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HomeMy WebLinkAbout05-1906HAROLD S. IRWIN, 111, ESQUIRE ATTORNEY ID NO. 29920 64 SOUTH PITT STREET CARLISLE PA 17013 (717) 243-6090 ATTORNEY FOR PLAINTIFF DAVID R. HEYDT, V. IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLI KATHLEEN HEYDT, Defendant : CIVIL ACTION - LAW NO. 2005 - ?f-q",""CIVIL TERM : IN DIVORCE NOTICE You have been sued in court. If you wish to defend against the claims set forth following pages, you must take prompt action. You are warned that if you fail to the case may proceed without you and a decree in divorce or annulment rr entered against you by the court. A judgment may also be entered against you i other claim or relief requested in these papers by the plaintiff. You may lose me property or other rights important to you, including custody or visitation of your chi the so, be any v or When the ground for divorce is indignities or irretrievable breakdown of the mar age, you may request marriage counseling. A list of marriage counselors is available i the Office of the Prothonotary, Cumberland County Courthouse, Carlisle, Pennsyl ania 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPE TY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMEN 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 HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HE Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 17013 717-249-3166 DAVID R. HEYDT, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYL% v. CIVIL ACTION - LAW NO. 2005.OQ& CIVIL TERM KATHLEEN HEYDT, . Defendant : IN DIVORCE COMPLAINT IN DIVORCE UNDER 3301(c) OF THE DIVORCE CODE NOW, comes the plaintiff, by his attorney, Harold S. Irwin, III, Esquire, and files complaint in divorce against the defendant, representing as follows: 1. The plaintiff is DAVID R. HEYDT, an adult individual residing at 118 Road, Hummelstown, Dauphin County, Pennsylvania 17036. 2. The defendant is KATHLEEN HEYDT, an adult individual residing at 701 Sandbank Road, Mt. Holly Springs, Cumberland County, Pennsylvania 17065. 3. The parties have been residents of the Commonwealth of Pennsylvania at six months prior to the filing of this action in divorce. 4. The parties were married on May 13, 1988 in Virginia. 5. Pursuant to the Divorce Code, Section 3301(c), the plaintiff avers as the upon which this action is based that the marriage between the parties is irretrievably broken. 6. The plaintiff avers that he has been advised of the availability of counselirllg and that he has the right to request that the court require the parties to participate in counseling. WHEREFORE, the plaintiff demands judgment dissolving the marriage between tte two parties. I verify that the facts contained herein are true and correct. I understand that fats statements herein made are subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. April L 2005 DAVID R, HEYDT, HAROLD S. IRWIN, 111 Attorney for Plaintiff 64 South Pitt Street Carlisle, Pennsylvania 17013 (717) 243-6090 Supreme Court ID No. 29920 DAVID R. HEYDT, V. IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLV KATHLEEN HEYDT, Defendant : CIVIL ACTION - LAW : NO. 2005 - CIVIL TERM IN DIVORCE AFFIDAI The plaintiff, being duly sworn according to law, deposes and says: 1. I have been advised of the availability of marriage counseling and that I may request that the court require that my spouse and I participate in 2. 1 understand that the court maintains a list of marriage counselors in the Prothonotary's Office, which list is available to me upon request. 3. Being so advised, I do not request that the court require that my spouse participate in counseling prior to a divorce decree being handed down. I verify that the statements made in this affidavit are true and correct. I false statements herein made are subject to the penalties of 18 Pa. C.S. Section relating to unsworn falsification to authorities. April /` 2005 I ?f that R. HEYDT, C- h y? mow.. v, DAVID R. HEYDT, V. IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA KATHLEEN HEYDT, Defendant CIVIL ACTION - LAW NO. 2005 - 1906_CIVIL TERM IN DIVORCE AFFIDAVIT OF SERVICE OF COMPLAINT PURSUANT TO PA. R.C.P. RULE NO. 1920.4 (a)(1)(1) NOW, Harold S. Irwin, III, Esquire, being duly sworn according to law, does depose and state: 1. That he is a competent adult and attorney for the plaintiff in the above captioned action in divorce. 2. That a certified copy of the complaint in divorce was served upon the defendant on May 15, 2005, by personal service. 3. That an affidavit of service by the process server is attached hereto. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein made are subject to the penalties of 18 Pa. C. S. Section 4904, relating to unsworn falsification to authorities. May 26, 2005 Harold S. Irwin, III Attorney for plaintiff 64 South Pitt Street Carlisle, PA 17013 717-243-6090 Supreme Court ID No. 29920 AFFIDAVIT OF SERVICE Commonwealth of Pennsylvania County of Cumberland Court Of Common Pleas Court Case Number: 2005-1906 CIVIL TERM Plaintiff: David R. Heydt vs. Defendant: Kathleen Heydt For: Irwin Law Office Received by ROMINGER LEGAL to be served on Kathleen Heydt, 701 Sandbank Road, Mt. Holly Springs, PA 17065. I, ?,OrWV c7. ST OW , being duly sworn, depose and say that on the 15"* day of 97AY 200E at 5-:3or m., executed service by delivering a true copy of the Letter; Notice; Divorce Complaint; Plaintifrs Marriage Counseling Affidavit; Order of Court; Complaint for Custody; Verification; Marriage Settlement Agreement in accordance with state statutes in the manner marked below: INDIVIDUAL SERVICE: Served the within-named person. () SUBSTITUTE SERVICE: By serving as () POSTED SERVICE: After attempting service on _/_ at _ and on _/, at _ to a conspicuous place on the property described herein. () NON SERVICE: For the reason detailed in the Comments below. Military Status: ( ) Yes or 00 No If yes, what branch? Marital Status: N) Married or ( ) Single Name of Spouse DAyl`,-'? R. NMr COMMENTS: I certify that I have no interest in the above action, am of legal age and have proper authority in the jurisdiction in which this service was made. Sub ribed and Swam to before me on the day PROCESS SERVER # of , ? by the affiant who is Appointed in accordance pe ally nown to me. with State Statutes l7 ROMINGER LEGAL O RY PU C 48 W. High St. P.O. Box 1148 COMMONWEALTH OF PENNSYLVANIA Carlisle, PA 17013 Notarial Seal (717) 960-9260 Tammie L. Peters, Notary pudic Our Job Serial Number: 2005000155 South Middleton Twp., Cumberland County MY Commission Expires Sept 9, 20aft n O IW2-2005 Ostmsse Services, Inc. - P,oceu Swrvoes Toolbox V55i Member. Pennsylvania Association Of Notaries CD DAVID R. HEYDT, Plaintiff v KATHLEEN HEYDT, Defendant TO THE PROTHONOTARY: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : No. 2005-1906 CIVIL TERM : CIVIL ACTION-LAW : IN DIVORCE PRAECIPE Please enter the appearance of the undersigned on behalf of Defendant, Kathleen Heydt. Hubert X. Gilr y, Esquire Broujos & G' oy, P.C. 4 N. Hanove Street Carlisle, PA 17013 (717) 243-4574 Attorney for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff CIVIL ACTION - LAW V. IN DIVORCE KATHLEEN HEYDT, Defendant PRAECIPE TO ENTER APPEARANCE To the Prothonotary: Please enter the appearance of Diane G. Radcliff, Esquire, Supreme Court ID No. 32112, on behalf of the Defendant, Kathleen Heydt. Papers may be served at the address set forth below: Diane G. Radcliff 3448 Trindle Road Camp Hill, PA 17011 Phone: (717) 737-0100 Date: November 7, 2006 RADCLIFF, ESQUI Burt ID #32112 N ?1 f ^\TT" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff CIVIL ACTION - LAW V. IN DIVORCE KATHLEEN HEYDT, . Defendant PRAECIPE FOR WITHDRAWAL OF APPEARANCE To the Prothonotary: Withdraw my appearance on behalf of the Defendant, Kathleen Heydt. Date: 44? 0-G 6 HUBERT X. GILR , ESQUIRE 4 North Hano r Street Carlisle, P 17013 (717) 243-4574 C? ,? - ?-` ? u^ -? ..r, ? ? ' r?: , J ??? i._.. `t? Cs) .- t?j i ", ? ORIGINAL IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, Plaintiff V. KATHLEEN HEYDT, Defendant . NO. 05-1906 CIVIL TERM : CIVIL ACTION - LAW : IN DIVORCE NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Defendant. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Courthouse, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, COUNSEL FEES OR EXPENSES BEFORE THE FINAL DECREE OF DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD STREET CARLISLE, PA 17013 (717) 249-3166 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff : CIVIL ACTION - LAW V. IN DIVORCE KATHLEEN HEYDT, Defendant PETITION FOR ECONOMIC CLAIMS Petitioner, Kathleen Heydt, by her attorney, Diane G. Radcliff, Esquire, this Petition for Economic Claims and represents that: 1. Petitioner is Kathleen Heydt, Defendant in the above captioned case. 2. Respondent is David R. Heydt, Plaintiff in the above captioned case. 3. This action was commenced by the filing of a Divorce Complaint by the Respondent on April 14, 2005. 4. In theDivorce Complaint the Respondent raised the following claims: No Fault Divorce under Section 3301(c). 5. Petitioner wishes to raise the following economic claims in this Petition as permitted by the Domestic Relations Law. PETITIONER'S COUNT I EQUITABLE DISTRIBUTION 6. Petitioner incorporates by reference the averments set forth in Paragraphs 1-5 herein as fully as though the same were set forth at length. 7. Respondent and Petitioner have acquired property and debts, both real and personal, during their marriage from the date of marriage to the date of separation, all of which is "marital property". - 2 - 8. Respondent and/or Petitioner have acquired, prior to the marriage or subsequent thereto, "non-marital property" which has increased in value since the date of marriage and/or subsequent to its acquisition during the marriage, which increase in value is "marital property". 9. Respondent and Petitioner have been unable to agree as to an equitable division of said property as of the date of the filing of this Complaint. WHEREFORE, Petitioner requests this Honorable Court to equitably divide all marital property and debts of the parties. PETITIONER'S COUNT II ALIMONY PENDENTE LITE, ALIMONY 10. Petitioner incorporates by reference the averments set forth in Paragraphs 1-09 herein as fully as though the same were set forth at length. 11. Petitioner lacks sufficient property to provide for her reasonable means and is unable to support herself through appropriate employment. 12. Petitioner requires reasonable support to adequately maintain herself in accordance with the standard of living established during the marriage. WHEREFORE, Petitioner requests this Honorable Court to enter an award of alimony pendente lite until final hearing and hereafter enter an award of alimony permanently thereafter. PETITIONER'S COUNT III COUNSEL FEES AND COSTS 13. Petitioner incorporates by reference the averments set forth in Paragraphs 1-12 herein as fully as though the same were set forth at length. 14. Petitioner has employed legal counsel but is unable to pay the nece ssary and reasonable attorney's fees for said counsel. 15. Petitioner is in need of hiring various experts to appraise the parties' marital assets and does not have the funds to pay the necessary and reasonable fees. - 3 - WHEREFORE, Petitioner requests this Honorable Court to enter an award of interim counsel fees, costs and expenses and to order such additional sums hereafter as may be deemed necessary and appropriate and at final hearing to further award such additional counsel fees, costs and expenses as are deemed necessary and appropriate. Respectfully submitted, 4 DI E G DCLIFF, ESQa - 'P UIRE 3448 Trindle Road Camp Hill, PA 17011 Supreme Court ID #32112 Phone: (717) 737-0100 Attorney for Petitioner Date: 6 - 4 - VERIFICATION verify that the statements made in this Petition are true and correct. Petitioner understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. L KATHLEEN H YDT Date: CERTIFICATE OF SERVICE AND NOW this ndof DIANE G. RADCLIFF, ESQUIRE, Respectfully submitted, hereby certify that I have this day served a copy of the within PETITION FOR ECONOMIC CLAIMS upon the Respondent's attorney, Harold E. Irwin, III, Esquire, by mailing same by first class mail, postage prepaid, addressed as follows: Harold S. Irwin, III, Esquire 64 South Pitt Street Carlisle, PA 17013 J DI IF ESQUIRE end 34 Camp Hill, PA 17011 Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court ID # 32112 Attorney for Petitioner d f;1 i-_ 4r DAVID R. HEYDT, a IN THE COURT OF COMMON PLK" OF l10111tw 3 Ct/tN IMULAND COIINTY9 PENNSYLVANIA V. s CIVIL ACTION - LAW s NO. 2005 -1006 CIVIL TER#1 KATHLEEN HEYDTw s Defindont s IN DIVORCE AFFi#At?fT OP CONal?JIT 1. A complaint in divorce under Section 3301 (c) of the Divorce Code was Mad In this mother on or about April 14, 2005. Personal service of the complaint was made upon defendant on or about May 15, 2005 (see affidavit of service fled May 27,2W5). 2. The marriage of plalrrtllf and defendant is Irretrievably broken and ninety days love elapesd from the date of the service of the amended oompkdnt. 3. 1 consent to the entry of a flrtel decree in divorce after setvlr a of notice of ir*w&on to request entry of the divorce. Apra _, / , 2007 4):-Vez AL DAVID R. HEYOT ?AtYtR OF NOTtfiE OF Ib111'tefi'#'10M KHM OF A DIVRM OEM NNOi le JIM&1 aw TM Dri>+rowc 220 1. ' 1 consent to the entry of a final decree of divorce w*xxA notice. 2. 1 understand that I may lose r%#ft ooncerning alimony, division of property, lawyer's fees or expenses If 1 do not claim them before a divorce Is granted. 3. 1 understand that I will not be divorced until a divorce decree Is entered by the Court and that a copy of the decree vAl be sent to me Immediately after it is filed with the Prothonotary. I verify that the statements made in this afdavit are true and correct. 1 understand that false st&Wff enta herein are made subjed to the penalties of 18 Pa.C.S. Section 4904 reloitrrg to unswom falsftation to authorities. April LL, 2007 DAVID IIE HEYDT C= S l7? ? c s _ 47 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff CIVIL ACTION - LAW V. IN DIVORCE KATHLEEN HEYDT, Defendant PETITION FOR SPECIAL RELIEF/INJUNCTION AND NOW, comes the Petitioner, Kathleen Heydt, by her attorney, Diane G. Radcliff, Esquire, and files the above referenced Petition, and represents that: 1. Your Petitioner is Kathleen Heydt, (hereinafter referred to as "Wife"), the Defendant in the above captioned divorce action. 2. Your Respondent is David R. Heydt (hereinafter referred to as "Husband"), the Plaintiff in the above captioned divorce action. 3. The parties are husband and wife. They were married on May 13, 1988 and separated on September 1, 2004. 4. On April 14, 2005, Husband initiated this divorce action by the filing of a Divorce Complaint. 5. On November 17, 2006, Wife filed a Petition Raising Economic Claims, in which she raised the following claims: A. Equitable Distribution; B. Alimony Pendente Lite; C. Alimony; D. Counsel Fees and Costs. 6. During the course of their marriage, the parties acquired certain marital assets which are listed on the Table attached to this Petition as Exhibit "A" and made a part hereof. 7. The only major assets in this case are Husband's retirement plans. -1- 8. Husband has failed to provide Wife with all of the information she needs to value his retirement plans. 9. From the documentation that has been provided, it is apparent that husband has withdrawn and spent at least half of the value of this retirement plans, all of which was done without Wife's knowledge and consent. 10. Husband recently advised Wife that he is no longer employed. 11. Wife believes that due to Husband's lack of employment Husband will cause the further removal, disposition, alienation or encumbering of the marital assets listed on Exhibit "A", which will result in irreparable harm to Wife and will defeat her claims to a fair and equitable distribution thereof. 12. A copy of this Petition has been provided to husband's Attorney, Harold S. Irwin, III, Esquire, prior to the filing and no agreement has been reached as to the relief requested herein. 13. No judge has been assigned to this case. WHEREFORE, based on the foregoing, Wife respectfully requests this Honorable Court to enter an Order: A. Enjoining and prohibiting each of the parties from the removing, transferring, conveyancing, disposing, alienating or encumbering of any of the marital assets listed in the Table attached to the within Petition as Exhibit "A", including but not limited to any retirement plans and IRA accounts established using any funds acquired during the marriage, whether in cash or from roll over of marital retirement plans. B. Within ten (10) days of the date of this Order, requiring Husband to produce and submit to Defendant copies of his retirement plan statements issued from or after August 31, 2004 until the present date. C. Requiring the parties to maintain all Life Insurance Policies on his/her life, and Pension Plans, IRA accounts and 401 K plans, existing as of the date of the parties' separation on September 1, 2004. D. Requiring the parties to designate each other as the beneficiary of the death benefits on said policies, retirement plans or accounts to the extent that such policies or plans have death beneficiary or survivors benefits designations -2- E. Enjoining the parties from terminating or cancelling said Life Insurance Policies, Pension Plans, IRA Accounts and 401k Plans, and from making any withdrawals from or loans against said Life Insurance Policies, Pension Plans, IRA Accounts and 401 k Plans. F. Requiring Husband to pay the reasonable attorneys fees and costs incurred by wife in bringing the Petition. G. For such other and further relief as the Court may deem appropriate. Respectfully Submitted, DIAN CLI , ESQUIRE (Att ney Registr ion No 32112) 3448 Trin e oad, Camp Hill, PA 17011 Email: dianeradcliff@comcast.net Phone: (717) 737-0100 * Fax: (717) 975-0697 Counsel for Kathleen Heydt Dated: 1 ? / -2,8 1 6 - 3 - VERIFICATION Kathleen Heydt verifies that the statements made in the foregoing Petition are true and correct. She understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. . zale"t d?f? KATHLEEN HE,Y/DT Date: 111,2z// l? -4- CERTIFICATE OF SERVICE I hereby certify that I am this day serving the foregoing document upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure: Service by First Class Mail Addressed as Follows: Harold S. Irwin, III, Esquire 64 South Pitt Street Carlisle, PA 17013 (Counsel for David R. Heydt, Plaintiff) i DCLIFF, ESQUIRE ( ttorney egistration No 32112 34 le Road Camp Hill, PA 17011 Email: dianeradcliff@comcast.net Phone: (717) 737-0100 Fax: (717) 975-0697 Counsel for Kathleen Heydt, Defendant Dated: 2--? V - 5 - Kathleen Heydt vs. David R. Heydt DOM: 5/13/88 • DOS (Physical): 9/1/04 Date Prepared:May 7, 2007 MARITAL ASSETS AND DEBTS A B C D E F G H I Ln N B. Ref Owner Description Date Gross Value Distribution Value Distribute To Distribute To H n Wife 4 REAL ESTATE AND REi L.ESTA'TF, 0RTGAi3 5 RE-1 it 701 Sandbank Rd Mechanicsburg , PA Est 375,000 6 RE-1 it Chase 1" Mortgage #2656 Est 10.06 (271,743) 000' Ole 7 RE-1 it PNC HELOC #6093 Est. 10.06 (75,000) 8 RE-1 it Sales Cost @7% (26,250) 9 RE-1 it Est. Net Value -- 2,007 2,007 2,007 11 MOTOR VEHFCLESAND VEHICLE LIENS 12 V-1 W 1990 Ford Crown Vic TBD 13 V-1 -- Lien None 100 0ezzX-100 14 V-1 W 1990 Ford Net Value -- 0 0 0 0 16 V-2 H 1993 Ford F-150 King Cab Tk TBD 1XX10'f'0 00ezzz1 001X Z/ 17 V-2 -- Lien None or or OZZ 18 V-2 H 1993 Ford Tk Net Value -- 0 0 0 0 Y X, Y, Y, 20 STOCKS, BONDVCDVAND OTHER]NVESTMENTS 21 INV-1 H Disney Stock TBD TBD TBD 23 INV-2 H Dell Stock TBD TBD TBD 25 INV-3 H Other Mutual Funds and Stocks TBD TBD TBD 27 CASH, CHECKING ACGOUITS AND SAVING S ACCOUNTS 28 A-1 JT PNC Checking TBD 29 A-1 JT PNC Savings TBD 30 A-1 -- Net Value -- 0 0 0 32 RETIREME,NT'PLANS 33 Ret-1 H Yellow Roadway Retirement Savings Plan 12.31.04 80,182 80,182 80,182 35 Ret-2 H LLC Pension Plan -- TBD TBD TBD Exhibit "A" ? t _ % 1 wt S 4 HAROLD S. IRwIN, 111, ESQUIRE SUPRltME COURT 1D NO. 29920 64 SOUTH PITT STREET CARLISLE, PA 17013 71744346000 ATTORNEY FOR DEPENDANTS DAVID R. HEYDT, V. : IN THE COURT OF COMMON PLEAS OF Plalntm : CUMBERLAND COUNTY, PENNSYLVANIA KATHLEEN HEYDT, DNsndant : CIVIL ACTION - LAW : NO. 2005 -1906 CIVIL TERM IN DIVORCE PETITION TO WITHDRAW AS COUNSEL NOW comes Harold S. Irwin, III, Esquire, attorney for defendant, and presents this petition to withdraw as counsel, representing as follows: 1. Petitioner is Harold S. Irwin, III, attorney for defendant, with offices at 64 South Pitt Street, Carlisle, Cumberland County, Pennsylvania 17013. 2. Respondents are the plaintiff, David R. Heyt, and the defendant, Kathleen Heydt, whose legal counsel is Dianne Radcliff, Esquire, with offices located at 3448 Trindle Road, Camp Hill, Cumberland County, Pennsylvania 17011. 3. Petitioner has represented the defendant in this matter since April, 2005. 4. The current action is a divorce action which is in the discovery phase. 5. On Thursday, December 6, 2007, petitioner received an email from the plaintiff asking that petitioner withdraw his representation for the plaintiff. A copy of this email is incorporated herein by reference and attached hereto as Exhibit "A". 6. On December 8, 2007, petitioner notified counsel for the defendant regarding plaintiff's request, asking whether counsel had any objection to his withdraw. On December 10, 2007, counsel for defendant responded indicating that she has no objection to petitioner's withdrawal. Copies of these emails are incorporated herein by reference and attached hereto as Exhibit "U'. 7. No judge has entered any orders in this matter except that Judge Guido has just scheduled a hearing for Tuesday, December 11, 2007, regarding defendant's petition for an injunction. Plaintiff has been notified by petitioner of this recent petition for an injunction and the scheduling of this hearing. WHEREFORE, petitioner requests your Honorable Court to grant petitioner leave to withdraw from this case as counsel for plaintiff. December 10, 2007 HAROLD S. IRWIN, 111 Petitioner Carlisle, PA 17013 717-243-6090 Supreme Court ID No. 29920 64 South Pitt Street VERIFICATION The foregoing petition is true and correct to the best of my knowledge, information and belief. 1 understand that false statements made herein are subject to the penalties of 18 Pa.C.S.A. Section 4094, relating to unsworn falsification to authorities. December 10, 2007 - "? vL?- - " HAROLD S. IRWIN, I Petitioner Harold S. Irwin, III From: Dave Heydt [drheydt@comcast.net] Sent: Thursday, December 06, 2007 4:35 PM To: Harold S. Irwin, III Subject: Re: Your Bill Could you please withdraw your representation and let Attorney Radcliffe know. I will be representing myself. I will send you a check and I will need to stop by and get my file. Thanks, Dave Page 1 of 1 Harold S. Irwin, III From: Diane Radcliff [dianeradcliffOcomcast.net] Sent: Monday, December 10, 2007 9:00 AM To: Harold S. Irwin III Cc: Kathleen Heydt Subject: Re: Withdrawal of Representation Thanks for the heads up. I have no objection to your withdrawal and you may so advise the court Regards, Diane G. Radcliff, Esquire 3448 Trindle Road, Camp Hill, PA 17011 Phone: 717-737-0100 Fax: 717-975-0697 E-Mail: dianeradcliff@comcast.net NOTICE: This E-mail (including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. §§ 2510-2521, the attorney client privilege and attorney work product. This E-mail (including attachments) is confidential and legally privileged. If you are not the intended recipient, you are hereby notified that any retention, dissemination, distribution, or copying of this communication is strictly prohibited. Please reply to the sender that you have received the message in error; then delete it. Thank you. -------Original Message------- From: Harold S. Irwin. III Date: 12/8/2007 11:09:00 AM To: 'Diane Radcliff' Cc: 'Dave Heydt' Subject. Withdrawal of Representation Diane - Mr. Heydt has asked that I withdrawal my appearance in this case as he desires to represent himself. Please advise if you have any objection to my withdrawal. Very truly yours, Hal Irwin x Free Christmas Animations for your email - By IncrediMail! Click No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.5.503 / Virus Database: 269.16.17/1179 - Release Date: 12/9/2007 11:06 AM 12/10/2007 Tt` GJ -? ? ;J DEC 0 41D0?,1 . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, , Plaintiff V. KATHLEEN HEYDT, , Defendant . NO. 05-1906 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE TEMPORARY INJUNCTION AND ORDER FOR HEARING AND NOW, this (O day of , 2007, upon consideration of the within Petition, IT IS HEREBY ORDERED that: A hearing scheduled A the within Petitio for the aY ?? of , 20 01 at 3• 'clock , m. in Courtroom :§ of the Cumberland County Courthouse Carlisle, Pennsylvania. The parties shall appear at that date and time and give testimony and argument on the issues raised in the within Petition. AND IT IS FURTHER ORDERED that pending the hearing and further Order of Court, but without prejudice to either party: 1. The parties are each enjoined and prohibited from the removing, transferring, conveyancing, disposing, alienating or encumbering of any of the parties' marital assets including but not limited to any retirement plans and IRA accounts established using any funds acquired during the marriage, whether in cash or from roll over of marital retirement plans. 2. Within ten (10) days of the date of this Order, Plaintiff shall produce and submit to Defendant copies of his retirement plan statements issued from or after August 31) 2004 until the present date. 3. The parties shall maintain all Life Insurance Policies on his/her life, and Pension Plans, IRA accounts and 401K plans, existing as of the date of the parties' separation on September 1, 2004. 4. The parties shall each designate the other party as the beneficiary of the death benefits on said policies, retirement plans or accounts to the extent that such policies or plans have death beneficiary or survivors benefits designations. 5. The parties are further enjoined from terminating or cancelling said Life Insurance Policies, Pension Plans, IRA Accounts and 401 k Plans, and from making any withdrawals from or loans against said Life Insurance Policies, Pension Plans, IRA Accounts and 401k Plans. BY TH URT: J. Distribution to: Attorney for Plaintiff, David R. Heydt: Harold S. Irwin, III, Esquire 64 South Pitt Street Carlisle, PA 17013 Attorney for Defendant, Kathleen Heydt: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 dianeradcliff@comcast.net Phone: (717) 737-0100 Fax: 717-975-0697 ( O 1%" /-ra f LL 1 12?z f o7 ?7° t d ? a n, , ?, jn 3-7 DEC 10 2007,E S' HAROLD S. IRMIIN, III, !SQUIRE SUPREME COURT ID NO. 29M 64 SOUTH PITT STREET CARLISLE, PA 17013 7174434050 ATTORNEY FOR DEFENDANTS DAVID R. HEYDT, Plaintiff V. KATHLEEN HEYDT, Detandant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. ZOOS -1906 CIVIL TERM IN DIVORCE ORDER OF COURT A NOW, this //[ day of December, 2007, on petition of Harold S. Irwin, 111, Esquire, and based upon the request of the plaintiff and the consent of defendant's counsel, leave to petitioner to withdraw as counsel for the plaintiff is granted. B J. c _ 1r ' I t l' , o 9 th .6 14V Z 1 330 LOOZ 3-? JO f ti IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, Plaintiff V. KATHLEEN HEYDT, NO. 05-1906 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE Defendant ORDER AND NOW, this I / day of , 2007, the parties appearing before this Court for a hearing on Defendant's Petition for Special Relief /injunction, Defendant with her counsel, Diane G. Radcliff, Esquire, and Plaintiff pee IT IS HEREBY ORDERED that- jA44,4 14 ,ed 1. The parties are each enjoined and prohibited from the removing, transferring, conveyancing, disposing, alienating or encumbering of any of the parties' marital assets including but not limited to any retirement plans and IRA accounts established using any funds acquired during the marriage, whether in cash or from roll over of marital retirement plans. For purposes of this Order, this injunction shall include, BUT NOT BE LIMITED TO, the following retirement plans: A. Yellow Roadway Corporation Retirement Savings Plan (c/o Fidelity Investments, P.O. Box 5424, Cincinnati, OH 45250-5424) B. Roadway LLC Pension Plan (c/o State Street Retiree Services for Roadway LLC Pension Plan, P.O. Box 5149, Boston, MA 022065149) C. Fidelity c/o Fidelity Investments, Client Services, P.O. Box 770001, Cincinnati, OH 45277- 00451 D. A L1' -hrs. Cow??n?o Yol4ies 2. On or before December 17, 2007, Ot`aintiff shall produce and submit to Defendant of his retirement plan statements for all of his retirement plans including, but not ? ? t~ limited to the plans specified in paragraph 1 above, which were issued or after August 31, 2004 through December 11, 2007. Further, within five days of the date of his receipt, but in no event any later than February 1, 2008, Plaintiff shall produce and submit to Defendant copies of his retirement plan statements for all of his retirement plans including, but not limited to the plans specified in paragraph 1 above, which were issued or after December 11, 2007 through and including December 31, 2007. 3. The parties shall maintain all Life Insurance Policies on his/her life, and Pension Plans, IRA accounts and 401K plans, existing as of the date of the parties' separation on September 1, 2004. 4. The parties shall each designate the other party as the beneficiary of the death benefits on said policies, retirement plans or accounts to the extent that such policies or plans have death beneficiary or survivors benefits designations. 5. The parties are further enjoined from terminating or cancelling said Life Insurance Policies, Pension Plans, IRA Accounts and 401 k Plans, and from making any withdrawals from or loans against said Life Insurance Policies, Pension Plans, IRA Accounts and 401 k Plans. J. 0 ^e a 9 :9 WV 3 1 030 LITZ t,U.:j 31 Hi ?0 .111 -Cl] 11:3 b IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff CIVIL ACTION - LAW V. IN DIVORCE KATHLEEN HEYDT, Defendant INCOME AND EXPENSE STATEMENT OF KATHLEEN HEYDT I verify that the facts set forth in the following Income and Expenses Form, including all attachments thereto, are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to authorities. 0 DATE: -6L KATHLEEN 4*HEYT - 1 - I PART I. INCOME 1-11 LINCOME: DESCRIPTION BIWEEKLY MONTHLY YEARLY Gross Income $1,461.54 $3,166.67 $38 000 04 Subtotal Income $1,461.54 $3,166.67 , . $38 000 04 MANDATORY DEDUCTIONS , . FICA Federal Tax ($108.83 ($235.80) ($2,829.58) State Tax ($180.43 ($390.93) ($4,691.18) Local Tax ($43.67 ($94.62) ($1,135.42) PaSUI (Unemployment) ($22.76) ($49.31) ($591.76) Subtotal Mandatory Deductions ($0.88) ($356.57 ) ($1.91) ($772 57) ($22.88) $9 INSURANCE . ( ,270.82) Medical Insurance ($58.28) ($126.27) ($1,515.28) LTD Subtotal Insurance ($19.32) ($41.86) ($502.32) VOLUNTARY DEDUCTIONS ($77.60 ) ($168.1'3) ($2,017.60) Voluntary Retirement ($58.56 ($126.88) ($1,522.56) Cert of Indebt Ded E ($50.00 E ($108.30 ($1,300.00) Subtotal Voluntary Deductions ($108.56 ) ($235.29) ($2,822.56) SUMMARY Income $1,461.54 $3,166.67 $38 000 04 Mandatory Deductions ($356.57 ($772.57) , . ($9,270.82) Insurance ($77.60 ($168.13) ($2,017.60) Voluntary Deductions ($108.56 ) ($235.21) ($2,822.56) NET INCOME $918.81 $1,990.6 $23,889.06 -2- DESCRIPTION MONTHLY YEARLY Interest Et Dividends Pensions Et Annuities Social Security Rents Expense Account Gifts Unemployment Or Workman's Compensation Support or Alimony (not this case) Commissions or Tips Other TOTAL OTHER INCOME $0.00 $0.00 - 3 - DESCRIPTION HOME EXPENSES: First Mortgage Home Equity Loan/Line of Credit Maintenance and Repairs PART N EXPENSES $1,612.00 $800.00 $300.00 Electric $300.00 Gas $145.00 Cell Phone $100.00 Water $90.00 Fluctuates between $80-100 Sewer $65.00 Trash $50.00 EMPLOYMENT AND NON-MANDATORY EMPLOYMENT DEDUCTIONS Lunches $120.00 TAXES: Real Estate Taxes Municipal (Spring) $74.58 No Mortgage Escrow @ 895/yr FRealEstate Taxes School (Fall) $333.33 Jo Mortgage Escrow @ 4000/yr Tax $1.00 : H omeowners insurance $90.00 No Mortgage Escrow Automobile Insurance $150.00 Life Insurance $40.00 AUTOMOBILE EXPENSES: Payments $320.00 Fuel $250.00 Maintenance and Repair $100.00 License and Registration $3.00 MEDICAL EXPENSES NOT REIMBURSED BY INSURANCE: Doctor $100.00 Optical/Vision $20.00 Dental Orthod t' on is $100.00 "stimated for Natalie who needs braces Medicine/ Prescriptions $30.00 CN?S Property Appraisal indicates substantial repairs and finish work is required. Amt is estimated -4- UM-00nON EDUCATIONAL EXPENSES: College Books, Fees Et Supplies PERSONAL EXPENSES: Clothing Food Barber Et Hair Dresser CREDIT CARDS AND LOANS: CitiBank Sears JC Penney Home Depot MISCELLANEOUS EXPENSES: Child Care Entertainment Pay TV Vacations Gifts Legal Fees Charitable Contributions TOTAL EXPENSES PART II EXPENSES $100.00 $200.00 $500.00 $50.00 $100.00 $50.00 $50.00 $50.00 $160.00 $100.00 $60.00 $200.00 $100.00 $250.00 $30.00 $7,193.91 David and Chelsea books-full time college Balance C $2000 Balance C $200 Balance @ $500 Balance @ $1000 Kyle - Child Time - 5 - PART IV. INSURANCE INSURANCE INFORAATPI'QN TYPE COMPANY POLICY NO. Hospital Medical Health Accident Disability Income Dental Vision Other-Specify *H=Husband; W=Wife; J=Joint; C=Child COVERAGE H T_W-_F C -6- PART III. PROPERTY OWNED PART V. SUPPLEMENTAL INCOME STATEMENT [ I ] CHECK HERE IF NOT APPLICABLE (a) This form is to be filled out by a person: (1) Who operates a business or practices a profession, or (2) Who is a member of a partnership or joint venture, or (3) Who is a shareholder in and is salaried by a closed corporation or similar entity. (b) Attach to this statement a copy of the following documents relating to the partnership, joint venture, business, profession, corporation or similar entity (check block to indicate the document is attached): (1) The most recent Federal Income Tax Return. [ ] attached (2) The most recent Profit and Loss Statement. [ ] attached (c) Name of Business: Business Address: Business Telephone: (d) Nature of [] 2. [] 3. [] 4. [] 5. [] 6. Business (check one) Sole Proprietorship Partnership Joint Venture Professional Corporation Other (e) Name of accountant, controller or other person in charge of financial records: (f) Business Income: 1. Annual income from business: 2. How often is income received: 3. Gross income per pay period: 4. Net income per pay period: 5. Specify deductions, if any: CERTIFICATE OF SERVICE I, Diane G. Radcliff, Esquire, hereby certify that on I served a copy of the within INCOME AND EXPENSE STATEMENT, by mailing 4ame first class mail, postage prepaid, addressed as follows: David R. Heydt 118 Sparrow Road Hummelstown, PA 17036 MA,NE G. DCLIFF, ESQUIRE 3448 rindle Road Camp Hill, PA 17011 Supreme Court ID # 32112 Phone: (717) 737-0100 Fax: (717) 975-0697 Attorney for Defendant -8- Member ServkalBenefit Questions: Call 14100.34941806. Providers: All dawns should be submitted to your local Blue Cross and/or Blue Shield plan. Blues on Call: Calf 138843LUE-42B for 24-hour access to nurses who provide health education and support services. To Receive High Level Banefitw You must receive care from a network provider. M you choose to receive care through an o"-network provider, for other than emergency care, you will receive payment at a reduced level of benefits. Admissions to a Non-PPOBlue Provider Hospital or Facility: For Mental HealtWSubstance Abuse call t 3004628-0816; for at other admissions call 14100345- 3806. Member Submitted Claims: If the provider does not submit your claim to their local Blue Cross0ue Shield plan, send your claim to Highmark Blue Shield, P.O. Box 890173, Camp Hill, PA 17089.0173. www.highmarkbiueshield.com BT0061 'ter PPS. OBlue ?o ??tmaoe, FOODS SE KNOUSE FOOD COOPERATIVE PEACH GLEN, PA. 17375 ?r 0 1 '- Direct Deposit Summary XNOUSE FOODS COOPERATIVE INC. -- Please Detach and Retain this Statement. This is a Record of your Earnings and Tax Deductions as Reported to Local, State and Federal Governments. 06-07-08 80.00 1 1461.54 1461.54 1 938.23 Activity Vacation Perm/Bonus Sick Lv Romp Lv Comp Er Marital M-her o! Add,'1 Federal Add'1 Btate Period Usage .00 .00 .00 .00 .00 Status Dependents Withheld Withheld Balance 28.00 16.00 25.00 73.00 .00 S 0 .00 .00 Gross Earnings 1461.54 17538.48 Federal Income Tax 180.43 2166.66 FICA Deduction 108.83 1306.37 State Income Tax 43.67 524.04 State Unemp Tax .88 10.53 Local Income Tax 22.76 273.13 Health Insurance Dec 38.96 I., T D Insurance Ded 19.32 Cert of Indebt Ded 50.00 401K Contribution 58.46 701.52 Hours Worked 80.00 960.00 Fo 1040 Department of the Treasury - Internal Revenue Service r,, U.S. Individual Income Tax Return 2007 For the ear Jan 1 - Dec 31 , 2007 , or other tax ear be innin IRS Use Only - Do not write or staple in this space. _ Label g g Your first name f.41 Last name 2007, ending 20 OM B No. 1545-0074 (See instructions .) KathleeII Your s social secudty number Hedt Use the If a ioint return, spouse's first name MI Last name _ IRS label. use's so Clal iy ty number Otherwise, please print Home address (number and sheet) If ycu have 'al .O box, see insfrur,(ions or type. 701 Sand Bank Rd Apartment no. You must enter your City, town or post office. If you have a foreign address, see instructions. social security 'it number(s) above S Presidential . tate ZIP code Election Mount Holly S rin s Checking a box below will not Campaign PA 17065-1140 change your tax or refund. Check here if you, or your spouse if filin jointl w t $3 g y, an to go to this fund? (see in structions) - . . - . . . . . . ? You ? ? Spouse Filing Status 1 Single 2 4 X Head of household (with qualifying person) (See Marred tilingjoirnly (even if only one had income y ) . ) If the uali n instructions. q fy g person is a child Check only 3 Married filing separately. Erner spouse's SSN above & full but not your dependent, enter this child's one box. name here. ? name here ? Exemptions 5 6a Y Quaf in widow(er) with de ndent child (see instructions) ourself. If someone can claim you as a dependent, do not check box 6a. . Boxesn an checkbed o 6a d 8 Spouse b 6 1 . . . ' ' c Dependents: (2) Dependent's . No. of children (3) Dependent's (4) if on 6c who: social security relationship qualifying Eying *lived (1) First name number Last name to you child for child with you 4 tax credit • did not Chelsea L He dt ee (see instrs) live with you Dau hter due to divorce david M he dt eparat) If more than SOn (s eeinstrs) . four dependents, natalie C he dt Dependents on 6c not Dau hter see instructions. kyle R he dt ener entered above . of Total number of exemptions claimed SOn X Add numbers si . 7 Wa eS I on nes above . ? I ' Income Attach Form(s) W-2 here. Also attach forms W-2G and 1099-R if tax was withheld. If you did not get a W-2, see instructions. Enclose, but do not attach, any payment. Also, please use Form 1040-V. Adjusted Gross Income g , sa anes, tops, etc. Attach Form(s) W-2 8 a Taxable interest. Attach Schedule B if required . . . . b Tax-exempt interest. Do not include on line 8a . . . . . . , . I 8 bI 9 a Ordinary dividends. Attach Schedule B if required . . . . . . b Qualified dividends (see instrs) . . . . . . . . . . . . I 9 bI . . . . . . 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) . 11 Alimony received. . . . . . . 12 Business income or (loss). Attach Schedule C or C-EZ - . 13 Capital gain or (loss). Att Sch D if regd. If not read, ck here . . . . 14 ........... - - - ? Other gains or (losses). Attach Form 4797 . . 15a IRA distributions . . . . . . 15a 16a Pensions and annuitie - b Taxable amount (see instrs) . s . . 16a I b Taxable amount (see instrs) . 17 Rental real estate, royalties, partnerships, S corporations, trusts etc Attach Schedule E 18 Farm income or (loss). Attach Schedule F . - , . . . 19 Unemployment compensation - - _ 20 a Social security benefits . . . . - . 120 a I I b Taxable amount (see instrs) 21 Other income . _ 22 Add the amounts in the far right column for lines 7 through 21. This is your total income . . 23 Educator expenses (see instructions) . . . . 24 Certain business expenses of reserosts, performing artists and fee-'_al government officials. Attach Form 2106 or 2106-EZ 23 . . - - - . . 25 Health savings account deduction. Attach Form 8889 24 25 26 Moving expenses. Attach Form 3903 . 27 One-half of self-employment tax. Attach Schedule SE - - 26 27 28 Self-employed SEP, SIMPLE, and qualified plans . - - 28 29 Self-employed health insurance deduction (see instructions) . . . . 29 30 Penalty on early withdrawal of savings . - . . - - - . - 31 a Alimony, paid b Recipient's SSN. . . 30 - 32 IRA deduction (see instructions) . - . 31a _ - 33 Student loan interest deduction (see instructions) . . . . 32 33 34 Tuition and fees deduction. Attach Form 8917 - . . 34 35 Domestic production activities deduction. Attach Form 8903- 35 35 Add lines 23 - 31a and 32 - 35 . . Cli _ This is vcur -_-Lls'e_Cd L!L=.J3 n:. J5, Si- r 34,180. 8a 116. 9a 10 11 t 2 --- _ 13 14 15b 6b 7 - a 9 - 0b _ 1 - 2 34,296. Fotm 1640 Tax and Credits Kathleen Heydt Standard Deduction i People rho checked a,r;y G._n?_ .. j`i or ?4, Claimed ac a oeh n-t G.,,. ?.- .Ali U iile-5: Jointly i+rvri ii. , Qua! fytag . ... •oviccio4er), Head of househo•id $7,850 p 8, p lo ? Form 55 =6 Add lines 47 through 55. These are your total credits . - _ 5. Subtract line 56 from line 46. If line 56 is mor . than line ea Sts ,mount from line 37 (adjusted gross income) . . . :9a Check F You were born before January 2. '1943, Blind. Total boxes Spouse was born before January 2: ?943, Blind. checked ? 39a h 'f year spouse itemizes on a separate return, or you were a dual-status alien. see instrs and ck. here 0- 39b ?0 itemized deductions (from Schedule Al or your standard deduction (see Jett marainl - T1 Subtract line 40 from line 38 . _ . . . 41 0 12 If line 38 is $117,300 or less, multiply - - -I 41 claimed on line 6d. If line 38 is over $3'400 by the total number of exemptions v er $117,300, see the instructions _- in, 1 I,ne 42!5 m re 1 an line _. ...._r ; _. _ tiled, if an,, ray is fr„n 43 ?Y seo gt i ? Form(s) 8814 b ? Form 4972 c L Form(s) 8889. I - 5 Alternative minimum tax (see instructions) Attach Form 625? - 4µ ii: dePca•.ei1[ L. :i 2 cnpc'i ? ?, r• ii3` Fu-;fl L441 _ 47 I 0 Credit for the elderly or the disabled. Attach Schedule R 48 Residential energy credits. Attach Form 5695 - 50 Foreign tax credit. Attach Form 11 16 if required _ . . . . 51 Child tax credit (see instructions). Attach Form 8901 if required . . . 52 Retirement savin 0 . savings contributions credit. Attach Form 8880 - 53 rr ?;ts from: a ? C E] Fo" 8 '06 Form 8859 Form 8839. 54 Ij,` - ? Foy-, FC 1 - ,.. - - . . . 58 Sett-,rloyment 3?X. ,';:•.ar`h Setleduie SE . . . _ Other 59 Unreported social security and Medicare tax from: a ? Form 4137 b -axes . . 11 orm. . . T ?0F Additional tax an IRAs, other qualified retirement plans, etc. Attach Form 5329 if requi required 9 . 61 Advance earned income credit payments from Form(s) W-2 box 9 . . 62 Household employment taxes. Attach Schedule H Page 2 34 296. 25,402. ?_ 894. 17,000 - J. rl- { 0. 63 Add lines 57-62. This is your total tax . ' ' 82 i PaYm.-ents 64 Federal income tax withheld from Forms W-2 and 1099 s 63 0 F__- -- 65 2007 estimated tax 64 4,440. I if tirou 'nave a I Payments and amount applied from 2606 return . - 1 65 •-5 .1 ,ina a Earned income credit (EiC). . j ? ql:- 66a 7 -5 II cn;io, arra::r, I- n Nontaxable rcmoai pay election . . s ?66 bj _I 7 Eircess social security and tier 1 RRTA tax vdithheld (sce instructions) -° a8 Additional child tax credit. Attach Form 8812 . . . - - i 2 , 000 . 6° Amount paid'dfith request for extension to file (see instructions) Ica 7,1 Payments from: a ? Form 2439 b ? Form 4136 c ? =r,- . 71, Refundable credit for prior year minimum tax from Form 8801, line 27-' -'i 2 Add lines 54. 65, 66a, and 67 through 7i - These are yccr fota! Payments g 7 ? 79 If line 72 is more than line 63, s_ubtra.. ' 72 , . _ ` rt line 63 from line 72. This is the amount you overpaid . . . . 7' a . 73 7 7-0 r 4 Amount of line 73 you want refunded to you. If Form 8888 is attached check here A , nsfi-uct r,s b Routing number I 74a 7n r, i it in t . . . .031312738 c net ?X c :c>;nn n ; - - _ d Account number . I --- -- 500-475575 =o; m 888^0. 75 Amount of line N you want applied to our 2008 estimated tax > 71 i `.M U `i- ` 76 Amount you owe. Subtract line 72 from line 63. For details on hots to pay, see instnuciions _ e 77 Estimated lax pen. i,y (see instructions) I - I ?I 7- ------- ?i:ir£j Part- uo you a n, to aiiovi anemer .,.Con io discu„ this r,;urn v.rh the IRS j - -- 1 D=s:?, _ lsc'e n rt r ion - Lj .2 DosigneE' L See irstru i?al5. s _ jeep a Copy I I ? c TA L n C O _ c ? IG 3 3 I- - Z T I - G I L' T t; h' I` ? p J IQ O [[ " UJ I V o _ "' I- h WQI? '-- a oom W G C I O ., U'.- IL U ? Mp Q M a QJa pYVj O }z? U N m O=W- =G](? ti a u.U-ico zp} Q) .? 0 I E WQ G E W z J c 0 w 5 N ?W=I? Uco --i N . a+ m v, OC OQQ? lv/= f x O D O G O CL O zpW ? Y?Wt\ t_ > C) QO Yf?? U !- c w von m a ? ^ w v I o ? u I I ? I G .. ? c = c I? I- la I c O ILL I^ IT rc ? f I` I o? I I l i ? U c I u? ?E v c y f C u a` it C Z G ? IJ u w a D ? N tiD N T n nm " E m o L ' ? ? t n w n - ° m s' tp C 2 a G n ? t _ J N _ G ? LL H m cam t two. ;,c ? {,?3 i? a 1) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff CIVIL ACTION - LAW V. : IN DIVORCE KATHLEEN HEYDT, Defendant INVENTORY OF DEFENDANT, KATHLEEN HEYDT Defendant files the following inventory of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three years. Defendant verifies that the statements made in this inventory are true and correct. Defendant understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. KATHLEEN HEY PENDANT Dated: X DIA CLIFF, ESQUIRE 448 Trindle R d 7011'. Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court IQ #32112 Dated: ASSETS AND LIABILITIES 01: PARTIES Defendant marks on the list below those items applicable to the case at bar and itemizes the assets and debts on the following pages: (x) 1. Real Property and Real Estate Mortgages (x) 2. Motor Vehicles and Vehicle Liens (x) 3. Stocks, Bonds, Securities and Options () 4. Certificates of Deposit (x) 5. Checking Accounts, Cash () 6. Savings Accounts, Money Market and Savings Certificates () 7. Contents of Safe Deposit Boxes () 8. Trusts (x) 9. Life Insurance Policies O 10. Annuities () 11. Gifts () 12. Inheritances () 13. Patents, Copyrights, Inventions, Royalties () 14. Personal Property Outside the Home () 15. Business () 16. Employment Termination Benefits-Severance Pay, Worker's Compensation () 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 () 25. Household Furnishings and Personalty (x) 26. Other Assets () 27. Loans, Credit Cards and Other Debts -2- INFORMATIONAL NOTES AND CODES 1. "I" denotes that the entry (value) is verified by a document. 2. 'W' denotes documents/information to be supplied by the designated party. 3. "U" denotes an item about which a decision is required. 4. "NM" denotes non-marital property not subject to equitable distribution. 5. The values used in the various Tables herein ma , in some cases, be based on estimated values. Those estimated values are subject to adjustment upon appraisal or otherwise. 6. Any adjustment figures used in the various tables herein are for illustration purposes only and are nod to be deemed a representation on the part of the Defendant as to whether an adjustment should be made or the amount of the adjustment, if any is appropriate. -3- SECTION I. BACKGROUND INFORMATION The following Table #1 sets forth the background information relevant to this case: TABLE #1-A PARTIES DESCRIPTION HUSBAND WIFE Name David R. Heydt Kathleen Heydt Maiden Name -- Kathleen Dugas Address 118 Sparrow Road 70'! Sandbank Road Hummelstown, PA 17036 Mt. Holly Springs, PA 7065 Cell Phone No. 386-0529 E-mail drheydt(a-)-comcast.net kheydt(c?knouse.com Date of Birth 2/7/1959 10/29/1964 Age 49 43 Health Status Good Good Educational Background Bs Animal Nutrition Penn BS Microbiology 1 State 1986; 988 Penn State Same Grad classes Names and Relationship of Girlfriend 4 children of parties Persons Living with Party Date Moved to Current 3/2005 2001 Residence Date PA Residency Began 2)01 2001 Current Military Service N/A N/A Employer's Name Ruan Knouse Foods Occupation (Job Position) Research Technician Date Employment Commenced 2008 3/2006 Est. Income $65,000 - $82,000 $3,166.67 per month Was previously employed $38,000/yr b Roadway Express @ $82,000 ((fired and by Finelli Trucking )@ $76,492 (Quit) 2/13/08 assigned earning capacity $75,000 by DRO then employed by (( (Quit); ? TBD @ Now employed d by TBD -4- TABLE #1-B MARRIAGE INFORMATION DESCRIPTION' INFORMATION Date of Marriage 5/13/1988 Place of Marriage Williamsburg, PA Date of Separation 9/1/2004 Grounds for Divorce No Fault Consent & 2 year separation Prior Divorce Actions Between Parties N/A Number of this Marriage for Wife 1 Number of this Marriage for Husband 2 TABLE #1-C CHILDREN OF THIS MARRIAGE NAME AGE DATE OF SCHOOL CUSTODIAN OR BIRTH GRADE EMANCIPATION Chelsey L. Heydt 19 11/9/1988 2 Year Wife College David M. Heydt 18 3/31/1990 1St year Wife college Natalie C. Heydt 14 11/4/1993 Wife Kyle R. Heydt 10 2/7/1998 Wife TABLE #1-D SUPPORT FOR THIS MARRIAGE DESCRIPTION INFORMATION Name of Party Paying Support Husband, David R. Heydt Beneficiaries of Support Wife + 3 Children Amount of Support 2191.81 base support Allocation $1,168.98 child snort; w1022.84 Spousal (allocated $138.94 Spousal Support; $883.90 Mortgage contribution) Date of Order 5/16/08 Effective Date of Order 6/5/08 Docket Number of Support Order 00886 S 2006; Pacses #496108678 Comments: Order based on $75,000 earning capacity for Husband -5- TABLE i.1-E PRIOR MARRIAGES PARTY BER NU ? WW MANNER OF TERMINATION M VN TE MARRIAGE Husband 1 1988? Divorce TABLE #1-F CHILDREN OF OTHER RELATIONSHIPS/MARRIAGES PARTY NAME OF CHILD B TH AEE .OR ANCIV ION None N/A N/A N/A N/A TABLE #1-G SUPPORT/ALIMONY FOR PRIOR MARRIAGES/RELATIONSHIP DESCRIPTION INFORMATION INFORMATION Name of Party Paying Support N/A N/A Beneficiaries of Support N/A N/A Allocation N/A N/A Agreement or Order N/A N/A Date of Agreement or Order N/A N/A Docket Number of Support Order N/A N/A Comments: N/A N/A -6- TABLE #1-H PROCEEDINGS INFORMATION: COMPLAINT Complaint Filing Date 4/14/2005 Date of Service 5/15/2005 Manner of Service Process Server-perttonal Delivery Type of Divorce Requested Cunsent No-Fault 3301(c) Economic Claims Raised None ANSWER, COUNTERCLAIM AND/OR OTHER PLEADING RAISINGiECONOMIC CLAIMS Type of Pleading Defendant's Petition Raising Economic Claims Pleading Filing Date 11/17/2006 Type of Divorce Requested N/A Economic Claims Raised Equitable Distribution; APL; Alimony; Counsel Fees and Costs INCOME AND EXPENSE STATEMENTS Plaintiff's I&E Statement Filing Date None Filed Defendant's 18E Statement Filing Date Concurrent with this filing INVENT021E'S Plaintiff's Inventory Filing Date None Filed Defendant's Inventory Filing Date N/A 3301 C DOCUMENTS Plaintiff's 3301(c) Affidavit Date Plaintiff `s 3301(c) Affidavit Filing Date Defendant's 3301(c) Affidavit Date Defendant's 3301(c) Affidavit Filing Date Plaintiff's 3301(c) Waiver of Notice Date Plaintiff's 3301(c) Waiver Filing Date Defendant's 3301(c) Waiver of Notice Date Defendant's 3301(c) Waiver Filing Date- -7- TABLE #1-H PROCEEDINGS INFORMATION: 3301 D DOCUMENTS Date of Physical Separation 9/1/2004 Physical 2 Year Separation Date 9/1/2006 Defendant's 3301(d) Affidavit Date Defendant's 3301(d) Affidavit Date Filing Date 3301 (D) Affidavit Service Date Manner of Service of 3301(d) Affidavit Date of Defendant's Notice of Intent to Request Entry of Divorce Decree and Praecipe to Transmit Record Defendant's Notice to Request Entry of Divorce Decree and Praecipe to Transmit Record Service Date Manner of Service of Defendant's Notice to Request Entry of Divorce Decree and 33a1(d) Counter-Affidavit BIFURCAT N. Has the case been bifurcated? No Date of decree granting bifurcation N/A If bifurcation granted by consent or after hearing N/A PREVIOUSLY RES OLVED ISSUES Issue #1 Resolution Issue #2 Resolution -8- Kathleen Heydt vs. David R. Heydt DOM: 5/13/88 - DOS (Physical): 8.29.04 Date Prepared: June 16, 2008 # MARITAL AM ND DEBTS A B C D E F G H I Ln B. Ref Owner Description Date Gross Value Distribution Distribute To Distribute To No Value Husband Wife 5 RE-1 it 701 Sandbank Rd 3.08 335,000.00 Mechanicsburg , PA Eby Appraisal 6 RE-1 it Chase 1" Mortgage #2656 5.14.07 (267,506.94) 7 RE-1 it PNC HELOC #6093 8.26.07 +24,734.07) 8 RE-1 it Est. Net Value - 42,758.99 42,758.99 42,758.99 9 Comments: )P-See Chart 2-A at end of Table 2 for itemization of HELOC charges- Husband charged $47,703.69 post separation which is not a marital debt. Since Wife is keeping home he needs to repay that amount to wife. >Wde has made all payments on HELOC post separation; >HELOC balance now over $70,000.00 t t t 11 ,. . - - 'V-1 w 1990 Ford Crown Vic Est 2,000.00 2,000.00 2,000.00 12 Comments: >Vewhicle totaled 11/05 3 months after separation. $2000 is insurance value paid. 13 V-2 H 1993 Ford F-150 King Cab Tk Est 5,000.00 5,000.00 5,000.00 14 Comments: * Husband to provide KBB or NADA valuation of this vehicle F ?? T, 7, } r..ry-' 1 16 v-1 H Disney Stock TBD TBD TBD 17 Comments: * Husband to provide statement(s) of account as of DOS and current date 18 INV-2 H Dell Stock TBD TBD TBD 19 Comments: * Husband to provide statement(s) of account as of DOS and cun,;nt date 20 INV-3 H Other Mutual Funds and Stocks TBD TBD TBD 21 Comments: * Husband to provide statement(s) of accouni as of DOS and current date 23 A-1 JT PNC Checking #5453 9.2.04 906.10 906.10 906.10 2a 0 Comments: -9- Kathleen Heydt vs. David R. Heydt DOM: 5/13/88 - DOS (Physical): 8.29.04 Date Prepared: June 16, 2008 . h . MARITAL ASSETS D DEBTS A B C D E F G H I Ln B. Ref Owner Description Date Gross Value Distribution Distribute To Distribute To No Wife Value Husband j)"{{ 26 Ret-1 H Yellow Roadway Retirement 12.31.04 80,1$2.04 Savings Plan 27 Ret-1 H Loan Balance 12.31.04 (4,290.95) 28 Ret-1 H Net Value - 75,891.09 75,891.09 75,891.09 29 Comments: )P- Husband rolled over into an annuity with Life insurance Company of Southwest. Husband al owed to deteriorate from d no control over these funds original $80,000 value to approx $50,000 when withdrawn and rolled over in 1/08. Since Wife 11 , she submits DOS value should be used. >-Wife proposes that annuity valued at $50,000? Should be transferred to her as her equitable distribution share. 30 Ret-2 H Roadway LLC Pension Plan 9.30.04 67,688.26 67,688.26 67,688.26 31 Comments: )o-Withdrawn by Husband in 2005 and converted @ 64,124 to his own use; Husband paid $12,124 in withholding taxes which were unnecessary and should not be considered as not required for distribution. 33 D-1 Jt 2004 Jt. Income Tax Refund - 2004 7,557.00 7,557.00 7,557.00 routed to H's PNC PNC account #00 140145939 34 Comments: >-As per 2004 tax return funds routed and deposited into PNC account #00140145939. This was not wife's account so husband took all of the refund money which was earned during marriage. OMMMM 3s ASSET T10 37 Total of Assets 201,801.44 156,136.35 45,665.09 39 r 40 D-1 None Known NIA N/A N/A N/A 41 Comments: *There are no known debts other than the Home Equity loan referenced in RE#1 above or Table #2-A below 42 DEBT TOTA " 43 Total of Debts 0.00 0.00 0.00 -10- Kathleen Heydt vs. David R. Heydt DOM: 5/13/88 • DOS (Physical): 8.29.04 Date Prepared: June 16, 2008 MARITAL ASSETS AND DEBTS A B C D E F G H I Ln No B. Ref Owner Description Date Gross Value Distribution Distribute To Distribute To Value Husband Wife 45 NET TOTALS 46 Asset Totals from above 201,801.44 156,136.35 45,665.09 47 Debt Totals from Above 0.00 0.00 0.00 48 Net Total of Assets Minus Liabilities 201,801.44 156,136.35 45,665.09 50 -'5U1 ;, Vi ON` . . ADJUSTMENT FOR OVE , 51 Net Totals from above 201,801.44 156,136.35 45,665.09 52 Less Amount Due in 50/50 Division 100,900.72 100,900.72 53 Adjustment Figure for 50/50- Payment Due Wife (55,235.63) 55,235.63 54 Adjustment for Post Separation HELOC charges by Husband (47,703.69) 47,703.69 55 Final Amount for 50/50 division- Payment Due Wife (102,939.32) 102,939.32 MR 57 ADJUSTMENT FO 'O : -+45,15 -. I IGN' 58 Net Totals from above 201,801.44 156,136.35 45,665.09 59 Less Amount Due in 45/55 Division 90,810.65 110,990.79 6o Adjustment Figure for 45/55- Payment Due Wife (65,325.70) 65,325.70 61 Adjustment for Post Separation HELOC charges by Husband (47,703.69) 47,703.69 62 Final Amount for 55/45 division in Wife's favor- Payment Due Wife (113,029.39) 113,029.39 64 ADJUSTMENT FOR QV 401` I iSIOtV 65 Net Totals from above 201,801.44 156,136.35 45,665.09 66 Less Amount Due in 40/60 Division 80,720.58 121,080.86 67 Adjustment Figure for 40/60- Payment Due Wife (75,415.77) 75,415.77 68 Adjustment for Post Separation HELOC charges by Husband (47,703.69) 47,703.69 69 Final Amount for 60/40 division in Wife's favor- Payment Due Wife (123,119.46) 123,119.46 71 - Ste A ?' O M s}fft - 72 Overall Adjustment for 50/50 with Post Separation Loan Adjustment (102,939.32) 102,939.32 73 Overall Adjustment for 40/55 with Post Separation Loan Adjustment (113,029.39) 113,029.39 F74 Overall Adjustment for 40/60 with Post Separation Loan Adjustment (123,119.46) 123,119.46 -11- Kathleen Heydt vs. David R. Heydt DOM: 5/13/88 • DOS (Physical): 8.29.04 Date Prepared: June 16, 2008 Table 2-A Analysis of Home Equity Loan Charges Date Description Marital Husband Post Separation Wife Post Separation Total All loans 8.29.04 Balance at separation 19,734.20 19,734.20 8.29.04 Husband's Unknown Post Separation Loan 15,000.00 34,734.20 10.26.04 Wife's drywall loan 5,000.00 39,734.20 1.11.05 Wife's Car loan 2,000.00 41,734.20 1.18.05 Husband's Unknown Post Separation Loan 10,000.00 51,734.20 7.5.05 Husband's Unknown Post Separation Loan 10,000.00 61,734.20 4.14.06 Husband's Unknown Post Separation Loan 12,000.00 73,734.20 9.29.06 Husband's Unknown Post Separation Loan 703.69 74,437.89 10.13.06 Wife's Post Separation Loan for attorney and mortgage payments 7,396.49 81,834.38 8.29.04- 12.1.06 Totals 24,734.20 47,703.69 9,396.49 81,834.38 -12- SECTION III. F PERSONAL PROP The following Tables #3-A and # 3-13 set forth the household goods and contents and other personal property of the parties: ' Defendant does not believe that the existing division of household goods is in dispute, and thus Tables #1 And #2 have not been completed. TABLE #3-A HOUSEHOLD GOODS AND CONTENTS AND OTHER PERSONAL PROPERTY IN HUSBAND'S POSSESSION NO. DESCRIPTION UWNER POSSESSOR VALUE DATE VALUE BASIS FOR EXCLUSION IF NOW MARITAL N/A N/A N/A Husband N/A N/A N/A -- Comments: TOTAL HUSBAND'S POSSESSION N/A TABLE #3-B HOUSEHOLD GOODS AND CONTENTS AND OTHER PERSONAL (PROPERTY IN WIFE'S POSSESSION NO. DESCRIPTION OWNER POSSESSOR VALUE DATE VALUE BASIS FOR EXCLUSION IF NOW MARITAL N/A N/A N/A Wife N/A N/A N/A -- Comments: TOTAL WIFE'S POSSESSION N/A Note: Exclusions from marital property include property acquired before marriage, property acquired after separation, or property acquired during marriage by way of gift or inheritance from third party not a spouse. For gifts and inheritance also specify the source person. -13- SECTION IV. NON-MARITAL ASSETS AND DEBTS The following Table #4 sets forth the non-marital assets and debts of the parties: 2 Defendant/Wife is not aware of any non-marital assets or debts. Therefore, Table #4 has not been completed. TABLE #4 NON-MARITAL PROPERTY AND DEBTS A B C D E F G H I J Ln B. Owner Description Value Gross Value Non-Marital Marital Basis for Method of No Ref Date Value Value Exclusion If Valuation & Claimed to Be Supporting N/A I N/A I N/A I N/A I N/A N/A I N/A I N/A I N/A I N/A 2Note: Exclusions from marital property include property acquired before marriage, property acquired after separation, or property acquired during marriage by way of gift or inheritance from third party not a spouse. For gifts and inheritance also specify the source person. -14- SECTION V. PROPERTY TRANSFERRED The following Table #5 is Defendant's listing of all property which ryas transferred within 3 years of the date of the commencement of this action: Defendant/Wife does not know of any assets transferred within 3 years prior to the filing of this action for less than fair market value. Therefore, Table #5 has not bee completed. Defendant/Wife does aver, however, that Plaintiff/Husband liquidated substantial retirement assets post-separation and converted the same to his own use as appears more fully appears on Table #2. TABLE M PROPERTY TRANSFERRED NO. DESCRIPTION OF PROPERTY TRANSFER DATE CONSIDERATION TRANSFEROR TRANSFEREE NIA N/A N/A N/A N/A N/A -- Comments: -15- CERTIFICATE OF SERVICE I, Diane G. Radcliff, Esquire, hereby certify that on .-7 /,? 6 , 1 served a copy of the within Inventory, by mailing same by first class mail, post ge p epaid, addressed as follows: David R. Heydt 118 Sparrow Road Hummelstown, PA 17036 G. DCLIFF, ESQUIRE 44' e Road g Camp Hill, PA 17011 Supreme Court ID # 32112 Phone: (717) 737-0100 Fax: (717) 975-0697 Attorney for Defendant -16- t?i ; , ? Y,,,, ,?, _ ???? ? ?s, . '+w?T w i ? F Ks` ? ? ?? ?- f/www-y-..,. ? .? ? ? ?/ y?? iwnr t ? IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff CIVIL ACTION - LAW V. IN DIVORCE KATHLEEN HEYDT, Defendant MOTION FOR APPOINTMENT OF MASTER KATHLEEN HEYDT, Defendant, moves the Court to appoint a Master with respect to the following claims: [x] Divorce [ ] Annulment [x] Alimony [x] Alimony Pendente Lite [x] Distribution of Property [ ] Support [x] Counsel Fees [x] Costs and Expenses In support of the Motion the Defendant states: 1. Discovery is complete with respect to the claims for which the appointment of the Master is requested. 2. The non-moving party [X] has appeared in the action [X ] personally. 3. The statutory ground for the divorce is/are: Section 3301 (c) and Section 3301(d) No-Fault. 4. Check the applicable paragraphs: [ ] The action is not contested. [ ] An agreement has been reached with respect to the following claims: [X] The action is contested with respect to the following claims: All Claims except divorce . 5. The action does not involve complex issues of law or fact. 6. The hearing is expected to take one (1) day. 7. Additional information, if any, relevant tQtk Date: July 8, 2008 : None BI*NE-6,-RDCLIFF, ESQUIRE Attorney fc, Defendant Wit- E co W t , S. n JUL 0 9 2008 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff CIVIL ACTION - LAW V. IN DIVORCE KATHLEEN HEYDT, Defendant ORDER APPOINTING MASTER AND NOW, 2008, E. Robert Elicker, II, Esquire is appointed Master with respect to th ollo ng claims: [x] Divorce [x] Alimony [x] Distribution of Property [x] Counsel Fees [x] Costs and Expenses BY THE CO J. MOVING PARTY NON-MOVING PARTY Name: Kathleen Heydt Name: David R. Heydt Attorney Name and Diane G. Radcliff, Esquire Attorney Name and None Address: 3448 Trindle Road Address: Camp Hill, PA 17011 Attorney Telephone #: 717-737-0100 s Attorney Telephone #: N/A Attorney E-Mail: dianeradcliff@comcast.net Attorney E-Mail: N/A Party's Address and N/A Party's Address a.id David R. Heydt Telephone # if not Telephone # if not 118 Sparrow Road represented by counsel: represented by counsel: Hummeistown, PA 17036 Phone: Unknown E-Mail: drheydt@comcast.net '!- /o, of z a: LIJ rv IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-11906 CIVIL TERM Plaintiff CIVIL ACTION - LAW V. IN DIVORCE KATHLEEN HEYDT, . Defendant IF YOU WISH TO DENY ANY OF THE STATEMENTS SET FORTH IN THIS AFFIDAVIT, YOU MUST FILE A COUNTER-AFFIDAVIT WITHIN TWENTY DAYS AFTER THIS AFFIDAVIT HAS BEEN SERVED ON YOU OR THE STATEMENTS WILL BE ADMITTED. AFFIDAVIT UNDER SECTION 33010 OF THE DIVORCE CODE 1. The parties to this action separated on August 29,'2004,and have continued to live separate and apart for a period of at least two years. 2. The marriage is irretrievably broken. 3. l understand that I may lose rights concerningIII alimony, division of property, 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. Section 4904 relating to unsworn falsifications to authorities. Dater t KATH fttEN HEY T C3 +v cU ? i e F3 r, w'r _4 ^t r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, : NO. 05-, 1906 CIVIL TERM Plaintiff : CIVIL ACTION - LAW V. KATHLEEN HEYDT, Defendant : IN DIVORCE NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Defendant. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Courthouse, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, COUNSEL FEES OR EXPENSES BEFORE THE FINAL DECREE OF DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD STREET CARLISLE, PA 17013 (717) 249-3166 w Petition Raising Divorce Claims Prepared By: Diane G. Radcliff, Esquire 3448 Trindle Road, Camp Hill, PA 17011 Supreme Court ID # 32112 Phone: 717-737-0100 • Fax: 717-975-0697 • Email: dianeradcliff @comcast.net Attorney for Defendant, Kathleen Heydt IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff CIVIL!,ACTION - LAW V. IN DIVORCE KATHLEEN HEYDT, Defendant PETITION RAISING CLAIM FOR DIVORCE Petitioner, Kathleen Heydt, by her attorney, Diane G. Radcliff, Esquire, this Petition for Economic Claims and represents that: 1. Petitioner is Kathleen Heydt, Defendant in the abovle captioned case. 2. Respondent is David R. Heydt, Plaintiff in the above!, captioned case. 3. This action was commenced by the filing of a Divorce Complaint by the Respondent on April 14, 2005. 4. In the Divorce Complaint the Respondent raised thel,following claims: No Fault Divorce under Section 3301(c). 5. Petitioner wishes to raise the following claim for Divorce in this Petition as permitted by the Domestic Relations Law. - 2 - CLAIMS FOR DIVORCE 6. Petitioner/ Defendant incorporates by reference the averments set forth in Paragraphs 1-5 herein as fully as though the same were set forth at length. 7. The Plaintiff /Respondent is David R. Heydt , an adult individual who currently resides at 365-A Buttonwood Court, Hellam, York Count, PA since 2008. 11. The Defendant/ Petitioner is Kathleen Heydt, an adult individual residing at 701 Sandbank Road, Mt. Holly Springs, PA 17065 since 2001. 12. Plaintiff and Defendant have been bona fide residents in the Commonwealth for at least six (6) months previous to the filing of this Complaint. 13. Plaintiff and Defendant were married on 5/13/19881 in Williamsburg, PA. 14. There have been no prior actions of divorce or annulment between the parties. 15. Plaintiff and Defendant have been advised that counseling is available and that Plaintiff and Defendant may have the right to request that the Court require the parties to participate in counseling. 16. Neither Plaintiff nor Defendant are a member of Ithe Armed Services of the United States or any of its Allies. 17. Plaintiff avers that the grounds on which the action is based are: A. Section 3301(c) Mutual Consent No-Fault: The marriage is irretrievably broken; , B. Section 3301(d) Non-Consent No-Fault: The marriage is irretrievably broken and the parties are now living separate and ap rt. Once the parties have lived separate and apart for a period of two year , Plaintiff will submit an Affidavit alleging that the parties have lived separate nd apart for at least two (2) years and that the marriage is irretrievably broken C. Section 3301(a)(6) Indignities: Defendant hale offered such indignities to the person of the Plaintiff, the innocent and inj red spouse, as to render [his/her] condition intolerable and life burdensome, arid that this action is not collusive. D. Section 3301(a)(2) Adultery: Defendant has committed adultery. I?- 3 - 18. Plaintiff requests the Court to enter a decree of divorce. WHEREFORE, Plaintiff requests this Honorable Cojurt to enter a decree in divorce, divorcing the Plaintiff and Defendant. Respectfully submitted, DIANE-6-fb0C1jFF, ESQUIRE Camp Hill, PA 17011 Supreme Court ID #32112 Phone: (717) 737-0100 Attorney for Petitigner Date: 6 - 4 - • 1 11 VERIFICATION I verify that the statements made in this Petitions are true and correct. Petitioner understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. KA LEEN HE DT Date 7 7 0 CERTIFICATE OF SERVICE AND NOW this day of V 2r" 008 I DIANE G. RADCLIFF ESQUIRE hereby certify that I have this day served a copy of the within Petit Ion Raising Claim for Divorce upon the Respondent, by mailing same by first class mail, postage prepaid, addressed as follows: David R.. Heydt 365 Buttonwood Court Hellam, PA Respectfully submitted, 1 LIFF, ESQUIRE e mTr-mtt ) 17011 Phone: (717 737-0100 Fax: (717) 975-0697 Supreme Court ID # 32112 Attorney fo Petitioner III r-S " 4, Ste: ) v? IN THE COURT OF THE COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff CIVIL ACTION - LAW V. KATHLEEN HEYDT, Defendant TO THE PROTHONOTARY: IN DIVORCE ENTRY OF APPEARANCE Kindly enter my appearance for the Plaintiff, David R. Heydt, in the above matter, and designate 519 Walnut Street, Reading, PA 19601 as the place where papers, process and notices may be served. Date: 1 -6 Lisa . Gentile, Esquire Attorney I.D. No. 80251 .Tj IN THE COURT OF THE COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, Plaintiff V. KATHLEEN HEYDT, Defendant NO. 05-1906 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE PLAINTIFF, DAVID R. HEYDT'S, PRETRIAL STATEMENT Plaintiff, David R. Heydt, by and through his/her counsel, Lisa D. Gentile, Esquire, hereby submits the following Pretrial Statement: 1. MARITAL ASSETS Marital residence, vehicles of both parties, personal property, chattel, retirement accounts. 2. DEBTS/LIABILITIES Mortgage and home equity loan. 3. NAME AND ADDRESS OF EACH EXPERT None at this time. 4. SHORT SUMMARY OF TESTIMONY OF EXPERT n/a 5. NAME AND ADDRESS AND SHORT SUMMARY AND TESTIMONY OF EACH PERSON OTHER THAN THE PARTY Both parties to this action. 6. DEFENDANT'S INCOME $38,000.00 per year. Plaintiff requests that Defendant provide an updated pay stub. 7. DEFENDANT'S EXPENSES No unusual expenses. w 8. PLAINTIFF'S INCOME $72,800.00 per year. Plaintiff's income is reduced by child support, APL, and a mortgage contribution to Defendant. 9. PLAINTIFF'S EXPENSES See income and expense sheet. 10. VALUE OF PENSION AND RETIREMENT BENEFITS Plaintiff had a 401(k) account through his prior employer, Roadway. Actual date of separation value was $71,046.00, with outstanding loan balance of $4,290.95. Due to fluctuating stock market and the losses sustained to this asset by virtue of a decrease in the value of stocks this account significantly decreased in value. Plaintiff rolled over this asset into a Deferred Annuity Policy, guaranteeing that the asset would sustain no further losses. Current value of the account is $35,930.20, and is guaranteed not to decrease in value at any point. 11. COUNSEL FEES Plaintiff is not making a claim for attorney fees. Plaintiff denies that Defendant is entitled to attorney fees, as she has received significant support and APL since the parties' separation. 12. OTHER ISSUES 1. Rental value of the marital residence; 2. Plaintiff's mortgage contribution toward the residence and prior mortgage and home equity payments made by Plaintiff, 3. Plaintiff's contribution toward the acquisition of marital assets; 4. Inappropriateness of alimony; 5. Refinancing of mortgage and home equity; 6. Date of separation; 7. Defendant's ability to contribute to a non-marital 401 k post-separation; 8. Defendant's income tax refund; 13. EXHIBITS 1. All attached tables; 2. LSW Policy (annuity); 3. Pay stub of Plaintiff, 4. Roadway 401k statements showing decline in value due to stock market decreases; 5. Inventory of Plaintiff, 6. Support Order of parties; 7. Cancelled checks and statements from marital accounts and home equity account; 8. Defendant's income tax return. 14. PROPOSED RESOLUTION Defendant to retain the marital residence with all equity in the residence, and refinance the mortgage to remove Plaintiffs name from the mortgage. The parties would continue to pay- off the home equity account as described below. Defendant retains the value she received for the Ford Crown Victoria Plaintiff retains the value of the Ford F-150 truck. Defendant would retain all personal property in the house and barn, including animals, and Plaintiff would retain the personal property in his possession, along with the pool table, boat and soda machine, tools. Plaintiff would retain his pension funds that were liquidated and Defendant would receive Plaintiffs entire 401k account, now an annuity. Plaintiff would pay Defendant alimony in the amount of $556.00 a month, for a period not to exceed ninety months, which is equal to the monthly payment for the home equity. The home equity account would to be frozen. Plaintiff would pay child support for each child in the amount of $350.00 a month per child for support for each child who is under the age of eighteen and residing with Defendant. Finally, Plaintiff requests that all child support arrears be terminated as an offset for the unequal distribution proposed by him. Respectfully submitted, isa D. Gentile, Esquire Attorney I.D. No. 80251 Attorney for Plaintiff, David R. Heydt 519 Walnut Street Reading, PA 19601 610-376-6430 610-376-6431 fax IN THE COURT OF THE COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, Plaintiff V. KATHLEEN HEYDT, Defendant NO. 05-1906 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE CERTIFICATE OF SERVICE I, Lisa D. Gentile, Esquire, attorney for David R. Heydt, in the above-captioned matter, certify that on this date a true and correct copy of Plaintiff's Pre-Trial Statement was served upon all parties and/or attorneys of record, by facsimile and U.S. First Class Mail, to: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 E. Robert Elicker, II, Esquire Cumberland County Divorce Master's Office 9 North Hanover Street Carlise, PA 17013 Date: r? 1 Lisa D. Gentile, Esquire C R 7 I X QC) t „J +ti rr .00 IN THE COURT OF THE COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, Plaintiff V. KATHLEEN HEYDT, Defendant NO. 05-1906 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE PLAINTIFF'S RESPONSE TO DEFENDANT'S PETITION FOR ECONOMIC CLAIMS 1. Admitted. 2. Admitted. 3. Admitted. 4. Admitted. 5. Admitted upon information and belief. PETITIONER'S COUNT I EQUITABLE DISTRIBUTION 6. This is an incorporation paragraph to which no response is required. 7. Admitted. 8. Admitted. 9. Admitted. WHEREFORE, Plaintiff'Respondent, David R. Heydt, respectfully requests that this Honorable Court enter an Order equitably dividing all marital property and debts of the parties. PETITIONER'S COUNT If ALIMONY PENDENTE LITE, ALIMONY 10. This is an incorporation paragraph to which no response is required. 11. Denied. It is specifically denied that Petitioner lacks sufficient property to provide t for her reasonable means or that she is unable to support herself through appropriate employment. By way of further answer, Petitioner is gainfully employed, and has a net income greater than that of Respondent after receipt of child support. 12. Denied. It is specifically denied that Petitioner requires reasonable support to adequately maintain herself in accordance with the standard of living established during the marriage. By way of further answer, Petitioner is gainfully employed, has a net income greater than that of Respondent after receipt of child support, and refused to work during the parties' marriage. WHEREFORE, Plaintiff/Respondent, David R. Heydt, respectfully requests that this Honorable Court deny Petitioner's request for alimony pendente lite and alimony. PETITIONER'S COUNT III COUNSEL FEES AND COSTS 13. This is an incorporation paragraph to which no response is required. 14. Admitted in part; Denied in part. It is admitted that Petitioner has retained legal counsel. It is denied that Petitioner is unable to pay the necessary and reasonable attorney fees of her counsel. By way of further answer, Petitioner has been receiving support and alimony pendente lite from Respondent for an extended period of time, the purpose of which was to allow Petitioner to retain an attorney, and the amount of which exceeds her attorney fees relative to this divorce action. 15. Denied. It is specifically denied that Petitioner is in need of hiring various experts to appraise the parties' marital assets or that she is without the funds to pay the necessary and reasonable fees. By way of further answer, Petitioner has been receiving support and alimony pendente lite from Respondent for an extended period of time, the purpose of which was to allow Petitioner to maintain and defend a divorce action, and the amount of which exceeds her attorney fees relative to this divorce action. WHEREFORE, Plaintiff/Respondent, David R. Heydt, respectfully requests that this Honorable Court deny Petitioner's request for interim counsel fees, costs and expenses and to further deny Petitioner's request for additional counsel fees, costs and expenses. submitted, Lisa D. Gentile, Esquire Attorney I.D. No. 80251 Attorney for Plaintiff, David R. Heydt 519 Walnut Street Reading, PA 19601 610-376-6430 610-376-6431 fax ,; IN THE COURT OF THE COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, Plaintiff V. KATHLEEN HEYDT, Defendant NO. 05-1906 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE CERTIFICATE OF SERVICE I, Lisa D. Gentile, Esquire, attorney for David R. Heydt, in the above-captioned matter, certify that on this date a true and correct copy of Plaintiffs Response to Petition for Economic Claims was served upon all parties and/or attorneys of record, by facsimile and U.S. First Class Mail, to: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 E. Robert Elicker, II, Esquire Cumberland County Divorce Master's Office 9 North Hanover Street Carlise, PA 17013 Date: 0 L a D. Gentile, Esquire -Tf a e r?? Prepared By: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Supreme Court ID # 32112 Phone: 717-737-0100 Fax: 717-975-0697 Email: dianeradcliff @comcast.net Attorney for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff CIVIL ACTION - LAW V. . IN DIVORCE KATHLEEN HEYDT, . Defendant AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on April 14, 2005. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3 1 consent to the entry of a final Decree in Divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Dated: KAT LEEN HEYDT w -r7 c cz? Prepared By: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Supreme Court ID # 32112 Phone: 717-737-0100 Fax: 717-975-0697 Email: dianeradcliff @comcast.net Attorney for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, Plaintiff V. KATHLEEN HEYDT, Defendant NO. 05-1906 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301 (c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree in divorce without notice. 2. 1 understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. 1 understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Waiver 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: KATHLEEN HEYDT ? 7 C"> ? ,; T ? ?? ? d ?? ? ' , -?? c:"-- -?v <? ? ,'??? N -e? ? :? DAVID R. HEYDT, Plaintiff VS. KATHLEEN HEYDT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 05 - 1906 CIVIL IN DIVORCE ORDER OF COURT AND NOW, this day of , 2009, counsel and the parties having entered into an agreement and stipulation resolving the economic issues on January 20, 2009, the date set for a Master's hearing, the agreement and stipulation having been transcribed, the appointment of the Master is vacated and counsel can conclude the proceedings by the filing of a praecipe to transmit the record with the affidavits of consent of the parties so that a final decree in divorce can be entered. cc: -"? Lisa D. Gentile Attorney for Plaintiff ? Diane G. Radcliff Attorney for Defendant 120P ,C6 af?g`?g BY THE COURT, Q WICA, I Edg ar B. Bayley, P.J. r U- CY1 ° U < v ob f DAVID R. HEYDT, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. KATHLEEN HEYDT, CIVIL ACTION - LAW Defendant NO. 05-1906 CIVIL TERM THE MASTER: Today is Tuesday, January 20, 2009. This is the date set for a hearing to take testimony on the issues of marital misconduct, dissipation of marital assets, and date of separation. Present in the hearing room are the Plaintiff, David R. Heydt, and his counsel, Lisa D. Gentile, and the Defendant, Kathleen Heydt, and her counsel, Diane G. Radcliff. With respect to the issues that were to be addressed today, those issues have been resolved by stipulation or otherwise, and we do not need to proceed with a hearing and testimony on the matters scheduled for today. The complaint in divorce was filed on April 14, 2005, raising grounds for divorce of irretrievable breakdown of the marriage. Other claims for divorce were raised by the Defendant wife which were raised pursuant to a petition she filed with the Court. However, with respect to grounds for divorce the parties are going to proceed under Section 3301(c) of the Domestic Relations Code. Mr. Heydt filed an w A6 affidavit under Section 3301(c) and a waiver of notice of intention to request entry of divorce decree on May 1, 2007; the Master has been provided today with wife's affidavit and waiver. Wife's affidavit and waiver will be filed with the Prothonotary by the Master's office. Wife did previously file an affidavit under Section 3301(d) but that affidavit is not necessary today because we are proceeding under 3301 (c) . Wife filed a petition raising economic claims on November 17, 2006. The economic claims raised by wife are equitable distribution, alimony, alimony pendente lite, and counsel fees and expenses. After negotiations this morning, the Master has been advised that the parties have reached an agreement with respect to all outstanding economic issues. An agreement is going to be placed on the record in the presence of the parties. The agreement as stated on the record will be considered the substantive agreement of the parties not subject to any changes or modification except for correction of typographical errors which may be made during the transcription. Consequently, when the parties leave the hearing room today, they are bound by the terms of the agreement even though there is no subsequent signing of the agreement affirming the terms of settlement. The agreement will be sent to counsel for review J? L" to make correction of typographical errors; after typographical corrections have been made then the parties will be asked to sign the agreement affirming the terms of settlement as stated on the record. However, as previously stated, the parties are bound by the agreement today when they leave the hearing room even though there is no subsequent signing affirming the settlement. Upon receipt by the Master of the completed agreement, the Master will prepare an order vacating his appointment and counsel can then file a praecipe transmitting the record to the Court requesting a final decree in divorce. Ms. Radcliff. MS. RADCLIFF: 1. Wife shall receive the marital home located at 701 Sandbank Road, Mechanicsburg, Pennsylvania, under and subject to the following terms and conditions: a. The deed to the home shall be prepared by wife's counsel and signed and returned to wife's counsel by husband within fourteen days of his counsel's receipt of the same. b. Wife shall be solely responsible for the timely payment of the CHASE first mortgage number 2656 and the PNC HELOC loan number 6093. C. Wife shall apply for refinancing of the CHASE first mortgage and the PNC HELOC loan within two years of the date of this agreement so as to relieve husband from further liability thereunder. If wife is not able, after a good faith effort, to obtain that refinancing, then wife shall refinance those two loans by the date the parties' youngest child graduates from high school, approximately 7.5 years, and if she cannot obtain refinancing by that date, she shall then immediately list the home for sale and sell it at the best price attainable paying off the mortgages at the time of sale. a r d. If wife fails to timely make the payments due under the CHASE first mortgage or the PNC HELOC loan within thirty days of their due date, then wife shall be required to list the marital home for sale and to use her best efforts to sell it at the best price attainable so as to pay off the two mortgages and thereby relieve husband from further liability thereunder. e. Wife shall indemnify, protect, and hold husband harmless from any and all liability arising out of the CHASE first mortgage and PNC HELOC loan during the time period those loans remain in effect and husband remains liable thereunder. Wife agrees to indemnify and hold harmless husband from any and all other expenses associated with the marital residence. 2. Wife shall receive the 1990 Ford Crown Vic and/or the insurance proceeds she received for the prior damage and/or loss of that vehicle. 3. Husband shall receive the 1990 Ford F150 truck titled in his sole name. 4. Wife shall receive the funds in the PSECU account whether currently or taken by her as of the date of separation and said account shall be closed within fourteen days of the date of this agreement. 5. Husband shall receive any funds remaining in the PNC checking account number 5453 and any funds that he received from that account at the date of separation and to the extent possible that account shall be closed. 6. Husband's Yellow Roadway Retirement Savings Plan was previously closed and approximately $50,388.58 was received at that time, $39,863.84 of which was rolled over into an annuity with LSW policy number 65483OX and the remaining $6,233.79 retained by husband. Husband shall retain the funds, the $6,233.79 that he previously received, and the LSW annuity policy number 654830X shall be transferred to wife within fourteen days of the date of this agreement. Wife will take the necessary steps to effectuate that transfer. 7. Husband shall retain any funds that he previously received from the cashing in of his Roadway, LLC pension plan. 8. Husband shall retain the $7,557.00 he received from the party's 2004 joint income tax return. 9. Husband shall pay wife $800.00 per month in alimony effective February 1, 2009, and monthly thereafter for a total period of seven years under and subject to the following terms and conditions: a. The alimony shall be non-modifiable. b. The alimony shall not be considered in any subsequent child support calculations and shall not, for purposes of those calculations, be deducted from husband's income nor added to wife's income. C. The alimony for income tax purposes shall be deductible by husband on his income tax return and reportable by wife on her income tax return. d. The alimony shall be paid through Domestic Relations pursuant to a wage attachment. e. There is currently a spousal support award entered in the Cumberland County Domestic Relations action docketed to No. 886 S 2006, PACSES No. 496108678, requiring husband to pay wife spousal support in the amount of $1,060.46. That order shall terminate effective February 1, 2009. f. To assure that husband's wage attachment is timely modified to reflect this change, counsel shall notify Domestic Relations of the terms of this agreement on 1/20/09 so that any excess payments can be credited to husband against his arrears. g. Any arrears existing on the spousal support order shall be added to the alimony order and shall be paid in an amount determined by Domestic Relations but in no event shall the arrears for child support and the arrears added to the alimony order require husband to pay more than $191.56 a month toward the arrears. h. Both parties acknowledge that the current arrears payment of $191.56 are for arrears for both the child support and the existing spousal support arrears that were just referenced. 10. The PSECU custodial accounts for the children shall be assigned to the children when they reach age 18. Currently two of the children are already over the age of 18 and that assignment shall take place immediately. For the two minor children, husband shall remain as custodian of those accounts for the children and shall assign the balance over to them as each child reaches age 18. No money shall be withdrawn by husband from these accounts other than to assign the funds in them to the children as required above. 11. Both parties shall designate the children as beneficiaries on any life insurance policies that are provided to them through their employment at no cost until the youngest child reaches age 18 or graduates from high school, whichever shall last occur. In addition, either party shall have the right to elect to carry life insurance on the other party in such amounts as he or she selects provided that all of the costs for the premium shall be paid by that party until the youngest child reaches age 18 or graduates from high school, whichever shall last occur. If such policy is requested, the party on whose life the policy will be taken shall cooperate and take all steps necessary to ensure that that policy is issued. 12. Each of the parties waives any claim they may have against the other for counsel fees, costs, and expenses, and wife hereby withdraws any claim that she may have previously raised for such fees and costs. 13. Except as herein otherwise provided, each party may dispose of his or her property in any way and each party hereby waives and relinquishes any and all rights he or she now have or hereafter acquired under the present or future laws of any jurisdiction to share in the property or the estate of the other as a result of the marital relationship including, without limitation, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the other, and right to act as the administrator or executor of the other's estate. Each will, at the request of the other, execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interests, rights, and claims. MS. RADCLIFF: Kathleen, you've heard me state the terms of the agreement. Did you understand all of those terms? MS. HEYDT: Yes. MS. RADCLIFF: And are you in agreement with all of those terms? MS. HEYDT: Yes. MS. RADCLIFF: And you're not under the influence of any drugs or alcohol which prevent you from understanding this agreement here today? MS. HEYDT: No, not today. MS. RADCLIFF: And you haven't had your arm twisted or under duress or undue influence by anyone to force you into accepting the terms of this agreement? MS. HEYDT: No. THE MASTER: Ms. Gentile. MS. GENTILE: Mr. Heydt, you heard the agreement as Attorney Radcliff stated? MR. HEYDT: Yes, I did. MS. GENTILE: And did you understand it fully? MR. HEYDT: Yes. MS. GENTILE: And are you in agreement with all of the terms that were stated? MR. HEYDT: Yes. MS. GENTILE: And you're not under any coercion or influence to reach an agreement today? MR. HEYDT: No. MS. GENTILE: And you're not under the r influence of any drugs or alcohol? MR. HEYDT: No. MS. GENTILE: And the agreement that was set forth is the full agreement as you understand it? MR. HEYDT: Yes. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend to bind myself to the settlement as a contract obligating myself to the terms of settlement and subjecting myself to the methods and procedures of enforcement which may be imposed by law and in particular Section 3105 of the Domestic Relations Code. Plaintiff D to Pisa 1). Gentile, aintiff's counsel ilo Id ? C De endant Date ane adcliff, D 's counsel ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 05-1906 CIVIL State _Commonwealth of Pennsylvania OOriginal Order/Notice Co./City/Dist. of CUMBERLAND 496108678 @Amended Order/Notice Date of Order/Notice 02/25/09 886 S 2006 0 Terminate Order/Notice Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice RE: HEYDT, DAVID R. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 174-52-4553 Employee/Obligor's Social Security Number CENTRAL TRANSPORT INC. 9898101733 12225 STEPHENS RD Employee/Obligor's Case Identifier WARREN MI 48089-2010 (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. $ $ 1,040.14 95.76 $ 0.00 $ 0.00 $ 800.00 $ 95.80 $ 0.00 $ 0.00 per month in current child support per month in past-due child support 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 Arrears 12 weeks or greater? (g) yes O no for a total of $ 2, 031.70 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: $ abg AS per weekly pay period. $ 1, 015.85 per semimonthly pay period (twice a month) $ 937.71 per biweekly pay period (every two weeks) $ 2, 031.70 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 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. BY THE COURT: ?,. * X4 DRO: R.J. Shadday Service Type M OMB No.: 0970-0154 in A. Hess, Judge Form EN-028 Rev. 4 Worker ID $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If hecke?i you are required to provide asopy of this form to your?mployee. If yoVr employee works in a state that is di erent TTrom the state that issued this or er, a copy must be provi edd to your employee even if the box is not checked 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 3641505410 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME:HEYDT, DAVID R. EMPLOYEE'S CASE IDENTIFIER: 9898101733 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) (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 0 5 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by intemet 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: HEYDT, DAVID R. PACSES Case Number 496108678 Plaintiff Name KATHLEEN HEYDT Docket Attachment Amount 00886 S 2006 $ 1,135.90 Child(ren)'s Name(s): DOB NATALIE C. HEYDT 11/04./93 KYLE R. HEYDT a? / 0:7 f 9'8 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 Service Type M Addendum OMB No.: 0970-0154 PACSES Case Number 505110698 Plaintiff Name KATHLEEN HEYDT Docket Attachment Amount 05-1906 CIVIL$ 895.80 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 Form EN-028 Rev. 4 Worker I D $ IATT Ti In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: DAVID R. HEYDT Member ID Number: 9898101733 Please note: All correspondence must include the Member ED Number. MODIFIED ORDER OF ATTACEIMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name KATHLEEN HEYDT KATHLEEN HEYDT PACSES Docket Case Number Number 496108678 00886 S 2006 505110698 05-1906 CIVIL TOTAL ATTACHMENT AMOUNT: $ 2,031.70 Attachment Amount/Freauenc $ 1,135.90 /MONTH 895.80 MONTH / / Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of $ 4 6 7.5 7 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, DAVID R. HEYDT Social Security Number XXX-XX-4553 , Member ID Number 9898101733 . OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated OCTOBER 2 8, 2 0 0 7 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: FEB 2 6 2009 IEVIN . HESS, JUDGE DRO: R, J. SHADDAY Form EN-034 Rev.2 Service Type M Worker ID $ IATT r; cr% +°i DkVID IN THE COURT OF COMMON PLEAS K. LA i NT) F1= CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL. DIVISION V -rN L&E rA N LY ITT, : NO. 05 - M010 CIVIL TERM ???`?A NT PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Transmit the record, together with the following information to the court for entry of a divorce decree: 1. Ground for divorce: Irretrievable breakdown under 3301 (c) 3301(d) (1) of the Divorce Code. (Strike out inapplicable section) /? 2. Date and manner of service of the complaint: (r o m P LA i n(T S&J24e D O rN THE VEF7ErQA PJT VIA IN-0IYIDL4AL Sr<QVICE DI`s MA-1 is, zoos THG Al:? ,t-)Ay?T 6F StP-vice 3. Complete either paragraph (a) or (b). vVP+S -j-7i LEA W IT'H T71-05 COU QT 01?J a. Date of execution of the affidavit of consent required by 3301(c) of the A PQ It- 141z-CAS.. Divorce code: by plaintiff APR I L 241200 ; by defendant J- N u^01 2 b. (1) Date of execution of the affidavit required by 3301 (d) of the Divorce Code: n ? a^ (2) Date of filing and service of the plaintiffs affidavit upon the respondent: (\ ( 0- 4. Related claims pending: NONE, 5. Complete either (a) or (b) a. Date and manner of service of the notice of intention to file praecipe to transmit record, a copy of which is attached: b. Date of plaintiff's Waiver of Notice in 3301 (c) Divorce was filed with the Prothonotary: MAN( 1, 2.004 Date defendant's Waiver of Notice in 3301 (c) divorce was filed with the Prothonotary: P N U A I 204 Z 0 0ri Atto ey Plaintiff/Defendant ^ r_ ? t _ C_ 1 77 DAVID R. HEYDT V. KATHLEEN HEYDT IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 05-1906 DIVORCE DECREE AW%LR go *'t 7" A m AND NOW, it is ordered and decreed that DAVID R. HEYDT KATHLEEN HEYDT , plaintiff, and bonds of matrimony. defendant, are divorced from the Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: (If no claims remain indicate "None.") All issues have been resolved by Marital Agreement entered into on January 20, 2009 and executed by the parties on February 10 and February 16, 2009, which agreement is filed of record and incgrporated herein by reference, but shall not be merged into this Decree By the rt, Attest: J. r 1n IL rothonotary Al W04,.e X4W,, -4?9/ 124 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff : CIVIL ACTION - LAW V. KATHLEEN HEYDT, IN DIVORCE Defendant NOTICE OF ELECTION TO RETAKE FORMER NAME Notice is hereby given that the Defendant: in the above captioned Divorce Action, hereby elects to retake and hereafter use her previous name of Kathleen Geraldine Dugas. This election is made pursuant to the provisions of 54 P.S. 8704. ?' ?A? ?&? KATHLE N HEYDT (Signature married name) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND : ss: On the l ?Dday of ?- b1 , 2009, before a Notary Public, personally appeared Kathleen Heydt known to me to be the person whose name is subscribed to the within document, and acknowledged that she executed the foregoing for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and Notarial Seal. Notary Public ~L;FH OF PENNSYLVANIA Notarial Seal DIVO G. Raddlff, Notary Public Camp HUI Soro, Cumberland County * Cornn1WSIon Expires Jan.11, 2012 Member, Pennsylvania Association of Notaries (Signature former name) . r. )- J Tt it r r: yp r, a mot/ 2009 APR ^49 Fil 1: 2- culvi 'j r" stir A , $ 11. oo Ao A TTY COf 154(02 $?X*- aayy I8 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff CIVIL ACTION - LAW V. IN DIVORCE KATHLEEN HEYDT, Defendant CONSENT TO ORDER The undersigned Plaintiff-Participant and Defendant-Alternate Payee, hereby stipulate and agree that they consent to the entry of the foregoing Order. Witness: COMMONWEALTH OF PENNSYLVANIA Notarial Seal EMelis&i C. Moyer, Notary Public chesterTwp., Yorl(Courdy mission 6c ires Nov. 23 2009 Member, Pr,?;, ,6;,.,,r a Association of Notaries PLA&PICIPANT.-, (SEAL) DAVID R. HEYDT Date: y /5 ALT . ATE PAYEE: (SEAL) T'HLEEN HE T Date: 7 Nom o-5 5 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, Plaintiff . V. KATHLEEN HEYDT, now by resumption of former name, KATHLEEN GERALDINE DUGAS Defendant NO. 05-1906 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE Domestic Relations Order and Stipulation Certification I, Diane G. Radcliff, Esquire, Attorney for Defendant, hereby certify that: 1. 2. The only Judge assigned to this case is the Honorable Edward E. Guido. The parties have agreed to the entry of the Domestic Relations Order as evidenced by the Stipulation /Consent attached thereto. Respectfully submitted, 1 DCLIFF, ESQUIRE 3448 Trindl Road Camp Hill, PA 17011 (717) 737-0100 I.D. No. 32112 Attorney for Defendant FILET 7- 's OF THE a rr);` ' ^Trzy 299911i!','i It -4 AI l I : L 3 ORIGINAL MAY 151009 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DAVID R. HEYDT, NO. 05-1906 CIVIL TERM Plaintiff V. CIVIL ACTION - LAW IN DIVORCE KATHLEEN HEYDT, now by resumption of former name, KATHLEEN GERALDINE DUGAS Defendant DOMESTIC RELATIONS ORDER AND NOW this 10 day of ? 2009 upon consideration of the following Consent of the parties, the following is HEREBY OR ERED AND DECREED: A. IDENTIFYING INFORMATION 1. RECOGNITION OF RIGHT. This Order creates and recognizes the existence of an alternate payee's right to receive an interest in the Participant's Life Insurance Company of the Southwest Annuity Policy Number XXXXXXX, which is intended to be qualified under Internal Revenue Code of 1986 ("Code"). The Court intends this Order to be a Domestic Relations Order ("DRO") within the meaning of Code. The Court enters this DRO pursuant to its authority under 23 PA.C.S.A. 3502. 2. APPLICABLE ACCOUNTS. This DRO applies to David R. Heydt's Life Insurance Company of the Southwest Annuity Policy Number XXXXXXX. (For purposes of this DRO the above referenced annuity is hereafter referred to as the "Plan"). Any changes in Plan Administrator/Account Trustee, Account Sponsor, or name of the Account or Plan shall not affect Alternate Payee's rights as stipulated under this Order. 3. IDENTIFICATION OF THE PLAN ADMINISTRATOR/ACCOUNT TRUSTEE. The name and address of the Plan Administrator/Account Trustee is: Life Insurance Company of the Southwest P.O. Box 569080 Dallas, TX 75356-9080 4. IDENTIFICATION OF ACCOUNT OWNERS/PARTICIPANT. David R. Heydt is the owner of the Life Insurance Company of the Southwest Annuity Policy Number XXXXXXX and is designated as the Participant for purposes of this DRO and IRS Code requirements. (For purposes of this DRO David R. Heydt is hereafter referred to as the "Participant"). THE ORIGINAL DRO HAS BEEN REDACTED TO PROTECT SENSITIVE FINANCIAL INFORMATION SUCH AS SOCIAL SECURITY NUMBERS AND ACCOUNT NUMBERS 1 . 4 5. IDENTIFICATION OF ALTERNATE PAYEE. Kathleen Geraldine Dugas, formerly Kathleen Heydt, is the former spouse of the Participant and is designated as the Alternate Payee for purposes of this DRO and IRS Code requirements. (For purposes of this DRO Kathleen Geraldine Dugas is hereafter referred to as the "Alternate Payee") 6. INFORMATION PERTAINING TO PARTICIPANT. The following is information pertaining to the Participant: a. The Participant name is David R. Heydt. b. The Participant's mailing address is 3252 Staunton Ave, Dover, PA 17315. C. The Participant's social security number is XXX-XX-XXXX. d. The Participant's date of birth is 2/7/1959. 6. INFORMATION PERTAINING TO ALTERNATE PAYEE. The following is information pertaining to the Alternate Payee: a. The Alternate Payee's name is Kathleen G. Dugas, (formerly Kathleen Heydt). b. The Alternate Payee's address is 701 Sandbank Road, Mt. Holly Springs, PA 17065. C. The Alternate Payee's social security number is XXX-XX-XXXX. d. The Alternate Payee's date of birth is 10/29/1964. 7. NOTIFICATION OF ADDRESS CHANGE. The Alternate Payee shall have the duty to notify the Plan Administrator/Account Trustee of any changes in this mailing address subsequent to the entry of this Order. 8. DATE OF MARRIAGE AND DIVORCE. The parties were married on May 13, 1988 and divorced on April 7, 2009. B. DIVISION OF PARTICIPANT'S BENEFITS 9. ASSIGNMENT OF BENEFITS. This Order awards and assigns to Alternate Payee One Hundred Percent (100%) of the Participant's interest in Participant's Life Insurance Company of the Southwest Annuity Policy Number XXXXXXX together with all earnings thereon arising after the date of this Order, as her equitable distribution share of the Participant's interest in the Plan. 10. COMMENCEMENT AND FORM OF BENEFITS. The following shall apply to the commencement and form of benefits: a. All amounts allocated to the Alternate Payee pursuant to this Order shall be segregated, assigned, transferred and rolled over to and into Alternate Payee's IRA, Account No. XXXXXXX, with PNC Bank for the exclusive use of the Alternate Payee, and such account is to be the sole and separate property of the Alternate Payee. THE ORIGINAL DRO HAS BEEN REDACTED TO PROTECT SENSITIVE FINANCIAL INFORMATION SUCH AS SOCIAL SECURITY NUMBERS AND ACCOUNT NUMBERS 2 b. If the transfer to the Alternate Payee's IRA account is not permitted by the Plan Administrator/Account Trustee under the Plan, then the Alternate Payee's distributive share herein provided shall be held in a segregated account for her by the Plan Administrator/Account Trustee and distributed to her, together with all earnings thereon, when she becomes eligible for that distribution. C. The transfer of benefits from the Plan to the Alternate Payee as aforesaid is intended and designed to effectuate a tax free roll over of retirement benefits between spouses or former spouses pursuant to an order for equitable distribution of marital property as permitted by the rules and regulations of the Internal Revenue Code. 11. RIGHTS AFFORDED TO ACTIVE PARTICIPANTS. On and after the date that this Order is deemed to be a DRO, but before the Alternate Payee receives her distribution under the Plan, the Alternate Payee shall be entitled to all of the rights and election privileges that are afforded to active participants. 12. CERTIFICATION. All payments made pursuant to this Order shalt be conditioned on the certification by the Alternate Payee and the Participant to the Plan Administrator/Account Trustee of such information as the Plan Administrator/Account Trustee may reasonably require from such parties, including the information the Plan Administrator/Account Trustee requires to make the necessary calculation of the benefit amounts contained herein. 13. CONTINUATION OF DRO QUALIFICATION. It is the intention of the parties that this Order continue to qualify as a DRO under Code, as it may be amended from time to time, and that the Plan Administrator/Account Trustee shall reserve the right to reconfirm the qualified status of the Order at the time benefits become payable hereunder. 14. NON-CIRCUMVENTION. The Participant shall not take any action, affirmative or otherwise, that can circumvent the terms and provisions of this DRO, or that could diminish or extinguish the rights and entitlements of the Alternate Payee as set forth herein. Should the Participant take any action or inaction to the detriment of the Alternate Payee, he shall be required to make sufficient payments directly to the Alternate Payee to the extent necessary to neutralize the effects of her actions and inactions and to the extent of the Alternate Payee's full entitlements hereunder. C. MISCELLANEOUS PROVISIONS 15. LIMITATION AS TO FORM OF BENEFITS. This DRO does not require the Plan Administrator/Account Trustee to provide any type or form of benefit the Plan does not otherwise provide. THE ORIGINAL DRO HAS BEEN REDACTED TO PROTECT SENSITIVE FINANCIAL INFORMATION SUCH AS SOCIAL SECURITY NUMBERS AND ACCOUNT NUMBERS 3 19. BENEFITS PAYABLE TO ANOTHER ALTERNATE PAYEE: This DRO does not require the Plan Administrator/Account Trustee to pay any benefits which another Order previously determined to be a Domestic Relations Order requires the Plan to pay to another alternate payee. 20. NOTIFICATION BY PLAN ADMINISTRATOR: The Plan Administrator/Account Trustee promptly shall notify the Participant and the Alternate Payee of the receipt of this DRO and shall notify the Participant and the Alternate Payee of the Plan Administrator/Account Trustee's procedures for determining the qualified status of this DRO. The Plan Administrator/Account Trustee shall determine the qualified status of the DRO and shall notify the Participant and the Alternate Payee of the determination within a reasonable period of time after receipt of this DRO. 21. RETENTION OF JURISDICTION. The Court shall retain jurisdiction with respect to this Order to the extent required to maintain its qualified status and the original intent of the parties as stipulated herein. 22. PROPERTY DISTRIBUTION: This is a property distribution order made in and under the Divorce and Equitable Distribution statutes of the Commonwealth of Pennsylvania, and in accordance with the provisions of such statute, the portion being distributed to the Alternate Payee has been determined to be her property. 23. HEADINGS NOT PART OF ORDER: Any headings preceding the text of the several paragraphs and subparagraphs hereof, are inserted solely for convenience of reference and shall not constitute a part of this Order nor shall thaffte??its meaning, construction or effect. J. Distribution to: , 4-SA D. GENTILE, ESQUIRE 519 Walnut Street, Reading, PA Email: lisagentiL@aol.com Phone: 610-376-6430 Fax: 610-376-6431 Attorney for Plaintiff Z--DIANE G. RADCLIFF, ESQUIRE 19601 3448 Trindle Road, Camp Hill, PA 17011 Email: dianeradcliff@comcast.net Phone: (717) 737-0100 Fax: (717) 975-0697 n vo Attorney for Defendant THE ORIGINAL DRO HAS BEEN RED INFORMATION SUCH AS SOCIAL S ,N 'EP Te 4 0' PROTECT SENSITIVE FINANCIAL NUMBERS AND ACCOUNT NUMBERS lki, 9 Z 0 H d 91 0,14 6001 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 05-1906 CIVIL O Origi nal Order/Notice State Commonwealth of PennUlvania 496108678 o Amended Order/Notice Co./City/Dist. of CUMBERLAND 886 S 2006 OTerminateOrder/Notice Date of Order/Notice 02/23/10 Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice RE:HEYDT, DAVID R. E m ployer/With holder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 174-52-4553 Employee/Obligor's Social Security Number CENTRAL TRANSPORT INC. 9898101733 12225 STEPHENS RD Employee/Obligor's Case Identifier WARREN MI 48089-2010 (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. $ 1,040.3.4 per month in current child support $ 0.00 per month in past-due child support Arrears 12 weeks or greater? Oc,;?-.s ? no-, $ 0.00 per month in current medical support $ o. oo per month in past-due medical support per month in current spousal support $800.00 v =- $ 95.80 per month in past-due spousal support ?? i'--' $ 0.00 per month for genetic test costs $ 0.00 per month in other (specify) ' $ one-time lump sum payment for a total of $ 1,935.94 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: $ 446.76 per weekly pay period. $ 967.97 per semimonthly pay period (twice a month) $ 893.51 - per biweekly pay period (every two weeks) $ 1, 935.94 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFE ANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) L SEC?7URITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. . . I / OO IA ?r t BY THE COURT: Oler, Jr., 0/6 DRO: R. J. Shadday Service Type M OMB No.: 0970-0154 Form EN-028 Rev.5 Worker ID 21005 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If hecke?l you are required to provide a copy of this form to your m loyee. If yo r employeevyorks in a state that is di erent rrom the state that issued this order, a copy must be provi?edpto your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. if there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: if there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 3641505410 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME:HEYDT, DAVID R. EMPLOYEE'S CASE IDENTIFIER: 9898101733 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as. State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by Internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID 21005 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: HEYDT, DAVID R. PACSES Case Number 496108678 Plaintiff Name KATHLEEN G. DUGAS Docket Attachment Amount 00886 S 2006 $ 1,040.14 Child(ren)'s Name(s): DOB NATALIE C. HEYDT 11/04/93 KYLE R. HEYDT 02/07/98 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 Service Type M PACSES Case Number 505110698 Plaintiff Name KATHLEEN G. DUGAS Docket Attachment Amount 05-1906 CIVIL$ 895.80 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum OMB No.: 0970-0154 Form EN-028 Rev.5 Worker ID 21005 • INCOME WITHHOLDING FOR SUPPORT 0 ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT(IWO) 4q D log S 0 AMENDED IWO 0 ONE-TIMEORDERINOTICE FOR LUMP SUM PAYMENT zu,_, 19D(, C11I 1 1 (E) TERMINATION OF IWO Date: 04/08/13 ❑ Child Support Enforcement(CSE)Agency 0 Court ❑ Attorney ❑ Private Individual/Entity(Check One) NOTE:This livo must be regular on its face.Under certain circumstances you must reject this IWO and return it to the sender(see IWO instructions htt( w—w-w.acfhhs,aov/pr.Qgrams/ese/ngwtir-QLomplQyer/publicatiorVpublication.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. StaterrribetTerritory Commonwealth of Pennsylvania Remittance Identifier(include w1payment): 9898101733 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for ordwidocket Informalton) Private Individual/Entity, CSE Agency Case Identifier: (See Addendum for case summary) CENTRAL TRANSPORT, LLC RE: HEYDT,DAVID R. 12225 STEPHENS RD Employee/Obligor's Name(Last,First,Middle) WARREN MI 48089-2010 174-52-4553 Employee/Obllgoes Social Security Number (See Addendum for piainffff names associated with cases on attachment) Custodial Party/Obligee's Name(Last,First, Middle) Employer/income Withholdees FEIN 271096078 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 httD:1hmw.acfhhs. rams/eseinewhi em2MmdWbI1_caJt1W_pubI1catIon.htm-form Jf 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. 2710960780 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 fW fteVoyee/ obligor's income until further notice. $ 0.00 per month in current child support rYt Cri 330 $ 0.00 per month in past-due child support-Arrears 12 weeks or greater? 0 ost.; r $ 0.00 per month in current cash medical support C'n> I C:) $ 0,00 per month in past-due cash medical support < $ 0.00 per month in current spousal support 0.00 per month in past-due spousal support C_- om per month in other(must specify) CA.) 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 Information. 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 550/6 of disposable income for all orders. If the employee/obligors 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.aav/pMgrams/`cse/newhire/`empiMr/contacts/contact map, him 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$IATT ❑ Return to Sander[C�rle day atac ±ar(. Payment must be directed to an SDU in accordance with 42 USC J b){5)and(bXO)or Payee.{$(*-Pey menls to WU below). If payment is not - directed to an SDUITribal Payee or this IWO is not regular on its face, you must check thls box and roturn`1ft"OW O to the sender. Signature of Judgelissuing dial(if required by Stater or Tribal law): Print Name of Judgeflss4ing,O ial: Title of JudgeAssuing ficial. Date of Signature: MW If the employeelopligcar works in a State or for a Tribe that,is d#060iont,from the State or Tribe that issued this order,a copy-Of#41WO must be provided to the a ployeeelobligor. ❑ If checked,the employerlincome withholder must provide a copy of this form to the employeel9bilg9r. ADOffMAL INFGFUMTION FOR EMPLOY-MMCIDIPE VVITMOLOMS' Pennsylvania low(22 PA,C*S.§42'i< 4b))requires rarnktonce by an if an armplgye�r is ir�rdarec. to v to income frptm VNWO aura a and empWs 15 If an rn�r t " tt ,a ` fief two or more returned checks duo W nonsuftlent tests. plans calf thelf, lw ki�r Csai mks and Disbursement Unit(PA SOU)Employer CustamorAilervica at MAaftimVeam ",to: PA SC[ 1 chock tio: P *$CPU, P.Q. f, 12, f Piet► '17'1, 1,12 canOR M11 SEJV'CASH BEM"MAIL. State-specific contact and withholding informetIon can be found on the Federal Emfkloyer Servi s vredetfe kited at: Priority:Withholding for support has priority ovw any I s,r ur�r S, lay++. � at"��+e.irl „ �( §M6(bX7)). if a F I ftx b Wy is Con*1nM9 Payments: When remitting payments to an SOU U or Tribal CSI agency,you may combine ="qwlts from more Own one ar*40yeW MIgoes income In a sir ky m ent.You must,homer, obligor's portion of the payment. Paymeaf To U: You must send child support payments pays-We b ' ! to O ID a Tribal CSE agency.if Oft IWO party,court,or attorney),you must check the box above ate;ft by a Court,Attdmey,or Private Individual/En r amid the issued by a Tribal CSC agency,you must follow the"Remit pay to I on tl fob. Reporting the Pay Qae: You must report the pay date when sendl the pa ,on The qty Is the n which the amount was wild from the employeelobligor's w .You must y if applicable)of the employee/obligor's principal place of p m t tirXisa pariq�ls ,, erkt the withholding and forward the support payments. Multi :If theme is more than one lam 1f and" ar+a.ua limits, e Fedl, State,or Tribal wthhol � fi n support before payment of any past-due a"wt.Follow AhO or nom' " �ku��tk `�►f s��l place of employment to determine the appropriate a on t#i i. Lump Sum Payments: You may be required to notify a le or Trlk ..(;3E of rslni�jump sum payments to this employee/obligor such as bonuses,commissions,or severance pay.CorkMOT,e sender to 6610OW04,lf'y i sse k? }Wed, 'to report and/or wittthold lump sure payments. Liability: if you have any doubts about take vat of IWO OM 01110 af. If YOU fait to withtW i ,r empla e+e/ob igoes income os t#*t1R O dpi any penalties set by State or Tribal roure. Anti-disucriminatiarn: You are subject to a fine dolormirvId unilr to or Trlpst4sw fordische rgln an pr'frorrt employment,refusing to employ,or taking disciplinary ac agililit°ion ernes` b ' . 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 form currently in use, Form EN-025 06112 Service Type M Page 2 of 3 Worker ID $IATT - . . Employer's Name: CENTRAL TRANSPORT,LLC Employer FEIN: Ennpkoyew/ObigoeoNamw: HEYDT,DAVID R. 9898101733 CSE Agency Case Identifier: Order Identifier: Withholding Limits:You may not withhold monothanthekooaerot1)thmamounbaaUovwedbytheFede,eiConsuma/Cn*ddPnotepUon 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 an:State, Federal, local taxes;Social Security taxes;statutory pension contributions,and Medicare taxes.The Federal limit|m5D96of the disposable income if the obligor is supporting another fmmi|ymndGO%ofthediopoeob|eincomeiftheob|igorisnotmuppn,bng 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 monatbmntheomowntma||ovw»dundertho|mwnfMneionu1ngThbe.ForThbu|emp|oyorstincome withholders who receive a State IWO,you may not withhold more than the lesser of the limit set by the law of the jurisdiction inwhich 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 OCPA 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 retuming this form to the address listed in the Contact Information below: 2710960780 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[Tdbal Payee: Final Payment Amount: New Employer's Name: New Employees Address: CONTACT INFORMATION: To EmiRlMr/Income Withholder; |f you have any questions,contact WAGE ATTACHMENT UNIT(issuer name) by phone ot . bv fax mt . by email orwebsJWaat: . SendbanninmUon/noome status notice and other correspondence to:DOMESTIC RELATIONS SECTION, 13 N.HANOVER ST. P.O. BOX 320. CARLISLE. PA. 17013(Issuer address), To Empl9yeel0bligor: |f the employee/obligor has questions,contact WAGE A17ACHMENT UNIT(Issuer name) by phone at . by fax at by email orwebsitemt . IMPORTANT:The person completing this form is advised that the information may be shared Wth theemployom/ohUgm. OMB wv'oonm,v+ Form EN-028 06/12 Service Type K4 Page 3of3 Worker|Q$|ATT �� r: HEYQT,DAVID R. PAGSES•Cie bWMbK 49010 78 505110098 Plaintiff Name KATHLEek G.DUGAS I .D-UGAS Do" A48001W 0081 S 20016 $ 00 Child(ron)'s Na e(s): DOB Child(ran)'s Name(s):_ CUB KYLE R.HEYD'T 02/0719$ PACSES Case Mamba Ptaff Name $ ?; + Chiid(ren)'s Name(s): DOB Child(renys Narne(s): DOB PA ES'C"N# #fir PlaintlffName pla stiff Na+ne Docke t Atti3chmapt A=w DogMt AttliatkaW, , $ 0.00 T3: Child(ren)'s Name(s): DOB Child(ron}'s Names) DOB Addendum Farm EN-028 06/12 Service Type M OM8 Nw 0970-0154 Worker IQ$IATT • INCOME WITHHOLDING FOR SUPPORT O ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT(IWO) 4q L I onto-7<z ED CS I u to(),R O AMENDED IWO p/ /� O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT OVi S aD�l`a DS _ I q�� (� Ul O TERMINATION OF IWO Date: 04105/13 ❑ Child Support Enford"ent(CSE)Agency ® Court ❑ Attorney ❑ Private Indtvidual/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 hfD•//www acf hhs gov/ rc grams/eWnewhire/eml2igyer/12ublication/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): 9898101733 City/County/Dist.frribe CUMBERLAND Order Identifier: (See Addendum for ordeddocket informahon) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) TOWNE AIR FREIGHT RE: HEYDT,DAVID R. 24805 US 20 W Employee/Obligor's Name(Last,First,Middle) SOUTH BEND IN 46628-5911 174-52-4553 Employee/Obligor's Social Security Number (See Addendum lbr plalndff names associated with cases on attachment) Custodial Party/Obligee's Name(Last,First, Middle) Employer/Income Withholders FEIN 351097684 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 httn:/1www.acf.hhs.gooyJJpa=ms/csa/newhire! employer/pubticatioNruIilcation.htm-formal.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. 3510976840 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. (--, $ 816.00 per month in current child support $ 0.00 per month in past-due child support-Arrears 12 weeks or greater? @AFOO>w $ 0.00 perm n h in current cash medical support z� $ 0.00 per month in past-due cash medical support c ) I �u $ 800.00 per month in current spousal support C ' $ 95.80 per month in past-due spousal support $ 0.00 per month in other(must specify) for a Total Amount to Withhold of$ 1,711.80 per month. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the"Orde9rnformation. If your pay cycle does not match the ordered payment cycle,withhold one of the following amount: $ �RqG.03 per weekly pay period. $ 855.90 per semimonthly pay period(twice a month) $ 739.73 per biweekly pay period(every two weeks) $ 1,711.80 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 oov/ rrooarams/cse/newhire/em IIMr/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$IATT ❑ Return to Settler[Completed by Payment must be directed town 5f�U in accordance with 42 USC§W(bX5)and{b)((1)or Tribal Payee(see„1��nts to SOU Below). tf payment is not directed to an SDU/Tribaf Payee or this'IWO is not regular on its face,you must deck this box and return the 4W0 to the sender. Signature of JudgoJ' aing (if required by State or Tribal law): Print Name of Juellssutng1: Title of Judgelissuft Official: Date of Signature. s If the employeelobl gor works In a State or for a Tribe that is different from the State or Tribe that ssued this order,a copy of this IWO must be provided to hO emptoyee%btltgor. ❑ If checked,the employerlincome withholder must provide a copy of this form to the employee/obligor, AQPffX)NALl INFORMATION;FOR­EMPLOYERSANCONE,WITHHOLIDIERS Pennsylvania law(23 PA C.S. 4374(b))requires remli tance by an if an empJoyer is+ar ad to wi Id lacomo*am,*Qr* *n obe employee and employs 13 or more periods,or if an emplo, " hes a history of two or more red vn"cults tloo to nonsuf siient fords. a cat!ttwe Pomsyivania Stgft Cdt* ttti and Disbursement Unit(PA SCOU)Eft4loyer Customer Service at 11-87T470411II11104or instructions,PA Ij�j 421-0 0,00 PAwA to: PA SCOU Send elk to: rtrr tr 41=, P.O. B**ft142, Hwr*burv, Pa 1710644-12 IN A ff 1, N,,AK THE . 4t '`S"W,AM IM P,4CM do#Mwoas State-specific contact and withholding information can be found on the Federal Employer Services website 1ocated at: Priority: Withholding for support has priority over any other legalpr9cess,under State law against the earns,income (U SC 42 § bX7)). If a Fell t1XLjaVy Contitg,Pegs: When remitting payments to an SDU or Trite�agency;you may corn - *awvwA`1rorn more than one employeekbWs income Inr a singile,payment You mils#,hoer,s ii�y obligor's portion of the payment. Payments To SOU:You must send child support payments payable;by income wehhokding to theme SDCJ or to a Tribal C3E agency.If N& y11©iritruGts you tci s 4. �lt to an , ff +an ( .�p e citotliat party,court,or sta y).you must c hoWthe box a�bouti.a04 110 ",*0, .-_ t by a Court,Attgmey,,or Private IndividvallEntity and was issued by a Tribal CSE agency,you must follow the"Ft mf`" ' -' ski# "ci+rt tfs Ern. Reporting the Pay Date: You must report the pay date when s tlment The p'aJP t is tt3 which this amount was wll#dtield form the employeelvbligor's wages.You must 1pw of tls (et taffy if applicable)of the employee/obligor's principal place cif #"flit '` ` riff ti nt the withholding and f wward the support payments. Mull a IIll ills: if there is more thin one IW©a ar t-this o and you are unsWe to,f lly lc afl lW 0,to Federal, State,or Tribal w wliddir t ,you i t tlou iii; to c support before payment of any paiolue eiolt F, the plWe of aMployrne to determine the r�fi method. Lump Sum Payer: You may be required to no a�.+ar TriI ,C�.a�y of among I pynrits to this employee/obligor such as bonuses,commissions,' sewerantiee pay.Comer ro 1fet�lite ar69 to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO� lact If you fail to wiftolo fto from,,the employee/ s income as tho�► 1 sue.... you rir aim any penalties set by State or Tribal law/procedure. Anti-dieaAi� subject on: You are su to a hne lured or Trit I=law it I sn erni bli i #r#m employment, refusing to employ,or taking disciplinary action. �ti fir mf iii OMB Expiration Date—05/3112014.The OMB Expiration Date has no bearing on the termination date of the INFO;it identifies the version of the form currently in use, Form EN-028 06/12 Service Type M Page 2 of 3 Worker ID$IATT . 40 Employer's Name: Employer FEIN: Employee/Obligor's Name: HEYDT,DAVID R. 9898101733 CSE Agency Case Identifier; Order Identifier: Withholding Limits:You may not withhold more than the lesser of., 1)the amounts allowed by the Federal Consumer Credit Protection Act(CCPA)(15U.S.C. 1673(b));pr2)the amounts allowed by the State nr Tribe cf the employee/obligor's pdncipa 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 ha supporting another family and 6O96of the disposable income if the obligor im 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 employerstincome Withholders who receive n State|VVO.you may not withhold monethantha|eommrofthe||m|t set by the law of the jurisdiction|nwhich 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: 3510976840 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 SDUITribal Payee: Final Payment Amount: New Employer's Name: New Employers Address: CONTACT INFORMATION: To Empigyer/Incorne Withholder: |f you have any questions, contact WAGE ATTACHMENT UNIT(issuer name) by phone ot by fax od bv email urxw»boKmat: Send twnninoUom4nuome status notice and other correspondence to:DOMESTIC RELATIONS SECTION, 13 N—HANOVER ST. P.O. BOX 320, CARLISLE, PA. 17013(issuer address). To ErnRiMeMbligor: |f the employee/obligor has quaotiono.contact WAGE ATTACHMENT UNIT(issuer name) by phone ot . by fax ot ` by email orwoba|hsat IMPORTANT:The person completing this form is advised that the information may be shared with the employee/obligor. OMB wv'09m«,,^ Form EN-028 06V12 Service Type K4 Page 3of3 Worker!Og/AJ-F D : HEYDT,:DAVID R. 49,61086178 5051106" Elalold .r .� KATHLEEN G.DUG�AS KA G.DUCAS 00888 $ 816:1 054 M, $ Child(renys Name(s): DOB Child(ren)'s Name(s): DOB KYLE 1!.HEYDT E Jt 7 3 PACSES Can PA Cam rnber PiainBff.Name Plaines hiarrfe 0 $ ..': ., Child(ren)'s Name(s): DOB Child(ren)'s Name(s)' DOB PALS S Caw,Ny'itl� Mainfrif Mme PIfl Docket AUAGbMardAM Children}'s Name(s): DOB Child(ren)'s Nan*s): 008 Addendum Form EN-028-06/12 Service Type M OMSNo.:09710-0154 Worker ID$IATT INCOME WITHHOLDING FOR SUPPORT O ORIGINAL INCOME WITHHOLDJNG ORDER/NOTICE FOR SUPPORT (IWO) ���/,-� � D Amswoeoxwo / `,�. ~ ~"' . " �� � hL oom ~ ���, O ow FOR LUM SUM PAYMENT C) TERMINATION OF IWO ) /)/v^ .�� . " / D /'>o\ 03/24/14 O Child Support Enforcement (CSE).Agen-oiy S Court 0 Attorney O Private Individual/Entity (Check One) NOTE: This IWO this IWO and return it to the sende (see IWO |nutmctionohttp://w^ww.00[hhe.gov/pmgnamo/cso0onno/JwB'O970-0154inotmctinno.Pdf). If you receive this documerit 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 City/County/Dist./Tribe CUMBERLAND Private Individual/Entity Remittance Identifier (include w/payment): 9898101733 Order Identifier: (See Addendum for order/docket Information) CSE Agency Case Identifier: (See Addendum for case summary) TOWNE AIR FREIGHT 24805 US 20 W SOUTH BEND IN 46628-5911 Employer/Income Withholder's FEIN 351097684 Child(renys Name(s) (Last, First, Middle) ChHd(renys Birth Date(s) RE: HEYDT, DAVID R. Name (Last, First, Middle) 174-52-4553 Employeef0bligors Social Security Number (See Addendum for plaintiffnames associated with cases on ottachment) Custodial Party/Obligees Name (Last, First, Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you m this IWO and return it to the sender (see IWO instructions http://www.acf.hhs,gov/orograms/csefforms/ owa'0970'015* instructions.pd. If you receive this document from someone other thari a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached, 3510976840 See Addendum for dependent names and birth dates associated with cases on attachment ORDER INFORMATION: This documertt is based on the support or withhotding order from CUMBERLAND County, Commonwealth of Pennsylvania (GbabaD'hbo). You are required by Iaw to deduct these amounts from the empioyee/ obligor's income untfl further notice. � 0.00 per month in past-d e child support - Arrears 12 weeks or greater? � 0.00 per month in current cash medical support � 0.00 per month in past-due cash medical support � 0.00 per month in current spousal support Q 0.00 per month in past-due spousal support � 0.00 per month in other (must specify) for a Total Amount to Withhod of $ 0_00 per month. AMOUNTS TO WITHHOLD: You do not have to vary your pay nyo� hnbeinoompUanoavv�hthe Information. 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 tater 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 (Stoba/Tribo), the employer can obtain withholding UmitaVono. time naquinomentu, and any allowable employer fees at http://vw^w.an[hhu.gov/pnognama/ooe/nawhire/amp/oyerhznntacts/cortaot mop. !atrn for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970-0154 Service Type M Form EN-028 11/13 Worker ID $1ATT � Return to Sender by Employer/Income With must be directed to an SDU in accordance with 42 USC and 0d0\or Tribal Payee (see Payments toGDUbelmw). If payment is not directed to an SDU/TribaI 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 Ia Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: If the employee/obUgor 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 omployee/obligor. 0 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 caII 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 !NCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as thmEnplmyew/Obligmr's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MA/L. Sta<e-opaoifiocontact and withholding information can be found on the Federal Employer Services wobuite located at: httV://vmmw.ao[hhoJJov/pmgnonnmtoe/nowhie/omp|nyer/onntaots/contootnmp.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 pa me totoon8OUurTriba/CSEogunoy.youmoynomb|newdhhe}damountsfrnm more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obtigors 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/obiigor's wages. You must comply with the Iaw of the State (or TribaI Iaw 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 aU IWOs due to Federo|. Sto0e, or Tribal withholding |imita, you must honor all |VVOuto 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 a f upcoming /umpnumpeymantotnthio employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold Iump sum payments. Liability: If you have any doubts about the vaUdity 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 Iaw/procedure. Anti-discrimination: You are subject tnm fine determined under State or Tribal law for discharging onemployee/obligor �om employment, refusing ho employ, orhs�ngdimj�inoryoohon against an employee/obligor because of this VV OMB Expiration Date —05/3o2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the torm currently in use. Form EN-028 11/13 Service Type M Page 2 of 3 Worker |O$|AT7' Employer's Name: TOWNE AIR FREIGHT Employer FEIN: 351097684 Employee /Obligor's Name: HEYDT, DAVID R. 9898101733 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: 3510976840 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.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 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 Service Type M Page 3 of 3 Form EN -028 11/13 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: HEYDT, DAVID R. PACSES Case Number 496108678 PACSES Case Number 505110698 Plaintiff Name KATHLEEN G. DUGAS Plaintiff Name KATHLEEN G. DUGAS Docket Attachment Amount Docket Attachment Amount 00886 S 2006 $ 0.00 05-1906 CIVIL $ 0.00 Chi|d(nen)'oNamo(o): DOB Chi|d(nen)'sName(o): KYLE R. HEYDT 02/07/98 DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount s 0.00 Child(ren)'s Name(s): DOB Docket Attachment Amount � Ul0 Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount � 0.00 Child(ren)'s Name(s): DOB Service Type M Docket Attachment Amount � 0.00 Child(ren)'s Name(s): DOB Addendum OMB No,: 0970-0154 Form EN-028 11/13 Worker ID $1ATT In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 '3 -C1-� G7 Defendant Name: DAVID R. HEYDT Member ID Number: 9898101733 -RC- CD Please note: All correspondence must include the Member ID Number. t+ r Z3c.� ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATIOWBEN;EflTS r.� rr - Plaintiff Name KATHLEEN G. DUGAS KATHLEEN G. DUGAS Financial Break Down of Multiple Cases on Attachment PACSES Docket Case Number Number 496108678 505110698 00886 S 2006 05 -1906 CIVIL Attachment Amount/Frequency 816.00 / MONTH 895.80 / MONTH / TOTAL ATTACHMENT AMOUNT: $ 1,711.80 Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of $ 393.95 per week, or 50 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, DAVID R. HEYDT Social Security Number XXX -XX -4553 , Member ID Number 9898101733. OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and /or support arrearages. If the Defendants Unemployment Compensation benefits are attached by another Court or Courts for support and /or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673 (b)(2) and 23 Pa. C.S.A. § 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendants entitlement to Unemployment Compensation benefits, under the Application for. Benefits dated MARCH 16, 2014 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. Date of Order: MAR 2 5 2014 Service Type M BY THE COURT Form EN -530 Worker ID $IATT In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: DAVID R. HEYDT Member ID Number: 9898101733 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Plaintiff Name KATHLEEN G. DUGAS Financial Break Down of Multiple Cases on Attachment PACSES Docket Case Number Number 505110698 05-1906 CIVIL 4(161020g 8Nt S aD3lo Attachment Amount/equeicy ".. 895.88rt NDNT. t7 r", d co �,: . • c $ %= - L3 TOTAL ATTACHMENT AMOUNT: $ 895.80 Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of $206.16 per week, or 55.0%, of the Unemployment Compensation benefits otherwise payable to the Defendant, DAVID R. HEYDT Social Security Number XXX -XX -4553, Member ID Number 9898101733. OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated MARCH 16, 2014 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. Date of Order: JAN I. 3 2015 Service Type M BY THE COURT Albert H. Masland ,,; ;JUDGE Form EN -034 Worker ID $IATT M