HomeMy WebLinkAbout04-1135SHIPPENSBURG/ IN THE COURT OF COMMON PLEAS OF
SOUTH HAMPTON MANOR, L.P. CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff,
NO. 2004- II,.~ CIVIL TERM
V.
LEROY BARNETT and CIVIL ACTION-LAW
KATHY BARNETT, individually
and as the attorney-in-fact for
Leroy Barnett,
Defendants.
NOTICE
You have been sued in court. If you wish to defend against the claims set forth in the
following pages, you must take action within twenty (20) days after this complaint and notice are
served, by entering a written appearance personally or by an attorney and filing in writing with
the court, your defenses or objections to the claims set forth against you. You are warned that if
you fail to do so, the case may proceed without you and a judgment may be entered against you
by the court without further notice for any money claimed in the complaint or for any other claim
or relief requested by the plaintiff. You may lose money or property or other rights important to
you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION
ABOUT HIR1NG A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE
TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER
LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.
Cumberland County Bar Association
32 South Bedford Street
Carlisle, Pennsylvania 17013
(717) 249-3166
SHIPPENSBURG/ IN THE COURT OF COMMON PLEAS OF
SOUTH HAMPTON MANOR, L.P. CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff,
NO. 2004-//~ CIVIL TERM
V.
LEROY BARNETT and CIVIL ACTION-LAW
KATHY BARNETT, individually
and as the attorney-in-fact for
Leroy Barnett,
Defendants.
COMPLAINT
NOW, comes Shippensburg/South Hampton Manor Limited Partnership, ("Shippensburg
Health"), by and through its attorneys, O'BRIEN, BARIC & SCHERER, and files the within
Complaint and, in support thereof, sets forth the following:
1. Shippensburg/South Hampton Manor Limited Partnership is a Maryland limited
partnership duly authorized to conduct business in the Commonwealth of Pennsylvania.
2. Defendant, Leroy Barnett, is an adult individual with a residence address of 121
Walnut Bottom Road, Shippensburg, Cumberland County, Pennsylvania.
3. Defendant, Kathy Barnett, is an adult individual with a residence address of2611
Breezy Point Road, McConnellsburg, Fulton County, Pennsylvania.
4. Shippensburg Health operates a resident skilled nursing facility (the "facility")
located at 121 Walnut Bottom Road, Shippensburg, Cumberland County, Pennsylvania.
5. On or about July 22, 2003, Kathy Barnett sought to have Leroy Barnett admitted
to the facility.
6. On or about July 22, 2003, Kathy Barnett, as the attorney in fact for Leroy Bamett,
executed an Admission Agreement to have Leroy Barnett admitted to the facility. A true and
correct copy of the Admission Agreement is attached hereto as Exhibit "A" and is incorporated
by reference.
7. On or about July 22, 2003, Leroy Barnett became a resident of the facility.
8. On or about March 20, 1998, Kathy Barnett became the attorney in fact for Leroy
Barnett by virtue of a certain durable Power of Attorney. A true and correct copy of said Power
of Attorney is attached hereto as Exhibit "B" and is incorporated by reference.
9. Upon information and belief, the Power of Attorney has never been revoked.
10. As of February 24, 2004, there remains outstanding the sum of $34,818.00 in
accrued costs of care and services provided by Shippensburg Health to Leroy Barnett.
11. A true and correct statement of the amount due and owing is attached hereto as
Exhibit "C" and is incorporated by reference.
12. Demand has been made upon Kathy Barnett to pay, from the assets of Leroy
Barnett, the amount due and owing.
13. Demand has been made upon Leroy Barnett to pay the amount due and owing.
COUNT I- BREACH OF CONTRACT
SHIPPENSBURG HEALTH v. LEROY BARNETT AND
KATHY BARNETT, INDIVIDUALLY and as attorney in fact for Leroy Barnett
14. Plaintiff incorporates by reference paragraphs one through thirteen as though set
forth at length.
15. All conditions precedent to recovery under the Admission Agreement have been
fulfilled.
16. Kathy Barnett is obligated to use the assets and income of Leroy Barnett to satisfy
the debt due and owing to Shippensburg Health for the services and care provided to Leroy
Barnett by Shippensburg Health. Upon information and belief, Kathy Barnett has taken the funds
of Leroy Barnett and applied them for her own use and benefit.
17. Leroy Barnett is obligated to pay the costs of his care provided by Shippensburg
Health which are not covered by a third party payor.
18. The amount due and owing is not covered by a third party payor.
19. Leroy Barnett and Kathy Barnett, his attorney in fact, have breached the
Admission Agreement by failing and refusing to pay for the services and care rendered.
20. The Admission Agreement provided, in relevant part, as follows:
Penalties
We may not charge you interest if you pay your bill in time. Your payment is on
time if it is made within 45 days of the date the bill is post marked, or 30 days
after the end of the billing period, whichever is later. The penalty we charge is
5% of the amount due, calculated on a per day basis. If you or your representative
do not pay the money you owe us and we hire a collection agency or attorney, you
agree to be liable for their fees and court costs.
21. Late fees on the gross amount owed will run at $4.77 per diem.
WHEREFORE, Plaintiff requests judgment in its favor and against the Defendants for the
sum of $34,818.00 plus costs, expenses, interest, late fees and attorney fees.
COUNT II- MONEY ItAD AND RECEIVED
S}IIPPENSBURG ItEALTIt v. KATHY BARNETT
22. Plaintiff incorporates by reference paragraphs one through twenty-one as though
set forth at length.
23. During the period of Leroy Bamett's residency at the facility, Kathy Barnett has
received the sum of at least $16,216.00 in pension and social security benefits paid to Leroy
Barnett.
24. The proper use of these funds would have been to pay the costs of care accruing
for the care of Leroy Barnett at the facility.
25. At the time of receipt of these funds, Kathy Barnett knew she was obligated to pay
these funds over to Shippensburg Health for the costs ofLeroy Bamett's care at the facility.
26. Kathy Barnett gave no consideration for the funds of Leroy Barnett received by
Kathy Barnett.
27. Demand has been made upon Kathy Barnett to tender the funds of Leroy Barnett
to Shippensburg Health and she has failed and refused to do so.
WHEREFORE, Plaintiff requests judgment be entered in its favor and against Kathy
Barnett requiring her to:
a) return the subject matter in specie;
b) pay over the value if Kathy Bamett has consumed the money in beneficial use;
c) pay its value if Kathy Barnett has disposed of the funds received; and
d) award costs, expenses and interest.
Respectfully submitted,
O'BRIEN, BARIC & SCHERER
David A. Baric, Esquire
I.D. # 44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
Attorney for Plaintiff
dab.dir/shcc/barnett/eomplaint.pld
03/09/2004 15:57 7172495755 OBS PAGE 02
VERIFICATION,
The statements in the for~goJ.ng Complaint are based upon inforraation which has been
assembled by my attorney in this l.itigation. The language of the statements is not my owa, I
have read the s~atements; and to the extent that they are based upvn information which I have
given to my counsel, they are true and correct to the best of my l~owledg¢, information and
belief. I understand that false stmements h~rein are mad~ subject to the pcnal~es of 18 Pa.C.S. §
4904 relating to answom falsificat~.ons to authorities.
~/~ /.arty Coffl¢, Aclminis~'ator
Shippensburg Health Care C~nt~r
121 Walnut Bottom Road (717) 530-8300
Shippensburg, Pennsylvania FAX (717) 530-8304
17257-9005 TTY 1-800-654-5984
ADMISSION AGREEMENT
Ti'tis ??greeme~t i3 bg~veen Sh}p;ofn~burg Health Car~, Center (the "Facility" or "we" and)
_ ~Q.~ ~~__ (t,~e 'Resident' or~ you ) and, if 5ou or the court have
designated ~m~dividual to act on your bghalf, or t3er, is another individual to act ~ your
beEalf; or operation of law, ~h~ ~ ~ ("your representative ). A
chec~ist of the rights and responsib~ies applicable to your representative is listed in Exhibit 1
,tt~cl is i~corI~orated into this A=.t.
P~vin~ for Your Care
If you are applying to this facility ~s a private*pay resident, you must provide all financial
info~ation requested by us. If we later find that the information you or your representative
prc, vided was incomplete or inaccurate; we will consider that as a breach of tiffs Agreement
~hi::h gives us the right to pursue all I,..ga, remedies against you or your representative.
~j'l~o Can Be Required to Pay for Your C~re
Only you and your insurer can be required t<~ pa? for your care. No cqh~erg~m (i.e. a ~lrp/iy
~en~ber, fi'ice,d, neighbor,_=.~-~l representative or gt~ard~an) can be requit'e,:l to pay from their
own lands ~br your care, althoeg}~ ~e or she may know}ngly and v~)luntar~ls' agree to guarantee
p,~?~:~ent for tl:e cost of your care. We requi~'e the person responsible for ma~ng payments on
Ock,,l, t~ pa2; fo, ~our care under th. terms o[ t~, c:~,,~,'act m a tin, Ay manne..
If 3o ',re a beneficiaff of Meclicare, Medicaid or any other third-p:~ny payment plan, your
representative agrees to make all necessaq,~ payments fi'om your lands. Your representative
could face a civil penalty for intentionally failing to pay required amounts [Yom your hnds and
could face a crimSnal penalty for abusing your funds.
Private Pay Residents
The ~tems and se~'ices included in our daily n~te is basic room, board and general nursing care as
required b>~ your medical condition. Payment tbr items and semices that are included in the
daily rate and is payable one month in advance and due on the first of each month. Items and
seduces included in your daily rate are listed in Exhibit 2A.
You will be cha~ed separately for additional items and se~-ices not included in our daily rates
st.~clt as special nursing care, special equipment, pham~acy charges, laborato~ charges, medical
transportation and additional services such as telephone expense, dff clea~ng, beauty and barber
se~'ices and newspapers. Items and semices for w~ch you w~ll be charged are listed in E~bit
2B. Payment for these additional items and se~ices are due after you have requested them, and;
you have received and have been billed for them. WitCh 30 days ofreceidng an item or se~ce,
you have the right to ask us for an itemized financial statement that briefly but clearly describes
each item and the amount charged for it. You will be given an updated listing of services and
related charges, including an]< charges for services not covered under Medicare or by the
facilities basic per diem charges, annually on or about January 1 of each year.
Medicare Residents
We participate in the Medicare Program. Medicare may pay for some or all of your nursing
home care. For information on Medicare, see Exhibit 3, If you are eligible for Me~ticare, you
have the right to have claims/'or your nursing home care submitted to Medicare.
Medicaid Residents
We participate in the Medicaid program. For information on Medicaid, see Exhibit 3. You are
not required to give up any of your rights to Medicaid benefits to be admitted or to stay here. If
your private fimds are used up during your stay here and you are eligible for Medicaid; we will
accept Medicaid payments althoflgh Medicaid may require you to pay some amotmt in addition
to what Medicaid pays for your care. If you are planning on applying to Medical Assistance
later, you may want to find out now if your are "medically eligible" for nursing home payment
by Medicaid.
You are responsible for applying for and obtaining Medicaid benefits and we will assist you. We
may not charge, ask for, accept or receive any gift, mone)', donation or consideration other than
Medicaid reimbursement as a condition of your admission or continued stay here except that
Medicaid may require you to pay certain amounts from your private funds.
If you receive Medicaid, most of your nursing home charges such as room, board, and general
nursing care are covered, For a list of services covered by Medicaid, see Exhibit 4.A. The local
Board of Assistance will tell you whether you have to pay part of the charge for your care and, if
so, how much. Some of the items and services that we offer are not covered by Medicaid. If you
want any items or services, ~vhich are not covered by Medicaid, you or your representative will
have to pay for them. A list of the items and services not covered by Medicaid and the charges
for them are in Exhibit 4.B. Payment for items and services that are not covered by Medicaid is
due after you have requested them, and; have received and have been billed for them. Within 30
days of receiving the item or service, you have the right to ask us for an itemized statement that
briefly but clearly describes each item and the amount charged for it.
Increases in Char~es and Fees
Any time we increase a fee or charge for item or service or add a new item or service, we will
provide you and your representative with 30 days advance written notice.
Penalties
We may not cha~e you interest if you pay your bill in time. Your payment is on time if it is
made within 45 days of the date the bill is post marked, or 30 days after the end of the billing
period, wNchever is later. The penalty we charge is 5% of the amount due, calculated on a per
day basis.
If you or your representative do not pay the money you owe us and we hire a collection agency
or attorney, you agree to be liable for their fees and court costs.
Private Duty Nurses Geriatri~ Aides
If you want a private duty nurse or a private duty geriatric aide, you are responsible for selecting
a person licensed and/or certified according to Permsylvan/a laws and regulations. You are also
responsible for paying him or her and for letting us know that you have hired one. The person
you hire is not an employee or agent of the facility, but he or she must meet our sta, ndards and
follow our policies and prockdures. Employees of the Facility may not serve as private duty
nurses or private duty geriatric aides.
ltoldine Your Bed if You Leave the Facilitw
If you are hospitalized or on leave from the Facility, we will hold your bed for you as follows:
A. If you are private-pay resident, or are receMng in?atient care reimbursed under Medicare
Program (and you are not covered under Medicaid), unless you notify us otherwise, we
will hold your bed for as long as you pay for it at the daily rate you are currently being
charged.
B. If Medicaid pays for part or all of your nursing home care and you need to be
hospitalized, we will hold your bed for up to the ma.,dmum number of days required by
this state, currently 15 days. If you leave for any other reason, we ~vill hold your bed for
up to the maximum number of days required by this state, currently 18 days. You have a
right to be readrnitted to the facility to the first available appropriate bed. While we are
holding your bed, you are still required to pay the Facility any amount for which you are
liable as determined by the Medicaid Program.
C. If you have applied for Medicaid, your bed will be reserved in accordance with Paragraph
B. However, if you are found to be ineligible for Medicaid, then you are required to pay
for the bed as a private pay resident as described in Paragraph A.
D. Other third-party payers may or may not have a bed hold policy. We will discuss this if it
applies to you.
Your Rk, ht to Make Coml~laints and Surest Chan~es in Policies and Services
As a nursing home resident, you have many rights according to State and Federal law. These are
described in detail in Exhibit 6, wkich is attached and is part of this Contract.
You may make complaints about your care in the Facility and you may also suggest changes in
the policies and services of the Facility. You will not be harassed or discriminated against for
making a complaint or suggesting a change in a policy or service. You may present your
complaints to facility, management company or to one of the following State agencies:
Larry D. Cattle, LNHA Peter E. Perini, St,
Administrator President
Shippensburg Health Ca, re Center Magnolia Management, Inc.
12 l Walnut Bottom Road l 7 l0 Underpass Way
Shippensburg, PA 17257 Hagerstown, MD 21740
717-5304300 301-745-8700
Ombudsman Department of Health
Office of Aging 100 North Cameron Street
16 West High Street 2na Floor
Carlisle, PA 17013 Harrisburg, PA 17101
717-240-6110 717-783-3790
717-532-7286 Ext. 6110
Your Risht to Make Decisions
You have the right to make your own medical decisions and to manage your personal affairs. If
you become disabled, it may be necessary for someone else to make decisions for you. For this
reason, we recommend that you have a living will and/or advance directive for medical decisions
and a financial Power of Attorney but you are not required to do so. See Exhibit 7 for a
description of your legal rights to decide about your future medical treatment.
Transfer. Relocation and Discharge
You have the right to remain here, and you may not be transferred, relocated or discharged
against your will, except for the following reasons: (1) A medical reason (i.e. the facility cannot
provide the k/nd of care that you need, your condition has improved so that you no longer need
the care we provide, or a medical emergency arises; (2) Your welfare or the welfare of other
residents or staff; (3) Nonpayment for a stay, or (4) the Facility ceases to operate~
If we decide that you should be transferred or discharged, we will notify you, and an immediate
family member or legal representative, by letter 30 days in advance. If you are transferred
because of an emergency situation, we will provide the required notice as soon as practicable.
The letter will contain the reasons for the transfer or discharge and its effective date. The letter
will also tell you how you can appeal our decision to transfer or discharge you.
If you are discharged involuntarily, we will attempt to make other appropriate arrangements for
3'our care. However, if other arrangements are not available, your representative agrees to accept
you into his or her custody if it is medically appropriate.
Your Right to End This Contract
If you decide to end this Contract and leave the Facility, you must pay your bill before you leave.
You must give us five (5) days written notice to terminate t?fis contract. If you leave before the
end of that time, you must still pay for each day of the required notice.
In the event you die while a resident of the facility, your representative is responsible for making
the funeral arrangements. We will notify your representative immediately. If we. are unable to
reach your representative, we will contact the funeral home of your choice' to facilitate
arrangements.
Additional Documents
It is not possible to cover everything that is important to your stay in our Facility in .the body of
this Contract. Therefore, wi have included additional important documents as Exhibits. These
Exh/bits are part of this Contract. Please verify that you received the Exhibits and that the
contents of the Exhibits were explained to you by placing your initials on the line next to the
description of each Exhibit.
~(3 Rights Obligations of Representatives.
Exhibit
1.
and
}(t~-~b E 'xhibit 2. For Private Pay Residents: (a) Items and services covered by daily rate.
(b) Items and services not covered by daily rate.
~qt& Exhibit 3. How to Apply For and Use Medicare and Medicaid Benefits.
i~JKo Exh/bit 4. (a) Items and Services Covered by Medicaid.
(c) Items and Services Not Covered by Medicaid.
~'~¢ID Exhibit 5. Physicians Who Practice at the Facility.
~fft~'v) Exh/bit 6. Legal Rights of Pennsylvania to Decide Future Medical Treatment.
~m ti5 ExNbit 7, Policies and Procedures Concerning Your Personal Funds and Your
Personal Property.
~' (~' Exhibit 8. Services Provided by Outside Health Care Providers.
Changes in Law
Any provision of this Contract that is found to be invalid or unerfforceable as a result ora change
in State or Federal law will not invalidate the remaining provisions of this Contract. If there are
services we have agreed to provide that are later found to be impossible to render as a result of a
change in State or Federal law, it is agreed that to the extent possible, the Resident and the
Facility will continue to fulfill our respective obligations under this Contract consistent with the
law.
W~SS Wt-~REOF, the t~arties have executed this
t"Shippensburg Health Care Center
Witness Resident
If the Resident has been adjudicated disabled or the Resident's doctor deterrrfines that the
Resident is incapable of understanding or exercising his or her rights and responsibilities, the
Facility may require the signature of another person on this contract. The other person may be:
(1) An appointed healthcare agent under an advance directive for medical care; (2) A guardian or
Power of Attorney of the person; O) A surrogate or family member.
Witness (3 ~ /Responsible Party (Name)
Title: Indicate whether you are (I), (2) or (3)
PO~ER OF ATTOR/~Y
KNOW ALL MEN BY THESE PRESENTS, that I, I~ROY ~TT
Social Security Number: 164-34-1883, of RD 1, Box 463,
McConnellsburg, Fulton County, Pennsylvania 17233, make
constitute and appoint, my sister, KATHY ~%R~TT, as my true and
lawful attorney, for me and on my behalf, in my name and or in
her name, to take all actions and to perform all acts concerning
my affairs as she may deem necessary or advisable, in her
absolute discretion, as:' fully as I could do if personally
present, including, without limiting the generality of the
foregoing, for me and in my name and on my behalf:
1. To create a Trust for my benefit.
2. To make additions to an existing Trust for my
benefit.
3. To claim an elective share of the Estate
of my deceased spouse.
4. To disclaim any interest in property.
5. To renounce fiduciary positions.
6. To withdraw and receive the income or corpus
of a Trust.
7. To authorize my a~mission to a medical,
nursing, residential or similar facility and
to enter into agreements for my care.
8. To .authorize medical and surgical procedures.
9. To e~gage in real property transactions which
would include the following:
(a) Acquire or dispose of real property
(including the principal's residence)
or any interest therein, including,
but not limited to, the power to buy or
sell at public or private sale for cash
or credit or partly for each; exchange,
mortgage, encu~er, lease for any period
EXHIBIT "B"
~*~*; sales, puFchasg$, exchanges or leases;
· ~ buy at judicial sale any property on
~ .~.. which the principal holds a mortgage.
: - (b) ~anage, repair, improve, maintain,
restore alter, build, protect or
insure real property; demolish structures
or develop real esta=e or any interest
in real estate.
(c) Collect rent, sale proceeds and earnings
from real estate; pay, contest, protest
and comprise real estate taxes and
assessments.
~ (d) Release in whole or in part, assign the
whole or a part of, satisfy in whole or
in part and enforce any mortgage,
encumbrance, lien or ocher claim to
real property.
(e) Grant easements, dedicate real estate,
partition and subdivide real estate and
file plans, applications or other documents
in connection therewish.
(f) In general, exercise all powers with respect
to real property tha~ the principal could
if present.
10. To engage in tangible personal property transactions.
11. ~o engage in all stock, bond and other securities
transactions, including United States Treasury and
United States Government Agency Securities.
12. To engage in commodity and cption transactions.
13. To engage in banking and financial =ransactions.
14. To borrow money.
15. To enter safe deposit boxes.
16. To engage in insurance transactions.
17. To engage in retirement plan transactions.
18. To handle interests in estates and trusts.
19. To pursue claims and litigation.
~¢eive government benefits.
To pursue tax matter~, including the preparation
and filing of all income tax returns~
These powers are as defined in Chapter 56 of the PrQbate,
Estazes and Fiduciaries Code, as amended (20 Pa.C.S.A. ~5601, et.
seq.), which statute is incorporated herein by reference.
And to make and transact any and every kind of business of
every nature; hereby, ratifying and confirming all that my said
'attorney shall lawfully do or cause to be done by virtue of these
presents.
This Power of Attorney shall continue in force and may be
accepted and relied upon by anyone to whom it is presented
despite my purported revocation of it or my death, until actual
written notice of such event is received by such person. This
Power of Attorney shall not be affected by disability of the
principal.
This Power of Attorney has been executed in an original and
one (1) copy on this date.
~he following is a specimen signature of the person to whom
this Power of Attorney is given:
- nn IN WITNESS WHEREOF, I have. heraunto set my hand and seal on
his ( ) mark
/~L~ROC BARN~T~ ~- v
Witness:
State of Pennsylvania:
County of ~u~4Da :
On this, the c~ day of ~.tac)~ , 1998, before me, the
undersigned officer personally appeared LEROY BARNETT, known to
me (or satisfactorily proven) to be the ~erson whose name is
subscribed to the within instr~ent, and ~~ ~and
~ac~ ~ , who did witness his mark, and do attest to
its authenticity, and all do acknowledge that he executed the
same for the purposes therein contained.
In Witness Whereof, i have hereunto set my hand and official
seal.
~y Cotillion Expires:
Jill D. S~a~s, Nora, Pu I~
Shippensburg Health Care Center
121 Wanut Bottom Rd
Shippensburg, PA 17257
Date: February 24, 2004
Resident: Leroy Barnett Admit Date: ~ 7/22/2003
Billing Medical Total Account
Period R&B Supplies Charges Description Payments Balance
1 Balance Forward $0.00
2 8/1/03 - 8/21/03 $1,995.00 $1,995.00 19 days ~ 105.00 co-insurance $1,995.00
2 9/1/03 - 9/19/03 $2,205,00 $2,205.00 21 days @ 105.00 co-insurance $4,200.00
4 9/20/03- 9/30/03 $1,890.00 $1,890.00 10 days @ 189.00 $6,090.00
5 10/1/03- 10/31/03 $5,859.00 $5,859.00 31 days @189.00 $11,949.00
6 11/1/03- 11/30/03 $5,670.00 $5,670.00 30 days ~ 189.00 $17,619.00
7 12/1/03- 12/31/03 $5,859.00 $5,859.00 31 days ~189.00 $23,478.00
8 1/1/04- 1/31/04 $5,859.00 $5,859.00 31 days ~189.00 $29,337.00
9 2/1/04 - 2/29/04 $5,481.00 $5,481,00 29 days ~ 189.00 $34,818.00
10
11
12
13
14
PATIENT OWES LAST AMOUNT SHOWN IN BOLD
Should you have any questions about your statement, please call 717-530-8300.
EXHIBIT "C"
SHERIFF'S RETURN - OUT OF COUNTY
CASE NO: 2004-01135 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SHIPPENSBURG/SOUTH HAMPTON
VS
BARNETT LEROY ET AL
R. Thomas Kline Sheriff or Deputy Sheriff who being
duly sworn according to law, says, that he made a diligent search and
and inquiry for the within named DEFENDANT to wit:
BARNETT KATHY
but was unable to locate Her in his bailiwick. He therefore
deputized the sheriff of FULTON County, Pennsylvania, to
serve the within COMPLAINT & NOTICE
On March 29th , 2004 , this office was in receipt of the
attached return from FULTON
Sheriff's
Costs: SO answers~ ~. //~
Docketing 6.00 ? ~-/' ~-~~~ ~
Out of County 9.00 ~~~~
Surcharge 10.00 R. Thomas Kline
Dep Fulton County 36.48 Sheriff of Cumberland County
.00
61.48
03/29/2004
OBRIEN BARIC SCHERER
Sworn and subscribed to before me
this ~ day of ~,~7
~3V A.D.
~ ' Prothonotary r ·
In The Court of Common Pleas of Cumberland County, Pennsylvania
Shippensbur§ South Hampton Manor
¥S.
Leroy Barnett et al
SERVE: Kathy Barnett
No. 04-1135 civil
]NOW, Ma~rch 18, 2004 , I, SHERIFF OF CUMBERLAND COUNTY, PA, do
hereby deputize the Sheriffof ~,~ ~n County to execute this Writ, this
deputation being made at the request and risk of the Plaintiff.
Sheriff of Cumberland County, PA
Affidavit of Service
Now, ~t~£/-~ ~9/ ,20a~/ , at ~.'30 o'clock ~ M. se~ed the
by h~ding to
a copy of the original
and made known to the contents thereof.
So answers,
Sheriff of ~//6~r3 County, PA
COSTS
Sworn and subscribed before SERVICE $
me this ~q~ day of /"~rC~ ,20 Oq MILEAGE
AFFIDAVIT
() L~cLV PcCr~'g~r~MMISSION EXPIRES $
FIRST MONDAY IN
SHERIFF'S RETURN - REGULAR
CASE NO: 2004-01135 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SHIPPENSBURG/SOUTH HILMPTON
VS
BARNETT LEROY ET AL
VALERIE WEARY , Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE was served upon
BARNETT LEROY the
DEFENDANT , at 1320:00 HOURS, on the 19th day of March , 2004
at 121 WALNUT BOTTOM ROAD
SHIPPENSBURG, PA 17257 by handing to
DEBBIE HORRIDGE, DIRECTOR OF SOCIAL SERVICES
a true and attested copy of COMPLAINT & NOTICE together with
and at the same time directing Her attention to the contents thereof·
Sheriff's Costs: So Answers:
Docketing 18.00
Service 13.11
Affidavit .00 ·
Surcharge 10.00 R. Thomas Kline
.00
41.11 03/29/2004
OBRIEN BARIC SCHERER
meSW°rn and Subscribed to beforethis ~ day of By: ~::ty~e]riff
jt~o~ A.D.
~P~othonotary ' ! /
SHERIFF'S DEPARTMENT
COURTHOUSE-NORTH SECOND STREET, McCONNELLSBURG, PA 17233 (717) 485-4221
SHERIFF SERVICE iNsTRUcT~0Ns FOR SERVrCE OF PROCESS.
PROCESS RECEIPT, and AFFIDAVIT OF RETURN r~l~: Do not~h any copi~.
1 PLArNTIFF/.S/ <~ ~ 2~ COURT NUMSER
3. DEFENDA~¢/ / / 4. TYPE OF WRIT OR COMPLAINT:
5. ~E p~ ~ND~V~AL, COMPA~, CORPOR~ION, ETC, TO ~ERVICE OR DESCRiPTiON OF PROPERTY TO BE LEVIED, ATTACHED OR SOLD.
7. INDICATE UNUSUAL SERVICE: ~ COMMON.~F PA. ~ DEPUTIZE ~ OTHER /
NOW, __. I, SHERIFF OF FULTON COUNTY, PA., do hereby deputize the Sheriff of
County to execute this Writ and make return thereof according
to law. This deputation being made at the request and risk of the plaintiff.
8. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL A~IST IN EXPEOITING SERVICE:
NOTE ONLY APPLICABLE ON WRIT OF EXECUTION: N.S. WAIVER OF WATCHMAN -- Any deputy sheriff levying or attaching any property under
within writ may leave same without a watchman, in custody of whomever is found in possession, after notifying person of levy or attachment, without
liability on the part of such deputy or the sheriff to any plaintiff herein for any loss, destruction or removal of any such property before sheriff's sale thereof.
g. SIGNATURE of ATTORNEY or other ORIGINATOR 10. TELEPHONE NUMSER 11. DATE
12. SEND NOTICE OF SERVICE COPY TO NAME AND ADDRESS BELOW: (This area muet be completed If notice Is to be mailed)
13. I acknowledge receipt of the writ [. SIGNATURE of authorized FCSD Deputy or Clerk and Title 14. Date Received Expiration/Hearing date
or complaint as indicated above. ,~
16. I hereby CERTIFY and RETURN that I ,~l~' have personally served, [] have legal evidence of service as shown in *'Remarks", [] have executed as shown
in "Remarks", the writ or complaint de¢cribed on the individual, company, corporation, etc., at the address shown above or on the individual, company,
corporation, etc., at the address inserted below by handing a TRUE aRd ATTESTED COPY thereof.
17. r-r I hereby certify and return a NOT FOUND because I am unable to locate the individual, company, corporation, etc., named above. (See remarks below)
1 & Name and title of individual served (if not shown above) 19, A person of suitable age and diacretio~
20. Address of where served (complete only if different than shown above) (Street or RFD, Apartment No., City, 21. Date or Service 22. Time
Boro, Twp., State and Zip Code) AM
24. Advance Costs_..~..~, ~ 25. Service Costs 26. Notary
30, REMARKS:
SO
ANSWER.
31. AFFIRMED and subscribed to before me this ~.~-,~/
Prothonota~pu~ SHERIFF OF FULTON COUNTY
38. I ACKNOWLEDGE RECEIPT OF THE SHERIFP~ RETURN 81GNATURE ~ ~ 39 Date R~elved
SHIPPENSBURG/ : IN THE COURT OF COMMON PLEAS OF
SOUTH HAMPTON MANOR, L.P.:
Plaintiff, : CUMBERLAND COUNTY, PENNSYLVANIA
: NO. 2004-1135 CIVIL TERM
V. :
:
LEROY BARNE'IT and : CIVIL ACTION-LAW
KATHY BARNETF, individually :
and as the attorney-in-fact for :
Leroy Barnett, :
Defendants. :
PRAECIPE TO ENTER DEFAULT JUDGMENT
PURSUANT TO Pa.R.C.P. 1037
TO THE PROTHONOTARY:
Please enter judgment in favor of the Plaintiff, Shippensbutg/South Hampton Manor, L.P.
and against the Defendant, Kathy Barnett, for failure to file an answer to the Complaint of
Plaintiff.
A line and correct copy of the Notice of Default is appended hereto as Exhibit "A."
A Ixue and correct copy of the Certificate of Mailing for the Notice of Default is appended
hereto as Exhibit "B." I certify that the Notice of Default was given in accordance with
Pa.R.C.P. 237. !.
Plaintiffrequests judgment in the amount of $34,818.00 as set forth in the Complaint.
Respectfully submitted,//7
O' RIEN, RI & RER
David A. Baric, Esquire
I.D. # 44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
SHIPPENSBURG/ : IN THE COURT OF COMMON PLEAS OF
SOUTH HAMPTON MANOR, L.P.: CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff, :
: NO. 2004-1135 CIVIL TERM
V. :
:
LEROY BARNETT and : CIVIL ACTION-LAW
KATHY BARNETT, individually :
and as the attorney-in-fact for :
Leroy Barnett, :
Defendants. :
TO: Kathy Barnett
2611 Breezy Point Road
McCoanellsburg, Pennsylvania 17233
Date of Notice: April 28, 2004
IMPORTANT NOTICE
YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN
APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE
COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST
YOU. UNLESS YOU ACT wrrH1N TEN DAYS FROM THE DATE OF THIS NOTICE, A
JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU
MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE
THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR
CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND
OUT WHERE YOU CAN GET LEGAL HELP.
Cumberland County Bar Association
32 South Bedford Street
Carlisle, Pennsylvania 17013
Telephone: (717) 249-3166
David A. Baric, Esquire
17 West South S~reet
Carlisle, PA 17013
(717) 249-6873
EXHIBIT "A"
U,S. POSTAL S~qVICE CERTIFICATE OF MAILING
MAY BE USED FOR DOMESTIC AND INTERNATIONAL MAIL. D NOT
One ~,c, of o~in,~ mail ,dd.,.~ to: ~~
~ · -~a~
~ Form 3817, Mar. 1989
EXHIBIT "B"
CERTIFICATE OF SERVICE
I hereby certify that on October 20, 2004, I, David A. Baric, Esquire, of O'Brien, Baric &
Scherer did serve a copy oftbe Praecipe To Enter Default Judgment Pursuant To Pa.R.C.P. 1037,
by first class U.S. mail, postage prepaid, to the party listed below, as follows:
Kathy Barnett
2611 Breezy Point Road
McConnellsburg, Pennsylvania 17233
David A. Baric, Esquire