HomeMy WebLinkAbout08-4645D
Y
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 THE
TELEPHONE OR THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU
CAN GET LEGAL HELP.
CUMBERLAND COUNTY BAR ASSOCIATION
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
1-800-990-9108
717-249-3166
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH, DEPARTMENT OF
LABOR AND INDUSTRY, BUREAU OF
BUREAU OF LABOR LAW COMPLIANCE
o/b/o Donna Rozycki,
Plaintiff
V.
DELAWARE VALLEY COUNCIL OF
AMERICAN YOUTH HOSTELS INC. and
TA'JUANNA D. ANDERSON, individually,
Defendants
CQMPLAINT
CIVIL ACTION - LAW
DOCKET NO. W. y G %45 & a ?^
1. Plaintiff is the Bureau of Labor Law Compliance (Plaintiff) of the
Commonwealth of Pennsylvania, Department of Labor and Industry, responsible for
enforcement of the Pennsylvania Wage Payment and Collection Law (WPCL), act of
1961, P.L. 637, No. 329, 43 P.S. §§ 260.1-260.12.
2. Defendant Delaware Valley Council of American Youth Hostels Inc.
(DVC) operates as a Pennsylvania non-profit corporation with a business address located
at 1210 Sansom Street, Philadelphia County, Philadelphia, PA 19107.
3. Defendant Ta'Juanna D. Anderson is an adult individual who, at all times
relevant to this Complaint, was Executive Director and served as an agent for Defendant
DVC with respect to the matters alleged in this Complaint.
41
4. Defendant Anderson is a statutory employer pursuant to the definition of
"employer" as set forth in Section 2.1 of the WPCL, 43 P.S. § 260.2a, and is individually
liable for the alleged wages and statutory liquidated damages.
5. Plaintiff brings this action against Defendants DVC and Anderson on
behalf of their former employee Donna Rozycki (Claimant Rozycki), who is an adult
individual with an address of P.O. Box 1324, Harper's Ferry, West Virginia 25425.
COUNT I
(Wage Claim of Donna Rozycki)
6. Paragraphs 1 through 5 are realleged and incorporated by reference.
7. Under section 9.1(e) of the WPCL, 43 P.S. § 260.9a(e), Claimant Rozycki
executed and delivered to Plaintiff an assignment of her wage claim against Defendants.
A true and accurate copy of this assignment is appended as Exhibit "A ".
8. Defendants employed Claimant Rozycki as a hostel manager at the
Ironmaster's Mansion Hostel HI, located at 1212 Pine Grove Road, Cumberland County,
Gardners, PA 17324, from August 2004 through February 7, 2008.
9. Under the agreed-upon terms and conditions of this employment, Claimant',
Rozycki earned $5.65, $6.75, and $10 an hour.
10. For the pay periods beginning with September 26, 2005 and endingi
February 7, 2008, Claimant Rozycki worked a total of 3,360 hours.
11. Defendants failed to pay Claimant Rozycki her wages from September 26,
2005 to February 7, 2008, for unpaid wages of $24,570.00 {(1,000 hours x $5.65 per'
hour = $5,650.00) + (1,440 hours x $6.75 per hour = $9,720.00) + (920 hours x $10 per'
hour = $9,200) = $24,570). A true and accurate copy of the Bureau's audit of the
2
t September 26, 2005 to February 7, 2008 payroll summary showing wages owed by
Defendants is appended as Exhibit "B. "
12. Defendants are liable to Claimant Rozycki for unpaid wages totaling
$24,570.00 under Section 3 of the WPCL, 43 P.S. § 260.3.
13. These wages have remained unpaid for more than 30 days beyond Claimant
Rozycki's regular paydays or more than 60 days after proper claim was made without the
existence of any good-faith contest or dispute that they are due and owing to Claimant
Rozycki. Therefore, Defendants are additionally liable to Claimant Rozycki for statutory
liquidated damages in the amount equal of $6,142.50, under Section 10 of the WPCL, 43
P.S. § 260.10 (25% x $24,570.00 = $6,142.50).
19. The total amount of damages and statutory liquidated damages for which
Defendants are liable under the WPCL on behalf of Claimant Rozycki is $30,712.50.
WHEREFORE, Plaintiff Bureau of Labor Law Compliance requests judgment
against Defendants Delaware Valley Council of American Youth Hostels Inc and'
Ta'Juanna D. Anderson, individually, on behalf of Claimant Rozycki in the amount of
$30,712.50 due under the WPCL, or such other sum as this Honorable Court may
determine to be due said Claimant, together with costs of suit and reasonable attorney's'
fees under section 9.1(f) of the WPCL, 43 P. S. § 260.9a(f). The amount claimed does not
exceed the jurisdictional amount requiring arbitration referral by local rule.
Respectfully submitted,
Dated: oZ d0?
d
nifer errier
Assistant Counsel
3
Attorney Registration No. 204444
Commonwealth of Pennsylvania
Department of Labor and Industry
Office of Chief Counsel
Labor Law Compliance Division
Tenth Floor, Labor and Industry Bldg.
651 Boas Street
Harrisburg, PA 17121
Telephone: (717) 787-4186
Counsel for Plaintiff
4
EXHIBIT
64A91
MAR 0 5 2008
FORM BLLC
WAGE COMPLAINT
' JUN 2 7 2008
Office use only: WPBC MW CLL
This form is used for complaints under the Pennsylvania Minimum Wage Act of 1968 and the Wage Payment and
including the reverse side, that are applicable
lete all parts
ld com
h
,
p
ou
Collection Law. Persons returning this form s
to the specific law or laws under which a complaint is made.
RETURN TO:
Bureau of Labor Law Compliance J
1301 Labor & Industry Building U Q V o1Q 7Fr
Seventh & Forster Streets
Harrisburg, PA 17121
` rl S
C
Telephone: 717-705-5969 or
1-800-932-0665 ,
owl 3
FAX: 717-78787--0 0517
PLEASE PRINT:
Name of Person Filing Complaint
Address - 0 .
STREET CITY STA ZIP CODE
Date of Birth _ c Y/
Telephone Number where you can be reached between 8:30 a.m. and 5:00 p.m. 4 1 /
(INCLUDE AREA CODE)
E-mail Address Nc>L?? Fax Number
Type of Work Performed GL
., (- dy'C/ Z2S ??{'u,? e ??? vim! I?e Syr?Cr1i?
Location of Employment 7P`/Ke
STREET CITY C UNTY STATE ZIP CODEiI
va l1 e -LWC-r 1
? Telephone (?/S ) ?-
Company Name ?
, if any e•r" t G S? Ski - ?i-?r
o t,
Contact Person (Against whom Wage Claim is f' ed) ??G1Zyt-? 1 Cl?ldSr?/?
Address /a-IC? SaGi 'o V ?`r'2?t ?DAr1 l 12.E f?c? • / ??O
STREET CITY COUNTY STATE ZIP CODE
Date Hired Are you still employed by the named employer? ? Yes Q No
If No, the last date worked i-e-,6 - `L7 Was your termination: dVoluntary Involuntary
1 . Was there a written contract of employment between you and the named employer? ? Yes Vo
If Yes, please attach copy.
2. What was your regular payday to be? (check one) ? Weekly N/Bi-Weekly ? Monthly ? Other
? No ? Other (cash) ? v?t? ?!??
3. Were wages paid to you in a form other than a check. ?"? Yes
GLL P.Gl4 L Ly??
To
4. What was the latest rate of pay agreed upon between you and the named employer? V
?
Hourly $ J? Weekly $ Other, please explain -77
rl" -
What are the TOTAL wages claimed by you? $ _-2-b ;2 4Jam,., _
COMPLETE REVERSE SIDE
LLC-9 REV 11-07 (Pagel) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR & INDUSTRY BUREAU OF LABOR LAW COMPLIANCE
WAGE COMPLAINT FORM
Office use only: WP&C MW
CLL
This form is used for complaints under the Pennsylvania Minimum Wage Act of 1968 and the Wage Payment and
Collection Law. Persons returning this form should complete all parts, including the reverse side, that are applicable
to the specific law or laws under which a complaint is made.
RETURN TO:
PLEASE PRINT:
Name of Person Filing Complaint_
Address P- C-> - / 3
STREET V CITY STATE ZIP CODE
Date of Birth
Telephone Number where you can be reached between 8:30 a.m. and 5:00 p.m. 1 l 1 - 67 ?44
(INCLUDE AREA CODE)
E-mail Address l2.oP4--e- Fax Number ( )
Type of Work Performed 'TI
Location of Employment / 2! "z ! (?? ?O1`? /'?
STREET CITY COUNTY STATE ZIPMP
Company Name, if any VC, C( Cvuu?a /? ?/? L Telephone
Contact Person (Against whom Wage Claim is filed) i a ' ?/ r-cu ??a1? a??.?'T4f--?''°?t??? rr
Address / ?/O c L Y± "e
STREET CITY COUNTY STATE ZIP CODE
Date Hired T- - --2 l -? Are you still employed by the named employer? ? Yes [?/No
if No, the last date worked I eb ! ?-oo Was your termination: 29/Voluntary ?? Involuntary
1 . Was there a written contract of employment between you and the named employer? El Yes L?1/No
If Yes, please attach copy.
2. What was your regular payday to be? (check one) ? Weekly EiBi-Weekly ? Monthly ? Other
r ? d'?t
3. Were wages paid to you in a form other than a check? E?I`Yes ? No El Other (cash)
4. What was the latest rate of pay agreed upon between you and the named employer?
Hourly S&) , C0 Weekly $Other, please explain
What are the TOTAL wages claimed by you? $ ';?- S, --f
COMPLETE REVERSE SIDE
Bureau of Labor Law Compliance
1301 Labor & Industry Building
Seventh & Forster Streets
Harrisburg, PA 17121
Telephone: 717-705-5969 or
1-800-932-0665
FAX: 717-787-0517
LLC-9 REV 11-07 (Pagel) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR & INDUSTRY BUREAU OF LABOR LAW CO
WAGE COMPLAINT FORM
Office use only: WP&C MW
CLL
This form is used for complaints under the Pennsylvania Minimum Wage Act of 1968 and the Wage Payment and
Collection Law. Persons returning this form should complete all parts, including the reverse side, that are applicable
to the specific law or laws under which a complaint is made.
RETURN TO:
Bureau of Labor Law Compliance
1301 Labor & Industry Building
Seventh & Forster Streets
Harrisburg, PA 17121
Telephone: 717-705-5969 or
1-800-932-0665
FAX: 717-787-0517
PLEASE PRINT: '
Name of Person Filing Complaint C77/L^c 1O
Address ) /I
STREET CITY STC E ZIP CODE
Date of Birth
Telephone Number where you can be reached between 8:30 a.m. and 5:00 p.m. (c7D
(INCLUDE AREA CODE)
E-mail Address l/11? P Fax Number
Type of Work Performed fea
I ;I-
Location of Employment ( 7i1 2 tlz
STREET CITY
un c
STATE ZIP CODE 7 ,q
Company Name, if any a?? Telephone
Contact Person (Against whom Wage Claim is filed)
Address ?-lD GZ?YLc?d
STREET CITY COUNTY STATE ZIP CODE
Date Hired Are you still employed by the named employer? ? Yes [!?/No
If No, the last date worked 7_C7z _1' Was your termination: EV Voluntary ? Involuntary
1. Was there a written contract of employment between you and the named employer? ? Yes WNo
If Yes, please attach copy.
2. What was your regular payday to be? (check one) ? Weekly 4Bi-Weekly ? Monthly ? Other
3. Were wages paid to you in a form other than a check? 4 Yes ? No ? Other (cash) o? L.? 4AIt> 05L C
Tl„L,r
4. What was the latest rate of pay agreed upon between you and the named employer?
Hourly $ Weekly $Other, please explain
What are the TOTAL wages claimed by you? $ d'?? 0I" '7?
COMPLETE REVERSE SIDE
;a14.l 7_tlls
LLC-9 REV 11-07 (Pagel) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR & INDUSTRY BUREAU OF LABOR LAW COMPLIANCE
WAGE COMPLAINT FORM
Office use only: WP&C MW CLL
This form is used for complaints under the Pennsylvania Minimum Wage Act of 1968 and the Wage Payment and
Collection Law. Persons returning this form should complete all parts, including the reverse side, that are applicable
to the specific law or laws under which a complaint is made.
RETURN TO:
Bureau of Labor Law Compliance
1301 Labor & Industry Building
Seventh & Forster Streets
Harrisburg, PA 17121
Telephone: 717-705-5969 or
1-800-932-0665
FAX: 717-787-0517
PLEASE PRINT:
Name of Person Filing Complaint
Address ?C) k 3? tf? t''A C^'? r? L(?>PS2L" 1/! -%;-L-t ZrcS?1?f;?_s
CITY I STATE ZIP CODE
STREET
Date of Birth
Telephone Number where you can be reached between 8:30 a.m. and 5:00 p.m. (6d j) - 6
(INCLUDE AREA CODE)
E-mail Address _z- q4 P Fax Number ( ) - h?
Type of Work Performed k A?t?(a1 J
Location of Employment 1 ?17i 1?1Yt-? ?-d?`< ?,:? e?Y'! CY?IL-
STREET CITY C NTY STATE ZIP CODE' .7 t7 l`
!J f_- Gt wct oe_ ; /j Telephone
Company Name, If any -?/ (t ( 4r G
Contact Person (Against whom Wage Claim is filed)
Address
STREET fi CITY COUNTY STATE ZIP CODE
Date Hired Are you still employed by the named employer? ? Yes No
If No, the last date worked -?_e6' Was your termination: Voluntary ? Involuntary
1 . Was there a written contract of employment between you and the named employer? ? Yes U No
If Yes, please attach copy.
2. What was your regular payday to be? (check one) ? Weekly WBi-Weekly ? Monthly ? Other
3. Were wages paid to you in a form other than a check? A Yes ? No ? Other (cash) Gt-4 01 7P
4. What was the latest, rate of pay agreed upon between you and the named employer?
Hourly $ Weekly $ Other, please explain
What are the TOTAL wages claimed by you? $ IS COMPLETE REVERSE SIDE
LLC-9 REV 11-07 I1'age1) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR & INDUSTRY BUREAU OF LABOR LAW COMPLIANCE
(60,
Office use only: WP&C
WAGE COMPLAINT FORM
MW
CLL
This form is used for complaints under the Pennsylvania Minimum Wage Act of 1968 and the Wage Payment and
Collection Law. Persons returning this form should complete all parts, including the reverse side, that are applicable
to the specific law or laws under which a complaint is made.
RETURN TO:
Bureau of Labor Law Compliance
1301 Labor & Industry Building
Seventh & Forster Streets
Harrisburg, PA 17121
Telephone: 717-705-5969 or
1-800-932-0665
FAX: 717-787-0517
PLEASE PRINT: D?
Name of Person Filing Complaint 041%k1<:;G
Address c> Luc / 3 34L ?? r? Gd?? l=e v?j LUG/` vll2G?u as?5`%?
STREET CITY STATE ZIP CODED
Date of Birth z/
Telephone Number where you can be reached between 8:30 a.m. and 5:00 p.m. (3G7/ ) -V "71- 6 / '71'1-
(INCLUDE AREA CODE)
E-mail Address ivZszc? Fax Number ( ) A?VAle?-.
Type of Work Performed
Location of Employment Zl Y??-? n(dam L? c G4 ?°
STREET CITY COUN Y STATE
Company Name, if an T ?J /f ?H cG Telephone (- 4/5?)
Contact Person (Against whom Wage Claim is filed) c / Au Lnl_
ZIP CODE / -2
??v^?iI CTtI„
o?'?e??GUt. ?-2
Address 1-440 Ja LL?rr^?u ?? t-:Y1 c-
STREET CITY COUNTY STATE ZIP COD?4o
Date Hired E- Z1 Q Are you still employed by the named employer? ? Yes If No, the last date worked Was your termination: 4Voluntary ? Involuntary
1 . Was there a written contract of employment between you and the named employer? ? Yes V_(No
If Yes, please attach copy.
2. What was your regular payday to be? (check one) ? Weekly L" Bi-Weekly ? Monthly ? Other 3.- Were wages paid to you in a form other than a check? Yes ? No ? Other (cash)- W?/?35 < T
4. What was the latest rate of pay agreed upon between you and the named employer?
Hourly $ w or Weekly $Other, please explain
What are the TOTAL wages claimed by you? $
COMPLETE REVERSE SIDE
LLC-9 REV 11-07 (Pagel) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR & INDUSTRY BUREAU OF LABOR LAW COMPLIANCE
Office use only: WP&C
WAGE COMPLAINT FORM
MW
CLL
This form is used for complaints under the Pennsylvania Minimum Wage Act of 1968 and the Wage Payment and
Collection Law. Persons returning this form should complete all parts, including the reverse side, that are applicable
to the specific law or laws under which a complaint is made.
RETURN TO:
Bureau of Labor Law Compliance
1301 Labor & Industry Building
Seventh & Forster Streets
Harrisburg, PA 17121
Telephone: 717-705-5969 or
1-800-932-0665
FAX: 717-787-0517
PLEASE PRINT: J?
Name of Person Filing Complaint
Address I!> G ? r?r rte'', a,c' -s
STREET CITY STATE ZIP CODE'
Date of Birth
Telephone Number where you can be reached between 8:30 a.m. and 5:00 p.m. 1 01:?9l) 6
(INCLUDE AREA CODE)
E-mail Address
STREET CITY V COUNTY STATE ZIP CODE -7 3y'{jy
?(?- 'if 1Jo` ?(? t
Company Name, if any C: Telephone (°,-16) YjoZb_ S
Contact Person (Against whom Wage Claim is Iled)
Address ! ?!?c?.l/4 ?'l i o? 1 L?/T''`21v1 /`7? - /?O
STREET CITY COUNTY STATE ZIP COD,E?
Date Hired ?C y Are you still employed by the named ployer? ? Yes U No
Involurhtary
If No, the last date worked C,6 ?? Was your termination: ' VoluntaryPNo
1. Was there a written contract of employment between you and the named employer? E:1 Yes No
Fax Number ( 1
Type of Work Performed
Location of Employment
If Yes, please attach copy.
2. What was your regular payday to be? (check one) ? Weekly Bi-Weekly [_1 Monthly El Other
3. Were wages paid to you in a form other than a check? I(Yes ? No ? Other (cash)
4. What was the latest rate of pay agreed upon between you and the named employer??
Hourly $ Weekly $ Other, please explain
What are the TOTAL wages claimed by you? $ >? ?r f 3-
COMPLETE REVERSE SIDE
LLC-9 REV 11-07 (Pagel) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR & INDUSTRY BUREAU OF LABOR LAW COMPLIANCE
Office use only: WP&C
MW
CLL
This form is used for complaints under the Pennsylvania Minimum Wage Act of 1968 and the Wage Payment and
Collection Law. Persons returning this form should complete all parts, including the reverse side, that are applicable
to the specific law or laws under which a complaint is made.
RETURN TO:
Bureau of Labor Law Compliance
1301 Labor & Industry Building
Seventh & Forster Streets
Harrisburg, PA 17121
Telephone: 717-705-5969 or
1-800-932-0665
FAX: 717-787-0517
PLEASE PRINT:
WAGE COMPLAINT FORM
Address i??n - / 3 ?
Name of Person Filing Complaint
STREET Q CITY
Date of Birth
?C,,.??i?
Telephone Number where you can be reached between 8:30 a.m. and 5:00 p.m.
E-mail Address
40401 ? Fax Number ( )
Type of Work Performed 12v,• '4'
STREET CITY COUNTY STATE ZIP CODE
Date Hired a--( Are you still employed by the nam7voluntary ployer? ? Yes ?`Nn
If No, the last date worked tSZt?i? 7., -2?'Y Was your termination: ?? I nvoluntary
1 . Was there a written contract of employment between you and the named employer? ? Yes J No
If Yes, please attach copy.
2. What was your regular payday to be? (check one) ? Weekly IV] Bi-Weekly ? Monthly ? Other
3. Were wages paid to you in a form other than a check? DJ/yes ? No ? Other (cash)
4. What was the latest rate of pay agreed upon between you and the named employer? Hourly $ Je - ov Weekly $ Other, please explain ,/
What are the TOTAL wages claimed by you? $ 6I, 'q_-/' C `
V STATE ZIP CODE ?? T 6
(ate l ) Z/ 7
(INCLUDE AREA CODE)
Location of Employment / -2-1
?Gr.>C?- ?Z? 4????• . / (_??,,/??c?ar?y?
STREET CITY COUNTY STATE ZIP CODE Pa,
Company Name, if any f` a !zz I r Telephone 4;2-/ S?) / 7 a
T-
Contact Person (Against whom Wage Claim is filed)
Address ,/pct yc ??ll? a ?GL v>?-LGyI mot. `?c? / / O?
COMPLETE REVERSE SIDE 9
LLC-9 REV 11-07 (Pagel) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR & INDUSTRY BUREAU OF LABOR LAW CO
l?J
WAGE COMPLAINT FORM
Office use only: WPBC MW CLL
This form is used for complaints under the Pennsylvania Minimum Wage Act of 1968 and the Wage Payment and
Collection Law. Persons returning this form should complete all parts, including the reverse side, that are applicable
to the specific law or laws under which a complaint is made.
RETURN TO:
PLEASE PRINT:
Name of Person Filing Complaint
Addresses 131 3
STREET CITY
Date of Birth 'y/ Telephone Number where you can be reached between 8:30 a.m. and 5:00 p.m
E-mail Address I -OL-t- Fax Number ( )
Type of Work Performed 61 etzZ, ,? `Yl?issi _
Location of Employment 1 'z_j '2.- plu
STREET
V,
STATE ZIP
- It-'4w Company
(mil)x-16
(INCLUDE AREA CODE)
CITY `/ COUNTY STATE ZIP CODE
/
t, ?C_Telephone Ih/S ) i'y5 Gc?S /
Contact Person (Against whom Wage Claim is filetl)
Address !ld /
STREET CITY COUNTY STATE ZIP CODV1140
Date Hired z-?Are you still employed by the named ployer. q+tt7 L? Yes
If No, the last date worked Was your termination: I___, Voluntar
y 1nvolunt8ry
1. Was there a written contract of employment between you and the named employer? E Yes i,.VI? No
If Yes, please attach copy.
2. What was your regular payday to be? (check one), Wee I i_IjBi-Weekt
Y Y -? Monthly D Other
3. Were wages paid to you in a form other than a check? [f Yes ? No ! Other (cash) G, r ?'c'CX- Ili z?
4. What was the latest rate of pay agreed upon between you and the named employer? lL?e 7`?'? C?-G
Hourly $/Q 'd Weekly Other, please explain
What are the TOTAL wages claimed by you? $ v S? Z
COMPLETE REVERSE SIDE
LLC-9 REV 11-07 (Pagel{ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR & INDUSTRY BUREAU OF LABOR LAW COMPI ?aN} F
Bureau of Labor Law Compliance
1301 Labor & Industry Building
Seventh & Forster Streets
Harrisburg, PA 17121
Telephone: 717-705-5969 or
1-800-9324)665
FAX: 717-787-0517
Office use only: WP&C
WAGE COMPLAINT FORM
MW
C LL
This form is used for complaints under the Pennsylvania Minimum Wage Act of 1968 and the Wage Payment and
Collection Law. Persons returning this form should complete all parts, including the reverse side, that are applicable
to the specific law or laws under which a complaint is made.
RETURN TO:
PLEASE PRINT-
Name of Person Filing Complaint
Address ;??o - 'i5 t / 3 _?)?
C14"
- - - vc C - yt/a 6
STREET
Date of Birth CITY STATE ZIP CODE '
Telephone Number where you can be reached between 8:30 a.m. and 5:00 p.m. 45e?P1
), - Z
(INCLUDE AREA CODE)
E-mail Address Ae vk Fax Number
Type of Work Performed
Location of Employment
Bureau of Labor Law Compliance
1301 Labor & Industry Building
Seventh & Forster Streets
Harrisburg, PA 17121
Telephone: 717-705-5969 or
1-800-932-0665
FAX: 717-787-0517
J
Cu-v?t
5 -
STREET 0 CITY COUNTY STATE ZIP CODE ?? A-
Company Name, if any lo f Telephone S j ?ozcS ? «b
Contact Person (Against whom Wage Claim is filed) ??
Address / 161 Z
r e-y
STREET CITY - COUNTY STATE ZIP CODE
Date Hired Are you still employed by the named employer?"Yes i No
If No, the last date worked
- ?• 7,? ???? Was your termination: 11oluntary r j Involuntary
1. Was there a written contract of employment between you and the named employer? 171 Yes [4o
If Yes, please attach copy. -/
2. What was your regular payday to be? (check one) Weee y i 1! gi-Weekly ?i Monthly Other _
3. Were wages paid to you in a form other than a check? {' Yes No D Other (cash) ?-i vte- -
4. What was the latest rate of pay agreed upon between you and the named employer?
Hourly $ jO - Weekly $ Other, please explain
What are the TOTAL wages claimed by you? $ COMPLETE REVERSE SIDE
LLC•9 REV 11-07 (Pagel) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR & INDUSTRY BUREAU OF LABOR LAW COMPLIANCE
i
WAGE COMPLAINT FORM
Office use only: WP&C MW CLL
This form is used for complaints under the Pennsylvania Minimurn Wage Act of 1968 and the Wage Payment and
Collection Law. Persons returning this form should complete all parts, including the reverse side, that are applicable
to the specific law or laws under which a complaint is made.
RETURN TO:
PLEASE PRINT:
Bureau of Labor Law Compliance
1301 Labor & Industry Building
Seventh & Forster Streets
Harrisburg, PA 17121
Telephone: 717-705-5969 or
1-8W-932-0665
FAX: 717-787-0517
Name of Person Filing Complaint
Address ac) - f / 3?-
STREET 16ITY STATE IP CODE
Date of Birth
Telephone Number where you can be reached between 8:30 a.m. and 5:00 p.m. (6<J-/) 1'7 f
(INCLUDE AREA CODE)
E-mail Address ?2vu a Fax Number ( )
Type of Work Performed
Location of Employment /
Co? /
Company ame, 1 an? '
Contact Person (Against whom Wage Claim is filed)
,Telephone e-6-Z_ ?v
Address % Z/? stir 1D__ Q?j" 'ems ;?a % 2./
d ?]
STREET CITY COUNTY STATE ZIP CODE
Date Hired - ll)SG Are yoouu still employed by the named employer? [1] Yes LVJ1No
If No, the last date worked S Was your termination: EY Voluntar
7_1 Y :-Involuntary
1. Was there a written contract of employment between you and the named employer? Yes ?__, No
If Yes, please attach copy.
2. What was your regular payday to be? (check one) L Weekly _'?/Bi-Weekly i_ Monthly Other
3. Were wages paid to you in a form other than a check? LJ/Yes L No
..? Other (cash) r-Lt
4. What was the I#=,rate of pay agreed upon between you and the named empio}Ar?he-
Hourly $ 'J C7 Weekly $ Other, please explain
What are the TOTAL wages claimed b
by you? $ COMPLETE REVERSE SIDE
Lt-C-9 REV 11-07 (Paget) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR & INDUSTRY BUREAU OF LABOR LAW COMPLIANCE
40 WAGE COMPLAINT FORM
Office use only: WPBC MW
CLL
This form is used for complaints under the Pennsylvania Minimum Wage Act Collection Law. Persons returning this form should complete all parts, including the?reevverse side, ? Peapplicable
to the specific law or laws under which a complaint is made.
RETURN TO:
Bureau of Labor Law Compliance
1301 Labor & Indus Vy Building
Seventh & Forster Streets
Harrisburg, PA 17131
Telephone: 717-705-W9 or
1-M-9324MS
FAX: 717-787-0517
PLEASE PRINT:
Name of Person Filing Complaint ??e' ?/LjiLc 1
Address l ?G .c
LL1.>?? ar -,?
Date of Birth STATE
--A ? / q ? F"
Telephone Number where you can be rea h
C ed between 8:30 a.m. and 5:00 p.m. Ec e/) L"--
(INCLUDE AREA CODE) /
E-mail Address G)
Fax Number ( ) _
Type of Work Performed
Location of Employment i Zl Z 01 r p ? ?
STREET CITY
Company Name, if any '?t t'-
Contact Person (Against whom Wage Claim is fi 1
---M 1 T
STATE ZIP CODE
.Telephone (0210 I3 - G7Z> 6_?' C JO _
Address
STREET ?L?t'cG ?y
CITY COUNTY cx- 9(
Date Hived/1 STATE ZIP CODE /
Are you still employed by the named player? r---.
Y i + No
If No, the last date worked 2or
----? Was your termination: 1_-_, Voluntary ^?
1 • Was there a written contract of employment between you and the named employer? FL--,'yeS ` Involuntar y
If Yes, please attach v /No
2
3
4.
COPY.
What was your regular payday to be? (check on U Wee
Y /r-Bi-Weekly L; Monthly 0 Other
Were wages paid to you in a form other than a check? Z Yes L? No i I ,r ?
L? Other (cash) cxt ?,e? 1
What was the latest rate of pay agreed upon between you and the named empioyer? ?' `rte ? (7,
Hourly $ 9c5 . ?? Weekly $
Other, please explain
What are the TOTAL wages claimed by you?
COMPLETE REVERSE SIDE
••aY + 1-ur 41"0") C WEALTH OF PENNSYLVANIA OEPAR
TAIENT OF LAROR
'3<c,
6uREAU Of LAaaR -
I.AW COWILIANCE
WAGE COMPLAINT FORM
Office use only: WpBC
MW CLL
This form is used for complaints under the Pennsylvania Minimum Wage Act of 1968 and the Wage Pa
Collection Law. Persons returning this form should complete all parts, including the reverse side, thatarey a
to the specific law or laws under which a complaint is made, me t and
ppli able
RETURN TO:
Bureau of Labor Law Compliance
1301 Labor & Industry Building
Seventh & Forster Streets
Harrisburg, PA 17121
Telephone: 717-705-5969 or
1-800-932-M65
FAX: 717-787-0517
PLEASE PRINT:
Name of Person Filing Complaint ?
Address
STREET
CITY I C iN L S 5
Date of Birth STATE ZIP CODE
Telephone Number where you can be reached between 8:30 a.m. and 5:00 .
E-mail Address L (INCLUDE AREA CODE) - -r
Fax Number
Type of Work Performed
Location of Employment ?! Z pzcz _ `
STREET
a an/ e CITY [ECG
Company Name, if ' COUNTY STATE
ZIP CODE
Telephone
Contact Person (Against whom Wage Claim is filed)
Address 1-240 l:'
STREET
CITY COUNTY ! fd
Date Hired , STATE ZIP CODE
Are you still employed by the named mployer? `J Yes 4 No
If No, the last date wor ed
Was your termination: L-- Voluntary F Involuntary
1. • Was there a written contract of employment between you and the named employer? ;? oluntary
If Yes, please attach copy. Yes 'No
2. What was your regular payday to be? (check one
3• Were wages ) u Wee IY Bi-Weekly 0 Monthl
paid to you in a form other than a check? Lvj Yes No ; J y 0 Other _
4• What was the latest rate of Other (cash
pay agreed upon between you and the named em
ployer? l-U?-
Hourly $ %A c Weekly $ d
Other, please explain 'c?z-ae?_ ??.•
What are the TOTAL wages claimed by you? $
COMPLETE REVERSE SIDE
LLC-9 REV 11-07 (Paga11 COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF LABO & INDUS RY
BUREAU OF LABOR LAW COMPLIANCE
EXHIBIT
66][399
-- Summary of Wages Owed to Donna Rozycki
? -
1 - -
--
Week Ending Hours Worked Amount Under aid/Hr. Wages
_ Due
-fi - I I
? 7
-09/29/2005 - 40
_$5.65 $226.00
I- --- --- $5.65
10/27/2005--
_ 40 ---
11/03/2005 4p $226 00
11/24/2005 40
12/01 /2005 40
01 /26/2006 40
.65 - -- --- $226.00----
.65 - -- $226.00
.65 ---- --- s22a nn
02/02/2006
-
- -
- -40
-
--
$5.65 $226.00
-- -- - - --
--
$226 00
02/09/2006 40 $
5.65 $226
00
02/16/2006 40 - _
$5.65 .
_
$226
00
02/23/2006 40 _ $5.65 .
$226
00 -
03/02/2006 40
- _ _ $5.65 .
$226
00
03/09/2006 40
- $5.65 .
$226
00
03/1612006
03/23/2006 40
40
$5.65 .
-
U26-00
-
03/30/2006
- _
-
--
-
40
-- --
- -
?-----
--
- $5.65 026.00
_
00 _
$2
2
6
04/06/200_6
---
- 40
- -
-- $5.65 _
_
.
00 -
$226
04/13/2006
- - -- 40 -?
- - -
$5.65 .
{
$226
00
04/2_0/2006 40
- $5.65 .
00. _
$226
04/27/2006
- --
40 -
$5.65
_.
$226
00
05/04/2006 1 40
t - - -
$5.65
-- --- .
-
$226
00
05/11 /2006
- - 4_0
- - -- -
$
5.65 ._
-
$226
00
06/01/2006
-- 01/ 40
- --
--
-- _
5.65
$ .
$226
00
06/08/2006 -
- -
07/06/2006
6 -C - 40
46-
0 i -
-
- _
- $5.65
65 --
$5 .
-? $226.00 - -
----
-
_____
-
07/13/2006 - --- 40 - -
--- r .
5 - -
$
5.6 -- $226.00
$226
00
08/03/2006
8/03/200_6
- - - 40 - _
_
- $6.75 .
--
$270
00
08/10/2006 40 --
$6.7 75 .
t
$270
00
_ 08_/17/2006
- - - 40
- - -
$6.75 .
-- -
- --
08/24/2006 40
$6.75
$270
00
08/31 /2006
40
$6.75 _.
00 -
j $270
09/07/2006
--- a 40 -- - -----
$6.75 .
- -
$270
00
09/14/2006
- - --
40
_ __ _
?
- -
_
--
$6.75
.
_1
------ -
$270
00
09/21/2006 40 _
$6.75 .
270
09/28/2006
-
i28 40 $6.75
r --- --
00 - - _
$2
70
1
006
- -
? 40
- i - - .
$27
0
00
10/26/2006
- 40
$6.75 _
.
$270
00
1
1/02/2006
- 40
- - -
- -
$6.75 .
- ;
'? $276
00
_1/09/2006
1
-
11 /16/2006
-
40
- -
-
- -- --- -
-
_--
-
- .
r
$270.00
40 $d - ----- -__
$270.00
11/23/2006
- _ 40 $6.75 $270.00
_-
---
11/30/2006 40 $6.75 $270.0
0
12/07/2006 ?- ---- 40 ____ _ -- _
----- $6.75 _
- - - $
270.00
12/14/2006 - --- 40 -$6.75 _
- - - $270.00
12/21/2006 - - 40 $6.75 - $270.00
01126/2007 - 40 } $6.75 $270.00
02/02/2007 40 $6
.75 $270.00
02123/2007 -
40 _
$6.75 $270.00
03/02/2007 40 $6.75 $270.00
03/09/2007
- 03/16/2007
- 40
_ 40
-
- - $_6.7_5
- $6.75 -- -- $270.00
- - - $270.00 _-
03/23/2007 40 - -- - ---$6.75 $270.00 -- -
03/30/2007 40 $6.75 -- - - $270.00
- -
04/06/2007
40
$6.75 ___
$270.00
04113/2007 40
-
--- -- $6.75
-- _
$270.00
04/2012007
-
- 40
- - - - -
--
- - - $6.75 ----
- -- -, - -- $270.00- --
04127/2007 40
- 6.75 -
$ - - $2
70.00 -
05/04/2_0_07 40
- - -- _
$6.75 _
$
270.00
05/11/2007 40 $6.75 _
$270.00
0511812007 40 $6.75 $270.00
05/25/2007 40 $6.75 $
270.00
06101/2007 - 40
-
- -- -
- - 75 _
- - -- $270.00
06/2212007 40
-
-
--- 0 -
$10.0 - - - $400.00
07/06/2007
---- 40
-- --- _
$10.00 -- -$400.00
07/13/2007 40 $10.00 - - $400.00 - --
- -07/20/2007
- - - , - -- 40 -
-- --
-- -
- - -- $10.00 $400.00
0_7/27/2007
-- -
- 40
- ---
-- -
?_ - -$10.00 - -- --$400.00 -
08/03/2007 40
- $10.00
$400.00
-
08/24/2007-
-- - 40
- - - -
- $10.00 $400.00
08/31/2007 40 - $10.00 -- - $400.00
09/07/2007 ?
40
--
- r
-- - $10.00 -$400.00-
09/14/2007 -
_
_
- ---
40 _ $10.00 $400.00
09/21/2007 40 r _ _
00.00 - r--- $400.00-
-
09/28/2
007
- ---- -
40 -
- $10.0
0 - - -$400.00
_
10/05/2007 - -- 40 - 4 - _
- $10.00 - $400.00
10/1212007 +
40
$10.00
$
400.00
-
10/19/2007
_ --
--
-
- -- 40 - -
L _
$10.00 --
_
$400.0
0
10126/20
07 40
- -
-
- $10.00 _
$400.00
11/02/2007 40
- -
- - $10
700 - - $400.00
11/23/2007
-_ 0
-- --
-
-
+- ,
$10-00 -- - $400.00
11/30/2007
12/07/2007 40 _
_
40 - - $10.00 -
$10 .00 - $400.00
$400.00
01/2512008. I 40 ---
$10.00 - $400.00-
- 02/01/2008 40 $10.00 $400.00
A
R
•
v?rviiLUVif _ 40 _ $10.00
j -- -- ------ - ------ - -- t -- -$400.00
Total Hours--- 3360 -?? - -L----_- ? --- ? -----L -- -
Total Due $24,570.00
?R
y
VERIFICATION
I, A. ROBERT RISALITI, hereby state that I am the Director of the Bureau of
Labor Law Compliance, Department of Labor and Industry; that I am authorized to make
this statement on behalf of the Plaintiff; that I have read the foregoing Complaint; and that
the facts alleged therein are true and correct to the best of my knowledge, information and
belief.
This statement is made subject to the penalties of 18 Pa. C.S. § 4904, relating to
unsworn falsification to authorities.
Date: p
Bureau of Labor Law Compliance
?. dk.-t- 'Zx-
A. Robert Risaliti
Director
Bureau of Labor Law Compliance
.?
-?-?
-
,
-?'
,
_
jN
,? Y
...
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,
?
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}L, ? ?'3
,
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°? -
V'
SHERIFF'S RETURN - OUT OF COUNTY
CASE NO: 2008-04645 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
COMMONWEALTH DEPARTMENT OF LAB
VS
DELAWARE VALLEY COUNCIL OF AM
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:
DELAWARE VALLEY COUNCIL OF AMERICAN YOUTH HOSTELS INC
but was unable to locate Them in his bailiwick. He therefore
deputized the sheriff of PHILADELPHIA County, Pennsylvania, to
serve the within COMPLAINT & NOTICE
On September 9th , 2008 , this office was in receipt of the
attached return from PHILADELPHIA
Sheriff's Costs: So a
Docketing 18.00
Out of County 9.00
Surcharge 10.00 T mas Kline
Dep Philadelphia 136.00 r ff of Cumberland County
Postage 4.65 n-v
177.65 ? G/bi b8 !'
09/09/2008
COMMONWEALTH OF PENNSYLVANIA
Sworn and subscribe to before me
this _ day of ,
A. D.
SHERIFF'S RETURN - OUT OF COUNTY
CASE NO: 2008-04645 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
COMMONWEALTH DEPARTMENT OF LAB
VS
DELAWARE VALLEY COUNCIL OF AM
R. Thomas Kline
Sheriff or Deputy Sheriff who being
duly sworn according to law, says, that he made a diligent search and
and
w r T-. inquiry for the
Tr r??T mT . TTTT T.TT.TT T within named DEFENDANT to wit:
but was unable to locate Her in his bailiwick. He therefore
deputized the sheriff of PHILADELPHIA County, Pennsylvania, to
serve the within COMPLAINT & NOTICE
On September 9th , 2008 , this office was in receipt of the
attached return from PHILADELPHIA 1-17
Sheriff's Costs:
Docketing
Out of County
Surcharge
So
6.00 \
.00
.00
16.00 ? 9/!+?
09/09/2008
COMMONWEALTH OF PENNSYLVANIA
10.00 as Kline
.00 er' f of Cumberland County
Sworn and subscribe to before me
this day of ,
A. D.
In The Court of Common Pleas of Cumberland County, Pennsylvania
Carnionwealth, Department'of Labor & Industry etc
vs.
Delaware Valley Council of American Youth Hostels Inc et al
No. 08-4645 civil
SERVE: same
Now, August 4, 2008
hereby deputize the Sheriff of
I, SHERIFF OF CUMBERLAND COUNTY, PA, do
Philadelphia
deputation being made at the request and risk of the Plaintiff.
County to execute this Writ, this
Sheriff of Cumberland County, PA
Please mail return of service to Cumberland County Sheriff. Thank you.
D
Affidavit of Service
{ n6tl
Now, /? , 20, at _ o'clock _ M. served the
within
up
at
by handing to
a
and made known to
the contents thereof.
6r- ?i
lan e,? -5 0, do Xd# ?f { S ASS o answers,
k9flop-4-Q.
li), i) o3 03
30 ?n cl??
Sher"1''"Tr'0 CrR,.SS 5aN County, PA
'?e.r F to we.( ?5 ho P NLx,+ dov t r b
Sworn and sybscribed
me this ;UP day of (?-
iL fi'.
2006
copy of the original
coSTs
SERVICE _
MILEAGE _
AFFIDAVIT
10TARIAL SEAT.
MEL! =c" H. KAPLAN, Notori Public
C iv a-r Dhlladol0i9; PhiW :,.our!
In The Court of Common Pfeas of Cumberland County, Pennsylvania
Contionwealth, Department of Labor & Industry etc'
vs.
Delaware Valley Council of American Youth Hostels Inc et al
No. 08-4645 civil
SERVE: Ta'Juanna D. Anderson
Now, August 4, 2008 , I, SHERIFF OF CUMBERLAND COUNTY, PA, do
hereby deputize the Sheriff of Philadelphia County to execute this Writ, this
deputation being made at the request and risk of the Plaintiff.
Sheriff of Cumberland County, PA
Please mail return of service to Cumberland0Co unty Sheriff. Thank you.
Affidavit of Service
?? M0
Now, , 20at o'clock M. served the
within
upon `f(Q, \ And-Q-omo
at / 1-l U
by handing to
a
and made known to
the contents thereof.
?--CaM agt"q"' t w U7m?
0-5 lyd l I UU5 ? Gw L?
g)11I o a®3fm - ?b
I13I?`,S 9 3om??° Si?ellffof County, PA
??ss5
er F1e 94 b COSTS
r? COSTS
orfi s bscribed before SERVICE $
SW
me this day of t-A 66 , 20 OF MILEAGE
I/"\ A .. 1 1,/ / AFFIDAVIT
NOTARIAL SEAL
MELISSA H, KAPLAN, Notary Public
0iri of PhilsdNphla, Phlis,.ounty
copy of the original
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH, DEPARTMENT OF
LABOR AND INDUSTRY, BUREAU OF
BUREAU OF LABOR LAW COMPLIANCE
o/b/o Donna Rozycki,
Plaintiff
v.
DELAWARE VALLEY COUNCIL OF
AMERICAN YOUTH HOSTELS INC. and
TA'JUANNA D. ANDERSON, individually,
Defendants
CIVIL ACTION - LAW
DOCKET NO. 08-4645
PRAECIPE TO REISSUE COMPLAINT
A Complaint in this matter was filed with the Cumberland County Prothonotary on
August 5, 2008. The Sheriff in Philadelphia and Cumberland Counties were unable to
effectuate service on the Defendants. Since 30 days has passed since the initial filing,
Plaintiff is requesting the Prothonotary to reissue the Complaint so that Plaintiff may
again attempt service on the Defendants.
? nn
#nnifer L Berrier
Counsel or Plaintiff
Attorney I.D. No. 204444
Office of Chief Counsel
10`}' Floor, L & I Building
651 Boas Street
Harrisburg, PA 17121
Date: September 18, 2008
-V co
7 1r
O
SHERIFF'S RETURN - OUT OF COUNTY
CASE NO: 2008-04645 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
COMMONWEALTH DEPARTMENT OF LAB
VS
DELAWARE VALLEY COUNCIL OF AM
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:
DELAWARE VALLEY COUNCIL OF
AMERICAN YOUTH HOSTELS INC
but was unable to locate Them
in his bailiwick. He therefore
deputized the sheriff of PHTLAnFT,PNTA
serve the within COMPLAINT & NOTICE
County, Pennsylvania, to
On October 28th , 2008 , this office was in receipt of the
attached return from PHILADELPHIA
Sheriff's Costs: So answer
Docketing 18.00 - --'??
Out of County 9.00
Surcharge 10.00 Thomas Klin
Dep Philadelphia 272.00 Sheriff of Cumberland County
Postage 5.40
314 .4 0 l0?30?o S ?»
10/28/2008
COMMONWEALTH OF PA
Sworn and subscribe to before me
this day of
A.D. '
SHERIFF'S RETURN - OUT OF COUNTY
CASE NO: 2008-04645 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
COMMONWEALTH DEPARTMENT OF LAB
VS
DELAWARE VALLEY COUNCIL OF AM
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:
ANDERSON TA'JUANNA D
but was unable to locate Her in his bailiwick. He therefore
deputized the sheriff of PHILADELPHIA County, Pennsylvania, to
serve the within COMPLAINT & NOTICE
On October 28th , 2008 , this office was in receipt of the
attached return from PHILADELPHIA
Sheriff's Costs: So answers
Docketing 6.00 -'?
Out of County .00
Surcharge 10.00 R. Thomas Kline
.00 Sheriff of Cumberland County
.00
16.00 10/28/2008
COMMONWEALTH OF PA
Sworn and subscribe to before me
this day of
A. D.
In The Court of Common Pleas of Cumberland County,
Commonwealth, Department of Labor and Industry et lPennsylvania
vs.
Delaware Valley Council of American Youth Hostels Inc et al
SERVE: same
No. 08-4645 civil
Now, September 22, 2008 , I, SHERIFF OF CUMBERLAND COUNTY, PA, do
hereby deputize the Sheriff of Philadelphia
County to execute this Writ, this
deputation being made at the request and risk of the Plaintiff.
Sheriff of Cumberland County, pA
Please mail return of service to Cumberlan County Sheriff. Thank you.
_6
Affidavit of Service
Now, ,/ ?do
L 20 at __L_1 o'clock M. served
the
within
upon
at
by handing to
a
and made known to
copy of the original
the contents thereof.
So veers,
°f ? ?ad4.? .? t Q-Cou y, PA
t?fDCQSS ?.IU? ?
Sworn and subscribed bef e COSTS
me this y of 2 SERVICE $
MILEAGE
COMMON AVIT
MATERIAL SEAL
SUSAN L. RpgENFELD,
City of Philadel NP?ry PUblic
Mir Cemmission F Pi in, Ma ch 11. y
P
2012
• ? '
In The Court of Common Pleas of Cumberland Count,, Penns lvania
Commonwealth, Department of tabor and Industry et al, y
VS.
Delaware Valley Council of American Youth Hostels Inc et al
SERVE: Ta'Juanna D. Anderson
No. 08-4645 civil
Now September 22, 2008
, I, SHERIFF OF CUMBERLAND COUNTY, PA, do
hereby deputize the Sheriff of Philadelphia County to execute this Writ, this
deputation being made at the request and risk of the Plaintiff.
Sheriff of Cumberland County, PA
Please mail return of service to Cumberland Coy?nty Sheriff. Thank you.
rjo
Affidavit of Sem
Now, 20?
at o'clock M. served the
within
upon
at
by handing to
a
and made known to
copy of the original
s vo?e?n
Swdrn and subscribed
me this -c,21 day o?_?
So
/ Hof
?>lbcQ.SS ?2 /YQ
COSTS
SERVICE
the contents thereof.
MILEAGE
ROSENFELD, Notary Public
City of Philadelphia, Phila. County
w cemr-.issiQn_ExpimsMaNh-Lt.=
X2 fah c aCounty,
. IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH, DEPARTMENT OF
LABOR AND INDUSTRY, BUREAU OF
BUREAU OF LABOR LAW COMPLIANCE
o/b/o Donna Rozycki,
Plaintiff
V.
CIVIL ACTION - LAW
DOCKET NO. 08-4645
DELAWARE VALLEY COUNCIL OF
AMERICAN YOUTH HOSTELS INC. and
TA'JUANNA D. ANDERSON, individually,
Defendants
PRAECIPE TO SETTLE, DISCONTINUE AND END
TO THE PROTHONOTARY:
Kindly mark the above-captioned matter as settled, discontinued and ended.
Respectfully submitted,
Dated: d
ifer L, errier
Assistant Counsel
Attorney Registration No. 204444
Commonwealth of Pennsylvania
Department of Labor and Industry
Office of Chief Counsel
Labor Law Compliance Division
Tenth Floor, Labor and Industry Bldg.
651 Boas Street
Harrisburg, PA 17121
Telephone: (717) 787-4186
Counsel for Plaintiff
CERTIFICATE OF SERVICE
I, JENNIFER L. BERRIER, hereby certify that I have this 13th day of February
2008, served the foregoing Praecipe upon the persons and in the manner indicated below,
which service satisfies the pertinent rules of court:
Service First-Class Mail, Postage-Prepaid,
Addressed as follows:
Delaware Valley Council of American Youth Hostels Inc.
1210 Sansom Street
Philadelphia, PA 19107
Ta'Juanna D. Anderson
1210 Sansom Street
Philadelphia, PA 19107
J NNIF L. BERRIER
ssistant Counsel
Attorney Registration No. 204444
Commonwealth of Pennsylvania
Department of Labor and Industry
Office of Chief Counsel
Labor Law Compliance Division
Tenth Floor, Labor and Industry Building
Seventh and Forster Streets
Harrisburg, PA 17120
Telephone: (717) 787-4186
--Counsel for Plaintiff
2
r-? ,:"?
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