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Home My WebLink About01-6808LISA E. MARTIN, JOHN N. WALTERS and MARGARET T. WALTERS, individually and as Parents and :CUMBERLAND COUNTY, NaturalGuardians of DANIEL WALTERS, a Minor, :PENNSYLVANIA Petitioners : v. :NO. Ot -- :CIVIL ACTION - LAW Respondent : :IN THE COURT OF COMMON Pl ~EAS PETITION FOR APPROVAL OF COMPROMISE SETTLEMENT AND DISTRIBUTION OF PROCEEDS OF A MINOR'S COMPROMISE AND NOW, come Petitioners, JOHN N. WALTERS. and MARGARET T. WALTERS, individually and as parents and natural guardians of DANIEL WALTERS, a minor, and file this Petition to Compromise Action and for approval and distribution of settlement proceeds and aver the following in support thereof: 1. Petitioners JOHN N. WALTERS and MARGARET T. WALTERS (hereinafter "Petitioners") are adult individuals who currently reside at 100 Byron Nelson Circle, Etters, Pennsylvania, 17319. 2. Petitioners are the parents and natural guardians of DANIEL WALTERS, a minor, (hereinafter "Minor") who currently resides with Petitioners at the above address. o o ° Minor's date of birth is May 1, 1986. Respondent LISA E. MARTIN (hereinafter "Respondent") is an adult individual who currently resides at 116 Bungalow Road, Enola, Pennsylvania, 17025. This case arises from an automobile accident on November 15, 1998 wherein the vehicle of Respondent collided with that in which the Minor was a passenger. As a result of the accident, Minor was taken to Holy Spirit Hospital for evaluation at which time he was diagnosed with a cervical strain. A copy of the Emergency Room report is attached hereto as Exhibit "A". Minor had conservative follow-up treatment consisting of pain medication and rest. Respondent was insured under an auto policy issued by Nationwide Insurance Company (hereinafter "Nationwide"), an insurance company licensed to transact business in the Commonwealth of Pennsylvania, with a principal place of business at 1000 Nationwide Drive, Harrisburg, Pennsylvania, 17112. To date, Minor's medical bills have been paid by USAA. Petitioners have made a careful and diligent inquiry and investigation to ascertain the facts surrounding the accident, the responsibility of therefore and the nature, extent and seriousness of Minor's injuries. 11. As evidenced by that attached hereto as exhibit "B", the Minor's treating physician has opined that the Minor has obtained maximum medical improvement without the need for further treatment. 12. Nationwide has offered to compromise this claim for the mount of Five Thousand Three Hundred Dollars ($5,300.00) of which One Thousand Fifty Dollars ($1,050.00) is to be paid to Margaret T. Walters for out-of-pocket expenses incurred. 13. Petitioners believe that this compromise with Nationwide is fair and in the best interest of Minor. 14. Nationwide requests that Petitioners give a release in the form attached hereto as Exhibit "C". 15. Said compromise is in accordance with Pa.R.C.P. 2039. 16. Petitioners intend to deposit said proceeds of Minor's settlement in a trust account at Members First Federal Credit Union, a banking institution insured by the FDIC. 17. Proof of deposit shall be filed with the Court. WHEREFORE, Petitioners request that this Honorable Court enter an Order authorizing settlement in accordance with the aforementioned terms, and that Petitioners, individually and as parents and natural guardians of Minor Petitioner, may execute a general release in favor of Nationwide Insurance Company and its insured, LISA E. MARTIN. Respectfully submitted, JAMES, SMITH, DURKIN & CONNELLY LLP /~~, ESQUIRE Attorney I.D. ~29563 ]AP, ED W. HANDLEMAN, ESQUIRE Attorney I.D. #82629 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorney for Petitioners DATE DATE JOHN N. WALTERS, Individually and as Parent and Natural Guardian of DANIEL WALTERS, a minor as Parent and Natural Guardian of DANIEL WALTERS, a minor VERIFICATION The undersigned, JOHN N. WALTERS, Individually and as Parent and Natural Guardian of DANIEL WALTERS, a minor, hereby verifies that the facts set forth in the Petition for Approval of Compromise Settlement and Distribution of Proce2xts of a Minor's Compromise are tree and correct to the best of his knowledge, information and belief and further states that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unswom falsification to authorities. JOHN N. WALTERS VERIFICATION The undersigned, MARGARET T. WALTERS, Individually and as Parent and Natural Guardian of DANIEL WALTERS, a minor, hereby verifies that the facts set forth in the Petition for Approval of Compromise Settlement and Distribution of Proceeds of a Minor's Compromise are tree and correct to the best of her knowledge, infom~ation and belief and further states that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unswom falsification to authorities. Exhibit A CC HPI PMH AI.,LERGIES SH/FH ROS CONSTITUIT1ONAL EYES ENT NECK LUNGS CHEST CARDIAC Gl]ABDOMEN SKIN ADM, DATE: 11115/98 Thc patient ,s a 12-year-old white male who presents after a motor vehicle accident. The patient wa~ a restrained passenger ,n the front seat, Complains of para in h,s r,ght and left clawcle areas and right and left'dlac crest and lower cervical, upper thoracic vertebrae, cervical area at about the level of TI, T2. Denies any other specific complaints. Nil, Nil. Negative. The patient demes any head injury, loss of consciousness, blurred vision or vomiting pHYSICAL EXAMINATION The patient is a well,developed, well.nourished white male m no acute d~stress. Temperature 98.2° Fahrenheit, pulse 69, resp~rations 18, blood pressure 130/68. Conjunc~vae w~thoul discharge or mlect~on. Lids w~thout lesions. PERRL. Ears - Tympanic membraneS without perforation, mjeet~on or bulging. Mouth - Lips, teeth and gums normal Throat - Oropharynx w~thout lesions or exudate. Airway patent. Nose - Nasal mu¢~xsa normal. SinuseS- No sinus tenderness. The pataent ,~ tender on palpation over the level of about TI, T2, mostly parasp,mous area, but also m the mldline. Normal reSpiratory effort. Breath sounds equal No roles, rhonchl or wbeeze~. Nonreader to palpation. Regular rate and rhythm without murmurs, ectopy, rubs or gallops. Soft, nontender, normal bowel sounds, no masses. No hepatosplenomegaly- Normal color and ~urgoi'. The patient has paint on bis left forearm from something unrelated to the accident. Page 1 HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 NAME: WALTERS, DANIEL MR#: 403383 ROOM #: ECU DR.: Rudntck EXTREt~TIES NEUROLOGICAL PSYCHIATRIC LABORATORY ASSESSMENT Symmetrical. Full range of motion. Equal tone and strength. No io~nt tenderness or effusion. No clubbing or cyanos~s. Alert and oriented to person, place and t~me. Cranml nerves intact. Sensory and motor functmnz normal. Reflexes symmetrical. Oriented to person, place and tame Mood and affect appruprmte. A unnalysis was negative for blood. An x-ray of the patient's cervical spine, lumbosacral spree and T-spree were w~thm normal hm~z. ASSESSMENT PLAN Muscle strain. Ibuprofen or Tylenol for pain, warm soaks to 1he patient's tender areas on h~ back/neck for half hour every four hours for 72 hours. No gym for one week Follow up w~th ins family doctor ~thm one week's t~me. HR/ad D: 11/15/1998 T 11/16/1998 2395 Page 2 HOLY SPIRIT HOSPITAL Camp Hill, 17011 NAME. FF,4LTEILq, DANIEL MR#: 403385 ROOM # ECU DR: Rudtttek EIVI~RGENCY CARE L"NIT FAMILY HEALTH CENTER DISCHARGE INSTRUCTIONS HOLY SPIRIT HOSPITAL (717) 763-2316 (717) 763-2424 an effort to provide The examination aad tream~ent you have received in the Emergency Care Unit (ECU) have been rendered on aa emergency basis only, and are not intunded t9 be a substitute for or complete medical care, If you develop new problems or co~plicatlons .contact your physician or the Emergency Care Unit. FOLLOW THE INSTRUCTIONS CHECKED BELOW. d,ati'~nnt Inform~on~ Patient Information sheets contain important information to review and keep. ~ ) ~,~[n ( ) Conjunctivitis { ) Fever/Pad. Fever ( ) Laceration ( ) Seizure ( ) Alcohol reaction ( ) COPD ( ) Flu ( ) Neck Strain !J Sore Throat ( ) Allergic reaction ( } Corneal abrasion/foreign body ( ) Fracture ( ) Nosebleed J~.Sprains and Strains ( ) Asthma ( ) Croup/bronchitis ( ) Headache ( ) Otit[s Media '( ~ Threatened Miscarriage ( ) Back pain ( ) Crutch walking ( ) Head injury ( ) Pediatric Head Injury ( ) Toothache ( ) Bites-Human/Animal/insect ( ) Diarrhea and Vomiting/Pad. Vomiting ( ) Hyper[ension ( ) Pediatric URI ( ) URI and Colds ( ) Burn ( ) Drug/Alcohol abuse/addiction ( ) Immunization/Tetanus ( ) PID/VD ( ) UTI and Pyelonephrit[s ( ) Chest Pain ( ) Febrite Convulsion ( ) Kidney Stones ( ) Rash ( } Other WOUND CARE ~esent medications except: ( ) May gently wash over wound in 24 hours with soap snd water or peroxide. Do not soak in water. ( ) Change dressing times daily. Redress with Bacitracin/Neosporln and sterile dressing. d:'/, cc'.'C,"d ~/Diptherie Booster given. BRUISES, F~...R~ ~'"'~"tEl~vate the injured part for days to reduce swe[l[ng. ) Apply ice packs intermittently for days to reduce swelling. ) Ace wrap for suppor~ for days. ) Wear splint ( ) At all times until folrow-up. ( ) For activity as needed. ) Use sling for support. ) Use crutches: ( )As needed, weight beating as tolerated. ( ) At all times. NO WEIGHT BEARING for t ~-vvear cervical collar support for days· ( ) Rest, avoid bending, lifting, strenuous activity for days. (~bpply moist heat for '~0 m nutes ~ '-_~ times daily / ADDITIONAL INSTRUCTIONS ( ) Off work/school from. __ to ( ) Light Duty until: Restrictions: t £ _ NO gym/sports until ] //'~ ~ / ~ ~ ~Follow instructions on W(~rk/me~'s Co~np~nsation Form. ( ) Wear eye patch for hours. ( ) if nose bleed recurs, pinch nose firmly for 5 minutes continuously, return if bleeding not controlled. ( ) The prescribed antibiotic may reduce the effectiveness of medication you ere currently taking. Check package instructions or consult with Pharmacist, )The interpretation of your X-Reys are preliminary reading. Your films will be reviewed by a radiologist· You or your physician will be contacted if there ia a change in the diagnosis. ~,dditional Instructions: /~oUSe Advil (Ibuprofen) or Tylenol as pain, needed for fever rding to package instructions for age, weight. ( ) Use the following medicines according to package instructions: 1: 2: 3: ( ) The following medicines may cause drowsiness: DO NOT DRIVE OR OPERATE MACHINERY WHILE TAKING: This is our recommendation for follow-up, your If nsu~anca (HMO) requires a physician referral for specialty consultation, IT IS YOUR RESPONSIBILITY TO OBTAIN THE //~ESSARY APPROVAL. ollow-up with: ( ) Return to hospital ,,Family Doctor 7//'--- ("~,) ( ) WorkN et days for: ~Follow-up in · ~ ) Suture removal ( ) Call as soon as possible for appointment ) Pick up your X-Rays from the Radiology Department prior to your follow-up appointment. Call 763-2696 to have films ready. ) See your physician or specialist if not improved in days. ) Return to ECU if you feel your condition is worsening, especially if ) Your blood pressure wes elevated. Please have it rechecked by your physician. ) Test results have been given to you. Take them with you to the follow-up appointment. Test results given: F~CBC []CPRO [] EKG [] X-RAY COPY [] RENAL PRO. [] RECORDS COPY CHART [] GLUC. i~horabTIENT VERBALIZES UNDERSTANDING y acknowledge receipt of these instructions and understand them. I understand that I have had emergency treatment only and that I may be released before all of my medical problems are known or treated. I will arrange for follow up care as SIGNATURF~f \ .~ ~,r- _ . ! SIGNATURE'/f~/ ~;~ysieian - M.D. ] D.O~. Nu'r, 11/15/98 1546 HOLY SPZRIT HOSPITAL, C~(P HILL, PA 17011 DEI~ARTM~NT OF LABORATORY M~DICINE STEpHENBON S.P. SWA~DOSS'M.D., DIRICTOR LOCATION PA~E 1 Ae~9~ 0000127B~128 ~/C$~ 403a83 Loo&~£on~ ECU ROb~T Spec $' 1115:U00024S Ordered: URIN Coll: 11/15/98-!531 Recd' 11/15/98-1533 Status. COMP sub Dr: ED GROUP Req $' 00991856 COLOR CLARITY DH GLUC. BILI PROTEIN ~ITE LE~ EST Result Y~LLOW 7 0 NORMAL I~GATIVE NEGATIVE NEGATIV~ NEGATIVE NEGATIVE NEGATIVE AM, ST,YE 4 5-8 0 NORF~%L MG./DL NEGATIVE M~,/DL. ~TI~ ~TI~ ~TIVE HOLY SPIRIT HOSPITAL, ~ HILL, PA 170~1 PAgE I DATE, 11/17/98 RUN TI~ 0909 D~ART~ OF LA~ORAT. ORY~DICI~q~ ST~PHENSON S.P. SWAM~DOSS M.D., DIR3CTOR LOCATION WAi~TE£$,DANIEL G .A~C~s 0000127~7128 ~=~; 40~3fl3 98:B0O18603R COMP, Coll 11/15/98-1525 Recd NOT ~ERFO~D - I ,OREENNEGATI%'E 11/1~/~8-1~7 (R~0099186¢) ED GROUP MOLY SPIRIT ~K)SPITAL DEPARTMENT OF RADIOLOGY AND DIAGNOSTIC IMAGING CAMP MILL, PENNSYLVANIA 17011 (717) 763-2600 P~TIENT: WALTERS, DANIEL G DICTATION DATE: 11/15/98 5:36pm . MR= 403383 SOC SEC: 999-05-0186 ORD DR.~ ED GROUP, PT TYPE: ADM DATE4~98 02:37PM LOCATION ECU TRANSCRIPTION DATE 11/16/1998 07:55AM SERVICE: ECU EXAMINATION: cERVICAL sPINE COMMENTS: Alignment is normal and the disc interspaces are preserved. No bony abnormalities are seen. There is no encroachment on the neural foramina. The atlanto-axlal relationshzps appear normal. CONCLUSION: Normal cervical spine. DICTAcorD BY t DATE O~ EXAM: K.R. Haidet, M.D./lah 11/15/1998 HOLY SPIRIT HOSPITAL DEPARTMENT OF RADIOLOGIf AND DIA$~OSTIC ~ HI~, p~S~V~IA 17011 (717) 76~-2600 PATIENT" WALTERS, DANIEL G DICTATION DATE: 11/15/98 5:36pm · MR: 403383 SOC SEC: 999-05-0186 ORD DR.: ED GROUP, LOCATION~E~ TRANSCRIPTION DATE 11/16/1998 07:56A~ ARI~IVAL DATE: HOSP SERVICE{ ECU EXAMINATION: THORACIC SPINE (3V COMMENTS: Alignment is normal and the dxsc interspaces are preserved. The vertebral bodies are normal in height. The bony architecture is normal and there is no abnormal widening of the paraspinal stripe. CONCLUSION: Normal thoracic spme. DIC~A~ BY: DATE OF EX;IMz K.R. Haidet, ~l.D./lah 11/15/1998 HOLY SPIRIT HOSPITAL DEP~RTMENT OF RADIOLO~Y AND DIAGNOSTIC IMAGING CAMP HILL, PENNSYLVANIA 17011 (7X7) PATIENT~ WALTERS, DANIEL G MR: 405383 S0C SEC~ 999-05-0186 ORD DR.: ED GROUP, PT TYPE: E ADM DATE_l,~5~:37PM LOCATI0~--~ DICTATION DATE~ 11/15/98 5:36pm. T~ANS~RIPTION DATE 11/16/1998 07~57AM ARRIVAL DATE~ HOSP SER¥ICE~ ECU EXA~INATION~ LUMBAR SPINE (6V) COMMENTS: Alignment is normal and the disc intez~paces are preserved. The bony structures appear normal. The apophyseal and sacro-iliac Joints are unremarkable. CONCLUSION: Normal lumbar spine. DICTATED BY: DA~E OF EXAM: K.R. Harder, M.D./lah 11/15/1998 Exhibit B DAVID M. JOYNER, M.D., F.A.C.S. RICHARD J. BOAL, M.D. ROBERT IL DAHMUS, M.D, STEPHEN W. DAILEY, M.D. WILLIAM W. DEMUTH, M.D., F.A.C.S. JOHN IL I~ 11, M.D., F31,C.S. MARK IL GRUBB, M.D. RICHARD H. HALLOCK, M.D. ORTHOPEDIC INSTITUTE OF PENNSYLVANIA TELEPHONE: (717) 761-5530 · (800) 834-4020 FAX: (717) 737-7197 JAMES IL MAMSHER, M.D., F.A.C.S. GREGORY A, HANI%5, M.D, ALF~L~iDER IV~LENAK, M.D., F.A.C.S. ROBERT IL KANEDA, D.O. RONALD W. LIPI~, M.D., F.A.C.S, JASON J. LrlTON, M.D. STEVEN B. WOLF, M.D. THOMAS J. YUCHA, M.D, October 16, 2000 John McNalty, Esquire James, Smith, Durkin & Connelly LLP P.O. Box 650 Hershey, PA 17033 RE: OCT 4 2000 Daniel G. walters 212 17 2461 Dear Mr. McNally: The above patient was initially seen by me on December 16, 1998. He was a 12-year-old boy, who had no history of neck or low back pain and was seated as a passenger in the front seat of a car on November 15, 1998. The car was stopped and was rear-ended by another vehicle that he said might have been going 40 miles an hour. He noted the onset of neck and low back pain and was seen at Holy Spirit Hospital the day of injury where radiographs of his cervical spine, thoracic spine and lumbosacral spine were taken. They reportedly showed no abnormalities. When I saw Daniel, he was taking Advil and was having intermittent neck and Iow back pain. His orthopedic examination disclosed no objective findings of neck or low back abnormalities. I felt that Dan had strained his neck and low back in the vehicle accident and because of continued pain was unable to wrestle at that time. I felt that it was appropriate for him to continue taking Advil and sent him to the Keystone Spine Center for a program of back exercises, which he was to continue to do on his own. At that point I felt that no other investigative studies were indicated and expected his symptoms to subside with the passage of time. I did not feel that surgery would be necessary- When I saw Daniel on December 16, 1998, he was still symptomatic and had not z~ached maximum medical impzoveme~L. I do not know when he will do so. As have stated I do not know if any additional medical treatment is needed or prescribed because I have not seen him in nearly two years. If I can be of other help to you, please call on me. S incerel~:~ Jaso% J. Litt~In, M.D. JJL/clv ORThOPeDIC SURGEONS, LTD. ADDRESS ALL CORRESPONDENCE TO: 875 POPLAR CHURCH ROAD, CAMP HILL, FA 17011 II~RRI$~I3RG OFFICE ~J~F IllLL OFFICE HERSHEY OFFICE 450 pOWERS AVE. 890 POPLAR CHURCH RD., STE. 108 10 WEST CHOCOLATE AVE., STE. 105 CAMP HILL OFFICE CAMP filLL OFFICE. 875 pOPLAR CHURCH RD; 3916 TRINDLE RD. Exhibit C FULL AND FINAL RELEASE. FOR AND IN CONSIDERATION of the sum of FIVE THOUSAND THREE HUNDRED DOLLARS ($5,300.00) paid to the undersigned, JOHN N. WALTERS and MARGARET T. WALTERS, individually and as Parents and Natural Guardians of DANIEL WALTERS, a Minor, the receipt and sufficiency of which is hereby acknowledged, the undersigned agree to fully release, discharge, hold harmless, and indemnify NATIONWIDE INSURANCE COM.PANY, LISA E. MARTIN, and all other persons, associations and corporations, whether or not named herein, their heirs, executors, administrators, successors, assigns and insurers, and their respective agents, servants, employees and attorneys, from any or all causes of action, claims and demands of whatsoever kind on account of all known, and unknown injuries, losses and damages allegedly sustained by DANIEL WALTERS on November 15, 1998, and, specifically, from any claims, or joinders, for sole liability, contribution, indemnity or otherwise as a result of, arising from, or in any way connected with injuries sustah~ed by DANIEL WALTERS, and the defense and handling thereof from the inception of the claim until the date of this Full and Final Release. The undersigned understand and agree that the acceptance of said sum is not an admission of liability by any party named herein. It is expressly understood and agreed that.this Release and settlement is intended to cover and does cover not only all known injuries, losses, and damages, but any further injuries, losses, and damages which arise from or are related to the occurrences set forth in the Legal Action noted above and the handling and defense thereof. Nationwide Insurance Company will, however, pay for all future treatment to the Minor which resulted from automobile accident of November 15, 1998 to the extent not covered by other insurance, and such payments shall be made directly to the Minor's healthcare providers. It is further understood and agreed that this is the complete Release Agreement, and that there are no written or oral understandings or agreements, dkectly or indirectly connected with this Release and settlement that are not incorporated herein. This Agreement shall be binding upon and inure to the successors, assigns, heks, executors, administrators, and legal representatives of the respective parties hereto. The undersigned hereby declare and warrant that they are of legal age, the terms of this settlement have been completely read, and that they have discussed the terms of this settlement with legal counsel of choice; and said terms are fully understood and voluntarily accepted for this purpose of any and all claims on account of the injuries and damages above-mentioned, and for the express purpose of precluding forever any further or additional suits arising out of the aforesaid claims. WITNESS: JOHN N. WALTERS, Individually and as Parent and Natural Guardian of DANIEL WALTERS, a Minor DATE WITNESS: MARGARET T. WALTERS, Individually and as parent and Natural Guardian of DANIEL WALTERS, a Minor DATE TO YOU ~RE¢"I,iEREBy NOTIFIED TO PLEAD TO THE E NCLC/.~E D WITHIN A DEFAULT J~D~NT MAY BE E~ LAW OFFICE JAMES, SMITH, DURK~ & CONNELLY, LIJP E O. BOX 650 HERSHEY, PENNSYLVANIA 17033-0650 WE HEREBy CE Ib"Y THAT THE WITHIN IS A TRL!E ANDCEC~OI~EcT COPY OF THE JOHN N. WALTERS and MARGARET T. WALTERS, individually and as Parents and Natural Guardians of DANIEL WALTERS, a Minor, Petitioners LISA E. MARTiN, Respondent : iN ~ COURT OF COMMON PI F. AS : CUMBERLAND COUNTY, : PENNSYLVANIA : CIVIL ACTION- LAW ENTRY OF APPEARANCE Dated: //~/~ ! TO THE PROTHONOTARY: Kindly enter the appearance of the undersigned on behalf of the Petitioners, John N. Walters and Margaret T. Walters, Individually and as Parents and Natural Guardians of Daniel Walters, a Minor, with respect to the above-captioned matter. Respectfully submitted, JAMES, SMITlf, DURKIN & CONNELLY, LLP -~U-RKIN; ESQLqlLE / Attorney I.D. ~29563 JARAD W. HANDELMAN, ESQUIRE Attorney I.D. #82629 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant JOHN N. WALTERS and MARGARET T. WALTERS, individually and as Parents and :CUMBERLAND COUNTY, NaturalGuardians of DANIEL WALTERS, a Minor, :PENNSYLVANIA Petitioners : v. :NO. Or-- 6,gO? LISA E. MARTIN, :IN THE COURT OF COMMON PLEAS :CIVIL ACTION - LAW Respondent : ORDER AND NOW, this~_~_~ day of~, 2001, upon presemation of a Petition for Approval of Compromise Settlement and Distribution of Proceeds of a Minor's Compromise, it is hereby directed that a hearing, on the merits take place on the ~.~ day of ~ ., 2001J[at ~_.._'.'_._._.'t~' o'clock in the ~.m. JOHN N. WALTERS and MARGARET T. WALTERS, individually and as Parents and NaturalGuardians of DANIEL WALTERS, a Minor, Petitioners LISA E. MARTIN, Respondent :IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY, :PENNSYLVANIA . :NO. O[- ~0~ :CIVIL ACTION - LAW ORDER AND NOW, this-~z'~ day ofII ._._A~ , 200~the Petition of JOHN N. ! . WALTERS and MARGARET T. WALTERS, individually and as parents and natural guardians of DANIEL WALTERS, a Minor, is hereby GRANTED, with Minor's proceeds to be issued as follows: Settlement of $5,300.00, to be distributed as follows: $4,250.00 to DANIEL WALTERS in a guardianship account insured by a Federal governmental agency. $1,050.00 to MARGARET T. WALTERS for unreimbursed wage loss during the Minor's convalescence. 3. No withdrawals can be made from such account without Court approval until the minor reaches majority. 4. Proof of deposit shall be promptly filed of record. Petitioners may execute a general release in favor of Nationwide Insurance Company and LISA E. MARTIN. By the Co~ coUrT oF c°~°~ JOHN N. WALTERS and MARGARET : IN THE COURT OF COMMON PLEAS T. WALTERS, individually and as Parents and : CUMBERLAND COUNTY NaturalGuardians of DANIEL WALTERS, a Minor,: PENNSYLVANIA Petitioners : LISA.E. MARTIN, NO. 01-6808 CIVIL ACTION - LAW Respondent PRAECIPE TO SETTLE AND DISCONTINUE TO THE PROTHONOTARY OF YORK COUNTY: Kindly mark the above docket as settled, satisfied and discontinued as to all parties in this action. JAMES, SMITH, DURKIN & CONNELLY, LLP / JARAD W. HANDELMAN, ESQUIRE Attorney I.D.//82629 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Petitioners JOHN N. WALTERS and MARGARET T. WALTERS, individually and as Parents and NaturalGuardians of DANIEL WALTERS, a Minor, Petitioners LISA E. MARTIN, Respondent IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 01-6808 CIVIL ACTION - LAW PRAECIPE TO FILE PROOF OF DEPOSIT OF MINOR'S SETTLEMENT TO THE PROTHONOTARY OF YORK COUNTY: Please file, and make part of the record, the attached proof of deposit of Minor's settlement proceeds in accordance with the Order of Court dated January 2, 2002. Dated: JAMES, SMITH, DURKIN & CONNELLY, LLP J Attomey I.D. g29563 JARAD W. HANDELMAN, ESQUIRE Attomey I.D. #82629 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attomeys for Petitioners Members/ . P.O. Box 40 · Mechanicsburg, PA 17055-0040 (717) 697-1161 TOLL FREE (800) 283-2328 www.membersl st.org 205175 WALTERS/DAN S 100 BYRON NELSON CIRCLE ETTERS PA 17319-9435 CR RT: 0 FLAGS:R3,26 02/19/02 BR: 10wn:S BD: Ref:C24/ATM Dept:BOOK-R PR: .00 Password: SSN:212-17-2461 Affinity Code: PH:(717)938.-0197 Household: 0 WK:(000)000-0000 Number Date Memo 000001001 02/19/08 FUNDS FROZEN IN ACCOUNT UNTIL 5/1/04 PER COURT ORDER IMT Slx Desc Dt Open Balance Avail Rate YTD Div Lst Act Flags 00 RSA 051701 276.32 851 .0000 1.38 021908 40 ~ 30M 021908 4850.00 0 4.0300 .00 021902 22,40 Total Shares Pledged: 12775.00 Membersl FEDERAL CREDIT UNION February 19, 2002 Re: Daniel G Walters Karen Durkin PO Box 50 Hershey, PA 17033 Dear Karen; Members 1st FCU has established an account for Daniel G Walters. The funds in the account have been placed in a Certificate of Deposit and frozen until May 1, 2004 pursuant to the Order of the Court of Common Pleas of Cumberland County. The enclosed document shows the account name and the restriction placed on those funds. Please contact us for any additional assistance. Any questions or further communications should be directed to Gregory P Schank, AVP Branch Operations at 717-795-6003 or 1-800-283-2328 ext 6003. Respecfully, Isodean M Wodey Assistant Branch Manager Enclosure FEB 2 rl 2002 5000 Louise Drive · P.O. Box 40 ° Mechanicsburg, Pennsylvania 17055 ° (717) 697-1161 ° Fax (717) 795-6024 www. members 1 st.org C) CZ~ CD