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HomeMy WebLinkAbout06-4941"I t CRAIG J. BEISSEL, Plaintiff, VS. JENNIFER L. BEISSEL, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA NO.l, : CIVIL ACTION - LAW : IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action. You are warned that, if you fail to do so, the case may proceed without you and a decree of divorce or annulment be entered against you by the Court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary, Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. LAWYER REFERRAL SERVICE of the Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telephone (800) 990-9108 CRAIG J. BEISSEL, Plaintiff, VS. JENNIFER L. BEISSEL, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. CIVIL ACTION - LAW IN DIVORCE AVISO PARA DEFENDER Y RECLAMAR DERECHOS USTED HA SIDO DEMANDADO EN LA CORTE. Si desea defenderse de las quejas expuestas en las paginas seguientes, debe tomar accion con prontitud. se le avisa que si no se defiende, el caso pude proceder sin usted y decreto de divorcio o anulamiento puede ser emitido en su contra por las Corte. una decision puede tambien ser emitida en su contra por caulquier otra queja o compensacion eclamados por el demandante. Usted puede perder dinero, o propiedades u otros derechos importantes pars usted. Cuando la base para el divorcio es indignidades o rompimiento irreparable del matrimonio, usted puede solicitar consejo matrimonial. Una lista de consejeros matrimoniales esta disponible en la oficina del Prothonotary, en la Cumberland County, One Courthouse Square, Carlisle, PA 17013. SI USTED NO RECLAMA PENSION ALIMENTICIA, PROPIEDAD MARITAL, HONORARIOS DE ABOGADO U OTROS GASTOS ANTES DE QUE EL DECRETO FINAL DE DIVORCIO O ANULAMIENTO SEA EMTH10, USTED PUEDE PERDER EL DERECHO A RECLAMAR CUALQUIERA DE ELLOS. USTED DEBE LEVAR ESTE PAPEL A UN ABOGADO DE INMEDIATO. SO NO TIENE O NO PUEDE PAGAR UN ABOGADO, VAYA O LLAME A LA OFICINA INDICADA ABAJO PARA AVERIGUAR DONDE PUEDE OBTENER ASISTENCIA LEGAL. LAWYER REFERRAL SERVICE of the Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telefono (800) 990-9108 CRAIG J. BEISSEL, : IN THE COURT OF COMMON PLEAS OF Plaintiff, : CUMBERLAND COUNTY, PENNSYLVANIA VS. :NO. 66 - Cwi/ Tu.? JENNIFER L. BEISSEL, : CIVIL ACTION - LAW Defendant : IN DIVORCE COMPLAINT IN DIVORCE AND NOW, comes Plaintiff, Craig J. Beissel, (hereinafter referred to as "Plaintiff'), by and through his counsel, Linda A. Clotfelter, who files this Complaint in Divorce and in support thereof states the following: 1. Plaintiff is Craig J. Beissel, an adult individual who resides at 113 Mountainview Drive, Enola, Cumberland County, Pennsylvania 17025. 2. Defendant is Jennifer L. Beissel, (hereinafter "Defendant"), an adult individual who resides at 113 Mountainview Drive, Enola, Cumberland County, Pennsylvania 17025. 3. Plaintiff and Defendant have been bona fide residents of the Commonwealth of Pennsylvania for at least six (6) months immediately prior to the filing of this Divorce Complaint. 4. Plaintiff and Defendant were married on June 6, 1992, in Cumberland County, Pennsylvania. 5. The parties have been separate and apart within the meaning of the Pennsylvania Domestic Relations Code since May 1, 2006. 6. There have been no prior actions of divorce or for annulment between the parties. 7. Plaintiff avers that the marriage is irretrievably broken. 8. Plaintiff has been advised of the availability of counseling and that Plaintiff may have the right to Plaintiff does not desire counseling. 9. Plaintiff requests that the court to enter a decree of divorce. WHEREFORE, Plaintiff, Craig J. Beissel, respectfully requests that this Court enter a Decree of Divorce and grant such other relief as this Court deems just and proper. Respectfully submitted, LAW FIRM OF LINDA A. CLOTFELTER Date: 011 (0 y: Fjo U da A. Clotfelter, Esquire A torney ID No. 72963 21 East Trindle Road, Suite 100 Mechanicsburg, PA 17050 (717) 796-1930 telephone (717) 796-1933 facsimile Attorney for Plaintiff CRAIG J. BEISSEL, : IN THE COURT OF COMMON PLEAS OF Plaintiff, : CUMBERLAND COUNTY, PENNSYLVANIA Vs. : NO. JENNIFER L. BEISSEL, : CIVIL ACTION - LAW Defendant : IN DIVORCE VERIFICATION I, CRAIG J BEISSEL, verify that the statements in the foregoing COMPLAINT IN DIVORCE are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unworn falsification to authorities. Date: ?e?W nz CRAIG ISSEL, Plaintiff N T t_ n , ? t 9^ 7 1 r«?, ? -o ft T ` • N r+ m ; /A?` .y j ("I v x ? N N Q CRAIG J. BEISSEL, : IN THE COURT OF CC Plaintiff, : CUMBERLAND COUN VS. : NO. 06-4941 JENNIFER L. BEISSEL, : CIVIL ACTION - LAW Defendant : IN DIVORCE ACCEPTANCE OF SERVICE I, JENNIFER BEISSEL, Defendant in the above-captioned of the DIVORCE COMPLAINT Under Section 3301(c) or 3301(d) of Code on this date. Date: RJAI&I VION PLEAS OF ,PENNSYLVANIA hereby accept service Domestic Relations ?'? ` ' 5 ?}i V ...? .T? r'l ...? g'? '?. i CRAIG J. BEISSEL, : IN THE COURT OF C( Plaintiff, : CUMBERLAND COUN VS. :NO. 0 G- q q qj JENNIFER L. BEISSEL, : CIVIL ACTION - LAW Defendant : IN DIVORCE CERTIFICATE OF SERVICE AND NOW, this 6'' day of September, 2006, the undersigned and correct copy of the foregoing ACCEPTANCE OF SERVICE was party by United States First Class Mail, postage prepaid: Jennifer L. Beissel 113 Mountainview Drive Enola, PA 17025 Respectfully submitted, VION PLEAS OF PENNSYLVANIA certifies that a true upon the opposing LAW FIRM OF LINDA A. CLOTFELTER Li Ada A. Clotfelter, Esquire A rney ID No. 72963 5921 East Trindle Road, Suit Mechanicsburg, PA 17050 (717) 796-1930 telephone (717) 796-1933 facsimile Attorney for Plaintiff' 100 ,.. ,? ? ? ? ? ? ? ?` c?? -? -?, ? : ? ` .; ?r, ? . ' ? <..? . w? ; .{? ?. .I'' .. '?-: ?, a*a =: c ..?. ?,, 03 01/03/2008 13:00 FAX 17179753924 DISSINGER Z03- Craig J. Beissel, : IN THE COURT OF COMMON PLEAS Plaintiff : OF PENNSYLVANIA Vs. : CUMERLAND COUNTY BRANCH : CIVIL ACTION Jennifer L. Beissel, : NO. 0L- Defendant : IN DIVORCE PAAECIPE TO 11ITHDAAW APPR&RA MM To the Prothonotary: At the request of the Plaintiff, Craig J. Beissel, please withdraw my appearance as counsel of record. r r L nda Clotfelter (:torney for Plaint f To the Prothonotary: At the request of the Plaintiff, Craig J. Beissel, please enter my appearance as counsel of record. Mary A. tter Dissinger Attorney for Plaintiff Supreme Court ID 27736 28 N. 32nd Street Camp Hill, PA 17011 (717) 975-2840 (717)975-3924 - fax cc: Elizabeth Beckley, Esquire Linda Clotfelter, Esquire r °; r-z C cc) riopwimp- JAN 0 7 20 DIS' g ic. D CRAIG J. BEISSEL, :IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent :CUMBERLAND COUNTY, PENNSYLVANIA V. :CIVIL ACTION - LAW :IN DIVORCE JENNIFER L. BEISSEL, Defendant/Petitioner :NO. 06-4941 PETITION FOR EQUITABLE DISTRIBUTION, ALIMONY PENDENTE LITE, COUNSEL FEES, COSTS AND EXPENSES AND ALIMONY AND NOW comes the Defendant/Petitioner, Jennifer L. Beissel, who, by and through her attorneys, Elizabeth S. Beckley, Esquire, Charles O. Beckley, II, and Beckley & Madden, of Counsel, files this Petition for Equitable Distribution, Alimony Pendente Lite, Counsel Fees, Costs and Expenses and Alimony, in which she avers that: 1. Defendant/Petitioner, Jennifer L. Beissel, is an adult individual residing at 236 Erford Road, Camp Hill, Cumberland County, Pennsylvania 17011. 2. Plaintiff/Respondent, Craig J. Beissel, is an adult individual residing at 113 Mountain View Drive, Enola, Cumberland County, Pennsylvania 17025. 3. Plaintiff/Respondent filed a Divorce Complaint in this matter on or about August 24, 2006, at the above-captioned docket number. 4. Plaintiff/Respondent and Defendant/Petitioner have acquired property, both real and personal, during the marriage which constitutes marital property subject to equitable distribution under the Divorce Code. 5. Plaintiff/Respondent and Defendant/Petitioner each owned, prior to the marriage, both real and personal property which has increased in value during the marriage, and/or which has been exchanged for other property which has increased in value during the marriage, all of which property is marital property, subject to equitable distribution under the Divorce Code. 6. Plaintiff/Respondent and Defendant/Petitioner have been unable to agree as to an equitable division of said property. 7. Defendant/Petitioner lacks sufficient property to provide for her reasonable means and is unable to support herself in the standard of living established during the marriage through her employment. 8. Defendant/Petitioner has employed counsel, but is unable to pay the necessary and reasonable attorney's fees for said counsel. 9. Defendant/Petitioner is unable to sustain herself during the course of this litigation and will require alimony pendent elite in order to do so. 10. Defendant/Petitioner requires reasonable alimony to adequately maintain herself in accordance with the standard of living established during the marriage. 11. Plaintiff/Respondent has adequate earnings to provide for the Defendant's/Petitioner's support and to pay her counsel fees, costs and expenses. 2 WHEREFORE, Defendant/Petitioner, Jennifer L. Beissel, respectfully requests the Court to: (1) divide all marital property equitably between the parties; (2) enter an award of Alimony Pendente Lite, interim counsel fees, costs and expenses, until final hearing and thereupon award such additional counsel fees, costs and expenses as deemed appropriate; and (3) enter an award of alimony in her favor. DATED: Y$- of Counsel BECKLEY & MADDEN 212 North Third Street P.O. Box 11998 Harrisburg, PA 17108 (717) 233-7691 V 3 Respectfully submitted, VERIFICATION I, Jennifer L. Beissel, hereby verify that the statements made in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties 18 Pa. C. S. Section 4904, relating to unworn falsification to authorities. DATED: Q4ferB-e&k&?'issel CERTIFICATE OF SERVICE I, Elizabeth S. Beckley, Esquire, hereby certify that a true and correct copy of the foregoing document was this day served upon the person and in the manner indicated below. SERVICE BY FIRST CLASS MAIL: Mary A. Etter Dissinger, Esquire Dissinger and Dissinger 28 North Thirty-Second Street Camp Hill, PA 17011 DATED: i ?eth G ?.1 v? 1? C W o d 4 CK, o f r CRAIG J. BEISSEL, THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 06-4941 CIVIL TERM JENNIFER L. BEISSEL, IN DIVORCE Defendant/Petitioner : PACSES CASE NO: 636109944 ORDER OF COURT AND NOW, this 9th day of April, 2008, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before Jennifer L. Gibboney on April 29, 2008 at 9:00 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you. If you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Edgar B. Bayley, President Judge Copies mailed to: Petitioner Respondent Elizabeth S. Beckley, Esq. Mary A. Dissinger, Esq. Date of Order: April 9, 2008 Jennifer L. Gibboney, 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 9 ?,• tint 7 `•r? W CRAIG J. BEISSEL, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 06-4941 CIVIL TERM JENNIFER L. BEISSEL, IN DIVORCE Defendant/Petitioner PACSES CASE ID: 636109944 ORDER OF COURT AND NOW, this 29th day of April 2008, based upon the Court's determination that the Petitioner's monthly net income/earning capacity is $ 2,619.27 and the Respondent's monthly net income/earning capacity is $ 4,736.80, it is hereby ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit Four Hundred Thirty Eight and 00/100 Dollars ($ 438.00) per month payable bi-weekly as follows: $ 416.00 per month for Alimony Pendente Lite and $ 22.00 per month on arrears. First payment due: in accordance with Respondent's pay schedule. The effective date of the order is April 8, 2008. Arrears set at $ 314.56 as of April 29, 2008. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and, at its discretion, make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Jennifer L. Beissel. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the Respondent's name with their PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. cc360 The monthly obligation includes cash medical obligation in the amount of $250 annually for unreimbursed medical expenses incurred for the spouse. Unreimbursed medical expenses of the oblige that exceed $250 annually shall be allocated between the parties. The party seeking allocation of unreimbursed medical expenses must provide documentation of expenses to the other party no later than March 31" of the year following the calendar year in which the final medical bill to be allocated was received. The unreimbursed medical expenses are to be paid as follows: 64% by the Respondent and 36% by the Petitioner. [X] Respondent [] Petitioner [] Neither party to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the [] Petitioner [X] Respondent shall submit to the other party written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of: 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy o the benefits booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final twenty (20) after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. Consented: Petitioner Respondent Mailed copies on: April 30, 2008 to: Petitioner Respondent Elizabeth S. Beckley, Esq. Mary A. Dissinger, Esq. DRO: R.J. Shadday Petitioner's Attorney Respondent's Attorney BY THE COURT, 71?,- * A4 Kevin X- Hess, J. CRAIG J. BEISSEL, : IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 06-4941 CIVIL TERM JENNIFER L. BEISSEL, IN DIVORCE Defendant/Petitioner PACSES CASE ID: 636109944 NOTICE OF RIGHT TO REQUEST A HEARING The parties are hereby advised that they have until May 20.2008 to request a hearing do novo before the Court. File request in person at: Office of the Prothonotary 1 Courthouse Square Carlisle, PA 17013 Or mail to: Office of the Prothonotary 1 Courthouse Square Carlisle, PA 17013 CC363 C7 ? <? -; i ;`t _ _? = ' _ ?. ?? r , -? i _.... ... ` ? <'+ ?: 1 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Q Original Order/Notice Co./City/Dist. of CUMBERLAND 636109944, Amended Order/Notice Date of Order/Notice 05/01/08 06-4941 CIVIL O Terminate Order/Notice Case Number (See Addendum for case summary) RE:BEISSEL, CRAIG J. Employer/Withholder's Federal EIN Number BUREAU OF COMMONWEALTH* C/O WAGE ATTACHEMENT SECTION Employee/Obligor's Name (Last, First, MI) 813109926 210-54-3442 283 S 2008 Employee/Obligor's Social Security Number 1202101965 Employee/Obligor's Case Identifier PO BOX 8006 (See Addendum for plaintiff names HARRISBURG PA 17105-8006 associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1, 147.00 per month in current support $ 44 .00 per month in past-due support Arrears 12 weeks or greater? Dyes ® no $ o . 00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ 0.00 per month in other (specify) for a total of $ _ 1,191.00 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: $ 274.85.per weekly pay period. $ 549.69.per biweekly pay period (every two weeks). $ 595.50 per semimonthly pay period (twice a month). $ 1.191.0o per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: MAY 0 ^008 DRO: R.J. SHADDAY BY THE COURT: KEVIN A -ITESS, JUDGE Form EN-028 Rev Service Type 14 OMB No.: 0970-0154 Worker ID $IATT ti ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? different frrom the state thatdisssueprovide ordecop r, a ccopy? must be providedpto your employee evoen if the box is not chectked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2321722990 EMPLOYEE'S/OBLIGOR'S NAME: BEISSEL CRAIG J. EMPLOYEE'S CASE IDENTIFIER: 1202101965 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: if you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. * Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. i i. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.Pa.us Page 2 of 2 Service Type M OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BEISSEL, CRAIG J. PACSES Case Number 636109944 Plaintiff Name JENNIFER L. BEISSEL Docket Attachment Amount 06-4941 CIVIL$ 438.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number 813109926 Plaintiff Name JENNIFER L. BEISSEL Docket Attachment Amount 00283 S 2008 $ 753.00 Child(ren)'s Name(s): CAELYN J. BEISSEL DOB 01/10/94 ? 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 ?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. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type M OMB No.: 0970-0154 Worker ID $IATT Craig J. Beissel, IN THE COURT OF COMMON PLEAS Plaintiff OF CUMBERLAND COUNTY PENNSYLVANIA VS. CIVIL ACTION - CUSTODY Jennifer L. Beissel, . Defendant NO. N O T I C E T O D E F E N D You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO iOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE PA 17013 717-249-3166 Mary A EAttorney for Plaintiff Craig J. Beissel, Plaintiff VS. Jennifer L. Beissel, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - CUSTODY NO. COMPLAINT FOR CUSTODY 1. Plaintiff is Craig J. Beissel, residing at 2340 Magnolia Terrace Drive, Harrisburg, Dauphin County, Pennsylvania. 2. Defendant is Jennifer L. Beissel, residing at 236 Erford Road, Camp Hill, Cumberland County, Pennsylvania. 3. Plaintiff seeks custody of the following child: Name Present Residence Age Zaelyn J. Beissel 236 Erford Road, Camp Hill, PA DOB 01/10/94 14. The child was not born out of wedlock. 5. The child is presently in the custody of Defendant Jennifer L. Beissel, at 236 Erford Road, Camp Hill, Cumberland County, Pennsylvania. 6. Since birth, the child has resided with the following persons lat the following addresses: Persons Addresses Defendant Mother 236 Erford Rd, Donald Morgan, Mother's paramour - part-time basis Plaintiff Father 113 Mountain View Dr, Defendant Mother Donald Morgan, Mother's paramour on a part-time basis (Mother 113 Mountain View Dr. Donald Morgan, Mother's paramour on a part-time basis Plaintiff Father 113 Mountain View Dr, Defendant Mother Donald Morgan, Mother's paramour on a part-time basis Plaintiff Father Defendant Mother 113 Mountain View Dr Date 4/1/08- present 9/07- 4/1/08 7/07 - 9/07 spring 107 - 7/07 DOB - spring '07 7. The mother of the child is Jennifer L. Beissel, who currently resides at 236 Erford Road, Camp Hill, Cumberland County, ?ennsylvania. 3. She is married. a. The father of the child is Craig J. Beissel, who currently resides at 2340 Magnolia Terrace Drive, Harrisburg, Dauphin County, ?ennsylvania. L0. He is married. L1. The relationship of Plaintiff to the child is that of natural father. The Plaintiff currently resides alone except during his .Deriods of partial physical custody of the minor child. 12. The relationship of Defendant, to the child is that of natural mother. The Defendant currently resides with her paramour, Donald Morgan, on a part-time basis, and the minor child. 13. Plaintiff has not participated as a party or witness, or in another capacity, in other litigation concerning the custody of the child in this or another court. 14. Plaintiff has no information of a custody proceeding concerning the child pending in a court of this Commonwealth. 15. Plaintiff does not know of a person not a party to the proceedings who has physical custody of the child or claims to have custody or visitation rights with respect to the child. 16. The best interest and permanent welfare of the child will be served by granting Plaintiff periods of partial physical custody and joint legal custody at this time. 17. Each parent whose parental rights to the child has not been terminated and the person who has physical custody of the child have been named as parties to this action. All other persons, named below who are known to have or claim a right to custody or visitation of the child will be given notice of the pendency of this action and the right to intervene: NONE. WHEREFORE, Plaintiff requests the Court to grant parital physical custody and joint legal custody of the child to Plaintiff herein. Respectfully Submitted: DISSINGER AND DISSINGER By: Mary A. Etter Dissinger Attorney for Plaintiff Supreme Court I.D. #27736 28 N. 32nd Street Camp Hill, PA 17011 (717) 975-2840 (717) 975-3924 -fax VERIFICATION I, Craig J. Beissel, verify that the statements made in the Complaint for Custody 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. - M.,4!kz Craig . Beissel, Plaintiff Craig J. Beissel, Plaintiff VS. (Jennifer L. Beissel, Defendant : IN THE COURT OF COMMON PLEAS : OF PENNSYLVANIA : CUMBERLAND COUNTY BRANCH : CIVIL ACTION : NO. : IN CUSTODY CERTIFICATE OF SERVICE I, Mary A. Etter Dissinger, Esq., hereby certify that on the date set forth below I served a true and correct copy of the foregoing document upon the attorney for Defendant, by First Class United States mail addressed as follows: Elizabeth Beckley, Esq. 212 N. 3rd Street PO. Box 11998 Harrisburg, PA 17108-1998 t e : Mary A.' er `ssing , q. r-? am " C .. " ..sa g °O, ; + t' CRAIG J. BEISSEL, :IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA V. JENNIFER L. BEISSEL, Defendant CIVIL ACTION - LAW IN CUSTODY :NO. 06 - 4q4 STIPULATION OF CUSTODY THIS IS A STIPULATION AND AGREEMENT entered into the day and year hereinafter set forth, by and between CRAIG J. BEISSEL (hereinafter referred to as "Father") and JENNIFER L. BEISSEL (hereinafter referred to as "Mother"). WHEREAS, the parties are the parents of one (1) minor child, namely Caelyn J. Beissel, born January 10, 1994 (hereinafter referred to as the "child"); WHEREAS, the parties are presently living separate and apart and wish to establish an agreed upon Court Ordered arrangement relative to the physical and legal custody of their child; and WHEREAS, the parties hereby direct their Counsel to submit this Stipulation to the Court and ask that the Court enter a Custody Order adopting the terms hereof. NOW, THEREFORE, in consideration of the mutual covenants, promises and agreements as hereinafter set forth and intending to be legally bound hereby, the parties stipulate and agree as follows: 1. Mother and Father shall share legal custody of the minor child Caelyn J. Beissel. 2. Mother will have primary physical custody of the child 3. Father shall have partial physical custody according to the following scheduled: p.m.; and a. Alternating weekends from Friday at 6:00 p.m. till Sunday at 6:00 b. Every Tuesday evening from 6:00 p.m. until 8:30 p.m. 4. Transportation will be shared between the parties with the party receiving custody transporting the child. 5. The non-custodial parent will have reasonable telephone communication 1 with the child. 6. The parties both agree to take the child to a psychologist/counselor (Hazel Brown) covered by their health insurance. 7. The parties will share any and all information regarding the child with each other including the scheduling of appointments and the medicines the child may take from time to time. The sharing of information shall include, but not be limited to, medical, dental, religious or school records, and the residence address of the other party and the child. To the extent one parent has possession of any such records or information, that parent shall be required to share the same, or copies thereof, with the other parent within such reasonable time as to make the records and information of reasonable use to the other parent. Both parents shall be entitled to full participation in all educational and medical/treatment planning meetings and evaluations with regard to the minor child. Each parent shall be entitled to full and complete information from any physicial, dentist, teacher or authority and copies of any reports given to them as parents including, but not limited to: medical records, birth certificates, school or educational attendance records or report cards. Additionally, each parent shall be entitled to receive copies of any notices which come from school with regard to school pictures, extracurricular activities, children's parties, musical presentations, back-to-school nights, and the like. 8. The Holiday schedule will be as follows: a. Thanksgiving will be divided between the parties with Father having physical custody of the child on Wednesday at 6:00 p.m. until 2:00 p.m. Thanksgiving Day. Mother will have physical custody of the child on Thanksgiving from 2:00 p.m. until Friday at 6:00 p.m.; For the Thanksgiving Holiday, Father will provide all of the transportation for the child unless the parties agree otherwise; b. Christmas will be divided between the parties with Father having physical custody of the child on December 23 at 9:00 a.m. until December 24 at 9:00 p.m. Mother will have physical custody of the child on December 24 at 9:00 p.m. until December 26 at 9:00 a.m.; C. The New Years holiday will be divided between the parties with Mother having physical custody of the child on December 30 at 9:00 a.m. until January 1 at 9:00 a.m. Father will have physical custody of the child on January 1 at 9:00 a.m. until 6:00 p.m. the night before school resumes; and d. The parties will alternate the following holidays to include: Easter, Memorial Day, Independence Day, Labor Day and Columbus Day. This alternating schedule will begin with Father having custody of the child on Memorial Day in 2008. 2 The alternating holidays will begin the night before the holiday at 6:00 p.m. until 6:00 p.m. the day of the holiday. The party having custody on Independence Day will be allowed to return the child after attending a fireworks display if he/she chooses to take the child to see the same 9. Each party will be entitled to 2 non-consecutive weeks of custody during the child's summer school break. The parties are required to give each other at least 30 days notice of when he/she intends to exercise his/her vacation custodial period. 10. Father will have custody of the child on Father's Day and Mother will have custody of the child on Mother's Day. 11. Neither party shall do anything or say anything, nor permit a third party from doing or saying anything that may estrange the children from the other party, or injure the opinion of the child as to the other party, or may hamper the free and natural development of the child's love or affection for the other party. IN WITNESS WHEREFORE, the parties hereto intending to be legally bound by the terms hereof, set forth their hands and seals the day and year set forth below. WITNESS: A ? 61-11149 Ali- e6 5L t ==N- Craig . ssel to Mary ter Dissmger, Esq. Atty for Craig J. Beissel 44 4 r,17111,4 W1 -.A;IV L,' A QJ i el L. Beissel Date 1i E 4; 121?i-Ugr A for Jennifer L. Be' s • ,. - 7 C' ? ' . """? c y . Craig J. Beissel, Plaintiff i vs. ennifer L. Beissel, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - CUSTODY NO. 0(a - s+qq j ACCEPTANCE OF SERVICE I, Elizabeth Beckley, Esq., hereby accept service of the ustody Complaint, on behalf of my client, Jennifer L. Beissel, efendant, as delivered to me on , , 2008. AU Bec;lley & Madden PO Box 11998 Harrisburg, PA 17108 (717)233-7691 Supreme Court ID Attorney for Defend nt C Z C= E i '. ri 7 77 to C-n mam ? p 9 2. racoww-', ?uN s o zooe,? CRAIG J. BEISSEL, :IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA V. :CIVIL ACTION - LAW :CUSTODY JENNIFER L. BEISSEL, /•] Defendant :NO. 06- 4441 ORDER AND NOW, this 7-4 ' day of _, 2008, after careful review of the Stipulation of Custody entered into by the parties and attached hereto, and in accordance with the parties' request that said Stipulation of Custody be entered as an Order of Court, it is hereby ORDERED that the parties shall share legal and physical custody of their minor children pursuant to the terms of said Stipulation of Custody. BY THE COURT: c %4' BUZ I t Craig J. Beissel, Plaintiff VS. Jennifer L. Beissel, Defendant : IN THE COURT OF COMMON PLEAS : OF PENNSYLVANIA CUMBERLAND COUNTY BRANCH CIVIL ACTION NO. 06-4941 IN DIVORCE INVENTORY AND APPRAISEMENT OF CRAIG J. BEISSEL, PLAINTIFF Plaintiff files the following Inventory and Appraisement of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three (3) years. I, Craig J. Beissel, verify that the statements made in this Inventory and Appraisement are true and correct. I understand that false statements made herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Crai Beissel, Plaintiff INVENTORY AND APPRAISEMENT UNDER RULE 1920.33 updated 9/03/08 ITEM # A. MARITAL PROPERTY IN WHICH EITHER SPOUSE HAS LEGAL OR EQUITABLE INTEREST ON DATE OF SEP. B. IS PROPERTY EXCLUDED FROM MARITAL PROPERTY C. BASIS FOR CLAIMED EXCLUSION D. PERSON OR ENTITY WITH WHOM INTEREST IS HELD 1. Marital residence J 2. 03 trailblazer J 3. 05 Toyota highlander J 4. trailer H 5. H's retirement H 6. H's deferred Comp H 7. W's 401k W 8. H's checking acct yes post- dos H 9. H's savings acct yes post- dos H 10. W's PSECU checking acct W 11. W's PSECU savings acct W 12. Jt Members lst checking acct J 13. Jt Members lstsavings acct J 14. Household goods (see attached) 15. furniture (see attached) J 16. Longaberger Baskets J 17. CitiCard J 18. Members lst card J 19. Capital One card H 20. Capital One card ..6907 ? . INVENTORY AND APPRAISEMENT UNDER RULE 1920.33 Updated 9/3/08 ITEM # E. DATE ACQUIRED F. COST OR ACQUIRED VALUE G. VALUE ON DATE OF SEPARATION H. AMT OF LIEN ON DATE OF SEPARATION I, NATURE OF LIEN J. DATE OF LIEN K. LIEN HOLDER 1. 6/89 120000.00 220000.00- sold for net proceeds of 4611.51 146809.00/ 53849.94 1st/2nd mortgage 1st mort- Citi mort/2nd mort- Memb 1st 2. 2003 9005.00 c. 10300.00 3. 2005 16220.00 25427.60 PSECU 4. 1995 500.00 100.00 5. 1996 6. 12400.00 7. 1990 63379.00 8. 2007 9. 2007 10. 2007 129.73 11. 2007 29.80 12. 1992 830.36 13. 1992 5263.36 14. 1989 15. 1989 16. 1992 2500.00 2500.00 17. 1997 (23299.52) 18. 1995 (10244.79) 19. 2002 (17000.00) 20. 2002 (3897.98) 21. 1017.78 22• 2565.21 23• (133.10) Craig J. Beissel, : IN THE COURT OF COMMON PLEAS Plaintiff : OF PENNSYLVANIA VS. : CUMBERLAND COUNTY BRANCH : CIVIL ACTION Jennifer L. Beissel, : NO. 06-4941 Defendant : IN DIVORCE CERTIFICATE OF SERVICE I, Mary A. Etter Dissinger, hereby certify that on the date set forth below I served a true and correct copy of the Inventory and Appraisement upon the attorney for Defendant, by First Class United States mail addressed as follows: Elizabeth Beckley, Esq. PO Box 11998 Harrisburg, PA 17108 Date : U Mary A. Etter Dissing c'-? +?,, a ?:?> ? ? ??, tea := ?y . ..:. r..-, r`?.a yt`fT ?; h w w T Flit 1"G OF THE 20G9 MAP 31 AliI 1W 1 Craig J. Beissel, Plaintiff VS. Jennifer L. Beissel, Defendant L... : IN THE COURT OF COMMON PLEAS : OF PENNSYLVANIA : CUMBERLAND COUNTY BRANCH : CIVIL ACTION : NO. 06-4941 : IN DIVORCE NOTION FOR APPOIN KCRT OF MASTER Craig J. Beissel, Plaintiff, moves the court to appoint a master with respect to the following claims: (X) Divorce ( ) Annulment (X) Alimony (X) Alimony Pendente Lite (X) Distribution of Property ( ) Support (X) Counsel Fees (X) Costs and Expenses and in support of the motion states: (1) Discovery is complete as to the claim(s) for which the appointment of a Master is requested. (2) The Defendant has appeared in this action by her attorney, Elizabeth Beckley. (3) The statutory ground for divorce is irretrievable breakdown of the marriage. (4) The action is contested with respect to the following claims: alimony, alimony pendente lite, distribution of property, counsel fees, expenses and costs. (5) The action involves complex issues of law or fact. (6) The hearing is expected to take one day. (7) Additional information, if any, relevant to the motion: None. Date: o Mary A. Etter Dissinger Attorney for Plaintiff 28 North Thirty-Second Street Camp Hill, PA 17011 (717) 975-2840 cc: Elizabeth Beckley, Esquire Craig J. Beissel (Defendant) r . 11- Craig J. Beissel, : IN THE COURT OF COMMON PLEAS Plaintiff : OF PENNSYLVANIA VS. : CUMBERLAND COUNTY BRANCH : CIVIL ACTION Jennifer L. Beissel, : NO. 06-4941 Defendant : IN DIVORCE CERTIFICATE OF SERVICE I, Mary A. Etter Dissinger, hereby certify that on the date set forth below I served a true and correct copy of the foregoing document upon the attorney for the Plaintiff, by First Class United States Mail addressed as follows: Elizabeth Beckley Beckley & Madden PO Box 11998 Harrisburg, PA 17108 Date: 3/3/,7 ?^--f Mary A. Etter Dssinger ,_. F? t ' ?i APR 0120086 (Craig J. Beissel, Plaintiff VS. Jennifer L. Beissel, Defendant : IN THE COURT OF COMMON PLEAS : OF PENNSYLVANIA : CUMBERLAND COUNTY BRANCH : CIVIL ACTION : NO. 06-4941 : IN DIVORCE ORDER APPOINTING MASTER ,,nn AND NOW thi nd day of , 2009, l., T, Esquire, is appointed Master with respect to the following claims: (X) Divorce ( ) Annulment (X) Alimony (X) Alimony Pendente Lite (X) Distribution of Property ( ) Support (X) Counsel Fees (X) Costs and Expenses BY THE COURT: Qf 1 G? J. 61:6 0 Z- New CRAIG J. BEISSEL, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 06 - 4941 CIVIL JENNIFER L. BEISSEL, Defendant IN DIVORCE TO: Mary A. Etter Dissinger Elizabeth S. Beckley , Attorney for Plaintiff , Attorney for Defendant DATE: Wednesday, April 8, 2009 CERTIFICATION I certify that discovery is complete as to the claims for ?hich the Master has been appointed. OR IF DISCOVERY IS NOT COMPLETE: (a) Outline what information is required that is not complete in order to prepare the case for trial and indicate whether there are any outstanding interrogatories or discovery motions. (b) NOTE Provide approximate date when discovery will be complete and indicate what action is being taken to complete discovery. TE AL COUNSEL FOR DEFEN ) PRETRIAL DIRECTIVES WILL NOT BE ISSUED FOR THE FILING OF PRETRIAL STATEMENTS UNTIL COUNSEL HAVE CERTIFIED THAT DISCOVERY IS COMPLETE, OR OTHERWISE AT THE MASTER'S DISCRETION. AFTER RECEIVING THIS DOCUMENT FROM BOTH COUNSEL OR A PARTY TO THE ACTION, IF NOT REPRESENTED BY COUNSEL, INDICATING THAT DISCOVERY IS NOT COMPLETE, THE DIRECTIVE FOR FILING OF PRETRIAL STATEMENTS WILL BE ISSUED AT THE MASTER'S DISCRETION. HOWEVER, IF BOTH COUNSEL, OR A PARTY NOT REPRESENTED, CERTIFY THAT DISCOVERY IS COMPLETE, A DIRECTIVE TO FILE PRETRIAL STATEMENTS WILL BE ISSUED IMMEDIATELY. THE CERTIFICATION DOCUMENT SHOULD BE RETURNED TO THE MASTER'S OFFICE WITHIN TWO (2) WEEKS OF THE DATE SHOWN ON THE DOCUMENT. if W_ CERTIFICATE OF SERVICE Elizabeth S. Beckley, Esquire, hereby certify that a true and correct copy of the document was this day served upon the person and in the manner indicated below. SERVICE BY FIRST CLASS MAIL: Mary A. Etter Dissinger, Esquire Dissinger and Dissinger 28 North Thirty-Second Street Camp Hill, PA 17011 DATE / Vq 41i*S.11B36ck r . OP VA FILED- T! ` u^` IC T"sW 2: 4, .s 20 0q J. 'JIN - E P " "' -7 N, f CRAIG . BEISSEL, JN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA V. :CIVIL ACTION - LAW JN DIVORCE L. BEISSEL, Defendant :NO. 06 -- 4941 PRE-TRL&L STATEMENT OF JENNIFER L. BEISSEL tD NOW comes the Defendant, Jennifer L. Beissel, who, by and through her Elizabeth S. Beckley, Esquire, and Beckley & Madden, of Counsel, files the pre-trial statement. I. BACKGROUND and Ms. Beissel were married on June 6, 1992. They separated on May 1, 2006, a to irreconcilable differences. Mr. Beissel moved out of the marital residence and in ith his girlfriend in November, 2006. Mr. Beissel moved back in the marital residence in October, 2007, after he broke up with his girlfriend; however, he and Ms. Beissel never reconciled. The parties resided together until the marital residence was sold. When the parties separated, Ms. Beissel was 35 years old and Mr. Beissel was 45 years old. Ms. Beissel is employed by Modjeski and Masters, Inc. Mr. Beissel is employed by the Commonwealth of Pennsylvania. Mr. and Ms. Beissel are the parents of one minor child: Caelyn J. Beissel born January 1, 1994. Ms. Beissel has had primary physical custody of their minor child since the parties originally separated in May, 2006. 1 II. STATEMENT OF MARITAL ASSETS Marital Asset Value Trailer 1,000.00 2003 Ch evy Trailblazer 3,000.00 2005 To yota Highlander 0 - too much owed Cash in tty Dissinger's escrow 300.00 Wife's 01K 47,470.71 @ DOS $50,470.71 - 3,000 loan) Husband's Pension Husban s Deferred Comp plan Househ ,Id furnishings 112,574.00 as of 12/2007 12,000.00 @ DOS unknown III. STATEMENT OF NON-MARITAL ASSETS Non- rital Asset Value Husb d's pension post separation contributions Wife's 01 K post separation contributions Visa Members 1St -- Joint 10,244.79 (1,500 tax stimulus was applied to this debt) Capitol One -- Wife 3,990.12 Capitol One -- Husband 1,600.00 IV. STATEMENT OF MARITAL LIABILITIES Marital Liabilities Amount Citi Drivers - Joint 23,299.52 (3,861.51 was applied to this debt from marital residence proceeds) 2 V. EXPERT WITNESSES Cramer - Conrad Siegel - actuary who performed pension valuation VI. WITNESSES 1. =witriesses 2. as needed for rebuttal. VII. EXHIBITS 1. arties' 2006 - 2008 tax returns; 2. roof of parties' current income; 3. ension valuation; 4. Deferred Compensation plan statements; 5. 401K statements; 6. Proof of marital debt; 7. Such other exhibits as needed for rebuttal. VIII. PROPOSED RESOLUTION The following resolution is suggested: 1. 60/40 division of the marital assets with 60% going to Wife; 2. Wife to receive indefinite alimony; and 3. Wife to receive her counsel fees. . i IX. ESTIMATED LENGTH OF HEARING If this matter proceeds to a hearing, then Ms. Beissel estimates that the hearing will tak one half to one full day. DATE : 6-/-q Respectfully submitted, Of C unsel BEC EY & MADDEN 4 4 212 N. rd Street S9.B- ie P.O. Bo 11998 , Attorney for Defendant flarrisb g, PA 17108 Jennifer L. Beissel (717)23$-7691 4 CERTIFICATE OF SERVICE below. Elizabeth S. Beckley, Esquire, hereby certify that a true and correct copy of the document was this day served upon the person and in the manner indicated SERVICE BY FIRST CLASS MAIL: DA Mary A. Etter Dissinger, Esquire Dissinger and Dissinger 28 North Thirty-Second Street Camp Hill, PA 17011 4" i e ire CO AlWiM T? Ir r'?A Py ?u t 2D09 JUIN I F r 2': '4 _? r CRAIG jJ. BEISSEL, Plaintiff V. L. BEISSEL, Defendant JN THE COURT OF COMMON PLEAS OF :CUMBERLAND COUNTY, PENNSYLVANIA :CIVIL ACTION - LAW :IN DIVORCE :NO. 06 - 4941 COME AND EXPENSE STATEMENT OF JENNIFER L. BEISSEL verify that the statements made in this Income and Expense Statement are true and co ect. I understand that false statements herein are made subject to the penalties of 18 Pa. .S. §4904 relating to unsworn falsification to authorities. DATE 4Bfieissel Je r i INCOME AND EXPENSE STATEMENT OF JENNIFER L. BEISSEL SS# 194-64-4827 & ADDRESS: Modjeski & Masters, Inc. 4909 Louise Drive Mechanicsburg, PA 17055 JOB DVSCRIPTION: Accounting Clerk ty Period Toss Pay per Pay Period $1,613.70 ;mized Payroll Deductions: Federal Withholding 138.60 Social Security 98.38 Local Wage Tax 27.39 State Income Tax 49.68 Retirement (401 K deduction/loan) 127.04 Savings Bonds Credit Union Life Insurance Health Insurance OASDI/DIS Other (HI) (Medicare) 54.10 et Pay per Pay Period: $ 1,118.51 *(this pay period includes one hour of over time at 29.70 per hour) INCOME: Week Month Year ividends Security Account Unemployment Comp. Workmen's Comp. Other (Child Support $731.00/APL $416.00) 1,147.00 TOTAL, MONTHLY INCOME: I r Week Jtilities Electric Gas Oil Telephone Water Sewer Public Transportation Lunch (Caelyn & Jenn) Real estate A Property Income Other (per capita) Homeowners Automobile Life Accident Health Other Payments Fuel Repairs Month 1,159.00 80.00 80.00 84.00 30.00 38.33 (115 - Qtly) 200.00 261.00 150.00 50.00 Doctor Dentist Orthodonist Chiropractor Hospital Medicine Special Needs (glasses, 15.00 braces, etc.) Caelyn - Dr. Brown Private school Parochial school College Religious Other Year 480.00 1,135.00 360.00 656.00 202.00 Week Month Year P ersonal Clothing 200.00 Food 400.00 Barber/hairdresser 60.00 Credit payments 133.00 marital card Memberships oans Credit Union Other 401K 135.40 iscellaneous Household help Child care Papers/books/etc. 38.00 Entertainment 120.00 Pay TV 39.00 Vacation Gifts egal Fees 500.00 haritable contributions 40.00 ther (Caelyn sports etc.) 60.00 oan TOTAL , EXPENSES: $ PROPE RTY OWNED: Description Value Ownership hecking accounts 500.00 Jenn avings accounts 1,000.00 Jenn redit Union tocksBonds eal estate Other TOTA VALUE OF PROPERTY $ INSUR ANCE: Company Policy # Blue Cross- Other [edical Capital Blue Cross 005068550000 Blue Shield Other Health/Accident isability Income ental Guardian 438542 ision Cap. Blue Cross/NVA 005068550000 ;MENTAL INCOME STATEMENT a) This form is to be filed out by a person (check one): - (1) who operates a business or practices a profession, or - (2) who is a member of a partnership or joint venture, or - (3) who is a shareholder in and is salaried by a closed corporation or similar entity. b) Attach to this statement a copy of the following documents relating to the hip, joint venture, business, profession, corporation or similar entity: (1) the most recent Federal Income Tax Return, and (2) the most recent Profit and Loss Statement. c) Name of business: Address: Telephone Number: d) Nature of business (check one) (1) partnership (2) joint venture (3) profession (4) closed corporation (5) other e) Name of accountant, controller or other person in charge of financial •ecords: ;f) (1) Annual income from business: (2) Gross income per pay period:_ (3) Net income per pay period:_ (4) Specified deductions, if any:_ CERTIFICATE OF SERVICE Elizabeth S. Beckley, Esquire, hereby certify that a true and correct copy of the document was this day served upon the person and in the manner indicated below. SERVICE BY FIRST CLASS MAIL: Mary A. Etter Dissinger, Esquire Dissinger and Dissinger 28 North Thirty-Second Street Camp Hill, PA 17011 DATE C-IffizAetfi S. oc ui 'j'(??F(CLEC} 2Gnj 9 JU -1 F 1 2: c'l ?r J. BEISSEL, JN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA V. :CIVIL ACTION - LAW JN DIVORCE ER L. BEISSEL, Defendant :NO. 06 - 4941 INVENTORY OF JENNIFER L. BEISSEL iff, Jennifer L. Beissel, files the following inventory of all property owned or pos?essed by either party at the time this action was commenced and all property within the preceding three years. DA 62-1-67 - ;gfer Beissel ASSETS OF THE PARTIES X X X X X X laintiff marks on the list below those items applicable to the case at bar and the assets on the following pages. 1. Real Property 2. Motor vehicles 3. Stocks, bonds, securities and options 4. Certificates of deposit 5. Checking accounts, cash 6. Savings accounts, money market and savings certificates 7. Contents of safe deposit boxes 8. Trusts 9. Life insurance policies (indicate face value, cash surrender value and current beneficiaries) 10. Annuities 11. Gifts 12. Inheritances 13. Patents, copyrights, inventions, royalties 14. Personal property outside the home 15. Business (list all owners, including percentage of ownership, and officer/director positions held by a party with company) 16. Employment termination benefits -- severance pay, worker's compensation claim/award 17. Profit sharing plans 18. Pension plans (indicate employee contribution and date plan vests) 19. Retirement plans, Individual Retirement Accounts 20. Disability payments 21. Litigation claims (matured and unmatured) 22. MilitaryN.A. benefits 23. Education benefits 24. Debts due, including loans, mortgages held 25. Household furnishings and personalty (include as a total category and attached itemized list if distribution of such assets is in dispute) 26. Other (Jewelry) 1 MARITAL PROPERTY 2 2 2 5 19 19 19 25 * dntiff lists all marital property in which either or both spouses have a legal or interest individually or with any other person as of the date this action was .a. nber Description of Property Owners Approximate Value Trailer Joint 1,000.00 2003 Chevy Trailblazer Joint 3,000.00 2005 Toyota Highlander Wife 0 - too much owed Cash in escrow Joint 300.00 Wife's 401K Wife 50,470.71 PA Pension Husband 112,574.00 PA Deferred Comp Husband 12,000.00 Household contents Joint unknown ;s divided the personal property to their satisfaction at the time the marital .e was sold NON-MARITAL PROPERTY 19 19 'laintiff lists all property in which spouse has a legal or equitable interest which is to be excluded from marital property: Description of Property Husband's pension Wife's 401K Reason for Exclusion a portion is non-marital a portion is non-marital 2 PROPERTY TRANSFERRED Item I been Item iption Date of Person to Whom Value at date merty Transfer Transferred of aquigition al Residence was sold and the proceeds received were $4,611.51 which has to marital debt as evidenced below. alue as of Date LIABILITIES Item Nurr. 24 24 24 24 24 Description Names of Names of Amount of Property All Creditors All Debtor Owed Creditcard Citi Drivers Joint 23,299.52 (3,861.51 was applied to this debt from marital residence proceeds) Visa Members 1St Joint 10,244.79 (1,500 tax stimulus was applied to this debt) Creditcard Capitol One Wife 3,990.12 Creditcard Capitol One 401K loan M&M Husband Wife 1,600.00 3,000.00 3 CERTIFICATE OF SERVICE Elizabeth S. Beckley, Esquire, hereby certify that a true and correct copy of the document was this day served upon the person and in the manner indicated below. SERVICE BY FIRST CLASS MAIL: Mary A. Etter Dissinger, Esquire Dissinger and Dissinger 28 North Thirty-Second Street Camp Hill, PA 17011 DATEE 1: lD I 4ie thS. We 5, re PLEIC,- - T?!' 7f -If-, - t-- . ; i - ,- -, I iA y 'Nog f4 CRAIG J. BEISSEL, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 06-4941 CIVIL TERM JENNIFER L. BEISSEL, IN DIVORCE Defendant/Petitioner PACSES CASE: 636109944 ORDER OF COURT AND NOW to wit, this 2nd day of December, 2009, it is hereby Ordered that the Order for Alimony Pendente Lite is terminated, effective December 1, 2009, with a balance due in the amount of $209.65 and will be paid off at a rate of $22.00 per month, pursuant to an agreement of the parties that an Alimony obligation of $300.00 per month will be entered, effective December 1, 2009 for thirty six (36) months. This Order shall become final twenty (20) after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary's Office for a hearing de novo before the Court. BY THE COURT: X4 K Kin A. Hess, J. DRO: R.J. Shadday xc: Petitioner Respondent Elizabeth S. Beckley, Esq. Mary A. Etter Dissinger, Esq. Form OE-001 Service Type: M Worker: 21005 THE RY 2064 0 E C -2 1, i ?- 3 i ??+1??r 1ith?,r j ?l 1 I CRAIG J. BEISSEL, V. :IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA JENNIFER L. BEISSEL, Defendant :CIVIL ACTION - LAW :IN DIVORCE :NO. 06 -- 4941 AFFIDAVIT OF CONSENT 1. A complaint in divorce under Section 3301(c) of the Divorce Code was filed on August 24, 2006. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unworn falsification to authorities. Dated: <X14 OQ Craig J. eisse OF -? ?.? . ? 4? ? E Pt? 2009 DEC _D Fli 2' 11 0 4( - ill ?' CRAIG J. BEISSEL, V. :IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA JENNIFER L. BEISSEL, Defendant :CIVIL ACTION - LAW :IN DIVORCE :NO. 06 -- 4941 WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(C) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Dated: / ;? '210 Craig J6-.? . eissel 17 ff THE r .fin APY 2009 DEC -3 ivi Z: 17 CRAIG J. BEISSEL, :IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA V. :CIVIL ACTION - LAW :IN DIVORCE JENNIFER L. BEISSEL, Defendant :NO. 06 -- 4941 AFFIDAVIT OF CONSENT 1. A complaint in divorce under Section 3301(c) of the Divorce Code was filed on August 24, 2006. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Dated: 1er L. dBeissel F' ._ t. Y 20H DEC --3 FM 2' 11 CRAIG J. BEISSEL, V. :IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA JENNIFER L. BEISSEL, Defendant CIVIL ACTION - LAW IN DIVORCE :NO. 06 -- 4941 WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(C) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Dated: I L. Beissel FILE;. rfiCE ^,rM1° I ?, ii /y f T u- 2069 L/u jT 2009 DEC --3 PH 2: 17 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 12/02/09 Case Number (See Addendum for case summary) Employer/withholder's Federal EIN Number BUREAU OF COMMONWEALTH* C/O WAGE ATTACHMENT SECTION PO BOX 8006 HARRISBURG PA 17105-8006 210-54-3442 Employee/Obligor's Social Security Number 1202101965 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'slobligor's income until further notice even if the Order/Notice is not issued by your State. $ $ $ 728.00 22.00 0.00 $ 0.00 $ 300.00 $ 22.00 $ 0.00 $ 0.00 per month in current child support per month in past-due child support Arrears 12 weeks or greater? 0 yes (S) no per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) one-time lump sum payment for a total of $ 1,072.00 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: $ 247.38 per weekly pay period. $ 536.00 per semimonthly pay period (twice a month) $ 494.77 per biweekly pay period (every two weeks) $ 1, 072.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten 00) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. $ 4374(b)) requires remittance by an electronic Payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SEC ITY NUMBER IN RDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: DRO: R. J. Shadday Service Type M OMB No.: 0970-0154 813109926 283 S 2008 06-4941 CIVIL O Origi nal Order/Notice OAmended Order/Notice OTerminate Order/Notice OOne-Time Lump Sum/Notice RE:BEISSEL, CRAIG J. Employee/Obligor's Name (Last, First, MI) Form EN-028 Rev.5 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS 94e' ,eckei you hare required to provide aopy of this form to your employee. If your employeg orks in a state that is rent rom the state that issued this o er, a copy must be provided to your employee even if the box is not checed 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding, You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4. * Employeelobligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2321722990 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEEIOBLIGOR NO LONGER WORKS FOR: C7 EMPLOYEE'S/OBLIGOR'S NAME:BEISSEL, CRAIG J. EMPLOYEE'S CASE IDENTIFIER: 1202101965 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT. NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA 0 5 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE' ATTACHMENT UNIT 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BEISSEL, CRAIG J. PACSES Case Number 636109944 Plaintiff Name JENNIFER L. BEISSEL Docket Attachment Amount 06-4941 CIVIL$ 322.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Service Type M PACKS Case Number 813109926 Plaintiff Name JENNIFER L. BEISSEL Docket Attachment Amount 00283 S 2008 $ 750.00 Child(ren)'s Name(s): DOB CAELYN J. BEISSEL 01/10/94 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum OMB No.: 0970-0154 Form EN-028 Rev-5 Worker I D $ IATT ALE --) r 2009 DEC -3 F, Ml 2: 14 8 CRAIG J. BEISSEL, Plaintiff VS. JENNIFER L. BEISSEL, Defendant THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06 - 4941 CIVIL IN DIVORCE ORDER OF COURT AND NOW, this 19 day of AAAhM1.1t, , 2009, the economic claims raised in the proceedings having been resolved in accordance with a property settlement agreement dated December 2, 2009, the appointment of the Master is vacated and counsel can file a praecipe transmitting the record to the Court requesting a final decree in divorce. BY THE COURT, cc: ? Mary A. Etter Dissinger Attorney for Plaintiff ?izabeth S. Beckley Attorney for Defendant P ?r?'1 ? G EdgaQByle`y, P.J. FILE-IL 2009 DEC -3 PN 3.09 CU.x' ?, . i71i Craig J. Beissel, Plaintiff VS. Jennifer L. Beissel, i Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION NO. 06 - 4941 CIVIL IN DIVORCE PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Transmit the record, together with the following information, to the Court for entry of a divorce decree: 1. Grounds for divorce: Irretrievable breakdown under § 3301(c) 2. Date and manner of service of the Complaint: Personal service on Defendant evidenced by her signed acceptance of service dated August 29, 2006. 3. a. Date of execution of the Affidavit of Consent required by § 3301(c) of the Divorce Code: By Plaintiff December 2, 2009; by Defendant December 2, 2009. 4. Related claims pending: None. 5. Date Plaintiff's Waiver of Notice in § 3301(c) Divorce filed with the Prothonotary: December 2, 2009. 6.Date Defendant's Waiver of Notice in § 3301(c) Divorce filed with the Prothonotary: December 2, 2009. Respectfully submitted, DISSINGER AND DISSINGER Date: Mary A. Etter Dissinger Attorney for Plaintiff Supreme Court ID 27736 28 N. 32nd Street Camp Hill, PA 17011 (717)975-2840 (717)975-3924 - fax cc: Elizbeth Beckley, Esquire Craig J. Beissel FILED- ,-' iC? OF THE PIROTIHI `NOTARY 2009 DEC 10 Phi 3: 21 CRAIG J. BEISSEL : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA , PLAINTIFF V. JENNIFER L. BEISSEL By the Court, DEFENDANT : NO. 06-4941 CIVIL DIVORCE DECREE AND NOW, '1< /,(-, ZaC, g , it is ordered and decreed that Craig J. Beissel, plaintiff, and Jennifer L, Beissel, defendant, are divorced from the bonds of matrimony. Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: the finalization of two (2) QDRO's as required by the Property Settlement Agreement. The Property Settlement Agreement of the parties dated December 2, 2009, is hereby incorporated but not merged in this decree of divorce. Attes . J Protho tary y mut C SC ?a 4?? /2 Cory eA2tLgzL- 6 1 q4y e. &CL Icy ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania ?P_2io1 Oq q LA a Co./City/Dist. of CUMBERLAND Date of Order/Notice 12/24/09 ?? 4??1 C? v t' Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number BUREAU OF COMMONWEALTH* C/O WAGE ATTACHMENT SECTION PO BOX 8006 HARRISBURG PA 17105-8006 per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) 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'stobligor's income until further notice even if the Order/Notice is not issued by your State. $ $ $ 728.00 0.00 0.00 $ 0.00 $ 300.00 $ 22.00 $ 0.00 $ 0.00 for a total of $ one-time lump sum payment RE:BEISSEL, CRAIG J. OOriginal Order/Notice @Amended Order/Notice OTerminate Order/Notice (Done-Time Lump Sum/Notice Employee/Obligor's Name (Last, First, MI) O`s,?ZLO 210-54- 442 O Employee/Obligor's Social Security Number 283 S 2oOg 1202101965 Employee/Obligor's Case Identifier (See Addendlnn for plaintiff names associated With cases on attachment) Custodial Parent's Name (Last, First, MI) Arrears 12 weeks or greater? O yes (D no 1, 050.00 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: $ 242.31 per weekly pay period. $ 525.00 per semimonthly pay period (twice a month) $ 484.62 per biweekly pay period (every two weeks) $ 1, 050.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE HE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Ide ' ter) O CIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CAS7V/c? BY THE COURT: I-- O --?- r U (3 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS E] If heck you are required to pr vide a opy of this form to your m loyee. If yo r employee orks in a state that is diferent from the state that issuedthis order, a copy must be provi3edpto your emp?oyee even if tie box is not checked 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employeelobligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2321722990 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME:BEISSEL, CRAIG J. EMPLOYEE'S CASE IDENTIFIER: 1202101965 LAST KNOWN HOME ADDRESS: DATE OF SEPARATION: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA 0 5 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summarv of Cases on Attachment Defendant/Obligor: BEISSEL, CRAIG J. PACSES Case Number 636109944 PACSES Case Number 813109926 Plaintiff Name Plaintiff Name JENNIFER L. BEISSEL JENNIFER L. BEISSEL Docket Attachment Amount Docket Attachment Amount 06-4941 CIVIL$ 322.00 00283 S 2008 $ 728.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB CAELYN J. BEISSEL 01/10/94 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ALED-OFFICE OF 71-' F'ROT? ?P.!OTAAY 2009 DEC 3:0 PM 0 0 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dirt. of CUMBERLAND Date of Order/Notice 03/05/10 Case Number (See Addendum for case summary) EmployerAVithholder's Federal EIN Number BUREAU OF COMMONWEALTH* C/O WAGE ATTACHMENT SECTION PO BOX 8006 HARRISBURG PA 17105-8006 210-54-3442 Employee/Obligor's Social Security Number 1202101965 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. -.:k $ o. oo per month in current child support C ?- ? - - ?? $ 0.00 per month in past-due child support Arrears 12 weeks or greater? ?s g no. r $ 0.00 per month in current medical support ? s $ oo 0 per month in past-due medical support -- -nm $ . o . oo per month in current spousal support r © $ o . oo per month in past-due spousal support ?7 _ r F $ o . oo per month for genetic test costs _ nJ r7j $ o. oo per month in other (specify) •• $ one-time lump sum payment t C-n 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. $ o. oo per semimonthly pay period o . 00 per biweekly pay period (every two weeks) REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. / , A7 BY THE COURT: j /_? 0/ DRO: R.J. Shadday Service Type M Oler, Jr., Judge Form EN-028 Rev.5 ONIB No.: 0970-0154 Worker ID $IATT 813109926 283 S 2008 06-4941 CIVIL OOriginal Order/Notice OAmended Order/Notice 0 Terminate Order/Notice QOne-Time Lump Sum/Notice RE: BEISSEL, CRAIG J. Employee/Obligor's Name (Last, First, MI) (twice a month) 00 per monthly pay period. ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If heckefl you are required to provide gopy of this form to yourgmployee. if yoyr employee works in a state that is di erent Trom the state that issued this o er, a copy must be provi edd to your emp ogee even if the box is not checked 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the 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. 2321722990 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: C7 EMPLOYEE'S/OBLIGOR'S NAME:BEISSEL, CRAIG. J. EMPLOYEE'S CASE IDENTIFIER: 1202101965 LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: DATE OF SEPARATION: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BEISSEL, CRAIG J. PACSES Case Number 636109944 Plaintiff Name JENNIFER L. BEISSEL Docket Attachment Amount 06-4941 CIVIL$ 0.0o Child(ren)'s Name(s): DOB PACSES Case Number Plainti__ ff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB DOB Service Type M Addendum OMB No.: 0970-0154 PACSES Case Number 813109926 Plaintiff Name JENNIFER L. BEISSEL Docket Attachment Amount 00283 S 2008 $ 0.00 Child(ren)'s Name(s): DOB CAELYN J. BEISSEL 01/10/94 PACSES Case Number PlainUiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB Form EN-028 Rev.5 Worker ID $IATT ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT 06-4941 CIVIL OOriginal Order/Notice State Commonwealth of Pennsylvania 813109926 OAmgina Order/Notice Co./City/Dist. Of CUMBERLAND 283 S 2008 Terminate Order/Notice Date of Order/Notice 03/05/10 Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice RE: BEISSEL, CRAIG J. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 210-54-3442 Employee/Obligor's Social Security Number AECOM TECHNOLOGY 1202101965 4840 COX RD Employee/Obligor's Case Identifier GLEN ALLEN VA 23060-6292 (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. C? $ 72e. 00 per month in current child support $ 0.00 per month in past-due child support Arrears 12 weeks or greater? 1yes no- $ o . oo per month in current medical support = $ 0. oo per month in past-due medical support $ 300.00 per month in current spousal support $ 22.00 per month in past-due spousal support $ 0.00 per month for genetic test costs $ o . oo per month in other (specify) G $ one-time lump sum payment cn < for a total of $ 1,050.00 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: $ 242.31 per weekly pay period. $ 525.00 per semimonthly pay period (twice a month) $ 484.62 , per biweekly pay period (every two weeks) $ 1, 050.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Ide tifier) O CIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAI BY THE COURT: Z J. Wesley Oler, Jr., Judge DRO: R.J. Shadday Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS 0 If heckeP you are required to provide a copy of this form to your mployee. If yo41 r employee works in a state tha is di>?ferent from the state that issued this order, a copy must be provi?ed to your employee even if the box is not chec?ed. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the 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. 6110885220 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME:BEISSEL, CRAIG J. EMPLOYEE'S CASE IDENTIFIER: 1202101965 LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: DATE OF SEPARATION: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. * Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA 0 5 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M OMB No.: 097M 154 Worker ID $IATT ADDENDUM Summarv of Cases on Attachment Defendant/Obligor: BEISSEL, CRAIG J. PACSES Case Number 636109944 PACSES Case Number 813109926 Plaintiff Name Plaintiff Name JENNIFER L. BEISSEL JENNIFER L. BEISSEL Docket Attachment Amount Docket Attachment Amount 06-4941 CIVIL$ 322.00 00283 S 2008 $ 728.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB CAELYN J. BEISSEL 01/10/94 PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev.5 Service Type ty Worker ID $IATT OMB No.: 0970-0154 201g MAR 19 2' 33 CUP,; Craig J. Beissel, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 06-4941 CIVIL Jennifer L. Beissel, Defendant IN DIVORCE MOTION TO ENTER QUALIFIED DOMESTIC RELATIONS ORDERS And now comes Mary A. Etter Dissinger, attorney for Craig J. Beissel, and requests the Court to enter the attached two Qualified Domestic Relations Orders as Orders of Court, and in support of the Motion avers as follows: 1. The parties are Craig J. Beissel, Plaintiff, and Jennifer L. Beissel, Defendant. 2. The Defendant is represented by Elizabeth S. Beckley, Esquire. 3. The parties' Property Settlement Agreement dated December 2, 2009, was incorporated, but not merged into the Divorce Decree signed by this honorable Court by the honorable Kevin A. Hess on December 16, 2009. 4. The Agreement of the parties calls for the entry of two Qualified Domestic Relations Orders. 5. The parties have reached an agreement as to the terms of both Qualified Domestic Relations Orders, and copies of both Orders are attached hereto as Exhibits "A" and "B". 4 6. Movant requests the Court to enter the attached Qualified Domestic Relations Orders as two separate Orders of Court. 7. ' Counsel for the Defendant, Attorney Elizabeth S. Beckley concurs in this motion. Respectfully Submitted: Dissinger & Dissinger Mary A. tAttorney for Defendants Supreme Court ID # 27736 28 North 32nd Street Camp Hill, PA 17011 (717) 975-2840 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Craig J. Beissel CIVIL ACTION - LAW Plaintiff VS. IN DIVORCE Jennifer L. Beissel NO. 06-4941 Defendant STIPULATION FOR THE ENTRY OF "DOMESTIC RELATIONS ORDER" AND NOW, this day of , the parties, Craig J. Beissel, Plaintiff and Jennifer. L. Beissel, Defendant, do hereby Agree and Stipulate as follows: 1. The Plaintiff, Craig J. Beissel (hereinafter referred to as "Member") is a member of the Commonwealth of Pennsylvania, State Employees' Retirement System (hereinafter referred to as "SERS"). 2. SERS, as a creature of statue, is controlled by the State Employees' Retirement Code, 71 Pa. C.S. §§5101-5956 ("Retirement Code") 3. Member's date of birth and Social Security number are contained in the attached Addendum. 4. The Defendant, Jennifer L. Beissel (hereinafter referred to as "Alternate Payee") is the former spouse of Member. Alternate Payee's date of birth and Social Security number are contained in the attached Addendum. 5. Member's last known mailing address is: 83R Autumn Lane Enola, PA 17025 6. Alternate Payee's current mailing address is: 39 John's Drive Enola, PA 17025 EXHIBIT DRO Page 2 It is the responsibility of Alternate Payee to keep a current mailing address on file with SERS at all times. 7. The Member and the Alternate Payee agree that the Alternate Payee's equitable distribution portion of the Member's retirement benefits is $30,000. The equitable distribution amount shall not be adjusted for interest. 8. Member's retirement benefit is defined as all monies paid to or on behalf of Member by SERS, including any lump sum withdrawals or scheduled or ad hoc increases, but excluding the disability portion of any disability annuities paid to Member by SERS as a result of a disability which occurs before Member's marriage to Alternate Payee or after the date of Member's and Alternate Payee's final separation. Member's retirement benefit does not include any deferred compensation benefits paid to Member by SERS. The equitable distribution portion of the marital property component of Member's retirement benefit, as set forth in Paragraph 7, shall be payable to Alternate Payee and shall commence as soon as administratively feasible on or about the date Member actually enters pay status and SERS approves a Domestic Relations Order incorporating this Stipulation and Agreement, whichever is later. 9. Member hereby nominates Alternate Payee as an irrevocable beneficiary to the extent of Alternate Payee's equitable distribution portion of Member's retirement benefit for any death benefits payable by SERS, if the Member dies before the effective date of his retirement. This nomination shall become effective upon approval by the Secretary of the Retirement Board, or his authorized representative, of any Domestic Relations Order incorporating this Stipulation and Agreement. The balance of any death benefit remaining after the allocation of Alternate Payee's equitable distribution portion ("Balance") shall be paid to the beneficiaries named by Member on the last Nomination of Beneficiaries Form filed with the Retirement Board prior to Member's death. (a) If the last Nomination of Beneficiaries Form filed by Member prior to Member's death (a) predates any approved Domestic Relations Order incorporating this Stipulation and Agreement, and (b) names Alternate Payee as a beneficiary, then: (1) the terms of the Domestic Relations Order shall alone govern Alternate Payee's share of any death benefit, and (2) for DRO Page 3 purposes of paying the Balance via the last Nomination of Beneficiaries Form filed with the Retirement Board prior to Member's death, Alternate Payee shall be treated as if Alternate Payee predeceased Member. No portion of the Balance shall be payable to Alternate Payee's estate. (b) In addition, Member shall execute and deliver to Alternate Payee an authorization, in a form acceptable to SERS, which will authorize SERS to release to Alternate Payee all relevant information concerning Member's retirement account. Alternate Payee shall deliver the authorization to SERS which will allow the Alternate Payee to check that she has been and continues to be properly nominated under this paragraph. 10. The term and amounts of Member's retirement benefits payable to Alternate Payee after SERS approves a Domestic Relations Order incorporating this Stipulation and Agreement depends upon which options Member selects upon retirement. Member and Alternate Payee expressly agree that at the time Member files an Application for Retirement Allowance with SERS: (a) Member shall elect to take a lump sum withdrawal of his accumulated deductions of at least the amount of the Alternate Payee's equitable distribution share, as set forth in Paragraph 7. Alternate Payee's equitable distribution portion, as set forth in Paragraph 7, shall be payable from that withdrawal. (b) In addition, Member may select any SERS retirement option for his monthly annuity. 11. Alternate Payee may not exercise any right, privilege or option offered by SERS. SERS shall issue individual tax forms to Member and Alternate Payee for amounts paid to each. 12. The Member and Alternate Payee agree that if the Member becomes disabled, the Member shall file an application for disability retirement and he shall elect the maximum disability option. The Alternate Payee's share of the Member's disability retirement benefits shall be paid to the Alternate Payee, by deducting 25.0% of the early retirement portion of the Member's monthly disability retirement benefit and paying this amount to the Alternate Payee until and only until the Alternate Payee's share, as set forth in Paragraph 7, has been fully paid. DRO Page 4 If the Member dies while receiving a disability retirement benefit from SERS, any death benefit payable by SERS shall be paid to the Alternate Payee to the extent, if any, that her equitable distribution portion of the Member's retirement benefit, as set forth in Paragraph 7, exceeds the total of the monthly payments she previously received. The Member and Alternate Payee acknowledge that if no death benefit is payable from Member's account pursuant to the Disability Maximum Single Life Annuity option at the time of the Member's death, no additional payments will be made to the Alternate Payee. 13. In the event of the death of Alternate Payee prior to receipt of all of her payments payable to her from SERS under this Order, any death benefit or retirement benefit payable to Alternate Payee by SERS shall be paid to the Alternate Payee's estate to the extent of the Alternate Payee's equitable distribution portion of Member's retirement benefit. 14. In no event shall Alternate Payee have greater benefits or rights other than those which are available to Member. Alternate Payee is not entitled to any benefit not otherwise provided by SERS. The Alternate Payee is only entitled to the specific benefits offered by SERS as provided in this Order. All other rights, privileges and options offered by SERS not granted to Alternate Payee by this Order are preserved for Member. Member and Alternate Payee acknowledge that benefits paid pursuant to this Stipulation and Agreement are and shall remain subject to the Public Employee Pension Forfeiture Act, 43 P.S. §1311, et seq. 15. It is specifically intended and agreed by the parties hereto that this Order: (a) Does not require SERS to provide any type or form of benefit, or any option not otherwise provided under the Retirement Code; (b) Does not require SERS to provide increased benefits (determined on the basis of actuarial value) unless increased benefits are paid to Member based upon cost of living or increases based on other than actuarial values. 16. The parties intend and agree that the terms of this Stipulation and Agreement shall be approved, adopted and entered as a Domestic Relations Order. DRO Page 5 17. The Court of Common Pleas of Cumberland County, Pennsylvania, shall retain jurisdiction to amend any Domestic Relations Order incorporating this Stipulation and Agreement, but only for the purpose of establishing it or maintaining it as a Domestic Relations Order; provided, however, that no such amendment shall require SERS, to provide any type or form of benefit, or any option not otherwise provided by SERS, and further provided that no such amendment or right of the Court to so amend will invalidate this existing Order. 18. Upon entry as a Domestic Relations Order, a certified copy of the Domestic Relations Order and this Stipulation and Agreement and any attendant documents shall be served upon SERS immediately. The Domestic Relations Order shall take effect immediately upon SERS approval and SERS approval of any attendant documents and then shall remain in effect until further Order of the Court. WHEREFORE, the parties, intending to be legally bound by the terms of this Stipulation and Agreement, do hereunto place their hands and seals. BY THE COURT Plainti icipant Attorney for Plaintiff/Participant ridant/Alternate Payee ;:. Attorney or Dd n e ayee i ADDENDUM TO DOMESTIC RELATIONS ORDER For Submission to State Employees' Retirement System Only Due to the Federal Privacy Act, many state courts prohibit the inclusion of personal data in public records to prevent identity theft. Therefore, please forward the following information sheet to State Employees' Retirement System when submitting the court certified copy of the Domestic Relations Order. Do NOT file the Addendum with the court. Participant Information Name: Craig J. Beissel Address: 83R Autumn Lane Enola, PA 17025 SSN: 210-54-3442 Date of Birth: December 27, 1960 Alternate Payee Information Name: Jennifer L. Beissel Address: 39 Johns Drive Enola, PA 17025 SSN: 194-64-4827 Date of Birth: June 20, 1970 Participant Attornev's Information Name: Mary A. Etter Dissinger, Esq Address: Dissinger and Dissinger 28 N. 32nd Street Camp Hill, PA 17011 Phone Number: (717) 975-2840 Alternate Payee Attorney's Information Name: Elizabeth Beckley, Esq. Address: Beckley & Madden P.O. Box 11998 Harrisburg, PA 17108 Phone Number: (717) 233-7691 The court certified copy of the Domestic Relations Order and this Addendum should be sent to: State Employees' Retirement System Legal Office 30 North Third Street, Suite 150 Harrisburg, PA 17101-1716 Craig J. Beissel, Plaintiff VS. Jennifer L. Beissel, Defendant : IN THE COURT OF COMMON PLEAS : OF PENNSYLVANIA : CUMBERLAND COUNTY BRANCH : CIVIL ACTION : NO. 06-4941 : IN DIVORCE Domestic Relations Order AND NOW, this day of the stipulation and agreement of ordered and decreed as follows: the parties, it 2010, based upon is hereby 1. Parties: The parties hereto are husband and wife, in a divorce action in this Court at the above number. This Court has personal jurisdiction over the parties. The parties were married on June 6, 1992. They were divorced December 16, 2009. 2. Participant Information: The name of the Plan Participant is Craig Beissel, who resides at 83R Autumn Lane, Enola Pennsylvania 17025. His social security number is contained in the addendum to this domestic relations order. 3. Alternate Payee Information: Alternate Payee is Jennifer Beissel, who resides at 39 Johns Drive, Enola, Pennsylvania 17025. Her social security number is contained in the addendum attached to this domestic relations order. The Alternate Payee shall have the duty to notify the Plan of any changes in mailing address subsequent to the entry of this Order. 4. Plan Name: The name of the Plan to which this Order applies is the Commonwealth of Pennsylvania Deferred Compensation Program EXHIBIT a (hereinafter referred to as "Plan"). The name of the Participant's employer is the Commonwealth of Pennsylvania, Department of Transportation. Any changes in Plan Administrator, Plan Sponsor, or name of the Plan shall not affect Alternate Payee's rights as stipulated under this order. 5. Effect of this Order as a Qualified Domestic Relations Order: This Order creates and recognizes the existence of an Alternate Payee's right to receive a portion of the Participant's benefits payable under an employer-sponsored defined contribution plan under section 457(b) of the Internal Revenue Code (the "Code"). 6. Pursuant to State Domestic Relations Law: This Order is entered pursuant to the authority granted in the applicable domestic relations laws of the Commonwealth of Pennsylvania. 7. Provisions of Marital Property Rights: This Order relates to the provision of equitable distribution rights as a result of an Agreement between the Participant and the Alternate Payee, who are parties to a divorce action. 8. Amount of Alternate Payee's Benefit: This Order assigns to the Alternate Payee 1000 of the Participant's Total Account Balance accumulated under the Plan as of the date of this order. The Alternate Payee's benefit herein awarded shall be credited with any investment income (or losses) attributable thereon from the aforesaid valuation date, until the date of transfer of the Alternate Payeee's share to the Alternate Payee. Such total Account Balance shall include all amounts maintained under all of the various accounts and/or sub-accounts established on behalf of the Participant, including, but not limited to, any rollover, transfer, and the self directed brokerage account. Such benefits shall also be segregated and separately maintained in a non-forfeitable Account(s) established on behalf of the Alternate Payee. This Account(s) will initially be established proportionately in the same core investment options as the Participant account. Alternate Payee may make investment selections as and when permitted under the terms of the Plan. Alternate Payee's account shall experience gains and or losses according to the investment experience of the investment options in which Alternate Payee's share is invested. 9. Commencement Date and Form of Payment to Alternate Payee: If the Alternate Payee so elects on the appropriate Plan form that is submitted to the Plan, the benefits shall be paid to the Alternate Payee as soon as administratively feasible following the date this Order is approved as a QDRO by the Plan. Benefits will be payable to the Alternate Payee in any form or permissible option otherwise available to participants under the terms of the Plan. The Alternate Payee's account shall bear all fees and expenses as though the Alternate Payee were a Participant. 10. Alternate Payee's Rights and Privileges: On and after the date that this Order is deemed to be a QDRO, but before the Alternate Payee receives a total distribution under the Plan, the Alternate Payee shall be entitled to all of the rights and election privileges that are afforded to Plan beneficiaries, including, but not limited to the right to direct Plan investments, only to the extent permitted under the provision of the Plan. The Alternate Payee may not make contribution to the Alternate Payee account. 11. Death of Alternate Payee: In the event of the Alternate Payee's death prior to receiving the full amount of benefits assigned under this Order and under the benefit option chosen by the Alternate Payee, the remainder of any unpaid benefits under the terms of this Order shall be paid to the Alternate Payee's Estate. The Alternate Payee may not designate a beneficiary. 12. Death of Participant: Should the Participant predecease the Alternate Payee, such Participant's death shall in no way affect the Alternate Payee's right to the portion of the benefits as stipulated herein. 13. Savings Clause: This Order is not intended, and shall not be construed in such a manner as to require the Plan: a. to provide any type or form of benefits or any option not otherwise provided under the Plan; b. to provide increased benefits to the Alternate Payee; c. to pay any benefits to the Alternate Payee which are required to be paid to another alternate payee under another order previously determined to be a QDRO; or d. to make any payment or take any action which is inconsistent with any federal or state law, rule, regulation or applicable judicial decision. 14. Certification of Necessary Information: All payments made pursuant to this Order shall be conditioned on the certification by the Alternate Payee and the Participant to the Plan of such information as the Plan may reasonablely require from such parties. 15. Continued Qualified Status of Order: It is the intention of the parties that this DRO continue to qualify as a DRO under section 414(p) of the Code, as it may be amended from time to time, and that the Plan shall reserve the right to reconfirm the qualified status of the Order at the time benefits become payable. 16. Tax Treatment of Distributions Made Under this Order: For purposes of sections 402(a)(1) and 72 of the Code, or any successor Code section, any Alternate Payee who is the spouse or former spouse of the Participant shall be treated as the distributee of any distribution or payments made to the Alternate Payee under the terms of this Order, and as such, will be required to pay the appropriate federal income tax on such distributions. 17. Parties Responsibilities in Event of Error: In the event that the Plan inadvertently pays the Participant any benefits that are assigned to the Alternate Payee pursuant to the terms of this Order, the Participant shall immediately reimburse the Alternate Payee to the extent that the Participant has received such benefit payments by paying such amount directly to the Alternate Payee within ten (10) days of receipt. In the event that the Plan inadvertently pays the Alternate Payee any benefits that are to remain the sole property of the Participant pursuant to the terms of this order, the Alternate Payee shall return such payments to the Plan within ten (10) days of receipt. 18. Effect of Plan Termination: In the event of a Plan termination, the Alternate Payee shall be entitled to receive his or her portion of the Participant's benefits as stipulated herein in accordance with the Plan's termination provisions for participants and beneficiaries. 19. Continued Jurisdiction: The Court retains jurisdiction over this matter to amend this order to establish or maintain its status as a qualified domestic relations order under Code section 414(p), as amended and the original intent of the parties as stipulated herein. The Court shall also retain jurisdiction to enter such further orders as are necessary to enforce the assignment of benefits to the Alternate Payee as set forth herein. 20. Fee: A processing fee of $250.00 shall be charged one- half ($125.00) against the Alternate Payee's share/account and one-half ($125.00) against the Participant's remaining account. In the event that the Alternate Payee is awarded 100% of the Participant's account balance as of the date this Order is processed pursuant to this Order, the entire processing fee shall be charged to the Alternate Payee's account/share. If there are not sufficient funds in either party's account to pay that party's respective share of the fee, the difference shall be charged to the other party. BY THE COURT: J. Craig J Beissel Mary A. Etter Dissinger, Esq. 1L.1.1tJ -Johifer L. $eissel vF?l.iza?bet ? , . 19 ADDENDUM TO DOMESTIC RELATIONS ORDER For Submission to State Employees Retirement System Onl Due to the Federal Privacy Act, many State Courts prohibit the inclusion of personal data in public record, to prevent identity theft. Therefore, please forward the following information sheet to the State Employees Retirement System, when submitting the Court certified copy of the Domestic Relations Order. Do not file the Addendum with the Court. Participant Information Alternate Payee Information Name: Craig J. Beissel Address: 83 R Autumn Lane Enola, PA 17025 SSN: 210-54-3442 DOB: 12/27/60 Participant's Attorney Name: Mary A. Etter Dissinger, Esquire Address: 28 N. 32nd Street, Camp Hill, PA 17011 Phone Number: (717) 975-2840 Name: Jennifer L. Beissel Address: 39 Johns Drive Enola, PA 17025 SSN: 194-64-4827 DOB: 6/20/1970 Alternate Payee's Attorney Name: Elizabeth S. Beckley, Esquire Address: Beckley & Madden, P.O. Box 11998, Harrisburg, PA 17108 Phone Number: 717-233-7691 The Court certified copy of the Domestic Relations Order and the Addendum should be sent to: Great-West Retirement Services PO Box 173764 Denver, CO 80217-3764 Craig J. Beissel, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 06-4941 CIVIL Jennifer L. Beissel, Defendant IN DIVORCE CERTIFICATE OF SERVICE I, Mary A. Etter Dissinger, Esquire, hereby certify that on the date set forth below I served a true and correct copy of the foregoing document by First Class United States mail, addressed as follows: Elizabeth S. Beckley, Esq. Beckley and Madden P.O. Box 11998 Harrisburg, PA 17108 ?... f l , Date: 2010 Mary A. Etter Dissinger, Esq. COURT OF Plaintiff Defendant VS. NO. 06-4941 11"1-%1k KV10TT1-1 100T ATTi-%KTO l1DTlt1D11 AND NOW, this Z Beissel, Plaintiff and Jenz 1. The Plaintiff, Cz Commonwealth of Pennsyl "SERS'7. 2. SERS, as a cr 71 Pa. C.S. §§5101-5956 3. Member's date of Addendum. PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW IN DIVORCE ay of wi ^,-&S , za is , the parties, Craig J. L. Beissel, Defendant, do hereby Agree and Stipulate as follows: J. Beissel (hereinafter referred to as "Member") is a member of the ia, State Employees' Retirement System (hereinafter referred to as of statue, is controlled by the State Employees' Retirement Code, -ement Code"). and Social Security number are contained in the attached 4. The Defendant, J 'fer L. Beissel (hereinafter referred to as "Alternate Payee") is the former spouse of Member. Alt rnate Payee's date of birth and Social Security number are contained in the attached Add ndum. 5. Member's last known mailing address is: 83R Autu n Lane Enola, PA 17025 6. Alternate Payee's cu*ent mailing address is: 39 Jo 's Drive Enola, PA 17025 c:- a b - M S cn co ' DRO Page 2 It is the responsibility of Alternate Payee to keep a current mailing address on file with SERS at all times. 7. The Member and he Alternate Payee agree that the Alternate Payee's equitable distribution portion of the Member's retirement benefits is $30,000. The equitable distribution amount shall not be adjusted for interest. 8. Member's retirem nt benefit is defined as all monies paid to or on behalf of Member by SERS, including any lump s m withdrawals or scheduled or ad hoc increases, but excluding the disability portion of any disa ility annuities paid to Member by SERS as a result of a disability which occurs before Member' marriage to Alternate Payee or after the date of Member's and Alternate Payee's final separ tion. Member's retirement benefit does not include any deferred compensation benefits paid t property component of Mem] to Alternate Payee and shall Member actually enters pay this Stipulation and 9. Member hereby not of Alternate Payee's equitable benefits payable by SERS, if t: nomination shall become effec authorized representative, of Agreement. The balance of a: equitable distribution portion the last Nomination of Benefi Member by SERS. The equitable distribution portion of the marital is retirement benefit, as set forth in Paragraph 7, shall be payable )mmence as soon as administratively feasible on or about the date atus and SERS approves a Domestic Relations Order incorporating t, whichever is later. mates Alternate Payee as an irrevocable beneficiary to the extent istribution portion of Member's retirement benefit for any death Member dies before the effective date of his retirement. This ve upon approval by the Secretary of the Retirement Board, or his iy Domestic Relations Order incorporating this Stipulation and death benefit remaining after the allocation of Alternate Payee's Balance") shall be paid to the beneficiaries named by Member on cries Form filed with the Retirement Board prior to Member's death. (a) If the last N death (a) predates any apps Agreement, and (b) names j Relations Order shall alone .ation of Beneficiaries Form filed by Member prior to Member's Domestic Relations Order incorporating this Stipulation and late Payee as a beneficiary, then: (1) the terms of the Domestic ^n Alternate Payee's share of any death benefit, and (2) for DRO Page 3 purposes of paying the Bal ce via the last Nomination of Beneficiaries Form filed with the Retirement Board prior to ember's death, Alternate Payee shall be treated as if Alternate Payee predeceased Member. No i p rtion of the Balance shall be payable to Alternate Payee's estate. (b) In addition, ember shall execute and deliver to Alternate Payee an authorization, in a form acce table to SERS, which will authorize SERS to release to Alternate Payee all relevant informati n concerning Member's retirement account. Alternate Payee shall deliver the authorization to ERS which will allow the Alternate Payee to check that she has been and continues to be properly ominated under this paragraph. 10. The term and amo nts of Member's retirement benefits payable to Alternate Payee after SERS approves a Dome tic Relations Order incorporating this Stipulation and Agreement depends upon which options ember selects upon retirement. Member and Alternate Payee expressly agree that at the ti a Member files an Application for Retirement Allowance with SERS: (a) Member shall lect to take a lump sum withdrawal of his accumulated deductions of at least the amount of the ternate Payee's equitable distribution share, as set forth in Paragraph 7. Alternate Payee s equitable distribution portion, as set forth in Paragraph 7, shall be payable from that withdra al. (b) In addition, M mber may select any SERS retirement option for his monthly annuity. 11. Alternate Payee ma not exercise any right, privilege or option offered by SERS. SERS shall issue individual tax forms to Member and Alternate Payee for amounts paid to each. 12. The Member and Alt rnate Payee agree that if the Member becomes disabled, the Member shall file an applicatio for disability retirement and he shall elect the maximum disability option. The Alternate Payee's share of the Member's disability retirement benefits shall be paid to the Alternate Payee, y deducting 25.0% of the earl retirement portion of the Member's monthly disability ret rement benefit and paying this amount to the Alternate Payee until and only until the Alternat Payee's share, as set forth in Paragraph 7, has been fully paid. y DRO Page 4 If the Member dies while payable by SERS shall be distribution portion of the total of the monthly paymen acknowledge that if no deatl Maximum Single Life Annui will be made to the Alternate 13. In the event of the payable to her from SERS Alternate Payee by SERS Alternate Payee's equitable 14. In no event shall which are available to provided by SERS. The riving a disability retirement benefit from SERS, any death benefit d to the Alternate Payee to the extent, if any, that her equitable ember's retirement benefit, as set forth in Paragraph 7, exceeds the s she previously received. The Member and Alternate Payee benefit is payable from Member's account pursuant to the Disability y option at the time of the Member's death, no additional payments Payee. !ath of Alternate Payee prior to receipt of all of her payments r this Order, any death benefit or retirement benefit payable to be paid to the Alternate Payee's estate to the extent of the ;ribution portion of Member's retirement benefit. -pate Payee have greater benefits or rights other than those Alternate Payee is not entitled to any benefit not otherwise ;e Payee is only entitled to the specific benefits offered by SERS as rights, privileges and options offered by SERS not granted to -e preserved for Member. Member and Alternate Payee provided in this Order. All otl Alternate Payee by this Order acknowledge that benefits pail subject to the Public Employe( 15. It is specifically i pursuant to this Stipulation and Agreement are and shall remain Pension Forfeiture Act, 43 P.S. §1311, et seq. and agreed by the parties hereto that this Order: (a) Does not req otherwise provided under the (b) Does not requ actuarial value) unless increa, increases based on other than SERS to provide any type or form of benefit, or any option not ;irement Code; SERS to provide increased benefits (determined on the basis of benefits are paid to Member based upon cost of living or ial values. 16. The parties intend an agree that the terms of this Stipulation and Agreement shall be approved, adopted and entered a Domestic Relations Order. y DRO Page 5 17. The Court of Co mon Pleas of Cumberland County, Pennsylvania, shall retain jurisdiction to amend any D mestic Relations Order incorporating this Stipulation and Agreement, but only for the purpose of establishing it or maintaining it as a Domestic Relations Order; provided, however, t at no such amendment shall require SERS to provide any type or form of benefit, or any optio not otherwise provided by SERS, and further provided that no such amendment or right of the C urt to so amend will invalidate this existing Order. 15. Upon entry as a Order and this Stipulation SERS immediately. The Don approval and SERS approval further Order of the Court. WHEREFORE, the and Agreement, do hereunto Lestic Relations Order, a certified copy of the Domestic Relations Agreement and any attendant documents shall be served upon ;tic Relations Order shall take effect immediately upon SERS any attendant documents and then shall remain in effect until intending to be legally bound by the terms of this Stipulation ce their hands and seals. BY THE COURT i Attorney for Plaintiff/Parti T 1 Co -cs 14+4? /n . 1J1'sS r n-I?UZ- '3p.3/1v `zy7i nc THE ? K_C STAY : E it a?aat, : J Craig J. Beissel, Plaintiff VS. Jennifer L. Beissel, Defendant : IN THE COURT OF COMMON PLEAS : OF PENNSYLVANIA : CUMBERLAND COUNTY BRANCH : CIVIL ACTION : NO. 06-4941 : IN DIVORCE Domestic Relations Order AND NOW, this Z3.` day of -n-64'f C# , 2010, based upon the stipulation and agreement of the parties, it is hereby ordered and decreed as follows: 1. Parties: The par ies hereto are husband and wife, in a divorce action in this Cour at the above number. This Court has personal jurisdiction over tie parties. The parties were married on June 6, 1992. They were ivorced December 16, 2009. 2. Participant Information: The name of the Plan Participant is Craig Beissel, who resides at 83R Autumn Lane, Enola Pennsylvania 17025. His social security number is contained in the addendum to this domestic relations order. 3. Alternate Payee nformation: Alternate Payee is Jennifer Beissel, who reside at 39 . Johns Drive, Enola, Pennsylvania 17025. Her social security number is contained in the addendum attached to this domestic relations order. The Alternate Payee shall have the duty to notify the Plan of any changes in mailing ?ddress subsequent to the entry of this Order. 4. Plan Name: The n?me of the Plan to which this Order applies is the Commonwealth of Pennsylvania Deferred Compensation Program ¦ 40 (hereinafter refer ed to as "Plan"). The name of the Participant's empl yer is the Commonwealth of Pennsylvania, Department of Transportation. Any changes in Plan Administrator, Plan Sponsor, or name of the Plan shall not affect Alternate Payee's rights as stipulated under this order. 5. Effect of this der as a Qualified Domestic Relations Order: This Order creates and recognizes the existence of an Alternate _ Payee's right to receive a portion of the Participant's benefits payable under an employer-sponsored defined contribution plan under section 457(b) of the Internal Revenue Code (the "Code"). 6. Pursuant to Stat Domestic Relations Law: This Order is entered pursuant to the authority granted in the applicable domestic relations aws of the Commonwealth of Pennsylvania. 7. Provisions of Marital Property Rights: This Order relates to the provision of eq itable distribution rights as a result of an Agreement between tie Participant and the Alternate Payee, who are parties to a divorce action. 8. Amount of Altern Alternate Payee 100 accumulated under t Alternate Payee's b any investment inco aforesaid valuation Alternate Payeee's Account Balance sha the various account the Participant, in transfer, and the s, Such benefits shall in a non-forfeitabl Alternate Payee. Th proportionately in Participant account selections as and w Alternate Payee's a according to the in in which Alternate 9. Commencement Dati the Alternate Payee .te Payee's Benefit: This Order assigns to the of the Participant's Total Account Balance e Plan as of the date of this order. The nefit herein awarded shall be credited with .e (or losses) attributable thereon from the date, until the date of transfer of the hare to the Alternate Payee. Such total 1 include all amounts maintained under all of and/or sub-accounts established on behalf of luding, but not limited to, any rollover, if directed brokerage account. also be segregated and separately maintained Account(s) established on behalf of the s Account(s) will initially be established he same core investment options as the Alternate Payee may make investment en permitted under the terms of the Plan. count shall experience gains and or losses estment experience of the investment options ayee's share is invested. and Form of Payment to Alternate Payee: If o elects on the appropriate Plan form that i is submitted to the Alternate Payee as the date this Order will be payable to option otherwise av Plan. The Alternate expenses as though Plan, the benefits shall be paid to the oon as administratively feasible following is approved as a QDRO by the Plan. Benefits he Alternate Payee in any form or permissible ilable to participants under the terms of the Payee's account shall bear all fees and he Alternate Payee were a Participant. 10. Alternate Payee's Rights and Privileges: On and after the date that this Orde is deemed to be a QDRO, but before the Alternate Payee rec Ives a total distribution under the Plan, the Alternate Payee sha 1 be entitled to all of the rights and election privileges that are afforded to Plan beneficiaries, including, but not imited to the right to direct Plan investments, only t the extent permitted under the provision of the Plan. The Alter ate Payee may not make contribution to the Alternate Payee account. 11. Death of Alterna Payee's death prior assigned under this the Alternate Payee, the terms of this Or Estate. The Alternat 12. Death of Partici Alternate Payee, suc the Alternate Payee' stipulated herein. e Payee: In the event of the Alternate o receiving the full amount of benefits rder and under the benefit option chosen by the remainder of any unpaid benefits under er shall be paid to the Alternate Payee's Payee may not designate a beneficiary. nt: Should the Participant predecease the Participant's death shall in no way affect right to the portion of the benefits as 13. Savings Clause: his Order is not intended, and shall not be construed in such a anner as to require the Plan: a. to provide any type or form of benefits or any option not otherwise provided under the Plan; b. to provide in reased benefits to the Alternate Payee; c. to pay any be efits to the Alternate Payee which are required to be p id to another alternate payee under another order previously determined to be a QDRO; or d. to make any p yment or take any action which is inconsistent wit any federal or state law, rule, regulation or applicable ju icial decision. 14. Certificati n of Necessary Information: All payments made pursuant t this Order shall be conditioned on the certification b the Alternate Payee and the Participant to the Plan of suc information as the Plan may reasonablely require from su h parties. 15. Continued Q of the parties under section 4 time to time, a reconfirm the q benefits become 16. Tax Treatme For purposes of any successor C spouse or forme as the distribu the Alternate P such, will be r tax on such dis 17. Parties Resl that the Plan it benefits that a7 to the terms of immediately rein the Participant such amount dire days of receipt. ,alified Status of Order: It is the intention hat this DRO continue to qualify as a DRO 4(p) of the Code, as it may be amended from d that the Plan shall alified status of the payable. reserve the right to Order at the time t of Distributions Made Under this Order: sections 402(a)(1) and 72 of the Code, or de section, any Alternate Payee who is the spouse of the Participant shall be treated ee of any distribution or payments made to yee under the terms of this Order, and as quired to pay the appropriate federal income ributions. onsibilities in Event of Error: In the event advertently pays the Participant any e assigned to the Alternate Payee pursuant this Order, the Participant shall burse the Alternate Payee to the extent that has received such benefit payments by paying ctly to the Alternate Payee within ten (10) In the event that the Plan inadvertently pays the Alternate Payee any benefits that are to remain the sole property of the Participant pursuant to the terms of this Order, the Alternate Payee hall return such payments to the Plan within ten (10) Jays of receipt. 18. Effect of Plan Termination: In the event of a Plan termination, the Alternate Payee shall be entitled to receive his or h r portion of the Participant's benefits as stipulated herei in accordance with the Plan's termination provisions for p rticipants and beneficiaries. 19. Continued Ju over this matter maintain its sta under Code secti intent of the pa also retain juri isdiction: The Court retains jurisdiction to amend this Order to establish or us as a qualified domestic relations order n 414(p), as amended and the original ties as stipulated herein. The Court shall diction to enter such further orders as are necessary to e force the assignment of benefits to the Alternate Paye as set forth herein. 20. Fee: A process ing fee of $250.00 shall be charged one- half ($125.00) against the Alternate Payee's share/account and one-half (S125.00) against the Participant's remaining account. In the event that the Alternate Payee is awarded 100% of the Participant's account balance as of the date this Order is processed pursuant to this Order, the entire processing fee shall be charged to the Alternate Payee's account/share. If there are not sufficient funds in either party's accoun to pay that party's respective share of the fee, the diffe ence shall be charged to the other party. BY THE COURT: Craig JV B`eisse i fi fer L. ei sel 0 ?Al Mary A. Etter Dissinger, Esq. ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Penmylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 05/03/10 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number AECOM TECHNOLOGY 4840 COX RD GLEN ALLEN VA 23060-6292 210-54-3442 Employee/Obligor's Social Security Number 1202101965 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'stobligor's income until further notice even if the Order/Notice is not issued by your State. $ 1,048.00 per month in current child support $ o . oo per month in past-due child support Arrears 12 weeks or greater? Oyes ® no $ o . oo per month in current medical support $ 0.00 per month in past-due medical support $ 300.00 per month in current spousal support U $ 22.00 per month in past-due spousal support $ 0.00 per month for genetic test costs $ o . oo per month in other (specify) b $ one-time lump sum payment for a total of $ 1,370.00 per month to be forwarded to payee below. tv You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle doe.A of ch the ordered support payment cycle, use the following to determine how much to withhold: $ 316.15 per weekly pay period. $ 685. oo per semimonthly pay period (twice $ 632.31 per biweekly period (every two weeks) $ 1. 370.00 a month) pay rY per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. S 4374(b)) requires remittance by an electronic Payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please cal) the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SQ?ALf CURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: M4? 1 7/ 2 a" O DRO: R.J. Shadday Service Type m .. J. Wesley Oler, Jr., OMB No.: 0970-0154 813109926 283 S 2008 06-4941 CIVIL O Original Osier/Notice @Amended Order/Notice 0Terminate Order/Notice QOne-Time Lump Sum/Notice RE:BEISSEL, CRAIG J. Employee/Obligor's Name (Last, First, MI) Form EN-028 Rev.5 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? 94hecke#! you are required to per?vifle a Copy of this form to youroem?loyee . If y Vr employee yorks in a state that is i Brent rom the state that issu this order, a copy must be provi to your employee even if the box is not checked 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee'slobligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the 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. 6110885220 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME:BEISSEL, CRAIG J. EMPLOYEE'S CASE IDENTIFIER: 1202101965 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. if you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeetobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee%bligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If. you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240.6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.5 Service Type M 0M5 No.:0970-0154 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BEISSEL, CRAIG J. PACSES Case Number 636109944 Plaintiff Name JENNIFER L. BEISSEL Docket Attachment Amount 06-4941 CIVIL$ 322.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Service Type M OMB Na: 09704)154 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Form EN-028 Rev.5 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dirt. of CUMBERLAND Date of Order/Notice os/3o/l0 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number AECOM TECHNOLOGY 4840 COX RD GLEN ALLEN VA 23060-6292 06-4941 CIVIL OOriginal Order/Notice OAmended Order/Notice OTerminate Order/Notice QOne-Time Lump Sum/Notice Employee/Obligor's Name (Last, First, MI) 210-54-3442 Employee/Obligor's Social Security Number 1202101965 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, Mp See Addendum for dependent names and birth dates associated with cases on attachment. ORDER 1NFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 1,048.00 $ o.oo $ o.oo $ 0.00 $ 300.00 $ o.oo $ 0.00 $ o.oo for a total of $ per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) one-time lump sum payment Arrears 12 weeks or greater? 1, 348.00 per month to be forwarded to payee below. Q~s ~ nom ~~l~ ~ -aG, t ,^^7 ~~ N Q'~ You do not have to vary your pay cycle to be incompliance 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: $ 311.08 per weekly pay period. $ 674 , oo per semimonthly pay period (twice a month) $ 622.15 per biweekly pay period (every two weeks) $ i, 34s. 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 paydateldate of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic aayment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. IN ADDITION, PAYMENTS MUST INCLUDE THE above as the Employee/Obligor's Case den ' ier) ~ DO NOT SEND CASH BYMAIL./~ / BY THE COURT: / L„ ///, DRO: R.J. Box 69112, Harrisburg, Pa 17106-9112 DEf NDANT'S NAME AND THE PACSES MEMBER /D (shown ~ CIAL SkCURITY NUMBER IN ORDER TO BE PROCESSED. v Service Type M OMB No.: 0970-0754 813109926 X83 S 2008 RE:BEISSEL, CRAIG J. ., Form EN-028 Rev.S Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ~ If ~hecked you are required, to provide a~opy of this form to your~mployee. If your employee vl+orks in a state that is di Brent from the state that issued this or er, a copy must be provi edd to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee%bligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee%bligorsnd you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee%bligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 6110885220 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : ~ THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: ~ EMPLOYEE'S/OBLIGOR'S NAME:BEISSEL, CRAIG J. EMPLOYEE'S CASE IDENTIFIER: 1202101965 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT• NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee%bligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligorfr0m employment, refusing to employ, or taking disciplinary action against any employee%bligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: t) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. ~ t . Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 CARLISLE PA 17013 by FAX at (717) 240-6248 or by Internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.S Service Type M OMB No.: 0970-0154 Worker I D $ IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BEISSEL, CRAIG J. PACSES Case Number 636109944 Plaintiff Name JENNIFER L. BEISSEL Docket Attachment Amount 06-4941 CIVIL$ 300.00 Child(ren)'s Name(s): DOB PACSES Case Number 813109926 Plaintiff Name JENNIFER L. BEISSEL Docket Attachment Amount 00283 S 2008 $ 1,048.00 Child(ren)'s Name(s): DOB CAELYN J. BEISSEL 01/.10/94 PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oa Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev.S Service Type M OMBNo.:097P0154 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT (.0 314, 1 Cq q O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) O AMENDED IWO ?8' 13 I D gcl -Z O? _ t 1 I O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT W ?i T Q TERMINATION OF IWO ag D 5 -Zocb Date: 06/04/12 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions httl)://www.acf hhs ciov/programs/cse/newhire/employer/publication/publication htm forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. Staterriberferritory Commonwealth of Pennsylvania Remittance Identifier (include w/payment): 1202101965 City/County/Dist.rrribe CUMBERLAND Order Identifier: (See Addendum for order/docket /nformalton) Private Individual/Entity CSE Agencv Case Identifier: fSee Addendum fir -- --- AECOM TECHNOLOGY 4840 COX RD GLEN ALLEN VA 23060-6292 Employer/Income Withholder's FEIN 611088522 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: BEISSEL, CRAIG J Employee/Obligor's Name (Last, First, Middle) 210-54-3442 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www,acf.hhs g!2v/prrograms/cse/newhire/ em-p-loyer/publicationtpublication.htm form d. If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. 6110885220 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. $ 0.00 per month in current child support 2: .. $ 0.00 Per month in past-due child support -Arrears 12 weeks or greater? Q yps!?p ?.?. L $ 0.00 per month in current cash medical support c r- 1 , $ 0.00 per month in past-due cash medical support -?= 47 $ 300.00 per month in current spousal support - -r =7'. $ 0.00 per month in past-due spousal support = $ 0.00 per month in other (must specify) c= r,.) = for a Total Amount to Withhold of $ = r.; 300.00 per month. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: $ 69.04 per weekly pay period. $ 150.00 per semimonthly pay period (twice a month) $ 138.08 per biweekly pay period (every two weeks) $ 300.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs en 10 working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www acf hhs gov/programs/cse/newhire/employer/contacts/contact map htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970-0154 Form EN-028 06/12 Service Type M Worker ID 21205 ? Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal law): Print Name of Judge/issuing Official: Title of Judge/Issuing Official: Date of Signature: If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. ? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronir?.. FLayment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69142, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: hftp•/hs • w acf hhs g4v/o rams/cse/newhirelem looyer/contacWcontact mao:htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender.` Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions' on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date-05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN-028 06/12 Service Type M Page 2 of 3 Worker ID 21205 Employer's Name: AECOM TECHNOLOGY Employer FEIN: 611088522 Employee/Obligor's Name: BEISSEL, CRAIG J. 1202101965 CSE Agency Case Identifier: (See Addendum for case summara) Order Identifier: (See Addendum for order/docket information) Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below; 6110885220 O This person has never worked for this employer nor received periodic income. O This person no longer works for this employer nor receives periodic income Please provide the following information for the employee/obligor: Termination date: Last known address: Final Payment Date To SDU/Tribal Payee: New Employer's Name: Last known phone number: Final Payment Amount: New Employer's Address: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.childsupportstate pa us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA. 17013 (Issuer address). To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at www.childsupoortstate pa us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. OMB No.: 0970-0154 Form EN-028 06/12 Service Type M Page 3 of 3 Worker ID 21205 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: BEISSEL, CRAIG J. PACSES Case Number 636109944 Plaintiff Name JENNIFER L. BEISSEL Docket Attachment Amount 064941 CIVIL $ 300.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PAC ES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Service Type M PACSES Case Numb Plaintiff Name Docket Attachme $ Child(ren)'s Name(s): nt Amount 0.00 DOB PACSES Case Number Plaintiff Name Docket Attachm $ Child(ren)'s Name(s): ent Amount 0.00 DOB PACSES Case Number Plaintiff Name Docket Attach $ Child(ren)'s Name(s): ment Amount 0.00 DOB Addendum OMB No.: 0970-0154 Form EN-028 06112 Worker ID 21205