HomeMy WebLinkAbout04-3976SHIPPENSBURG/SOUTH HAMPTON
MANOR, L.P.
Plaintiff,
1N THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2004- .-~9"'/~:~ CIVIL TERM
CATHERINE JONES,
Defendant.
CIVIL ACTION-LAW
NOTICE
You have been sued in court. If you wish to defend against the claims set forth in the
following pages, you must take action within twenty (20) days after this complaint and notice are
served, by entering a written appearance personally or by an attorney and filing in writing with
the court, your defenses or objections to the claims set forth against you. You are warned that if
you fail to do so, the case may proceed without you and a judgment may be entered against you
by the court without further notice for any money claimed in the complaint or for any other claim
or relief requested by the plaintiff. You may lose money or property or other rights important to
you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, Pennsylvania 17013
(717) 249-3166
SHIPPENSBURG/SOUTH HAMPTON
MANOR, L.P.,
Plaintiff,
CATHERINE JONES,
: IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY,
: PENNSYLVANIA
:NO.
: CIVIL ACTION-LAW
:
Defendant. :
COMPLAINT
NOW, comes Shippensburg/South Hampton Manor, L.P. ("Shippensburgv Health Care"), by and
through its attorneys, O'BRIEN, BARIC & SCHERER, and files the within Complaint and, in support
thereof, sets forth the following:
I. Shippensburg/South Hampton Manor L.P. is a Maryland limited partnership duly
authorized to conduct business in the Commonwealth of Pennsylvania.
2. Shippensburg/South Hampton Manor, L. P. owns and operates a skilled nursing facility
("facility") located at 121 Walnut Bottom Road, Shippensburg, Cumberland County, Pennsylvania.
3. Defendant, Catherine Jones, is an adult individual residing at 121 Walnut Bottom Road,
Shippensburg, Cumberland County, Pennsylvania.
4. On or about December 8, 2003, Catherine Jones sought to be admitted to the facility.
5. In connection with seeking admission to the facility, Catherine Jones represented to
Shippensburg Health Care that her daughter, Alice Jones-Pressley had authority to act as her agent.
6. On or about December 8, 2003, Alice Jones-Pressley, as the agent for Catherine Jones,
executed an Admission Agreement for Catherine Jones. A true and correct copy of the Admission
Agreement is attached hereto as Exhibit "A" and is incorporated by reference.
7. On or about December 8, 2003, Catherine Jones became a resident of the facility.
8. As of August 1, 2004, there exists an outstanding balance due of $44,6 ! 0.15 for the costs
of care provided to Catherine Jones by Shippensburg Health Care.
9. A true and correct statement of the amount due and owing is attached hereto as Exhibit
"B" and is incorporated by reference.
10. Demand has been made upon Catherine Jones to pay the amount due and owing.
11. The Admission Agreement provides, in relevant part, as follows: "If you or your
representative do not pay the money you owe us and we hire a collection agency or attorney, you agree to
be liable for their fees and corm costs."
COUNT I- BREACH OF CONTRACT
SHIPPENSBURG HEALTH CARE CENTER v. CATHERINE JONES
Plaintiff incorporates by reference paragraphs one through eleven as though set forth at
12.
length.
13.
14.
All conditions precedent to recovery under the Admission Agreement have been fulfilled.
Catherine Jones is obligated to pay for the costs of care provided to her by Shippensburg
Health Care Center.
15. The amount due and owing is not covered by a third party payor.
16. Catherine Jones has breached the Admission Agreement.
17. Late fees of $6. I 1 per diem will begin to accrue forty-five days from the date of the last
bill for the balance of $44,610.55.
WHEREFORE, Plaintiff requests judgment in its favor and against Defendant for the sum of
$44,610.55, plus attorney fees, costs and expenses, late fees, interest and any additional amount coming
due to the date of award.
18.
at length.
19.
COUNT II-QUANTUM MERUIT
SHIPPENSBURG HEALTH CARE CENTER v. CATIIERINE JONES
Plaintiff incorporates by reference paragraphs one through seventeen as though set forth
During the period of her residency, Catherine Jones has enjoyed the benefit of care and
services provided to her by Shippensburg Health Care Center.
20. Catherine Jones has failed and refused to pay for the costs her care and services provided
by Shippensburg Health Care Center.
21. Catherine Jones has been unjustly enriched by her use and enjoyment of the services and
care provided by Shippensburg Health Care Center without making payment therefor.
WHEREFORE, Plaintiffrequests judgment in its favor and against Defendant for the sum of
$44,610.55 plus any additional amounts coming due for costs of care provided to the date of award plus
costs, expenses and interest.
Respectfully submitted,
,,.O'BRIEN, BARIC & SCHF~
David A. Baric, Esquire
ID#44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
Attorney for Plaintiff
08/05/2004 15:13
V~RIFICATION
I vedfy that the statements made in the foregoing Complaint are true and correct. I
understand that false statements made herein are made subject to the penalties of 18 Pa.
C.S. § 4904, relating to unsworn falsification to authorities.
Date: August ~, 2004
CAre Cfr FRX NO. :7175308~04 ~u]. 26 2004 10:14RM
121 Wa/nut Bottom Road
Shippensb~rg, Permsyl vania
17257-9005
(717) 530-8300
FAX (717) $30~8304
TTY 1-800-654-5984
ADMISSION AGREEMENT
.rh:s Aoreement ~a.l~twe n Shlppen~burg Health ..ate Center (the Facd~ty or we and)
..C,2r~.~ C_,.....~..~.~_~5~ ............... (the "Resident" or "you") and, if' you or the courl- have
designated ail indlvktual to act on ,your 1)etult} or there is another individual to act on your
behalf, et' operat o I of {aw, ~4ctcec...._~_o~_.g$ - ~:55~d.-:{_ ("yom' representative"). A
checklist of the rights and ~esponsibi!ities applicable ~o your representative is listed in Exhibit f
and is incorporated ir~(o this Agreemer~t
pa'~in:z for Your Care_
If y:m are al}plying to this fhcility as a private-p0y resident, you must provide all financial
infon~atioa requested by us, If we later lind that the information you or your representative
provided was incernplere or inaccurate; we will consider that as a breach of this Agreement
which th, es us the dghl to pursue all legal remedies against you or your represerUadve
· .B__'Jie...¢:StrX_l*e l,k-g.qirrd.t...o pay for Veto- C>Lr!: ,
Or;l.,,' you and y:'mr hisurer can be required to pay ibr )'our care, N~o___o. Lb. eLpersor}.. (ie. a family
member, D'iend, neighbor, legal representative c)t guardian) can be required to pay f'rom tN:ir
own fimds fbr your care, although be o~ she may knowingly and voltmla:ily agrl:'c, to guarantee
payment fbr the cosl of your care We requh'e the per:ion responsible tbr making payments on
vo~.a behalf to pay ~br your care under the terms of flits contract in a timely manner.
1F ,..:;,u are a beneficla~y of Medicare, Medicaid or any other third-party payment plan, your
relm~s=))t~live agrees to make all nece,,sa.ry payments fkom your fimds Your representative
could f~ce a eMI penahy for intentionally ~ailing to pay required amounts from your funds and
could fiaee a criminal penalty fbr abusing your ftltlds.
Private Pay Reside.ts
The items and services included in our daily rate is basic room, board and general nursing care as
required by your medical condition. Payment for items and setMces that nrc included ir) Ibc
daily rate aad is payable one month in advance and due on the first of each month Items and
services included in your daily rate are listed in Exhibit 2A
You will be charged separately for additional items and services not included in our daily rates
such as special t:ursing care, special equipment, pharmacy charges, laboratory charges, medi¢~2
transpmta¢on and additional services such as te!cehune expen,qe, dr)., cleaning, beauty and barber
services and newspapers. Items and selwices i:br ~q~ch you will be charged am listed in Exhibit
2.B. Payment fi)r these additional items and set-vices are due after you )rave reqtmsted them, and;
you have received and have bee, billed t~,' them. Within 30 days of recelvlng art item or service,
Exhibit "A"
'FRO~l.:SM~ensburg Health Came Ctr F~X NO. :7175~08~04 Jul. 26 ~004 ~0:14AM
you have the right to ask us for an itemized financial statement that briefly but clearly describes
each item and the anount charged for it. You will be given an updated listing o/' services and
related charges, inauding any charges for services not covered under Medicare or by the
facilities basic per dcm charges, anm,ally on or about January 1 of'each year,
Medicare Re~idmts
'We participate in the Medicare Program. Medicare may pay for some or all of your nursing
home cam. For information on Medicare, see Exhibit 3. If you are eligible for Medicare, you
have the right to have claims for your nursing home care subrn.itted to Medicare.
, Medicaid Residents
We participate in the Medicaid program. For information on Medicaid, see Exhibit 3. You are
not required to give up any of your rights to Medicaid benefits to be admitted or to stay here. If
your private funds are used up during your stay here and yon are eligible for Medicaid; we will
accept Medicaid paymcl~ts although Medicaid may require yeti to pay some amount in addition
to what Medicaid pays for your care. Il' you are planning on applying to Medical Assistance
later, you may want to find out now ii'your are "medically eligible" for nursing home payment
by Medicaid.
You are responsible for applying for and obtahfing Medicaid benefits and we will assist you. We
may not charge, ask for. accept or receive any gift, money, donation or consideration other than
Medicaid reimbursement as a condition of your admission or continued stay here except that
Medicaid may require you to pay certain arnounts fl-om your private rituals.
If you receive Medicaid, most of your nursing home charges such as room, board, and general
nursing care are covered. For a list of services covered by Medicaid, see Exhibit 4. A. The local
Board of Assistance will tell you whether you have to pay part of the charge for your care and, if
so, how much Some of the items and services that we ofl'kr are not covered by Medicaid. If you
want any items or services, which are not covered by Medicaid, you or your representative will
have to pay for them. A list of the items and services not covered by Medicaid and the chm'ges
for them are in Exhibit 4B Payment for items and services that are not covered by Medicaid is
due afbr you have requested them, and; have received and have been billed for them. Within 30
days of receiving the item or service, you have the right to ask us I-'or an itemized statement that
briefly but clem-ly describes each item and the amount charged lbr it.
Increases in Chard, es and Fees
Any time we increase a :~'ec or charge fo/~kem .?[ service or add a new item or service, we will
provide you and ycmr representative wit~ 30 day~dvance written notice.
Penalties
We may not charg~ you interest if you pay your bill in time. Your payment is on time if it is
made within zl5 days of the date the bill is post marked, or 30 days after the end of the billing
period, whichever is later. The penalty we charge is(56/o'~fthe amount due, calctdated oe a per
day basis.
'¢R0~':ShippEnsbu~9 H~a~th C;ar6 Cfr FRX NO. :7175308304 ~ut. 26 2884 10:ZSRM P~7
If you or your representative do not pay the money you owe us and we hire a collection agency
or attorney, you agree to be liable for their fees and court costs.
Private Dutv Nurses Geriatric Aides
It' you want a pfivate duty nurse or a. private duty geriatric aide, you are responsible for selecting
a person licensed and/or certified according to Pennsylvarda laws and regulations. You are also
responsible for paying him or her and for letting us know that you have hired one. The person
you hire is not an employee or agent of the facility, but he or she mu~t meet our standards and
follow our policies and procedures. Employees of the Facility may not serve as private duty
nurses or private duty geriatric aides.
. Holding Your Bed if You Leave tile Facility
if you are hospitalized or on leave fi'om the Facility, we will hold your bed for you as follows;
If you arc private-pay rcsidcnt, or are receiving inp~tie~t care reimbursed under Medicare
Program (and you are not covered under Medicaid), unless you notily us otherwise, we
will hold your bed for as long as you pay for it at the d~ly rate you are currently being
charged.
If' Medicaid pays tbr part or all of your nursing home care ancl you need to be
hospitalized, we wi¢_hold-Y~ur bed for up to the maximum number of days required by
this state, currentll~l 5 da_ys~ if you leave for any other reason, we will hold your bed for
up to the maxlmum"~alb~er of days reqnired by this state, currentl3('-~'r~,~ ' You have a
fight to be readmltted to the facility to the first available appropriate-bed: While we are
holding your bed, you are still required to pay the Facility any amount fi*r which you are
liable as determined by the Medicaid Program.
If you have applied for Medicaid, your bed will be reserved in accordance with Paragraph
B. However, if you are found to be ineligible for Medicaid, then you are required to pay
for the bed as a private pay resident as described in Paragraph A.
Other third-party payers may or may not have a bed hold policy. We will discuss this if it
applies to you,
Your Right to Make Complaints and Sug~,est Changes in Policies and Services
As a nursing home resident, you have many rights according to State and Federal law. These are
described in detail in Exhibit 6, which is attached and is part of this Contract.
You may make complaints about your care in the Facility and you may also suggest changes in
the policies and services of the Facility. You will not be harassed or discriminated against ¢.~r
making a complaint or suggesting a change in a policy or service, You may present your
complaints to facility, management company or to one of the following State agencies:
~RO~:Shipp~nSburg H~alth Car~ Ctr FAX NO. :7175308304 Jul. ~6 ~00~ 10:iSAM P18
Larry D. Cottle, LNHA
Administrator
Shippensburg Health Care Center
121 Walnut Bottom Road
Shippensburg, PA 17257
717~530-8300
Peter E. Perlnl, Sr.
President
~Magnolia Management, Inc.
1710 Underpass Way
Hagerstown, M D 21740
301-745-8700
~,'Ombudsman
Ottice of Aging
16 West High Street
Carlisle, PA 17013
717-240-61 I0
717-532-7286 Ext. 6110
Department of Health
100 North Cameron Street
2Na Floor
Harrisburg, PA 17101
717-783-3790
Your Ilight to Make Decisions
· You have the right to make your own medical decisions and to manage your personal affhirs. If
you become disabled, it may be necessary tot' someone else to [nake decisions for you. For this
reason, we recommend that you have a living will and/or advance directive for medical decisions
and a financial Power of Attorney but you are not required to do so. See Exhibit 7 for a
description of your legal rights to decide about your fi. lture medical treatment.
Transfer, Relocation and Discharge
You have the right to remain here, and you may not be transferred, relocated or discharged
against your will, except for the following reasons: (i) A medical reason (i.e. the facility cannot
provide the kind of care that you need, your condition has improved so that yon no longer need
the care we provide, or a medical emergency arises; (2) Your welhre or the welfare of other
residents or sta~ (3) Nonpayment for a stay, or (4) the Facility ceases to operate.
If we decide that you should be transferred or discharged, we will notify you, and an immediate
family member or legal representative, by letter 30 days in advance. If you are transferred
because of an emergency situation, we will provide the required notice as soon as practicable.
The letter will contain the reasons for the transfer or discharge and its effective date The letter
will also tell you bow you can appeal our decision to transt'er or discharge you.
If you are discharged involuntarily, we will attempt to make other appropriate arrangements -for
your care. However, if other arrangements are not available, your representative agrees to accept
you into his or her custody if it is medically appropriate
Your Right to End This Coutraet
If you decide to end this Contract and leave the Facility, you must pay your bill before you leave.
You must give us flve (5) days written notice to terminate this contract. If you leave before the
end of that time, you must still pay for each day of the required notice
~RO~-:Skipp~nsburg Health Care C~r ¢RX NO. :7&75300304 ~u~. 26 2004 iO:ISRM
In the event you die while a resldent of the t'acility, your representative is responsible for making
the funeral arrangements, We will notify your representative immediately, If we are unable to
reach your representative~ we will contact the funeral home of your choice to facilitate
arrangernents~
Additional Documents
It is not possible to cover evetb, thing that is important to your stay in our Facility in the body of
this Contract. Therefore, we have included additional important documents as Exhibits. These
Exhibits are part of this Contract. Please verify that you received the Exlfihits and that rite
contents of the Exhibits were explained to you by placing your initials on the line next to the
description of each Exhibit.
(J-'~ Exhibit 1, Rights and Obligations of Representatives.
C:_)-~"j(( I-x tibit 2. For Private Pay Residents: (a) Items and services covered by daily rate,
(b) Items and services not covered by daily ram
Extfibit 3 How to Apply For Use
attd
Medicare
and
Medicaid
Benefits,
Exhibit 4. (a) Items and Services Covered by Medicaid,
---Tf-' (e) Items and Services Not Covered by Medicaid
~t~.), Exhibit S Physicians Who Practice at the Facihty
~.f-~ Exhibit 6, ' ' s ' ' '
Legal Rights o[ Penn,¢ylvama to Decide Future Medical Treatment.
(~ Exhibit 7,
¢~_ Exhibit 8.
Policies and Procedures Concerning Your Personal Funds and Your
Personal Property.
Services Provided by Outside Health Care Providers
Changes in Law
ga~y provision of this Contract that is found to be invalid or unenforceable as a result of a change
in State or Federal law will not invalidate the remaining provisions of this Contract. If there are
services we have agreed to provide that are later found to be impossible to render as a result ora
change in State or Federal law, it is agreed that to the extent possible, the Resident and the
Facility will continue to fulfill our respective obligations under this Contract consistent with the
law,
~FRDN~ :SKippensbur9 Health Care Ctr FAX NO. :7175308304 Jul. 26 2004 10:iGAM P20
WITNESS WHEREOF; the parties have executed this Contract on tiffs _
Witness
~ 1't~,, day of__
~;i~ie, Administrator
Sh'ppensburg Health Care Center
Witness Resident
If' the Resident has been adjudicated disabled or the Res'dent s doctor determines that the
Resident is incapable of understanding or exercising his or her rights and responsibilities, the
Facility may require the signature of another person on this contract, The other person may be:
(1) An appointed healthcare agent under an advance direc~tive for_~medieal care; A guardian or
Power of Attorney of the person; (3) A surrogate ~er~ (2)
FROM :Shippensbur9 Hmaith Care Crc FAX NO, :7175388384 Jul, 26 2884 18:IiRM P4
STATEMENT
SHIPPENSBURG HEALTH CARE CTR
121 WALNUT BOTTOM RD
SHIPPENSBURG, PA 17257
Facility Phone: 717-530-8300'
Resident: CATHERINE JONES
ALICE PRESSLEY
309 N 28TH ST
Harrisburg, PA
Date Service Through
Char~es
07/31/04 07/01/04 07/31/04
"re. letted Preblll Chamee
'-'08/01/04 08/01/04 08/31/04
Statement Date: 07/16/04
Qty Description
Sub Total as of 06/30/04
31 Room Charges
Sub Total
Balance
31 Pmbill Room Charges
Sub Total
Total Amount Due
Amount
33,202.15
5,704.00
5,704.00
38,906.15
5,704.00
5,704,00
44,610.15
i :~ A S T D U E
PLEASE REMIT
Exhibit "B"
SHERIFF'S RETURN - REGULAR
CASE NO: 2004-03976 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SHIPPENSBURG/SOUTH HAMPTON MAN
VS
JONES CATHERINE
JASON VIORAL , Sheriff or Deputy Sheriff of
Cumberland County, Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE
JONES CATHERINE
DEFENDANT , at 2015:00 HOURS, on the
at 121 WALNUT BOTTOM ROAD
SHIPPENSBURG, PA 17257
CATHERINE JONES
a true and attested copy of
was served upon
the
8th day of SeDtember, __
2004
by handing to
COMPLAINT & NOTICE
together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs:
Docketing 18
Service 14
Affidavit
Surcharge 10
42
00
06
00
00
00
06
Sworn and Subscribed to before
me this /6 ~ day of
So Answers:
R. Thomas Kline
09/09/2004
OBRIEN BARIC SCHERER
By: /~
uty Sheriff
SHIPPENSBURG/
SOUTH HAMPTON MANOR, LP
Plaintiff
CATHERINE JONES
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2004-3976 CIVIL TERM
CIVIL ACTION-LAW
PRAECIPE TO ENTER DEFAULT JUDGMENT
PURSUANT TO Pa.R.C.P. 1037
TO THE PROTHONOTARY:
Please enter judgment in favor of the Plaintift; Shippensburg/South Hampton Manor, L.P.
and against the Defendant, Catherine Jones, for failure to file an answer to the Complaint of
Plaintiff. A true and correct copy of the return of service from the Sheriff of Cumberland
County is appended hereto as Exhibit "A."
A tree and correct copy of the Notice of Default is appended hereto as Exhibit "B.'
A tree and correct copy of the Certificate of Mailing for the Notice of Default is appended
hereto as Exhibit "C." I certify that the Notice of Default was given in accordance with
Pa.R.C.P. 237.1.
Plaintiffrequests judgment in the amount of $44,610.55 as set forth in the Complaint.
Respectfully submitted,
David A. Baric, Esquire
I.D. # 44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
SHERIFF'S RETURN -
CASE NO: 2004-03976 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLJYND
SHIPPENSBURG/SOUTH HAMPTON MAN
VS
JONES CATHERINE
REGULAR
JASON VIOR3kL , Sheriff or Deputy Sheriff of
Cumberland County, Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE
JONES CATHERINE
DEFENDANT , at 2015:00 HOURS, on the
at 121 WALNUT BOTTOM ROAD
SHIPPENSBURG, PA 17257
CATHERINE JONES
a true and attested copy of
was served upon
the
8th day of September, __
2004
by handing to
COMPLAINT & NOTICE
together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs:
Docketing '18.00
Service 14.06
Affidavit .00
Surcharge 10.00
.00
42.06
Sworn and Subscribed to before
me this day of
A.D.
Prothonotary
So Answers:
R. Thomas Kline
09/09/2004
OBRIEN BARIC SCHERER
EXHIBIT "A"
SHIPPENSBURG!
SOUTH HAMPTON MANOR, LP
Plaintiff
CATHERINE JONES :
Defendant :
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2004-3976 CIVIL TERM
CIVIL ACTION-LAW
TO:
Catherine Jones
121 Walnut Bottom Road
Shippensburg, Pennsylvania 17257
Date of Notice: September 29, 2004
IMPORTANT NOTICE
YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN
APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE
COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST
YOU. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE, A
JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU
MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE
THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR
CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND
OUT WHERE YOU CAN GET LEGAL HELP.
Cumberland County Bar Association
32 South Bedford Street
Carlisle, Pennsylvania 17013
Telephone: (717) 249-3166
/~IEN, BARIC~AND SCH/~
David A. Baric, Esquire
19 West South Street
Carlisle, PA 17013
(717) 249-6873
dab.dir/shcc/jones/default, ntc
EXHIBIT "B"
PS Form 3817, January2001
EXHIBIT "C"
CERTIFICATE OF SERVICE
I hereby certify that on October 12, 2004, I, David A. Baric, Esquire, of O'Brien, Baric &
Scherer did serve a copy of the Praecipe To Enter Default Judgment Pursuant To Pa.R.C.P. 1037,
by first class U.S. mail, postage prepaid, to the parties listed below, as follows:
Catherine Jones
121 Walnut Bottom Road
Shippensburg, Pennsylvania 17257
David A. Baric, Esquire
il
SHIPPENSBURGI
SOUTH HAMPTON MANOR, LP
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2004-3976 CIVIL TERM
v.
CATHERINE JONES
Defendant
CIVIL ACTION-LAW
PRAECIPE TO SATISFY
TO THE PROTHONOTARY:
Please mark the judgment entered in the above-captioned matter on October 12, 2004 as
satisfied.
Respectfully submitted,
David A. Baric, Esquire
LD. # 44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
dab.dirlshcc/joneslsatisfy.pra
CERTIFICATE OF SERVICE
I hereby certiJY that on January 26, 2005, I, David A. Baric, Esquire of O'Brien, Baric &
Scherer, did serve a copy of the Praecipe To SatisJY, by first class U.S. mail, postage prepaid, to the
party listed below, as follows:
David A. Baric, Esquire
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