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HomeMy WebLinkAbout99-03855 ti `; F IFILr3\UATtFIL[\GCNDOCWw155-PRA IVm Oaa1N (W.'4199110155 AAI R.11.d W241W 1::1:5 PM 9133 1 ERIC LEMAY and KRISTY LEMAY, IN THE COURT OF COMMON PLEAS OF Individually and as Parents and Natural CUMBERLAND COUNTY, PENNSYLVANIA Guardians of JACOB W. LEMAY, a Minor Plaintiffs NO. 1999 -3rSS Leuu V. CIVIL ACTION - LAW BRIAN L. YEAGY and AMY M. YEAGY, Defendants TO THE CUMBERLAND COUNTY PROTHONOTARY: Please issue a writ of summons against Brian L. Yeagy and Amy M. Yeagy, 996 Roxbury Road, Shippensburg, PA , as Defendants in the above-captioned action and return same to the undersigned for service. MARTSON DEARDORFF WILLIAMS & OTTO By X5 G orge B. Faller, Jr., Es i e I.D. No. 49813 Ten East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Plaintiffs Dated: June 24, 1999 C\j a Commonwealth of Pennsylvania County of Cumberland Eric Lemay and Kristy Lemay, Individually and as Parents and Natural Guardians of Jacob W. Lemay, a Minor Court of Common Pleas K Brian L. Yeagy and Amy M. Yeagy No - ----- 49rM5_Livi ----------------- 19---- 996 Roxbury Road Shippensburg, PA In atvalictim-=-.Law ------------------ To __ kiA?I_L.Yeaw-And- Am-M, -yeW__ You are hereby notified that --- -----Eric - Lemay and Kristy Lemay, Individually-and as_P_a_r_e_n_t_s_and- Natural _ -- Guardians of Jacob W. Lemay, a Minor --- the Plaintiffs havecommenced an action in ------ Civil. _BC_ti,on_=_LaK against you which you are required to defend or a default judgment may be entered against you. (SEAL) /s/-Curtis Long ---------R.- ----------- -------------------- Ptothonotary Date -___ JUOQ .z4----------------- 19_49_ By ---11LC DeputttS''rrtcL4-Ey? s .1 Uri LO N co rn ON. A I"p 11 G '9 >1 N 41 •i N A i $ tf1 W N Ul O ? j 1 ; 14 a' Ul I', O 'i rl H 1, O W ' O 1 W co M 4 7+ N N ; ttl G . S •.i N V ' 1 L I ro a a I p Cd WH r.4 C y ? .14 ; C A W w J N a O w 0 4 L a • F.\FILESDATAFILEIGENWC99\9133,ACC. 1t1. CM41W M28M 0241 WPM Revkld. W29/9009.35.09AM 91!1.1 ERIC LEMAY and KRISTY LEMAY, : IN THE COURT OF COMMON PLEAS OF Individually and as Parents and Natural : CUMBERLAND COUNTY, PENNSYLVANIA Guardians of JACOB W. LEMAY, a Minor : Plaintiffs NO. 99-3855 CIVIL V. CIVIL ACTION - LAW BRIAN L. YEAGY and AMY M. YEAGY, Defendants AC FPTANCFIE RV-1CE I, John N. Keller, Esquire, accept service of the Writ of Summons on behalf of Defendants and certify that I am authorized to do so in accordance with Pa. R.C.P. 402. KELLER, KELLER & FREY By M N. Kellett Esquire Walnut Street Waynesboro, PA 17268-1646 1??-2557 Attorneys for Defendants Dated: ??/j of /f IT C".W ULLIrva 11133 SI 1'M X<vi,N IIA 141.1111 l 33A I'M CEICH ICAl -01_ -S1 RVIS_F. 1, Tricia D. Eckenroad, an authorized agent for Martson Deardorff Williams & Otto, hereby certify that a copy of the foregoing Acceptance of Service was served this date by depositing same in the Post Office at Carlisle, PA, first class mail, postage prepaid, addressed as follows: John N. Keller, Esquire KELLER, KELLER & FREY 100 Walnut Street Waynesboro, PA 17268-1646 MARTSON DEARDORFF WILLIAMS & OTTO ?BY Y O Tricia D. Eckenroad ?i East High Street Carlisle, PA 17013 (717) 243-3341 Dated: July 14, 1999 cl' in - u' u- U m IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Eric Lemay and Kristy Lemay, individually and as Parents and Natural Guardians of Jacob W. Lemay, a minor, Plaintiffs Vs. Brian L. Yeagy and Amy M. Yeagy, Defendants TO THE PROTHONOTARY: Civil Action - Law No. 99-3855-Civil PRAECIPE Please enter our appearance for the Defendants. KELLER, KELLER AND FREY By Jo a. Keller Pa. Supreme Ct. I.D. #25577 100 Walnut Street Waynesboro, PA 17268 (717) 762-3331 ? C .1 Cl cn i a? ?J FIFIUSUATAPI LE161 wP?nnlJJ.lwl r.lu FmIDN 210Xi991U0120AM Nova) 011ftW034e 3UP.11 9111 1 ERIC LEMAY and KRISTY LEMAY, IN THE COURT OF COMMON PLEAS OF Individually and as Parents and Natural CUMBERLAND COUNTY, PENNSYLVANIA Guardians of JACOB W. LEMAY, a Minor Petitioners NO. 1999-3855 CIVIL V. CIVIL ACTION - LAW ERIE INSURANCE GROUP, BRIAN L. YEAGY and AMY M. YEAGY, Respondents ORDER OF COURT AND NOW, this 7i day of January, 2000, a hearing is set to consider the Petition to Approve Minor's Compromise. The hearing will be held before the Honorable Edward E. Guido on !t/ed.. ?/PJ1( 9 2000. Qp BY THE R , RKS r> pENNS (LVAN!A emilV ERIC LEMAY and KRISTY LEMAY, IN THE COURT OF COMMON PLEAS OF Individually and as Parents and Natural CUMBERLAND COUNTY, PENNSYLVANIA Guardians of JACOB W. LEMAY, a Minor Petitioner NO. 1999 - 3855 CIVIL V. CIVIL ACTION - LAW ERIE INSURANCE GROUP, BRIAN L. YEAGY and AMY M. YEAGY, Respondents ORDER OF COURT AND NOW, this day of January, 2000, upon consideration of the Petition to Approve Minor's Compromise, it is approved. Respondents are ordered to pay all claims in the amount of $25,000.00, as set forth in the said Petition, in return for a release of claims which Petitioners Eric Lemay and Kristy Lemay are authorized to sign. The settlement is approved with disbursements as follows: Attorneys' Fees and Costs: $6,428.01 Department of Public Welfare: 2,888.28 Structured Settlement Present Value: 14.000.00 Lump Sums Payment Date Age Amount Guaranteed 06/16/2012 18 $3,000 Guaranteed 06/16/2013 19 $5,000 Guaranteed 06/16/2014 20 $5,000 Guaranteed 06/16/2015 21 $5,000 Guaranteed 06/16/2019 25 $12,716 Guaranteed Payout: $30,716 Expected Payout: $30,716 $23.316.29 The remaining funds in the amount of $1,683.71 shall be deposited in a federally insured account, which shall be restricted so that no funds maybe removed therefrom prior to August 16, 2012, without further Order of this Court. In the event that Jacob Lemay should die before any payment set forth above becomes due and owing, such payments shall be made to the Estate ofJacob Lemay. After attaining the age o f majority, Jacob Lemay may submit a change of beneficiary in writing to the Assignee in a form acceptable to the Assignee. The obligation of the Defendants to make the periodic payments set forth above may be assigned to Eric Family Life Insurance Company and funded by an annuity contract issued by Erie Insurance Company and/or Erie Insurance Exchange, an insurer. Petitioners' counsel is to file proofofsaid account with the Prothonotary within five business days after it is opened. BY THE COURT, J. ERIC LEMAY and KRISTY LEMAY, IN THE COURT OF COMMON PLEAS OF Individually and as Parents and Natural CUMBERLAND COUNTY, PENNSYLVANIA Guardians of JACOB W. LEMAY, a Minor Petitioner NO. 1999 - 3855 CIVIL V. CIVIL ACTION - LAW ERIE INSURANCE GROUP, BRIAN L. YEAGY and AMY M. YEAGY, Respondents PETITION TO APPROVE MINOR'S COMPROMISE I . Petitioners, Eric and Kristy Lemay, are the parents and natural guardians ofthe minor Petitioner, Jacob W. Lemay, whose date of birth is August 16, 1994. 2. The Respondent Erie Insurance Group is an insurance company licensed to do business in Pennsylvania with a mai ling address at P.O. Box 903, Waynesboro, Pennsylvania 17268. 3. The Respondents Brian L. Yeagy and Amy M. Yeagy are adult individuals residing at 996 Roxbury Road, Shippensburg, Pennsylvania 17257. 4. On or about August 19, 1997, Petitioner Kristy Lemay and the minor Petitioner were visiting with Respondent Amy Yeagy at the Yeagy residence. 5. On the aforesaid date, the minor Petitioner received injuries as a result of being attacked and bitten by the Respondents Yeagy's Chow-German Shepherd dog. 6. At the time of the foregoing incident, the Respondent Erie Insurance Group provided homeowner insurance coverage to the Respondents Yeagy. 7. As a result of the incident, the minor Petitioner, Jacob Lemay, was admitted as an inpatient at Chambersburg Hospital with dog bite wounds to the face with complex left upper eyelid laceration, left nasal lacrimal duct injury to the upper cuniculus, through-and-through eyelid laceration and parietal scalp laceration. 8. As a result of the foregoing injuries, minor Petitioner underwent an operative procedure to repair the left upper eyelid including muscle tendon repair, upper cuniculus nasal lacrimal duct and placement of nasal lacrimal duct stent and repair of left parietal scalp laceration. 9. As evidenced by the note of Peter G. Wallick, M.D., dated December 10, 1997, the minor Petitioner was not having any problems with his eye and the Petitioners were pleased with the result from the scar. The plan for treatment was follow up as needed. (A copy of said note is attached hereto as Exhibit "A"). 10. Medical expenses for treatment of minor Petitioner totaled $8,695.40 and were paid and subject to a medical lien in the amount of $2,888.28 to the Department of Public Welfare. (A copy of the Statement of Claim Summary is attached hereto as Exhibit "B"). 11. The Respondent Erie has agreed to pay $25,000.00 to the minor Petitioner and seeks court approval in exchange for it General Release. (A copy of said Release is attached hereto as Exhibit "C"). 12. The Respondent Erie will pay Petitioners $11,000.00 upon settlement followed by a structured settlement with a present value of $14,000.00 beginning when minor Petitioner reaches 18 years of age through 21 with the balance being paid at age 25. Said structure has a guaranteed payout of $30,716.00. (A copy of the proposed structured settlement is attached hereto as Exhibit "D"). 13. Petitioners have agreed to pay 25% of the $25,000.00 settlement to their attorneys, Manson Deardorff Williams & Otto, and costs which total $178.01. Petitioners' portion of the initial $11,000.00 settlement payment will be in the amount of$1,683.71. (A copy ofthe Settlement Distribution is attached hereto as Exhibit "E"). 14. The Petitioners, Eric Lemay and Kristy Lemay, have reviewed the foregoing Petition. WHEREFORE, Petitioners request that this Court approve the foregoing minor's settlement. MARTSON DEARDORFF WILLIAMS & OTTO By George. Faller, Jr., uire I.D. No. 49813 Ten East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Petitioners Dated: January 6, 2000 VERIFICATION George B. Faller, Jr., Esquire, of the firth of MARTSON DEARDORFF WILLIAMS & OTTO, attorneys for Petitioners in the within action, certifies that the statements made in the foregoing Petition are true and correct to the best of his knowledge, information and belief. He understands that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. &&'? - G r . Faller, Jr., Esquire Exhibit A PETER G. WALLICK, M.D. PLASTIC AND RECONSTRUCTIVE SURGERY JACOB LEMAY 12-10-97 HISTORY: Follow up left upper eyelid dogbite laceration and nasal lacrimal duct injury. Both parents were present. He is not having a problem with teering. No problems with his eye. Parents are pleased with the result from the scar. EXAM: Left upper eyelid scar is flat, faded and has no unusual characteristics. There is no unusual scar contracture. IMPRESSION: Good result. No nasal lacrimal duct problems noted by the parent. PLAN: Follow up PRN. cc. Dr. Fry DICiA?p ?0VT Cc" t!tPW ?L ivai ca?, EXHIBIT "A" Exhibit B COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFME BUREAU OF FINANCIAL OPERATIONS TPL SECTION - CASUALTY UNIT PO BOX - 5486 HARRISBURG PA 17l"55 September 16, 1999 STATEMENT OF CLAIM SUMMARY >`?I LEMAY, JACOB ny?lyyj: 120126 296 4A., Rfii, N R"A' Pei Ri". 4? , i W9, CLAIMS 8,696.40 2,888.28 F nryy #'`F.' ,a?t. y, clzr r Ti xaa{k'' , fr; CURRENT SOC - .00 2,888.28 EXHIBIT 'IB'I CpMfAONWEALTNOFpENpISYWANUI ?' QEFARTMENT OF PVBOC WKFARE { EIN.;2380Q??13, ;r, Exhibit C GENERAL RELEASE AND SETTLEMENT AGREEMENT Minor For the consideration as outlined below which is hereby acknowledged and also for future acknowledgement, I/we release and discharge, and for myself/ourselves my/our heirs, representatives, executors, administrators, successors and assigns, do hereby remise, release and forever discharge Brian L. Yeagy and Amy M. Yeagy hereinafter referred to as the releasee(s), his/her/their/its heirs, executors, administrators, insurers, successors and assigns, and any and all other persons, firms, corporations, associations, of and from any and all causes of action, suits, judgments, claims and demands of whatsoever kind, in law or in equity, known and unknown, which I/we now have or may hereafter have, and/or which the minor Jacob W. Lemay now has or may hereafter have, especially the claimed legal liability of releasee(s), which liability releasee(s) expressly deny(ies), arising from or by reason of any and all bodily or personal injury and/or property damage known and unknown, foreseen and unforeseen which heretofore has/have been or which hereafter may be sustained by me/us or the minor aforementioned arising out of the accident on or about August 19, 1997, at or near Shippensburg, in the County of Cumberland, in the State of Pennsylvania, in which the minor aforementioned sustained personal injuries and/or property damage. I/We agree that the consideration set forth below is specifically applicable to and paid to me/us with respect to any and all damage to any property, either real or personal, of mine/ours or the minor aforementioned, and with respect to any and all personal or bodily injury of mine/ours or the minor aforementioned, whether presently known or unknown, foreseen or unforeseen or which may subsequently develop and the consequences thereof, all as arising from the aforementioned accident. I/We further agree that the consideration set forth below is specifically applicable to and paid to me/us with respect to any right of contribution the I/we or the minor aforementioned may have against the releasee(s), his/her/their/its heirs, executors, administrators, insurers, successors and assigns relative to claims of others that may be brought against me/us or the minor aforementioned by reason of said accident. I/We further agree that the consideration set forth below is specifically applicable to my/our agreement that I/we or the minor aforementioned will not join nor attempt to join the releasee(s), his/her/their/its executors, administrators, insurers, successors and assigns in any capacity, in any action that may be brought against me/us or the minor aforementioned arising out of said accident. In consideration of the below payment, I/we for myself/ourselves and my/our heirs, representatives, executors, administrators, successors, and assigns do hereby: (1) agree to indemnify and hold forever harmless the releasee(s) and his/her/its/their representatives, administrators, or assigns, against loss from any and all further claims, demands or actions that may hereafter be made at any time or brought against the releasee(s) by me/us or the minor aforementioned, or by anyone in our behalf for the purpose of enforcing a further claim, for which this release is given; (2) warrant that I/we have received no money or other valuable consideration from any other person or persons by reason of any causes of action, suits, covenants, agreements, judgments, claims and demands of whatsoever kind, which I/we now have or may hereafter have, for injuries to person or property arising out of the aforementioned accident or for the other matters for which this release is given. 1/We understand that in consideration for this release and the execution of a Direction of Payments form for Erie Family Life, Erie Insurance Company and/or Erie Insurance Exchange agrees to make the following payments: $11,000.00 lump sum initial payment; and then $3,000.00 on June 12, 2012; $5,000.00 on June 16, 2013; $5,000.00 on June 16, 2014; $5,000.00 on June 16, 2015; and $12,716.00 on June 16, 2019. I/We understand that in the event of death of Jacob W. Lemay prior to the date specified for the last guaranteed payment, the balance of any guaranteed payments shall continue to be paid on the same basis as outlined above, to the Estate of Jacob W. Lemay. EXHIBIT "C" ST21 809196 Page 1 GENERAL RELEASE AND SETTLEMENT AGREEMENT Minor I/We further understand and agree that, with the exception of any consideration that may be payable upon approval of this Agreement as provided above, all future payments hereunder will be funded by the purchase of an annuity from Erie Family Life Insurance Company, which, by its terms will provide for the payment of the above amounts. The Releasing Party hereto shall have no legal interest vested or contingent in such Contract. I/We also understand that notwithstanding any other provision of the Agreement, the Insurer shall at all times remain directly responsible for the payment of all sums and obligations contained in this agreement, in the event of insolvency or any other default of the Erie Family Life Insurance Company. I /We expressly acknowledge and represent that: (1) My/our rights against Insurer, Erie Insurance Company and/or Erie Insurance Exchange, are no greater than those of a general creditor. (2) Insurer, Erie Insurance Company and/or Erie Insurance Exchange, has not made, nor are they under a duty to make funds available to me/us except as provided within this settlement agreement and set forth above. (3) Insurer, Erie Insurance Company and/or Erie Insurance Exchange, is not required to set aside funds for me/us or to otherwise secure their obligation to me/us. (4) I/We have no right to accelerate, defer, increase or decrease the amount of any payment to be made under this Agreement. (5) I/We are not entitled to control the investment of any funds which Insurer, Erie Insurance Company and/or Erie Insurance Exchange, may set aside for its own benefit to fund the payments required to be made pursuant to this agreement; that any annuity or other contract which may be required by the Insurer, Erie Insurance Company and/or Erie Insurance Exchange, shall be and remain the sole property of the Insurer, Erie Insurance Company and/or Erie Insurance Exchange, and that I/we shall have no ownership rights whatsoever, either actual or constructive, in any such annuity, including no right to change the beneficiary or other control thereof, or any rights of a secured party herein. Intending to be legally bound thereby, WITNESS my/our hand(s) and seal(s) this day of WITNESS (Seal) Father-Guardian (Seal) Mother Minor NOTICE: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects the person to criminal and civil penalties." ST21 eostss Page2 Exhibit D 'Z:Aa &A o14 a,u J40a Erie Insurance Group cxas rena:.: aArn ERIE FAMILY LIFE INSURANCE COMPANY 100 ERIE INSURANCE PLACE ERIE, PA 16530 LUU4 Page 1 Summary of Benefits for JACOB W. LEMAY Quote Id : 010-17-0321470-05 Settlement Date : 01/15/2000 Quote Date : 12/02/1999 State : PA Sex Male Data of Birth 06/16/1994 Lump Sums -- Payment Date - Age Amount -- ----------- Guaranteed -^ -------------- .. 06/16/2012 ...- is ------------ $3,000 Guaranteed 06/16/2013 19 $5,000 Guaranteed 06/16/2014 20 $5,000 Guaranteed 06/16/2015 21 $5,000 Guaranteed 06/16/2019 25 $12,716 Guaranteed Payout : $30,716 Expected Payout Rate Series : SSLT13 First Payment Date: 06/16/2012 Guaranteed for 30 Days State Premium Tax 0.00% Tax Age 5 $30,716 + This quote is valid for 30 days from the quote date and is subject to review for accuracy by the Company, This quote assumes the premium required to provide the benefits indicated will be received by the Company on or before the settlement date. If the premium is received after the settlement date, the premium required may change. EXHIBIT "D" Exhibit E SETTLEMENT DISTRIBUTION Attorneys' Fees and Costs: $6,428.01 Department of Public Welfare: 2,888.28 Structured Settlement Present Value: 14.000.00 Lump Sums Payment Date Age Amount Guaranteed 06/16/2012 18 $3,000 Guaranteed 06/16/2013 19 $5,000 Guaranteed 06/16/2014 20 $5,000 Guaranteed 06/16/2015 21 $5,000 Guaranteed 06/16/2019 25 $12,716 Guaranteed Payout: $30,716 Expected Payout: $30,716 $23.316.29 The remaining funds in the amount of $1,683.71 shall be deposited in a federally insured account, which shall be restricted so that no funds may be removed therefrom prior to August 16, 2012, without further Order of this Court. EXHIBIT "E" CERTIFICATE. OF SERVICE. I, Lori A. Sullivan, an authorized agent for Martson Deardorff Williams & Otto, hereby certify that a copy of the foregoing Petition to Approve Minor's Compromise was served this date by depositing same in the Post Office at Carlisle, PA, first class mail, postage prepaid, addressed as follows: Mr. John S. Olver, AIC Claims Adjuster Erie Insurance Group P.O. Box 903 Waynesboro, PA 17268-0903 Mr. and Mrs. Brian L. Yeagy 996 Roxbury Road Shippensburg, PA 17257 MARTSON DEARDORFF WILLIAMS & OTTO B i t ?& 7 Lon A-Sullivan Ten East High Street Carlisle, PA 17013 (717) 243-3341 Dated: January 6, 2000 ti r• c. i?,? r ERIC LEMAY and KRISTY LEMAY, IN THE COURT OF COMMON PLEAS OF Individually and as Parents and Natural CUMBERLAND COUNTY, PENNSYLVANIA Guardians of JACOB W. LEMAY, a Minor Petitioner NO. 1999 - 3855 CIVIL V. CIVIL ACTION - LAW ERIE INSURANCE GROUP, BRIAN L. YEAGY and AMY M. YEAGY, Respondents ORDER OF COURT AND NOW, this lgfl ?l day of January, 2000, upon consideration of the Petition to Approve Minor's Compromise, it is approved. Respondents are ordered to pay all claims in the amount of $25,000.00, as set forth in the said Petition, in return for a release of claims which Petitioners Eric Lemay and Kristy Lemay are aulhorizcd to :d ;n. The settlement is approved with disbursements as follows: Attorneys' Fees and Costs: $6,428.01 Department of Public Welfare: 2,888.28 Structured Settlement Present Value: 14.000.00 Lump Sums Payment Date Age Amount Guaranteed 06/16/2012 18 $3,000 Guaranteed 06/16/2013 19 $5,000 Guaranteed 06/16/2014 20 $5,000 Guaranteed 06/16/2015 21 $5,000 Guaranteed 06/16/2019 25 $12,716 Guaranteed Payout: $30,716 Expected Payout: $30,716 $23.316.29 The remaining funds in the amount of $1,683.71 shall be deposited in a federally insured account, which shall be restricted so that no funds maybe removed therefrom prior to August 16, 2012, without further Order of this Court. In the event that Jacob Lemay should die before any payment set forth above becomes due and owing, such payments shall be made to the Estate ofJacob Lemay. After attaining the age ofmajority, Jacob Lemay may submit a change ofbeneficiary in writing to the Assignee in a form acceptable to the Assignee. The obligation of the Defendants to make the periodic payments set forth above may be assigned to Erie Family Life Insurance Company and funded by an annuity contract issued by Erie Insurance Company and/or Erie Insurance Exchange, an insurer. Petitioners' counsel is to file proofofsaid account with the Prothonotary within five business days after it is opened. BY THE C T _4 J. } Cl) urn t^. 1..'_t' Y G. L C I1 . v V'luisluATAF11.L,Gend,K CRW l iI I 0C410d Wl071M 0948 JI AM RcvLiW 03107rw 11 49 10 AN 0111 1 ERIC LEMAY and KRISTY LEMAY, IN THE COURT OF COMMON PLEAS OF Individually and as Parents and Natural CUMBERLAND COUNTY, PENNSYLVANIA Guardians of JACOB W. LEMAY, a Minor Petitioners NO. 1999 - 3855 CIVIL V. CIVIL ACTION - LAW ERIE INSURANCE GROUP, BRIAN L. YEAGY and AMY M. YEAGY, Respondents PRAECIPE TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Please file the attached Proof of Deposit consistent with Judge Guido's Order of January 19, 2000 as proof of deposit of the balance of the settlement funds regarding the Petition to Approve Minor's Compromise. MARTSON DEARDORFF WILLIAMS & OTTO By ::2 . A 21 George B. Faller, Jr., E u' e I.D. No. 49813 Ten East High Street Carlisle, PA 17013-3093 (717) 243-3341 Attorneys for Petitioners Date: March 7, 2000 ?c M?.1R/I?n - UFA`tnowJWn i mit u 11t 1n .. .. .. ... 1w11JVV&O 601.1,a 8825 J9 Iw knrt llmn Ann h„. ,N..,•.,..,. I Pebruar _.?-•---xx 2000 PAY Eric Lemav and Kristy Lemay Parents and Natural. TO THE Guardians of Jacob W. Lema 1 ORDER OF a •1......:... 1.-°• , '" ? ter.: , DOLLARS Fl lal % -- TRUST ACCOUNT ? I I d MEMO--S@tt,lement n seeds ? 11'00882511' 1':0 313 04 7 201: 26720 2033211• AL riprn ..• .. .. .. ... 11 m .. ..• ... ... ... .... o. c? .. ,. ... e. ..? n ?.. ? ?.. •. .. ..? .. ran r.. 81-- - -._- -.----w 503 No - I "w"'NtUUTMER E/NON TRANSFERABLE . TIME CERTIFICATE OF DEPOSIT 0 ? M OR ? F Jacob W. Lemayt (8-16-94 dob) minor ?y-g 9 0 ONIFKM.I•a ACt.KAT.f,UK,RMTBMAKpKF a?9 •„ RRS-1 N RK o. Box 60 ? M OR [IF Rr1at y M. Lemay, V,K,N 179-??'-941 ,., ., „•,,...„ ?AKNr x+m:uNAplwm ?.m"?»;' , . ? SHIPPENSBURG,PA 17257 717-532-6114 COatodian ,, , , uqN' NO4ANANINF p m 50. 150 BI' 333 Walnut Dale Rd (no vithdravale can a made rrdw"Chis acct MEMBER FDIC Shippeneburg PA 532-6013 17253 until 8-16-2012, by court oT? NNSIUWN r k 87 / ^ J 4,7d.- dpNK 0 A 0 T U01 HAS DEPOSITED IN THIS BANK -1 J 1113 I? THE GO O $ 2.646.47 \ REVERSE SIDE 2-18-2000 24 months "l1BEEN NOTIFIED FIAT I AMSUB,IECT M BACKNOT UP 1ATTIEIOLOIN(I A?SA IIF LILT OF ANAIL' PE TO RV U.T ALL INTEREST T pR w6ENOS OR THE INTERNAL REVENUE SERLACC RR; NOTIFIED ME THAT I AM NO LONG DEPOSSITOITOCT TO BACKUP MTH146LFIINQ B ER R'S SIGNATURE '1. ?. . -.l '! l"AUTHORIZED - SIGNATURE _, SEMI-ANNUALLY ? MAIL CHECK ANNUALLY [XCOMPOUNDING - A ADD-ON ? CREDIT ACCT NO. FCC _ NBLE MATURITY CEIENFICATE UfEM3 011 Q AUTOMATICALLY RENEWABLE CERTIFICATE %JivrCi A OOOZ E Z 933 C73A1303N CERTIFICATE OF SERVICE 1, Christina L. Steele, 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, PA, first class mail, postage prepaid, addressed as follows: Mr. John S. Olver, AIC Claims Adjuster Erie Insurance Group P.O. Box 903 Waynesboro, PA 17268-0903 The Honorable Edward E. Guido Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Mr. and Ms. Eric Lemay 333 Walnut Drive Road Shippensburg, PA 17257 MARTSON DEARDORFF WILLIAMS & OTTO BY?/c11//LG?ts Christina L. Steele Ten East High Street Carlisle, PA 17013 (717) 243-3341 Dated: March 7, 2000 a; C Z C r• '.{ rn V to o U MAR'rsoN DE.ARUORPF Wn1lANIS & 0-1 1-0 MID 1NIowx1I(TN Am- F W-11x & TIN GACI Hum .Sim:l. CARISI E, PIINNSYIVANIA 17013 ,rF:I.Cr11ONI: (717) 245-1341 FAChm1u.1; (717) 243-1850 IN'I'llRNEI www.plllwu.COm The Honorable Edward E. Guido Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 MAR 9 - 2000 March 7, 2000 A1111WI'A:S n' C OUNSF.1111R5 At IAU' Wit I IA%I 11. MAKISO.N JIgIN H. Fowil It III 1)AN11'I K. I)IA14001111; "1*IInpIA%1. Wit IIAKIS IV(, V. 01-11) 111 01114111. 17. FALLIUIR.' CARI. Cl. RIAIII III N61.VIN T WARNER MAMA A. DI NI INDIA 'Buono CI Nn1nu Cnu'I'xlel. SI'I'r IAl III' RE: Eric Lemay and Kristy Lemay, Individually and as Parents and Natural Guardians of Jacob W. Lemay, a minor v. Erie Insurance Company, Brian L. Yeagy and Amy gv 0. 1999-3855- ?Civil - Cumberland County C.C P. Our File No. 9133.1 Dear Judge Guido: Enclosed please find a copy of the Praecipe and Proof of Deposit regarding the settlement which you approved on January 19, 2000. I am also enclosing a copy of the Order, which you signed, for your reference. As you can see, the amount of the deposit is more than you had ordered, this was because the Department of Public Welfare was willing to compromise their lien. Since our attorney's fees had been taken from the gross amount of the settlement, the total amount of the compromise from the department of Welfare was added to the minor's recovery. Very truly yours, GBF/cls Enclosure cc: Mr. John S. Oliver, AIC MN DES?ORFF WILLIAMS & OTTO G Fallcr, Jr. Mr. and Ms. Eric Lemay FIFILLS`I)AIAFILI:'i)mlvcnr")NlcdI f t.-O.-A( I NF0RMA'r 10N • AI e di ERIC LEMAY and KRISTY LEMAY, Individually and as Parents and Natural Guardians of JACOB W. LEMAY, a Minor Petitioner V. ERIE INSURANCE GROUP, BRIAN L. YEAGY and AMY M. YEAGY, Respondents IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 1999 - 3855 CIVIL CIVIL ACTION - LAW ORDER OF COURT AND NOW, this ---A day of January, 2000, upon consideration of the Petition to Approve Minor's Compromise, it is approved. Respondents are ordered to pay all claims in the amount of $25,000.00, as set forth in the said Petition, in return for a release of claims which Petitioners Eric Lemay and Kristy Lemay are authorized to sign. The settlement is approved with disbursements as follows: Attorneys' Fees and Costs: $6,428.01 Department of Public Welfare: 2,888.28 Structured Settlement Present Value: 14.000.00 Lump Sums Payment Date Age Amount Guaranteed 06/16/2012 18 $3,000 Guaranteed 06/16/2013 19 $5,000 Q Guaranteed 06/16/2014 20 $5,000 O O Guaranteed 06/16/2015 Guaranteed 06/16/2019 21 25 $5,000 $12,716 Guaranteed Payout: $30,716 Expected Payout: $30,716 $23 29 316 . . The remaining funds in the amount of $1,683.71 shall be deposited in a federally insured account, which shall be restricted so that no funds may be removed therefrom prior to August 16, 2012, without further order of this Court. In the event that Jacob Lemay should die before any payment set forth above becomes due and owing, such payments shall be made to the Estate of Jacob Lemay. After attaining the age of majority, Jacob Lemay may submit a change of beneficiary in writing to the Assignee in a form acceptable to the Assignee. The obligation of the Defendants to make the periodic payments set forth above may be assigned to Erie Family Life Insurance Company and funded by an annuity contract issued by Erie Insurance Company and/or Erie Insurance Exchange, an insurer. Petitioners' counsel is to file proofofsaid account with the Prothonotary within five business days after it is opened. BY THE COURT, J. TRUE CORY FROM R800R0 to Tftemom whareof, I here urtto 99 my bane attd tlro seal o? ?J C?tu at CarlfslY, R?. rnl ;,y F WILFSDATAFILRWmelm cUA913Ip,4I Oeurd 0199/990941)1 AM Rnued 03MIM 1119 16 AM 91311 ERIC LEMAY and KRISTY LEMAY, : IN THE COURT OF COMMON PLEAS OF Individually and as Parents and Natural : CUMBERLAND COUNTY, PENNSYLVANIA Guardians of JACOB W. LEMAY a Minor : Petitioners NO. 1999 - 3855 CIVIL V. CIVIL ACTION-LAW ERIE INSURANCE GROUP, BRIAN L. YEAGY and AMY M. YEAGY, Respondents PRAECIPE TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Please file the attached Proof of Deposit consistent with Judge Guido's Order of January 19, 2000 as proof of deposit of the balance of the settlement funds regarding the Petition to Approve Minor's Compromise. MARTSON DEARDORFF WILLIAMS & OTTO B y bem- Lieorge B. alter, Jr., Esquire I.D. No. 49813 Ten East High Street Carlisle, PA 17013-3093 (717) 243-3341 Attorneys for Petitioners Date: March 7, 2000 O M?AIIn(ONjUle`IXYu1 WI,LUEMINUito •• • •• •. 60 412 coniz ., .. 882.5., J13 wwlv.br > 1111 E.R11MI11 I'll'. 5111f11 T..°°°.TWR1•.°'^"°° 1 1, , Februar 2 x c TfNlr .1111 ? 11 1I1 __ _ _ 1_ i _L1l.lLy_ P AY Eric Lemav and Kristy Lemay Parents and Natural - TO THE ORDER OF Guardians of Jacob W. Leman ORDER ? '7 812 646 A 7 I .,. ._ . ?_ DOLLARS 65 r." Flna?clal , ` TUS T UST ACC R OUNT MEMO S l m t Prnraeds 11E00aa25n' 1:0 3 1 304 7 20 rn re . . rn E: 26720 2033211E . v r.. rn ? ..r .a e. or m ... .n • Mr n,l m e. m r. m v . VU n .. . .a r.. ?, r.. .. ..r .. mum.. u.. r:n v . n .. r?o m. No. 503_ c, c --...._?..- .. ?nA•E i - - TIME CERTIFICATE OF DEPOSIT owKEAWI, or ACCDIMT • co.wM[A r1IAPo,e Jacob W. Lemay, minorapj.,714 g O?PG?BWox RAN, I ? M OR ? F (8-16-94 dob) 179- • CRwmwri SHIPPENSBURG, PA 17257 t ?MOR ?F Kristy M. Lemay, ,.. .,?J011f ."RN?, =n"",hwn..n 717-Sat-8114 CBatodian GO-t503 333 Walnut bale Rd (no withdrawals can e fties'E'efiie acct 313 Shippenaburg PA 17253 until 8-16-2012, by court orl??r 532 d $ 2,646.47 MEMBER PDIC -6013 ombluwN r o D 13ANK DA2,b46dols47cts HAS DEPOSITED IN THIS BANK _ O MONTHLY ? SEI-ANNUALLY IFCOMPOUNOING g F4;U_m1rm8R PER ANNUMMAIL CHECK onth2-1-002 6:03 ap9 D O-mLTIA?R TT'E O?K1D ANN? CREDIT ACCT No - -----_""" "°' ""'•`^'•e num°en IS MY C(MDECi TAKMVERICEHTWIG1gH r'IfUNOEA PENALTIES OF PERMRV I GERTIFV TNATIAM NOT SUBJECT TO BACKUP VRTHHOLDING, EITHER BECAUSE G "'NOLE MATURITY CERTIFICATE(BEY DK HAVENOTBEEN NOTFND THAT 'AM SUBJECT TOBACKUP L•ATHHOLDIND ASA RFSULT OF A FALLLIRE TOREPORT Q AUTOMATICALLYRENEEKBLECEm1FICAR ALL NTEREST OR 1XVIDEN3S. OR THE INTERNAL REVENUE SERVICE IMS NOTIFIED ME THAT 1 AM NO LONGER SUBJECT TO BACKUP VATHIKKCNG. SIGNATUURRES AUTHORIZED .F1)]-I, SIGNATURE E .9 low O K CERTIFICATE OF SERVICE I, Christina L. Steele, 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, PA, first class mail, postage prepaid, addressed as follows: Mr. John S. Olver, AIC Claims Adjuster Erie Insurance Group P.O. Box 903 Waynesboro, PA 17268-0903 The Honorable Edward E. Guido Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Mr. and Ms. Eric Lemay 333 Walnut Drive Road Shippensburg, PA 17257 MARTSON DEARDORFF WILLIAMS & OTTO Byf&W . Christina L. Steele Ten East High Street Carlisle, PA 17013 (717) 243-3341 Dated: March 7, 2000 F 71LWDATAFILRIGmd%CU 9W-W& .Vnlm C.MW 03MM W 48.31 AM Robes 0913100031] 30 PM 91131 ERIC LEMAY and KRISTY LEMAY, IN THE COURT OF COMMON PLEAS OF Individually and as Parents and Natural CUMBERLAND COUNTY, PENNSYLVANIA Guardians of JACOB W. LEMAY, a Minor Petitioners NO. 1999 - 3855 CIVIL V. CIVIL ACTION - LAW ERIE INSURANCE GROUP, BRIAN L. YEAGY and AMY M. YEAGY, Respondents PRAECIPE TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Please mark the above captioned case settled and discontinued and issue a certificate reflecting same. MARTSO EARD F WILLIAMS & OTTO By George B. Faller, Jr., Esq 're I.D. No. 49813 Ten East High Street Carlisle, PA 17013-3093 (717) 243-3341 Attorneys for Petitioners Date: May 23, 2000 CERTIFICATE OF SERVICE I, Nichole L. Myers, 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, PA, first class mail, postage prepaid, addressed as follows: Mr. John S. Olver, AIC Claims Adjuster Erie Insurance Group P.O. Box 903 Waynesboro, PA 17268-0903 MARTSON DEARDORFF WILLIAMS & OTTO BY F. ) (,;/ Nichole L. Myers Ten East High Street Carlisle, PA 17013 (717) 243-3341 Dated: May 23, 2000 CT F' lf) L; Ltl r_? CJ, c?: S G! ? . [? ` j ? , ii.: CV Ci'_ =' L, ?_ . . U , ?.. ?