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Home My WebLink About00-04300 " JUN 2 7 20~ SHOLLENBERGER & J ANUZZI, LLP 1820 Linglestown Road P.O. Box 60545 Harrisburg, Pennsylvania 17106-0545 Telephone Number: (717) 234-3700 Fax Number: (717) 234-8212 Attome s for Plaintiff SHANIQUA PAYNE and SHAKEASHA PAYNE, Her Mother and Natural Guardian Plaintiffs IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. (")("} - 4'd66 CI~,J 't~ SHERRY AMSLER, Respondent '.'_H.. , ."'" , .<~-=-~~------'---'-. CIVIL ACTION - LAW JURY TRIAL DEMANDED QB..OE~ AND NOW this "Z'r day of 1"^'- ,2000, upon consideration of the Plaintiff's Petition to Approve Compromise Settlement and Distribution of Proceeds, Plaintiff's request for approval of the Compromise Settlement in the above captioned matter is approved. Plaintiff's contingent fee agreement with counsel is approved and Plaintiff's counsel shall collect fees, costs and expenses set forth in Plaintiff's Petition and the exhibits attached hereto from the proceeds of this settlement. The balance of the proceeds shall be deposited in one or more savings accounts in the name of Shaniqua Payne in banks, building and loan associations or savings and loan associations, deposits of which are insured by a Federal governmental agency provided that the amount deposited in anyone savings institution shall not exceed the amount to which accounts are thus insured. No withdrawal shall be made from any such account until Shaniecsha Payne shall attain her majority, except as authorized by further Order of this Court. Proof of the deposit, along with a signature card for each account, shall be promptly filed of record with the Court. J~ ~.~q'OO it V-- 'i~ .~ ~hlIi.IH~.lllll"I;.j]l.ij!i_jiiiiib~a1;i1iiUP~~""~"''''!ff1['lE::Jl)'ii ~ ~".. -~~. '~ t:mjJ~ 'v'iN\fAlASNN3d AlNnCO ON\f1i:i38V1Jn:) SO II? l~d 9Z Nor 00 IUV'O'^'~"'"'''' '" '0 ^ovl l,.lUrLLuc.;Ci :J;"LL;; .' iO!:J::iOcD311:! .. L.~ i ~~,~,' ",~" -" .."" - , ~ '. '.\J ." ' ....' .". ""'"'' ... . , SHOLLENBERGER & J ANUZZI, LLP 1820 Linglestown Road P.O. Box 60545 Harrisburg, Pennsylvania 17106-0545 Telephone Number; (717) 234-3700 Fax Number; (717) 234-8212 Attome s for Plaintiff SHANIQUA PAYNE and SHAKEASHA PAYNE, Her Mother and Natural Guardian Plaintiffs IN THE COURT OF COl\1MON PLEAS CUMBERLAND COUNTY, PENNSYL V ANlA v. NO. SHERRY AMSLER, Respondent CIVIL ACTION - LAW JURY TRIAL DEMANDED ~QRDEJ1 AND NOW this day of , 2000, upon consideration of the within Petition, a hearing shall be scheduled in the above captioned matter to determine whether or not the Court's approval shall be given to the within Compromise Settlement and Proposed Distribution of Settlement Proceeds. Hearing to be held on the Courtroom Number at day of a.m./p.m. , 2000 in J. , SHOLLENBERGER & J ANUZZI, LLP 1820 Linglestown Road P.O. Box 60545 Harrisburg, Pennsylvania 17106-0545 Telephone Nwnber: (717) 234-3700 Fax Nwnber: (717) 234-8212 Attome s for Plaintiff SHANlQUA PAYNE and SHAKEASHA PAYNE, Her Mother and Natural Guardian Plaintiffs v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL VANIA NO. cv-Lf.3~ ~ I~ SHERRY AMSLER, CIVIL ACTION - LA W_ Respondent JURY TRIAL DEMANDED __n__ ,_ . PETITION'TO APPRQvE COM}>g9M'ISES[tTLEMENT &. 'QISTRI!!Q!!QN~QF PRQ(:EEl!~ AND NOW come the Petitioners, SHANIQUA PAYNE, a minor, and SHAKEASHA PAYNE, her Mother and natural guardian, by and through their attomeys, SHOLLENBERGER & JANUZZI, LLP, and respectfully represent the following: 1. Petitioner, SHANIQUA PAYNE, is a minor, having been born on August 28, 1990 and resides with Shakeasha Payne, her Mother, at 2407 A Cedar Run Drive, Camp Hill, Cumberland County, Pennsylvania. 2. Petitioner, Shakeasha Payne is the Mother and natural guardian of SHANIQUA PAYNE and is an adult individual residing at the above stated address. 3. On or about April 10, 1999, Petitioner, SHANIQUA PAYNE, suffered injuries in the nature of a contusion to the left hip when the vehicle she was riding in was struck by a vehicle being operated by the Respondent. 4. As a result of the above referenced incident, Petitioner, SHANIQUA PAYNE, required treatment at the Polyclinic Hospital and follow-up treatment with her family physician, Kline Family Practice. Medical bills incurred for said treatment have been paid under the first party benefits coverage of Petitioner, Shakeasha Payne's auto insurance provided by Motorist Mutual Insurance Co. Petitioner has not received any medical treatment for injuries related to this incident since April 30, 1999. Medical records are attached hereto as Exhibit "A". - , , - '~ r J 5. Petitioner, SHANIQUA PAYNE, alleges she sustained the above referenced injuries as a result of the negligence of the Respondent named herein. 6. The Respondent, while not admitting liability, has offered to settle this claim for $1 ,000.00. 7. The Petitioner, SHANIQUA PAYNE, by Petitioner, Shakeasha Payne, her Mother and natural guardian, believes that the offer of settlement is fair and reasonable. 8. The Petitioner, SHANIQUA PAYNE, by Shaakeasha Payne her Mother and natural guardian, has retained the services of SHOLLENBERGER & JANUZZI, LLP. The aforesaid attorneys have agreed to handle this claim without a fee. 9. The Petitioner has further agreed to payout of her share of the recovery any and all costs incurred or advanced on her behalf. The amount of the costs that were incurred and advanced on Petitioner, SHANIQUA PAYNE's behalf to date in this matter total $45.50. An itemization of all costs is attached hereto, incorporated herein and marked as Exhibit "B". 1 O. The Petitioners request the court approve the compromised settlement and allow the distribution as follows: Shollenberger & Januzzi, LLP (reimbursement of costs advanced) $ 45.50 SHANIQUA PAYNE, In Trust $954.50 11. The Petitioner, SHANIQUA PAYNE, by Petitioner, Shakeasha Payne, her Mother and natural guardian, requests that upon approval of the proposed compromise settlement they be authorized to issue a good and sufficient release of any further liability against the Respondent and to discontinue the above action against the Respondent named herein. WHEREFORE, Petitioner, SHANIQUA PAYNE, by Petitioner, Shakeasha Payne, her Mother and natural guardian, requests this Honorable Court approve the Compromise Settlement and Distribution of Proceeds and approve Petitioner's fee agreement with counsel. " . Dated: Respectfully submitted, ""]',,1 SHOLLENBER ER & JANUZZI, LLP June 22, 2000 By: Karl J;) zzi, Esq. Attar ey 1.0. #65575 ,"'~':"b~~~I:t.~... n l.:!i!1 I 1iIiIIiIU'~ ~ """ 11II1 """ "0""" ~riNillIl1 ~ l _j.1I1.... ~.8Jjl(jilirg'M' ~I<ll:m$!i~ ,,,",,"'" -,ui .",?~, ,"" ,..!\!!'!>.. ,.., ~, ~ _, ,"0 ~-- -p ~ ~ ~ II) ~ !i- lk. . . . d Cl 1 -{) )J () -..} () I I ~ ll' V ~ ~ ~ ~ f J ,~. .- .- - o ,,;: ::~ -01,-'.1 Ilj( ~f i~t~; :"'">C: 7 =::J -.. --" o o ~-- n '::;--J ::-.1 i'J C;... ~.._" .' >'. '~~ ~;; ::.D -< => (j\ ..- . " \.- 8 , . --", ',",-~L ".i-,' -~<- i' _,'" , 'c _ "~"', "''''~C ,,,,~,,, ---.- '. ,,:__ ,__,_~ "" ~ ". '"';,,:;L,,~~~:~ c,' :" "':':"";;{;~~' ",,': ~ :J' ,,~\il~~;.;;>~~~,~;>~<~~' "0' SHOLLENBERGER & JANUZZI, LLP 1820 UNGLESTOWN ROAD P. O. BOX 60545 TIMOTHY A. SHOJl.ENBERGER KARL J. JANUZZI RON S. CHIMA' HARRISBURG, PA. 17106-0545 (717) 234-3700 FAX (717) 234-8212 Writer's Direct E-mail -kii@.shollianlaw.com "'Also member of New Jersey Bar October 18, 2000 with offices in Elizabethvi!le (71 7) 362-4472 Wilkes-Barre (570) 822-0711 Honorable Kevin A. Hess Office of the Prothonotary Cumberland County Courthouse One Courthouse Square Carlisle, Pa. 17013 RE: Shaniecsha Payne & Shaniqua Payne No. 00-4299 No. 00-4300 Dear Judge Hess: Enclosed are the proof of deposit papers for the above referenced individuals. KJJ:mm Enclosures ~"""""'~+W"" - ~- Members 1st federal Credit Union PO Box 40, 5000 Louise Drive Mechanicsburg, Pa 17055 October 16, 2000 Atty. Carlton Januzzi PO Box 60545 1829 Lingleston Road Harrisburg, Pa 171 06 Dear Sir: Enclosed are copies of the two accounts established for Shaniqua N. Payne account number 197491 and Shaniecsha N. Payne account number 197490, per your court order. Both children have a Savings Account with the credit union, earning an Annual Percentage Yield of 2.90%. Both of these accounts are restricted accounts. The funds cannot be withdrawn until the children reach the age of majority, or by Order of the Court. If you have any questions or if I can be of further assistance to you in this matter, please call me at 795-6013. S~3).~ Yvonne D. Lossing 6- ...1-- . ..;,;,"".,.. "j,- "- . ~ ~~ - I ',"""",-1'1. " - , illIi~.,,_! , 197491 PAYNE/SHANIQUA N 2207 A CEDAR RUN DRIVE REF: PASSWORD: AFFINITY CODE: HOUSEHOLD: 10/13/00 BR: 5 OWN:S BD: 08/28/1990 DEPT:CROSS-R PR: .00 SSN:181-72-5847 PH: (717) 761-8985 WK:(OOO)OOO-OOOO o CAMPHILL PA 17011 CR RT: 0 FLAGS: R3, NUMBER DATE MEMO 000001001 10/04/00 COURT ORDERED ACCOUNT NO TRANSACTIONS ALLOWED UNTIL 08/28/08 SFX DESC DT OPEN BALANCE AVAIL RATE YTD DIV LST ACT 00 RSA 100400 954.50 0.0000 .00 100400 TOTAL SHARES PLEDGED: 1500.00 MEMBERS 1ST FEDERAL CREDIT UNION ID: [ ] TRAN CODE: [ ] PARAMETERS: [ [ FLAGS DATE: [10/13/00] ] ] ~","",'~~ . , L . , "-~ "',; 197490 PAYNE/SHANIECSHA N 2207 A CEDAR RUN DRIVE REF: PASSWORD: AFFINITY CODE: HOUSEHOLD: 10/13/00 BR: 5 OWN:S BD: 09/05/1995 DEPT:CROSS-R PR: .00 SSN:177-76-4260 PH: (717) 761-8985 WK: (000) 000-0000 o CAMPHILL PA 17011 CR RT: 0 FLAGS: R3, NUMBER DATE MEMO 000001001 10/04/00 COURT ORDERED ACCOUNT NO TRANSACTIONS ALLOWED UNTIL 09/05/03 SFX DESC DT OPEN BALANCE AVAIL RATE YTD DIV LST ACT 00 RSA 100400 254.50 0 .0000 .00 100400 TOTAL SHARES PLEDGED: 1000.00 MEMBERS 1ST FEDERAL CREDIT UNION ID: [ ] TRAN CODE: [ ] PARAMETERS: [ [ FLAGS DATE: [10/13/00] ] ] d.~ "-~~ ~. MEMBERS 1ST Feu Membership/Service Application COURT ORDERr-D Account A Member,hip Information ^"..","INo'"o L,o,1 PAVNF FI,., SHANTOIIA MkIdI.lolll.1 SSNlEJ,N Dllleolmnh Mn,." SI'.P' EK~IveDllteol_"'Ch.ng. CII~ CAMPHIll ~'~" Z1p17011 v......Th.... HDmoP_ 717 7 "'..."Th.... Bu,""'..PIlooo B Ernployo, Nnm. ~"~^<kI""" NfA ..~ 11l.1.1I"....hlp) SSNlEIN. Ds.leollllnh ~ ll\el.lIlNlShlp) SSNlE'J.N. DoleolB;nh CRK FI.ld 01 M~~b~FtIP (M1iT'~F 1=1 I S p'jm'IM.rnl>e"J.n'lftcauon ArT~ ,k"nIM.mbe'ldonljh""llon E.MOIIAddrms, Mombo..\ol Emp.I"1 JoirtlMorrtJe,loonlllleerlon [I . "Type ot Account X: Regular Savings' [] Supplemental Savings o Investment Savings XISingl@ IJJoinl I] Single DJoinl o Single CJJolnt [[ Checkillg 0 Holiday Club CJ Vacation Club 00 Other r.nIIRT oRnER IISinglEl i:lJolnt elSlngle DJolnl DSlngte o Joint o Single o JoInt 'Joml.""in~."'d_f"'''nYfolnl.ub'occourrf Ie Type of ownership (Select one) l)(tndlvlduatAccount I I PUGMA Account r I EslateAccount []Partnershlp []Organlzatlonal I :JoinlAcllounl flTrustAccounl 11SoleProprlelorshlp I-I Corporation rJOther --- -'----- .-- [[ Overdraft Protection (Number in order of prefere~ce-1, 2, 3, etc.) AccounlNumber Savings (00) Checking (11) CheckDlgUNumber PSL( AccounlNumber Savings (00) Check_lng(11) SmI\ngs(tlO} Checking (11) Savings (00) Checking (11) Investm Savings (05) Supplemental s(01) \IT\Ies\men\Sav\ngs{OS) Supplemental Savings (01) Investment Savings (05) Supplemental Savings (01) PSL( )_ Account Number PSl\ )_ Account Number ____ ,__, PSL( )_ Ch ard' (lncludesMA I I For Member I I ForJllinIOwner(s) . Checking account required No Fee for Check Card U MAce/ATM Card [1 For Member UForJointOwner(s) D Call.24.. [] Members s ne.. Fee Applicable for MAce/ATM Card .. PIN required. See Section J. No Fee lor Call-24 & Members 1st Online F Complete tor Check Card and MAC"/ATM CARD ACCOUNTS TO BE ACCESSED AT ATM ;, Savjng~ I I Checking (POS) I'] PSL ( ) 1.1 Investment Savings n Key loan ( o Supplemental Savings Completlll for Call-24 and Members 1st Online CALL. ND MEMBERS 1 ST ONLINE ACCOUNT-TO.ACCOUNT T FERS. I requesllhe abl1lty to transfer funds from my accountnu 'ndlcatedinSecllonltothefollowlngseparalelynumbereda s. 1. Name of Account Holder ame or Account Holder Name of Account Holder 2. 3. H W-9 Certification of Taxpayer Identification Number (Social Security Number) Certification ~ Underpenallies olpe~ury, 1 cerlllylhat: 1. The number shown onlhis form Is my oorrect la~payer Identilicallon number, and Ta~payer Id~nlificalion Verllication By signing balow. I certify. In accordance wilh the IRS W-9 Inslructlons and under penBltles of perjury. Ihallha Social Security number {SSN)/Employee Identil1eation Number (EIN) shown Is my cotrl~ctldenlllicallon number and Ihat I am NOT, unless deslgnaled below, subjeclto backup wllhholdlng because,lhBvenolbeennoliliadlllatlamsubjecllobackupwilhholdlngasaresultofafallureloreportalldMdendsorlnleresl,orbecauselhelRS hasnoliliedmethatlamnolongersubjecllobackupwllhholding. I I I am subject to backup withholding 0 I am not a U.S. Citizen or Resident (Complete W.8 Form) D I am Exempt The Inlernal Revenue Servtcedoes not require your ~ .~~ oonsent 10 any provisions of this documenl other than Ihecertilicalionsrequlredloavoldbackupwilhholdlng. ~rtmaly inber Ig lUre' p~, Da~~----- "--~- IlWe have ~ad and agre910 the Members 1s1 Check Card, MAG"IATM Card, Call,24 and/or Members ls1 Onlln91erms and conditions, and the Electronic Funds Transler {EFT) disclosure slalemenl. IIWe agree lhallhe Informallon above Is lrua and complete alld aulhoriza Members 1st to oblalnanl'inlormallonnecessary to Ihlsappllcallon. I hereby make applieallon for membership In Ihe Members lsl Federal Credil Union, and agree to conform 10 its bylaws and amendmenls Ihereof. copies 01 wt1lch have been made available 10 m9, and 10 subscribe for at leasl one (1) share. Members 1st Is hereby aulhori~ed to recognize any orlhesignaruressubscrlbedherelolnlhepaymeJltollundsorlhelrensacllonolanybuslnessforthlsaccountandallsub-accoull1s.laeknowledge reeeipl of Ihe Membership Accounl Agreamenl which contains all relevant contractual obligalions fotthls account and allsub-accounls, I Blso aeknowl9dg9 receipt 01 Ihe RegulatioJl Disclosure Pamphlel. ------5I:1ANlQUA...N..-....ElI VNJ: :~emberNama primalYmemberSlgnalU~ II7I'1lMmI~lb';1>1l.~,-, . ate 197491-PA Account Number X JolllI;.h~ Dale PrinIPrjmaryMembe~sFormerNam9(Nomo""ongo~nly) X ~~~~ Dale 1_, .. Please enclose e $2'5.00check ormoneyordorpll)'sbreto Membtml1af F~U 10 eafsbrlsfl m.m~rBfll", ___._ ~ Fo'olfleou.o""'" Member1l1o'FederalCredltUnlon " Tt... aO\lIlci1t1on ap?rov~ by Ih" . 'Board; ,Exet:u1iv.. CorP,.-;lIoo; or . _ Ml!I'I1b<!'sh;p QlfIQ'l' Oal'! - - -- ,--,._-- I Slg~e~~ (Perscnrepresenlingapp,ovalappllcal,onj ---:------.-- . ~,,: ,------. ... Membership Infonnation A'couot""m" lo" Fimt Mlddlel",".t I;SNlE,I.N. O.'eofBlnh ~: PAYNE SHANIECSHA N 177-76-4260 09-05-1995 ~:jIro"' E<<SOIiveOotoolAdd",..Clwlnge 201 A CEDAR RllN DRIVE ,,' Sl,'e ., IV....Tho'. H7i7~onD761_8985 CAMPHILl PA 17011 Emp,,,,,.,N"m~'nd_,",, RIA jV.."'Ther8 _n...Phon. (AolatIO"oIllpl SSNiE,I.N D.'.oIBI~h .....""""" (R"latIO"oI1l~l SSN/HN D.I.oIBI~1> Momb"", ,., I Fi<l~~~~";t""~ IEllgIDllity) '" ,ee" '0'""' E,MoIIAdd",.. Emp.lnl, CRK I P"m"M~n~ 1~.nmlc.'I"" I JOIntM"",l>lfldonllrlClllloo I JoinlMomber 1don~11"'IDn [B Type of Account XI Regular Savings' [I Supplemental Savings o Investment Savings XX Single UJoint [JSingle rlJoinl DSlngls o Joinl II Checking [J Holiday Club 0 Vacation Club ex Other COURT ORDER 115ingls ['!Jolnt DSing!e o Joint rJSlngle o Joint DSlngls o Joint '.h>Inr..wng,<eQlJI,1Id1o<8nyfolnl.ub."""""", Ie Type of Ownership (Select one) XllndlvldualAccounl I I PUGMA Account I JEslateAccount CPartnership 1..'1 Organizational I !JointAccount I I Trust Account LI Sole Proprietorship 1'1 Corporation I I Other -~---- --- MEMBERS 1ST Feu Membership/Service Application CQURT ORDERed account [A Overdraft Protection (Number in order of preference-1, 2, 3, etc.) 14" A SavingS(e Checking (11) Account Number Savings (00) _ Checking(11) Savings (OO) _ Checking (11) Savings (00) Checking (11) Check DIgit Number lnveslment Savings (05) Supplemental Savings (01) nt Savings (05) Supplemen . gs(01) Investment Savings (05) Supplemental Savings (01) Inveslmentsavings(05) Supplemental Savings (01) PSL( PSL( )_ Account Number PsL( )_ Account Number PsL( E Select Electronic Service --;-,-~ ckCerdo (Include IATMaccess) I I For Member I I ForJolntOWner(s) o Checking account required No Fee lor Check Card o MAC.JATM Ca o For Member o ForJointOwner(s) D Mem tOnllne" Applicable lor MAc-/A M Card .. PIN required. See Section No Fee for Call-24 & Membera 18tOnll"8 i.~_ _~omplete for Check Card and MAC"/ATM CARD ACCOUNTS TO BE ACCESSED AT ATM I I Savings 1.1 Checking (POS) U PSL ( ) LJ Investment Savings 0 Key Loan ( o Supplemental Savings [G Complete for C811-24 and Members 1st Online CAll-~ MEMBERS 1ST ONLINE ACCOUNT-TO-ACCQUNT TRANSFERS. I request the ability to transfer funds from my account number' . Section 110 the following separately numbered accounts. AccountNum Name of Account Holder 2. Account Number Name of Account Holder 3., ,_ "Account Number - Name of Account Holder jOH W-9 Certification of Taxpayer Identification Number (Social Security Number) Cerlilication-Under penalties o! perjury, I cerll!ylhat: I, The number shown on this form Is my correct taxpayer Idantlflcatlon number, end TexpayerldenllflcaiionVerlllcallon By signing below, I certify. In accordance wllh Ihe IRS W,glnstruclions end under peneltles of perjury. 1l1ellhe Social Security number (SSN}lEmployee Identilicalion Number (EIN} shown is my correct Identlficallon number end thet I em NOT, unless designated below, subject to backup withholding because,lhavenotbeennoti!iedthatlemsubjecttobackupwlthholdIngasaresultolafallurelofeporlalldlvldendsorintereSl.orbecausethelRS hesnotlfiad me that lamnolongersubjecttobackupwithholdlng . 'I lamsubjecttobackupwithholding II 1 am nol a U.s. Citizen or Resident (Complete W-8 Form) [J lamEKempt The Inlelnal Revenue Service does not require YOUf ~~~~~,_:J\~___ consont 10 any plOvisioflsof this document other than the cerlillcatlons required to avoid backup withholding. IT: 0 ItWe have road afld agree to the Members 1st Check Card, MAC"'/ATM Card, Call-24 andfor Members lS1 Online terms end conditions. end lhe ElectlOnic Funds Transler (EFT) disclosure statement. I/We agree that the Informallon above is true end complete and authorize Members 1st to obtain any inlormation necessary to this appllcalion. I hereby maka application for membership in the Members lsl Federal Credit Union, and agree to conform 10 Its bylaws and amendmants thereol, copies 01 which have been made available to me, and to subscribe for at least one (1) shafO. Members 1st Is hereby authorized 10 recognize any 01 lhe signatures subscrilnldherelo in the payment of funds or the tra nsection 01 any buslnesa for this account and all sub-accounts. I acknowl edge receipt 01 the Membership Account Agreement which contains all relevant contractual obligations lor this eccount end all sub-accounts. I also acknowledge receipt ollhe Ragulallon Disclosure Pamphlet. ...5HANIE-CSl:l/l ~I DIIVNI= Please Print Primary Member Name , _ ~r,n,\,.,"'it' :'Jiifi1'~~~ilF~I'!~. 197490-PA Primary m~~ber signat e - Date Account Numb-er , ~ Dale Print Primary Membe~s Former Name (Nama ",","go o"~l , -- Date \.;;,."" """.., T"'~ Rllr"",,alion apprO'/e-;! by ll'le .. Please "nclose a $2$.00 chedr Or mon"y order payabl.. 10 MembeB hI FeU 10 ellfebllsh membeBhJp. Members 101 Federal Cl1ldll Union Board: -:-~ F.xOC'.tHvf.' C?mm~c,<,!: Of ':: 1~<:lfIlb<'!rn"~ Otf!Oilr Oa'<'!'~_~ .\ \Slgned'_ (Person represenl,ng approval appl.cal'onl +~-