY, ROBERT S.
EMPLOYEE'S CASE IDENTIFIER: 5402100251 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER:
FINAL PAYMENT AMOUNT:
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should
have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding.
Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she
is employed governs.
9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place
of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes,
Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the
obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, that
50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State,
you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser
of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of
the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for
health care premiums in determining disposable income and applying appropriate withholding limits.
10. Additional info:
*NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the
state that issued this order with respect to these items.
11. Send Termination Notice and
other correspondence to:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
Service Type M
If you or your employee/obligor have any questions
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by internet www.childsupport.state.pa.us
OMB No.: 0970-0154
Page 2 of 2
Form EN-028
Worker ID $IATT
ADDENDUM
Summary of Cases on Attachment
DefendanUObligor: LOWRY, ROBERT S.
PACSES Case Number 248104975
Plaintiff Name
KAREN A. LOWRY
Docket Attachment Amount
02-5040 CIVIL $ 200.00
Child(ren)'s Name(s): DOB
PACSES Case Number 733104854
Plaintiff Name
KAREN A. LOWRY
Docket Attachment Amount
00826 S 2002 $ 798.00
Child(ren)'s Name(s): DOB
CHRISTIAN NATHANIEL LOWRY 03/31/00
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
Addendum Form EN-028
Service Type M OMB No.: 0970-0154 Worker ID $IATT
i
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
State: Commonwealth of Pennsylvania 7331 D4 2-c34-
Co./City/Dist. of: CUMBERLAND
Date of Order/Notice: 07/01 /11
Case Number (See A e?for case summary)
EmployerNVithholder's Federal EIN Number
ALLEN DISTRIBUTION`
PO BOX 62
PLAINFIELD PA 17081-0062
RE: LOWRY, ROBERT S.
D,- 50 ?-D 0-1 \J) )
0 Original Order/Notice
(. Amended Order/Notice
0 Terminate Order/Notice
0 One-Time Lump Sum/Notice
Employee/Obligor's Name (Last, First, MI)
162-48-0922
Employee/Obligors Social Secun7Vu_m_l5_er
5402100251
Employee/Obligor's Case Identifier
(See Addendum for plaintiff names
associated with cases on attachment)
Custodial Parent's Name (Last, First, MI)
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts
from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your
State.
$ 798.00 per month in current child support
$ 52.00 per month in past-due child support Arrears 12 weeks or greater? O yes 0 no
$ 0.00 per month in current medical support
$ 0.00 per month in past-due medical support
$ 165.00 per month in current spousal support
C ? "Yt
$ 35.00 per month in past-due spousal support
$ 0.00 per month for genetic test costs
$ 0.00 per month in other (specify) rrj
$ one-time lump sum paymentA J ;?Dq
for a total of $ 1,050.00 per month to be forwarded to payee below. ?C:) -?
You do not have to vary your pay cycle to be in compliance with the support order. If your pay 5ycpe dd-0 n tch
the ordered support payment cycle, use the following to determine how much to withhold: >
$ ?44A31 per weekly pay period. $ 525.00 per semimonthly play period.
(twice a month)
$ 'k4. iea per biweekly pay period (every two weeks) $ 1,050.00 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 Emp/oyee/Obligor's Case Idendri OR??IAL SECURITY NUMBER IN ORDER TO BE
PROCESSED. DO NOT SEND CASH. BY AIL. ?
BY THE COURT: Tr, I,-
6V Wesley Mer, Jr., Judge /
OMB No. 0970-0154 Form EN-028
Service Type M 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. If your employee works in a state that is
different from the state that issued this order, a copy must be provided to your employee even if the box is not checked.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the
requesting agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment
to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to
each employee/obligor.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of
the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement
the withholding order and forward the support payments.
4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support
against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you
must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the
greatest extent possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for
you. Please provide the information requested and return a copy of this Order/Nptice to the A®ency identified below. 2515764450
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE EMPLOYEIEJOBLIGOR NO LONG WORKS FOR: O
EMPLOYEE'S/OBLIGOR'S NAME: LOWRY ROBERT S.
EMPLOYEE'S CASE IDENTIFIER: 5402100251 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 flail 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.
y
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 Wsnits: 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/obligoes 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.ch3ldsuppgrt.state.pa.us
Service Type M
OMB No.: 0970-0154
Page 2 of 2
Form EN-028
Worker ID $IATT
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: LOWRY, ROBERT S.
PACSES Case Number 248104975 PACSES Case Number 733104854
Plaintiff Name Plaintiff Name
KAREN A. LOWRY KAREN A. LOWRY
Docket Attachment Amount Docket Attachment Amount
02-5040 CIVIL $ 200.00 00826 S 2002 $ 850.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s):
CHRISTIAN NATHANIEL LOWRY
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
DOB
03/31/00
PACSES Case Numb r
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
Addendum Form EN-028
Service Type M OMB No.: 0970-0154 Worker ID $IATT
In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013
Phone: (717) 240-6225 Fax: (717) 240-6248
Defendant Name: ROBERT S. LOWRY
Member ID Number: 5402100251
Please note: All correspondence must include the Member ID Number.
MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS
Financial Break Down of Multiple Cases on Attachment
PAES
PI iff N m Case Number N Docket
umber Attachment Amount/Frequency
KA A!{?bWA 248104975 02-5040 CIVIL 200.00 / MONTH
KA A.CMW 733104854 00826 S 2002 850.00 / MONTH
Vp n! /
Q
ts.p L)
CL Q !
at)C f' tin $ /
Via- ...! Cr
L- CDOU" TOTAL ATTACHMENT AMOUNT: $ 1,050.00
LL- =
c°l?+ U
Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment
Compensation Benefits (OUCB), is hereby directed to attach the lesser of $241.64 per week, or 55.0%,
of the Unemployment Compensation benefits otherwise payable to the Defendant, ROBERT S. LOWRY
Social Security Number XXX-XX-0922, Member ID Number 5402100251 . OUCB is ordered to remit the
amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received
from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages.
If the Defendant's Unemployment Compensation benefits are attached by another Court or
Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so
that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to
15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g).
This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall
remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the
Application for Benefits dated MARCH 15, 2009 is exhausted, expired or deferred.
OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this
Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations
Section of this Court.
BY THE COURT
Date of Order:
Service Type M
)Otl
J. Wesley OI , Jr., Judge
Form EN-034
Worker ID $IATT
In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013
Phone: (717) 240-6225 Fax: (717) 240-6248
P-a C'
Defendant Name: ROBERT S. LOWRY
Member ID Number: 5402100251 zM ? r i
Please note: All correspondence must include the Member ID Number. Cnt- r1'
C7
-<> ?
<
MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT Btt? F;FS
a cn
M x
Financial Break Down of Multiple Cases on Attachment
Plaintiff Namg
KAREN A. LOWRY
KAREN A. LOWRY
PACSES Docket
Case Number Number
248104975 02-5040 CIVIL
733104854 00826 S 2002
TOTAL ATTACHMENT AMOUNT:
Attachment Amount/Frequency
200.00 / MONTH
850.00 MONTH
1,050.00
Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment
Compensation Benefits (OUCB), is hereby directed to attach the lesser of $241.64 per week, or 55.0%,
of the Unemployment Compensation benefits otherwise payable to the Defendant, ROBERT S. LOWRY
Social Security Number XXX-XX-0922, Member ID Number 5402100251 . OUCB is ordered to remit the
amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received
from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages.
If the Defendant's Unemployment Compensation benefits are attached by another Court or
Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so
that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to
15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g).
This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall
remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the
Application for Benefits dated MARCH 15, 2009 is exhausted, expired or deferred.
OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this
Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations
Section of this Court.
BY THE COURT
JAN 0 3 2012
Date of Order.
JUDGE
Form EN-034
Service Type M Worker ID $IATT
INCOME WITHHOLDING FOR SUPPORT
D ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT (IWO)
AMENDED IWO ? 0 1 D L. -7 G
)
ONE•TIMEORDER/NOTICE FOR LUMP SUM PAYMENT rr'? 11 /y II
Q TERMINATION OF IWO 0A - _.1 L 'i D I V) 1
?'15"? iU4<?`-DLV
Date: 01/02112
[] Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One)
NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO
instructions htto://www.acf.hhs.gov/programs/cse/newhire/employer/publication/publication htm - forms). If you receive this document from
someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached.
watei 1 noel i erniory uommonweann of Pennsylvania Remittance Identifier (include w/payment): 5402100251 _
City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket informalton)
Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary)
ALLEN DISTRIBUTION'
PO BOX 62
PLAINFIELD PA 17081-0062
Employer/Income Withholder's FEIN
Child(ren)'s Name(s) (Last, First, Middle)
Child(ren)'s Birth Date(s)
RE: LOWRY, ROBERT S.
Employee/Obligor's Name (Last, First, Middle)
162-48-0922
Employee/Obligor's Social Security Number
(See Addendum for plaintiff names
associated with cases on attachment)
Custodial Party/Obligee's Name (Last, First,
Middle)
NOTE: This IWO must be regular on its face.
Under certain circumstances you must reject this
IWO and return it to the sender (see IWO
instructions
receive this document from someone other
a State or Tribal CSE agency or a Court, a
of the underlying order must be attached.
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County,
Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts fE
m tAg en ogee/
,
obligor's income until further notice.'
$ 798.00 per month in current child support -V:x
$ 52.00 per month in past-due child support - Arrears 12 weeks or greater? Q Ow "'urr,
$ 0.00 per month in current cash medical support
$ 0.00 per month in past-due cash medical support -<= --t
$ 165.00 per month in current spousal support ?C) -r?
$ 35.00 permonth in past-due spousal support ?`' ?
$ 0.00 per month in other (must specify)
for a Total Amount to Withhold of $ 1,050.00 per month. Co
AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information.
If your pay cycle does not match the ordered payment cycle, withhold one of the following amount:
$_?42, -1-1 per weekly pay period. $ 525.00 per semimonthly pay period (twice a month)
$ 474. 4,1 per biweekly pay period (every two weeks) $ 1,050.00 per monthly pay period.
$ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.
REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is CUMBERLAND Counter,
Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that
occurs ten (10) working days after the date of this Order/Notice. Send payment within even 7 working days of the
pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up
to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not
CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), obtain withholding limitations, time
requirements, and any allowable employer fees at =://www.acf hhs aov/rrograms/cse/newhire/employer/contacts/
contact map.htm for the employee/obligor's principal place of employment.
Document Tracking Identifier
OMB No.: 0970-0154 Form EN-028 11/11
Service Type M Worker ID $IATT
? Return to Sender [Completed by Employerlincome Withholder. Payment must be directed to an SDU in
accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not
directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to
the sender.
Signature of Judge/Issuing Official (if required by State or Tribal law):
Print Name of Judge/Issuing Official:
Title of Judge/Issuing Official:
Date of Signature: ION 0 l3a2
If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO
must be provided to the employee/obligor.
? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor.
ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered
to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of
two or more returned checks due to nonsufflcient funds. Please call the Pennsylvania State Collections and
Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as
the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT
SEND CASH BY MAIL.
State-specific contact and withholding information can be found on the Federal Employer Services website located at:
http:/Lww acf hhs oov/12rograms/cse/`newhire/em looye /contacts/contarA maap httm
Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42
§666(b)(7)). If a Federal tax levy is in effect, please notify the sender.
Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from
more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/
obligor's portion of the payment.
Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a
Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial
party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent
by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was
issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form.
Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the
amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if
applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement
the withholding and forward the support payments.
Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to
Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current
support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal
place of employment to determine the appropriate allocation method.
Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this
employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to
report and/or withhold lump sum payments.
Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the
employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and
any penalties set by State or Tribal law/procedure.
Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO.
OMB Expiration Date - 05/3112014. The OMB Expiration Date has no bearing on the termination date of the 1WO; it identifies the version of the form currently in use.
Form EN-028 11/11
Service Type M Page 2 of 3 Worker ID $IATT
Employer's Name: ALLEN DISTRIBUTION* Employer FEIN: -
Employee/Obligor's Name. LOWRY ROBERT S.
CSE Agency Case Identifier: (See Addendum for case summanr) Order Identifier: (See Addendum for order/docket information)
Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection
Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of
employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such
as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of
the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting
another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State
or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in
this section.
For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income
withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which
the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)).
Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in
determining disposable income and applying appropriate withholding limits.
Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the
Employer should calculate the CCPA limit using the lower percentage.
Additional Information:
NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you a
no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by
returning this form to the address listed in the Contact Information below:
Q This person has never worked for this employer nor received periodic income.
Q This person no longer works for this employer nor receives periodic income.
Please provide the following information for the employee/obligor:
Termination date:
Last known address:
Last known phone number:
Final Payment Date To SDU/Tribal Payee:
New Employer's Name:
New Employer's Address:
Final Payment Amount:
CONTACT INFORMATION:
To Employerlincome Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name)
by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.childsupgort.state.pa.us.
Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST.
P.O. BOX 320, CARLISLE. PA. 17013 (Issuer address).
To Em looyee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name)
by phone at (7717) 240-6225, by fax at (717) 240-6248, by email or website at www.childsupport.state.pa.us.
IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor.
Service Type M
OMB No.: 0970-0154
Page 3 of 3
Form EN-028 11/11
Worker ID $IATT
ADDENDUM
Summary of Comes on Attachment
Defendant/Obligor: LOWRY, ROBERT S.
PASSES Case Number 248104975
Plaintiff Name
KAREN A. LOWRY
Docket Attachment Amount
02-5040 CIVIL $ 200.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACKS Case Number
Plaintiff Name
pocket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number 733104854
Plaintiff Name
KAREN A. LOWRY
Docket Attachment Amount
00826 S 2002 $ 850.00
Child(ren)'s Name(s): DOB
CHRISTIAN NATHANIEL LOWRY 03/31100
PACKS Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
DQcke Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
Addendum Form EN-028 11 /11
Service Type M OMB No.: 0970-0154 Worker ID $IATT
In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013
Phone: (717) 240-6225
Defendant Name: ROBERT S. LOWRY
Member ID Number: 5402100251
Fax: (717) 240-6248
"V a
NI 73
Please note: note: All correspondence must include the Member ID Number. >
c-7-3
ORDER TO VACATE ATTACHMENT OF UNEMPLOYMENT BENEUTS
Plaintiff Name
KAREN A. LOWRY
KAREN A. LOWRY
Financial Break Down of Multiple Cases on A tachment
PACSES Docket
Case Number Number
248104975
733104854
02-5040 CIVIL
00826 S 2002
0.)
Attachment Amount/Frequency
i 200.00 / MONTH
798.00 / MONTH
/
i
/
TOTAL ATTACHMENT AMOUNT: $
998.00
The prior Order of this Court directing the Department of Labor and Industry, Office of
Unemployment Compensation Benefits (OUCB), to attach $229.67 or 50% per week of
the Unemployment Compensation benefits of ROBERT S. LOWRY, Social Security
Number XXX-XX-0922, Member ID Number 5402100251 is hereby vacated.
This Order to Vacate shall be effective upon receipt of the notice of the Order by the
Department and shall remain in effect until a further Order of the Court is filed.
Date of Order: MAR 1 8, 2014
Service Type M
BY THE COURT
Form EN-035
Worker ID $IATT
rn
c, •
CD