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PATRICIA HARE, I'nrent nnd
Naturnl Guardian of CHI US TOP HER
HARE, A Minor,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
Plaintiffs
VS.
No.
BOROUGH OF NEW CUMBERLAND,
Defendant
ORDER
AND NOW, this _ day of
-, 1998, upon consideration of [he within Petition
For Approval Of Minor's Settlement, it is hereby ORDERED that the settlement for the gross
amount 01'$15,000 be and is hereby approved. Petitioner, Patricia Hare, Parent and Natural
Guardian of Christophel' Hare, a Minor, is hereby authorized to execute the proposed Release.
Distribution of the proceeds is directed as follows:
I.
To Patricia Hare, Parent and Natural Guardian of
Christopher Hare, a Minor, to be placed in an
insured savings account 01' other bank certificate
with no withdrawal 01' expenditure to be made from
said account until Christopher Hare attains the age
ofm~ority.
$6,452.29
2. To the following medical providers:
A. Pediatric Surgery, Ltd.
B. Polyclinic Medical Center
C. Pathology Associates
D. Harrisburg Hospital
4. Aftcr invcstigation and ncgotiation, thc partics hcrcto havc ugrccd to rcsolvc this
claim for the sum of $15,000. A proposcd Rclcasc is attach cd hcrcto and marked Exhibit "A."
From thc procecds of this scttlcmcnt, the Ibllowing mcdical bills incurred as a result ofthc
instant action will be paid:
A. Pediatric Surgcry, Ltd. $ 643.00
B. Polyclinic M(~dical Center $2,976.28
C. Pathology Associates $ 17.00
D. Harrisburg Hospital $ 620.03
E. A. Z. Ritzman & Associates $ 48.00
F. Central Pennsylvania Anesthesiology, Ltd. $ 455.50
TOTAL MEDICAL BILLINGS: $4.797.81
5. The Plaintiff and counsel have agreed to a 25% attorney's fee from the amount of
the gross settlement, which in this case is $3,750. Counsel is not seeking reimbursement for any
expense incurred in this case.
6. Petitioner, Patricia Hare, asks that the Court approve this settlement as detailed
above, with the provision that the balance of the proceeds after the deductions noted herein will
be deposited in an insured or other bank certificates with no withdraws or expenditure to be made
from said account until Christopher Hare attend the age of m!\iority 01' unless authorized by a
prior Order of Court.
5
WHEREFORE, Petitioner, Patricia Hare, respectfully requests the Honorable Court to
approve settlement as detailed above.
Respectfully submitted,
~
-----
David 1. Foster, E quire
!.D. No. 23151
COSTOPOULOS, FOSTER & FIELDS
831 Market Street/ P.O. Box 222
Lemoyne, P A 17043-0222
Phone: (717)761-2121
- Allomey for the Plaintiffs
Dated: ~ 2..'-1-1 Iq'1~
6
S INSURANCE
eleOIVe
(2)
RELEASE AND INDEMNITY AGREEMENT
Know all Men by these p~esents: Whereas on or about April 29,
1995, an accident occurred, reSUlting in bOdily injuries to
Christopher Hare, a minor 7, years of age, herein to as the
minor, and, whereas claims are made against NEW CUMBERLAND
BOROUGH for money compensation for such injuries by William
Peterson&Patricia Hare, for themselves and as parents, guardian,
or next of kin and each of our respective heirs, executors and
administrators of the minor (the minor and the parents of the
milLor, for themselves and as guardian or next of kin and each of
our respective heirs, executors and administrators, being herein
referred to as the claimants), and whereas, a dispute has arisen
with respect to the legal liability for such injuries, and said
liability being expressly denied;
Now therefore, the claimants, in full accord and satisfaction of
such disputed claims, do hereby aCknowledge the receipt of the
sum of $15,000 Dollars, to be paid by the said NEW CUMBERLAND
BOROUGH and, in consideration thereof, the claimants do hereby
remise, release, and forever discharge the said NEW CUMBERLAND
BOROUGH, and his, her, their, or its successors and assigns,
heirs, executors and administrators of and from any and all
claims, demands, rights, or causes of action of whatsoever kind
or nature, arising from, or by reason of, any and all known or
unknown, foreseen or unforeseen bodily or personal injuries,
damage to property, and the consequences thereof, which
heretofore have been, or which hereafter may be, sustained by the
said minor or by the said claimants, or by any other person or
persons having a legal interest therein in consequence of such
accident or resulting injuries.
And, furthermore, William Peterson & Patricia Hare, the said
parents, guardian or next of kin of the minor do hereby expressly
stipulate and agree, in considerat:ion of the aforesaid payment,
to indemnify and hold forever harmless the said NEW CUMBERLAND
BOROUGH, and his, her, or their, or its successors and assigns,
heirs, executors and administrators against loss from any and all
further claims, demands or actions in law or in equity that may
hereafter at any time be made or brought by the said minor or by
anyone on behalf of said minor for the purpose of enforcing a
further claim for damages on account of the injuries sustained in
consequence of the aforesaid accident, and the parents, guardian
or next of kin hereby waive any and all rights of exemption, both
as to real and personal property, to which they may be entitled
under the laws of this or any other state as against such claim
for reimbursement or indemnity.
INDEMNIFYING GENERAL RELEASE
FOR MINOR'S COMPROMISE
PLAINTIFF'S
I EX71BIT
KNOW ALL PERSONS BY THESE PRESENTS THAT, I, patricia Hare,
indi vidually and as the parent, natural and legal guardian of
Christopher Hare, a minor, 7 years of age, for and in consideration
of Fifteen Thousand ($15,000.00), does hereby remise, release and
forever discharge New Cumberland Borough, its heirs, executors,
administrators and insurers, and any and all other persons, firms,
corporations and entities, and their heirs, administrators,
executors and assigns of and from all, and all manner of actions
and causes of action, suits, debts, dues, accounts, bonds
covenants, contracts, agreements, judgments, claims, damages and
demands whatsoever in law or equity which Christopher Hare or the
undersigned, had, has or may in the future develop as a result of
any and all injuries and damages arising from or in any way related
to an incident which occurred on April 29, 1995 at the New
Cumberland Borough Park, Pennsylvania and which is more
particularly described in the Petition for Court Approval of
Minor r s Compromise filed in the New Cumberland County Court of
Common Pleas, Docket No. 98-3566, Civil, which against New
Cumberland Borough, its insurers and all other firms, persons,
corporations and/or entities, either Christopher Hare or the
undersigned ever had, now have, or which our heirs, executors,
administrators, successors of assigns or any of them hereafter can,
shall or may have, as the result of the said incident which
occurred on or about April 29, 1995 at or near the premises located
at the New Cumberland Borough Park in Pennsylvania.
As further consideration for the payment of said sum, the
undersigned, hereby agrees to indemnify New Cumberland Borough and
its insurers, and hold them harmless, of and from any and all
claims for damages of whatnoevcl' naturc ell' klnrl on the parot of said
minor or his legal I:epreuentativeu 'Inri which n:'lates to or arises
from the above-described incid('nt, TIH' uncl"'I'ui<JnC!c1 does hereby
further agree to reimbuuJc 01' IIldkr, ,!ood any 10s8 or damages or
costs the New Cumbel'l.ancl 1301"ouqh 01' i tu insurers, may sustain on
account of any furthel' claimll by 01: on behalf of said minor as a
resul t of the a fOI:ClO,lid ine idcnt , The undersigned hereby waives
any and all rightll of r'Y.clllptioJJ both ilS to real and personal
property to which nhe may ill, ('nt i tled under the laws of this or any
other state ilS againut ouch clitlmEl [or reimbursement, contribution
and/or indemnity by (lithel' the New Cumberland Borough or its
insurers.
The unclerlllglH'd voIuntacily and willingly has entered into
this agreement and funlle!!.' warrants and understands that this
Release reprefJenta a compl'omiuecl and final settlement of a disputed
claim and thilt the p,lymenU, being made on behalf of the parties
which are specHically identified herein as releasees and their
insurers, do not confJtitute an admission of liability or
responsibil i ty,
PATRICIA IIAI~E, Pit rent itnd
Natural Guardian of
CIIJUSTOPIIER IIARE, A MInor,
Plitl.ntl.[fn
IN TilE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
BOROUGII OF NE\1 CUMllEI1LAND,
Defendilnt
NO. 98-3566 CIVIL TERM
ORDER OF COURT
AND NOW, this 12th day of August, 1998, upon oral
motion made in open court on behalf of the Plaintiffs in this
case for a withdrawal of the sum of $800.00 for the purchase of
a go-cart for Christopher flare, that withdrawal is approved.
By the Court,
David J. Foster, Esquire
Counsel for Plaintiffs
Marla B. Bigeleisen, Esquire
Counsel for Defendant
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Order of Court. Proof of the deposit shall be promptly filed of
record.
B. '1'0 the following medical providers:
'I
1. Pediatric Surgery, Ltd.
2. Polyclinic Medical Center
3. Pathology Associates
4. Harrisburg Hospital
5. A.Z. Ritzman & Associates
6. Central Pennsylvania
Anesthesiology, Ltd.
7. Costopoulos, Foster & Fields
(attorney's fees)
Total Settlement
By the Court,
David J. Foster, Esquire
Counsel for Plaintiffs
~,~<.<..,) rY>V.'&<l 'ii111{ri~
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Marla B. Bigeleisen, Esquire
Counsel for Defendant
:srs
$ 643.00
$ 2,976.28
$ 17.00
$ 620.03
$ 48.00
$ 445.50
$ 3.750.00
$15,000.00
Cf)SlllflUlllu~, Fosler,,~ F'l'lch
II)': Ull\'icJ .1. "'lJsfer, ES'luire
1.1l. N". 2JI51
HJ I M"rko' S'roolll'.o. II", 222
1.01ll"Y"o, /',\ I7fJ4J.fJ222
I'h""o: 717.7(,1-2121
ORIGINAL
AUnrlll'Y for 1'l'fIHolIl'r
PAT/UClA I1AI{E, l'lIrent lInd
NlItll"lIl Guardiall fJfCHlHSTOPIIE/{
HARE, A Minor,
IN TilE COURT OF COMMON PLEAS
CUMIlE/H.AND COUNTY, PENNA.
Plaintiffs
v.
BOROUGH OF NEW CUMBERLAND
Defendllnt
DOCKET NO.: 98-3566 Civil Term
PETIT/ON FOR COlJln APPROVAL FOI{ D/SBUI{SEMENT
OF FUNUS F/WM MINOR'S SETTLEMENT
AND NOW. comes David.l. Foster, Esquire, Costopoulos, Fosler & Fields on behalfof
Patricia Hare, Parent and Natural Guardian of Chris lop her Hare, a Minor, and in support thereof
sets lorth the following:
I. On August 12, 1998, this Honorable Court (the Honorable.l. Wesley Oler, .11'.)
approved the minor's se!l/ement in the above-caplioncd matter. A copy of the Order of Court
approving that settlement is attached herein and marked Exhibit A, as well as the additional
Order of Court that date approving withdrawal of the sum of $800.00 lor the purchase of a go-
cart 101' the minor child, Christophel' Hare.
2. Pursuant to that Order, [he proceeds were placed into an appropriate account with
Dauphin Deposit Bank and Trust Company (now M&T Bank). A copy of the notarized
statement frolll Dauphin Deposit Bank attesting to that is attached hereto and marked Exhibit B.
3. The minor child, Christophel' Hare, turns 18 years old on August 7, 2006.
4. Christophel' Hare received his automobile driver's license on April 2,2005; he is
currently a senior at York Suburban High School, and is employed at the Yorkshire Center (with
his school) doing janitorial work.
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.. · ttATRICIA HARE, Parent and
Natural Guardian of
CHRISTOPHER HARE, A Minor,
Plaintiffs
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
BOROUGH OF NEW CUMBERLAND,
Defendant
NO. 98-3566 CIVIL TERM
ORDER OF COURT
consideration of the Petition for Court Approval of Minor'S
settlement, and following a hearing, the settlement is approved,
AND NOW, this 12th day of August, 1998, upon
and it is ordered and directed as follows:
... r"
1.
Petitioner, ~atricia Hare, parent and natural
guardian of
Christopher Hare, a ~inor, is hereby authorized to
..1:
proposed release which has been marked as
execute the
Plaintiff's Exhibit 1.
follows "
A. To Patricia Hare, parent and natural guardian
2. Distribution of the proceeds is directed as
,."
of Christopher Hare, the"s\.1m of $6/452.29. This money is to be
deposited in one or more savings accounts in the name of the
minor in banks, building and loan associations, savings and
loan associations or credi,t. unions, deposits in which are
insured by a Federal governmental agency, provided that the
"amount deposited in any 'one such savings institution shall not
exceed the amount to which accounts are thus insured, or in one
or more accounts in the name of the minor, investing only in
securities guaranteed by the United States government or a
Federal governmental agency managed by responsible financial
institutions. No withdrawal may be made from the account until
the minor attains
....
.. ,
m_jori'y, "XO"P' -. -u'hori'"d by - prio I
EXHIBIT
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~rder of Court. Proof of the deposit shall be promptly filed of
record.
B. To the following medical providers:
l. pediatric Surgery, Ltd. $ 643.00
2. Polyclinic Medical Center $ 2,976.28
3. Pathology Associates $ 17.00
4. Harrisburg Hospital $ 620.03
5. A.Z. Ritzman & Associates $ 48.00
6. Central Pennsylvania
Anesthesiology, Ltd. $ 445.50
7. Costopoulos, Foster & Fields
(attorney's fees) S 3.750.00
Total Settlement $15,000.00
:i By the Court,
~David J. Foster, Esquire
Counsel for Plaintiffs
Marla B. Bigeleisen, Esquire
Counsel for Defendant
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NON.NEGOTlABLE I NON TRANSFERABLE
A: HiN ;DEPOSIT BANK AND TRUST COMP A~Y
~:,.,' I. Memher I'DIC
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'D~POSITORI~)"" 'tHRlSTOPHER S' HARE
~, '. ourt order-no! to be redeemed
. unti).;'l~~!i! I!Qe of.,maior ty-rxgeJ;>t for
'201 A SUMMIT AVE,t"enewa y court
ADDRESS ;NEWCUMBEflLAND PA 17070 n..il".. . IfASDEPOSITEDINTfIlSOANK
,
$1 5,652.29
NO.
8141234870
19.9.;7.~;]I.! 4
UlIi'ljllOMJl.llIIIjI
I~SUE
DATE
TERM OF
CERTIFICATE
MATURITV
DATE
INITIAL
INTEREST RATE
5.270
o SINGLE MATURfTY CERTIFICATE
lEI AUTOMATICALLY RENEWABLE CERTIFICATE
ORANCIJ
TVPE
INTEREST PA V AOLE
o MDNTHl V 0 SEMI,MINUA _ ,,;:
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REDEMPTION AMO!l.~~~ ;'1'
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CAPITALlZEO
CREDIT ACCT.NO.
. "08/26/98 . 13 MONTHS 09126199
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CHANGES TO CERTIFICATE OF DEPOSIT INFORMATION AT RENEWAL
TYPE
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DATE CHANGED
NEW MATURITY DATE
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DEPDSIT AMDUNT
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NEW BALANCE
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EMPLOYEE I BRANCH NUMBER
TYPE
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DATE CHANGEO
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NEW BALANCE
CUSTOMER SIGNATURE
EMPLDYEE I BRANCH NUMBER
8'<>31111 REV 61" Glenda Jo Cheppo C',
08/26/98
.. Substantial Penalty for Early Withdrawal
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No. /99r - 35"& ~
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· ttATRICIA HARE, Parent and
Natural Guardian of
CHRISTOPHER HARE, A Minor,
Plaintiffs
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
BOROUGH OF NEW CUMBERLAND,
Defendant
NO. 98-3566 CIVIL TERM
ORDER OF COURT
AND NOW, this 12th day of August, 1998, upon
consideration of the Petition for Court Approval of Minor's
settlement, and following a hearing, the settlement is approved,
and it is ordered and directed as follows:
1. Petitioner, Patricia Hare, parent and natural
guardian of Christopher Hare, a minor, is hereby authorized to
execute the proposed releale which has been marked as
Plaintiff's Exhibit 1.
2. Distribution of the proceeds is directed as
follows:
A. To Patricia Hare, parent and natural guardian
of Christopher Hare, the'sum of $6,452.29. This money is to be
deposited in one or more savings accounts in the name of the
minor in banks, building and loan associations, savings and
loan associations or credit unions, deposits in which are
insured by a Federal governmental agency, provided that the
'amount deposited in anyone such savings institution shall not
exceed the amount to which accounts are thus insured, or in one
or more accounts in the name of the minor, investing only in
securities guaranteed by the United States government or a
Federal governmental agency managed by responsible financial
institutions. No withdrawal may be made from the account until
the minor attains majority, except as authorized by a prio
i
I
EXHIBIT
It
.~
'.
.
..
~rder of Court. Proof of the deposit shall be promptly filed of
record.
B. To the following medical providers:
Total Settlement
$ 643.00
$ 2,976.28
$ 17.00
$ 620.03
$ 48.00
$ 445.50
$ 3.750.00
$15,000.00
1. pediatric Surgery, Ltd.
2. Polyclinic Medical Center
3. pathology Associates
4. Harrisburg Hospital
5. A.Z. Ritzman & Associates
6. Central Pennsylvania
Anesthesiology, Ltd.
7. Costopoulos, Foster & Fields
(attorney's fees)
By the Court,
~David J. Foster, Esquire
Counsel for Plaintiffs
Marla B. Bigeleisen, Esquire
Counsel for Defendant
:srs
.
... .'T
....
PATRICIA HARE, Parent and
~~~tural Guardian of
. ~HRISTOPHER HARE, A Minor,
Plaintiffs
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
V.
BOROUGH 0F NEW CUMBERLAND,
Defendant
NO. 98-3566 CIVIL TERM
..
ORDER OF COURT
AND NOW, this 12th day of August, 1998, upon oral
motion made in open court on behalf of the Plaintiffs in this
case for a withdrawal of the sum of $800.00 for the purchase of
t
I
a go-cart for Chti~topher Hare, that withdrawal is approved.
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By the Court,
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Jlavid J. Foster,~ire
Counsel forPlaintif$s.
'Marla B. Bigeleisen; Esquire
Counsel for Defendant
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i, ,,~_." I'll OFFICE. 213 MARKET STREET, RARRISBURG, PENNSYLVANIA 17105
'Wi" ,717255-2121
:0.
David J Foster
831 Market Street
P.O. box 222
Lemoyne, Pennsylvania 17043-0222 ~.
~~_.
Re: Hare V. New Cumberland Mrough
....
Dear Mr. Foster:
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I hav~ enclosed the following copies for you. The first is the Certifica'&,
of Deposit in the amount of $5,652.29. The second is a copy of the Treasurer'.
Check which we issued for $800.00, for the Go Cart. .'.(
Any further questions please feel free to call Myself or Glenda Cheppo
at the Fairview Office of Dauphin Deposit Bank, our number is 938-1829.
<:~rj.
Very truly yours,
.' C\
~~ /tPJu,XR.J
Dana L Rhine
Sr. Customer Sen.ice Specialist
(() (J2! ~
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My Commission Expires:'
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Glen t~<;<:':::-,o. NotafY Public
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MY_Qomm~slon Expires Oct. a. 2001
Member, Pennsylvania AssociatiOn of Notalies
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EXHIBIT
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NON.NEGOTIABLE I NON TRANSFERABLE
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A' EPOSIT BANK AND TRUST COMPANY
Member FDIC
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Q.EPOSITOR~j.. !CHRISTOPHER S1-tARE
~ou~t o~de~-not to be ~edeemed
unti~~t~e ,qe of-majority-except fo~
201 A SUMMIT AVp:enewal by court
ADDRESS NEW,CUMBERLAND PA 17070 ,-,r""r HAS DEPOSITED INTHlS BANK
it
NO.
8141234870
l
160.70.3814
U"~ll~ ,0 ........~
T...KP....U,0 NUl,lBEJI
$1 5,652.29
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, 08/26/98 .13 MONTHS 09/26/99
5.270
INTEREST PAYABLE
o MONTHLY 0 SEMI.ANNUA . :~ '
o ANNUAt.l Y '...
o aUARTERL Y IllI AT MATURITY,'
REDEMPTION AMO ."
~A1L CHECK
CAPITALIZED
CREDIT ACeT.NO.
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D).TE
TERM OF
CERTIFICATE
MATURITY
DATE
INITIAL
INTEREST RATE
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f8I AUTOMATICALLY RENEWABLE CERTIFICATE
BRANCH
TYPE
045
823
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AUTHORIZED
SIGNA lURE
CHANGES TO CERTIFICATE OF DEPOSIT INFORMATION AT RENEWAL
TYPE
TERM
INTEREST RATE
DATE CHANGED
NEW MATURITY DATE
DEPOSIT AMOUNT
. WITHDRAWAL AMOUNT ..
NEW BALAN&!
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TYPE
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EMPLOYEE I BRANCH NUMBER
CUSTOMER SIGNATURE
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CUSTOMER SIGNATURE
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DATE CHANGED
N
A TURITY DATE
.W-
DEMIT AMOUNT
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NEW BALANCE
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EMPLOYEE f BRANCH NUMBER
BP-03111l REV 6195 Glenda Jo Cheppo'
08/26/98
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PUflCHASEA Of! FUll
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STATE
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I, th&;lpst Pennsylvania Salvage DecilerIScrapPr~r8usiness listed ~ve, hereby certify that the vehicle described,on
the front of this certificate has been flattened, crushed, or processed to the extent that it is no ,longer identifiable as a vehicle
and shall nof be:retitled orrecanstructed.
FlA
,CRUS E OR PR
SED
SIGNATURE OF SAlV~E DEA\,,~FySCMP PROCESSOR
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EXHIBIT
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ADVANCE AUTO PARTS
THE BEST PART IS OUR PEOPLE
1045 Mt. Rose Avenue
York PA 17403
(717) 845-9030 2/07/200621:52
STORE #: 06032
CUSTOMER NEEDS LIST
NOT A VALlO RECEIPT
Page 1
DONT USE
lKR~~~08~f~~~~tBeretta.3.1L.
Mufflers
---------------------"-------- ------------
Wa 1ker #22605 Qty:
~Mit; Single Outlet - LlO LIFElINE
. Prices Subiect to Chenge 78.48
Exhaust Pipe
_________.__________________ ___ __n________
Walker . #43431 Qty:
~Ef~tiI~font - I VEAA AEPLACEMENT IF
. Prices Subiect to Chenge 31.4B
Exhaust Extension Pipe
-----------------------------------------
Wa lker #45063 Qty:
~e~:.~e~t~n!;lItAill~fd Assv. Reolece RII
. Prices Subiect to Chenge 22.96
Tail Pipe
-----------------------------------------
Walker #41299 Qty:
Soautl. 1Ft,: F\an!: ~ull Outlet; Teil; Pert
AeD. Dr Un,u. ns. 1 VR REPL
. Prices Subiect ta Chenge 6.24
Catalytic Converter
-----------------------------------------
Walker #15703 Qty:
,~(;~U !;S[~U'I~t~~r; pi~l~q~tw:i ~e~~o: OE
Qd1l1QnelB1dlo ers ~~iti~9 The Of
mM{ia~ _eguli 18.b880Mlc!
. ..,~.::..+... r~':!!'~~ 69.88
ADVANCE AUTO PARTS
Page 2
Idle Air Parts
GP Sorensen #779-10010 Qty: 1
Idle Air Contral Velue; MFI - 1 VR REPL
. Prices Subiect to Chenge 32.44
1~g;.5~9f~~g~~!:u5~R G~~~~~M
Radiator
-----------------------------------------
Ready-Rad #433716 Oty:
AutD.eti~ rrenslisSionf'sBrelS lenkl;
~/CqposrJBrnss .ahe' w tfOderd
~g~~lmnlhie~vl rn"ilF ~~Mtn~!pt/Ai r
. Prices Subiect to Change 148.88
SUB TOTAL
TAX 6X
TOTAL
ASSOCIATE: 22
THANK YOU FOR SHOPPING AT
NOT A VALID RECEIPT
390.36
23.42
413.78
E'~r;,.ll(-J re
GORDON'S 01-17
I. TAX
FEES
PURCHASE
PRICE
lESS
TRADE-IN
TAXABLE
AMOUNT
L Sales Tax Due
" 6% (.06) Sales Tax
" 7% (.07) Phila. Res.
2. Title Fee
3. Lien
Fee
4. Registration or
Processing Fee
5. Duplicate Reg.
Fee
No. of Cards
6. Transfer Fee
7. Increase Fee
8. Replacement
Fee
TOTAL PAID
1. T emporafy T dig
2. Paper Work
Fee
3. Notary Stamp
GRAND TOTAL
(Add 9 & 10 + 4 & 5)
u J,).( tvr..J,-,;J
L ~
L ,.:;. lJ
.3L" '-~ -.:;.
;;,--g 3D
30 <.00
if -:.> < -0
v, -'
Send Dna
Check in
This Amount
02/0~/2005 14:51 717~323S74
DRAI7EY
PAGE 01
~AlIstate.
""'....in good hoMo.
ALLSTATE INDEMNITY COMPANY
AUTO INSURANCE PROPOSAL
FEBRUARY 09. 2006
ESPECIALLY PREPARED FOR:
CHRISTOPHER HARE
521 S AMBEMARLE STREET
YORK PA 17403
PREPARED BY:
STEPHEN T. DRAISEY
EXCLUSIVE AGENT
564 OLD YORK ROAD
ETTERS PA 17319
717 - 932-4944
FAX 717 - 932-3974
PENNSYLVANIA SELECT PERSONAL AUTO
Thank you for your interest in Allstate insurance. I look forward to
serving YOU. and I will make 1t my personal responsibility to make
sure you receive prompt. professional service every step of the way
should you choose our coverage. Please call if you have any qUestions.
Territory PGS Class code
Vehicle 1 142 V B1 W 2
Tables
o
Coverage
Bod; ly Injury
Property Damage
Medical Payments
Vehicle Totals;
POLICY CHARGES
Pol icy Fee
1991 BERETTA
Limits Premiums
15/30 549.26
5 Included
5000 92. 30
641. 56
30.00
Total Policy Premiums: 671.56
PASSIVE RESTRAINT DISCOUNT INCLUDED LIMITEO TORT APPLIES
PREFERRED POLICY DISCOUNT INCLUDED
This proposal is not a contract or binder of coverage. All coverages
are subject to the terms and condltlonS contalned ln the policy and
endorsements. The premiums shown are for a 6 month POllCY per1od.
If you have any questions, please contact me at the above number. ~
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RECEIVED FEB 212006
)4
j
PATRICIA HARE, Parent and
Natural Guardian of CHRISTOPHER
HARE, A Minor,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNA.
Plaintiffs
v.
BOROUGH OF NEW CUMBERLAND
Defendant
DOCKET NO.: 98-3566 Civil Term
ORDER OF COURT
AND NOW, this 71,..) dayof
Fe~
, 2006, upon consideration
of the within Petition for Court Approval for Disbursement of Funds from Minor's Settlement,
said Petition is GRANTED, and the Petitioner, Patricia Hare, is hereby authorized to withdraw
from Christopher Hare's minor's account the sum of$I,l73.84.
By the Court:
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