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HomeMy WebLinkAbout10-7816IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION Plaintiff(s) & Address(es) Adele M. Sims, Administratrix of Estate of Harold T. Sims & Trustee Ad Litem for all persons entitled to share in damages for the Wrongful Death of Harold T. Sims vs. Defendant(s) & Address(es) Mary C. O'Donnell and Thomas O'Donnell, 1106 Centre Street, Ashland, PA 17921 and Eric Locke, 107 E. Biddle St., Gordon, PA 17936 C ~ Case No. ~~~'~_-Civil TenOi r.,,a ~ '~-~ ~ 7 Civil Action_ ~ ~ ~ r'~rg `~ ~ ~ 4~, t -~ ~~ ~ N ~t;~`t PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY/CLERK OF SAID COURT: Issue summons in the above case Writ of Summons shall be issued and forwarded to A rn ri 1 s 1 6 ice J ~ sLEt~ Date : December 21, 2010 Signature of Attorney Print Name: R. Mark Thomas, Esgwre Address: 101 South Market Street Mechanicsburg, PA 17055 Telephone #:717-796-2100 Supreme Court ID Number: 41301 ~, 5: / WRIT.sOF~ SUMMONS ~~,°1Qr.~i. ~. ~'~~'lrtclr (3a/1~ /lYln'1at D'h~,nNC~ll ana' ~i^;~ L~'~ -~ YOU AbCE_-2~OTIFiED THAT THE ABOVE-NAMED PLAINTIFF(S) HAS/HAVE COMMENCED AN ..ACTION AGA3NST YOU. •/ Date: ~ . ~ l ~O/D othonotary/ 1 ivil Division by eputy ~~o~ •~~ ~ • G~ J ,~~`' a5ac,7~ SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff Jody S Smith Chief Deputy Richard W Stewart Solicitor >, _rq i, Tk V4 I Adele M. Sims, Administratrix of Estate of Harold T. Sims vs. Thomas & Mary O'Donnell (et al.) SHERIFF'S RETURN OF SERVICE Case Number 2010-7816 12/21/2010 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Thomas & Mary O'Donnell, but was unable to locate them in his bailiwick. He therefore deputized the Sheriff of Schuylkill County, Pennsylvania to serve the within Writ of Summons according to law. 12/21/2010 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Eric Locke, but was unable to locate him in his bailiwick. He therefore deputized the Sheriff of Schuylkill County, Pennsylvania to serve the within Writ of Summons according to law. 02/02/2011 Schuylkill County Return: And now, February 2, 2011 I, Joseph Groody, Sheriff of Schuylkill County, Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for Eric Locke the defendant named in the within Writ of Summons and that I am unable to find him in the County of Schuylkill and therefore return same NOT FOUND. Request for service at 107 E. Biddle Street, Pennsylvania 17936 the defendant was not found. 02/02/2011 Schuylkill County Return: And now, February 2, 2011 I, Joseph Groody, Sheriff of Schuylkill County, Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for Thomas & Mary O'Donnell the defendants named in the within Writ of Summons and that I am unable to find them in the County of Schuylkill and therefore return same NOT FOUND. Request for service at 1106 Centre Street, Ashland, Pennsylvania 17921 the defendant was not found. SHERIFF COST: $53.44 February 04, 2011 SO ANSWERS, RON R ANDERSON, SHERIFF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION Adele M. Sims, Administratrix of Estate of Harold T. Sims & Trustee Ad Litem for all persons entitled to share in damages for the Wrongful Death of Harold T. Sims, Plaintiff, vs. Mary C. O'Donnell and Thomas O'Donnell, 1106 Centre Street, Ashland, PA 17921, and Eric Locke, 107 E. Biddle St., Gordon, PA 17936, Defendants Case No. 10-7816 Civil 01 6 j a =2 rw t cl _ : PETITION FOR COURT APPROVAL TO SETTLE WRONGFUL DEATH AND SURVIVAL CLAIMS PURSUANT TO 20 P S §3323 1. On December 22, 2008, Harold T. Sims died intestate. 2. On January 15, 2009, letters of administration were issued by the Cumberland County Register of Wills to Adele M. Sims, the decedent's spouse at No. 21-09-0047. 3. On December 22, 2008, Harold T. Sims, age 56, was struck and killed by a car while crossing the road in the 100 block of Bridge Street, New Cumberland, Cumberland County, Pennsylvania. (A copy of the police accident report is attached hereto and incorporated herein as Petitioner's Exhibit "A".) 4. Harold T. Sims was declared dead at the scene of the accident and the records indicate that he died instantaneously. 5. Harold T. Sims, deceased, is survived by his wife, Adele M. Sims, who is also the Petitioner herein, and a daughter, namely Kristen Sims, age 33. 6. A cause of action for Wrongful Death and a Survival Action were commenced on December 21, 2010, on behalf of the personal representative and the intestate heirs at Case No. 10-7816 Civil Term. 7. The only persons entitled to recovery of damages for either wrongful death or the survival action are: A. Adele M. Sims, decedent's spouse 1007 Bridge Street New Cumberland, PA 17070 B. Kristen Sims, sole surviving child of decedent 509 Fifth Street New Cumberland, PA 17070 8. Each person named above has been given notice of the filing of the cause of action for Wrongful Death and the Survival action, along with the court term and number of the case. These are the only persons entitled by law to recover damages in these actions. 9. The decedent's parents predeceased the decedent. 10. Adele M. Sims is the spouse of the decedent and was dependent upon the decedent for support and maintenance. 11. Kristen Sims, decedent's daughter, regularly received some financial support from the decedent. In addition, decedent provided'. weekly childcare for Kristen's minor child while Kristen was employed outside of the home. Kristen Sims must now pay for the childcare previously provided by decedent. 12. The only damages recoverable under the Wrongful Death Act include: A. Funeral Expenses - $8,058.45 B. Administrative Expenses - $70.00 C. Pecuniary Loss - i. Adele M. Sims - $250,000.00 -- loss of society and comfort ii. Kristen Sims - $7,800.00 per year for childcare 13. Damages recoverable under the Survival Action equal $503,547.25, calculated as follows: A. Loss of future earnings - i. New Cumberland Car Wash - $56,261.25 (see Exhibit "B") ii. Pension benefits - $709,500.00 (see Exhibit "B") B. Deductions for personal maintenance - ($262,214.00) (see Exhibit "B") 14. The Defendants in the wrongful death and survival action were Eric M. Locke, the driver of the car which struck and killed Harold T. Sims, deceased, and Mary C. O'Donnell, the owner of the car being drive by Defendant, Eric M. Locke. 15. Defendant, Eric M. Locke, was insured by Erie Insurance Group under Claim No. 0101710115801/BI, which provided coverage limits in the amount of $100,000.00. Erie Insurance has tendered the policy limits of $100,000.00 as evidenced by the attached general release (see Exhibit "C"). 16. Defendant, Mary C. O'Donnell's car was insured by the State Farm Insurance Company under Policy No. 0673868-D05-38G, which provided coverage limits in the amount of $100,000.00. State Farm Insurance has tendered the policy limits of $100,000.00 as evidenced by the attached general release (see Exhibit "D"). 17. The combined total recovery of Plaintiffs for the Wrongful Death action and the Survival action is $200,000.00. 18. Harold T. Sims died intestate. 19. No minors or incompetents have an interest in the proceeds recovered under the settlement, compromise and discontinuance proposed herein. 20. The Pennsylvania Department of Revenue, Inheritance Tax Division, has had the opportunity to review this Petition and the proposed division of the proceeds between the Wrongful Death Action and the Survival Action. 21. As stated in the Approval Letter attached hereto as Exhibit "E", the Department of Revenue has given approval to the following proposed division of proceeds between the Wrongful Death action and the Survival action: A. Wrongful Death Action - 80% or $160,000.00 B. Survival Action - 20% or $40,000.00 22. Attached hereto as Exhibit "F" is a fully executed Contingent Fee Agreement providing for legal fees in the amount of thirty percent (30%) of the total amount recovered, i.e., $60,000.00, payable as follows: A. Wrongful Death action - $48,000.00 B. Survival action - $12,000.00 23. All proceeds from both the Wrongful Death Action and the Survival Action shall be distributed to the beneficiaries in the proportion that each would take the personal estate of the decedent in the case of intestacy. 24. With respect to the Wrongful Death claim, under the intestate laws of Pennsylvania, Adele M. Sims is to receive the first $30,000.00 of the proceeds, plus one-half (1/2) of the balance of the Wrongful Death proceeds, or a total of $95,000.00, which shall be taken by her without liability to creditors of Harold T. Sims, deceased, but subject to a pro rata portion of the legal fees equaling $28,500.00. 25. With respect to the Wrongful Death claim, Kristen Sims is to receive the balance of the proceeds, or a total of $65,000.00, again, without liability to creditor of Harold T. Sims, deceased, but subject to a pro raga portion of the legal fees equaling $19,500.00. 26. With respect to the Survival action, proceeds totaling $40,000.00 shall be distributed to the estate, subject to a pro rata portion of the legal fees equaling $12,000.00. 27. Following payment to all verified creditors of decedent, the balance of the proceeds in the estate shall be distributed according to the intestate laws of distribution. 28. It is believed and, therefore averred that the proposed division of the insurance proceeds between the Wrongful Death action and the Survival Action is fair to all parties concerned. WHEREFORE, Petitioner prays this Honorable Court will sign the attached Order concerning the proposed division of proceeds and the proposed distribution of those proceeds. Respectfully submitted, ,rte R. Mark Thomas, Esquire Attorney No. 41301 101 South :Market Street Mechanicsburg, PA 17055 Telephone: 717-796-2100 Fax: 717-796-3600 Email: rmarkthomas@gmail.com VERIFICATION I, ADELE M. SIMS, Administratrix of the Estate of Harold T. Sims, hereby verify that the statements made in the foregoing Petition for Court Approval to Settle Wrongful Death and Survival Claims Pursuant to 20 P.S. § 3323 are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904, relating to unsworn falsification to authorities. Dated: X L'&-4 ADELE M. SIMS, Administratrix 1 E 7 e 9 ?. COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTIN( )RM Case Closed Reportable Crash "AA 500 1 4a) Yes Q No ® Yes Q No FORM # AA-500 (12/02) Page E0 P 1:31.2598 Crash Number I Incident Number _ Police Agency Patrol Zone ??aG© x F a Age cy Name Precinct Investigation Date (MM-DD-IGM),, A4AAk K'7 t7 0 Jig ' 11, W Dispatch Time (mil) Arrival Time (mil) Investigator Badge N ber 10 18 y 1) 10 16 1 ;;F f/ JKU i d . Revie Bade Number Approval Date (MM-DD-YYYY) 11112- 'm-ZD O o County County Name Municipality Municipality Name I ' NY of Week O Sun Q Thu o z Al) U1 Crash Date (MM-DD-YYYY) Crash Time (mil) No of Units . People Injured Killed* *If > 00 ©- - © m m ® complete Form F Mon Q Fri O Tue Q Sat Q Wed Q Unk Workzon -(If Yes, Complete Yes No School Bus O Yes No School Zone ,o Yes ® No Form M, Section 29) Related Related, Notify PENNDOTQ Yes 40 No Maintenance o ? Intersection T vn e IMnter ti-Leg O 4 Way Intersection Q "Y" Intersection Q Q Off Rump Q Railroad Crossin Intersecti ction g ® Midblock Traffic Cir l / *S cia ! m Location x s c e Q "T" Intersection Q Q On Ramp Q Cross over Q Other Round About * See Overlay . Route Number Segment (Optional) Travel Lanes Speed Limit O North - House Number (if applicable) p Q ] .c 0 FoT/ South 46 a Street Name Street Ending O East For Mid-block crashes only. Use a C 0 O West ?. S postal House Number and make sure Principal Roadway Street Name is O Unknown filled in if using this option Route SS a O Interstate r--, Turnpike O Turnpike O State O County O Local Road O Private Other/ (Not Turnpike) (East/West) Spur Highway Road or Street Road Unknown t Route: Number _ Segment (Optional) Travel Lanes Speed Limit 0 ;- North C . o O South m m c O East Street Name Street Endin C g m O West 1= 4' e O Unknown 10 10 Sing Route Q Interstate Q Turnpike ? Turnpike Q' State O County O Local Road O Private O Other/ N (Not Turnpike) (EastAAtest) Spur Highway Road or Street Road Unknown Intersecting Rt Num. Or Mile Post Or Segment Marker c 0 North Feet N South Or Intersectin Street Name c u Please g St Ending 0 O East o ac Enter c Information m f B A J a I `( I O West IF iie 1,4 E E---?-J Or Miles m ? or OTH • 2 v Landmarks `g if using This Option Intersecting Rt Num Or Mile Post Or Segment Marker ^r c L p O North 1:11 Distance From Crash S I i0 - °1 O South cene to Landmark 1 1; ? Or Intersecting Street Name St Ending O East (For Crash between C c EIJ O-West Landmark P and Landmark 2) vt t5 Degrees Minutes Seconds Degrees Minutes Seconds Latitude: Longitude: - m m•m•m m m •m • m in Traffic Control Device - O Yield Sign Q Police Officer or Flagman - Not Applicable Q Traffic Signal" Active RR Crossing O Other Type TCD O TO Functioninar Device Functionin Emergency ® No Controls Q Functioning Q Preem tive Improperly p Controls Flashing Traffic O Signal O Stop Sign O Passive RR O Unknown Crossing Controls Signal o Device Not O Device Functioning 0 Unknown Functioning Properly d 3 Lane Dosed (If "Not Applicable", skip rest of the Lane Closure section) _ O North ?LLane Closure O East 4D North and South Q All p O Not Applicable O Partially ! Fully Q Unknown DkvcdOn 0 South Q West Q East and West (N,S,E,W) C C Traffic Yes ® No Q Detoure d Unknown Q r.. e Q< 30 Min. Q 30-60 Min. 1-3 hrs O 3-6 hrs Q 6-9 hrs Q> 9 hours Q Unknown Ex H to ; T- ;4 11 COMMONWEALTH OF PU'"SYLVANIA POLICE CRASH REPORTIk FORM - Page: AA 500 2 Policel' Only o III IIIIIIIIIII III 1111111 Crash Number x1312698 o Motor Vehicle in `® Transport Q Hit & Run Vehicle Q Illegally Parked Q Legally Parked Q Non - Motorized Viet Commercial Vehicle C V- r ., Unit Pedestrian'on Skates, Disabled From Q Pedestrian Q Q Q Train Q Phantom Vehicle in Wheelchair, etc Previous Crash Q Yes • No (If "Pedestrian' or "Pedestrian on Skates, in Wheelchair, etc", Complete Form M, Section P8)' (If Yes,, Complete Form C) Unit No First Name MI Date of Birth (MM-DD-YYYY) ® 151,0101 © ® Q t? t/ Delete? Last Name Telephone Number Z Address / State zip Driver License Number State Class .E V 1 41 1,9 C 10 Alcohol/Druos Suspected Driver or Pedestrian Physical Condition 'a No Q Illegal Drugs Q Medication Apparently Illegal D'(ug Normal Q Use 0 Fatigue Q Medication d Q Alcohol Q Alcohol and Drugs Q Unknown ' Had Been Q Q Sick Q Aslee Q Unk L = _• p nown Drinking Alcohol Test Type p` oW Test Not Given Q Breath Q Other Primary Vehicle Code Violation Charged? v Q Blood ' Q Urine Q Unknown if y, Q Yes Q No F .e Test Given y nkn Alcohol Test Results Q Test Refused Q Resultr n Driver Presence 1=Driver Operated 3=Driver Fled Scene " Q Test Given, Contaminated Results Vehicle 4=Hit and Run Z 2=No Driver 9=Unknown Owner/Driver 00=Not Applicable 02=Private Vehicle Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh ? 01=Private Vehicle Owned/ Owned/Leased by Driver 05=PENNDOT Vehicle 08=Other Municipal 98=Other F Leased by Driver 03=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown 7 TZ Same as Owner First Name Owner Last Name or Business Name (If Pedestrian, skip this Section) Driver Q / ©? f ` , L ,v N Address / City / State / Zip Vehicle Make *Make Code I/D6 &WE -X- A Of lXzabrla' Z VIN Model Year Vehide Model (see overlay) Is- y o 11 Q12 -? ] 670 Ti Xss . Lice nse Plate Reg. State Est. Speed Vehicle Towed Towed By ) ? r- ?v Ix Q Is- 1 6 ,' -1 1= ? L? rn w I M Yes Q No laV1 Insurance Insurance Company Policy No ?-?y, /? Yes Q No Q known Ikt?. . AP, GQ I y e? ?J U(7 (/ i?06-3 L CS m C Trailin4 Tv? 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No Tag Year Tag St Unit TrNo. aili of ? Unit ? 2=Towing Truck 5=Camper 8=Other ng Units: g 3=Towing Utility Trailer 6=Full Trailer 9=Unk v nown Direction of ? *Vehicle Position Travel S m *Movement a ( *See O l Special Usage ver ay Vehicle Color Vehicle Type 05=Large Truck 20=Unicycle, Bicycle, Q 12=Commercial 06=Yellow 07=Silver 01=Automobile 06=SUV Tricycle 02=Motor cle 07=Van cy 21 =Other Pedalcycle Passenger 00=Not A li eh cable irier 08=Gold 01=Blue 09=Brown 03=13us 10=Snowmobile 22=H67rse & Buggy 04=Small Truck 11 =Farm Equip 23=Horse & Rider 01=Fire V 13= ax 02=Ambulance 21=Tractor Trailer 02=Red 10=Orange 03=White 11 =Purple (If "02" Complete Form 12=Construction Equip 24=Train M, Section 26) 13=ATV 25=Trolley 03=Police 22=Twin Trailer 08=Other Emergency 23=Triple Trailer 04=Green 12=Other 05=Black 99=Unknown (/f 18=Other Tye Spec Veh 98=Other "20" or "21 ", Complete 19=Unk. Type Spec Veh 99=Unknown Form M, S _ tion 27) Vehicle 31 =Modified Veh 11=Pupil"'Transport 99=Unknown Initial Impact Point f O 004n-Collision 14=Undercarriage / 01-12=Clock Points 15=Towed Unit Damage Indicator O=None 2=Functional 2 1=Minor 3=Disablin q" ` Gradient 3=Downhill © 4=Bottom of Hill 1=Level 5 Hill T Road Alionment © 1=Straight 13=Top 99=Unknown 9=Unknown = op 2=Uphill 2=Curved 9=Unknown 9=Unknown uRM a AA-sou (12jo2) POLICE COPY COMMONWEALTH OF PEI"''SYLVANIA J POLICE CRASH REPORTI1 , .=ORM A A Page: :y AA 500 2 Police Use Only US !IIIIIIIIIIIIIII Crash Number --1 P 1312698 0 0 Motor Vehicle in Hit & Run Vehicle Q Q Illegally Parked Q Legally Parked QNon -Motorized Type Transport Commercial Vehicle Unit Pedestrian Q Pedestrian on Skates, Q Disabled From Q Train Q Phantom Vehicle Q Yes ® No in Wheelchair, etc Previous Crash (If "Pedestrian" or "Pedestrian on Skates, in Wheelchair, etc", Complete Form M, Section 28) (If Yes, Complete Form C) Unit No First Name MI Date of Birth (MM-DD-YYYY) 0V I/* I le GGc Ej a6 r / Is Delete? Last Name Telephone Number Q / m S m 0 Address / City / State Zi '? e s5 AJK Akd6wimf4 4AD -? l Driver License Number State Class c t Alcohol/Drugs Suspected Driver or Pedestrian Phvsical Condition m V Q No Q Illegal Drugs Q Medication Q Apparently Illegal Drug Q Fatigue Medication Normal Q Use Q d Q Alcohol Q Alcohol and Drugs IS Unknown Q Had Been Q Sick Q Aslee k ® U L p n nown Drinking Alcohol Test Type p Q Test Not Given Q Breath Q Other Primary Vehicle Code Violation Charged? Q Blood Q Urine Q Unknown if Q Yes Q No r Test Given > Alcohol Test Results Q Test Refused Q Results Unknown Driver Presence 1=Driver Operated 3=Driver Fled Scene MEE Q Test Given, Contaminated Results ? Vehicle 4=Hit and Run 2=No Driver 9=Unknown Owner/Driver 00=Not Applicable 02=Private Vehicle Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh 01 =Private Vehicle Owned/ Owned/Leased by Driver 05=PENNDOT Vehicle 08=Other Municipal 98=Other Leased by Driver 03=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown ED Same as Owner First Name Owner Last Name or Business Name (If Pedestrian, skip this Section) Driver Q Address / City / State / Zip Vehicle Make *Make Code VIN Model Year Vehicle Model (see overlay) License Plate Reg. State Est. Speed Vehicle Towed Towed By Q Yes Q No Insurance Insurance Company Policy No Q Yes Q No Q known C 4 Trailing Type 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No Tag Year Tag St Unit T No. of ? Unit ? 2=Towing Truck 5=Camper 8=Other m r a Units g 3=Towing Utility Trailer 6=Full Trailer 9 U k V = n nown Direction of 1-1 Vehicle Position rav'f T- *Movement *See l O O l Special Usage ver ver ay Vehicle Color Vehicle Type 05=Large Truck 20=Unicycle, Bicycle, m 12=Commercial 06=Yellow m 07=Silver 01=Automobile 06=SUV Tricycle 07=Van 21 m 02=Motorc l Oth Passenger 00=Not Applicable Carrier yc e = er Pedalcycle 08=Gold 01=131ue 09=13rown 03=Bus 10=Snowmobile 22=Horse & Buggy 04=Small Truck 11 =Farm Equip 23=Horse & Rider 01 =Fire Veh 13=Taxi 02=Ambulance 21 =Tractor Trailer 02=Red 10=Orange (If °02" Complete Form 12=Construction Equip 24=Train 03=Police 22=Twin Trailer 03=White 11 =Purple M, Section 26) 13=ATV 25=Trolley 08=Other Emergency 23=Triple Trailer 04=Green 12=0ther 05=131ack 99=Unknown (If "20" or '71 -, Complete 18=Other Type Spec Veh 98=Other Form M, Section 27) 19=Unk. Type Spec Veh 99=Unknown Vehicle 31 =Modified Veh 11=Pupil Transport 99=Unknown Initial Impact Point m 00=N6n-Collision 14=Undercarriage Damage Indicator O=None 2=Functional Gradient 3=Downhill 4=Bottom of Hill Road Alignment 1=St i ht 01-12=Clock Points 15=Towed Un Minor 3=Disabling F] 1 h Level a S=Top of Hill ra g 2=Curved 1:1 13=Top 99=Unknown 9=Unknown Uphill 9=Unknown 9=Unknown rvnm 9 AA-5W (iM2) POLICE COPY F COMMONWEALTH OF ' -INSYLVANIA POLICE CRASH REPORTr..ai FORM Page AA 1500 3, Police Use Only m 11111111111111111111 Crash Number v 1312696 Person Tyke: A 1=Driver 2 Seat Position: D 00=Not A Passenger/Occupant 01 D i ll V hi l Equir?ment One: E Safely 00=None Used /Not Applicable i n: (_j O=Not Applicable =Rgsenger 7=POdestnan = ver - A r e c es 02=Front Seat Middle Position 01=Shoulder Belt Used 02=Lap Belt Used 1=Not Ejected 2=Totally Ejected 8=Other 03=Front Seat Right Side 03=Lap And Shoulder Belt Used 3=Partially Ejected 9=Unknown 04=Second Row - Left Side Or 04=Child Safety Seat Used 9=Unknown Motorcycle Passenger' 05=Motorcycle Helmet Used 05=Second Row - Middle Position 06=Second Row - Right Side 06=Bicycle Helmet Used 10=Safety Belt Used Improperly F1Jection Path: ` l C F =Female B M=Male 07=Third Row Or Greater - Left Side 11 =Child Safety Seat Used Improperly 12=Helmet Used Improperly O=Not Ejected / Not App icable 1=T rough Side Door Opening p « m U =Unknown 08=Third Row Or Greater - Middle Position 90=Restraint Used, Type Unknown 99=Unknown 2=Through Side Window 3=Through Windshield p o 09=Third Row Or Greater Right Side Safely Equipment Two: Back Door 4=Through 5=Throu gh Back Door Tail ate Opening c d irUu1y Severity: U=Not Injured 10 Sleeper Section of Truckcab 11=1n Other Enclosed g 6=Throuh Roof p Don Sunroof/ F 00=Nome Used / Not Applicable Convertible 01 =Front Air Bag Deployed (For This Seat) Top Down 7 Th h R f Q, 1=Killed Passenger Or Cargo Area 02=Side Air Bag Deployed (For This S = roug oo Opening (Convertible eat) Top Up) 0 d 2=Major Injury 3=Moderate 12=ln Open Area (Back Of Pickup, Etc.) 03=Other Type Air Bag Deployed 04=Multiple Air Bags Deployed 9=Unknown Injury 13=Trailing Unit 05=Motorcycle Eye Protection 4=Minor Injury 8=Injury, Unk 14=Riding On Vehicle Exterior 15=Bus Passenger 06=Bicyclist Wearing Elbow/Knee/Pads Extrication: 10=Air Bag Not Deployed, Switch On O=Not Applicable Severity 9=Unknown if 98=Other 99=Unknown 11 =Air Bag Not Deployed, Switch Off 12=Air Bag Not Deployed, 1=Not Extricated 2=Extricated By Mechanical Means Injury 13=UnkBag SwitcRemoved h Setti Prior To Crash) Air 3=Freed By Non - Mechanical Means 8 =Other 19=Unknown If Air Bag Deployed 99=Unknown 9=Unknown i EMS Agency: Medical Facility: Unit No Person No OF] ® Delete? Date of Birth (MM-DD-YYYY) A B C o FO-R-1 171-61 D E F G H I ®®® Name/ Address / Phone EMS Transport Same tor Me 1X_ ?/ 1 ?- ?I M as Aerato ' c?? i s?a S . 66 O Yes ®No Unit No Person No Delete? Date of Birth (MM-DD-YYYY) A B C CD & -1/ is 1-1119 -X 00® D E F G H I 0 o 6? d ®E© Name / Address / Phone r?i r EMS Transport 44, 11-4 Same as /? ?(}5S .?iUD 6 t 7? Yes ®No Operator Unit No Person No m m Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I 0 m-m ??EI FIFI? Name / Address / Phone EMS Transport Same as Operator 0 Yes 0 No Unit No Person No m m Delete? Date of Birth° (MM-DD-YYYY) A B C D E F G H I 0 m-m ??[] EIF ? Name / Address / Phone EMS Transport ? Same as Operator 0 Yes 0 No Unit Person Delete? Date Birth (-DD CD 0 0 L? m m m Name / Address / Phone EMS Transport Same as Operator 0 Yes 0 No Unit No Person No m m Delete? Date of Birth (MM-DD-YYYY) A B nnC D E F G H I 0 m-m El ?1:1 F-1?Ll Name / Address / Phone EMS Transport Same as Operator 0 Yes 0 No FORM # AA-500 (12/02) POLICE COPY COMMONWEALTH OF PE"'ISYLVANIA i POLICE CRASH REPORTII , ,-'ORM Page AA 500 4 , Police Use Only = 10 ?_' I, 1111111111111111111 Crash Number P 1312698 Crash Description O=Non-Collision 2=Head On 4=Angle 6=Sideswipe 8=Hit Pedestrian ^ 1=Rear End 3=Rear to Rear 5=Sideswi a (Opposite Direction) g 0 0 (Backing) (Same irection) 7=Hit Fixed Object 9=Other/Unknown E 1 Relation to Roadway 1=0n Travel Lanes 3=Median 5=Outside Trafficway 7=Gore (Ramp Intersection) E 2=Shoulder 4=Roadside 6=1n Parking Lane 9=Unknown 2.1 s a 01 1=Daylight 3=Dark - Street 5=Dawn B=Other Illumination Li hts 2 D k 9 F I j = ar - No 6=Dark -Unknown L Street Lights 4=Dusk Roadway Lighting r Weather Conditions V:1 1=No Adverse Conditions 3=Sleet (Hail) 5=Fog 7=Sleet & Fog 9=Unknown E 2=Rain 4=Snow 6=Rain & Fog 8=Other Road Surface Conditions O=Dry 2=$and, Mud, Dirt, 4=Slush 6=Ice Patches 8=Other 1=Wet 3=Snow Covered 5=Ice 7=W tpr : Standing or moving Harm Event L/R Most? Utility Pole Number 1 ® © Harmful Events (Harm Event) 30=Hit Fence Or Wall 01=Hit Unit 1 31 =Hit Building Unit No 02=Hit Unit 2 32=Hit Culvert 2 ? ® m 03=Hit Unit 3 33=Hit Bridge Pier Or Abutment 04=Hit Unit 4 34=Hit Parapet End 05=Hit Unit 5 35=Hit Bridge Rail 06 Hi h 36 Please Put m ? 3 CD Events i = t Ot er Traffic Unit =Hit Boulder Or Obstacle 07=Hit Deer On Roadway 08=Hit Other Animal 37=Hit Im act Att t n Sequential p enua or 09=Collision With Other Non 38=Hit Fire Hydrant 0 Order 4 m Q Fixed Object 39=Hit Roadway Equipment 11 =Struck By Unit 1 40=Hit Mail Box 2 12=Struck By Unit 2 41 =Hit Traffic Island 13 St k B 42 i Hi E = ruc = y Un t 3 t Snow Bank o Hann Event L/R Most? Utility Pole Number 14=Struck By Unit 4 43=Hit Temporary Construction c +, 1 m ? Q 15=Struck By Unit 5 Barrier 16=Struck By Other Traffic Unit 48=Hit Other Fixed Object Unit No I? 21 =Hit Tree Or Shrubber 49=Hit Unknown Fixed Object > W m 2 F y 22=Hit Embankment 50=.Overturn/Roll Over 23=Hit Uiifify Pole 51=Struck By Thrown Or Falling 24 Hi T ffi = t ra c Sign Object wAPlease Put -Events in 3, Q 25=Hit Guard Rail 52=Pot Holes Or Other 26=Hit Guard Rail End Pavement Irregularities 27 Hit Curb 53=Jacknife Sequential 28=Hit Concrete Or 54=Fire In Vehicle Order 4 m Longitudinal Barrier 58=Other Non-Collision 29=Hit Ditch 99=Unknown Harmful Event r F Tlar-mful irst Unit No Harm Event Most Unit No Harm Event ? m m A-fJn m m vet rn Driver Action (D) 17=Careless Or Illegal 00=No Contributing Action" Backing On Roadway e rash t re rash 01=Driver Was Distracted 18=Driving On The Wrong 02=Driving Using Hand Held Phone Side Of Road Do not repeat this information on muWple pages 03=Driving Using Hands Free Phone 19=Making Improper Environmental /Roadway Potential Factors (EM) 1 6 2 m 3 m 04=Making Illegal U-Turn Entrance To Highway 05=Improper/Careless Turning 20=Making Improper Exlt 06 T i = urn ng From Wrong Lane From Highway 00=None 11=Slippery Road Conditions (Ice/Snow) 01 Wi d 07=Proceeding W/O 21 =Careless Parking/Unparking Clearance After Stop 22 O /U d = n y Conditions 12=Substance On Roadway 02=Sudden Weather Conditions 13=Potholes = ver n er 08=Running Stop Sign Compensation At Curve 09=Runnin Red Li ht 03=Other Weather Conditions 14=Broken Or Cracked Pavement g g 23=Speeding 10=Failure To Res ond To 04=Deer In Roadway 15=TCD Obstructed p 24=Drivin Too Fast For Conditions Other C 9 ontrol Device 05=Obstacle On Roadway 16=Soft Shoulder Or Shoulder Drop Off 06=01her Animal In Roadwa 28 0th R d 25=Failure le Maintain Proper Speed 11=Taiating 26=Driver =Driver Fleein Police (Pol Ch ) d y = er oa way Factor 07=Glare 29=Other Environmental Factor g ase 12=Sud den Slovvin topping 13=I1legally Stoppe On RRoad 27=Driver Inexperienced e 08=Work Zone Related 99=Unknown Or Lane 28=Failure To Use Specialized Equip 14=Careless Passin g 92=Affected B Ph i l C di i y ys ca on t on Change Possible Vehicle Failures (V) 12=Wipers 15=PassinIn No Passing Zone 98=Other Improper Driving Actions r 00=None 06=Exhaust 13=Driver Seating/Control 16=Driving The Wrong Way On 99=Unknown .° 01=Tires 07=Headlights 14=Body, Doors, Hood, Etc 1-Way Street « 02=Brake System 08=Signal Lights 15=Trailer Hitch 03=Steering System 09=Other Lights 16=Wheels ension 1 1 00 04=Sus 17=Airba s H Not Q/ 1 d U 2 m 3 m 4 m g p = orn 05=Power Train 11 =Mirrors 18=Trailer Overloaded C Unit /?• ,? l 19=Unsecure/Shifted No iJ / 1 U Q 2 m Trailer Load Unit No m 1 m 2 m 3 m 4 m 20=Improper Towing Nort m 21 =Obstructed Windshield m 99=Unknown 1 2 Pedestrian Action (P) 03=Working 00=None 04=Pushing Vehicle 05 A h = pproac ing Or Leaving Vehicle 01=Entering Or Crossing At 06 W ki Indicated Prime Factor Unit No Factor Code = or ng On Vehicle Specified Location 02=Walking, Running, Jogging, 07=Standing m not repeat this information on ? EZI multiple pages. 98=Other Or Pldying 99=Unknown E/R V D P 40 Q Q Q If E/R is the Prime Factor Unit No 3 Unit No m en Type, leave Unit No blank ou w ww_rnn i..,x... 191 POLICE COPY COMMONWEALTH OF Pr' - gSYLVANIA POLICE CRASH REPORTIN%- iORM Page M 500 5' Police Use Only IIIIIIIIIIIIIHIII Cra'sh Number x1312698 2 Narrative and additional witnesses: (J/?]? ?l 11/l?S I Kf?(/? ?1Nl?j w?t5 ?RQS?itllr 6 /D UAJ11-A?/ 6-111ICY `7-91G Tf4W I1vAcreO w?AJOEM m A ? o r?i?o2 z C CN StAi IN ITIJL:SS wi4 ItG+vG . C t-l Accident Investigation Notification Issued? - Property Damage O Pg&-,P' it- (t5 v t" of Tpr U065 WA -1 0. /aril WAN 771 l jleW-s ,5j PC /moo ?&L)E5K-i NO CIE 1117" hAVwAY. DMI- Ah CANE 'AA M &r- R nu4D /Vor S/Emw 7w- TD 11 POLICE COPY COMMONWEALTH OF PEA' ,YLVANIA A A POLICE CRASH REPORTINGa eORM page AA Sob N ' Police Use Only Q 29 fORiA8 AA-iOfNJ (12/02) : : , . New ?IIIIIIIIIIIIIII Cras,um,.1 O Change/ Continuation Narrative and additional witnesses: a t 4 Z V c A M M m C K: .. COMMONWETH OF PEN' POLI E CRASSH PORTI G rORM YLVANIA Q' New I IIIIII III I II'?IIIII I? Crash Number Page AA 500T ? Police Use Only m O Change/ Continuation -- !el Q Road Surface Tvpe Special Jurisdiction O Brick or Block Q Dirt 0 Military O Other Federal Sites 24 O Concrete O Slag, Gravel or Q Other ® No Special Q Indian Reservation O Other Stone Jurisdiction Blacktop O Unknown O College/University 0 Unknown National Park O Campus Please complete Unit Information for each unit involved in a fatal crash. Do not repeat the information in the fields above on multiple pages. Unit No Principle Impact Point O ! O Non-Collision 011 12 010 Restrictions Not a Penn lvania X10 02 0 Driver Restrictions Q Q ry Q Top Compliance Complied With Driver O 09 03 O Restrictions Not Unknown Iib No Restrictions/ O Complied With O Compliance O Undercarriage 08 V104 Not Applicable O Compliance (::)Towed Unit O O Unknown 07 06 05 Driver Endorsement O Required - O Not a Pennsylvania Q Unknown O O O a Compliance Complied With Driver Required - Non O Unknown Avoidance Maneuver .? O Compliance Compliance c 8 None Required No Avoidance zs O Required - Maneuver O Braking - Other O Other Avoidance Compliance Unknown Evidence Maneuver Braking - Skid Steering - Evidence Driver License O Not Required for O Unk if CDL or O Marks Evident O or Driver Stated O Inconclusive Compliance Vehicle Class CDL Required 0 No Valid License Not a Pennsylvania Braking - No Skid for Class O Driver O Marks, Driver O Steering and Braking O Unknown Evidence or Stated O Not Licensed a Valid License for O Unknown Stated Class Under Ride Indicator Underride, No Drug Test Type Other No Underride or Override, Other O Blood O Override O InComp t usionment 0 Vehicle 40 None O Urine O Unknown if Test Given Underride, Underride, Unknown if Drua Test Results - (Up to Four Results) ? Q Compartment O Compartment O Underride or 0 = No Test Given 5 = Amphetamines Intrusion Intrusion Unknown Override 1 = No Drug Reported 6 = PCP 2 = Marijuana 8 = Other Emergency Use O Lights Flashing ( Both Lights and 3 = Cocaine 9 =Unknown Test ? Not in Emergency Siren 4 = Opiates Results O Use O Siren Sounding O Unknown Unit No Principle Impact Point O ® O Non-Collision 011 12 010 O 2 Driver Restrictions O Restrictions O Not a Pennsylvania ®1<2? omp Dance Complied With Driver O Top Restrictions Not Unknown O 09 03 Q No Restrictions/ O Complied With 0 Compliance 0 Undercarriage ® Not Applicable Compliance O 08 04 O O O Towed Unit Unknown 07 06 050 A= Driver Endorsement Q Required - O Not a Pennsylvania Q Unknown O O CC MCI Dance Complied With Driver o O Required - Non O Unknown Avoidance Maneuver w Compliance e Is None Required Compliance No Avoidance is «, O Required - G& Maneuver 0 Braking -Other O Other Avoidance X Compliance Unknown Evidence Maneuver Driver License Not Required for Unk if CDL or O Marks Braking - Skid Evident 0 Steering e Evidence Q Inconclusive 0 or Driver Stated O Vehicle Class CDL Required omp? I?ance No Valid License Not a Penns lvania Braking - No Skid 0 for Class 0 y O Marks, Driver O Steering and Braking Q Unknown O Not Licensed O Valid License for Driver Stated Evidence or Stated Class O Unknown Under Ride Indicator Drug Test Type Underride, No , Other O Blood O Other ®.No Underride or Q Compartment O Override None O Urine O Unknown if Test Override Intrusion Vehicle Given Underride, Underride, Unknown if Drug Test Results - (Up to Four Results) ? r ? Q Compartment O Compartment O Underride or Intrusion Intrusion Unknown Override 0 = No Test Given 5 =Amphetamines 1 = No Drug Reported 6= PCP D Use Both Lights and 2 = Marijuana 8 = Other Emergency Lights Flashing Q 3 = Cocaine 9 = Unknown Test Siren 4 = Opiates Results O Not in Emergency Use O Siren Sounding O Unknown Pf :tFOt311A.3kh/? rf a , I ras.F F iF i. f :?t i 37 i Yr . t i i(i ?Y a t- i+?? i? r i +t. t s. a i,.t? jet t t ?tY. w F ;.. fi'yi{.r F9 - i a s r f +?J r t ?I s . e a: . .. ir zi.• i s . ?+_? r t _' a r! i ` J A 4 f f- a 7 4:'(? S ' i e fi S YaY SURVIVAL ACTION DAMAGES Loss of Future Income Decedent was 56 years of age with a life expectancy of 21.5 years. He received a pension from the Federal Government, the 2008 value of which was $32,988.00. Assuming a pension value of $33,000.00/year for 21.5 years equals $709,500.00. Decedent was employed at New Cumberland Car Wash averaging $6,251.25/year since 2005. Assuming he continued until age 65, his loss of future earnings equals $56,261.25. Total loss of future earnings is $765,761.25. Deductions Shelter @ $500.00/month for 21.5 years is $129,000.00. Food @ $100.00/week, or $433.00/month, for 21.5 years is $111,714.00. Clothing @ $500.00/year for 21.5 years is $10,750.00. Medical care @ $200.00 deductible per year is $4,300.00. Leisure @ $300.00/year is $6,450.00. Total deductions are 262,214.00. Total future income of $765,761.25 minus $262,214.00 leaves total damages of $503,547.25. EXHIBIT "B" GENERAL RELEASE CLAIM #. 010171011580 For the consideration of One Hundred Thousand Dollars and 00/100--- --- -- dollars ($100,000.00 ) receipt of which is hereby acknowledged, I/we release and discharge, and for myself/ourselves and for my/our heirs, representatives, executors, administrators, successors and assigns, do hereby remise, release and forever discharge Eric M. Locke and Danielle Locke hereinafter referred to as the releasee s), his/her/their/its heirs, executors, administrators, insurers, successors and assigns, and any and all other persons, Irms, corporations, associations, of and from any and all causes of action, suits, rights, judgments, claims and demands of whatsoever kind, in law or in equity, known nd unknown, which I/we now have or may hereafter have, especially the claimed legal liability of releasee(ss arising from or by reason of any and all bodily or personal injuries and/or property damage known and unknown, foreseen and unforeseen which heretofore has/have been or which hereafter may be sustained by me/us arising out of the accident on or about December 22 2008 YEAR at or near Bridge Street, New Cumberland in the county of Cumberland which liability releasee(s) expressly deny(ies). in the State of Pennsylvania I/We agree that the consideration set forth above is specifically applicable to and paid to me/us with respect to any and all damage to arrt?y property, either real or personal, of mine ours and with respect to any and all personal or bodily injury of minelours, whether presently known or unknown, foreseen or unforeseen or which may subsequently develop and the consequences thereof, all as arising out of the aforementioned accident. I/We further agree that the considegration set forth above is specifical y applicable to and paid to me/us with respect to any right of contribution that I/we may have against the releaseeM, his/her/their/its heirs, exe utors, administrators, insurers, successors and assigns relative to claims of others that may be brought against me/us by reason of said accident. I/We further agree that the consideration se? forth above i7 specifically applicable to my/our agreement that I/we will not join nor attempt to join the releasee s , his/her/their/its heirs, executors, administrators, insurers, successors and assigns in any capacity, in any action that may be brought against me/us arising out of said accident. I/We yyvvarrant for myself/ourselves and my/our heirs, representatives, executors, administrators, successors and assigns that I/we have received no money or other valuable consideration from any other person or persons by reason of any causes of action, suits, covenants, agreement, judgments, claims and demands of whatsoever kind, which I/we now have or may hereafter have, for injuries to mylour person or property or for the other matters for which this release is given. I/We further understand and agree that this Release is inclusive of any and all present and future liens or claims for subrogation against the payments to be made in accordance with this Release. Iwe understand and agree that I/we are responsible for the payment of any liens or charges against the payments to be made hereunder should an such liens, subrogation, claims or claims for expenses and charges be asserted. This includes, but is not limited to, medical expense liens, workers compensation liens, ERIA liens, liens asserted by any federal, state or local governmental entity or agency or an medical expense cla?im. -Should any person or entity make claim for ayment o any liens or charges against The ERIE or their counsel, Ilwe agree to indemnify and hold harmless The ERIE and their counsel from any and alt such liens, charges, fees, claims, attorney fees, costs, interests and any other sum. I/We understand that this settlement is the compromise of a disputed claim, and that the payment is not to be construed as an admission of liability on the part of the persons, firms and corporations hereby released by whom liability is expressly denied. g?4 Intending to be legally bound thereby, WITNESS my/our hand(s) and seal(s) this _ day of V NOTICE: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or 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 the person to criminal and civil penalties. WIT SS - / . l ^ I eG (Seal) --- (Seal) C-41A-PA (R) 12/04 ,-x#' )bl„7- 11C d Release For the Sole Consideration of 38-1-605-859 One hundred thousand and 00/100 --- - ----.? (***100,000.00** )°'-' dollars the receipt and sufficiency whereof is hereby acknowledged, the undersigned hereby releases and forever discharges Mary O'Donnell her heirs, 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 22nd day of December, 2008 (year) at or near New Cumberland, PA 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 fitness Whereof, We- have hereunto set hand(s) and seal(s) this ?y day of (year). Signed X Name: Signed X Name: i ??(? ?? (1(? S /? I ( Pennsylvania 104077.16 03-30-2010 IB t7- Address k-.' 1001319 / 710R3?S pennsylvania DEPARTMENT OF REVENUE January 28, 2011 R. Mark Thomas, Esquire Law Office 101 Market Street Mechanicsburg, PA 17055 Re: Estate of Harold T. Sims File Number 2109-0047 Court of Common Pleas Cumberland County Dear Mr. Thomas: The Department of Revenue has received the Petition for Approval of Settlement Claim to be filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action. It has. ` been forwarded to this Bureau for the Commonwealth's approval of the allocation of the proceeds paid to settle the actions. Pursuant to the Petition, the 56 year old decedent died as a result of a motor vehicle accident. Decedent is survived by his wife and one adult child. Please be advised that, based upon these facts and for inheritance tax purposes only, this Department has no objection to the proposed allocation of the net proceeds of this action, $112,000.00 to the wrongful death claim and $ 28,000.00 to the survival claim. Proceeds of a survival action are an asset included in the decedent's estate and are subject to the imposition of Pennsylvania inheritance tax. 42 Pa.C.S.A. §8302; 72 P.S. §9106, 9107. Costs and fees must be deducted in the same percentages as the proceeds are allocated. In re Estate of Merryman, 669 A.2d 1059 (Pa. Cmwlth. 1995). I trust that this letter is a sufficient representation of the Department's position on this matter. As the Department has no objections to the Petition, an attorney from the Department of Revenue will not be attending any hearing regarding it. Please contact me if you or the Court has any questions or requires anything additional from this Bureau. Jah rely, on E. Baker Trust Valuation Specialist Inheritance Tax Division Bureau of Individual Taxes I PO Box 280601 1 Harrisburg, PA 17128 1 717.783.5824 1 shabaker@state.pa.us CONTINGENT FEE AGREEMENT Involving loll a-zeFs ACC/GtP?? !YJ !??IG6? J rp??J?/r25 Gtk?.? The undersigned hereby retains and employs the Law Office of R. Mark Thomas, Esquire, as counsel to institute suit, adjust or settle claims or actions as he deems advisable for the recovery of damages with regard to the above captioned matter, hereby giving the said attorney the right to take all legal steps to enforce said claims. It is also hereby understood and agreed that following investigation and evaluation of the undersigned client's case, R. Mark Thomas, Esquire, reserves the right to withdraw his representation of the client if, in his legal opinion, the case lacks legal and/or factual merit. It is further understood and agreed that client reserves the right to terminate the services of the Law Office of R. Mark Thomas, Esquire, as counsel, provided the client reimburses the Law Office of R. Mark Thomas, Esquire for all costs and expenditures that have been advanced or prepaid by counsel. CONTINGENT FEZ In cons_deration of services rendered by R. Mark Thomas, Esquire, the terms of this Ccntinaent Fete Agreement are as follows: (a) In the event of settlement before the filing of suit by the attorney, the attorney shall retain percent of anv sums received from any verdict or settlement. (b) In the event of settlement or ver after suit has been filed, the attorney shall retain percent of any sums received from any verdict or settlement. (c) It is hereby understood and agreed that if any of the claimants are minors or decedent's estates, such claim is subject to the approval of the Court. COSTS AND EXPENSES (a) It is hereby understood and agreed that all expenses incident to the investigation, institution, prosecution and trial of the case shall be borne by the undersigned client. (b) If costs are required to be advanced by the attorney to investigate, institute, prosecute or facilitate settlement or trial, it is hereby understood and agreed that all advanced costs will be :reimbursed by the undersigned client. (c) Any sums due and owing to physicians, hospitals, nurses, or other professional services rendered as a result of this case shall be deducted and paid by the undersigned client, if applicable. SHOULD NO MONEY BE RECOVERED ATTORNEY HAS NO CLAIM AGAINST THE SERVICES RENDERED, EXCEPT FOR THE RF BY THE ATTORNEY ON CLIENT'S BEHALF. I hereby acknowledge receipt of Agreement. Date Da Ye BY SUIT OR SETTLEMENT, THE UNDERSIGNED CLIENT FOR ANY :COVERY OF ANY COSTS ADVANCED a duplicate original of this 7 d7 Atto ney Client .. s IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION Adele M. Sims, Administratrix of Estate of Harold T. Sims & Trustee Ad Litem for all persons entitled to share in damages for the Wrongful Death of Harold T. Sims, Case No. 10-7816 Civil Term Plaintiff, VS. Mary C. O'Donnell and Thomas O'Donnell, 1106 Centre Street, Ashland, PA 17921, and Eric Locke, 107 E. Biddle St., Gordon, PA 17936, Defendants .rn r r- cu rr+ ?? ca-m ORDER AND NOW, this day of 61-4 a?' , 2011, upon consideration of the within Petition for Court Approval for the division and distribution of proceeds recovered in the Wrongful Death Action and the Survival Action, and with the approval of the Department of Revenue as to the proposal contained within this Petition, it is hereby ordered that the proposed distribution is approved and the proceeds shall be distributed as follows: 1. The estate of Harold T. Sims shall receive $28,000.00; 2. Adele M. Sims, decedent's spouse, shall receive $66,500.00; Kristen Sims, decedent's issue, shall receive $45,500.00; 4. Attorney's fees to R. Mark Thomas, Esquire, in the amount of $60,000.00. By the Court, ? , R. HUk?Momas, ad J ? C0Pq al ?r? IN THE COURT OF COMMON PLEAS OF C o C CUMBERLAND COUNTY, PENNSYLVANIA mm b. x-n z= -0 n CIVIL DIVISION -<> w r G T Adele M. Sims, Administratrix of Estate of r-° Z n. a ZC --n °'n Harold T. Sims & Trustee Ad Litem for CD ?;.c -= ; all persons entitled to share in damages for the Wrongful Death of Harold T. Sims, Case No. 10-7816 Civil Te rm Plaintiff vs. Mary C. O'Donnell and Thomas O'Donnell, 1106 Centre Street, Ashland, PA 17921, and Eric Locke, 107 E. Biddle Street, Gordon, PA 17936, Defendants PRAECIPE TO SETTLE DISCONTINUE AND END To the Prothonotary: Kindly discontinue the above-captioned case which has been settled between the parties. Dated: April / , 2011 Respectfully submitted, R. Mark Thomas, Esquire Attorney No. 41301 101 South Market Street Mechanicsburg, PA 17055 Telephone: (717) 796-2100 Attorney for Plaintiff