HomeMy WebLinkAbout08-5105IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: Estate of Logan M. Norris CIVIL DIVISION
NO. D- 5 Lys-
PETITION ?.
FOR APPROVAL OF
SETTLEMENT AND ALLOCATION OF
PROCEEDS OF WRONGFUL DEATH
AND SURVIAL ACTION
Filed on Behalf of the Petitioner:
State Farm Mutual Automobile
Insurance Company
Counsel of Record for This Party:
Kevin D. Rauch, Esquire
Pa. I.D. #83058
SUMMERS, McDONNELL, HUDOCK,
GUTHRIE and SKEEL, L.L.P.
Firm #911
1017 Mumma Road, Suite 300
Lemoyne, PA 17043
(717) 901-5916
#16331
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: Estate of Logan M. Norris CIVIL DIVISION
NO.
(Jury Trial Demanded)
PETITION FOR APPROVAL OF SETTLEMENT AND ALLOCATION OF PROCEEDS
OF WRONGFUL DEATH AND SURVIAL ACTION
AND NOW, comes the Petitioner, State Farm Mutual Automobile Insurance
Company, by and through its counsel, Summers, McDonnell, Hudock, Guthrie & Skeel,
L.L.P., and Kevin D. Rauch, Esquire and sets forth the following Petition for Approval of
Settlement and Allocation of Proceeds of Wrongful Death and Survival Action, and in
support thereof avers as follows:
1. This claim arises out of a motor vehicle accident which occurred on May 1,
2008, on Interstate 81, near Walker Road, Chambersburg, Pennsylvania.
2. At that time, Logan M. Norris, was a pedestrian, that was changing the tire
to a vehicle on the side of Interstate 81.
3. At that time, Anthony C. Kratochvil was operating a vehicle traveling south
on Interstate 81which struck Mr. Norris.
4. As a result of the accident, Mr. Norris was fatally injured. Attached hereto
as Exhibit "A" is a copy of Mr. Norris' Death Certificate.
5. On May 1, 2008, the vehicle operated by Anthony C. Kratochvil was
owned by Vincent C. Kratochvil, and insured under policy of automobile insurance
issued by Petitioner, State Farm Mutual Automobile Insurance Company. This policy,
bearing policy number 7175-974-38R provided a total of $100,000 in policy limits for
such accident (see State Farm Mutual Automobile Insurance Certifications of Limits,
attached hereto as Exhibit "B").
6. Mr. Norris' father, Richard F. Norris, was duly qualified as Administrator of
Logan M. Norris' Estate on May 23, 2008, by the Registrar of Wills of Cumberland
County, Pennsylvania. Attached hereto as Exhibit "C" is a copy of the grant of letters.
7. As Administrator of the Estate, Richard F. Norris has made a claim to
State Farm for benefits under a wrongful death and survival action, although no suit has
been filed.
8. The name, address, relationship and share of each person entitled to
share under the wrongful death action are as follows:
Richard F. Norris - Father
24 Doe Drive
Carlisle, PA 17015
9. Notice of this Petition has been given to the above in accordance with the
Pennsylvania Rule of Civil Procedure 2205.
10. Logan M. Norris' mother, Esther Dickey, predeceased him on July 27,
2005. Attached hereto as Exhibit "D" is a copy of the death certificate.
11. Mr. Norris, as Executor of the Estate of Logan M. Norris has entered into a
settlement agreement with the Petitioner, State Farm Mutual Automobile Insurance
Company, to settle the wrongful death and survival action subject to this Court's
approval of the settlement action pursuant to 20 Pa.Cons.State.Ann. 3323 (b). Attached
hereto as Exhibit "E" is a copy of the Release.
12. The total amount of the proposed settlement is the policy limits of
$100,000.
13. There is no other coverage which applies to this action.
14. Decedent did not have a Will.
15. Mr. Norris, as Administrator of the Estate of Logan M. Norris avers that the
assets of the Estate will be sufficient to satisfy all debts, pay all creditors and pay
inheritance taxes.
16. Subject to the approval of this Honorable Court, the Petitioner agrees that
the settlement of $100,000.00 is in the best interest of the Estate.
17. If the Petition is granted, the settlement proceeds will be distributed as
follows:
Wrongful Death Action
Richard F. Norris - the sum of $10,000.00
Survival Action
Estate of Logan M. Norris - the sum of $90,000.00
WHEREFORE, the Petitioner respectfully requests that this Honorable Court
approve the settlement of Mr. Norris' Estate against State Farm Mutual Automobile
Insurance Company for a total of $100,000.00.
Respectfully submitted,
SUMMERS, McDONNELL, HUDOCK,
GUTHRIE $ SKEEL, L.L.P.
By: L-1),Lk l
Ke in . Rauch, Esquire
Counsel for Petitioner,
State Farm Mutual Automobile
Insurance Company
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: Estate of Logan M. Norris CIVIL DIVISION
NO.
(Jury Trial Demanded)
ORDER
AND NOW, this day of , 2008, it is hereby
ORDERED, ADJUDGED AND DECREED that the settlement of Logan M. Norris' Estate
against State Farm Mutual Automobile Insurance Company is approved for full and final
settlement of any and all claims arising from the motor vehicle accident which occurred
on May 1, 2008, in Chambersburg, Pennsylvania for. a total of $100,000.00 to be
distributed as follows:
Wrongful Death Action
Richard F. Norris - the sum of $10,000.00
Survival Action
Estate of Logan M. Norris - the sum of $90,000.00
BY THE COURT:
J.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing PETITION
FOR APPROVAL OF SETTLEMENT AND ALLOCATION OF PROCEEDS OF
WRONGFUL DEATH AND SURVIAL ACTION has been mailed by U.S. Mail to
counsel of record via first class mail, postage pre-paid, this day of
Aunud-_, 2008.
Richard F. Norris
Patricia Norris
24 Doe Drive
Carlisle, PA 17015
Holly McClintock
Pennsylvania Department of Revenue
Bureau of Individual Taxes
P.O. Box 280601
Harrisburg, PA 17128-0601
By:_ Llue
Kevin D. Rauch, Esquire
Counsel for Petitioner
State Farm Mutual Automobile
Insurance Company
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: Estate of Logan M. Norris CIVIL DIVISION
NO. 08-5105
PRAECIPE TO ADD EXHIBITS TO
PETITION FOR APPROVAL OF
SETTLEMENT AND ALLOCATION OF
PROCEEDS OF WRONGFUL DEATH
AND SURVIAL ACTION
Filed on Behalf of the Petitioner:
State Farm Mutual Automobile
Insurance Company
Counsel of Record for This Party:
Kevin D. Rauch, Esquire
Pa. I.D. #83058
SUMMERS, McDONNELL, HUDOCK,
GUTHRIE and SKEEL, L.L.P.
Firm #911
1017 Mumma Road, Suite 300
Lemoyne, PA 17043
(717) 901-5916
#16331
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: Estate of Logan M. Norris CIVIL DIVISION
NO. 08-5105
(Jury Trial Demanded)
PRAECIPE TO ADD EXHIBITS TO PETITION FOR APPROVAL OF SETTLEMENT
AND ALLOCATION OF PROCEEDS OF WRONGFUL DEATH AND SURVIVAL
ACTION
TO: THE PROTHONOTARY
Kindly add the enclosed exhibits to the Petition for Approval of Settlement and
Allocation of Proceed of Wrongful Death and Survival Action in the above-captioned
case.
Respectfully submitted,
SUMMERS, McDONNELL, HUDOCK,
GUTHRIE & SKEEL, L.L.P.
ir'-ck (A-S
By:
Kevin D. Rauch, Esquire
Counsel for Petitioner,
State Farm Mutual Automobile
Insurance Company
Exh?,b; ?-
a
State Farm Ins. 6/20/2008 3:00 PM PAGE 2/003 Fax Server
b-5/271/2008 13-:14 7172498636 RICHAFD H RRIS PHrE 011'2
LOCAL REGISTRAR' CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
F. for this certificate Ss5,00 ... This is to certify that the info mation here given i
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! 4?'\ crY1{ tl} cnl?ied from an original Certificate of Death
'it duly filed -with me as Local Registrar. The original
certificate will be forwnded to the State vital
7-: Records Office for Permanent Ming.
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6
STATE FARM
State Farm Insurance Companies
INSURANCE
CERTIFICATE OF COVERAGE
Claim Number: 38-L456-408
Vehicle Number: 003
The undersigned is a Claim Team Manager for:
State Farm County Mutual Insurance Company of Texas
State Farm Lloyds, Inc.
ate Farm Indemnity Company
M'Sate Farm Mutual Automobile Insurance Company
State Farm Fire and Casualty Company
Claim Central - Complex
PO Box 142
Concordville, PA 19331-0142
This certifies that policy number 7175-974-38R, covering a 2000
Chevrolet Cavalier, was issued to Vincent C Kratochvil and Shelly
Kratochvil and was in effect on the accident date of May 1, 2008.
The coverages and limits of liability for this policy on that
date were:
A 100/300/100,02 25,000,H,U 15/30,W 15/30,F 2,500,Y1,Z2
This policy provides Limited Tort.
Veronica Sansom
Claim Team Manager
State of Pennsylvania
)ss.
County of Washington
Subscribed and sworn to before me this day of( '
(Year) ?,
r
Notary Public
COMMONWEALTH OF PENNSYLVANIA
M ommis4gglSQcp1re :
Lori Knight, Notary Public
North Strabane Twp., Washington County
StKgEgef' T"aM ?tl°nAd"Mobile Insurance Company
HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001
&6 %IV
cooo
State Farm Ins
6/20/2008 3:00 PM PAGE 3/003
ilE/ 2 7 /'2"ClOR 1:_.14 1724,386=6
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Fax Server
PAGE 02//2
SHORT CERTIFICATE
i , GL ENDA FA RNER S TRA SBA UGH
Recris~te for the Probate of Wills and GrRnLinq
Lecte,rs of Administration in and for
("UM2- RLANL) Ccun ty, do hereby certify that on
the 23rd day of May, 'rwc The iigancd and Eight,
Letters of ADMINISTRATION
in common form were grRnted by the Register- of
said Count:
y , old the
es tc't t-e of LOGAN M NORRIS 1a to of LQWF_R FRANKFORD TOWNSHIP
(First "IYOFIA. LORI
i_a said cctrs2 ty, dec 4 •a-, ed, to RICHARD F NORRIS _
rAI/ ip hrlytl/G, Lo-W
._s_z:d that same has not since Leer revohcd.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed t-he
Seal of said at CARLISLE, FE tTSYLVA TIA., t}pis 23rd day c7f M.
Two Thousand and Eight-.
'•i 1 e 11io . 2006- 00563
-'i 1 e NO. 2 i - 08- 0563
Date cf Death 510112008
#, 048-82--6807
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011"J"lly).
cE>ury
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NOT V.AL-IP WITHOUT ORIGINAL LIGlL4YURE AND XPRESSE.13 SEAL
PIl:,'H-lFD f-]OR 'IS
c"11 14111 1l1„ ^ 13 c9 L? 4/_5 l y40P
Exh????
1.805 REV 3105
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 11731750
No.
H105.H3AN.?J87
TyPHP.RINT
IN ' NAA E OF.MaaDEN (Fww Mldtly
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BLAOK INK i. De'ni Se Pc
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COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF nFeru
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RELEASE
For the Sole Consideration of One Hundred Thousand ($100,000.00) Dollars the
receipt and sufficiency whereof is hereby acknowledged, the undersigned, Richard
Norris, as Administrator of the estate of Logan M. Norris, hereby releases and forever
discharges Anthony C. Kratochvil, his executors, administrators, agents and assigns,
and all other persons, firms or corporations liable or, who might be claimed to be liable,
none of whom admit any liability to the undersigned but all expressly deny any liability,
from any and all claims, demands, damages, actions, causes of action or suits of any kind
or nature whatsoever, and particularly on account of all injuries, known and unknown, both
to person and property, which have resulted or may in the future develop from an accident
which occurred on or about the 1St day of May, 2008, on Interstate 81, near Walker Road,
in Chambersburg, Cumberland County, Pennsylvania. This includes, but is not limited to,
any and all claims filed in the Court of Common Pleas of Cumberland County.
This release expressly reserves all rights of the parties released to pursue their legal
remedies, if any, against the undersigned, their heirs, executors, agents and assigns.
Undersigned hereby declares that the terms of this settlement have been completely read
and are fully understood and voluntarily accepted for the purpose of making a full and final
compromise adjustment and settlement of any and all claims, disputed or otherwise, on
account of the injuries and damages above mentioned, and for the express purpose of
precluding forever any further or additional claims arising out of the aforesaid accident.
Undersigned hereby accepts draft or drafts as final payment of the consideration set forth
above.
Any person who knowingly and with intent to defraud any insurance company or
other person files an application for insurance or a 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 such person to criminal and civil penalties.
In Witness Whereof,
have hereunto set -,!?g hand and seal this ? day of 2008.
In esence of.
Signed
Witness
X
Richard F. Norris
Administrator of the Estate
Of Logan M. Norris
VERIFICATION
I, Richard F. Norris, hereby certify that I am the Administrator of the Estate of the
deceased, Logan M. Norris. I reviewed the proposed settlement as set forth in the
foregoing Petition and Proposed Order. The averments of facts contained in the PETITION
FOR APPROVAL OF SETTLEMENT AND ALLOCATION OF PROCEEDS OF
WRONGFUL DEATH AND SURVIAL ACTION are true and correct to the best of our
knowledge, information and belief. I recommend that the Court approve this settlement
and understand that this certification is made pursuant to provisions of 18 Pa.C.S. §4904
relating to unsworn falsification to authorities.
Dated: ? 7 ?eloP
Richard F. Norris,
Administrator of the Estate of Logan M. Norris
#16331
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing PRAECIPE TO
ADD EXHIBITS TO PETITION FOR APPROVAL OF SETTLEMENT AND
ALLOCATION OF PROCEEDS OF WRONGFUL DEATH AND SURVIAL ACTION
has been mailed by U.S. Mail to counsel of record via first class mail, postage pre-paid,
this day of AAU+ , 2008.
Richard F. Norris
Patricia Norris
24 Doe Drive
Carlisle, PA 17015
Holly McClintock
Pennsylvania Department of Revenue
Bureau of Individual Taxes
P.O. Box 280601
Harrisburg, PA 17128-0601
Y• LD-Lk ?">
Kevin D. Rauch, Esquire
Counsel for Petitioner
State Farm Mutual Automobile
Insurance Company
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: Estate of Logan M. Norris CIVIL DIVISION
NO. O g?,, -.5-1 ® 5- c f 4,eflt,
(Jury Trial Demanded)
ORDER
AND NOW, this O? day of 4-0--X? , 2008, it is hereby
ORDERED, ADJUDGED AND DECREED that the settlement of Logan M. Norris' Estate
against State Farm Mutual Automobile Insurance Company is approved for full and final
settlement of any and all claims arising from the motor vehicle accident which occurred
on May 1, 2008, in Chambersburg, Pennsylvania for a total of $100,000.00 to be
distributed as follows:
Wrongful Death Action
Richard F. Norris - the sum of $10,000.00
Survival Action
Estate of Logan M. Norris - the sum of $90,000.00
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: Estate of Logan M. Norris CIVIL DIVISION
NO. 08-5105
(Jury Trial Demanded)
PRAECIPE TO SETTLE AND DISCONTINUE
TO: THE PROTHONOTARY
Please marked the above-referenced matter SETTLED and DISCONTINUED,
with prejudice.
Respectfully submitted,
By:
Richard Norris, Administrator of the Estate of
Logan Norris
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