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Home My WebLink About01-0980William P. Douglas, Esq. Supreme Court ~[.D. #3?926 Douglas, Douglas & Douglas 27 W. High St. Carlisle, PA 17013 Telephone (717) 243-1790 Shaffer, as Parents and Natural ' ,~, ~e ~,-ourr or common Pleas of Guardians of Derek Shaffer, a minor Cumberland County, Pennsylvania Petitioner/Plaintiff i No. 01- ~ 90 Civil Term VS Twin Ponds Arena Civil action law .......................... Respondent/D~fendant Settlement Approval Petition for Approval of Minor's Settlement 1. Your Petitioners, Kendra J. Shaffer and Thomas L. Shaffer, are the parents and guardians of Derek Shaffer, a minor, and the aforesaid reside at 105 Steelstown, d., Newwlle, Cumberland County, Pennsylvania. 2. The minor child, Derek Shaffer, was born on June 25, 1983. His Social Security Number is 169-70-6689. 3. The respondent is Twin Ponds Arena, 101 Salem Church Road North, Mechanicsburg, Cumberland County, Pennsylvania. 4. On February 16, 1997, the minor, Derek Shaffer, was ice skating at the Twin Ponds facility, owned and operated by the defendant, and, while there, he fell and suffered a laceration to his ear, which has left some permanent scarring. While it is possible that additional cosmetic surgery may be done with respect to the scar, no further medical treatment is determined to be medically necessary with resp .ect to said injury. 5. To date, all past medical bills have been paid and there are no outstanding bills. 6. The Petitioners have agreed to settle this matter for the sum of $12,000.00. 7. All sums set forth above constitute damages on account of personal injury/wrongful death, arising from the occurrence, within the meaning of § 104(a)(2) of the Internal Revenue Code of 1986, as amended. 8. Your Petitioners request the Court direct that the sum of Six Thousand Dollars ($6,000.00) be paid directly to Petitioners/M/nor on behalf of Minor's recent purchase of a 1993 Honda Civic (current book value is $7,000.00). Petitioners and M/nor have requested the disbursement of the monies to avoid paying interest charges/fees on a loan to cover the purchase cost. Further, Minor is a 17-year-old male who is currently in 11th grade at Big Spring High School. It is the Petitioners' desire to limit the Minor's working hours per week dur/ng the school year as the Minor is covered under an Individualized Education Program for a Language Processing Learning Disability. If Minor is required to take a purchase loan from a lending institution for the vehicle, he will require additional working hours to pay the monthly payment, which could adversely affect his school studies. Petitioners currently cover M/nor under their insurance policy through Erie Insurange Group, and intend to do so until his graduation from high school in June 2002. The Minor's vehicle will reasonably provide transportation to school events, work, as well as transportation to academics after high school graduation. 9. Your Petitioners request the Court direct that the Six Thousand Dollars ($6,000.00) balance be placed in a federally-insured savings account or certificate of deposit, to be marked, "Not to be withdrawn until age 18, or further Order of a Court." 9. Your Petitioners further request that the Court direct that the federally- insured bank or savings institution be permitted to pay federal and state income tax on the income earned on behalf of the minor in the said account/accounts. WHEREFORE, your Petitioners pray that the settlement be approved. William P. Douglas, Esq. Attorney for Petitioners William P. Doug, las, Eso. Supreme Court I.D. #3~926 Douglas, Douglas & Douglas 27 W. High St. Carlisle, PA 17013 Telephone (717) 243-1790 · ~t~ the ~-ourt ot Common Pleas of " Shaffer, as Parents and Natural Cumberland County· Pennsylvania Guardians of Derek Shaffer, a minor Petitioner/Plaintiffi No. 01- Civil Term vs Twin Ponds Arena Civil action law Settlement Approval .................................... ..R..espondent/Defendant i AFFIDAVIT I hereby swear or affirm that the Foregoing is true and correct to the best of my knowledge and/or information and belief. This fs made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. · 2001 K~n~ra i. Sha~r -///- ~ Parent and I~tural Guarc~a~a of Derek Shaffer William P. Douglas, Esq. Supreme Court LD. #37926 Douglas, Douglas & Douglas 27 W. High St. Carlisle, PA 17013 Telephone (717) 243-1790 Shaffer, as Parents and Natural Cumberland County, Pennsylvania Guardians of Derek Shaffer, a minor Petiti mer/Plaintiffi No. 01- ~'J>~) Civil Term VS Civil action law Twin Ponds Arena Settlement Approval Respondent,/Defendant i ORDER AND NOW, to wit, this the c~o~tay of ~/~.{a/u4.2001, a hearing is scheduled for the ~_~day of .~o'~.~ ,2001, at ~;.,~ o ~'clock, ~,..M., in Court Room Number ,.~ , of the ~umberland County Court House, Carlisle, Pennsylvania. o2-27-01 Shaffer, as Parents and Natural Guardians of Derek Shaffer, a minor Petitioner/Plaintiffi Cumberland County, Pennsylvania No. 01- Civil Term Vs Civil action law Twin Ponds Arena Settlement Approval Respondent/Defendant · ORDER /ill NOW,to wit thisth~.d, ayof[~ , 2001, a hearing having AND previously been held in th~s matter, it is hereb~ ordered that the settlement in the amount of Twelve Thousand Dollars ($12,000.00) l~or personal injuries to the minor, Derek Shaffer, is approved. The proceeds are to be paid as follows; Kendra J. Shaffer and Thomas L. Shafer, as parents and natural guardians of Derek Shaffer, a minor, for the purchase of a 1993 Honda Civic $6,000.00 Kendra L. Shaffer and Thomas L. Shafer, as parents and natural guardians of Derek Sharer, a minor $6,000.00 The $6,000.00 proceeds of the settlement for the minor child are to be deposited in a federally-insured savings account and/or certificate of deposit, marked "Not to be withdrawn until age 18 or further Order of a Court". The minor child, Derek Shaffer, was bom on June 25, 1983. His Social Security Number is 169-70-6689. All sums set forth above constitute damages on account of personal injuries, arising from the occurrence, within the meaning of § 104(a)(2) of the Internal Revenue Code of 1986, as amended. IT IS FURTHER ORDERED that the institution in which said funds are deposited is hereby granted permission to use such income from said funds that is necessary to pay income tax which may become due and payable as a result of the said funds being on deposit in their institution. THE GUARDIANS shall provide a certificate to the Prothonotary setting forth the place of deposit, account number, in compliance with the above provision. William P. Douglas, Esq. Supreme Court LD. #37926 Douglas, Douglas & Douglas 27 W. High St. Carlisle, PA 17013 Telephone (717) 243-1790 Shaffer, as Parents and Natural Cumberland County, Pennsylvania Guardians of Derek Shaffer, a minor Petitioner~Plaintiffi No. 01- q £0 Civil Term vs Civil action law Twin Ponds Arena Settlement Approval Respondent/Defendant To; Praecipe to Issue a Writ of Summons Curtis R. Long, Prothonotary Dear Mr. Long: Please issue a writ of summons against Twin Ponds Arena, 101 Salem Church Road North, Mechanicsburg, Pennsylvania. William P. Douklas}(Esq. Attorney for Petit~ner February 20,2001 Commonwealth of Pennsylvania County of Cumberland "i~'~"j""~t~'~¥~:"~nd Thomas L. ' In the Court of Common Pleas of ' Shaffer, as Parents and Natural Cumberland County, Pennsylvania Guardians of Derek Shaffer, a minor Petitioner/Plaintiffi.. No. 01- q£O Civil Term VS Civil action law Twin Ponds Arena Settlement Approval Respondent/Defendant Writ of Summons To: Twin Ponds Arena 101 Salem Church Road North Mechanicsburg, PA 17055 You are hereby notified that Kendra J. Shaffer and Thomas L. Shaffer, as Parents and Natural Guardians of Derek Shaffer, a minor, have brought an action against you. February 20,2001 Deputy Prothonotary