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02-1884
TIMOTHY A. LEEN, Plaintiff VS. BRENDA S. LEEN, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION-LAW IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS YOU HAVE BEEN SUED IN COURT. If you wish to defend against the c]sirus set forth in the following pages, you must take prompt action. You are wamed 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 agsinst you for any other claim or relief requested in these papers by the P]s~rttiff. 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 Court Administrator, Cumberland County Courthouse, Hanover Street, Carlisle, PA. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND Or. rr WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 TIMOTHY A. LEEN, Plaintiff VS. BRENDA S. LEEN, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION-LAW IN DIVORCE COMPLAINT 1. The Plaintiff Timothy A. Leen, is an adult individual whose residence is 9 A Glenwood Drive, Camp Hill, Cumberland County, Pennsylvania 17011. 2. The Defendant Brenda A. Leen, is an adult individual whose residence is 12 East Keller Street, Mechanicsburg, Cumberland County, Pennsylvania 17055. 3. The Plaintiff has been a bonafide resident in the Commonwealth of Pennsylvania for at least six months immediately prior to the filing of this Complaint. 4. The Plaintiff and Defendant were married on June 27, 1991, in Glens F~lls, New York. 5. There have been no prior actions of divorce or annulment between the parties. 6. The Plaintiff avers that there are two children of the parties under the age of 18: Spencer T. Leen, bom January 1, 1990 and Alexander N. Leen, bom August 26, 1993. 7. Neither of the parties in this action is presently a member of the Amxed Forces. 8. The Plaintiff and Defendant are citizens of the United States. 9. The Social Security Number of the Plaintiff is 201-52-4340 and the Social Security Number of the Defendant is 181-50-0257. 9. The Plaintiff has been advised of the availability of marriage counseling and that he may have the right to request the Court to require the parties to participate in such counseling. Being so advised, Plaintiff does not request that the Court recp,ire the parties to participate in counseling prior to a Divorce Decree being handed down by the Court. 10. The Plaintiff avers the grounds on which the action is based is that the marriage is irretrievably broken. WHEREFORE, the Pl~ir~tiff requests the Court to enter a Decree of Divorce. Respectfully submitted, BY /J~urcell, Jr., Esq~,~re v 1719 North Front Street Harrisburg, PA 17102 (717) 234-4178 VERIFICATION I verify that the statements made in the foregoing Complaint in Divorce are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unswom falsification to authorities. Dated: Timothy A. Leen TIMOTHY A. LEEN, Plaintiff VS. BRENDA S. LEEN, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : : NO. 02-1884 CIVIL TERM : CIVIL ACTION-LAW : IN DIVORCE PRAECIPE TO THE PROTHONOTARY; Please reinstate the Divorce Complaint in the above referenced matter. PURCELL, KRUG & HALLER BY · P~---~.ll, Jr. 955 1719 North Front Street Harrisburg, PA 17102 (717) 2344178 SHERIFF'S CASE NO: 2002-01884 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND LEEN TIMOTHY A VS LEEN BRENDA S RETURN - REGUL~AR BRIAN BARRICK Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT - DIVORCE was served upon LEEN BRENDA S the DEFENDANT at 2106:00 HOURS, at 18 WEST KELLER STREET MECHANICSBURG, PA 17055 BRENDA LEEN on the 19th day of August , 2002 by handing to a true and attested copy of COMPLAINT - DIVORCE together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing 18.00 Service 6.90 Affidavit .00 Surcharge 10.00 .00 34.90 Sworn and Subscribed to before me this x/~- day of ~n-~ .... J~ ~ A.D. ~P~ot honot ary ' So Answers: R. Thomas Kline 08/20/2002 Deputy Sheriff TIMOTHY A. LEEN, VS, BRENDA S. LEEN, Plaintiff Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 02-1884 CIVIL TERM IN DIVORCE MOTION FOR HEARING ON REQUEST FOR ALIMONY PENDENTE LITE AND COUNSEL FEES AND EXPENSER AND NOW comes the above-named Defendant, by her attorney, Samuel L. Andes, and moves this court to schedule a conference at the Domestic Relations Office on the request for Alimony Pendente Lite made in her Petition for Economic Relief, a copy of 'which is attached hereto. Date Supreme Court ID # 17225 525 N. 12~h Street Lemoyne, PA 17043 (717) 761-5361 TIMOTHY A. LEEN, Plaintiff VS, BRENDA S. LEEN, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 02-1884 CIVIL TERM IN DIVORCE DEFENDANT'S PETITION FOR ECONOMIC RELIEF AND NOW comes the above-named Defendant, by her attorney, Samuel L. Andes, and makes the following Petition for Economic Relief: COUNT I - EQUITABLE DISTRIBUTION 1. During the course of the marriage, the parties have acquired numerous items of property, both real and personal, which are held in joint names and in the individual names of each of the parties hereto. WHEREFORE, Defendant prays this Honorable Court, after requiring full disclosure by the Plaintiff, to equitably divide the property, both real and personal, owned by the parties hereto as marital property. COUNT II - ALIMONY 2. Defendant lacks sufficient property to provide for her reasonable needs in accordance with the standard of living of the parties established during the marriage. 3. Defendant is unable to support herself in accordance with the standard of living of the parties established during the marriage through appropriate employment. 4. The Plaintiff is employed and enjoys a substantial income from which he is able to contribute to the support and maintenance of Defendant and to pay her alimony in accordance with the Divorce Code of Pennsylvania. WHEREFORE, Defendant prays this Honorable Court to enter an Order awarding Defendant from Plaintiff permanent alimony in such sums as are reasonable and adequate to support and maintain Defendant in the station of life to which she has become accustomed during the marriage. matter. 8. COUNT III - ALIMONY PENDENTE LITE 5. Defendant is without sufficient income to support and maintain herself during the pendency of this action. 6. Plaintiff enjoys a substantial income and is well able to contribute to the support and maintenance of Defendant during the course of this action. WHEREFORE, Defendant prays this Honorable Court to order Plaintiff to pay her reasonable alimony pendente lite during the pendency of this action. COUNT IV - COUNSEL FEES AND EXPENSES Defendant is without sufficient fUnds to retain counsel to represent her in this Without competent counsel, Defendant cannot adequately prosecute her claims against Plaintiff and cannot adequately litigate her rights in this matter. 9. Plaintiff enjoys a substantial income and is well able to bear the expense of Defendant's attorney and the expenses of this litigation. WHEREFORE, Defendant prays this Honorable Court to order Plaintiff to pay the legal fees and expenses incurred by Defendant in the litigation of this action. I verify that the statements made in this Petition for Economic Relief are true and correct, I understand that any false statements in this Petition are subject to the penalties of 18 Pa. C,S, 4904 (unsworn falsification to authorities). DATE: S~o.~l L.~ndes-~'J ' -~' ~' Attorney for Defendant Supreme Court ID 1722§ 525 North 12th Street Lemoyne, PA 17043 TIMOTHY A. LEEN, Plaintiff VS. BRENDA S. LEEN, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 02-1884 CIVIL TERM IN DIVORCE DEFENDANT'S PETITION FOR ECONOMIC RELIEF AND NOW comes the above-named Defendant, by her attorney, Samuel L. Andes, and makes the following Petition for Economic Relief: COUNT I - EQUITABLE DISTRIBUTION 1. During the course of the marriage, the parties have acquired numerous items of property, both real and personal, which are held in joint names and in the individual names of each of the parties hereto. WHEREFORE, Defendant prays this Honorable Court, after requiring full disclosure by the Plaintiff, to equitably divide the property, both real and personal, owned by the parties hereto as marital property. _COUNT II - ALIMONY 2. Defendant lacks sufficient property to provide for her reasonable needs in accordance with the standard of living of the parties established during the marriage. 3. Defendant is unable to support herself in accordance with the standard of living of the parties established during the marriage through appropriate employment. 4. The Plaintiff is employed and enjoys a substantial income from which he is able to contribute to the support and maintenance of Defendant and to pay her alimony in accordance with the Divorce Code of Pennsylvania. WHEREFORE, Defendant prays this Honorable Court to enter an Order awarding Defendant from Plaintiff permanent alimony in such sums as are reasonable and adequate to support and maintain Defendant in the station of life to which she has become accustomed during the marriage. ~COUNT III - ALIMONY PENDENTE LITI 5. Defendant is without sufficient income to support and maintain herself during the pendency of this action. 6. Plaintiff enjoys a substantial income and is well able to contribute to the support and maintenance of Defendant during the course of this action. WHEREFORE, Defendant prays this Honorable Court to order Plaintiff to pay her reasonable alimony pendente lite during the pendency of this action. COUNT IV - COUNSEL FEES AND EXPENSES 7. Defendant is without sufficient fUnds to retain counsel to represent her in this matter. 8. Without competent counsel, Defendant cannot adequately prosecute her claims against Plaintiff and cannot adequately litigate her rights in this matter. 9. Plaintiff enjoys a substantial income and is well able to bear the expense of Defendant's attorney and the expenses of this litigation. WHEREFORE, Defendant prays this Honorable Court to order Plaintiff to pay the legal fees and expenses incurred by Defendant in the litigation of this action. I verify that the statements made in this Petition for Economic Relief are true and correct. I understand that any false statements in this Petition are subject to the penalties of 18 Pa. C.S. 4904 (unsworn falsification to authorities). DATE: Attorney for Defendant Supreme Court ID 17225 525 North 12th Street Lemoyne, PA 17043 TIMOTHY A. LEEN, Plaiotiff/Respondent VS. BRENDA S. LEEN, Defendant/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 2002-1884 CIVIL TERM IN DIVORCE DR~ 32151 Pacse~ 147104946 ORDER OF COURT AND NOW, this 15th day of October, 2002, upon consideration of the attached Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before ~ on October 24, 2002 at 10:30 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may reconunend that an Order for Alimony Pendente Lite be entered. NOTE: This pea'on will be heard an the same date and time as Case #'s $48104883 and 172104791 already schedule,1 YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. Mail copies on Petitioner 10-15-02 to: < Respondent Samuel Andes, Esquire John Purcell, Esquin Date of Order: October 15, 12002 BY THE COURT, George E. Hoffer, President Judge YOU HAVE T~E RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 TIMOTHY A. LEEN, VS. BRENDA S. LEEN, Plaintiff Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 02-1884 CIVIL TERM IN DIVORCE .MOTION FOR HEARING ON REQUEST FOR ALIMONY ,PENDENTE LITE AND COUNSEL FEES AND EXPENS_F~ AND NOW comes the above-named Defendant, by her attorney, Samuel L. Andes, and moves this court to schedule a conference at the Domestic Relations Office on the request for Alimony Pendente Lite made in her Petition for Economic Relief, a copy of which is attached hereto. Date Attorney ~fendant ~ Supreme Court ID # 17225 525 N. 12th Street Lemoyne, PA 17043 (717) 761-5361 TIMOTHY A. LEEN, VS, BRENDA S. LEEN, Plaintiff Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 02-1884 CIVIL TERM IN DIVORCE DEFENDANT'S PETITION FOR ECONOMIC RELIEF AND NOW comes the above-named Defendant, by her attorney, Samuel L. Andes, and makes the following Petition for Economic Relief: _C. OUNT I - EQUITABLE DISTRIBUTIO.~' 1. During the course of the marriage, the parties have acquired numerous items of property, both real and personal, which are held in joint names and in the individual names of each of the parties hereto. WHEREFORE, Defendant prays this Honorable Court, after requiring full disclosure by the Plaintiff, to equitably divide the property, both real and personal, owned by the parties hereto as marital property. COUNT II - ALIMONY 2. Defendant lacks sufficient property to provide for her reasonable needs in accordance with the standard of living of the parties established during the marriage. 3. Defendant is unable to support herself in accordance with the standard of living of the parties established during the marriage through appropriate employment. 4. The Plaintiff is employed and enjoys a substantial income from which he is able to contribute to the support and maintenance of Defendant and to pay her alimony in accordance with the Divorce Code of Pennsylvania. WHEREFORE, Defendant prays this Honorable Court to enter an Order awarding Defendant from Plaintiff permanent alimony in such sums as are reasonable and adequate to support and maintain Defendant in the station of life to which she has become accustomed during the marriage. matter. 8. COUNT III - ALIMONY PENDENTE LITF 5. Defendant is without sufficient income to support and maintain herself during the pendency of this action. 6. Plaintiff enjoys a substantial income and is well able to contribute to the support and maintenance of Defendant during the course of this action. WHEREFORE, Defendant prays this Honorable Court to order Plaintiff to pay her reasonable alimony pendente lite during the pendency of this action. COUNT IV - COUNSEL FEES AND EXPENSER Defendant is without sufficient funds to retain counsel to represent her in this Without competent counsel, Defendant cannot adequately prosecute her claims against Plaintiff and cannot adequately litigate her rights in this matter. 9. Plaintiff enjoys a substantial income and is well able to bear the expense of Defendant's attorney and the expenses of this litigation. WHEREFORE, Defendant prays this Honorable Court to order Plaintiff to pay the legal fees and expenses incurred by Defendant in the litigation of this action. I verify that the statements made in this Petition for Economic Relief are true and correct. I understand that any false statements in this Petition are subject to the penalties of 18 Pa. C.S. 4904 (unsworn falsification to authorities). DATE: BRENDA S. LEEN Attorney for Defendant Supreme Court ID 17225 525 North 12th Street Lemoyne, PA 17043 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: TIMOTHY A. LEEN Member ID Number: 7939101023 Please note: All correspondence must include the Member ID Nmnber. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Financial Break Down of Multiple Cases on Attachment PACSES Docket Plaintiff Name Case Number Number BRENDA S. LEEN 147104946 02-1884 CIVIL Attachment Amount/Frequency / MONTH 297.00 1 / TOTAL ATTACHMENT AMOI~NT: $ 297. oo Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 68.54 per week, or 50 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, TIMOTHY A. LEEN Social Security Number 201-52-4340 , Member ID Number 7939101023 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673 (b)(2) and 23 Pa. C.S.A. § 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated MAY 25, 2 003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: Service Type Iq Form EN-530 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist of CUMBERLAND Date of Order/Notice 06/25/03 Tribunal/Case Number (See Addendum for case summary) RE: L~N, TIMOTHY A. Employer/Withholder's Federal FIN Number CLEAN VENTURE/CYCLE CHEM 201 S 1 ST ST ELIZABETH NJ 07206-1502 C) Original Order/Notice C) Amended Order/Notice (~ Terminate Order/Notice Employee/Obligor's Name (Last, First, MI) 201-52-4340 Employee/Ob]igor's Social Security Number 7939101023 Employee/ObJigor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? C)yes (~) no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ o. 00 per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ o. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). if remittin8 by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL ?' ~~!~: BY THE courT: /') "- . t,~Z::~'.'~ ~,~Z--~.- ;l~ Form EN-028 Worker ID STA?T Date of Order: Service Type M OMB NO.: 0970-0154 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS [] Ifchecke~l you are requ red to provide a copy of th s form to youremnloyee. If your employee works in a state thatis different trom the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effeci before receipt of this order have priori~/. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. ~,~,y,~,~,~, ,, ~,u ,~,,,,,~u,~,~.~,, ,,,,,~,,o,,,~,u,,L,,,~,,,,,,,,~,,~ ,,,~., .,~,,,mvy~,,,,.~,' You mustcomplywiththelawofthe state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 9430908980 EMPLOYEE'S/OBLIGOR'S NAME: LEEN, TIMOTHY A. EMPLOYEE'S CASE IDENTIFIER: 7939].01023 DATE OF SEPARATION:. LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the Stale in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. § 1673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at ~or by internet www.childsupportstate.pa, us Page 2 of 2 Form EN-028 Service Type M OMB NO.: 0970~0154 Worker ID $ IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./Ci~/Dist of CUMBER~ Date of Order/Notice 07/3_7/03 Tribunal/Case Number (See Addendum for case summary) RE: I,~RN, TIMOTHY A. Employer/Withho~der's Federal E~N Number SQUARE D 201 CUMBERLAND PKWY MECHANICSBORG PA 17055-5664 (~ Original Order/Notice O Amended Order/Notice O Terminate Order/Notice Empioyee/Obligor's Name (Last, First, MI) 201-52-4340 Employee/Obligor's Social Security Number 7939101023 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 297. oo per month in current support $' o. oo per month in past-due support Arrears 12 weeks or greater? C)yes (~) no $ 0. oo per month in medical support $ o. oo per month for genetic test costs $ per month in other (specify) for a total of $ 2 9'/. 0 0 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 68.54 per weekly pay period. $ 13 7.08 per biweekly pay period (every two weeks). $ 148.50 per semimonthly pay period (twice a month). $ 297. oo per monthly pay period. RF_MITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL.~=~~ ~ BY THE COURT: ~ ~ Date of Order: ,~JL ~. ~ ~I~ '~ -~ - -~'3 /~/~l~(~/ Form EN-028 Service Type M OM~ No.:09704)154~ Worker ID $IATT ADDITIONAl INFORMATION TO EMPLOYERS AND OTHER WlTHHOLDERS [] If checked you are requ red to provide a copy of th s form to youremployee, f your employee works in a state that is different from the state that issued this order, a copy must be prov deal to your employee even fthe box is not checked. 1. We appreciate the voluntary compliance of Federally recognized indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priorib/over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal ta~ levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. ............................................... You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the suppor~ payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one OrdedNotice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 4671000024 EMPLOYEE'S/OBLIGOR'S NAME: T,~.Rlq, TIMOTHY A. EMPLOYEE'S CASE IDENTIFIER: 7939101023 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold mom than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER P.O. BOX 320 CARLISLE PA 1 7013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupportstate.pa, us Page 2 of 2 Form EN-028 Service Type M OMB No.: 0970~0154 Worker ID $ IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: LEEN, TIMOTHY A. PACSES Case Number 147104946 Plaintiff Name BRENDA S. LEEN Docket Attachment Amount 02-1884 CIVIL $ 297.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name .Docket Attachment Amount $ 0.0o Child(ren)'s Name(s): DOB [] If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. [] If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB [] If checked, you are required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.o0 Child(ren)'s Name(s): DOB [] f checked you are required to enroll the child(ren) identified above in any health insurance coverage ava lab e through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.o0 Child(ren)'s Name(s): DOB [] If checked, you are required to enroll the child(ten) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.o0 Child(ren)'s Name(s): DOB : [] If checked, you are required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum Form EN-028 Worker ID $IATT Set'vice Type M OMB NO.: 0970.0154 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co.~City~Dist. of CUMBERLAND Date of Order/Notice 07/31/03 Tribunal/Case Number (See Addendum for case summary) C) Original Order/Notice (~) Amended Order/Notice C) Terminate Order/Notice 15mpioyer/Withholder's Federal EIN Number SQUARE D 201 CUMBERI~ND PKWY MECHANICSBURG PA 17055-5664 RE:LEEN, TIMOTHY A. Employee/Obligor's Name (Last, First, MI) 201-$2-4340 Employee/Obligor's Social Security Number 7939101023 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAI~D County, Commonwealth of Pennsylvania. By law, you am required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 297. oo per month in current support $ 50. oo per month in past-due support Arrears 12 weeks or greater? (~)yes C) no $ 0. oo per month in medical support $ 0. oo per month for genetic test costs $ per month in other (specify) for a total of $ 347. O0 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 80.08 per weekly pay period. $ ~.60.15 per biweekly pay period (every two weeks). $ 173.5o per semimonthly pay period (twice a month). $ 347. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Date of Order: Service Type M Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: OMB No.: O'~'~s4 Worker ID $ ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS [] fghecked you are required to provide a~opy of th s form to your~mployee. If your employee works in a state thal; is dinerent from the state that issued th s omer, a copy must be provioed to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this~Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obliger's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* Repo,'ting the PaydateJDate of Withholding. You must report the paydateJdate of withholding when sending the payment. The paydate/date of withholding ~s the dat~ on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obliger's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you am unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obliger's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 4671000024 EMPLOYEE'S/OBLIGeR'S NAME: LEEN, TIMOTHY A. EMPLOYEE'S CASE IDENTIFIER: '7939101023 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obliger's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law govems unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold mom than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (1 5 U.S.C. §1673 (b)l; or 2) the amounts allowed by the State of the employee's/obliger's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: if you or your agent am served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (71 7) 240-6248 or by internet www.childsupportstate.pa.us Page 2 of 2 Form EN-028 Service Type M OMB NO.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment DefendanUObligor: LEEN, TIMOTHY A. PACSES Case Number 147104946 Plaintiff Name BRENDA S. LEEN Docket Attachment Amount 02-1884 CIVIL $ 347.00 Child(ren)'s Name(s): DOB I'~-]lf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Chiid(mn)'s Name(s): DOB [] If checked, you are required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB [] If checked, you are required to enroll the child(mn) identified above in any health in, surance coverage available through the employee's/obligor s employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB [] If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB iiiiiiii! !!!iiiill ii iiiiiiiil iilii iiiiiii iii! i!ii!iii~? iliii iiiiiiiii iii?ii!il iiiii?ii iiii iiii !i iii?ii ?iii iiiiiiiiii iiiiiii !i i!!i iliiil i ii [] If checked, you am required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOg [] If checked, you are required to enroll the child(mn) identified above in any health i.n, surance coverage available through the employee's/obligor s employment. Addendum Form EN-028 Service Type M o~B No.;0970-0154 Worker ID $IATT In the Court of Common Pleas of Phone: {717) 240-6225 DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISI~, PA. 17013 County, Pennsylvania Fax: (717) 240-6248 Defendant Name: TIMOTHY A. LEEN Member ID Number: 7939101023 Please note: All correspondence mu.st include the Member ID Number. MODIFIED ORDER OF ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiple Cases on Attachment PACSES Docket Plaintiff Name Case Number Number BR~rDA S. LEEN 147104946 02-1884 CIVIL Attachment Amount/Freauenc¥ 347.00 !MONTH / TOTAL ATTACHMENT AMOUNT: $ 347.00 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $ 80.08 perweek, or 55.0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, TIMOTHY A. LEEN Social Security Number 201-52-4340 , Member ID Number 793 9101023 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the mount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached doe? not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673(b)(2) and 23 Pa. C.S..§ 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated MAY 25, 2003 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. Date of Order: Service Type M BY THE COURT Form EN_03JUDGE4 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist of CUMBERLAND Date of Order/Notice 08/08/03 Tribunal/Case Number (See Addendum for case summary) RE: LEEN, TIMOTHY A. Employer/Withholder's Federal EIN Number SQUARE D COMPANY * PO BOX 27446 P~ALEIGH NC 27611-7446 (~ Original Order/Notice C) Amended Order/Notice C) Terminate Order/Notice Employee/Obligor's Name (Last, First, MI) 201-52-4340 Employee/Obiigor's Social Security Number "/93910~.023 Employee/Obli§or's Case Identifier (See Addendum for plaintiff names associated with cases on affachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 297. oo per month in currant support $ 50. oo per month in past-due support Arrears 12 weeks or greater? (~)yes C) no $ 0. oo per month in medical support $ 0. oo per month for genetic test costs $ per month in other (specify) for a total of $ 347.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 80.00 per weekly pay period. $ 160- 15 per biweekly pay period (every two weeks). $ 173.50 per semimonthly pay period (twice a month). $ 347.00 per monthly pay period. REMITTANCE INFORMATION: You must be§in withholding no later than the first pay period occurring ten (10) working days after the date of this OrdeffNotice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PA CSES MEMBER ID (shown above as the Employee/Obligor's Case Identifi~r).Q~ S~3~J~SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. - ~- / ,./-03 BY THE COUR,T:. /'~ .~ Service Type M o~4B No.:0970~9154 Worker ID $IATT ADDITIONAL ~NFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS [] f~hecke.d you are required to provide a copy of this form to your~mp[oyee. If yogr employe?,.w, or,ks in.a state,that, is, dinerent trom the state that issued this order, a copy must be prov aed to your employee even, the uox ~s not cnecKea. 1. We appreciate the voluntary compliance of Federally recognized indian tribes, tribally-owned businesses, and indian-owned businesses Jocated on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority, if there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* Reporting'the Paydate/Date of withholding. Yot~ must ~eport the paydateJdate of withholding when sending the payment. The p'ayd~te/date ' ' ' ~h amount wa~he~mployee's wages. You must comply with the law of the state of the empioyee's/obiigor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you am unable to honor ali support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of emp~oyee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6, Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below, WITHHOLDER'S ID: 3624406830 EMPLOYEE'S/OBLIGOR'S NAME: T,EEN, TIMOTHY A. EMPLOYEE'S CASE IDENTIFIER: 7939'[01023 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. if you have any questions about lump sum payments, contact the person or authority be[ow. 8. Liability: If you fail to withhold income as the OrdedNotice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law, Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/ob[igor because of a support withholding. Pennsylvania State law governs un[ess the ob[igor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U,S.C. § 1673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 1 1. Additional Info: *NOTE: If yo,u or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 if you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 NO: 0970-(3154 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: LEEN, TIMOTHY A. PACSES Case Number 147104946 Plaintiff Name BRENDA S. LE~N Docket Attachment Amount 02-1884 CIVIL $ 347.00 Child(mn)'s Name(s): DOB ]"~']lf checked, you are required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB [] If checked, you am required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB [] If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available throu§h the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB : [] If checked, you are required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB [] If checked, you am required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(mn)'s Name(s): DOB [] If checked, you are required to enroll the child(mn) identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M Addendum OMB No.: 0970-0154 Form EN-028 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 09/11/03 Tribunal/Case Number (See Addendum for case summary) (~) Original Order/Notice C) Amended Order/Notice C) Terminate Order/Notice Employer/¥Vithholder's Federal EIN Number HASTINGS CORP. 1631 BRIDGE ST NEW CUMBERLAND PA 17070-1174 RE: LEEN, TIMOTHY A. Employee/Obligor's Name (Last, First, Mi) 201-52-4340 Employee/Ob]igor's Social Security Number 7939101.023 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated witl~ cases on attachment) Custodial Parent's Name (Last, First, Mr) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 39'7, oo per month in current support $ 50. oo per month in past-due support Arrears 12 weeks or greater? (~)yes C) no $ 0. oo per month in medical support $ o. oo per month for genetic test costs $ per month in other (specify) for a total of $ 347.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 80.08 per weekly pay period. $ 160.1.5 per biweekly pay period (every two weeks). $ 1.'73.50 per semimonthly pay period (twice a month). $ 3,t'7. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no Pater than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer tothe laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Date of Order: SEP 1 g 2003 Service Type M Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: /'~ ~,- Il ~ Form EN-028 OMB No.: 097(~154 J~ Worker ID $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ~ f.ghecke,d you are required to provide a~opy of th s form to your ~mployee. If yogr employee worlds in a state that is different trom the state that issued th s oraer, a copy must be providecl to your employee even if the oox is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income, Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one empthyee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* Report;ng the Paydate/Date of Withh~must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on whid~amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments, 5? Employee/Obligor with Multiple Support Holdings: If them is mom than one Order/Notice to Withhold Income for Support against this employee/obligor and you am unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 2321459890 EMPLOYEE'S/OBLIGOR'S NAME: LEEN, TIMOTI-[Y A. EMPLOYEE'S CASE IDENTIFIER: 7939~.01023 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the OrdedNotice directs, you am liable for both the accumulated amount you should have withheld from the employe~/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You am subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold mom than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. § 1673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. t t. Additional Info: *NOTE: if you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P,O. BOX 320 CARLISLE PA 1 7013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (71 7) 240-6225 or by FAX at (71 7) 240-6248 or by intemet www.childsupportstate.pa.us Page 2 of 2 Form EN~028 Service Type M oM~ No.:0970q)154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: LEEN, TIMOTHY A. PACSES Case Number 147104946 Plaintiff Name BRENDA S. LEEN Docket Attachment Amount 02-1884 CIVIL$ 347.00 Chiid(ren)'s Name(s): DOB [] If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the emp[oyee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.o0 Child(mn)'s Name(s): DOB [] If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.0o Child(ren)'s Name(s): DOB r'-llf checked, you are required to enroll the child(ten) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB I-"[If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOg [~]lf checked, you are required to enroll the child(ren) identified above in any health i.n, surance coverage available through the employee's/obligor s employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.o0 Child(ren)'s Name(s): DOB ii~ili ??!! ii ii!~i~ ii!? iii? [] If checked, you am required to enroll the child(ten) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum Form EN-028 Service Type M oM6 No.:097o-0154 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 09/25/03 Tribunal/Case Number (See Addendum for case summary) RE: LEEN, TIMOTHY A. Employer/VVithholder's Federal EIN Number HASTINGS CORP. 1631 BRIDGE ST NEW CUMBERLAND PA 17070-1174 C) Original Order/Notice C) Amended Order/Notice (~) Terminate Order/Notice Employee/Obligor's Name (Last, First, MI) 201-52-4340 Employee/Obligor's Social Security Number 7939101023 Employee/Obligor'$ Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORD£R INFORMATION: This is an ©rder/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ o. oo per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes (~) no $ 0. o0 per month in medical support $ 0. o0 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ o. 0o per weekly pay period. $ 0. oo per biweekly pay period (every two weeks). $ 0. oo per semimonthly pay period (twice a month). $ 0. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. ~' " ~ ' i~"~: ~ ? ,ki Y J E couirr: /'7 Date °f Order:~l~_' ~ ~L ~//~. Form EN-028 Se~ice Type M OMBNO.:097~0194 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS [] Ifchecked you are required to prpvide a ~:opy of this form to your~mployee. If your employee works in a state that, is different trom the state that issue~J this oraer, a copy must be provioed to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. .... ~ ......... : ............................................................. ' .............. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #t 0 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 232~.45989o EMPLOYEE'S/OBLIGOR'S NAME: T,EEN, TIMOTHY A. EMPLOYEE'S CASE IDENTIFIER: 7939101023 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he ,:)r she is employed governs. 9. Anti-discrimination: You are subject to a fine determined understate law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed govems. 10.* Withholding Limits: You may not withhold more than the lesser of: 1 ) the amounts; allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly eamings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state tl~at issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 1 7013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (71 7) 240-6225 or by FAX at ~Z..1.ZI~ or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Service Type M OMB NO.: 0970-0154 Worker ID $'rATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of C~ERL~'~D Date of Order/Notice lO/07/o3 Tribunal/Case Number (See Addendum for case summary) (~) Original Order/Notice O Amended Order/Notice O Terminate Order/Notice Empl~er/Withholder'sFede~[EIN Number 4000 INDUSTRIAL RD HARRISBURO PA 17110-2947 RIS: LEEN, TIMOT~{Y A. 61V ,I £rnployee/Obligor's Name (Last, First, MI) 201-52-4340 Employee/Obligor's Social Security Number '793910'[023 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 297.00 per month in current support $ 50.00 per month in past-due support Arrears '12 weeks or greated (~)yes C) no $ o. oo per month in medical support $ 0. oo per month for genetic test costs $ per month in other (specify) for a total of $ 34'7.00 per month to be forwarded to payee below, You do not have to vary your pay cycle to be in compliance with the support order, If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 8 o. 08 per weekly pay period. $ 160.15 per biweekly pay period (every two weeks), $ 173.50 per semimonthly pay period (twice a month). $ 34?. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/obligor's a§gregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-95§0 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: OCT 0 8 2003 DRO: RICKIE SHADDAY OMB NO.; 0970-0154 Service Type BY THE COU T: Form EN-O28 Worker ID SZATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS [] If ~;hecked you are required to prpvide a ~:opy of this form to your employee, If yogr employee works in a state ~thal; is dinerent from the state that issued this omer, a copy must be providec~ to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* Reporting the Paydat~:)~te of Withholding. You must report the paydate/date of withholding when ~nding the payment. The paydate/date of withholding ~s the date on which amou,lt was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 68380000&8 EMPLOYEE'S/OBLIGOR'S NAME: T,E~N, TIMOTHY A. EMPLOYEE'S CASE IDENTIFIER: ?93910'1023 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs, 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed govems. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. § 1673 (b) l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). Al)WE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (71 7) 240-6248 or by intemet www.childsupport.state.pa.us Page 2 of 2 Form EN~028 Service Type M 0~6 N0:0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant~Obllgor: LEEN, TIMOTHY A. PACSES Case Number 147104946 Plaintiff Name BRENDA S. LEEN pocket Attachment Amount 02-1884 CIVIL $ 347.00 ChiJd(ren)'s Name(s): Dog I-~]lf checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSE5 Case Number Plaintiff Name Docket Attachment Amount $ 0.0o Child(ren)'s Name(s): DOB [] If checked, you are required to enroll the child(ten) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB I-'Ill checked, you are required to enroll the child(ten) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB : []if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.o0 Child(ren)'s Name(s): DOB !!(i!( i iiiiiiii !!ii i ill~; iii ii? iil iii~!!~i ii [] If checked, you are required to enroll the child(ren identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB [] If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT oRDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pent Co./City/Dist. of CUMBERLA~ Date of Order/Notice 10/17 Tribunal/Case Number (SeeA Employer/~Vithholder's Federal EIN N, THE SYGMA NETWORK PO BOX 7327 DUBLIN OH 43017-0 See Addendum ORDER INFORMATION: Thi from CUMBERIaAND amounts from the above-namE issued by your State. $ 297.00 per month i $ 50.00 per month i $ 0.00 per month i $ 0.00 per month $ per month for a total of $ 347.0 You do not have to vary your the ordered support payment, $ 80. o8 per weekly $ 1.60.15 per biweek $ 173.50 per semim( $ 347.00 per monthl REMITTANCE INFORMATIOI You must begin withholding r Order/Notice. Send payment deduct a fee to defray the allowable amount. The total ' aggregate disposable weekly t needed (See #10 on pg. 2). If remitting by EFT/EDI, pleasi Customer Service at 1-877-67 Make Remittance Payabl Send check to: Pennsylv. IN ADDITION, PAYMENTS above as the Employee/Obli8 DO NOT SEND CASH BY M/ Date of Order: [JCl 2 0 Service Type M sylvania f03 ]dendum for case summary) {~) Original Order/Notice C) Amended Order/Notice C) Terminate Order/Notice mber RE:LEEN, OF OHIO INC 709 TIMOTHY A. Employee/Obligor's Name (Last, First, M 201-52-4340 Employee/Obligor's Social Security Nurn 7939101023 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on atlachment) Custodial Parent's Name (Last, First, MI) ~r dependent names and birth dates associated with cases on attachment. . is an Order/Notice to Withhold Income for Support based upon an order for support County, Commonwealth of Pennsylvania. By law, you are required to deduct thes d employee's/obligor's income until further notice even if the Order/Notice is not n current support n past-due support Arrears 12 weeks or greater? (~)yes C) no n medical support or genetic test costs n other (specify) .) per month to be forwarded to payee below. )ay cycle to be in compliance with the support order. If your pay cycle does not mab ycle, use the following to determine how much to withhold: pay period. y pay period (every two weeks). nthly pay period (twice a month). ~ pay period. later than the first pay period occurring ten (10) working days after the date of this ,ithin seven (7) working days of the paydate/date of withholding. You are entitled tc of withholding. Refer to the laws governing the work state of your employee for the vithheld amount, and your fee, cannot exceed 55% of the employee's/obligor's arnings. For the purpose of the limitation on withholding, the following information call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer ~-9580 for instructions. to: PA SCDU da SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 lUST INCLUDE THE DEFENDANTS NAME AND THE PACSES MEMBER ID (shown )r's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSEL IL. ~ ~! ' BY THE COUJl~ j~ ,~ Form EN-028 OMBNo:0970-01S4 Worker ID $IAT[ )er ADDITION, [] If checked you are requi different trom the state 1. We appreciate the voluntary comt businesses located on a reservation ti 2. Priority: Withholding under thisl Federal tax levies in effect before reo agency listed below. 3. Combining Payments: You can o each agency requesting withholding. employee/obligor. 4/RepoC~;aF, the Paydate/Date of W paTd,,~e/da~e of w]thhold lng ], the da state of the emp[oyee's/ob[igor's prin withholding order and forward the SL 5.* Employee/Obligor with Multiple this employee/obligor and you am ur the law of the state of employee's/ob possible. (See #10 below) 6. Termination Notification: You m Please provide the information tuque WITHHOLDER'S ID: EMPLOYEE'S/OBUGOR'S EMPLOYEE'S CASE IDENTI LAST KNOWN HOME ADI NEW EMPLOYER'S NAME/ 7. Lump Sum Payments: You may I: severance pay. If you have any ques 8. Liability: If you fail towithhold ir withheld from the employee/obligor' the obligor is employed in another S1 9. Anti-discrimination: You are sub refusing to employ, or taking discipli~ governs unless the obligor is employ 10.* Withholding Limits: You may r Protection Act (t 5 U.S.C. §1673 (b)l The Federal limit applies to the aggr¢ deductions such as: State, Federal, 11. Additional Info: * NOTE: If you or your agent are law of the state that issued this kL INFORMATION TO EMPLOYERS AND O'rHER WITHHOLDERS ed to provide a ~:opy of this form to your~mp oyee If your employee works in a state that, is ~t issued this or(~er, a copy must be proviued to your employee even if the box is not checked. liance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned at choose to withhold in accordance with this notice. )rder/Notice has priority over any other legal process under State law against the same income. ~t of this order have priority. If there are Federal tax levies in effect please contact the requestir Jine withheld amounts from more than one employee/obligor's income in a single payment t You must, however, separately identify the portion of the single payment that is attributable to ( ~ ,~,, ,,,,,.~,, ,,,,,~,u,,~ ,,,~ ,,,,,,,,~,u ,,,,,,, ,,,~ ~,,,v,~,~=~ ~ ,,,~,. You must comply w~th the law c :ipal place of employment with respect to the time periods within which you must implement th ~port payments. Support Holdings: If there is more than one Order/Notice to Withhold Income for Support agail able to honor all support Order/Notices due to Federal or State withholding limits, you must foil or's principal place of employment. You must honor all Orders/Notices to the greatest extent ;t promptly notify the Requesting Agency when the employee/obligor is no longer working for ;ted and return a copy of this Order/Notice to the Agency identified below. ~46080 AME: LEEN, TIMOTHY A. FIER: 7939101023 DATE OF SEPARATION: ~RESS: kDDRESS: e required to report and withhold from lump sum payments such as bonuses, commissions, or ions about lump sum payments, contact the persor or authority below. come as the Order/Notice directs, you are liable for both the accumulated amount you should h income and other penalties set by Pennsylvania Slate law. Pennsylvania State law governs unl, ~te, in which case the law of the State in which he or she is employed governs. ect to a fine determined under State law for discharging an employee/obligor from employment, ~ary action against any employee/obligor because of a support withholding. Pennsylvania State in another State, in which case the law of the State in which he or she is employed governs. : withhold more than the lesser of: 1 ) the amounts allowed by the Federal Consumer Cred it or 2) the amounts allowed by the State of the employee's/obligor's principal place of employm~ ;ate disposable weekly eamings (ADWE). ADWE is the net income left after making mandatory :al taxes; Social Security taxes; and Medicare taxes. served with a copy of this order in the state that issued the order, you are to follow der with respect to these items. Submitted By: DOMESTIC RELATIONS S 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 1 701 3 :TION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at ('71 7) 240-6248 or by internet www.childsupportstate.pa.us Page 2 of 2 Form EN-028 Service Type M :h fthe )w aw at. T OMB NO.~ 0970-0154 Worker ID $I~ ADDENDUM Summary of Cases on Attachment IObligor: T,EEN, TIMOTHY A. Defendanl PACSES Case Number 147104946 Plaintiff Name BRgoq~e?' LEENAttachment ^moUnt 02- ~-i~ ezvzL$ 347.09 Child(ren)'s Name(s): ' DOB [ I~]lf checked, you are required to el roll the child(ren) identified above in any health insura~ ,ce coverage available through the employee's/obligor's em )loyment PACSE5 Case Number Plaintiff Name Docket Attachment Arno mt $ 0.0~ Child(ren)'s Name(s): DOB I~lf checked, you are required to e~ roll the child(ren) identified above in any health insura ~ce coverage available through the employee's/obligor's em )loyment. PACSES Case Number Plaintiff Name Docket Attachment Am( ~nt $ 0. Child(ren)'s Name(s): DOB I I I [] If checked, you are required to e, roll the child(ren) identified above in any health insura ~ce coverage available through the employee's/obligor's em )loyment Service Type M PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): I~lf checked, you are required to enroll the child(ren) identified above in any health insurance coverage availab through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(mn)'s Name(s): )B [] If checked, you are required to enroll the child(ten) identified above in any health insurance coverage availab through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(renys Name(s): [] If checked, you are required to enroll the child(ren) identified above in any health insurance coverage availab through the employee's/obligor's employment. Addendum OMB NO.: 0970~)154 Form EN-028 Worker ID ATT ORDER/NOTICE TO WITHHOLD INCOME FOR !SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 10/31/03 Tribunal/Case Number (See Addendum for case summary) RE: T,R~N', TIMOTHY A. Employer/Withholder's Federal EIN Number THE SYGMA NETWORK OF OHIO INC PO BOX 7327 DUBLIN OH 43017-0709 C) Original Order/Notice C) Amended Order/Notice (~ Terminate Order/Notice Employee/Obligor's Name (Last, First, MI) 201-52-4340 Fmployee/Obligor's Social Securi~ Number 7939101023 Employee/Obligor'$ Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ o. 00 per month in current support $ 0. o0 per month in past-due support Arrears 12 weeks or greater? Oyes (~) no $ o. 0o per month in medical support $ o. 0o per month for genetic test costs $ per month in other (specify) for a total of $ 0. O0 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0, OD per biweekly pay period (every two weeks). $ 0 · 00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (1 O) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-675-9580 for instructions. Make Remittance Payable tot PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CAS. MA,L. ^,~-,, ~_B_Y TH~? co~/~lr': // ~· .3 20n*~ /, I / // .-, /// Date of Order:_ 1/ Form EN-028 Worker ID STAT? Service Type M OMB NO~: 0970'0154 ~1/ ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ' [] fchecked you are requ red to prov de acopy of this form to youremo oyee. If your employee works in a state thatis different from the state that ssubcl th s order, a copy must be prov dedto your employee even if the box s not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. ....................................................................... , .......... You must comply with the law ofthe state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. $.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 7602546080 EMPLOYEE'S/OBLIGOR'S NAME: LEEN, TIMOTHY A. EMPLOYEE'S CASE IDENTIFIER: 7939101023 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be requital to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law govems unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You am subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because cf a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold mom than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE iD the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes~ and Medicare taxes. 1 1. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 1 7013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717~ 240-6248 or by internet www.childsupportstate.pa.us Page 2 of 2 Form EN-028 Service Type M OMBNo.:09700154 Worker ID $IATT In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION BRENDA S. LEEN ) Docket Number Plaintiff ) vs. ) PACSES Case Number TIMOTHY A. LEEN ) Defendant ) Other State ID Number 02-1884 CIVIL 147104946 PETITION FOR MODIFICATION OF AN EXISTING SUPPORT ORDER 1. The petition of TIMOTHY ANDREW LEEN respectfully represents that on OCTOHER 24, 200e , an Order of Court was entered for Alimony P~nd~nt~ Lit~ for BRENDA SUE LEEN Service Type M Form OM-501 Worker ID 21005 LEEN v. LEEN PACSES Case Number: 147104946 2. Petitioner is entitled to 0 increase O decrease (~) termination O reinstatement O other of this Order because of the following material and substantial change(s) in WHEREFORE, Petitioner requests that the Court modify the existing order for support. Petitioner Attorney for Petitioner I verify that the statements made in this complaim are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to unswom falsification to authorities. Date Petltloner Page 2 of 2 Service Type lq Form OM-501 Worker ID 21005 TIMOTHY A. LEEN, Plaintiff/Respondent/Petitioner : VS. : BRENDA S. LEEN, : Defendant/Petitioner/Respondent : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 2002-1884 CIVIL TERM IN DIVORc E Pacses# 147104946 ORDER OF COURT AND NOW, this 18~h day of November, 20031, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby dfi"ected that the parties and their respective counsel appear before ~ on December 16 2003 PA 17013, after which ~'.'~2'.~~_ o_ z~o.s at 10:30 A.M. for a entered. - .....onrerence officer ma-- .~*,,~s~nce, at 13 N. Hanover e .... y recommend that all Order for au~^_ ~, . or., LarllSle, ..... ~,uuy renaente Lite be YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) Yunr pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, Completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical COverage which you may have, or may have available to you warrant IforFyYo°uUrfaiar3let;.appear f°r the conference or bring therequired documents' theCourtmayissuea Mail copies on Petitioner 11-21-03 to: < Respondent Samuel Andes, Esqu/re John Purcell, Esquire Date of Order: November 18 2003 BY THE COURT, George E. Holler. President Judge · R. J,l~hndd~(¥. Confe~ ..... r~,x~ 7 ' YOU HAVE THE RIGHT TO A LAWYER, WHO ~ ...... h .......... ,~mcer ( /! REPRESENT YOU. YOU DO NOT HAVE A IF "~'°'r A fTEND TIlE CONFERENCE AND OR TELEPHONE THE OFFICE SET FORTH BELOw TO FIND OUT WHERE YOU MAY GET LEGAL HELP. LAWYER OR CANNOT AFFORD ONE, GO TO CUMBERLAND COUNTy BAR ASSOCIATION 2 LIBERTy AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 CC361 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION TIMOTHY r.R~N Plaintiff/Respondent/Petitioner vs. BRENDA LEEN Defendant/Petitioner/Respondent ) Docket Number ) ) PACSES Case Number ) ) Other State ID Number 02-1884 CIVIL 147104946 ORDER AND NOW, to wit, on this 16TH DAY OF DECEMBER, 2003 IT IS HEREBY ORDERED that the APL order in this case be O Vacated or (~) Suspended or C) Terminated without prejudice or C) Terminated and Vacated, effective OCTOBER 13, 2003 , due to: THE WIFE NOT APPEARING FOR THE SCHEDULED CONFERENCE ON THIS DATE A2TD THE DEFENDA/qT BEING UNEMPLOYED AND HAVING THE CARE AND CUSTODY OF THE pARTIES' TWO CHILDREN. COLLECTION ON THE REMAINING BALANCE OF $1318.44 WILL BE HELD IN ABEYANCE AND MAY BE USED FOR ANY RETROACTIVE ARREARS ON THE CHILD SUPPORT COMPLAINT FILED UNDER DOCKET NOS. 864 S 2002 AND PACSES#348104883. DRO: RJ Shadday xc: plaintiff defendant John Purcell, Esquire Service Type M BY THE COURT://~ a~ ley Ole;~,~ .- '~--~ J-UDGE Form 0E-504 Worker ID 21005 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co.~City~Dist. of CCn~3ER~ Date of Order/Notice 12/16/o3 Tribunal/Case Number (See Addendum for case summary) C) Original Order/Notice C) Amended Order/Notice (~) Terminate Order/Notice £mployer/Withholder's Federal EIN Number SQUARE D COMPANY * PO BOX 27446 RALEIGH NC 27611-7446 RE:LEEN, TIMOTHY A. E mployee/Obligor's Name (Last, First, MI) 201-52-4340 EmpioyeodObligor's Social Security Number 79393.01023 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated w~th cases o~ attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Not/ce to Withhold Income for Support based upon an order for support from CUMBERLAND CounO/, Commonwealth of Pennsylvania, By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? C)yes (~ no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0,00 per biweekly pay period (every two weeks). $ 0,00 per semimonthly pay period (twice a month). $ 0,00 per monthly pay period. REMITTANCE IHFORMA TION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You am entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the wor~ state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of tbe employee's/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by FFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMRER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMRER IN ORDER TO RE PROCESSED. DO NOT SEND CASH BY MAIL. ........ ~ --*-~L By THE COURT: //} /~ Date of Order: , Sewice Ty~ M OM~ No. 097~154~ Worker ID $~TT ADDITIONAL INFORMATION TO I:MPLOYI:RS AND OTHFR WITHHOLDI:RS [] If~hecke~ you are required to provide a ~:opy of this form to your~mployee. If your employee works in a state thatis dinerent from the state that issuedthis order, a copy must be provided to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federa) tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below~ 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* Repo,'ting the PaydateJ'Date of Withholding. You must report the paydate/date of withholding when sendlng the payment. The paydate/date of withholding is the date on which ~mount was withheld from the employe~'s wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Nsf ice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 3624406830 EMPLOYEE'S/OBLIGOR'S NAME: LEEN, TIMOTHY A. EMPLOYEE'S CASE IDENTIFIER: ?939101023 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you. should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of: 1 ) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVERST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE A'CI-ACHMENT UNIT by telephone at (717) 240-622.5 or by FAX at [717) 240-6248 or by intemet www.childsupport.state.pa, us Service Type Page 2 of 2 Form EN-028 Worker ID $IATT ORDFR/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist of CUM~ER.t,AND Date of Order/Notice ].2/16/o3 Tribunal/Case Number (See Addendum for case summary) O Original Orde#Notice O Amended Order/Notice (~) Terminate Order/Notice Employer/VVithholder's Federal EIN Number SQUARE D 201 CUMBERLAND Pk'WY MECHANICSBURG PA 17055-5664 RI?: LEEN, TIMOTHY A. £mpioyee/Obligor's Name (Last, Firsb MI) 201-52-4340 I~mployee/Obli§or's Social Security Number '1939101023 E mpioyee/Obiigor's Case identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment~ ORDER INFORMATION: This is an Order/Notice to Withhold income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? C) yes (~) no $ 0.0o per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order, if your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your emp}oyee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed {See #10 on pg, 2), If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at ]-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. ~ , .. ~ ~, ~ Form EN-028 5e~ice Type M o~ NO.: 0~S~ Worker ID $ IATT ADDITIONAL iNFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS [] fchecked you are required to prpv de a %ropy of th s form to your employee. If your employee worlds in a state thai;is different from the state that issued this oreer, a copy must be prov tied to your employee even if tl~eeox is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice, 2. Priority: Withholding under this Order/Notice has pdority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3, Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* Reporting-tire Payclate/Date of Withholding. You must report the-paydateJdate of withholding when sending the payment. The paydateMate of withholding is the date on which anroLmt was withheld fl~om the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold lncome for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #t0 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 46?1000024 EMPLOYEE'S/OBLIGOR'S NAME: LEEN, TIMOTHY A. EMPLOYEE'S CASE IDENTIFIER: 7939Z01023 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. §. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from emp}oyment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N, HANOVER ST P.O. BOX 320 CARUSLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www. childsupport.state.pa.us Service Type M Page 2 of 2 Form EN-028 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co.~City~Dist. of CUMBERLAND Date of Order/Notice 12/16/03 Tribunal/Case Number (See Addendum for case summary) C) Original Order/Notice C) Amended Order/Notice (~ Terminate Order/Notice Employer/Withholder's Federal EIN Number SYGMA NETWORK 4000 INDUSTRIAL RD HARRISBURG PA 17110-2947 R£:LEEN, TIMOTHY A. Employee/Obligor's Name (Last, Firsb MI) 201-52-4340 Employee/Obligor's Social Security Number 7939101023 Employee/Obligor'$ Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERI~ND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? C)yes (~) no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ 0.0o per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55*/0 of the employee's/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to.' PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Ohligor's Case Identifier) OR SOCIAl SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. ~ , , /~ ~-0 ~ .... BY THE COJJRT: /~' Date of Order: ' ' ,-f/~'3 L/~/// Form EN-028 $e~ice Ty~e ~ o~ No.:097~154 Worker ID 8~ ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHO/DERS [] I~hecke~J you are required to prpvide a~opy of this form to yourcmployee. If yogr employe~,worlcs in a state tha~kis, dinerent trore the state that issuecl this omer, a copy must be provided to your employee even it the oox is not chec eo. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* Reporting the Paydate/Date of Withholding. You Must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Terminafio. Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 6838000048 EMPLOYEE'S/OBLIGOR'S NAME: LEEN, TIMOTHY A. EMPLOYEE'S CASE IDENTIFIER: '/939101023 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-di~crimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State Jaw governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed govems. 10.* Withholding Lim~: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandato~ deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 1L Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: ~DOMESTIC RELATIONS SECTION 13 N. HANQVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupportstate.pa.us Page 2 of 2 Form EN-028 Service Type M OM[~ NO.: 0970~1 $4 Worker ID $IATT In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: TIMOTHY A. LEEN Member ID Number: 7939101023 Please note: All correspondence must include the Member ID Number. ORDER TO VACATE ATFACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiole Cases on Attachment PACSES Docket Plaintiff Name Case Number Number BRI~'~DA S. LEEN 147104946 02-1884 CIVIL AtmchmentAmoun~FreQuenc¥ /MONTH 347.00 1 / TOTAL ATTACHMENT AMOUNT: $ 0.0 o The prior Order of this Court directing the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), to attach $ o. 0 o or so % per week of the Unemployment Compensation benefits of TIMOTHY A..LEEN , Social Security Number 201-s2-4340 , Member ID Number 7939101023 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: Service Type M Form EN-035 Worker ID $IATT TIMOTHY A. LEEN : Plaintiff/Respondent/Petitioner : VS. : BRENDA S. LEEN : De fendanffPetitioiner/Respondent: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 2002-1884 CIVIL TERM IN DIVORCE DR# ORDER OF COURT NOTICE OF RESCHEDULED CONFERENCE AND NOW, this 27th day of January, 2004, upon consideration of the attached Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shadda¥ on Februar~ 19~ 2004 at 10:30 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommet~d that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Ret~m, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, George E. Hoffer, President Judge Mail copies on Petitioner /-~,q~9~/ to: < Respondent Samuel Andes, Esquire John Purcell, Esquire Date of Order: January 27, 2004 R[/J. Sbadday, Conference Officer YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 CC361 TIMOTHY A. LEEN, Plaintiff VS. BRENDA S. LEEN, Defendant · IN THE COURT OF COMMON PLEAS · CUMBERLAND COUNTY, PENNSYLVANIA : NO. 02-1884 CIVIL TERM : CIVIL ACTION-LAW :IN DIVORCE AFFIDAVIT OF CONSENT 1. a Complaint in Divorce under Section 3301(c) of the divorce Code was flied on April 17, 2002. 2. The marriage of Plaintiff and Defendant i~; irretrievably broken and ninety 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. ~ TIMOTHY A. LEEN WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE ONDER §3301(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 and Waiver are true and correct. I understand that false statements herein arE; made subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities. Date; April 16, 2004 /~-~ ~ TIMOTHY A. LEEN TIMOTHY A. LEEN, Plaintiff VS. BRENDA S. LEEN, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : : NO. 02-1884 CIVIL TERM : CIVIL ACTION-LAW : IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301(c) of the divorce Code was filed on April 17, 2002. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of filing and serv~ice 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. WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER §3301(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 fights 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 mutil 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 and Waiver are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities. Date: Brenda S. Leen TIMOTHY A. LEEN, Plaintiff VS. BRENDA S. LEEN, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 02-1884 CIVIL TERM : CIVIL ACTION-LAW : IN DIVORCE PRAECIPE TO TRANSMIT RECORD THE PROTHONOTARY: Transmit the record, together with the follo~ving information, to the Court for entry of a Divorce Decree: 1. Ground for divorce: Irretrievable breakdown under Section (x) 3301(c) of the Divorce Code. 2. Date and manner of service of the Complaint: August 19, 2002 by Cumberland County Sheriff 3. (a) Date of execution of the Affidavit of Consent required by Section 3301(c) of the Divorce Code: by Plaintiff: April 16, 2004 by Defendant: April 16, 2004 4. Related claims pending: Praecipe Withdrawing Claims filed contemporaneously herewith 5. (a) Date and manner of service of the Notice of Intention to file Praecipe to transmit record, a copy of which is attached: (b) Date of PlaintifFs Waiver of Notice in 3301(c) Divc,rce was filed with Prothonotary: Filed contemporaneously herewith Date of Defendant's Waiver of Notice in 3301(c) Divorce was filed with the Prothonotary: Filed contemporaneously h~~ j~C~L, JR. ESQ. STATE OF TIMOTHY A. LE~N IN THE COURT OF COM~4ON PLEAS OF CUMBERLAND COUNTY , ~~~ ~ PENNA. Plaintiff VERSUS BRENDA S. LEEN Defendant NO. 1884 CIVIL TE~ 2002 DECREE IN DIVORCE AND NOW, ~ ~,, ~O DECREED THAT T~mothy A. Leen , ~.,~.~L~, IT IS ORDERED AND , PLAINTIFF, Brenda S. Leen DEFENDANT, AND ARE DIVORCED FROM THE BONDS OF MATRIMONY. THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT YET BEEN ENTERED; None BY THE COURT: // ~ ATifS T~~/~~ J' /~ .~/ PROTHONOTAR;