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William p, Douglas, Esq.
Supreme Court ID. #37926
Douglas, Douglas & Douglas
27 W, High St.
Carlisle, P A 17013
Telephone (717) 243-1790
.....Teoiiar(rA:..Ro.sa;..Sr::..as.l~xec.ufor..ofth.e......T................iii.lhe..C.o.uifo(Commoii..pIeas.or.............l
Estate of Mollie M. Rosa, deceased; and i Cumberland County Pennsylvania i
Leonard A. Rosa, Sr., Individually ! !
Plaintiff! '
vs
. Hill Shopping Center and Dollar General Store,
Inc.
2000-~~
Civil Term
'Defendants !"'"
Petition for Settlement Approval
Civil Action Law
~.......................................................................................................................................................................................................................,
Praecipe to Issue a Writ of Summons
To: Curtis R. Long, Prothonotary
Dear Mr. Long:
Please issue a writ of summons against Hill Shopping Center
and Dollar General Store, Inc. at 2 Springs A venue, Gettysburg,
Adams County, Pennsylvania.
William P. Dougla Esq.
Attorney for Petit ner
December 27, 2000
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Commonwealth of Pennsylvania
County of Cumberland
'......Tsonard..;.::..Ro.sa;..Sr:;..as...Executor..of!h.s......r...............iri"ths..Couifof'Commoii..p"lsas.o(..............l
Estate of Mollie M. Rosa, deceased; and: Cumberland County Pennsylvania
Leonard A. Rosa, Sr., Individually I
Plaintilt!
vs
2000 - &150~
Civil Term
Hill Shopping Center and Dollar General Store,
Inc.
....,.............................................................................~~.f:~.~.~~:~..1..................~~~~.~~~~.g0!.~A.~~[~.~.~.~~;.~~~.~~:~....,.............
Writ of Summons
To: Dollar General Store, Inc.
2 Springs Avenue
Gettysburg, P A
You are hereby notified that Leonard A. Rosa, Sr.,
as Executor of the Estate of Mollie M. Rosa, deceased; and
Leonard A. Rosa, Sr., Individually, has brought an action
against you.
-tlHU/1 4f'~h~
. ... Deputy Pr th. . otary
December 27, 2000
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Commonwealth of Pennsylvania
County of Cumberland
""Teonarifi\:"Rii'sa:"Sr:';'as"E.xecuio'i"iif!h'e""""T""'''nnmniri"the"cii'liifiifCommoiin'P'feas"of,,"".""nm,
Estate of Mollie M, Rosa, deceased; and : Cumberland County Pennsylvania
Leonard A, Rosa, Sr" Individually !
Plaintiff!
vs
2000 - f:jCO 8'
Civil Term
Hill Shopping Center and Dollar General Store,
Inc,
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Writ of Summons
To: Hill Shopping Center
2 Springs Avenue
Gettysburg, P A
You are hereby notified that Leonard A, Rosa, Sr.,
as Executor of the Estate of Mollie M, Rosa, deceased; and
Leonard A. Rosa, Sr., Individually, has brought an action
against you,
-if-~ t/JX~
f Deputy P 0 onotary
December 27, 2000
TRUE COpy FROM RECORD .
1ft TestinIony wl!8f1Of. I here unto_ my h8I14'
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[Teoii8:ia.A:...Ros'ii;..Sr:;as"Execuior..ofihe..Esi8:te'..............Tii.ihe..Coiirto(C.o.mmo.ii..pieas..of"......................
i of Mollie M. Rosa, deceased; and Leonard A. Cumberland County Pennsylvania
Rosa, Sr., Individually
Plaintiff
vs
2000 - ~C~ Civil Term
Hill Shopping Center and Dollar General Corp.
Defendants
Petition for Settlement Approval
..........""".,..,.........mmm^m................."mmmm.giyiL~.~!i9.~....~<:ly.rm
Order of Court
AND NOW, this 27th day of December, 2000, in consideration if the attached
petition, the proposed settlement of $170,000.00 is hereby approved, and the
following distribution is permitted:
Leonard A. Rosa, Sr., Executor
$41,566.46
$1,657.92
Leonard A. Rosa, Sr.
(63% return of costs advanced)
Douglas, Douglas & Douglas
Joseph A. Cutro, Esq.
Medicare Parts A and B
$37,777.77
$18,888.88
$70,108.97
By the Court,
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William P. Douglas, Esq,
Supreme Court LD.#37926
Douglas, Douglas & Douglas
27 W. High St.
POB 261
Carlisle Pa 17013
Telephone 717-243-1790
rCeonilia.A:...Rosa;...si:.;..asExecuior..offhe..Esiilie..........................Tn.Ihe..CourfofCoiiimonPieas'6(mmmmm..
i of Mollie M. Rosa, deceased; and Leonard A. Cumberland County Pennsylvania
, Rosa, Sr., Individually
Plaintiff
vs
Hill Shopping Center and Dollar General Store, I
Inc. I
Defendants I
2000 - -=t''501:.
Civil Term
L.......................................................................................
Petition for Settlement Approval
Civil Action Law
Petition for Approval of Compromise Settlement
and Proposed Distribution
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TO THE HONORABLE, THE JUDGES OF SAID COURT:
1. Your petitioner, Leonard A. Rosa, Sr., is an adult individual residing at
981 Ridge Road, Gettysburg, Pennsylvania.
2. Leonard A. Rosa, Sr. was married to Mollie M. Rosa at the time of her
death and had three children. Their names are Leonard A. Rosa, Jr.,
Lenore Rosa Egan and Robert Rosa. All of the aforesaid individuals are
emancipated adults.
3. On October 5, 1999, Mollie M. Rosa died testate.
4. On August 15, 1999, Mollie M. Rosa tripped and fell in a newly paved
parking lot in Gettysburg, Adams County, Pennsylvania which was under
the care custody and control of the defendants.
5. As a result of the fall she suffered a fractured hip which required medical
treatment and surgical intervention.
6. The St. Paul Insurance Company has agreed to pay $170,000.00 to settle all
claims which may be presented by or on behalf of Leonard A. Rosa, Sr.,
individually and as executor of the estate of Mollie M. Rosa and/or Mollie
M. Rosa as the result of the injuries she sustained in her fall.
7. On October 26,1999, Leonard A. Rosa, Sr. was appointed as Executor of
the Estate of Mollie M. Rosa by the Register of Wills of Adams County
Pennsylvania.
8. Leonard A. Rosa, Sr., individually and as executor has agreed upon a
contingent fee of 33-1/3% of any recovery in this matter.
9. Prior to her death Molly Rosa incurred medical expenses which were paid
by Medicare parts A and B. Medicare has asserted a lien which is
contested by the petitioner. The total lien asserted by Medicare for Parts A
and B is in the amount of $107,650.34.
10. Total legal fees in this matter are in the amount of 56,666.66, legal fees to
pursue the Medicare lien are in the amount of $35,883.44. Total expenses
incurred to pursue this claim are in the amount of $2,631.62. Medicare
Parts A and B are responsible for 63% of aforesaid costs in the amount of
$1,657.92.
11. Your petitioner, Leonard A. Rosa, Sr. individually and as the executor of
the estate of Mollie M. Rosa, requests that the following distribution be
approved to the Estate of Mollie M. Rosa for the injuries suffered by her
prior to her death;
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Leonard A. Rosa, Sr., Executor $41,566.46
Leonard A. Rosa, Sr. $1,657.92
(63% return of costs advanced)
Douglas, Douglas & Douglas $37,777.77
Joseph A. Cutre, Esq. $18,888.88
Medicare Parts A and B $70,108.97
WHEREFORE, it is prayed that the aforesaid settlement of $170,000.00 and the
proposed distribution be approved.
DOUGLAS, DOUGLAS & DOUGLAS
By
William P. Douglas, Es
Attorney for the petitio
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Affidavit
Leonard A. Rosa, Sr. swears and affirms that the averments of the within petition
are true and correct, to the best of his knowledge, information, and belief.
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Leonard A. Rosa, Sr.
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William P. Douglas, Esq.
Supreme Court 1.0, #37926
Douglas, Douglas & Douglas
27 W. High St.
Carlisle, P A 17013
Teleplume (717) 243-1790
[TeonaiiL(.Rosa;.sr:;"iis"l~xecuio;:-oniis"Estiite.T".."............iil.tiis..cou.ifofcommoii..i5ieas.or..............j
1 of Mollie M. Rosa, deceased; and Leonard A. 1 Cumberland County Pennsylvania 1
, Rosa, Sr., Individually ,
I ~ P~'I
I Hill Shopping Center and Dollar General Store, !
I Inc. I
! Defendants! Petition for Settlement Approval
! ! Civil Action Law .
~........................................................................................................................................................................................................................~
2000 - <tg06
Civil Term
Praecipe to Mark Docket Settled and Discontinued
To: Curtis R. Long, Prothonotary
Dear Mr. Long:
Please mark the above-captioned matter settled and discontinued.
William P. Douglas sq.
Attorney for Plain .ffs
Date: December 27, 2000
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