HomeMy WebLinkAbout03-11-11IN THE CUMBERLAND COUNTY COURT OF COMMON PLEAS
IN RE: MADELYN GOOD, a minor
No. 11- ~j3
PETITION TO RELEASE FUNDS TO MINOR
Now comes Petitioner, Julie Good, parent and Natural guardian of Madelyn
Good, a minor, by and through her attorney, Jane Adams, Esq., and avers as follows:
i. Madelyn Good received an estate after the death of her Father on
November 8, 2004.
2. In accord with said estate, the funds were ordered to be placed in a Money
Market Account and not to be drawn upon except for the use of payment and
preparation of taxes regarding the estate until the minor, Madelyn Good, reaches the
age of 18. Attached hereto as `Exhibit A'
3. Madelyn Good will turn the age of i8 on June i, 2020.
4. The funds from this settlement are in a Money Market Account with Wells
Fargo in Fairview Heights, Illinois.
5. Petitioner seeks to withdraw $3097.00 out of said account, in order for the
minor, Madelyn Good, to receive orthodontic treatment. Estimates for the orthodontic
treatment are attached as Exhibit "B".
6. Affidavit of the mother is attached and incorporated herein.
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WHEREFORE, Petitioners ask this Honorable Court to enter an order releasing
said funds.
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Respectfully submitted:
J Adams, Esquire
. No. 79465
7 West South Street
Carlisle, Pa. 17013
ATTORNEY FOR PETITIONER
IN THE CUMBERLAND COUNTY COURT OF COMMON PLEAS
IN RE: MADELYN GOOD, a minor
No. 11- ~, ~ C
AFFIDAVIT
I, Julie Good, as the parent and natural guardian of Madelyn Good, a minor, do
believe and hereby affirm that the released funds from Wells Fargo will be used solely
for orthodontic treatment for the minor child, Madelyn Good. I believe it to be in the
child's best interest.
I verify that I am the petitioner and that the statements made in the foregoing Petition 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.
Julie Good
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THIRD JUDICIAL CIRCUIT 4 -
MADISON COUNTY, ILLINOIS
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ORDER ,
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MAR-11~-2011 12:39 FROM: FRED J. ALGA DMD 717-795-0843 70:7172412456 P.1
Cre~Hn SmIW eh~t,CAnoRe Llvef
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116 Cumberland Parkway ~ (717) 697-6393
Mechanicsburg, PA 17055 admin@albeorthodontia.com
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Payment Options for Active Treatment
Patient Name: Madelyn Good
Treatment Fee:
Records Fee:
$2,985.00
$275.00
Total fee:
$3,260.00
Date: 3/10/11
Treatment Type: Phase 1
The orthodontk fee Includes aN visits and procedures performed In our office over the estimated length of treatment This includes
dfagnosticrecords,applJancesnecessaryforacHveheatmentandretainers. The fee remains unchanged regardlessofwhether
heamenitakes more or Jess rime than originally estimated, provided we are receiving the expected amountofcooperation.
If appliances need to be replaced due to loss, excessive breakage, misuse or careless handling, there will be a replacement charge.
Ourservices may be discontinued only due ro tack ofcooperation, multiple felled appointments, or faflure ro adhere ro the
Nnancial arrangements.
Option A: Payment in Full (Discount 9~6)
Treatment Fee: $3,260.00
Less Cash/Check (5%): 5163.40
Payment Due: 53,097.00
Option B: springstone Patient F(nancing
* No initial payment
Treatment Fee: 53,260.00
Less Credit Cd (3%): 592.8.4
Payment Due: 53,1 fa2.20
* Toll-free number is (800)-630-1663 or
~yn~godnastonoolan.com
Take 12-48 months to pay (including a minimal finance charge)
Rate and payments are fixed throughout the term of your loan
Option C: Interest-Free Office Payment Pian
Treatment Fee: $3,260.00
Initial Payment Due: ~QQ (due at next appointment)
Total Balance Due: 52,280.00
Balance paid in: 12 Months
Monthly payment of: 5190.00 (due by the 1 st of the month)
There are no finance, Interest or service charges in connection
with the above office payment p1an.Monthly payments will be set up
by automatic deduction from ~sa/Mastercard/
Debit card and electronic check Braking.
A late fee of 525.00 will be charged for late monehly payments.
It is critical ihatyou meet yourFinancial obligation.
lfyourfinancialsituation changes, we will be glad to
discuss rearranging yourpaymentschedule to fit your new
circumstance.
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