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HomeMy WebLinkAbout04-28-08 P..) ~ 6';;, ~ L:(J ' _.: ~ --_ r-= ..- rr. 1~3 ~ - ~ ; __~t ~ ~ - =- i -~ .. W ANGINO & ROVNER, P.C. Joseph M. Melillo. Esquire Attorney 1D No.: 2621 1 4503 North Front Street Harrisburg, I'A 171 IO-1708 (717)238-6791 FAX (717) 238-5610 Attorneys for Plaintiffs} E-mail: jmelillo~i?angino-rovner.com In Re: Estate of ROBERT P. STROUS, THE COURT OF COMMON PLEAS deceased, CUMBERLAND COUNTY, PENNSYLVANIA Petitioner 0.21-07-0176 PLAINTIFF'S PETITION FOR APPROVAL OF SETTLEMENT AND PROPOSED DISTRIBUTION OF PROCEEDS OF WRONGFUL DEATH AND SURVIVAL ACTION AND NOW come Petitioners, Zane P. Strous and Eric R. Strous, Co-Executors of the Estate of Robert P. Strous, deceased, by and through their attorneys, Angino & Rovner, P.C., by Joseph M. Melillo, Esquire, and hereby petition this Court pursuant to Pa.R.C.P. 2206(b)(1) for an Order designating the persons entitled to share in the damages which Plaintiffs have recovered their negotiated settlement. The settlements were achieved without the necessity for initiating a law suit. In support thereof, Petitioners aver as follows: 1. Petitioners' decedent, Robert P. Strous, was killed in an automobile accident occurring on February 18, 2007, at the intersection of Lisburn Road and Route 174 in Mechanicsburg, Cumberland County, Pennsylvania. 379335 1 r 2. The other vehicle involved in the intersectional collision was operated by Svetlana Brown. 3. A copy of the police report for the subject accident is attached hereto as Exhibit «A „ 4. On February 23, 2007, Petitioners Zane P. Strous and Eric R. Strous were granted Letters Testamentary by the Register of Wills, Cumberland County, to the above-captioned number, 200700176. 5. Petitioners' decedent's Last Will and Testament, dated March 24, 1994, appointed Zane P. Strous and Eric R. Strous to act as executors in the event that his wife, Shirley E. Strous, predeceased him or failed to qualify. 6. Shirley E. Strous was deceased at the time of Robert P. Strous' death. 7. Pursuant to the Will, Robert P. Strous' four children, Zane P. Strous, Eric R. Strous, Kirk E. Strous and Lance M. Strous, were to equally share their father's. estate in the event that their mother, Shirley E. Strous, predeceased him. 8. A copy of the Last Will and Testament is attached hereto as Exhibit "B." 9. On or about July 18, 2007, Petitioners entered into contingent fee agreement with Angino & Rovner, P.C., which provides fora 30% fee, together with expenses, in the event that the aforementioned accident case is settled without the need to initiate a law suit. 10. Petitioners' counsel thoroughly investigated the subject accident, and determined that there were three insurance policies applicable for the payment of said claim, to wit: 379335 2 a. A GEICO policy insuring Svetlana Brown, with a policy limit of $20,000.00 per person, as evidenced by the Certification of Limits, attached hereto as Exhibit "C." b. An underinsured motorist policy insuring the vehicle which Mr. Strous was operating, owned by his passenger, Melvetta Liddick, in the amount of $15,000.00 per person, as evidenced by certified declaration sheet for policy number Q09-0119747, also documenting reduced limits of uninsured and underinsured motorist coverage, all attached hereto as Exhibit "D." c. Underinsured motorist policy insuring Robert P. Strous and his personal automobile, issued by GEICO, in the amount of $50,000.00, attached hereto as Exhibit "E." 11. All three insurers have tendered their limits, totaling $85,000.00, and the underinsured motorist carriers have waived their right to subrogation, as evidenced by the additional letters from Erie and GEICO, attached hereto as Exhibit "F." 12. Petitioners requested an Affidavit of No Other Insurance from Svetlana Brown, and an Affidavit was received and is attached hereto as Exhibit "G." 13. Petitioners' counsel also investigated a potential claim against the township for its road configuration, with the assistance of an expert engineer, James C. Druecker, P.E., but ultimately concluded that such an action would not be productive. 14. Robert P. Strous was born on July 25, 1929, and was therefore 77 years old at the time of his death. 379335 3 15. His income at the time of death consisted of Social Security in the amount of $13,338.00 per year, and a limited Teamsters pension, which amounted to $1,308.00 for the year 2006. 16. Petitioners believe that under all the circumstances, the settlement for all available policy limits is reasonable and should be approved. 17. The three contributing insurance companies have requested that Petitioners sign Releases, which are attached hereto as Exhibit "H." 18. Petitioners' counsel has communicated with the Pennsylvania Department of Revenue, requesting that any allocation be split between the Survival and Wrongful Death actions, one-third to the Survival action and two-thirds to the Wrongful Death claim, and the Department has issued a letter approving this arrangement, attached hereto as Exhibit "I.". 19. The decedent's estate has sufficient assets to pay all outstanding claims and expenses, including administration and funeral costs. 20. Petitioners therefore propose the following distribution of settlement proceeds: a. Counsel fees - $25,500.00; b. Litigation costs - $1,093.74, as per accounting summary, attached hereto as Exhibit "J;" c. One-third of the balance distributed to the estate; and, d. Net proceeds distributed to the Wrongful Death action in the amount of $38,770.27 (65-2/3%), payable in equal shares to Zane P. Strous, Eric R. Strous, Kirk E. Strous and Lance M. Strous. 37933 4 21. The paying insurers have requested, upon approval of the settlement, that Petitioners execute the Releases attached hereto. WHEREFORE, Petitioners pray that this Court order the following: a. That the settlement is approved and Releases necessary to consummate it may be executed; b. The proceeds of the Wrongful Death and Survival Act be distributed as described in Paragraphs 20(c) and (d), above; c. That counsel fees and expenses be reimbursed to the law firm of Angino & Rovner, P.C., as described in Paragraphs 20 (a) and (b), above. Respectfully submitted, Date: April -? ~ , 2008 379335 ANGINO & ROVNER, P.C. J e M. Melillo ttorney I.D. No. 26211 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 A>±torne~~ for Pe±itiorers 5 . I COMMOAIWEALTH OF PE._,.~YLVAPIIA J ~ POLICE CRASH REPORTfNG FORnN x,47 - Case Clased Reportable Crash AA 500 1 ~ es ®No t• Yes O No t e ~~uuuiuiumuiii ~,.._~, ~ P1245196 ~._,_~, incident Number Police A envy Patrol Zone p A envy Name Precinct Investigation Date (MM-DD-YYYY) ~ ~/~ ST.~trF ~ria;'c~' C'As1au~E CJ a - l P ~ a v Q Dispatch Time (mil) Arrival Time {mil) Investigator Badge Number d Reviewer Badge Number Approval Date (MM-DD-YYYY) /~ 2D ~ 2 ! ~ ~ ~'ZS'- Z ~ 4 County County Narne Municipality Munici ality Name Dav of Week a Z I ~u+~6~2(.4Nlj Z o 7 MoNRo ~ ~ow ~ S ~+rP ~ Sun Q Thu ~ Crash pate (MM-DD-YYYY) Crash Time (mil) No of Units People Injured Killed* *If > 00 Q Mon Q Fri ~ Tue Q Sat complete o a t g- 2 0 0 "'- f Z d O~ o y ~ a ~ Form F Q Wed Q Unk Workzone ~~ Yes, Complete Q Yes ~ No School Bus Q Yes ~ No School Zone 0 Yes ~ No Notify PENNDOTO Yes ~ No orm M, Section 23) Related Related Maintenance e Z. Intersection TvoeTvoe Multi-Leg 0 4 Way Intersection Q "Y" Intersection Q Q Off Ramp 0 Railroad Crossing Intersection 5_,ne___cial Location p o „ ~ Q Midblock 0 ^T" Intersection Q Traffic Circlet Q On Ramp Q Crossover [~ Other Round About * See Overla Route Number Segment (Optional) Trave! Lanes Speed Limit ~ North House Number (if applicable) o _ it 7 y v 2 5 5 s 0 south ~~ ~ Street Name Street Ending c 0 East For Mid-block crashes only. Use O m West postal House Number and make sate . '_ _ ~j ~ ~ L S fV G S ~ ~ S N (t- S R^ ~ 0 Q Unknown principal Roadway Street Name is filled in if usin this g option ~ Sionino (~ Interstate Q Turnpike O Turnpike - State Q County Q Local Road O Private Q Other/ (Not Turnpike) (East/West) Spur Highway Road or Street Road Unknown ~ Route Number Segment (Optional) Travel lanes Speed Limit ~ North ,o a G `' 3- O v 0 2 ~ a .~ O South ~ Street Endin c 0 East ~ Street Name 9 ~ e d a ~1 E S -~' ~ _' ~ g U~ N (Z A o Q Unknown d e ~ ' SiBanrna Q Interstate Q Turnpike Q Turnpike ~ State Q County Q Local Road 0 Private Q Other/ & (Not Tumpike) (East/West) Spur Highway Road or Street Road Unknown Intersecting Rt Num Or Mile Post Or Segment Marker Feet Q N h p ort ro ,~ `m °~ C~ South ~ " ~' £ Or In rsetting treet N e Ending ~ Q East O il ~ Please ~ r M es r~ .r Enter ti i f ^j ~ m Q Wen ~ ^ ~ m on orma n f . o LL or 80TH ~ Landmarks g if Using r egment arker ~ N Inters ct g Rt Num O Mi a os p (~ North Distance From Crash m ~ This Option ~ " ^ Y ~ d '" Q South Scene to Landmark 1 a N N ' ~ ~ Or Intersecting Street Name St Ending ~ (~ East for Crash between ( Landmark 1 and G ~ m m Q Wit Landmark 2) m Degrees Minutes Seconds Degrees Minutes Seconds ~ Latitude: y 0 ~ 0 : ~ ~ O~ Longitude: -- ? 7 O y ~ O / ~ u Traffi~Controf device Q Yield Sign Q Police Officer or Flagman Q Not Applicable Q Traffic Signal AQive RR Crossing 0 Other Type TCD 0 ~ Furrttionina Device Functioning Emergency Q No Controls 0 Ym r ~ Preemptive p operly Si nal i ~ Controls Flashing Traffic nal ~ Stop Sign Q Q Unknown Q Si ro g Device Not Device Functionin Q g~ p y g 0 Unknown Functionin Pro eri g ss ng Controls C °: (tf 'Not Applicable ", skip rest of the Lane Ciowre section) Lane closure O North Q East Q North and South ~ All p Q Not Applicable 0 Partially ~ Fully Q Unknown ~~ Q South Q West Q East and West (N,S,E,W) ~ V IC d Yes ~ No Q Esfi Time O < 30 Min. Q 30-60 Min. ~ 1-3 hrs ~ 3-6 hrs Q 6-9 hrs Q> 9 hours Q Unknown J S Unknown Q SZ¢F€d FOAM R AA500 (ty02) PENNDOT COPY _ " 1 COMfIHONIftIEALTH OP P~WRfSYLVAi1lIA • , ~ POLIO C4t~-SF! Et~PORYi~G ¢OaifiVi Page: AA 500 2 Police a0n~~ ~!/ ~ ~ KN~1911~1~1 ~a...~.. ~1 Pizasiss ' Motor Vehicle in O Hit & Run Vehicle ~ Illegally Parked O Legally Parked ONon -Motorized ~ Comrrterdal Vehicle ~ Type Transport Unit Pedestrian on Skates, Disabled From - O Pedestrian O O O Train O Phantom Vehicle ~ Yes ~ No in Wheelchair, etc Previous Crash Complete form C) (If Yes (If "Pedestrian' or "Pedestrian on Skates, in Wheelchair, etc', Com Iete Form M, Section 28) , Unit No first Name M1 Date of Birth (MM-DD-YYYY) o f S v E T ~. a n, A V~ v 8' l$ t q 4 Last Name Tele hone Number Delete? p ~, 2 o w N _ Address / Ci /State Zi Lab ~'Dt~1Q,4D0 Yi` ,~rS,H oRE /yfp z I z / a a Driver License Number State Class B~$o-?~ ~~3 ~~ YS` ~~ ~~ b Alcohol/Drogs Suspected Driver or pedestrian Physical Condition ~ Ille al Dru s Q Medication ~ No O 9 9 Apparently Illegal Drug Fati ue Medication ~ Normal O Use O g O d Q Alcohol O Alcohol and Drugs O Unknovm Had Been ~ p O Unknown O Sick Aslee ~ Drinking > ` Alcohol Test Type h ~ O prlmarv Vehicle Code Violation Chargedl p o er t ~ Test Not Given Q Breath if ~'es ~ No ~_ s Unknown Q Blood ~ Urine Q Test Given > Alcohol Test Results O Test Refused O Resun~wn Test Given Driver Presence 1=Driver Operated 3=Driver Fled Scene Vehicle 4=Hit and Run , ~ ~ nt min ted R sult O O C ^ ~ 2 U D k i . o a a e s ver 9= n =No nown r OwneNDriver 00=Not Applicable OZ=Private Vehicle Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh p1=private Vehicle Owned! OwnedlLeased by Driver 05=PENNDOT Vehicle 08=Other Municipal 98=Other p / Leased by Driver 03=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown Same as Owner First Name Owner Last Name or Business Name (!f Pedestrian, skip this Section) Driver ~ ~~~~ Address /City /State /Zip Vehicle Make intake Code a~{oza y 9 VIN Model Year Vehicle Model (see overlay) 3 T ~~ H a o V -7 t a v s S ~O 3 ,z o c, t ~~v License Plate Reg. State Est. Speed Vehicle Towed Towed By g~ t~ B M p q~ q ~ Yes O No WN{EC~2's ~`a~.i~vC~ Insurance Insurance Company Policy No p ~ Yes O No O known E (.O ,~rlvrt~-~ ~ ~ 9G68y0 p Tra_!i~ Tvpe 1=Towing Pass. Veh 4=Mobile/Modular Nome 7=Semi-Trailer Tag No Tag Vear Tag St ~~ ~ ~ Unrt No. of ^ unit ~ 2=Tawm9 Tru ~ 5=tamper B=Other ( Trailing 0 u 3=Towin Utili Trailer 6=Full Trailer 9=Unknown u Units: v ~ Direction of ^ iVehicle Position es N ~ d ~ 'Movement ~ i5ee d ~ O rla Special usage rav y ve Vehicle Color Vehide Type 05=Large Truck 20=Unicycle, Bicycle, ~ ~ 12=Commercial Passenger 06=Yellow ~} '~ 07=Silver 01=Automobile 06=5UV Tricycle p (p 02=Motor cle 07=Van 21=Other Pedalcycle 4` 00=Not Applicable Carrier Ot=Fire Veh 13=Taxi 08=Gold 03=Bus 10=Snowmobile Z2=Horse & Buggy 02=Ambulance 21=Tractor Trailer 01=Blue 09=Brown 04=Small Truck 1 1=farm Equip 23=Horse & Rider 03=Police 22=Twin Trailer 02=Red 10=Orange (!f "DZ", Complete Form 12=Construction Equip Z4=Train 08=Other Emergency 23=Triple Trailer 03=White 11=Purple 04=Green 12=Other M, Section 26) 13=AN 25=Trolley (If "20" or "Z1 ", Complete 18=Other Type Spec Veh 98=Other Vehicle 31=Modified Veh 11=Pupil Transport 99=Unknown 05=Black 99=Unknown form M, Section 77) 19=Unk. Type Spec Veh 99=Unknown Initial Impact Point Damage lnditator Gradient 3=Downhill Road Alignment 00=Non-Collision 14=Undercarriage 1 ,~ To d Unit k P t 15 12 Cl i 01 O=None 2=Functional ~ 1=Minor 3=Disabling 4=Bottom of Hi11 a 1=Level S=Top of Hill 1=$uaight ^ 2=Curved t s = we o n - = oc 9=Unk n 2=Uphill k 13=Top 99=Unknawn now 9=Un nown 9=Unknown u t' t. Fovea r q,4_5pp t~zro21 PENNDOT COPY COIlflRflOR!lM~~iLT1~Q OP PERli1lSYLVARII~- .. POLIO C6tA5a9 REPORTIRIG IFORM Page: AA 500 2 P° ~ a iG /i ~ iiiimiduisufl~ ~...~.~ ~ v 1245196 M ~ or Vihicle in ~ Hit & Run Vehicle O Illegally Parked O Legally Parked QNon -Motorized Commercial Vehicle c an ` po Type Unit Pedestrian on Skates, Disabled From ~ Train O Phantom Vehicle O Pedestrian O ~ Q Yes ~ No Previous Crash in Wheelchair, etc (!f Yes, Complete Form C) (If "Pedestrian` or "Pedestrian on Skates, in Wheelchair, etc', Com lete Form M, Section 18) Unit No First Name MI Date of Birth (MM-DD-YYYY) ~~ 2 R a B e d ~- ® a? ~ S r q ~ last Name Tele hone Number Delete? O $ T i2 o v 5 7r~- ~~}S= 8765 Address / Ci /State Zi c '~ ~` 11nn O So~rK GEOftG- ST7QEET f"t~~AN=.C$ ,,~~ ~ t ~ o r r Driver License Number State Class ~ o~ s 7~-~ s3 PA 0 AfmhoUDrugs Suspected Driver or Pedestrian Physica! Condition N ~ Ill al Dru s O Medication ~ No O e9 9 Apparently illegal Drug Fati ue Medication ®Normal ~ Use ~ g ~ d O Alcohol O Alcohol and Drugs O Unknown Had Been O Sick O Asleep Q Unknown ~ Drinking L L Alcohol Test Type h h O O Primary Vehicle Code Violation Charged? p er t ~ Test Not Given Q Breat O Yes ' No Q Blood ~ Urine O Test Grven+f NONE f!NOwn! ~ Unknown Alcohol Test Results O Test Refused O Results Gi T Driver Presence 1=Driver Operated 3=Driver Fled Scene Vehicle 4=Hit and Run ven, est lt t d R O ~ C i a 2 9 u k N D i na ontam esu s e r ver = n nown = o OwnedDriver 00=Not Applicable 02=Private Vehicle Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh 01=Private Vehicle Owned/ Owned/Leased by Driver 05=PENNDOT Vehicle 08=Other Municipal 98=Other O ~ Leased by Rriver 03=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown Same as Owner First Name owner Last Name or Business Name {!f Pedestrian, skip this Section) Driver Q~ E L V E E -~- ,Q L T D D ~ L Address / Ci /State /Zip Vehicle Make *Make Code zs0 PEACt•( Gf-FN .1~AV,;t1.E ~pAD G~~>,ue4.s ,Pa r~3a IoyvrA I ~ VIN Model Year Vehicle Model (see overlay) ~` 7- E N- D e c V 3 5 6 b~ 6 8 7 9 ~ o o leAU r,( License Plate Reg. State Est. Speed Vehicle Towed Towed 8y 9 o k o A L A P A q 9 5 ~ Yes O No wa}EtCEI"s -[t~W~NG insurance Insurance Company Policy No p ~ Yes Q No O ~RrE 1?~-5~i ANCE C,~ 0 9~ ~ - 9 ? y ~ ~ r .. known gg p Trailln ~~ 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Fag No Tag Year Tag St ~ Unit No. of Unrt 2=Towing Truck S=Camper B=Other Trailing~O k l m v nown l Trailer 9=Un 3=Towing Utility Trailer 6=Fu Units: d ~ Direction of ^ *Vehicle Position •Movemenf W d ~ O I See l O Special Usaye rave ver ay Vehicle Color Vehicle Type 05=Large Truck 20=Unicycle, Bicycle, ° ° 1 Z=Commercial Passenger 06=Yellow 07=Silver V ~ 01=Automobile 06=5UV Tricycle ~ 02=Motor cle 07=Van 21=Other Pedalcycle rP cY 00=Not Applicable Carrier 01=Fire Veh 13=Taxi 08=Gold 01=Blue 09=Brown 03=Bus 10=Snowmobile 22=Horse & Buggy 04=Small Truck 11=Farm Equip 23=Horse & Rider 02=Ambulance 21=Tractor Trailer 03=Police 22=Twin Trailer 02=Red 10=Orange (If °02° Complete form 12=Construction Equip 24=Train Og=Other Emergency 23=Triple Trailer 03=White 11=Purple M, Section 16) 13=ATV 25=Trolley Vehicle 31=Modified Veh 04=Green 12=Other k 99=Unknown Bl 05 (If "'20" or °2T ", Complete 18=Other Type Spec Veh 98=Other Type Spec Veh 99=Unknown 19=Unk 11=pupil Transport 99=Unknown ac = . Form M, Section 17) initial impact Point Damage Indicator Gradient 3=Downhill Road Alignment 00=Non-Collision 14=Undercarriage o ~ ^ O=None 2=Functional 3 1=Minor 3=Disabling ~ 1=Level 4=Bottom of Hill ~ S=Top of Hill ^ 1=Straight ~ 2=Curved 01-12=Clock Points 15=Towed Unit 9 U k 2=Uphill 13=Top 99=Unknown n = nown g=Unknown 9=Unknown yFORM p Aa-500 (12KY2) PENNDOT COPY - ~ COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM Page AA 500 3 a i~~ii yy -~ ~ `~ uioumouuse o..._r ~ v 1245196 r w s Q t=Driver 2=Passenger 7=Pedestrian 8=Other 9=Unknown ~~ B F =Female M=Male U =Unknown r~jurvty: O=Not Injured 1=Killed 2=Major Injury 3=Moderate Injury 4=Minor Injury B=Injury, Unk Severity 9=Unknown if Injury 00=Not APassenger/Occupant 01=Driver -All Vehicles 02=Front Seat Middle Position 03=Front Seat Right Side 04=Second Row -Left Side Or Motorcycle Passenger 05=Second Row • Middle Position 06=Second Row -Right Side 07=Third Row Or Greater - Left Side 08=Third Row Or Greater - Middle Position 09=Third Row Or Greater - Right Side 10=Sleeper Section of Truckcab 1 1=In Other Enclosed Passenger Or Cargo Area 12=1n Open Area (Back Of Pickup, Etc.) 13=Trailing Unit )4=Riding On Vehicle Exterior 15=Bus Passenger 98=Other 99-Unknown l- -Y" I E 00=None Used /Not Applicable 01=Shoulder Belt Used 02=Lap Belt Used 03=Lap And Shoulder Belt Used 04=Child Safety Seat Used 05=Motorcycle Helmet Used 06=8i cle Helmet Used 10=Safety Belt Used Impropedy 11=Child Safety Seat Used Improperly 12=Helmet Used Improperly 90=Restraint Used, Type Unknown 99=Unknown ,~afgty~quioment Two: F 00=None Used /Not Applicable 01=Front Air Bag Deployed {For This Seat} 02=Side Air Bag Dep}oyed (For This Seat) 03=Other Type Air Bag Deployed 04=Multiple Air Bags Deployed 05=Motorcycle Eye Protection Ob=Bicyclist Wearing Elbow/Knee/Pads 10=Air Bag Not peployed, Switch On 11=Air Bag Not Depioyed, Switch Off 12=Air Bag Not Deployed, Unk Switch Setting 13=Air Bag Removed {Prior To Crash) 19=Unknown ff Air Bag Deployed 99=Unknown G 1=Not Ejected 2=Totally Ejected 3=Partially Ejected 9=Unknown H Ejection Path: O=Not Ejected /Not Applicable 1=Through Side Door Opening 2=Through Side Window 3=Through Windshield 4=Through Back Door S=Through Back Door Tailgate Opening 6=Through Roof Opening (Sunroof/ Convertible Top Down) 7=~Fhrough Roof Opening (Convertible Top Up) 9=Unknown n i O=Not Applicable 1=Not Extricated 2=Extricated By Mechanical Means 3=Freed By Non -Mechanical Means 8=Other 9=Unknown ENIS Agency: SfIVFA S~ftS-.a(j- EMS Medical Facility: /~~iQSFEi=Y IGt~ia~e- ~SPJTs}~ Unit No Person No Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I o , o ~ o ~ ~ - ~ $ - I ~ ~ 3 ooa ~ ~ ~ 3 o t ooa Name /Address /Phone EMS Transport Same as Operator Q Yes ~ No Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H I Delete? o ~ a ~ O o ~ - , ~ - I 9 ~ 3 oao ~ 3 ~ 3 ~ ~ oao Name /Address /Phone EMS Transport Same as G'E02GTA V. D aC~vrJ ~pLpt,~DD ~.OcTJait7~!E /`f/, f Z/Z/o (~ Yes ®No Operator trt D Unit No Person No Delete? Date of Birth (MM-DD-YYYY) R if L U t r• V t'I 11 o~ o- O v -~ - a s- 1 9 2 g 0©~ °~ 0 3 ~ a 0 °OL~J Name /Address /Phone EMS Transport Same as ®Yes O No Operator Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H I Deletes ~~~ O 3 O 3 / o ~ a- o ]~ O X 3- 0 8- [ `~ 3 7 Name /Address /Phone EMS Transport Same as ~ll~I,UEErA 3~ L,rDflrc.s` .2so ~~ GIEN ~DA~A-(.E QD. ~'AZO-+i:Li,P,q !'73~`f ~ Yes O No operator Unit Nno Person No W m Date of Birth (MM-DD-YYYY) A B C D E F G H I DeOe1 m-m ~^^mmm^a~ Name /Address !Phone EM5 Trans ort p Same as Operator O Yes (~ No Unit No Persomn No m I 1 ~ Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I O m-~ ~^^~mm~^^ ____ - Name /Address /Phone EMS Trans rt po Same as Operator O Yes Q No FORM t AaSOO (tvoz) PENNDOT COPY - ~ COMMONWEALTH OF PENNSYLVANIA - POLICE CRASH REPORTING FORM Page AA 500 4 `"'~fo~_°jy(v'~//yY ~ b 5 IIIIIIIIVIIIIIiYI ~..~.., ~ a 1245196 Crash Descriotion O=Non-Collision 2=Head On 4=Angle 6=Sideswipe B=Hit Pedestrian 1=Rear End 3=Rear is Rear 5=$ideswippQ (Opposite Direction) (Backing) (Same Auection) 7=Hit Rxed Object 9-0ther/Unknown o ~ F € ~ Relation to Roadway 1=0n Travel Lanes 3=Median 5-0utside Trafficway 7=Gore {Ramp Intersection) ~ ~ 2=Shoulder 4=Roadside 6=1n Parking Lane 9=Unknown -° ~ i ti ill 1=Daylight 3=Dark -Street 5=Dawn 8=Other N ~ V um na on 2= ark - No Lights 6=Dark -Unknown Street Li hts 4=Dusk Roadway U hting r m t a - Weather Conditions 1=No Adverse 3=Sleet Hail S=Fog 7=Sleet ~ Fog 9=Unknown ~ Conditions ( ) v~ 2=Rain 4=Snow 6=Rain 8 Fog B=Other ~ _ .. Road Surface Conditions C7 O=Dry 2=Sand, Mud, Dirt, 4=Slush fi=Ice Patches B=Other T=W ter -Standing it S I = ce 1=Wet 3=Snow Covered or Moving Harm Event 1/R Most? Utility Pole Number Harmful Events (Harm Event) 30=Hit Fence Or Wall 3 0 ~ ® 01=Hit Unit i 31=Hit Building 2 32=Hit Culvert i U i Unit No t n t 02=H 03=Hit Unit 3 33=H+t Bridge Pier Or Abutment O I Z m ^ ~ 04=Hit Unit 4 34=Hit Parapet End 05=Hit Unit 5 35=Hit Bridge Rail 06=Hit Other Traffic Unit 36=Hit Boulder Or Obstacle Please Put Events in 3 m ^ ~ 07=Hit Deer On Roadway 08=Hit Other Animal 37=Hit Impact Attenuator Sequential 09=Collision With Other Non 38=Hit Fire Hydrant i Order 4 ~ ~ ~ ~~~ pment Fixed Object 39=Hit Roadway Equ 11=Struck B~ Unit 1 40=Hit Mail Box it Z 41=Hit Traffic Island k B U 1Z S n = truc E 13=Struck By Unit 3 42=Hit Snow Bank Construction 4 43=Hit Tem ora i k o` ~ Harm Event L/R Most? Utility Pole Number p ry 14=Struc By Un t 15=Struck By Unit 5 Barrier 1 1 ( 0 16=Struck By Other Traffic Unit 48=Hit Other Fixed Ob1'ect 49=Hit Unknown Rxed Object T bb d Unit No ery 21=Hit ree Or Shru 22=Hit Embankment 50=0vertum/Roll Over W '" p 2 Z ~ ^ ~ 23=Hit Utility Pole 51=Struck By Thrown Or Falling n Object 24=Hit Traffic Si c g 25=Hit Guard Rail 52=Pot Holes Or Other ~ Please Put 3 m ~ ~ ~, Events in Z6=Hit Guard Rail End Pavement Irregularities 27=Hit Curb 53=Jacknife Sequential 28=Hit Concrete 4r 54=Fire In Vehicle Longitudinal Barrier 58=Other Non-Collision Order 4 m ^ O 29=Hit Ditch 99=Unknown Harmfu{ Event first Unit No Harm Event Most Unit No Harm Event Driver Action (D) 17=Careless Or Illegal ~mfu! ~ ~ ~fu! ~ ~ vent rn O I O ~ vent rn O l Q 1 00=No Contributing Action Backing On Roadway 01=Driver Was Distracted 18=Driving On The Wrong tt~h t~h 02=Driving Using Hand Held Phone Side Of Road 0o not repeat this information on multiple pages 03=Driving Using Hands Free Phone 19=Making Improper h E t T H tg way n rance o 04=Making tliegal U-Turn Environmenfa!/Roadway 1 m Z m 3 m e ~ 05=Improper/Careless Turning 20=Making Improper Exit From Wrong Lane From Hi 06=Turnin hwa Potential factors (E/R) g g y JUn arkin 07=Proceedin W/0 21=Careless Parbn 00=None 11=51i a Road Conditions (ICe/Snow) Pp rY g p g g Clearance After Stop 22=OverNnder 01=Windy Conditions 12=Substance On Roadway 08=Running Stop Sign Compensation At Curve 02=Sudden Weather Conditions 13=Potholes 03=Other Weather Conditions 14=Broken Or tracked Pavement d 09=Running Red lig t 23=Speeding 10=Failure To Resppoond To 24=Driving Too Fast For Conditions 04=Deer In Roadway 15=TCD Obstructe Other Traffic Control Device 25=Failure To Maintain Proper Speed 05=Obstacle On Roadway 16=Soft Shoulder Or Shoulder Drop Off F d 11=Tailgating9 ZS=Driver Fleeing Police (Pot Chase) /St i 2 S i actor way 06=Other Animal In Roadway 28=Other Roa = ng opp 1 udden Slow ng 27=Driver Inexperienced 07=Glare 29=Other Environmental Factor 08=Work Zone Related 99=Unknown 13=Illegally Stopp On RRoad 28=Failure To Use Specialized Equip 14 ee Passing Or Lane g2=Aff d B Ph sical Condition t c y y ec e Chan A Possible Vehicle Failures (V) 12=Wipers 13=Driver Seatin Control g/ 15=Passing 1n No Passingg Zone 98=Other Improper Driving Actions 16=Drivin The Wron Wa On 99=Unknown 9 9 Y 00=None 06=Exhaust e 14=Hod ,Doors, Hood, Etc 01=Tiles 07=Headlights Y 1-Wa Street Y ~ 15=Trailer Hitch 02=Brake System 06=Signal Lights 16=Wheels 03=Steering System 09=Other Lights Unit 1 Z No O ( t? ~ ~ m 3 m 4 m ~ 04=Suspension 10=Horn 17=Airbags ~ 05=Power Train 11=Mirrors 18=Trailer Overloaded 19=Unsecure/Shifted Trailer Load i U Unit ~ i m 2 m 3 m 4 m ~~ Q g c V n t ~ t p 0 2 m No 0 ( 20=Improper Towing No 21-ObsVucted Windshield Unit m t Q V 2 m 99=Unknown a pedestrian Action (Py 03=Working 00=None 04=Pushing Vehicle No 0 01=Entering Or Crossing At 05=Approaching Or Leaving Vehicle Specified Location 06=Working On Vehicle indicated Prime Factor Unit No factor Code 02=Walking, Running, Jogging, 07=Standing 98=Other l Do not repeat this intormaton on ~ ~ multiple pages. d ) Q g Or Playing 99=Unknown E/ R V D P tf E/R i P i th f Unit No d j p o Unit No p a a ~ 0 ~ ~ 0 r s e me actor Type, leave Unii No blank t! u t: n FORM r na-sao (t~1 PENNDOT COPY J COMMONWEALTH OF PENNSYLVANIA ~Iq~lll~l„i„I~„~III~ Crash Number i -- ,,. POLICE CRA5H REPORTING FORM 50~ 5 Pdi Only Pam P 1245196 i iy o 6 rCryryLV 1 {.UYY COMMONVYEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM AA 550 N CRASH NUMBER P 1 2 4 5 1 9 6 INCIDENT NUMBER H 0 2- 1 6 4 1 1 4 4 PAGE: 0 0 7 UNIT 1: CELL PHONE PRESENT, NOT IN USE UNIT 2: CELL PHONE PRESENT, NOT IN USE SR 174 IS A TWO LANE ASPHALT ROADWAY WHICH TRAVERSES RURAL MONROE TOWNSHIP, CUMBERLAND COUNTY, PA IN AN EASTNVEST DIRECTION. THE ROADWAY IS APPROXIMATELY 22 FEET WIDE. THERE IS ONE EASTBOUND LANE AND ONE WEST BOUND LANE OF TRAVEL. THE WIDTH OF EACH LANE IS APPROXIMATELY 11 FEET. TWO SOLID DOUBLE YELLOW PAVEMENT STRIPING LINES SEPARATES THE LANES OF TRAVEL. THE EDGE OF EACH LANE IS MARKED WITH A SOLID WHITE FOG LINE WHICH LEADS TO THE BERM OF THE ROADWAY. THE DISTANCE FROM THE WHITE FOG LINE TO THE BERM IS APPROXIMATELY 3 FEET. WEST LISBURN ROAD IS A TWO LANE ASPHALT ROADWAY WHICH TRAVERSES IN THE NORTH/SOUTH DIRECTION. THE ROADWAY IS APPROXIMATELY 22 FEET WIDE. THERE IS ONE NORTH BOUND LANE AND ONE SOUTH BOUND LANE OF TRAVEL. THE WIDTH OF EACH LANE IS APPROXIMATELY 11 FEET. TWO SOLID DOUBLE YELLOW PAVEMENT STRIPING LINES SEPARATES THE LANES OF TRAVEL. THE EDGE OF EACH LANE 1S MARKED WITH A SOLID WHITE FOG LINE WHICH LEADS TO THE BERM OF THE ROADWAY. THE DISTANCE FROM THE WHITE FOG LINE TO THE BERM IS APPROXIMATELY 3 FEET. THE ROAD IS fN GOOD REPAIR WITH NO DEFECTS OBSERVED. THE ROADWAY WAS DRY AT THE TIME OF THE COLLISION AND THERE WAS INTERMITTENT SNOW SQUALLS IN THE AREA. THE COLLISION OCCURRED AT THE HOURS OF DAYLIGHT. SYNOPSIS: THIS TWO VEbiICLE CRASH OCCRRED~AS UNIT 1 WAS TRAVELING NORTH ON WEST LISBURN ROAD AND UNIT 2 WAS TRAVELING WEST ON SR174. UNIT 1 FAILED TO STOP AT THE PROPERLY POSTED STOP SIGN LOCATED ON THE EAST BERM OF THE ROADWAY AND IMPACTED THE DRIVER'S SIDE OF UNIT 2 IN THE CENTER OF THE INTERSECTION. AFTER IMPACT, UNIT 1 TRAVELED APPROXIMATELY ~6 FEET NORTH WEST AND CAME TO FINAL REST ON THE NORTH SHOULDER OF SR174 FACING IN THE NORTH DIRECTION. AFTER IMPACT, UNIT 2 TRAVELED APPROXIMATELY ~~~ FEET WEST AND IMPACTED A SNOW PILE EMBANKMENT ~~ PENNDOT COPY COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM AA 550 N CRASH NUMBER P 1 2 4 5 1 9 6 INCIDENT NUMBER H 0 2- 1 6 4 1 1 4 4 PAGE: 0 0 8 LOCATED ON THE NORTH BERM OF SR174. AFTER SECONDARY IMPACT OF THE SNOW EMBANKMENT, UNIT 2 ROLLED ON ITS PASSENGER SIDE AND CAME TO FINAL REST FACING IN THE WEST DIRECTION ON THE NORTH BERM OF SR1T4. BOTH UNITS WERE IN THE AFOREMENTIONED POSITION UPON MY ARRIVAL. PHYSICAL EVIDENCE AT THE SCENE OF THE CRASH: UNIT 1 ROADWAY EVIDENCE: NO TIRE MARKS OBSERVED UNIT 2 ROADWAY EVIDENCE: NO TIRE MARKS OBSERVED UNIT 1 VEHICLE DAMAGE: I OBSERVED UNIT 1 WITH SEVERE FRONT END DAMAGE. I OBSERVED THE DRIVER AND PASSENGER OF UNIT 1 OUTSIDE OF THE VEHICLE. UNIT 2 VEHICLE DAMAGE: I OBSERVED UNIT 2 WITH SEVERE DRIVER'S SIDE DAMAGE. I OBSERVED THE DRIVER AND PASSENGER OF UNIT 2 STILL BELTED INSIDE THE UNIT. OTHER ROADWAY EVIDENCE: ON 02/18/07 AT APPROXIMATELY 1215 HOURS, WITNESS 1, (SHOENFELT}WAS INTERVIEWED AT THE SCENE OF THE CRASH BY TPR RONALD C. CAREY. (SEE ATTACHED SUPPLEMENTAL} ON 02/18/07 AT APPROXIMATELY 1220 HOURS, THE PASSENGER OF UNIT 1 WAS INTERVIEWED AT THE SCENE OF THE CRASH BY TPR RONALD C. CAREY. (SEE ATTACHED SUPPLEMENTAL) PENNDOT COPY COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM AA 550 N CRASH NUMBER P 1 2 4 5 1 9 6 INCIDENT NUMBER H 0 2- 1 6 4 1 1 4 4 PAGE: 0 0 9 ON 02/18!07 AT APPROXIMATELY 1227 HOURS, THE OPERATOR OF UNIT 1 WAS INTERVIEWEDAT THE SCENE OF THE CRASH BY TPR RONALD C. CAREY. {SEE ATTACHED SUPPLEMENTAL) THE OPERATOR OF UNIT 2 WAS PRONOUNCED DEAD AT THE SCENE OF THE CRASH. THE PASSENGER OF UNIT 2 WAS UNRESPONSIVE AT THE SCENE OF THE CRASH AND WAS LIFE FLIGHTED TO HERSHEY MEDICAL CENTER, THEREFORE, NO INTERVIEW WAS CONDUCTED. CORPORAL DAVID GOULDY, SHIFT SUPERVISOR, TROOP H CARLISLE WAS CONTACTED AND RESPONDED TO THE SCENE. CORPORAL GOULDY THEN REQUESTED THE C.A.R.S. UNIT AND FORENSIC SERVICES UNIT TO RESPOND TO THE SCENE. ON 02(18/07 AT 1247 HOURS, TPR R. CAREY REQUESTED THROUGH GDC THAT C.A.R.S. AND F.S.U. BE CONTACTED TO RESPOND TO THE SCENE. (SEE ATTACHED SUPPLEMENTAL) ON 02/18/07 AT 1251 HOURS, TPR GARY MAINZER, TROOP H HARRISBURG, C.A.R.S. UNIT RESPONDED TO THE SCENE OF THE CRASH. ON 02/18/07 AT 1251 HOURS, TPR MATTHEW FRAMPTON, TROOP H HARRISBURG, FORENSIC SERVICES UNIT RESPONDED TO THE SCENE OF THE CRASH TO TAKE PHOTOGRAPHS. THE PHOTOGRAPHS WILL BE RETAINED AT TROOP H FORENSIC SERVICES UNIT. (SEE ATTACHED SUPPLEMENTAL) ON 02/18/07 CUMBERLAND COUNTY 911 NOTIFIED THE CUMBERLAND COUNTY CORONER'S OFFICE. DEPUTY CORONER MIKE NORRIS ARRIVED AT THE SCENE AT APPROXIMATELY 1235 HOURS. THE OPERATOR OF UNIT 2 WAS EXTRACTED BY MONROE FIRE DEPARTMENT. NORRIS THEN PRONOUNCED THE OPERATOR OF UNIT 2 DEAD AT APPROXIMATELY 1238 HOURS. OPERATOR OF UNIT 2 WAS THEN TRANSPORTED BY SILVER SPRING EMS TO THE HOLY SPIRIT MORGUE. THE PASSENGER OF UNIT 2 WAS ALSO EXTRACTED BY MONROE FIRE DEPARTMENT AND PENNDOT COPY COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPpRTING FORM AA 550 N CRASH NUMBER P 1 2 4 5 1 9 6 INCIDENT NUMBER H 0 2- 1 6 4 1 1 4 4 PAGE: 0 1 0 LIFE FLIGHTED TO HERSHEY MEDICAL CENTER. THE OPERATOR AND PASSENGER OF UNIT 1 WERE ASSESSED BY WEST SHORE EMS. THE OPERAOTR AND PASSENGER BOTH REFUSED MEDICAL TREATMENT. AN AUTOPSY WAS PERFORMED ON THE OPERATOR OF UNIT 2. THE MANNER OF DEATH WAS ON OPERATOR OF UNIT 2 WAS AS A RESULT OF BLUNT FORCE TRAUMA. (A AUTOPSY REPORT WILL FOLLOW) NOTIFICATIONS: NOTIFICATION OF OPERATOR OF UNIT 2'S NEXT OF KIN WAS MADE BY CORONER MIKE NORRIS ON 02!18107. THE DIRECTOR OF BUREAU OF PATROL WAS NOTIFIED OF THE TRAFFIC FATALITY FR6-4 VIA TELETYPE. REFER TO ATTACHED MESSAGE OF FATAL CRASH DATA. SP7-0015 WAS MAILED TO OPERATOR OF UNIT 1. SP7-0015 WAS MAILED TO NEXT OF KIN OF OPERATOR OF UNIT 2 AND PASSENGER OF UNIT 2. BOTH UNIT 1 AND UNIT 2 WERE TOWED FROM THE SCENE BY WHEELER'S TOWING AND TAKEN TO WHEELER'S TOWING WHERE THEY WERE SECURED INSIDE A FENCED iN LOT. ON 02/22/07 AT 1505 HOURS, i SPOKE TO ADA MICHELLE SIBERT REGARDING POSSIBLE CHARGES IN THE CRASH. SIBERT STATED THAT AT THIS TIME, THERE WILL BE NO ADDITIONAL CHARGES BUT WOULD LIKE TO RUN THE INFORMATION BY THE DISTRICT ATTORNEY ON 02/23/07 AND WOULD GET BACK TO ME. ON 02123!07, RECEIVED AN E-MAIL MESSAGE FROM SIBERT ADVISING THAT SHE WAS INSTRUCTED TO INTERVIEW THE VICT[M'S FAMILY AND OBTAIN ADDITIONAL REPORTS. SHE ALSO ADVISED THAT THE VEHICLES ARE NOT TO BE RELEASED UNTIL SHE ADVISES OF POSSIBLE CHARGES. ON 02/23!07 AT 1530 HOURS, I INTERVIEWED THE PASSENGER OF UNIT 2. SHE STATED THAT SHE AND HER BOYFRIEND, BOB, WERE TRAVELING WEST ON SR 174. SHE STATED "SHE DOES NOT KNOW HOW FAST THEY WERE GOING BUT KNOWS THAT HE ALWAYS DROVE THE SPEED LIMIT." SHE STATED, "ALL I REMEMBER IS THE PENNDOT COPY COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM AA 550 N CRASH NUMBER P 1 2 4 5 1 9 6 INCIDENT NUMBER H 0 2- 1 6 4 1 1 4 4 PAGE: 0 1 1 IMPACT OF THE CRASH AND DID NOT SEE THE OTHER VEHICLE TRAVELING THE OTHER WAY." SHE FURTHER RELATED THAT SHE REMEMBERS BLACKING IN AND OUT A FEW TIMES BUT WHEN 5HE BECAME CONSCIOUS, SHE REALIZED THAT THEY WERE IN A WRECK. UNIT 2'S OPERATOR'S LICENSE WAS SURRENDERED TO THE CORONER, MIKE NORRiS, AT THE SCENE OF THE CRASH. A NEWS RELEASE WAS PREPARED AND SUBMITTED. THIS REPORT TO REMAIN OPEN PENDING A POSSIBLE C.A.R.S. SUPPLEMENTAL AND POSSIBLE CHARGES BEING FILED OR CITATIONS. PENNDOT COPY L -_ '^' ~ O~ ~ C~SaG~ E~IRYI ~ ~093R/i ~!~- Pa e ~ New II~ II~IIIul~llfl~~llllll~ Crash Number 9 ~ .ri0~ F Po~~i~' use onry Change! ' / f10~" /G y//y~ ~ O Continuation ~ j ~ T s / ~ G Road Surface Tvpe Special Jurisdiction O Military O Other Federal Sites Q Brick or Block O Dirt ca O Conve#e Slag, Gravel or O Other ~ No Special O Indian Reservation O ether O Stone Jurisdiction ~ Blacktop O Unknown CollegelUniversity Unknown O Nations{ Park O Campus O Please complete Unit Information for each unit involved in a fatal crash. Do not repeat the information in the fields above on multiple pages. Unit No Principle impact Point ~ ~ t O Non-tollision Oll 12 Ol0 Driver Restrictions Restrictions Not a Pennsylvania O Complied With O Driver Compliance Restrictiorn Not Unknown O 0 ® No Restrictions/ Complied With Compliance Not Applicable Compliance 0 ~ Unknown 4 ~ O Required - O Not a Pennsylvania Driver Endorsement Complied With Driver Compliance Required -Non Unknown O O ,o r Compliance Compliance ®None Required ~ = Required - O Compliance Unknown c Driver License O Not Required for O Unk if CDL or [ompilartte Vehicle Class CDL Required O No Valid License O Not a Pennsylvania for Class Driver O Not Licensed ~ Valid License for O Unknown Class Drug Test Type O Blood O Other ® None O Urine O Unknown if Test Given Druo Test Results - (Up to Four Results) ^ 0 = No Test Given 5 =Amphetamines 1 = No Drug Reported 6 =PCP D 2 = Marihuana 3 =Cocaine 8 =Other 9 =Unknown Test ~ ^ 4 =Opiates Results Unit No O ~ Driver Restrictions O Restrictions O Not a Pennsylvania o~ Complied With Driver No RestrRions/ ® Restrictions Not O Complied With Unknown OCompliance Not Applicable Compliance O ~ Unknown 'r. Driver Endorsement Required - O Not a Pennsylvania O +e Dine ranee Complied With Driver Required -Non lia ce O C Unknown O ~ None Required omp n Compliance O Required - Compliance Unkno wn ~ Driver License Dine ranee Not Required for O Vehicle Class O Unk if CDL or CDL Required No Valid License O Not a Pennsylvania O for Class Driver O Not Licerued ~ Valid License for O Unknown Class Orug lest Type O Blood O Other ~ None Urine O O Unknown if Test Given DrutLTest Results - (Up to Four Results) A h t i 5 ^ ^ 0 = No Test Given mp e am nes = t = No Drug Repo rted 6 =PCP D 2 =Marijuana 3 =Cocaine 8 =Other 9 = Unknawn Test ~ ^ 4 =Opiates Results 010 02 0 O Top O 09 03 O O Undercarriage 0 040 O Towed Unit O 07 06 0 O O O Unknown O Avoidance Maneuver No Avoidance ~ Maneuver Brakin Other O Other Avoidance 9 0 e Evide Maneuver O Braking -Skid Marks Evident O Steering -Evidence O Inconclusive or Driver Stated Braking - No Skid Driver O Marks Steering and Braking O Unknown ~ , Stated Evidence or Stated Under Ride indicator Underride, No No Underride or ® Override, Other O Compartment O Vehicle Override Intrusion Underride, Underride, Unknown if O Compartment O Compartment O Underride or Intrusion Intrusion Unknown Override Emergency Use O Lights Flashing O Both Lights and Not in Emergenty ® Use Siren Q Siren Sounding O Unknown Principle impact Point ONon-Collision O ~ 12 ~ 1 0 Flo 020- 0 Top 0 09 03 O O Undercarriage O 08 04 O O Towed Unit OJ p~ 0 06 0 O Unknown O Avoidance Maneuver ~ No Avoidance Maneuver Braking -Other Other Avoidance O O Evidence Maneuver O Braking -Skid Marks Evident O Steering -Evidence O Inconclusive or Driver Stated Braking - No Skid Driver O Marks Steerin and erakin Unknown g 0 0 e , Stated Evidenc or Stated Under Ride indicator - No Underride or Underride, No Override, Other O Compartment O Vehicle Override Intrusion Underride, Q Compartment Underride, Unknown if O Compartment O Underride or Intrusion Intrus+on Unknown Override Eme en Use O Lights Flashing O Both Lights and Siren ~ Not in Emergency Use O Siren Sounding O Unknown FORF~ Q M-506F(1'l~i~ PENIPdDOT COPY -' ~ P~ E CRASH REPORTIiVG,FORMAP6IA O New ~ ~~~~~~~ ~~~~ ~,~11 ~~It "~~ Crash Number " - Case Closed Reportable Crash Pa e . Change/ ~j 5d~ ~ O Yes O No ~ Yes O No ~ ~ ~ Continuation ~ l ~ 5 ~ ` incident Number Polite A envy Patrol Zon¢ ~ D Z. -~~ ~f t t ~r ~k 6 8 N o 2 [~] p A en Name Precinct Investigation Date (MM-DD-YYYY) t PA SYA~~~ ~L~C~ RI~SL~ Z12D a Dispatdti Time (mi!} Arrival Time (mil) Investi ator Badge Number ~ Y ~Rt~~ ~G~~~~ 3 d Reviewer Badge Number Ap royal Date (MM-DD-YYYY) ~+mr County County Name Municipality Municipali Name Osi~L Qf.~~k ~ A ~ ~ ~ ~ O Sun O Thu ~ R ~ Crash Date ({~M''M'-~~D''D~-Y~~YYY) Crash Time (mil) Na of Units People t~I-nj~-u~~r-e~d--7~ Killed* *(If > 00, Form F) ~ r L-.LJ ^ ~ t_1._J m Complete O Mon O Fri O Tue Q Sat O Wed (~ Unk Workzone{~ yes Complete O Yes O No School Bus O Yes O No Form ~ Section 79} Related School Zone O Yes O NO Related NOS PEAINDOTO Yes O No Mairtter-ance ~ ~* Inte 'on woe O 4 Way Intersection O 'Y' Intersection (~ Multi-Leg (~ Off Ramp O Railroad Crossing lntersedron * i ~~ c O Midblock (~ 'T' Intersection 0 Traffic Cirde! ~ On Ramp O Crossover O Other Round About * See Overta Route Number Segment (Optional} Travel lanes Speed Limit O North House Number (if applicable) m m ? O South ~ m Street Name Street Ending ~ (~ East For Mid-block cashes only. Use p, •,~ O West Postal House Number and make sure ~ m O O Unknown f~l4ed 'Pin lif u in th'K o na~ K ti g p s o d g O Interstate ~ Turnpike O Turnpike O State O County O Local Road O Private O Other/ (Not Turnpike) (East/West) Spur Highway Road or Street Road Unknown ~ ~ Route Number Segment (Optional) Travel Lanes Speed Limit Q North ,y c m 4 O South F Street Name Street Ending ~ O East ~ O West m O O Unknown ~ _ " $ Sianina Q Interstate O Turnpike O Tumpike O State O County O Local Road O Private 0 Other/ (Not Turnpike) (East/West) Spur Highway Road or Street Road Unknown Intersecting Rt Num Or Mile Pozt Or Segment Marker Feet p O N rth ~ ~ ~. ^ e N o a South ''o ~ ~ V Please Enter v Or Intersecting Street Name St Ending ~ ~ E ~ ~ O East O West Or Miles E ~ information for BOTH ~ m ~ ks a d L ment Marker tin Rt Num Or Mite Post Or Se t e i ~ an m r v ~ if Using This Option g ers c g n "~ c ^ O A ~ O North Distance From Crash Scene to Landmark t . „ O South +`N°1 V w ~ E ~ Or intersecting Street Name St Ending ~ ~ O East {For Crash between f-andmark 1 and ~ 1 m ~ O West Landmark 2) ~ Degrees Minutes Seconds Degrees Minu tes Seconds t°y m m Latitude. m Longitude: -- m ~ m'm 'm • L~L_! • L~1~ ~ rra€~c r'enrroi Device Police Officer or O Yield Sign ~ Flagman O Not Applicable O Traffic Signal Active RR Crossing O O Other Type TCD t~ FuncFinanina Emer e O No Controls >O Device Functioning O Preem t~e Improperly p i j flashing Traffic Controls O Si nal O Stop Sign O Passive RR O Unknown g Crossing Controls gnal S (~ Device Not O Device Functioning O Unknown Functioning Properly ~ rare nesed {ff •Not Applicable", skip rest of the Lane gosure section) Lar-e ~lnsw~e O North O East O North and South Q A11 ~ O Not Applicable O Partially O Fully O Unknown ~-~D Q South Q West (~ East and West (N,S,E,W) m ~C Fraffic Yes O No O Ret2Yl~d Unknov/n O ~'~~ Q < 30 Min. rO 30.60 Min. Q 1-3 hrs O 3-6 hrs O 6-9 hrs > 9 hours 0 Q Unknown Slued 1 a r e s FOB ° ~aa~c i'~i PENdMDOT COPY -. _._! , CO~MMOR1lNE~+LY40 OF IPEWWSVLVAWIA ~}4i'Ij~!!f {~I~I~~I~~~~ Crash Number _ POLICE CR/45F1 1REPOIRYIWG FORM Page O New ~0 U AA 5OU N Police Use Oily `,~ } L y,' 1~~ ~ ~ ~ ® ont,nuation r ~ ~ 7 S ` ~ b z2 Narrative and additional witnesses: A~~G !~~ R R~' ; (~~ ~ ~~ ON o2 S o~ ~ ~ IZ~ ~-~RS• `' u~sT~ T 'N~~ `" A FA"cA ~T '[ Z '~t nt ~- SR (~ `l ~k ~~ U~Sfl ~ ~ RD!~ ~ Mf~AD r C ~ R +~ -r 7 ~~.~ i ~ ~rl ~, -~oR ; . ~' a. oN o~ 1 0 -C 33 ~ ~ S 01 ~~ -T A tJ ~ o S 3~ hn L - t~ t~, ~ ~ L~~' - ~ ~ Z~ ~ LD1? ~ S . ~ E 'CPR , Rel. n~ NzE ~~p , A. a S~ D~IZ ~ -r suREM '~~ art ~c~-1E S~nl~ . o re ~a~ 1 ~ ~ ~ d RS. ~ ~ RZ ~ ~ E, ~ ~ F w RDA ~ ~ H a n ~H~ P c O~'CD L- ~~i~LO M 1~~~ ~~~ ~ tiU Ut)~ LL ~ N d ~ ~ ~ A ~~~ TRUD F R~ ~ S~ R\,11 I7. ,. ro ~~~. ~ Q ~ ~ t~~ ~"~ S, ~V ,# x Fonts r M~oou f~1 PEIVAfDOT COPY i ` - -- ~ i ~ COR/iR/IORIWEALTFI OF PEWRISYLV~IRIIA _ ~Jw w nn POLICE CIt~SF9 6tEPO1tTIRIG POiRM Page rv1JOO N Pdice Use Ony J „_ // ~/ / C 1 ~ New I~IU~~~I~~l~II~III{III Crash Number O Change/ r / ~ / o Continuation Y 7 Narrative and additional witnesses: _ ., ~ , On 02/ 18/07 at 1203 I, Tpr. Ronald C. CAREY, responded to a reported one vehicle versus a ree - pon my arrwa o serve a ue oyo a av ~ on i s passenger the occu ants. A second vehicle a red T t • v 4 w1 i ~_ corner of the intersection of W. Lisburn Rd. and Boiling Springs Rd. ~r - .. and hit the blue car causint; a violent im pact." ' ~ , _ _ ~, ~ o ora o ve., a tmoce, ,was assen er in the red Rav 4. BROWN t•elated that she did have leer seat W related that she was listening to her i-pud and did not know what happened. ~ ~ ~ •, ~, „ at the scene ~/ ~~ ' y the road" and that "everything happened so fast she does not know exactl what took pace. ROWN related that she was the drive-• of the red Rav 4 and xhat she did have 3 ~ e ime o e cras 1. A •# On 02/18/07 at i2~17 IlOUCS 1 rec nested throw=h tine CDC that C.A.R.S. AND F.S.U. be a' contacted due the crash being a fatality. this time I trans orted BROWN and her dau =hter from the sce Lisburn Rd. and Williams Grove Rd. where a friend picked them up. FORM IF pp3pON (~~p~ PEPINDOT COPY ,~.... COMAfIONVYEALTH OF PE1~iTISY1.VAN1A •• POLICE CRASH REPORTING FORM Pages AA 500 D h°°' °s ~"" l~Q~-/6y/l~S~ Arrival limes ^G~i ? ' Municipality: ~O ~ County: Cv~~E/u-~°'"r~ ? nmES at~c1~4~6~s~.c~ . a~S ` ~E~ ri~'t °F 4 ~~ ~~ ~~ ,SNOus +~AN ~ ~ ~ ~ ` +~R ` ? C J ~ ,i t i ' R Nn . ~ . n+P1~ ~ 3 N•w Crash NumI:K ~ .. Changed ~ P 1 ~ ~ ~ ~ 9 Condnuadon 2 ~ ~ a ~~ r? ~' 55 ~~ ~Iut ' . pd ~~ •._~ ,t.~-~ ~.r.J ~ ~ ~--srae szb.a tvos ~ Suw~ . ~r Q~~N pVti COPY LAST WILL AND TESTAMENT ~\ LAW OFFICES S NELBAKER B BRENNEMAN I, ROBERT P. STROUS, of the Borough of Mechanicsburg, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at i any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executrix or Executors or (Executor, as the case may be, hereinafter named, as soon as 'iconveniently may be done after my decease. SECOND. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated unto my wife, namely, SHIRLEY E. STROUS, absolutely and in fee simple, if she survives me by as many as sixty (oU) days. THIRD. If my wife, SHIRLEY E. STROUS, does not survive me by as many as sixty (60) days, then and in that event, I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, in equal shares unto my four children, namely, ZANE P. STROUS, ERIC R. STROUS, KIRK E. STROUS and LANCE M. STROUS, share and share alike, absolutely and in fee simple. If any of my said children should predecease me without leaving issue to survive me, then and in that event, I order and dir~act th=t the share of m_y estate othere:ise attributable to ary such deceased beneficiary shall lapse and my residuary estate shall be distributed among those surviving beneficiaries as -. ;• '1 i~ ~./ 1:`i~~l ~,.. :lJly QS ~C,I ~u ~G c~.~ LrLi, provided herein. r~~ LAW OFFICES SNELBAKER BRENNEMAN If, however, any of my said children should predecease me and leave lawful issue to survive me, then and in that event, I order and direct that the share of my estate otherwise attributable to such deceased beneficiary shall be distributed unto his issue per stirpes by representation and not per capita, subject, however, to the protective trust provisions set forth in Item Fourth hereinbelow with respect to any beneficiary who has not attained the age of twenty-three (23) years at the time of my i~ death. FOURTH. If any beneficiary of this, my Last Will and Testament, has not attained the age of twenty-three (23) years at 'the time of distribution of my Estate, I order and direct that the distributive share of such person shall be paid over and delivered unto MELLON BANK, N.A., (or its successor by merger, consolidation or other corporate reorganization) as my testamentary Trustee, IN TRUST, NEVERTHELESS, to hold, manage, invest, accumulate income and reinvest until said beneficiary attains the age of twenty-three (23) years, at which time said trust shall be terminated and the net proceeds thereof be paid over to the beneficiary absolutely. I authorize and empower my said Trustee to invest the assets of said trust in any reasonable manner and not be limited or restricted to so-called "legal" or statutory investments for fiduciaries. I designate any trust hereunder to be a spend-thrift trust. The beneficiary shall have no right to invade, pledge, assign or otherwise dispose of the assets of said trust (including income) nor shall any creditor of a beneficiary have any right to seize, levy or execute upon said assets by reason of -2- any pledge, assignment or other transfer, voluntarily or involuntarily, made by said beneficiary. I further authorize and empower my said Trustee to use, consume, expend and apply from time to time such amounts of principal and income of and from said trust which in the exercise of its sole discretion shall be determined to be reasonable and f necessary for the beneficiary's education. The term "education" shall be construed and interpreted to mean college or other post- highschool training which is intended to improve the beneficiary's productivity as an adult or enhance the quality of his or her life. In considering what is reasonable and necessary, my said Trustee shall take into consideration the primary responsibility of the beneficiary's surviving parent to I~provide such education. It is my will and intention that the foregoing discretionary provision for education shall be supplementary to the parent's primary responsibility. Z.ASTLY. I nominate, constitute and appoint my wife, SAIRLEY E. STROU5, to be the Executrix of this, my Last Will and Testament, but if for any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint my two sons, namely, ZANE P. STROUS and ERIC R. STROUS, to be the Executors hereof (or either of them in the event that one should fail to qualify as my personal representative or cease so to serve), each and all to serve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, ROBERT P. STROUS, have hereunto set LAW OFFICES S NELBAKER my hand and seal to this, my Last Will and Testament which >* H REMNEMAN ~i~ ,. consists of four (4) typewritten pages to each of which I have affixed my signature this 24th day of March A.D., One Thousand Nine Hundred Ninety-four (1994). __~ ~ ~~"~~' ( SEAL ) Robert P. Strous The preceding instrument, consisting of this and three (3) other typewritten pages, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by ROBERT P. STROUS, the Testator therein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have subscribed our names as witnes s hereto. ~;' `• -- ,~._. .. ~-~ LAW OFfICES SNELBAKER BRENNEMAN -4- COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) We, ROBERT P. STROUS, RICHARD C. SNELBAKER and JANET R. STEGNER, the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the best of his or her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Later Witness ---- : - i Witness ~ LAW OFFICES SNELBAKER B RENNEMAN (Subscribed, sworn to and acknowledged before me by ROBERT P. 'ISTROUS, the Testator, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANET R. STEGNER, witnesses, this 24th (day of March, 1994. Notary Public Seat/ ~,~ Pattida J. Ttmmsoe, ~~ ~ire5 Dec. 31,1934 R:i~rtber. Perxsyh"~ °~ ~' ~ ® ® Government Employees Insurance Company ^ GEICO General Insurance Company - ^ GEICO Indemnity Company - 9e1C®.C®1'f1 ^ GEICO Casualty Company One GEICO Boulevard ^ Fredericksburg, VA 1~~,;~?~,}CATION OF LIlVIITS To Whom It May Concern: This will certify that GEICO General Insurance Company has issued an automobile policy, 2007966845, to: Rayburn T. Brown 636 Colorado Ave. Baltimore, MD 21210-2103 that was in effect on the accident date of 02/18/07 providing the following coverage on a 2001 Toyota Rav4, Vehicle Identification Number (VIN) JTEHH2OV710058638: Bodily Injury Liability $20,000 per person/ Property Damage Liability First Part~~ Benefits Medical Expenses Income Loss Funeral Expenses Accidental Death Extraordinary Medical Benefits Uninsured Motorist Bodily Injury Stackable - Underinsured Motorist Bodily Injury Stackable - Comprehensive Coverage Collision Coverage Tort Option Rental Reimbursement Emergency Road Service H1 PA (11/OS) $40,000 per accident $15,000 per accident N/A per person NONE per person NONE N/A per person N/A per person N/A per person N/A per person/ N/A per accident N/A per person/ N/A per accident N/A deductible N/A deductible N/A N/A Per Day N/A Per Accident N/A r- Elaine Rensing Claims Manager a.~cx. Ln BIGRr~ ERIE ERIE _NSURANCE EXCHANGE ,~.I, INSURANCE PIONEER FAMILY AUTO POLICY ~ROePPI AMENDED DECLARATIONS O1 * * EFFECTIVE 11/,10/06 '~~ Erie. PA 16530 ATTACH THIS TO YOUR POLICY . ERIEm REASON FOR AMENDMENT - SEE *** ON FIRST DECLARATIONS PAGE AGENT ITEM ~.. POLICY PERIOD POLICY NUMBER AA7613 KENNETH P. FAUST 09/01/06 TO 09/01/07. Q09 0119747 H ITEM }. NAMED INSURED AND ADDRESS ITEM 3.OTHER INTEREST MELVEETA J LIDDICK 250 PEACH GLEN IDAVILLE RD GARDNERS PA 17324-9625 AS LISTED BELOW AGENT - KENNETH P. FAUST AGENT PHONE - (717) 564-1287 4930 CHAMBERS HILL RD. HARRISBURG PA 17111 2413 ************************************************************ * CONGRATULATIONS! A PIONEER EXPERIENCE RATING CREDIT HAS * BEEN APPLIED TO YOUR POLICY PREMIUM. ************************************************************ ITEM 4. AUTOS COVERED AUTO YR MAKE VIN ST TER SYM RATING CLASS 1 05 TOYO RAV4 AWD JTEHD20V356026879 PA 4F H A1AL FM65 ITEM 5. INSURANCE IS PROVIDED WHERE A PREMIUM, OR INCL, IS SHOWN FOR THE COVERAGE. COVERAGES, LIMITS AND ANNUAL PREMIUMS ARE AS FOLLOWS- M EQUALS THOUSAND $ #1 DDP *****GOOD DRIVER RATES APPLY***** --- THE FULL TORT OPTION APPLIES TO ALL PRIVATE PASSENGER VEHICLES. --- LIABILITY PROTECTION- BODILY INJURY $50M/PERSON $100M/ACC 105 PROPERTY DAMAGE $50M/ACC 103 FIRST PARTY BENEFITS- MEDICAL EXPENSE $5M 46 INCOME LOSS $1M/MONTH, $5M MAXIMUM 9 ACCIDENTAL DEATH $5M 2 FUNERAL BENEFIT $2.5M 2 UNINSURED MOTORISTS COVERAGE- BOD INJ $15M/PERSON $30M/ACC-STACKED 11 UNDERINSURED MOTORISTS COVERAGE- BOD INJ $15M/PERSON $30M/ACC-STACKED 34 PHYSICAL DAMAGE COVERAGES- COMPREHENSIVE - $250 DED 81 COLLISION - $250 DED 275 OPTIONAL COVERAGES- ROAD SERVICE 4 TRANSP EXPENSES - COMP $40/DAY, $1,800/LOSS 11 TRANSP EXPENSES - LOLL $40/DAY, $1,800/LOSS 24 TOTAL ANNUAL PREMIUM FOR EACH AUTO 707 TOTAL ANNUAL POLICY PREMIUM $ 707 ADDITIONAL CHARGE DUE TO THIS CHANGE $ 67 '-ITEM 6. APPLICABLE POLICY, ENDORSEMENTS, EXCEPTIONS TO DECLARATIONS ITEMS ALL AUTOS - FAP 04/97, UF2106 05/01, AFPNOl 10/98, AFPA03 04/03. AUTO 1 - AFPU01 07/06. ***AMENDED TERRITORY ***RATING CLASS REVISED ***MULTI POLICY DISCOUNT DELETED ***AMENDED ADDRESS OF NAMED INSURED ANTI-THEFT DISCOUNT APPLIES-ALARM AUTO 1 PASSIVE RESTRAINT DISCOUNT APPLIES - DUAL AIRBAGS AUTO 1 ANTI-LOCK BRAKE DISCOUNT APPLIED AUTO 1 N AGTKPF 11/14/06 01I22I20F_i8 ~i8: ~i5 ?1?5542545 FAUST INSURANCE FAGE X71 Applicant: MELVEETA J LIDDICK Page No: 9 Agsnt: AA7613 KENNETH H. FAUST Binder No: QJB-1234972 REQIIE$,i" FOR LOWER LIMITS DF IJNdERINStJRED MOTORIST CQVERAGiE ay signing this form, l am requesting for myself and members of my household underinsured motorist coverage in an amount less than the limits of my bodily injury IiatHiity coverage. I am knowingly and voluntarily rejecting underinsured motorist coverage in an amount equal to my bodily injury liability limits, Rather, I am requesting the following amount of underinsured motorist coverege: x15,001) EACH I'IItSON #30,dOQ EACH ACCIDENT _. _- EACI-t A,CCt[l1~NT {Combinod Single T~imit} ~..: X ~' ~~ p ~ ---, Signature First Named lnsuned Date ~1JLLJLij~~ ~^: 04 717564545 FAIJST INSURANCE RAGE 01 • ~~ Applicant: MELVEETA J LID[]IGK Paga Na: 8 Agent AA76f 3 KEIVNETI-I H. FAUST Binder Na: a9&1234972 REQUEST FC?Ft LOWI=R LIMITS OF UNINSURED MO'YORIST COVERAGE By signing this form, I am requesting for myself and members of my household uninsured motorist covr3rage in an amount less than the limits of my bodily injury liability ca~erage. I am knowingry and wluntarily rejecting uninsured motorist couenage in an amount equal to my bodily injury liability limits. Rather, I am requesting the following amount of uninsured matcrtst coverage: 516,000 EACH PER5ON 130,000 FACH ACCIDENT ~AC~-1 ACCIDENT (Combined Sizi~le t_,irnit) X First Named Msured ~ ~i ~ s~ Dste ~' C ® TEL: 1-600-fs-. -4000 FAX: 1-305-503-9276 geico.com GEICO GENERAL INSURANCE COMPANY 5260 Western Avenue, Chevy Chase, Maryland 20615 FAMILY AUTOMOBILE POLfCY RENEWAL DECLARATIONS Item 1: Named Insured and Address ROBERT P STROUS 300 S GEORGE ST MECHANICSBURG PA 1 7055-4 1 1 7 E-Mail Address: rsstrouspa aol.com Policy Number: 4054-56-37-49 U-31-DP (19) This is a description of your coverage. Please keep for your records. Date Issued: 10-30-06 ' Policy Period From 12-13-06 to 06-13-07 12:01 a.m. Local time at the address of the named insured. The insured vehicle(s) will be regularly garaged in the town and state shown in Item 1, except as noted in the Vehicle Segment. Contract Type: A30PA CONTRACT AMENDMENTS: ALL VEHICLES - A184 A30PA A54PA UNIT ENDORSEMENTS: A115 (VEH 1); A431 (VEH 1); A469 (VEH 1); A472 (VEH 1) - As a GEICO Family Auto Policyholder, when you or your spouse (if residing with you) rents a car in the United 5: States or Canada, the rental car is covered under your GEICO policy. The same policy provisions and conditions, coverage limits and deductibles that apply to your personal car also apply to the rental car. If you have more than ~' one car insured, the rental car would be covered with the broadest (highest limits, lowest deductibles) coverages ' included anywhere on your policy. Remember, Comprehensive and/or Collision coverages are extended only when you carry these coverages on your own vehicles. IMPORTANT: If you carry Multi-Risk coverage, the Mechanical Breakdown component does not extend to rental vehicles. -Any person who knowingly and with intent to injure or defraud any insurer files an application or claim containing any false, incomplete or misleading information shall, upon conviction, be subject to imprisonment for up to seven years and payment of a fine of up to $15,000. -Please review the reverse side of this page for coverage and discount information. -The GEICO Property Agency can arrange for your homeowner's, renter's and condominium owner's insurance needs. Just call toll-free at 1-888-306-9500. Refinancing? Let us provide the new Homeowner's Policy you need. -You are currently carrying the Full Tort Option on your policy. -Reminder -Physical damage coverage will not cover loss for custom options on an owned auto, including equipment, furnishings or finishings including paint, if the existence of those options has not been previously reported to us. Please call us at 1-800-841-3000 if you have any questions or wish to purchase additional coverage for customized equipment not included above. INSURED COPY PAGE 1 TURN OVER GEICO GENERAL INSURANCE COMPANY U-37-DP (20) Date Issued: 10-30-06 T-2 Policy Number; 4054-56-37-49 _ VEFIICLE RATED LOCATION CLASS 1 01 CHEV 2GCEK19V01 1 371 850 MECHANICSBURG PA 17055 A -N -75-79 B COVERAGES m _ LIMITS OR Coverage applies where a premium or 0.00 is shown for the vehicle. DEDUCTIBLES Vehicle 1 BODILY INJURY LIABILITY EACH PERSON/EACH OCCURRENCE '. $50,000/100,000 47.90 PROPERTY DAMAGE LIABILITY $50,000 53.40 FIRST PARTY BENEFITS OPTION U 36.20 UNINSURED MOTORISTS/WITH STACKING EACH PERSON/EACH OCCURRENCE $50,000/$100,000 15.90 UNDERINSURED MOTORIST/WITH STACKING EACH PERSON/EACH OCC.U.~RENCE $50,000/$100,000 12.70 COMPREHENSIVE X250 DED 21.40 COLLISION X500 DED 97.00 EMERGENCY ROAD SERVICE FULL 7.20 RENTAL REIMBURSEMENT $25 PER DAY 13.50 $750 MAX PREMIUMS Vehicle Vehicle SIX MONTH PREMIUM PER VEHICLE: $ 305.20 If you elect to pay your premium in installments, you may be subject to an additional fee for each installment. The fee amount will be shown on your billing statements and is subject to change. Premiums for these vehicles are based on the following Discounts and/or Surcharges: DISCOUNTS ANTI-LOCK BRAKES (VEH 1); ANTI-THEFT DEVICE (VEH 1); 5 YEAR GOOD DRIVING (VEH 1); PASSIVE RESTRAINT/AIR BAG (VEH 1) Lienholder Vehicle Lienholder Vehicle Lienholder Vehicle INSURED COPY PAGE 02 - _ _ ^ Government Employees Insurance Company ~~'~®`a ^ GEICO General Insurance Company ^ GEICO Indemnity Company ^ GEICO Casualty Company One Geico Blvd Fredericksburg, VA 22412-0004 09/27/2007 Angino & Rovner Pc Mr. Joseph Melillo 4503 North Front Street Harrisburg, PA 17110-1799 Company Name: GEICO General Insurance Company = Claim Number: 029228302-0101-027 __ Loss Date: February 18, 2007 Policyholder: Robert Strous Your Client: The Estate of Robert Strous Dear Mr. Melillo: _= This letter is in response to your letter dated September 20, 2007. GEICO hereby consents to your clients entering into the third party settlement and waives subrogation of the Underinsured Motorist Bodily Injury (UMBI) claim. If you have any questions or would like to discuss this matter please call me at the number below. Sincerely, Christine Faulhaber J205 (800)841-1003X7715 Claims Department E00020 ~~ Erse ti\. lnsur~nce Kerry J. Ritchey, CPCtI, AIC Resistant Vice President & Claims Manager Branch Office 4901 Louise Drive Rossmoyne Business Center P.O. Box 2013 Mechanicsburg, PA 17055-0710 717.795.8200 Toll Free 1.800.382.1304 Fax 717.795.2315 www.erieinsurance.com September 27, 2007 Joseph Melillo, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110-1799 Re: Your Client: The Estate of Robert Strous Erie Claim No.: 010170906009 Erie Insured: Melveeta Liddick Date of Loss: February 18, 2007 Dear Mr. Melillo: I am in receipt of both your letters dated September 20, 2007. Be advised, Erie will be in a position to waive our subrogation rights versus Ms. Brown when you are in a position to conclude the claim with her carrier Geico Insurance. In regard to your request for a certified copy of Ms. Liddick's policy. Be advised, I have forwarded an authorization to Ms.Ziddick and once T receive the completed authorization, I will ask our Home Office to respond directly to your request. If you have any questions please contact me. Since y, glas G. Kocher Claims Representative (717) 774-5007 The ERIF Is Above All In Service. We commit, care and serve. It's our true blue promise. __ _ -- J ~ ~ ~ ~ ~ ~. ~ ~~~ . rr ss ~e~~~ OF ~~~ ~ ~~ : Personally appeared before me, a Notary Public, in and for said Commonwealth and ~ J G County, Svetlana Brown, who resides at ~j ( C~ L ~ %? CZ ~'( t7 ~U~ ~C ~~~~~'~ ~ l'YI/~~ ~~./u and who, being duly sworn according to law, deposes and states that on or about February 18, 2007, the date of the accident, in Cumberland County, Pennsylvania, that is the subject of GEICO Claim No. 017959847-0101-047, I did not have any other applicable automobile insurance policy, liability policy, umbrella policy, or excess coverage of any kind that would apply to this accident other than that provided under Policy Number 2007966845, providing coverage on a 2001 Toyota RAV4, V1N JTEHH20V7100586~8, in the amount of $20,000.00 per person, $40,000.00 per accident. I represent and swear that there was no other insurance coverage whatsoever available to indemnify me for any judgment obtained by the personal representative of the Estate of Robert Strous, against me because of said accident. I further affirm that the facts set forth in the foregoing are true and correct to the best of my knowledge, information and belief. SVETLANA BROWN Swom to and subscribed `f~'1 before me this ~ day of _~ ;vii, '~;~~,(,•1~ , 2008. .~''G~~~~'~'y No ary Public FE ~~ ~ i' P~ -~, ~; 'J'ir1 ~ i 376026 ~ 1 r l7-~:"~ ~ Z- Y ~. ,_ RELEASE IN FULL OF ALL CLAIMS CLAIM #017959847-0101-047 Uwe, Zane P. and Eric R Strous administrators of the estate of Robert P. Strous, Releasor(s), Of City of MechanincsburgState PA Being over the age of majority, for and in consideration of a draft for the sum of twenty thousand and 00/100 dollars ($20,000.00), lawful money of the United States of America to me/us in hand paid, the receipt of which is hereby acknowledged, do for myself/ourselves, my/our heirs, executors, administrators, successors and assigns, hereby remise, release, and forever discharge Rayburn T. and Svetlana V. Brown. Releasee(s), successors and assigns, and/or his, her or their associates, heirs, executors and administrators, and all other persons, fums or corporations of and from any and every claim, demand, right or cause of action, of whatever kind of nature, on account of or in any way growing out of any and all personal injuries and consequences thereof including, but not limited to, all causes of action preserved by the wrongful death statute applicable, any loss of services and consortium, any injuries which may exist but which at this time are unknown and unanticipated and which may develop at some time in the future, all unforeseen developments arising from known injuries, and any and all property damage resulting or to result from an accident that occurred on or about the 18th day of February, 2007, at or near Lisburn Rd in Mechanicsburg, PA. and especially all liability arising out of said accident including, but not limited to, al] liability for contribution and/or indemnity. AS A FURTHER CONSIDERATION FOR THE MAKING OF SAID SETTLEMENT AND PAYMENT, IT IS EXPRESSLY WARRANTED AND AGREED: (1) That Uwe understand fully that this is a final settlement and disposition of the disputes both as to the legal liability for said accident, casualty, or event and as to the nature and extent of the injury, illness, disease, and/or damage v~~hich Uwe have sustained and Uwe understand that liability is denied by Rayburn T. and Svetlana V. Brown Releasee(s), and it is covenanted and agreed between the Releasor(s) and Releasee(s) herein that this release and settlement is not to be construed as consent or an admission of liability on the part of said Releasee(s); that this release and settlement agreement shall not be used by said Releasor(s) or any one on his behalf as a defense or estoppel in any action which is now pending or may be brought hereafter by said Releasee(s) against said Releasor(s) or his agents and servants, and any claim or whatever kind or nature the Releasee(s) might have or hereafter having arising from said accident is expressly reserved to them. (2) That the undersigned will indemnify and save harmless the Releasee(s) from any and every claim or demand, of every kind or character which may ever be asserted by reason of said injuries, illness, or disease or the effects or consequences thereof, or damage to property or person. (3) That no promise, agreement, statement or representation not herein expressed has been made to or relied upon by me/us and this release contains the entire agreement between the parties. 1N WITNESS WHEREOF, Uwe have hereunto set my/our hand and seal this day of THIS IS A RELEASE (SIGNATURE) IN FULL (SIGNATURE) CERTIFICATE OF WITNESSES We certify that this release was signed in our presence by the above who acknowledged that he/they understood it fully. WITNESS WITNESS STATE OF COUNTYOF ADDRES ADDRESS 20 On this day of 20 ,before me personally appeared to me known to be the person(s) named in and who executed the above release and acknowledged that _ executed the same as own free act and deed. (OFFICIAL TITLE) C-27 (11-00) NS MEMBER NATIONAL INSURANCE CRIME BUREAU Page 1 oft CLAIM #: 010170906009 SS Under policy # Q09-0119747 issued by ERIE INSURANCE EXCHANGE/ERIE INSURANCE COMPANY, I/We, claiming coverage for myself/ourselves or on behalf of The Estate of Robert P. Strous in consideration of Fifteen Thousand ($15,000.00) dollars, which I/We have received, RELEASE AND DISCHARGE ERIE INSURANCE EXCHANGE/ERIE INSURANCE COMPANY from any and all claims, causes of action or other rights which I/We have, have had or could have under the Underinsured Motorists coverage as set forth in said policy, which claims, causes of action or other rights arose or could have arisen as a result of a loss or accident which happened on the 18th day of February, 2007, at or near The Intersection of Boiling Springs Road and West Lisburn Road, Monroe Township, in the county of Cumberland, in the State of Pennsylvania. In consideration of such payment, I/We agree as follows: 1) to assign Erie Insurance Exchange/Erie Insurance Company to my/our rights of recovery against any person(s) or party(ies) legally liable to me/us, to the amount of and for the purpose of the payment noted above; 2) that UWe have not and will not make any separate settlement with nor give any separate release to any person(s) or party(ies) who caused or are alleged to have caused the above mentioned loss or accident; 3) that suit may be instituted by Erie Insurance Exchange/Erie Insurance Company in my/our name; 4) to execute all papers required to commence such suit; and 5) to cooperate in prosecuting any or all actions which Erie Insurance Exchange/Erie Insurance Company may bring to recover from any person(s) or party(ies) for the claims or causes of action which I/We have growing out of said loss or accident. It is expressly understood and agreed that, out of any amount recovered, costs of collection, including by not limited to counsel fees, shall be first paid to ERIE INSURANCE EXCHANGE/ERIE INSURANCE COMPANY. Except in states which apply comparative negligence in determining legal liability, any recovery in excess of collection costs shall be paid to me/us, up to the full extent of my/our loss. In states which apply comparative negligence, any recovery of my/our loss, in excess of collection costs, shall be reduced by a factor equal to the percentage of my/our negligence which contributed to cause the above mentioned accident, before it is paid to me/us. I/We further understand and agree that this RELEASE AND AGREEMENT is inclusive of any and all present and future liens or claims for subrogation against the payments to be made in accordance with this RELEASE AND AGREEMENT. UWe understand and agree that Uwe are responsible for the payment of any liens or charges against the payments to be made hereunder should any such liens, subrogation, claims or claims for expenses and charges be asserted. This includes, but is not limited to, medical expense liens, worker's compensation liens, ERISA liens, liens asserted by any federal, state or local governmental entity or agency or any medical expense claim. Should any person or entity make claim for payment of any liens or charges against ERIE INSURANCE EXCHANGE/ERIE INSURANCE COMPANY or their counsel, Uwe agree to indemnify and hold harmless ERIE INSURANCE EXCHANGE/ERIE INSURANCE COMPANY and their counsel from any and all such liens, chazges, fees, claims, attorney fees, costs, interests and any other sum I/We understand that this settlement is the compromise of a disputed claim, and that the payment is not to be construed as an admission of liability on the part of the persons, firms and corporations hereby released by whom liability is expressly denied. (CAUTION: READ BEFORE SIGNING) Intending to be legally bo~.u:d LLhereby, V:TITI`?ESS my/cur hand(s) and seal(s) this day cf Witnessed by: STATE OF COUNTY OF On this day of to me known to be the person _ executed the same as My commission expires RELEASE AND AGREEMENT (SEAL) (SEAL) ,before me personally appeared , who executed the foregoing instrument, and acknow]edged that free act and deed. Notary Public 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. RELEASE AGREEMENT Claim Number: 029228302-0101-027 I/We, Zane P. and Eric R. Strous administrators of the estate of Robert P. Strous, Releasor(s), of Mechanicsburg, Pennsylvania, being over the age of majority, for and in consideration of a draft for the sum of Fifty thousand dollars ($50,000.00), lawful money of the United States of America, to Zane P. and Eric R. Strous in hand paid, the receipt of which is hereby acknowledged, do for ourselves, our heirs, executors, administrators, successors and assigns, herby remise, release and forever discharge Government Employees Insurance Company, Releasee, its successors and assigns, from any and all claims for Underinsured motorist benefits arising under the terms and conditions of Policy No. 4054563749. Arising as a result of any and all loss and injury which may now exist, but which at this time may be unknown and unanticipated or which may develop at some time in the future, or any and all unforeseen developments arising from said injuries from an accident that occurred on or about the 18th day of February, 2007, at or near Lisburn Road in Mechanicsburg, PA. As a further consideration for the making of said settlement and payment, it is expressly warranted and agreed. That this is a final settlement and disposition of the disputes for any and all legal claims for Underinsured motorist benefits resulting for said accident, the liability for which is denied by Government Employees Insurance Company, Releasee, and it is covenanted and agreed between Releasor(s) and Releasee herein that this release and settlement is not to be construed as consent or admission of liability on the part of Releasee, and that this release and settlement agreement shall not be used by Releasor(s) or any one of them as a defense or estoppel in any action which is now pending or may be brought hereinafter by Releasee against the Releasor(s) or its agents and servants on any claim for Underinsured motorist benefits arising from said accident. The undersigned will indemnify and save harmless Releasee from any and all claims and demands for Underinsured motorist benefits of any kind or character which may be asserted by reason of said injuries, illness or disease, or the effects or consequences thereof. That no promise, agreement, statement or representation not herein expressed has been made to or relied upon by Zane P. and Eric R Strous ,and this Release contains the entire agreement between the parties. IN WITNESS WEREOF, we have hereunto set our hands and seals this day of 20 Witness Witness PA UM/LIIM (11/03) _ BUREAU OF INDIVIDUAL TAXES _ INHERITANCE TAX DIVISION - Po Box 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE WEB ADDRESS VJWW.state.pa.us April 1, 2008 Joseph M. Melillo Angino & Rovner, PC 4503 N. Front St. Harrisburg, PA 17110 Re: Estate of Robert P. Strous File Number: 2107-0176 Court Number: CCP Cumberland Co. No. 21-07-0176 Dear Melillo: The Department of Revenue has received the Petition for Approval of Settlement Claim to be filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action. It has been forwarded to this Bureau for the Commonwealth's approval of the allocation of the proceeds paid to settle the actions. Pursuant to the Petition, the 77-year-old-decedent died as a result of a motor vehicle accident. Decedent is survived by his adult children. Please be advised that, based upon these facts and for inheritance tax purposes only, this Department has no objection to the proposed allocation of the net proceeds of this action, $28,770.27 to the wrongful death claim and $19,935.99 to the survival claim. Proceeds of a survival action are an asset included in the decedent's estate and are subject to the imposition of Pennsylvania inheritance tax. 42 Pa. C.S.A. §8302; 72 P.S. §§9106, 9107. Costs and fees must be deducted in the same percentages as the proceeds are allocated. In re Estate of Merryman, 669 A.2d 1059 (Pa. Cmwlth. 1995). I trust that this letter is a sufficient representation of the Department's position on this matter. As the Department has no objections to the Petition, an attorney from the Department of Revenue will not be attending any hearing regarding it. Please contact me if you or the Court has any questions or requires anything additional from this Bureau. Finally, the approval of this allocation is limited to this estate and does not reflect the position that the Department may take in any other proposed distribution of proceeds of a wrongful death/survival action. Sincerely, ~l ~c . l/'~ ,~ Holl A. McClintock ~ Y Trust Valuation Specialist Inheritance Tax Division Bureau of Individual Taxes PHONE: 717-787-1794 FAx: 717-783-3467 EMAIL: hmcclintocC~state.pa.us O O O O O O O O N N O 0 0~ O O ~ O ~ Lf~ O ~ ~ ~ ~ O O i~ O~ N O N N Op d~ tf~ ~ N tt~ tt~ M I` O~ f~ lf~ In (f} ~ r ER ~ ~ ~ M F" ~ r !~} ER E!-} ~ Efl EA CO Ef? Efl O ~ ~ ~ V 0 F... W ~"" ~" N O W V m ~ O O ~ u. z O N w a ~ o 0 0 0 ~ o o , , , ~ ~_~_~ a~ m m .a ~, rn ~ ~ ti W _ _ _ ~ ~ ~ N ~ N O (If (a (15 O . ~ O W N N N N N N~ N G N U- C ~ C C C C C ~ ~ ~ ~ ~ ~ L.L. F " N Li. 0 ~ ~/ O Q L ~ S G ~ ~ ~ O W U ~ ~ ~ d F- O ~ .~ N 0 a ~ o o ~ ~ U ~ ~ ~ Z ~ a q O ~ c n o ~ ~ H- O Q ~~~~~~ ~~~~ ~cn t-" ~ (' oZf atS ~S otS ots a2S O oZS atS o2S ~ a- ~ ; Q Q Q Q Q Q U Q Q Q U~ U ~ , J r~ ti ti ti~~~~ ti ti W o 0 0 0 0 0 0 0 0 0 0 I- 00 ~ N o0 N O o0 a0 ~- 00 ~' Q NOON ~- N t- NON ~ O N M M M~ ti M N M M 0~0 0 0 0 0 0 0 0 0 0 0 0 >C rn~ O M VERIFICATION I, Zane P. Strous, Petitioner, have read the foregoing Petition for Approval of Settlement and do hereby declare and affirm that the facts set forth therein are true and correct to the best of my knowledge, information and belief. I understand that this Verification is made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities. WITNESS: Date: ,i ,~- ~~ane P. Strous 380145 VERIFICATION I, Eric R.. Strous, Petitioner, have read the foregoing Petition for Approval of Settlement and do hereby declare and affirm that the facts set forth therein are true and correct to the best of my knowledge, information and belief. I understand that this Verification is made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities. WITNESS: Date: ~' S 't Eric K. Strous 380145 ~•a ANGINO & ROVNER, P.C. Joseph M. Melillo, Esquire Attorney ID No.: 2621 1 4503 North Front Street Harrisburg, PA 17110-1708 (717)238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: jmelillo@angino-rovner.com In Re: Estate of ROBERT P. STROUS deceased, Petitioner THE COURT OF COMMON PLEAS ~MBERLAND COUNTY, PENNSYLVANIA O. 21-07-0176 CERTIFICATE OF CONCURRENCE I, Kirk E. Strous, identified as a beneficiary in the Petition for Approval of Settlement, hereby concur in the settlement and distribution proposed. Date: ~ KIRK E. STROUS 380143 ar ~ s- ANGINO & ROVNER, P.C. Joseph M. Melillo, Esquire Attorney ID No.: 2621 1 4503 North Front Street Harrisburg, PA 17110-1708 (717)238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: jmelillo@angino-rovner.com In Re: Estate of ROBERT P. STROUS, N THE COURT OF COMMON PLEAS deceased, CUMBERLAND COUNTY, PENNSYLVANIA Petitioner O. 21-07-0176 CERTIFICATE OF CONCURRENCE I, Lance M. Strous, identified as a beneficiary in the Petition for Approval of Settlement, hereby concur in the settlement and distribution proposed. ~'- ~ ~ ~~~ Date: ~, ~ ~~~ ~' LANCE M. STROUS 22''z=t/~--' 380143 CERTIFICATE OF SERVICE AND NOW, this ~ $~ day of April 2008, I, Richard C . Snelbaker hereby certify that a true and correct copy of the foregoing was sent to the followin indiv~d ads g ~~~ by placing same in the first class, United States mail, eck-~ sj~ur~ postage prepaid, at ~ ennll~isylvania, addressed as follows: Kirk Strous 16 Circle Drive Camp Hill, PA 17011 Lance Strous 6192 Haymarket Way Mechanicsburg, PA 1.7050 Rated: April X18 , 2008 379335 ~~-~ ichard C. Snelbaker Snelbaker & Brenneman, P. C. 44 West Main Street Mechanicsburg, PA 17055 Attorneys for Estate of Robert P. Strous, Deceased. 6