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HomeMy WebLinkAbout02-5865ANNA NICKOLE HENRY, a minor, by DONNA M. HENRY, her parent and natural guardian, DONNA M. HENRY, in her own right, and SAMUEL C. HENRY, Plaintiffs TINA M. MAGARO and JOHN R. WIERMAN, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 0'~-~ 5-~5-- PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY: Kindly issue Writs of Summons against the following Defendants: Tina M. Magaro R. D. #2, Box 289 Newport, PA 17074 John R. Wierman R. D. #2, Box 289 Newport, PA 17074 METZGER, WICKERSHAM, KNAUSS & ERB, P.C. Dated: By Andrew C. Spears, Esquire Attorney I.D. No. 87737 P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 Attorneys for Plaintiffs Document #: 246675.1 SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 2002-05865 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND HENRY ANNA NICKOLE ET AL VS MAGARO TINA ET AL R. Thomas Kline , Sheriff or Deputy Sheriff who being duly sworn according to law, says, that he made a diligent search and and inquiry for the within named DEFENDANT , to wit: MAGARO TINA M but was unable to locate Her in his bailiwick. He therefore deputized the sheriff of PERRY County, Pennsylvania, to serve the within WRIT OF SUMMONS On January attached return from PERRY Sheriff's Costs: Docketing Out of County Surcharge Dep Perry County 9th , 2003 , this office was in receipt of the 18.00 9.00 10.00 58.66 .00 95.66 0 /09/2003 METZGER WICKERSHAM R. Thomas Kline Sheriff of Cumberland County Sworn and subscribed to before me this /,~ day of ~ ~ ~ A. D. ~ ~ Prothonotary' SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 2002-05865 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND HENRY ANNA NICKOLE ET AL VS MAGARO TINA ET AL R. Thomas Kline , Sheriff or Deputy Sheriff who being duly sworn according to law, says, that he made a diligent search and and inquiry for the within named DEFENDANT , to wit: WIERMAN JOHN R but was unable to locate Him in his bailiwick. He therefore deputized the sheriff of PERRY County, Pennsylvania, to serve the within WRIT OF SUMMONS On January 9th , 2003 , this office was in receipt of the attached return from PERRY Sheriff's Costs: Docketing Out of County Surcharge 6.00 .00 10.00 .00 .00 16.00 01/09/2003 METZGER WICKERSHAM Sheriff of Cumberland County Sworn and subscribed to before me this /3 ~ day of~ ~_~ A.D. Prothonotary In The Court of Common Pleas of Cumberland County, Pennsylvania Anna Nickole Henry et al VS. Tina M. Magaro et al SERbqE: s~ne No. 02 5865 civil December 12, 2002 hereby deputize the Sheriff of Perry deputation being made at the request and risk of the Plaintiff. Sheriff of Cumberland County, PA , I, SHERIFF OF CUMBERLPd'qD COUNTY, PA, do County to ~xecute this Writ, this Affidavit of Service Now, January 7, p ., 20 03 , ~ 4: 35 o'clock. M. served the within Writ of Summons upon Tina M. Magaro RD2 Box 279 Newport, Pa. 17074 ( Saville Twp) by handing to Tina M. Magaro, Defendant True & Attested a and made known to her copy of the original Writ of Summons the contents thereof. So answers, James T. Bennett Deputy ~hefif~of I Perry County, PA Sworn and subscribed before me this ~ day of ,~--~ ;ma/ql, 200.'~ ' 0 N0 ARIAL SlAt (~ I ~E FLICKIN~ N~B~~ I ~ gOMMIS~ ON ~PIR~ FEB. lB, 20~ I COSTS SERVICE IvIILEAGE AFFIDAVIT In The Court of Common Pleas of Cumberland County, Pennsylvania Anna Nickole Henry et al VS. Tina M. Magaro et al SERVE: John R. Wierman No. 02 5865 civil ~ow, December 12, 2002 hereby deputize the Sheriff of ' Perry deputation being made at the request and risk of the Plaintiff. Sheriff of Cumberland County, PA ., I, SHERIFF OF CUMBERLAND COUNTY, PA, do County to ~xecute this Writ, this }XJ0W, within Affidavit of Service January 7, ,20 03 ~ 4:35 Writ of Summons o'clock P M. served the upon John R. Wierman at RD2 Box 279 Newport, PA. 17074 ( Saville Twp) by handing to Tina M. Magaro, adult in charge True & Attested and made known to her copy of the original Writ of Summons the contents thereof. So answers, James T. Bennett Deputy§hefiffof V Perry County, PA Sworn and subscribed before me this ~4/~ day of -T&~ta ~, 20 0_3 NOIARIAL SEAL (I I I&%qGARET £ FLICKINGER, NOTARY P~I~JC I MYCOMMI$SIOH I~P1R~F£B. 16, 2001. COSTS SERVICE MILEAGE AFFIDAVIT ANNA NICKOLE HENRY, a minor, by : DONNA M. HENRY, her parent and : natural guardian, DONNA M. HENRY, in : her own right, and SAMUEL C. HENRY, : Plaintiffs : CIVIL ACTION - LAW : v. : NO. 02-5865 : Defendants : TINA M. MAGARO and JOHN R. WlERMAN, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA PETITION FOR APPROVAL OF MINOR PLAINTIFF'S COMPROMISE SETTLEMENT ORPHAN'S COURT OF CUMBERLAND COUNTY: Pursuant to Pa.R.C.P. No. 2039, Donna M. Henry, as parent and natural guardian of Auna Nickole Henry, files this Petition for Court Approval of Minor Plaintiff's Compromise Settlement, and in support thereof avers the following: 1. Petitioner, Donna M. Henry, is an adult individual currently residing at 527 Salmon Road, Mechanicsburg, Cumberland County, Pennsylvania, 17050. 2. Petitioner, is the parent and natural guardian of minor Plaintiff, Anna Nickole Henry, who resides with her and who is six years old, having been bom on December 8, 1996. 3. Minor Plaintiff, Anna Nickole Henry, has selected Petitioner, as her parent and natural guardian, to represent her interests in this Petition. 4. Defendant Tina M. Magaro is an adult individual residing at RD #2, Box 289, Newport, Perry County, Pennsylvania, 17074. Document #: 293075.1 5. Defendant John R. Wierman is an adult individual residing at RD #2, Box 289, Newport, Perry County, Pennsylvania, 17074. 6. On December 15, 2000, minor Plaintiff, Anna Nickole Henry was a passenger in a motor vehicle operated by her mother, Petitioner Donna Henry, when her vehicle was struck by a vehicle driven by Defendant Wierman and owned by Defendant Magaro. A true and correct copy of the Police Accident Report for the motor vehicle accident on December 15, 2002 is attached hereto as Exhibit "A" incorporated herein by reference. 7. Immediately after the accident, Anna Nickole complained to her mother that she was having back pain. An ambulance was called, but when it arrived, Ann Nickole became frightened and started screaming and was not able to be transported. 8. However, Anna Nickole continued to complain ofproblams with her hip and back pain and on March 21, 2001, Anna Nickole was seen by William W. Demuth, MD at Orthopedic Institute of Pennsylvania for an evaluation of post traumatic back and hip pain. A true and correct copy of Dr. Demuth's records are attached hereto as Exhibit "B" and incorporated herein by reference. 9. As the records indicate, Anna Nickole has had some physical problems in her life. She had a feeding tube inserted at that time due to severe reflux and she has been diagnosed as ADHD with slightly autistic symptoms. 10. Anna Nickole told Dr. Demuth she had pain in the general region of her bora columbar spine but could not be more specific. Further, she also stated that on occasion her hip hurt and pointed to the right side near the greater chocanter. 293075-1 1 I. Dr. Demuth diagnosed her with post traumatic hip and back pain and advised her to follow up if the pain continued. 12. Anna Nickole is a gift suffering from autism as well as ADHD and ODD. 13. Autistic children are very pattern oriented. Any change in their pattern and normal behavior can cause them great anxiety. 14. Therefore, due to some anxiety suffered by her daughter, Petitioner Donna M. Henry took her to a family counseling clinic on April 5, 2001 for behavior therapy for problems resulting from the accident. A true and correct copy of the Mechanicsburg Individual and Family Counseling records are attached hereto as Exhibit "C" and incorporated by reference. 15. Anna Nickole related through her therapist that she had an increase in fears since being in the auto accident on December 15, 2000 and has had severe separation problems from her mother. 16. Further, she often tells her mother that she worries about another car accident and is extremely agitated when in the car. 17. Anna Nickole went through sessions of behavior therapy as a result of the accident from approximately April 15, 2001 until approximately May 16, 2002. 18. Minor PlaintiffAnna Nickole Henry's medical bills totaled $887.00. $228.00 has been processed and paid for by Donna M. Henry's automobile insurance carrier. In addition, Petitioner Donna M. Henry has paid out-of-pocket expenses of $610.00 for the family behavior counseling. 19. Minor Plaintiff Anna Nickole Henry was not employed at the time of the accident and there is no wage loss claim at this time. 293075-1 20. Defendant Tina M. Magaro's liability insurer State Farm Insurance Companies has offered $4,000~00 in full and final settlement of Anna Nickole Henry's claim. A true and correct copy of the letter from State Farm citing this offer and a copy of the insurance declaration page setting forth the liability coverage is attached hereto as Exhibit "D" and incorporated herein by reference. 21. Petitioner believes that the acceptance of the offer in settlement of the liability claim against Defendant would be in the best interest of the Minor Plaintiff Anna Nickole Henry. 22. Petitioner, after consultation with their counsel, detenuined that the best interest of the minor Plaintiff Anna Nickole Henry will be served by using the settlement money for the immediate benefit of the minor Plaintiff Anna Nickole Henry to help pay for current counseling expenses at Pennsylvania Counseling Services and the care of the minor Plaintiff. 23. Counsel was retained by the Petitioner to represent the minor Plaintiff on a contingent fee basis of 25% of gross recovery, which fee is fair and reasonable for time and effort expended on behalf of the minor Plaintiff Anna Nickole Henry. A copy of the Fee Agreement is attached hereto as Exhibit "E" and incorporated herein by reference. 24. Petitioner respectfully requests that this Honorable Court approve of the minor compromise settlement of the claim in a gross amount of $4,000.00 out of which Petitioner will receive directly for the benefit of the minor the sum of $3,000.00 and counsel will receive the sum of $1,000.00. 25. Upon approval, Petitioner will also s~gn the Proposed Settlement Agreement and Release, a copy which is attached hereto as Exhibit "F" and incorporated herein by reference. 293075-1 26. Upon approval of the Minor Compromise Settlement, the Petitioner also desires to discontinue the action filed against Tina Magaro and John Wierman, upon receipt of the lump sum to be paid on behalf of Tina Magaro and John Wierman. 27. Defendants consent to the filing of this Petition. The Petitioner seeks approval of the Minor Compromise Settlement as set forth 28. above. WHEREFORE, Petitioner respectfully requests that this Honorable Court approve of the Minor Plaintiff Compromise Settlement and enter an Order distributing the funds as follows: (1) To be paid to Donna M. Henry, who is appointed guardian of Anna Nickole Henry, the sum of $3,000.00 for the immediate benefit of Anna Nickole Henry; and (2) To be paid to Metzger, Wickersham, Knauss & Erb, P.C. for counsel fees, $1,000.00. METZGER, WICKERSHAM, KNAUSS & ERB, P.C. Dated: December .. L-~ , 2003 By: Andrew C. Spears Esquire Attorney I.D. No. 87737 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 Attorney for Plaintiffs 293075-1 VERIFICATION I, Donna M. Henry, individually and as parent and natural guardian of Anna Nickole Henry, have read the foregoing Petition for Approval of Minor Plaintiff's Compromise Settlement and do swear or affirm that the facts set forth in the foregoing Petition are true and correct to the best of my knowledge, information and belief. I understand that this Verification is made subject to the penalties of 18 Pa.C.S.A. §4904, relating to unswom falsification to authorities. Date: Donna M. Henry, as parent and naffral guardian of Anna Nickole Henry Document #: 247814.1 VERIFICATION The undersigned hereby certifies that he is the attorney for Plaintiff, Anna Nickole Henry, by Donna M. Henry, parent and natural guardian, and that the facts in the foregoing Petition for Approval of Minor Plaintiff's Compromise Settlement are tree and correct to the best of his knowledge, information and belief, and that said matters relating to the Petition for Approval of Minor Plaintiff's Compromise Settlement are as known to the undersigned as to the clients, Plaintiff, Anna Nickole Henry, by Donna M. Henry, her parent and natural guardian, said knowledge being based upon information contained in the attomey's file in this matter, and further states that false statements herein are made subject to the penalties of 18 Pa. C.S.A. {}4904 relating to unswom falsification to authorities. Andrew C. Spears, Esquire Document #: 247814.1 ~1~>~ NOTIFICATION ~OF ACCIDENT INVESTIGATION HAMPDEN TOWNSHIP POLICE DEPARTMENT 230 SOUTH SPORTING HILL ROAD, MECHANICSBURG, PA 17055-3097 o (717) 761-2609 Notice is hereby given that the accident ident f ed below is being investigated by the Hampden Township Police and that the Commonweaith of Pennsylvania Police Accident Report will be subm tted as prescribed by Section 3746 (c) of the Vehicle Code. POUCE INCIDENT NUMBER 39. PAIITLEO" ~;:' PA.KED? ~ ~ j 37. REG. ADDRESS 43. Y~R ~C/ J'44. M~KE % / & ZIPCOOE ~ BODY TYPE) 47, BODY ~. SPECIAL 49. VEHICLE ~7. BODY UNK 50 INITIAL IMPACT 51 VEHICLE ~T~VEL ~0 INITIAL IMPACT ~51 VEHICLE 52. TRAVEL ilO. C'~.STATE ~.~ ADDRESS ~'Z7 ':0 /~0~ ' 64. COMM. VEH- 65 DRIVER ~ 66 DRVER ~ 64. COMM Vm. j 65 J 66 DRIVER R CONF~ OWNER j ADDRESS i PHONE ORTHOPEDIC INSTITUTE OF PENNSYLVANIA (717) 761-5530 Patient: Anna N. Henry Chart #: 18213628 DOB: 12/08/96 SSN: 160 78 0681 Page # 1 3/21/2001 WILLIA~ W. D~UTH, M.D. LEVEL THREE Trindle Road Office CHIEF COMPLAINT: Anna Henry was seen in consultation at the request of Brad Henken, M.D., for evaluation of post traumatic back and hip pain. HISTORY OF COMPLAINT: Anna's mother is a patient of mine and mentioned prior to the visit some of the issues she has had since the motor vehicle collision which occurred on 12/15/2000. This young lady was accompanied by her mother today. By history she was in a car seat in the back of their van when their vehicle was apparently rearended by another ~ehicle. Apparently this was noisy and moved the van forward, and she had commended on some back pain when this had occurred. She had a number of challenges before the accident with her growth and development, and actually has a feeding tube due to severe reflux. She also has ADHD, which you are aware of from your records. I received some notes also from the physical therapist who had been working with her. REVIEW OF SYSTEMS: Review of systems, past medical history, family history and social history have been recorded and reviewed. PHYSICAL EXAM: On examination today she is a very delightful young lady who is quite helpful. She related some discomfort in the general region of her thoracolumbar spine, but could not be specific. She states also that occasionally her hip hurts and pointed to the right side near the greater trochanter. I observed her moving about the office quite well, and she asked many questions and seemed to be quite active, showing no pain behavior. The discomfort often is an issue near bedtime and at other times if she is getting up and down from the floor. It is sharp in character according to the mother. She symmetric deep tendon reflexes in knees and ankles. Great toe extensors are normal. She has no asymmetry. In her lower extremity exam, there is some mild femoral anteversion bilaterally, more so on the right than the left, that is well within the normal range. She has a gastrostomy feeding tube in her left abdominal region. The patient has no spasm in her back. There is no ecchymosis or edema. Skin is intact. Mobility of her lower back, including forward bending, is normal. I see no evidence of significant scoliosis. Pelvis and shoulders are level. DIAGNOSTIC TESTS: Radiographs of her thoracolumbar spine are normal. Radiographs of her hips are normal. She is skeletally mature. No fractures are noted. Both hips are well located. DIAGNOSIS: Post traumatic back and hip pain. PLAN: Given the reassurance of the x-rays, I think she can simply go about her business with regular activities. I will see her in the future should this be a long term problem, but I don't think it will be a long term issue. Most likely muscle spasm was the source of the injury. ORTHOPEDIC INSTITUTE OF PENNSYLVANIA (717) 761-5530 Patient: Anna N. Henry Chart #: 18213628 DOB: 12/08/96 SSN: 160 78 0681 Page % 2 ................................ -CONTINUED- 3/21/2001 WILLIAM W. DEMUTH, M.D. LEVEL THREE WWD/kal RADIOLOGY RESULTS LS SPINE X-RAYS: IMPRESSION: SEE ABOVE STUDY. WWD/kal Radiographs of her thoracolumbar spine are normal. INFANT PELVIS-CHILD X-RAYS: Radiographs of her hips are n~rmal. She is skeletally mature. No fractures are noted. Both hips are well located. IMPRESSION: SEE ABOVE STUDY. WWD/kal LTR-DR DE~UT~ CONSULTLETTER (Ref) HENKEN DO, H BRAD 791-2 DOB j ~, ~ 2~C~ ~::, Age Doctor Employer ss~ Marital Status Occupat~n Mother Employer DOS~ W # Father Employer Spouse Employer oos w, DOB W # Chip (School) Responsible Part7 if Child Alternate/Other Cohtact Accident Description . /3 ~'~" d- · Sports .Auto ~ Work Related ' of Symptoms first appeared ~f not [njur~ I J- Address ~ t ~ Address Add~ess /0 .o 0 Address Send Iette~ to: Family Or..~ Referring Dr. ~x Neither_ .... F[EALTH HISTORY' . , Uodate The following is very important to us in taking care of your health, Please take time to completely ~nd accutataly fill out - all of this information Please also mak~ sure you update this information as changes occur. Patient,~Name ~'-~]~]~ ~/~.~(~/~ Medications You Are Taking (Also list herbal su~plemenis and vitamins Medication Name ' //~ .Amou~t · - , ,~,-~.~¢t · ' .' .-.. Chart Number Are you taking diet medication? No ~ 'Yes Year ~orious illness, injury or surgery Hospital Pa~t'Medisal ltisto~y ' High or low blood Liver disease Taberculosis..--':% ' [ ] Ulcer in stomach/:,,. ', ' OsteopCro¢is :?."' [ ] Amaitis [] Other bone / join(disease [ ] Any nervous system disease [ ] [1 [1 [1 [] Height Weight ~ ~7 //,~ .~, Social ltistory Do you smoke? No.~_ Yes Amount Do you drink alcohol? No_~_ Yes Amount Do you iasc street drags? No X Yes Amount Continued on back of page .......... .-~ast year, have you heartburn or indigestion? ................................................................... ho~el:~bvements that were bloody or tarry? any recent change in your bo.wel habits? .................... ~ ..................... frequent urination duringthe,day or night?.' ................................ : ........ any recent loss of control of your I~ladder? ......................................... burning with urination?....~ ................................................................ difficulty starting.your urination? ................... : .................................... 'excessi~~ Urination?.:./d~:~:: ......... : ................... ]; ............. : ....... ~ ........... thirst ......... ;: ......... :..:.2 .: ............................................. ,~?~ ~r~nes~ .of bfeath'or whe~ezing :,~..:).....,:9 .................... :...w':':': ......... ~)nic cot~gh?! ......... :.: ...~.... x.x,:'..~.:::2~ ......................... :;:2.: ............. pain with. activity? ........... .~?.f.q':.... 2:..::2 ............ . . . .. .--:z:f,,.~ :~ .... ,- - heart or palp~tattons ...................................................... ':: ........ swollen feet or ankles..: ......... : ................................................ : ......... uent headaches ? :.. :../,.....x..: ............................................. ;. ;" ...... dental br other mouth probiems? ........................................................ fre/ dent nose bleeds?.....:: ................................................................ .......................................... ; ................... 28 No No '~ No x/ No No '¢ No )4 No No No No-' No No No No No_ ~'f Yes ..... No No bt. or j o ints~.:~[: :. ;: 7. ;:. :. ........................... :::: ........ .~..7. x~.:~g;.'- joints? ........ ~.';.:.).~'....~;.~ ................................................ i:~i~:_:- No cold hands / feet7 ............................................................................ : gangrene? ....................................... ; ........................................ :.: ..... recent nUmbness in arms or legs? ...................................................... chromc fatague ..................................................................... ; ........... uncontrolled bleeding? ....................................................................... No No Yes: · No '~ Yes ' 29 weight loss? ..................................................................................... No ~ 30 weight gain? ..................................................................................... No--~ 31 heat / cold intolerance? ..................................................................... No ~ The above information is true and correct to the best of my belief. Patient signature Yes Ye~ Yes ORTHOPEDIC INSTITUTE OF PENNSYLVANIA (717) 761-5530 Patient: Anna N. Henry Chart 0: 18213628 DOB: 12/08/96 SSN: 160 78 0681 Page # 1 3/21/2001 WILLIAM W. DEMUTH, M.D. P, ADIOLOGY RESULTS LS SPINE X-P~AYS: Radiographs of her thoracolumbar spine are normal. IMPRESSION: SEE ABOVE STUDY. WWD/kal INFANT PELVIS-CHILD X-rAYS: Radiographs of her hips are normal. She is skeletally mature. No fractures are noted. Both hips are well located. IMPRESSION: SEE ABOVE STUDY. WWD/kal · FAMILY CO{JHSELINQ CUHIC The {.Inlted Hetho~ist Home for Children 5120 Simpson Ferny Road t4echanlcsburg, PA 17055 PL~SZ ~'R~'h'T - top lec~lon ~e£er? ~o Person ,(adul~ o~child) being ~eea bM ~he~apis~ Li~ ~y major heal[h p~l~ ~o= which you c~e=~ly recetv~ !~,~,~ w~ ~//~,' ~' - ' ~ave ~o~ ever received 'p~ychol~cal/~sychia~ri¢ ~elp cr co~seling o~ any kind before? 7 , Xf ~ea, please e~lain Were M~ eve~ hos;tt~lized ~or ~sychiatr~c/~sychol~tcal p=0blems?., ~ 0 I~ yes, please e~leta .. HOH~ ADD~£$S ~ (i! dt f~e=ent) E~LOYE~ NA~: .. -~:~eet Zip Code DATE OF BIRTh:. AGE~_ EMPLOYS[ PH0t~, ( ) client ~7~3~0 (OVER PLEASE) Work Phone, (")~ Work ~hone: ( Stolon l.,enllb: .... Fa~y The: Medicific~ 'l'ypt ~f~sslon: In blcdicitlons ~ltdicit~ou , Ce~s: 1) Z) 4) ~) ~) ~) 3) ~) 'iS.gO I/ ~) ~) ~ ~) ~) ~) / / 2) 4~ Oo.~s: 1) 3) $~sslon l~n=lh: 3~ A Parcr~s Handbook of F~li~1%' T~rapy Play Ecssion DemOnstration Notc As you watch the therapist hold a special play session with your child, jot down notes, observations, questions, and concerns below. What toys and activities does your~elect? What types of pretend.play or imaginary roles doe. s y~u~ child engage in? What feelings does your child seem to be expressing? What questions a~nd concerns do you have? · © 2000, Play Therapy Presz Pleaze feel free to make additional copies of this form ag needed 38 Ged,: I) Assessment/Dia~nosls: ~( 'F3,pe ors. sTem SeSsion L~n~th: (;ods: !) Ind' ~ouplcs/'~en~lY~ Medicttlou~ Date ~l~lo')-- 2) 4) Date ~lc,.Sicatloos Asse. ment~iegnosls: ~::>~.,~-F,_:.~, r/ - / ~ ' ' ....... Plan: Medicalloas, hlcdicitlons Plan: State Farm Insurance Companies November 12, 2003 Andrew C. Spears, Esq. Metzger Wickersham P O Box 5300 Harrisburg, PA 17110 State Farm Insurance 115 Limekiln Road PO Box 257 New Cumberland PA 17070-0257 RE: Claim Number: Date of Loss: Our Insured: Your Client: Dear Mr. Spears: 38-J607-359 December 15, 2000 Tina Magaro Donna Henry/Anna Henry, a minor This letter serves to confirm our offer of policy limits of $15,000.00 to settle Donna Henry's claim. I enclose a Certificate of Coverage per your request. Anna Henry's claim settlement of $4,000.00 will require Court Approval. Please forward when available for payment. Thank you. Sincerely, Nadine Alviani Claim Representative (717) 774-9052 State Farm Mutual Automobile Insurance Company HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 State Farm Insurance CERTIFICATE OF COVERAGE Claim Number: 38-J607-359 Companies 115 Limekiln Road PO Box 257 New Cumberland PA 17070-0267 The undersigned is a Claim Team Manager for: _ State Farm County Mutual Insurance Company of Texas State Farm Lloyds, Inc. ~ate Farm Indemnity Company /State Farm Mutual Automobile Insurance Company State Farm Fire and Casualty Company This certifies that policy number 7075-948-38K Car 001, covering a 1988 Chevrolet S10 Blazer, was issued to Tina Magaro and was in effect on the accident date of December 15, 2000. The coverages and limits of liability for this policy on that date were: A 15/30/5, C2 5,000, D, G250, H, F 1500 This policy provides Limited tort. Kar _~~:L ~la~Team M~n//~' BurY~a~U~ ChFC State of County of )ss. My Commission Expires: Subscribed and Sworn to before me this [~_ day offs_ (Year) ~)~' -~ State Farm Mutual Automobile Insurance Company HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 _CONTINGENT FEE AGREEMENT We, Donna M. Henry and Ann Nickole Henry, retain and authorize the law frrrn of Metzger, Wickersham, Knauss & Erb, P.C., to do whatever they deem necessary or desirable in order to represent us in all claims for compensation and reimbursement for personal injuries, wage loss, and economic and other damages resulting from an auto accident. 1. h ' _ ttomey s Fees: The fee of the attorneys shall be contingent as follows: (a) Twenty-five percent (¢5%) of gross recovery; Co) SHOULD THERE BE NO RECOVERY BY SUIT OR SETTLEMENT, SAID ATTORNEYS DO NOT HAVE ANY CLAIM AGAINST US OF ANy KIND FOR LEGAL SERVICES RENDERED. 2. .Expenses of Litigation: Actual expenses incurred on the business of the client shall be borne by the client and our attorney shall be reimbursed out of the balance, after deduction of attorneys fees, of any recovery for all legal expenses incurred in the prosecution of this claim which have paid by us. not already been We do hereby agree to pay all expenses incurred by our attorney in the preparation and presentation of this case and do understand that these expenses include, but may not be limited to, costs of medical reports and records, stenographic expenses connected with depositions, expert witness fees, photocopying charges, and mileage charges connected with the rendering of legal services. We understand that we are responsible for payment of these expenses regardless of the eventual outcome of the case and further understand that if our attorney deems it necessary, we may be asked to advance these costs prior to the incurring of any such expenses or the scheduling of any deposition. 3. We hereby further agree that our attorney may charge ns reasonable additional compensation if it is necessary to try the case more than once, if the case is appealed, or if proceedings in other courts are necessary because of the change of circumstance of a party or for other reasons. Document #.. 196134.1 4. We hereby further agree that our attorney is hereby authorized to bring suit or to settle and compromise the claim, to execute all documents pertaining thereto, and to do all lawful acts requisite for effecting the claim on our behalf. 5. We further authorize our attorney to pay out of any proceeds of settlement or trial any unpaid medical bills for Izeatments or services made necessary by the injuries sustained in this accident and any workers' compensation liens. 6. We agree that my attorney accepts this employment on the condition that he will investigate this claim, and if it appears to be a recoverable claim, he will proceed to handle the claim; but if, after investigation, the claim does not appear to be recoverable, said attomey shall then have the right to rescind this Agreement. 7. We hereby further agree that if we decide to terminate this authority before any settlement is offered or any award is obtained the firm shall be entitled to reasonable compensation for all work done on the case up to that point. We agree that reasonable compensation for Clark DeVere, Esquire, or any other attorney involved in the handling of this case, shall be Two Hundred Dollars ($200.00) per hour, or such higher rate as shall constitute his standard billing rate at the time that the work is performed. 8. We agree that my attorney may withdraw from this case at any time after reasonable notice to us, and we agree to keep him advised of our whereabouts at all times and to cooperate at all times in the preparation and trial of this case, to appear upon reasonable notice for depositions and Court appearances, and to comply with all reasonable requests made of us in connection with the preparation and presentation of this case. 9. I understand and agree that in the event that my account is mined over for collection because of nnpaid fees and/or costs/expenses, I will be responsible for payment of the costs of suit as well as reasonable attorney fees incurred in the collection of the monies owed to Metzger, Wickersham, Knauss & Erb, P.C. 1N WITNESS WHEREOF, we have signed below on this /.~ day of ~)e'c'~/~ ~ ~/~- , 2002. CL T: ~' Document #: 196154,1 METZGER, W~HAM, KNAUSS & ERB, P.C. ATTORNEY: Andrew C. Spears, Esquire CERTIFICATE OF SERVICE I, Andrew C. Spears, Esquire, of the law firm of Metzger, Wickersham, Knauss & Erb, P.C., hereby certify that I ~rved a tree and correct copy of the forgoing document with reference to the thi ~'~d foregoing action by first class mail, prepaid postage, 's,~___ ay of December, 2003, on the following: Tina M. Magaro R. D. #2, Box 289 Newport, PA 17074 John R. Wierman R.D. #2, Box 289 Newport, PA 17074 Andrew C. Spears, Document #: 247814.1 $[NCEI888 3211 Ngrth Front Street P.O. Box 5300 Harrisburg, Penr~svlw%~ 17110-0300 Other Offices Colbnial Park Me~hanicsburg. Mi]]ersburg Shippensb~ urfi ANNA NICKOL]! IIENRY, a minor, by : DONNA M. tIENRY, her parent and : natural guardian, DONNA M. HENRY, in : her own right, and SAMUEL ('. HENRY, : l'lainti film 1N T]IE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW v. NO. 02~5865 TINA M. MAGAP, O and .IOl IN R. WIERMAN, I)efendants : DECREE AND NOW, this f day of ~_~ ~ , 2003. np(m consideration of thc Petition lbr Approval of Mmur Plaintiff's Compromise Settlement, it is hereby ORI)ERF~I) and I)IiCREID that the settlement fbr thc gross snm of Four Thousand Dollars ($4,000.00) is APPROVED. Counsel fkes and expenses are [bund to be fair and reasonable and also approved as set tbrth below. The distribution is directed as lbllows: To be paid to Donna M. ttcnry, ,,,,'ho is appointed guardian of Anna Nickolc I lcnry lbr thc purposes of this Petition, the sum of $3,000.00 for thc immediate benefit of Anna Nickole Henry; and (2) To be paid to Metzgcr, Wickersham, P.C. lbr counsel fees the sum of $1,000.00. Donna M. Henry, as parent and uatural gtlardian of Anna Nickole Henry, is authorized ti) sign thc Settlement Agreement and Release, attached to the Petition, and discontinne this action upon dclix ery of thc cash payments totaling $4,000.00. cc: ,' Andre,.,. ('. Spears, Esquire .. ~[ ina M. Magaro 'John R. Vv'ierman BY THE COURT: V i!: ., ANNA NICKOLE HENRY, a minor, by DONNA M. HENRY, her parent and natural guardian, DONNA M. HENRY, in her own right, and SAMUEL C. HENRY, Plaimiffs TINA M. MAGARO and JOHN R. WIERMAN, Defendants 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CiVIL ACTION - LAW NO. PRAECIPE TO THE PROTHONOTARY: Please discontinue this matter, without prejudice. Respectfully submitted, METZGER, WlCKERSHAM, KNAUSS & ERB, P.C. By Andrew C. Spears, Esquire Attorney I.D. No. 87737 P.O. Box 5300 3211 North Front Street Harrisburg, PA 17110-0300 (717) 238-8187 Attorneys for Plaintiff #288371 CERTIFICATE OF SERVICE I, Andrew C. Spears, Esquire, of the law firm of Metzger, Wickersham, Knauss & Erb, P.C., hereby certify that I served a tree and exact copy of the Praecipe to Dismiss by first class mail, prepaid, this*'~¥~day of January, 2004, on the following: Tina M. Magaro R. D. #2, Box 289 Newport, PA 17074 John R. Wierman R. D. #2, Box 289 Newport, PA 17074 Andrew C. Spears #288371 -2-