HomeMy WebLinkAbout08-5778t"
•
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
AMERICAN FAMILY INSURANCE I CIVIL DIVISION
subrogee of CHERRY C. FAULKNER
I
I
Plaintiff(s), 1 nr?l
I No. 2008 5779 (i?
V.
i
GEORGE P. JOHNSON, 1
an individual 1
I
I
Defendant(s), 1
I
I COMPLAINT
I
I
I Code No.
I
I Filed on Behalf of:
I
I PLAINTIFF
I
I
I
I ATTORNEY OF RECORD FOR THIS PARTY
I
I Louis B. Swartz
I
I PA. ID # 00242
I
I
ISWARTZ, LOVEJOY & ASSOCIATES
116th FLOOR LAW AND FINANCE BUILDING
(PITTSBURGH, PENNSYLVANIA 15219
I
I
1(412) 288-0300
%81277
NOTE: THIS IS AN ATTEMPT TO COLLECT A DEBT AND ANY INFORMATION
OBTAINED FROM YOU WILL BE USED FOR THAT PURPOSE
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I
COMMONWEALTH OF PENNSYLVANIA
POLICE CRASH REPORTtidG FORM
-AA 5W 1 Can Cbsed RepOrtable Gash 0?1
O Yn O Q YLQ No t+rtident Number ?
07-003733
A Name
D North Middleton Township 1'o-t
s o
rw* fmd) A+rtval r_. GnFI) h ator
1503 1504
Rew OFFICER GROVE
a..
Page I of 7
Crash Number
ratite 'Patrol
21208
Invest' fikm Dote (MM Dt3 YYY
09 - 10 -2007
HJEFFREY a Number 26-13
RUDOLPH of Data (MM pD YyYy
09 l
co coon Name 1 - it - 2007
a 21 timberland ?' ? - Ron- Marne
a Crash Dote (W&DD_YyrY3 208 orth Middleton Township
Cr" O ?,
09 - 10 - 2007 Time 670 No of Units O Thu
1503 ru76d• •n»0 O Mon OF,
Workt-QftAf 2910 Yes O No Stttool Bus ' 1 (} FI FF e O rue 0 Sat
Unk
I....,.,_? 0 No Related O Yes 0 Wed
a Y O M O a Way Intersection O ?Y• Intersection O M,dt; try Rimed O res Q rb PTO res O No
S
idbkxk O 'T• lniasection 0 traffic Circle! Intersettrorn O
Round About O On Off Ramp O Rafrwd Crossing =;R?
? Nrmrber meet fOptktrnaq Travel Lon" Spy ii+nit ?? O Crossover Q Off, •Q
Overly See
- street Name 02 3s ? O North
a rasa NwmbK (d apdicabk?
HARRISBURG O South
Street Boding O East
PK 0 West For
? crashes and make an
QQ O WInt-ers ol T ump&d 0 Turnpke Turnpike Cite O O Unknown ? vm'I?R°ad?"ar Sigel None is
East WKQ this option
Route Muni -- I
ZZI I tiata Spur Kghway O O LDGW l) Travel tsitea Spytit ev 0 Road 0 lkrkno
S DOW/
rvn
ED O North
Streetstreet?
a 0 south
Street Ending O East
It 8mme Interstate E: D 0 west '
O Ton ke 0 Unknown
(Not Turnprke} O (E t) O Sp O H way 0 courtly Lacaf Rand
-C: D b+t«secy !Rl Nom a, mile Host Road O or Sweet 0 Road O Unknown
IN & at NArItK
Please Or btteft"dir Street Uwe • C O North Feet
Enter 1 O South 0
worrnation CHARLES st -J
a f
L&I r aom An Rt Nom Or MR, Host - $T 0 0 East West or ikliks
it LW o
Th. Zo ~ or ?. ?
OP1in t gasiker -
12 Or Intersect S J O North Distance From Crash
CALVARY St Ending O Scene to landmark t
O East for Crash between Landmark I ( Minutes Seconds O West L--j Landmark 2)
latiwde: lL.?` JI ?:?
i Ditude - min=1
CD
O Not appkcaeta OTrafficSignet O reed gn 0 ?9Polite Of . of J J?-11
Attiup
Flash'
O Signal Traffic RR Cross O mun
0 Stop Sig, C :)Passive RR Otlter Type 7CD O No Controls (:)w>ceFunctianing 0
Emerw'y
skjw
f DNaltpb" (AF •?r ?4noitobk ; De** rest a the t+neCCkontrots mxe O Unknown O iD?'tun Jct?ioning O owning O
Yes 0 Unknown
O No 0 O Fully O Unknown 4witi2atum O O East O North and South c) AR
Unknown 0 Aw,-aw O c 30 Min. O 3060 Min. O West O East and West (N.s.E.m
MIN r A,s,sas naeN _ O 1-3 hrs O 3-6 hrs 0 6,9 hr,
> 9 hours
- Q OUnknown
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J COM TH (W KNE8SYLVA IA
POLICE CRASH REPORnw Fes; Imp
Page. Crash Number
AA 500 2 ^ a u,e or+r
T p W0063513
o Motor Vehicle
in
g ,tea transport O Hit a Rum Vehicle p ?gabY Parked p
lkrit Leg* Parked O Non • hotaized Coneerercal Veleicle Skates
o Pedestrian, O :ede WheNchtaMrr,' O Disabled From 0 Train p Yes ONO
etc .scan, Previous Crash O Phantom Vehicle
Pedestrian on skateq in TMM!ir, etc', Co kte Form M, Section 18 (n Yes, Complete Form Q
unit No Fbst lye
QI GEORGE MI Date of Airtl (MM-DD•YYYYI
P? 07 26 1953
Delete? Lag Name
O JOHNSON Tek a Number
Address / / State 7173853306
600 BALTIMORE AVENUE MOUNT HOLLY SPRINGS PA
D$var LRerrse Number 5
16180893 State Clan 1706
PA
9e AkoMs se:'
o Na p ukgar Drugs O Medication Ddvrr e r 11 1 11n Phrrisa! eardidran
O Alcohol O Alcohol and Drugs o Unknown O ? p Sick tal Drug p Fatigue p Medication
ktrho?r?e tuna O sick p A:leap O Unknown
e O Test Not Given O Breath O Other tkl?ide Cott- Ift"on
O Blood p Urine O T? C"oN"nif 38Q2 O Yom?
o Test Results O No
p Test Refused no" p?
a? p Test Given, O Resuhs 1-Driver Dperated 3=Driver tied Scene
Contaminated Results 1LJ1 Vehicle 4--Hit and Run
Q 00=Not Applicable L_ 2=No Driver 93-=Driver
PrW 0Nott A4 Vehicle Ownedr 02= ? Vehicle Not 04=State Police Vehicle 07-Munkipal Poke Veh
02 leased Ve Driver 0+kd4eased by WPM OS`PE?T Vehkk OB=other t kmmiopal tea) Gov Veh
03-Rented
KVehicle 0610drer state Gov Veh Goverruoem Vehk*
99-Unknown
Same as owner First Name Owner last Name a grtshfess ft-
Driver p LISA (HPed .Wry VW Section)
Address / /state / I;ip SMALLWOOD
24 SOUTH BALTIMORE AVEA MT HOLLY SPGS PA 1706 vPont iac Make 22
VIN Pont
1 G214'11477NF223713 Mod" vow Vehicle Model Lsee overlay)
ueenese Plate 1992 GRAND PRIX
sub Est Speed V-OhA* Totemd rowed
rrGGF7GGF7569 insurance Company PA
Flolicy NO Yes p No LEBOS TOWING
0 Yes O No o Un-
known --- - - ----
1z t
No. Of a"i^9 Pass. Veh 4=MObildNbdular Home r=Semi-Trailer Tag No -
a Trailing 0 2=Tbwing Truck S.Camper Tag Year T St
Urp li 3-Towing Uf ft Trar7er 9-other
6.FvM Trailer 9=Urrk?towrt
a WR-!y Q Weh de Iosldae?
01 •Mowenrent 01 -see
overlay
06.YNbw 05=large Trod 20.Unicycle, 8icyce,
12-Comawrdal
FOL
Silver old Q I 12 Motorcydt OYat 21 Peel 004" Applicable C
08--G
02I-Blue
01.81ue ? 03=Bus 10eSnowmobire 22?eorse a Bt?g y 01-Fire Veh 13=Tail
10aOraw n fff ,?' 04eSmA Truck 11-Farm Equip 13:Horse a Rider- 02=Ambulance 21=Trador Trailer
03=White i 1.Pu Complete lam 12={oRStru W Equip 24=Tram 03:DUlitt
0 .Green 11= her At Setria & 13=ATV 25=T 08-0ther Em 21=Twin Trailer
ergenTri*
ry 23=Mod Trotter
05=81ack gg r (if '20' or '21 ; Complete 18d)ther Type Spec Veh 98¦t? Vehicle
Veh
Fam M, Section 2 19.Unk. Type Spec Veh 9g.{Mk? 11=Pupil Transport g? nown
3
Ibirrt
Q2 O?Non Coaision 14=Under Gr nt 3=0ow„fti¢ RoadAnl
01'13 op Points T Unknown ? El OWIAXW t.Aeypn 3.Disabkng El 1=level 4-TOP tom h it Nil 1.Stralght
Clock is. 9-Unknown ph 2.Curved
r+ruaootraozr 2.U N 9=Urpknorvn 9.Urtnriwn
PENMDOT COPY
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runt URS W0063513
! •.
J Co"M')W*M1W C* S,RVAPOA
POUCE C)A94 REPWING MW.
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AA 500 2 r--r usr cny Page:
?-= J
p Motor vehicle in W0063513
Transport O Nit a Run vehicle p *9* Parked O tegaffy Parked
O Non
Page 3 of 7
crab Number
O Pedestrian O ?edestrian on Skates. O pisabler{ F Motowed COMM&W VW*k
(f'Ped rom
5 m +r. etc Previous Crash Q Train Q PhanFom vehicle O Yes 0 No
estrian ' or 'Pedestrian on Shale,; in fteeMhair, etc ;
Unit No C
First Name kte Form M, Section 28) IN Ye; Camoere form a
02 CHERRY M, two of Binh (MM-0D-YYYY)
Delete? fast Name [04 1950
O FAULKNER T Nurrrbar
Address f r Stage 4178651948 P!v
963 KICKAPOO AVENUE SPRINGFIELD MO
°rilva? ucerssee Number 658040054
429960551 age uass
ss ° -- EMO ?J
O No O oleo Drugs O Medication oriVer or Redesbiarl d w Corrd oon
O Akohd O Al""hol and Drugs Q Unknown O NwN O I 0 Fatigue O Medication
mho! rest Tune Q Q sick O Asleep Q Unknown
0 Test Not Gwen O Breath Yehirk Code Vioratian
z O Other O Bloo
Q Urine 0 Tenskt C?ivend O Yes Charm, ONO
t
? Ten O Test Refused Unknown ----.J
O Results 1=Driver Operated 3-Driver Fled Scene
O . O TContaminaest Ginnted vehicle
Results D 4.Hit and Run
q Yet 2=W Driver 9=Unknovi"
DO=Not '?? 02=Private Vehicle Not 04=State Police Vehicle 07?Murtit::
O1 01-fthate Vehicle Owrkd/ Ownedltessed by Driver O?PENNOoli Vehicle es-other Mrai
' Veh 09-Federal Gov Veh
Loosed by Dever r 03-Rented vehicle 98--Other
06-Other State Gov Veh
S Owner Fst Name Gom wnnt Vehicle 9%u known
k Owner Last Name or Business man,
O CHERRY FAULKNER >NPedksnranr sk d* pm)
Address IF ? state f zip
963 KICKAPOO AVENUE SPRINGFIELD MO 658040054 vclc Make *MWW code
VIN Jee !Will 02
1J8GL58K72WI80160 MOB Yaar vahkle Model 6 e Overlay)
ucerrse Plate 2002 LIBERTY
Reg. State Est Speed VWd,* Towed
762ZAE MO Towed s
?w.arxa O Yes O No LEBOS TOWING
b--cline company
O Yes O No O kr own Pocky No
AMERICAN fiAMILY MU UAL
y 073434500674FPPA - -
=Towin Pans. Veh
-- ikrits on f? ? Tn
S=Camper 8=Other fdAAoddat Home 7 Trailer Tag Na rag Year Tag St
U ?9 Utility trailer 6-FuM Trader
of ?t 9-Unknown
01 ?="."W? 01 'see
Overlay
006
YeNDW
06 01=Automobde Tn" 20-U'Pk. Bicycle. Fop 12Cornrnercial
Silver mold 02CbbtOr[yde 07-van 21 mother 00=Flota
0t-ek,e 09-bows 0324 10=Snovvrttobde Bugq?k Garner
02=Red 10?range (11 '92 C 04=Small Truck 1 harm Equip 232=Norse & Riderr" 02-Ambulance 011-Fire Veh t3eTa>a
D3=White t 1?urple fete Form 12Corrstrutbon Equip 2A--Train 03-PoNce 21=tractor Trader
04=Green 12¦OMkr clDn 261 13-ATV 22=Twin Trailer
05.86ck 99=UT nknown (Pf 70' or ?? . Complete 18, ther Type SDK Veh 98-0thee, 08 vewemergencY 23=Triple Trader
favor+t? Section 77) 19=Unk. Type Spec Veh 99=Unkro n It_Pripq Transport 99-Unk ,Ven
10 W-MM-Colksion 14 Unde cart
L----j 1 Level 5=Top of 01-12 ?bck Points 15= Towed tlnitW D 10 ne 3-Functioryl dfent 4e- Dom a HM 13-Top 99-Unknown 9-Unknown= n D 2-tlphiA 9=Urrkn?wn i D 2 Curv?ed
? t
r M.?t'X 9=Unknown
PENNDOT WPY
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i
3
rnnt CRS W0063513
_..1
AA 50a
A 1=Dries`
COMMONWEALTH OF PENNSYLVANIA
POLICE CRASH REPORTING FORM
3 roar use Dray PAPI
4
2.Passenger
??
other
9-Unknown
13 Fkmale
M=Male
U =Unknown
ftlasmw-
3=rMd r Ir te'"'
. wy
4
8 Unkry
9oUrhkrhowrh if
"UrY
D ge?C E
o1.Draer - a veh nc?ks
01=front Seat Middle Position
03,4ront Seat Right Side
04=Second Row - left Side Or
tor 05=SeCOnd Passe
Middle Position
OC>=Secand Row -11 Side
07=Thirdide Row Or Greater -
left S
OB=Thrd Row Or Greater -
09+c7hird Row Or Greater -
Right Side *tW I--In Ot hersfandoaed Truck,* F
01=iap Belt used --
03-W And Shoulder Beh Used
0 M Safety Seat used
lleknet *kmt uw
Z-S'safety Mt Used b+properly
12-HelmeSNeratp Used Improperly
90=Restraint UseQ 1yPPkrZ
99=Unknown
Passenger Or Cargo Area
12
O
A
0 1 --Front Air
:S,de Arc &9 Deed wor This Stat)
02
(B
pen
rea
SB?k Of Pickup. Etc.)
t3.traRfng Unit
This Seat)
03=01her Type Air
Bag
04-4A* Air Bags Depoyed
14. 1 us irassenver'de Ex[erior
I
9 Eye Prowl.6n
06=MO??
0t=Bicydist Wearing ' E meads
er
999 Unkn
own 1
M.
11?W Bag Not Depbycd switch
.
ch Off
1z Bag ft
?a y?
S%I
13=Air Bag Remover"If4im T
G
o
ash)
19=Unknown B Air Bap Deployed
99-Unknovm
? s <o„
W0063513
G
I.Nol 2=Tote Ejected ed
3?Pa ' Ejected
9=Unknown
H
O=Na EJe? / Not Applic"
I4Thmugh Side Door Opening
3--Through Side Window mrdo"
S=Throughgfh Back Dom
5=Th?0ug-h Back Door Tg gau
7eCOnK"* TopDown) (5unroob 9
Roof Opening (Cornertibfe
9=Unokrn .
' ?t 1
1=Extrioll0d By MecharhicM Means
33x9-? By Non - Mechanical Means
9--Unknown
EMS icy: GOODWILL SERVICES Iwedkal F-111I CARLISLE REGIONAL MEDICAL CENTER
Unit No merson No 0e1 Dab of Birth Nm-DD-wm
01 O1 p 07 -P6 -b953 a?? 01 D 00E 00 F 1G OM t
".?/Ad*em /?hene QQQDDD
? MZ as
opwator
JOHNSON, GEORGE P 600 BALTIMORE A VENUE MOOT HOLLY SPRIN EMS Transpon
tfnh No Person No O Yes (] No
DekteT Dote of lkth (MMMMODD.yyyYJ D
02 pNlleme / Add 0 / ?_~---J - 1950 FF 0n OJ 03 E 10 f IG p J
??? FAULKNER, CHERRY L--?ODDCI
C 963 KICKAPOO AVEm JE Si) ti D MO 65. °IS Transport
UNt no Dekte7 Osir o M C: loll III (MAA-0D yyyY) O Yes O No
KI 02 No 0
?_J L_J 2 F 0? 03 03 10 ?LJQ
Akrree ! Access /Phone
E] So" as
JEANETTE GACHES 1510 N. WASHINTONG AVEN SPRINGFIELD MO 6
EARS Transport
Person
No Dektei Date of B`" .- - - O Yes O No
(~-J "sake / Address /
phopm
Some as
Operator E==
Unk No -Person,
D0
Name / AddO / Phone
Same as
Operator
Uric No N° D@10*7 02% of Bill
O
Name, Address / Phan
somme as
Operator
+erhr r Maro plan
-----1 UULJI -I=m DD?
EMS Transport
O Yes O No
EMS Transport
O Yes ONO
F-1000
EMS Transport
OYes ONoI
PENNDOT COPY
hKpa/www.dot6.state.pa.us/icons/Printlmages/XmlFiles/20070898551JVhRudolnh200709_- gnni,)nm
Print CRS W0063513
J COMMONIIN MTH OF PE)NNISYLVAN1tA
POLICE CRASH REPORTWG FORM
AA 500 4 P?
• 5
Cush ue?••:•.rt.? Q 0=Nor?Colepn 2.mw on
1= ar EM 3.t r b Rear
i R 1w 1-Ooulde? ?
4=Aoad"
t EWirnlnabon r7-1 1-0309N
?.k _ e..a .
alb/ lli mr E `
D1?1n una 1
02=t Lk* 2
03-W Unit 3
W=W Unit 4
0swo ung S
06.HR Other Tmf1k Lk*
07=?ft Deer
OBd#t Other Animal
09=Cdisiion With O#w Non
12 3
14xSM do By Unit 4
15=sb rock By Unit 5
16-Strudt By Other Traffic UM
22=F6t Tree Or Slrt?blery
22WQ a?nnyy
2S.MGardS?Z
26-94 Guard Rai End
27wKd Curb
28-M Conveta or
29=J1%Mc?hw Barrier
"°O61 4.Oy? ?' NIIR101p1
?_ 1 1
()
d Swf?ce _ 4=Snow d Fog
-
CardFtYons Q •1 Wet . out
In1it No 1 2? ? 0 ?----
O1 2 02 O
Pkrtt in =00
3
Ewvus in
Segue W +aarr °QEl O
Nxm Event Up A1ost7 Able kwnber
Unk No t I 1 Lr O
fR?20
All hq
Evens in 3
=1Elo
Order
F' Urtlt No Heim iveM Moo
untlb "arm Event
15W. Wrm-fid
Win O1 27 KIP frivimN 7n,
a. na ?v»c sir:adnypM om er..n pq„
aenbF/Roedwvv
?11;A11 1 00 200 3D
roo
oiwfw* co"lions I'SkVeq R On R kWSnow)
e 1
Wather Condi r, 13 1
aY
D
0.&& RoWeather Conditions 14=1roken Or Cracked P,,Wt I
04.Oeer
i On Roi 15=TCD Obstructed 1
Q Animal In ROa 28?=09W p0 y qw? O?oP ON t
88=WOdk Zone Related 29 0dlerk frt.nomnental Facia t
i
II?s101e Vdwolh. fseFr.es t.
OOdMOre--..---"'?- M 12=1Arpers
06haiat t3=Driver
D1=res SNdrg2ormd 1i
02morake System 07?ts t tMedMT. sDoors. Hood. Etc
0043= = S teerro , *wn 1- ?r lights 16.Nedt tlrth
No
0 }t=Mirrors 1&i Overjoaded
unit
No 01 t 00 t 1 __ J Tracer Load wn
?--3 21.arlprp K Towi riom no
MD 02 t Op z 99 n ? podftws. Action O
4
I
A1rwe facevr Lr__J
Unit No Factor Code
- ebb-- --=
? Al
01
spofi d LpOr C"ing
02
W 03=Working
X05=/ ing Or
0 Leaving Vchide cftft
Verde
E!R ry G O1 ' 98
1 r gM""a+9. jogging.
O 0%= ki
.C:) O 0 O
vorur M E/R is the Prime Factor
TM ka.e Umf NO Wlk .Unit Ib p 1 99-Unknown
-unit No 02 PD
. 4a.asena"
PENN
DOT COPY -"
Page 5 of 7
WINE Gash Mrmber
W0063513
4e 0pp ==I
!Ib 74" Pimp ham)
ftxb free "Mme
LLTUM
fCare
Twing
Wrong tine
v W/o
I Aft Z.
Z7Z?
HicR C w4 Derive
On
Ming or Larv
No Passing Zane
e Wrong Way On
]=Sleet 8 Fog
biown
8.03W
6=OtlNt
333 ?t Fern Or Hal! BJ*V
32=w cww"
U-Ni1 p WOr Abutment
3S.Hit 6ri Rod
36.d1A Boulder Or Obstacle
37 O Roadway
439-M., %y Equipment
D&M 41-NiL TrOk WaW
42=Hit snow Bank
° NhTNemporary CwWnx%ion
48="k OMerF4edp??
49-Hit Unknown P. Otyect
50--overummol Ow
SSlftStruck By
Tlwown Or Filing
Owl
S2.Pot Holes Or Other
53-UdnNe Ries
54.rve in Ve*lp
sB.ONer loon CoNis"
99-Mnown Hamtfui Es"t
i
On The
Road
22?"
Comperwtion At Curve
24.onr. 70o Fast For Conditions
25=FA re To prow Speed
.Orkv i- - OW Chard
27
98=Failwe To RedP
hiWOByoer?DrnxgC?Acbo
9
O1 1 98 3 ?J
1 1EOOD I= 3C]
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9/20/2007
rnnt uKJ WU0635 t 3
0
COMMONWEALTH OF PENNSYLVANIA
POLICE CRASH REPORTING FORM
AA 500 5 A*ux a3 P'96
1 Page 6 of 7
Crash Number
W0063513
0
L LANCE WOODELL PO BOX 204 ELIZABETHTOWN PA 17022 .
2 NANCY GOODLING 7176295009
1025 CRYSRAL CREEK MECHANICSBURG PA 7175807553
Nanatfve a"d +ddtdaral messes:
Unit 1 was traveling North on SR 0011 Harrisburg Pike when cNodfkptJW ur kwedt O ?oPe? ?? O
the East Bound. Unit 1 then traveled across the center line and struck Unit 2,
which was traveling South in the South Bound lane. Unit 1 lost the rear driver
side fire and carne to rest on the shoulder of the North Bound lane. Unit i
driver was taken to Carlisle Regional M edical Center for injuries sustanded in
the accident
roar • anaaess"
PEWAM COPY
J?
http://www.dot6.state.pa.us/icons/PrintImages/XmlFiles/20070898551 J WRudolph200709... 9/20/2007
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Crash Number. VVD063513
Incident Number: 07-003733
oN-
C?
S=?L F.7
r
HARRISBURG PIKE (SR
11)
Page 7 of 7
http://www.dot6. gate.pa.us/icons/Printimages/Xm]Files/2007089855 I JWRudo1ph200709... 9/20/2
",°-- 007
s.
inc# 3733
NOTIFTION OF
ORTH 14IDDLE
TON OW SHIPAPOLICDE
Date
REPORTABLE 2051 Spring Road • Carlisle. Pennsylvania ALENT ?D 6
17013 • (717) 243-7910
NOTICE IS HEREBY GIVEN THAT THE A
TOWNSHIP POLICE DEPARTMENT AND CI TME COMMO IDENTIFIED BELO* IS BEING INVESTIGATED BY THE NORTH MIDDLETON
BE SUBMITTED AS PRESCRIBED BY SECTION 3746 (C) OF?VEHIC EPNE YLVANIA POLICE ACCIDENT REPORT WILL
[j NON-REPORTABLE
NOTICE IS HEREBY GIVEN THAT THE ACCIDENT IDENTIFIED BELOW IS NOT BEING INVESTIGATED BY THE NORTH
MIDDLETON TOWNS REPORT WILL NOT HISUBMICE DEPA
AS RTMENT A PRESCRIBED THAT THE SECTION COMMONWEALTH OF PENNSYLVANIA POLICE ACCIDENT
3746 (C) OF THE VEHICLE CODE.
PHONE
YEAR/MAI(E/MODEL / b LATE
VEH. AEG. NO. B STATF
VIN
INSURANCE CO.
OWNER NAME & ADDRESS
// OPEMTOA NO.
2 ?? A i??rs /I?w ?f
sTAEET AnoRESS
cxnr
YEAR/MAKE/MODEL
REG.
INSURANCE Co. ? r
OWNER NAME d ADDRESS C S
D.O.B.
TITLE
PHONE
PHONE
STATE TITLE
a srATE - vIN
WODE ------_ POLICY
f -dG - 75/Fpp q
a
' OPERATOR'S NAME PHONE??19-
OPEgATOA NO. a STATE
3 CLASS D.O.B. PHONE
sTREETAppgESg
YEARIMAKE)MODEL STATE zrP -- TITLE
AeG. No. a sTATe -....
INSURANCE CO. vEH. VIN
CODE --- POLICY
OWNER NAME & ADDRESS --
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Badge No. of
881277
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL DIVISION
AMERICAN FAMILY INSURANCE
subrogee of CHERRY C. FAULKNER
Plaintiff(s),
No. 2008
V.
GEORGE P. JOHNSON,
an individual
Defendant(s),
VERIFICATION
The undersigned, WA? ! , avers
that he/she is the of Plaintiff,
is authorized to make this verification on behalf of
Plaintiff, the statements of fact contained in the attached
Complaint are true and correct to the best of his/her
information, knowledge and belief, and are made subject
to the penalties of 18 Pa. Cons. Stat. Ann. Section 4904
relating to unsworn falsification to authorities.
Date q4716
VERIFCOM.PLE
1
V V
Ca n
i
SHERIFF'S RETURN - NOT FOUND
CASE NO: 2008-05778 P
COMMONTWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
AMERICAN FAMILY INSURANCE
VS
JOHNSON GEORGE P
R. Thomas Kline Sheriff or Deputy Sheriff, who being
duly sworn according to law, says, that he made a diligent search and
inquiry for the within named DEFENDANT
JOHNSON GEORGE P but was
unable to locate Him in his bailiwick. He therefore returns the
COMPLAINT & NOTICE ,
NOT FOUND , as to
the within named DEFENDANT JOHNSON GEORGE P
552 CROSSROAD SCHOOL ROAD
CARLISLE, PA 17015-9450
OWNER HAD HOUSE BUILT & SHE DOES NOT KNOW DEFENDANT. SHE
RECEIVED MAIL FOR DEFENDANT FROM PLAINTIFF, RETURNED IT.
Sheriff's Costs: So )4?f
Docketing 18.00
Service 9.00
Not Found 5.00 R. Thomas Kline
ff of Cumberland County
Surcharge 10.00 (!/US/SWARTZ
*00
42.00 10/01/2008
Sworn and Subscribed to before
me this day of ,
A.D.
David D. Bueff
Prothonotary
VrkS. Sohonage, ESQ
Solicitor
Wgnee X Simpson
1" Deputy Prothonotary
Irene E. Morrow
2"d Deputy Prothonotary
Office of the Prothonotary
Cum6erfand County, Bennsykania
DS ' J ! L CIVIL TERM
ORDER OF TERMINATION OF COURT CASES
AND NOW THIS 25T" DAY OF OCTOBER, 2011, AFTER MAILING NOTICE OF
INTENTION TO PROCEED AND RECEIVING NO RESPONSE - THE ABOVE
CASE IS HEREBY TERMINATED WITH PREJUDICE IN ACCORDANCE WITH PA
R.C.P 230.2
BY THE COURT,
DAVID D. BUELL
PROTHONOTARY
One Courthouse Square • Suite 100 • Carlsfe, P.A 17013 • (717 240-6195 9 Fax (717 240-6573