HomeMy WebLinkAbout02-4380 NM INCOME WITHHOLDING FOR SUPPORT I U 7 L-��-
O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT(IWO)
Q j f u (JI I
AMENDED l I D
O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT
Q TER)WINAT10`N'OF IWO`=" ` + A: Date: 03/27/13
❑ Child Support Enforcement(CSE)Agency ® Court ❑ Attorney ❑ Private Individual/Entity(Check One)
NOTE:This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender(see IWO
instructions http://www acf hhsgov/programs/csetnewhire/em foyer/publication/publication htm-forms). If you receive this document from
someone other than a State or Tribal CSE agency or a Court,a copy of the underlying order must be attached.
State/Tribe/Territory Commonwealth of Pennsylvania Remittance Identifier(include w/payment): 7556101044
City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket lnformalton)
Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary)
SOCIAL SECURITY ADMINISTRATION RE: FARLEY,MICHAEL P.
2620 YORKTOWNE BLVD Employee/Obligor's Name(Last,First,Middle)
BRICK NJ 08723-7949 184-48-3770
Employee/Obligor's Social Security Number
(See Addendum for plaintiff names
associated with cases on attachment)
Custodial Party/Obligee's Name(Last,First,
Middle)
Employer/Income Withholder's FEIN NOTE:This IWO must be regular on its face.
Under certain circumstances you must reject
Child(ren)'s Name(s)(Last, First,Middle) Child(ren)'s Birth Date(s) this IWO and return it to the sender(see IWO
instructions
http:ltwww.acf.hhs.gov/proarams/cse/newhi
empWer/jpublir,ation/`publication.htm-form d. If
you receive this document from someone other
than a State or Tribal CSE agency or a Court,a
copy of the underlying order must be attached.
2318100277
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County,
Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from4he employee/
obligor's income until further notice.
$ 0.00 per month in current child support
..�,
$ 0.00 per month in past-due child support- Arrears 12 weeks or greater? O yew� n
$ 0.00 per month in current cash medical support ' `'
$ 0.00 permonth in past-due cash medical support
$— 0._ per month in current spousal support :1
$ 250.00 per month in past-due spousal support =c`` '
$ 0.00 per month in other(must specify) .,
for a Total Amount to Withhold of$ 250.00 per month.
AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information.
If your pay cycle does not match the ordered payment cycle, withhold one of the following amount:
$ 57.53 per weekly pay period. $ 125.00 per semimonthly pay period (twice a month)
$ 115.07 per biweekly pay period (every two weeks) $ 250.00 per monthly pay period.
$ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.
REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth
of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten 1
working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If
you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55° of
disposable income for all orders. If the employee/obligor's principal place of employment is not within the
Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements,
and any allowable employer fees at http://www acf hhs gov/ rograms/cse/newhire/em foyer/contacts/contact_mal2.
htm for the employee/obligor's principal place of employment.
Document Tracking Identifier
OMB No.:0970-0154 Form EN-028 06/12
Service Type M Worker ID$OINC
❑ Return to Sender[Completed by Employerlineome Withholder].. Payment must be directed to an SDU in
accordance with 42 USC§666(b)(5)and (b)(6)or Tribal Payee (see Payments to SDU below). If payment is not
directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to
the sender.
Signature of Judge/issuing Official(if required by State or Tribal law):
Print Name of Judge/Issuing Official: Abort I
Title of Judge/issuing Official:
Date of Signature: R= 2 8,21111,,
If the empioyee/obligor works in a State or for a Tribe that is di'f'ferent from the State or Tribe that issued this order,a copy of this IWO
must be provided to the employee/obligor.
❑ If checked,the employer/income withholder must provide a copy of this form to the employee/obligor.
ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS
Pennsylvania law(23 PA C.S.§4374(b))requires remittance by an etectre c payment method if an employer is ordered
to withhold income from more than one employee and employs 15 or more persons,or if an employer has a history of
two or more returned checks due to nonsufffclent funds. Please call the Pennsylvania State Collection$and
Disbursement Unit(PA SCDU)Employer Customer Service at 1-877.676.OW for instructions. PA FtPS CODE 42 000 00
Make Remittance PaysiWo 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 PACSE'S M66 W 1D(shown above as
the Employee✓ Wiger's Case Identl€Ier)OR SOCIAL'SECURITY NUIIMIER IN ORDER TO BE PROOM$ED. o mo
SEND CASH BY MAIL.
State-specific contact and withholding information can be found on the Federal Employer Services website located at:
llttp�twww.acf'hs.00y]12 °'c Dmakk t a'A`/,QgnLactsio,onW MU,
�►tm
Priority:Withholding for support has priority over any other legal process under State law against the same income(USC 42
§666(bK7)). If a Federal tax levy is in effect, please notify the sender.
Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from
more than one employee/obligor's income in a single payment. You must, however,separately identify each employee/
obligor's portion of the payment.
Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a
Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SITU(e.g , payable jot he custodial
party, court, or attorney),you must check the box above and return this notice to the;sender. Excopl*M: If, .PNO was sent
by a Court,Attorney, or Private Individual/Entity and the initial order was ontefedbefore January 1, 1 or the order was
issued by a Tribal CSE agency, you must follow the"Remit paymesrtt to"instructions on this form.
Reporting the Pay Date: You must report the pay date when sending the payment.The.pay date is the date on which the
amount was withheld from the employee/obligor's wages. You must comply with the law of the State(or Tribal law if
applicable)of the employee/obligor's principal place of employment regarding time periods within which you must implement
the withholding and forward the support payments.
Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all 1WO$due to
Federal,State, or Tribal withholding limits,you must honor alt IWM to the gr astest extent possible,givintJ pribtity to current
support before payment of any past-due support. Follow the Ste or Tribal later/procure of the employ ob gor's prirtclpal
place of employment to determine the appropriate allocation method.
Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this
employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to
report and/or withhold lump sum payments.
Liability: If you have any doubts about the validity of this IWO,contact the sender. If you fail to withhold income from the
employee/obligor's income as the IWO directs,you are liable for both the accumulated amount you should have withheld and
any penalties set by State or Tribal law/procedure.
Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this WO.
OMB Expiration Date—05/31/2014.The OMB Expiration Date has no bearing on the termination date of the IWO;it identifies the version of the farm currently in use.
Form EN-028 06112
Service Type M Page 2 of 3 Worker ICS $OINC
Employees Name: SOCIAL SECURITY ADMINISTRATION Employer FEIN:
Employee/Obligor's Name: FARLEY,MICHAEL P. 7556101044
CSE Agency Case Identifier:Me Addendum for case summa rl Order Identifier:(&o Addendum for orderldocket information
Withholding Limits:You may not withhold more than the lesser of: 1)the amounts allowed by the Federal Consumer Credit Protection
Act CCPA)(15 U.S.C. 1673(b));or 2)the amounts allowed by the State or Tribe of the employee/obligor's principal place of
employment(see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such
as: State, Federal, local taxes;Social Security taxes; statutory pension contributions; and Medicare taxes.The Federal limit is 50%of
the disposable income if the obligor is supporting another family and 60%of the disposable income if the obligor is not supporting
another family. However,those limits increase 5%-to 55%and 65%-if the arrears are greater than 12 weeks, If permitted by the State
or Tribe,you may deduct a fee for administrative costs.The combined support amount and fee may not exceed the limit indicated in
this section.
For Tribal orders,you may not withhold more than the amounts allowed under the law of the issuing Tribe.For Tribal employers/income
withholders who receive a State IWO,you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which
the employer/income withholder is located or the maximum amount permitted under section 303(d)of the CCPA(15 U.S.C. 1673(b)).
Depending upon applicable State or Tribal law,you may need to also consider the amounts paid for health care premiums in
determining disposable income and applying appropriate withholding limits.
Arrears greater than 12 weeks?If the Order Information does not indicate that the arrears are greater than 12 weeks,then the
Employer should calculate the CCPA limit using the lower percentage.
Additional Information:
NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are
no longer withholding income for this employee/obligor,an employer must promptly notify the CSE agency and/or the sender by
returning this form to the address listed in the Contact Information below: 2318100277
0 This person has never worked for this employer nor received periodic income.
0 This person no longer works for this employer nor receives periodic income.
Please provide the following information for the employee/obligor:
Termination date: Last known phone number:
Last known address:
Final Payment Date To SDLI/Tribal Payee: Final Payment Amount:
New Employer's Name:
New Employer's Address:
CONTACT INFORMATION:
To Employer/Income Withholder: If you have any questions,contact WAGE ATTACHMENT UNIT(issuer name)
by phone at(717)240-6225, by fax at(717)240-62481 by email or website at:www.childsupgort.state.pa.us.
Send termination/income status notice and other correspondence to:DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST.
P.O. BOX 320, CARLISLE, PA. 17013(issuer address).
To EmRlQyee/0bI1igor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT(issuer name)
by phone at(717)240-6225, by fax at(717)240-6248, by email or website at www.chIIdsupI2ortstate.pa,ua.
IMPORTANT:The person completing this form is advised that the information may be shared with the employee/obligor.
OMB No.:0970-0154 Form EN-028 06/12
Service Type M Page 3 of 3 Worker ID$OINC
ADDENDUM
Summant of Cam an AftUbmant
Defendant/016 gor: FARLEY, MICHAEL P.
PACSES Case Number 909107484 PACSU"se.Number
Plaintiff Name Plaintiff Name
BRIGITTE B.MONTGOMERY
Docke Attachment Amgun Ooake Attachment Amgunt
02-4380 CIVIL $ 28ff.00 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
PACSES Case Number PACES Can Number
Plaintiff Name Plaintiff Name
Docke Attachment AmQUnt Docket
$ 0.00 $ 000
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
PACSES Case Number PACSES Case Number
Plain ff Name ladiff N m
Qoc Attachment Amoun [3Qe Attac mol.A=unt
$ 0.00 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
Addendum Form EN-0 0 06/12
Service Type M ores No.:0870-0154 Worker ID $OINC
BRIGITTE MONTGOMERY, IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
•
VS. • CIVIL ACTION - DIVORCE
NO. 02-4380 CIVIL TERM
MICHAEL P. FARLEY, IN DIVORCE
Defendant PACSES Case No: 909107484
C3
czn
rn �
rrl ORDER OF COURT max'
C./)r-""
AND NOW to wit, on this 30th day of September, 2013, it is hereby Orderechatcthe
--s rzl =�
CD _:
Domestic Relations Section dismiss their interest in the above captioned Alimony matter
pursuant to no enforcement action being pursued by the Plaintiff and the last payment being
processed on March 21, 2012.
The Alimony account is closed with a balance of$3,672.96 owed to the Plaintiff
This Order shall become final twenty (20) days after the mailing of the notices of
the entry of the Order to the parties unless either party files a written demand with the
Office of the Prothonotary for a hearing de novo before the Court.
BY THE COURT:
Albert H. Masland, J.
DRO: R.J. Shadday
xc: Petitioner
Respondent
Form 0E-001
Service Type:M Worker:21005
INCOME WITHHOLDING FOR SUPPORT q09 137 484-
O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT(IWO) DA , 4-3'30 a i v 1 I
O AMENDED IWO
• ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT
O TERMINATION OF IWO Date: 09/30/13
❑ Child Support Enforcement(CSE)Agency ® Court ❑ Attorney ❑ Private Individual/Entity(Check One)
NOTE:This IWO must be,regular,on its fe,ce{Under certain circumstances you must reject this IWO and return it to the sender(see IWO
instructions http://www.acf.hhs.gov/programs/cse/newhire/employer/publication/publication.htm-forms). If you receive this document from
someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached.
State/Tribe/Territory Commonwealth of Pennsylvania Remittance Identifier(include w/payment): 7556101044
City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket information)
Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary)
SOCIAL SECURITY ADMINISTRATION RE: FARLEY,MICHAEL P.
2620 YORKTOWNE BLVD Employee/Obligor's Name(Last, First,Middle)
BRICK NJ 08723-7949 184-48-3770
Employee/Obligor's Social Security Number
(See Addendum for plaintiff names
associated with cases on attachment)
Custodial Party/Obligee's Name(Last, First,
Middle)
Employer/Income Withholder's FEIN NOTE:This IWO must be regular on its face.
Under certain circumstances you must reject
Child(ren)'s Name(s)(Last,First,Middle) Child(ren)'s Birth Date(s) this IWO and return it to the sender(see IWO
instructions
htto://www.acf.hhs.gov/programs/cse/newhire/
employer/publication/oublication.htm-forms). If
you receive this document from someone other
than a State or Tribal CSE agency or a Court,a
copy of the underlying order must be attached.
2318100277
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County,
Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/
obligor's income until further notice.
$ 0.00 per month in current child support
$ 0.00 per month in past-due child support- Arrears 12 weeks or greater? 0 yes no=
$ 0.00 per month in current cash medical support --I -oi
$ 0.00 per month in past-due cash medical support r I fir:
$ 0.00 per month in current spousal support r--= —4."—"r
$ 0.00 per month in past-due spousal support c
$ 0.00 per month in other(must specify) zQ _"
for a Total Amount to Withhold of$ 0.00 per month.
AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order InformaTfon.
If your pay cycle does not match the ordered payment cycle,withhold one of the following amount:
$ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period (twice a month)
$ 0.00 per biweekly pay period(every two weeks) $ 0.00 per monthly pay period.
$ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.
REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth
of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10)
working days after the date of this Order/Notice. Send payment within seven (7)working days of the pay date. If
you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of
disposable income for all orders. If the employee/obligor's principal place of employment is not within the
Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements,
and any allowable employer fees at http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact_map.
htm for the employee/obligor's principal place of employment.
Document Tracking Identifier
OMB No.:0970-0154 Form EN-028 06/12
-
Service Type M Worker ID $OINC
❑ Return to Sender[Completed by Employer/Income Withholder]. Payment must be directed to an SDU in _
Y Y l Y �
accordance with 42 USC§666(b)(5)and (b)(6)or Tribal Payee(see Payments to SDU below). If payment is not
directed to an SDUTtribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to
the sender.
Signature of Judge/Issuing Official (if required by State or Tribal law):
Print Name of Judge/Issuing Official: •.Mat
Title of Judge/Issuing Official:
Date of Signature: OCT .Q.,1 2013
If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO
must be provided to the employee/obligor.
❑ If checked,the employer/income withholder must provide a copy of this form to the employee/obligor.
ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS
Pennsylvania law(23 PA C.S.§4374(b)) requires remittance by an electronic payment method if an employer is ordered
to withhold income from more than one employee and employs 15 or more persons,or if an employer has a history of
two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and
Disbursement Unit(PA SCDU)Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID(shown above as
the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT
SEND CASH BY MAIL.
State-specific contact and withholding information can be found on the Federal Employer Services website located at:
http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact_map.htm
Priority: Withholding for support has priority over any other legal process under State law against the same income(USC 42
§666(b)(7)). If a Federal tax levy is in effect, please notify the sender.
Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from
more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/
obligor's portion of the payment.
Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a
Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial
party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent
by a Court,Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was
issued by a Tribal CSE agency, you must follow the"Remit payment to"instructions on this form.
Reporting the Pay Date: You must report the pay date when sending the payment.The pay date is the date on which the
amount was withheld from the employee/obligor's wages. You must comply with the law of the State(or Tribal law if
applicable)of the employee/obligor's principal place of employment regarding time periods within which you must implement
the withholding and forward the support payments.
Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to
Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current
support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal
place of employment to determine the appropriate allocation method.
Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this
employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to
report and/or withhold lump sum payments.
Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the
employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and
any penalties set by State or Tribal law/procedure.
Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO.
OMB Expiration Date—05/31/2014.The OMB Expiration bate has no bearing on the termination date of the IWO;it identifies the version of the form currently in use.
Form EN-028 06/12
Service Type M Page 2 of 3 Worker ID $OINC
Employer's Name: SOCIAL SECURITY ADMINISTRATION Employer FEIN:
Employee/Obligor's Name: FARLEY, MICHAEL P. 7556101044
CSE Agency Case Identifier:(See Addendum for case summary) Order Identifier:(See Addendum for order/docket information)
Withholding Limits:You may not withhold more than the lesser of: 1)the amounts allowed by the Federal Consumer Credit Protection
Act(CCPA)(15 U.S.C. 1673(b)); or 2)the amounts allowed by the State or Tribe of the employee/obligor's principal place of
employment(see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such
as: State, Federal,local taxes;Social Security taxes; statutory pension contributions; and Medicare taxes.The Federal limit is 50%of
the disposable income if the obligor is supporting another family and 60%of the disposable income if the obligor is not supporting
another family. However,those limits increase 5%-to 55%and 65%-if the arrears are greater than 12 weeks. If permitted by the State
or Tribe,you may deduct a fee for administrative costs.The combined support amount and fee may not exceed the limit indicated in
this section.
For Tribal orders,you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income
withholders who receive a State IWO,you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which
the employer/income withholder is located or the maximum amount permitted under section 303(d)of the CCPA(15 U.S.C. 1673(b)).
Depending upon applicable State or Tribal law,you may need to also consider the amounts paid for health care premiums in
determining disposable income and applying appropriate withholding limits.
Arrears greater than 12 weeks?If the Order Information does not indicate that the arrears are greater than 12 weeks,then the
Employer should calculate the CCPA limit using the lower percentage.
Additional Information:
NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are
no longer withholding income for this employee/obligor,an employer must promptly notify the CSE agency and/or the sender by
returning this form to the address listed in the Contact Information below: 2318100277
0 This person has never worked for this employer nor received periodic income.
0 This person no longer works for this employer nor receives periodic income.
Please provide the following information for the employee/obligor:
Termination date: Last known phone number:
Last known address:
Final Payment Date To SDU/Tribal Payee: Final Payment Amount:
New Employer's Name:
New Employer's Address:
CONTACT INFORMATION:
To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name)
by phone at(717)240-6225, by fax at(717)240-6248, by email or website at:www.childsupport.state.ba.us.
Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST.
P.O. BOX 320. CARLISLE. PA. 17013(Issuer address).
To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT(Issuer name)
by phone at(717)240-6225, by fax at(717)240-6248, by email or website at www.childsupport.state.pa.us.
IMPORTANT:The person completing this form is advised that the information may be shared with the employee/obligor.
OMB No.:0970-0154 Form EN-028 06/12
Service Type M Page 3 of 3 Worker ID $OINC
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: FARLEY, MICHAEL P.
PACSES Case Number 909107484 PACSES Case Number
Plaintiff Name Plaintiff Name
BRIGITTE B. MONTGOMERY
Docket Attachment Amount Docket Attachment Amount
02-4380 CIVIL $ 0.00 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
PACSES Case Number PACSES Case Number
Plaintiff Name 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 PACSES Case Number
Plaintiff Name 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 Form EN-028 06/12
Service Type M OMB No 0970-0154 Worker ID $OINC
4.
In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
BRIGITTE B. MONTGOMERY
Plaintiff ) Docket Number: 02-4380 CIVIL
vs
MICHAEL P. FARLEY ) PACSES Case Number: 909107484
Defendant
TO: Commonwealth of Pennsylvania ,
Treasury Department .;
Bureau of Unclaimed Property moo c� �`'..
PO Box 1837 =rn -4 4,rri
Harrisburg, PA 17105 CJ) I
Lump Sum Order of Attachment of Income ' '
Pursuant to the laws of the Commonwealth of Pennsylvania, the income of
MICHAEL P. FARLEY Defendant, Social Security Number 184-48-3770, Treasury Claim
Number, 13205897,13289073, is hereby attached as follows: You are directed to pay to
the CUMBERLAND County Domestic Relations Section a lump sum payment in the
amount of$3,672.96 due from Defendant's unclaimed property for payment toward an
arrears balance of$3,672.96 owed as of SEPTEMBER 26, 2013. The attached payment
must be sent to the CUMBERLAND County Domestic Relations Section as soon as
administratively possible. The check should be made payable to and mailed to the
CUMBERLAND County Domestic Relations Section, 13 N. HANOVER ST,
P.O. BOX 320, CARLISLE PA 17013. Advise the Domestic Relations Section if no
property is found for the defendant.
THE MEMBER NUMBER, 7556101044, AND NAME OF
DEFENDANT MUST APPEAR ON THE FACE OF THE CHECK TO APPLY CREDIT
TO THE PROPER ACCOUNT.
This order of attachment for support is binding upon you until further notice and
shall have priority over any attachment, execution, garnishment or wage attachment
under state or local law except one relating to a prior support order.
Form EN-700 07/13
Service Type M Worker ID 21208
MONTGOMERY v. FARLEY PACSES Case Number: 909107484
You are notified further that pursuant to law:
1. The Defendant has been notified that an order of attachment for support would
be issued.
2. Willful failure to comply with this order may result in i) you being adjudged in
contempt of court and committed to jail or fined by the court; ii) you being held
liable for any amount not withheld or withheld but not forwarded to the
Domestic Relations Section; and iii) attachment of your funds or property.
3. The attachment of income or the possibility thereof as a basis, in whole or in
part, for the discharge of an employee or any disciplinary action against or
demotion of an employee is prohibited. Violation may result in i) you being
adjudged in contempt and committed to jail or fined by the court and ii) an
action against you by the employee for damages.
4. The term "income" as defined by law includes compensation for services,
including, but not limited to, wages; salaries; fees; compensation in kind;
commissions and similar items; income derived from business; gains derived
from dealings in property; interest; rents; royalties; dividends; annuities;
income from life insurance and endowment contracts; all forms of retirement;
pensions; income from discharge of indebtedness; distributive share of
partnership gross income; income in respect of a decedent; income from and
interest in an estate or trust; military retirement benefits; railroad employment
retirement benefits; social security benefits; temporary and permanent
disability benefits; Worker's compensation and unemployment compensation;
or other entitlements to money or lump sum awards, without regard to
source, including lottery winnings; income tax refunds; insurance
compensation or settlements; awards or verdicts; and any form of payment
due to and collectible by an individual regardless of source.
BY THE COURT
SEPTEMBER 26, 2013
DATE
J U Albert ft
Form EN-700 07/13
Service Type M Page 2 of 2 Worker ID 21208