Loading...
HomeMy WebLinkAbout81-2193As of oq~a~-~ casE# ~- aig3 HAS BEEN SCANNED. ALL EARLIER FILINGS TO THIS CASE HAVE BEEN MICROFILMED. ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State commonwealth of Pennsylvania CO.lCity/Dist.Of CUMBERLAND Date of Order/Notice 09/22/06 Case Number (See Addendum for case summary) Employer/Withholder's Federa{ EIN Number CUMBERLAND APOTHECARY INC 3300 MARKET ST CAMP HILL PA 16979 l t~.P ~ ~ ~~ ~.~ 8~-~~93 Ctu~L O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: WENTZEL, WILLIAM T. Employee/Obligor's Name (Last, First, Mp 204-30-5067 Employee/Obligor's Social Security Number 8750000028 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. $ o . oo per month in current support $ o . oo per month in past-due support Arrears 12 weeks or greater? Qyes (~ no $ o . oo per month in current and past-due medical support $ o . o o per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 Per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ o . oo per weekly pay period. $ o . oo per biweekly pay period (every two weeks). $ o . 00 per semimonthly pay period (twice a month). $ o . oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55°!0 of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #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 1N ADD-TION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER 1D (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER 1N ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY T COURT: Date of Order: s~~ ~ v ~`~~~ v ~ G Ede- ~ ~a y ~e y, Form EN- 8 Rev. 1 Service Type M OMBNo.:0970-0154 Worker ID $IATT -., ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ^ If checked you are required, to provide a copy of this form to your em loyee. If yo r employee works in.a state that is different from the state that issued this order, a copy must be providedpto your emp~oyee even if the box ~s 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 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.* is- .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: 2322599530 EMPLOYEE'S/OBLIGOR'S NAME: WENTZEL WILLIAM T . EMPLOYEE'S CASE IDENTIFIER: 8750000028 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAMEJADDRESS: 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%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 (15 U.S.C. ~ 1673 (b)1; or 2) the amounts allowed by the State of the employee'slobligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the 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. ~ 1.Submitted By: If you or your employee%bligor 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. 1 Service Type M Worker I D $ IATT OMB NO.: 0970-0754 f .~ ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WENTZEL, WILLIAM T. PACSES Case Number 761000021 Plaintiff Name SUSAN M. WENTZEL Docket Attachment Amount 2193 CV 81 $ 0.00 Child(ren)'s Name(s): DOB ©If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ^ If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB ^ If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount ~ o.oo Child(ren)'s Name(s): DOB ^ If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB ^ If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB ^ If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type M Worker ID $IATT OMB No.: 0970-0154 f."'..~ ~~ ,,"" ~~ G~3 ~ ~i ' ,,,,~.~ }' -`G , _ ~ }•. PACSES CASE NO. 761000021 SUSAN M. WENTZEL, IN THE COURT OF COMMON PLEAS OF PLAINTIFF CUMBERLAND COUNTY, PENNSYLVANIA V. DOMESTIC RELATION SECTION CIVIL ACTION -DIVORCE WILLIAM T. WENTZEL, DEFENDANT NO. 2193 CV 81 ORDER OF COURT AND NOW, this 20th day of April, 2007, the Court being informed by the Domestic Relations Section that the above-captioned case meets case closure criteria due to the Order no longer being able to be enforced under state law through the Domestic Relations Section, IT IS HEREBY ORDERED AND DIRECTED that the above captioned case be closed without prejudice pursuant Pa R.C. P. § 1910.19. This case is closed with arrears of $1,182,641.00, through April 30, 2007, due to the plaintiff. The Cumberland County Domestic Relations Section dismisses their interest in the alimony matter. This Order shall become final twenty days after the mailing of the notice of the entry of the order to the parties unless either party files a written demand with the Domestic Relations Section for a hearing de novo before the Court. BY THE COURT, 3 Edgar B. Bayley, Judge DRO: R. J Shadday xc: Plaintiff Defendant Samuel L. Andes, Esq. Service Type M FORM 0E-001 Worker 21005 f ~ ~ ;~" _ ~ ~ -~-_ ~ < ~ " ':I" -, - ~ ,,5 r-; f-- ~ -, ~ ~ 4. . In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SUSAN M. WENTZEL Plaintiff ) vs. ) PACSES Case Number 7 610 0 WILLIAM T. WENTZEL ) Defendant ) Other State ID Number PETITION FOR CONTEMPT -DEFENDANT ) Docket Number 2193 CI 81 TO THE HONORABLE, THE JUDGES OF SAID COURT: 1. Petitioner is CUMBERLAND County Domestic Relations Section. 2. Defendant is WILLIAM T. WENTZEL who resides at 359 VALLEY RD, ETTERS, PA. 17319-8918-59 3. On JUNE 29, 19x2 an order of support was entered by the Honorable Court directing Defendant to pay the sum of $ 3, 260.91 per month for the support of his/her dependent(s). 4. Defendant has failed to comply with the order as entered by the Court by failing to: ® pay as ordered. ^ provide information which was ordered. ^ appear as ordered. ^ other: 5. The arrearages under the Order amount to $ 442, 534.41 aS Of SEPTEMBER 16, 1999 WHEREFORE, Petitioner prays that the Court issue an order directing the attendance of Defendant at a hearing of said Petition and hereafter to make an adjudication of contempt. I verify that the statements made in this Petition are true and correct to the best of my knowledge. I understand that false statements herein are made to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities. "! ~~L~-~~f ~~ CHARLES CAROTHER5 Date Signature 7~7Cv~~ri l~l~~C: w\CIJ~< c~ 6~0~1.~C~ Form EN-007 Service Type M Worker ID 213 O 1 c: ..~ c ~ ..G ~~' n-~ -,: ~ . i _ ~,~ G7 ~ f`., i', - ; ; ~.. T` ~-~ i7 ,.~ C ~ ~ ~ cn In the Court of Common Pleas of CUMBERLAND DOMESTIC RELATIONS SECTION ~~i~ County, Pennsylvania Defendant Name: WILLIAM T. WENTZEL Member ID Number: a75ooooozs Please note: All correspondence must include the Member ID N~ber. P R S CONSULTANTS INC 201 DEPOT ST P 0 BOX 852 LATROBE PA 15650 ORDER OF ATTACHMENT OF INCOME Financial Break Down of Multip le Cases on Attachment PACSES Docket Plaintiff Name Case Number Number Attachment Amount/Frequency SUSAN M. WENTZEL 761000021 2193 CI 81 $ 3,258.75 /MONTH / / $ / / / $ / TOTAL ATTAC HMENT AMOUNT: $ 3, 25s .75 TO: P R S CONSULTANTS INC Pursuant to the laws of the Commonwealth of Pennsylvania the income of WILLIAM T. WENTZEL ,defendant obligor, SSN 204-30-5067 of: 359 VALLEY RD, ETTERS, PA. 17319-8918-59 is hereby attached to the following extent. You are directed to pay to the Office of the Domestic Relations Section of the Court of Common Pleas of CUMBERLAND County the sum of $ 3, 258.75 per MONTH from the income due the defendant obligor. The attachment payment must be sent to the Domestic Relations Section within seven business days of the date the defendant obligor is paid. Form EN-028 Service Type M Worker ID $IATT .WILLIAM T. WENTZEL PACSES Member Number: 8750000028 CHECKS SHOULD BE MADE PAYABLE TO: DOMESTIC RELATIONS SECTION AND SENT TO THE DOMESTIC RELATIONS SECTION AT: P.O. BOX 320, CARLISLE, PA. 17013 PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. This order of attachment for support is binding upon you until further notice and shall have priority over any attachment, execution, garnishment or wage attachment under state or local law except one relating to a prior support order. You must commence the attachment of the defendant obligor's income as soon as possible but no later than fourteen days from the date of the issuance of this Order of Attachment. You are notified further that pursuant to law: 1. The defendant obligor has been notified that an order of attachment for support would be issued. 2. Willful failure to comply with this order may result in (i) your being adjudged in contempt of court and committed to jail or fined by the court; (ii) your being held liable for any amount not withheld or withheld but not forwarded to the Domestic Relations Section; and (iii) attachment of your funds or property. 3. The attachment of income or the possibility thereof as a basis, in whole or in part, for the discharge of an employee or any disciplinary action against or demotion of an employee is prohibited. Violation may result in (i) your being adjudged in contempt and committed to jail or fined by the court and (ii) an action against you by the employee for damages. Page 2 of 4 Form EN-028 Service Type M Worker ID $ IATT WILLIAM T. WENTZEL PACSES Member Number: 8750000028 4. If there are in your employment one or more additional employees whose incomes are subject to the Order of the Court of Common Pleas of CUMBERLAND County for attachment of support, you may combine the attachment payments into a single payment to the Domestic Relations Section and separately identify the portion attributable to each obligor. 5. You must notify the Domestic Relations Section when the defendant obligor terminates employment and provide the Section with the employee's last known address and the name and address of the new employer, if known. 6. The maximum amount of the attachment shall not exceed 55 % of the employee's net income which is within the limits set in the Consumer Credit Protection Act, 15 U.S.C.§1673. 7. The term "income" as defined by law includes compensation for services, including, but not limited to, wages, salaries, fees, compensation in kind, commissions and similar items; income derived from business; gains derived from dealings in property; interest; rents; royalties, dividends, annuities; income from life insurance and endowment contracts; all forms of retirement; pensions; income from discharge of indebtedness; distributive share of partnership gross income; income in respect of a decedent; income from an interest in an estate or trust; military retirement benefits; railroad employment retirement benefits, social security benefits; temporary and permanent disability benefits; worker's compensation and unemployment compensation. Page 3 of 4 Form EN-028 Service Type M Worker ID $IATT ' WILLIAM T. WENTZEL PACSES Member Number: 8750000028 GENERAL INSTRUCTIONS t. Employers may elect to deduct up to 2% of the attachment amount for their costs. This amount must not be deducted from the attachment. It must be paid from the employee's net earnings after the income attachment deduction has been made. 2. Dates monies were withheld from the employees' pay must be provided on the payment transmittal form to the Domestic Relations Office. 3. If you choose to make payments via an electronic funds transfer, instructions may be requested from the Domestic Relations Office. Date of Order: July 19, 1999 BY THE COURT: EDGAR B. BAYLEY, JUDGE ,. Page 4 of 4 Form EN-028 Service Type M Worker ID $ IATT C; `', r ~~ -[; :' f' - '..~~ 1' t ,~. -,~ ~ r~ In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION Defendant Name: WILLIAM T. WENTZEL Member ID Number: s 7 s o 0 0 0 0 2 s Please note: All correspondence must include the Member ID Number. CUMBERLAND APOTHECARY INC 3300 MARKET ST CAMP HILL PA 16979 Plaintiff Name SUSAN M. WENTZEL ORDER OF ATTACHMENT OF INCOME ti Financial Break Down of Multiple Cases on Attachment PACSES Docket Attachment Amount/Frequency Case Number Number 761000021 2193 CI 81 $ 3,258.75 /MONTH TOTAL ATTACHMENT AMOUNT: TO: CUMBERLAND APOTHECARY INC $ ~ $ 3,258.75 Pursuant to the laws of the Commonwealth of Pennsylvania the income of WILLIAM T. WENTZEL ,defendant obligor, SSN 204-30-5067 of: 359 VALLEY RD, ETTERS, PA. 17319-8918-59 is hereby attached to the following extent. You are directed to pay to the Office of the Domestic Relations Section of the Court of Common Pleas of CUMBERLAND County the sum of $ 3 , 2 5 8.7 5 per MONTH from the income due the defendant obligor. The attachment payment must be sent to the Domestic Relations Section within seven business days of the date the defendant obligor is paid. Form EN-028 Service Type M Worker ID $IATT WILLIAM T. WENTZEL PACSES Member Number: 8750000028 CHECKS SHOULD BE MADE PAYABLE TO: DOMESTIC RELATIONS SECTION AND SENT TO THE DOMESTIC RELATIONS SECTION AT: P.O. BOX 320, CARLISLE, PA. 17013 PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. This order of attachment for support is binding upon you until further notice and shall have priority over any attachment, execution, garnishment or wage attachment under state or local law except one relating to a prior support order. You must commence the attachment of the defendant obligor's income as soon as possible but no later than fourteen days from the date of the issuance of this Order of Attachment. You are notified further that pursuant to law: 1. The defendant obligor has been notified that an order of attachment for support would be issued. 2. Willful failure to comply with this order may result in (i) your being adjudged in contempt of court and committed to jail or fined by the court; (ii) your being held liable for any amount not withheld or withheld but not forwarded to the Domestic Relations Section; and (iii) attachment of your funds or property. 3. The attachment of income or the possibility thereof as a basis, in whole or in part, for the discharge of an employee or any disciplinary action against or demotion of an employee is prohibited. Violation may result in (i) your being adjudged in contempt and committed to jail or fined by the court and (ii) an action against you by the employee for damages. Page 2 of 4 Form EN-028 Service Type M Worker ID $ IATT WILLIAM T. WENTZEL PACSES Member Number: 8750000028 4. If there are in your employment one or more additional employees whose incomes are subject to the Order of the Court of Common Pleas of CUMBERLAND County for attachment of support, you may combine the attachment payments into a single payment to the Domestic Relations Section and separately identify the portion attributable to each obligor. 5. You must notify the Domestic Relations Section when the defendant obligor terminates employment and provide the Section with the employee's last known address and the name and address of the new employer, if known. 6. The maximum amount of the attachment shall not exceed 55 % of the employee's net income which is within the limits set in the Consumer Credit Protection Act, 15 U.S.C. §1673. 7. The term "income" as defined by law includes compensation for services, including, but not limited to, wages, salaries, fees, compensation in kind, commissions and similar items; income derived from business; gains derived from dealings in property; interest; rents; royalties, dividends, annuities; income from life insurance and endowment contracts; all forms of retirement; pensions; income from discharge of indebtedness; distributive share of partnership gross income; income in respect of a decedent; income from an interest in an estate or trust; military retirement benefits; railroad employment retirement benefits, social security benefits; temporary and permanent disability benefits; worker's compensation and unemployment compensation. Page 3 of 4 Form EN-028 Service Type M Worker ID $ IATT WILLIAM T. WENTZEL PACSES Member Number: 8750000028 GENERAL INSTRUCTIONS ~. Employers may elect to deduct up to 2% of the attachment amount for their costs. This amount must not be deducted from the attachment. It must be paid from the employee's net earnings after the income attachment deduction has been made. 2. Dates monies were withheld from the employees' pay must be provided on the payment transmittal form to the Domestic Relations Office. 3. If you choose to make payments via an electronic funds transfer, instructions may be requested from the Domestic Relations Office. BY THE COURT: Date of Order: May 24 , 1999 Service Type M EDGAR B. BAYL Y, JUDGE Page 4 of 4 Form EN-028 Worker ID $ IATT (-3 i n r.~ - : ., _ . ,= ~ %J _ ~ `~' ~• ~. ~T. °'~., "" ~ ' ~~ ~ ~ ~~ -c r c -~ i ~, f In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION Defendant Name: WILLIAM T. wENTZEL Member ID Number: s7sooooo2s Please note: Atl correspondence must include the Member ID Number. CUMBERLAND APOTHECARY INC 3300 MARKET ST CAMP HILL PA 16979 Plaintiff Name SUSAN M. WENTZEL ORDER -TERMINATION OF INCOME ATTACHMENT Financial Break Down o~ Multiple Cases on Attachment PACSES Docket Attachment AmountlFreguency Case Number Number 761000021 2193 CI 81 $ 3,258.75 /MONTH / / / / / / $ / TOTAL ATTACHMENT AMOUNT: $ 3 , 258.75 TO: CUMBERLAND APOTHECARY INC AND NOW, th1S 19TH DAY OF JULY, 1999 the Income Attachment Order dated MAY 19 , 19 9 9 in the amount o f $ 3 , 2 5 S . 7 5 for WILLIAM T. WENTZEL 204-30-5067 is hereby TERMINATED. Effective immediately, you are directed to cease all payments and collections from the income of Defendant which were authorized by said Order. BY THE COURT: Date of Order: July 21, 1999 Service Type M . t ~ ~ ~,,: :.r' /;mot ,, EDGAR'B. BAYLEY, JUDGE Form BN-032 Worker ID $IATT ~ .., .7 .. ,~ ~.. `:., . .,• a DR 9, 918 SUSAN M. WENTZEL, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLnAND COUNTY, PENNSYLVANIA • ~Ui v. 2193 fig' 1981 WILLIAM T. WENTZEL, DOMESTIC RELATIONS SECTION Defendant CIVIL ACTION - SUPPORT ORDER OF COURT AND NOW, this 18th day of October, 1999, this matter having been called on a petition to hold defendant in contempt, I adjudicate you in contempt. Disposition is deferred on the following conditions: 1. That defendant pay 55 percent of net of only taxes and mandatory deductions; 2. That defendant immediately change his witholding status to married with two exemptions, and the withholding on his paycheck shall reflect the status of filing jointly with two exemptions; 3. And that defendant's weekly payment shall not be less than $150.00 per week. If the allotment does not meet that amount he shall pay the balance directly on time to the D.R.O. Office. Samuel L. Andes, Esquire For the Plaintiff Johnna Deily, Esquire For the Defendant It ~ -q ^^ `l -~ ~~~ ~• ~ ; -- i~ ~.,.~ ; `~ i `. ~~ .y~. ~ ,.-, , ~ C : ~~ _ 1~. ~a C ` = ' _ ~ ' ~ ~ 7 ~? i ~(^ ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT ~~-t' % `~ ~~--Y ~~ State Commonwealth of Pennsylvania XQ Original Order/Notice CO./City/DISt. Of CUMBERLAND Q Amended Order/Notice Date of Order/Notice 07/26/00 Q Terminate Order/Notice Court/Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number CUMBERLAND APOTHECARY INC Employer/4Vithholder's Name 3300 MARKET ST Employer/Withholder's Address CAMP HILL PA 16979 RE: WENTZEL, WILLIAM T. Employee/Obligor's Name (Last, First, MI) 204-30-5067 Employee/Obligor's Social Security Number ) 8750000028 Employee/Obligor's Case Identifier (See Addendum for plaintihf names associated with cases on attachment) Custodial Parent's Name (Last, First, Mq 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. $ 3, 250.00 per month in current support $ 0. 00 per month in past-due support Arrears 12 weeks or greater? ®yes Q no $ 0.00 per month in medical support $ o . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 3, 250.00 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: $ 750.00 per weekly pay period. $ 1. 500.00 per biweekly pay period (every two weeks). $ 1.625.00 per semimonthly pay period (twice a month). $ 3 .250.00 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 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 pg. 2). If remitting by EFT/E DI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 1 71 06-91 1 2 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY E COUR .~~ ~~ Date of Order: July 27, 2000 EDGAR B. BAYLEY, JUDGE Service Type M OMB No.: 0970-0154 Expiration Date: 12/31/00 Form EN-028 Worker ID $IATT DRO: Charles C. Carothers IV t' ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ^ If•checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* . You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee%bligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #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. WITHHOLDER'S ID: 2322599530 EMPLOYEE'S/OBLIGOR'S NAME: WENTZEL, WILLIAM T. EMPLOYEE'S CASE IDENTIFIER: 8750000028 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S 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%bligor 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. 10. *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. Requesting Agency: DOMESTIC RELATIONS SECTION 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 @ Service Type M Page 2 of 2 OMB No.: 0970-0154 Expiration Date: 12/31/00 Form EN-028 Worker ID $IATT ' ~ ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WENTZEL, WILLIAM T. PACSES Case Number 761000021 PACSES Case Number Plaintiff Name Plaintiff Name SUSAN M. WENTZEL Docket Attachment Amount Docket Attachment Amount 2193 CI 81 $ 3,250.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): ^ If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB ^ If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Narne(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. DOB ^ If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB ^ If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB ^ If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum Form EN-028 Service Type M Worker ID $IATT OMB No.: 0970-0154 Expiration Date: 12/31/00