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HomeMy WebLinkAbout02-1655CARLOS PABON : IN THE COURT OF COMMON PLEAS PLAINTIFF : CUMBERLAND COUNTY, PENNSYLVANIA VS CIVIL ACTION - DIVORCE SANDRA 1.DELGADO DEFENDANT : NO. pa NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for 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 first floor in the Dauphin Court Courthouse, Front and Market Streets, Harrisburg, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 CARLOS PABON : IN THE COURT OF COMMON PLEAS PLAINTIFF : CUMBERLAND COUNTY, PENNSYLVANIA VS CIVIL ACTION - DIVORCE SANDRA 1. DELGADO DEFENDANT : NO. (21 u COMPLAINT IN DIVORCE AND NOW, comes the Plaintiff, Carlos Pabon, by his attorney, Gail Guida Souders, Esquire, and pursuant to Section 3301 (d) of the Pennsylvania Divorce Code, seeks to obtain a Decree in Divorce from the Defendant, Sandra I. Delgado, upon the grounds set forth: COUNTI DIVORCE 1. The Plaintiff, Carlos Pabon, is an adult individual residing at 709 Cumberland Point Circle, Mechanicsburg, Cumberland County, Pennsylvania, 17055. 2. The Defendant, Sandra I. Delgado, is an adult individual residing at Suite 232 Calle Martinez #36, Juncos, Puerto Rico 00777. 3. Plaintiff have been bona fide resident of the Commonwealth of Pennsylvania for at least six (6) months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on March 15, 1989 in Puerto Rico. 5. Plaintiff has been advised of the availability of counseling and that Plaintiff may have the right to request that the Court require the parties to participate in counseling and does not request the same. 6. There have been no prior actions of divorce or annulment between the parties in this or any other jurisdiction. 7. The Plaintiff and Defendant are both citizens of the United States of America. States. 8. The Defendant is not a retired member of the Armed Services of the United 9. The parties have two children together; Louis Orlando Pabon, born June 11, 1990 and Karina I. Pabon, born July 14, 1992. 10. The Plaintiff avers that the grounds on which the action is based are: (a) That the marriage is irretrievably broken under 23 Pa. Const. Stat. § 3301(d). (b) The parties have been separated since May 1991. 11. The plaintiff requests this Honorable Court to enter a Decree of Divorce. WHEREFORE, Plaintiff requests your Honorable Court enter a Decree as follows dissolving the marriage between the parties. Respectfully submitted Gail Guida Souders Attorney for Plaintiff Guida Law Offices, P.C. 503 North Front Street Harrisburg, PA 17101 Supreme Court ID # 68740 I verify that the statements made in this Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities. 4,6 0? 1 P INTIFF DATE: GSJ5 Ca ATTORNEY FOR PLAINTIFF N? 5u f G so b. zx : 4 }? ,- + - ?r n c< ob v r7i e CARLOS PABON : IN THE COURT OF COMMON PLEAS PLAINTIFF : CUMBERLAND COUNTY, PENNSYLVANIA VS CIVIL ACTION - DIVORCE SANDRA I. DELGADO DEFENDANT : NO. 02-1655 Civil Term CERTIFICATE OF SERVICE I hereby certify that I am this day serving the Divorce Complaint and Plaintiff's Affidavit of Consent upon the persons and in the manner indicated below, which service satisfies the requirements of Pennsylvania Rule of Civil Procedure, 403: Service by U.S. mail to: Sandra I. Delgado Suite 232 Calle Martinez #36 Juncos, Puerto Rico 00777 Date: April 23, 2002 Gail Guida Souders Guida Law Offices, P.C. 503 N. Front St. Harrisburg, PA 17101 (717) 236-6440 Supreme Court ID #68740 r z m L" rn JUNC06 Pk 4i)' no Postage 107 M Certified Fee LM Return Receipt Fee (Endorsement Required) C3 C3 Restricted Delivery Fee p (Endorsement Required) O Total Peetege A Feel C3 ? N e (Please Pdnt Cleo m treeq Apt. No.; or PO 07 D Sroro, ZIP+4 • Cwnptete items 1, 2, and 3. Also complete Mm 4 if Restricted Delivery is desired. ¦ P1tnt your name aAd-address on the reverse so first we can_returgthe card to you. • AMch this clad t$ttVAftk of the mailpiece, or an the front If space permits. 1. AAaie Addressed to: &x(\drek_ --r• `De.\gado , k-\- - a', Q' Cc' U YY ofAi,n( -L 3 ,)XnccES, PW_,16o V-e c o (3O-11-1 Received by (Please Print OMW B. Dat Do" °:A Wature ? Agent n5. Is delivery addreea?Hferertt iron item 17?., Y? if YES, enter delivery address below: NOW 3. " Type eernnea Mail ? Express Mail ? Registered ? Return Receipt for MerchwAn ? Insured Mail ? C.O.D. 4. Restricted Delivery? (Extra Fee) ? Yes 2. (RWWWk= mservice how ?.U q?] 3?1?(? G6C? 53q 5?3 `? PS Form 3611, March 2001 Domestic Raton Receipt 10259"14A-140. rr- -c T L CARLOS PABON : IN THE COURT OF COMMON PLEAS PLAINTIFF : CUMBERLAND COUNTY, PENNSYLVANIA VS CIVIL ACTION - DIVORCE SANDRA I. DELGADO DEFENDANT :NO. 02-1655 Civil Terra AFFIDAVIT OF CONSENT 1. The parties to this action separated in May, 1991 and have continued to live separate and apart for a period of at least two years. 2. The marriage of plaintiff and defendant is irretrievably broken. 3. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. DATE (Plaintiff) N 0 C!>? t13 m r`y ? _..}( ?? N Uj IN THE COURT OF COMMON CARLOS PABON PLEAS CUMBERLAND PLAINTIFF COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE SANDRA I. DELGADO NO. 02-1655 CIVIL TERM DEFENDANT ---------------------------------------------------- ANSWER TO COMPLAINT COMES NOW, defendant who respectfully states and praises. 1. That the defendant objects and disagrees on the allegations of Paragraph 2 of the Complaint, because of the fact that she resides at Doctor Barrera Street, Apt. 1, Comer of Corchado, Juncos, Puerto Rico. 2. The defendant objects and disagrees to the allegations in Paragraph 4 of the Complaint due to the fact that the defendant was married to the Plaintiff on March P, 1990, in Puerto Rico, and not as stated in Paragraph 4, see Exhibit I. 3. The defendant objects and disagrees to the allegations in Paragraph 9, letter (b) in as much as, parties in the above mentioned case were separated and have been separated since March 1995. 4. Defendant alleges that the child support received for their 2 children: Louis Orlando Pab6n and Karina I. Pabbn was set at $50.00 a week by order of the court on January 4, 1994, see Exhibit II (A&B) and by the Administration for Child Support Enforcement of Puerto Rico, on December 11, 1997. The Plaintiff arrears for the amount of $10,781.84 5. The defendant demands an increase on the child support due to the increase of Cost of Living. 6. The Claimant demands a reasonable amount to be established for Alimony support not less than $200.00 per week. Respectfully submitted by Sandra Delgado, Defendant, residing at Doctor Barrera Street, Apt. 1, Juncos, Puerto Rico 00777. Y/Y SAND . DEI?GAW l ` , t E p :o t i , 3 r Y: . r y f EXHIBIT I D PARTAINIENTO DE SALUD awFARTMENT OF HEAL" PEGISTRO DBMOGRAFl00 (DEMOGRAPHIC REGISTRY) cERTIFICrFd'KON E ik ATR"d1ONIO R. a F.. M S i 4 1 Vv AIU? RC DL CEIFICADO 'CERTIFICATE NUMBER.) 152 199© 00050-005165-160070 NOMBRE DEL CONTRAYENI"E: (GROOM'S NAME) CARLOS PABON ARZUAGA EDAD (AGE) F'E'CHA NACIMIENTO (BIRTHRATE) 18 MAR 1971 LUGAR NACIMIENTO (BIRTHPLACE) f { S ., V ;^ j , y?1! ' a a< I'A,7ARI)O, PUERTO RICO E DEL PADRE (F'ATHER'S NAME) NOMBRE DE LA MADRE (MOTHER'S NAME) ivOMBR, ISMF?FL PABON ISABEL ARZUAGA Iuk DE LA CONTRAYENTE (BRIDE'S NAME) SANDRA IVETTE DELGADO RIVERA EDAD (AGE) II,iHA NACIMIENTO (BIR.THDATE) 16 EN'F; 1974 r UGAR NACIMIENTO (BIRTHPLACE) CAGUAS, PUERTO RICO NOMBRL DEL PADRE (F'ATHER'S NAME) NOMBRE DE LA MADRE (MOTHER'S NAME) G :[ L2=0 DELGADO I SABEL RI VERA LUGAR ;E CEI,EBRACION (CELEBRATION PLACE) )-WCQS, PUER"T"O RICO 7 CE'CHAS (DATES): CELEBRATION (CELEBRATION) 03 MAR 199(} P ''fit'? EXPEDICION (DATE ISSUED) " i.) Ji!DI 2007. k INSCRIPCION (REGISTRATION) 09 MAR 1990 r-? t { ?z * * 'A' * '?[ }' fk' '?(' ?( ?' •A• `k ?( '1' 'rf '?(' '!!' 'If ?' .k yY '?1..'A..I?('?[ ?" '11 'If ? *? ?' lS' *.? 1?' 'M' '?( 1?'ii '/i I( .x. 'A'..k '?{' 'k ** Nf f -114 4XI 7 I, iBDV 3t7'k,NCAA: 9 l L , 47t' fiNt "('. ICI r! R K: I+kq:5 AP'n?•' i. I a qp. n! f. e? r sAg „a!Igho u? rtau..?c. b ando Solud... ca tv Vida cv6aer aYi?rs.a.:ia?a.? );rofr?d?Eya is 9 i n r yA, rwww+r?" P L AA ?+is. 7: per` y Yl,.'e?{ ?? v ?i } F% 9 ?:8?? ? ? ?•• 7 { Via! ??, I y + v i5 esta IN THE EXHIBIT II A COURT OF COMMON PLEAS OF DAUPHIN COUNTY DOMESTIC RELATIONS SECTION iuphin Claim Settlement for: . 011,(,JJrc Obligee ui rh iC iiLtw((U $ OHICE 2 6 1994 - Case No. 190959 NO. 11)4Z W `13 V. Civil-Action - Support Cur105 PC" ? on Obligor ORDER OF SUPPORT AND NOW 3cvnuar V 9 I ??l -1 + the Obli or in the abo - g ve entitled case is hereby directed to pay the sum of $ 50.001-N5.000,1 arrec,rs per week effec tive ?-3u-`I3 for the support of tya _ Lu-s 0• Patron L-11-to a^0 Karma .I. P?bon (j 2-, ?F The Obligor's wages are/are not hereby attached for said support obligation. If arrearages on the Order accumulate to an amount equal to four. (4) weeks of support, a wage attachment shall automatically be issued against the Obligor for payment of support plus arrearages without further notice. Both parties are hereby notified that they are under a continuing obligation to inform the Domestic Relations Section of any change of address or employment. Failure to do so shall be a violation of this Order. Violation of this Order may result in imprisonment of up to six (6) month. Either party may within ten days after the mailing of the notice of entry of the Order file a written demand with the Domestic Relations Section for a hearing before the Court. Court Costs of $ 55,00 are to be paid by the Obligor within thirty (30) days of this Order. Obligor to provide medical. coverage for chi.ld/childr.en when available at reasonable cost through employer.. BY T}IE CO(JI2T: J. Dom. ReI. - 6 11 A EXHIBIT II B Departamento de la Familia ADMINISTRACION PARA EL SUSTENTO DE MENORES San Juan, Puerto Rico ASUME 30 DE MAYO DE 2002 MAY 30, 2002 Nombre y direction del Solicitante Name and address of Applicant SANDRA I. DELGADO RIVERA JUNCO PR 00777 Peticionario(a): SANDRA DELGADO RIVERA Petitioner Peticionado(a): CARLOS PABON ARZUAGA Respondent Numero de Caso: 0024660 Case Number Region: HUMACAO Region Numero de caso ASUME: 0024660 ASUME Case Number CERTIFICACION DE ESTADO DE CUENTA CERTIFIED STATEMENT OF ACCOUNT Nuestro expendiente demuestran que el estado de pagos por concepto de pensiones alimentarias, en el caso de referencia, es el siguiente al dla de hoy: Our records show that the statement of child support payments on the above referenced case is the following to this date: rl Sentencia ® Orden ® Resolucion Judgement Order Resolution Fecha de efectividad de la Sentencia, Orden o Resolucion: 11 DE DICIEMBRE DE 1997 Date of effectiveness of Judgement, Order or Resolution: DECEMBER 11, 1997 Pension alimentaria fijada:$ 50.00 Amount of Child Support ordered: $ 50.00 Frecuencla de pago:/Frequency of payment: SEMANALNVEEKLY Balance: $ 10781.84 Balance: $ 10781.84 Fecha de veri verificacion:30 DE MAYO DE 2002 Date of verification: MAY 30, 2002 i= Certif(co que este documento resume la information contenida en el sistem ecaf izad (PRACSES) de la Administration para el Sustento de Menores. Podra ser corroborada a tr 6.%.* enores (636- 6737) de lunes a viemes de 8:00 am- 4:30pm. Pagos hechos contrario a la de'r estah ecid a consideran voluntarios y no pagos a la pension alimentaria. Deder6 acudir al foro co poly dient? ra el solicitar el que Be le de crdidito por las mismas. 4-- i yy I certify that this document summarizes the information contained on the automated files (PRACSES system) of the AdminiAe;; f OhifB Eforcement. By calling 1.800-636.6737 rno ay thru friday from 8:00 am to 4:30 pm. Payments. made contrary to the establisshed orden are considered voluntary and not child support payments. You must go to tpb g0propiate forum to request credit for these payments. JACKEL)NE ARZUAGA BETANCOURT Funcionario/Authorized Officer ASUME OFICINA LOCAL DE JUNCOS II, PO BOX 507 JUNCOS PR 00777 ¦ (787) 734-5075 ASM-510 Rw. 07/01 o ?? `_ ? =? t;,? ? ? o _?iQ r'S_ ?= •_>c'S ?? ?? ? ?Y; o? ;? w ?m CARLOSPABON PLAINTIFF VS SANDRA 1. DELGADO DEFENDANT : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 02-1655 Civil Term Counter-Affidavit under § 3301 (d) of the divorce code 1. Check either (a) or (b): ? (a) I do not oppose the entry of a divorce decree. ? (b) I oppose the entry of a divorce decree because (Check (i), (ii) or both): ? (i) The parties to this action have not lived separate and apart for a period of at least two years. A (ii) The marriage is not irretrievably broken. 2. Check either (a) or (b): ? (a) I do not wish to make any claims for economic relief. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. (b) I wish to claim economic relief which may include alimony, division of property, lawyer's fees or expenses or other important rights. I understand that in addition to checking (b) above, I must also file all of my economic claims with the prothonotary in writing and serve them on the other party. If I fail to do so before the date set forth on the Notice of Intention To Request Divorce Decree, the divorce decree may be entered without further delay. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unworn falsification to authorities. DATE .Tine 7, 9009 _)Oal ho AFFIDAVIT NO. 7F236 (Defendant) NOTICE: IF YOU DO NOT WISH TO OPPOSE THE ENTRY OF A DIVORCE DECREE AND YOU DO NOT WISH TO MAKE ANY CLAIM FOR ECONOMIC RELIEF, YOU SHOULD NOT FILE THIS COUNTER-AFFIDAVIT. Sworn and subscribed on to me by Sandra I. Delgado Rivera, whom is personally known to me to be the individual described on this day 7th of June of 2002, through her respective identification, Social Security #: 581-45-5649. CARLOS PABON, Plaintiff/Respondent V. SANDRA L DELGADO, Defendant/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION IN DIVORCE NO. 02 - 1655 CIVIL TERM AMENDED ANSWER AND COUNTERCLAIM AND NOW comes Sandra I. Delgado, the defendant/petitioner in the above-captioned divorce action, by and through her attorneys, the Family Law Clinic, and sets forth the following Amended Answer and Counterclaim pursuant to Pa.R.C.P. No. 1920.14 and 1920.15: AMENDED ANSWER 1. Admitted. 2. Denied. Defendant resides at Doctor Barrera Street, Apt. 1, Comer of Corchado, Juncos, Puerto Rico. Defendant's mailing address is Suite 232, Calle Martinez 1#36, Juncos, Puerto Rico 00777. 3. Admitted. 4. Denied. Plaintiff and Defendant were married on March 3, 1990 in Puerto Rico. 5. Defendant has no information or knowledge of this fact. 6. Denied. Defendant had previously filed an action in divorce in Puerto Rico in or about February of 2001, but dismissed that action. 7. Admitted. 8. Admitted. 9. Admitted. 10. Admitted as to paragraph (a). Denied as to paragraph (b). The parties separated in March of 1995. 11. Admitted. COUNTERCLAIM Count I - Alimony 12. Petitioner, Sandra Delgado, and Respondent, Carlos Pabon, were married on March 3, 1990 in Puerto Rico. 13. Petitioner currently resides in Puerto Rico. Respondent currently resides in Cumberland County, Pennsylvania. 14. On or about April 4, 2002, Respondent filed a Complaint in Divorce in Cumberland County, Pennsylvania. 15. On or about June 10, 2002, Petitioner filed an Answer and Counter-Affidavit through an attorney in Puerto Rico stating that she wanted to file an economic claim for alimony. 16. Petitioner subsequently obtained representation in Cumberland County, Pennsylvania at the Family Law Clinic, which provides free legal services to those who qualify. The Family Law Clinic entered its appearance in this matter on July 22, 2002. 17. Petitioner is unemployed and receiving public assistance in the form of food stamps and public housing. 18• Petitioner receives child support from Respondent in the amount of fifty dollars per week and an additional five dollars per week for arrearages. 19. Petitioner was not employed during the course of the parties marriage or since the separation of the parties. The parties agreed that Petitioner would stay at home and care for the parties' children. 20. Petitioner does not have a college education or any other post-high school training. 21. Respondent is employed and is financially able to provide for the reasonable needs of the Petitioner. 22. Petitioner requires reasonable support to adequately maintain herself in accordance with the standards of living established during the marriage. 23• Petitioner lacks sufficient property to provide for her reasonable needs and is unable to support herself through full-time employment. 24• Petitioner incorporates herein paragraphs 12 through 23. 25. Petitioner has incurred counsel fees in Puerto Rico along with other costs and expenses in defending this action and prosecuting her claim. 26• Petitioner is not in a financial position to meet the costs and expenses of defending this action and prosecuting her claim. 27. Petitioner believes that Respondent has the financial means to pay the counsel fees, costs and expenses of Petitioner. 28. Petitioner requires an award of alimony pendente lite to adequately maintain herself and remain on equal footing with Respondent during the pendency of the divorce proceeding. WHEREFORE, Petitioner requests that the Court enter an award of reasonable alimony, alimony pendente lite, counsel fees, costs and expenses, and such other relief as the Court deems just. 2 OZ Date Respectfully submitted, Jennifer everly Certified Legal Intern OM PLACE ROBER E. RAINS LUCY JOHNSTON-WALSH Supervising Attorneys FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717) 243-2968 VERIFICATION I verify that the statements made in this Petition for Alimony are true and correct to the best of my personal knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C. S. §4904, relating to unsworn falsification to authorities. Date Q?cC' Sandra I. Delgado Defendant/Petitioner CERTIFICATE OF SERVICE I, Jennifer Heverly, Certified Legal Intern, Family Law Clinic, hereby certify that I served a true and correct copy of the Amended Answer and Counterclaim in Alimony on Gail Guida Souders, Esq. of Guida Law Offices, 503 North Street, Harrisburg, PA 17101, by depositing a copy of the same in the United States mail, postage prepaid, this 224 day of 2002. Jennifer everly Certified Legal Intern THE FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717) 243-2968 LL N 1.A.Ir ) • 'l cv k 5 1?? CARLOS PABON, Plaintiff/Respondent V. SANDRA I. DELGADO, Defendant/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION IN DIVORCE NO. 02 - 1655 CIVIL TERM PRAECIPE TO PROCEED IN FORMA PAUPERIS To the Prothonotary: Kindly allow Sandra L Delgado, Defendant/Petitioner in the above-captioned action, to proceed in forma pauperis. The Family Law Clinic, attorneys for the parry proceeding in forma pauperis, certifies that we believe the party is unable to pay the costs and that we are providing free legal service to the party. Respectfully submitted, LZZ Date (:::? ? '!C? Jennife everly Certified Legal Intern 4_cc?, THOI.PLACE ROBn E. RAINS LUCY JOHNSTON-WALSH Supervising Attorney FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 717-243-2968 C .i CARLOS PABON, Plaintiff V. SANDRA I.DELGADO, Defendant To the Prothonotary: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION IN DIVORCE NO. 02 - 1655 CIVIL TERM PRAECIPE TO ENTER APPEARANCE Please enter the appearance of the Family Law Clinic on behalf of Sandra I. Delgado, the Defendant in the above captioned matter. ZZ 102, Date Jenm er everly Certified Legal Intern Gum. R BE E INS THOMAS M. PLACE LUCY JOHNSTON-WALSH Supervising Attorney FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 717/243-2968 CERTIFICATE OF SERVICE I, Jennifer Heverly, Certified Legal Intern, Family Law Clinic, hereby certify that I am serving a true and correct copy of Praecipe to Enter Appearance on Gail Guida Souders, Esq., at Guida Law Offices, 503 North Street, Harrisburg, PA 17101, by depositing a copy of the same in the United States mail, First Class, postage prepaid, this day of 2002. Jenni er ever y Certifie Legal Intern THE FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717) 243-2968 ? N ?? .{ tom 'Cr . CARLOS PABON, Plaintiff/Respondent V. SANDRA I. DELGADO, Defendant/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION IN DIVORCE NO. 02 - 1655 CIVIL TERM AMENDED ANSWER AND COUNTERCLAIM AND NOW comes Sandra I. Delgado, the defendant/petitioner in the above-captioned divorce action, by and through her attorneys, the Family Law Clinic, and sets forth the following Amended Answer and Counterclaim pursuant to Pa. R.C.P. No. 1920.14 and 1920.15: AMENDED ANSWER 1. Admitted. 2. Denied. Defendant resides at Doctor Barrera Street, Apt. 1, Comer of Corchado, Juncos, Puerto Rico. Defendant's mailing address is Suite 232, Calle Martinez #36, Juncos, Puerto Rico 00777. 3. Admitted. 4. Denied. Plaintiff and Defendant were married on March 3, 1990 in Puerto Rico. 5. Defendant has no information or knowledge of this fact. 6. Denied. Defendant had previously filed an action in divorce in Puerto Rico in or about February of 2001, but dismissed that action. 7. Admitted. 8. Admitted. 9. Admitted. 10. Admitted as to paragraph (a). Denied as to paragraph (b). The parties separated in March of 1995. 11. Admitted. COUNTERCLAIM Count I - Alimony 12. Petitioner, Sandra Delgado, and Respondent, Carlos Pabon, were married on March 3, 1990 in Puerto Rico. 13. Petitioner currently resides in Puerto Rico. Respondent currently resides in Cumberland County, Pennsylvania. 14. On or about April 4, 2002, Respondent filed a Complaint in Divorce in Cumberland County, Pennsylvania. 15. On or about June 10, 2002, Petitioner filed an Answer and Counter-Affidavit through an attorney in Puerto Rico stating that she wanted to file an economic claim for alimony. 16. Petitioner subsequently obtained representation in Cumberland County, Pennsylvania at the Family Law Clinic, which provides free legal services to those who qualify. The Family Law Clinic entered its appearance in this matter on July 22, 2002. 17. Petitioner is unemployed and receiving public assistance in the form of food stamps and public housing. 18. Petitioner receives child support from Respondent in the amount of fifty dollars per week and an additional five dollars per week for arrearages. 19. Petitioner was not employed during the course of the parties marriage or since the separation of the parties. The parties agreed that Petitioner would stay at home and care for the parties' children. 20. Petitioner does not have a college education or any other post-high school training. 21. Respondent is employed and is financially able to provide for the reasonable needs of the Petitioner. 22. Petitioner requires reasonable support to adequately maintain herself in accordance with the standards of living established during the marriage. 23. Petitioner lacks sufficient property to provide for her reasonable needs and is unable to support herself through full-time employment. Count II - Alimony Pendente Lite and Counsel Fees, Costs, and Expenses 24. Petitioner incorporates herein paragraphs 12 through 23. 25. Petitioner has incurred counsel fees in Puerto Rico along with other costs and expenses in defending this action and prosecuting her claim. 26. Petitioner is not in a financial position to meet the costs and expenses of defending this action and prosecuting her claim. 27. Petitioner believes that Respondent has the financial means to pay the counsel fees, costs and expenses of Petitioner. 28. Petitioner requires an award of alimony pendente lite to adequately maintain herself and remain on equal footing with Respondent during the pendency of the divorce proceeding. WHEREFORE, Petitioner requests that the Court enter an award of reasonable alimony, alimony pendente lite, counsel fees, costs and expenses, and such other relief as the Court deems just. Respectfully submitted, n' Z _C??Q raiLq:?? Date Jennif Heverly Certified Legal Intern THO . PLACE ROBE E. RAINS LUCY JOHNSTON-WALSH Supervising Attorneys FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717) 243-2968 VERIFICATION I verify that the statements made in this Petition for Alimony are true and correct to the best of my personal knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C. S. §4904, relating to unsworn falsification to authorities. /Oz Da Sandra I. D lgado Defendant/Petitioner CERTIFICATE OF SERVICE I, Jennifer Heverly, Certified Legal Intern, Family Law Clinic, hereby certify that I served a true and correct copy of the Amended Answer and Counterclaim in Alimony on Gail Guida Souders, Esq. of Guida Law Offices, 503 North Street, Harrisburg, PA 17101, by depositing a copy of the same in the United States mail, postage prepaid, this 2Zv-J day of w 2002. CID Jennifer, everly Certified Legal Intern THE FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717) 243-2968 yl'., ? n C N b :V:13 rTl -Z7 M cn y__? f CARLOS PABON, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 2002-1655 CIVIL TERM SANDRA L DELGADO, IN DIVORCE Defendant/Petitioner DR# 32149 Pacses# 127104941 ORDER OF COURT AND NOW, this 22nd day of October, 2002, upon consideration of the attached Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shaddav on November 22, 2002 at 10.30 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11® (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, George E. Hoffer, President Judge Mail copies on Petitioner 10-22-02 to: < Respondent Lucy Johnston-Walsh Gail Souders, Esquire fA / Date of Order: October 22, 2002 '? R. J. Sh• delay, Conference Officer YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 O,pj& c ? CD 2 r'' . GUIDA LAW OFFICES, P.C. 503 NORTH FRONT STREET HARRISBURG, PA 17101 GAIL GUIDA SOUDERS, ESQUIRE PHONE: (717) 236-6440 FAX: (717) 236-9599 November 4, 2002 Re: Pabon v. Delgado I hereby release Gail Guida Souders, Esquire as my attorney in the case docketed at 02-1655 Civil Term. ?? o -nom Date Carlos abon % . J E;= 7 rn_ r jil Cn In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SANDRA DELGADO ) Order Number 2002-1655 CV Plaintiff ) VS. ) PACSES Case Number 127104941/3 Iy9 CARLOS PABON ) Docket Number 02-1655 CIVIL Defendant ) Other State ID Number ORDER OF COURT 0 Final ® Interim 0 Modified AND NOW, 22ND DAY OF NOVEMBER, 2002 based upon the Court's determination that the Payee's monthly net income is $ 790.46 and the Payor's monthly net income is $ 2, 988.11 , it is hereby ordered that the Payor pay to the Pennsylvania State Collection and Disbursement Unit FOUR HUNDRED TWENTY THREE AND 67/100 Dollars ($ 423.67 ) a month payable MONTHLY as follows: first payment due NEXT PAY DATE. The effective date of the order is 10/11/02 . Arrears set at $ 804.00 as of NOVEMBER 22, 2002 are due in full IMMEDIATELY. All terms of this Order are subject to collection and/or enforcement by contempt proceedings, credit bureau reporting, tax refund offset certification, driver's license revocation, and the freeze and seize of financial assets. These enforcement/collection mechanisms will not be initiated as long as obligor does not owe overdue support. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all the means listed above. For the Support of: Name SANDRA DELGADO Form OE-518 Service Type M Worker ID 21005 VNVAIASWd ,vr;nr nNl?nwP9,vino U :C Wd 9 Z AON ZO n ,, 3K)I14 -i7'_I1J DELGADO V. PABON PACSES Case Number: 127104941 The defendant owes a total Of $ 423.67 per month payable MONTHLY ' $ 402.00 for current support and $ 21.67 for arrears. The defendant must also pay fees/costs as indicated below. This order is allocated and monies are to be applied as follows: Frequency Codes: 1 =One Time B =BiWeekly 2 =Bi-Monthly 5=Semi-Annually S =Semi-Monthly A=Annuall S M=Monthly Q=Quarterly Payment Amount/ Y W =Weekly FEr (] it nr Deht Tvn D srr' tinn $402.00 /M ALI PEND LITE SANDRA DELGADO $ 0.00 / $ 0.00 / $ 0.00 / $0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / Said money to be turned over by the Pa SCDU to: SANDRA DELGADO . Payments must be made by check or money order. All checks and money orders must be made payable to Pa SCDU and mailed to: Pa SCDU P.O. Box 69110 Harrisburg, Pa 17106-9110 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. Service Type M Page 2 of 4 Form 0E-518 Worker ID 21005 DELGADO V. PABON PACSES Case Number: 127104941 Unreimbursed medical expenses that exceed $250.00 annually per child and/or spouse are to be paid as follows: o % by defendant and 100 % by plaintiff. The plaintiff is responsible to pay the first $250.00 annually (per child and/or spouse) in unreimbursed medical expenses. O Defendant0 Plaintiff ® Neither panty to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the QPlaintiff O Defendant shall submit to the person having custody of the child(ren) written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of : 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any, cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. Other Conditions: THIS ORDER IS BASED UPON THE CALCULATIONS USED IN THE DOMESTIC RELATIONS SECTION, COURT OF COMMON PLEAS, DAUPHIN COUNTY PENNSYLVANIA ORDER OF CHILD SUPPORT ON NOVEMBER 8, 2002 FOR THE PARTIES TWO CHILDREN. Defendant shall pay the following fees: Fee Total Fee De_crsTntion $0.00 for PavmeT mamma $0.00 for Payable at $ o . c o per $0.00 for Payable at $ 0. 0 0 per $0.00 for Payable at $ o . o o per $0.00 for Payable at $ o . o 0 per Payable at $ o . o 0 per Service Type M Page 3 of 4 Form OE-518 Worker ID 21005 DELGADO V. PABON PACSES Case Number: 127104943 IMPORTANT LEGAL NOTICE PARTIES MUST WITHIN SEVEN DAYS INFORM THE DOMESTIC :RELATIONS SECTION AND THE OTHER PARTIES, IN WRITING, OF ANY MATERIAL CHANGE IN CIRCUMSTANCES RELEVANT TO THE LEVEL OF SUPPORT OR THE ADMINISTRATION OF THE; SUPPORT ORDER, INCLUDING, BUT NOT LIMITED TO, LOSS OR CHANGE OF INCOME OR EMPLOYMENT AND CHANGE OF PERSONAL ADDRESS OR CHANGE OF ADDRESS OF ANY CHILD RECEIVING SUPPORT. A PARTY WHO WILLFULLY FAILS TO REPORT A MATERIAL CHANGE IN CIRCUMSTANCES MAY BE ADJUDGED IN CONTEMPT OF COURT, AND MAYBE FINED OR IMPRISONED. PENNSYLVANIA LAW PROVIDES THAT ALL SUPPORT ORDERS SHALL BE REVIEWED AT LEAST ONCE EVERY THREE (3) YEARS IF SUCH REVIEW IS REQUESTED BY ONE OF THE PARTIES. IF YOU WISH TO REQUEST A REVIEW AND ADJUSTMENT OF YOUR ORDER, YOU MUST DO THE FOLLOWING: CALL YOUR ATTORNEY. AN UNREPRESENTED PERSON WHO WANTS TO MODIFY (ADJUST) A SUPPORT ORDER SHOULD CONTACT THE DOMESTIC RELATIONS SECTION. ALL CHARGING ORDERS FOR SPOUSAL SUPPORT AND ALIMONY PENDENTE LITE, INCLUDING UNALLOCATED ORDERS FOR CHILD AND SPOUSAL SUPPORT OR CHILD SUPPORT AND ALIMONY PENDENTE LITE, SHALL TERMINATE UPON DEATH OF THE PAYEE. A MANDATORY INCOME ATTACHMENT WILL ISSUE UNLESS THE DEFENDANT IS NOT IN ARREARS IN PAYMENT IN AN AMOUNT EQUAL TO OR GREATER THAN ONE MONTH'S SUPPORT OBLIGATION AND (1) THE COURT FINDS THAT THERE IS GOOD CAUSE NOT TO REQUIRE IMMEDIATE INCOME WITHHOLDING; OR (2) A WRITTEN AGREEMENT IS REACHED BETWEEN THE PARTIES WHICH PROVIDES FOR AN ALTERNATE ARRANGEMENT. UNPAID ARREARAGE BALANCES MAY BE REPORTED TO CREDIT AGENCIES. ON AND AFTER THE DATE IT IS DUE, EACH UNPAID SUPPORT PAYMENT SHALL CONSTITUTE, BY OPERATION OF LAW, A JUDGMENT AGAINST YOU, AS WIELL AS A LIEN AGAINST REAL PROPERTY. IT IS FURTHER ORDERED that, upon payor's failure to comply with this order, payor may be arrested and brought before the Court for a Contempt hearing; payor's wages, salary, commissions, and/or income may be attached in accordance with law; this Order will be increased without further hearing by o % a month until all arrearages are paid in full. Payor is responsible for court costs and fees. Copies delivered to parties . Date Consented: Plaintiff Defendant DRO: RJ Shadday xc: plaintiff defendant Lucy Johnston-Walsh, Esquire Gail Souders, Esquire Plaintiff's Attorney Defendant's Attorney BY THE CO Vr.Y? t1 r d-ar?nuJF?lf Edward E. G-iido Judge Page 4 of 4 Form OE-518 Service Type M Worker ID 21005 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT ])/-/o -/155 ??!!//L State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 11/22/02 Tribunal/Case Number (See Addendum for case summary) Employer/withholder's Federal EIN Number ATLAS ROOFING PAYROLL 817 SPANGLER RD CAMP HILL PA 17011-5823 RE: PABON, CARLOS @ Original Order/Notice O Amended Order/Notice O Terminate Order/Notice Employee/Obligor's Name (Last, First, MI) 262-67-8766 Employee/Obligor's Social Security Number 6498000212 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases at attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 402.00 per month in current support $ 21.67 per month in past-due support Arrears 12 weeks or greater? Dyes ® no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ . per month in other (specify) for a total of $ 423 , 87 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: $ 97.77 per weekly pay period. $ 195.54 per biweekly pay period (every two weeks). $ 211.84 per semimonthly pay period (twice a month). $ 423.67 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate%late of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance, Payable to: PA SCDU. Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S 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: NDy 4 0 2002 Service Type M BY THE COURT Form EN-028 OMB No. 0970-m54 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If heck you are required, to provide a opy of this form to your em loyee. If yo r employee works in a state that is dierent from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor, 4.* M V1 WILI II IVIU 1115 VV.4.1I JGnUU.b,.... Vu,...... ..... paydate/date of withholding is the date on whieh amount was withileld from thr e'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. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee%bligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and, return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME: PABON. CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a .tine determined under State law for discharging an employee obligor from employment, refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal' Consumer Credit Protection Act (15 U.S.C. §1673 01; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: If you or your ernployee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet ww%v.childsupport.state.pa.us Page 2 of 2 Form EN-028 Service Type M OMUNo.:OW0,01s4 Worker ID $1ATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PABON, CARLOS PACSES Case Number 127104941"; wv9 PACSES Case Number Plaintiff Name Plaintiff Name_ SANDRA DELGADO Docket Attachment Amount Docket Attachment Amount 02-1655 CIVIL$ 423.67 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB n F,- r N 7a t. r'eL ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT -2?&- 26da - /&S7`- C? / State Commonwealth of Pennsylvania Pw? f Co./City/Dist. of CUMBERLAND Date of Order/Notice 01/06/03 Tribunal/Case Number (See Addendum for case summary)l-- kf S (?g9,006696 EmployerAVithholder's Federal EIN Number RE: PABON, CARLOS O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice Employee/Obligor's Name (Last, First, MI) 262-67-8766 Employee/Obligor's Social Security Number ATLAS ROOFING 6498000212 PAYROLL Employee/Obligor's Case Identifier 817 S PANGLER RD (See Addendum for plaintiff names CAMP HILL PA 17011-5823 associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1, 261.00 per month in current support $ 129.67 per month in past-due support Arrears 12 weeks or greater? Oyes Q no $ 0.00 per month in medical support $ 0 .00 per month for genetic test costs $ per month in other (specify) for a total of $ 1, 390.67 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 320.92 per weekly pay period. $ 641.85 per biweekly pay period (every two weeks). $ 695.34 per semimonthly pay period (twice a month). $ 1.390.67 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing, the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S 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 CO? Date of Order: N 7 ji Z7 / IG `?! r Form EN-028 Service Type M? ?.?,No.:0970-0154 Worker ID 21005 % -'j .173 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If?hecko you are required to provide a copy of this form to your mployee. If yo r employee works in a state that is di erent Trom the state that issued this order, a copy must be provi?ed to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* gem You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME: PABON, CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor 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. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT Service Type M Page 2 of 2 OMB No.: 0970-0154 Form EN-028 Worker ID 2100-9 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PABON, CARLOS PACSES Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 423.67 Child(ren)'s Name(s): DOB PACKS Case Number 699000690 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 666 S 1993 $ 967.00 Child(ren)'s Name(s): DOB PABON LUIS O. 06/11/90. , ?A12SMA; I . PAT?f7? ... 07;??.4 X9.2 ?if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ............... ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID 21005 OMB No.: 0970-0154 C) 1. t Ct l cn CARLOS PABON, VS. IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA SANDRA L. DELGADO, Defendant CIVIL ACTION -DIVORCE NO. 024655 CIVIL TERM : IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under §3301(c) of the Divorce Code was filed on April 4, 2002. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. 3. 1 consent to the entry of a final Decree in Divorce after service of notice of intention to request entry of the Decree. I verify that the statements made in this Affidavit are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to authorities. -tlds Pab ,Plaintiff Date: as -03 w N _ Cxi `?i -OCO 20i ? { YC~ ; iN CARLOS PABON, Plaintiff VS. SANDRA L. DELGADO, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION - DIVORCE : NO. 02-1655 CIVIL TERM IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 13301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final Decree of Divorce without notice. 2. 1 understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. 1 understand that I will not be divorced until a Divorce Decree is entered by the Court and that a copy of the Decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Affidavit are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to authorities. Carl Pabon Plaintiff Date: 0 C---) ::) C to -c r ue ?- ? ? .'[s ?, .? ? - Earn c f) ? f?3 4aCIi In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Defendant Name: CARLOS PABON Member ID Number: 6498000212 Please note: All correspondence must include the Member ID Number. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name SANDRA DELGADO SANDRA DELGADO PACSES Docket Case Number Number 127104941 02-1655 CIVIL 699000690 66E S 1993 TOTAL ATTACHMENT AMOUNT: Attachment Amount/Fregi ency $ 423.67 /MONTH` $ 967.00 MONTH / $ 1,390.67 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 320 . 92 per week, or 5 5 of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLO S PABON Soc ial Security Number 2 6 2- 6 7- 8 7 6 6, Member ID Number 6498000212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/ot support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673 (b)(2) and 23 Pa. C.S.A. § 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 16, 2003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: NLAR 1 a 2003 JUDGE Form EN-530 Service Type M Worker ID $IATT ?, -? - ?? ? _=_, ,? f, __ .. ;. CCU -- ? ?, , ti` _ -?? - - .? ? c.? _? . _ ? a„i ?? -% CARLOS PABON, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION : IN DIVORCE SANDRA I. DELGADO, : NO. 02 - 1655 CIVIL TERM Defendant/Petitioner MARITAL SETTLEMENT AGREEMENT THIS AGREEMENT, is made this day of 2003, between Plaintiff, Carlos Pabon ("Husband"), and Defendant, Sandra I. Delgado ("Wife"). WHEREAS, Husband and Wife desire to enter into an agreement as to all economic issues between the parties, except child support which is docketed at Delgado v. Pabon, Docket No. 15020 DR 93, PACSES Case Number 699000690, and except as set forth below, and to have this agreement made an Order of Court; NOW, THEREFORE, Wife and Husband, each intending to be legally bound hereby, agree as follows: DIVORCE The parties have lived separate and apart since March 1995. 2. Each party will execute an Affidavit of Consent and a Waiver of Notice of Intent to Request Divorce Decree within ten (10) days of the signing of this Agreement. INCOME TAX This Agreement does not relate to or resolve in any way, any federal, state or local income tax liability that either or both of the parties may have to taxing authorities, or any potential liability that either has to the other regarding income tax. DEBTS 4. Except as otherwise identified in this agreement, the parties represent and warrant to one another that they are not aware of any other items of marital debt. PERSONAL PROPERTY All clothing, personal property and household fumishings have been divided between the parties to their mutual satisfaction, and neither party will make any claim to such items that are now in the possession or control of the other. MEDICAL COVERAGE 6. Husband shall provide medical coverage for the parties' children. Husband is currently insured through his employer, Atlas Roofing Corporation, by Aetna. Husband shall pay the necessary premiums for the children to be insured. Husband shall provide wife with insurance cards for the children within 30 days of the signing of this agreement. ALIMONY PENDENTE LITIS COSTS, COUNSEL FEES, ALIMONY 7. Husband shall continue to pay alimony pendente lite, as ordered by the Court, until the divorce is final. Wife agrees to forgive arrears the husband accrued in alimony pendente lite, in the amount of $1,000. 8. After the divorce decree is entered, husband shall pay wife alimony in a total amount of $9,600. The parties agree that husband has a seasonal work schedule. Therefore, the parties agree to the following schedule: Husband shall pay wife $950 per month from December to May. The breakdown of the payment is as follows: $722.58 for child support, $91 for child support arrears, and $136.42 for medical coverage of the children. Husband shall pay wife $1,525 per month from June to ]November. The breakdown of the payment is as follows: $722.58 for child support, $108 for child support arrears, $136.42 for medical coverage of the children, and $558 for alimony. Time is of the essence. If husband misses a payment by more than ten days after the due date of payment, husband shall be responsible for the full balance due and owing. In the event that husband fails to make full and timely payment of alimony in accordance with this paragraph, the $1,000 of forgiven unpaid alimony pendente lite shall be added to his alimony obligation. The alimony payments shall cease once husband paid wife a total of $9,600 in alimony. However, child support payments shall continue as ordered. 9. The alimony shall be subject to modification for substantial changes, and subject to termination by law. 10. Husband shall pay wife $214 in costs for her prior counsel fees and certified mail costs within 60 days of the signing of this agreement. 11. 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, and seek any other remedy allowed under Pennsylvania law. 12. Any party breaching this agreement shall be responsible for the payment of all legal fees and costs incurred by the other in enforcing his or her rights under this agreement, or seeking such other remedy or relief that may be available to him or her. 13. The Cumberland County Domestic Relations Office shall be the enforcer of this Agreement, including all claims made within this Agreement, including child support, alimony pendente lite, and alimony. FULL AND FINAL SETTLEMENT OF ALL CLAIMS 14. Except as provided herein, and except as to the issue of child support, which is separate and apart from this agreement, and is docketed at Delgado v. Pabon, Docket No. 15020 DR 93, PACSES Case Number 699000690, Husband and Wife agree that the execution of this agreement is a full and final settlement of all economic and other claims between them, including, without limitation, the ownership and equitable distribution of marital property, the past, present and future spousal support, alimony, alimony pendente lite and/or maintenance of either of them, and in general, any and all claims and all other possible claims by one against the other or against their respective estates. BINDING ON PARTIES AND OTHERS 15. This agreement shall be binding on the parties and their respective heirs, executors, administrators and assigns. INCORPORATION 16. The parties intend this agreement to be incorporated, but not merged, into the divorce decree. 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. 17. The parties intend to be legally bound by the terms of this agreement, and intend that it be filed with the Court as satisfaction of the alimony pendente lite, costs, counsel fees, and alimony claims. However, the parties agree that failure to file this agreement with the Court shall have no effect on the parties' obligations or the ability to utilize any remedy for enforcement. MODIFICATION TO BE IN WRITING 18. No modification or waiver of any of the terms hereof shall be valid unless in writing and signed by both parties. LAW OF PENNSYLVANIA APPLICABLE 19. This Agreement shall be construed in accordance with the laws of the Commonwealth of Pennsylvania. INTEGRATION 20. This Agreement constitutes the entire understanding of the parties and supersedes any and all prior agreements and negotiations between them. There are no representations or warranties other than those expressly set forth herein. NO WAIVER OF DEFAULT21. This Agreement shall remain in full force and effect unless terminated under the terms of this Agreement. The failure of either party to insist upon strict performance of any of the provisions of this Agreement shall in no way affect the right of such party thereafter to enforce the same, nor shall the waiver of any breach of any provision hereof be construed as a waiver of any subsequent default of the same or similar nature, nor shall it be construed as a waiver of strict performance of any other obligations herein. ADDRESSES OF PARTIES 22. As long as any obligations remain to be performed pursuant to the provisions of this Agreement, each party shall have the affirmative obligation to keep the other informed of his or her residence address, and shall promptly notify the other in writing of any change of address by giving the new residence address. ADVICE OF COUNSEL 23. The provisions of this Agreement and their legal effect have been fully explained to Wife, by her counsel, The Family Law Clinic. Husband is unrepresented. Husband acknowledges that he has been informed that the Family Law Clinic represents only wife in this matter and has given him no legal advice, except to seek his own legal counsel, which he has declined to do so. Each party confirms that he or she fully understands the terms, conditions and provisions of this Agreement and believes them to be fair, adequate and reasonable under the existing facts and circumstances. The parties further confirm that each is entering; into this Agreement freely and voluntarily and that execution of this Agreement is not the result of any duress, undue influence, collusion, or improper or illegal agreements. 24. Each of the parties has carefully read and fully considered this Agreement and all of the statements, t r ss o ions, and provisions thereof prior to signing below. CA OS P ON, Plaintiff/Respondent SANDRA I. DELGAD , Defendant/Petitioner ? dP?P ?G,/?vyvV??wl? Lar Mammana Certified Legal Intern THOM,? L LACE ROBERT E. RAINS LUCYJOHNSTON-WALSH Supervising; Attorneys THE FAMILY LAW CLINIC Attorneys far Defendant CARLOS PABON, Plaintiff/Respondent Demandante V. SANDRA I.DELGADO, Defendant/Petitioner Demandado :EN LA CORTE DE ARGUMENTOS COMUNES DEL :CONDADO DE CUMBERLAND, PENSILVANIA :PROCEDIMIENTO CIVIL EN DIVORCIO :NO. 02 - 1655 CIVIL TERM ACUERDO DE ESTABLECIMIENTO MATRIMONIAL ESTE ACUERDO, es hecho este dia de 2003, entre Demandante, Carlos Pabon ("Esposo" ), y Demandada, Sandra I. Delgado ("Esposa"). VISTO QUE, Esposo y Esposa quieren a entrar en un acuerdo a todos asuntos economicos entre los partidos, menos la manutensi6n de hijos menores que es etiquetada a Delgado v. Pabon, Docket No. 15020 DR 93, PACSES Case Number 699000690, y excepto que escrito abajo, y para tener este acuardo hecho un Mando del Corte; AHORA, POR ESTO, Esposa y Esposo, cada uno teniend.o la intenci6n de ser obligado por ley, concuerdan como sigue; DIVORCIO Los partidos han vivido separadamente y aparte desde marzo 1995. 2. Cada partido ejecutara un Afidavit de Consentimiento y un Renuncia de Notificaci6n de Intenci6n a Pedir la Entrada de un Decreto de Divorcio dentro de diez (10) dias de firmando este Acuerdo. IMPUESTO SOME LA RENTA Este Acuerdo no relata a o resolve en cualquier manera, cualquier obligaci6n de impuestos sobre la renta federal, estatal, o local que uno y otro o ambos de los partidos tendria a los autoridades de los impuestos, o cualquier obligaci6n potencial que uno y otro tiene al otro tocante al impuesto sobre la renta. DEUDAS 4. Excepto cuando este acuerdo dice al contrario,los partidos representan y autorizan al otro que no tiene conocimiento sobre cualquier otro objeto de deuda matrimonial. PROPIEDAD PERSONAL 5. Todo la ropa, la propiedad personal, y los muebles dom6sticos han sido partidos entre los partidos a su satisfacci6n, y ningun partido hard cualquier reclarno a las cosas que ahora estan en el posesi6n o el mando del otro. COBERTURA MEDICA 6. El Esposo proveerd cobertura medica para los hijos de los partidos. El Esposo actualmente es asegurado por su dueflo, Atlas Roofing Corporation, por Aetna. El pagard los premios necesarios para que los hijos son asegurados. El Esposo proveerd la Esposa con cartas del seguro para los hijos dentro de 30 dias de la firma de este acuerdo. ALIMENTOS PENDENTE LITE, GASTOS, HONORARIOS DEL ABOGADO, ALIMENTOS 7. El Esposo continuard a pagar alimentos pendente lite, corno ordenado por la Corte, hasta el divorcio ha acabado. La Esposa concuerda a perdonar los atrasos accumulados por alimentos pendente lite, en la cantidad de $1,000. 8. Despues del decreto de divorcio es entrado, el esposo le pagara a la esposa alimentos en una cantidad final de $9,600. Los partidos concuerdan que el esposo tiene un trabajo estacional. Por consiguiente, los partidos concuerdan a la lista siguiente: El esposo le pagara a la esposa $950 por mez desde diciembre hasta mayo. $722.58 sera usado para la manutenci6n de los hijos, $91 sera usado para los atrasos de manutenci6n de los hijos, y $136.42 sera usado para la cobertura medica de los hijos. El esposo le pagara a la esposa $1,525 por mez desde junio hasta noviembre. $722.58 para la manutenci6n de los hijos, $108 para los atrasos de manutenci6n de los hijos, $136.42 para la cobertura mddica de los hijos, y $558 para los alimentos. Tiempo es to mas importante. Si el esposo pierda un pago por mas de diez dias despues del plazo, el esposo sera responsable para el saldo completo debido. En caso del esposo falta a pagar completamente y a tiempo de acuerdo con este parrafo, el $1,000 de alimentos pendente lite no pagado pero perdonado sera anadido a su obligaci6n de alimentos. Los pagos de alimentos pararan cuando el esposo ha pagado un total de $9,600 en alimentos. Sin embargo, los pagos para la manutensi6n de los hijos continuaran como ordenado. 9. Los alimentos seran sometido a modificaci6n para cambios substanciales, y sometido a terminaci6n por la ley. 10. Dentro de 60 dias de la firma de este acuerdo, el esposo le pagara a la esposa $214 en gastos para sus honorarios de abogado previos y gastos para los correos certificados. REMEDIOS 11. Si uno y otro partido incumpla cualquier provisi6n de este acuerdo, el otro partido tendra el derecho, a su voluntud, para poner pleito para danos causados por el incumplimiento, y buscar a cualquier otro remedio permitido por la ley de Pensilvania. 12. Cualquier partido que incumple este acuerdo sera responsable para el pago de todos los honorarios de abogodo y gastos incurridos por otro mientras haci.endo cumplir sus derechos bajo este acuerdo, o buscando a otro remedio o reparaci6n que seria obtenible a el o ella. HACIENDO CUMPLIR EL ACUERDO 13. La Oficina De Relaciones Domesticas Del Condado De Cumberland sera la autoridad que hace cumplir este acuerdo, incluyendo todos reclamos hechos adentro este Acuerdo, incluyendo la manutensi6n de los hijos, alimentos pendente lite, y alimentos. ESTABLECIMIENTO COMPLETO Y FINAL DE TOWS LOS RECLAMOS 14. Excepto como estipulado adentro, y excepto como tocante al asunto de manutensi6n de los hijos, que es separado de este acuerdo, y es docketed a Delgado v Pabon, Docket No. 15020 DR 93, PACSES Case Number 699000690, Esposo y Esposa concuerdan que la ejecuci6n de este acuerdo es un establecimiento completo y final de todos los reclamos economicos y otros reclamos entre de ellos, incluyendo, sin limitaci6n, la pertenencia y distribution justo de propiedad matrimonial, la manutensi6n conyugal, alimentos, alimentos pendente lite y/o la manutensi6n de uno y otro de esos en el pasado, presente, y futuro, generalmente, cualquieres y todos los reclamos y todos otros reclamos posibles por uno contra otro o contra sus estados respectivos. COMPULSIVO A LOS PARTIDOS Y OTROS 15. Este acuerdo sera compulsivo a los partidos y sus herederos, ejecutores, administradores, y asignas respectivos. INCORPORAC16N 16. Los partidos tienen la intenci6n de este acuerdo ser incorporado, pero no unido, en el decreto de divorcio. Este acuerdo continuara en fuerza y efecto completo despues de tal tiempo que un decreto de divorcio final seria entrado tocante a los partidos. 17. Los partidos tienen la intenci6n para ser obligado legalmente por los provisiones de este acuerdo y tienen la intenci6n que to es registrado con la Corte Como satisfaccibn de los reclamos para alimentos pendente lite, gastos, honorarios del abogado, y alimentos. Sin embargo, los partidos concuerdan que el fracaso a registrar este acuerdo con la Corte no efectuara los obligaciones de los partidos o la habilidad para utilizar cualquier remedio para hacer cumplir. NECESARIO OUE MODIFICACI6N SEA ESCRITO 18. Ninguna modificaci6n o renuncia de cualquier provision sera valida a menos que la sea escrita y firmada por ambos partidos. LEY DE PENSILVANIA ES APLICABLE 19. Este Acuerdo sera construido siguiente los leyes de la Republica de Pensilvania INTEGRAC16N 20. Este Acuerdo constituye todo la comprensi6n de los partidos y anula cualquieres y todos acuerdos y negociaciones previos entre de ellos. No hay representaciones o garantias ademas de las adentro este Acuerdo. RENUNCIA O INCUMPLIMIENTO ES PROHIBIDO 21. Este Acuerdo quedara en fuerza y efecto completo a menos que sea terminado bajo las provisiones de este Acuerdo. El fracaso de uno y otro partido para insistir en la ejecuci6n estricta de cualquier provision de este Acuerdo no efectua el del-echo de tal partido despues de esto para hacer cumplir to mismo, ni sera construida la renuncia de cualquier incumplimiento de cualquier provision de esto como una renuncia de cualquier incumplimiento subsecuente de un caracter del mismo o similar, ni sera construida como una renuncia de ejecuci6n estricta de cualquieres otras obligaciones adentro. DIRECCIONES DE LOS PARTIDOS 22. Siempre que cualquieres obligations quedan para ser ejecutadas siguiente las provisiones de este Acuerdo, uno y otro partido tendra la obligaci6n affirmativa para informarle al otro a su direcci6n residencial, y le notificara puntualmente al otro a cualquier cambio de direcci6n por dando el direcci6n residencial nuevo. CONSEJO DE ABOGADOS 23. Las provisiones de este Acuerdo y sus effecto legal han sido explicado completamente a la Esposa, por su abogado, The Family Law Clinic. El Esposo no tiene abogado. El Esposo reconoce que 61 ha sido informado que The Family Law Clinic representa solamente la Esposa en esta materia, y no ha le dado consejo legal, excepto para buscar a su propio abogado, to que el ha rehusado a hacer. Cada partido confirma que 61 o ella comprende completamente los provisiones de este Acuerdo y cree que las esten justas, adecuadas, y razonables bajo los verdades y circunstancias. Los partidos confirman adicionalmente que cada esta entrando en este Acuerdo libremente y voluntariomente y la ejecuci6n de este Acuerdo no es de resultas de cualquier coacci6n, influencia impropia, colusi6n, o acuerdos impropios o Regales. 24. Cada de los partidos ha leido cuidadosamente y ha considerado completamente este Acuerdo y todos de los declaraciones y provisiones de eso antes de firmando abajo. d? CAR S PABON mandante AND I. DEL ADO, e ti',1 Lira Mammana Interno Legal Certificado 1 THOM T . PLACE ROBERT E. RAINS LUCY JOHNSTON-WALSH Abogados Rlevisados FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 717-243-2968 Abogados del Demandado ?? n _..? ? ? , -- . . : ? :.':1 y ?{ CARLOS PABON, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 02 - 1655 CIVIL SANDRA L. DELGADO, Defendant IN DIVORCE ORDER OF COURT AND NOW, this 7 day of 2003, the economic claims raised in the proceedings having been resolved in accordance with a marital settlement agreement dated August 1, 2003, the appointment off the Master is vacated and counsel can file a praecipe transmitting the record to the Court requesting a final decree in divorce. cc: Carlos Pabon Plaintiff Zamily Law Clinic Attorneys for Defendant BY THE COURT, Res os-o?-U3 Y VINVAIASNN?d U :Z , :J i.- 1i IV CO In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER Sr, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: CARLOS PABON Member ID Number: 6498000212 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multi ple Cases on Attachment PACSES Docket Plaintiff Name Case Number Number Attachment Amount/Frequency SANDRA DELGADO 127104941 02-1655 CIVIL $ 1,358.00 /MONTH SANDRA DELGADO 699000690 666 S 1993 $ 830.58 MONTH TOTAL ATTACHMENT AMOUNT: $ 2,188.58 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 5 o 5.06 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLOS PABON Social Security Number 262-67-8766 , Member ID Number 6498000212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support atrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached wider this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 16, 2003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: NU 2 9 1U03 n E 6AJhSEO E l0C,1 JUDGE Form EN-034 Service Type M Worker ID $IATT "v- Anoed C') Cj. o C _ !n i c?l. w c' 5;0 C r rn C N v -?4 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT O original Order/Notice State Commonwealth of Pennsylvania O Amended Order/Notice Co./City/Dist. of CUMBERLAND Date of Order/Notice 08/28/03 O Terminate Order/Notice Tribunal/Case Number (See Addendum for case summary) RE: PABON, CARLOS Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) ?,? GG4 s 1993 ATLAS ROOFING PAYROLL 817 SPANGLER RD CAMP HILL PA 17011-5823 twas s 4 1; ?,0004 96 x/11 ?a•it, sv-e,aC "%fs 13,710elfgl 262-67-8766 Employee/Obligor's Social Security Number 6498000212 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1, 522. 58 per month in current support $ 666.00 per month in past-due support Arrears 1.2 weeks or greater? Oyes Q no $ o. oo per month in medical support $ 0 . oo per month for genetic test costs $ per month in other (specify) for a total of $ 2,188.58 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: $ 505.06 per weekly pay period. $ 1. 01o .11 per biweekly pay period (every two weeks). $ 1.094.29 per semimonthly pay period (twice a month). $ 2. 188.58 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S 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. r ? w' c . a Date of Order: AUG 2 9 2003 Service Type m +` 4 THE COURT: ccScul9rGC? E G G/OQ '?JX• E Form EN-028 OMB No.: 09709154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS ANpD OTHER WWITHHOLDERS t ? diderecntefrom the state thatdissued thiiseorger, a ccopy must be provided to your ?emplI yee even it the box .- not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tar: levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* uu iuwl icyvn .??? Nuy ............... ..........._._...o _.. _.. _ _ ., e'rwa . You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME: PABON CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any 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. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at 717 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Service Type m OMB No. 09]0-0154 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PASON, CARLOS PACKS Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 1,358.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum OMB No.: 0970-0154 PACSES Case Plumber 699000690 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 666 S 1993 $ 830.58 Child(reN's PJame(s): DOB LUIS 0. PABON 06/11/90 KARTNA T. PABON 07/14/92 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the ernployee's/obligor's employment. PACSES Case Number Plaintiff Name ? 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. Form EN-028 WorkerlD $IATT s ca ra roe d C-D r GC; 'tea ; ::r: ? rv ? ORDER/NOTICE TO WITHHOLD INCOME FOR'. SUPPORT State Commonwealth of Pennsylvania 0original Order/Notice Co./City/Dist. of CUMBERLAND O Amended Order/Notice Date of Order/Notice 09/02/03 O Terminate Order/Notice Tribunal/Case Number (See Addendum for case summary) RE: PABON, CARLOS Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 262-67-8766 Employee/Obligor's Social Security Number ATLAS ROOFING 6498000212 PAYROLL 1 ?i?( ?1('JVa _?(p fS- (71,V1 Employee/Obligor's Case Identifier 817 SPANGLER RD ?r/CS•f S ?a 0 e / 9 V ( (see Addendum for plaintiff names CAMP HILL PA 17011-5823 7 associated with cases on attachment) DKf Custodial Parent's Name (Last, First, MI) (o(!' . / 123 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 722.58 per month in current support $ 666.00 per month in past-due support Arrears 12 weeks or greater/ Oyes Q no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 1,388.58 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: $ 320.44 )er weekly pay period. $ 640.88 per biweekly pay period (every two weeks). $ 694.29. per semimonthly pay period (twice a month). $ 1.388.58 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifi r JAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: CEO] `Z D BY THE COURT: I? Form EN-028 Service Type M OMB No, 097"154 WorkerID 21205 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS opy of this form to your m loyee. If yo r employee works in a state that is ? If hecked you are required to provide a ditc#erent from the state that issued this o ?er, a copy must be provac?ed to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* Reporting the Pa?dateffiate of Withholding. )'.ti muo repoit the payd te/date of vithholding vv i.e.. sendi ig the pay ... ent. :Fire se's wager. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME: PABON, CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for' both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor 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. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (IS U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: * NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 OMB No, 09704M 54 Form EN-028 Worker ID 21205 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PABON, CARLOS PACSES Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 558.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number 699000690 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 666 S 1993 $ 830.58 Child(ren)'s Name(s): DOB LUIS O. PABON 06111190 I€ARINA T . PA136N ':'. 07 f 14 f 92 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M OMB No, 097M154 Worker ID 21205 r r? ;:? o <_w -??:; ?47 :i_ Ri?r ?7 -a 1 i °? ? ?_:: 1 ..r . ' U3 ; l.. A r ? C ? ,fin _? ? `17 _! ?? ? In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SANDRA DELGADO ) Docket Plumber 02-1655 CIVIL Plaintiff ) VS. ) PACSES Case Number 127104941 CARLOS PABON ) Defendant ) Other State ID Number ORDER AND NOW, toyl'lt, on this 28TH DAY OF AUGUST, 2003 IT IS HEREBY ORDERED that the -,04 order in this case be O Vacated or 0Suspended or ® Terminated without prejudice or Q Terminated and Vacated, effective JUNE 1, 2003 , due to: THE PARTIES' MARITAL SETTLEMENT AGREEMENT. PLAINTIFF REMITS THE ALIMONY PENDENTE LITE BALANCE OF $670.70. DRO: RJ Shadday xC: plaintiff defendant Lucy Johnston-Walsh, Esqure BY THE COURT: Edward E. Guido JUDGE Form OE-504 Service Type M Worker ID 21005 a r e n, •[ [_{ r W ? Fri - n CARLOS PABON, Plaintiff VS. SANDRA I.DELGADO, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 02-1655 CIVIL ACTION - LAW DIVORCE PLAINTIFF'S AFFIDAVIT OF CONSENT UNDER SECTION 3301(c) OF THE DIVORCE CODE AND WAIVER OF COUNSELING 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on April 4, 2002. 2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety 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 verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unworn falsification to authorities. Date: Signature:. GGL? - Carlos Pabo ? -, < - ?- ., „ <> -,? J U: i T! "?':' ? ? U _ ??_ ?' ? ' 1 :.. .f i ' C-j ? ;:. - ' =,? ,n C' i "' (:: ? j? ti C• -? CARLOSPABON, Plaintiff VS. SANDRA I.DELGADO, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 02-1655 CIVIL ACTION - LAW DIVORCE PLAINTIFF'S WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce witl Lout notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees, or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. 4. I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unworn falsification to authorities. Dated: /a-O 3 Signature: , G - Carlos Pabo ?'•,..: r ?n _ nm??, _,.? _ ? ?' ??' ? ? 1 ,' ?rj / _ 1 .I 2?( '' ?l .' _? ?? CARLOS PABON, : THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : No. 02-1655 CIVIL TERM SANDRA I. DELGADO, CIVIL ACTION -LAW Defendant : IN DIVORCE TO THE PROTHONOTARY: Kindly enter the appearance of Jeannd B. Costopoulos, Esquire, as attorney of record for Plaintiff, Carlos Pabon, in the above captioned matter. Dated: BY: Je 6 B. Costopoulos, Esquire 5000 Ritter Road, Suite 202, Box 779 Mechanicsburg, PA 17055 Phone: (717) 790-9546 Supreme Ct. ID No. 68735 CARLOS PABON, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA No. 02-1655 CIVIL TERM SANDRA I. DELGADO, : CIVIL ACTION -LAW Defendant : IN DIVORCE CERTIFICATE OF 4RRVICE I, Jeannd B. Costopoulos, Esquire, hereby certify that I am this day serving a copy of the foregoing document upon the persons, and in the manner, indicated below, which service satisfies the requirements of the PA Rules of Civil Procedure, by depositing a copy of the same with the United States Post Office at Mechanicsburg, Pennsylvania, through first class mail, prepaid, and addressed as follows: Family Law Clinic The Dale F. Shughart Community Law Center 45 North Pitt Street Carlisle, PA 17013 7 _ BY: Je d B. Costopoulos, Esquire ATTORNEY FOR PLAINTIFF 5000 Ritter Road, Suite 202, Box 779 Mechanicsburg, PA 17055 Phone: ('717) 790-9546 Supreme Ct. ID No. 68735 Dated: 2 ?? ° o tZ? mmkt r rn y ?? o b . c i O yC; C- ;.J ? tc7'x7 rn In the Court of Common Pleas of CUMBERLAND County, Pennsylvania 13 N. HANODOMESTIC V.O. OX 3 OS CARLISLE, PA. 17013 Phone: (717) 240.6225 Fax: (717) 240.6248 Defendant Name: CARLOS PABON Member ID Number: 6498000212 Please note: AO correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name SANDRA DELGADO SANDRA DELGADO PACSES Docket Case Number Number 127104941 02-1655 CIVIL 699000690 666 S 1993 TOTAL ATTACHMENT AMOUNT: Attachment AmoundFreauencv $ 402.00 MONTH 830.58 /MH 1,232.58 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 284.44 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLOS PABON Social Security Number 262-67-8766 ,Member ID Number 6498000212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 16, 2003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT OCT 0 6 2003 Date of Order: t:vcc?r?-,phi C-- ['o fi??J O r JUDGE Service Type M Form EN-034 Worker ID $1ATT (? t CJ ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania 0 Original Order/Notice Co./City/Dist. of CUMBERLAND Date of Order/Notice 10/03/03 0 Amended Order/Notice Tribunal/Case Number (See Addendum for case summary) O Terminate Order/Notice Employer/. . ...... der's Federal UN Number RE. PABON, CP.RLOS Employee/Obligor's Name (Last, First, Mp ATLAS ROOFING PAYROLL 817 SPANGLER RD CAMP HILL PA 17011-5823 ,&?/ d00d /G65 e/ m- Pg0Sf,S. 1a?/0V9V1 262-67-8766 Employee/Obligor's Social Security Number 6498000212 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) - 66,6 s /`t%3 P/70-v S (,q oo0ro 90 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1,124.58 per month in current support $ 108.0o per month in past-due support $ o. oo per month in medical support Arrears 12 weeks or greaten (9) Yes Q no $ pport 0 oo per month for genetic test costs $ per month in other (specify) for a total of $ 1, 232.58 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the suppori order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 294 44 per weekly pay period. $ 56888 per biweekly pay period (every two weeks). $ 616.29 per semimonthly pay period (twice a month). $ 1.232 58 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten 00) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Empfoyee/Obfigor's Casey i DO NOT SEND CASH BY MAIL, w AL SECURITY NU TO BE PROCESSED. 0 BY THE COURT: nr n Date of Order: .,h Service Type M Form EN-028 OMB No.: 0970-0154 Worker ID $IATT d? ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? di a entefromothe state thatdssoue?thseorderPa oothis form to your employee. If yo r employee works in a state that is py must be provided to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. ree` wit state of the employee's/obligor's principal place You must comply with the law of the of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one OrderrNotice to Withhold Income for Support this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, the law of the state of employee's/obligor's principal place of employment. you must follow possible. (See #10 below) You must honor all Orders/Notices to the greatest you must f root 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency WITHHOLDER'S ID: 3978000035 identified below. EMPLOYEE'S/OBLIGOR'S NAME: PABON CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 LAST KNOWN HOME ADDRESS: DATE OF SEPARATION:. NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any 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. 10.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 01; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION If you or your employee /obligor have any questions, 13 N. HANOVER contact WAGE ATTACHMENT UNIT 13 BOX 320 by telephone at X717) 2q0-6225 or CARLISLE PA 17013 by FAX at (717) 24 ?6248 or by internet www.cViildsupport.state.pa.us Service Type M Page 2 of 2 Form EN-028 OMB No.: 097"15q Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PAEON, CARLOS PACSES Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 402.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child (rent identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'-3 Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $ IATT canned c, C. -V Ci rt y(._ ) f?? -G In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SANDRA DELGADO Vs. CARLOS PAEON Plaintiff Defendant AND NOW to wit, this Docket Number ) PACSES Case Number Other State ID Number Order 02-1655 CIVIL 127104941 OCTOBER 3, 2003 it is hereby Ordered that: THE ORDER OF AUGUST 28, 2003 IS VACATED AS THE DIVORCE IS NOT FINAL AND THE ORDER OF NOVEMBER 22, 2002, FOR ALIMONY PENDENTE LITE IS REINSTATED IN IT'S ENTIRETY. BY THE COURT: DRO: RJ Shadday xC: Plaintiff defendant Lucy Johnston-Walsh, Esquire Service Type M Edward E. Cltido JUDGE Form OE-001 Worker ID 21005 n ?-? ,? ?- w -n r T U.e ""7 ?1':, .?{ ?? r - ? - 11i (;" ?i _ - y'l ? ?? ./'I 1i ? .J'7 ?? ? ? '? CARLOS PABON, Plaintiff vs. SANDRA I.DELGADO, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 02-1655 CIVIL ACTION - LAW DIVORCE DEFENDANT'S AFFIDAVIT OF CONSENT UNDER SECTION 3301(c) OF THE DIVORCE CODE AND WAIVER OF COUNSELING L A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on April 4,2002. 2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety 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 verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unworn falsification to authorities. Date: q Z(r Lig Signature San dra I. Delgado c-> - ? ?, ? == rom ?, ?? ? ,? -, Z-?' C i ?? - (-) ?. i. . e1n ? rF' C.. .. _. . ?. (D "? CARLOSPABON, Plaintiff VS. SANDRA I.DELGADO, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 02-1655 CIVIL ACTION - LAW DIVORCE DEFENDANT'S WAIVER OF NOTICE OF INTENTION F TO REQUEST ENTRY OF A DIVORCE DECREE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees, or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. 4. I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Dated: Signature: Sandra I. Delg 7 ;'l o CARLOS PABON, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. : No. 02-1655 SANDRA I. DELGADO, CIVIL ACTION -LAW Defendant DIVORCE ACCEPTANCE. OF SERVICE On or about April 20, 2002, I, Sandra I. Delgado, Defendant in the above case, accepted service of the Complaint in Divorce that was filed on April 4, 2002 at the above term and docket number. Date: 9 6 7?_X? &Ajr6'% Sandra I. Delgado 1 Z C E, C CARLOSPABON, Plaintiff VS. SANDRA I.DELGADO, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 02-1655 CIVIL ACTION - LAW DIVORCE PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Please transmit the record, together with the following information, to the Court for entry of a divorce decree: 1. Ground for Divorce: Irretrievable breakdown under §3301(c) of the Divorce Code. 2. Date and Manner of service of the Complaint: Service by acceptance by Defendant on or about April 20, 2002 - see attached Acceptance of Service. 3. Date of execution of the Affidavit of Consent required by §3301(c) of the Divorce Code: by the Plaintiff: 9/12/03; by the Defendant: 9/26/03. 4. Related claims pending: None. 5. Date Plaintiff s Waiver of Notice in §3301(c) divorce was filed with the prothonotary: 9/15/03. Date Defendant's Waiver of Notice in §3101(c) divorce was filed with the prothonotary: filed simultaneously with this Praecipe to Transmit Record. Respectfully Submitted: J e B. Costopoulos, Esquire Attorney for Plaintiff 5000 Ritter Road, Suite 202, Box 779 Mechanicsburg, PA 17055 Phone: (717) 790-9546 PA S.Ct. ID No. 68735 Dated: ?? ?/ 0 rn 2,rr: L r _1 (? fo CARLOS PABON, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE SANDRA L. DELGADO NO. 02-1655 CIVIL TERM , Defendant IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under §3301 (c) of the Divorce Code was filed April 4, 2002. 2. The marriage of plaintiff and defendant: is irretrievably broken and days have elapsed from the date of filing and service of the Complaint. 1 1 consent to the entry of a final Decree in Divorce after service of notice intention to request entry of the Decree. I verify that the statements made in this Affidavit are true and correct to best of my knowledge, information and belief. I understand that false statem herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsv falsification to authorities. ?i -dos Pab Plaintiff Date: w , N N i iV f33 ca c= c? c a c', ?:, -°Ri 3i N N ? 7 ? r CARLOS PABON, Plaintiff vs. SANDRA L. DELGADO, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 02-1655 CIVIL TERM IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 53301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final Decree of Divorce without notice. 2. 1 understand that I may lose rights concerning alimony, division property, lawyer's fees or expenses if I do not claim them before a divorce is grante 3. 1 understand that I will not be divorced until a Divorce Decree is enter by the Court and that a copy of the Decree will be! sent to me immediately after it filed with the Prothonotary. I verify that the statements made in this Affidavit are true and correct to best of my knowledge, information and belief. I understand that false statem herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsv falsification to authorities. Carl Pabon, Plaintiff Date: -O `} p ?? C S L {{??y ? r1 CA ` c' y® i v c CARLOSPABON, Plaintiff VS. SANDRA I.DELGADO, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 02-1655 CIVIL ACTION - LAW DIVORCE PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Please transmit the record, together with the following information, to the Court for entry of a divorce decree: 1. Ground for Divorce: Irretrievable breakdown under §3301(c) of the Divorce Code. 2. Date and Manner of service of the Complaint: Service by acceptance by Defendant on or about April 20, 2002 - see attached Acceptance of Service. 3. Date of execution of the Affidavit of Consent required by §3301(c) of the Divorce Code: by the Plaintiff. 9/12/03; by the Defendant: 9/26/03. 4. Related claims pending: None. 5. Date Plaintiffs Waiver of Notice in §3301(c) divorce was filed with the prothonotary: 9/15/03. Date Defendant's Waiver of Notice in §3301(c) divorce was filed with the prothonotary: filed simultaneously with this Praecipe to Transmit Record. Respectfully Submitted: Dated: id-A-1129 J 6e Eostopoulos, Esquire Attorney for Plaintiff 5000 Ritter Road, Suite 202, Box 779 Mechanicsburg, PA 17055 Phone: (717) 790-9546 PA S.Ct. ID No. 68735 n Cr %. _-? Z?Ii 1 ?iT: _? j -- L? ??. ?. >? C... .. ?° IN THE COURT OF COMMON PLEAS CARLOS PABON VERSUS SANDRA I. DELGADO DECREE IN DIVORCE AND NOW, (/AIL, IT IS ORDERED AND DECREED THAT CARLOS PABON OF CUMBERLAND COUNTY STATE OF PENNA. t? No. 02-1655 AND SANDRA I. DELGADO ARE DIVORCED FROM THE BONDS OF MATRIMONY. , PLAINTIFF, ,DEFENDANT, 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; None. IT IS FURTHER ORDERED AND DECREED that t terms, provisions and conditions of a certain Marital Settlement Agreement filed on dti}l; 24 3993, as -by ;rte f a +h's Decree in Divorce by reference as _jjuwg4 fully set forth herein a this Decree in Divorce. Y TH ATTEST: J .R Fl(fTHONOTARY iY z " ° pro S/., 0?0, 6<w ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 12/01/03 Tribunal/Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number ATLAS ROOFING PAYROLL 817 SPANGLER RD CAMP HILL PA 17011-5823 O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: PABON, CARLOS Employee/Obligor's Name (Last, First, MI) AIVQI-S 19- /Wll9yl 262-67-8766 Employee/Obligor's Social Security Number 6498000212 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) S 19L?3 C ctMW Parent's Name (Last, First, MI) '14411019-S 6,994tJ0690 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1, 124.58 per month in current support $ 91. oo per month in past-due support Arrears 12 weeks or greater; ®yes 0 no $ 0.00 per month in medical support $ o . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 1, 215.58 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: $ 280.52 per weekly pay period. $ 561, o4 per biweekly pay period (every two weeks). $ 607.79 per semimonthly pay period (twice a month). $ 1.215.58 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case, Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL t sj , BY THE COURT: DEC - 2 603 Date of Order: Service Type M F vi Form EN-028 OMB No, 097MI54 Wnrkar lf) $IATT ed ADDITIONAL INFORMATION TO EMPLOYERS AmNpD OTHER WITHHOLDERS d. [J diherent from the state thatdissued thiiseorde , a ccoppy must be provined to your emplWoyee evoen if tworks x is not check is 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* _1 vU II ma IcF- V- r..r.....-,.__._ ?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. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME: PABON CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: ]DOMESTIC RELATIONS SECTION 13 N HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 248 or by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 OMB NO.: 097"154 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PABON, CARLOS PACSES Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 402.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the ernployee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M WorkerlD $IATT OMB No.: 0910-0154 `5 zn, y N ? J7 Cd In the Court of Common Pleas of CUMBERLAND County, Pennsylvania 13 N. HANOVVER ST P.O RELATIONS BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: CARLOS PA13ON Member ID Number: 6498000212 Please note: All correspondence must include the member In Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name SANDRA DELGADO SANDRA DELGADO PACSES Docket Case Number Number 127104941 02-1655 CIVIL 699000690 666 S 1993 TOTAL ATTACHMENT AMOUNT: Attachment Amount/Frequency $ 402.00 /MONTH S$$ 813.58 MONTH J / $ 1,215.58 / Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 280.52 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLOS PA13ON Social Security Number 2 6 2 - 6 7 - 8 7 6 6 , ID Number 6498000212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 16, 2003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: LLIC - 2 26J3 Service Type M z i??< ?}/?D C c ic7 JUDGE Form EN-034 Worker ID $IATT 2 ?A kr, T r ? } W In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SANDRA DELGADO ) Docket Number 02-1655 CIVIL Plaintiff ) VS. ) PACSES Case Number 127104941 CARLOS PABON Defendant ) Other State ID Number ORDER AND NOW, to wit, on this 22ND DAY OF MARCH, 2004 IT IS HEREBY ORDERED that the APL order in this case be Q Vacated or 0Suspended or ® Terminated without prejudice or Q Terminated and Vacated, effective OCTOBER 15, 2003 , due to: THE PARTIES' MARITAL SETTLEMENT AGREEMENT AND DIVORCE DECREE OF OCTOBER 15, 2003. THE CREDIT OF $900.41 ON THE ALIMONY PENDENTE LITE ACCOUNT WILL BE DIRECTED TO THE ALIMONY ACCOUNT. v DRO: RJ Shadday xc: plaintiff defendant Lucy Johnston-Walsh, Esquire IY,, THE C ar d E. Guido JUDGE Service Type M Form OE-504 Worker ID 21005 (" _; n> <> C5 - s ? i _?= 3J ? ?1 ii _ l _ "?• -1 ff) Q.i iLJ V l _J .; -1l .. C?J ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of P nnsyly-nia 0Original order/Notice Co./City/Dirt. of CUMBERLAND O Amended Order/Notice Date of Order/Notice 03/22/04 O Terminate Order/Notice Tribunal/Case Number (See Addendum for case summary) RE: PABON, CARLOS Employer/withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) ATLAS ROOFING PAYROLL 817 SPANGLER RD CAMP HILL PA 17011-5823 Pr4c'4? s ?a-?iov9 S'/ /9 5?3 f)eSFS S9,0 066 94 262-67-8766 Employee/Obligor's Social Security Number 6498000212 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1, 522. 58 per month in current support $ 91 . oo per month in past-due support Arrears 12 weeks or greater? Oyes Q no $ 0.00 per month in medical support $ o, too per month for genetic test costs per month in other (specify) for a total of $ 1, 613.58 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: $ 372.36 per weekly pay period. $ 744 73 per biweekly pay period (every two weeks). $ 806.79 per semimonthly pay period (twice a month). $ 1. 613 58 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten 00) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier 9A, ), IAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL ^ r^ """ p? BY THE COURT: Date of Order: MAR 2 3 2004 Form EN-028 Type M OMB No: 0970-0154 WorkerlD $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? Ifghecke you are required to pr vide a opy of this form to your employee. If your employee orks in a state that is di erent rom the state that issue pthis order, a copy must be provided to your employee even if t it box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4. 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 forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME:- PABON, CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M If you or your employeelobligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240.6248 or by internet www.childsupport.state.pa.us Page 2 of 2 OMB No.: 09760154 Form EN-028 Worker ID $1ATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PABON, CARLOS PACKS Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 800.00 Child(ren)'s Name(s): DOB PACSES Case Number 699000690 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 666 S 1993 $ 813.58 Child(ren)'s Name(s): DOB LUIS O. PABON 06 /11/90 K"INA S. PABONI , 07/14/92 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M OMB No.: 09J0-0154 Worker ID $ IATT C) ? ? Q LJ l ' (J ..-?4... +i.N Sin'4?Y?ti In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: CARLOS PABON Member ID Number: 6498000212 Please note: AB correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name SANDRA DELGADO SANDRA DELGADO PACSES Docket Case Number Number 127104941 02-1655 CIVIL 699000690 666 S 1993 TOTAL ATTACHMENT AMOUNT: Attachment AmounNFreauencv $ 800.00 /MONTH $$$ 813.58 /MONTH / / / 1,613.58 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 372.36 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLOS PABON Social Security Number 262-67-8766 , Member ID Number 6498000212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 16, 2003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: MAR 2 3 2UDM ?tv g p e1 . G c t? O JUDGE Form EN-034 Service Type M Worker ID $ IATT C) v Yi T ? 11 r? GJ J' G; c ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Penn vlvania 0Original Order/Notice Co./City/Dist. of CUMBERLAND O Amended Order/Notice Date of Order/Notice 06/01/04 O Terminate Order/Notice Tribunal/Case Number (See Addendum for case summary) RE: PABON, CARLOS Employedwithholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 262-67-8766 ATLAS ROOFING Employee/Obligor's Social Security Number PAYROLL 6498000212 Employee/Obligor's Case Identifier 817 SPANGLER RD (See Addendum for plaintiff names CAMP HILL PA 17011-5823 dM-165'5'(7 /e_ J?'T r U associated with cases on attachment) ACIq,Custodial Parent's Name (Last, First, MI) S See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1, 522.58 per month in current support $ 666. o o per month in past-due support Arrears 12 weeks or greater? ® yes Q no $ 0.00 per month in medical support $ o . o o per month for genetic test costs $ per month in other (specify) for a total of $ 2,188.58 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: $ 505.06 per weekly pay period. $ 1.01o.11 per biweekly pay period (every two weeks). $ 1. 094.29 per semimonthly pay period (twice a month). $ 2.188.58 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU ,I Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Date of Order:_ U2 -- ??2u D E it i 6 7U oLC Service Type M Form EN-028 OMB No.: 0910-0154 Worker lq $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND I OTHER WITHHOLDERS ke(f youthe are required to pr vide a copy of this form to your 3,21 oyee. If your employee yo ks in a state that is Brenthecrrom state that issuedthis order, a copy must be provio your employee even if tl e box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. agency listed below. If there are Federal tax levies in effect please contact the requesting 3. Combining Payments: You can combine withheld amounts from more than one erriployee%obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employeelobligor. 4.- R-- i?-N.o-rb.?._n._._ .. _ _.._ .,.. .n??n. _.._.. _....,.,,Yb uic pnyrnenr--tf><._ - You must comply with the he law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. Possible. (See #10 below) You must honor all Orders/Notices to the greatest extent 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME: PABON CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 LAST KNOWN HOME ADDRESS: DATE OF SEPARATION:-. NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee%obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10. * Withholding Limits: You may not withhold more than the lesser of., 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, 1 N. HANOVER ST contact WAGE ATTACHMENT UNIT P.O. BOX 320 by telephone at X17) 24`5 or CARLISLE PA 17013 by FAX at (710-6248 or by internet www.childsupport.state.pa us Service Type M Page 2 of 2 Form EN-028 OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: pABON, CARLOS Service Type M Addendum Form EN-028 OMB No.: 09700154 Worker ID $IATT (? Il o O f- o r -il . V ril J .. L? In the Court of Common Pleas of CUMEBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER Sr, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: CARLOS PABON Member ID Number: 6498000212 Please note: An correspondence must include the Member m Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multi ple Cases on Attachment PACSES Case Number Docket Number Attachment AmountlFreauencv Plaintiff Name 127104941 02-1655 CIVIL $ 1,358.00 /MONTH SANDRA DELGADO 699000690 666 S 199?'; $ 830.58 MONTH SANDRA DELGADO $ S / $ / / TOTAL ATTACHMENT AMOUNT: $ 2,188.58 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 505.06 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLOS PABON Social Security Number 262-67-8766 , Member ID Number 6498000212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached trader this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 16, 2003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: Jl1N -2_ LDc??g JUDGE Form EN-034 Service Type m Worker ID $ IATT p <? N r G.J In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: CARLOS PABON Member ID Number: 6498000212 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name SANDRA DELGADO SANDRA DELGADO PACSES Docket Case Number Number 127104941 02-1655 CIVIL 699000690 666 S 1993 TOTAL ATTACHMENT AMOUNT: $ 1,613.58 Attachment Amount/Freauenc $ 800.00 /MONTH $$$ 813.58 MONTH / $ z / Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 372.36 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLOS PABON Social Security Number 2 6 2- 6 7- 8 7 6 6, Member ID Number 64 9 8 0 0 0 212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 16, 2 0 0 3 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT 11FC 0 2 Date of Order: ?? JUDGE Form EN-034 Service Type M Worker ID $ IATT r -Ti r e?'j i '{ '1 Sy ^ ? e C-4 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. Of CUMBERLAND Date of Order/Notice 12/01/04 Tribunal/Case Number (See Addendum for case summary) RE: PABON, CARLOS EmployerNVithholder's Federal EIN Number /J") 0441 ATLAS ROOFING PAYROLL 817 SPANGLER RD CAMP HILL PA 17011-5823 ??-mo5-T CLv 5 '13 O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice Employee/Obligor's Name (Last, First, MI) 262-67-8766 Employee/Obligor's Social Security Number 6498000212 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1, 522.58 per month in current support $ 91.0o per month in past-due support Arrears 12 weeks or greater? ®yes Q no $ o. 00 per month in medical support $ 0. 00 per month for genetic test costs $ per month in other (specify) for a total of $ 1, 613.58 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: $ 372.36 per weekly pay period. $ 744.73 per biweekly pay period (every two weeks). $ 806.79 per semimonthly pay period (twice a month). $ 1, 613. 58 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S 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 COUJ T: Date of Order: DEC 02 Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT O ..:?v... "a. 1`?F 1.. ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS N ? If heckefl you are required to provide asopy of this form to your3aloyee. If your employee works in a state that is di erent rrom the state that issued this or er, a copy must be provi eeccff to your emp ogee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* Reporting the Paydate/Date of Withholding. You must report the paydate/date of wit iholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld frorn the se'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. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME: PABON, CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet wwvv.chi I dsu pport. state. pa. us Page 2 of 2 OMB No.: 0970-0154 Form EN-028 Worker ID $IATT ? r4 ? ;?_? ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PABON, CARLOS PACKS Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 800.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M PACSES Case Number 699000690 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 666 S 1993 $ 813.58 Child(ren)'s Name(s): DOB LUIS 0.PABON 0.6.1.1119q ................ MINA ;:: pA6t)N "' Q'7 l f.. 9 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the erployee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name ? If checked', you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum OMB No.: 0970-0154 Form EN-028 Worker I D $ zATT C7 ? 0 T T+ -ra t? - r n ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dirt. of CUMBERLAND Date of Order/Notice 06/01/05 Case Number (See Addendum for case summary) EmployerANithholder's Federal EIN Number ATLAS ROOFING PAYROLL 817 SPANGLER RD CAMP HILL PA 17011-5823 O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: PABON, CARLOS Employee/Obligor's Name (Last, First, MI) dm. rs 1a-'71eV F 1 hey. 6610 s /5'9 3 Pis 0190006196 262-67-8766 Employee/Obligor's Social Security Number 6498000212 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1, 007. oo per month in current support $ 666.00 per month in past-due support Arrears 12 weeks or greater? Oyes Q no $ 0, 00 per month in current and past-due medical support $ o . oo per month for genetic test costs $ per month in other (specify) for a total of $ 1, 673.00 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: $ 386.08 per weekly pay period. $ 772.15 per biweekly pay period (every two weeks). $ 836.50 per semimonthly pay period (twice a month). $ 1.673 .0o per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 INADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. f.ufi - 3 2005_ /-W3-L Date of Order: Service Type M BY THE COURT: F EN 02 OMB No.: 0970-0154 orm - 8 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? if Zcke you are required to provide a 4opy of t is form to yyourem?loyee. If yog mployee vthorks in a state tha?is di Brent frrom the state that issued this ortler, a copy must be rovi a to our em o ee even if a box is not chec ed. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3. You must comply with the law of the 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: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME: PABON, CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any 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 0 5 U.S.C. §1673 01; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 OMB No.: 0970-0154 Form EN-028 Worker ID $IATT Sc an re, 0 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PABON, CARLOS PACSES Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 558.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M ID $IATT OMB NO, 0970-0154 Worker 0 o ^?ti cn 17`1 rr? ? c . f!i 7'_ - 1 rK "_: W N r w 0 ny ISM C? --c I r.:.,=rnne4s In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Defendant Name: CARLOS PABON Member ID Number: 6498000212 Fax: (717) 240-6248 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multip le Cases on Attachment Plaintiff Name PACSES Case Number Docket Number Attachment Amount/Frequency SANDRA DELGADO 127104941 02-1655 CIVIL $ 558.00 /MONTH SANDRA DELGADO 699000690 666 S 1993 $ 1,115.00 /MONTH / TOTAL ATTACHMENT AMOUNT: $ 1,673.00 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 386.08 per week, or 55 . o %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLOS PABON Social Security Number 262-67-8766 , Member ID Number 6498000212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(8). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 145, 2003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: 4?? ` E 7fin5 ?vtiy,$p E (cc IdG JUDGE Form EN-034 Service Type M Worker ID $IATT ? a CJ's o m'+ c cn L-' ca ?? T 47 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dirt. of CUMBERLAND Date of Order/Notice 07/29/05 Case Number (See Addendum for case summary) O Original OrdedNotice O Amended Order/Notice O Terminate Order/Notice Employer/Withholder's Federal FIN Number RE: PABON, CARLOS Employee/Obligor's Name (Last, First, MU 262-67-8766 Employee/Obligor's Social Security Number ATLAS ROOFING 6498000212 PAYROLL _Mll o7A0J? •/6ST AWL Employee/Obligor's Case Identifier 817 SPANGLER RD AVSF-S ?a7?OLj/C?'7? (See Addendum for plaintiff names CAMP HILL PA 17011-5623 associated with cases on attachment) jl,Dr GliCe s 1993 Custodial Parent's Name (Last, First, Mp ?,V_gfS b?tgDOd(9f? See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 745. 0o per month in current support $ 666. oo per month in past-due support Arrears 12 weeks or greater? (R) yes Q no $ o. oo per month in current and past-due medical support $ o . E o per month for genetic test costs $ per month in other (specify) for a total of $ 1, 411.00 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: $ 325.62 per weekly pay period. $ 651.23 per biweekly pay period (every two weeks). $ 705.50 per semimonthly pay period (twice a month). $ 1.411.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information needed (See #9 on page 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. ? BY THE COURT: Date of Order: AUG 1 2005 &U1J?4-e0 ur Form EN-028 Service Type M OMB No-09le-e15Y WorkerlD $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? Ifheckef you are required to provide aSopy of this form to your employee, if yo r employee works in a state that is di erent from the state that issued this or er, 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. paydate/oate-Otwithhottling-isth . 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: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME: PABON, CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAMEIADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (71 7) 240-6248 or by internet www.childsupport.state.pa,us Page 2 of 2 OMB No. 0970-0154 Form EN-028 Worker ID $ZATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PABON, CARLOS PACSES Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 558.00 Child(ren)'s Name(s): DOB PACSES Case Number 699000690 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 666 S 1993 $ 853.00 Child(ren)'s Name(s): DOB LUIS O. PABON 06/11/90 KARINA 1. PABON 07/14/'.92 OIf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB E3 If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Olf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee'slobligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB []If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Olf checked, you are required to enroll the child(ren) O If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT ome No.: uvn-aun -? ?? C"f „} ; ' .r' ???: ;?t `f l 1 ?J V? ," ;n C ?? ?1 4r In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: CARLOS PABON Member ID Number: 6498000212 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multip le Cases on Attachment PACSES Docket Plaintiff Name Case Number Number Attachment Amount/Freauencv SANDRA DELGADO 127104941 02-1655 CIVIL $ 558.00 /MONTH SANDRA DELGADO 699000690 666 S 1993 $ 853.00 MONTH TOTAL ATTACHMENT AMOUNT: $ 1,411.00 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 325.62 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLOS PABON Social Security Number 262-67-8766 , Member ID Number 6498000212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 16, 2003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT ' 1 2003 "" Date of Order: I A06 ?dwa E ?i.?G JUDGE Form EN-034 Service Type M Worker ID $IATT ., In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Defendant Name: CARLOS PABON Member ID Number: 6498000212 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Fax: (717) 240-6248 Financial Break Down of Multiple Cases on Attachment Plaintiff Name SANDRA DELGADO SANDRA DELGADO PACKS Docket Case Number Number 127104941 02-1655 CIVIL 699000690 666 S 1993 TOTAL ATTACHMENT AMOUNT: $ 1,394.00 Attachment Amount/Freauencv $ 558.00 /MONTH $$$ 836.00 MONTH / / / Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 320.81 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLOS PABON Social Security Number 2 6 2- 6 7- 8 7 6 6, Member ID Number 6498000212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 16, 2003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. Date of Order: JUN 0 4 2007 DRO: R. J. Shaadday Service Type M BY THE COURT ?. N Edward E. Guido, JUDGE Form EN-034 Worker ID $ IATT t'? a __.? -.cz s'S:' v,..- ? ?,,.` ? ?. ? Q ? r ..? L?_ ? :.r.: G? ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State commonwealth of Pennsylvania- 127104941 Co./City/Dist. of CUMBERLAND 02-1655 CIVIL Date of Order/Notice 06/01/07 699000690 Case Number (See Addendum for case summary) 666 S 93 RE: PABON. CARLOS E m pl oye r/With holder's Federal EIN Number ATLAS ROOFING PAYROLL 817 SPANGLER RD CAMP HILL PA 17011-5823 Employee/Obligor's Name (Last, First, MI) 262-67-8766 Employee/Obligor's Social Security Number 6498000212 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 745 .00 per month in current support $ 649.00 per month in past-due support Arrears 12 weeks or greater? Oyes O no $ 0.00 per month in current and past-due medical support $ 0.0 o per month for genetic test costs $ 0.00 per month in other (specify) for a total of $ 1, 394.00 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: $ 321.69 per weekly pay period. $ 64-1 _ 38 per biweekly pay period (every two weeks). $ 697. oo per semimonthly pay period (twice a month). $ 1, 394. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. ?+ 0000007? BY THE COURif!? Date of Order: JUN 0 4 2007 DRO: R.J. Shadday Service Type m O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice Edward E. Guido, Judge Form EN-028 Rev. 1 OMB No.: 0970-0154 Worker I D $ IATT 1,394' " 12• -A 21.69* 1.394 • x 12• 26 ?,43•36* i-+ V ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? ifghecw you are required to provide a copy of this form to your mployee. If yo r employee works ina state that is di Brent trom the state that issued this order, a copy must be provi?ed to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* ?umg wncn ?ciiuu?g u?c Nay „c ,. You must comply with the law of the III WRI-11 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: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME: PABON, CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: DOMESTIC RELATIONS SECTION 13 N HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Service Type M OMB No.: 097"154 Form EN-028 Rev. 1 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PABON, CARLOS PACSES Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 558.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number 699000690 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 666 S 1993 $ 836.00 Child(ren)'s Name(s): DOB LUIS O. PABON 06/11/90 YAR:MA I . PASON 07 / 14 / 92 Elf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB E] If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB E] If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB E] If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type M Worker ID $IATT OMB No.: 0970.0154 ??;. c.-- ?,?- • ' . :? ,, • . r,,rM1' ? £`?Y ?` ? t 1 : `i?? .? .f ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania 699000690 Co./City/Dist. of CUMBERLAND 666 S 93 Date of Order/Notice 07/25/07 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number ATLAS ROOFING PAYROLL 817 SPANGLER RD CAMP HILL PA 17011-5823 127104941 02-1655 CIVIL O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: PABON, CARLOS Employee/Obligor's Name (Last, First, MI) 262-67-8766 Employee/Obligor's Social Security Number 6498000212 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 745 . oo per month in current support $ 558.00 per month in past-due support Arrears 12 weeks or greater? ®yes Q no $ 0. oo per month in current and past-due medical support $ 0.00 per month for genetic test costs $ 0.00 per month in other (specify) for a total of $ 1, 303.00 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: $ 300.69 per weekly pay period. $ 601.3$ per biweekly pay period (every two weeks). $ 651.50 per semimonthly pay period (twice a month). $ 1.303 . o0 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: JUL 26 2007 DRO: R.J. Shadday Service Type M BY THE COURT: Fdward E. Guido, Judge Form EN-028 Rev. OMB No.: 0970-0154 Worker I D $ IATT 1 c. ' 4 1,37 ?. x r ?. J ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecke? you are required to provide a Gopy of this form to your uloyee. If your employee works in a state that is di Brent rrom the state that issued this order, a copy must be provi edd to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the PaydateVDate of Withholding. You munot repoit the paydate/date of vvit.holding, when sending the payllielit. The paydate/date of withholding is the date on which arnount was vvithheld from tile employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME: PABON, CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11.Submitted By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 Form EN-028 Rev. 1 Worker ID $IATT OMB No.: 0970-0154 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PABON, CARLOS PACSES Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 558.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M PACSES Case Number 699000690 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 666 S 1993 $ 745.00 Child(ren)'s Name(s): DOB LUIS O. PA$ON 06/,11/,9,0 M,I.NA I- PAS ON 01 / 14 / 9 2 ® If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker ID $IATT c ? ? s? ? :r' -ttt ???.. U7 ?. ? O ?? ?} ? Y C? ':: tSZ In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: CARLOS PABON Member ID Number: 6498000212 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiple Cases on Attachment PACSES Plaintiff Name Case Number Docket Number Attachment Amount/Frequency SANDRA DELGADO 127104941 02-1655 CIVIL $ 558.00 /MONTH SANDRA DELGADO 699000690 666 S 1993 $ $ 745.00 MONTH S / / / TOTAL ATTACHMENT AMOUNT: $ 1,303.00 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 2 9 9.8 7 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLOS PABON Social Security Number 2 62 - 6 7 - 8 7 6 6 , Member ID Number 6498000212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(8). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 16, 2003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: J U L 2 6 2007 EDWARD E. GUIDO, JUDGE DRO: R.J. SHADDAY Form EN-034 Service Type M Worker ID $ IATT G? C:? `? "£3? ? ' 1 3 ? C17=, t1 t? ??' ? ? ? ?? ( ; v ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 127104941 O Original Order/Notice State Commonwealth of Pennsylvania 02-1655 CIVIL Co./City/Dist. Of CUMBERLAND O Amended Order/Notice Date of Order/Notice 09/03/07 699000690 Q Terminate Order/Notice Case Number (See Addendum for case summary) 666 S 93 RE: PABON, CARLOS Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) ATLAS ROOFING PAYROLL 817 SPANGLER RD CAMP HILL PA 17011-5823 262-67-8766 Employee/Obligor's Social Security Number 6498000212 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 745.00 per month in current support $ 649. oo per month in past-due support Arrears 12 weeks or greater? Oyes Q no $ 0.00 per month in current and past due medical support $ 0.00 per month for genetic test costs $ 0.00 per month in other (specify) for a total of $ 1, 394.00 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: $ 321.69 per weekly pay period. $ 643.38.per biweekly pay period (every two weeks). $ 697.00 per semimonthly pay period (twice a month). $ 1.394.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Orders c 4 2007 DRO: R.J. SHADDAY Service Type M BY THE COURT- EDWARD , JUDGE OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker ID $ IATT t 1 Zi ? ? e et* 1 !'? 6 a ?. ?- f rl r? '? • ? j .... ty+ f • •'? ?J 1 ?? w n s 5 ?, ? ? ? 1n-K ? ? P '. J ?? ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? I f hecke you are requiT to provide a opy of this form to your m loyee. If yo r employee works in a state that is di Brent from the state that issued this order, a copy must be provisoo your employee even if the box is not cheCKed. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydat&E)ate of Withholding. You mustreport the paydateldate of withholding when sending, the payinelit. The paydateldate of wit! tholdhir, is the date on which amount was wit' iheld hioin t! ie ernployee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 3978000035 EMPLOYEE'S/OBLIGOR'S NAME: PABON, CARLOS EMPLOYEE'S CASE IDENTIFIER: 6498000212 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 employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker I D $ IATT V ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PABON, CARLOS PACSES Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 558.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ® If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 F1 if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 .............................. ...................,.:.:. , .,::.... _ ...... El If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 c" ?.-? ' ?? t._ . ',, - ?? p f ' d r"y i... er ti t (,?? .?i{ -» ?,d,` In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Defendant Name: CARLOS PABON Member ID Number: 6498000212 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Fax: (717) 240-6248 Financial Break Down of Multiple Cases on Attachment Plaintiff Name SANDRA DELGADO SANDRA DELGADO PACSES Docket Case Number Number 127104941 02-1655 CIVIL 699000690 666 S 1993 TOTAL ATTACHMENT AMOUNT: $ 1,394.00 Attachment Amount/Freauenc $ 8558.00 36.00 /MONTH Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 3 2 0.81 per week, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLOS PABON Social Security Number 2 6 2- 6 7- 8 7 6 6, Member ID Number 6 4 9 8 0 0 0 212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 16, 2 0 0 3 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: 7 EDWARD E. GUIDO, JUDGE DRO: R. J. SHADDAY Service Type M Form EN-034 Worker ID $ IATT ?"`? ?? :t ---? ? ?'`?' ? i -r? ?? ?.== ?- - -? { . ;? _:w .?. n .. ?? =_ i --?, 02-1655 CIVIL ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dirt. of CUMBERLAND Date of Order/Notice 06/19/08 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number ATLAS ROOFING PAYROLL 817 SPANGLER RD CAMP HILL PA 17011-5823 Employee/Obligor's Name (Last, First, MI) 262-67-8766 Employee/Obligor's Social Security Number 6498000212 Employee/0bligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 657.00 $ $ 91.00 0.00 $ 0.00 $ 0.00 $ 558.00 $ 0.00 $ 0.00 for a total of $ per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) one-time lump sum payment 1,306.00 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: $ 301.38 per weekly pay period. $ 653.00 per semimonthly pay period (twice a month) $ 602.77 per biweekly pay period (every two weeks) $ 1, 306.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME CSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECU NUMB ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Arrears 12 weeks or greater? (S) yes Q no 699000690 OOriginal Order/Notice 666 S 93 @Amended order/Notice OTerminate Order/Notice QOne-Time Lump Sum/Notice RE: pABON, CARLOS EDWARD E. GUIDO, Form EN-00228 Rev. 3 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS E] if?hecke?l you are required to provide a Gopy of this form to your employee. If your employee works in a state that is di er ent rom 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.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 3978000035 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME: PABON EMPLOYEE'S CASE IDENTIFIER: 6498000212 LAST KNOWN HOME ADDRESS: DATE OF SEPARATION: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: * NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by Internet www.childsupport.state.pa.us Service Type M CARLOS Page 2 of 2 OMB No.: 0970-0154 Form EN-028 Rev. 3 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: PABON, CARLOS PACKS Case Number 127104941 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 02-1655 CIVIL$ 558.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number 699000690 Plaintiff Name SANDRA DELGADO Docket Attachment Amount 666 S 1993 $ 748.00 Child(ren)'s Name(s): DOB KARINA I,.. PABON 0714/92. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name ?ifchecked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ............... ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 3 Service Type M OMB No.: 0970-0154 Worker ID $IATT }+.a C? CO. Tt r,.a art rn i In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: CARLOS PABON Member ID Number: 6498000212 Please note: All correspondence must include the Member ID Number. MODIFIED ORDER OF ATTACIDWENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiple Cases on Attachment Docket PACSES Plaintiff Name Case Number Number Number Attacbment Amount/Freauencv SANDRA DELGADO 127104941 02-1655 CIVIL $ 558.00 /MONTH SANDRA DELGADO 699000690 666 S 1993 $ 748.00 MONTH TOTAL ATTACHMENT AMOUNT: $ 1,306.00 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 3 0 0.5 6 per week, or 55 . o %, of the Unemployment Compensation benefits otherwise payable to the Defendant, CARLOS PABON Social Security Number XXX-XX-8766 , Member ID Number 6498000212 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated FEBRUARY 16, 2 0 0 3 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE Date of Order: JUN 2 0 2008 DRO: R.J. SHADDAY EDWARD E. GUIDO, Service Type M JUDGE Form EN-034 Rev.1 Worker ID $ IATT n r' '? =?rs ?. :?', ????? .? ? s „,- ? ?? °?a ,?. ? :: ? c;.- {? _' -i