HomeMy WebLinkAbout08-5362
010170278508 LS
JUDGEMENT NOTE
Mechanicsburg , Pennsylvania, 11-14-2007 , $3,345.95
FOR VALUE RECEIVED, I/we promise to pay to the order of Erie Insurance Group
the sum of Three thousand three hundred forty-five and 95/100 said sum to be
payable said sum to be as follows: One hundred dollars, ($100.00 on the 15th day of
December, 2007 and One hundred dollars, ($100.00) on the 15th day of every
month thereafter until the entire amount is paid in full.
Uwe hereby authorize and empower any attorney of any Court of Record of Pennsylvania
or elsewhere, to appear for and confess Judgment against me for the sum due and payable
hereon, pursuant to PA. R.C.P. 2951 (a) (1) with or without declaration, with costs of
suit, interest at the rate of 6% per annum, an attorney's fee, release of errors, and without
stay of execution; and I/we also waive the right of inquisition on any real estate that may
be levied upon to collect this note; and Uwe do hereby voluntarily condemn the same and
authorize the Prothonotary to enter said voluntary condemnation upon any Fieri Facias
that may be issued to collect said Judgment; and I/we further agree that said estate may
be sold on a Fieri Facias, and I/we do hereby waive and release all relief from any and all
appraisement, stay of execution, exemption or bankruptcy laws of this or any other state
now in force or hereafter to be passed.
(L.S.)
Samuel Ortiz
A.S.)
This note is given executed without duress or coercion and with full and complete
understanding that upon failure to make payment as agreed, that my operating privileges
may be suspended.
Further, I do hereby acknowledge that the damage incurred in the accident of
December 11, 1996, for which this note is given resulted from my negligence and fault,
and I do hereby acknowledge and waive my right to any hearing or trial on that issue.
DRIVER DATE OF BIRTH X OV- q- 1978
DRIVER OPERATOR NO. X 03 779
OWNER DATE OF BIRTH X
OWNER OPERATOR NO. X
MAM
X (L.S.)
Samuel Ortiz
X
AUG 2 9 M08
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Luis Ayala
c/o Erie Insurance Group
Plaintiff
vs
Samuel Ortiz
Defendant
To: Samuel Ortiz, Defendant (s):
In the Court of Common Pleas
Cumberland County
Pennsylvania
S3L 1 C`'"`'Q ??'
Docket No. OF,
Civil Action
You are hereby notified that on 9 , 2008, the following (Oder)
(Depwujr?Judgment) has been entered against you in the above captioned case.
Date: JX ?? P s
(Prothonotary)
Samuel Ortiz
13 Buttonwood Lane
Carlisle, PA 17015
RAMSSURG
AUG 2 9 2008
Erie
Insurance'
Branch Office 4901 Louise Drive • Rossmoyne Business Center • P.O. Box 2013 • Mechanicsburg, PA 17055-0710
717.795.8200 Toll Free 1.800.382.1304 • Fax 717.795.2315 • www.erieinsurance.com
Cumberland County Prothonotary
Cumberland County Courthouse
I Courthouse Square
Carlisle, PA 17013
Erie Claim #: 010170278508 LS
Our Insured: Luis A. Ayala
Date of Loss: 12/11/1996
Defendant: Samuel Ortiz
No. and Term: # 08-5362 Civil
Dear Sir or Madam:
Kerry J. Ritchey, CPCU, AIC
Assistant Vice President & Claims Manager
I certify that the above-captioned Judgment is a result of a Motor Vehicle Accident.
Sincerely,
yau? &Louella Sanders
Subrogation Specialist
1-800-382-1304
LS/nlh
The ERIE is Above All in SERVICE
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