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by DENNY pnYNE on 08-30-94
JOSEPH PCJDLUCf~Y
PO no;: 1 ~;a
StylE.'
LIC. Plat I!:
Po11nt Cadr?:
Pr"oc. D.it~:
Insurer
Adjuster
RpprJiser:
C!.l i "Il.1nt
NEW K!rlG37CWN, p~ 17072
Phone: 7SG -277'-)/
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INSTALLMENT AGREEMENT
File Number: 3-18829l-PI
As a result of a motor vehicle accident which occur~ed at Mechanicsburg,
Pennsylvania, on August 26, 1994, the undersigned, hereafter known as Party
of the First Part, does hereby agree to effect settlement of claim fer
damages and/or personal injuries suffered by and Joseph Podlucky, Insured,
bereafter known as the Party of the Second Part, on tbe following terms:
The Party of the First Part agrees to pay the sum of Six Hundred Sixty r"o
and 29/100, ($662.29) to the Party of the Second Part or to bis/her personal
representative at tbe rate of $100.00 or more per month, first payment of
$100.00 due October 30, 1995.
Upon compliance witb the provisions of this agreement the Party of the Second
Part shall deliver to the Party of tbe First Part a complete and
unconditional release from all claims and causes of action he/sbe now has or
hereafter may bave against the Party or the First Part on account of damages
and/or personal injuries resulting from the accident referred to.
By'execution and acceptance of this agreement the Party of tbe First Pa~t ~u."
the Party of the Second Part each agree that the same may be used by the
Registrar of the Bureau of Motor Vebicles in the administration of the Safety
Responsibility Act. It is furtber agreed tbat default in payment "r .1:.y
installment for 30 days after the same shall become due, shall, at the option
of tbe Party of the, Second Part, cause the entire sum then remaining unpaid
to become at once due and payable. .
. ."Wllliam Wright, :'OU MUST DATE AN'n SIG1:i BEi.OW.u}
I/We herewith certify tbat I/we h~ve carefully read the foregoing agreement
and'understand the contents tbereof and sign this agreement as my own free
act land lwith the intW{n ion to be legally bound hereby, this x..2:::., day ot!
X ^ 4JU'De'r" . 1 X, .
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WITNESSES: '
x:~)" 'ug~ul~
W~ht,.. I
Party of the First PJrt
'X>'
x__._._..__.... _, ..... . ,. _.._
x
iJtlrty at tho firut i'art
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