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Home My WebLink About06-3723MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW IN DIVORCE JAMES WRIGHT, Defendant : NO. 06- 37Z? CIVIL TERM NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary, Cumberland County Courthouse, Carlisle, 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, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 32 South Bedford Street Carlisle, Pennsylvania 17013 (717) 249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. MICHELLE WRIGHT, Plaintiff V. JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW IN DIVORCE NO. 06- 3'7d3 CIVIL TERM COMPLAINT FOR DIVORCE, ALIMONY, AND EQUITABLE DISTRIBUTION The plaintiff, Michelle Wright, by her attorneys, the Family Law Clinic, sets forth the following cause of action in divorce and equitable distribution: COUNTI DIVORCE UNDER 23 Pa.C.S. 443301(c), 3301(d), and 3301(a)(6) OF THE DIVORCE CODE 1. Plaintiff is Michelle Wright, who currently resides at 142 South 30th Street, Apartment 6, Camp Hill, Cumberland County, PA 17011, since March 2006. 2. Defendant is James Wright, who currently resides at 111 May Drive, Apartment 4, Camp Hill, Cumberland County, PA 17011, since July 1998. 3. Plaintiff has been a bona fide resident in the Commonwealth for at least six months immediately previous to the filing of this complaint. 4. Plaintiff and Defendant were married on July 22, 2000 in Mechanicsburg, Cumberland County, Pennsylvania. Plaintiff and Defendant have lived separate and apart since November 19, 2005. 6. There have been no prior actions for divorce or for annulment between the parties. The marriage is irretrievably broken. 8. Defendant has offered such indignities to plaintiff, an injured and innocent spouse, as to render her condition intolerable and life burdensome. 9. Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the court require the parties to participate in counseling. WHEREFORE, Plaintiff requests the court to enter a decree of divorce. COUNT II ALIMONY 10. Plaintiff repeats and realleges paragraphs one through nine. 11. Plaintiff requires support to adequately maintain herself in accordance with a reasonable standard of living. 12. Plaintiff has been and will continue to be the primary caretaker of her minor child. 13. Plaintiff has not been able to acquire work to adequately support herself. 14. Defendant, during the marriage, agreed that Plaintiff would not work outside the home, and provided all necessary support for her and her child. 15. Defendant is employed and financially able to provide for his reasonable needs and the reasonable needs of the Plaintiff. WHEREFORE, Plaintiff requests the Court to enter an award of reasonable alimony, and such other relief as the Court deems just. COUNT III EQUITABLE DISTRIBUTION 16. Plaintiff repeats and realleges paragraphs one through nine. 17. Plaintiff and Defendant have acquired property during their marriage, including, but not limited to: a. Defendant's truck. WHEREFORE, Plaintiff requests the court to enter a decree dividing the property equitably between the parties and such relief as the court deems just. Respectfully Submitted, Date _ Zo _ Q T 1 Hammill ertified Legal Intern Ro ains Tho s Place Anne MacDonald-Fox Lucy Johnston-Walsh Supervising Attorney FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717)243-2968 VERIFICATION I verify that the statements made in the foregoing complaint are true and correct, to the best of my knowledge, information and belief I understand making any false statement would subject me to the penalties of 18 Pa.C.S. §4904, relating to unworn falsification to authorities. Date Z6 - 22.- 06 Plaintiff `{ I ? Michelle Wright r.n rl c [ J __ Jp •h , V C -. 1? .. i T l p ? ,J ? it f ? ( ? Y J -<. MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW : IN CUSTODY JAMES WRIGHT, Defendant NO. 06- 3?CIVIL TERM PRAECIPE TO PROCEED IN FORMA PAUPERIS TO THE PROTHONOTARY: Kindly allow Michelle Wright, Plaintiff, to proceed in forma pauperis. The Family Law Clinic, attorneys for the party 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. Date kRespectfully , ubmitted, mill Legal Intern ROBE T E. INS THO S M. PLACE ANNE MACDONALD-FOX LUCY JOHNSTON-WALSH Supervising Attorneys FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 717-243-2968 r, ?:_a ?, cl^ ''r ., t;,.. ?? '4, ? ;{ r .? ?? ?. MICHELLE WRIGHT, Plaintiff v JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION-LAW DIVORCE No. 06-3723 CIVIL TERM PRAECIPE TO REINSTATE COMPLAINT To The Prothonotary: Please reinstate the Divorce Complaint at the above-captioned docket, originally filed on June 29, 2006. L 1Hammill rtified Legal Intern --e4. Lucy J st -Walsh, sq. Supervising Attorney Date: ) 0 -1 ;L- V ? r?.a ?? ?? ?. C?__? _ - _.,, ??.? -i +? ?? ` MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant : No. 06 - 3723 CIVIL TERM PRAECIPE TO REINSTATE COMPLAINT To The Prothonotary: Please reinstate the Divorce Complaint at the above - captioned docket, originally filed on June 29, 2006. 11im" a 11?/ Samara A. Gomez Certified Legal Intern Meg Riesmeyer, Esq. Supervising Attorney Date: 3 2? " { c .n , MICHELLE WRIGHT, Plaintiff V. JAMES WRIGHT Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW IN CUSTODY : NO. 06-3723 CIVIL TERM PRAECIPE TO PROCEED IN FORMA PAUPERIS TO THE PROTHONOTARY: Kindly allow Michelle Wright, Plaintiff, to proceed in forma pauperis. The Family Law Clinic, attorneys for the party 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. Date '41 ?_l /00 Respectfully submitted, Samara Gomez Certified Legal Intern &_t& ROBERVF E. RAINS THOMAS M. PLACE ANNE MACDONALD-FOX LUCY JOHNSTON-WALSH MEGAN RIESMEYER Supervising Attorneys FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 717-243-2968 C5 i fV MICHELLE WRIGHT, Plaintiff V. JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW DIVORCE : No. 06 - 3723 CIVIL TERM PRAECIPE TO REINSTATE COMPLAINT To The Prothonotary: Please reinstate the Divorce Complaint at the above - captioned docket, originally filed on June 29, 2006. Samara A. Gomez Certified Legal Intern Megan iesmeyer, Esq. Supervising Attorney Date: ?-i 127 /C)3 O cz? 'C i SHERIFF'S RETURN - OUT OF COUNTY AP* 4 CASE NO: 2006-03723 P { COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND WRIGHT MICHELLE VS WRIGHT JAMES R. Thomas Kline Sheriff or Deputy Sheriff who being duly sworn according to law, says, that he made a diligent search and and inquiry for the within named DEFENDANT to wit: T.TTI T / TTT TAINT-:T fl but was unable to locate Them deputized the sheriff of YORK serve the within COMPLAINT - DIVORCE County, Pennsylvania, to On May 24th , 2007 , this office was in receipt of the attached return from YORK Sheriff's Costs: So answer Docketing 18.00 Out of County 9.00 Surcharge 10.00 R. Thomas Kline .00 Sheriff of Cumberland County .00 37.00 ?S/30/67 7L 00/00/0000 Sworn and subscribe to before me this day of in his bailiwick. He therefore A. D. COUNTY OF YORK AV' lif OFFICE OF THE SHERIFF 45 N. GEORGE ST., YORK, PA 17401 SERVICE CALI., (717) 771-9601 SHERIFF SERVICE INS?TRUCTIOM PROCESS RECEIPT and AFFIDAVIT OF RETURN PLEASE TYPE ONLY LNE 1 THRU 12 DO NOT DETACH ANY COPES 1 PLAINTIFF/Sl 2 COURT NUMBER Michelle Wright 06-3723 civil 3. DEFENDANT/S/ 4. TYPE OF Notice WRIT QR COMP Z T - t a n d C o m p C I D Janes Wright in Divorce SERVE 5. NAME OF INDIVIDUAL, COMPANY, CORPORATION. ETC TO SERVE OR DESCRIPTION OF PROPERTY TO BE LEVIED, ATTACHED, OR SOLD Jarnes Wriqht 6 ADDRESS (STREET OR RFO WITH BOX NUMBER, APT NO, CITY, BORO. TWP, STATE AND ZIP CODE) AT E: Brothers Trucking 40 Willow Spring Circle York, PA 17402 7. INDICATE SERVICE U PERSONAL U PERSON IN CHARGE DEPUTIZE U CERT MAIL U 1ST CLASS MAIL U POSTED J OTHER NOW April 27 .20 07 I, SHER COUNTY, PA, do hereby deputize the sheriff of York COUNTY to execute this Writ and m return there ording to law. This deputization being made at the request and risk of the plaintiff., 8. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING S DIJ IrIVIC? F C O ? T Y Cunbtrland NO ADVANCE FEE IFP Please mail return of service to CLunberland County Sheriff. Thank you. NOTE: ONLY APPLICABLE ON WRIT OF EXECUTION: N.B. WAIVER OF WATCHMAN - Any deputy sheriff levying upon or attaching any property under within writ may leave same without a watchman, in custody of whomever is found in possession, after notifying person of levy or attachment, without liability on the part of such deputy or the sheriff to any plaintiff herein for any loss, destruction, or removal of any property before shenfrs sale thereof 8. TYPE NAME and ADDRESS of ATTORNEY / ORIGINATOR and SIGNATURE M E G A N R I E S M E Y E R 10. TELEPHONE NUMBER 11 DATE FILED 45 NORTH PITT STREET, CARLISLE, PA 17013 1717-243-2968 4/27/2007 12. SEND NOTICE OF SERVICE COPY TO NAME AND ADDRESS BELOW: (This area must be completed d notice is to be mailed) CUMBERLAND CO SHERIFF SPACE BELOW FOR USE OF THE SHERIFF - DO NOT WRITE BELOW TM LUIS 13. 1 acknowledge receipt of the writ 01/2007 . DATE RECEIVED 15 Expiration/Hearing Date or complaint as indicated above. MJ MC G I L L Y C SO 5/27/2007 16. HOW SERVED: PERSONAL ( ) RESIDENCE ( ) POSTED( ) POCK) SHERIFF'S OFFICE ( ) OTHER( ) SEE REMARKS BELOW 17. U I hereby certify and return a NOT FOUND because I am unable to locate the individual, company, etc named above. (See remarks below.) 23. Advance Costs 24. Service Costs 25 N/F 26. Mileage 27. Postage 28. Sub Total 29. Pound 30 Notary 31. Surchg. 32 Tot. Costs 33 Costs Due or Refund Check No I F P 34. Foreign County Costs 35. Advance Costs 36 Service Costs 37. Notary Cert. 38. MileagelQostaprlNot Found 39. Total Costs 40. Costs Due or Refund 17th ANSWERS 41. AFFIRME0i subscri:to bef re me thi N ? 44. na Si it 45. E" 1 H v10 42. day of C - Dep. Sherff ? "{ SEJ°t>= M X /NOTARY NOTARIAL --- 46. Signature of York 47 ATE LISA L. BC1Vt?Ri+N, NOTARY PUBLIC SlreriB r is e9 SJ ??za(:f t o5 Sh?ritr /17/0 7 CITY OF YORK, YORK COUNTY , y MY C° ;j t ?X°iGS rIJ?. 12, 2065 48. Signature of Foreign 49 DATE County Sheriff 50. 1 ACKNOWLEDGE RECEIPT OF THE SHERIFF'S RETURN SIGNATURE 151 DATE RECEIVED OF AUTHORIZED ISSUING AUTHORITY AND TITLE 1. WHITE - Isstsng Authority 2. PINK - Attorney 3. CANARY - Sheriffs Office 4. BLUE - Shears Office vct *MO A LS I- 1 JAMS 311 .40 301.4.0 OUG03V MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant : No. 06 - 3723 CIVIL TERM PETITION PURSUANT TO Pa.R.C.P RULE 430 FOR SPECIAL ORDER OF COURT DIRECTING METHOD OF SERVICE OF PROCESS Petitioner, Michelle Wright, by her attorneys, the Family Law Clinic, respectfully requests this Court to enter an Order directing method of service on Defendant James Wright by publication, once in the Carlisle Sentinel newspaper and once in the Cumberland County Law Journal, and in support of the petition states the following: 1. Plaintiff is Michelle Wright whose current address is 142 South 30t' Street, Apartment 6, Camp Hill, Cumberland County, Pennsylvania 17011. 2. Defendant is James Wright whose last known address was 111 May Drive, Apartment 4, Camp Hill, Cumberland County, Pennsylvania 17011. 3. Plaintiff is a bona fide resident of the Commonwealth of Pennsylvania and has been for at least 6 months prior to the filing of the original Divorce Complaint. 4. Plaintiff and Defendant were married on July 22, 2000 in Mechanicsburg, Cumberland County, Pennsylvania. 5. The parties separated on November 19, 2005, and have lived separate and apart since that time. 6. On June 29, 2006, a Complaint for Divorce was filed in the Cumberland County Courthouse attached hereto as "Exhibit A". 7. Plaintiff, at the time the Divorce Complaint was originally filed on June 29, 2006, believed that Defendant lived at 111 May Drive, Apartment 4, Camp Hill, Cumberland County, Pennsylvania 17011. 8. Plaintiff has not seen nor spoken to Defendant since May 2006 when she spoke to him on the telephone to try to coordinate a visit between Defendant and Plaintiff's son. 9. Plaintiff learned in February 2007, from Defendant's landlord that Defendant had been evicted from his residence at 111 May Drive, Apartment 4, Camp Hill, Cumberland County, Pennsylvania 17011. 10. Plaintiff has had no knowledge of Defendant residence or whereabouts since February 2007. 11. Plaintiff has no contact with any of Defendant's family other than Defendant's cousin, Susan Kittril, who has no knowledge of Defendant's residence or whereabouts and has no contact with Defendant. 12. Plaintiff has no contact with or knowledge of any of Defendant's friends or acquaintances. 13. Plaintiff has made a good faith effort to locate Defendant including the following: a. On July 5, 2006 and November 14, 2006, Plaintiff s counsel attempted to serve Defendant via certified mail, restricted, return receipt requested at his residence, 111 May Drive, Apartment 4, Camp Hill, Cumberland County, Pennsylvania 17011. The letters were returned by the United States Post Office as "Return to Sender / Unclaimed / Unable to Forward". b. In October 2006, Plaintiff employed three of her friends to attempt to serve Defendant at Giant Super Food Store, 3301 Trindle Road, Camphill, Cumberland County, Pennsylvania, 17011. Plaintiff s friends were unable to serve Defendant because Defendant refused to take hold of the envelope in which the Divorce Complaint was sealed. Defendant further stated that he wanted to be served by a sheriff. C. On January 25, 2007, Plaintiff's counsel attempted to serve Defendant via certified mail, restricted, return receipt requested at his place of employment at Brothers Trucking, 40 Willow Spring Circle, York Pennsylvania 17402. The letters were returned by the United States Post Office as "Unclaimed". d. On April 27, 2007, Plaintiff's counsel employed R. Thomas Kline, Sheriff of Cumberland County to effect service on Defendant at his place of employment at Brothers Trucking Company, 40 Willow Spring Circle, York Pennsylvania 17402. Sheriff Kline deputized the Sheriff of York County, William M. Hose, to serve Defendant. Sheriff Hose was unsuccessful at his attempt to serve Defendant. e. On June 26, 2007, Plaintiff's counsel employed an internet search program called Accurint (www.accurint.com) to locate the Defendant. A records search under Defendant's name, social security number and birthdate indicated that Defendant had resided at 111 May Drive, Apartment 4, Camp Hill, Cumberland County, Pennsylvania 17011 until August 2006 and that his mailing address from August 2006 to present is PO Box 310, Camp Hill, Cumberland County, Pennsylvania, 17001 - 0310. f. On June 26, 2007, Plaintiff's counsel made a Request for Change of Address or Boxholder Information Needed for Service of Legal Process to the Postmaster of Camp Hill, Cumberland County, Pennsylvania, 17011, pursuant to the Freedom of Information Act, 39 C.F.R. Part 265. The request was for the name and street address of the holder of PO Box 310, Camp Hill, Cumberland County, Pennsylvania, 17001 - 0310. The request was returned by the Postmaster and the Postmaster confirmed that the holder of PO Box 310, Camp Hill, Cumberland County, Pennsylvania, 17001 - 0310 resides at 111 May Drive, which is the address of Defendant. g. Plaintiff s counsel has attempted to serve Defendant at PO Box 310, Camphill, Pa, 17001-0310 and all attempts have failed. h. Plaintiff knows of no further friends or family members to whom she may address inquiries regarding Defendant's whereabouts. 8. Plaintiff does not know where the Defendant is residing. Furthermore, Plaintiff has no way of obtaining such information. WHEREFORE, Plaintiff requests that this Court enter an order directing method of service of the Complaint for Divorce under § 3301 (d) as follows: by publishing the Notice attached hereto as "Exhibit B", once in the Cumberland County Law Journal and once in the Carlisle Sentinel newspaper. Date: Respectfully submitted, 0(2, (2-, C la Lenz Certified Legal Intern ROBER - INS THOMAS M. PLACE ANNE MACDONALD-FOX LUCY JOHNSTON-WALSH MEGAN RIESMEYER Supervising Attorneys THE FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717) 243-2968 Fax: (717) 243-3639 MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW : DIVORCE JAMES WRIGHT, Defendant : No. 06 - 3723 CIVIL TERM AFFIDAVIT 1. 2 3. 4. I, Charla Lenz, am currently employed as a Certified Legal Intern by Plaintiff s counsel, the Family Law Clinic, located at 45 North Pitt Street, Carlisle, Cumberland County, Pennsylvania 17013. I have been engaging in an ongoing effort to locate the Defendant, James Wright. The official case records at the Family Law Clinic indicate that prior to my efforts, other Certified Legal Interns had attempted to locate and serve the Defendant at his home address, his PO Box and his place of employment without success. I have exhausted all reasonable means to attempt to locate the Defendant and have maintained a record of all attempts. My effort included: a. Searches on specialized date archive sites maintained by Lexis-Nexis (Accurint) for Defendant. b. Searches on multiple internet person locator websites. C. Request to the United States Postmaster of Camp Hill, Cumberland County, Pennsylvania 17011, for boxholder street address for Defendant's last known PO Box pursuant to the Freedom of Information Act, 39 C.F.R. Part 265. d. Questioned Plaintiff about any and all possible relatives, friends or associates who may know the Defendant's whereabouts. e. Contacted two phone numbers provided by Accurint associated with Defendant's Social Security Number. i. The first number, associated with his last known address at 1 I 1 May Drive, Apartment 4, Camp Hill, Cumberland County, Pennsylvania 17011, had been disconnected. ii. The second number repeatedly reaches an answering machine. I have left several messages on the machine and have received no return call. 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: 1 Charla Lenz Certified Legal Intern VERIFICATION I verify that the statements made in this Petition for Special Order Directing Method of Service are true and correct to the best of my personal knowledge 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: ? '- '1 Michelle Wr t, Plaintiff PLAINTIFF'S EXHIBIT MICHELLE WRIGHT, Plaintiff V. JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION - LAW : IN DIVORCE NO. 06- j -] 13 NOTICE TO DEFEND AND CLAIM RIGHTS CIVIL TERM You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary, Cumberland County Courthouse, Carlisle, 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, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 32 South Bedford Street , Carlisle, Pennsylvania 17013 `(717) 249-3166 77 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW : IN DIVORCE JAMES WRIGHT, Defendant : NO. 06- CIVIL TERM COMPLAINT FOR DIVORCE, ALIMONY, AND EQUITABLE DISTRIBUTION . The plaintiff, Michelle Wright, by her attorneys, the Family Law Clinic, sets forth the following cause of action in divorce and equitable distribution: COUNTI DIVORCE UNDER 23 Pa.C.S. 5§3301(c), 3301(d), and 3301(a)(6) OF THE DIVORCE CODE 1. Plaintiff is Michelle Wright, who currently resides at 142 South 30'' Street, Apartment 6, Camp Hill, Cumberland County, PA 17011, since March 2006. 2. Defendant is James Wright, who currently resides at 111 May Drive, Apartment 4, Camp Hill, Cumberland County, PA 17011, since July 1998. 3. Plaintiff has been a bona fide resident in the Commonwealth for at least six months immediately previous to the filing of this complaint. 4. Plaintiff and Defendant were married on July 22, 2000 in Mechanicsburg, Cumberland County, Pennsylvania. 5. Plaintiff and Defendant have lived separate and apart since November 19, 2005. 6. There have been no prior actions for divorce or for annulment between the parties. 7. The marriage is irretrievably broken. 8. Defendant has offered such indignities to plaintiff, an injured and innocent spouse, as to render her condition intolerable and life burdensome. 9. Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the court require the parties to participate in counseling. WHEREFORE, Plaintiff requests the court to enter a decree of divorce. COUNT II ALIMONY 10. Plaintiff repeats and realleges paragraphs one through nine. 11. Plaintiff requires support to adequately maintain herself in accordance with a reasonable standard of living. 12. Plaintiff has been and will continue to be the primary caretaker of her minor child. 13. Plaintiff has not been able to acquire work to adequately support herself. 14. Defendant, during the marriage, agreed that Plaintiff would not work outside the home, and provided all necessary support for her and her child. 15. Defendant is employed and financially able to provide for his reasonable needs and the reasonable needs of the Plaintiff. WHEREFORE, Plaintiff requests the Court to enter an award of reasonable alimony, and such other relief as the Court deems just. COUNT III EQUITABLE DISTRIBUTION 16. Plaintiff repeats and realleges paragraphs one through nine. 17. Plaintiff and Defendant have acquired property during their marriage, including, but not limited to: a. Defendant's truck. WHEREFORE, Plaintiff requests the court to enter a decree dividing the property equitably between the parties and such relief as the court deems just. Respectfully Submitted, Date 6- A- v J' 1 Hammill ertified Legal Intern Rob rt ains Tho . Place Anne MacDonald-Fox Lucy Johnston-Walsh Supervising Attorney FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717)243-2968 VERIFICATION I verify that the statements made in the foregoing complaint are true and correct, to the best of my knowledge, information and belief. I understand making any false statement would subject me to the penalties of 18 Pa.C.S. §4904, relatine to unsworn falsification to authorities. Date 'C6 - 22-- CC Plaintiff `'tO, lt Michelle Wright LEGAL NOTICE In the Court of Common Pleas of Cumberland County, Pennsylvania NO. 06-3723 CIVIL TERM IN DIVORCE MICHELLE WRIGHT V. JAMES WRIGHT TO: JAMES R UBIN WRIGHT YOU HAVE BEEN SUED IN COURT. The Plaintiff, Michelle Wright, by her attorneys, the Family Law Clinic, has filed a Complaint for Divorce under § 3301(c), 3301(d) and 3301(a)(6) of the Divorce Code. If you wish to defend against this claim, you must enter a written appearance personally or by attorney and file your defenses or objections in writing with the court. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce may be entered against you by the Court. You may lose property or other rights important to you. YOU SHOULD TAKE THIS NOTICE TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717) 249-3166 ..,rl MICHELLE WRIGHT, Plaintiff V. JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW DIVORCE : No. 06 - 3723 CIVIL TERM PRAECIPE TO REINSTATE COMPLAINT To The Prothonotary: Please reinstate the Divorce Complaint originally filed on June 29, 2006 in the above captioned matter. 6L"'yk Charla Lenz Certified Legal Intern X Anne Mac ona -Fox Supervising Attorney FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717)243-2968 Date: ?- MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant : No. 06 - 3723 CIVIL TERM PRAECIPE TO PROCEED IN FORMA PAUPERIS TO THE PROTHONOTARY: Kindly allow Michelle Wright, Plaintiff, to proceed in forma pauperis. The Family Law Clinic, attorneys for the party 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. Date ' Respectfully submitted, h Charla Lenz Certified Legal Intern ROBER INS THOMAS M. PLACE ANNE MACDONALD-FOX LUCY JOHNSTON-WALSH MEGAN RIESMEYER Supervising Attorneys FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 717-243-2968 MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant : No. 06 - 3723 CIVIL TERM AMENDMENT TO PETITION PURSUANT TO Pa.R.C.P RULE 430 FOR SPECIAL ORDER OF COURT DIRECTING METHOD OF SERVICE OF PROCESS The Plaintiff, Michelle Wright, by and through her attorneys, the Family Law Clinic, amends her Petition Pursuant to Pa.R.C.P Rule 430 for Special Order of Court Directing Method of Service of Process, filed December 4, 2007, to include the following numbered paragraphs: 14. Persuant to Cumberland County Local Rule 208.3(a)(2) no other Judge has ruled upon any issue or matter in this case. However, the parties have been involved as opposing parties to a Protection from Abuse Order, docket number: 2001-5586, and Support Order, docket number: 01007 Support 2003, in which the Honorable Judges Guido and Oler have ruled, respectively. 15. Persuant to Cumberland County Local Rule 208.3(a)(9) no concurrence has been sought because there is no opposing counsel of record in this matter. Respectfully submitted, Date: Charla Lenz Certified Legal Intern ROB S THOMAS . PLACE ANNE MACDONALD-FOX LUCY JOHNSTON-WALSH MEGAN RIESMEYER Supervising Attorneys THE FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717) 243-2968 Fax: (717) 243-3639 t { n DEC 0 5 2007 /Yr ?/ MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant : No. 06 - 3723 CIVIL TERM ORDER OF C0 A On this 7_ day of , 2007, on consideration of the attached Petition Pursuant to Pa.R.C.P. Rule 430 for Special Order Directing Method of Service, it is ordered that service of the Complaint and Plaintiff's Affidavit under Section 3301(d) be made by publication of the attached notice, once in the Cumberland County Law Journal and once in the Carlisle Sentinel. J. no 6 9 0 1 '02A a 110JZ s % MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, ; Defendant : NO. 06-3723 CIVIL TERM PRAECIPE TO FILE PROOF OF PUBLICATION TO THE PROTHONOTARY: Kindly file the attached proof of publication in the above docketed case. Date 1 4p Res tfully submitted, Ruchika pia Certified Legal Intern ROBE E. RAINS 117 THOMAS M. PLACE ANNE MACDONALD-FOX LUCY JOHNSTON-WALSH MEGAN RIESMEYER Supervising Attorneys FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 717-243-2968 J I. C7 0 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Tammy Shoemaker Classified Advertising Manager of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTNEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following day(s) December 22, 2007 COPY OF NOTICE OF PUBLICATION 141 . COOK oft gnP"s01 Affiant further deposes that he/she is not r T interested in the subject matter of the IN olv0 i aforesaid notice or advertisemMwe ent, and that all allegations in the foregoing statement lrga tT. Tt®t MiotollaW per as to time, place and character of N*%"*0 publication are true. Ga4e. tf you eR OW . 1AJ * ardt"Y Oro I" *+ Yauaye! a?rout?iF+o'doiro?lh? Goo ow1i1 41 ?gu a+a a dacras at atvoros niay #i'. ttpidnst yau? t3eW1. Kou rney10" property or other ri?+ts knportmt to you. Y0 %? ?- 7tNTPRGE TO Y YER AT 08, - KC 00 DViDET 1 TI??AIIOF4rY J4 H. p na.i?w?? ia. THM OFFICE MAY 9t A$L€ to Sworn to and subscribed before me this IT11(K T+!]K t1dT AGrr ttEs T twY bFRE ?7th. day of December. 2007. LEEiAi' G?EB TQ ELt018LE PERBdNR AT A Qr,?Cg* OR NO F Cu rW Cou Bar AnociaWn 3250 Be QV4 street G "A i7} 24"1863 rNotary Pub My commission expires: 010f COMMONWEALTH OF PENNSYLVANIA Notarial Seal Christina L. Wolfe, Notary Pubic Carlisle Boro, Curnbeftd County W Comrrtission E)ires Sept 1, 2008 Member. Pennsylvania Association Ot Notaries o ?? p re C? MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant NO. 06-3723 CIVIL TERM PRAECIPE TO FILE PROOF OF PUBLICATION TO THE PROTHONOTARY: Kindly file the attached proof of publication in the above docketed case. Date ?1g Respectfully submitted, Ruchika G Certified Legal Intern fA-1j4A'4 1Z1U"Z_!!fZ-4'x _ ROBER INS THOMAS M. PLACE ANNE MACDONALD-FOX LUCY JOHNSTON-WALSH MEGAN RIESMEYER Supervising Attorneys FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 717-243-2968 ?--g-g r= ?? ?. t.L7 :.,, ._?., .: =?+ - ?._ ?;7 ,.?; ?. PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, Viz February 22, 2008 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. C- J a Marie Coyne, ditor SWORN TO AND SUBSCRIBED before me this 22 day of February, 2008 Notary NOTARIAL SEAL DEBORAH A COLLINS Notary Public CARLISLE BORO, CUMBERLAND COUNTY My Commission Expires Apr 28, 2010 CUMBERLAND LAW JOURNAL LEGAL NOTICE In the Court of Common Pleas of Cumberland County, Pennsylvania NO. 06-3723 CIVIL TERM MICHELLE WRIGHT V. JAMES WRIGHT IN DIVORCE TO: JAMES RUBIN WRIGHT YOU HAVE BEEN SUED IN COURT. The Plaintiff, Michelle Wright, by her attorneys, the Family Law Clinic, has filed a Complaint for Divorce under §3301(c), 3301(d) and 3301(a)(6) of the Divorce Code. If you wish to defend against this claim, you must enter a written appearance per- sonally or by attorney and file your defenses or objections in writing with the court. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce may be entered against you by the Court. You may lose property or other rights important to you. YOU SHOULD TAKE THIS NO- TICE TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMA- TION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A RE- DUCED FEE OR NO FEE. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717) 249-3166 Feb. 22 N '- ?(ry W e r w w 1? .? d MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION - LAW :IN DIVORCE JAMES WRIGHT, Defendant : NO. 06-3723 CIVIL TERM NOTICE TO DEFENDANT If you wish to deny any of the allegations set forth in this affidavit, you must file a counter affidavit within twenty days after this affidavit has been served on you or the statements will be admitted. PLAINTIFF'S AFFIDAVIT UNDER SECTION 3301(d) OF THE DIVORCE CODE 1. The parties to this action separated in November 19, 2005, and have continued to live separate and apart for a period of at least 2 years. 2. The marriage 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 67 , MICHELLE WRI T Plaintiff C ,± .,'? R.) ?? ?7 ?? ?.. r ? ` f..?.: ? ?. r ? ? ? ?>. ?... ? k. ! I ?? :? C,C, "'? MICHELLE WRIGHT, Plaintiff V. JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW DIVORCE : NO. 06-3723 CIVIL TERM PRAECIPE TO WITHDRAW EQUITABLE DISTRIBUTION COUNT To the Prothonotary: Please withdraw the Count for Equitable Distribution (Count III) in the above-captioned matter filed in the Cumberland County Courthouse on June 29, 2006. Date: q A?Ruca?tCpta Certified Legal Intern A 1'h A &- Anne acDonald-Fox Thomas Place Robert Rains Megan Riesmeyer Supervising Attorneys The Family Law Clinic 45 N. Pitt Street Carlisle, PA 17013 (717)243-2968 HIM X f MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW JAMES WRIGHT, :DIVORCE Defendant NO. 06-3723 CIVIL TERM INCOME AND EXPENSE STATEMENT OF I verify that the statements made in this Income and Expense Statement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Date: 3U Michelle"Wright INCOME Employer: &ZC-0 V'n Lnc Employer's Address: Type of Work: _ s As5cc??-?? Payroll Number: _ 23 - 30 5q 19.9 Pay Period (weekly, biweekly, etc.): L g i(L Gross Pay per Pay Period: $ 2• Itemized Payroll Deductions: Federal Withholding $ 5-j2- Social Security Local Wage Tax State Income Taxi Retirement Savings Bonds Credit Union Life Insurance Health Insurance Other (specify) Net Pay per Pay Period: $ egg?h Other Income: Interest Dividends Pension Annuity Social Security Rents Royalties Expense Account Gifts Unemployment Comp. Workmen's Comp. ?LYI? ?Ur: rllflQ Total TOTAL INCOME EXPENSES Home Mortgag rent Maintenance Utilities Electric Gas Oil Telephone Water Sewer Employment Public transportation Lunch Taxes Real estate Personal property Income Insurance Homeowners Automobile Life Accident Health Week Month (Fill in Appropriate Column) S?LlLS?' Weekly Monthly (Fill in Appropriate Column) $ $LaDaYD ?D•C? (mob- `? $ $ pqe, Year Yearly Other Automobile Payments $ $ $ Fuel Repairs Medical Doctor $ $ $ Dentist Orthodontist Hospital Medicine Special needs (glasses, braces, orthopedic devices) Education Private school $ $ $ Parochial school College Religious Personal Clothing $ Food $ $3`o fizzpw-m'i.?1 ago Barber/hairdresser Credit payments Credit card , Charge account D Iz Memberships Loans Credit Union $ $ $ Household help $ $ $ Child care Papers/books/magazines Entertainment s r for 12 ?rp1 Pay TV le Vacation Gifts Legal fees Charitable contributions Other child support - Alimony payments Other Total Expenses $ $ $ PROPERTY OWNED Ownership* Description Value H W J Checking accounts Savings accounts + ?? - - Credit Union - - - Stocks/bonds - - - Real estate - - - Other - - - Total $ - - - INSURANCE Coverage* Company Policy No. H W C Hospital Blue Cross Other - - - Medical - - - Blue Shield Other - - - Health/Accident - - - Disability Income - - - Dental - - - Other - - - * H=Husband; W=Wife; J=Joint; C=Child SUPPLEMENTAL INCOME STATEMENT (If you are self-employed or if you are salaried by a business of which you are owner in whole or in part, you must also fill out the Supplemental Income Statement.) (a) This form is to be filled out by a person (circle one): (1) who operates a business or practices a profession, or (2) who is a member of a partnership or joint venture, or (3) who is a shareholder in and is salaried by a closed corporation or similar entity. (b) Attach to this statement a copy of the following documents relating to the partnership, joint venture, business, profession, corporation or similar entity: (1) the most recent Federal Income Tax Return, and (2) the most recent Profit and Loss Statement. (c) Name of business: Address and Telephone Number: (d) Nature of business (circle one) (1) partnership (2) joint venture (3) profession (4) closed corporation (5) other (e) Name of accountant, controller or other person in charge of financial records: (f) Annual income from business: (1) How often is income received? (2) Gross income per pay period: _ (3) Net income per pay period: (4) Specified deductions, if any: _ Department of the Treasury-Internal Revenue Service Form 1040-- U.S. Individual Income Ti Label (See A MICHELLE A WRIGHT Instructions) B Use the E Mabel. L 142 SOUTH 30TH APT 6 Otherwise. E CAMPHILL Please Print R or type. E PresiderrtW Election Campaign ? Check here If You. or Your spouse alum LUV / 99 RS Use Ond -- not write orstWk in eft spece. OMB No. 1545.0074 Your social security number 180-84-1853 Spouse's social security no. PA 17011-0000-000 ? You must enter A you SSN(s) above. Cheddng a box below wig not change your tax or refund. Filing Status 1 single 4 IN Head of household (with qua i f tg person). (See Inst.) If the 2 Married fling jointly (even if only one had income) qualifying person is a child but not your dependent enter this Check only 3 Married filing separately. Enter spouse's SSN above and child's name here. ? one box. full name here. ? 5 Qua with dependent child see instructions Exemptions 6a Yourself. If someone can claim you as a dependent, do not check box 6a .......... i Chocked if more than four N b Spouse . on 6a and 6b 1 . ........ ... ...... • • • dependents, see instnxions. c Dependents: (2) Dependent's social No. of children n u' if ual on 6c t° (3) Dependent's (4) id for ch? g 01 security number iv you relationship to you credit (see inst) 1 First name Last name a DESHAWN WILLIAMS 186-84-3022 ON yooud to dl- vorce or ration (see st) - t l ere aboen _ ve d Total number of exemptions claimed ...................... Add numbers on lines above ? 0 2 Income 7 Wages. s=ue tips, et. Arad, Form(s) w-2 7 3 , 0 4 9 8a Taxable interest. Attach Schedule B If required ...................... 8a Form(s ) Attach Also here. W2 b Tax-exempt interest Do not include on line 8a ...... 8b attach Forms 9a Ordinary dividends. Attach Schedule B if required ..... .......... W-2G and b Qualified dividends (see instructions) ........... 9b 1099-R 1ftax 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) ... 10 was withheld. 11 Alimony received .................................... 11 If you did not 12 Business income or (loss). Attach Schedule C or C-EZ ................ 12 get a W-2, 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here .. ? M 13 see instructions. 14 Other gains or (losses). Attach Form 4797 ...... ................ 14 15a IRA distributions ...... 158 b Taxable amount (see inst.) .. 15b 16a Pensions and annuities .. 16a b Taxable amount (see inst.) .. 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, eta Attach Schedule E .. 17 Enclose, but do 18 Farm income or (loss). Attach Schedule F ........................ 18 not attach. any 19 Unemployment compensation .. • ......... ................ • 19 payment Also, 20a Social security benefits .. 1 20a I b Taxable amount (see inst.) .. 20b please use Form 21 Other income. List type $ amount (see inst.) 21 104etf. 22 Add the amounts in the far right column for lines 7 through 21. This is r total income ? 22 3,049 Adjusted 23 Educator expenses (see instructions ) ........... 23 ` - Gross 24 Certain business expenses of reservists, performing artists, & Incoine fee-basis government officials. Attach Form 2106 or 2106-EZ 24 25 Health savings account deduction. Attach Form 8889 ... 25 26 Moving expenses. Attach Form 3903 ........... 26 27 One-half of self-employment tax. Attach Schedule SE ... 27 28 Self-employed SEP, SIMPLE, and qualified plans ..... 28 29 Self-employed health insurance deduction (see instructions) 29 J 30 Penalty on early withdrawal of savings ...... ..... 30 31a Alimony paid b Recipients SSN ? 31a 32 IRA deduction (see instructions) ..... ......... 32 33 Student loan interest deduction (see instructions) ..... 33 ` 34 Tution and fees deduction. Attach Forth 8917 .... .. .. 34 35 Domestic production activities deduction. Attach Form 8903 35 36 Add lines 23 through 31a and 32 through 35 ... .................... 36 3,049 MICHELLE A WRIGHT 180-84-1853 Form 1040 2 Tax and 38 Amount from One 37 (adjusted gross income) .... .............. 38 3,049 Credits 39a Check You were born before January 2,194-3, 8 Blind. Total boxes it Spouse was bom before Jan. 2, 1943, Blind. checked ? 39a Standard b if yow spouse itemizes m a separate reAWm or you were, a duakAWAs aNen, see hsL and check here b- 39b Deduction 40 Itemized deductions (from Schedule A) or your standard deduction (sae left margin) ...... 40 7,850 for - 41 Subtract line 40 from line 38 ................................... 41 (4,801) e People 42 If fine 38 is $117,300 or less, multiply $3,400 by the total number of exemptions claimed on One 6d. who checked If One 38 is over $117,300, see the worksheet in the instructions ............. 42 6,800 any box an ? 32 °r 3eb or who 43 Taxable Income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0. . . . . . 43 can be 44 Tax (see inst. check it any tax is tram; a Form(s) 8814 b a Form 4972 e a Form(s) 8889 44 claYred as a deverident 45 Alternative minimum tax (see instructions). Attach Form 6251 .................. 45 see N linst 46 o 46 Add lines 44 and 45 .. . . . - 10, e ° 47 Credit for child and dependent care expenses. Attach Form 2441.. 47 • - • ' Skoe Worried fling 48 Credit for the elderly or the disabled. Attach Schedule R ...... 48 $' 49 Education credits. Attach Form 8863 ................ 49 marled tiling 50 Residential energy credits. Attach Form 5695 ............ 50 dos 51 Foreign tax credit. Attach Form 1116 if required ........... 51 widow(er). 52 Child tax credit (see instructions). Attach Form 8901 if required .. 52 $10,700 53 Retirement savings contributions credit Attach Form 8880 ... .. 53 Head of household, 54 Credits from: a 8 Form 8396 b 8 Form 8859 c 8 Form 8839. 54 $7,850 55 Other credits: a Form 3800 b Form 8801 c Form 55 56 Add lines 47 through 55. These are your total credits ...................... 56 57 Subtrad fine 56 from line 46. If line 56 is more than line 46, enter -0 . .............. ? 57 58 Sag-employment tax. Attach Schedule SE ...... ;gs 59 Unreported social security and Medicare tax from. a Form 4137 • b. .Form 8919 ' .... 59 Other 60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 If required ..... 60 Taxes 61 Advance earned income credit payments from Form(s) W-2, box 9 61 ................ 62 Household employment taxes. Attach Schedule H ........................ 62 63 Add lines 57 through 62. This is your total tax . ....................... j, 63 Payments 64 Federal income tax withheld from Forms W-2 and 1099 ...... 64 90 65 2007 estimated tax payments and amount applied from 2006 return . 65 you hris If a 66a Earned income credit (EIC) ..... . .......... 66a 1,029 walifYing chid, attach b Nontaxable combat pay election .. ? 66b Schedule EIC. 67 Excess social security and tier 1 RRTA tax withheld (see instructions) 67 68 Additional child tax credit Attach Form 8812 ............ 68 69 Amount paid with uest for extension to file (see instructions) ... 69 70 Payments from: ° LJ Form 2439 b 0 Form 4136 cl]Form 8885 70 71 Refundable credit for prior year minimum tax from Form 8801, line 27 71 72 Add lines 64, 65, 66a, and 67 through 71. These are our total payments .......... ? 72 1,119 Refund 73 If line 72 is more than One 63, subtract line 63 from line 72. This is the amount you overpaid ... 73 1,119 Direct see 74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here ? a .... 74a 1,119 epowt? s ? b Routing number 036076150 ? c Type: Checking Q Savings and nn in 74b, ? d Account number 6 2 2 0 3 7 3 514 740, and 74d, or Form 8m- 75 Amount of line 73 you want applied to our 2008 estimated tax ? 75 Amount 76 Amount you owe. Subtract line 72 from line 63. For details on how to pay, see instructions ... ? 76 You Owe 77 Esilimated tax penalty see instructions 77 ._ Third Party Do you want to afiow another person to discuss this return with the IRS (see instrucfions)? lees ? Phone ? iw- Ill. nernis no. no* Underpenalliim dperiury, l declare that 1 have examined this rabxn and schedules and ata?nerds and to the bast d my Imordadge and ballet, they Sign are true corroet and complain, Declaration of pneparer (ewer than ta?ayer)0 all intonation of what prepaner has any aimMedge. Here Your signature Date Your oaw Joint return? pation Daytime phone number See instr. SALES ASSOCIATE 717-763-1100 Keep a copy Spouse's signature. If a joint return, both must sign. Date Spouse's occupation for your records. ?; Paid Preparers' Date Check if self Preparers SSN or PTIN { Preparees signature ernployed Use Only Firm's name (or IN yours if self-employed), Phone no. address, and ZIP code 2007 P.I. Enterprises, ina 7US012 •- ._ -- Schedule EIC Earned Income Credit , OMB No. 15450074 (Form 1040A or 1040) Qualifying Child Information 10'0 2007 D"w*w* of #m Tronury Complete and attach to Form 1040A or 1040 EIC InEerral Revenue service only if you have a qualifying child. AMecrrnent Sequence No. 43 Name(s) shown on return Your social security number MICHELLE A WRIGHT 180-84-1853 Before you begin: See the instructions for Fort 1040A, lines 40a and 40b, or Form 1040, lines 66a and 66b, to make sure that (a) you can take the EIC, and (b) you have a qualifying child. • If you take the EIC even though you are not eltg!bK you may not be allowed to take the credit for up to 10 years. See back of schedule for details. Q • It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child. Caution • Be sure the child's name on line 1 and social security number (SSN) on line 2 agree with the child's social security card. Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child's social security card is not correct, call the Social Security Administration at 1-800-772-1213. Qualifying Child Information Child 1 Child 2 1 Child's name If you have more than two qualifying children, you only have to list two to get the maximum credit. 2 Child's SSN The dnld must have an SSN as defined on page 41 of the Form 1040A instructions or page 47 of the Form 1040 instructions unless the child was bom and died in 2007. If your child was bom and died in 2007 and did not have an SSN, enter "Died" on this line and attach a copy of the child's birth certificate. 3 Child's year of birth 4 If the child was born before 1989-- a Was the child under age 24 at the end of 2007 and a student? b Was the child permanently and totally disabled during any part of 2007? 5 Child's relationship to you (for example, son, daughter, grandchild, niece, nephew, foster child, etc.) 6 Number of months child lived with you in the United States during 2007 • If the child lived with you for more than half of 2007 but less than 7 months, enter "7". Last name I First name last WILL 186-84-3022 Year 1994 Year If born after 1988, skip lines 4a and 4b; go If bom after 1988, skip lines 4a and 4b; go to line 5. to line 5. Yes. No. 0 Yes. ED No. Go to tine 5. Continue. Go to line s Continue. Yes. F? No. E-1 Yes. E-1 No. Continue. The child is not a Continue. The child is not a qualifying child. oualifAno child. SON 12 months I months • If the child was bom or died in 2007 and your home was the child's home for the entire time Do not enter more than 12 months. Do not enter more than 12 months. he or she was alive during 2007, enter "12". ?"IP You may also be able to take the additional child tax credit if your child (a) was under age 17 at the end of 2007, and (b) is a U.S. citizen or resident alien. For more details, see the instructions for line 41 of Forth 1040A or line 68 of Form 1040. SPA For Paperwork Reduction Act Notice, see Form 1040A or 1040 instructions. Schedule EIC (Form 1040A or 1040) 2007 2007 jI I P.M Enterprises ina 7US431 0701910028 PA SCHEDULE W-2S Wage Statement Summary PA-40 W-2S (09-07) (1) 2007 OFFICIAL USE ONLY Summary of PA Taxable Employe% Non-employee, and Miscellaneous Compen sation Name shown first on the PA-40 (if filing jointly) Social Security Number (shown rim) MICHELLE A WRIGHT 180-84-1853 Use this schedule to list and calculate your total PA taxable compensation and PA tax withheld ft m all sources. Use this schedule to list and calculate your total PA taxable compensation and PA tax withhold from all sources. Part A Instructions: List each Federal Form W-2 for you and your spouse, if married, received from your employer(s). In the first column enter T for the taxpayer's Social Security Number that appears first on the PA tax return and enter S for the second or spouse SSN. From the Forms W-2, enter each employer's Federal Employer Identification Number (EIN). Enter the amounts from the Fors W-2 in each column. IMPORTANT: You do not have to submit a copy of your For W-2 if you earned all your income in Pennsylvania and your employer reported your PA wages correctly and withheld the correct amount of PA income tax. You must submit a copy of your Form W-2 in c artain circumstances. See the PA Schedule W-2S instructions for a list of when a copy of a W-2 is required. Part B Instructions: list each source of income received during the taxable year on a form or statement other than a Federal For W-2. Enter each payer's name. List the payment type that most closely describes the source of your non-employee wort. Enter the amount of other compensation that you earned. If the for or statement does not have separately stated amounts, enter the amount shown in both Federal and PA columns. IMPORTANT: You must submit a copy of each for and statement that you list in Part B, whether or not the payer withheld any PA income tax and regardless of whether or not the income was taxable in PA. CAUTION: The federal and Pennsylvania (state) wages may be different in Part A and Part B. -- - ------ - ---• -- - "_._ ....- -....-..v.v w .u-n- -9 WWII 0%mmuUms in Min Tromar. Part A - Federal Forms W-2 T/S T Employer EIN from box b 233039789 Federal wages from box 1 3049 Medicare wages from box 5 3049 PA compensation from box 16 3049 PA income tax with- held from box 17 93 Total Part A- Add the Pennsylvania columns 3049 93 Part B - Miscellaneous and Non-employee Compensation from Federal Forms 10998, 1099MISC, and other statements YOU MUST SUBMIT COPIES OF EACH FORM OR STATEMENT LISTED IN THIS PART _ A. T/S B. Type C. Payer name D. 10998 E. Total Federal FF. Adjusted Plan G. PA compensation H. PA tax withheld Code Amount Basis Total Part B - Add the Pennsvivania columns TOTAL - Add the totals from Parts A and B 3049 3 Enter the TOTALS on your PA tax return on: Line 1a Line 13 • -,•••°••' •71•x• ?A-ULUF I== o. jury oucy pay C. Director's fee 0. Expert witness fee E. Honorarium F. Covenant not to compete G. Damages or settlement for lost wages, other than personal injury H. Other nonemployee compensation. Describe. 1. Distribution from employer sponsored retirement, pension, or qualified deferred compensation plan J. Distribution from IRA (Traditional or Roth) K. Distribution from Life Insurance, Annuity or Endowment Contracts L. Distribution from Charitable Gift Annuities 2007 111 Pt, Enterprises. Inc. 7PA261 0701910028 n7ni.gi.nnPA J 0700113311 L PA-40 - 2007 Pennsylvania Income Tax Return ENTER ONE LETTER OR NUMBER IN EACH BOX. Do Not Use Your Preprinted Label 180841853 WRIGHT MICHELLE A occupation SALES ASS O Occupation 142 SOUTH 30TH APT 6 CAMPHILL 717-763-1100 PA 17011 21100 la Gross Compensation. Do not include exempt income, such as combat zone pay and qualifying retirement benefits. See the instructions. 1 b Unreimbursed Employee Business Expenses. 1 c Net Compensation. Subtract Line 1 b from Line 1 a. 2 Interest Income. Complete PA Schedule A if required. 3 Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required. 4 Net Income or Loss from the Operation of a Business, Profession, or Farm. 5 Net Gain or Loss from the Sale, Exchange, or Disposition of Property. 6 Net Income or Loss from Rents, Royalties, Patents, or Copyrights. 7 Estate or Trust Income. Complete and submit PA Schedule J. 8 Gambling and Lottery Winnings. Complete and submit PA Schedule T. 9 Total PA Taxable Income. Add only the positive income amounts from Lines 1c, 2, 3, 4, 5, 6, 7, and 8. DO NOT ADD any losses reported on Lines 4, 5, or 6. 10 Other Deductions. Enter the appropriate code for the type of deduction. See the instructions for additional information. 11 Adjusted PA Taxable Income. Subtract Line 10 from Line 9. 20071IIPetz Entmpd., Inc. 7PA011 N Extension. N Amended Return. R Residency Status. PA Resident/NonresideW Part Year Resident from to S Single/Married, Filing Jointly/Married, Filing Separately/Final Return/Deceased Date of death N Farmers. 1a 3049 1b 0 1C 3049 2 0 3 0 4 0 5 0 6 0 7 0 8 0 9 3049 10 0 11 3049 EC Page 1 of 2 FC 0700113311 FM I PA-40 - 2007 0700213325 Social Security Number 180841853 Name(s) MICHELLE A WRIGHT I 12 94 13 93 14 0 15 0 16 0 17 0 18 0 19a 00 19b 0 20 0 21 0 22 0 23 0 24 93 25 1 26 0 27 1 28 0 29 0 30 0 31 0 32 p 33 0 34 0 35 0 12 PA Tax Liability. Multiply Una 11 by 3.07 percent (0.0307). 13 Total PA Tax Withheld. See the instructions. 14 Credit from your 2006 PA Income Tax return. 15 2007 Estimated Installment Payments. 16 2007 Extension Payment. 17 Nonresident Tax Withheld from your PA Schedule(s) NRK-1. (Nonresidents only) 18 Total Estimated Payments and Credits. Add Unes 14,15,16, and 17. Tax Forgiveness Credit. 19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased 19b Dependents, Part B, Una 2, PA Schedule SP 20 Total Eligibility Income from Part C, Une 11, PA Schedule SP. 21 Tax Forgiveness Credit from Part D, Line 16, PA Schedule SP. 22 Resident Credit Submit your PA Schedule(s) G-SIG-L and/or RK-1. 23 Total Other Credits. Submit your PA Schedule OC. 24 TOTAL PAYMENTS and CREDITS. Add lines 13, 18, 21, 22, and 23. 25 TAX DUE If lure 12 is more than Una 24, enter the difference here. 26 Penalties and Interest See the instructions. Enter Code: If including form REV-1630, mark the N 27 TOTAL PAYMENT. Add Unes 25 and 26. 28 OVERPAYMENT. If Line 24 is more than the total of Line 12 and Line 26, enter the difference here. The total of Lines 29 through 35 must equal Line 28. 29 Refund - Amount of Line 28 you want as a check mailed to you. Refund 30 Credit - Amount of Line 28 you want as a credit to your 2008 estimated account. 31 Amount of Une 28 you want to donate to the Wild Resource Conservation Fund. 32 Amount of Line 28 you want to donate to the Military Family Relief Assistance Program. 33 Amount of Line 28 you want to donate to the Governor Robert P. Casey Memorial Organ and Tissue Donation Awareness Trust Fund. 34 Amount of Line 28 you want to donate to the Juvenile (Type 1) Diabetes Cure Research Fund. 35 Amount of Line 28 you want to donate to the Breast and Cervical Cancer Research Fund. Signature(s). under peraftin of perjury, a frig dadarn OW I jWQ haw =a4wd >A awn. Iadudiap all accoff9wrA g admdulds and sb and ho the base of my (our) bdiid, V" arc true, correct, and compieee. Your Signature Spouse's Signature, if filing jointly Preparers Name and Telephone Number 2007 Pet En*mdses, Inc. 7PA012 0700213325 Firm EIN Preparer's SSN/PTIN Date Page 2 of 2 0700213325 IBBB"B -? enuanaa;o luougjed ejumw+lsuusd wg o; opmAd AINO 3sn JLN3W1aVd3a V d J" asuow Jo 4*040 WIBM l I I H d W V 3 9 Idd H10E HinoS 2bT OOIT $ OOTT-E9L-LTL d 3113H3IW AMR 1Nnovyv 1N3r4AVd OLTQT600LO ESgT-h4-04'[ L J H3HOnOA 1N3VUlVd Vd A-Vd IOW LAdVdL 'Oul ' 3 zPdl lm iom OR+.Cfaio. 1-5-0004 t Wages, tips. tither r,-xnpen_aticn } 7. Federal Income tax .?ithneM COPY 3- 3°049.97 t9(1.1;3 3 Social -xur,ly :-:ages Social secunty, lax riilhhild To Be Filed With Employee's 3Q19.97 ( 189.10 FEDERAL I s Medicare moe9 And tips 6 Medicare tax ,riihheld Tax Return 3049.97 44.22 c. Employers came. address. and ZIP code `- HOSCOVS DEPT STORE LLC 4500 PERKIOMEN AVE READING PA 19606 Scciai sacurity Pros 18 Altorated ries 12a See instructions for box 12 9 N07nce EIC payment 10 Dependent are b-cffts i 12b X i ( 11 Nonqualitletl 00 00 plans 1A Omer 112c -' J-1 I b -.tea. `;!cat?an numb ?.F;!:11 12d --23-3039789 .00 a Enp??}'ea soda) senlntY nuMc& 13 StatWary neb-em Third-pany- ernWoyee lan sires pav 180-84-1853 Ip I ? I e Enlployea s name, address, and ZIP code '- MICHELLE A WRIGHT 142 SOUTH 30TH ST. APT.#6 CAMP HILL PA 17011-0000 15, S,*te Employer's s`.3te !.^..i.... per 15 SLa;e r:,0es. saps. e'w. 17 5tatz In:,;n•..: time PA 6-39270 3049.97 93.63 ?0 U:Cylif}' 3049.97 i 60.93 { CAMPHILL RE T hu ,nforrnannn .c hair., Form -2 Wage and Tau: Statement 2007 - herisncd Ip the unp+l of Iha T,easury_-Irs 001 004902905A PNC Bank, N.A. Boscov's Department Store, LLC 60=162 Jeannette, PA s PO Box 4505 433 Reading PA 19606 blepmount $*****0.00 Debtor in Possession Date 10/30/08 Paya I Case No 0811637 Zero and 00/100 Dollars --------- --- Pay 00012 0285 10!30/08 To The MICHELLE A WRIGHT Order 4 HARVARD PL APTD Of CAMP HILL PA 17011 This check is void after 180 days from issue date . _ wf? ?- Authorized l-Oure °-? 0 ?y q ?y? r s a 0 ""tt'?F? ?; i"t F ----PLEAsE rO it AIWO .: pt-aw . .. Hoscov's Department Store, LLC PNC Bank, N.A. 001 004895525A 60-162 Jeannette, PA f A a PO Box 4505 Reading PA 19606 Debtor in Possession Date 10/23/08 Payable Amount $*****0.Ob Case No 0811637 Pay Zero and 00/100 Dollars This check is void after 180 days from issue date 00012 0285 lo/23/08 To The MICHELLE A WRIGHT Order 4 HARVARD PL Of APT D CAMP HILL PA 17011 Authorized ignature --- PLEASE FOLD AND DETACH ALONG THIS P hi€ ORATION--______-_-_._ CHECK NUNMER 00499rfi25A SOCIAL PERIOD EMPLOYEE NAME SECURITY ENDING MICHELLP.A WRIGHT EDERA ***-**-185qDF HOURLY RATE OR FL'rAX DEPARTMIENSALARY STATUS - 7.25 S 002 0285 NETPAY --$***190.67 -- CURRENT YEAR TO DA Z E CURRENT CURRENT YEAR TO DATE YEAR TO DATE; TAXES AND DEDUCTIONS DEDUCTIONS DEDUCTIONS : EARNINGS HOURS EARNINGS ??-- - EARNINGS HOURS -6,13 246.30 REGULAR 18.91 137.10 1235.36 8956.41 FEDERAL TAX 3.30 _ 139.32 OVERTIME 14.85 161.50 MEDICARE _ 14.12 595.71 VACATION _ 30.75 224.78 OASDI 4.55 141.95 HOLIDAY 12.50 90.62 CAMPHILL R TAX 70.00 PA STATE TAX 6.99 Y 294.96 INTEREST ---- 14 5.78 --- MiSC PAY 39.00 I PA SUI/SDi TAX _ ?--- _ 1.00 43.00 ----? -- 6.25 45.31 C HILL LST ----- BIRTHDAY - 5.00 PERSONAL 12.50 90.63 12.50 90.63 G.C. MISC T 13.2$ _ D1SA6 INS TOTAL py 31.41 227.73 1312.21 961$.25 PRticEBErrEFtrs - DIRECT I)EPOSIT - - i YEAR TO DATE ---- DESCRIP?[Ohf CURRENT _ ACCOUNT_`_ ROUTING AMOUNT J - 16220373514 03607615 190.67 - -^ _- - 1 Boscov's Department Store, LLC PNC Bank, N.A. 001 004886303A PO Box 4505 60-162 Jeannette, PA 0-33 Reading PA 19606 Debtor in Possession Date 10/16/08 Payable Amount $*****O.00 Case No 0811637 Pay Zero and 00/100 Dollars - 00012 0285 10116MO To The MICHELLE A WRIGHT order 142 SOUTH 30TH ST. Of APT46 CAMP HILL PA 171011 This check is void after 180 days from issue date y#?. Authorized ignature FOLD AND DETACH ALONG THIS PERFORATION-..?_ SUCIAL PERIOD EMPLOYEE NAME SECURITY ENDING ?MICHELLE AWRIGHT ***'**'1853 10/11/08 ' ---T?T ?ED$RAL TAX -- DATE HOURLY F 6&E OR F DEPARTMENT PAID SALARY I STATUS 7.25 S 002 0285 10/16/08 NET PAY $***188.76 CURRENT CURRENT YEAR TO DATE :EARNIN:GS 1iQUR5 ARNINGS HOURS REGUL30.92 224.17 1216.45 OVERTIME 14.85 30.75 VACATION HOLIDAY 12.50 HiL PAY 6.25 BIRTHDAY --i- -- - YEAR Tp DAT@ EARNINGS 8819.31 161.50 224.78 90.62 39. u0 3 1 . - CURRENT YEAR TO DATE TAXES ANA DEDUCTIONS DBDUCTTONS DEDUCTIONS FEDERAL TAX 5.77 240.17 MEDICARE _ 3.25 136.02 OASDI 13.90 581.59 CAMPHILL R TAX 4.48 187... PA STA(E 1'AX 6.88 287.97 - PA SUI/SDI TAX 13 5 ?' - -` C HILL LST 1.00 42.00 G.C. MISC 5.00 DISAB INS 12.45 _ C 520.00 CLUB VA TOTAL PAY 30.92 224.17 --- DIRECT DEPOSPC ACCOUNT ROUTING AMOUNT 12 80.80 9380.52 FRIDGE BENEPI"1 S T - _- - - T - - D}SCRiPT ION C1JRCtEN'f YEAR TO llATC _ - 76 15 188 6220373514 036076 . Boscov's Department Store, LLC PNC Bank. N.A. 001 004869017A PO Box 4505 O-W Jeannette, PA 433 Reading PA 19606 Debtor in Possession Date 10/02/08 Payable Amount $****"0.00 Case No 0811637 Pay Zero and 00/100 Dollars - - This check is void after 18o days from issue date 00012 0285 10/02/08 o The in so UT H H ST. Order i42 SOUTH 30TH ST. d , Of APT.16 Authorized tgnature CAMP HML PA 17011 #----.PLEASE PLEASE FOLD AND DETACH ALONG THIS PERFORATION ----,-+ CHECK NUKWR 004869017A Boscov's Department Store, LLC PNC Bank, N.A. 001 PO Box 4505 60=162 Jeannette, PA 004861256A t Reading PA 19606 433 Debtor in Possession Date 09/25/08 Payable Amount $*****0.00 Case No 0811637 Pay Zero and 00/100 Dollars W012 0285 09/25/08 To The MICHELLE A WRIGHT Order 142 SOUTH 30TH ST. Of APT.#6 CAMP HILL PA 17011 This check is void after 180 days from issue date Authorized ignature ?_ - -._- -- PLEASE FOLD AND DETACH ALONG THIS PERFORATION -._- ( CHECK NUMBER 004861256A ? _- - -- - -----? EMPLOYEE NAME SOCIAL PERIOD SECURITY ENDING M16-IELLEAWRIGHT ***-**-1853 09/20/081 HOURLY RATE OR FEDERAL TAX _DATE SALARY STATUS DEPARTMENT PAID 7.25 S002 0285 - 109/25/08 NET PAY - - - ---- sF * * 174.92 L - --- EARNINGS 'CURRENT CURRENT, YEAR TO DATE YEAR TO DATE CURRENT YEAR TO DATE HOURS EARNINGS HOURS EARNINGS TAXES AND DEDUCTIONS C UCTION$ DEDUCTIONS REGULAR 32.17 233.23 3 1123.80 8147.60 FEDERAL TAX j-- 6.68 222.94 OVERTIME 14.85 161.50 MEDICARE 3.38 126.28 -VACATION 30.75 224.78 OASD1 14.46 539.95 ! HOLIDAY 12.50 90.62 CAMPHILL R TAX j 4.66 173.98 ------------------ - ---------- Mtct r Ppv - __ 39.nn? PA CTATF TAX 7.1/i 7F7 AS I ------------- BIRTHDAY 6.25 45.31 PA SUI/SDI TAX - - 14 5.24 C HILL LST 1 00 39.00 _ G.C. MISC 5.00 --- - - - --? --- DISAB INS 83 11.62 t - - - - - -- - ----_ -- VAC CLUB 20.06 f 500 - - 500.0 TOTAL PAY 32.17 1 233.23 1188.15 8708.81 llIREGT DEPOSIT FRINGE BENEFITS ACCOUNT _ ROUTING AMOUNT DESCRIP'T'ION CURRENT YEAR r0 DATE 6220373514 03607615 174.92 1 . , Pay Boscov's Department Store, LLC PNC Bank N.A. 001 PO Box 4505 ¢0=162 Jeannette, PA 0"MU24 Reading PA 19606 433 Debtor in Possession Date 09/18/08 Payable Amount $ * * * * * 0.00 Case No 0811637 Zero and 00/100 Dollars 00012 0285 09/18/08 To The MICHELLE A WRIGHT Order 142 SOUTH 30TH ST. Of APT.#6 CAMP HILL PA 17011 This check is oid after 180 days from issue date ?/-JC??Ica7??C ? Authorized Signature IA s /I arr 6?1d L 1e C.ll . is:' , . ;-, - I 'f,R TI3 ;, _> Et?f-OI'1 ----- CHECK NUNMER 004853428A EMPLOYEE NAME SOCIAL PERIOD SECURITY ENDING MICHELLEA WRIGHT ***-**-1853 09/13/08 HOURLY RATE OR FEDERAL TAX DATE DEPARTMENT I 1 SALARY ? STATUS PAID I EARNINGS CURREN HOURS REGULAR - 24.41 OVERTIME VACATION HOLIDAY 7.25 i S002 0285 09/18/08 NET PAY $***132.30 ! CURRENT EARNINGS YEAR TO DATE HOURS T YEAR TO DATE CURRENT I YEAR TO DATE. EARNINGS TAXES AND DEDUCTIONS DEDUCTIONS' DEDUCTIONS ? - 176.97 1091 63 7914.37 - -- -- FEDERAL TAX --- -- - 1.05 ! 216.26 14.85 161.50 MEDICARE 2 57 122 90 30.75 224 78 OASDI - --- . 10.98 - 525.49 j 12.50 90.62 T CAMPHILL R TAX - 3 53 fi 169 32 ' M I SC PAY i ( --t-- _ --- -t-------- --- I 39.00 I PA STATE TAX 5.43 i 260.1.9 1 BIRTHDAY 6.25 45.31 PA SUI/SDI TAX 11 5.10 J C HILL LST 1.00 i - _ - - - - -- -- 38.00 __. G.C. MiSC 5.00 1 - -- T -; DISAS INS _ 10.79 _ ? -- ? ------) -_ -?_ VAC CLUB --- 20.00 ?---- 480.00 --- - ------- TOTAL PAY 24.41 176.97 i 1155.98 8475.58 DIRECT DEPOSIT FRINGE BENEFITS .1GC'OGST _ ROIiI'ISG AMOUE'T _ DESCRICTIOY CURRENT YEAkTODATE. 6220373514 ! 03607615 I 132.30 ------------------ Boscov'S Department Store, LLC 60 162 PNC Bank. N.A. 001 00483762M PO Box 4505 433 Jeannette, PA l Reading PA 19606 Debtor in Possession Date 09/04/08 Payable Amount $*****0.00 Case No 0811637 Pay Zero and 00/100 Dollars 00012 OM 09/04/06 To The NUCHELLE A WRIGHT Order 142 SOUTH 30TH ST. Of APTJ6 CAMP HILL PA 17011 This check is void after 180 days from issue date - Authorized-DSignature CHECK NUNUM OOM76M EMPLOYEE NAME SHCURICURrTY: PERIOD _ENDING MICHELLE A WRIGHT ***-**-1853 08/30/08 HOURLY RATE OR SALARY FEDERAL TAX STATUS - DEPARTMENT - DATE PAID 7.25 S 002 0285 09/04/08 EARNINGS CURRENT 'KQURS CURRENT EARNINGS YEAR TO DATE HOURS YBARTO DAT EARNINGS E NET PAY $***206.08 GURR)?NT YEAR TO DATE TAXES AND DEDUCTIONS DEDUCTIONS bRDUpTIONS REGULAR 37.59 272.53 1043.13 7562.75 FEDERAL TAX 10.61 203.55 OVERTIME 9.05 98.42 MEDICARE 3.96 116.23 VACATION 30.75 224.78 OASDI 16.90 496.97 HOLIDAY urc, oev 6.25 45.31 39 .00 CAMPHILL R TAX PA STATE 'A 5.45 x.37 160.13 niA n4 i BIRTHDAY f 6.25 45.31 PA SUI/SDI TAX _ .16 4.82 C HILL LST 1.00 36.00 G.C. MISC 5.00 DISAB INS _ 9.96 _ VAC CLUB 20.00 440.00 TOTAL PAY 37.59 272.53 1095.43 8015.57 D IRECT DEPOSIT FRINGE BENEFITS CCOUNT ROUTING AMOUNT DESCRIV ION CURRENT 1'F11RTO DATE A ;6220373514 03607615 206.08 _ Boscov's Department Store, LLC PNC Bank. N.A. 001 004Q9586A PO Box 4505 433 Jeannette, PA • Reading PA 19606 3s Debtor in Possession Date 08/28/08 Payable Amount $*****0.00 Case No 0811637 pay Zero and 00/100 Dollars _ 00012 02% 08!!.9/08 This check is void after 180 days from issue date To The MICHELLE A WRIGHT Order 142 SOUTH 30TH ST. Q Of AP'I'46 .r ,d c CAMP HILL PA 17011 - 1 Authorized Signature j ----PLEASE FOLD AND DETAC JN.I_ONG T ia1 P"sE°.RIFC) AAMON A So PERIOD EMPLOYEE NAME i SECURITY SECURITY ENDING MICHELLE AWRIGIIT ***-**-1853 08/23/08 HOURLY RATE OR FEDERAL TAX DEPARTMENT DATE SALARY STATUS PAID 7.25--- - S002 0285 08/28/08 NHTPAY $***153.38 EARNINGS CURB- HOURS CUMNT EARNINGS YEAR TO DATE H t*S YBA$ LO DATE HAIWNOS -- -- TAXES A" DEDUCTIONS CUItRBIYT DEDUCTION$ 1' Ati TO Di1T$' DEDUCTIONS REGULAR 28.32 205.32 1005.54 7290.22 FEDERAL TAX 3.89 192.94 OVERTIME 9.05 98.42 MEDICARE 2.97 112.27 VACATION 30.75 224.78 OASDI 12.73 480.07 HOLIDAY 6.25 45.31 CAMPHILL R TAX 4.10 154.68 14?417 PAY 35.0^ PA £T!:TS Tt..X 6.31) 327.70 BIRTHDAY 6.25 _ 45.31 PA SUI/SDI TAX ` .12 _ _ 4.66 _ C HILL LST 1.00 35.00 j G.C. MISC 5.00 DISAB INS u .83 9.96 - VAC CLUB 20.00 420.00 TOTAL PAY 28.32 205.32 1057.84 7743.04 D IRECT DEPOSIT FRINGE BENEFITS ACCOUNT - ROUTING AMOUNT DESCRIPTION CURRENT YEAR TO DATE 6220373514 03607615 153.38 Boscov's Department Store, LLC PNC Bank N .A. ~^ v h001 PO Box 4505 60-162 Jeannette PA 004821586A « Reading PA 19606 433 Debtor in Possession Date 08/21/08 „ ,? Case No 0811637 Payable Amount $,? 0.00 pay Zero and 00/100 Dollars 00012 0285 08/21/08 To The MICHELLE A WRIGHT Order 142 SOUTH 30TH ST. Of APT46 CAMP HML PA 17011 This check is void after 180 days from issue date Authorized ignature _-------PLEASE FOLD AND DETACH ALONG THIS CHECK NUM ER 0046215"A Boscov's Department Store, LLC PNC Bank, N.A. 001 004813495A kO- PO Box 4505 433 62 Jeannette, PA Reading PA 19606 Date 08/14/08 Payable Amount $*****0.00 Pay Zero and 00/100 Dollars 00012 0285 08/14/08 To The MICHELLE A WRIGHT Order 142 SOUTH 30TH ST. Of APT.#6 CAMP HILL PA 17011 This check is void after 180 days from issue date •C??? sZ Authorized + Signature - ---- ----- -- P? I .IdSE FOLD AND DETACH AL_O*1t;.9. THIS PEF1F0T3AT6M4------ CHECK NUMBER 004813495A T - - EMPLOYEE NAME SOCIAL SECURITY [f`ERIOU - ENDIN0 MICHELLEA WRIGHT ***-**-1653 08/09/08 HOURLY"RATE OR FEbffRAL TAX T« DEPARTMENT DATE; _ SALARY STATUS PAID 7.25 S002 0285 08/14/08 NET PAY , $***161.89 EARNINGS REGULAR OVERTIME VACATION `HOLIDAY MISC PAY BIRTHDAY IuUM, FSARIVINWS HOURS 29.84 216.34 943.81 9.05 30,75 6,25 6.25 C EAR TO DATE, TAXES AND DEDUCTIONS EARNINGS DQ 68_42.68 1 _ FEDERAL TAX 98.42 MEDICARE 224.78 j OASDI 45.31 - CAMPHILL R TAX 39.01 PA RTATE TAX -`45:31T_PA SUI/SDI TAX C HILL LST -}- G.C. MISC DISAB INS VAC CLUB TOTAL PAY I 29.84 I 216.34 996.11 f 7295.50 1 ?-- - DIREC"C DEPO5r1' FRINGE ACCOUNT ROUTING AMOUNT y_ DESCRIPTION CUR -- 6220375514 03607615 161.89 ENT' YEAR TO DATE :TIONS DEDUCTIONS 4.99 181.47 3.13 105.78 13.41 452.32 4.32 145.74 6.464 223,96 i -H 13 _ _ 4.39 1.00 33.00 5.00 .83 9.13 20.00 380.00 NEPITS -- ----- fi' YEAR"I'ODATE Boscov's Department Store, LLC PNC Bank, N.A. 001 PO Box 4505 403162 Jeannette, PA 004805341A Reading PA 19606 Date 08/07/08 Payable Amount $*****0.00 Pay Zero and 00/100 Dollars This check is void after 180 days from issue date Authorized ignsture W012 0285 08/07/08 To The MICHELLE A WRIGHT Order 142 SOUTH 30TH ST. Of APT.#6 CAMP HILL PA 17011 I CHECK NU11ER 004905341A EMPLOYEE NAME - SOCIAL SECURITY PERIOD ENDING MICHELLEA WRIGHT ***-**-1853 08/02/08 - „. HOURLYRATEOR SALARY hBDgRALTAX` STATUS --- DEPARTMENT DATE PAID 7.25 S 002 0285 08/07/08 NETPAY' _ _ $***158.45 "- EARN[NGS, REGULAR OVERTIME VACATION HOLIDAY MISC PAY -- - - CURRENT HOURS,: 29.08 CURRENT _.EARNINGS 210.83 YEAR TO DATE HOURS 913.97 9.05 30.75 6.25 YEARTO DATE : EARNINGS ..,, 6626.34 98.42 224.78 45.31 39 00 TAXES AND DEDUCTIONS ' TIONS FEDERAL TAX - MEDICARE OASDI CAMPHILL R TAX PA STATE TAX CURRENT DED.IICTIONS 4.44 3.06 13.07 4.21 YEAR TO DATE DEDUCTIONS 176.48 102.65 438.91 141.42 -- - RTHDAY BI _ __ - _ .25 . -- 45.31 _ --- - _. - PA SUI/SDI TAX 6.47 .13 217.32 -- 4.26 C HILL LST _ 1.00 32.00 G.C. MISC _ 5.00 DISAB INS 8.30 _ _ VAC CLUB 20.00 360.00 TOTAL PAY 29.08 210.83 966.27 7079.16 D IRECT DEPOSIT PRINCE BENEFITS ACCOUNT _ -- 6220373514 ROUTING 03607615 AMOUNT 158.45 _E)ESCRIPTIOM T CURRENT ='- - -- - YF??RTO DATE A --___._ --PLEAS F FLU AND, t.)ETA,mot'', AL N'(, 0.s Boscov's Department Store. LLC 60-162 PNC Bank, N.A. 001 • PO Box 4505 Jeannette, PA Reading PA 19606 433 Date 07/31/08 Payable Amount $*****0.00 Pay Zero and 00/100 Dollars 00012 0285 07/31/08 To The MICHELLE A WRIGHT order 142 SOUTH 30TH ST. Of APT.^ CAMP HILL PA 17011 This check is void after 180 days from issue date Authorized StgnaWre t= -EASE FOLD ANAL, DE T C" Ai. ON PER.. --- I CHECK NUMBER 004797138A --- SOCIAL PERIOD' EMPLOYEE NAME SECURITY ENDING MICHELLE AWRIGHT - -- *"*-**-1853 07/26/08 HOURLY RATE OR FEDERAL TAX T DATE DEPARTMENT SALARY STATUS PAID 7.25 S002 0285 07/31/08 NET PAY $ * * * 169.23 L CURRENT CURRENT ' YEAR TO DATE 'YEAR TO DATE TAXES AND DEDUCTIONS CURRENT YEAR TO DATE EARNINGS HOURS EARNINGS HOURS EARNINGS DEDUCTIONS DEDUCTIONS ' j REGULAR 884.89 6415.51 FEDERAL TAX _ 5.83 172.04 OVERTIME 9.05 98.42 MEDICARE 3.26 99.59 VACATION 30.75 224.78 30.75 224.78 1 OASDI 13.94 425.84 HOLIDAY 6.25 45.31 CAMPHILL R TAX 4.49 137.21 ytgr opy 39.00 PA STATE TAX i 40 210.105 BIRTHDAY 6.25 45.31 PA SUI/SDI TAX 13 4.13 C HILL LST 1.00 31.00 - - -? G.C. M1SC 5.00 j -- DISAB INS 8.30 VAC CLLR 20.00 340.00 E TOTAL PAY ! 30.75 224.78 1 937.19 6868.33 DIRECT DEPOSIT FRINGE BENEFITS - ~ -ACCOUNT 6220373514 ROtYC1N0 03607615 . AMOUNT 169.23 RESCNII TION _ T CURRENT YEAR TO RAPE _ -_- 004797138A Boscov's Department Store, LLC PNC Bank, N.A. 001 004788862A w PO Box 4505 433 Jeannette, PA Reading PA 19606 433 Date 07/24/08 Payable Amount S*****0.00 Pay Zero and 00/100 Dollars 00012 0285 07/24/D8 This check is void after 180 days from issue date To The MICHELLE A WRIGHT Order 142 SOUTH 30TH ST. Of APT.#6 y CAMP HILL PA 17011 Authorized Signature PLEASE FOLD AND X-OINIG, THIS PFRFQ;7hArI0N;------ CHECK NUMBER 004706662A EMPLOYEE NAME SbCIAL ' SECURt" PERIOD ENDING, MICHEUEA WRIGHT ***-**-1853 07/19/08 146URLY RATE OR SALARY PEDERALTAX STATUS DEPARTMENT DATE PAID 7.25 S 002 0285 07/24/08 NET PAY $* * * 163.55 EARNINGS CIIRRBNT HOURS CURRENT EARNINGS YEARTODATE HOURS YEARTODATE EARNINGS TAXES AND DEDUCTIONS CURRENT DEDUCTIONS YEAR TODAT18 DEDUCTIONS REGULAR 30.14 218.52 884.89 6415.51 FEDERAL TAX 5.21 166.21 OVERTIME 9.05 98.42 MEDICARE _ 3.17 96.33 HOLIDAY 6.25 45.31 OASDI 13.55 411.90 MISC PAY 39.00 CAMPHILL R TAX 4.37 132.72 RIRTHPAY 6.25 45.31 _ P.A. -'TATE TAX _6_.71 203.55 _ PA SUI/SDI TAX .13 4.00 C HILL LST _ 1.0.0_ _ 30.00 G.C. MISC 5.00 DISAB INS .83 8.30 VAC CLUB 20.00 320.00 TOTAL PAY i 30.14 218.52 906.44 6643.55 DIRECT DEPOSIT FRINGE BENEFITS ACCOUNT ROUTING AMOUNT DESCRIPTION CURRENT YrAR TO DATE 6220373514 03607615 163.55 goscov's Department Store, LLC PNC Bank, N.A. 001 004780391A 60162 Jeannette, PA PO Box 4505 433 Reading PA 19606 0.00 ***** Date 07/17/08 PayableAmount $ Zero and 00/ 100 Dollars Pay 00012 0285 07/17/08 To The MICHELIS A VMGHT Order 142 SOUTH 30TH ST. Of APT.416 17011 CAMP HILL PA EARNINGS REGULAR _ OVERTIME HOLIDAY MISC PAY BIRTHDAY This check is void after 180 days from issue date / 'alt Authorized Signature PLEASE FOLU ANE1 DETACH /.L - ; i TPW- rF E-.RF0RAT101 ---- .30 212.43 TOTAL PAY 29.30 I 212.43 DIRECT DEPOSIT ACCOUNT ROUTING_ AMOUNT _ 6220373514 03607615 159.69 CM!CKNUKWR 004780391A - SOCIAL PHR10D EMPLOYEE NAME SECURITY ENDING aF*w-"-1853 07/12/08 MICHELLE A WRIGHT HOURLY RATE OR FEDSRAI TAX DEPARTMENT DATE SALARY STATUS PAID 7.25 - S002 0285 07/17/08 NET PAY $**"159.69 01IATE YEARTO;OATE CUR, NT YEAR TO DATE IRS EARNINGS TAXES AND DEDUCTIONS DEDUCTION'S DEDUCTIONS 4.60 161.00 4,75 6196,99 FEDERAL TAX 3.08 93.16 9.05 98.42 MEDICARE 13,17 398.35 6.25 45.31 OASDI 39.00 CAMPHILL R TAX 4.24 - 128.35 _625 45._3.1 PA STATE TAX 6.52 197.24 -1-_ ? PA SU1/SDI TAX .13 3.87 C HILL LST 1.00 29.00 G.C. MISC 5.00 DISAB INS - 7.47 VAC CLUB 20.00 300.00 76.30 6425.03 l FRINGRBF149FM _ I I nccrotwtio' T CURRFNT EAR TO DATE Boscov's Department Store, LLC PNC Bank, N.A 001 004777038A PO Box 4505 60=162 Jeannette, PA " ass Reading PA 19606 Date 07/10/08 Payable Amount $*****0.00 Pay Zero and 00/100 Dollars 00012 0285 07110/08 To The MICHELLE A WRIGHT Order 142 SOUTH 30TH 5P. APT.#6 CAMP HILL PA 17011 This check is void after 180 days from issue date ?????? ? nature Auth H ?i?-__--- - - -PLEASE FOLD AND DE'S°Ato? A LON(A THIS PERFORATION I CHECK NUNMER 004772038A 1 -'- SOCIAL PERIOD EMPLOYEE NAME SECURITY ENDING MICHELLBAwBICHT ***-**-1853 07/05/08 Hp(lRLYRATEOR FEDERAL TAX ,DEPARTMENT DATE PAID SALARY STATUS 7.25 S002 0285 07/10/08 36 51 * * * CURRENT CURRENT YEAR TO DATE " YEAR TO DATE . 2 NET PAY $ CURRENT YEAR TO DATE TAX99 AND DEDUCTIONS DEDUCTIONS DEDUCTIONS' EARNINGS f HOURS EARNINGS HOURS EARNINGS 56 5984 FEDERAL TAX 17.72 156.40 REGULAR 24.80 179.80 825.45 . 42 98 MEDICARE 4.83 90.08 OVERTIME ; 9.05 98.42 9.05 1 . 31 45 20.83 385.78 ; OASDI HOLIDAY 6.25 45.31 ! 6.25 . 00 39 CAMPHILL R TAX 6.67 124.11 MISC PAY 10.00 6 25 . 45.31 PA STATF TAX 10_?4 _ 190.77 BIRTHDAY . PA SU-I/SDI TAX 20 _ 3.74 C HILL LST 1.00 28.00 t-"- MISC G C 5.00 . . ISAB INS .83 _ 7.47 D VAC CLUB 20.00 280.00 TOTAL PAY 40.10 333.53 847.00 6212.60 FRINGE BENEFITS ACCOUNT DIRECT DEPOSIT ROUTING -- AMOUNT -" -NT -- - DESCRIPTION CURRE YFILR TO DXTE 6220373514 03607615 251.36 - Boscov's Department Store, LLC ao162 PNC Ba Bank, .A 001 004763655A eannette PA A, PO Box 4505 433 J Reading PA 19606 Date 07/03/08 Payable Amount $*****0.00 Pay Zero and 00/ 100 Dollars 00012 0285 07)03/06 To The MIS-LE A WRIGHT Order 142 SOUTH 30TH ST. Of APT-16 CAMP HILL PA 17011 This check is void after 180 days from issue date Authorized Sgnature ----- - ---- --PL.E=ASE FOLD AND DETACH A'`t. ()ls G THIS PE8FOAATi0N---- _.. EARNINGS NOU$S SARNLN? REGULAR 32.19 233. MI$ C PAY 6. i BIRTHDAY j TOTAL PAY 32.19 I 239.38 DIRECT DEPOSIT ACCOUNT ROU_INC AMOUNT 6220373514 03607615 180.51 CHECK NUPAWR 0047636%A - -- SOCIAL PSRTOI) EMPLOYEE NAME SSCVRITY MICHELLE WRIGHT ***-**-1853 06/28/08 HOURLY RATE OR FEDERAL TAX; DEPARTMENT DATE SALARY STATUS PAID 7.25 S 002 0285 07/03/08 NET PAY $* * * 180.51 `O DATE' YEAR TO DATE CURItBNT AR TO ATE TEES AND DEDUCTIONS' DEDU.C'I'IONS DE}?UCTIONS !RS EARNINGS 0.65 5804.76 FEDERAL TAX 7.29 138.68 29.00 MEDICARE 3.47 85.25 6.25 45.31 j OASDI 14.84 364.50 CAMPHILL R TAX 4.78 117.44 PA STATF TAY 7, ZS -1110 G-A l 1.00 27.00 -- iVAC S.14 3.54 5.00 6.64 20.00 260.00 90 5879.07 UYRAI_1M DESCRIPTION CURRENT Boscov's Department Store, LLC PNC Bank. N.A. 001 004755178A PO Box 4505 60=162 Jeannette, PA 433 Reading PA 19606 Date 06/26/08 Payable Amount $*****0.00 7nrn and oA/100 Dollars pay 00012 0285 06/26/08 To The AUCHELLE A WRIGHT Order 142 SOUTH 30TH ST. APT.#6 CAMP HILL PA 17011 This check is void after 180 days from issue date -y Authorized ignature --------PL.-ASE FOLD AND DETACH ALONG THIS PE PDP1ATI0N-----.------- CHECK NUMBER 0047017M RRBNT CURRSNT YEAR TO DATE ' EARNINGS HOURS EARNINGS HOURS REGULAR 31.78 230.41 768.46 MISC PAY i BIRTHDAY 6.25 SOCIAL PERIOD EMPLOYEE NAME SECURITY ENDING MICHELLEAWRIGHT ***-**-185306/21/08 14OURLY RATE OR FEDERAL TAX DEPARTMENT DATE' SALARY STATUS PAID 7.25 S002 0285 06/26/08 NET PAY $* * * 172.74 YLAR TO DA7 B CURRlTN7 AR.? O DATE TAXES AND DEDUCTIONS D$Dt)CT1QNS DI3biIC1ION$ EARNINGS 5571.38 FEDERAL TAX 6.40 131.39 23.00 MEDICARE 3.35 81.78 45.31 OASDI 14.28 349.66 CAMPHILL R TAX 4.60 112.66 PA STATE. TAX 7.07 .173.13 PA SUI/SDI TAX .14 3.40 C HILL LST G.C. MISC DISAB INS 1.00 .83 26.00 5.00 6.64 VAC CLUB 20.00 _ 240.00 TOTAL PAY 31.78 230.41 7 C -? DIRECT DEPOSIT OUNT 74.71 5639.69 IIES(RlPTION T FEtiNCiEBENEFITS CURRENT YE R TO DATE ACCOUNT ROUTING 3607615 AM 74 172 - 6220373514 0 . K F .. `.., PNC Bank, N.A 001 004746712A Boscov's Department Store, LLC 60=162 Jeannette, PA PO Box 4505 433 Reading PA 19606 $*****0.00 Date 06/19/08 Payable Amount Pay To The order Of 1 i i Zero and 00/100 Dollars oOO12 0285 06/19/M MICHELLE A WRIGHT 143 sOVTH 30TH ST. APTJ6 17011 CAMP HmL PA PLEASE FOLD AND DETACH ALONG THIS PE-FA t„ PATIO: N This check is void after 180 days from issue date e Authorized , tgnature tiu7A 6712A Boscov's ` Department Store, LLC PNC 13an1.: N.A. 001. 004738179A k "-1 z Jeannette, PA PO Box 4505 433 Reading PA 19606 **0.00 Date 06/12/08 Payable Amount $*** Pay Zero and 00/100 Dollars 00012 020 06/12/08 To The MICHELLE A WEIGHT order 142 SOUTH 30TH ST. APT46 CAMP HILL, PA 17011 This check is void after 180 days from issue date '/)?a Authorized -gnamre E - - - - PLEB°AS FOLD AND DETACH ALONG THIS PERFORATION------ ---- ----- Boscov,s Department Store, LLC PW flank, N.A 001 00472%21A 60-162 Jeannette, PA PO Box 4505 43= Reading PA 19606 Date 06/05/08 Payable Amount $ * .** * *0.00 Zero and 00/100 Dollars Pay --- - This check is void after 180 days from issue date 00012 0285 06/05/08 To The MICHELLE A WRIGHT Order 142 SOUTH 30TH ST. Of APT./6 Authorize6nature CAMP HILL PA 17011 --------PLEASE FOLD AND DETACH ALONG THIS PERFORATION -- e r PNC Bank, N.A. 001, 004721002A Boscov's Department Store. LLC 60_i62 Jeannette, PA ` PO Box 4505 433 Reading PA 19606 **0.00 Date 05/29/08 Payable Amount $*** pay Zero and 00/100 Dollars 00012 0285 06/29/08 To The MICHELLE A WItIGHT Order 142 SOUTH 30TH ST. APT-#6 Of CA3Ap HILL PA 17011 This check is void after 180 days from issue date Authorized ignature PLEASE FOLD AND DETACH ALONG THIS PERFORATION- --' $pscov's Department Store LLC NC Bank NA 001 004712373A 60-162 Jeannette, ?'A F10 Box 4505 433 Reading PA 19606 Date 05/22/08 payable Amount $ *****0,00 pay Zero and 00/100 Dollars 6 ooo12 o285 05/22/08 To The MICHELLE A WRIGHT Order 142 SOUTH 30TH ST. APT16 CAMP HII.L PA 17011 This check is void after 18o days from issue date 4e'e?6 t? Authorized igneture PLEASE FOLD AND DETACH ALONG THIS PERFORATION TOTAL PAY L CHEm NUMBER 004712373A +. , HIM E-11 1ALMS p O1)1 store,LLC PNC Bank, N.A ?ti?352 A r? Boscoy'S Department 60;62 Jeannette, PA PO Box 4505 433 Reading PA 19606 *****000 ?#e 05/15/08 Payable Amount $Zero and 00/100 Dollars 00012 02851 06/15/08 To The SU-E A WRIGHT 142 SOUTH 30TH ST. APTJ6 order Of CAWHILL PA 17011 This check is void after 180 days from issue date b? I 1 tf X Authorizes ignature PLEASE FOLD AND DETACH ALONG THIS PERFORATION Boscov's Department Store. LLC PNC B inl N-A 001 004694777A 60-162 Jeannette, PA PO Box 4505 433 Reading PA 19606 ** *X0.00 Date 05/08/08 Payable Amount $ Pay Zero and 00/100 Dollars ------ -- -- --- - ------ This check is void after 180 days from issue date 00012 0285 05N8/08 To The MICHELLE A WRIGHT order 142 soUTH 30TH ST. Authorkzed kgnature Of APT16 CAMP BML PA 17011 PLEASE FOLD AND DETACH ALONG THIS PERFORATION Boscov's Department Store, LLC PNC Bank N.A. 001 M ?. w PO Box 4505 6033162 Jeannette, PA 004686064A Reading PA 19606 Date 05/01/08 Payable Amount %**N**0.00 Pay Zero and 00/100 Dollars 00012 0285 05/01/08 To The MICHELLE A WRIGHT Order 142 SOUTH 30TH ST. Of APTJ6 CAMP HILL PA 17011 This check is void after 180 days from issue date -?676cl- Authorized Signature PLEASE: FOLD AND DETACH ALONG THIS PERFORATION CHECK NUMBER 004686064A SOCIAL PERIOD EMPLOYEE NAME SECURITY ENDING MICHELLEA WRIGHT ***-**-1853 04/26/08 HOURLY RATE OR SALARY P06ERALTAX STATUS DEPARTMENT DATE PAID 7.25 S002 0285 05/01/08 NET PAY $***164.17 EARNINGS >- CURRENT` HOURS , CURRENT EARNINGS YEAR TO DATE HOURS MBAR 1t1 DATE EARNINGS TAXES AND DEDUCTIONS CURRENT DEDUCTIONS YEAR TO DATE DEDUCTIONS.` REGULAR 30.10 218.23 528.23 3829.70 FEDERAL TAX 5.18 84.45 MISC PAY I I 9.00 MEDICARE 3.16 i 55.66 OASOI _ _13.53 238.00 CAMPHILL R TAX 4.36 76.68 _ I __ -?--- PA STATE TAX PA SUI/SDI TAX ~ 6°70_ .13 117.84 2.31 I C HILL LST - 1.00 18.00 G.C. MISC _ 5.00 DISAB INS -- ------- i--- 3.32 _ _ VAC CLUB 20.00 80.00 I TOTAL PAY 30.10 218.23 528.23 3838.70 Y 1nCT DEP0S1T FRINaE Bektm s ACCOUNT ROUTING _ AMOUNT DESCRIPTION `CURRENT _ YEARTO DATE 6220373514 03607615 164.17 #?, ., a , ,-_ _, _. .. , __ MICHELLE WRIGHT, Plaintiff, Petitioner V. JAMES WRIGHT, Defendant, Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW DIVORCE : NO. 06-3723 CIVIL TERM PETITION TO BIFURCATE DIVORCE PROCEEDING PURSUANT TO PA R.C.P. 1920.16 and PA.C.S. 3323(c)(1) Plaintiff, Michelle Wright, by and through her attorneys, The Family Law Clinic, files this Petition for Bifurcation pursuant to PA.R.C.P. 1920.16 and PA.C.S. 3323(c)(1) and requests that this Honorable Court enter an order bifurcating the divorce proceeding so that Petitioner may proceed with the diviorce complaint pursuant to 23 Pa.C.S § 3301(d), reserving jurisdiction over the remaining alimony claim, and converting the current spousal support order into an order for alimony pendente lite. In support of this Petition, Petitioner represents that: 1. Petitioner is Michelle Wright whose current address is 4 Harvard Place, Apt D, Camp Hill, Cumberland County, Pennsylvania 17011. 2. Respondent is James Wright whose last known address is believed to be 202 Susquehanna Avenue, York, York County, Pennsylvania 17403. 3. Petitioner filed a divorce complaint on June 29, 2006, alleging that the marriage was irretrievably broken under sections 3301(c), 3301(d) and 3301(a)(6) of the Divorce Code. The Complaint was last reinstated on December 4, 2007 and Respondent was served through publication in the Sentinel on December 22, 2007 and in the Cumberland County Law Journal on February 22, 2008. 4. Petitioner served the Respondent with the Notice of Intention to Request Entry of § 3301(d) Divorce Decree concurrently with this Petition. 5. Petitioner receives $300/month in Spousal Support from Respondent as the result of a Court Order dated March 31, 2006 with Docket Number 01007 S 2003, PACSES Number 304105930. 6. The parties have not been able to resolve the issue of alimony. 7. Petitioner has attempted to move this Divorce proceeding forward. A Court Order dated December 7, 2007 permitted notice by publication of the Divorce Complaint because Respondent could not be found. 8. Respondent has continually evaded service of all documents in this divorce' action. 9. Petitioner requests this bifurcation because she believes she has a valid alimony claim that she would like to pursue despite her divorce and given the fact that Respondent's refusal to accept service has caused litigation to extend for over two and a half years. 10. Petitioner will benefit from the bifurcation of these proceedings because she and Respondent have been separated for over three years and the Divorce action has been pending for two and a half years, and Petitioner would like to move on with her life. 11. Respondent will not be harmed if this order is granted since he is currently paying spousal support in the amount which is requested for alimony pendente lite. 12. The Family Law Clinic has not obtained concurrence of opposing counsel pursuant to C.C.R.P. 208.2 because Respondent is acting pro se and therefore no concurrence is necessary. 13. The Honorable Judge Edward E. Guido has previously ruled in this case. WHEREFORE, Petitioner respectfully requests that this court enter an order bifurcating the divorce proceeding so that Petitioner may proceed with the divorce complaint pursuant to 23 Pa.C.S § 3301(d), reserving jurisdiction over the remaining alimony claim, and converting the current spousal support order into an order for alimony pendente lite. 'e? Date w Lo q - - J / RROBElit E. RAINS THOMAS M. PLACE ANNE MACDONALD-FOX MEGAN RIESMEYER KATE CRAMER-LAWRENCE Supervising Attorneys FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 Telephone: (717) 243-2968 Fax: (717) 243-3639 Certified Legal Inter VERIFICATION I verify that the statements made in this Petition for Bifurcation 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: 09-06-CR Michelle Wrigh Petitioner ? w ?-, ?-, ? -?--t ?' r=_ :ca c?=: - ? ? , ._._ i .? ?? x? ZY . °C MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant NO. 06-3723 CIVIL TERM MOTION FOR APPOINTMENT OF MASTER Michelle Wright, Plaintiff, through her counsel, the Family Law Clinic, moves the court to appoint a Master with respect to the following claims: () Divorce () Distribution of Property O Annulment O Support (X) Alimony O Counsel Fees O Alimony Pendente Lite O Costs and Expenses Plaintiff, in support of the motion, states: 1. Discovery is complete as to the claim for which the appointment of a master is requested. 2. Plaintiff filed for divorce on June 29, 2006 under §§ 3301(a)(6), (c) and (d) of the Divorce Complaint. The Divorce Complaint included counts for Alimony and Equitable Distribution. 3. Defendant was served with the Divorce Complaint by publication in the Sentinel on December 22, 2007 and the Cumberland County Law Journal on February 22, 2008. 4. Plaintiff filed a Praecipe to Withdraw Equitable Distribution Count on September 19, 2008. 5. The claim for Alimony is contested. 6. The claim for Alimony does not involve complex issues of law and/or fact. 7. A hearing is expected to take two hours. WHEREFORE, Plaintiff requests that a master be appointed to hear the Alimony claim. Date Adam Britcher Certified Legal Intern Megan lkiesmeyer Supervising Attorney FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 717-243-2968 Fax 717-243-3639 s t ?, co MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff, Petitioner : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant, Respondent : NO. 06-3723 CIVIL TERM AFFIDAVIT OF SERVICE I, ADAM BRITCHER, hereby certify that I personally served a true and correct copy of the Petition to Bifurcate Divorce Proceeding Pursuant to PA R.C.P. 1920.16 and PA.C.S. 3323(c)(1), Notice of Intention to Request Eentry of § 3301(d) Divorce Decree, Defendant's Counter-Affidavit Uunder §3301(d) of the Divorce Code, and Motion for Appointment of Master on JAMES WRIGHT, at the Cumberland County Courthouse, 1 Courthouse Square, Carlisle, PA, 17013 at / 4.m. on March 6, 2009. I verify that the statements made in this Affidavit of Service are true and correct to the best of my personal knowledge and belief. 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: 5/& to ADAM BRITCHER Certified Legal Intern ZD, ?,_ } ca CD am j ; t a s ? ' MAR 0 9 2009G MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant NO. 06-3723 CIVIL TERM ORDER APPOINTING MASTER AND NOW, this J0 day of GuC.? 2009, Robert Elicker, Esquire, is appointed master with respect to the following claim: Alimony. By the CA 1% J. 9-- OD ? L? '°ct ' i `'ray ! C-A . MICHELLE WRIGHT, Plaintiff, Petitioner V. JAMES WRIGHT, Defendant, Respondent hAii 0 9 20006 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW DIVORCE NO. 06-3723 CIVIL TERM RULE TO SHOW CAUSE WHY BIFURCATION SHOULD NOT BE GRANTED AND , 2009 upon consideration NOW this day of M of the attached Petition to Bifurcate, a rule is entered upon Respondent, James Wright to show cause why the request for bifurcation should not be granted. 3b 4b/ in Courtroom-? of the Rule returnable oajk!?4 Cumberland County Courthouse. B E COURT: J. _ f rUCY7 71 cy' ?» h w? 60/w/e 1r??t to jJ 4 ? - _ AL -? MICHELLE WRIGHT, Plaintiff V. JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW DIVORCE NO. 06-3723 CIVIL TERM AFFIDAVIT OF SERVICE I, Adam Britcher, Certified Legal Intern, hereby certify that I served, via United States Mail, First Class, a true and correct copy of the Rule To Show Cause Why Bifurcation Should Not Be Granted, on Defendant, James Wright, at 202 Susquehanna Avenue, York, PA 17403, at on March 17, 2009. I verify that the statements made in this Affidavit of Service are true and correct to the best of my personal knowledge and belief. 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: 7 (71o9 Adam Britcher Certified Legal Intern ( t In cr, MICHELLE WRIGHT, Plaintiff, Petitioner V. JAMES WRIGHT, Defendant, Respondent I, Adam Britcher, Mail, First Class, a true Defendant, James Wright, at I verify that the of my personal knowledge the penalties of 18 Pa.C.S. /y 619 ate IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW DIVORCE NO. 06-3723 CIVIL TERM AFFIDAVIT OF SERVICE Legal Intern, hereby certify that I am serving, via United States correct copy of the Praecipe to Withdraw Petition to Bifurcate, on 2 Susquehanna Avenue, York, PA 17403, on April 14, 2009. nts made in this Affidavit of Service are true and correct to the best belief. I understand that false statements herein are made subject to 4, relating to unworn falsification to authorities. Adam Britcher Certified Legal Intern FILED-QfFICE OF TPE Pi".01T P !OTARY 2009 APP 14 PH 2, 22 Cul, ?. I NI- ` p;::.% Cdr, ? :'' MICHELLE WRIGHT, Plaintiff, Petitioner V. JAMES WRIGHT, Defendant, Respondent To The Prothonotary: Please withdraw the Date IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW DIVORCE NO. 06-3723 CIVIL TERM to Bifurcate at the above-captioned docket. Adam Britcher Certified Legal Intern Anne MacDonald-Fox Thomas Place Robert Rains Megan Riesmeyer Supervising Attorneys FAMILY LAW CLINIC 45 N. Pitt Street Carlisle, PA 17013 717-243-2968 Fax: 717-243-3639 Attorneys for Plaintiff ??1..V l.?I SV4.. OF THE ?, t ?GARY 2009 APR 14 P 2: 22 MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff, Petitioner : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant, Respondent : NO. 06-3723 CIVIL TERM AFFIDAVIT OF SERVICE I, Adam Britcher, Certified Legal Intern, hereby certify that I am serving, via United States Mail, First Class, a true and correct copy of the Plaintiffs Pre-Hearing Memorandum, on Defendant, James Wright, at 202 Susquehanna Avenue, York, PA 17403, on May 11, 2009. I verify that the statements made in this Affidavit of Service are true and correct to the best of my personal knowledge and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unworn falsification to 1_(b , Date Adam Britcher Certified Legal Intern FILED- ,'F 1CE OF THE t ?rq TAFIY 2009 MAY I PM 2: 3 9 r i-I u ! ,_!A MICHELLE WRIGHT, Plaintiff V. JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW DIVORCE : NO. 06-3723 CIVIL TERM INCOME AND EXPENSE STATEMENT OF IAi Chelle A 00p- I verify that the statements made in this Income and Expense Statement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Date: cZ5 - ©-1 - 09 MICHELLE WRI HT INCOME Employer: L-SaSc(pkjs i'1 C Employer's Address: Type of Work: 5cx1c- sW 6, e Payroll Number: a3 d SCI-1%9 Pay Period (weekly, biweekly, etc.): t,jq?Kl_:!?4 Gross Pay per Pay Period: $ Xt4 .q) Itemized Payroll Deductions: Federal Withholding Social Security M • Bt Local Wage Tax 5. CIR State Income Tax 1-.55 Retirement 15.00 Savings Bonds Credit Union Life Insurance Health Insurance Other (specify) '- t' ?-' ;I; ?nS -:20/a =.yl edl= 5.31 Net Pay per Pay Period: $ 0- Other Income: Interest Dividends Pension Annuity Social Security Rents Royalties Expense Account Gifts Unemployment Comp. Workmen's Comp. Week Month Year (Fill in Appropriate Column) Total TOTAL INCOME EXPENSES Weekly Monthly Home (Fill in Appr priate Column) Mortgage/rent $ Gqo ' `? Maintenance Utilities Electric tc cc Gas 8D.00 Oil Telephone Water Sewer Employment Public transportation $i $ g5' 'LQ?tu- Lunch I CO Taxes Real estate $ $ Personal property Income Insurance Homeowners $ $ Automobile Life Accident Health Yearly $` -T- Other Automobile Payments $ $ $ Fuel Repairs Medical Doctor $ $ $ Dentist Orthodontist Hospital Medicine Special needs (glasses, braces, orthopedic devices) Education Private school $ $ $ Parochial school College Religious Personal Clothing $ $ 5T $ Food , Barber/hairdresser Credit payments Credit card Charge account (?O Memberships Loans Credit Union $ $ $ Miscellaneous Household help $ $ $ Child care Papers/books/magazines Entertainment Pay TV Vacation Gifts Legal fees Charitable contributions Other child support Alimony payments Other Total Expenses $ ?O C50 $1 4C)r - CIO $ 395 -cD PROPERTY OWNED Ownership* Description Value H J Checking accounts Savings accounts Credit Union Stocks/bonds Real estate Other Total INSURANCE Hospital Blue Cross Other Medical Blue Shield Other Health/Accident Disability Income Dental Other a.1 $ Coverage* Company Policy No. H W C * H=Husband; W=Wife; J=Joint; C=Child SUPPLEMENTAL INCOME STATEMENT (If you are self-employed or if you are salaried by a business of which you are owner in whole or in part, you must also fill out the Supplemental Income Statement.) (a) This form is to be filled out by a person (check one): [error] (1) who operates a business or practices a profession, or [error] (2) who is a member of a partnership or joint venture, or [error] (3) who is a shareholder in and is salaried by a closed corporation or similar entity. (b) Attach to this statement a copy of the following documents relating to the partnership, joint venture, business, profession, corporation or similar entity: (1) the most recent Federal Income Tax Return, and (2) the most recent Profit and Loss Statement. (c) Name of business: Address and Telephone Number: (d) Nature of business (check one) [error] (1) partnership [error] (2) joint venture [error] (3) profession [error] (4) closed corporation [error] (5) other (e) Name of accountant, controller or other person in charge of financial records: (f) Annual income from business: (1) How often is income received? (2) Gross income per pay period: _ (3) Net income per pay period: _ (4) Specified deductions, if any: _ Form 1040 Department of the Treasury--Internal Revenue Service U.S. Individual Income Tax Return 2008 ss IRS Use Only--Do not write or staple in this space. Label OMB No. 1545-0074 (See L MICHELLE A WRIGHT Your social security number instructions) B 180-84-1853 Use the E Spouse's social security no. IRS L label. 4 HARVARD PL APT D Otherwise, E CAMPH I LL PA 17011- 0000-000 You must enter please print R your SSN(s) above. or type. E Checking a box below will not Presidential chap e your tax or refund. Election Campaign ? Check here if you, or ourspouse if filing jointly, want $3 to o to this fund see instr. . ? You Souse 1 Single 4 Head of household (with qualifying person). (See inst.) If the Filing Status 2 Married filing jointly (even if only one had income) qualifying person is a child but not your dependent, enter this Check only 3 Married filing separately. Enter spouse's SSN above and child's name here. ? one box. full name here. ? 5 Qualifying widow er with dependent child see instructions Exemptions 6a If more than four b Yourself. If someone can claim you as a dependent, do not check box 6a . . . . . . . . . . Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . dependents, see instructions. C Dependents: 1 First name Last name (2) Dependent's social security number (3) Dependent's relationship to you (4) J if qualifying child for child tax credit (see inst.) DESHAWN WILLIAMS 186-84-3022 SON X Boxes checked on 6a and 6b 1 No. of children on 6c who: 01 ? lived with you •did not live with you due to di- vorce or sepa- ration (see inst.) - Dependents on 6c not entered above d Total number of exemptions claimed . Add numbers on lines above ? LL 2 7 , , , , , , , , , , , , , , , , Wages, salaries, tips, etc. Attach Form(s) W-2 7 11,763 Income 8a , , , Taxable interest. Attach Schedule B if required . . . . . . . . . . . . . . . . . 8a Attach Form(s) W-2 here. Also attach Forms b 9a Tax-exempt interest. Do not include on line 8a . . . . . . . 8b Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a W-213; and 1099-R if tax b 10 Qualified dividends (see instructions) . . . . . . . . . . . . 9b Taxable refunds, credits, or offsets of state and local income taxes (see instructions) . . . . 10 was withheld. 11 Alimony received 11 did t If 12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . . . . . . 12 no you get a W-2 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . ? L 13 , see instructions. 14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . 14 15a IRA distributions . . . . . . 15a b Taxable amount (see inst.) . 15b 16a Pensions and annuities . . . 16a b Taxable amount (see inst.) . 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17 18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . 18 Enclose, but do ot attach an 19 Unemployment compensation . . . . . . . . . . . . . 19 , y n payment. Also 20a Social security benefits . . . 120a I I b Taxable amount (see inst.) . 20b , please use Form 21 Other income. List type & amount (see inst.) 21 1040-V. 22 Add the amounts in the far right column for lines 7 through 21. This is our total income ? 22 11 , 7 6 3 23 Educator expenses (see page 28) . . . . . . . . . . . . . 23 Adjusted Gross 24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ 24 Income 25 Health savings account deduction. Attach Form 8889. 25 26 Moving expenses. Attach Form 3903 . . . . . . . . . .. 26 27 One-half of self-employment tax. Attach Schedule SE . . . . 27 28 Self-employed SEP, SIMPLE, and qualified plans . . . . . 28 29 Self-employed health insurance deduction (see instructions) 29 30 Penalty on early withdrawal of savings . . . . . . . . . . . 30 31a Alimony paid b Recipient's SSN ? 31a 32 IRA deduction (see instructions) . . . . . . . . . .. . . . . 32 33 Student loan interest deduction (see instructions) . 33 34 Tuition and fees deduction. Attach Form 8917 . 34 35 Domestic production activities deduction. Attach Form 8903 35 36 Add lines 23 through 31a and 32 through 35 . . . . . . . . . . . . . . . . . . . . . . . . 36 37 Subtract line 36 from line 22. This is your adjusted gross_ incom e . 0. 37 11,763 SPA For Disclosure, Privacy Act, & Paperwork Reduction Act Notice, see instructions. zoos oI I Petz Enterprises, Inc. 8US011 Form 1040 (2008) MICHELLE A WRIGHT nee 180-84-1853 Pace 2 V V _ 38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . . . . . . . 38 111763 Tax and Credits 39a Check r You were born before January 2, 1944, B Blind. I Total boxes if: _1L 8 Spouse was born before Jan. 2, 1944, Blind. checked ? 39a b If your spouse itemizes on a separate return or you were a dual-status alien, see inst. & check here ? 39b Standard c Check if standard deduction includes real estate taxes or disaster loss (see instructions) ? 39c Deduction 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . . . . . 40 8 , 0 0 0 for -- 41 Subtract line 40 from line 38 . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . 41 3 , 7 6 3 0 People 42 If line 38 is over $119,975, or you provided housing to a Midwestern displaced individual, see page who checked any box on 36. Otherwise, multiply $3,500 by the total number of exemptions claimed on line 6d. . . . . . . . 42 7,000 line 39a, 39b, or 39c or 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . . . . . 43 who can 44 Tax (see inst.). Check if any tax is from: a 11 Form(s) 8814 b 11 Form 4972 . . . . . . . . . . 44 claimed as s a dependent, 45 Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . . . . . . . . . . 45 see inst . 46 Add lines 44 and 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ? 46 • All others: 47 Foreign tax credit. Attach Form 1116 if required . . . . . . . . . . . 47 Single or Married filing 48 Credit for child and dependent care expenses. Attach Form 2441 48 separately, 450 $5 49 Credit for the elderly or the disabled. Attach Schedule R . . . . . . 49 , Married filin 50 Education credits. Attach Form 8863 . . . . . . . . . . . . . . . . 50 g jointly or lif i 51 Retirement savings contributions credit. Attach Form 8880 . . . . . 51 Qua y ng widow(er), 52 Child tax credit (see instructions). Attach Form 8901 if required . . . 52 $10,900 53 Credits from Form: a 8396 b 0 8839 c 05695 53 Head of household, 54 Other credits from Form: a[] 3800 b 0 8801 c 54 $8,000 55 Add lines 47 through 54. These are your total credits 55 56 Subtract line 55 from line 46. If line 55 is more than line 46, enter -0- . ? 56 57 Self-employment tax. Attach Schedule SE . . . . . . . .. . . . . . . . . . . . . . . . . . 57 Other 58 Unreported social security and Medicare tax from Form: a 04137 b n 8919 . . . . . . . 58 Taxes other qualified retirement plans, etc. Attach Form 5329 if required . . . . . 59 Additional tax on IRAs 59 , 60 Additional taxes: all AEIC payments b 1l Household employment taxes. Attach Schedule H 60 ...................... , 61 Add lines 56 through 60. This is our total tax . 1111 61 62 Federal income tax withheld from Forms W-2 and 1099 . . . . . . 62 295 Payments 63 2008 estimated tax payments and amount applied from 2007 return 63 If you have a 64 a Earned income credit (EIC) . . . . . . . . . . . . . . alif in 64a 2, 917 y g qu child, attach b Nontaxable combat pay election . . . . 164b Schedule EIC. 65 Excess social security and tier 1 RRTA tax withheld (see instructions) 65 66 Additional child tax credit. Attach Form 8812 . . .. . . . . . .. . 66 489 67 Amount paid with request for extension to file (see instructions) . . . 67 68 Credits from Form: a112439 b04136 c[]8801 do 8885 68 69 First-time homebuyer credit. Attach Form 5405 . . . . . . . . . 69 70 Recovery rebate credit (see worksheet in the instructions) . . .. . . 70 ..... 71 Add lines 62 through 70. These are our total payments . ... ? ......... 71 3,701 Refund 72 If line 71 is more than line 61, subtract line 61 from line 71. This is the amount you overpaid . . . 72 3 , 7 01 Direct 73a Amount of line 72 you want refunded to you. If Form 8888 is attached, check here ? 0 . . . . 73a 3 , 7 01 deposit? See e: Checking Savings 036076150 0, c T b 10- b R ti yp ng num er ou page 63 and fill in 73b, 73c, ? d Account number 6220373514 and 73d, or Form 8888. 74 Amount of line 72 you want applied to our 2009 estimated tax ? 74 A..,......? 75 Amount you owe. Subtract line 71 from line 61. For details on how to pay, see instructions). . . ? 75 You Owe 76 Estimated tax penalty see instructions 76 Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. No Desi nee Designee's Phone I, Personal Identification ? 9 name 10 no. number (PIN) Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they Sign are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Here Your signature Date Your occupation Daytime phone number Joint retum?' SALES ASSOCITE 717-343-3522 See instr. Keep a copy Spouse's signature. If a joint return, both must sign. Date Spouse's occupation for your Date heck if self- _ I Preparer's SSN or PTIN Paid Preparer s' signature Preparer's Firm's name (or Use Only yours if self-employe address, and ZIP _co( 20081 I Petz Enterprises, Inc. 8US012 Phone no. Form 1040 (2008) OMB No. 1545-0074 SCHEDULES A&B Schedule A-Itemized Deductions (Form 1040) (Schedule B is on Side 2) 2008 Department of the Treasury Intemal Revenue Service (99) 10, Attach to Form 1040. lo- See instructions for Schedules A&B Form 1040. Attachment Sequence No. 07 Name(s) shown on Form 1040 Your social security number MICHELLE A WRIGHT 180-84-1853 Medical Caution. Do not include expenses reimbursed or paid by others. and Dental 1 Medical and dental expenses (see instructions) . . . . . . . . . . 1 Expenses 2 Enter amt. from Form 1040, line 38 . 2 3 Multiply line 2 by 7.5% (.075) . . . . . . . . . . . . . . . . . . 3 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- ................ 4 Taxes You 5 State and local (check only one box): Paid a Income taxes, or 5 602 J b M General sales taxes 6 Real estate taxes (see instructions) . . . . . . . . . . . . . . . . 6 7 Personal property taxes . . . . . . . . . . . . . . . . . . . . . 7 (See 8 Other taxes. List type & amount ? instructions.) 8 9 Add lines 5 through 8 9 602 Interest 10 Home mortgage interest and points reported to you on Form 1098 10 You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see instructions (See and show that person's name, identifying no., and address ? instructions.) Personal Note 11 . interest is not 12 Points not reported to you on Form 1098. See inst. for special rules 12 deductible. 13 Qualified mortgage insurance premiums (see instructions) . . . . 13 14 Investment interest. Attach Form 4952 if required. (See instructions) 14 15 Add lines 10 through 14 ...................... ... ........... 15 Gifts to 16 Gifts by cash or check. If you made any gift of $250 or more, see Charity instructions ........................... 16 If you made a 17 Other than by cash or check. If any gift of $250 or more, see gift and got a instructions. You must attach Form 8283 if over $5003ee sum. oa . 17 300 benefit for it, 18 Carryover from prior year . . . . . . . . . .. . . . . . . . . . 18 see instructions. 19 Add lines 16 through 18 ...................... ... ........... 19 300 Casualty and Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. (See instructions) ................ 20 Job Expenses 21 Unreimbursed employee expenses--job travel, union dues, job and Certain education, etc. Attach Form 2106or 2106-EZ if required. (See inst.) Miscellaneous ? 21 Deductions 22 Tax preparation fees . 22 79 (See 23 Other expenses--investment, safe deposit box, etc. List type and instructions.) amount ? 23 24 Add lines 21 through 23 . . . . . . . . . .. . . . . . . . . . 24 79 25 Enter amt. from Form 1040, line 38 . 25 11,763 26 Multiply line 25 by 2% (.02) . . . . . . . . . .. . . . . . . . . 26 235 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- ... ........... 27 Other 28 Other--from list in instructions. List type and amount ? Miscellaneous Deductions 28 Total 29 Is Form 1040, line 38, over $159,950 (over $79,975 if married filing separately)? Itemized ® No. Your deduction is not limited. Add the amounts in the far right column Deductions for lines 4 through 28. Also, enter this amount on Form 1040, line 40. 0, 29 902 F] I Yes. Your deduction may be limited. See instructions for the amount to enter. 30 If you elect to itemize deductions even though they are less than your standard deduction, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ? SPA For Paperwork Reduction Act Notice, see Form 1040 instructions. 2008 =I I Petz Enterprises, inc. 8US071 Schedule A (Form 1040) 2008 Schedule EIC Earned Income Credit 51C OMB No. 1545-0074 (Form 1040A or 1040) Qualifying Child Information 10M12008 Department of the Treasury Complete and attach to Form 1040A or 1040 Attachment Internal Revenue Service (99) only if you have a qualifying child. Sequence No. 43 Name(s) shown on return Your social security number MICHELLE A WRIGHT 180-84-1853 Before you begin: • See the instructions for Form 1040A, lines 40a and 40b, or Form 1040, lines 64a and 64b, to make sure that (a) you can take the EIC, and (b) you have a qualifying child. • Be sure the child's name on line 1 and social security number (SSN) on line 2 agree with the child's social security card. Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child's social security card is not correct, call the Social Security Administration at 1-800-772-1213. • If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See back of schedule for details. Caution • It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child. Qualifying Child Information Child 1 Child 2 ' First name Last name First name Last name 1 s name Child If you have more than two qualifying children, you only have to list two to get the maximum credit. ESHAWN WILLIAMS 2 Child's SSN The child must have an SSN as defined on page 43 of the Form 1040A instructions or page 49 of the Form 1040 instructions unless the child was born and died in 2008. If your child was born and died in 2008 and did not have an SSN, enter "Died" on this line and attach a copy of the child's birth certificate, death certificate, or 186-84-3022 hospital medical records. 3 Child's year of birth Year 1994 Year If born after 1989, skip lines 4a and 4b; go If born after 1989, ski p lines 4a and 4b; go to line 5. to line 5. 4 If the child was born before 1990-- a Was the child under age 24 at the end F-1 Yes. No. ? Yes. No. of 2008 and a student? Go to line 5. Continue. Go to line 5. Continue. b Was the child permanently and totally El Yes. 1:1 No. F1 Yes. El No. disabled during any part of 2008? The child is not a Continue Continue. The child is not a . qualifying child. qualifying child. 5 Child's relationship to you (for example, son, daughter, grandchild, niece, nephew, foster child, etc.) SON 6 Number of months child lived with you in the United States during 2008 • If the child lived with you for more than half of 2008 but less than 7 months, enter 7". 12 months months • If the child was born or died in 2008 and your home was the child's home for the entire time Do not enter more than 12 months. Do not enter more than 12 months. he or she was alive during 2008, enter "12". TIP You may also be able to take the additional child tax credit if your child (a) was under age 17 at the end of 2008, and (b) is a U.S. citizen, U.S. National, or U.S. resident alien. For more details, see the instructions for line 41 of Form 1040A or line 66 of Form 1040. SPA For Paperwork Reduction Act Notice, see Form 1040A or 1040 instructions. Schedule EIC (Form 1040A or 1040) 2008 2008 F1 Petz Enterprises Inc. 8US431 1?Q OMB No. 1545-0074 F.,. 8812 Additional Child Tax Credit laaa°I?? 2008 8812 Department of the Treasury Complete and attach to Form 1040, Form 1040A, or Form 1040NR. Attachment Internal Revenue Service (99) Sequence No. 47 Name(s) shown on return Your social security number MICHELLE A WRIGHT 180-84-1853 Part I All Filers _ 1 Enter the amount from line 1 of your Child Tax Credit Worksheet on page 43 of the Form 1040 instructions, page 38 of the Form 1040A instructions, or page 19 of the Form 1040NR instructions. If you used Pub. 972, enter the amount from line 8 of the worksheet on page 4 of the publication . . . . . . . . . .. . . . . . . . 1 2 Enter the amount from Form 1040, line 52, Form 1040A, line 33, or Form 1040NR, line 47 . . . . . . . . . .. L2 3 Subtract line 2 from line 1. If zero, stop; you cannot take this credit . . . . . . . . . . . . . . . . . . . . . 4a Earned income (see instructions on side 2). If your main home was in a Midwestern disaster area when the disaster occurred, and you are electing to use 2007 earned income, check here . . . . . . . . . . . . . . . . ? 4a 11,763 b Nontaxable combat pay (see instructions on side 2) . . . .. . . . . .. . . . . . . . 4b 5 Is the amount on line 4a more than $8,500? No. Leave line 5 blank and enter -0- on line 6. Yes. Subtract $8,500 from the amount on line 4a. Enter the result . . . . 5 3,263 6 Multiply the amount on line 5 by 15% (.15) and enter the result . . . . . . . . . . . . . . . . . . . . . . . Next. Do you have three or more qualifying children? ® No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part II and enter the smaller of line 3 or line 6 on line 13. a Yes. If line 6 is equal to or more than line 3, skip Part II and enter the amount from line 3 on line 13. Otherwise. ao to line 7. 1,000 1,000 3 6 Part 11 Certain Filers Who Have Three or More Quali In Gnilaren 7 Withheld social security and Medicare taxes from Form(s) W-2, boxes 4 and 6. If married filing jointly, include your spouse's amounts with yours. If you worked for a railroad, see the instructions on side 2 . . . . . . . . . . . . . . 7 8 1040 filers: Enter the total of the amounts from Form 1040, lines 27 and 58, plus any taxes that you identified using code "UT" and entered on the dotted line next to line 61. 1040A filers: Enter -0-. 8 1040NR filers: Enter the total of the amounts from Form 1040NR, line 53, plus any taxes that you identified using code "UT" and entered on the dotted line next to line 57. 9 Add lines 7 and 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 10 1040 filers: Enter the total of the amounts from Form 1040, lines 64a and 65. 1040A filers: Enter the total of the amount from Form 1040A, line 40a, plus any excess social security & tier 1 RRTA taxes with- 10 held that you entered to the left of line 43 (see instructions). 1040NR filers: Enter the amount from Form 1040NR, line 60. 11 Subtract line 10 from line 9. If zero or less, enter -0- . . . . . . . . . . .. ... .. . . . . . . . . . . . . . 0_1 12 Enter the larger of line 6 or line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Next, enter the smaller of line 3 or line 12 on line 13. Part III Tax Credit 12 13 This is your additional child tax credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 489 Enter this amount on Form 1.040 1040, line 66, Form 1040A, line 1046NR 41, or Form 1040NR, line 61. SPA For Paperwork Reduction Act Notice, see instructions. 2008 Petz Enterprises, Inc. 8US471 Form 8812 (2008) 489 J 0800111320 1 PA-40 - 2008 Pennsylvania Income Tax Return ENTER ONE LETTER OR NUMBER IN EACH BOX. Do Not Use Your Preprinted Label 180841853 WRIGHT MICHELLE APT D 4 HARVARD PL CAMPHILL 717-343-3522 A Occupation SALES ASS O Occupation PA 17011 21100 la Gross Compensation. Do not include exempt income, such as combat zone pay and qualifying retirement benefits. See the instructions. lb Unreimbursed Employee Business Expenses. 1c Net Compensation. Subtract Line 1b from Line 1a. N Extension. N Amended Return. R Residency Status. PA Resident/ Nonresident/ Part-Year Resident from to S Single/Married, Filing Jointly/ Married, Filing Separately/ Final Return/Deceased Date of death N Farmers. School District Name. C A M P H I L L 2 Interest Income. Complete PA Schedule A if required. 3 Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required. 4 Net Income or Loss from the Operation of a Business, Profession, or Farm. 5 Net Gain or Loss from the Sale, Exchange, or Disposition of Property. 6 Net Income or Loss from Rents, Royalties, Patents, or Copyrights. 7 Estate or Trust Income. Complete and submit PA Schedule J. 8 Gambling and Lottery Winnings. Complete and submit PA Schedule T. 9 Total PA Taxable Income. Add only the positive income amounts from Lines 1c, 2, 3, 4, 5, 6, 7, and 8. DO NOT ADD any losses reported on Lines 4, 5, or 6. 10 Other Deductions. Enter the appropriate code for the type of deduction. See the instructions for additional information. 11 Adjusted PA Taxable Income. Subtract Line 10 from Line 9. 2008 M-11 Petz Enterprises, Inc. BPA011 EC Page 1 of 2 FC 1a 11898 1b 0 1C 11898 2 0 3 0 4 0 5 0 6 0 7 0 8 0 9 11898 10 0 11 11898 1 0800111320 W 1 1 0800111320 1 J PA-40 - 2008 Social Security Number 0800211336 180841853 Name(s) MICHELLE A WRIGHT 12 PA Tax Liability. Multiply Line 11 by 3.07 percent (0.0307). 13 Total PA Tax Withheld. See the instructions. 14 Credit from your 2007 PA Income Tax return. 15 2008 Estimated Installment Payments. 16 2008 Extension Payment. 17 Nonresident Tax Withheld from your PA Schedule(s) NRK-1. (Nonresidents only) 18 Total Estimated Payments and Credits. Add Lines 14, 15, 16, and 17. Tax Forgiveness Credit. Submit PA Schedule SP. 19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased 19b Dependents, Part B, Line 2, PA Schedule SP 20 Total Eligibility Income from Part C, Line 11, PA Schedule SP. 21 Tax Forgiveness Credit from Part D, Line 16, PA Schedule SP. 22 Resident Credit. Submit your PA Schedule(s) G-R with your PA Schedule(s) G-S/G-L and/or RK-1. 23 Total Other Credits. Submit your PA Schedule OC. 24 TOTAL PAYMENTS and CREDITS. Add lines 13, 18, 21, 22, and 23. 25 TAX DUE. If line 12 is more than Line 24, enter the difference here. 26 Penalties and Interest. See the instructions. Enter Code: If including form REV-1630, mark the box. N 27 TOTAL PAYMENT. Add Lines 25 and 26. 28 OVERPAYMENT. If Line 24 is more than the total of Line 12 and Line 26, enter the difference here. The total of Lines 29 through 35 must equal Line 28. 29 Refund - Amount of Line 28 you want as a check mailed to you. Refund 30 Credit - Amount of Line 28 you want as a credit to your 2009 estimated account. 31 Amount of Line 28 you want to donate to the Wild Resource Conservation Fund. 32 Amount of Line 28 you want to donate to the Military Family Relief Assistance Program. 33 Amount of Line 28 you want to donate to the Governor Robert P. Casey Memorial Organ and Tissue Donation Awareness Trust Fund. 34 Amount of Line 28 you want to donate to the Juvenile (Type 1) Diabetes Cure Research Fund. 35 Amount of Line 28 you want to donate to the PA Breast Cancer Coalition's Breast and Cervical Cancer Research Fund. Signature(s). Under penalties of perjury, I (we) declare that I (we) have examined this return, including all accompanying schedules and statements, and to the best of my (our) belief, they are true, correct, and complete. Your Signature I Spouse's Signature, if filing jointly Preparer's Name and Telephone Number 2008 Petz Enterprises, Inc. 8PA012 Date Page 2 of 2 I 12 365 13 365 14 0 15 0 16 0 17 0 18 0 19a 00 19b 0 20 0 21 0 22 0 23 0 24 365 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0 Firm FEIN Preparer's SSN/PTIN L 0800211336 0800211336 J Table of Additional Statements MTrT4RLLR A WRIGHT 180-84-1853 STM 01 - US SCH A Description NON CASH CONTRIBUTIONS Line 16 - Non-Cash Contributions Amount 300 Total 300 1 0801910027 PA SCHEDULE W-2S Wage Statement Summary PA-40 W-2S (09-08) (1) 2008 OFFICIAL USE ONLY Summa of PA Taxable Employee, Non-employee, and Miscellaneous Compensation Name shown first on the PA-40 (if filing jointly) Social Security Number (shown first) MICHELLE A WRIGHT 180-84-1853 Use this schedule to list and calculate your total PA taxable compensation and PA tax withheld from all sources. Use this schedule to list and calculate your total PA taxable compensation and PA tax withheld from all sources. Part A Instructions: List each Federal Form W-2 for you and your spouse, if married, received from your employer(s). In the first column enter T for the taxpayer's Social Security Number that appears first on the PA tax return and enter S for the second or spouse SSN. From the Forms W-2, enter each employers Federal Employer Identification Number (EIN). Enter the amounts from the Forms W-2 in each column. IMPORTANT: You do not have to submit a copy of your Form W-2 if you earned all your income in Pennsylvania and your employer reported your PA wages correctly and withheld the correct amount of PA income tax. You must submit a copy of your Form W-2 in certain circumstances. See the PA Schedule W-2S instructions for a list of when a copy of a W-2 is required. Part B Instructions: List each source of income received during the taxable year on a form or statement other than a Federal Form W-2. Enter each payer's name. List the payment type that most closely describes the source of your non-employee compensation. Enter the amount of other compensation that you earned. If the form or statement does not have separately stated amounts, enter the amount shown in both Federal and PA columns. IMPORTANT: You must submit a copy of each form and statement that you list in Part B, whether or not the payer withheld any PA income tax and regardless of whether or not the income was taxable in PA. CAUTION: The federal and Pennsylvania (state) wages may be different in Part A and Part B. W ..........e.4 ......e a..ftr .. raw nhetnrnnv thie echpdulp nr make vour own schedules in this fromat. Part A - Federal Forms W-2 T/S Employer EIN from box b Federal wages from box 1 Medicare wages from box 5 PA compensation from box 16 PA income tax with- held from box 17 T 263758510 11763 11898 11898 365 Total Part A- Add the Pennsylvania columns 11898 365 Part B - Miscellaneous and Non-employee Compensation from Federal Forms 1099R, 1099MISC, and other statements YOU MUST SUBMIT COPIES OF EACH FORM OR STATEMENT LISTED IN THIS PART A. T/S B. Type C. Payer name D. 1099R E. Total federal amount F. Adjusted plan G. PA compensation H. PA tax withheld Total Part B - Add the Pennsylvania columns TOTAL - Add the totals from Parts A and B 118 98 365 Enter the TOTALS on your PA tax return on: Line 1a Line 13 Payment type: A. Executor fee E. Honorarium L. B. Jury duty pay F. Covenant not to compete C. Director's fee u. txpen waness ice G. Damages or settlement for lost wages, other than personal injury H. Other nonemployee compensation. Describe: 1. Distribution from employer sponsored retirement, pension, or qualified deferred compensation plan J. Distribution from IRA (Traditional or Roth) K. Distribution from Life Insurance, Annuity or Endowment Contracts L. Distribution from Charitable Gift Annuities 2008 I I Petz Enterprises, Inc. 8PA261 0801910027 0801910027 J ore, LLC PNC Bank, N.A. 001 004909856A [ Boscov s Department St y u PO Box 4505 6k-162 Jeannette, PA 433 Reading PA 19606 Debtor in Possession Date 11/06/08 Payable Amount S*****O.00 Case No 0811637 Pay Zero and 00/100 Dollars - This check is void after 180 days from issue date 00012 0285 11/06/08 To The MICIMLLE A VMGHT order 4 HARVARD PL APT D CAMP HILL PA 17011 Authorized ignaturn Of i #--- -PLEASE FOLD ANN DETACH ALONG THiS PERFORA7rjON-- CHECK Numa R 00490965" EMPLOYEE NAME ENDM. G - EERT PtA10*0" - ---- - -- --3 11 1/08 MICHELLE A WRIGHT _-_ HOURLY RATE OR l FBDERIILTAT DPLO RY STATUS 7.25 S 00211/06/08 NET PAY S*** 181.60 CUR NT MBAR r _ CURRENT CURRENT YEAR TO DATE YEAR TO DAB TAXES AND DEDUCTIONS TO" , ATE EARNINGS HOURS BARNIN<i5 HOURS EARN?KGS DBDUCTIQNS DBDUCT.IONS: 251.39 REGULAR 31.50 228.38 1289.15 9346.39 FEDERAL TAX3:37 145.03 OVERTIME 14.85 161.50 MEDICARE VACATION 30.75 224.78 ?OASDI 14.41 620.14 1 199.82 HOLIDAY 12.50 90.62 CAMPHILL R TAX 4.64 7.13 ;07.05 INTEREST 10.00 PA STATE TAX 4 00 43.00 PA SUI/SDI TAX .14 6.02 MISC PAY _ -- 6.25 45,31 I 401K CMP DEDJ15.00 15.00 BIRTHDAY - 00 45.00 - - C HILL LST _ 1._ PERSONAL 12.50 90.63 5.00 G.C. MISC DISAB INS 13.28 TOTAL PAY 31.50 232.38 1366.00 10012.23 - - FRINGE $EN6FITS DIRF.G'r DEPOSIT DESCRIPTION CIIRRSNT yEARTO DATE y- ACCOUNT ROUTING AMOUNT 181.60 Boscov's Department Store. LLC PNC Bank, 001 004916774A 60162 PO Box 4505 a33 Reading PA 19606 Debtor in Possession Date 11/13/08 Payable Amount $*****0.00 Case No 0811637 Pay Zero and 00/100 Dollars 00012 0285 11/13/08 This check is void after 180 days from issue date To The MICHELLE A WRIGHT Order 4 HARVARD PL Of APT D CAMP HILL PA 17011 - ""'°°"aed gnamre PLEASE; FOLD A14D DETACH ALONG T HIS PERFORATION I CEEM NUNMER 004916774A -- ---- - SOCIAL PIRW* EMPLOYER NAME SEGURrrY SMDIPIG MICHELLEA WRIGHT ***-"*-1853 11/08/08 r HOURLY RATE OR _FEDERAL TAX DEPARTMENT SALARY STATUS DATE PAID 7.25 S002 0285 11/13/08 NET PAY $***167.15 CURRENT CURRENT YEAR TO DATE EARNINGS HOURS EARNINGS HOURS REGULAR 29.62 214.75 1318.77 OVERTIME 14.85 30.75 VACATION HOLIDAY -T 12.50 t4rEv¢Sr - } MISC?PAY BIRTHDAY I 6.25 PERSONAL 12.50 YEAR f0 DATE - G RU?RENT YE TO DATE EARNINGS TAXES AND DEDUCTIONS DBDi{CTiONS bRDtlGtIO 9561.14 FEDERAL TAX 3.33 254.72 161.50 MEDICARE 3.12 _ 148.15 224.78 OASD1 13.31 633.45 90.62 CAMPHILL R TAX 4.29 204.11 an n0 PA STATE TAX A So 3t3 f?. 43.00 PA SUI/SDI TAX .13 6.15 -- 45.31 401K CMP DED 15.00 30.00 90.63 C HILL LST 1.00 - 46.00 G.C. MISC 5.00 DISAB INS .83 14.11 TOTAL PAY 29.62 214.75 1395.62 DIRECT DEPOSIT AMOUNT 10226.98 DESCRII'TION FRINGE BENEFITS CURRENT YG RTO DATE ACCOUNT ROUTING C******3514 ***::*** 167 15 . - Boscov's Department Store. LLC X62 PNC Bank, N.A. 001 004924004A PO Box 4505 Jeannette, PA Reading PA 19606 ass Debtor in Possession Date 11/20/08 PtyableAmovnt $*****0.00 Case No 0811637 Pay Zero and 00/ 100 Dollars This check is void after 180 days from issue date 00012 0285 11/20/08 To The N901E LE A WRIGHT w Order 4 HARVARD PL Of APT D CAMP HILL PA 17011 -r--Authorizedianatvre --PLEASE FOLD AND DETACH ALONG THIS PERFORATION RNINGS EGULAR R OVERTIME RREMT H F1 T 29.2 R$StiT YffAR TO DATE 6AFININGS, HOURS 211.12 1347.89 14.85 30.75 --.. SotrTr >?, EMPLOYER NAM sac»errr 0.M MICHELLEAWRIGHT ***-**-1853 11/15/08 HOURLY RATE OR FEDERAL TAX DEPARTMENT DATE SALARY STATUS PAID 7.25 -- 5000285? 11/20/08 NET PAY" $**«165.17 MBAR TO DATE TAXES AND DEDUCTIONS GtI YRAlt?:AAT1t: DE1111G7t'I.6 EARNINGS DRQIJCTIi1N$ 9772.26 FEDERAL TAX 2.97 257.69 161.50 MEDICARE 3.06 151.21 224.78 OASDI 13.09 646.54 VACATION R TAX 22 4 208.33 HOLIDAY ;RTERwT SC PAY M1 12.50 _ 90.62 10.= 43.00 CAMPHILL PA STATE TAX y PA SUI/SDI TAX - . 6.48 .13 32 6.28 00 45 _ BIRTHDAY 6.25 45.31 401K CMP DED L LST 15.00 00 1 . 47.00 50 12 90.63 C HIL . PERSONAL . 5.00 G.C. MISC DISAB INS - 14.11 TOTAL PAY 29.12 DEPOSIT 211.12 14 24.74 10438.10 _ FRINGE 99"PITS DIRECT CURRENT YEAR'TO DATE ACCOUNT ? TROUTING AMOUNT DESCRIPTION **** ******,r* 165 17 -- ** 3514 . Pay To The Order Of Boscov's Department Store, LLC PNC Bank, N.A. 001 004"1736A PO Sox 4505 6° X62 Jeannette, PA Reading PA 19606 433 Debtor in Possession Date 11/26/08 Payable Amount $*****O.00 Case No 0811637 Zero and 00/100 Dollars 0001 0285 11/$6N8 This check is void after 180 d$ys from issue date , MICHELLE A WRIGHT 4 HARVARD PL APT D CAMP HILL PA 17011 -' Authorized -stun 41 PLEASE FOLD AND DETACH ALONG THIS PE RFO ATION----------- c2MMMoIIIMIR E EMPLOYEE HAKE MICHELLEA WRIGHT HOURLY --"Ti OR E SALARY 7.25 NET PAY EARNINGS CURRENT HOtiRS CtJ}Iitt?NT BAMINUS YEAR TO DATE HOURS REGULAR 29.25 212.06 1377.14 OVERTIME VACATION i 14.85 30.75 HOLIDAY 12.50 INTEREST - - MISC PAY BIRTHDAY __ j ? 6.25 PERSONAL 12.50 TOTAL PAY 29.25 212.06 ±:1453.99 DIRECT DEPOSIT ACCOUNT ROUTING AMOUNT __ ******3514 w****«** 165.07 10DA1ti iINGS 984.32 161.50 Z 224.78 90.62 STATE 43.00 PA SUI/SDI TAX 45.31 401K CMP DED 90.63 C HILL LST G.C. MISC OISAB INS 10650.16 004"1736A SOCfiSL PRRIO'D - 38CURIYT ENDIN NG - ?****-***-1853 11/22/08 *E TAX TATUS OBPARTI[ENT p* PAID S 002 0285 11/26/08 $***165.07 CUItIt>:N'T QAT14 NS DEDUCTI.- w.IDUOiiONS 3.06 260.75 3.07 _ 154.28 13.15 659.69 4.24 212.57 6.51 326.63 .13 _ 6.41 5.00 60.00 1.00 48.00 5.00 ,83 14.94 I S WRGE EiENf MB TCLJR YEAR TO DATE Boscov's Department Store, LLC PNC Bank. N.A. 001 004939869A PO Box 4505 6-01 2 Jeannette, PA Reading PA 19606 ass Debtor in Possession Date 12/04/08 Payable Amount $*****0.00 Case No 0811637 Pay Zero and 00/100 Dollars 00012 0285 IZM4/08 To The PECEMLLE A WRIGHT Order 4 HARVARD PL Of APT D CAMP HILL PA This check is void after 180 dads from issue date 17011 - Author?d nature • PLEASE FOLD AND DETACH XM"X! -i THIS PERFORATION___-_ -._`. i ARNINGS REGULAR OVERTIME VACATION HOLIDAY :...en .ES.t IV RRENT HOURS 28.62 5.61 6.50 RRENT SARNINt35 207.50 61.01 47.13 -. _ YEAR TO DATE HOURS 1405.76 20.46 30.75 19.00 Sft5,6 1'BRroD EMPLOYER NAME SECURITY $.RDtNG MICHEUEAwRIGHT - -?? ***-**-1853 11/29/08 HOURLYIIATBOR PEDERALTAX DEPARTMENT DATE SALARY STATUS PAID 7.25 S002 0285 12/04/08 N ET PAY $* * * 245.88 it TO 00R E TAXES AND OR "IONS CURRENT ' TO ifATB DROUtTIONS DEDUPTIONS EARNINGS 10191.82 FEDERAL TAX 13.42 _ 274.17 222.51 MEDICARE _ 4.58 158.86 224.78 OASDI 19.57 679.26 137.75 CAMPHILL R TAX 6.31 _ 218.88 _.._1P=.f]1?-- sA:rVT1c_:TAX -3-T S. -- . MISC PAY BIRTHDAY PERSONAL -? ? _-_ - - 6.25 12.50 ; 43.00 45.31 90.63 PA SUI/SDI TAX 401K CMP DED C HILL LST G.C. MISC .19 _ 15.00 1.00 6.60 75.00 49.00 5.00 DISAB INS 14.94 TOTAL PAY 40.73 DIRECTDEPOSIT 315.64 14 94.72 10965.80 _ FRINGE BENEPITS EAR TO DATE UTING AMOUNT DESCRIPTION CURRENT Y ACCOUNT ******3514 . RO ******** 245.88 _ ent Store, LLC PNC Bank, N.A. 001 $O Departm b Jeannette PA 004948206A PO Box ox 4 4505 3 a33 , Reading PA 19606 Date 12/11/08 Payable Amount S *****0.00 zero and 00/ 100 Dollars Pay This check is void after 180 days from issue date 00012 0285 12AIAS To The InCH UJ E A WRIGHT Order 4 HARVARD PL APT D Authorized u++ture CA11H' HILL PA 17011 +_____.. ---PLEASE FOLD AND DETACH ALONG THIS PERFORATION- --- -- CIBCK NUMIMM 004"=06A f - -- 50GtAI. "i'Bfft#dD } RKPLOYEE NAVE SECURrCY 8101wo MICHELLE A WRIG14T ++r_r-1853 12/06/08 _ HOURLY RATE OR FADSSAi YAX DBPAR'I'NUM ; DAiB PAID SALARY STATUS> - . , 0285 12/11/08 7.25 S002 NET PAY Cu '[t; A CURR CURItBH? YBAIt TO A'rE AR '10 DATE TAXES AND DEDUCTMOIIS nBD}1C'CIam ...})SI11It!'?}Q}?S EARNINGS HouRS eARI}ias ?loUes 98 1437 gtING5 10425.42 FEDERAL TAX 5.22 279.39 REGULAR 32.22 233.60 . 46 20 222.51 MEDICARE 3.39 162.25 OVERTIME . 30.75 224.78 OASDI .48 14 467 693.74 223.55 VACATION 19.00 AX 137.75 CAMPMILL R T . 7 17 343,49 HOLIDAY 10.00 PA STATE TAX . 14 6.74 _ INTEREST 43.00 PA Sul/SDI TAX . 00 15 90.00 MISC PAY 6'25 I 45.31 401K CMP DED . 00 1 50.00 BIRTHDAY - . 12.50 90.63 CHILL LST . 9.00 PERSONAL G.C. MISC 76 15 DISAB INS .82 . TOTAL PAY 32.22 233.60 1526.94 11199.40 rxrirGaser>sr?Ts DIRECT DLPOSIT --- - - - - DESCRIP'1'lON --- CIiRRG+f`l YFa1RT0 DQTF. _ _._ ACCOUNT ROUTING AMOUNT Boscov's Department Store. LLC PNC Bank, N.A. 001 004956583A PO Box 4505 60162 Jeannette, PA 433 Reading PA 19606 Date 12/18/08 Payable Amount $w""""0.00 Pay Zero and 00/100 Dollars 00012 0285 12/18/08 To The MICH I E A wRIGHT order 4 HARVARD PL APT D CAMP HILL PA 17011 This check is void after 180 days from issue date Authoruxd ignetu- PLEASE FOLD AND DETACH ALONG THIS PERFORATION- - i CHIRCKNUMem 004956583A EMPLO"R IRA= SE DA" SKI STAT-M 7.25 0285 - 12/18/08 FEDERAL TAX 4.98 284.37 MEDICARE 3.35 165.60 DASDI 14.34 708.08 CAMPHILL 4.62 228.17 PA SUI/SDI TAX .14 E -.01K CMP-DED C HILL LST -1.00-- 5.00 DISAS INS Boscov's Department Store. LLC 68-162 PNC Bank, N.A. 001 004964901A PO Box 4505 Jeannette, PA Reading PA 19606 a33 Date 12/24/08 Payable Amount $ * * * * *0.00 pay Zero and 00/100 Dollars 00012 0285 12/ AM To The MICHELLE A WRIGHT Order 4 HARVARD PL Of APT D CAMP HILL PA 17011 This check is void after 180 days from issue date r Authorized nature t---- ----PLEASE FOLD AND DETACH t?LONG THIS PERFORATION _- 1 i ?_ (-- EARNINGS REGULAR OVERTIME VACATION HOLIDAY INTEREST MISC PAY URRENT It41U..KS 32.04 WNT YFU TO DATE BAItNING$ .< HOURS - 232.29 1501.36 20.46 30.75 19.00 6.25 EH MI H YEAR Tb DATE" C I?NC to D TAXES AND DEDUCTIONS DBDQ I??ILS DSDTl1'r?ION.$;; BARNINa$, - 10884.93 FEDERAL TAX _,? 5.08 289.45 222.51 MEDICARE - 3.37 168.97 224.78 OASDI 14.40 722.48 137.75 CAMPHILL R TAX 4.64 232.81 10.00 PA STATE TAX 7.13 357.72 47.00 PA $UI/SDI TAX .14 7.02 45.31 401K CMP DED - 15.00 120.00 BIRTHDAY ILL LST 00 1 52.00 PERSONAL 12.50 90.63 - C H G.C. MISC DISAB INS . .82 5.00 16.58 TOTAL PAY 32.04 232.29 1590.32 11662.91 OSIT ?E PRING137MEFI7S P DIRECT _ URRENT YS RTODATE NT MO DESCRIPTION C ACCOUNT ROUTING U A __ 71 180 3514 . CHICK NQI? 00 %MlA SOCIAX. >F1d1ttOD - PLOYBH NAME SHCURPIY BNDiNO CHELLEA WRIGHT ? ***_**'185$ 12/20/08 OURLY RAT$ A12 RaDERXL'PA7( DgPAR11[BNT ??? SALARY STATUS FiktD 7.25 S 002 0285 12/24/08 NET PAY---- -- $***180.71 $oscov's Department Store, LLC PNC Bank, N.A. 001 004973122A 60=162 Jeannette, PA PO Box 4505 433 Reading PA 19606 **000 Date 12/31/08 Payable Amount $*** Pay Zero and 00/ 100 Dollars 00012 0285 12l31/W To The MICHUJX A WRIGHT Order 4 HARVARD PL Of MD HILL PA 17011 i A CMMNUKBBR 004973122A AwRlai7 HOU OR MDMXAL TAX DER Mr PAID CSITATUS 7.25 S002 0285 12/31/08 NETPAY .,DATE FEDERAL TAX 6.46 295-91 MEDICARE 3.56 172.53 OASDI 5.25 737.73 A) PA SIA1 IAX ?.!)5 51 401K CMP DED 52.00 ?3_ CHILL T__ 1i 5.00 DISAB INS This check is void after 1so days from issue date Authorved nature A _ - PLEASE FOLD AND DETACH ALONG THIS PERFORATION ---- Boswv's Department Store. LLC PNC Bank N.A. 001 004900894A PO Box 4505 X142 Jeannette, PA Reading PA 19606 433 Date 01/08/09 Pa,WeAummt $****"0.00 Zero and 00/ 100 Dollars 00012 01/08/09 This check is void after 180 days from issue date To lu WCEMJ E A WRIGHT order 4 HARVARD PL APT D(s CAItPHILL PA 17011 n St'inature FOLD AND DETACH ALONG THIS PERFORATION CKBCK NUNMER 004990884A EMPLOYEE NAME Soot" SRCURITY PERIOD BNDING Ivttc4LLEAwRIGtTr ***-*•_1853 01/03/09 i HOUKYRATSOR SALARY, "DERALUX STATUS DEPARTMENT DATA PAID 7.25 S002 0285 01/08/09 NRT 1PAY $"*"173.38 EAl2NiNGS CIl "' HQE1R=? CURRENT EARNINGS TftO TOD !l; HOURS, YEAIZTO'DATE EARNINGS TAXES AND DEDUCTIONS CUkRE19T, D800CTIQN3 YEAR: DATE DEDUCTIONS REGULAR 23.64 171.39 23.64 171.39 FEDERAL TAX 1.21 1.21 HOLIDAY 6.50 47.13 6.50 47.13 MEDICARE 3.17 3.17 OASDI 13.55 13.55 _ v CAMPHILL R TAX 4.37 4.37 PJ1 STATE TAX 6.71 6,71 PA SUI/SDI TAX .13 .13 401K C!W DED 15.00 15.00 C HILL LST 1.00 1.00 TOTAL PAY 30.14 218.52 30.14 218.52 D IRECT DEPOSIT FRINGE 61INUMTS ACCOUNT ROUTING AMOUNT DESCRIPTION CURRENT YEAR:TO DATE ******3514 ******** 173.38 Bgscov's Department Store. LLC PNC Bank. N.A. Uo l 0049879M PO Box 4505 x_62 Jeannette. PA 433 Reading PA 19606 Date 01/15/09 pay"eAmo>Qtt «««""ooo PAY I- Zero and 00/100 Dollars This check is void after 180 days from issue date 00012 0286 01XW" TO The 1laCHELLEA WSaGHT Order 4 Hll1tY/1RO PZ. Of APr D CAMPEML PA' 17011 Authorized Aw- A -----------PLEASE CHBCc NUNUM 004W78M k , RNINGS .. REGULAR HOLIDAY R:[t6NT ` HOURS 24.23 Uj&? YEARTPDATII EARNINGS HOURS - 175.67 47.87 6.50 EMPLOYEE NAMH S&CCURI TY ' ENDING MICHELLEAWRIGHT **%-*"-1853 01/10/09 'L P" HOURLY12KrE OR PSD$R/II;.rAX DEFAFI M114T Q PAIV A SALAV STA 7S D 7.25 S 002 0285 01/15/09 NET PAY $**"136.40 YRAR To DATE CORRffNT VFU TO DATE TAXES AND DRDIICT10115 DEDUCTIONS DEDUCTIONS EARNINGS 1.21 347.06 FEDERAL TAX _ 47.13 MEDICARE 2.55 5.72 OASDI 10.89 24.44 3.51 7.88 CAMPHILL R TAX - ( PA STATE TAX_ _ 5.39 12.10 PA SUI/SDI TAX .11 .24 401K CMP DED 00 15 30.00 C HILL LST _ . 1.00 2.00 -- 82 .82 DISAS INS TOTAL PAY 24.23 175.67 54.37 394.19 _ IRECT DEPOSIT FRINGE WNEFTTS D -- T YEAR TO DATE UNT A DESCRIPTION CURREN ACCbUNT ROUTING _ MQ ****** .+•+www** 40 136 3514 . - Boscov% Department store, LLC PNC Bank, N .A. 001 004994WIA PO Box 4505 0162 Jeannette. PA 433 Reading PA 19606 Date 01/22/09 Pay6leAMOMt $r""«"0.00 Zero and 00/100 Dollars ---- fty This check is void after 180 days from issue date 00012 028.5 OVUM TO The MICHELLE A WRIGKT order 4 HARVARD PL '. Of APT D CALM P IMX PA 171011 Authorized tanature +-_.--._ -_--PLEASE F=OLD AND DETACH ALONG THIS PERFORATION---_.--.- --+ CHECK NUMMIER 004"4667A RNINGS REGULAR HOLIDAY r - -'-- ---- - - SOCIAL PSRIOA EMPLOYEE NAME SECURrrY ENDING MICHELLEA WRIGHT 1853 01/17/09 HOURLY RATE OR FEDERAL TAX DEPARTMENT OAS SALARY STATUS PAiI) -- 7.25 -- - S 002 0285 01/22/09 NKT PAT-- - $"""171.37 CURRENT CURI?$NT YEAR TO PATE YEAR TO DATE CU1tRENT YEAR TO DATE TAXES AND REDUCTIONS D,SDuCTIONS DEDUCTIONS HOUI?s EARNI.NG$ HOURS EARNINGS 29.78 215.91 77.65 562.97 FEDERAL TAX - t--- 95 2.16 6.50 47.13 MEDICARE-13 8.85 OASDt 13.39 37.83 -t --? CAMPHILL R TAX - Fk STATE-TAX PA SUI/SD( TAX 401K CMP DED L LST ? 4.31 -6.63- 13 155.00 1.00 12.19 13. ".P { ,37 45.00 3.00 _ C HIL •82 DISAS INS TOTAL PAY 29.78 215.91 84.15 610.10 O t FR1N(i8 BENEFITS r DEP SIT D.W CURRENT YE" TO DATE -` ACCOUNT ROUTING AMOUNT DESCRIPTION __- * ******** 37 171 3514 ***** . Boscov's Department Store. LLC PNC Bank N.A. 001 00500iSB6A PO Box 4505 433 62 Jeannette. PA Reading PA 19606 Date 01/29/09 PayWeAmotmt W ""O.00 Zero and 00/100 Dollars 00012 0285 01/29/09 This check is void after 180 days from issue date To The WCEMLLE A WRIGHT ^ Order 4 RARYARD PL of APT D i. , CAMPHO L PA 17011 Authorized gnature a PLEASE FOLD AND DETACH ALONG THIS PERFORATION CHECK NUMMM - 00600138" -- - EMPLOYES NAME SOCIAL SECURITY PERIOD BNOING MICHELiEA WPJGHT ***-**-1853 01/24/09 HOURLY RATE OR SALARY PBDIERAI::1'AX STATUS DRP' SNT ' DATE PAID 7.25 S002 0285 01/29/09 BARPf?NG$ ctisNT IROORS CURBBl4Y> 6.ARNINOS YEARI?Q A7E HOURS TO.A!AT SARNIIi(i5 8 NET PAY $***149.62 C k1OpATE TAXES ANA DBDtICTION5 DSIIttIC`CiONS 11BDUCi`ION3 REGULAR 26.42 191.55 104.07 754.52 FEDERAL TAX 2.16 HOLIDAY 6.50 47.13 MEDICARE 2.85 11.70 MISC PAY 5.00 5.00 OASDI -_12.18 50.01 CAMPHILL R TAX 3.93 16.12 -_ __ PA STATE TAW _ A+_0_ 24.76 PA SUI/SDI TAX _.12 .49 - 401K CMP DED 15.00 60.00 C HILL LST 1.00 4.00 G.C. MISC _ 5.00 5.00 DISAB INS .82 1.64 TOTAL PAY 26.42 196.55 110.57 806.65 DIRECTOEPOSIT FRINGE BENEFITS ACCOUNT Rourw AM UNf DESCRIPTION CURRENT YEARTO DATE ******3514 ******** 149.62 -•: w.?r-?.-.s,.r< _ +.+,.,......r- ..9...ms+,?,.......ar -,.r,.r;-c.....,?...?.-^.err,,+,..n.;,, .m?,c.<+ae?acs,?w.n..nr,•.-. u a?S 'z*a?w-,aw.}P :.a!_.,: r,VCnheln.:..a.,u,-.acn+.wnl'?k^pm?+??-+n..: rc??-r... Boscov's Department Store, LLC PNC Bank; N.A. 001 005008020 PO Box 4505 433 62 Jeannette, PA Reading PA 19606 Date 02/05/09 Payable Amount $*****0.00 Pay Zero and 00/ 100 Dollars 00012 028.5 02/05/09 This check is void after 180 days from issue date To The AUCH ELLE A WRIGHT Order 4 HARVARD PL ' Of APT D CAW HILL PA 17011 Authorized gnnture t ---- PLEASE FOLD AND DETACH ALONG THIS PERFORATION ,: EXPLOYRE NAME ssSOCcualTIAL Y lq?IN Bwo1oD tl MICHELLEAWRIGHT ***-**-1853 01/31/09 HOURLY RATE OR SALARY It'BDRRAL TAX STATES DEPARTMENT DATE PAID 7.25 S002 0285 02/05/09 NST PAY $* ** 161.32 EARNINGS CURRENT HOURS' CURRENT EARNIN.G5 YRAR TO DATE HOURS YEAR TO DATE EARNINGS' - TAXES AND DEDUCTIONS CURRRENT DEDUCTIONS; TBAIt TO DATE DBDUCTIONS.; REGULAR 28.04 203.29 132.11 957.81 FEDERAL TAX _ 2.16 HOLIDAY 6.50 47.13 MEDICARE 2.94 14.64 MISC PAY 5.00 OASDI 12.61 62.62 CAMPHILL R TAX 4.06 20.18 Pe STATE T?1Y S.Z?f 31.00 PA SUI/SDI TAX .12 .61 _ 401K CMP DED 15.00 75.00 C HILL LST 1.00 5.00 G.C. MISC 5.00 DISAB INS 1.64 TOTAL PAY 28.04 203.29 138.61 1009.94 D IRECT DEPOSIT FRINQE pENEFiTS ACCOUNT ROUTING AMOUNT 08SCRIVI'ION? CURRFN'1' YEAR TO. DATE ******3514 ******** 161.32 Boscov's Department Store, LLC 60=162 PNC Bank, N.A. 001 005021146A PO Box 4505 433 Jeannette, PA Reading PA 19606 Date 02/19/09 Payable Amount $* * * * *0.00 fty Zero and 00/ 100 Dollars 00012 0M 02/19/09 This check is void after 180 days from issue date To The M CEELJX A WRIGHT Order 4 HARVARD PL Of APT D CAMP HILL PA 17011 Authorized igneture - - PLEASE FOLD AND DETACH ALONG THIS PERFORATION ? CHECK NUMBER 006021146A EMPLOYEE NAME - SOCIAL SECURITY PERIOD aNQ1NG MICHELLEAWRIGHT ***-**-1853 02/14/09 HOURLY RATE OR PEDBRAL TAX T- DEPARTMENT DATE SALARY STATUS PAID 7.25 S002 0285 02/19/09 L NET PAY $* * * 178.81 I t f EARNINGS CURRENT CURRENT YEAR TO DATE r YEAR TO DATE CURRENT' YEAR TO DATE HOURS EARNINGS HOURS i EARNINGS TAXES AND DEDUCTIONS DEDUCTIONS DEDUCTIONS REGULAR 31.11 225.55 194.29 1408.62 FEDERAL TAX 1.91 5.95 HOLIDAY T 6.50 47.13 MEDICARE _ 3.27 21.18 MISC PAY 5.00 OASDI _ 13.99 90.57 M AX 4.51 29.19 PA 6.92 44.84 STATE TAX -- ?- - ? - ? -- F- PA SUI/SDI TAX .14 --- - .89 ff - _ i 401K CMP DED 15.00 105.00 C C HILL LST 1.00 7.00 t G.C. MISC 5.00 DISAB INS 2.46 TOTAL PAY i 31.11 225.55 200.79 1460.75 DIRECT DEPOSIT FRINGE DENEFITS f ACCOUNT ROUTING AMOUNT DESCRIPTION CURRENT Y]FARTO DATE ' *«****3514 ******** 178.81 - - .?I1?1F;81?I!????LI,I.??`11.?1?OJ`?..?/n11.41'?R.(?a#lt4',Rs?l!}1.14,t?7avar,eA:F..a?;,Ses??i=_.."9 g+!t,'/?:^'???, 't n s't_<',ye°mJ?.?*,s.,.? C4±-^?s?,o, S\ .; An;.,!°^,v ..-:.?-?.e-,•F?ls ;nags-"'4aus?r'x%5:?-?-+.?^m xs?n-.. - Boscov's Department Store, LLC PNC Bank. N.A. 001 005027637A PO Box 4505 60--1°2 Jeannette, PA Reading PA 19606 as3 Dote 02/26/09 Payable Amount $* * * * *0.00 Pay To The Order Of Zero and 00/100 Dollars 00012 028.9 02/26N9 This check is void after 180 days from issue date MIC EL E A WRIGIff 4 HARVARD PL _ APT D CAMP HILL PA 17011 Authorized Signature - --------- PLEASE FOLD AND DETACH ALONG THIS PERFORATION CHB(XNUMBER 006027"TA r- - -- EMPLOYEE HAM 541?IJfi?. SRct!!C< Tv PBAIoo. 6Y•11? it; MICHELLEA WRIGHT ***-**-1853 02/21/09 HoURtIr RATS OR SALARY PEORM TALC STATUS DEPARTMENT DATE ..'PAID 7.25 S002 0285 02/26/09 NET F'AY $*** 178.33 EARNINGS Gt/RRRW HOURS CU$ow-: BARNINQS 1fJGl1R10IJAC" HOl)RS YEARTODATi; EAMI{N(iS TAXES AND DEDUCTIONS CORRIElY`Y DBD1fGfII11i5 AR'I`A DATE' DBDltC?'IONS REGULAR 31.17 225.98 225.46 1634.60 FEDERAL TAX 1.95 7.90 HOLIDAY 6.50 47.13 MEDICARE 3.28 24.46 MISC PAY 5.00 OASDI 14.01 104.58 CA14PHILL R TAX 4.51 33.70 -- _-- I t`A STATE TAX PA SUI/SDI TAX 401K CMP DED C HILL LST G.G. MISC DISAB INS x.94 _ .14 15.00 1.00 .82 1.03 120.00 8.00 5.00 3.28 TOTAL PAY 31.17 225.98 231.96 1686.73 DIRECT DEPOSIT - FRIIW BEN6ErI75 ACCOUNT ROUTING . AMOUNT _ DESCRII'1lON CURRENT YF:1R. O DATW*i ******3514 *******? 178.33 ' - ?,. .ti.. a a5?.r TCS t9 tew?ffM.??^??g(f,?e;rR'1L?L'V .., ?.yy,•twr.?u-s+n j. Boscov's Department Store, LLC _ PNC Bank, N.A. 001 005034086A o Box 4505 Bank, _ bo0-ibz Jeannette. PA 433 Reading PA 19606 Date 03/05/09 Payable Amount $*****0.00 Pay To The order Of Zero and 00/100 Dollars 00012 0285 03/05/09 This check is void after 180 days from issue date MICHELLE A WRIGHT 4 HARVARD PL APT D CAMP HILL PA 17011 T- Authors:ea enetnre 4 PI FAAF FOLD AND DETACH ALONG THIS PERFORATION - -- SOCIAL PVRtOD EMPLOYEE NAME SECURITY ENDING MICHELLE A WRIGHT ??- - ***-**-18'553 02/28/09 HOURLY RATE OR FEDBRAL TAX DEPARTMENT DATE PAID SALARY STATUS 7.25 S 002 0285 _ 03/05/09 NET PAY $ * * * 176.86 1 TTUCTIONSONS CURRENT CURRENT YEAR TO DATE YEAR TO DATH- EDUCTION$ DEDUCTIONS EARNINGS TAXES AND DEDUCTIONS DEDUCTIONS _ HOURS EARNINGS HOURS EARNING5 REGULAR 30.76 223.01 256.22 1857.61 FEDERAL TAX i 1.66 9.56 HOLIDAY 6.50 47.13 MEDICARE 3.23 27.69 MISC PAY 5.00 OASDI - 13.82 118.40 -- CAMPHILL R TAX 4.46 38.16 PA STATE TAX 6.85 58.63 ; ?- - - PA SUI/SDi TAX .13 1.16 -- - - --- - 401K CMP DED C HILL LST G.C. MISC DISAB INS 15.00 1.00 - --- 135.00 9.00 5.00 3.28 TOTAL PAY 30.76 223.01 2 DIRECT DEPOSIT M )UNT 62.72 1909.74 DESCRIPTSON? FRINGE UENEFITS CURRENCYEAR TO DATE ACCOUNT ******3514 ROU iNG _ ***«**** A 176.86 Boscov's Department Store. LLC PNC Bank, N.A. 001 005040505A PO Box 4505 JQ:1§2 Jeannette, PA Reading PA 19606 433 Date 03/12/09 Payable Amount $****"0.00 pay Zero and 04/100 Dollars 0001$ 0285 033/12/09 This check is void after 180 days from issue date To The MC MLLE A WRIGHl' Order 4 HARVARD PL / / Of APT D - /? CAW HILL PA 17011 1 Authorized anature #'--- ---PLEASE FOLD AND DETACH A#.I THIS PERI=OR/MON --- _ -- -? SOCIAL PERIOD EMPLOYEE NAME SECURITY ENDING MICHELLEA WRIGHT *"*-**-1853 03/07/09 HOURLY RATE OR FEDJfMI, TAX DEPARTMENT DATE SALARY- STATUS PAID 7.25 S002 0285 03/12/09 NET PAY $* * * 179.56 EARNINGS CURRENT HOURS CURRENT EARNINGS YEAR TO DATE _ HOURS YEAR TO DATE EARN INGS TAXES AND DEDUCTIONS CURRENT DEDUCTIONS YEAR TO DATE -DEDUCTIONS REGULAR 31.39 227.58 287.61 2085.19 FEDERAL T AX 2.11 11.67 HOLIDAY 6.50 j 47.13 _ _ - MEDICARE 3.30 j 30.99 MISC PAY - 5.00 OASDI _ 14.11 132.51 j CAMPHILL R TAX 4.55 42.71 _ ? _ - PA STATE TAX 6.99 65.62 PA SUI/SDI TAX .14 1.30 1 401K CMP DED 15.00 50.00 CHILL LST 1.00 10.00 G.C. MISC 5.00 DISAB INS .82 4.10 TOTAL PAY 31.39 227.58 294.11 2137.32 D IRECT DEPOSIT FRINGE BENEFITS AGG.OUNT ROUTING AMOUNT DESCRIPTION -- CURRENT YEAR TO DATE - ******3514 ******** 179.56 r. i Boscov's Department Store, LLC so- 102 Jeannette. PA 001 0050"931A PO Box 4505 433 Reading PA 19606 Date 03/19/09 Payable Amount $* * * * *0.00 Zero and 00/100 Dollars -- - pay 00012 0285 03/19/09 This check is void after 180 days from issue date To The MICHELLE A WRIGHT Order 4 HARVARD PL APT D CAMP HILL PA 17011 Authorized Qnature 4- PLEASE FOLD AND DETACH ALONG THIS PERFORATION W "M CHECK NQIIHIER 005046931A EMPLOYEE NAME SOCIAL PERIOD SECURITY ENDING r MICHELLEAwRIGI[T 1853 03/14/09 " HOURLY RATE OR FEDERALTAX DEPARTM DATE SALARY STATUS ENT PAID" - 7.25 - - S002 0285 T 03/19/09 NET PAY $*N"174.74 CURRENT Y `R TO DATE CURRENT CURRENT YEAR TO DATE YEAR TO ]DATE EARNINGS TAXES AND DEDUCTIONS HOURS ? EARNINGS HOURS EARNINGS _ _ DEDUCTIONS H CTiONS REGULAR 30.38 220.26 317.99 2305.45 FEDERAL TAX 1.38 _13.05 HOLIDAY 6.50 47.13 MEDICARE 3.19 i 34.18 MISC PAY _ 5.00 ' OASDI i CAMPHILL R TAX - --- - _ _ 13.66 j 4.40 - - 146.17 47.11 P.2± SWE 1M _? 6.76 72.38 PA SUI/SDI TAX .13 7-_ 1.43 _ 401K CMP DED 15.00 _ 165.00 C HILL LST 1.00 11.00 G.C. MISC -- - 5.00 - _ DISAB INS 4.10 TOTAL PAY 30.38 220.26 324.49 2357.58 - DIRECT DEPOSIT - FRINGE BENEFITS ACCOUNT ROUTING AMOUNT' DESCRIPTION CURRENT' YEARTO'DATE ******3514 ******** 174.74 Boacov's Department Store, LLC _ PNC Bank, N.A. 001 PO Box 4505 60-162 Jeannette, PA Reading PA 19606 433 Date 03/26/09 Payable Amount $ * * * * *0.00 Pay Zero and 00/100 Dollars 00012 0285 03/09 This check is void after 180 days from issue date To The AUCHE X A WRIGHT Order 4 HARVARD PL Of APT D CAW HILL PA 17011 Authorised Signature ---PLEASE FOLD AND DETA H s I..ON THIS PERFORATION - -----+ I CHECK HOI1Bl? . 005053355A EMPLOYEE NAME SOC1A4: PEItIOp SECURITY ENDING E MICIIELLEAWRIGHT *-1853 03/21/09 m** -* HOURLY RATE OR FEDERALTAX SALARY STATUS - DATE DEPARTMENT PAID 7.25 S002 0285 03/26/09 NET PAY $***175.15 EARNINGS CURRENT HOURS CURRENT EARNINGS YEAR TO DATE HOURS YEAR TO DATE EARNINGS TAXES AND DEDUCTIONS -CURRENT DEDUCTIONS YEAR T ''DATE DEDUCTIONS REGULAR _ 30.36 220.11 348.35 2525.56 FEDERAL TAX 13.05 HOLIDAY 6.50 47.13 _ MEDICARE 3.20 37.38 MISC PAY 5.00 OASDI 13.65 159.82 ` CAMPHILL R TAX 4.40 51.51 - - - - - - - - PA STAT E_ LAX.-. 6..70 79.14 PA SUI/SDI TAX .13 v 1.56 401K CM P DED _ 15.00 180.00 _ C HILL LST 1.00 12.00 G.C. MISC _ 5.00 DISAB INS .82 4.92 TOTAL PAY 30.36 220.11 354.85 2577.69 DIRECT DEPOSIT FRINGE 8ENEFRo r ACCOUNT ROUTING AMOUNT DESCRIPTION CURRENT YEAR TO DATE ******3514 «******* 175.15 Hoscov's Department Store. LLC PNC Bank, N.A. 001 005M9790A PO Box 4505 4 3162 Jeannette, PA Reading PA 19606 ]late 04/02/09 Payable Amount S""*"NO-00 Pay Zero and 00/100 Dollars 00012 0285 04/02/09 This check is void after 180 days from issue date To The MICEMLE A WRIGHT Order 4 HARVARD PL Of APT D CAMP HILL PA 17011 ?Auuzv?d S gnature PLEASE FOLD AND sDr :TA - H ALONG THIS PF_- =4FORATIO I?- i t CHECK ND1YI M 005059780A EMPLOYEE'NAME 5oclA,l. PERIOD SECURITY ENDING t MICHELLEAWRIGHT *""-**-1853 03/28/09 HOURLY RATE OR FEDERAL TAX DATE DEPARTMENT SALARY STATUS PAID 7.25 S 002 0285 04/02/09 -- - NET PAY $* * * 187.68 -CURRENT YEAR TO DATE CURRENT CURRENT YEAR TO DATE YEAR TO DATE TAXES AND DEDUCTIONS EARNINGS _ DEDUCTIONS DEDUCTIONS _ FOURS II; RNINGS HOURS EARNINGS REGULAR 32.21 233.52 380.56 2759.08 FEDERAL TAX 13.051 6.50 ! 47.13 MEDICARE 3.38 1 40.76 1 HOLIDAY MISC PAY - 7 -- _ - 5.00 ! - OASDI _ i 14.48 CAMPHILL R TAX 4.67 - - FA 'STATE fi4X - 7 i.7_.. PA SUI/SDI TAX 14 s 174.30 56.18 - . bh:3i 1.70 -- """- fi 401K CMP DED 15.00 195.00 -T I C HILL LST 1.00 13.00 G.C. MISC - 5.00 -- DLSA& INS 4.92 TOTAL PAY ?- 32.21 233.52` 3 DfRECT DEPOSI I' 87.06 2811.21 FRINGE BENEFrrS ACCOUNT ROUTING AMOUNT 065GRIPI ION CURRENT' AR TO DATE ******3514 ******** 187.68 - S47'8gl ?? hl5£+?r LNIIOWV O?FiI00N LYf100?Y 3ldUO.LN?k - JN,Mn:) NOIldRI?S3il _ _- j 1,ISOMO L0321Ia I?N30 9?J?11?I:1 ----?-- SlI -J : - LS'8£0£ Z41 '8th 9£'LZZ 9£'l£ Atld 1tl101 ? i i i V* S Z8, SNI M I0 - I OTS 00' L isl ii N G -- - - G3G dWO 'XoG -_._-_- ' - -+- - - - xvi i0S/Ins vd 1 =- -- _ _ -- t 78 --- -_ W -- 0 -Uo -j AV' - 171 7 '1 1 ~ W b llIHdl.,iVO 7S'7 ZL 09 - -- ' Atld GSIW _ 5 6£'M 60'% - Iasvo 00 • 04I10N 90'h? g _:- c6'L?i 0? Os'4 3?tla103i! -? -_ - --- -------- 'LZZ ? WK I _ _- -- ivim ' - Xdl IV8303? 7h 9862 ! W L0 91 Wil l _ 9Z _ b0 SNOT ^0030 SN01`OC030? -- -- - 5"?i d813 I SdnOII SONLxJY3 SMOH SNO1 L011030 aNY S3XV1 v0 OL?Iv3A JN388110 ( LN3Zll?nO l S'JN1NSV8 _-- L 31y0 01 Ny3A ! LNaasn,o ! 3J V0 OL SY3A 3 L - ---- -Sti891 €**S Add13,N 60/60/60! 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PE?'?3?'SYL?,I, NIA MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant NO. 06-3723 CIVIL TERM AFFIDAVIT OF SERVICE I, Adam Britcher, Certified Legal Intern, hereby certify that I am serving, via United States Mail, First Class, a true and correct copy of the NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 on Defendant, James Wright, residing at, 202 Susquehanna Avenue, York, PA 17403. I verify that the statements made in this Affidavit of Service are true and correct to the best of my personal knowledge 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 Adam Britcher Certified Legal Intern OF MugJ_: 2' 3 rta {F Cam;; 714 MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant : NO. 06-3723 CIVIL TERM AFFIDAVIT OF SERVICE I, Adam Britcher, Certified Legal Intern, hereby certify that I am serving, via United States Mail, First Class, a true and correct copy of the NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 on Defendant, James Wright, residing at, 202 Susquehanna Avenue, York, PA 17403. I verify that the statements made in this Affidavit of Service are true and correct to the best of my personal knowledge 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. I Date Adam Britcher Certified Legal Intern OF 'MEL 2 0 0 9 AlL - 7 Ft h : 5 i MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant NO. 06-3723 CIVIL TERM CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22, Michelle Wright, through her attorneys the Family Law Clinic, certifies that: (1) a notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) a copy of the notice of intent, including the proposed subpoena is attached to this certificate, (3) no objection to the subpoena has been received, and (4) the subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. -7 H)O Date Adam Britcher Certified Legal Intern ?e - ;Anne td-Fox Thomas Place Robert Rains Megan Riesmeyer Supervising Attorneys FAMILY LAW CLINIC 45 N. Pitt Street Carlisle, PA 17013 717-243-2968 Fax: 717-243-3639 Attorneys for Plaintiff MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSY1s?A> =_- us v. : CIVIL ACTION - LAW - r - DIVORCE JAMES WRIGHT, ^ 1 Defendant NO. 06-3723 CIVIL TERM AFFIDAVIT OF SERVICE I, Adam Britcher, Certified Legal Intern, hereby certify that I am serving, via United States Mail, First Class, a true and correct copy of the NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULI 4009.21 on Defendant, James Wright, residing at, 202 Susquehanna Avenue, York, PA 17403. I verify that the statements made in this Affidavit of Service are true and correct to the best of my personal knowledge 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. Z?Z 3 Date Adam Britcher Certified Legal Intern MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant NO. 06-3723 CIVIL TERM NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVER' PURSUANT TO RULE 4009.21 Michelle Wright, through her attorneys, The Family Law Clinic, intends to serve a subpoena identical to the one attached to this notice. You have twenty (20) days from the dat;-. listed below in which to file of record and serve upon the undersigned-ann-objection to subpoena. If no objection is made the subpoena may be served. the z3 lcl? ? Date 1 Arne la onald-Fox Thomas Place Robert Rains Megan Riesmeyer Supervising Attorneys FAMILY LAW CLINIC 45 N. Pitt Street Carlisle, PA 17013 717-243-2968 Fax: 717-243-3639 Attorneys for Plaintiff Adam Britcher Certified Legal Intern MICHELLE ? RIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW JAMES WRIGHT, :DIVORCE Defendant NO. 06-372-31 CIVIL TERM SUBPOENA TO PRODUCE DOCUMENTS OR TBINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: TempStar Staffing, 4411 North 5a' Street Highway, Temple, PA 19560 Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: Any employment records of James Wright including any records showing his wages and any copies of previous pay checks at the Family Law Clinic, 45 North Pitt Street, Carlisle, Cumberland County, Pennsylvania, 17013. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: Name: Anne MacDonald-Fox Address: Family Law Clinic 45 North Pitt Street Carlisle, PA 17013 Telephone: 717-24-3-2968 Supreme Court ID # 87727 BY THE COURT: Date: Prothonotary/Clerk, Civil Division Seal of Court Deputy ?n? ? ??i? ?? ?; .7 L'..``?? v??u ? ? ? ;'?? L? f?• MICHELLE WRIGHT, Plaintiff V. JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW DIVORCE NO. 06-3723 CIVIL TERM CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22, Michelle Wright, through her attorneys the Family Law Clinic, certifies that: (1) a notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) a copy of the notice of intent, including the proposed subpoena is attached to this certificate, (3) no objection to the subpoena has been received, and (4) the subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. Date Adam Britcher Certified Legal Intern kaw &I oa? 17 Anne acDonald-Fox Thomas Place Robert Rains Megan Riesmeyer Supervising Attorneys FAMILY LAW CLINIC 45 N. Pitt Street Carlisle, PA 17013 717-243-2968 Fax: 717-243-3639 Attorneys for Plaintiff MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant : NO. 06-3723 CIVIL TERM AFFIDAVIT OF SERVICE ! ?rn I, Adam Britcher, Certified Legal Intern, hereby certify that I am serving, via Umif6d State, fail, First Class, a true and correct copy of the NOTICE OF INTENT TO SERVE A C-r7 `gip JBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 on Defendant, James Wright, residing at, 202 Susquehanna Avenue, York, PA 17403. I verify that the statements made in this Affidavit of Service are true and correct to the best of my personal knowledge and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unworn falsification to authorities. 7/7/ Date Adam Britcher Certified Legal Intern MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant : NO. 06-3723 CIVIL TERM NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 Michelle Wright, through her attorneys, The Family Law Clinic, intends to serve a subpoena identical to the one attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an-o j tion to the subpoena. If no objection is made the subpoena may be served. r^E (? -7 /7 Date ?,( J Adam Britcher Certified Legal Intern e 1IacDonald-Fox Thomas Place Robert Rains Megan Riesmeyer Supervising Attorneys FAMILY LAW CLINIC 45 N. Pitt Street Carlisle, PA 17013 717-243-2968 Fax: 717-243-3639 Attorneys for Plaintiff MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant : NO. 06-3723 CIVIL TERM SUBPOENA TO PRODUCE DOCUMENTS OR TFI NGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: ES3, LLC, 4875 Susquehanna Trail, York, PA 17402 Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: Any employment records of James Wright including any records showing his wages and any copies of previous pay checks at the Family Law Clinic, 45 North Pitt Street, Carlisle, Cumberland County, Pennsylvania, 17013. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: Name: Address Telephone: Supreme Court ID 9 BY THE COURT: Prothonotary/Clerk, Civil Division Date: Megan Riesmeyer Family Law Clinic 45 North Pitt Street Carlisle, PA 17013 717-243-2968 92411 Seal of Court Deputy F1LUD -C,! :RUE OF THE 2009 JUL 27 P 34 00 GUAY MICHELLE WRIGHT, IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant : NO. 06-3723 CIVIL TERM CERTIFICATE OF SERVICE I, Adam Britcher, Certified Legal Intern, hereby certify that I am serving, via United States Mail, First Class, a true and correct copy of the PLAINTIFF'S PRE-HEARING MEMORANDUM and AFFIDAVIT OF MICHELLE WRIGHT on Defendant, James Wright, residing at, 202 Susquehanna Avenue, York, PA 17403. I verify that the statements made in this Certificate of Service are true and correct to the best of my personal knowledge and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unworn falsification to authorities. T17 oq Date Certified Legal Intern Ff LE) i O 1^!: r`.` r 2 109 AIDS .i F i i ! 5 ? ICIU"v- 11,J7 MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant : NO. 06-3723 CIVIL TERM AMENDED CERTIFICATE OF SERVICE I, Adam Britcher, Certified Legal Intern, hereby amend the Certificate of Service filed on August 7, 2009. I hereby certify that I served, via United States Mail, First Class, a true and correct copy of the PLAINTIFF'S PRE-HEARING MEMORANDUM on Defendant, James Wright, residing at, 202 Susquehanna Avenue, York, PA 17403. I verify that the statements made in this Certificate of Service are true and correct to the best of my personal knowledge and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to ur f 7h bate Adam Britcher Certified Legal Intern :t THE u9P'UI-7 F ?C?1 D MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSY ?VAA3A , V. : CIVIL ACTION - LAW -ts rT ;P DIVORCE 1 ' JAMES WRIGHT, =: Defendant NO. 06-3723 CIVIL TERM AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under §§ 3301(c) of the Divorce Code was filed on June 29, 2006. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. Date ©3 130110 40-u?e MICHELLE WRIG Plaintiff MICHELLE WRIGHT, Plaintiff V. JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW DIVORCE NO. 06-3723 CIVIL TERM A --i _. f) -%; U11 1541, C) WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 43301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Date ?? l y MICHELLE WRIGHT, aintiff MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V : CIVIL ACTION - LAW r1a . n DIVORCE JAMES WRIGHT, ? Defendant r- NO. 06-3723 CIVIL TERM AFFIDAVIT OF CONSENT C3 J a "< 1. A Complaint in Divorce under §§ 3301(c) of the Divorce Code was filed on June 29, 2006. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unworn falsification to authorities. Date ? 'r` fA, 'DI 'p-ca, -t 0 JAMES,WRIGHT,! MICHELLE WRIGHT, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION - LAW DIVORCE JAMES WRIGHT, Defendant NO. 06-3723 CIVIL TERM 0 C a 0 ' M o ? . M . WAIVER OF NOTICE OF INTENTION TO REQUEST 3a T_-_} ENTRY OF A DIVORCE DECREE UNDER r ' 43301(c) OF THE DIVORCE CODE T ! Cr 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Date -"" 4?- --?, C) , NCO( C) MICHELLE WRIGHT, Plaintiff VS. JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06 - 3723 CIVIL IN DIVORCE ORDER OF COURT AND NOW, this V t? day of , 2010, counsel and the parties having entered into an agreement and stipulation resolving the economic issues on April 30, 2010, the date set for a Master's hearing, the agreement and stipulation having been transcribed, the appointment of the Master is vacated and counsel can conclude the proceedings by the filing of a praecipe to transmit the record with the affidavits of consent of the parties so that a final decree in divorce can be entered. BY THE COURT, cc: ZThe Family Law Clinic Attorney for Plaintiff James Wright Defendant (Pro Se) Kevi P. J. - o Tl 11 P _Fri MICHELLE WRIGHT, Plaintiff v. JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION- LAW IN DIVORCE AND CUSTODY No. 06-3723 CIVIL TERM t~ PRAECIPE TO TRANSMIT RECORD ~ ~:, ~ ~ :; ~~' ! - ~J 4-r ~ '" -r ` -~ i ~ ~ To the Prothonotary: ` ~ f'. ~' i"`J -; + -r ~' ~=~. Transmit the record, together with the following information, to the court forestry o~$ ~ .' ; . Wit; divorce decree: :~- ~, . _ ~ - ~ 4 °~~ ~. _ . ., i 1. Ground for divorce: §3301(c) of the Divorce Code. L=.. ~~ ~ 2. Date and manner of service of the complaint: Served on Defendant by publication in THE SENTINEL on December 22, 2007 and in THE CUMBERLAND LAW JOURNAL on February 22, 2008. 3. Date of execution of the affidavit of consent required by §3301 (c) of the Divorce Code: by Plaintiff-March 30, 2010; by Defendant-March 30, 2010. 4. Related claims pending: None 5. Date Plaintiff s Waiver of Notice was filed with the Prothonotary: March 31, 2010. Date Defendant's Waiver of Notice was filed with the Prothonotary :March 31, 2010. 2~ 0 Date Alice Richards CertAfi,~d Legal Int,~rn Megan Riesmeyer Supervising Attorneys FAMILY LAW CLINIC 45 N. Pitt Street Carlisle, PA 17013 717-243-2968 Fax: 717-243-3639 Attorneys for Plaintiff MICHELLE WRIGHT, IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA v. :CIVIL ACTION-LAW DIVORCE ~ . 2" ~, `rl JAMES WRIGHT, : ~ !~~~ ~ ~''= Defendant NO.06 - 3723 CIVIL TERM ~` ""` '~`' _ ;.,, -c c ~,,:. ~= w -~t .,~, CERTIFICATE OF SERVICE t"<~ ~ - "'~ "- ~"" ~.. J _ - .~ .~ _r..i -.y I, Alice Richards, Certified Legal Intern, Family Law Clinic, hereby certify that I served a true and correct copy of the Praecipe to Transmit Record and Divorce Information Sheet on Mr. James Wright, residing at 329 Kurtz Ave, York, Pennsylvania, 17401, by depositing a copy of the same in the United States mail on May 21, 2010. ~~ ~ c1~ ~, Alice Richards Certified Legal Intern FAMILY LAW CLINIC 45 North Pitt Street Carlisle, PA 17013 (717) 243-2968 Fax: (717) 243-3639 MICHELLE WRIGHT, Plaintiff vs. JAMES WRIGHT, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA N0. 06 - 3723 CIVIL IN DIVORCE ORDER OF COURT AND NOW, this ~~ day of , 2010, counsel and the parties having entered into an agreement and stipulation resolving the economic issues on April 30, 2010, the date set for a Master's hearing, the agreement and stipulation having been transcribed, the appointment of the Master 15 vacated and counsel can conclude the proceedings by the filing of a praecipe to transmit the record with the affidavits of consent of the parties so that a final decree in divorce can be entered. BY THE COURT, iD D. BUELL ~ ~ 37x3 ~onotary Berland County 100 ~'Delrf~rouse Square ( ~~'~t':rF ~~ ~ ~~t+ ~~:~~ ~~~Y ale PA 17013 1~~0 ~~ Y ~ 3 ~~ Iv: ~ 7 CLJ~r {~ . ', ,_t'k ~r '~ ~"'1_ ' ~i JAMES WRIGHT 111 MAY DRIVE APARTMEN~' CAMP HILL, .~,:~.s7 ~;:~l~.~ ~~ ~~ PEES POgT4~~ z' ~ . 7 `n': ~1">'~' f'IINIY [SIlLV1S o z ~ ~ $ 00.44° 000463?59R ~,1~viJf~ ?r~~i~~ MAILED FROM ZIPCQDE ' 7n - 3 FIIX:Llw 37t5 {~E ~ O~ Q5~1~.l:LC] ~avT~R~ -rc~ s~t~t~GR ?+~flT C+~1._I'k'~RA}3LE AS ~I?DRE s~SE:i~ i,.~Nl~t~i~.,~ TO f't'JRWARia ~+~ ~ 3'7O~tt.~'~ ~244.:s`.?.yy3S ``t~Cf:ttL:I~jj-t~~t~ SA:: -~5--+~t7 1,,,1{I~~~lI~~a1~311~>>fl~ttll,<~ttitiii~~~~l~~r~l~~t)zii{~a~t~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MICHELLE WRIGHT V. JAMES WRIGHT N O. 06-3723 DIVORCE DECREE AND NOW, ~ " `~ ~~ ~~~ , it is ordered and decreed that MICHELLE WRIGHT plaintiff, and JAMES WRIGHT ,defendant, are divorced from the bonds of matrimony. Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: (If no claims remain indicate "None.") None. the Court, Attest: J. l~ / Pr thonotary d= - L- ~~ 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: JAMES R. WRIGHT N Member ID Number: 0344101243 '' ^- Please note: All correspondence must include the Member ID Number. I (MJ i MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BEN?Sa ." c.n Financial Break Down of Multiple Cases on Attachment 00 - Plaintiff Name MICHELLE A. WHITE PACSES Docket. Attachment Amount/Frequency Case Number Number 304105930 06-3723 CIVIL 352.00 MONTH TOTAL ATTACHMENT AMOUNT: $ 352.00 Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of $81.01 per week, or 50.0%, of the Unemployment Compensation benefits otherwise payable to the Defendant, JAMES R. WRIGHT Social Security Number XXX-XX-5327, Member ID Number 0344101243. OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(8). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated SEPTEMBER 12, 2010 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: IVIAR 0 2 202 * X4 zo" 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 Fax: (717) 240-6248 CD --4 G' Z-r". C:)' Z ?. CD r' w. p^ C-) Plaintiff Name MICHELLE A. WHITE ?G N Financial Break Down of Multiple Cases on Attachment' PACSES Docket Case Number Number 304105930 06-3723 CIVIL --C C? Attachment Amount/Frequency 216.67 MONTH TOTAL ATTACHMENT AMOUNT: $ 216.67 Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of $49.86 per week, or 50.0%, of the Unemployment Compensation benefits otherwise payable to the Defendant, JAMES R. WRIGHT Social Security Number XXX-XX-5327, Member ID Number 0344101243. OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S. § 4348(g). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated SEPTEMBER 12, 2010 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: MAR 1 ? 2012 lie n fl. I-less, JUDGE Form EN-034 Service Type M Worker ID $IATT Defendant Name: JAMES R. WRIGHT Member ID Number: 0344101243 C-) Please note: All correspondence must include the Member ID Number.y INCOME WITHHOLDING FOR SUPPORT Q ORIGINAL INCOME WITHHOLDING ORDERMOTICE FOR SUPPORT (IWO) O AMENDEDIWO O ONE-TIMEORDERINOTICE FOR LUMP SUM PAYMENT Q TERMINATION OF IWO ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO must be°regularon its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions htt D'//WWW acf hhs_.goV/programs/cse/newhire/employer/publication/publication htm - forms). If you receive this document from someone other than'a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. Staterrribe/Terdtory Commonwealth of Pennsylvania Remittance Identifier (include wlpayment): U4441u124.5 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket informaiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) AEROTEK COMMERCIAL STAFFING' C/O PAYROLL GARNISHMENTS 7301 PARKWAY DR S HANOVER MD 21076-1159 Employer/Income Withholder's FEIN 521822806 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ C obligor's income until further notice. U $ 0.00 per month in current child support $_ 0.00 per month in past-due child support - Arrears 12 weeks or greater? •O (Pno -*Na-- $ 0.00 per month in current cash medical support ?._ .; $ 0.00 per month in past-due cash medical support $ 216.67 per month in current spousal support c-' $ 0.00 per month in past-due spousal support - -? `77 $ 0.00 per month in other (must specify) for a Total Amount to Withhold of $ 216.67 per month. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: $ 50.00 per weekly pay period. $ 108.34 per semimonthly pay period (twice a month) $ I CO_ Py per biweekly pay period (every two weeks) $ 216.67 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten 10 working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employeelobligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www acf hhs gov/programs/cse/newhire/employer/contacts/contact map. htm for the employee/obligor's principal place of employment. RE: WRIGHT, JAMES R Employee/Obligor's Name (Last, First, Middle) 176-50-5327 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) DL- - --s `7?2_? CI UI(_ Date: 08/06/12 NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions ) http:tiwww.aef.hhs.gov/prggrams/cse/newhire employgr/i)ublicgtion/publication.htm - forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. 5218228060 Document Tracking Identifier Service Type M OMB No.: 097MI54 Form EN-028 06/12 Worker ID $IATT ? Return to Sender [Completed by Employer/income Withholder]. Payment must rye directed tea L ?v._ accordance with 42 USC §666(b)(5) and (b)(6) or Triba! Payee (see Payments to SDU below). If payment is no, directed to an SDU(Tribal Payee or this IW0 is not regular orl its face. you must check this box and return the I`dV0 i, the sender Signature of Judge/Issuing Official (if required by State or Tribal law): G....- Print Name of Judge/Issuing Official: Title of Judge/Issuing Official Date of Signature: Ll If; fl 566 If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this Mo must be provided to the employee/obligor. ? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: http://www acf hhs gov/programs/-cse/newhir,e/employer/contacts/contact map htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date - 05,13112014 The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN-028 06/12 Employer's Name: AEROTEK COMMERCIAL STAFFING` Employer FEIN: 521822806 0344101243 Employee/Obligor's Name: WRIGHT, JAMES R. CSE Agency Case Identifier: (See Addendum for case summary) Order Identifier: (See Addendum for order/docket information) Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 5218228060 Q This person has never worked for this employer nor received periodic income. Q This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known address: Last known phone number: Final Payment Date To SDU/Tribal Payee: New Employer's Name: New Employer's Address: Final Payment Amount: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.childsupport.state.pa.us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST. P.O. BOX 320 CARLISLE. PA. 17013 (Issuer address). To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at 717 240-6225, by fax at L717) 240-6248, by email or website at www.childsuoport.state.pa.us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. Service Type M OMB No.: 0970-0154 Page 3 of 3 Form EN-028 06/12 Worker ID $IATT ADDENDUM Summary_of.Cases on Attachment Defendant/Obligor: WRIGH-l, .,AMES R. PACKS Case Number 304105930 PACSES Case Number Plaintiff Name Plaintiff Name MICHELLE A. WHITE Docket Attachment Amount Docket Attachment Amount 06-3723 CIVIL $ 216.67 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACKS Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 06/12 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: JAMES R. WRIGHT , Member ID Number: 0344101243r -.� ... - ,:r: Please note:All correspondence must include the Member ID Number. DIY' ORDER TO VACATE ATTACHMENT OF UNEMPLOYMENT BENtS fr r Financial Break Down of Multiple Cases on Attachment PACSES Docket Attachment Amount/Frequency uenc Plaintiff Name Case Number Number 4 Y MICHELLE A.WHITE 304105930 06-3723 CIVIL 216,67 / MONTH TOTAL ATTACHMENT AMOUNT: $ 216.67 The prior Order of this Court directing the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), to attach$49.86 or 50% per week of the Unemployment Compensation benefits of JAMES R. WRIGHT, Social Security Number XXX-XX-5327, Member ID Number 0344101243 is hereby vacated. This Order to Vacate shall be effective upon receipt of the notice of the Order by the Department and shall remain in effect until a further Order of the Court is filed. BY THE COURT Date of Order: `? 0 2 2013 A PIbey JUDGE Form EN-035 Service Type M Worker ID $IATT MAR-28-2013 THU 02.06 PM MIST NORTH MIDDLETON FAX No 717:J355?': 0 ntiFnfl7 w iiiiiir Our File No.: 115229 RECEIVEI ) MAR 282013 LVNV FUNDING LLC ) ) COURT OF COMMON PLEAS OF Plaintiff ) CUMBERLAND COUNTY vs. ) ) JOHN P WISE ) NO.: 08-1596 901 S SPRING GARDEN ST LOT 48 ) _ , CARLISLE, PA 17015 ) Civil Action a 4 • XXX-XX-0905 ) 3a• ::'!.';:-1.' !* -=: Defendant ) ; s ) VZ MEMBERS 1 ST FCU ) Garnishee ) . INTERROGATO S TO GARNISHEE TO: MEMBERS 1 ST FCU, Garnishee: You are required to file answers to the following Interrogatories within twenty(20) days after service upon you. Failure to do so may result in judgment against you. 1. At the time you were served or at any subsequent time did you owe the defendant(s) any money or were you liable to defendant(s)on any negotiable or other written instrument, or did defendant(s) claim that you owed defendant(s)any money or were liable to defendant(s)for any reason? 1 es 2. At the time you were served or at any subsequent time was there in your possession, custody, control or in the joint possession, custody or control of yourself and one or more persons any property of any nature owned solely or in part by the defendant(s)? N,-\ 3. At the time you were served or any subsequent time did you hold legal title to any property of any nature owed solely or in part by the defendant(s) or in which the defendant held or claimed any interest? n +u 4, At the time you were served or at any subsequent time did you hold as fiduciary any property in which the defendants) had any interest? N 0 5. At any time before or after you were served did the defendant(s)transfer or deliver any property to you or to any person or place pursuant to your direction or consent and what was the consideration thereof? N 3 6. At any time after you were served did you pay, transfer or deliver any money or property to the defendant(s) or to any person or place pursuant to the defendant's direction or otherwise discharge any claim of the defendant(s) against you? NO 7. If you are a bank or other financial institution, at the time you were served or any subsequent time did the defendant(s) have funds on deposit in an account in which funds are deposited electronically on a recun-ing - - F -' 1 M1ST UORTH MIDDLETON FAX No. 7172585506 P. 007/007 a .0 ;oasis and which are identified as being funds that upon deposit are exempt from execution, levy or attachment under Pennsylvania or Federal law? If so, identify each account and state the reason for the exemption and the entity electronically depositing those funds on a recurrin basis. 8, if you are a bank or other finan 'al institution,of the time you were erved or at any subsequent time did the defendant(s)have funds on deposit in an account in which the funds on deposit,not including any otherwise exempt funds, did not exceed the amount of the general exemption under 42PA.C.S.§8123? If so, identify each account. N ,) L 9. How much is the value of any property in your possession belonging to the defendant(s)? r Cu'j jc 50 ,c14. :ER�En/�10. In the space below, the plaintiff may set forth additional appropriate interrogatories. 2 8 2011 Dated: 3)/1/( 9 David J. Apot'77,Esquire APOTHAKER&ASSOCIATES,P.C. 520 Fellowship Road C306 PO Box 5496 Mount Laurel,New Jersey 08054 (856)780-1000 Attorneys for Plaintiff 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: JAMES R. WRIGHT Member ID Number: 0344101243 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 PACSES Docket Plaintiff Name Case Number Number Attachment Amo n/Frelitencv MICHELLE A.WHITE 304105930 griatiganie 216. MOTH °= r11 mo 1..,.. %;c-, $ a— c m:> TOTAL ATTACHMENT AMOUNT: $ 216.6" ;' Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of$49.86 per week, or 55%, of the Unemployment Compensation benefits otherwise payable to the Defendant, JAMES R. WRIGHT Social Security Number XXX-XX-5327, Member ID Number 0344101243. OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673 (b)(2)and 23 Pa. C.S.A. §4348 (g). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated SEPTEMBER 12, 2010 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE • RT Date of Order: APR 16 ZOO Thomas A.Phkoey JUDGE Form EN-530 Service Type M Worker ID $IATT • INCOME WITHHOLDING FOR SUPPORT 50 q t q�so O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT(IWO) 0 323 c`v;l O AMENDEDIWO �- O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT O TERMINATION OF IWO Date: 06/06/13 ❑ Child Support Enforcement(CSE)Agency ® Court ❑ Attorney ❑ Private Individual/Entity(Check One) NOTE:This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender(see IWO instructions http://www.acf.hhs.gov/programs/cse/newhire/employer/publication/publication htm-forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court,a copy of the underlying order must be attached. State/Tribe/Territory Commonwealth of Pennsylvania Remittance Identifier(include w/payment): 0344101243 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket informalton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) WORKMEN'S COMP INSURANCE RE: WRIGHT,JAMES R. C/O ACORDIA NORTHEAST Employee/Obligor's Name(Last, First,Middle) PO BOX 1220 176-50-5327 MECHANICSBURG PA 17055-1220 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name(Last, First, Middle) Employer/Income Withholder's FEIN NOTE:This IWO must be regular on its face. Under certain circumstances you must reject Child(ren)'s Name(s)(Last, First, Middle) Child(ren)'s Birth Date(s) this IWO and return it to the sender(see IWO instructions http://www.acf.hhs gov/programs/cse/newhire/ gmployerJpublication/i)ublication.htm-forms).If you receive this document from someone other than a State or Tribal CSE agency or a Court,a copy of the underlying order must be attached. 5840100105 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. wl.i $ 0.00 per month in current child support C=a $ 0.00 per month in past-due child support- Arrears 12 weeks or greater? O yew no__ $ 0.00 per month in current cash medical support ` $ 0.00 per month in past-due cash medical support n ; $ 0.00 per month in current spousal support $ 216.67 per month in past-due spousal support $ 0.00 per month in other(must specify) -- ' for a Total Amount to Withhold of$ 216.67 per month. j AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: $ SO.00 per weekly pay period. $ 108.34 per semimonthly pay period (twice a month) $ IQO.M per biweekly pay period (every two weeks) $ 216.67 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten 10 working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www.acf.hhs gov/programs/cse/newhire/employer/contacts/contact_map. htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.:0970-0154 Form EN-028 06/12 Service Type M Worker ID $OINC ❑ Return to Sender[Completed by Employer/Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5)and (b)(6)or Tribal Payee(see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official: —rhoh—a—sM Mew Title of Judge/Issuing Official: Date of Signature: If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. ❑ If checked,the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law(23 PA C.S.§4374(b))requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons,or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit(PA SCDU)Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER/D(shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: http://www.acf.hhs.gov/programs/cse/newh ire/employer/contacts/contact map.ht Priority: Withholding for support has priority over any other legal process under State law against the same income(USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court,Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the"Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment.The pay date is the date on which the amount was withheld from the employee/obligor's wages.You must comply with the law of the State(or Tribal law if applicable)of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date—05/31/2014.The OMB Expiration Date has no bearing on the termination date of the IWO;it identifies the version of the form currently in use. Form EN-028 06/12 Service Type M Page 2 of 3 Worker ID $OINC Employees Name: WORKMEN'S COMP INSURANCE Employer FEIN: Employee/Obligor's Name: WRIGHT,JAMES R. 0344101243 CSE Agency Case Identifier:(See Addendum for case summa Order Identifier:(See Addendum for orde r/ 0ocket information Withholding Limits:You may not withhold more than the lesser of- 1)the amounts allowed by the Federal Consumer Credit Protection Act(CCPA)(15 U.S.C. 1673(b)); or 2)the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment(see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as:State, Federal, local taxes;Social Security taxes; statutory pension contributions;and Medicare taxes.The Federal limit is 50%of the disposable income if the obligor is supporting another family and 60%of the disposable income if the obligor is not supporting another family. However,those limits increase 5%-to 55%and 65%-if the arrears are greater than 12 weeks. If permitted by the State or Tribe,you may deduct a fee for administrative costs.The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders,you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO,you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d)of the CCPA(15 U.S.C. 1673(b)). Depending upon applicable State or Tribal law,you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks?If the Order Information does not indicate that the arrears are greater than 12 weeks,then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are no longer withholding income for this employee/obligor,an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 5840100105 0 This person has never worked for this employer nor received periodic income. 0 This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: Final Payment Amount: New Employer's Name: New Employees Address: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT(issuer name) by phone at(717)240-6225, by fax at(717)240-6248, by email or website at:www.childsul2port.state.pa.ga. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST. P.O. BOX 320, CARLISLE, PA, 17013(issuer address). To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT(issuer name) by phone at(717)_,240-6225, by fax at(717)240-6248, by email or website at www.ch I Idsupport.state.pa,u . IMPORTANT:The person completing this form is advised that the information may be shared with the employee/obligor. OMB No.:0970-0154 Form EN-028 06/12 Service Type M Page 3 of 3 Worker ID$OINC 4 r ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WRIGHT, JAMES R. PACSES Case Number 304105930 PACSES Case Number Plaintiff Name Plaintiff Name MICHELLE A.WHITE Docket Attachment Amoun Docke t Attachment Amount 06-3723 CIVIL $ 216.67 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docke Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 06/12 Service Type M OMB No.:0970-0154 Worker ID $OINC , ° INCOME WITHHOLDING FOR SUPPORT 6V ORIGINAL INCOME WITHHOLDING onoEn/woncs FOR SUPPORT 0wo> K�a y) O AMewoEuxmo ~�=- ��1��~��V�� Oows-nMsonocwwonCs FOR LUMP SUM PAYMENT D TERMINATION opxwo ' omw: n Child Support Enforcement(CSE)Agency court E) Attorney C3 Private Individual/Entity(Check One) NOTE:This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender(see IWO instructions http://www.acf.hhs.gov/programs/cse/newhire/employer/publication/publication.htm-forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court,a copy of the underlying order must be attached. Statefrribe/Territory Commonwealth of Pennsylvania Remittance Identifier(include w/payment): 0344101243 City/County/Dist.tTribe CUMBERLAND Order Identifier: (See Addendum for orderldocket Informalton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) SOCIAL SECURITY ADMINISTRATION RE: WRIGHT,JAMES R. STE 1 Employee/Obligor's Name(Last,First,Middle) 200 S SPRING GARDEN ST 176-50-5327 CARLISLE PA 17013-2578 Employee/Obligot's Social Security Number (See Addendum lbr plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name(Last,First, Employer/income Withholders FEIN NOTE:This IWO must be regular on its face. Under certain circumstances you must reject Child(ren)'s Name(s)(Last,First,Middle) Child(ren)'s Birth Date(s) this IWO and return it to the sender(see IWO instructions you receive this document from someone other than a State or Tribal CSE agency or a Court,a copy of the underlying order must be attached.. See Addendum for dependent names and birth dates associated with cases on attachment ORDER INFORMATION: This document io based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). `fouonanaqu�nydbv)a��mdeduotthae�ornoun 0o heomp|0�ea/ � C= . obligor's income until further notice. z,- $ 0.00 Der month in current child support MCD C- F�i�� $ pa�Dl�O�l|npa��duechUdauppod- ��rnmor� ��vv�m��wr�nmat�� ym�=�� nu� -or- $ 0.00 per month�in current cash medical support $ 0.00 per month \n past-due cash medical support <�� $ 0.00 Der month in current spousal support > �c �c- $ 216.67 per month in past-due spousal support $ om per month lin other(must specify) for aTotal Amount to Withhold o4$ 216.67 per month. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. \ \f your pay cyc|e does not match the ordered payment cycle, withhold one of the following amount: $ per weekly pay pehod. $ 108.34 per semimonthly pay period(twice amonth) $ per biweekly pay period(every two weeks) $ 216.67 per monthly pay period. $ Lump Sum Payment: Do not stop any existing |VVO unless you receive termination order. REMITTANCE INFORMATION. If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (Gtate/Tr|bm). you must begin withholding no later than the first pay period that occurs b3D(1{) working days after the date of . Send payment within working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (Gbah*/[hbe), the employer can obtain withholding Um\taUono, time naqu}rernento, and any allowable employer fees ot http://www.acf.hhs.gov/procirams/cse/newhire/employer/contacts/contact map. h1m for the emp|oyea/obUgo/e principal place ofemployment. Document Tracking Identifier OMB mv'oom*,»^ Form EN-O28OG/12 Garvice�Type K8 Worker |D$O|NC 1 J ❑ Return to Sender[Completed by Employer/income Withholder). Payment must be directed to an SOU in accordance with 42 USC§666(b)(5)and (b)(6)or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official: PIGICCAA Title of Judge/issuing Official: At Date of Signature: 161- AS &in If the employee/obligor works in a'State or for a Tribe that is different from the State or Tribe that issued this order,a copy of this IWO must be provided to the employee/obligor. ❑ If checked,the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law(23 PA C.S.§4374(b))requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons,or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit(PA SCDU)Employer Customer Service at 1-877.676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID(shown above as the EmployeelObligor's Case Identifier)OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: http://www,acf.hhs.cigvlproarams/cse/newhire/employer/contacts/contect map.htm Priority:Withholding for support has priority over any other legal process under State law against the same income(USC 42 §666(b)(7)). if a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency,you may combine withheld amounts from more than one employee/obligor's income in a single payment.You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU(e.g., payable to the custodial party, court, or attorney),you must check the box above and return this notice to the sender, Exception: If this IWO was sent by a Court,Attorney,or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the"Remit payment to"instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment.The pay date is the date on which the amount was withheld from the employee/obligor's wages.You must comply with the law of the State(or Tribal law if applicable)of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date—05/31/2014.The OMB Expiration Date has no bearing on the termination date of the IWO;it identifies the version of the form currently in use. Form EN-028 06/12 Service Type M Page 2 of 3 Worker ID$OINC Employees Name: Employer FEIN: Name: CSE Agency Case Identifier: Order Identifier:(See Addendum for orderldocket information Withholding Limits:You may not withhold more than the lesser of: 1)the amounts allowed by the Federal Consumer Credit Protection Act(CCPA)(15 U.S.C. 1673(b));or 2)the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment(see REMITTANCE INFORMATION).Disposable income is the net income left after making mandatory deductions such as:State, Federal, local taxes;Social Security taxes;statutory pension contributions;and Medicare taxes,The Federal limit is 50%of the disposable income if the obligor(s supporting another fami\yond8O96cf(hed|mpooub|einuomeifthenbUQorinnotaupporUng another family. However,those limits increase 5%-to 55%and 65%-if the arrears are greater than 12 weeks. If permitted by the State or Tribe,you may deduct a fee for administrative costs.The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders,you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO,you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the empfoyer/income withholder is located or the maximum amount permitted under section 303(d)of the CCPA(15 U.S.C. 1673(b)). Depending upon applicable State or Tribal law,you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. - Arrears greater than 12 weeks?If the Order Information does not indicate that the arrears are greater than 12 weeks,then the \ Employer should calculate the CCPA limit using the lower percentage. | Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 8384100092 0 This person has never worked for this employer nor received periodic income. 0 This person no longer works for this employer nor receives periodic income, Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: Final Payment Amount: New Employer's Name: New Employer's Address: CONTACT INFORMATION: To Employer/Income Withholder: K you have any questions, contact WAGE ATTACHMENT UNIT(issuer name) hy phone at by fax ot . by email orvvmbsibaat: . Sendbamninadon/inoome status notice and other correspondence to:DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST. RO. BOX 320, CARLISLE, PA. 17013(Issuer address), To Employee/Obligor: |f the employee/obligor has questions,contact WAGE ATTACHMENT UNIT(Issuer name) by phone ot . by fax at . by email o,webziteot . IMPORTANT:The person completing this form in advised that the information may be shared with the omp|oyoe/ob|ignr. OMB w*.:o9m-01o* Form EN-O28D8/12 Service Type K8 Page 3of3 Worker |O$O|NC | ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WRIGHT, JAMES R. PACSES Case Number 304105930 PACSES Case Number Plaintiff Name Plaintiff Nam MICHELLE A.WHITE Dacket Attachment Amount Docket Attachment Amount 06-3723 CIVIL $ 216.67 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plain-tiff Name Docket Attachment Amount Docke Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACKS Case Number PACSES Case Number Plaintiff Name Plaintiff Nam Doc et Attachment Amount Docke Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 06112 Service Type M OMB No.:0970-0154 Worker ID$OINC MICHELLE A. WHITE, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY,PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 06-3723 CIVIL TERM JAMES R. WRIGHT, IN DIVORCE Defendant/Respondent PACSES Case No: 304105930 ORDER OF COURT AND NOW to wit, on this 19th day of June, 2013, it is hereby Ordered that the Cumberland County Domestic Relations Section dismiss their interest in the above captioned alimony matter pursuant to the obligation ending on June 1, 2013 pursuant to the parties' agreement of April 30, 2010. The alimony account is closed with a balance of$1,427.64 owed to the Petitioner. This Order shall become final twenty (20) days after the mailing of the notices of the entry of the Order to the parties unless either party files a written demand with the Office of the Prothonotary for a hearing de novo before the Court. BE C AThomas Placey, �, J., C c . DRO: R.J. Shadday i CD xc: Petitioner Respondent C) William G. Martin, Jr., Esq. 5 ; Form OE-001 Service Type:M Worker:21005 INCOME WITHHOLDING FOR SUPPORT Jb4 105 93b O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT(IWO) 1 �� C1 V I I O AMENDEDIWO (Q I O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT Q TERMINATION OF IWO Date: 06/19/13 ❑ Child Support Enforcement(CSE)Agency ® Court ❑ Attorney ❑ Private Individual/Entity(Check One) NOTE:This") �(r>i�st bet�e (lar"-0rQS fti2iJnder certain circumstances you must reject this IWO and return it to the sender(see IWO instructions http://ww .acf.hhs.gov/programs/cse/newhire/employer/publication/publication.htm-forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Tribe/Territory Commonwealth of Pennsylvania Remittance Identifier(include w/payment): 0344101243 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket informaiton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) WORKMEN'S COMP INSURANCE RE: WRIGHT,JAMES R. C/O ACORDIA NORTHEAST Employee/Obligor's Name(Last, First,Middle) PO BOX 1220 176-50-5327 MECHANICSBURG PA 17055-1220 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) _ c > Custodial Party/Obligee's Name(Last, First, Middle) EmploygrIrlcorpWitlolr's FEIN NOTE:This IWO must be regular on its face. Under certain circumstances you must reject Childtr Name(s)(first,Middle) Child(ren)'s Birth Date(s) this IWO and return it to the sender(see IWO tt� -?- instructions �_t X http://www.acf.hhs.gov/programs/cse/newhire/ employer/publication/publication.htm-forms.If you receive this document from someone other �,� , than a State or Tribal CSE agency or a Court,a copy of the underlying order must be attached. 5840100105 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. $ 0.00 per month in current child support $ 0.00 per month in past-due child support- Arrears 12 weeks or greater? p yes O no $ 0.00 per month in current cash medical support �.. C_: $ 0.00 per month in past-due cash medical support C:o w $ 0.00 per month in current spousal support $ 0.00 per month in past-due spousal support �_cn G $ 0.00 per month in other(must specify) for a Total Amount to Withhold of$ 0.00 per month. `3 rn -� AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with th-e er Information. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay peTlod (twtb a month) $ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten 10 working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www.acf.hhs.ciov/programs/cse/newhire/employer/contacts/contact map. htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.:0970-0154 Form EN-028 06/12 Service Type M Worker ID$OINC M Return to Sender[Completed by Employer/income Withholder]. Payment must be directed toanSDUin accordance with 42USC§666(b)(5)and ( or Tribal Payee(see Payments to SDUbelow). Kpayment is not directed tmanSOU/Trbo| Payee or this |VVOio not regular on its face, you must check this box and return the /VVOho the d Signature of Judge/Issuing Official (if required by State or Tribal law):e"__ Print Name of Judge/Issuing Official: P)*&AA"JUDft Title of Judge/Issuing Official: V X Date of Signature: JUN 20 N ` If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order,a copy of this IWO must be provided 0o the omp|oyee/obUgor. rl If checked,the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law(23 PA C.S.§4374(b)) requires remittance bymn electronic payment method |fmn employer|sordered to withhold income from more than one employee and employs 15mn more persons,orifmwemployer has a history mf two or more returned checks due tononauffin|mntfunds. Please call the Pennsylvania State Collections and Disbursement Unit(PA SCDU)Emnp|oywr Customer Service at 1^@77-67G-B580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDKJ Send check to: Pennsylvania SCIDU, P.O. Box 69112° Harrisburg, Pal 17106~9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID(shown above as thmEmployee/Obligor's Case Identirter)OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED, DO NOT SEND CASH BYMAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: PA Withholding for support has priority over any other legal process under State law against the same income(USC 42 §GGG(b)(7)). |fa Federal tax levy isin effect, please notify the sender. Combining Payments: When remitting payments 1oonSDUorThba|CSEogency.youmoyuombinewiUhhe|damoun1shom more than one employee/obligor's income in a single payment.You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDUur\oo Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU(e.g., payable to the custodial party,court,orottorney),you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued bya Tribal CSE agency,you must follow the"Remit payment to"instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the emp|oyee/obUgnr'a wages.You must comply with the law of the State(or Tribal law if applicable)of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple 1WOs: |f there ia more than one |VVO against this employee/obligor ondyouaneunab|etofulh/honoraU |VVDsdueto Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible,giving priority hnuurnent support before payment of any past-due support. Follow the State or Tribal law/procedure uf the emp|oyee/ob|igo/oprincipal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay, Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: |f you have any doubts about the validity of this |VVO. contact the sender. |f you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal|av/pnocoduna. Anti^disor|rn|nation: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ,or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date-05m1omw.The OMB Expiration Date has oouvariou=,the termination date*the mm'x identifies the version m the form currently muse. Form EN-U28O8/12 � Service Type KA Page 2of3 Worker |O$[}|NC R n Employer's Name: WORKMEN'S COMP INSURANCE Employer FEIN: Employee/Obligor's Name: WRIGHT,JAMES R. 0344101243 CSE Agency Case Identifier:LSee Addendum for case summary) Order Identifier:(See Addendum for order/docket information) Withholding Limits:You may not withhold more than the lesser of: 1)the amounts allowed by the Federal Consumer Credit Protection Act(CCPA)(15 U.S.C. 1673(b));or 2)the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment(see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes;Social Security taxes;statutory pension contributions; and Medicare taxes.The Federal limit is 50%of the disposable income if the obligor is supporting another family and 60%of the disposable income if the obligor is not supporting another family. However,those limits increase 5%-to 55%and 65%-if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs.The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders,you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO,you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d)of the CCPA(15 U.S.C. 1673(b)). Depending upon applicable State or Tribal law,you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks?If the Order Information does not indicate that the arrears are greater than 12 weeks,then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 5840100105 Q This person has never worked for this employer nor received periodic income. O This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: Final Payment Amount: New Employer's Name: New Employer's Address: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT(Issuer name) by phone at(717)240-6225, by fax at(717)240-6248, by email or website at:www.childsupport.state.pa.us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST. P.O. BOX 320, CARLISLE, PA. 17013(Issuer address). To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT(Issuer name) by phone at(717)240-6225, by fax at(717)240-6248, by email or website at www.childsupport.state.pa.us. IMPORTANT:The person completing this form is advised that the information may be shared with the employee/obligor. OMB No.:0970-0154 Form EN-028 06/12 Service Type M Page 3 of 3 Worker ID$OINC r , ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WRIGHT, JAMES R. PACSES Case Number 304105930 PACSES Case Number Plaintiff Name Plaintiff Name MICHELLE A.WHITE Docket Attachment Amount Docke Attachment Amount 06-3723 CIVIL $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name D cke Afachment Amount Docke Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amoun Docke Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Narhe(s): DOB Addendum Form EN-028 06/12 Service Type M OMB No.:0970.0154 Worker ID $OINC INCOME WITHHOLDING FOR SUPPORT Jc) O5 9,3d O ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT(IWO) h/& _ ��3 CI VI ' O AMENDED IWO D C. O ONE-TIMEORDERMOTICE FOR LUMP SUM PAYMENT (D TERMINATION OF IWO Date: 06/19/13 ❑ Child Support Enforcement(CSE)Agency ® Court ❑ Attorney ❑ Private Individual/Entity(Check One) NOTE., is TWO must;be regular o�n #slfae.rnder certain circumstances you must reject this IWO and return it to the sender(see IWO instruc � '`//www acfhs gov/programs/cse/newhire/employer/publication/publication htm-forms). If you receive this document from someone other than a State or Tribal'CSE agency or a Court,a copy of the underlying order must be attached. State/Tribe/Territory Commonwealth of Pennsylvania Remittance Identifier(include w/payment): 0344101243 City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket informalton) Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary) SOCIAL SECURITY ADMINISTRATION RE: WRIGHT JAMES R. STE 1 Employee/Obligor's Name(Last, First,Middle) 200 S SPRING GARDEN ST 176-50-5327 CARLISLE PA 17013-2578 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) f` CD Custodial Party/Obligee's Name(Last, First, Middle) Empl�4lnc, Wi g_*er's FEIN NOTE:This IWO must be regular on its face. h— > Under certain circumstances you must reject Chilc�rga)'s NMe(s , First,Middle) Child(ren)'s Birth Date(s) this IWO and return it to the sender(see IWO ;-;"J LC N instructions htti)://www.acf.hhs.gov/i)ro-grams/cse/newhire/ Lei employer/publication/aublication htm formsL I Z . If you receive this document from someone other than a State or Tribal CSE agency or a Court,a ' ._ ' copy of the underlying order must be attached. 8384100092 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. $ 0.00 per month in current child support $ 0.00 per month in past-due child support- Arrears 12 weeks or greater? p yes O rgo,, $ 0.00 per month in current cash medical support $ 0.00 per month in past-due cash medical support ° $ 0.00 per month in current spousal support -i m $ 0.00 per month in past-due spousal support $ 0.00 per month in other(must specify) for a Total Amount to Withhold of$ 0.00 per month. CD v rn AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with t0g)rder Information. If your pay cycle does not match the ordered payment cycle, withhold one of the following amoL.m11 N $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period (twice a month) $ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten 10 working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http•//www acf hhs gov/programs/cse/newhire/employer/contacts/contact map. htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.:0970-0154 Form EN-028 06/12 Service Type M Worker ID$OINC [3 Return to Sender[Completed by Employer/income Withholder]. Payment must be directed toanSDUin ' ° accordance with 42LSC§666(b)(5)and ( or Tribal Payee(see Payments to SDUbelow). Kpayment is not directed t¢anSOU/Trba| Payee or this |VVOis not regular on its face, you must check this box and return the |VV[>bo the sender. Signature of Judge/issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official: I i -A jupw Title of Judge/issuing Official: nww"V-V Date of Signature: jud 2 0 2013 If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the omp|oyee/ob|igor. 11 If checked,the emptoyer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOREKoPLOYERSIANCOK0E WITHHOLDERS Pennsylvania law(23 PA C.S.§4374(b))requires remittance bymn electronic payment method |fmn employer 2s ordered tm withhold income from more than one employee and employs 15wr more persons,orffmm employer has a history of two pr more returned checks due Wmnonmwfficiwwtfunds. Please call the Pennsylvania State Collections and Disbursement Unit(PA SCDU)Employer Customer Service mt1~877~676-958o for instructions. PA FhPS CODE 42$O0 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU. 9».O. Box @9112, Harrisburg, 0»a 17106-9112 ' IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER 6D(shown above ma |hefmployealObWgmr's CaseIdentirter)OR SOCIAL SECURITY NUMBER 0V ORDER 7O BE PROCESSED. DO NOT | SEND CASH BY"MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: � Withholding for support has priority over any other legal process under State law against the same income(USC 42 §G66(b)(7)). |fa Federal tax levy iain effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency,you may combine withheld amounts from more than one employee/obligor's income in a single payment.You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SOU(e.g., payable to the custodial party, court, orattonney) you must check the box above and return this notice to the sender. Exception: If this IWO was sent bym Court,Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency,you must follow the"Remit payment to"instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment.The pay date ia the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State(or Tribal law if applicable)of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple lWOo' |f there ia more than one |VVOagainst this employee/obligor andyouaneunab(etofu|k/honoraU |VVOmduebu Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment 10 determine the appropriate allocation method. Lump Sum Payments: You may be required bu notify a State or Tribal CSE agency of upcoming lump sum payments tothis employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO,contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal |aw/prnuedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date-05/31/2014,The OMB Expiration Date has no bearing on the termination date of the IWO:It identifies the version of the form currently in use. \ | Form EN-0280U/12 Service Type yN Page 2of3 Worker |[)$(]|NC Employer's Name: SOCIAL SECURITY ADMINISTRATION Employer FEIN: Employee/Obligor's Name: WRIGHT,JAMES R. 0344101243 CSE Agency Case Identifier:(See Addendum for case summary) Order Identifier:(See Addendum for order/docket information) Withholding Limits:You may not withhold more than the lesser of: 1)the amounts allowed by the Federal Consumer Credit Protection Act(CCPA)(15 U.S.C. 1673(b)); or 2)the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment(see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes.The Federal limit is 50%of the disposable income if the obligor is supporting another family and 60%of the disposable income if the obligor is not supporting another family. However,those limits increase 5%-to 55%and 65%-if the arrears are greater than 12 weeks. If permitted by the State or Tribe,you may deduct a fee for administrative costs.The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders,you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO,you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d)of the CCPA(15 U.S.C. 1673(b)). Depending upon applicable State or Tribal law,you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks?If the Order Information does not indicate that the arrears are greater than 12 weeks,then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 8384100092 • This person has never worked for this employer nor received periodic income. • This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: Final Payment Amount: New Employer's Name: New Employer's Address: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT(Issuer name) by phone at(717)240-6225, by fax at(717)240-6248, by email or website at:www.child support.state.pa.us, Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST. P.O. BOX 320, CARLISLE, PA. 17013(Issuer address). To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT(Issuer name) by phone at(717)240-6225, by fax at(717)240-6248, by email or website at www.childsupport.state.pa.us. IMPORTANT:The person completing this form is advised that the information may be shared with the employee/obligor. OMB No.:0970-0154 Form EN-028 06/12 Service Type M Page 3 of 3 Worker ID $OINC ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WRIGHT, JAMES R. PACSES Case Number 304105930 PACSES Case Number Plaintiff Name Plaintiff Name MICHELLE A.WHITE Docke Attachment Amount Docket Attachment Amount 06-3723 CIVIL $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Doc et Attachment Amount D c et Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB i PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Doc a Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 06/12 Service Type M OMB No.:0970-0154 Worker ID$OINC 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: JAMES R. WRIGHT Member ID Number: 0344101243 cZ Please note:All correspondence must include the Member ID Number. ORDER TO VACATE ATTACHMENT OF UNEMPLOYMENT BEREFIfS �. cc) Zt- : Financial Break Down of Multiple Cases on Attachment cb PACSES Docket Attachment Amount/Frequency uenc Plaintiff Name Case Number Number q y MICHELLE A.WHITE 304105930 06-3723 CIVIL 216c67 / MONTN 3 0 / c. TOTAL ATTACHMENT AMOUNT: $ 21'6 rh ._ --+o -<:;r- The prior Order of this Court directing the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), to attach$49.86 or 50% per week of the Unemployment Compensation benefits of JAMES R. WRIGHT, Social Security Number XXX-XX-5327, Member ID Number 0344101243 is hereby vacated. This Order to Vacate shall be effective upon receipt of the notice of the Order by the Department and shall remain in effect until a further Order of the Court is filed. BY THE Date of Order: JUN 2 0 T JUDGE Form EN-035 Service Type M Worker ID $IATT