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HomeMy WebLinkAbout02-0517IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, CIVIL ACTION - LAW Plaintiff, VS. NO. 6a - S•l7 CIVIL DONALD E. BRICKER, Defendant. IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgement 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 grounds for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the office of the Prothonotary at Cumberland County Courthouse, Carlisle, PA 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 17013 717-249-3166 A COUNT FOR ALIMUIV Y rit 1vUL1,4 r. Ll l r, la xi.%.,JuI-, ?- ??------- AND A HEARING IS REQUESTED. WEIGLE, PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, CIVIL ACTION - LAW Plaintiff, CIVIL VS. NO. az - sr7 DONALD E. BRICKER, Defendant. IN DIVORCE COMPLAINT IN DIVORCE COUNT I - IRRETRIEVABLE BREAKDOWN AND NOW, comes the above named Plaintiff, Robin Rae Bricker, by and through her attorneys, Weigle, Perkins & Associates, and Jerry A. Weigle, Esquire, and seeks to obtain a Decree in Divorce from the above-named Defendant, upon the grounds hereinafter more fully set forth: 1. Plaintiff, Robin Rae Bricker, is an adult individual presently residing at 629 Pintail Drive, Horntown, Accomac County, Virginia 23395, with a mailing address of PO Box 272, Horntown, VA 23395, since June, 2001. 2. Defendant, Donald E. Bricker, is an adult individual presently residing at 154 Neil Road, Shippensburg, Cumberland County, Pennsylvania, 17257, since November 1997. 3. The Plaintiff and Defendant are nationals and citizens of the United States of America. The Defendant has been a bona fide resident of the Commonwealth of Pennsylvania for at least six (6) months immediately previous to the filing of the Complaint in Divorce. The Plaintiff currently resides within the Commonwealth of Virginia. 4. The Plaintiff and Defendant were married on July 23, 1993, in Chambersburg, Franklin County, Pennsylvania. 5. Plaintiff previously filed a Complaint in Divorce in Franklin County, Pennsylvania, to No. 2000- 984 Civil, on March 28, 2000. Said Complaint was withdrawn on or about June 15, 2000, when the parties reconciled. 6. Plaintiff has been advised that counseling is available and the Plaintiff may have the right to request that the court require the parties to participate in counseling. 7. The marriage is irretrievably broken. WEIGLE, PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 8. The parties have lived separate and apart since June, 2001. 9. The Plaintiff requests the court to enter a decree of divorce. WHEREFORE, the Plaintiff prays your Honorable Court to enter a Decree in Divorce from the bonds of matrimony and for such other and further relief to which Plaintiff shall be entitled. COUNT II - INDIGNITIES GROUNDS FOR DIVORCE 10. Paragraphs 1 through 9 of this Complaint are incorporated herein by reference as though set forth in full. 11. Defendant has offered to the person of the Plaintiff, Plaintiff being the innocent and injured spouse, such indignities as to render Plaintiffs condition intolerable and Plaintiffs life burdensome. WHEREFORE, the Plaintiff prays your Honorable Court to enter a Decree in Divorce from the bonds of matrimony and for such other and further relief to which Plaintiff shall be entitled. COUNT III - EQUITABLE DISTRIBUTION 12. Paragraphs 10 through 11 of Plaintiffs Complaint are incorporated herein by reference as though set forth in full. 13. Plaintiff and Defendant have legally and beneficially acquired property, both real and personal, during their marriage from July 23, 1993, until June, 2001, date of separation, all of which property is "marital property". 14. Plaintiff and/or Defendant have acquired, prior to the marriage or subsequent thereto, "non- marital property" which has increased in value since the date of the marriage and or subsequent to its acquisition during the marriage, which increase in value as marital property. 15. Plaintiff and Defendant have been unable to agree as to an equitable division of said property to the date of the filing of this Complaint and substantial portions of said property are in the exclusive control of Defendant. 16. Plaintiff requests the Court to equitably divide all marital property. II WHEREFORE, Plaintiff requests the Court to equitably divide all marital property and to enjoin Plaintiff and Defendant from the removal, disposition, alienation, or encumbering of all real and personal property of the parties. WEIGLE, PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 COUNT IV - ALIMONY PENDENTE LITE 17. Paragraphs 12 through 16 of Plaintiff s Complaint are incorporated herein by reference as though set forth in full. 18. Plaintiff is presently employed on a part-time basis but is without adequate funds to support herself and is presently unable to sustain herself and to pay necessary legal costs during the pendency of this action. 19. Defendant is presently employed and draws substantial sums of income from his employment. 20. Defendant has railed and refused to support Plaintiff adequately since the parties' separation. 21. Plaintiff requests that this petition be heard by the Cumberland County Domestic Relations Office. 22. Plaintiff prays your Honorable Court grant a Rule on Defendant to show cause why an Order should not be made upon him to pay Plaintiff alimony pendente lite. WHEREFORE, the Plaintiff prays your Honorable Court to enter a Decree in Divorce from the bonds of matrimony and for such other and further relief to which Plaintiff shall be entitled. WEIGLE, PERKINS & ASSOCIATES Q Ferry A. Weigle, Esquire Attorney for Plaintiff Attorney ID # 01624 126 East King Street Shippensburg, PA 17257 717-532-7388 WEIGLE, PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 VERIFICATION I verify that the statements made in the foregoing Complaint in Divorce are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa C.S. § 4904, relating to unworn falsification to authorities. Dated: / / -D9 -a2 Robi Bricker, Plaintiff WEIGLE, PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 \ tl CCU Q f T-1 ?(w It Gil '';-- _r g(? QJ } C) ?' , n V) z a N? a 064 N Z H A i N 0. H •?Z?a? Dz? ? z F o cv i wo Zee MARK, WEIGLE AND PERKINS, ATTORNEYS AT LAW 126 EAST KING STREET, SHIPPENSSURG, PENNA. 17257 TELEPHONE: (717) 532-7388 FAX: (717) 532.6552 ROBIN RAE BRICKER, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 2002-517 CIVIL TERM DONALD E. BRICKER, IN DIVORCE Defendant/Respondent DR# 31422 Pacses# 971104227 ORDER OF COURT AND NOW, this 31" day of January, 2002, upon consideration of the attached Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shaddav on March 1. 2001 at 10:30 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, George E. Hoffer, President Judge Mail copies on Petitioner 1-31-02 to: < Respondent Jerry Weigle, Esquire Date of Order: January 31, 2002 R J. Shadday, Conference Officer YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, Plaintiff CIVIL ACTION - LAW V. NO. 2002-517 DONALD E. BRICKER, Defendant IN DIVORCE ENTRY OF APPEARANCE TO PROTHONTARY: Please enter my appearance on behalf of the Defendant, DONALD E. BRICKER, in the above-captioned matter. Respectfully submitted, Dated: -? /I3fOZ- HANFT & KNIGHT, P.C. kae_p 22 ? Michael J. Hanft, Esquire Attorney ID No. 57976 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013-9142 (717) 249-5373 F:\Usa Folder\Fvm Docs\Gendocs2002\2625- I =try. appw .wpd n <--, z? `, -? rrt ?_?, r ?-? ... ?. ?:: ? :: »_ «- D C' T7 Z f _... '. _ ? ? ? r . , ? - .. ?ti, . .? ?R C31 -? ? C IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, CIVIL ACTION - LAW Plaintiff, VS. NO. 02-517 CIVIL DONALD E. BRICKER, Defendant. IN DIVORCE AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND Rhonda R. Wolford, being duly sworn according to law, deposes and says that on February 6, 2002, a true and attested copy of Divorce Complaint and Notice to Defend was served upon the Defendant, Donald E. Bricker. Manner of service: by mailing the same postage paid, certified mail, addressee only, and return receipt requested, at Shippensburg, Pennsylvania, addressed as follows: Donald E. Bricker 154 Neil Road Shippensburg, PA 17257 Sworn to and subscribed before me this 4' day of 12002. Notary Public y- c Von4da R. Wolford Notarial Seal Petfta l -Tbme, Notary Public Shippensbulg Boro, Cumberland County MY Commission Expires June 7,20M WEIGLE, PERKINS 6, ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ROBIN RAE BRICKER, CIVIL ACTION - LAW Plaintiff, NO. 02-517 CIVIL VS. DONALD E. BRICKER, IN DIVORCE Defendant. PROOF OF SERVICE (Domes tic f ;ovided) m.' ti m l q ()I{3- Postage $ 10.57 0257 7 Certified Fee 04 ul 41.50 Postmark r,.t Return Receipt Fee Here C3 (Fndomemem Required) 43.20 O R_ it d Delivery Fee C3 (Erldoreement Required) $ 17.37 02/05/2002 C3 loW Poenga a Fees m a ---------------------------------- 0 C3 0 r ------------------- ¦p?dear t andla 2 ror adds Medea. I s1w wish tD radxlvs the %IkrMrip esrvk:es (IN r a t ywnanw 3.4a, and 4b. pe" rb rw na old addna on 1M mares OHM tarn W that ws can MUM Wa B7Qri h19): r oes ya y ou owd to aAd?acht tlYa brm to the ft d of the mplpl a:w on IM back N opau doss rest 1. ? Addresses s Address )I(ROWL-W DoWery mmmar 2 W . . s .Wdr•itwmA oWFaauntod'onthemdpsawtowsrad 81he Ratum RscNPt ws show to whan tM a1Nde wr dolv*W aW sw dsla COtIBUIi pos4rtester for tN. ddWomd. 3. Arlds Addressed to: 4a. ArIldis Number - ooo3- 54o3 x113 nalA C. 13r icy er Dr aq erAw Type A d , 154 Aetl 2oar? ` ? Csrtl e 13 Egiress R Md ? Insured l Slit p pens) wq ' P f) I ?l a 5 PAwm Rnoeipl for M1wdwdds ? COD r li f D y ve e 7. Date o ??nn Addressee's Add.- (OrMyHregwsbd 8 5. Received By (Print Wame) . and foe is paid) PS F.: 3811, December 1994 lozsasa7au® n9 uomeaw new.. ow•r• WEIGLE, PERKINS 6 ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 ?_ fer `i? ' Il :Rl I 1- i-'J t _ v7 .' cr ?t_ 7, `? '?C_ _.?. '.?ci =?? a ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT W o?Olia - 5/ 7 6- state Commonwealth of Pennsylvania /0/71eS?17 (/+7116VD,)-7 Co./City/Dirt. of CUMBERLAND Date of Order/Notice 03/01/02 Court/Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number MARTIN'S FAMOUS PASTRY SHOPPE, Employer/withholder's Name 1000 POTATO ROLL IN Employer/Withholder's Address CHAMBERSBURG PA 17201-8897 (D Original Order/Notice O Amended Order/Notice O Terminate Order/Notice ) RE: BRICKER, DONALD E. Employee/Obligor's Name (Last, First, MI) 201-42-6781 Employee/Obligor's Social Security Number 1802000236 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MO 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. $ 2, 025.00 per month in current support $ 175.00 per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ o . 00 per month in medical support $ 0. oo per month for genetic test costs $ per month in other (specify) for a total of $ 2, 200.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 507.69 per weekly pay period. $ 1. o15.3e per biweekly pay period (every two weeks). $ 1. 100.00 per semimonthly pay period (twice a month). $ 2, 200.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Date of Order: 4 2002 KC G'/ t/ Q . /(,&,S TU lpE ,. Form EN-028 Service Type M sNo.:097om54 Worker ID $IATT ?7 -0? E.xEration Date: 12nl/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.* You must comply with the law of the paydate/date of withholding 05 tire da 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%bligor 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: 2512919770 EMPLOYEE'S/OBLIGOR'S NAME: BRICKER DONALD E. EMPLOYEE'S CASE IDENTIFIER: 1802000236 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employeetobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of., 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type to if you or your employeelobligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet Page 2 of 2 OMB No.: 097ao154 Expiation Date: 12/31/00 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BRICKER, DONALD E. PACSES Case Number 9 71104 2 2 7/3/ ya,a' PACSES Case Number Plaintiff Name Plaintiff Name ROBIN R. BRICKER Docket Attachment Amount Docket Attachment Amount 02-517 CIVIL $ 2,200.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M OMB NO.:w7o-otsa WorkerID $IATT Expiration Date: 12/31/00 C) u' i r o b0 c t o ? IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, Plaintiff/Petitioner CIVIL ACTION - DIVORCE V. No. 2002-517 (Civil Term) D.R. No. 31422 DONALD E. BRICKER, PACSES No. 971104227 Defendant/Respondent DEMAND FOR HEARING DATE OF ORDER: March 4, 2002 AMOUNT: $2,025.00 per month plus $175.00 per month on arrears FOR: Alimony Pendente Lite REASON(S): The amount for support was computed using bonuses which vary from year to year and are not guaranteed. The current calculation was computed using a $6,224.40 bonus received on December 28 2001 The March 4 2002 Order specifically obligates Defendant/Respondent to pay 40% of any bonuses received Thus the $6,224.40 bonus was improperly included in calculating the Defendant/ReMondent's monthly net income. PARTY FILING DEMAND FOR HEARING: Defendant/Respondent HANF & KNIGHT, P.C. Michael J. Hanft, Es uire Attorney I.D. No. 57976 3' l2-Uz Date Lindsay Gingrich Maclay, Esquire Attorney I.D. No. 87954 19 Brookwood Avenue, Suite 106 Carlisle, Pennsylvania 17013-9142 (717) 249-5373 Attorneys for Defendant/Respondent F1Uw Folder,Firtu D sNGendocs20 U625-I.suppon.appeal.wpd r n L fti C i ?Iris a.>, c? ?, ? ?.: ; rC.; ca ..,? ,> c_, "? Y tl' ? tJ . _?, C '?- { `' '? ? ? , Y ; ; S'? !N ? ?] ,: R c IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, Plaintiff/Petitioner CIVIL ACTION - DIVORCE V. No. 2002-517 (Civil Term) D.R. No. 31422 DONALD E. BRICKER, PACSES No. 971104227 Defendant/Respondent PRAECIPE TO WITHDRAW SUPPORT APPEAL TO THE PROTHONOTARY: Please withdraw the Support Appeal filed on March 13, 2002 in the above-referenced matter. HANFT & KNIGHT, P.C. Date: '1--V OY ?wi/?/ABGU ?(I C ichael J. a ft, E uire Attorney I.D. No. 57976 Lindsay Gingrich Maclay, Esquire Attorney I.D. No. 87954 19 Brookwood Avenue, Suite 106 Carlisle, Pennsylvania 17013-9142 (717) 249-5373 Attorneys for Defendant F.\USR FOJdM DO \G &.o 200=625-1 wjh&awsupp.rt appee"d ?a ? z,?;;: ,. ?,?; ; ,. _ _? v ?, ?-,, <? . -._? ?. _? '?_? ^?. ,?, (, ;? ?? ` J ?,r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, Plaintiff V. CIVIL ACTION - LAW IN DIVORCE DONALD E. BRICKER, NO. 02-517 Defendant NOTICE TO PLAINTIFF If you wish to deny any of the statements set forth in this Affidavit, you must file a counter- affidavit within twenty (20) days after this affidavit has been served on you or the statements will be admitted. DEFENDANT'S AFFIDAVIT UNDER SECTION 3301(d) OF THE DIVORCE CODE 1. The parties to this action separated in June of 2001 and have continued to live separate and apart from each other for a period of at least two years. 2. The marriage is irretrievably broken. 3. I understand that I may lose rights concerning alimony, division ofproperty, lawyer's fees or expenses if I do not claim them before a divorce is granted. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. Date: )-1I-oj Donald E. Bricker, Defendant F.\User Folder\FGm Was\Gendocs2003\2625-I aff con 3301d.wpd IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, Plaintiff CIVIL ACTION - LAW V. DONALD E. BRICKER, Defendant NO. 02-517 CIVIL TERM IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REOUEST ENTRY OF A DIVORCE. DECREE UNDER $3301 (C) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division ofproperty, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. Date: 9 a 7-0 3 Donald E. Bricker FAJUs,F.Id Tirt Doc,\Ce.o 20032625-1w.wv notwpd ORDER/NOTICE TO WITHHOLD INCOME FOR, SUPPORT State Commonwealth of Pennsylvania O Original Order/Notice Co./City/Dist. of CUMBERLAND O Amended Order/Notice Dote of Order/Notice 12/29/03 O Terminate Order/Notice Tribunal/Case Number (See Addendum for case summary) RE: BRICKER, DONALD E. EmployerM/ithholder's Federal [IN Number ',...// Employee/Obligor's Name (Last, First, MI) g7?ia?l L_ / 201-42-6781 Employee/Obligor's Social Security Number MARTIN'S FAMOUS PASTRY SHOPPE, 1802000236 1000 POTATO ROLL LN UUI -?' 7 Employee/Obligor's Case Identifier CHAMBERSBURG PA 17201-8897 (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. $ 2, 025. 00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0. oo per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 2, 025.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 467.31 per weekly pay period. $ 934.62 per biweekly pay period (every two weeks). $ 1.012.5o per semimonthly pay period (twice a month). $ 2.025. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: JAN U 2 LWT Form EN-028 Service Type M OMBNo.:097MI54 WorkerlD $IATT BY TH;%ILlf: h( ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? I f,?heckefl you are required to provide copy of this form to your mployee. If yoUr employee works in a state that is ai erent rom the state that issued this o er, a copy must be provi?ed 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 this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* Repo. thig the-11 iholding Mien sending the payment. The pa?date/date th.hrolding is the date - which ee's-w .. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 2512919770 EMPLOYEE'S/OBLIGOR'S NAME: BRICKER, DONALD E. EMPLOYEE'S CASE IDENTIFIER: 1802000236 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: * NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: 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) !40-6248 or by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 OMB No.: 0970-0154 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment DefendanWbligor: BRICKER PACSES Case Number 971104227 Plaintiff Name ROBIN R. BRICKER Docket Attachment Amount 02-517 CIVIL $ 2,025.00 Child(ren)'s Name(s): DOB DONALD E. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(re n) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment, through the ernployee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT OMB No.:OWO-0154 1 N - r ti7 W Jrn '. cn r < IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, CIVIL ACTION - LAW Plaintiff, NO. 02-517 CIVIL V. ' DONALD E. BRICKER, Defendant. IN DIVORCE COUNTER-AFFIDAVIT UNDER & 3301(d) OF' THE DIVORCE CODE 1. (b) I oppose the entry of a divorce decree. 2. (b) I have claimed economic relief in the divorce Complaint filed January 30, 2002 and served February 6, 2002. I verify that the statements made in this counter-affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Dated: Rob'n f ae Bricke , Plaintiff WEIGLE & ASSOCIATES. PC. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 c? ? o C_ d TI -T --i T_? I?? r f?> ? C% -' J _?Q '"' 1 w C?i 4J _? __I ?? %" ;? -C v- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, Plaintiff No. 02-517 V. CIVIL ACTION - LAW DONALD E. BRICKER, IN DIVORCE Defendant PETITION FOR MODIFICATION OR TERMINATION OF AN EXISTING ORDER FOR ALIMONY PENDENTE LITE 1. Petitioner, Donald E. Bricker is an adult individual residing at 154 Neil Road, Shippensburg, Cumberland County, Pennsylvania. Petitioner's date of birth is April 2, 1950, and his social security number is 201-42-6781. Respondent, Robin Rae Bricker is an adult individual whose last known address is 629 Pintail Drive, Homtown, Accomac County, Virginia. Respondent's date of birth is May 22, 1961, and her social security number is unknown. 2. The petition of Donald E. Bricker respectfully represents that on March 4, 2002, an Order of Court was entered for alimonypendente lite docketed to Cumberland County No. 2002-517. A true and correct copy of the order is attached to this petition. 3. Petitioner is entitled to termination or modification of this Order because of the following material and substantial change(s) in circumstances: Petitioner's earning capacity has decreased due to his six-month disability, which has not yet been approved for long-term disability. WHEREFORE, Petitioner requests that the Court modify or terminate the existing order for alimony pendente lite. P? 2?6, 260lq- Respectfully Submitted, KNIGHT & ASSOCIATES, RC. Sua-n M. Shultz, Attorney I.D. No. 90946 11 Roadway Drive, Suite B Carlisle, Pennsylvania 17013 (717) 249-5373 Attorneys for Petitioner F AUser Fo)derTmm Docs%midoc52006A2625-]pet modify. V1 wpd VERIFICATION I verify that the statements made in this complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Date Donald E. Bricker ROBIN RAE BRICKER, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 2002-517 CIVIL TERM DONALD E. BRICKER, IN DIVORCE Defendant/Respondent DR# 31422 Pacses# 971104227 ORDER OF COURT AND NOW, this 4s' day of March, 2002, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $1,176.36 and Respondent's monthly net income/earning capacity is $6,240.55, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $2,200.00 per month payable weekly as follows; $467.31 per week for alimony pendente lite and $40,38 per week on arrears. First payment due next pay date at $507.69 per week. Arrears set at $4,050.00 as of March 1, 2002. The effective date of the order is January 30, 2002. Husband is to make a direct payment of 40% of any and all net bonuses to wife within five days upon receipt of said bonus. He shall provede verification of said boinus to wife and send verification of same and verification of payment to the Domestic Relations Office within five days. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S. § 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Robin R. Bricker. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to, PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. Respondent to provide medical insurance coverage.. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. DRO: R. J. shadday BY THE COURT, Mailed copies on Petitioner 3A-02 to: < Respondent Michael Hang, Esquire f Jerry Weigle, Esquire Kevin A. Hess J. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, Plaintiff No. 02-517 V. CIVIL ACTION - LAW DONALD E. BRICKER, IN DIVORCE Defendant CERTIFICATE OF SERVICE I hereby certify that I am this t4 day of 4e-i4 , 2006, causing a copy of the Petition for Modification or Termination of an Existing Order for Alimony Pendente Lite be served upon the following person in the manner indicated: By First Class United States Mail, postage pre-paid on: Jerry A. Weigle, Esquire Weigle & Associates, P.C. 126 East King Street Shippensburg, Pennsylvania 17257-4295 Attorney for Respondent SrarrM. Shultz, Esc trireme Attorney I.D. No. 90946 11 Roadway Drive, Suite B Carlisle, Pennsylvania 17013 (717) 249-5373 Attorneys for Petitioner P'AUser foldeMirm DocsVGendccs2006@625-I pet modify V1 wed ROBIN R. BRICKER, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE, NO. 02-517 CIVIL. TERM DONALD E. BRICKER, IN DIVORCE Defendant/Petitioner PACSES # 971104227 ORDER OF COURT AND NOW, this 31st day of March, 2006, a petition has been tiled against you, Robin R. Bricker, to modify an existing Alimony Pendente Lite Order. You are ordered to appear in person at the Domestic Relations Section, 13 North Hanover Street, Carlisle, Pennsylvania, on April 27, 2006 at 10:30 A.M. for a conference and to remain until dismissed by the Court. If you fail to appear as provided in this Order, an Order of Court may be entered against you. You are further ordered to bring to the conference: (l) a true copy of your most recent Federal Income Tax Return, including W-2's as tiled (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by the Rule 1910.11. (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Edgar B. Bayley, President Judge Copies mailed March 31, 2006 to: Petitioner Respondent Sean M. Shultz, Fsq. Jerry A. Weigle, Esq. I Date of Order: March 31, 2006 k-i. adday, Conference Officer YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE ANDS REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE.. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 ?_ ?,> ;; -, . ,? :; _ ; ,, ?.? ' ?- :a , . ?,: In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION ROBIN R. BRICKER ) Docket Number 02-517 CIVIL Plaintiff /Respondent ) VS. ) PACSES Case Number 971104227 DONALD E. BRICKER ) Defendant/Petitioner ) Other State ID Number ORDER AND NOW, to wit, on this 11TH DAY OF MAY, 2006 IT IS HEREBY ORDERED that the support order in this case be Q Vacated or 0Suspended or Q Terminated without prejudice or Q Terminated and Vacated, effective MARCH 25, 2006 , due to: THE TERMINATION OF DEFENDANT'S SHORT TERM DISABILITY ON MARCH 25, 2006. -THERE IS CURRENTLY A CREDIT IN THE AMOUNT OF $1882.31. -DEFENDANT IS TO MAINTAIN MEDICAL INSURANCE ON WIFE THROUGH SEPTEMBER 25, 2006 AND TO ASSIST HER IN OBTAINING COBRA BENEFITS AFTER THE TERMINATION OF THE MEDICAL INSURANCE. --DEFENDANT IS TO REPORT TO THE DOMESTIC RELATIONS SECTION ON THE DISPOSITION OF THE LONG TERM DISABILITY CLAIM AND/OR SOCIAL SECURITY BENEFITS THAT HE MAY BE ENTITLED. -THE SPOUSAL SUPPORT ORDER MAY BE REVIEWED UPON THE CALL OF EITHER PARTY. BY THE COURT: Kevin A ess, 4 JUDGE DRO: R.J. Shadday Form OE-504 Service Type M Worker ID 21005 ViNVAIASnIN3d I h -8 WV S I AN 90oz AtM ONCHiOdd 3H13fl 3CH--o-03113 ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 05/11/06 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number MARTIN'S FAMOUS PASTRY SHOPPE, 1000 POTATO ROLL LN CHAMBERSBURG PA 17201-8897 201-42-6781 Employee/Obligor's Social Security Number 1802000236 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MU See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ o.0o per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Qyes ® no $ 0. 00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ o. oo per weekly pay period. $ o. 0o per biweekly pay period (every two weeks). $ o. oo per semimonthly pay period (twice a month). $ o . 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). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: .6111101P Service Type m q71/ 042Z7 02 517 Ci vi 1 O Original Order/Notice O Amended Order/Notice 0 Terminate Order/Notice RE: BRICKER, DONALD E. Employee/Obligor's Name (Last, First, MI) BY THE COURT: OMB No. 097"154 Form EN-028 Worker ID 21205 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? Ifghecke you are required to provide a?opy of this form to your mployee. If your employee works in a state that is di Brent rom the state that issued this order, a copy must be proviged 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.* Repoiting tL e Paydate/Date of Withholding. You most report the pay 'at ' late of Mthholding Mien sending the pay ... elit. TIT . You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2512919770 EMPLOYEE'S/OBLIGOR'S NAME: BRICKER, DONALD E. EMPLOYEE'S CASE IDENTIFIER: 1802000236 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: 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 171 7) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 OMB No.: 0970.0154 Form EN-028 Worker ID $IATT Z1 :S WV 91 AN 90oz 'AdViON01-UNd'd 3N1 3O 334d:+O,O3llJ I ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BRICKER, DONALD E. PACSES Case Number 971104227 PACSES Case Number Plaintiff Name Plaintiff Name ROBIN R. BRICKER Docket Attachment Amount Docket Attachment Amount 02-517 CIVIL $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Service Type M Addendum Form EN-028 OMB No.: 0970-0154 Worker ID $IATT IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, CIVIL ACTION - LAW Plaintiff, V. NO. 02-517 CIVIL DONALD E. BRICKER, Defendant. IN DIVORCE MOTION FOR APPOINTMENT OF MASTER Robin Rae Bricker, Plaintiff, moves the Court to appoint a Master with respect to the following claims: (X) Divorce (X) Distribution of Property ( ) Annulment ( ) Support (X) Alimony ( ) Counsel Fees ( ) Alimony Pendente Lite (X) Costs and Expenses and in support of the motion states: 1. Discovery is complete as to the claim(s) for which the appointment of a Master is requested. (real estate to be appraised; Defendant's pension to be valued). 2. The defendant has appeared in the action by his attorney, Sean M. Shultz, Esquire. 3. The statutory ground(s) for divorce is more than two year separation. 4. Delete the inapplicable paragraph(s): (a) The action is not consented. (c) The action is contested with respect to the following claims: alimony, distribution of property, costs and expenses. 5. The action does not involve complex issues of law or fact. 6. The hearing is expected to take % day. WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 7. Additional information, if any, relevant to the motion: None 8. Inventory was filed on 5 ?0O (o Date: ? 1 <16 (,P Attorney ID # 01624 126 East King Street Shippensburg, PA 17257 Telephone (717)532-7388 WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 WEIGLE & ASSOCIATES, P.C. c P 2 ?- ?K cr+ G rn Fn - 0 r ? ?. ? " ? ' y Cam? m. C c --1 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, Plaintiff, V. DONALD E. BRICKER, Defendant. CIVIL ACTION - LAW NO. 02-517 CIVIL IN DIVORCE INVENTORY OF ROBIN RAE BRICKER Rob) Rae Brick 9f, Plaintiff STREET - SHIPPENSBURG, PA 17257-1397 Plaintiff files the following inventory of all property owned or possessed by either parry at the time this action was commenced and all property transferred within the preceding three (3) years. Plaintiff verifies that the statements made in this inventory are true and correct. Plaintiff understands that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unworn falsification to authorities. ASSETS OF PARTIES Plaintiff marks on the list below those items applicable to the case at bar and itemizes the assets on the following pages: (X) 1. Real property (X) 2. Motor vehicles (X) 3. Stocks, bonds, securities and options ( ) 4. Certificates of deposit (X) 5. Checking accounts, cash (X) 6. Savings accounts, money market and savings certificates ( ) 7. Contents of safe deposit boxes ( ) 8. Trusts ( ) 9. Life insurance policies (indicate face value, cash surrender value and current beneficiaries). ( ) 10. Annuities () 11. Gifts ( ) 12. Inheritances ( ) 13. Patents, copyrights, inventions, royalties (X) 14. Personal property outside the home ( ) 15. Business (list all owners, including percentage of ownership, and officer / director positions held by a party with company) ( ) 16. Employment termination benefits - severance pay, worker's compensation claim / award ( ) 17. Profit sharing plans (X) 18. Pension plans (indicate employee contribution and date plan vests) (X) 19. Retirement plans, Individual Retirement Accounts ( ) 20. Disability payments ( ) 21. Litigation claims (matured and unmatured) ( ) 22. MilitaryN.A. benefits ( ) 23. Education benefits ( ) 24. Debts due, including loans, mortgages held (X) 25. Household furnishings and personalty (include as a total category and attach itemized list if distribution of such assets is in dispute) (X) 26. Other A. Three time shares B. Farm animals (goats) C. Farm/yard equipment ['REET - SHIPPENSBURG. PA 17257-1397 MARITAL PROPERTY Plaintiff lists all marital property in which either or both spouses have a legal or equitable interest individually or with any other person as of the date this action was commenced: Item Description Names of Number of Property All Owners 1. Home (farmette) real estate Both 2. 1997 Mercury Villager Both Flat trailer with side rails Both Motorcycle with travel trailer Both Ford truck with cap 3. Ameritrade stock shares Husband 5. Checking account Both 6. Savings account Both 14. Small rototiller In Husband's Possession Van seat In Husband's Possession DeWalt drill with charger and battery In Husband's Possession Power saw In Husband's Possession Golf cart In Husband's Possession Battery charger In Husband's Possession Radar detector In Husband's Possession Camera In Husband's Possession Binoculars In Husband's Possession Fishing & camping equipment In Husband's Possession Pontoon boat with motor & trailer In Husband's Possession Large generator In Husband's Possession Welder In Husband's Possession All power and hand tools In Husband's Possession VHF radio and loran In Husband's Possession Motorcycle leather with black chaps In Husband's Possession Movie camera In Husband's Possession Log Splitter In Husband's Possession 18. Pension plan Husband 19. Retirement Plan Husband WEIGLE 6 ASSOCIATES. P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 25. Hot tub Both Piano In Husband's Possession Washer and Dryer In Husband's Possession Wicker bedroom suite In Husband's Possession Oak bedroom suite In Husband's Possession Blue loveseat with couch In Husband's Possession Large China closet In Husband's Possession Grandfather clock In Husband's Possession Leather jacket In Husband's Possession Mounted sailfish In Husband's Possession Carnival glass In Husband's Possession 3 pieces olive green luggage In Husband's Possession Computer with monitor In Husband's Possession 2 tv sets In Husband's Possession 1 VCR In Husband's Possession Veneer bedroom set In Wife's Possession Movie camera In Wife's Possession Karaoke machine In Wife's Possession 3 wall paintings In Husband's Possession Gun cabinet In Husband's Possession 7 guns In Husband's Possession Lamps In Husband's Possession Dishes & cookware In Husband's Possession Towels, sheets & blankets In Husband's Possession All wall paintings and minors In Husband's Possession All Christmas decorations In Husband's Possession I refrigerator In Husband's Possession Living room suite with end tables In Husband's Possession Water bed suite In Husband's Possession Dining room suite In Husband's Possession China closet In Husband's Possession 2 refrigerators In Husband's Possession Stove In Husband's Possession Upright freezer In Husband's Possession Chest freezer In Husband's Possession 2 desks with chairs In Husband's Possession 1 computer with monitor, software & printer In Husband's Possession Air conditioner In Husband's Possession 1 large screen TV with surround sound In Husband's Possession 2 stereos - I with CD player & amplifier In Husband's Possession All appliances In Husband's Possession 1 TV - 18" In Husband's Possession 2 VCRs In Husband's Possession Microwave with stand In Husband's Possession WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 26.A. Sea Garden Ft. Lauderdale, Florida, time share Both Santa Barbara, Florida, time share Both Palm Springs, Florida, time share Both 26.B. 100 goats, steers, peacocks & chickens In Husband's Possession 26.C. Tractor with rake In Husband's Possession Skid loader with plow and lift In Husband's Possession Bush hog In Husband's Possession Manure spreader In Husband's Possession Riding lawn mower with trailer & leaf catcher In Husband's Possession NON-MARITAL PROPERTY Plaintiff lists all property in which a spouse has a legal or equitable interest which is claimed to be excluded from marital property: Item Description Reason for Number of Property Exclusion 1. Trails End, Virginia campsite (2 lots) Husband acquired prior to marriage WEIGLE & ASSOCIATES. P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 PROPERTY TRANSFERRED Item Description Date of Number of Property Transfer LIABILITIES Item Description Number of Property Dated: ji ur' aO0(o Consideration Names of All Creditors Respectfully submitted, Vqiry A. W igle, Esquire Attorney for Plaintiff Attorney ID #01624 Weigle & Associates, P.C. 126 East King Street Shippensburg, PA 17257 717-532-7388 Person to Whom Transferred Names of All Debtors r WEIGLE 6 ASSOCIATES. P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 a lz? c ? ? -Z Y • - . t n? G 3;, RECEIVED AUG 1 6 '1006 Y: l.- V IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, CIVIL ACTION - LAW Plaintiff, V. NO. 02-517 CIVIL DONALD E. BRICKER, Defendant. IN DIVORCE ORDER APPOINTING MASTER AND NOW, t'! 2006, is appointed Master with respect to the following claims: 64. 0 BY THE C ?" W\roo ?', J. WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 r -" i} N 1 ROBIN R. BRICKER, THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 02-517 CIVIL, TERM DONALD E. BRICKER, IN DIVORCE Defendant/Respondent PACSES CASE NO: 971104227 ORDER OF COURT AND NOW, this 26th day of October, 2006, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shadday on November 14, 2006 at 1:30 P.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Edgar B. Bayley, President Judge Copies mailed to: Petitioner Respondent Jerry A. Weigle, Esq. Sean M. Shultz, Esq. i f .14 Date of Order: October 26, 2006 Ai k i?,. . Sh . day, nference Officer /1' / YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 ca ? J r {? - ? Ol _ ... .,. J .t( 9 E.J?1 I ROBIN R. BRICKER, Plaintiff/Petitioner VS. DONALD E. BRICKER, Defendant/Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 02-517 CIVIL TERM IN DIVORCE PACSES # 971104227 ORDER OF COURT AND NOW, this 14th day of November, 2006, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $0 and Respondent's monthly net income/earning capacity is $0, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $2416.67 per month payable as follows: $2200.00 per month for alimony pendente lite and $216.67 per month on arrears. First payment due next pay date. Arrears set at $4400.00 as of November 14, 2006. The effective date of the order is September 25, 2006. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Robin R. Bricker. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the Respondent's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. cc360 This Order is based upon an agreement of the parties. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. Consented: Petitioner Respondent Petitioner's Attorney Respondent's Attorney BY THE COURT, I:;--. * X4 K n A. Hess, J. Mailed copies on: November 14, 2006 to: Petitioner Respondent Jerry A. Weigle, Esq. Sean M. Schiltz, Esq. DRO: R.J. Shadday ? CD - (7-n) , 7 r tat j t'T ;. Y ?_ 97//044227 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT Qa • .6/ 7 Gl1//L State Commonwealth of Pennsylvania ( Original Order/Notice Co./City/Dist. of CUMBERLAND O Amended Order/Notice Date of Order/Notice 11/14/06 O Terminate Order/Notice Case Number (See Addendum for case summary) RE: BRICKER, DONALD E. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) MARTIN'S FAMOUS PASTRY SHOPPE, 1000 POTATO ROLL LN CHAMBERSBURG PA 17201-8897 201-42-6781 Employee/Obligor's Social Security Number 1802000236 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. $ 2, 200. 00 per month in current support $ 216.67 per month in past-due support Arrears 12 weeks or greater? Dyes ® no $ 0.00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 2,416.67 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: $ 557.69 per weekly pay period. $ 1,115.39 per biweekly pay period (every two weeks). $ 1, 208.34 per semimonthly pay period (twice a month). $ 2, 416.67 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER 1D (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: NOV 1 5 2006 F EN 028 R orm - ev. Service Type M OMB No.: 0970-0154 Worker I D $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecke? you are required to provide a opy of this form to your m loyee. If yo1? r employee ?yorks in a state that is diferent from the state that issued this order, a copy must be provigedpto 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 employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2512919770 EMPLOYEE'S/OBLIGOR'S NAME: BRICKER, DONALD E. EMPLOYEE'S CASE IDENTIFIER: 1802000236 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: ]DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Service Type M OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BRICKER, DONALD E. PACSES Case Number 971104227 PACSES Case Number Plaintiff Name Plaintiff Name ROBIN R. BRICKER Docket Attachment Amount Docket Attachment Amount 02-517 CIVIL $ 2,416.67 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type M Worker ID $IATT OMB No.: 0970-0154 c_-D n JY,( _ VTI ;z= -10 _ ya r uy ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 02-517 CIVIL State Commonwealth of Pennsylvania OOriginal Order/Notice Co./City/Dist. of CUMBERLAND OAmended Order/Notice Date of Order/Notice 07/31/08 0Terminate Order/Notice Case Number (See Addendum for case summary) QOne-Time Lump Sum/Notice RE:BRICKER, DONALD E. Employe r/withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 201-42-6781 Employee/Obligor's Social Security Number MARTIN'S FAMOUS PASTRY SHOPPE, 1802000236 1000 POTATO ROLL LN Employee/Obligor's Case Identifier CHAMBERSBURG PA 17201-8897 (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ o.00 per month in current child support $ 0.00 per month in past-due child support Arrears 12 weeks or greater? Dyes 0 no $ 0.00 per month in current medical support $ 0.00 per month in past-due medical support $ 2,200.00 per month in current spousal support $ o. oo per month in past-due spousal support $ o . oo per month for genetic test costs $ 0.00 per month in other (specify) $ one-time lump sum payment for a total of $ 2,200.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 507.69 , per weekly pay period. $ 1, loo . oo per semimonthly pay period (twice a month) $ 1015,38 per biweekly pay period (every two weeks) $ 2, 200.00 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). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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. BY THE COURT: DRO: R.J. SHADDAY Service Type M OMB No.: 0970-0154 , * A/, A. HESS, Form E 028 Rev. 3 Worker I D $ IATT 2,2p? • x 52• 5ogo69* ?.?' 2?24Q• x 12«s 26•s 1,01 318* ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If 4heckefl you are required to provide a Gopy of this form to your mployee. If your employee works in a state that is di erent firom the state that issued this order, a copy must be proviged 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 employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2512919770 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : M THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME: BRICKER, DONALD E. EMPLOYEE'S CASE IDENTIFIER: 2802000236 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Service Type M OMB No.: 0970-0154 Form EN-028 Rev. 3 Worker ID $IATT 1' -,t ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BRICKER, DONALD E. PACKS Case Number 971104227 Plaintiff Name ROBIN R. BRICKER Docket Attachment Amount 02-517 CIVIL $ 2,200.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ?if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum OMB No.: 0970-0154 Form EN-028 Rev. 3 Worker ID $ IATT ?..,,} n,,.3 ?-. } r-? ?t1 :.?* --•t m ? .. _t„ _i __.,.. : _. C.> 7 , _. > '? ? ' -r .` ...`. _d,1 .. '-C ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 02-517 CIVIL State Commonwealth of Pennsylvania OOriginal Order/Notice Co./City/Dist. of CUMBERLAND OAmended Order/Notice Date of Order/Notice 02/06/09 XOTerminate Order/Notice Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice RE:BRICKER, DONALD E. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 201-42-6781 Employee/Obligor's Social Security Number MARTIN'S FAMOUS PASTRY SHOPPE, 1802000236 1000 POTATO ROLL LN Employee/Obligor's Case Identifier CHAMBERSBURG PA 17201-8897 (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 $ o. oo per month in past-due child support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in current medical support $ o.0o per month in past-due medical support $ o . oo per month in current spousal support $ 0. oo per month in past-due spousal support $ 0.00 per month for genetic test costs $ o . oo per month in other (specify) $ one-time lump sum payment for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0. 00 per semimonthly pay period (twice a month) $ o . 00 per biweekly pay period (every two weeks) $ o . oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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. , * X4, BY THE COURT: yl? /?evin A. Hess, Judge DRO: R.J. Shadday / Form EN-028 Rev. 4 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS I heck you are required to pr vide a?opy of this form to yourzyloyee. If yorr employee orks in a state that is iterent from the state that issuedthis o er, a copy must be provi to your employee even if tie 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 employeelobligor. 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 employeelobligor 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. 2512919770 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: [3 EMPLOYEE'S/OBLIGOR'S NAME: BRICKER, DONALD E. EMPLOYEE'S CASE IDENTIFIER: 1802000236 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 employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a 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 If you of your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or BOX 320 CARLISLE PA 17013 by FAX at (717) 240-6248 or CAR by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev. 4 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BRICKER, DONALD E. PACSES Case Number 971104227 PACKS Case Number Plaintiff Name Plaintiff Name ROBIN R. BRICKER Docket Attachment Amount Docket Attachment Amount 02-517 CIVIL $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Service Type M OMB No.: 0970-0154 Form EN-028 Rev. 4 Worker I D $ IATT ? ? ? -xt _ .ca r'>f' ?„ - r" cz? nY - ?? ? • ++y rr •i• ` ? ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 03/03/09 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number SOCIAL SECURITY ADMINISTRATION STE 1 200 S SPRING GARDEN ST CARLISLE PA 17013-2578 201-42-6781 Employee/Obligor's Social Security Number 1802000236 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. $ $ $ 0.00 0.00 0.00 $ 0.00 $ 2,200.00 $ 216.67 $ 0.00 $ 0.00 per month in current child support per month in past-due child support Arrears 12 weeks or greater? per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) one-time lump sum payment for a total of $ 2,416.67 per month to be forwarded to payee below. O yes ® no 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: $ 556.17 per weekly pay period. $ 1, 208.34 per semimonthly pay period (twice a month) $ 11112-33 per biweekly pay period (every two weeks) $ 2,416.67 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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 EmployeelObligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: ??• A Ke)?kl A. Hess, Judge DRO-. R. J. Shadday Service Type M OMB No.: 0970-0154 OOriginal Order/Notice 971104227 OAmended Order/Notice 02-517 CIVIL 0Terminate Order/Notice (Done-Time Lump Sum/Notice RE:BRICKER, DONALD E. Employee/Obligor's Name (Last, First, MI) Form EN-028 Rev. 4 Worker ID $OINC t ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ecke? you are required to provide aopy of this form to your m loyee. If yoVr employee works in a state that is , vent from the state that issued this o er, a copy must be provi?edpto your employee even If t e box UP s not checked d 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must 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 employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 8384100092 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME: BRICKER, DONALD E. EMPLOYEE'S CASE IDENTIFIER: 1802000236 LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: DATE OF SEPARATION: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (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. 1 1. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev. 4 Service Type M OMB No.: 0970-0154 Worker ID $oINC op .. ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BRICKER, DONALD E. PACSES Case Number 971104227 PACSES Case Number Plaintiff Name Plaintiff Name ROBIN R. BRICKER Docket Attachment Amount Docket Attachment Amount 02-517 CIVIL $ 2,416.67 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name PACSES Case Number Plaintiff Name Service Type M Addendum OMB No.: 0970-0154 PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name Form EN-028 Rev. 4 Worker ID $oINC! ??`` ?7; ? ? C ?' . . , . lrlr ?, ?;, fi...? ,, ? , ? , _f EE Y - r?i ? ? 0 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION ROBIN R. BRICKER ) Docket Number 02-517 Plaintiff ) vs. ) PACSES Case Number 97 1 1 04227 DONALD E. BRICKER ) Defendant ) Other State ID Number PETITION FOR MODIFICATION OF AN EXISTING SUPPORT ORDER 1. The petition of DONALD E. BRICKER respectfully represents that on November 14, 2006, an Order of Court was entered for the support of ROBIN RAE BRICKER A true and correct copy of the order is attached to this petition. Service Type M Form OM-501 Worker ID 21205 BRICKER V. BRICKER PACSES Case Number: 971104227 2. Petitioner is entitled to O increase (/decrease O termination O reinstatement O other of this Order because of the following material and substantial change(s) in circumstance: PLEASE STATE YOUR REASON(S) FOR REQUESTING A MODIFICATION OF YOUR CURRENT SUPPORT ORDER HERE: Decrease in income due to disability WHEREFORE, Petitioner requests that support. the Court modify the existin r for Petitioner Attorney for Petitioner I verify that the statements made in this complaint are true and correct. I understand that false statements herein are made to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities. .3110/0 I Date ?'-n '?3? - - Petitioner 4+*,ar Ftn P416h •rw Service Type M Page 2 of 2 Form OM-501 Worker ID 21205 ROBIN R. BRICKER, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 02-517 CIVIL TERM DONALD E. BRICKER, IN DIVORCE Defendant/Respondent PACSES # 971104227 ORDER OF COURT AND NOW, this 14th day of November, 2006, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $0 and Respondent's monthly net income/earning capacity is $0, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $2416.67 per month payable as follows: $2200.00 per month for alimony pendente lite and $216.67 per month on arrears. First payment due next pay date. Arrears set at $4400.00 as of November 14, 2006. The effective date of the order is September 25, 2006. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Robin R. Bricker. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the Respondent's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. cc360 M This Order is based upon an agreement of the parties. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. Consented: Petitioner Respondent Petitioner's Attorney Respondent's Attorney BY THE COURT, K n A. Hess, J. IMailed copies on: November 14. 2006 to: Petitioner Respondent Jerry A. Weigle, Esq. Sean M. Schiltz, Esq. DRO: R.J. Shadday m ROBIN R. BRICKER, THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 02-517 CIVIL TERM DONALD E. BRICKER, IN DIVORCE Defendant/Petitioner : PACSES CASE NO: 971104227 ORDER OF COURT AND NOW, this 13`h day of March, 2009, a petition has been filed against you, Robin R. Bricker, to modify an existing Alimony Pendente Lite Order. You are ordered to appear in person at the Domestic Relations Section, 13 North Hanover Street, Carlisle, Pennsylvania, on April 7. 2009 at 9:00 A.M. for a conference and to remain until dismissed by the Court. If you fail to appear as provided in this Order, an Order of Court may be entered against you. You are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by the Rule 1910.11. (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Edgar B. Bayley, President Judge Copies mailed to: Petitioner Respondent Sean M. Shultz, Esq. Jerry A. Weigle, Esq. Date of Order: March 13, 2009 R. J. S day, Conference Officer V /01' YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REP NT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 `3 Cj r? w ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 02-517 CIVIL OOriginal Order/Notice State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND OAmended Order/Notice Date of Order/Notice 04/02/09 OTerminate Order/Notice Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice RE:BRICKER, DONALD E. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) SOCIAL SECURITY ADMINISTRATION STE 1 201-42-6781 Employee/Obligor's Social Security Number 1802000236 Employee/Obligor's Case Identifier 200 S SPRING GARDEN ST (See Addendum for plaintiff names CARLISLE PA 17013-2578 associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current child support $ 0.00 per month in past-due child support Arrears 12 weeks or greater? ryes ® no $ o . oo per month in current medical support $ 0.00 per month in past-due medical support $ 0.00 per month in current spousal support $ o . oo per month in past-due spousal support $ 0.00 per month for genetic test costs $ o. oo per month in other (specify) $ one-time lump sum payment for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0. oo per semimonthly pay period $ o . o o per biweekly pay period (every two weeks) (twice a month) o. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. 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. BY THE COURT. Form EN-028 Rev. 4 Service Type M OMB No.: 097"] 54 Worker ID $oINC ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If hecked you are required to provide a copy of this form to your mployee. If yo r employee orks in a state that is dierent from the state that issued this order, a copy must be provi?ed to your empyoyee even if tie box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 8384100092 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME:BRICKER, DONALD E. EMPLOYEE'S CASE IDENTIFIER: 1802000236 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) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev. 4 Service Type M OMB No.: 0970-0154 Worker ID $OINC f I ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BRICKER, DONALD E. PACSES Case Number 971104227 PACSES Case Number Plaintiff Name Plaintiff Name ROBIN R. BRICKER Docket Attachment Amount Docket Attachment Amount 02-517 CIVIL $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev. 4 Service Type M OMB No.: 0970-0154 Worker ID $OINC RUD-OFFICE OF THE WTHONOTARY 2M APR - 3 PM 2:37 ljt.NTY ROBIN R. BRICKER, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 02-517 CIVIL TERM DONALD E. BRICKER, IN DIVORCE Defendant PACSES CASE: 971104227 ORDER OF COURT AND NOW to wit, this 8th day of June, 2009, it is hereby Ordered that the above captioned Alimony Pendente Lite Order is terminated effective April 2, 2009 pursuant to the parties' Martial Settlement Agreement. The account is closed with a balance owed in the amount of $4,394.51. The Cumberland County Domestic Relations Sections dismisses their interest in the collection of the remaining balance. This Order shall become final twenty (20) days after the mailing of the notice of the entry of the order to the parties unless either party files a written demand with the Domestic Relations Section for a hearing de novo before the Court. BY THE COURT: 4. X4 - ?5?- Kev' Hess, J. DRO: R.J. Shadday xc: Petitioner Respondent Sean M. Shultz, Esq. Jerry A. Weigle, Esq. Form OE-001 Service Type: M Worker: 21005 AIMFHCE f HONOTARY 2009 JUN -8 PM 3: 88 Cl1l, B a,', PEN<1\aSYLVA 1 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, Plaintiff No. 02-517 CIVIL V. IN DIVORCE DONALD E. BRICKER, Defendant AFFIDAVIT OF CONSENT STATE OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) 1. A Complaint in divorce under Section 3301(c) of the Divorce Code was filed on January 30, 2002. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final Decree of Divorce after service of notice of intention to request entry of the Decree. 4. 1 have been advised of the availability of marriage counseling and understand that I may request that the Court require that my spouse and I participate in counseling prior to a Divorce Decree being handed down by the Court. I verify that the statements made in this affidavit are true and correct. 1 understand that false statements herein are made subject to the penalties of 18 Pa. C. S., Section 4904 relating to unswom falsification to authorities. Date: 2009 e Donald E. Bricker FILE -.(,j LL.:iIE OF THIS F',RoT-'1-- 0",ARY 2009 SEP 18 PIS 3: 2 4 C;UPAw,,: <:. 5,JJ NTY PEINI vSYI EVAN'lA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, Plaintiff No. 02-517 CIVIL V. IN DIVORCE DONALD E. BRICKER, Defendant WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 43301(C) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. Date: Donald E. Bricker RLFD-,-'? FIGF OF THE Fw OTHONOTARY 2009 SEP 18 PM 3: 2 5 -,6, NNTY PNNSI,IZ-VANIA AV f `LEI J c ,?;, v 1 \' i i "- 0 r,A t 10 Ff1l 12: S 4 MAR 0 9 2010 IN THE COURT OF COMMON PLEAS OF T `J I QTY CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, CIVIL ACTION - LAW Plaintiff, V. NO. 02-517 CIVIL DONALD E. BRICKER, Defendant. IN DIVORCE QUALIFIED DOMESTIC RELATIONS ORDER FOR 401(x) PLAN This Order is entered in connection with a division of marital property pursuant to the divorce of the parties. This Order is intended to be a `qualified domestic relations order" within the meaning of Section 414(p) of the Internal and Section 206 of the Employee Retirement ("ERISA"). It is hereby ORDERED, ADJUDGED Code of 1986, as amended (the "Code") Security Act of 1974, as amended DECREED: 1. Background. This Order pertains to the Martin's Famous Pastry Shoppe, Inc. 401(k) Profit Sharing Plan (herinafter referred to as the "Plan"); is incorporated into the judgment order dissolving the marriage of the parties; and may be amended if necessary to comply with the Code. The Court retains jurisdiction of the subject matter hereof and the parties hereto to enforce the terms of this Order. 2. Applicable Law. This Order is intended to be a Qualified Domestic Relations Order (hereinafter referred to as "QDRO") as that term is defined in Section 414(p) of the Internal Revenue Code and Section 206(d)(3) of ERISA. This Order relates to the equitable division of martial property as defined under the Pennsylvania Domestic Relations Code of 1980, as amended. 3. Definitions. As used in this Order, the following terms shall apply: y WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 a. "Participant" shall mean Donald E. Bricker, whose current address is 154 Neil Road, Shippensburg, Pennsylvania 17257 and whose Social Security Number is 201-42-6781 and whose date of birth is April 2, 1950. b. "Payee" shall mean Robin R. Bricker, whose current address is 1329 Colona Road, Pocomoke, MD 21851 and whose Social Security Number is 249-33-9850 and whose date of birth is May 22, 1961. C. "Administrator" shall mean Martin's Famous Pastry Shoppe, Inc.1000 Potato Roll Lane, Chambersburg, PA 17202, or their designated party. 4. Assignment to Payee. The Payee (who is the former spouse of the Participant) is awarded and assigned One Hundred Thousand Dollars' ($100,000.00) of amount of the retirement account accrued during the marriage. At the time of the divorce action, the Participants account was valued at approximately $ 164,683.00. The Payee ps awarded and assigned the full sum of the $100,000.00. 5. Commencement of Assigned Benefit to Payee. The Payee shall receive the assigned benefit under the Plan as soon as a imstratively practicable following the Administrator's determination that this Order is a Quali ied Domestic Relations Order. 6. Form of Payment. The Payee shall receive the assigned benefit under this Order in the form of a single sum cash payment designated to a separate account of the Payee's choice. 7. Death of the Participate. The death of the Participate, either before or after the Payee has received payment of the Payee's assigned benefit, shall neither affect the Payee's right to payment of the assigned benefit nor entitle the Payee to additional benefits. F. Death of the Payee. If the Payer; dies prior to receiving payment of benefits assigned under this Order, the benefits payable under this Order shall be paid to Payee's estate. 9. Mailing to Last Known Address. Alll appropriate payments, notices and other communications shall be mailed to the Participate and ''the Payee at the respective addresses set forth above, until such time as the Participant or Payee advises the Administrator in writing of the occurrence of a change of address. Any benefit payment or communication to the Payee at the Payee's last known address shall operate on a complete Ildischarge of the obligations, with respect to such payment or communication of the Plan. WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 10. Parties to Cooperate. If the Administrator of the Plan does not agree that this is a "Qualified" Domestic Relations Order under Code Section 414(p), each party shall cooperate and do all things reasonably necessary to devise a form of Order acceptable to the Administrator as a Qualified Domestic Relations Order. Date: /lp,z,,,f /v ZO/a Witness: wul rnl.?" 3/101Io )?/I'S /fern BY THE COURT: Participate: Donald R. Bricker Date: -k- / d Payee: Robii R. Date: WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 FILED a uE 2010 APR 23 Nil 3: 13 IN THE COURT OF COMMON PLE ,0F([.LAN1,A. CUMBERLAND COUNTY, PENNSYLVANIA. ROBIN RAE BRICKER, Plaintiff No. 02-517 CIVIL V. IN DIVORCE DONALD E. BRICKER, Defendant MOTION TO AMEND QUALIFIED DOMESTIC RELATIONS ORDER FOR 401(x) PLAN And now, this 23`d day of April, 2010, comes Donald E. Bricker, Defendant, by his counsel, Sean M. Shultz, Esquire, and respectfully represents the following: 1. Plaintiff is Robin Rae Bricker, who resides at 1329 Colona Road, Pocomoke, Maryland 21851. 2. Defendant is Donald E. Bricker, who resides at 154 Neil Road, Shippensburg, Pennsylvania 17257. 3. On March 10, 2010, a Qualified Domestic Relations Order for 401(k) Plan prepared by Plaintiff's counsel, was entered in the above-captioned matter. A copy of said Order is attached hereto as Exhibit "A". 4. Plaintiff's counsel was contacted by the financial institution holding the funds referenced in the Order requesting more specific language including the account number, in the Order. 5. Paragraph 4 of the Order is as follows: "Assignment to Payee. The Payee (who is the former spouse of the Participant) is awarded and assigned One Hundred Thousand Dollars ($100,000.00) of amount of the retirement account accrued during the marriage. At the time of the divorce action, the Participants account was valued at approximately $164,683.00. The Payee is awarded and assigned the full sum of the $100,000.00." 6. Paragraph 4 should be amended as follows: "Assignment to Payee. At the time of the divorce action, the Participant's retirement account was valued at approximately $164,683.00. The Payee, who is the former spouse of the Participant, is awarded and assigned the full sum of One Hundred Thousand Dollars ($100,000.00) from Wells Fargo Advisors in Account No. 26688490." 7. Jerry Weigle, counsel for Plaintiff concurs with this Motion. 8. The Honorable Kevin Hess has been assigned to this matter. WHEREFORE, Defendant respectfully requests your honorable court amend the Qualified Domestic Relations Order for 401(k) Plan as requested. Respectfully submitted, LAW OFFICE OF SEAN M. SHULTZ, P.C. Sean M. Shultz, Esquire Attorney ID No. 90946 4 Irvine Row Carlisle, Pennsylvania 17013 (717) 701-8412 Attorney for Defendant Exhibit "A" MAR 0 9 2010 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, CIVIL ACTION - LAW Plaintiff, V. NO. 02-517 CIVIL DONALD E. BRICKER, Defendant. IN DIVORCE QUALIFIED DOMESTIC RELATIONS ORDER FOR 401(x) PLAN This Order is entered in connection with a division of marital property pursuant to the divorce of the parties. This Order is intended to be a "qualified domestic relations order" within the meaning of Section 414(p) of the Internal Revenue Code of 1986, as amended (the "Code") and Section 206 of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"). It is hereby ORDERED, ADJUDGED AND DECREED: 1. Background. This Order pertains to the Martin's Famous Pastry Shoppe, Inc. 401(k) Profit Sharing Plan (herinafter referred to as the "Plan"); is incorporated into the judgment order dissolving the marriage of the parties; and may be amended if necessary to comply with the Code. The Court retains jurisdiction of the subject matter hereof and the parties hereto to enforce thle teLnTtS of this Order. 2. Applicable Law. This Order is intended to be a Qualified Domestic Relations Order (hereinafter referred to as "QDRO") as that term is defined in Section 414(p) of the Internal Revenue Code and Section 206(d)(3) of ERISA. This Order relates to the equitable division of martial property as defined under the Pennsylvania Domestic Relations Code of 1980, as amended. 3. Definitions. As used in this Order, the following terms shall apply: WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 a. "Participant" shall mean Donald E. Bricker, whose current address is 154 Neil Road, Shippensburg, Pennsylvania 17257 and whose Social Security Number is 201-42-6781 and whose date of birth is April 2, 1950. b. "Payee" shall mean Robin R. Bricker, whose current address is 1329 Colona Road, Pocomoke, MD 21851 and whose Social Security Number is 249-33-9850 and whose date of birth is May 22, 1961. C. "Administrator" shall mean Martin's Famous Pastry Shoppe, Inc. 1000 Potato Roll Lane, Chambersburg, PA 17202, or their designated party. 4. Assignment to Payee. The Payee (who is the former spouse of the Participant) is awarded and assigned One Hundred Thousand Dollars ($100,000.00) of amount of the retirement account accrued during the marriage. At the time of the divorce action, the Participants account was valued at approximately $ 164,683.00. The Payee is awarded and assigned the full sum of the $100,000.00. 5. Commencement of Assigned Benefits to Payee. The Payee shall receive the assigned benefit under the Plan as soon as administratively practicable following the Administrator's determination that this Order is a Qualified Domestic Relations Order. 6. Form of Payment. The Payee shall receive the assigned benefit under this Order in the form of a single sum cash payment designated to a separate account of the Payee's choice. 7. Death of the Participate. The death of the Participate, either before or after the Payee has received payment of the Payee's assigned benefit, shall neither affect the Payee's right to payment of the assigned benefit nor entitle the Payee to additional benefits. Q. Death of the Payne. Ir t Payee. it" the Payec dies prior to receiving ra5'n=ert of benefits assigned under this Order, the benefits payable under this Order shall be paid to Payee's estate. 9. Mailing to Last Known Address. All appropriate payments, notices and other communications shall be mailed to the Participate and the Payee at the respective addresses set forth above, until such time as the Participant or Payee advises the Administrator in writing of the occurrence of a change of address. Any benefit payment or communication to the Payee at the Payee's last known address shall operate on a complete discharge of the obligations, with respect to such payment or communication of the Plan. WEIGLE & ASSOCIATES. P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 10. Parties to Cooperate. If the Administrator of the Plan does not agree that this is a "Qualified" Domestic Relations Order under Code Section 414(p), each party shall cooperate and do all things reasonably necessary to devise a form of Order acceptable to the Administrator as a Qualified Domestic Relations Order. BY THE COURT: Date-M (I ?J.Al.:?-1-!-O 1 Q /S OHM ? 9,40nii J. Witness: Participate: Donald R. Bricker Date: a4 ,k / d i L TRtM 0MV ?l11 N MaARO to t??lirnoe? l1w? wt ngr hMNf wd,ht.?.t a;,.rs?.L4_. ?..LLL?r?t ?anorr 4--rtw* r WEIGLE G ASSOCIATES, P.C. - ATTORNE\'S LAW - Payee: Robii RIM Date: _? 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBIN RAE BRICKER, Plaintiff No. 02-517 CIVIL V. IN DIVORCE DONALD E. BRICKER, Defendant CERTIFICATE OF SERVICE AND NOW, this 23`d day of April, 2010, I, Sean M. Shultz, Esquire, hereby certify that I have this day served the following person with a copy of the foregoing Motion by first class, United States Mail, postage pre-paid, addressed as follows: Jerry A. Weigle, Esquire WEIGLE & ASSOCIATES, P.C. 126 East King Street Shippensburg, Pennsylvania 17257-1397 Attorney for Plaintiff Respectfully submitted, LAW OFFICE OF SEAN M. SHULTZ, P.C. Sean M. Shultz, Esquire Attorney ID No. 90946 4 Irvine Row Carlisle, Pennsylvania 17013 (717) 701-8412 Attorney for Defendant