Loading...
HomeMy WebLinkAbout05-5734 MARIA P. COGNETTI & ASSOCIATES KRISTOPHER T. SMULL, ESQUIRE Attorney J.D. No. 69140 210 Grandview Avenue, Suite 102 Camp Hill, PA 17011 Telephone No. (717) 909-4060 Attorneys for Plaintiff JOHN E. Y ANKOWSKl, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLV ANlA v. : NO. OS - S'72/1 CNIL ACTION - LAW IN DNORCE Cu;L~0( SUZIE M. GORSE- Y ANKOWSKl, Defendant NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in Court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a Decree of Divorce or annulment may be entered against you by the Court. A 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. 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 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DNISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DNORCE 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, P A 17013 (717) 249-3166 MARIA P. COGNETTI & ASSOCIATES KRlSTOPHER T. SMULL, ESQUIRE Attorney I.D. No. 69140 210 Grandview Avenue, Suite 102 Camp Hill,PA 17011 Telephone No. (717) 909-4060 Attorneys for Plaintiff JOHN E. YANKOWSKI, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 05 - ~7JY CIVIL ACTION - LAW IN DNORCE CiuL~~ SUZIE M. GORSE- YANKOWSKI, Defendant COMPLAINT UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. Plaintiff is John E. Yankowski, who has resided at 4 Memory Lane, Enola, Cumberland County, Pennsylvania, February 2005. 2. Defendant is Suzie M. Gorse-Yankowski, who has resided at 4 Memory Lane, Enola, Cumberland County, Pennsylvania, February 2005. 3. Plaintiff and Defendant have been bona fide residents in the Commonwealth for at least six (6) months immediately previous to the filing ofthis Complaint. 4. The Plaintiff and Defendant were married on May 23,2003 in Junction City, Kansas. 5. There have been no prior actions of divorce or for annulment between the parties. 6. Plaintiff is presently a member ofthe Army National Guard of Michigan. Defendant is not a member ofthe anned forces of the United States. 7. The Plaintiff and Defendant are both citizens of the United States. 8. Plaintiff has been advised of the availability of marriage counseling and that he may have the right to request the Court to require the parties to participate in such counseling. Being so advised, Plaintiff does not request that the Court require the parties to participate in counseling prior to a divorce decree being handed down by the Court. 9. Plaintiff avers that there are no children of the parties under the age of eighteen (18). COUNT I - DIVORCE 10. The Plaintiff avers that the marriage of the parties is irretrievably broken. WHEREFORE, Plaintiff requests the Court enter a decree in divorce. COUNT II - EOUlTABLE DISTRIBUTION 11. During the marriage, Plaintiff and Defendant have acquired various items of marital property, both real and personal, which are subject to equitable distribution under Chapter 35 of the Divorce Code. WHEREFORE, Plaintiff respectfully requests that this Honorable Court equitably distribute all property, both real and personal, owned by the parties. Date: October 31, 2005 Respectfully Submitted: MAmA P. COGNETTI & ASSOCIATES \ I . [Iv ! /, By: 210 Grandview Avenue, Suite 102 Camp Hill, PA 17011 Telephone No. (717) 909-4060 Attorney for Plaintiff VERIFICATION I, John E. Yankowski, hereby verify and state that the facts set forth in the foregoing document are true and correct to the best of my information, knowledge and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. 94904 relating to unsworn verification to authorities. Date: ;:; I u~T ciS; L--' L ~. E. YANKO~ ""- .....:t C>- ut ..c:: ----.c: - (::) ~~ t.v v-.. () t -bG. *l Qj ....... ....... R.;--o C). \) D . V( ~ g (> t.'L~.; t~~ [ :-tJ '- p:~ ~P-- -f---. _ '-i.... r--- -;>: ;:"'; ~~_." ~;~; :."3 .-<. ~ CJ ,-; -- ...., C:') = on ~ ~- o -< f W ~8 ~..,., ~~ :(~ ~t'. CJo ::J'T, L. ~r' ::~(') ~~rn =-t );,> :~ -0 ::.it: ~ (.[1 JOHN E. Y ANKOWSKl, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL VANIA v. : NO. 05-5734 - CIVIL TERM SUZIE M. GORSE- YANKOWSKI, Defendant : CIVIL ACTION - LAW : IN DIVORCE MOTION FOR ALIMONY PENDENTE LITE HEARING On behalf of Defendant, SUZIE M. GORSE-YANKOWSKI, please schedule an Alimony Pendente Lite hearing in connection with Defendant's Petition for Related Claims filed in the Prothonotary's Office of Cumberland County on November 17,2005. Respectfully submitted: r44 is. Robert B. Lieberman, Esquire 500 North Third Street, 12th Floor P.O. Box 1004 Harrisburg, P A 171 08-1 004 (717) 236-1485 Attorney for Defendant ,-) ::.'....1 ::;~ -." '-'" ~. ~ , ~, ~\ ',e) .-- --r- " ~, .~/ -/'.-> ''---/ . JOHN E. YANKOWSKI, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 05-5734 - CIVIL TERM SUZIE M. GORSE- YANKOWSKI, Defendant CIVIL ACTION - LAW IN DIVORCE PETITION FOR RELATED CLAIMS UNDER DIVORCE CODE The petition of SUZIE M. GORSE-YANKOWSKI, by and through her attorney, ROBERT B. LIEBERMAN, ESQUIRE, respectfully represents that: I. Petitioner is the Defendant in the above-captioned divorce matter. 2. Plaintiff and Defendant have acquired property, during their marriage until the date of their separation, which property is marital. 3. Defendant requests this Court to preserve her right to have all marital property of the parties equitably distributed. 4. Defendant lacks sufficient property to provide for her reasonable needs and is unable to adequately support herself through appropriate employment. 5. Defendant requires reasonable support to adequately maintain herself. 6. Defendant requests this Court to preserve her right to seek an award of alimony pendente lite, alimony following the entry of a Decree in Divorce and additional financial assistance as deemed appropriate. 7. Defendant has employed Robert B. Lieberman, Esquire as counsel but is unable to pay the necessary and reasonable attorney's fees for said counsel and any related costs and expenses. 8. Defendant requests the Court to allow her equitable distribution of marital property, alimony penende lite, reasonable counsel fees, costs and expenses, pursuant to the Divorce Code and Rules of Civil Procedure and at final hearing to further award alimony and such additional sums to pay existing obligations as are deemed appropriate. WHEREFORE, Petitioner prays that your Honorable Court to preserve her claims for equitable distribution of marital property, alimony pendente lite, alimony, counsel fees, costs and expenses. Respectfully submitted, DATED: [I' \1.. ~t ~8. Robert B. Lieberman, Esquire 500 N. Third Street, 12th Floor Harrisburg, PA 17101 (717) 236-1485 Attorney for Defendant/Petitioner VERIFICATION I verify that the statements made in the foregoing Petition for Related Claims are true and correct based upon my personal knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 94904, relating to unsworn falsification to authorities. DATED: 1/ f 11. .. ~ M. Gorse- Yankowski, dant JOHN E. YANKOWSKI, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 05-5734 - CIVIL TERM SUZIE M. GORSE- YANKOWSKI, Defendant CIVIL ACTION - LAW IN DIVORCE CERTIFICATE OF SERVICE On this I 7 day of ~ ~005, I certify that a copy of the foregoing Petition for Related Claims was served upon the attorney for the Plaintiff by depositing same in the United States Mail, postage pre-paid, addressed as follows: Kristopher T. Smull, Esquire MARIA P. COGNETTI & ASSOCIATES 210 Grandview Avenue, Suite 102 Camp Hill, PA 17011 1.0 ........l ~'h~ /~JJ. - ~ Robert B. Lieberman, Esquire 500 N. Third St., 12th Floor Harrisburg, PA 17101 (717) 236-1485 Attorney for Defendant/Petitioner - .--y...,..~..7 -* --- .~\ -- ~ ~ ("":'.~ 'P-- ,~ '-'- -----:1 '0 -c <f< r- ~ ~. .~ -? -~ --., ....;:s_ ) .~- .~ \.. " c, ~ - ""'" " " ";:': ~ 3\ I'> i-,~, ':). ~ "- ~ :----- '~ Q ~ c~, , --~"' , "',' , , I.',"T' '- :::i ~,:., ,-;? - _' JOHN E. YANKOWSKI, Plaintiff/Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE SUZIE M. GORSE-YANKOWSKI, Defendant/Petitioner NO. 05-5734 CIVIL TERM IN DIVORCE PACSES # 905107830 ORDER OF COURT AND NOW, this 17th day of November, 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.i. Shaddav on December 7.2005 at 9:00 A.M. for a conference, at 13 N. Hanover St.. Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (I) 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<9 (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. Mail copies on November 17,2005 BY THE COURT. George E. Hoffer, President Judge ~-4~ hadday, Conference oftfc;;;;:-- (1 'J 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. to: Petitioner Respondent Robert B. Lieberman, Esquire Kristopher Smull. Esquire ~ R. J Date of Order: November 17. 2005 CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 r' C' ....t ...,~= c:. _.-C ~ r-,) C') \..f) ~ ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of pennsylvania Ca./City/Dist. af CUMBERLAND Date af Order/Natice 01/10/06 Case Number (See Addendum for case summary) 905107830 05-5734 CIVIL @Original Order/Notice o Amended Order/Notice o Terminate Order/Notice FCI USA INC 825 OLD TRAIL RD ETTERS PA 17319-9392 RE, YANKOWSKI, JOHN E. Employee/Obligor's Name (Last First, Mil 286-60-0991 Employee/Obligor's Social Security Number 4847101583 Employee/Obligor's Case Identifier (Spp Addendum for plailftiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) Employeri\Nithholder's Federal EIN Number See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TION: This is an Order/Natice to' Withhald Income far Suppart based upan an arder far suppart fram CUMBERLAND Caunty, Cammanwealth af Pennsylvania. By law, yau are required to' deduct these amaunts fram the abave-named emplayee's/abligar's incame until further natice even if the Order/Natice is nat issued by yaur State. $ 500.00 per manth in current suppart $ 0.00 per manth in past-due suppart Arrears 12 weeks ar greater? Oyes @ nO' $ 0.00 per month in current and past-due medical suppart $ 0.00 per month far genetic test casts $ per month in ather (specify) far a total of $ 500.00 per month to be forwarded to payee below. Yau dO' nat have to' vary yaur pay cycle to' be in compliance with the suppart order. If your pay cycle daes nat match the ardered support payment cycle, use the fallawing to determine haw much to withhold: $ 115.38 per weekly pay period. $ 230.77 per biweekly pay period (every two weeks). $ 250.00 per semimonthly pay peri ad (twice a month). $ 500.00 per manthly pay periad. REMITTANCE INFORMATION: You must begin withholding nO' later than the first pay periad occurring ten (10) warking days after the date af this Order/Natice. Send payment within seven (7) warking days af the paydateldate af withholding. Yau are entitled to' deduct a fee to' defray the cast af withhalding. Refer to' the laws gaverning the wark state af yaur employee for the allowable amaunt. The tatal withheld amount, and your fee, cannot exceed 55% of the employee'sl 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 instructians. Make Remittance Payable to: PA SCOU Send check to: Pennsylvania SCOU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Juige Form EN-a28 Worker ID $IATT Date of Order: JAN 1 1. ?:~:;~. ,;....I"'Q Edward DRO: R.J. Shadday Service Type M OMB No:.1J97M1 S4 ADDITIONAL INFORMATION TO EMPLOYERS AND OTl-IER WITHHOLDERS o If ~hecked you are required to provide a copy of this form to your employee. If your employee works in a state that is different from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each em ployee/ob I igor. 3. *'RefJUll;l.g tk. r aydatelDate'vf '~V;ll,lloIJ;1I5' YOu Illu:)llepVll tll€'payJato;:/Jate v( vvitl,nnfdmg-wl,€,I ;,clll.J;r rg [I,,::: f-Iaym-ent:-Th-e- tJaydatdJate 01 ~"lll,l,old;1I0;;' tIle ddk VII "wh+ch--a, 1I0lJI II vva5-vv;ll,l,cIJ LV'lIlllc t::'lltJlvyee'-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: 0606699290 EMPLOYEE'SIOBlIGOR'S NAME: YANKOWSKI, JOHN E. EMPLOYEE'S CASE IDENTIFIER: 4847101583 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 ~;upport 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. 91673 (b)l; 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 (ADWEI. 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 ill 7) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form E N-028 Worker ID $IATT Service Type M OMS No.: 0970-0154 ..... ADDENDUM Summary of Cases on Attachment Defendant/Obligor: YANKOWSKI, JOHN E. PACSES Case Number 905107830 Plaintiff Name SUZANNE M. GORSE-YANKOWSKI Docket Attachment Amount 05-5734 CIVIL$ 500.00 Child(ren)'s Name(s): PACSES Case Number Plaintiff Name DOS Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOS o 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. o 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 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOS Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOS o 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) in any health insurance coverage available employee's/obligor's employment. PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOS Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOS o 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. o 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 Worker ID $IATT SelVice Type M OMBNo.:097()"{)154 ,'--'"j :;",-, <..~<, '.~> /' /' ,,-", , .) ". , ",... -..------ MARIA P. COGNETTI & ASSOCIATES KRISTOPHER T. SMULL, ESQUIRE Attorney I.D. No. 69140 210 Grandview Avenue, Suite 102 Camp Hill, PA 17011 Telephone No. (717) 909-4060 Attorneys for Plaintiff/Petitioner JOHN E. YANKOWSKI, Plaintiff/Petitioner IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 05-5734 SUZIE M. GORSE-YANKOWSKI, Defendant/Respondent CIVIL ACTION - LAW IN DIVORCE PETITION FOR ENFORCEMENT OF PROPERTY SETTLEMENT AGREEMENT AND NOW, comes the Plaintiff, John E. Yankowski, by and through his attorney, Kristopher T. Smull, Esquire, with this Petition for Enforcement of a Property Settlement Agreement and in support thereof respectfully represents as follows: 1. Petitioner is John E. Yankowski (hereinafter "Husband"). 2. Respondent is Suzie M. Gorse-Yankowski (hereinafter "Wife"). 3. The parties hereto were married on May 23,2003 in Junction City, Kansas. 4. Husband filed a Complaint in Divorce to the above term and number on November 3,2005. 5. On December 14, 2006, the parties executed a comprehensive Property Settlement Agreement resolving all issues relative to the dissolution of their marital status. A true and correct copy of said Agreement is attached hereto, made a part hereof and marked Exhibit "A." 6. Paragraph 4 of said Agreement states that: "Both parties hereby express their agreement that the marriage is irretrievably broken and express their intent to execute any and all Affidavits or other documents necessary for the parties to obtain an absolute divorce pursuant to Section 3301(c) of the Divorce Code within seven (7) days following the expiration of the ninety (90) day statutory waiting period. The parties hereby waive all rights to request court ordered counseling under the Divorce Code. It is further specifically understood and agreed by the parties that the provisions of this Agreement as to equitable distribution of property of the parties are accepted by each party as a final settlement for all purposes whatsoever, as contemplated by the Pennsylvania Divorce Code. 7. The ninety (90) day statutory waiting period expired on or about February 10, 2006; however, Wife has refused to execute her Affidavit of Consent and Waiver of Notice to allow Husband to proceed with obtaining a Decree in Divorce. 8. Wife placed numerous demands on Husband as a prerequisite to her signing said affidavit and waiver. Said demands were not required by the parties' agreement; however, in an effort to compromise and move the matter to a conclusion Husband complied with Wife's demands. 9. Despite complying with Wife's demands, Wife has, to date, not signed the affidavit or waiver and has made further demands of Husband. 10. In addition, Wife has refused to sign the parties' joint Federal Income Tax Return for tax year 2005 unless Husband pays her share of the anticipated return to her prior to the refund being received. Pursuant to paragraph 22 of the parties' agreement the parties were to file jointly and divide any refund equally. Wife's refusal to sign said return may result in unnecessary fees and penalties being assessed and may result in a significantly lower refund. VERIFICATION I, John E. Yankowski, hereby verify and state that the facts set forth in the foregoing document are true and correct to the best of my information, knowledge and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. 94904 relating to unsworn verification to authorities. Date: .3/3/ loro PROPERTY SETTLEMENT AGREEMENT . A TIllS AGREEMENT, made this 11- tay Of~5, by and between Jolm E. Yankowski, of 4 Memory Lane, Enola, Cumberland County, Pennsylvania (hereinafter referred to as "HUSBAND") and Suzanne M. Yankowski, of 4 Memory Lane, Enola, Cumberland County, Pennsylvania (hereinafterreferred to as "WIFE"): WITNESSETH: WHEREAS, the parties were married on May 23,2003, in Junction City, Kansas; and WlfEREAS, no children have been born of this marriage; and WlIEREAS, diverse, unhappy differences, disputes and difficulties have arisen between the parties and it is the intention of HUSBAND and WIFE to Iive.separate and apart, and the parties hereto are desirous of settling fully and finally their respective financial and property rights and obligations as between each other, including, without limitation by specification: the settling of all matters between them relating to the ownership and equitable distribution of real and personal property; settling of all matters between them relating to the past, present and future support, alimony and/or maintenance of WIFE by HUSBAND or of HUSBAND by WIFE; the settling of any and all claims and possible claims by one against the other or against their respective estates. '. A ..........................-"'.---..---.::-.'......<...............-.., NOW, THEREFORE, in consideratiqn of the premises and of the mutual promises, covenal1ts and undertakiugs hereinafter set forth and for other good and valuable consideration, receipt of which is hereby acknowledged by each of the parties hereto, HUSBAND and WIFE, each intending to be legally bound hereby covenant and agree as follows: 1. SEPARATION: HUSBAND and WIFE shall at all times hereafter have the right to live separate and apart from each other and to reside from time to time at such place or places as they shall respectively deem fit, free from any control, restraint or interference whatsoever by the other. Neither party shall lIlolest the other or endeavor to compel the other to cohabit or dwell with him or her by any legal or other proceedings. The foregoing provisions shall not be taken to be an admission on the part of either HUSBAND or WIFE of the lawfulness or unlawfulness ofthe causes leading to their living apart. 2. INTERFERENCE: Each party shall be free from interference, authority, and contact by the other, as fully as ifhe or she were single and unmarried, except as may be necessary to carry out the provisions of this Agreement. Neither party shall molest the other or attempt to endeavor to molest the other, nor cOlIlpel the other to cohabit with the other, nor in any way harass or malign the other, nor in any way interfere with the peaceful existence, separate and apart from the other. -2- 3. AGREEMENT NOT A BAR TO DIVORCE PROCEEDINGS: This Agreement shall not be considered to affect or bar the right of HUSBAND or WIFE to a divorce on lawful grounds as such grCllUlds now exist or shall hereafter exist or to such defense as may be available to either party. This Agreement is not intended to condone and shall not be deemed to be a condonation on the part of either party hereto of any act or acts on the part of the other party which have occasioned the disputes or unhappy differences which have occurred prior to or which may occur subsequent to the date hereof. 4. SUBSEOUENT DIVORCE: The pilJties hereby acknowledge that HUSBAND has filed a Complaint in Divorce in Crnnberland County to Docket No. 05-5734, claiming that the marriage is irretrievably broken under Section 3301(c) of the Pennsylvania Divorce Code. Both parties hereby express their agreement that the marriage is irretrievably broken and express their intent to execute aIiyand all Affidavits or other documents necessary for the parties to obtain an absolute divorce pursUaIit to Section 3301(c) of the Divorce Code within seven (7) days following the expiration of the- ninety (90) day statutory waiting period. The parties hereby waive all rights to request court ordered counseling under the Divorce Code. It is further specifically understood and agreed by the parties that the provisions of this Agreement as to equitable distribution of property of the parties are accepted by each party as a final settlement for all purposes whatsoever, as contemplated by the Pennsylvania Divorce Code. Should a decree, judgment or order of divorce be obtained by either of the parties in this or any other state, country or jurisdiction, each ofthe parties hereby consents and agrees that this -3- Agreement and all Df its covenants shall not be affected in any way by such separatiDn or divDrce; and that nothing in any such decree, judgment, order or further mDdification or revision thereof shall alter, amend or vary any term of this Agreement, whether or not either or bDth of the parties shall remarry. It is the specific intent of the parties to permit this Agreement to survive any judgment and to be forever binding and cDnclusive upon the parties. 5. INCORPORATION IN DIVORCE DECREE: It is further agreed, covenanted and stipulated that this Agreement, or the essential parts hereof, shall be incorporated in any decree hereinafter entered by any court of competent jurisdiction in any divorce proceedings that have been or may be instituted by the parties for the purpose of enforcing the contractual obligations of the parties. This Agreement shall not be merged in any such decree but shall in all respects survive the same and be forever binding and conclusive upon the parties. 6. EFFECTIVE DATE: The effective date of this Agreement shall be the "date of execution" or "execution date," defined as the date upon which it is executed by the parties ifthey have each executed this Agreement at the same date. Otherwise, the "date of execution" Dr "execution date" Dfthis Agreement shall be defined as the date of execution by the party last executing this Agreement. 7. DISTRIBUTION DATE: The transfer of property, funds and/or documents provided for herein, shall only take place on the "distribution date," which shall be defined as the -4- date of execution of this Agreement unless otherwise specified herein. However, the support and/or alimony payments, if any, provided for in this Agreement shall take effect as set forth in this Agreement. 8. MUTUAL RELEASE: HUSBAND and WIFE each do hereby mutually remise, release, quit-claim and forever discharge the other and the estate of such other, for all time to come, and for all prnposes whatsoever, of and from any and all rights, title and interest, or claims in or against the property (including income and gain from property hereafter accruing) of the other or against the estate of such other, of whatever natureandwheresoever situated, which he or she now has or at any time hereafter may have against the other, the estate of such other or any part thereof, whether arising out of any former acts, contracts, engagements or liabilities of such other or by way of dower or curtesy, or claims in the nature of dower or curtesy or widow's or widower's rights, family exemption or similar allowance, or under the intestate laws, or the right to take against the spouse's will, or the right to treat a lifetime conveyance by the other as a testamentary gift, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any State, Commonwealth or territory of the United States, or (c) any couiJ.try or any rights which either party may have or at any time hereafter shall have for past, present or future support or maintenance, alimony, alimony pendente lite, counsel fees, division of property, costs or expenses, whether arising as a result of the marital relationship or otherwise, except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any -5- provisions thereof It is the intention of HUSBAND and WlFE to give each other by the execution of this Agreement a full, complete and general release with respect to any and all property of any kind or nature, real, personal or mixed, which the other now owns or may hereafter acquire, except and only except all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. It is further agreed that this Agreement shall be and constitute a full and final resolution of any and all claims which each of the parties may have against the other for equitable division of property, alimony, counsel fees and expenses, alimony pendente lite or any other claims pursuant to the Pennsylvania Divorce Code or the divorce laws of any other jurisdiction. 9. ADVICE OF COUNSEL: The provisions ofthis Agreement and its legal effect have been fully explained to the parties by their respective counsel; Kristopher T. Smull, Esquire, for HUSBAND and Robert B. Lieberman, Esqnire, for WlFE. HUSBAND and WlFE aclmowledge that this Agreement is not the result of any duress or undue influence and that it is not the result of aIlY collusion or improper or illegal agreement or agreements. The parties further acknowledge that they have each made to the other a full accounting oftheir respective assets, estate, liabilities, and sources of income and that they waive any specific enumeration thereof for the purpose of this Agreement. Each party agrees that he or she shall not, at any future time, raise as a defense, or otherwise, the lack of such disclosure in any legal proceeding involving this Agreement, with the exception of disclosure that may have been fraudulently withheld. -6- 1 O. WARRANTY AS TO EXISTING OBLIGATIONS: Each party represents that they have not heretofore incurred or contracted for any debt or liability or obligation for which the estate of the other party may be responsible or liable except as maybe provided for in this Agreement. Each party agrees to indemnifY and hold the other party harmless for and against any and all such debts, liabilities or obligations of every kind which may have heretofore been incurred by them, including those for necessities, except for the obligations arising out of this Agreement. 11. WARRANTY AS TO FUTURE OBLIGATIONS: HUSBAND and WIFE covenant, warrant, represent and agree that with the exception of obligations set forth in this Agreement, neither of them shall hereafter incur any liability whatsoever for which the estate of the other may be liable. Each party shall indemnifY and hold hannless the other party for and against any and all debts, charges and liabilities incurred by the other after the execution date of this Agreement, except as may be otherwise specifically provided for by the terms of this Agreement. 12. PERSONAL PROPERTY: The parties have divided between them, to their mutual satisfaction, the personal effects, household furniture and furnishings, and all other articles of personal property which have heretofore been used by them in common, and neither party will make any claim to any such items which are now in the possession or under the control of the other. Should it become necessary, the parties each agree to sign any titles or documents necessary to give effect to this paragraph upon request. -7- By these presents, each of the parties hereby specifically waives, releases, renounces and forever abandons whatever claims he or she may have with respect to any personal property which is in the possession of the other, and which shall become the sole and separate property of the other from the date of execution hereof. 13. DIVISION OF REAL PROPKRTY: The real estate owned by the parties as tenants by the entireties and situated at 4 Memory Lane, Enola, Cumberland County, Pennsylvania, has been sold by the agreement of the parties, such settlement to be held on December 14, 2005. Upon settlement Of the sale of said real estate and after payment of the balance due on the mortgage, payment of the costs of sale, and payment to HUSBAND of $800.00 for the debt on his automobile, the remaining net proceeds shall be distributed to WIFE. Both parties further agree to do everything presently or in the future necessary and to execute all documents required for the sale of said real estate. WIFE agrees that the following debts in her name shall be paid out of the proceeds she receives from the sale of the home: American Express credit card, Capital One Visa credit card, Artvan furniture loan, and the Home Depot credit card. WIFE shall indemnify and hold HUSBAND hannless for any obligation for said debts. HUSBAND agrees to be solely responsible for the payment of any remaining balances due and owing for the cable, electric, gas and water bills. If, however, the home is not sold on December 14, 2005, HUSBAND agrees to continue to pay the mortgage, taxes and insurance costs and utilities related to the home in exchange for which -8- WIFE waives her right to receive alimony, as set forth herein in paragraph 18, until such time as the home is sold. 14. BANK ACCOUNTS: HUSBAND and WIFE acknowledge that they each possess certain bank accounts and the like in their respective names. They hereby agree that each shall become sole owner oftheir respective accounts and they each hereby waive any interest in, or claim to, any funds held by the other in such accounts. The parties agree that they are the joint owners of an account with PNC Ban1c The parties agree to meet at PNC Bank, after the closing on the marital residence, in order to close this joint bank account.. 15. PENSIONS. ANNUITIES AND/OR RETIREMENT BENEFITS: A. Fcr USA. Inc. Employee 401(1<:) Savings Plan #092497 . HUSBAND is currently the owner of a 40 1 (k) through his employment with FCr USA, Inc. In consideration of the mntual promises contained herein HUSBAND agrees to transfer FOUR THOUSAND NINE HUNDRED AND TWENTY.FIVE ($4,925.00) DOLLARS from his 401 (k), together with all interest accruing thereon from the execution date hereofto the date of the transfer of the funds, to WIFE. The parties agree that the transfer to WIFE shall be effectuated in a manner which shall not cause the funds to lose their tax-free status, and the transfer shall be made pursuant to a Qualified Domestic Relations Order (as that term is defined by the Internal Revenue Code and ERISA, hereinafter "QDRO"), the form ofthe order to be set forth in a stipulation which shall be signed by both parties, subj ect to the prior approval of their respective counsel and the plan administrator, -9- and entered as an Order of Court. WIFE shall be solely responsible for the cost and preparation of the QDRO. B. WIFE agrees that any monies, other than those listed above, which HUSBAND has acquired through his interests in either pensions, profit sharing, savings and thrift plans, annuities and/or retirement benefits through his present or past employers shall remain his sole and exclusive property. Specifically, WIFE waives any interest in and to HUSBAND's Unifonned Services Account Thrift Savings Plan. WIFE agrees to waive any interest she may . have in sllch property and further agrees that she will not assert any such claim in the future. 16. MOTOR VEIDCLES: With respect to the motor vehicles owned by the parties, they agree that each shall retain the vehicle currently titled in their respective names and that said vehicle shall be and remain the sole and exclusive property of said party.... As previously stated 'l\~t)C).b~~~ above, in paragraph 13, Wife agrees that the current past due amount of $1,697.55 owing ~ 1:1f/ GMAC account # 045-9019-22318 shall be paid out of the proceeds of the sale of the parties' home. After said payment each party agrees to be solely responsible for the amounts presently due and owing against his or her respective automobile. The parties were the joint owners of a Chevrolet Biscayne which was sold subsequent to the parties' separation. The parties have divided the proceeds of said sale equally between them with Wife receiving the sum of ONE THOUSAND TWO HUNDRED ($1,200.00) DOLLARS. WIFE agrees that said payment fully satisfies her interest in said vehicle and agrees that she waiVes her right to assert any claim in the future. -10- 17. AFTER-ACOUIRED PROPERTY: Each of the parties shall hereafter own and enjoy, independently of any claim or right of the other, all items of property, be they real, personal or mixed, tangible or intangible, which are hereafter acquired by him or her, with full power in him or her to dispose of the same as fully and effectively, in all respects and for all purposes, as though he or she were umnarried. 18. ALIMONY: HUSBAND shall, from January 1, 2006 and for a period of fifteen (15) months terminating on March 1, 2007, pay to WIFE the sum of FIVE HUNDRED ($500.00) DOLLARS pet month for her separate support and maintenance. Said payments will be made. through the Domestic Relations Section of Cumberland County through a wage attachment. Said payments shall be deducted bi-weekly, in the amount of$230.77, from HUSBAND's paycheck. This payment is intended to be included in WIFE's income and deducted from HUSBAND's gross income pursuant to federal tax laws. WIFE agrees that all ofthe said payments shall be included as income of WIFE in het applicable tax return and she shall pay such taxes as may be required by reason of such inclusion. The parties further agree that they specifically intend this amount to be non-modifiable by either party. Said alimony shall terminate prior to the expiration of said fifteen (15) months only upon the death of either party or upon Wife's remarriage or cohabitation with an unrelated member of the same or opposite sex. -11- 19. MOVING COSTS: In consideration of the mutual promises contained herein, HUSBAND shall pay SIX THOUSAND ($6,000.00) DOLLARS in cash to WJFE at the time of the closing on the marital home, for her moving expenses. 20. mAL TII INSURANCE: HUSBAND shall be responsible for and shall maintain health insurance benefits for WJFE through his employer from the effective date of this Agreement through December 31,2006. HUSBAND shall supply WJFE with proof of such coverage upon her request. The parties agree that any non-covered, extraordinary medical and/or dental expenses shalLbe paid solely by WJFE. 21. COUNSEL FEES: Neither party shall have any liability to the other for reimbursement of attorney's fees incurred by the other party in connection with the negotiation and preparation of this Agreement or in connection with any legal or equitable proceedings between the parties whi'ch have preceded the execution of this Agreement. 22. FEDERAL AND STATE INCOME TAX RETURNS: The parties agree that they shaH file joint Federal and State income tax returns for the tax year 2005. They agree that should any tax be due and owing on either return, it shaH be considered a joint liability and shall be borne equally by the parties. However, should such tax, interest, penalty or expense be determined to have been caused by the misrepresentations or failures to disclose the nature and extent of his or her separate income on the aforesaid joint returns it shaH be paid solely and -12- . . . entirely by the individual responsible. Should a refund be forthcoming, the parties shall divide it equally. 23. INCOME TAX PRIOR RETURNS: The parties have heretofore filed joint Federal and State tax returns. Both parties agree that in the event any deficiency in Federal or State income tax is proposed, or any assessment of any such tax is made against either of them, each will indelll.tJify and hold hannless the other from arid against any loss or liability for any such tax deficiency or assessment arid any interest, penalty and expense incurred in connection therewith. Such tax, interest, penalty or expense shall be paid solely and entirely by the individuaJ who is fmally determined to be the cause of the misrepresentations or failures to disclose the nature and extent of his or her separate income on the aforesaid joint returns. 24. APPLICABILITY OF TAX LAW TO PROPERTY TRANSFERS: The parties hereby agree and express their intent that any transfer of property pursuant to this Agreement shall be within the scope and applicability ofthe Deficit Reduction Act of 1984 (hereinafter the "Act"), specifically, the provisions of said Act pertaining to the transfers of property between spouses and former spouses. The parties agree to sign and cause to be filed any elections or other documents required by the Internal Revenue Service to render the Act applicable to the transfers set forth in this Agreement without recognition of gain on such transfer and subj ect to the carry-over basis provisions of the said Act. -13- 25. TAX ADVICE: Both parties hereto hereby acknowledge and agree that they have had the opportunity to retain their own accountants, certified public accountants, tax advisor, or tax attorney with reference to the tax implications of this Agreement. Neither party has been given any tax advice whatsoever by their respective attorneys. Both parties hereby acknowledge that they have been advised, by their respective attorneys, to seek their own independent tax advice by retaining an accountant, certified public accolUltant, tax attorney, or tax advisor with reference to the tax: implications involved in this Agreement. Further, the parties acknowledge and agree that their signatures to this Agreement serve as their acknowledgment that they have read this particular paragraph and have had the opportunity to seek independent tax advice. 26. EFFECT OF DIVORCE DECREE: The parties agree that, except as otherwise specifically provided herein, this Agreement shall continue in full force and effect after such time as a final Decree in Divorce may be entered with respect to the parties. 27. BREACH: If either party breaches any provision of this Agreement, the other party shall have the right, at his or her election, to sue for damages for such breach or seek such other remedies or relief as may be available to him or her, and the party breaching this contract shall be responsible for payment of reasonable legal fees and costs incurred by the other in enforcing their rights lUlder this Agreement. -14- 28. WAIVER OF CLAIMS: 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 shall now have or hereafter acquire, under the present and 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, dower, curtesy, statutory allowance, widow's allowance, widower's allowance, right to take in intestacy, right to take against the Will of the other, and the right to act as administrator or executor of the other's estate. Each party 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 c1ai\ils. 29. ENTIRE AGREEMENT: This Agreement contains the entire understanding of the parties and there are no representations, warranties, covenants or undertakings other than those expressly set forth herein. 30. FINANCIAL DISCLOSURE: The parties confInn that they have relied on the completeness and substantial accuracy ofthe financial disclosure of the other as an inducement to the execution of this Agreement. The parties acknowledge that there has been no fonnal discovery conducted in their pending divorce action and that neither party has filed an Inventory and Appraisement as required by Section 3505(b) ofthe Pennsylvania Divorce Code. Notwithstanding the foregoing, the rights of either party to pursue a claim for equitable distribution, pursuant to the Pennsylvania Divorce Code, of any interest owned by the other party in an asset of any nature at -15- any time prior to the date of execution ofthis Agreement that was not disclosed to the other party or his or her counsel prior to the date of the within Agreement is expressly reserved. In the event that either party, at any time hereafter, discovers such an undisclosed asset, that party shall have the right to petition the Court of Common Pleas of Ctunberland County to make equitable distribution of said asset. The non-disclosing party shall be responsible for payment of counsel fees, costs or expenses incurred by the other party in seeking equitable distribution of said asset. Notwithstanding the foregoing, the Agreement shall in all other respects remain in full fOrce and effect. 31. AGREEMENT BINDING ON HEIRS: This Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors and assigns. 32. AODlTIONAL INSTRUMENTS: Each ofthe parties shall, from time to time, at the request ofthe other, execute, acknowledge and deliver to the other any and all further instruments that may be reasonably required to give full force and effect to the provisions of this Agreement. 33. VOID CLAUSES: If any term, condition, clause or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, then only that tenn, -16- condition, clause or provision shall be stricken from this Agreement and in all other respects this Agreement shall be valid and continue in full force, effect and operation. 34. INDEPENDENT SEPARATE COVENANTS: It is specifically understood and agreed by and between the parties hereto that each paragraph hereof shall be deemed to be a separate and independent Agreement. 35. MODIFICATION AND WAIvER: A modification or waiver of any of the provisions of this Agreement shall be effective only if made in writing and e.xecuted with the same formality as this Agreement. The failure of either party to insist upon strict performance of any of the provisioI1s of this Agreement shall not be construed as a waiver of any subsequent defaults of the same or similar nature. 36. DESCRIPTIVE HEADINGS: The descriptive headings used herein are for convenience only. They shall have no affect whatsoever in determining the rights or obligations of the parties. -17- 37. APPLICABLE LAW: This Agreement shall be construed under the laws ofthe Commonwealth ofPeunsylvania and more specifically under the Divorce Code of 1980 and any amendments thereto. IN w.rrNESS WHEREOF, the parties hereto have set their hands and seals the date and year first above written. WITNESS ~-!);~vr--~ ....~~~~ WITNESS -18- COMMONWEALTH OF PENNSYLV ~ )SS: COUNTYOF 6--\.",b.tr\n...~ ) On this, the ~ day of 0.C-e.-lN\-'r.u.r ,2005, before me, a Notary Public, the undersigned officer, personally appeared John E. Yankowski, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Property Settlement Agreement and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand aiJ.d official seal. CJ" {cAbL N6 ary Public NOWltAI. SEAl. JAN E MILlER NotaIy PublIc UPPER AllEN 1WP. CUMBERlAND COUNTY My Commission Explr.. Sep 30. 2009 COMMONWEALTH OF PENNSYLV ~ )SS: COUNTY OF Cu (Y"\.6ct--~ <'--.d. ) On this, the [4 day of ~'iY'~" , 2005, before me, a Notary Public, the undersigned officer, persoually appeared Suzanne M. Yankowski, known to me (or satisfactorily proveu) to be the person whose name is subscribed to the foregoing Property Settlement Agreement and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Q Fnf,lL o Public NOTARIAl. SEAl. JAN E MIlLER Notary Public Ul'PER ALLEN 1WP. CUMBERlAND COUN1Y My Commission Explres Sep 30. 2009 -19- CERTIFICATE OF SERVICE I, Kristopher T. Smull, Esquire, Attorney for John E. Yankowski, herein, do hereby certify that on this date I served the foregoing Petition for Enforcement of Property Settlement Agreement by depositing a true and exact copy thereof in the United States mail, first class, postage prepaid, addressed as follows: Robert B. Lieberman, Esquire 500 N. Third Street P.O. Box 1004 Harrisburg, PAl 71 08 Respectfully Submitted: Date: March 31, 2006 MARIA P. \ / l NETTI & ASSOCIATES By: L/ /f 210 Grandview Avenue, Suite 102 Camp Hill, P A 17011 Telephone No. (717) 909-4060 Attorney for Plaintiff ~, ~.~-, r,,j C) "On <\ 2. '7 APR 0 6 ZD06jtl' JOHN E. YANKOWSKI, Plaintiff/Petitioner : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 05-5734 SUZIE M. GORSE-YANKOWSKI, Defendant/Respondent : CIVIL ACTION - LAW : IN DIVORCE AND NOW, to wit, this RULETOSHOWCA~ . C. f'Cr'\ day of , 2006, upon consideration of Plaintiff s Petition for Enforcement of Property Settlement Agreement, a Rule is hereby issued upon the Defendant to show cause, if any, why the relief requested should not be granted. f ).oO~ c:;r t"Of)p.~ <- '- ~L~ ~ ;r;;:rrE:~c..rJ;...,. BY THE COURT: , ..., 1,,10 I, Dated: .1. vo'lP /D r: I '0 -~ . -..) /11:,';:'}, L - (' . . L . ~ ~~~J 9C02 ,. ~ ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND DateofOrder/Notice 04/03/06 Case Number (See Addendum for case summary) 905107830 05-5734 CIVIL o Original Order/Notice o Amended Order/Notice (8) Terminate Order/Notice FCI USA INC 825 OLD TRAIL RD ETTERS PA 17319-9392 RE: YANKOWSKI, JOHN E. Employee/Obligor's Name (last, First, MlJ 286-60-0991 Employee/Obligor's Social Security Number 4847101583 Employee/Obligor's Case Identifier (Spe Addendum for plaintiff name-s ClSsodated with cases on attachment) Custodial Parent's Name (Last, First, MI) EmployerfWithholder's Federal EIN Number See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0 . 00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes 0 no $ 0.00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0 . 00 per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ 0 . 00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee'sl 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, PA YMENTS 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: 1 t'J', C) h~.\ '~;' 4 2DC6 Judge Form EN-028 Worker ID $IATT Edward E. Guido, DRO: R.J. Shadday Service Type M OMB No.: O'J70-01S'1 ~ ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If ~hecked you are required to provide a copy of this form to your employee. If your employee works in a state that is different from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3. * RepOJt;Jlg tIle raydate/Date vf 'vV;lLI.oIJi,lg. YOu [[lUst lepoll tile fJaydatcfJdk vf vv;tLLuldil,g vvJI~rr seJ.dillg tlle--payJII6IL fhe- payddteldate-of-vvitJ ,I,olditrg is tin:: Jalt:: VII VVII~(L d.1\\VU\\t waS vv;lLl,eIJ f.otll tlre en,ployee's vVclE;d. 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 belowl 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 identjfied below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0606699290 EMPLOYEE'S/OBlIGOR'S NAME: YANKOWSKI, JOHN E. EMPLOYEE'S CASE IDENTIFIER: 4847101583 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. jf 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. B. 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 115 U.S.c. 91673 (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. Fortriba! 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) 240-624B or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Worker ID $IATT Service Type M OMB No.; 0970-01-'i4 ... ADDENDUM Summary of Cases on Attachment Defendant/Obligor: YANKOWSKI, JOHN E. PACSES Case Number 905107830 Plaintiff Name SUZANNE M. GORSE-YANKOWSKI Docket Attachment Amount 05-5734 CIVIL$ 0.00 Child(ren)'s Name(s): PACSES Case Number Plaintiff Name DOS Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOS o 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. o 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 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Childlren)'s Name(s): DOS Docket Attachment Amount $ 0.00 Childlren)'s Namels): DOS o If checked, you are required to enroll the child(renJ identified above in any health insurance coverage available through the employee's/obligor's employment. o If checked, you are required to enroll the child(renJ identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOS Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOS o 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. Dlf 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 Worker ID $IATT Service Type M OMB No,: 0'170-01:;4 .-1 .\ (.,' ~ (,.\ . , , , ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 05/01/06 Case Number (See Addendum for case summary) 905107830 05-5734 CIVIL @Original Order/Notice o Amended Order/Notice o Terminate Order/Notice FCI USA INC 825 OLD TRAIL RD ETTERS PA 17319-9392 RE: YANKOWSKI, JOHN E. Employee/Obligor's Name (last, First, Mil 286-60-0991 Employee/Obligor's Social Security Number 4847101583 Employee/Obligor's Case Identifier (5"" Adckndum for plaintiff names associated with cases on attachment) Custodial Parent's Name (last. First, MI) EmployerM'ithholder's Federal EIN Number 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'sfobligor's income until further notice even if the Order/Notice is not issued by your State. $ 500.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes @ 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 $ 500 . 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: $ 115.38 per weekly pay period. $ 230.77 per biweekly pay period (every two weeks). $ 250.00 per semimonthly pay period (twice a month). $ 500.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydateldate 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'sf 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 '-877-676-9580 for instructions. Make Remittance Payable to: P A SCOU Send check to: Pennsylvania seou, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS 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. Edward Juige Form EN-028 Worker ID $IATT Date of Order: t~At 0 2 2006 DRO: R.J. Shadday Service Type M OM8 No.: 0970.0154 . , ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If s;hecked you are required to provide a copy of this fonn to your employee. If yovr employee works in.a state thai is ditterent from the state that issued this order, a copy must be provided to your employee even If the box IS not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3. * RCt-'v,l;"5 lIle rayd.atelDdle vf'l/aJ,J,oIJ;"g. YOu lIlUS! Icpo,l tile fJClydatt::dak: uf vv:lI.I,vld;"o yvl.e!, ;:10>;,.\1;1 tg lIll;; .....ayll1e.,l. TIle "'Clyddbddate of vvitLlloldihg;5 till;;: dale 0.. vvl.;c1. <11I1VUlIl \/Va:) vv;U.I,eld r.Olll lL~ clIlplvyll;e's VYQ&d. You must comply with the law of the state of the employee'slobligor's principal place of employment with respect to the time periods within which you must implement the withholding order and fOlward 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'slobligor'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: 0606699290 EMPLOYEE'S/OBLlGOR'S NAME: YANKOWSKI, JOlIN E. EMPLOYEE'S CASE IDENTIFIER: 4847101583 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. AntHliscrimination: 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 govems 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.5.c. 91673 (b)l; or 2) the amounts allowed by the State of the employee'slobligor'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 Jaw 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 17171 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-0l8 Worker ID $IATT Service Type M OMB No.: 0970.0154 , .. '. ADDENDUM Summary of Cases on Attachment Defendant/Obligor: YANKOWSKI, JOHN E. PACSES Case Number 905107830 Plaintiff Name SUZANNE M. GORSE-YANKOWSKI Docket Attachment Amount os:s:734 CIVIL$ 500.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee'slobligor's employment. o If checked, you are required to enroll the child(ren) identjfied above in any health insurance coverage available through the employee'slobligor's employment. PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ::;:::.::::-::<:.".="-,,.::::::,:::,::::-:,,::,:,::::::",::'::..,'::::,:.::,:,::::.,::::.:-....":-:::-,'::::-::-:::.-':-:::,,-:,-::".'::-.::.:,:',:,:-::"'.:-.:-:';:::':-:--:...::.:-....<,;,',:.'::::-....:-.,:.<-,,::.:.,'.::.,:.,:.::::::::::':::" . ..... '.. "'''..-''''......'''' "....." "........ ""................ ..... ..................... o If checl<ed,you~;e;.,qui;edt; ~nroll th~ ~hild(ren) .. .. . identified above in any health insurance coverage available through the employee'slobligor's employment. o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee'slobligor's employment. Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name "","~"""",,-, ".,- -,-"" , ........."'''''......,,'''......''''''.............. ..-"'''......''''.......'' "..... ',",','-''',-,,',' """"," "-,',,,','-" eEf~h~~l<ed, ~;~arerequired to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ':'.:-::::-':-::-'::,,::::":."":':""':':':-:"":"'--:':::':-""'-'-:':':::'-':'::"::":':::"":':':':':,.,..:-:-:-',.::.-, ":',-:,,::'.-.:.:.::,:-:-:' -....-......:.:'.','.'.'-,.,',.,'.'-'."-'-,,'..'-,.,-'.,'-,:,'-'."'"".'.'-' ".-..-"......-.... .....-......... o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee'slobligor's employment. l Addendum Form EN-028 Worker ID $IATT Service Type. -M . OMS No.: 0970-0154 ~~? ,--' ,~<) C:'> ,,~ ~ ._~: PAXED 7ifJ 1- 2S4Clf--. \ ('> o ~Cn .-4 :r.~ r\'-c. -'::-~'C) ~!~~'~ :,:~)rn ~:~ ,cD '''<; -''('' t::: c vO -" MARIA P. COGNETTI & ASSOCIATES KRISTOPHER T. SMULL, ESQUIRE Attorney J.D. No. 69140 210 Grandview Avenue, Suite 102 Camp Hill, PA 17011 Telephone No. (717) 909-4060 Attorneys for Plaintiff JOHN E. Y ANKOWSKl, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 05-5734 SUZIE M. GORSE- Y ANKOWSKl, Defendant CIVIL ACTION - LAW IN DIVORCE PRAECIPE TO THE PROTHONOTARY: Please withdraw the Plaintiffs Petition for Special Relief Pursuant to Pa.R.Civ.P. 1920.43(a) docketed to the above-captioned action, which was filed on April 4, 2006 and mark the matter as settled. Respectfully Submitted: MARIA P. COGNETTI & ASSOCIATES Date: ~2(IOb By: KRISTOPHER T. SMULL, ESQUIRE Attorney LD. No. 69140 210 Grandview Avenue, Suite 102 Camp Hill, P A 17011 Telephone No. (717) 909-4060 Attorney for Plaintiff . CERTIFICATE OF SERVICE I, Kristopher T. Smull, Esquire, Attorney for Plaintiff herein, do hereby certify that on this date I served the foregoing Praecipe pursuant to PA.C.S.A. ~3502(c) by depositing a true and exact copy thereof in the United States mail, first class, postage prepaid, addressed as follows: Robert B. Lieberman, Esquire 500 N. Third Street P.O. Box 1004 Harrisburg, P A 17108 Respectfully Submitted: MARIA P. COGNETTI & ASSOCIATES Date: tl/ Z-K I (j b By: \ r KRIST HER T. SMULL, ESQUIRE AttorneyLD. No. 69140 210 Grandview Avenue, Suite 102 Camp Hill, PA 17011 Telephone No. (717) 909-4060 Attorney for Plaintiff 0 ,....., 0 "'" ~.; ':C:_-;) -0 Q...... - :::;v. ..4 \"'; :I:: -r1 . niF -<:. I _-<)fTI ~_1)~) W , , -:~j "-> --0 ,,'~) (c:~, ~ ~{cfTl ,. r:-? =~ :;-=: .~- :2 (JI ~ ..,.. JOHN E. YANKOWSKI, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 05-5734 - CIVIL TERM SUZIE M. GORSE- YANKOWSKI, Defendant : CIVIL ACTION - LAW : IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on November 3, 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. I consent to the entry of a final decree of 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. !j4904 relating to unsworn falsification to authorities. DATED: q //11 0 (p 'i ~ ~ 1 C) c << ::) ~..> c"~~ C:::l ,;.::,..... :;:.:. -t,- ",w' ~~) N JOHN E. YANKOWSKI, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 05-5734 - CIVIL TERM SUZIE M. GORSE- YANKOWSKI, Defendant : CIVIL ACTION - LAW : IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REOUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(C) OF THE DIVORCE CODE I. I consent to the entry of a final Decree in Divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses ifI 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 ofthe decree will be sent to me immediately after it is filed with the Prothonotary . I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of I 8 Pa. C.S. ~ 4904 relating to unsworn falsification to authorities. DATED:;.j /if /fJ &, ~~i!'t!g(/k(' Jt!~ Suzie . Gorse-Yankowski, I Defendant r.....) () ~~~ K"1'\ 0.... ~...-\ -e. rn \ .:::- -() -.,-." ~'1 f'..-' ~-;:.. .. ..., In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SUZANNE M. GORSE-YANKOWSKI ) Docket Number 05-5734 CIVIL Plaintiff ) vs. ) PACSES Case Number 905107830 JOHN E. YANKOWSKI ) Defendant ) Other State ID Number Order AND NOW to wit, this JUNE 5, 2006 it is hereby Ordered that: DEFENDANT IS GIVEN CREDIT IN THE THE AMOUNT OF $500.00 FOR A DIRECT PAYMENT TO PLAINTIFF PAID ON MARCH 10, 2006 WITH CHECK #141. BY THE COURT: ~~~ JUDGE DRO: R. J. Shadday Service Type M Form OE-520 Worker ID 21005 May 30, 2006 Docket Number: 05-5734 CIVIL JUN 0 5 2006 PACSES Case Number:.W&fA.e;wM Domestic Relations Section 13 N. Hanover St. P.O. Box 320 Carlisle, PA 17013 DearR. J. Shadday, The check that Mr. Yankowski sent me was for the month of January, 2006. I have not received any other payments from him. Sincerely, Suzanne Gorse-Yankowski o ~~; .:::, ~~~-~ ,...., =' .::::::> C7' c.... c:: ..~ o II :::! _J_ -n r11 i"';' fr. C;=, {-; __ :1 , (J1 v -;~ e'" el1 \..0 :'i .~::l ~J;::::.. ~..o -< PROPERTY SETTLEMENT AGREEMENT TIllS AGREEMENT, made thi) ~ay Of~ by and between John E. Yankowski, of 4 Memory Lane, Enola, Cumberland County, Pennsylvania (hereinafter referred to as "HUSBAND") and Suzanne M. Yankowski, of 4 Memory Lane, Enola, Cumberland County, Pennsylvania (hereinafter referred to as "WIFE"): WITNESSETH: WHEREAS, the parties were married on May 23, 2003, in Junction City, Kansas; and WHEREAS, no children have been born of this marriage; and WHEREAS, diverse, unhappy differences, disputes and difficulties have arisen between the parties and it is the intention of HUSBAND and WIFE to live separate and apart, and the parties hereto are desirous of settling fully and fmally their respective financial and property rights and obligations as between each other, including, without limitation by specification: the settling of all matters between them relating to the ownership and equitable distribution of real and personal property; settling of all matters between them relating to the past, present and future support, alimony and/or maintenance of WIFE by HUSBAND or of HUSBAND by WIFE; the settling of any and all claims and possible claims by one against the other or against their respective estates. NOW, THEREFORE, in consideration of the premises and of the mutual promises, covenants and undertakings hereinafter set forth and for other good and valuable consideration, receipt of which is hereby acknowledged by each of the parties hereto, HUSBAND and WIFE, each intending to be legally bound hereby covenant and agree as follows: 1. SEPARATION: HUSBAND and WIFE shall at all times hereafter have the right to live separate and apart from each other and to reside from time to time at such place or places as they shall respectively deem fit, free from any control, restraint or interference whatsoever by the other. Neither party shall molest the other or endeavor to compel the other to cohabit or dwell with him or her by any legal or other proceedings. The foregoing provisions shall not be taken to be an admission on the part of either HUSBAND or WIFE of the lawfulness or unlawfulness of the causes leading to their living apart. 2. INTERFERENCE: Each party shall be free from interference, authority, and contact by the other, as fully as if he or she were single and unmarried, except as may be necessary to carry out the provisions of this Agreement. Neither party shall molest the other or attempt to endeavor to molest the other, nor compel the other to cohabit with the other, nor in any way harass or malign the other, nor in any way interfere with the peaceful existence, separate and apart from the other. -2- 3. AGREEMENT NOT A BAR TO DIVORCE PROCEEDINGS: This Agreement shall not be considered to affect or bar the right of HUSBAND or WIFE to a divorce on lawful grounds as such grounds now exist or shall hereafter exist or to such defense as may be available to either party. This Agreement is not intended to condone and shall not be deemed to be a condonation on the part of either party hereto of any act or acts on the part of the other party which have occasioned the disputes or unhappy differences which have occurred prior to or which may occur subsequent to the date hereof. 4. SUBSEOUENT DIVORCE: The parties hereby acknowledge that HUSBAND has filed a Complaint in Divorce in Cumberland County to Docket No. 05-5734, claiming that the marriage is irretrievably broken under Section 3301(c) of the Pennsylvania Divorce Code. Both parties hereby express their agreement that the marriage is irretrievably broken and express their intent to execute any and all Affidavits or other documents necessary for the parties to obtain an absolute divorce pursuant to Section 3301(c) of the Divorce Code within seven (7) days following the expiration of the ninety (90) day statutory waiting period. The parties hereby waive all rights to request court ordered counseling under the Divorce Code. It is further specifically understood and agreed by the parties that the provisions of this Agreement as to equitable distribution of property of the parties are accepted by each party as a final settlement for all purposes whatsoever, as contemplated by the Pennsylvania Divorce Code. Should a decree, judgment or order of divorce be obtained by either of the parties in this or any other state, country or jurisdiction, each of the parties hereby consents and agrees that this -3- Agreement and all of its covenants shall not be affected in any way by such separation or divorce; and that nothing in any such decree, judgment, order or further modification or revision thereof shall alter, amend or vary any term of this Agreement, whether or not either or both of the parties shall remarry. It is the specific intent of the parties to permit this Agreement to survive any judgment and to be forever binding and conclusive upon the parties. 5. INCORPORATION IN DIVORCE DECREE: It is further agreed, covenanted and stipulated that this Agreement, or the essential parts hereof, shall be incorporated in any decree hereinafter entered by any court of competent jurisdiction in any divorce proceedings that have been or may be instituted by the parties for the purpose of enforcing the contractual obligations of the parties. This Agreement shall not be merged in any such decree but shall in all respects survive the same and be forever binding and conclusive upon the parties. 6. EFFECTIVE DATE: The effective date of this Agreement shall be the "date of execution" or "execution date," defined as the date upon which it is executed by the parties if they have each executed this Agreement at the same date. Otherwise, the "date of execution" or "execution date" of this Agreement shall be defined as the date of execution by the party last executing this Agreement. 7. DISTRIBUTION DATE: The transfer of property, funds and/or documents provided for herein, shall only take place on the "distribution date," which shall be defined as the -4- date of execution of this Agreement unless otherwise specified herein. However, the support and/or alimony payments, if any, provided for in this Agreement shall take effect as set forth in this Agreement. 8. MUTUAL RELEASE: HUSBAND and WIFE each do hereby mutually remise, release, quit-claim and forever discharge the other and the estate of such other, for all time to come, and for all purposes whatsoever, of and from any and all rights, title and interest, or claims in or against the property (including income and gain from property hereafter accruing) of the other or against the estate of such other, of whatever nature and wheresoever situated, which he or she now has or at any time hereafter may have against the other, the estate of such other or any part thereof, whether arising out of any former acts, contracts, engagements or liabilities of such other or by way of dower or curtesy, or claims in the nature of dower or curtesy or widow's or widower's rights, family exemption or similar allowance, or under the intestate laws, or the right to take against the spouse's will, or the right to treat a lifetime conveyance by the other as a testamentary gift, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any State, Commonwealth or territory of the United States, or (c) any country or any rights which either party may have or at any time hereafter shall have for past, present or future support or maintenance, alimony, alimony pendente lite, counsel fees, division of property, costs or expenses, whether arising as a result of the marital relationship or otherwise, except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any -5- provisions thereof. It is the intention of HUSBAND and WIFE to give each other by the execution of this Agreement a full, complete and general release with respect to any and all property of any kind or nature, real, personal or mixed, which the other now owns or may hereafter acquire, except and only except all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. It is further agreed that this Agreement shall be and constitute a full and final resolution of any and all claims which each of the parties may have against the other for equitable division of property, alimony, counsel fees and expenses, alimony pendente lite or any other claims pursuant to the Pennsylvania Divorce Code or the divorce laws of any other jurisdiction. 9. ADVICE OF COUNSEL: The provisions of this Agreement and its legal effect have been fully explained to the parties by their respective counsel; Kristopher T. Smull, Esquire, for HUSBAND and Robert B. Lieberman, Esquire, for WIFE. HUSBAND and WIFE acknowledge that this Agreement is not the result of any duress or undue influence and that it is not the result of any collusion or improper or illegal agreement or agreements. The parties further acknowledge that they have each made to the other a full accounting of their respective assets, estate, liabilities, and sources of income and that they waive any specific enumeration thereof for the purpose of this Agreement. Each party agrees that he or she shall not, at any future time, raise as a defense, or otherwise, the lack of such disclosure in any legal proceeding involving this Agreement, with the exception of disclosure that may have been fraudulently withheld. -6- 10. WARRANTY AS TO EXISTING OBLIGATIONS: Each party represents that they have not heretofore incurred or contracted for any debt or liability or obligation for which the estate of the other party may be responsible or liable except as may be provided for in this Agreement. Each party agrees to indenmify and hold the other party harmless for and against any and all such debts, liabilities or obligations of every kind which may have heretofore been incurred by them, including those for necessities, except for the obligations arising out of this Agreement. 11. WARRANTY AS TO FUTURE OBLIGATIONS: HUSBAND and WIFE covenant, warrant, represent and agree that with the exception of obligations set forth in this Agreement, neither of them shall hereafter incur any liability whatsoever for which the estate of the other may be liable. Each party shall indemnify and hold harmless the other party for and against any and all debts, charges and liabilities incurred by the other after the execution date of this Agreement, except as may be otherwise specifically provided for by the terms of this Agreement. 12. PERSONAL PROPERTY: The parties have divided between them, to their mutual satisfaction, the personal effects, household furniture and furnishings, and all other articles of personal property which have heretofore been used by them in common, and neither party will make any claim to any such items which are now in the possession or under the control of the other. Should it become necessary, the parties each agree to sign any titles or documents necessary to give effect to this paragraph upon request. -7- By these presents, each of the parties hereby specifically waives, releases, renounces and forever abandons whatever claims he or she may have with respect to any personal property which is in the possession of the other, and which shall become the sole and separate property of the other from the date of execution hereof. 13. DIVISION OF REAL PROPERTY: The real estate owned by the parties as tenants by the entireties and situated at 4 Memory Lane, Enola, Cumberland County, Pennsylvania, has been sold by the agreement of the parties, such settlement to be held on December 14, 2005. Upon settlement of the sale of said real estate and after payment of the balance due on the mortgage, payment of the costs of sale, and payment to HUSBAND of$800.00 for the debt on his automobile, the remaining net proceeds shall be distributed to WIFE. Both parties further agree to do everything presently or in the future necessary and to execute all documents required for the sale of said real estate. WIFE agrees that the following debts in her name shall be paid out of the proceeds she receives from the sale ofthe home: American Express credit card, Capital One Visa credit card, Artvan furniture loan, and the Home Depot credit card. WIFE shall indemnify and hold HUSBAND harmless for any obligation for said debts. HUSBAND agrees to be solely responsible for the payment of any remaining balances due and owing for the cable, electric, gas and water bills. If, however, the home is not sold on December 14,2005, HUSBAND agrees to continue to pay the mortgage, taxes and insurance costs and utilities related to the home in exchange for which -8- WIFE waives her right to receive alimony, as set forth herein in paragraph 18, until such time as the home is sold. 14. BANK ACCOUNTS: HUSBAND and WIFE acknowledge that they each possess certain bank accounts and the like in their respective names. They hereby agree that each shall become sole owner of their respective accounts and they each hereby waive any interest in, or claim to, any funds held by the other in such accounts. The parties agree that they are the joint owners of an account with PNC Bank. The parties agree to meet at PNC Bank, after the closing on the marital residence, in order to close this joint bank account. 15. PENSIONS. ANNUITIES AND/OR RETIREMENT BENEFITS: A. FCI USA. Inc. Emolovee 40Hk) Savings Plan #092497 - HUSBAND is currently the owner of a 401(k) through his employment with FCI USA, Inc. In consideration of the mutual promises contained herein HUSBAND agrees to transfer FOUR THOUSAND NINE HUNDRED AND TWENTY-FIVE ($4,925.00) DOLLARS from his 401(k), together with all interest accruing thereon from the execution date hereofto the date of the transfer of the funds, to WIFE. The parties agree that the transfer to WIFE shall be effectuated in a manner which shall not cause the funds to lose their tax-free status, and the transfer shall be made pursuant to a Qualified Domestic Relations Order (as that term is defined by the Internal Revenue Code and ERISA, hereinafter "QDRO"), the form of the order to be set forth in a stipulation which shall be signed by both parties, subject to the prior approval of their respective counsel and the plan administrator, -9- and entered as an Order of Court. WIFE shall be solely responsible for the cost and preparation of the QDRO. B. WIFE agrees that any monies, other than those listed above, which HUSBAND has acquired through his interests in either pensions, profit sharing, savings and thrift plans, annuities and/or retirement benefits through his present or past employers shall remain his sole and exclusive property. Specifically, WIFE waives any interest in and to HUSBAND's Uniformed Services Account Thrift Savings Plan. WIFE agrees to waive any interest she may . have in such property and further agrees that she will not assert any such claim in the future. 16. MOTOR VEHICLES: With respect to the motor vehicles owned by the parties, they agree that each shall retain the vehicle currently titled in their respective names and that said vehicle shall be and remain the sole and exclusive property of said party. As previously stated $8"0. -'~ above, in paragraph 13, Wife agrees that the current past due amount oHIll,8'H.J':! owiTI'fo& U GMAC account # 045-9019-22318 shall be paid out of the proceeds of the sale of the parties' home. After said payment each party agrees to be solely responsible for the amounts presently due and owing against his or her respective automobile. The parties were the joint owners of a Chevrolet Biscayne which was sold subsequent to the parties' separation. The parties have divided the proceeds of said sale equally between them with Wife receiving the sum of ONE THOUSAND TWO HUNDRED ($1,200.00) DOLLARS. WIFE agrees that said payment fully satisfies her interest in said vehicle and agrees that she waives her right to assert any claim in the future. -10- 17. AFTER-ACOUlRED PROPERTY: Each of the parties shall hereafter own and enjoy, independently of any claim or right of the other, all items of property, be they real, personal or mixed, tangible or intangible, which are hereafter acquired by him or her, with full power in him or her to dispose of the same as fully and effectively, in all respects and for all purposes, as though he or she were unmarried. 18. ALIMONY: HUSBAND shall, from January 1, 2006 and for a period of fifteen (15) months terminating on March 1, 2007, pay to WIFE the sum ofFNE HUNDRED ($500.00) DOLLARS per month for her separate support and maintenance. Said payments will be made through the Domestic Relations Section of Cumberland County through a wage attachment. Said payments shall be deducted bi-weekly, in the amount of$230.77, from HUSBAND's paycheck. This payment is intended to be included in WIFE's income and deducted from HUSBAND's gross income pursuant to federal tax laws. WIFE agrees that all of the said payments shall be included as income of WIFE in her applicable tax return and she shall pay such taxes as may be required by reason of such inclusion. The parties further agree that they specifically intend this amount to be non-modifiable by either party. Said alimony shall terminate prior to the expiration of said fifteen (15) months only upon the death of either party or upon Wife's remarriage or cohabitation with an unrelated member of the same or opposite sex. -11- 19. MOVING COSTS: In consideration of the mutual promises contained herein, HUSBAND shall pay SIX THOUSAND ($6,000.00) DOLLARS in cash to WIFE at the time of the closing on the marital home, for her moving expenses. 20. HEALTH INSURANCE: HUSBAND shall be responsible for and shall maintain health insurance benefits for WIFE through his employer from the effective date of this Agreement through December 31, 2006. HUSBAND shall supply WIFE with proof of such coverage upon her request. The parties agree that any non-covered, extraordinary medical and/or dental expenses shall be paid solely by WIFE. 21. COUNSEL FEES: Neither party shall have any liability to the other for reimbursement of attorney's fees incurred by the other party in connection with the negotiation and preparation of this Agreement or in connection with any legal or equitable proceedings between the parties which have preceded the execution ofthis Agreement. 22. FEDERAL AND STATE INCOME TAX RETURNS: The parties agree that they shall file joint Federal and State income tax returns for the tax year 2005. They agree that should any tax be due and owing on either return, it shall be considered a joint liability and shall be borne equally by the parties. However, should such tax, interest, penalty or expense be determined to have been caused by the misrepresentations or failures to disclose the nature and extent of his or her separate income on the aforesaid joint returns it shall be paid solely and -12- entirely by the individual responsible. Should a refund be forthcoming, the parties shall divide it equally. 23. INCOME TAX PRIOR RETURNS: The parties have heretofore filed joint Federal and State tax returns. Both parties agree that in the event any deficiency in Federal or State income tax is proposed, or any assessment of any such tax is made against either of them, each will indemnifY and hold harmless the other from and against any loss or liability for any such tax deficiency or assessment and any interest, penalty and expense incurred in connection therewith. Such tax, interest, penalty or expense shall be paid solely and entirely by the individual who is fmally determined to be the cause of the misrepresentations or failures to disclose the nature and extent of his or her separate income on the aforesaid joint returns. 24. APPLICABILITY OF TAX LAW TO PROPERTY TRANSFERS: The parties hereby agree and express their intent that any transfer of property pursuant to this Agreement shall be within the scope and applicability of the Deficit Reduction Act of 1984 (hereinafter the "Act"), specifically, the provisions of said Act pertaining to the transfers of property between spouses and former spouses. The parties agree to sign and cause to be filed any elections or other documents required by the Internal Revenue Service to render the Act applicable to the transfers set forth in this Agreement without recognition of gain on such transfer and subject to the carry-over basis provisions of the said Act. -13- 25. TAX ADVICE: Both parties hereto hereby acknowledge and agree that they have had the opportunity to retain their own accountants, certified public accountants, tax advisor, or tax attorney with reference to the tax implications of this Agreement. Neither party has been given any tax advice whatsoever by their respective attorneys. Both parties hereby acknowledge that they have been advised, by their respective attorneys, to seek their own independent tax advice by retaining an accountant, certified public accountant, tax attorney, or tax advisor with reference to the tax implications involved in this Agreement. Further, the parties acknowledge and agree that their signatures to this Agreement serve as their acknowledgment that they have read this particular paragraph and have had the opportunity to seek independent tax advice. 26. EFFECT OF DIVORCE DECREE: The parties agree that, except as otherwise specifically provided herein, this Agreement shall continue in full force and effect after such time as a final Decree in Divorce may be entered with respect to the parties. 27. BREACH: If either party breaches any provision of this Agreement, the other party shall have the right, at his or her election, to sue for damages for such breach or seek such other remedies or relief as may be available to him or her, and the party breaching this contract shall be responsible for payment of reasonable legal fees and costs incurred by the other in enforcing their rights under this Agreement. -14- 28. WAIVER OF CLAIMS: 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 shall now have or hereafter acquire, under the present and 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, dower, curtesy, statutory allowance, widow's allowance, widower's allowance, right to take in intestacy, right to take against the Will of the other, and the right to act as administrator or executor of the other's estate. Each party 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. 29. ENTIRE AGREEMENT: This Agreement contains the entire understanding of the parties and there are no representations, warranties, covenants or undertakings other than those expressly set forth herein. 30. FINANCIAL DISCLOSURE: The parties confirm that they have relied on the completeness and substantial accuracy of the financial disclosure ofthe other as an inducement to the execution of this Agreement. The parties acknowledge that there has been no formal discovery conducted in their pending divorce action and that neither party has filed an Inventory and Appraisement as required by Section 3505(b) ofthe Pennsylvania Divorce Code. Notwithstanding the foregoing, the rights of either party to pursue a claim for equitable distribution, pursuant to the Pennsylvania Divorce Code, of any interest owned by the other party in an asset of any nature at -15- any time prior to the date of execution of this Agreement that was not disclosed to the other party or his or her counsel prior to the date of the within Agreement is expressly reserved. In the event that either party, at any time hereafter, discovers such an undisclosed asset, that party shall have the right to petition the Court of Common Pleas of Cumberland County to make equitable distribution of said asset. The non-disclosing party shall be responsible for payment of counsel fees, costs or expenses incurred by the other party in seeking equitable distribution of said asset. Notwithstanding the foregoing, the Agreement shall in all other respects remain in full force and effect. 31. AGREEMENT BINDING ON HEIRS: This Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors and assigns. 32. ADDITIONAL INSTRUMENTS: Each of the parties shall, from time to time, at the request of the other, execute, acknowledge and deliver to the other any and all further instruments that may be reasonably required to give full force and effect to the provisions of this Agreement. 33. VOID CLAUSES: If any term, condition, clause or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, then only that term, -16- condition, clause or provision shall be stricken from this Agreement and in all other respects this Agreement shall be valid and continue in full force, effect and operation. 34. INDEPENDENT SEPARATE COVENANTS: It is specifically understood and agreed by and between the parties hereto that each paragraph hereof shall be deemed to be a separate and independent Agreement. 35. MODIFICATION AND WAIVER: A modification or waiver of any of the provisions of this Agreement shall be effective only if made in writing and executed with the same formality as this Agreement. The failure of either party to insist upon strict performance of any of the provisions of this Agreement shall not be construed as a waiver of any subsequent defaults of the same or similar nature. 36. DESCRIPTIVE HEADINGS: The descriptive headings used herein are for convenience only. They shall have no affect whatsoever in determining the rights or obligations of the parties. -17- 37. APPLICABLE LAW: This Agreement shall be construed under the laws of the Commonwealth of Pennsylvania and more specifically under the Divorce Code of 1980 and any amendments thereto. IN WITNESS WHEREOF, the parties hereto have set their hands and seals the date and year first above written. ~. , r WITNESS ,.,.... ..:;t., ~ WITNESS -18- COMMONWEALTH OF PENNSYL V ANIIY )SS: COUNTY oI(u f'<\.6rl9. ~ ) On this, the 1:L day o~lJ<'..~r ,2005, before me, a Notary Public, the undersigned officer, personally appeared John E. Yankowski, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Property Settlement Agreement and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~t~L N Public NONW.IfAl. oWl E MI.LEII -., PublIc lI'PItt AWN NIP. CUMBWlD COUNIV MIl C<ln.........., EJCpINo Iep 30, 2OlI9 COMMONWEALTH OF PENNSYL V ANIIY )SS: COUNTY OF (y. rY\D.e.\J6. ~ ) On this, the )'-\ day of ~",,6.t r .2005, before me, a Notary Public, the undersigned officer, personally appeared Suzanne M. Yankowski, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Property Settlement Agreement and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. C-~ C m;J k- N6't Public NOUIIIW.IfAl. oWl E MI.LEII -., PublIc _AWNNIP.~COUNIV MIl C<l.......... ExpiIeI SlIp 30. 2OlI9 -19- f'--'-...._.~. '-'--""l ..,~, ,..,<'i...... ..~. ,: i'l'.' ., , " I .. .', <';~,' ""'~,).. > ,.0:"':' ;';'.L'~ ,..,..,.. ','.- ~,_._,.,',...-_..._".",.,--~._...~,......,~......--"'..---- n .. .. :) n c .-/ -r I ;1 CJ -"; 1") C": C r~""'-""""-"-""""'''''--~ . ",:1, ";.,.' : :\""?i'\',~. ',\:\ .. ,..,..... " t J ,~.. I:\Client Directory\Yankowski\Pleadings\Divorce Pleadings\Accept ofServ.wpd MARIA P. COGNETTI & ASSOCIATES KRISTOPHER T. SMULL, ESQUIRE Attorney I.D. No. 69140 210 Grandview Avenue, Suite 102 CarnpHill, PA 17011 Telephone No. (717) 909-4060 Attorneys for Plaintiff JOHN E. Y ANKOWSKl, Plaintiff v. SUZIE M. GORSE- Y ANKOWSKl, Defendant November 9, 2005 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL V ANlA : NO. 05-5734 CIVIL ACTION - LAW IN DIVORCE ACCEPTANCE OF SERVICE I, Robert B. Lieberman, Esquire, accept service of the Complaint in Divorce, on behalf of my client, Suzie M. Gorse-Yankowski, Defendant, therein. Dated) 1./ 0 . oS P.t'l<X}?. ~.~t Robert B. Lieberman, Esquire 500 N. Third Street P.O. Box 1004 Harrisburg, P A 17108 1 -... !'J '-~ ,:;;;, <.':'.'~ .-1 1-;-0: :_,.) MARIA P. COGNETTI & ASSOCIATES KRISTOPHER T. SMULL, ESQUIRE Attorney I.D. No. 69140 210 Grandview Avenue, Suite 102 CampHill,PA 17011 Telephone No. (717) 909-4060 Attorneys for Plaintiff JOHN E. Y ANKOWSKl, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL V ANlA v. NO. 05-5734 SUZIE M. GORSE- Y ANKOWSKl, Defendant CNlL ACTION - LAW IN DNORCE AFFIDAVIT OF CONSENT 1. AComplaint in Divorce under Section 3301(c) of the Divorce Code was filed on November 3,2005. 2. The marriage of Plaintiff and Defendant is irretrievably broken, and ninety (90) days have elapsed from the date of 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! do not claim them before the 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. 94904 relating to unsworn falsification to authorities. Date: '1 /1/06 MARIA P. COGNETTI & ASSOCIATES KRISTOPHER T. SMULL, ESQlilRE Attorney LD. No. 69140 210 Grandview Avenue, Suite 102 CampHill,PA 17011 Telephone No. (717) 909-4060 Attorneys for Plaintiff JOHN E. Y ANKOWSKl, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL V ANlA v. NO. 05-5734 SUZIE M. GORSE- Y ANKOWSKl, Defendant CIVIL ACTION - LAW IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REOUEST ENTRY OF DIVORCE DECREE UNDER S 3301(c) OF THE DIVORCE CODE I. 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! do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a Divorce Decree is entered by the Court and that a copy of the Decree will be sent to me immediately after it is filed with the Prothonotary. I verifY that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. S 4904 relating to unsworn falsification to authorities. DATE: 7/1/06 -r-,;' ,~ " c ...., c;;:.) '; j C;'--' ~:~ .-, -'r~ ;+j c.._ c' -ry r:) ,~ c' . ./ MARIA P. COGNETTI & ASSOCIATES KRISTOPHER T. SMULL, ESQillRE Attorney J.D. No. 69140 210 Grandview Avenue, Suite 102 Camp Hill, PA 17011 Telephone No. (717) 909-4060 Attorneys for Plaintiff JOHN E. Y ANKOWSKl, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYL V ANlA v. : NO. 05-5734 SUZIE M. GORSE- Y ANKOWSKl, Defendant : CIVIL ACTION - LAW : 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. Ground for divorce: Irretrievable breakdown under S 3301(c) of the Divorce Code. 2. Date and manner of service of the Complaint: Service was accepted by Attorney for Defendant, Robert B. Lieberman, Esquire, on November 10, 2005 by regular maiL 3. Date of execution ofthe Affidavit of Consent required by S 3301(c) of the Divorce Code: by Plaintiff, John E. Yankowski on July 7,2006; by Defendant, Suzie M. Gorse- Yankowski, on April 11, 2006. 4. Related claims pending: Settled by Agreement dated December 14, 2005. .... ./ 5. Date Plaintiff's Waiver of Notice in S 3301(c) Divorce was filed with the Prothonotary: Waiver of Notice is being filed simultaneously herewith. Date Defendant's Waiver of Notice in S 3301(c) Divorce was filed with the Prothonotary: April 11 , 2006. Respectfully Submitted: MARIA P. OGNETTI & ASSOCIATES \ Date: July 7, 2006 By: KRI PHER T. SMULL, ESQUIRE Attorney J.D. No. 69140 210 Grandview Avenue, Suite 102 Camp Hill, PA 17011 Telephone No. (717) 909-4060 Attorney for Plaintiff - . (.) -\'\ c_ :::1 f_:~!~\ -;~ \, : :"-~ ' (--:-'" c IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNA. JOHN E. YANKOWSKI, Plaintiff No. 05-5734 CIVIL TERM VERSUS SUZIE M. GORSE-YANKOWSKI, Defendant DECREE IN DIVORCE AND NOW, ':J~ II" JOHN E. YANKOWSKI JI/.'(J 1A.,f1 , 2006 ,IT IS ORDERED AND DECREED THAT , PLAINTIFF, AND SUZIE M. GORSE-YANKOWSKI , 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 terms of the parties' Property Settlement Agreement dated December 14, 2005, herewith. 'msd~ { -.- .. '! P'OTHONOT"" J. 1- ~ ~ 'Xl?'f'L ~ ~-f5) ~. }e-{.. 1- r'f/.. . . ' , .... " ". . .. . )'"'" . .., ~"-;..~ \. ... . ,;., l . . . , John E. Yankowski Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - LAW Suzie M. Gorse-Yankowski Defendant NO. 05-5734 QUAUFmDDOMESTIC RELATIONS ORDER L This Order relates to the provision of marital property rights to't1i~ Altem,ate Payee pursuant to a Property Settlement Agreement entered into on December 14, 2005. 2. This Order creates and recognizes the existence of an Alternate Payee's right to receive a portion ofthe Participant's benefits payable under an employer sponsored defined contribution plan which is intended to be qualified under Intemal Revenue Code of 1986 ("Code") ~401(a). The Court intends this order to be a Qualified Domestic Relations Order ("QDRO") within the meaning of Code ~414(p) and ~206(d) of the Employee Retirement Income Security Act of 1974 as amended ("ERISA"). The Court enters this QDRO pursuant to its authority under the 23 P.C.S.A. ~3502. 3. This QDRO applies to the FCI USA, Inc. Employee 401(k) Savings Plan ("Plan"). Further, this Order shall apply to any successor plan to the Plan or any other plan(s) to which liability for provision of the Participant's benefits described below is incurred. Anybenefits accrued by the Participant under a predecessor plan of the employer or any other defined contribution plan sponsored by the Participant's employer, whereby liability for benefits accrued under such predecessor plan or other defined contribution plan has been transferred to the Plan, shall also be subject to the terms of this Order. Any changes in Plan Administrator, Plan sponsor, or name of the Plan shall not affect Alternate Payee's rights as stipulated under this Order. 4. John E. Yankowski ("Participant") is a participant in the Plan. Suzie M. Gorse- Yankowski ("Altemate Payee"), the former spouse of the Participant, is the altemate payee for purposes of this QDRO. 5. The Participant's name, mailing address, Social Security number and date of birth are: John E. Yankowski 423 Walnut Street, Apt. 103 Harrisburg, PA 17101 Social Security #: 286-60-0991 Date of Birth: July 2, 1961 6. The Alternate Payee's name, mailing address, Social Security number and date of birth are: .. QDRO Page 2 Suzie M. Gorse-Yankowski 24257 Rosebud Avenue East Pointe, MI 48021 Social Security #: 378-84-9504 Date of Birth: April 8, 1964 The Alternate Payee shall have the duty to notify the Plan Administrator in writing of any changes in this mailing address subsequent to the entry of this Order. 7. The portion of the Participant's plan benefits payable to the Alternate Payee under this QDRO is $4,925 of the Participant's total account balance under the Plan as of December 14, 2005, together with investment gains or losses attributable thereon from December 14, 2005, until the date of distribution. 8. This QDRO does not require the Plan to provide any type or form of benefit the Plan does not otherwise provide. 9. This QDRO does not require the Plan to provide increased benefits. 10. This QDRO does not require the Plan to pay any benefits which another order previously determined to be a qualified domestic relations order requires the Plan to pay to another alternate payee. . 11. The Plan shall distribute to the Alternate Payee her benefits (as designated in Paragraph 7 of this Order), as soon as administratively feasible following the Plan Administrator's approval of this Order. 12. The distribution pursuant to an election by the Alternate Payee shall be a lump sum payment to her or a direct rollover to an Individual Retirement Account for her benefit. 13. On and after the date that this order is deemed to be a QDRO, 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 Plan beneficiaries, including, but not limited to, the right to name a beneficiary and the right to direct her Plan investments to the extent permitted under the Plan. 14. All payments made pursuant to this order shall be conditioned on the certification by the Alternate Payee and the Participant to the Plan Administrator of such information as the Plan Administrator may reasonably require from such parties. 15. It is the intention of the parties that this QDRO continue to qualify as a QDRO under Code g414(p), as it may be amended from time to time, and that the Plan Administrator shall reserve the right to reconfirm the qualified status of the order at the time benefits become payable hereunder. 16. In the event that the Plan inadvertently pays to the Participant any benefits that are assigned to the Alternate Payee pursuant to the terms of this order, the Participant shall i=ediately reimburse the Alternate Payee to the extent that he has received such benefit . ~! .. . QDRO Page 3 payments and shall forthwith pay such amount so received directly to the Alternate Payee within ten (10) days of receipt. In the event that the Plan inadvertently pays to the Alternate Payee any benefits that are assigned to the Participant pursuant to the terms of this order, the Alternate Payee shall immediately reimburse the Participant to the extent that she has received such benefit payments and shall forthwith pay such amount so received directly to the Participant within ten (10) day of receipt. 17. After payment of the amount required by this QDRO, the Alternate Payee shall have no further claim against the Participant's interest in the Plan. 18. The Alternate Payee assumes sole responsibility for the tax consequences of the distribution under this QDRO. 19. The Alternate Payee's right to the amount assigned to her under this QDRO shall not be affected by the Participant's death (whether before or after benefit payments to the Alternate Payee have commenced). In the event of the Alternate Payee's death prior to the co=encement of benefit payments to the Alternate Payee pursuant to this QDRO, the Plan shall pay the remaining benefits under this QDRO as soon as practicable to any beneficiary designated by the Alternate .Payee and recorded with the Plan Administrator under the terms of the Plan. If no designated beneficiary survives the Alternate Payee, benefits shall be paid to the Alternate Payee's estate. 20. The Plan shall treat this QDRO in accordance with Code ~414(p)(7). While the Plan is determining whether this order isa qualified domestic relations order, the Plan Administrator shall separately account for the amounts which would have been payable to the Alternate Payee while the Plan is determining the qualified status of this QDRO. 21. The Plan Administrator promptly shall notify the Participant and the Alternate Payee of the receipt ofthis QDRO and shall notify the Participant and the Alternate Payee of the Plan's procedures for determining the qualified status of this QDRO. The Plan Administrator shall determine the qualified status of the QDRO and shall notify the Participant and the Alternate Payee of the determination within a reasonable period of time after receipt of this QDRO. " <ii' . . . . . , QDRO Page 4 22. 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. Accepted and ordered this ao ~ day of ~~ , ~ CONSENT TO ORDER: PLAINTIFFIPARTIClPANT r;1~(}6 A'ITORNEY FOR PLAINTIFFI PARTIe T ~ l~i06 Date BY THE COURT ~.~/. ~,.'~ -. -'- '/.'.. ... ,/ Judge DEFE~,.,ANT/ALTERNATE PAYEE /) Cd" y ../7', ~ ... . \'4:. - , . -Signature A'ITORNEY FOR DEFENDANT! ALTERNATE PAYEE ?~.?J.~.~... . Signature . a~./ J 'i ~ 1f:1; C{, . S"~ {, Dat~ /'(1 . . " . ~yo~ ~ ~ 2 ~ ~*' -rJ '?o.oe'[ ~tf '-:',7) ,~~ II ,I ,_,' '''' .\~ i ",1 () n~,'l" -: c-. r, ,'" "-,,.' (::j ~_,Jl . 'j'!-! . . . JOHN E. YANKOWSKI, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 05-5734 SUZIE M. GORSE- YANKOWSKI, Defendant : CIVIL ACTION - LAW : IN DIVORCE PRAECIPE FOR WITHDRAWAL/ENTRY OF APPEARANCE TO THE PROTHONOTARY: Kindly withdraw my appearance on behalf of John E. Yankowski, the Plaintiff in the above-captioned matter. Respectfully Submitted: MARIA P. COGNETTI & ASSOCIATES Date: '7 ( 2-'1/ Db By: \~ KRISTOPHER T. SMULL, ESQUIRE Attorney J.D. No. 69140 210 Grandview Avenue, Suite 102 Camp Hill, P A 17011 Telephone No. (717) 909-4060 AHomcy for Plaintiff TO THE PROTHONOTARY: Kindly enter my appearance on behalf of John E. Yankowski, the Plaintiff in the above-captioned matter. Date: 112'1(06 By: J~O~ - o f; rc~ C-' 0" C) (.-) -\ I .:;.- -"'-, ~-,' f'.) ., -.l IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN E. YANKOWSKI, Plaintiff vs. : File No. 05-5734 Civil Term : IN DIVORCE SUZIE M. GORSE- YANKOWSKI, Defendant NOTICE TO RESUME PRIOR SURNAME Notice is hereby given that the Defendant, SUZIE M. GORSE- YANKOWSKI, in the above matter, after the entry of a Final Decree in Divorce dated July 18. 2006, hereby elects to resume the prior surname of SUZIE M. GORSE, and gives this written notice avowing her intention pursuant to the provisions of 54 P.S. 704. ~ ;JII Date: 1I/1~/D0 / Y[~;t1~V~ " SIgn ture / ! ' Vf1. i / STATE OF MICHIGAN ) COUNTY OF MACOMB ) '& '""' / On the I / '7. day of .tV c? cJ &;tI6Ci/L , 2006, before me, the Prothonotary or the notary public, personally appeared the above affiant 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 d~ L Prothonotary or Notary Public j/0l31t: IW.;II //fTVtrc-FG- / /V CJ//'1 f:7 jl V/.!Jvl C /1677#(;- /N j/--tO{O-'1/t5 (()uHJ A/lc/I #7 co fl(M/~J/()"'/ v~/,c(/:J ',J -/9 .-tJ8 1 ~ "iq. r-:> c:> '[ ~ (::..::') <:7' c:::l ~ r-{l c:' ~ D- r'v - ,< .....J ~ ~ " ~ ...0 ...c. - - t ., ~ CJ r0 -L... JOHN E. YANKOWSKI, Plaintiff/Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA VS. CIVIL ACTION - DIVORCE SUZANNE M. GORSE-YANKOWSKI, Defendant/Petitioner NO. 05-5734 CIVIL TERM IN DIVORCE PACSES # 905107830 $JRDER OF COURT AND NOW to wit, this 20th 4ay of March 2007, it is hereby Ordered that, the ! Cumberland County Domestic Relatipns Section dismiss their interest in the above captioned matter pursuant to the parties' prope~y settlement agreement of December 14, 2005 and the Respondent fulfilling his obligation tPr fifteen (15) months of alimony payments, with a credit of $76.94. BY THE COURT: Ed~ J. DRO: R.I. Shadday xc: Petitioner Respondent Robert B. Lieberman, Esq. Service Type: M Fonn OE-OOl Worker: 21005 C1 c; %\ -0 \.)"1 Oits :Z,t;,. (j;", ::..c C'c r- '-. ~C. ~~(;~ -.-. <.- .r :z, 2. ~ ~ ~ ...-i ~ ~~ '; ~\ ~ ~~ ~ ~ <p.. ~ ~ cJ" o L ORDER/NOTICE TOiWITHHOlD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 03/20/07 I Case Number (See Addendum for case summ4ry) : 905107830 05-5734 CIVIL a Original Order/Notice a Amended Order/Notice @ Terminate Order/Notice FCI USA INC 825 OLD TRAIL RD ETTERS PA 17319-9392 RE: YANKOWSKI, JOHN E. Employee/Obligor's Name (Last, First, Mil 286-60-0991 Employee/Obligor's Social Security Number 4847101583 Employee/Obligor's Case Identifier (See Addendum 101' plaintiH names associated with cases on attachment) Custodial Parent's Name (Last, First, Mil Employer/Withholder's Federal EIN Number See Addendum for dependent n4mes and birth dates associated with cases on attachment. I ORDER INFORMA TJON: This is an Order/Nqtice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Co~monwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee'sfobligor's income until further notice even if the Order/Notice is not issued by your State. . $ 0 . 00 per month in current supp~rt $ 0 . 00 per month in past-due sup~ort Arrears 12 weeks or greater? ayes (X) no $ 0 . 00 per month in current and past-due medical support $ 0.00 per month for genetic tes~osts $ per month in other (sped ) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to belin compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the f~lIowing to determine how much to withhold: $ 0.00 per weekly pay period. $ 0.00 per biweekly pay period (~very two weeks). $ 0.00 per semimonthly pay periQd (twice a month). $ 0.00 per monthly pay period. ! REMITTANCE INFORMATION: You must begin withholding no later than thf first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven m working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholdin~. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amournt, and your fee, cannot exceed 55% of the employee'sf 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.S4 ~ 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 SCPU Send check to: Pennsylvania SeDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLU E THE DEfENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Ide tifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL..~ BYTHECOUR~ Date of Order: ~R 2 1 20Ul ~ Edward E. Guido, Judge Form EN-028 Rev. 1 Worker 10 $IATT DRO: R.J. Shadday Service Type M OMB No.: 0970-0154 " ("" ... ADDITIONAL INFORMATIOIN TO EMPLOYERS AND OTHER WITHHOLDERS o If ~hecked you are required to provide a co~y of this form to your employee. If YOl,Jr employee works in a state that is different from the state that issued this order,! a copy must be provided to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has pr ority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order ha e priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld a ounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, howev r, separately identify the portion of the single payment that is attributable to each employee/obligor. 3. * Repolti',g tl,e PaydatefDate of \.Vitl.holdillg. You m~st report the paydatefdate of vvitl,holding when sendil.g ti,e payment. The . .. .. . You must comply with the law of the state of the employee's/obligor's principal place of empl yment 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:llf there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all s~pport Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal pl~ce of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) I 5. Termination Notification: You must promptly noti . the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a opy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER W RKS FOR: 0606699290 EMPLOYEE'S/OBLlGOR'S NAME: Y KOWSKI JOHN E. EMPLOYEE'S CASE IDENTIFIER: 4847 01583 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: I NEW EMPLOYER'S NAME/ADDRESS: r 6. Lump Sum Payments: You may be required to rep~rt and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump bum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Ordfr/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and othrr penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which casr 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 again~t 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. 91673 (b)1; or 2) the amou~ts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable tNeek1y earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social iSecurity taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuin~ 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 4 copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev. 1 Worker ID $IATT Service Type M OMB No.: 0970.{)154 ADDENDUM Summ~rv of Cases on Attachment I YANK01SKI, JOHN E. PACSES Case Number Plaintiff Name Defendant/Obligor: PACSES Case Number 905107830 Plaintiff Name SUZANNE M. GORSE-YANKOWSKI Docket Attachment Amount 05-5734 CIVIL$ 0.00 Child(ren)'s Name(s): [J>OB you are required to enroll the child(ren) i in any health insurance coverage availilble through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DaB you are required to enroll the in any health insurance coverage the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DaB If checked, you are required to enroll the child ren) in any health insurance coverage vailable employee's/obligor's employment. Addendum Service Type M OMB No.: 0970-0154 Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DaB you are required to enroll the child(ren) in any health insurance coverage available employee'slobligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DaB If checked, you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DaB If checked, you are required to enroll the child(ren) above in any health insurance coverage available employee'slobligor's employment. Form EN-028 Rev. 1 Worker ID $IATT (") ,...;) 0 c::::> C c:;::I " ~ ....,,; -T)CD ::x: ~~ n-lrr > ;:-:: ~".!~~- ;;:0 -:7 'j-.- N -o~ V:l~!: ~ -< .':- t~~:~' --{ -0 :r: +l ~~ i~~< :x 00 J>(: w am z ~ =2 U1 0 -<