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Created: IOJ04/0001:S4:03PM
t Revised: 03/07/0103:25:13PM
7550.63
CHAD ULRICH, a minor, D.O.B. 10/17/90 :
and CHELSEA ULRICH, a minor, D.O.B.
8/12/94 by their Legal Guardian, KEITH
ULRICH
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
v.
NO. 2001- /30(, ~ I~
CIVIL ACTION-LAW
LARUEEN WELLS ULRICH
Defendant
JURY TRIAL DEMANDED
ORDER
AND NOW, this I t"'::y of J(AIltH
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CHAD ULRICH, a minor, D.O.B. 10/17/90,:
and CHELSEA ULRICH, a minor, D,O.B.
8/12/94, by their Legal Guardian, KEITH
ULRICH
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
v.
NO. 2001- 1%(. ~ Tt.v-
CNIL ACTION-LAW
LARUEEN WELLS ULRICH
Defendant
JURY TRIAL DEMANDED
ORDER
AND NOW, this_day of
, _, upon consideration of the foregoing
Petition for Approval of Minors' Settlement, Defendant is ordered to pay all claims in the amounts
as set forth in the Petition. $800.00 of said funds shall be deposited in a federally insured account
for minor, Chelsea Uhich, and shall not be removed until minor, Chelsea Ulrich, reaches age 18 or
upon further order of this Court, which shall retain continuing jurisdiction. $15,000.00 shall be
placed in a structured settlement as set forth in the Petition for minor, Chad Ulrich. Plaintiffs are
authorized to execute a General Release to settle all claims as set forth above.
BY THE COURT,
, J.
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CHAD ULRICH, a minor, D.O.B. 10/17/90, :
and CHELSEA ULRICH, a minor, D.O.B.
8/12/94, by their Legal Guardian, KEITH
ULRICH
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
v.
NO. 2001- /30l. ~ T L<--
CIVIL ACTION-LAW
LARUEEN WELLS ULRICH
Defendant
JURY TRIAL DEMANDED
PETITION FOR APPROVAL OF MINORS' SETTLEMENT
1.
8/12/94.
Minor Plaintiffs are Chad Ulrich, D.O.B. 10/17/90 and Chelsea Ulrich, D.O.B.
2. Plaintiff, Keith Ulrich, is the minor Plaintiffs' father and Legal Guardian, who resides
with them at 25 Regency Woods North, Carli$le, PA 17013.
3. On or about August 10, 1996"Defendant, Laureen Wells Ulrich, was traveling on
Sunnyside Drive at its intersection withRt. 944 in Middlesex Township, Cumberland County, when
an accident occurred. Minor Plaintiffs were passengers in her car.
4. As a result ofthe accident, the )llinor Plaintiffs sustained personal injuries and were
transported to the Emergency Room at Hershey Medical Center. Minor Plaintiff, Chelsea Ulrich,
suffered a cut on her mouth, a bruise on her c\J.eek and a scrape of her foot. Minor Plaintiff, Chad
Ulrich, suffered a black and bruised eye, a cut over the right eye, requiring 7 stitches and a cut on
top of his head, requiring 30 stitches. The minor Plaintiffs were covered by a policy of motor
vehicle insurance with State Auto Insurance Company which has paid all of the medical expenses
associated with the treatment and care of the minor Plaintiffs.
5. The parties desire to obtain Court approval of a settlement for the minor Plaintiffs,
and their father and legal guardian, Keith Ulri<!:h, has agreed to accept $15,800.00 in the settlement.
6. Said settlement of$15,800.00shall be paid as follows:
(a) $800.00 for minor Plaintiff, Chelsea Ulrich, to be deposited in a federally
insured account; and
(b) $15,000.00 to be placed into a structured settlement with Safeco Insurance
Company, which will pay minor Plaintiff, Chad Ulrich, or his estate, on
October 17, 2011, the amount of$30,6l9.00,
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WHEREFORE, Plaintiffs request that this Honorable Court schedule a hearing to consider
approval of the Minors' Compromise.
MARTS ON DEARDORFF WILLIAMS & OTTO
By ~ f)~ Q..J1h
Daniel K Deardorff, Esquire
LD, No. 17837
Ten East High Street
Carlisle, PA 17013-3093
(717) 243-3341
Attorneys for Defendant
Date: March 7 I 2001
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CHAD ULRICH, a minor, D,O.B. 10/17/90 :
and CHELSEA ULRICH, a minor, D.O.B.
8/12/94 by their Legal Guardian, KEITH
ULRICH
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
v,
NO. 200~-
CIVIL ACTION-LAW
LARUEEN WELLS ULRICH
Defendant
JURY TRIAL DEMANDED
CONSENT OF PETITIONER AND LEGAL GUARDIAN
The undersigned, Keith Ulrich, Plaintiff, in the above captioned action and father of Chad
Ulrich and Chelsea Ulrich, has read the foregoing Petition for Approval of Minor' s Settlement, and
has reviewed the terms of said Petition and settlement and hereby consents to the Petition and agrees
to said settlement.
;:f1u-/J 7.-L!
Keith Ulrich
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VERIFICATION
The foregoing Petition for Approval of Minors ' Settlement is based upon information which
has been gathered by counsel in the preparation of the lawsuit. The language of the document is that
of counsel and not my own, I have read the document and to the extent that it is based upon
information which I have given to counsel, it is true and correct to the best of my knowledge,
information and belief. To the extent that the content of the document is that of counsel, I have
relied upon counsel in making this verification.
This statement and verification are made subject to the penalties of 18 Pa. C.S. Section 4904
relating to unsworn falsification to authorities, which provides that if I make knowingly false
averments, I may be subject to criminal penalties.
~d jJ -dJ,
Keith Ulrich, Parent and Legal Guardian
of Chad Ulrich and Chelsea Ulrich,
Minor Plaintiffs
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CERTIFICATE OF SERVICE
I, Tricia D. Eckenroad, an authorized agent for Martson Deardorff Williams & Otto, hereby
certify that a copy of the foregoing Petition was served this date by depositing same in the Post
Office at Carlisle, P A, first class mail, postage prepaid, addressed as follows:
Mr. Keith Ulrich
25 Regency Woods North
Carlisle, P A 17013
MARTS ON DEARDORFF WILLIAMS & OTTO
ricia D. Eckenroad
East High Street
Carlisle, PA 17013
(717) 243-3341
Dated: March 7,2001
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EPS SETTLEMENTS GROUP
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DEC-11-2000 10:08
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513 389 6300
SETTLE~NT PROPOSAL
For
<t;had Ulrich
Date orBi~th: October 17,1990
These Quotes are ~alid Until December 21, 2000
Proposall
Guaranteed Lomn Sum
$30,619 guaranteed lllD1p sum payable at agei2J
(on October 17, 2011).
TOTAL
Proposal 2
Guaranteed LUllJp Sums
$10,000 guaranteed lump sum payable at age 18
(on October 17, 2008). .
$17,886 guaranteed lump sum payable at age 2i
(on October 17,2011). !
TOTAL
Guarauteed
BenefIt
$30,619
530,619
Guaranteed
Benefit
$10,000
$17,886
$27,886
These ql10tes are from SAFECO Life InsurllD~e Company, rated A+ by the A.M. Best Company.
Tbeir assignee is SAFECO ""'signed Beneilts $erviee COJDpany.
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, PERSONAL INJURY PROTECTION PAYMENT SCHEDULE \~
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P, i: P. Cloimonl Chad Ulrich I nsured Keeth P. " Laureen Wells Ulri.ch
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",:-r,,~?> 9-35 '7t. SILVER SPRING AMB & RES ASSN D/S: I 8 9 96 180 .00 1,268 6~
/,7"'11 Jq(~ q.,,-i5-'1k HERSHEY MED CTR/DIV OF DIAG RADI LOGY D/S: 8 9 96 160 .00 1,428 6c
: I 1/ "qq Cj _...;;; 410 MILTON S HERSHEY MEDICAL CTR D/S: 8 9,10 96 4,498 35 5,926 9t
Ai-r-;,<l<::c '1-riS''1", MILTON S HERSHEY MEDICAL CTR D/S: - 8 9 96 2,327 00 8,253 91
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PERSONAL INJURY PROTECTION PAYMENT SCHEDULE
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Insured Keith P. & Laureen Wells Ulrich
I WAGE 5 AN D
Claim No. 10 PAP 5 187 621 10
5 E R'Y ICE 51 O/L: 8-9-96 Adj. lf602
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F:\FILES\DATAFILE\STA TE,DOC\65-ord.lIajt
Created: 06/26/01 04,51:35 PM
Revised: 06/27/01 08:30-19 AM
1550.65
,
CHAD ULRICH, a minor, D.O.B. 10/17/90,
and CHELSEA ULRICH, a minor, D.O.B.
8/12/94, by their Legal Guardian, KEITH
ULRICH
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
v.
: NO. 2000-1306
: CIVIL ACTION-LAW
LARUEEN WELLS ULRICH
Defendant
: JURY TRIAL DEMANDED
ORDER
AND NOW, this "J.,.J. day of :r ~ ' J.co/, upon consideration ofthe foregoing Petition
for Approval of Minors , Settlement and Stipulation thereto and after hearing on April 11, 2001, Defendant
is ordered to pay all claims in the amounts as follows: $800,00 of said funds shall be deposited in a federally
insured bank account for minor, Chelsea Ulrich, and shall not be removed until minor, Chelsea Ulrich, reaches
age 18 or upon further order of this Court, which shall retain continuing jurisdiction. $15,000.00 shall be
placed in a certificate of deposit in a federally insured bank and shall not be removed until minor, Chad Ulrich
reaches age 18 or upon further order of this Court. Proof of deposits are to be filed with the Court, Plaintiffs
are authorized to execute a General Release to settle all claims as set forth above.
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F:\FILES\DATAFILE\STA TE.DOa65-sti.1fajl
Created: 06/26101 04;51:35 PM
Revised: 06127/01 08:40'33 AM
7550.65
CHAD ULRICH, a minor, D.O,B. 10/17/90,
and CHELSEA ULRICH, a minor, D.O.B.
8/12/94, by their Legal Guardian, KEITH
ULRICH
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
v.
: NO. 2000-1306
: CNILACTION-LAW
LARUEEN WELLS ULRICH
Defendant
: JURY TRIAL DEMANDED
STIPULATION OF THE PARTIES
1.
13, 2001.
2.
A Petition for Approval of Minors' Settlement was filed in the above captioned case on March
A copy is attached hereto as Exhibit "A".
On April 11, 2001, a hearing was held at which time the Plaintiffs were present and the
proposed settlement was discussed.
3. The hearing was continued by the court to give the parties the opportunity to present a
stipulation.
4. Plaintiffs now request the settlement for the minor Plaintiffs to be in cash: $800.00 for Chelsea
Ulrich and $15,000.00 for Chad Ulrich instead ofa structured settlement.
5, Defendant is agreeable to amend the Petition for a cash payout rather than a structured
settlement.
6. Plaintiffs will deposit their settlement funds into a federally insured account in the Bank of
Landisburg, Shermansdale, Pennsylvania. The deposit for Chad Ulrich will be into a Certificate of Deposit.
7. The parties request the Court to enter an Order approving the Minors' Settlement pursuant to
the above terms.
;G!dfJdJ
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Daniel K. Deardorff, Esquire ~
Attorney for Defendant
Keith Ulrich, Parent and Legal Guardian
of Chelsea and Chad Ulrich
Date~
Date~{
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COMMONWEALTH OF PENNSYLVANIA )
): ss.
COUNTY OF CUMBERLAND
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11--
On this ~ i day of ::r "r --ve.. , 2001, before me, the undersigned officer, personally appeared
Keith Ulrich, Parent and Legal Guardian of Chad and Chelsea Ulrich, known to me (or satisfactorily proven)
to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed
the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
<]jOJJJCU(l 5. 6J~AL)
NOTARIAL SEAL
BARBARA S. WILDAY, Notary Public
"Carlisle Boro., Cumberland County
Mv Commission Exnires Feb. 18, 2002
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CHAD ULRICH, a minor, D.O.B. 10/17/90, :
and CHELSEA ULRICH, a minor, D.O.B.
8/12/94, by their Legal Guardian, KEITH
ULRICH
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
Plaintiffs
v.
NO.2001- (JOf,
CIVIL ACTION-LAW
LARUEEN WELLS ULRICH
Defendant
JURY TRIAL DEMANDED
1.
8/12/94.
PETITION FOR APPRO~ OF MINORS' SETTLEMENT
Minor Plaintiffs are Chad U~Ch, D.O.B. 10/17/90 and Chelsea Ulrich, D.O.B,
!
2. Plaintiff, Keith Ulrich, is the inor Plaintiffs' father and Legal Guardian, who resides
with them at 25 Regency Woods North, Carl'sle, PA 17013.
3. On or about August 10, 1996 Defendant, Laureen Wells Ulrich, was traveling on
Sunnyside Drive at its intersection with Rt. 9 4 in Middlesex Township, Cumberland County, when
an accident occurred. Minor Plaintiffs were assengers in her car.
4. As a result of the accident, th minor Plaintiffs sustained personal injuries and were
transported to the Emergency Room at Hers ey Medical Center. Minor Plaintiff, Chelsea Ulrich,
suffered a cut on her mouth, a bruise on her heek and a scrape of her foot. Minor Plaintiff, Chad
Ulrich, suffered a black and bruised eye, act over the right eye, requiring 7 stitches and a cut on
top of his head, requiring 30 stitches. The minor Plaintiffs were covered by a policy of motor
vehicle insurance with State Auto Insurance ompany which has paid all of the medical expenses
associated with the treatment and care of the minor Plaintiffs.
5. The parties desire to obtain C urt approval of a settlement for the minor Plaintiffs,
and their father and legal guardian, Keith VI ch, has agreed to accept $15,800.00 in the settlement.
6. Said settlement of$15,800.0 shall be paid as follows:
(a) $800.00 for minor PI intiff, Chelsea Ulrich, to be deposited in a federally
(b)
insured account; and I
$15,000.00 to be Plact' d into a structured settlement with Safeco Insurance
Company, which wil pay minor Plaintiff, Chad Ulrich, or his estate, on
I
October 17, 2011, the I amount of$30,619.00.
!
EXHIBIT
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WHEREFORE, Plaintiffs request that this Honorable Court schedule a hearing to consider
approval of the Minors' Compromise.
MARTSON DEARDORFF WILLIAMS & OTTO
By '9- ~Cr. U1h
Daniel K Deardorff, Esquire
I.D. No. 17837
Ten East High Street
Carlisle, PA 17013-3093
(717) 243-3341
Attorneys for Defendant
Date: March 7 I 2001
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CHAD ULRICH, a minor, D.O.B. 10/17/90 :
and CHELSEA ULRICH, a minor, D.O.B.
8/12/94 by their Legal Guardian, KEITH
ULRICH
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
NO. 200~- I ~o~
CIVIL ACTION-LAW
v.
LARUEEN WELLS ULRICH
Defendant
JURY TRIAL DEMANDED
CONSENT OF PETITIONER AND LEGAL GUARDIAN
The undersigned, Keith Ulrich, Plaintiff, in the above captioned action and father of Chad
Ulrich and Chelsea Ulrich, has read the foregoing Petition for Approval of Minor' s Settlement, and
has reviewed the terms of said Petition and settlement and hereby consents to the Petition and agrees
to said settlement.
;t;//-/J ~1J
Keith Ulrich
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VERIFICATION
The foregoing Petition for Approval of Minors ' Settlement is based upon information which
has been gathered by counsel in the preparation of the lawsuit. The language of the document is that
of counsel and not my own. I have read the document and to the extent that it is based upon
information which I have given to counsel, it is true and correct to the best of my knowledge,
information and belief. To the extent that the content of the document is that of counsel, I have
relied upon counsel in making this verification.
This statement and verification are made subject to the penalties of18 Pa. C.S. Section 4904
relating to unsworn falsification to authorities, which provides that if I make knowingly false
averments, I may be subject to criminal penalties.
~d fJ -dJ
Keith Ulrich, Parent and Legal Guardian
of Chad Ulrich and Chelsea Ulrich,
Minor Plaintiffs
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CHAD ULRICH, a minor, D.O.B.
10/17/90 and CHELSEA ULRICH,
a minor, D.O.B. 8/12/94 by
their Legal Guardian,
KEITH ULRICH,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
NO. 2001-1306 CIVIL TERM
v.
LARUE EN WELLS ULRICH,
Defendant
CIVIL ACTION - LAW
IN RE: PETITION TO APPROVE MINOR'S COMPROMISE
ORDER OF COURT
AND NOW, this 11th day of April, 2001, after
conference with counsel and petitioner in connection with the
petition to approve a minor's compromise, this matter is
continued to give the parties the opportunity to present a
stipulation to the Court with proposed order for signature.
By the Court,
Keith Ulricb
25 Regency Woods North
Carlisle, PA 17013
Plaintiff, Pro se
. ~\
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Edward E. Guido, J.
Daniel K. Deardorff, Esquire
Attorney fo~ Defendant
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Created: IO/04/0001:54:03PM
Revised: 08f,02l0104:33:CllPM
7550.65
CHAD ULRICH, a minor, D.O.B. 10/17/90 :
and CHELSEA ULRICH, a minor, D.O.B.
8/12/94 by their Legal Guardian, KEITH
ULRICH
Plaintiffs
v.
LARUEEN WELLS ULRICH
Defendant
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2000-/30<..
CIVIL ACTION-LAW
JURY TRIAL DEMANDED
PRAECIPE
TO: THE CUMBERLAND COUNTY PROTHONOTARY:
We file herewith the proof of deposits as required by the Order of Court dated July 2, 2001.
Said proofs of deposits are attached hereto.
Date: August 2,2001
MARTS ON DEARDORFF WILLIAMS & OTTO
By QJ ~-
Daniel K. Deardorff, Esquire
l.D. No. 17837
Ten East High Street
Carlisle, P A 17013-3093
(717) 243-3341
Attorneys for Petitioner
CERTIFICATE OF DEPOSIT ;1lF?~
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GEUT NAME AND NUMBER NATURE OF PAYMENT
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KEITH ULRICH HER FATHER
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CERTIFICATE OF SERVICE
I, Ami 1. Thumma, an authorized agent for Martson Deardorff Williams & Otto, hereby
certify that a copy of the foregoing Praecipe was served this date by depositing same in the Post
Office at Carlisle, P A, first class mail, postage prepaid, addressed as follows:
Mr. Keith Ulrich
25 Regency Woods North
Carlisle, PA 17013
MARTS ON DEARDORFF WILLIAMS & OTTO
By ~~~~~
Ami 1. Th a
Ten East Rig Street
Carlisle, PA 17013
(717) 243-3341
Dated: August 2, 2001
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