Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
05-4570
PHYLLIS A. LANTZ, Plaintiff VS. JESSE H. LANTZ, III, Defendant N O T I C E : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : CIVIL ACTION : NO. 0Y. q s 10 : IN DIVORCE T O D E F E N D You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the 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: Office of the Prothonotary Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013-3387 IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE PA 17013 717-249-3166 PHYLLIS A. LANTZ, : IN THE COURT OF COMMON PLEAS Plaintiff : OF CUMBERLAND COUNTY : PENNSYLVANIA VS. CIVIL ACTION JESSE H. LANTZ, III, NO. OS- vS70 Defendant IN DIVORCE NOTICE OF RIGHT TO COUNSELING You are one of the parties in the above captioned action in divorce. By virtue of Section 202 of the Pennsylvania Divorce Code, it is a duty of the Court to advise both parties of the availability of counseling and upon request of either provide both parties a list of qualified professionals who provide such services. Accordingly, if you desire counseling a list of marriage counselors is available in the office of the Prothonotary at: Office of the Prothonotary Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013-3387 PHYLLIS A. LANTZ, Plaintiff VS. JESSE H. LANTZ, III, Defendant : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : CIVIL ACTION : NO. CS-4'S7 C Cw-QT : IN DIVORCE CONSOLIDATED COMPLAINT IN DIVORCE 1. Plaintiff is Phyllis A. Lantz, a citizen of Pennsylvania, residing at 515 Poplar Church Road, Camp Hill, Cumberland County, Pennsylvania. 2. Defendant is Jesse H. Lantz, a citizen of Pennsylvania, residing at some location in Dillsburg, Cumberland County, Pennsylvania. 3. Plaintiff and Defendant are sui iuris and have been bonafide residents of the Commonwealth of Pennsylvania for at least six months immediately preceding the filing of this Complaint. 4. The parties are husband and wife and were lawfully married on June 17, 1997, in Cumberland County, Pennsylvania. 5. The marriage is irretrievably broken. 6. Neither Plaintiff nor Defendant are in the military or naval service of the United States or its allies within the provisions of the Soldiers' & Sailors' Civil Relief Act of the Congress of 1940 and its amendments. 7. There has been no prior action for divorce or annulment instituted by either of the parties in this or any other jurisdiction. 8. The Plaintiff has been advised of the availability of counseling and of the right to request that the Court require the parties to participate in counseling. COUNT I Request for a Fault Divorce under 3301(a)(6) of the Divorce Code 9. The prior paragraphs of this Complaint are incorporated herein by reference thereto. 10. Defendant has offered such indignities to the Plaintiff, who is the innocent and injured spouse, as to render Plaintiff's condition intolerable and life burdensome. 11. This action is not collusive. 12. Plaintiff has been advised of the availability of counseling and that Plaintiff and Defendant have the right to request the Court to require the parties to participate in such counseling. WHEREFORE, Plaintiff respectfully requests that the Court enter a Decree of Divorce, pursuant to 3301(a)(6) of the Divorce Code. COUNT II Request for Divorce Due to Irretrievable Breakdown Under 3301(c) of the Divorce Code 13. The prior paragraphs of this Complaint are incorporated herein by reference thereto. 14. The marriage of the parties is irretrievably broken. 15. After ninety (90) days have elapsed from the date of the filing of this Complaint, Plaintiff intends to file an affidavit consenting to a divorce. Plaintiff believes that Defendant may also file such an affidavit. 16. Plaintiff has been advised of the availability of counseling and that Plaintiff and Defendant have the right to request the Court to require the parties to participate in such counseling. WHEREFORE, if both parties file affidavits to a divorce after ninety (90) days have elapsed from the filing of this Complaint, Plaintiff respectfully requests the Court to enter a Decree of Divorce, pursuant to 3301(c) of the Divorce Code. COUNT III Request for Divorce Due to irretrievable Breakdown Under 3301(d) of the Divorce Code 17. The prior paragraphs of this Complaint are incorporated herein by reference thereto. 18. The marriage of the parties is irretrievably broken. 19. After a period of two (2) years has elapsed from the date of separation, Plaintiff intends to file her affidavit of having lived separate and apart. 20. Plaintiff has been advised of the availability of counseling and that Plaintiff and Defendant have the right to request the Court to require the parties to participate in such counseling. WHEREFORE, if two (2) years have elapsed from the date of separation and Plaintiff has filed her affidavit, Plaintiff respectfully requests the Court to enter a Decree of Divorce, pursuant to 3301(d) of the Divorce Code. COUNT IV Request for Equitable Distribution of Marital Property Under 3104, 3323, 3501, 3502 and 3503 of the Divorce Code 21. The prior paragraphs of this Complaint are incorporated herein by reference thereto. 22. Plaintiff and Defendant have acquired property, both real and personal during their marriage from the date of said marriage until the date of their separation. 23. Plaintiff and Defendant have been unable to agree as to an equitable distribution of said property. WHEREFORE, Plaintiff respectfully requests the Court to equitably distribute the marital property of the parties, pursuant to 3104 and 3502(a) of the Divorce Code. COUNT V Request for Alimony Pendente Lite and Alimony under 3104, 3323, 3701, 3702 and 3704 of the Divorce Code 24. The prior paragraphs of this Complaint are incorporated herein by reference thereto. 25. Plaintiff is unable to sustain herself during the course of litigation. 26. Plaintiff lacks sufficient property to provide for her reasonable needs and is unable to sustain herself through appropriate employment. 27. Defendant has the means and ability to pay Alimony Pendente Lite and Alimony to Plaintiff. WHEREFORE, Plaintiff requests the Court to enter an award of alimony pendente lite until final hearing and thereupon to enter an order of alimony in her favor. COUNT VI Request for Counsel Fees, Costs and Expenses Under 3104, 3323, 3502(e) and 3702 of the Divorce Code 28. The prior paragraphs of this Complaint are incorporated herein by reference thereto. 29. Plaintiff has employed Mary A. Etter Dissinger, of the law firm of Dissinger and Dissinger to represent her in this matrimonial cause. 30. Plaintiff is unable to pay the necessary counsel fees, costs, and expenses and Defendant is more than able to pay them. WHEREFORE, reserving the right to apply to the Court for temporary counsel fees, costs and expenses, prior to final hearing, Plaintiff requests that, after final hearing, the Court order Defendant to pay Plaintiff's reasonable counsel fees, costs and expenses. Respectfully submitted, DISSINGER and DISSINGER Mary A. Etter Dissinger, squire Attorney for Plaintiff Supreme Court ID # 27736 28 North Thirty-second Street Camp Hill, PA 17011 (717) 975-2840 VERIFICATION I, Phyllis A. Lantz, verify that the statements made in the Divorce Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification. Phyllis A. Lantz, Plaintiff \. U? r ? ,,,,,,((("' ??' .? ?? W ? ?.. d, ?, O ? ? c ? ? ? L ?' c N F d° t7 ^? .?? ?l ? ?' s =? Rl C? y., ;, --? 4`? PHYLLIS A. LANTZ, Plaintiff Vs. JESSE H. LANTZ, III, Defendant : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION : NO. 05-4570 : IN DIVORCE MOTION FOR HEARING ON PLAINTIFF'S PETITION FOR "Wriell " LITE AND NOW comes Mary A. Etter Dissinger, Esquire, counsel for Phyllis A. Lantz, and requests the Court to schedule a hearing on her Petition for Alimony Pendente Lite. Respectfully Submitted, DISSINGER & DISSINGER ,2;&, Mary A. tter Dissinger, Attorney at Law Supreme Court ID #27736 28 North Thirty-second Street Camp Hill, PA 17011 (717)975-2840 PHYLLIS A. LANTZ, Plaintiff VS. JESSE H. LANTZ, III, Defendant : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : CIVIL ACTION : NO. 05-4570 : IN DIVORCE CERTIFICATE OF SERVICE I, Mary A. Etter Dissinger, Esquire, do hereby certify that a copy of the foregoing document has been duly served upon Jesse H. Lantz, III, by depositing same in the United States Mail, postage prepaid, addressed as follows: Jesse H. Lantz, III Young's Grove 612 Range End Road Lot #92 Dillsburg, PA 17019 Date: vZa /d.5- Mary A Etter Dissinger G r-? ""c'? ^'^C -?- (? .{V?? I ,-.? ?? s ? ?.? ?;,? N ch? o? TY ii ', '' 1?7 %-J 1 .i i. - ?.. Tl1 __ _ ?.. 7 ,.? Y' ?; w '.G r.^ ? .L. PHYLLIS A. LANTZ, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 2005-4570 CIVIL TERM JESSE H. LANTZ, HI, IN DIVORCE Defendant/Respondnet PACSES # 107107680 ORDER OF COURT AND NOW, this 266 day of September, 2005, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shaddav on October 18. 2005 at 1:30 P.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, George E. Hoffer, President Judge Mail copies on Petitioner 09/26/05 to: Respondent Mary A. Etter Dissinger, Esq. Date of Order: September 26, 2005 > J. Slj dday, onference Officer / YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND ` REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 CC361 r? N 3 :7 CTS ? J i 7U SHERIFF'S RETURN - REGULAR CASE NO: 2005-04570 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND LANTZ PHYLLIS A VS LANTZ JESSE H III GERALD WORTHINGTON Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT - DIVORCE was served upon LANTZ JESSE H I the DEFENDANT , at 1618:00 HOURS, on the 15th day of September, 2005 at KAUFFMAN BUS COMPANY 1565 JERUSALEM ROAD MECHANICSBURG, PA 17055 by handing to JESSE H LANTZ III a true and attested copy of COMPLAINT - DIVORCE together with and at the same time directing His attention to the contents thereof. Sheriffs Costs: Docketing 18.00 Service 9.60 Postage .37 Surcharge 10.00 nn J I . I I Sworn and Subscribed to before me this day of Ate A.D. , Sheriff or Deputy Sheriff of So Answers: R. Thomas Kline 09/16/2005 DISSINGER & DISSINGER By: Deputy Sher' 614 Prot on tary PHYLLIS A. LANTZ, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 05-4570 CIVIL TERM JESSE H. LANTZ, IN DIVORCE Defendant/Respondent PACSES# 107107680 ORDER OF COURT AND NOW, this 18`h day of October, 2005, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $1852.46 and Respondent's monthly net income/earning capacity is $2206.51, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $142.00 per month payable monthly as follows; $142.00 for alimony pendente lite and $0.00 on arrears. First payment due on or before October 24, 2005. Arrears set at $142.00 as of October 18, 2005. The effective date of the order is September 26, 2005. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Phyllis A. Lantz. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the Respondent's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. cc360 Unreimbursed medical expenses that exceed $250.00 annually are to be paid as follows: 0% by Respondent and 100% by Petitioner. The Petitioner is responsible to pay the first $250.00 annually in unreimbursed medical expenses. Neither party to provide medical insurance coverage. Proof of coverage shall consist, at minimum, of. 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. This Order takes into consideration that husband is making a $704.16 per month bankruptcy payment for a joint bankruptcy obligation. DRO does not consider husband's second income because of his continued bankruptcy payments since 2001. Consented: Petitioner Respondent Petitioner's Attorney Respondent's Attorney 13Y; f George E. Hoffer, P. Judge DRO: R. I Shadday Mailed copies on: Petitioner October 18, 2005 Respondent Mary A. Etter-Dissinger, Esq. Barbara Sumple-Sullivan, Esq. ? Il ' " r _ C1:) ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania 107107680 QOriginal Order/Notice Co./City/Dist. of CUMBERLAND 05-4570 CIVIL O Amended Order/Notice Date of Order/Notice 10/18/05 Q Terminate Order/Notice Case Number (See Addendum for case summary) RE: LANTZ, JESSE H. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) KAUFFMAN BUS SERVICE INC 1565 JERUSALEM RD MECHANICSBURG PA 17055 200-36-4722 Employee/Obligor's Social Security Number 8972000025 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 142.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Dyes ® no $ 0.00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 142.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 32.77 per weekly pay period. $ 65.54 per biweekly pay period (every two weeks). $ 71. oo per semimonthly pay period (twice a month). $ 142. o0 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY T11 R Date of Order: OCT 1 0 2005 I P• George E. Hoffer, P. Judge DRO: R.J. Shadday Form EN-028 Service Type M OMBNo,:0970-0,54 WorkerlD $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If Necked you are required to provide a copy of this form to your mployee. If yo r employee works in a state that is di erent from the state that issued this order, a copy must be provi?ed 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 tire Payddte1Date-ofWithh0fdirrg- You ... u5t report tire paydateklate ol mthholdnir MMI. Mrdllir 11M IJ.yMurlt. 1 11C dafe 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. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2318920100 EMPLOYEE'S/OBLIGOR'S NAME: LANTZ, JESSE H. EMPLOYEE'S CASE IDENTIFIER: 8972000025 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 01; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes;, and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 OMB No.: 097"154 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: LANTZ, JESSE H. PACSES Case Number 107107680 Plaintiff Name PHYLLIS A. LANTZ Docket Attachment Amount 05-4570 CIVIL$ 142.00 Child(rem's Name(s): DOB ?If checked, you are required to enroll the child (rent identified above in any health insurance coverage available through the employee's/obligor's employment. ?if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type m OMB No.. 097o-01 54 Worker ID $IATT ?,.? n_5 ?.r ) ?,;1 O C.: -? `'J ?... - _? l I ?. 1 \! ?? In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION PHYLLIS A. LANTZ ) Docket Number 05-4570 CIVIL Plaintiff ) Vs. ) PACSES Case Number 107107680 JESSE H. LANTZ ) Defendant ) Other State ID Number Order AND NOW to wit, this NOVEMBER 7, 2005 it is hereby Ordered that: DEFENDANT IS GIVEN CREDIT IN THE AMOUNT OF $142.00 FOR DIRECT PAYMENT TO THE PLAINTIFF. BY Iff COURT: 2w4nn P.J. JUDGE Form OE-520 Service Type M Worker ID 21005 :7 CJ ??l 4Jl -rj k T _, CID J tr7 A) Y- IN THE COURT OF COM ON PLEAS OF CUMBERLAND COUNTY, PE?1iNSYLVANIA PHYILIS A. LAN!'Z,. Plaintiff Plaintiff VS. . JESSE H. LAWZ, III, Defendant NO. 05 - 4570 Jesse H. Lantz, III MOTION FOR APPOLNM= OF MASTER (?) (Defendant), moves the court to appoint a master with respect to the following claims: (X ) Divorce O Distribution of Property ( ) Annulment ( ) Support (X ) Alimony (X) Counsel Fees (X ) Alimony Pendente Lite (X) Costs and Expenses and in support of the motion states: (1) Discovery is complete as to the claims (s) for which the appointment of a master is requested. her (2') The 15laintiff (has) W appeared in the action (personally) (by attorney, Mary A. Etter pissincagr ,Esquire). 3301(d) (3) The staturory ground (s) for divorce (is) ( ) 3301(c) and (4) Delete the inapplicable paragraph(s): (a) The action is not contested. (b) An agreement has been reached with respect to the following claims: (c) The action is contested with respect to the following ?aime:Equitable Distribution, APL, Alimony, Counsel Fees,'Costs and Expenses or fact. The action (6) The hearing is expected to take One 0 (7) Additional information, if any. re-1 t does not involve issues o Date: September 5 , 2007 (da7x) . ytorney for () Barbara SAP (Dle-Sullivan ORDER AP.OINTING :MASTER .Esquire AND NOW , 2007 Esquire, is appointed master with respeci'to the following claims: By the Court; J C= 0 P c -n n 5 PHYLLIS A. LANTZ, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 05 - 4570 JESSE H. LANTZ, III, CIVIL ACTION -LAW Defendant : IN DIVORCE NOTICE TO PLAINTIFF If you wish to deny any of the statements set forth in this Affidavit, you must file a Counter- affidavit within TWENTY (20) DAYS after this affidavit has been served on you or the statements will be admitted. DEFENDANT'S AFFIDAVIT UNDER SECTION 3301(D) OF THE DIVORCE CODE 1. The parties to this action separated on August 26, 2005, and have continued to live separate and apart for a period of at least two (2) years. 2. The marriage is irretrievably broken. 3. I understand that I may lose rights concerning spousal support, alimony, division of marital property, attorneys' fees or expenses if I do not claim them before a divorce is granted. I VERIFY THAT THE STATEMENTS MADE IN THE FOREGOING AFFIDAVIT 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.A. SECTION 4904 RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES. DATED: d 70 2007 PHYLLIS A. LANTZ, : IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 05 - 4570 JESSE H. LANTZ, III, CIVIL ACTION -LAW Defendant IN DIVORCE COUNTER-AFFIDAVIT UNDER SECTION 3301(d) OF THE DIVORCE CODE 1. Check either (a) or (b): _ (a) I do not oppose the entry of a divorce decree. _ (b) I oppose the entry of a divorce decree because (Check (1) (ii) or both): _ (I) The parties to this action have not lived separate and apart for a period of at least two years. _ (ii) The marriage is not irretrievably broken. 2. Check either (a) or (b): _ (a) I do not wish to make any claims for economic relief. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. _ (b) I wish to claim economic relief which may include alimony, division of property, lawyer's fees or expenses or other important rights. I understand that in addition to checking (b) above, I must also file all of my economic claims with the prothonotary in writing and serve them on the other party. If I fail to do so before the date set forth on the Notice of Intention to Request Divorce Decree, the divorce decree may be entered without further notice to me, and I shall be unable thereafter to file any economic claims. I verify that the statements made in this counter-affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unworn falsification to authorities. Dated: Phyllis A. Lantz, Plaintiff NOTICE: If you do not wish to oppose the entry of a divorce decree and you do not wish to make any claim for economic relief, you should not file this counter-affidavit. C= 0 r t ; t Yt r HIM -? ; 173 Ul .,? IN THE COURT OF COM ON PLEAS OF CLMERLAND COUNTY, PENNSYLVANL4 PHYf LIS A. LANI'Z, Plaintiff Plaintiff vs. JESSE H. LAWZ, III, Defendant sea o7 2007 ad M. 05 - 4570 MOTION FOR APPOINMKENT OF ?`' &STER Jesse H. Lantz, III _(RJ29UMW) (Defendant), moves the court to appoint a master with respect to the following claims: (g ) Divorce O Distribution of Property ( ) Annulment ( ) Support (X ) Alimony (X ) Counsel Fees (g ) Alimony Pendente Lite (X ) Costs and Expenses and in support of the motion states: (1) Discovery is complete as to the claims(s) for which the appointment of a master is requested. har (2) The Plaintiff. (has) 099W appeared in the action (personally) (by attorney, Mary A. Et ,Esquire). 3301(d) (3) The staturory ground.(s) for divorce (is) ( ) 3301(c) and (4) Delete the inapplicable paragraph(s): (a) The action is not contested. (b) An agreement has been reached with respect to the following claims: ((c) The action is contested with respect to the following :Equitable Distribution, APL, Alimony, Counsel Fees, Costs and Expenses (5) The action (does not involve) complex issues of law or fact. (6) The hearing is expected to take One- (da7z) (7) Additional information, if any. rel t e m ion: Date: September 5 2007 toraev for (?) (Def endant) , ORDER APPOn=, G MASTER Barbara Sumple- llivan, Esquire A NOW ?(? ? 2007 Esquire, is appointed' star with respect"to the following claims: C? c cis a r F ff) C ' --- CDM . d " c,n Cn '?. PHYLLIS A.. LANTZ, IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 05 - 4570 JESSE H. LANTZ, III, CIVIL ACTION`- LAW Defendant : IN DIVORCE COUNTER-AFFIDAVIT UNDER SECTION 3301(d) OF THE DIVORCE CODE 1. Check either (a) or (b): _ (a) I do not oppose the entry of a divorce decree. _ (b) I oppose the entry of a divorce decree because (Check (I) (ii) or both): _ (I) The parties to this action have not lived separate and apart for a period of at least two years. _ (ii) The marriage is not irretrievably broken. 2. Check either (a) or (b): _ (a) I do not wish to make any claims for economic relief. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. (b) I wish to claim economic relief which may include alimony, division ofpro, lawyer's fees or expenses o other important rights. Go WIP 4 s 2 ryc ? 91/1-4/05 by 5kC-.+"f I understand that in addition to checking (b) above, I must also file all of my economic claims with the prothonotary in writing and serve them on the other party. If I fail to do so before the date set forth on the Notice of Intention to Request Divorce Decree, the divorce decree may be entered without further notice to me, and I shall be unable thereafter to file any economic claims. I verify that the statements made in this counter-affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Dated: Z 7 qw-0-1.0, a-,' 2s??& Phyllis A. Lantz, Plaintiff NOTICE: If you do not wish to oppose the entry of a divorce decree and you do not wish to make any claim for economic relief, you should not file this counter-affidavit. ? ? ? ? ?r v ? _ r. .?. ? ? ? `- ?' y,. ? S? `a ..- P ""C PHYLLIS A. LANTZ, Plaintiff VS. JESSE H. LANTZ, III, Defendant : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : CIVIL ACTION : NO. 05-4570 : IN DIVORCE INCOME AND EXPENSE STATEMENT OF PHYLLIS A. LANTZ, PLAINTIFF INCOME (a) Wages/Salary Employer: CAPITAL BLUE CROSS Address: Job Title/Description: Pay Period ....................- Bi-weekly Gross pay per pay period ....... $ 855.00 Payroll Deductions: Federal Withholding........ $ 76.16 Social Security............ $ 51.85 Medicare Tax ............... $ 12.13 State Income Tax........... $ 25.67 Local Wage Tax ............. $ 13.38 Retirement ................. $ 18.79 Health Insurance........... $ PAUCEE ..................... $ .77 Net Pay per period......... $ 639.60 (b) Other Income Spousal Support........... Interest & Dividends...... Pension/Annuity........... Social Security........... Rents/Royalties........... Expense Account........... Gifts ..................... Unemployment Compensation. Worker's Compensation..... TOTAL ...................... Week Month Year $ $ 142.00 $ T EXPENSES Household Week Home Rent .............. $ Maintenance....... $ Utilities-Electric $ Heat.... $ Telephone $ Water, Sewer, Refuse $ Employment Transportation.... $ Lunches........... $ Taxes Real Estate....... $ Personal Property. $ Insurance Homeowners........ $ Automobile........ $ Life .............. $ Accident.......... $ Health............ $ Other ............. $ Automobile Payments.......... $ Fuel .............. $ Repairs........... $ Medical Doctor ............. $ Dentist............ $ Orthodontist....... $ Hospital........... $ Medicine........... $ Special needs...... (Glasses, contacts) $ Education Private School.... $ Parochial School.. $ College........... $ Personal Clothing.......... $ Food .............. $ Barber, Hairdresser $ Household Supplies $ Credit Cards...... $ Loans ............. $ Miscellaneous Child Household Child Week Month Month $ $ 240.00 $ $ $ 52.00 $ $ $ 200.97 $ $ $ 117.00 $ $ $ 200.00 annually $ $ 70.00 $ $ $ 315.00 $ Household help.... $ $ $ $ Child care........ $ $ $ $ Papers, Books, Magazines......... $ $ $ $ Cable ............. $ $ $ $ Vacation.......... $ $ $ $ Entertainment..... $ $ $ $ Gifts ............. $ $ $ $ Contributions..... $ $ $ $ Legal fees........ $ $ $ 100.00 $ Other child support $ $ $ $ Alimony payments.. $ $ $ $ Other (marital guinea pigs) $ $ 92.00 $ TOTAL EXPENSES...... $ $ $ $ PROPERTY OWNED Checking Account Savings Account Credit Union Stocks/Bonds Real Estate Other TOTAL PROPERTY INSURANCE DESCRIPTION VALUE COMPANY Medical Health/ Accident Disability Income Other (H=Husband W=Wife C=Child/Children) $ 383.60 $ 40.00 POLICY # OWNERSHIP H W J - X _ COVERAGE H W C VERIFICATION I, Phyllis A. Lantz, verify that the statements made in this Income and Expense Statement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Date: ?9 4 7 -0c x yo-Z24 Phyllis A. Lantz PHYLLIS A. LANTZ, : IN THE COURT OF COMMON PLEAS Plaintiff : OF CUMBERLAND COUNTY : PENNSYLVANIA VS. : CIVIL ACTION JESSE H. LANTZ, III, : NO. 05-4570 Defendant : IN DIVORCE CERTIFICATE OF SERVICE I, Mary A. Etter Dissinger, Esquire, hereby certify that on the date set forth below I served a true and correct copy of the Income and Expense Statement upon the attorney for the Defendant, by First Class United States Mail addressed as follows: Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 Date: Mary A. Etter Dissinger Attorney for Plaintiff Supreme Court ID # 27736 28 N. 32nd Street Camp Hill, PA 17011 (717) 975-2840 (717) 975-3924 - fax ?,..? ?? ?} ? r `' j , l'? T•? }:,,, +:.' „r _A?: ?? ? . 4 PHYLLIS A. LANTZ, Plaintiff vs. JESSE H. LANTZ, III, Defendant : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : CIVIL ACTION : NO. 05-4570 : IN DIVORCE INVENTORY AND APPRAISEIENT OF PHYLLIS A. LANTZ, PLAINTIFF Plaintiff files the following Inventory and Appraisement of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three (3) years. I, Phyllis A. Lantz, verify that the statements made in this Inventory and Appraisement are true and correct. I understand that false statements made herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. hyl is A. Lantz, Plain iff INVENTORY AND APPRAISEMENT UNDER RULE 1920.33 ITEM # A. MARITAL PROPERTY IN WHICH EITHER SPOUSE HAS LEGAL OR EQUITABLE INTEREST ON DATE OF SEP. B. IS PROPERTY EXCLUDED FROM MARITAL PROPERTY C. BASIS FOR CLAIMED EXCLUSION D. PERSON OR ENTITY WITH WHOM INTEREST IS HELD 1. Marital Residence Joint 2. Am. Choice F.C.U - #36988 - suffix 01 Joint 3. Am. Choice F.C.U - #36988 - suffix 02 Joint 4. Commerce Bank -...3511 Checking Joint 5. Roth IRA-...3712 - 205/211/233 Wife 6. Phoenix Fund - ...9793 Wife 7. Commerce Bank -...3529 Checking Wife 8. W's HighMark Pension (65yrs) Wife 9. W's 401k - HighMark in part part premarital Wife 10. truck Husband 11. 1991 Grand Am yes pre marital Wife 12. 1988 Buick Regal J 13. Ford Taurus yes gift from W's mother W 14. Baltimore Life Annuity in part part premarital Wife 15. Life Insurance Wife 16. Verizon (wife paid) Husband 17. Bankruptcy Husband 18. Sewer Bill (w paid) Husband 19. PPL (w paid) Husband 20. Holy Spirit Husband 21. IRS - 2004 taxes Joint 22. Heating oil (w pd $50) Husband 23. Verizon Husband 24. PPL Husband 25. Pa Am Water Husband 26. Real Estate Taxes Joint 27. Shipley Oil Husband 28. Rolling Green Cemetary Joint 29. 401k Loan W 30. Dickens Village J 31. Nikon Camera H 32. Computer/printer J 33. Riding mower J 34. Snow blower J 35. Bank of America Card 36. Chase Card 37. Citi Financial Card ...5009 38. Citi Financial Card ...2872 39. Discover Card 40. 1st Bank card 41. 1st Select 42. JC Penny card 43. Lowes card 44. PSECU card 45. Sears card 46. Texaco cared 47. Bricker Auction -to wife INVENTORY AND APPRAISEMENT UNDER RULE 1920.33 ITEM # E. DATE ACQUIRED F. COST OR ACQUIRED VALUE G. VALUE ON DATE OF SEPARATION H. AMT OF LIEN ON DATE OF SEPARATION I. NATURE OF LIEN J. DATE OF LIEN R. LIEN HOLDER 1. ? 129,200.00 2. 35.19 3. 65.23 4. (-40.21) 5. 3767.78 6. 2072.77 7. 1019.17 8. 9. 26,318.00 10. 11. 2,000.00 per bankruptcy 12. 13. 14. 15,091.91 15. 929.00 16. (29.95) 17. (29500.00) 18, (123.20) 19. (148.91) 20. (62.60) 21. (929.18) 22. (355.18) 23. (52.96) 24. (241.72) 25. (89.35) 26. c(2,000.00) 27. (274.00) 28. 2,000.00 297 (13,925.00) 30. 2,000.00 31. 250.00 32. 500.00 33. 175.00 34. 175.00 35. (2872.15) 36. (1198.79) 37. (2490.00) 38. (6847.84) 39. (2783.60) 40. (1018.87) 41. (2091.97) 42. (4111.45) 43. (147.11) 44. (3125.36) 45. (580.73) 46. ( ) 47. ( ) PHYLLIS A. LANTZ, : IN THE COURT OF COMMON PLEAS Plaintiff : OF CUMBERLAND COUNTY : PENNSYLVANIA VS. : CIVIL ACTION JESSE H. LANTZ, III, : NO. 05-4570 Defendant : IN DIVORCE CERTIFICATE OF SERVICE I, Mary A. Etter Dissinger, Esquire, hereby certify that on the date set forth below I served a true and correct copy of the Inventory and Appraisement upon Barbara Sumple Sullivan, Esquire, the attorney for Defendant, by First Class United States mail addressed as follows: Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 Date: Mary A. Etter Dissinger _ ? -? e??t --? -?; ....? i .?a ?.?. i?.? 1? 1 ' ? ?? A?J In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION PHYLLIS A. LANTZ ) Docket Number 05-4570 CIVIL Plaintiff ) vs. ) PACSES Case Number 107107680 JESSE H. LANTZ ) Defendant ) Other State ID Number PETITION FOR MODIFICATION OF AN EXISTING SUPPORT ORDER 1. The petition of JESSE H. LANTZ respectfully represents that on OCTOBER 18, 2005 , an Order of Court was entered for the support of PHYLLIS A. LANTZ A true and correct copy of the order is attached to this petition. Form OM-501 Service Type M Worker ID 21502 LAWZ V. LANTZ PACSES Case Number: 107107680 2. Petitioner is entitled to 0 increase 0 decrease termination 0 reinstatement 0 other of this Order because of the following material and substantial change(s) in circumstance: WHEREFORE, Petitioner requests that the Court modify the existing er for support. Petitioner Attorney for Petitioner I verify that the statements made in this complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to unworn falsification to authorities. 011- (q-09' /??- z Date Pet inner Page 2 of 2 Form OM-501 Service Type M Worker ID 21502 r? M - -za _ PHYLLIS A. LANTZ, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 05-4570 CIVIL TERM JESSE H. LANTZ, III, IN DIVORCE Defendant PACSES Case No: 107107680 ORDER OF COURT AND NOW to wit, this 14th day of February 2008, it is hereby Ordered that the Alimony Pendente Lite Order is terminated pursuant to the parties' Stipulation and Agreement signed on this date in front of the Divorce Master. The above captioned case is closed with no balance due the Plaintiff. This Order shall become final twenty (20) days after the mailing of the notice of the entry of the order to the parties unless either party files a written demand with the Domestic Relations Section for a hearing de novo before the Court. BY THE COURT: T?% -L U4 M. L. Ebert, Jr., J. DRO: R.J. Shadday xc: Petitioner Respondent Mary A. Etter Dissinger, Esq. Barbara Sumple Sullivan, Esq. Form OE-001 Service Type: M Worker: 21005 N C= 0 -s- co 23 M M f {C ( ` ...SLw l ?l C Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 PHYLLIS A. LANTZ, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. JESSE H. LANTZ, III, Defendant NO. 05 - 4570 CIVIL ACTION -LAW IN DIVORCE AFFIDAVIT OF CONSENT A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on September 6, 2005. 2. The marriage of the Plaintiff and Defendant is irretrievably broken. Ninety days have elapsed since the filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. 4. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 5. I verify that the statements made in this affidavit are true and correct. I understand that false statements are made subject to the penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. DATE: PHYLLIS A. LANTZ C i ri PHYLLIS A. LANTZ, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 05 - 4570 JESSE H. LANTZ, III, CIVIL ACTION -LAW Defendant IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 43301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statement herein are made subject to the penalties of 18 Pa.C.S. 34904 relating to unsworn falsification to authorities. IJ DATE: a 2008 PHYL IS A. LANTZ n r??4???i "°4! _.-_'l'1 GaJ ?. 4L7 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 PHYLLIS A. LANTZ, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. JESSE H. LANTZ, III, Defendant NO. 05 - 4570 CIVIL ACTION -LAW IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on September 6, 2005. 2. The marriage of the Plaintiff and Defendant is irretrievably broken. Ninety days have elapsed since the filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. 4. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 5. I verify that the statements made in this affidavit are true and correct. I understand that false statements are made subject to the penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. DATE: / ?3 <? ? -n ` , -? ? tJi ;=j?? -? ; ? ?y ?.: -r, `T; ? ? _ ? ^F ?, PHYLLIS A. LANTZ, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 05 - 4570 JESSE H. LANTZ,111, CIVIL ACTION -LAW Defendant IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 0301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statement herein are made subject to the penalties of 18 Pa.C.S. 34904 relating to unsworn falsification to authorities. DATE: r / , 2008 Zo ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 02/14/08 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number 107107680 O Original Order/Notice 05-4570 CIVIL 0 Amended Order/Notice O Terminate Order/Notice RE: LANTZ, JESSE H. Employee/Obligor's Name (Last, First, MI) 200-36-4722 Employee/Obligor's Social Security Number KAUFFMAN BUS SERVICE INC 8972000025 1565 JERUSALEM RD Employee/Obligor's Case Identifier MECHANICSBURG PA 17055 (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MO See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ o. o0 per month in current support $ 0. oo per month in past-due support Arrears 12 weeks or greater? Oyes 0 no $ o , 00 per month in current and past-due medical support $ o . 00 per month for genetic test costs $ 0. 00 per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ o . oo per weekly pay period. $ o. oo per biweekly pay period (every two weeks). $ _ o. oo per semimonthly pay period (twice a month). $ o. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: FEB 1` 5 2008 DRO: R.J. SHADDAY Service Type M BY THE COURT: t M.L. EBERT, JR., UjDM Form EN-028 Rev. 1 OMB No.: 0970-0154 Worker I D $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hheckefd you are required to provide a copy of this form to your?mployee. If yotrr employee wo di rks in a state that is Brent rom the state that issued this order, a copy must be provi ed 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 employeetobl igor. 3.* Repoiting the Paydate/Date of Withhumcling. You must report the paydate/date of withholding w ien sending the payment. paydateldate of withholding is the date on which amount was withhe'd frorn the employee's . You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2318920100 EMPLOYEE'S/OBLIGOR'S NAME: LANTZ, JESSE H. EMPLOYEE'S CASE IDENTIFIER: 8972000025 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employeelobligor 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 (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11.Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 OMB No.: 0970-W 54 Form EN-028 Rev. 1 Worker I D $ IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: LANTZ, JESSE H. PACSES Case Number 107107680 Plaintiff Name PHYLLIS A. LANTZ Docket Attachment Amount 05-4570 CIVIL$ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type M Worker ID $zATT OMB No.: 0970-0154 . t Tl PHYLLIS A. LANTZ, Plaintiff VS. JESSE H. LANTZ, III, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 05 - 4570 CIVIL IN DIVORCE ORDER OF COURT AND NOW, this day of , 2008, counsel and the parties having entered into an agreement and stipulation resolving the economic issues on February 14, 2008, the date set for a conference with counsel and the parties, 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. BY THE COURT, GVj Edgar B. Bayley, J. cc: ? Mary A. Etter Dissinger Attorney for Plaintiff ? Barbara Sumple-Sullivan Attorney for Defendant a/! 4?oY3 eb , ?" ?' ? " L era- U- ? ::.3 0 C ? PHYLLIS A. LANTZ, Plaintiff VS. JESSE H. LANTZ, III,: Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 05 - 4570 CIVIL IN DIVORCE THE MASTER: Today is Thursday, February 14, 2008. This is the date set for a conference in the above-captioned divorce proceedings. Present in the hearing room are the Plaintiff, Phyllis A. Lantz, and her counsel Mary A. Etter Dissinger, and the Defendant, Jesse H. Lantz, III, and his counsel Barbara Sumple-Sullivan. This action was commenced by the filing of a complaint in divorce on September 6, 2005, raising grounds for divorce of irretrievable breakdown of the marriage and indignities. The Master has been provided affidavits of consent and waivers of notice of intention to request entry of divorce decree. The affidavits and waivers have been dated today and will be filed with the Prothonotary by the Master's office. The divorce can, therefore, conclude under Section 3301(c) of the Domestic Relations Code. The complaint also raised economic claims of equitable distribution, alimony, alimony pendente lite, and counsel fees and expenses. The Master has been advised that after negotiations today, the parties and counsel have reached a 1 comprehensive agreement with respect to the outstanding economic issues. Counsel are going to put the agreement 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 modifications except for correction of typographical errors which may be made during the transcription. Counsel will be asked to review the draft of the agreement for typographical errors and make any changes as necessary to correct those errors. Nevertheless, the substantive part of the agreement is binding on the parties and counsel and will not be subject to any modifications. When the parties leave the hearing room today, they are bound by the terms of agreement as stated on the record even though they have not subsequently signed the agreement affirming the terms of settlement. Counsel are going to let the Master know if they want to return today to review the draft of the agreement and affirm the terms of settlement by signature or whether they want to have the agreement sent out by mail for review and signature. The parties were married on June 17, 1995, (Paragraph 4 in the complaint incorrectly states the date of marriage as June 17, 1997. The correct date has been affirmed by counsel and the parties). The parties separated on August 26, 2005. There are no children of this marriage. 2 Upon receipt by the Master of a 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. Sumple-Sullivan. MS. SUMPLE-SULLIVAN: The parties have agreed to the following plan of distribution of their properties and liabilities. 1. The parties owned property located at 515 Poplar Church Road, Wormleysburg, Pennsylvania. That property was sold on March 10, 2006, and there were no assets to distribute to the parties. 2. The parties, at the time of separation, had a 1990 Ford truck. That truck shall become the sole property of husband and wife agrees to execute any documents necessary to transfer title to husband if that is jointly titled. There was a second and third vehicle, a 1991 Grand Am and a 1992 Ford Taurus. Both of those vehicles shall be the sole and separate property of wife. To the extent that titles need to be executed by him, husband will execute the titles transferring sole ownership to wife for those two vehicles. 3. During the marriage the parties had accounts with the Americhoice Federal Credit Union and Commerce Bank. The parties have divided those accounts and accepted the division. Those have been closed and there are no sums available for distribution. 4. During the marriage certain retirement benefits were in fact earned by wife and certain retirement vehicles were in fact raised. These include an American Fund Roth IRA, a Phoenix fund, an annuity through HighMark, and a HighMark 401(k). All of those retirement vehicles shall stay the sole and separate property of wife subject to the following division to husband. Husband shall receive the sum of $15,000.00 from a roll over from the HighMark 401(k). Husband shall receive 1/2 of the marital portion 3 of the HighMark annuity upon wife's retirement. If wife should die prior to her retirement, husband will receive 40% percent of the pre-retirement death benefit of the annuity. Husband shall be responsible for the costs incurred in drafting the QDRO or other documents necessary to effectuate the roll over and the division of the HighMark annuity. Wife shall provide the initial information as to what is required by her employer for effectuating those roll overs. MS. DISSINGER: The 401(k) is no longer with HighMark. It is now with Wachovia. To the extent, that there is going to be a roll over for the 401(k), it will be from the successor company Wachovia. MS. SUMPLE-SULLIVAN: 5. The parties have various life insurance policies through Baltimore Life. Wife shall be the sole owner of the Baltimore Life annuity policies which are currently in existence. Husband's life insurance policy had been cashed post-separation. The sums that he realized from the cashing of that policy shall be his sole and separate property and wife waives any claims to those sums. 6. During the marriage and post-separation various debts were incurred by the parties for taxes, utilities, and for their individual bankruptcy. Each party waives claims against the other for credits for any of those debts that they paid during that time period. However, there is an outstanding joint debt which is due to attorney Craig Diehl in the amount of $5,938.92. Husband shall be solely responsible for that debt to attorney Diehl and shall indemnify and hold wife harmless from that obligation. MS. DISSINGER: Upon his failure to do so, if wife incurs any legal fees in regard to that debt, he will reimburse her in full all her counsel fees. 7. The personal property has been mutually agreed upon and divided between the parties so that all property in the 4 I possession of each party shall be their sole and separate property. 8. Wife has been assigned and given ownership the cemetery plots and husband waives any and all claims to those plots. MS. DISSINGER: If the parties own those plots jointly, husband will cooperate in executing whatever documents are necessary to transfer ownership solely to wife. With regard to the taxes, during the marriage the parties received an invoice from the IRS for the 2004 taxes because they were not properly filed. Husband has assumed and paid that debt and seeks no further contribution from wife. MS. SUMPLE-SULLIVAN: 9. Effective today, February 14, 2008, the support order that is entered on behalf of wife through the Cumberland County Domestic Relations Office shall terminate. Both parties waive any claim against the other for any future support in the form of alimony pendente lite or alimony. 10. Each party waives any claims against the other for counsel fees, expenses and costs. 11. 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 may now have or hereafter acquire 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 administrator or executor in 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 5 advisable to carry into effect this mutual waiver and relinquishment of all such interest, rights, and claims. MS. DISSINGER: Phyllis, you've heard the agreement that attorney Sumple-Sullivan put on the record and you have heard me butt in a couple of times and add some things that she has accepted, do the statements that we've made today represent what you are willing to and do agree to today that resolve all of your domestic issues with Mr. Lantz? MS. LANTZ: Yes. THE MASTER: Do you understand the terms of the agreement? MS. LANTZ: Yes. THE MASTER: Do you have any questions about it? MS. LANTZ: No questions. MS. SUMPLE-SULLIVAN: Jesse, you've been in the hearing room as I dictated the agreement that was reached between counsel and ourselves, do you understand the terms of the agreement? MR. LANTZ: Yes. MS. SUMPLE-SULLIVAN: Are you voluntarily accepting the terms of the agreement? MR. LANTZ: Yes. MS. SUMPLE-SULLIVAN: And you understand that 6 f that will conclude all of your rights and claims against Phyllis as part of this divorce proceeding? MR. LANTZ: 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. WITNESS: Mary A. Etter Dissi'r r Aza: iff a rbara Sumple-Sullivan Attorney for Defendant DATE: (0 , 6Q 4a- PhyIlis A. Lar}tz 9- (q- 6 J-- sse H. Lantz, II 7 PHYLLIS A. LANTZ, Plaintiff VS. JESSE H. LANTZ, III, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION NO. 05-4570 IN DIVORCE PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Transmit the record, together with the following information, to the Court for entry of a divorce decree: 1. Grounds for divorce: Irretrievable breakdown under § 3301(c) of the Divorce Code. 2. Date and manner of service of the Complaint: September 15, 2005, by Sheriff Service, Deputy Sheriff, Gerald Worthington. 3. Date of execution of the Affidavit of Consent required by § 3301(c) of the Divorce Code: By Plaintiff February 14, 2008; by Defendant February 14, 2008. I 4. Related claims pending: NONE. 5. Date Plaintiff's Waiver of Notice in § 3301(c) Divorce filed with the Prothonotary: February 14, 2008 Date Defendant's Waiver of Notice in § 3301(c) Divorce filed with the Prothonotary: February 14, 2008 Respectfully submitted, DISSINGER AND DISSINGER Date: J1 /Gk Mary A. Etter Dissinger Attorney for Plaintiff Supreme Court ID # 27736 28 N. 32nd Street Camp Hill, PA 17011 717-975-2840 cc: Barbara Sumple-Sullivan, Esquire ... * ? ? a -?•s _? _ ....? .., ,?.,.? t?; -.. ? _..,,, __ c..a ., IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNA. PHYLL I S A. LANTZ PLAINTIFF VERSUS JESSE H. LANTZ, III DEFENDANT No. 05-4570 DECREE IN DIVORCE AND NOW, M 4,.ft,YN ?i , , IT IS ORDERED AND PHYLLIS A. LANTZ DECREED THAT , PLAINTIFF, JESSE H. LANTZ, III AND DEFENDANT, ARE DIVORCED FROM THE BONDS OF MATRIMONY. THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT YET BEEN ENTERED; The Marriage Separation Agreement of the parties dated February 14, 2008, is hereby incorporated but not merged. BY THE COURT: ?k " 9, ?-' - , \ % ATTEST: J. ROTHONOTARY Js n,r, 14 Phyllis A. Lantz Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUN'T'Y, PENNSYLVANIA VS. CIVIL ACTION - LAW - IN DIVORCE Jesse H. Lantz, III NO. 05-4570 Defendant DOMESTIC RELATIONS ORDER This Domestic Relations Order ("Order") is intended to meet the requirements of a qualified domestic relations order ("QDRO"), as that term is defined in Section 206(d)(3) of the Employee Retirement Income Security Act of 1974 ("ERISA") and Section 414(p) of the Internal Revenue Code of 1986 ("Code"), and shall be modified as necessary to continue to meet the requirements of ERISA and the Code. The result of such qualification is that this Order will then become a QDRO. This Order is granted in accordance with 23 Pa. C.S.A. §3502, which relates to marital property rights, child support, and/or spousal support between spouses and former spouses in matrimonial actions. THE COURT FINDS AND IT IS HEREBY ORDERED AS FOLLOWS: Section 1. Identification of Plan. This Order applies to benefits under the Highmark Retirement Plan (the "Plan"). It shall also apply to and bind any successor plan to the Plan. The name and address of the Plan Administrator is: Personnel and Compensation Committee, Highmark Inc., 1800 Center Street, Camp Hill, PA 17089-0089. Section 2. Identification of Participant and Alternate Payee. (a) Phyllis A. Lantz is hereafter referred to as the "Participant." The Participant's current and last known address is 80 Front Street, West Fairview, PA 17025. This address may be changed, from time to time, by written notice to the Plan Administrator. It is the responsibility of the party whose address has changed to provide such notice. The Participant's Social Security Number is 192-50-4980. The Participant is not currently receiving benefits under this Plan. (b) Jesse H. Lantz, III is hereafter referred to as the "Alternate Payee." The Alternate Payee's current and last known address is 612 Range End Road, Lot 92, Dillsburg, PA 17019. This address may be changed, from time to time, by written notice to the Plan Administrator. It is the responsibility of the party whose address has changed to provide such notice. The Alternate Payee's Social Security Number is 200-36-4722. The Alternate Payee is the Former Spouse of the Participant. (c) On February 14, 2008, the parties entered into a Marital Settlement Agreement, which Agreement relates to the provision of marital property rights to the Alternate Payee, as the Former Spouse of the Participant. (d) The Participant and the Alternate Payee were married on June 17, 1995, and said marriage is registered in Cumberland County, Pennsylvania. (e) Both the Participant and the Alternate Payee shall have the duty to notify the Personnel and Compensation Committee in writing of any changes in his or her respective mailing addresses subsequent to the entry of this Order. Section 3. Starting Date for Benefit Payments. Distribution of the benefit assigned to the Alternate Payee shall be made or commence upon the Alternate Payee's request as soon as permitted by the Plan on or after the Participant's attainment of his or her "earliest retirement age," as defined in Code Section 414(p)(4)(B). However, if the "Actuarial Equivalent" (as that term is defined in Section 1.02 of the Plan) present value of the Alternate Payee's benefit is $5,000 or less, and payment of such benefit has not commenced, the form of distribution of the benefit shall be in a single cash lump sum payment. Section 4. Form of Benefit. The Alternate Payee shall have the right to elect to receive a distribution of the assigned benefits in any form permitted under the Plan with respect to the Participant (other than in the form of either: (1) a joint and survivor annuity payable for the benefit of the Alternate Payee and the Alternate Payee's contingent beneficiary under Section 8.05(a)(1) of the Plan, or (2) an increased benefit paid prior to the commencement of the Participant's eligibility for primary Social Security benefits and a reduced benefit thereafter under Section 8.05(a)(4) of the Plan), unless the Actuarial Equivalent present value of the Alternative Payee's benefit is $5,000 or less and payment of such benefits has not commenced, in which event the form of distribution shall be a single cash lump sum payment. The payments expected to be made to the Alternate Payee over the life expectancy of the Alternate Payee shall be the Actuarial Equivalent of the benefit amount set forth in Section 5 below. Section 5. Amount of Benefit to be Paid to Alternate Payee. Starting at the time specified in Section 3, under the terms of this Order, the Alternate Payee is to receive retirement benefits from the Plan from and out of the benefits otherwise payable to the Participant: a) In the amount of 50% of the marital portion of the vested accrued benefit of the Participant determined as the earlier of her date of cessation of benefit accruals or the date that the Alternate Payee commences his benefits hereunder. The marital portion of the Participant's accrued benefit shall be determined by multiplying the Participant's accrued benefit by a fraction (less than or equal to 1.0), the numerator of which is the number of months of the Participant's participation in the Plan from June 17, 1995, the date of marriage, to August 26, 2005, the date of separation, and the denominator of which is the total number of months of the Participant's participation in the plan as of the earlier of her date of cessation of benefit accruals or the date 2 that the Alternate Payee commences his benefits hereunder, and the Participant's benefit is reduced accordingly. b) If the Alternate Payee elects to commence receiving benefits prior to the Participant's normal retirement age, the Alternate Payee's separate benefit will be reduced for such early commencement using Plan factors in effect at such commencement. Once determined, the Alternate Payee's portion of the Plan benefit shall be actuarially adjusted using Plan factors in effect at the time benefit payments commence to the Alternate Payee. Such actuarial adjustment will take into account the age difference between the Participant and the Alternate Payee. The Alternate Payee's benefits are to be actuarially adjusted to the Alternate Payee's own life expectancy. In addition to the above, the Alternate Payee shall receive a pro rata share of any post-retirement cost-of-living adjustments or other economic improvements made to the Participant's benefits on or after the date of the Participant's retirement or the date on which benefit accruals cease. Such pro rata share shall be calculated in the same manner as the Alternate Payee's share of the Participant's retirement benefits is calculated pursuant to this Section 5. Further, The Alternate Payee shall be entitled to a pro rata share of any employer-provided early retirement subsidy provided to the Participant on the date of retirement, and in the event the Alternate Payee has already commenced benefits on the date of the Participant's retirement, then the amounts payable to the Alternate Payee shall be increased in accordance with the Plan Administrator's practices and the Plan's actuarial principles in order to provide the Alternate Payee with a pro rata share of such early retirement subsidy. Such pro rata share shall be calculated in the same manner as the Alternate Payee's share of the Participant's retirement benefit is calculated pursuant to Section 5 of this Order. In the event the Alternate Payee commences benefit payments prior to the Participant, the Alternate Payee shall not be entitled to receive any early retirement subsidy. Section 6. Death Benefits. If the Alternate Payee dies before his "Annuity Starting Date" (as that term is defined in Section 1.04 of the Plan), the Alternate Payee's interest assigned hereunder shall be restored to the Participant's benefit, but no retroactive payment shall be made to or on behalf of the Participant as a result of the Alternate Payee's death after the Participant's Annuity Starting Date. Except as stated above, the benefit assigned hereunder to the Alternate Payee shall not be reduced, abated or terminated as a result of the death of the Participant. The Alternate Payee will not be entitled to any survivor benefits with respect to the portion of the Participant's accrued benefit under the Plan not otherwise assigned to the Alternate Payee under this Order. Section 7. Compliance with Applicable Laws. Nothing in this Order shall require the Plan to: (1) pay any benefits not permitted under ERISA or the Code; 3 Section 8. (2) provide any type or form of benefit, or option, not otherwise provided in the Plan; (3) provide increased benefits (determined on the basis of actuarial value); or (4) pay benefits of the Participant to the Alternate Payee that are required to be paid to another alternate payee under another order previously determined to be a QDRO. Reservation of Jurisdiction. The Court retains jurisdiction to establish or maintain this Order as a QDRO; provided, however, no amendment of this Order shall contain a requirement with respect to the Plan of a type described in Section 7 above. DATED this III day of 20A. JUDGE CONSENT TO ORDER: f x 1?d Plainti articipant Date De ndant/AJ?ernate Payee Date r ??yl d Attorney for Plaintiff/ Date Attorney for Defendant/ Date Participant Alternate Payee 4 c? ?? .rs ?? a °"a rn , ?? . • - ? "? u ? .-- .i u ?? LAW OFFICES BARBARA SUMPLE-SULLIVAN 549 BRIDGE STREET NEW CUMBERLAND, PENNSYLVANIA 17070-1951 PHONE (717) 774-1445 FAX (717) 774-7059 June 20, 2008 Mr. Curtis R. Long Prothonotary Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Phyllis A. Lantz v. Jesse H. Lantz, III No. 2005 - 04570 / Cumberland County Dear Mr. Long: Enclosed herewith please find an original and two (2) copies of a Domestic Relations Order to be entered as a court order regarding Plaintiff's Highmark Retirement Plan in the above captioned matter. The Honorable M. L. Ebert, Jr. signed the parties' Divorce Decree. Please forward for entry as an order and return certified copies of the Qualified Domestic Relations Orders to my office in the enclosed self-addressed stamped envelope. Should you require any additional information, please do not hesitate to contact the undersigned. BSS/lh Enclosures cc: Mary A. Etter Dissinger, Esquire Mr. Jesse H. Lantz, III Barbara Sumple-Sullivan