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Home My WebLink About03-1772 TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER 1. D. 1160267 22nd Fl.,1845 Walnut Street Ph i 1 a ., P A 19103 (215) 569-5050.- Plaintiff(s) THE MILTON S. HERSHEY MEDICAL CENTER P.O. Box 853 Hershey, PA 17033 ATTORNEY FOR Plainti.ff VB Defendanls(s) JOSHUA NAVARRETE & JILL M. NAVARRETE, h/w 11 E. Shady Lane Eno1a, PA 17025 COURT OF COMMON PLEAS DIVISION CUMBERLAND COUNTY TERM. No. 03 - 1'7?~ (J,olCT~ NOTICE CIVIL ACTION COMPLAINT A VI SO You ha ve been sued in court. If you wish to defend against the claims set forth in the following pages. you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or byattorneyand filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and ajudgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff, You may 10lle money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TEJ,.EPHONE THE OFFICE SET FORTH BELOWTO FINDOUTWHERE YOU CAN GET LEGAL HELP. Le han dernandlldo a usted en la corte. Si uSled quiere defenderse de estas demandas expuestas en IllS paginas siguientes. Wited tiene veinte (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Haec falla asentar una comparencia escrita 0 en persona 0 con un abogado y entregara la corte en forma escrita sus defenslls 0 s.Us objeciones alas demandas en contra de su persona. Sea avisado que si usted no se defiende.1a corte tomara medidas y puede continullr la demanda en contra suya sin previo aviso 0 notificacion. . Ademas.la corte puede decidir a fa vor del demandante y requiere que usted cumpla con todas las provisiones de eSla demllnda. Usted puede perder di~ero 0 SUS propicdlldes 0 olros dcrechos importanlCs pam Ullled. LLEVE ESTA DEMANDA A UNABOGADO INMEDIATAMENTE. 5J NO TIENE A BOGADO 0 SI NO TIEN E .EL OJ NERO SUFI CI ENTE DE PAGAR TAL SERVICIO. VA YA EN PERSONA 0 LI.AME POR TEI.F.FONO A LA OFICINA CUYA OIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDF SF PUEDE CONSEGUIR ASISTENCIA LEGAL. BAR ASSOCIATION CUMBERLAND COUNTY 2 LIBERTY AVENUE CARLISLE, PA 17013 (717)249-3166 OR (800)990-9108 COMPLAINT - CIVIL ACTION COUNT I THE MILTON S. HERSHEY MEDICAL CENTER V. JILL M. NAVARRETE 1. Plaintiff is a non-profit corporation located at the address indicated in the caption hereof. 2. Count I defendant is an individual who resides at the address indicated in the caption hereof. 3. As the result of a certain medical condition, Count I defendant was treated at the plaintiff hospital on June 5, 2000 thru September 26, 2001. 4. The amounts, quantities and nature of the medical care rendered, the date on which said medical care was rendered, and the charges therefore are set forth in Exhibit "A", which is incorporated herein as if set forth at length. 5. Said medical care was commensurate with the condition 'of Count I defendant and was necessary for the health and welfare of Count I defendant. 6. At or about the time of Count I defendant's treatment at the plaintiff hospital, implied, constructive and oral con- tracts arose between Count I defendant and plaintiff by the terms of which Count I defendant became obligated to pay plaintiff the charges incurred for the medical care rendered by plaintiff to Count I defendant. THIS DOCUMENT IS BEING USED IN CONNECTION WITH THE COLLECTION OF A DEBTi ANY INFORMATION OBTAINED MAY BE USED FOR THAT PURPOSE. 7. Count I defendant refuses to pay the balance due although plaintiff has made demand that Count I defendant do so. 8. As a result of the foregoing, there is due and owing from Count I defendant to plaintiff the sum indicated in Exhibit "A". WHEREFORE, plaintiff demands judgment against Count I defendant for the sum of $32,136.10 plus six percent (6%) interest per annum from the date of discharge to the date of judgment, record costs and non-record costs. COUNT II THE MILTON S. HERSHEY MEDICAL CENTER V. JOSHUA NAVARRETE 9. The foregoing paragraphs are incorporated herein as if set forth at length. 10. Count II defendant is an individual who resides at the address indicated in the caption hereof. 11. Count II defendant is the spouse of Count I defendant. 12. Defendant's spouse was treated at the plaintiff hospital on June 5, 2000 thru September 26, 2001. 13. Said medical care was commensurate with the condition of defendant's spouse and was necessary for the health and welfare of defendant's spouse. 14. Count I defendant is indigent. 15. Count II defendant is financially able to pay for the medical care of Count I defendant. THIS DOCUMENT IS BEING USED IN CONNECTION WITH THE COLLECTION OF A DEBT; ANY INFORMATION OBTAINED MAY BE USED FOR THAT PURPOSE. 16. By virtue of the marital relationship, the Act of 1937, June 24, P.L. 2045, Sec. 3, as amended, 62 Pa. Cons. Stat. Ann. Sec. 1973 and Article 1, Sec. 28 of the Pennsylvania Constitution and all other applicable statutes, laws and ordinances, Count II defendant has a duty to support Count I defendant. 18. Count II defendant has been unjustly enriched by plain- tiff's discharge of Count II defendant's duty to support Count I defendant, which duty Count II defendant failed to perform. 19. Count II defendant refuses to pay the balance due, although plaintiff has made demand that Count II defendant do so. 20. As a result of the foregoing, there is due and owing from Count II defendant to plaintiff the sum indicated in Exhibit "A". WHEREFORE, plaintiff demands judgment against Count II defendant for the sum of $32,136.10 plus six percent (6%) interest per annum from the date of discharge to the date of judgment, record costs and non-record costs. TABAS & ROSEN, P.C. L~~UFFER, -;:QUlRE Attorney for Plaintiff THIS DOCUMENT IS BEING USED IN CONNECTION WITH THE COLLECTION OF A DEBT; ANY INFORMATION OBTAINED MAY BE USED FOR THAT PURPOSE. MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 07/24/02 at 09:40 AM PAGE: 1 Guarantor: NAVARRETE JILL S 11 E SHADY LANE ENOLA, PA 17025-0000 Patient: NAVARRETE JILL S Acct No: 1469348 -------------------------------------------------------------------------------- I Svc Code I Date Description I Units I Debits Credits -------------------------------------------------------------------------------- 04/22/01 04/22/01 04/22/01 04/22/01 04/22/01 04/22/01 04/22/01 04/22/01 04/22/01 04/22/01 04/22/01 04/22/01 04/22/01 04/22/01 04/22/01 04/23/01 04/23/01 04/23/01 04/23/01 04/23/01 04/23/01 04/23/01 04/23/01 04/23/01 04/23/01 04/23/01 04/23/01 04/23/01 04/23/01 04/23/01 04/23/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 10144 101003 101004 101005 104398 104597 105052 105059 105656 245579 246563 246747 247051 251008 273482 10144 246493 246563 246747 247051 251008 273482 307059 347001 600510 620170 621386 626080 667724 667765 670330 10145 104042 104065 104398 191024 191091 245233 245717 246020 246085 246182 I CRITICAL CARE UNIT ABO BLOOD GROUP ANTIBODY SCREEN RH TYPE ELECTROLYTES HCG, BETA PARTIAL THROMBOPLAS T PROTHROMBIN TIME CBC W/PLT CNT, NO DIF SODIUM CHLORIDE 1 ML DEXAMETHASONE 4 MG RANITIDINE 150 MG CODEINE SULFATE 30 MG CLONAZEPAM 0.5MG CITALOPRAM 20MG TAB I CRITICAL CARE UNIT DEXAMETHASONE 4 MG/ML DEXAMETHASONE 4 MG RANITIDINE 150 MG CODEINE SULFATE 30 MG CLONAZEPAM 0.5MG CITALOPRAM 20MG TAB SKULL 1-3 VIEWS MRI BRAIN UNENHANCED PULSE OXYMETER SENSOR BAG, DRAINAGE 1CP MON IV KCL 20MEQ+D5 NACL I-V DILUENT NML SALIN STOCKING, KNEE ANTIEM SCD SLEEVES, KNEE LEN IV INFUSION SET, UNIV T INTERMEDIATE CARE U CREATININE, BLOOD UREA NITROGEN (BUN), ELECTROLYTES LVL5 SURGICAL PATHOLO GRP2 STAIN-HISTO GELFOAM SPONGE SIZE 1 DEXAMETHASONE 4 MG/ML BACITRACIN 50000 U CODEINE PHOSPHATE 60 GLYCOPYRROLATE 0.2 MG 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 4 2 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 1 1 2 2 2125.00 15.00 27.00 14.00 22.00 57.00 27.00 17.00 22.00 2.15 4.20 2.10 2.10 2.10 5.25 2125.00 4.50 8.40 4.20 2.10 4.20 5.25 98.00 1183.00 18.00 42.00 8.00 7.00 8.00 68.00 6.00 1025.00 8.00 7.00 22.00 72.00 24.00 164.00 5.05 7.60 4.80 4.70 -------------------------------------------------------------------------------- - Continue - A-I MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 07/24/02 at 09:40 AM PAGE: 2 Guarantor: NAVARRETE JILL S 11 E SHADY LANE ENOLA, PA 17025-0000 Patient: NAVARRETE JILL S Acct No: 1469348 -------------------------------------------------------------------------------- I Svc Code I Date Description I Units I Debits Credits -------------------------------------------------------------------------------- 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/24/01 04/25/01 04/25/01 04/25/01 246249 246316 246405 246415 246478 246493 246539 246563 246703 246706 247051 247786 251008 272192 272199 272661 272987 410032 410052 410060 410061 410067 462000 462015 462133 462136 462380 467428 467434 467451 469172 469973 502000 503129 515202 515402 515502 621386 670334 315 601 10145 POVIDONE IODINE 30 GM NEOSTIGMINE 10 ML THIOPENTAL SODIUM 5 G THROMBIN TOPICAL 1000 SODIUM CHLORIDE 30 ML DEXAMETHASONE 4 MG/ML TRIMETHOBENZAMIDE 100 DEXAMETHASONE 4 MG LORAZEPAM 2 MG MORPHINE SULFATE 2 MG CODEINE SULFATE 30 MG MORPHINE SULFATE 10 M CLONAZEPAM 0.5MG RANITIDINE RTU ONDANSETRON 2MG/ML 2M ROCURONIUM BROMIDE 10 CEFAZOLIN 1 GM PRE-MI O.R. TIME @ 15MIN INC MAJOR SET-UP, ADD. SUP ELECTROCAUTERY BIPOLAR CAUTERY MICROSCOPE NEURO SURGERY OR SUPP MICROSCOPE DRAPE CONT RANEY SCALP CLIP PERFORATOR,CRANIOTOME IRRIGATION TUBING SET BUR HOLE COVERS CORTEX SCREW 1.5MM PLATE, 13 MM CRANIAL SURGICEL-ALL SIZES NEURO PACK ANESTHESIA TIME-HOSP BAIR HUGGER LOWER BOD SINGLE LINE SET UP MONITORING DAY ADD-ON KIT IV KCL 20MEQ+D5 NACL IV INFUSION SET, UNIV INITIAL EVALUATION IN INITIAL EVALUATION-PT T INTERMEDIATE CARE U 1 1 1 1 2 3 1 1 1 1 1 1 1 1 1 1 1 18 1 1 1 1 1 1 3 1 1 3 16 2 1 1 18 1 1 3 1 1 1 1 1 1 2.90 2.10 8.85 20.70 4.20 6.30 2.80 2.10 6.00 2.45 2.10 2.10 2.10 9.35 51.50 76.70 8.55 3402.00 965.00 23.00 33.00 334.00 126.00 29.00 30.00 184.00 62.00 633.00 1008.00 82.00 67.00 107.00 971. 75 30.00 83.00 216.00 48.00 8.00 7.00 190.00 115.00 1025.00 -------------------------------------------------------------------------------- - Continue - [t-o{ MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 07/24/02 at 09:40 AM PAGE: 3 Guarantor: NAVARRETE JILL S 11 E SHADY LANE ENOLA, PA 17025-0000 Patient: NAVARRETE JILL S Acct No: 1469348 -------------------------------------------------------------------------------- Date I Svc Code I Description I Units I Debits Credits -------------------------------------------------------------------------------- 04/25/01 104131 POTASSIUM (K), BLOOD 1 8.00 04/25/01 104398 ELECTROLYTES 1 22.00 04/25/01 105035 HCG QUALITATIVE, BLOO 1 33.00 04/25/01 105656 CBC W/PLT CNT, NO DIF 1 22.00 04/25/01 106041 OSMOLALITY, SERUM 1 38.00 04/25/01 246400 PROMETHAZINE 25 MG/ML 1 4.05 04/25/01 246541 TRIMETHOBENZAMIDE 200 1 2.10 04/25/01 246563 DEXAMETHASONE 4 MG 3 6.30 04/25/01 246706 MORPHINE SULFATE 2 MG 4 9.80 04/25/01 246747 RANITIDINE 150 MG 2 4.20 04/25/01 246924 PROMETHAZINE 25 MG 1 10.65 04/25/01 251008 CLONAZEPAM 0.5MG 2 4.20 04/25/01 273482 CITALOPRAM 20MG TAB 2 10.50 04/25/01 621274 I V DEXTROSE 5%-0.9 S 3 15.00 04/25/01 621386 IV KCL 20MEQ+D5 NACL 2 16.00 04/26/01 434 THERAPEUT ACTIVITIES 1 38.00 04/26/01 435 ACT DAILY LIVING 15 M 1 38.00 04/26/01 684 GAIT TRAINING 15 MIN 2 76.00 04/26/01 10145 T INTERMEDIATE CARE U 1 1025.00 04/26/01 104398 ELECTROLYTES 1 22.00 04/26/01 104597 HCG, BETA 1 57.00 04/26/01 104684 PROGESTERONE 1 65.00 04/26/01 246162 FENTANYL CITRATE 5 ML 1 2.10 04/26/01 246478 SODIUM CHLORIDE 30 ML 1 2.10 04/26/01 246563 DEXAMETHASONE 4 MG 3 6.30 04/26/01 246747 RANITIDINE 150 MG 2 4.20 04/26/01 246923 PROMETHAZINE 25MG 1 2.10 04/26/01 247051 CODEINE SULFATE 30 MG 2 4.20 04/26/01 247786 MORPHINE SULFATE 10 M 1 3.60 04/26/01 251008 CLONAZEPAM 0.5MG 1 2.10 04/26/01 272425 MIDAZOLAM 1MG/ML 2ML 1 2.10 04/26/01 273120 DEXAMETHATSONE 2 MG T 1 2.10 04/26/01 273482 CITALOPRAM 20MG TAB 2 10.50 04/26/01 516902 EZPAP TREATMENT SUBSE 1 42.00 04/26/01 516904 OXIMETRY DAY 4 140.00 04/27/01 684 GAIT TRAINING 15 MIN 1 38.00 04/27/01 11531 INSTR ADAP EQUIPMENT 1 38.00 04/27/01 246747 RANITIDINE 150 MG 1 2.10 04/27/01 251008 CLONAZEPAM 0.5MG 1 2.10 04/27/01 273120 DEXAMETHATSONE 2 MG T 2 4.20 04/27/01 273482 CITALOPRAM 20MG TAB 1 5.25 fJ3 MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 07/24/02 at 09:40 AM PAGE: 4 Guarantor: NAVARRETE JILL S 11 E SHADY LANE ENOLA, PA 17025-0000 Patient: NAVARRETE JILL S Acct No: 1469348 -------------------------------------------------------------------------------- Date I Svc Code I Description I Units I Debits Credits -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- * - Not posted Balance: 19109.10 I -------------------------- A-i MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 07/31/02 at 04:12 PM PAGE: 1 Guarantor: NAVARRETE JILL S 11 E SHADY LANE ENOLA, PA 17025-0000 Patient: NAVARRETE JILL S Acct No: 1504401 -------------------------------------------------------------------------------- Date I Svc Code I Description I Units I Debits Credits -------------------------------------------------------------------------------- 05/07/01 11/30/01 11/30/01 07/22/02 07/22/02 787004 980090 980091 980092 980093 PREGNANCY TEST HOSPITAL BAD DEBT W/O HOSPITAL BAD DEBT PLA RETURN HOSPITAL BAD D RETURN FROM B/D HOSP 1 -1 1 -1 1 33.00 33.00- 33.00 33.00- -------------------------------------------------------------------------------- 33.00 * - Not posted Balance: 33.00 I -------------------------- ft~ MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 07/24/02 at 09:40 AM PAGE: 1 Guarantor: NAVARRETE JILL S 11 E SHADY LANE ENOLA, PA 17025-0000 Patient: NAVARRETE JILL S Acct No: 1919644 -------------------------------------------------------------------------------- Date I Svc Code I Description I Units I Debits Credits -------------------------------------------------------------------------------- 109/26/01 09/26/01 347062 1 MRI BRAIN UNENH & ENHI 347149 MRI GADOLINIUM CONTRA 1 1 1535.00 I 144.00 -------------------------------------------------------------------------------- * - Not posted Balance: 1679.00 I -------------------------- ft~b >ENNSTATE JILL S NAVARRETE 1 of 2 11 E SHADY LANE " The Milton S. Hershey Medical Center APT 1W STATEMENT The College of MediclOe ENOLA PA 17025 DATE: 07/20/02 LAST STATEMENT ACCOUNT # 776838 DATE: 06/22/02 .. IF ANY QUESTIONS, PLEASE CONTACT: MSHMC PATIENT FINANCIAL SERVICES FED TAX ID # 251857035 PROCEDURE^DIAG . .__,-, . .u ".< .~.' ,- ". PAYMENT/ GUARANTOR DATE CODE CODE QTY DESCRIPTION INS CHARGE ADJUSTMENT BALANCE >>> PATIENT: JILL S NAVARRETE 776838 798957 PERFORMED BY: DIVISION OF HOMENS HEALTH PLACE OF SVC: OP PHYSICIAN 06/05/00 99385 V72.3 ROUT/GYN EXAM NEW 18-39 75.00 06/30/00 INSURANCE NOT IN EFFECT 0.00 09/25/00 APPLIED TO DEDUCTIBLE 0.00 75.00 1469348 PERFORMED BY: DIV OF DIAG RADIOLOGY PLACE OF SVC: INPATIENT 04/23/01 7055126 348.0 MRI BRAIN UNENHANCED 320.00 09/10/01 NO COVERAGE FOR THIS DATE 0.00 320.00 PERFORMED BY: DIV OF NEURO SURGERY 04/23/01 99222.57 331.4 INITIAL HOSPTIAL CARE 250.00 09/14/01 NO COVERAGE FOR THIS DATE 0.00 250.00 PERFORMED BY: TRAUMA SURGERY DIV 04/23/01 99232 518.5 DAILY HOSPITAL CARE 133.00 09/14/01 NO COVERAGE FOR THIS DATE 0.00 133.00 PERFORMED BY: DIV OF DIAG RADIOLOGY 04/23/01 7025026 742.3 SKULL <4 VIEWS 74.00 09/10/01 NO COVERAGE FOR THIS DATE 0.00 74.00 PERFORMED BY: DIV OF NEURO SURGERY 04/24/01 61510.RT 742.4 CRANI EXC BR TUM SUPRA 6544.00 09/14/01 NO COVERAGE FOR THIS DATE 0.00 10/09/01 NO COVERAGE FOR THIS DATE 0.00 6544.00 04/24/01 69990.RT 742.4 MICRO-SURGERY ADD ON 798.00 09/14/01 NO COVERAGE FOR THIS DATE 0.00 10/09/01 NO COVERAGE FOR THIS DATE 0.00 798.00 PERFORMED BY: DIV OF ANATOMIC PATHOLOGY 04/24/01 8830726 742.4 TISSUE EXAM LEVEL 5 289.00 09/13/01 NO COVERAGE FOR THIS DATE 0.00 289.00 04/24/01 8831326 742.4 2 SPECIAL STAINS-HISTO 86.00 09/13/01 NO COVERAGE FOR THIS DATE 0.00 86.00 PERFORMED BY: DIV OF ANESTHESIA 04/24/01 00210.GC 742.4 30 CRANTMY TREPHNTN BONE FLP 2100.00 10/15/01 BALANCE TRANSFER TO GUAR 2100.00 1504401 PERFORMED BY: DIVISION OF WOMENS HEALTH PLACE OF SVC: OP PHYSICIAN 05/07/01 99212.GE 634.90 OUTPATIENT VISIT EST 46.00 46.00 1690315 PERFORMED BY: DIV OF NEURO SURGERY PLACE OF SVC: OP PHYSICIAN 08/01/01 99212.GC 239.6 OUTPATIENT VISIT EST 48.00 09/14/01 NO COVERAGE FOR THIS DATE 0.00 48.00 1919644 1f.1 o CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK ----_._-,._..._-_.~---,-..". >ENNSTATE ~ The Milton S. Hershey Medical Center . The College of Medicmc JILL S NAVARRETE 11 E SHADY LANE APT 1W ENOLA PA 17025 ACCOUNT # 776838 2 of 2 STATEMENT DATE: 07/20/02 LAST STATEMENT DATE: 06/22/02 FED TAX ID # 251857035 CHARGE PAYMENT! GUARANTOR ADJUSTMENT BALANCE '" IF ANY QUESTIONS, PLEASE CONTACT: MSHMC PATIENT FINANCIAL SERVICES PROCEDURE DIAG DATE CODE CODE QTY DESCRIPTION PERFORMED BY: DIV OF DIAG RADIOLOGY PLACE OF SVC: OP HOSPITAL 09/26/01 7055326 784.0 MRI BRAIN UNEN ENH INS 486.00 486.00 09/26/01 99213 10/10/01 239.6 1920026 PERFORMED BY: DIV OF NEURO SURGERY PLACE OF SVC: OP PHYSICIAN OUTPATIENT VISIT EST NO COVERAGE FOR THIS DATE BALANCE: JILL S NAVARRETE 66.00 $11315.00 0.00 66.00 IF YOU HAVE ANY QUESTIONS ABOUT THE AMOUNT YOUR INSURANCE COMPANY PAID, CONTACT THEM DIRECTLY. FOR ANY OTHER QUESTIONS REGARDING YOUR BALANCE, PLEASE CONTACT OUR OFFICE. IF PAYMENT HAS BEEN MADE, THANK YOU AND DISREGARD THIS BILL. RJKO PLEASE NOTE: TO KEEP YOUR ACCOUNT CURRENT, OUR POLICY IS TO APPLY YOUR PAYMENT TO THE OLDEST OUTSTANDING BALANCE. BALANCE SUMMARY RESPONSIBLE PARTY *** GUARANTOR RESPONSIBILITY POLICY # TOTAL $ 11315.00 ------------------------n-l-UyJE..Q!J_I.MI.:[:..f},Jg.~~_LQ.nlJ..r;J:L~..rHU!..UY-'!fJ-~-q!Tqf!1..fJ2!J]LQ/J_9.E..~]A!_~rtCEJy!_'!l.II_'L'!.9J!.!Lf-IJ..'!.!Ylg!!I.:[_1_____________n________________. STATEMENT DATE: GUARANTOR RESPONSIBILITY: MINIMUM PAYMENT: 07/20/02 $ 11315.00 $ 11315.00 BF6 776838 MSHMC PHYSICIANS GROUP BILLING SERVICES POBOX 854 HERSHEY PA 17033-0854 00000776838 UP 0000000001131500072002 Mail To: MSHMC PHYSICIANS GROUP POBOX 828611 PHILA PA 19182-8611 JILL S NAVARRETE 11 E SHADY LANE APT lW ENOLA PA 17025 'FICE USE ONL Y .; CHECK ONE FOR CREDIT CARD PAYMENT, PLEASE FILL IN INFORMATION BELOW .........'.iWRITETI:iISiAGQOVN'/Y 776838 _M/C _VISA EXP DATE $ 11315.00 .AMol.,lN ENCL 08/10/02 C : F6BO YP: DMND CARDHOLDER NAME (PRINT) fj-l CREDIT CARD SIGNATURE MSHMC PHYSICIANS GROUP ----,._._~-_.,~--- -~-.,,--,,-". o CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK ---- - -..- ----..-..----------..----."..----- <II ....0\: ro' I CONSENT UPON ADMISSION TO HOSPITAL ~OR MEDICAL TREA TMENT PA TIE NT NAME ,.. R ~4 7 76 B J 8 ] 0 3 3 _ 1 2E I 3 COSt fd6Q348 OQ/t4/1?7n PA TIE NT NUMBER ADMISSIOfj DA 7'Ii.4 v .\ Q !; E T ~ _' I II S ~ -c.....L h 4 pc w' I( S ~~ PjH' ~.l ~ '. , 1 I, (or ~ .v.J1tua Nu.Vc1..rr~,-" 'f~- on behalf of ,J; 'I ~A'JI'1116r'J' t7t'.. l. lJ ~ knowing that I, (he/she) am (is) suffering from a condition requiring hospital care, do hereby voluntarily consent to such hospital care encompassing routine diagnostic procedures and medical treatment by the inedical staff of University Hospital, The Milton S. Her- shey Medical Center, their assistants, or their designees as necessary in their judgement. I am aware that the practice of medicine and surgery is not an exact scifmce, and I acknowledge that no guarantees have been made to me as to the result of treatments or examinations in the hospital. For the purpose of advancing medical knowledge I con- sent to the admittance of medical students ~nq other observers in accordance with ordinary practices of this' medical facility. Tl7is form has been fully explained tome. I certify that I under$,.tand its contents and have agreed to these provisions. . ~~ WITNESS . PA T1ENT'S SIGNA TURE Patient is unable to consent becaus~ he/she is:. o a minor : o undergoing emergency treatment ---- ~her, describe nJ-1A/lah U I ~- ~ WITNESS ~ ~- ~ /~ ., C0 ' ~LAnVE 00 LEGAL --MDIAN SIGNATURE 51 bfJr.,c. ~ RELA TlONSHIP HOSPITAL MEDICAL RECORD RELEASE AUTHORIZA TlON/PERSONAL EFFECTS The Milton S. Hershey Medical Center may disclose information about me and the treatment for which I am being admitted, in- cluding copies of my medical records, to (1) my health insurance company, (2) my employer, (3) any person or firm which conducts reviews of my treatment at the University Hospital, The Milton S. Hershey Medical Center on behalf of my health insurance company or my employer, and (4) the peer review organization designated by the appropriate governrpental bodies to review hospital utiliza- tion under the Medicare program. This information will be used by these parties to determine the medical necessity of the medical and hospital services I will be receiving, and to promote timely and appropriate discharge from the hospital, The information may also be used to get all or part of my hospital bill paid. I have read this consent and understand it fully. I have had the opportunity to ask any questions relating to this consent, and any questions I pad, have been answered to my satisfaction. Safety deposit boxes are maintained in the Hospital FInancial Management Office for the safekeeping of patient's valuable per- sonal effects. Patients are ~ed to avail themselves of this facility as the Hospital does not assume responsibility for any valuables. The undersigned accepts ttie full responsibility for any personal effects taken to the hospital room, including but not limited to such things as money, dentures, eye glasses, contact lenses, hearing aids, radios, and television sets. DATE ~-pl..~ -Of DA TE 'ARE T OR GUARDIA PA TIENT RESPONSIBILITY AGREEMENT I, the undii~ned, do hereby acknowledge and accept financial responsibility for the payment of all charges For services rendered to -:Ii' J I jJt'i 1 JiLJ/ V -c ../-c.. I, the undersigned, do hereby acknowledge and understand that all charges not covered by insurance will be payable in full prior to or upon date of and time of discharge. I, the undersigned, authorize the hospital to make a credit investigation if necessary. I hereby assign and authorize payment directly to The Milton S. Hershey Medical Center Hospital, Pennsylvania State University. Should the account become delinquent, and should it become necessary for the account to be referred to an attorney or collec- tion agency for collection or suit, una Ig d shall pay the reasonaG1.9 -attorney's fees or collection expense. Signed Witness' Date "I-:J S- -6/ ~ P -"/Yl LA Date () '-I /~~J All".,. S wi" be accepted lor admiSSion without n>ga<rJ to "'ce, 0010<, creed, ,",Igion, ne,,:'aJ origin or sex. .~v NAVARRETE, JILL M. 11776838 $20,821.10 (Hosp) $11,315.00 (Phys) VERIFICATION visor of Financial Counselors and Collection of Milton S. Hershey LINDA SCHLADER hereby states that she is the Super- Medical Center, The Pennsylvania State University and verifies that the statements made in the foregoing plead;i..ng are true and correct" to the best of her knowledge, information and belief. The undersigned understands that the statements therein to unsworn falsification to authorities. are made subject to the penalties of 18 Pa. C.S. ~4904 relating !h~ DATE: 4!~~ 1 --_..~.-.-._~-,-,- (:J ~ f(j p II) 'i fL !'1 C/) C' f" '- ~ 0 c W ~ , 6"- , -eJ - --0 ~ ~ F 6" 0 r ~ ~.,,:- ., ".::. ~- )--. :.) , I .. :-) - ( ,. ~ al - She. Do( Sel Aft Sur SWorn me thi -~ ( j SHERIFF'S RETURN - REGULAR CASE NO: 2003-01772 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND MILTON S HERSHEY MEDICAL CENTE VS ~AVARRETE JOSHUA ET AL CPL. MICHAEL BARRICK , Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon the NAVARRETE JOSHUA ,~ DEFENDANT , at 0933:00 HOURS, on the 30th day of April at 11 E SHADY LANE by handing to ENOLA, PA 17025 JILL M. NAVARRETE, WIFE together with a true and attested copy of COMPLAINT & NOTICE and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge So?~~ 18.00 10.35 .00 10.00 .00 38.35 R. Thomas Kline Sworn and subscribed to before By: 05/01/2003 TABAS & ROSEN h' ~ me t ~ s 1 '- day of ~ /,}tN3 A.D. Ch~J(l ~A~/'d ~, othonotary , TABAS & ROSEN, p.e. BY, LIlw:IS e. TRJl.t1FFIlR, IlSQUIRIl ID No. I 60267 1845 'Walnut Street,. 22nd Floor Philadelphia, PA 19103 (215) 569-5050 ' THE MILTON S. HERSHEY MEDICAL CENTER P,O, BOX 853 HERSHEY, PA 17033 COURT OF COMMON PLEAS APRIL TERM, 2003 VS. JOSHUA NAVARRETE & JILL M. NAVARRETE,h/w 1"- E. SHADY LANE ENOLA, PA 17025 NO.: 03-1772 CIVIL TERM ORDER FOR JUDGMENT FOR WANT OF AN ANSWER AND ASSESSMENT OF DAMAGES TO THE PROTHONOTARY: Kindly enter judgment in the sum of $ 35,424.94 in favor of the Plaintiff(s) in the above entitled matter for failure of the Defendant(s) to file an Answer'to Plaintiff(s) Complaint in Civil Action and assess Plaintiff(s) damages as follows: Amount of Claim: $ 32,136.10 Interest at 6% per annum from date of discharge 9/26/01 Total 3,288.84 $35,424.94 ~~ Attorne; ~ (or -:;> Plaintiff(s) I assess damages .as ~ve (21A~~ /). . ~ Pro Prothonotary CJ "..'A JUNE 11, 2003 I,.~~ :::::?....................certil) that the above names are correct and the Precise Residence Address of the Judgment creditor is Address .......... .... ....... ...~.~m~......, .... ................._.... Address at ~",fehdants ....................s.n.me....................__...,.. ~o~~.c:P:R];~t::;~~~a:~~;; Defendant " JOSHUA NAVARRETE Ad~tm 11 E. SHADY LANE, ENOLA, PA 17025 THE MILTON S HERSHEY MEDICAL CENTER P.O. BOX 853 HERSHEY, PA 17033 VS COURT OF COMMON PLEAS APRIL TERM, 2003 JOSHUA NAVARRETE & JILL M. NAVARRETE, h/w 11 E. SHADY LANE ENOLA, PA 17025 NO. 03-1772 CIVIL TERM AFFIDAVIT OF NON MILITARY SERVICE COMMONWEALTH OF PA COUNTY OF PHILADEtPHIA ~ LEWIS C. TRAUFFER being legally sworn, deposes and says: (a) that the defendant(s) is/are not in the Military or Naval Service of the United States or of its allies, or otherwise within the provisions of the Soldiers' and Sailors' Civil relief action of Congress of 1940 as amended; (b) that defendant JOSHUA NAVARRETE is over 21 years of age and resides at 11 E. SHADY LANE, ENOLA, PA 17025 and is employed in Private Business. (c) that defendant JILL NAVARRETTE is over 21 years of age and resides at 11 SHADY LANE, ENOLA, PA 17025 and is employed in Private Business. Affiant has ascertained the foregoing information by inquiry and belief and makes this Affidavit with due authority. ~~ LEWIS C. T~FFER, ESQUIRE Attorney for the Plaintiff -----::, Sworn to and subsc!"~ed before me on thisQ3J day Of':}vN 'i' ~ C \l) . f Acsl~~ NOT Y PUBLIC NOTARIAL SEAL KENNETH C. SLOVITSKY, Notary Public City of Philadelphia, Phila. County My Commission Expiras Nov, 17, 2004 SHERIFF'S RETURN - REGULAR CASE NO: 2003-0177.. k COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND MILTON S HERSHEY MEDICAL CENTE VS ~AVARRETE JOSHUA.ET AL CPL. MICHAEL BARRICK , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon NAVARRETE JOSHUA the DEFENDANT , at 0933:00 HOURS, on the 30th day of April , 2003 at 11 E SHADY LANE ENOLA, PA 17025 by handing to JILL M. NAVARRETE, WIFE a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 18.00 10.35 .00 10.00 .00 38.35 So A.l"J.swers:, ;(:.?! .~JlC~~ffi.-:A' R. Thomas Kline day of ~~~~/~o"~agSEN ~. By: I ~ , , puty S Sworn and Subscribed to before me this A.D. Prothonotary SHERIFF'S RETURN - REGULAR CASE NO: 2003-0177:0 k COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND MILTON S HERSHEY MEDICAL CENTE VS NAVARRETE JOSHUA ET AL CPL. MICHAEL BARRICK , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE NAVARRETE JILL M was served upon the DEFENDANT , at 0933:00 HOURS, on the 30th day of April , 2003 at 11 E,SHADY LANE ENOLA, PA 17025 JILL M. NAVARRETE by handing to a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 6.00 ' .00 .00 10.00 .00 16.00 Sworn and Subscribed to before me this day of A.D. Prothonotary So Answers: _~r::.;?/,,t~rfr' .,.,. ,Jo" ,"".:.._."<,,::;.'-".,,,...,,~ .~..,~.A'~ 1- ""-..-.. ",;~..,"" . '."~~ -"'",<- R. Thomas Kline '-' ,.-- TABAS & ROSEN, P.C. BY, LEWIS C. TRAUIl'FBR, BSQUJ:RB ID No., 60267 1845 Walnut Street, 22nd Floor Philadelphia, PA 19103 (215)569-5050 THE MJ:LTON S. P.O. Box 853 Hershey, PA HERSHEY MEDICAL CENTER COURT OF COMMON PLEAS 17033 VS JOSHUA NAVARRETE & JILL M. NAVARRETE, 11 E. Shady Lane Enola, PA 17025 CUMBERLAND COUNTY h/w NO. 03-1772 Civil Term NOTICE OF INTENTION TO TAKE DEFAULT JUDGMENT TO: Joshua Navarrete 11 E. Shady Lane, Eno1a, PA 17025 DATE OF NOTICE/FECHA DEL AVISO, May 21, 2003 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO TAKE ACTION REQUIRED OF YOU IN THIS CASE. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICB TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY B~ ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717)249-3166 OR (800)990-9108 AVISO IMPORTANTE USTED ESTA EN REBELDIA PORQUE HA FALLADO EN TOMAR LA ACCION EXIGIDA DE SUP PARTE EN ESTE CASO. A MENOS DE QUE USTED ACTUE ENTRO DE DIEZ DE LA FECHA DE ESTE AVISO, SE PUEDE REGISTRAR UNA SENTENCIA CONTRA USTED SIN EL BBNEFICIO DE UNA AUDIENCIA Y PUEDE PERDER SU PROPIEDAD 0 DERECHOS IMPORTANTES. USTBD DEBE LLEVAR ESTE AVIOS A UN ABOGADO ENSEGUIDA. SI USTED NO TIENE UN ABOGADO Y NO PAGAR POR LOST SERVICIOS DE UN ABOGADO, DEBE COMUNlCARSE CON LA SIGUIENTE OFICINA PARA AVERlGUAR DONDE PUEDE OBTENER AYUDA LEGAL. CUMBERLAND COUNTY, B~ ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717)249-3166 OR (800)990-9108 LEWIS C. TRAUPFER, ESQUIRE ATTORNEY FOR THE PLAINTIFF THIS CORRESPONDENCE IS BEING USED TO COLLECT A DEBT AND THE INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. , , TAIlAS " ROSEN, P.C. BY: LEWIS C. TRAUFFBR, BSQUIRB ID No.: 60267 1845 Walnut Street, 22nd Floor Philadelphia, PA 19103 (215) 569-5050 THE MILTON S. P.O. Box 853 Hershey, PA HBRSHBY MEDICAL CENTBR COURT OF COMMON PLEAS 17033 VS JOSHUA NAVARRBTE " JILL M. NAVARRETE, 11 B. Shady Lane Enola, PA 17025 CUMBBRLAND COUNTY h/w NO. 03-1772 Civil Ter.m NOTICE OF INTENTION TO TAKE DBFAULT JUDGMENT TO. Jill Navarrete 11 E. Shady Lane, Enola, PA 17025 DATE OF NOTICE/FBCHA DEL AVISO, May 21, 2003 IMPORTANT NOTICB YOU ARE IN DBFAULT BECAUSE YOU HAVE FAILED TO TAKE ACTION RBQUIRED OF YOU IN THIS CASE. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE A JUDGMENT MAY BE ENTERBD AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE GO TO OR TBLEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717)249-3166 OR (800)990-9108 AVISO IMPORTANTE USTED ESTA EN REBELDIA PORQUE HA FALLADO EN TOMAR LA ACCION EXIGIDA DE SUP PARTE EN ESTE CASO. A MENOS DE QUE USTED ACTUE ENTRO DE DIEZ DE LA FECHA DE ESTE AVISO, SE PUEDE REGISTRAR UNA SENTENCIA CONTRA USTED SIN EL BENEFICIO DE UNA AUDIENCIA Y PUEDE PERDER SU PROPIEDAD 0 DERECHOS IMPORTANTES. USTED DEBE LLEVAR ESTE AVIOS A UN ABOGADO ENSEGUIDA. SI USTED NO TIENE UN ABOGADO Y NO PAGAR POR LOST SERVICIOS DE UN ABOGADO, DEBE COMUNICARSE CON LA SIGUIENTE OFICINA PARA AVERIGUAR DONDE PUEDE OBTEmR AYUDA LEGAL. CUMBERLAND COUNTY BAR A8S0CIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717)249-3166 OR (800)990-9108 LEWIS C. TRAUFFER, ESQUIRE ATTORNEY FOR THE PLAINTIFF THIS CORRESPONDENCE IS BEING USED TO COLLECT A DBBT AND THE INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. ~ n ~ () C) 0 (C) 01 ...a c f..) -n *- , :g;: '- 0 ;:Rh' '- ~( :;:: 0 '" 1"'-' ~ en?: Ci -- -- < (J) W ~ :tJ ~L.: _or ....,... f'- ~C:I . ~ p:: - '~!, ) ~ W :;:;c Cd ,--~ en N c: .j ~< -~ J> ftJ' ..-..J U't~ =< cO:> :0 ~(j' -< f-- r--- --<.. , TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER I.D. No. 60267 1845 Walnut Street, 22nd Fl. Philadelphia, PA 19103 (215) 569-5050 Attorney for Plaintiff MILTON S. HERSHEY MEDICAL CENTER THE PENNSYLVANIA STATE UNIVERSITY COURT OF COMMON PLEAS CUMBERLAND COUNTY VS JOSHUA NAVARRETE & JILL M. NAVARRETE, h/w NO. 03-1772 Civil Term P RAE C I P E TO THE PROTHONOTARY: Please void the judicial lien entered in the above matter as to JOSHUA NAVARRETE & JILL M. NAVARRETE according to bankruptcy rules. L:-;;S'~~~~IRE Attorney for Plaintiff Form BI8 (Official Form 18)(12103) United States Bankruptcy Court Middle District of Pennsylvania Case No. 1 :03-bk-07502-MDF Chapter 7 In re: Oebtor(s) (name(s) used by the debtor(s) in the last 6 years, including married, maiden, trade, and address): Joshua Navarrete Jill Meyers Navarrete 2117 Princeton Avenue 2117 Princeton Avenue Apt 2 Apt 2 Camp Hill, PA 17011 Camp Hill, PA 17011 Social Security No.: xxx-xx-1519 xxx-xx-9929 Employer's Tax 1.0. No,: DISCHARGE OF DEBTOR It appearing that the debtor is entitled to a discharge, IT IS ORDERED: The debtor is granted a discharge under section 727 of title II, United States Code, (the Bankruptcy Code). BY THE COURT Dated: 11/30/04 -ry~ JOa /lfM"vU- United States Bankruptcy Judge SEE THE BACK OF THIS ORDER FOR IMPORTANT INFORMATION. FORM B 18 continued (7197) EXPLANATION OF BANKRUPTCY DISCHARGE IN A CHAPTER 7 CASE This court order grants a discharge to the person named as the debtor. It is not a dismissal of the case and it does not determine how much money, if any, the trustee will pay to creditors. Collection of DischarO'ed Debts Prohibited The discharge prohibits any attempt to collect from the debtor a debt that has been discharged, For example, a creditor is not permitted to contact a debtor by mail, phone, or otherwise, to file or continue a lawsuit, to attach wages or other property, or to take any other action to collect a discharged debt from the debtor. [In a case involving community property:] [Thcre are also special rules that protect certain community property owned by the debtor's spouse, even if that spouse did not file a bankruptcy case.] A creditor who violates this order can be required to pay damages and attorney's fees to the debtor. However, a creditor may have the right to enforce a valid lien, such as a mortgage or security interest, against the debtor's property after the bankruptcy, if that lien was not avoided or eliminated in the bankruptcy case. Also, a debtor may voluntarily pay any debt that has been discharged. Debts That are Discharl!ed The chapter 7 discharge order eliminates a debtor's legal obligation to pay a debt that is discharged. Most, but not all, types of debts are discharged if the debt existed on the date the bankruptcy case was filed. (If this case was begun under a different chapter of the Bankruptcy Code and converted to chapter 7, the discharge applies to debts owed when the bankruptcy case was converted.) Debts that are Not Dischar~ed. Some of the common types of debts which are llQ1 discharged in a chapter 7 bankruptcy case are: a, Debts for most taxes; b. Debts that are in the nature of alimony, maintenance, or support; C. Debts for most student loans; d. Debts for most fines, penalties, forfeitures, or criminal restitution obligations; e. Debts for personal injuries or death caused by the debtor's operation of a motor vehicle while intoxicated; f. Somc debts which were not properly listed by the debtor; g. Dcbts that the bankruptcy court specifically has decided or will decide in this bankruptcy case arc not discharged; h. Debts for which the debtor has given up the discharge protections by signing a reaffirmation agreement in compliance with the Bankruptcy Code reqnircments for reaffirmation of debts. This information is only a general summary of the bankruptcy discharge. There are exceptions to these general rules. Because the law is complicated, you may want to consult an attorney to determine the cxact effect of the discharge in this ease. J 1 :03-bk-07502-MDF Joshua Navarrete and Jill Meyers Navarrete Case type: bk Chapter: 7 Asset: No Vol: v Judge: Mary D France Date filed: 1212212003 Date discharged: 11130/2004 Date terminated: 1210612004 Date of last filing: 1210812004 Creditors AMO RECOVERIES PO BOX 100038 KENNESAW, GA 30156 BLANCA NAVARRETE ROMERO 4031 MAJESTIC LANE APTE FAIRFAX, VA 22033 BUREAU OF ACCOUNT MGT PO BOX 8875 CAMP HILL, PA 17001-8875 CAPITAL ONE PO BOX 85015 RICHMOND, VA 23285 CENTRAL CREDIT CONTROL PO BOX 988 HARRISBURG,PA 17108 CHASE RECEIVABLES 1247 BROADWAY SONOMA, CA 95476 COMCAST 4008 N DUPONT HWY NEW CASTLE, DE 19720 COMMERCIAL RECOVERY SYSTEMS PO BOX 570909 DALLAS, TX 75357 CUMB COUNTY CLERK OF COURTS ONE COURTHOUSE SQUARE CARLISLE, P A 17013 CUMBERLAND COUNTY CONTROLLER ONE COURTHOUSE SQUARE CARLISLE, PA 17013 DEBT RECOVERY SOLUTIONS PO BOX 9001 WESTBURY, NY 11590 (cr) (cr) (cr) (cr) (cr) (cr) (cr) (cr) (cr) (cr) (cr) https:llecf.pamb.lIscourts.govlcgi-bin/CrcditorQry.pJ?855204933338271-L _168 _ 0-1 12/14104 DISTRICT DIRECTOR IRS ATTN: SPECIAL PROCEDURES (cr) PO BOX 12051 PHILADELPHIA, PA 19105 DIVERSIFIED CONSULTANTS, INC PO BOX 551268 (cr) JACKSONVILLE, FL 32255 DONALD C DONAGHER JR INC PO BOX 988 (cr) HARRISBURG, PA 17108 EAST PENNSBORO SCHOOL DISTRICT 890 V ALLEY ROAD (cr) ENOLA, P A 17025 EAST PENNSBORO TOWNSHIP 98 S ENOLA DR (cr) ENOLA, P A 17025 FEDERMAN AND PHELAN ONE PENN CENTER PLAZA (cr) SUITE 1400 PHILADELPHIA, PA 19103 FIRST FINANCIAL BANK PO BOX 1895 (cr) EL DORADO, AR 71731 FREYSINGER HYUNDAI 6115 CARLISLE PIKE (cr) MECHANICSBURG, P A 17055 GAIL GUIDA SOUDERS ESQ III LOCUST ST (cr) HARRISBURG, PA 17101 GC SERVICES L TD PARTNERSHIP PO BOX 2667 (cr) HOUSTON, TX 77252 HBCS 118 LUKENS DR (cr) NEW CASTLE, P A 19720 HOLY SPIRIT COMM MENT HEALTH 503 N 21ST ST ( cr) CAMP HILL. PA 17011 HOLY SPIRIT HOSPITAL 503 N 21ST ST (cr) CAMP HILL, PA 17011 https:l!ccf.pamb. uscoUl1s.govlcgi-binlCreditorQry.pl?855204933338271-L 168 0-1 12114104 HYUNDAI MOTOR FINANCE CO PO BOX 20809 (cr) FOUNTAIN VALLEY, CA 92728 IRS SPECIAL PROCEDURES BRANCH (cr) PO BOX 628 PITTSBURGH, PA 15230 JASMINE FIGUROA 136 LAUREL ST (cr) LANCASTER, PA 17601 JOSHUA AND JILL NAVARRETE 2117 PRINCETON AVE (cr) APT 2 CAMP HILL, PA 17011 MILTON S HERSHEY MED CTR PO BOX 853 (cr) HERSHEY,PA 17033 MRS ASSOCIATES, INC 3 EXECUTIVE CAMPUS (cr) SUITE 400 CHERRY HILL, NJ 08002 NATIONAL RECOVERY AGENCY PO BOX 67015 (cr) HARRISBURG,PA 17106 NEUROLOGICAL SURGERY LTD 920 CENTURY DR (cr) MECHANICS BURG, P A 17055 NORTH AMERICAN COLL AGENCY PO BOX 827 (cr) EDGEMONT, P A 19028 PALISADES COLLECTION LLC PO BOX 1244 (cr) ENGLEWOOD CLIFFS, NJ 07632 PENN CREDIT CORP PO BOX 988 (cr) HARRISBURG,PA 17108 PENNSYLV ANIA AMERICAN WATER PO BOX 578 (cr) ALTON, IL 62002 PHILIP C BRIGANTI ESQ 74 W POMFRET ST (cr) CARLISLE, PA 17013 https:llecf.pamb.uscourts.gov/cgi-binICreditorQry.p1?855204933338271-L 168 0-1 12/14104 PINNACLE HEALTH SYSTEMS PO BOX 2353 (cr) HARRlSBURG, PA 17105 POWELL, ROGERS and SPEAKS PO BOX 61107 (cr) HARRlSBURG, PA 17106 PPL ELECTRIC UTILITIES 827 HAUSMAN RD (cr) ALLENTOWN, PA 18104 PROVIDIAN NATIONAL BANK PO BOX 660763 (cr) DALLAS, TX 75266 PUBLISHERS AGENCY/DATA CENTER PO BOX 755 (cr) BRENTWOOD, CA 94513 QUANTUM IMAGING 2527 CRANBERRY HIGHWAY (cr) WAREHAM, MA 02571 SEARS PO BOX 182149 (cr) COLUMBUS, OHIO 43218 SERVICE OIL CO PO BOX 1677 (cr) HARRISBURG, PA 17105 SHEPHERDSTOWN FAMILY PRACTICE 2140 FISHER RD (cr) MECHANICSBURG, PA 17055 SHERMAN FINANCIAL GROUP 9700 BISSONET (cr) SUITE 2000 HOUSTON, TX 77036 SICO PO BOX 1677 (cr) HARRISBURG,PA 17105 SKY RECOVERY SERVICES LTD 12000 WESTHEIMER (cr) SUITE 233 HOUSTON, TX 77077 SPIRIT PHYSICIAN SERVICES 205 GRANDVIEW AVE (cr) SUITE 210 https:l/ecfpamb llscollrts.gov/cgi-bin/CreditorQry.pl?855204933338271_L ] 68 0-1 12/14/04 CAMPHILL,PA 17011 SPRINT PO BOX 96064 CHARLOTTE, NC 28296-0064 SURPASRESOURCECORP 3120 HAYES RD SUITE 200 HOUSTON, TX 77082 T-MOBILE PO BOX 742596 CINCINNATI, OHIO 45274 T ABAS AND ROSEN PC 1845 WALNUT ST 22ND FLOOR PHILADELPHIA, PA 19103 TELECHECK SERVICES INC PO BOX 17380 DENVER, CO 80217 UNIVERSAL FIDELITY CORP PO BOX 941911 HOUSTON, TX 77094 VERIZON PO BOX 28000 LEHIGH V ALEY, P A 18002 WASHINGTON MUTUAL FINANCE 9-A NORTH PROGRESS AVE HARRISBURG, PA 17109 WFNNB PO BOX 182274 COLUMBUS, OH 43218 WOLPOFF and ABRAMSON, LLP TWO IRVINGTON CENTRE 702 KING FARM BLVD ROCKVILLE, MD 20850 (cr) (cr) (cr) (cr) (cr) (cr) (cr) (cr) (cr) (cr) ~,m~m_m"=m..==~,_r~'__'='_'____mm=",.=~'=="_____'~-~'-'m~=~--",_~_~_~"",~,"~,,~_~_~,",~_'~'__-'--m~=.,~._m_""==~=~-'_r=__mr~__",_m_"_'____=._'_~"__=_ PACER Service Center Transaction Receipt 12/t4/200407:53:38 !tr0070 IICHent Code: 11195675 Jcreditor Ilsearch II t :03,bk-07502-MDF PACER Login: Description: https:llecf.pamb,uscourts.govlcgi-binICreditorQry.p1 785 520493 3 3 3 8271- L _168 __ 0-1 121] 4104 .-~ ) :'-'i"\ -_J ',t ';"'r' --r: - . 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