Loading...
HomeMy WebLinkAbout11-5641COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS Judicial District, County Of NOTICE OF APPEAL FROM DISTRICT JUSTICE JUDGMENT COMMON PLEAS No. /i - S(6111 Omrna m NOTICE OF APPEAL Notice is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the District Justice on the date and in the case referenced below. ADDRESS OF AP ELLANT c" STAT ZIP CODE , 11af? iZ ? ?? I S' OAT OF JUDGMENT IN THE CASE OF (Plaintiff) (Defenda ?>rAVIV\e.l?. L t?cc.5 ?a (`n ?z,hG?,t 16 4-C:v -00MD g --x011 This block will be signed ONLY when this notation is required under Pa. R.C.P.D.J. No. 10088. This Notice of Appeal, when received by the District Justice, will operate as a SUPERSEDEAS to the judgment for possession in this case. appellant was claimant (see 1001(6) in action before a District Justice, A COMPLAINT MUST BE FILED within twenty (20) days after riling the NOTICE of APPEAL. Signature of Prothonotary or Deputy PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE (This section of form to be used ONLY when appellant was DEFENDANT (see Pa.R.C.P.D.J. No. 1001(7) in action before District Justice. IF NOT USED, detach from copy of notice of appeal to be served upon appellee. PRAECIPE: To Prothonotary Enter rule upon i)G4?)Ie k Lic-OLS appellee(s), to file a complaint in this appeal Name of appellee(s) (Common Pleas No. within twenty (20) days after service of rule or suffer entry of judgment of non pros. Signature of appellant or attorney or agent RULE: To lo? L t)crt appellee(s) Name of appellee(s) (1) You are notified that a rule is hereby entered upon you to file a complaint in this appeal within twenty (20) days after the date of service of this rule upon you by personal service or by certified or registered mail. (2) If you do not file a complaint within this time, a JUDGMENT OF NON PROS MAY BE ENTERED AGAINST YOU. (3) The date of service of this rule if service was by mail is the date of the mailing. L:?Su Date: ' 2011 , hingm Signature of rothonota or Deputy YOU MUST INCLUDE A COPY OF THE NOTICE OF JUDGMENT/TRANSCRIPT FORM WITH THIS NOTICE OF APPEAL. AOPC 312-02 WHITE -COURT FILE TO BE FILED WITH PROTHONOTARY GREEN - COURT FILE YELLOW- APPELLANT'S COPY PINK -COPY TO BE SERVED ON APPELLEE GOLD -COPY TO BE SERVED ON DISTRICT JUSTICE PROOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE COMPLAINT (This proof of service MUST BE FILED WITHIN TEN (10) DAYS AFTER filing of the notice of appeal. Check applicable boxes.) COMMONWEALTH OF PENNSYLVANIA COUNTY OF ; ss AFFIDAVIT: I hereby (swear) (affirm) that I served ? a copy of the Notice of Appeal, Common Pleas , upon the District Justice designated therein on (date of service) 20 , ? by personal service ? by (certified) (registered) mail, sender's receipt attached hereto, and upon the appellee, (name) , on ,20 ? by personal service ? by (certified) (registered) mail, sender's receipt attached hereto. (SWORN) (AFFIRMED) AND SUBSCRIBED BEFORE ME THIS DAY OF 20 Signature of affrant Signature of official before whom affidavit was made Title of official My commission expires on 20 VINVAIA?NU ,?1Nf1-- I slowna so 01 WV 41 1W 1IN AVIONONLOW 3Hl 30 COMMONWEALTH OF PENNSYLVANIA Notice of Judgment/Transcript Civil COUNTY OF CUMBERLAND Case Mag. Dist. No: MDJ-09-3-04 MDJ Name: Honorable Thomas A. Placey Address: 5275 East Trindle Road Suite 110 Mechanicsburg, PA 17050 Telephone: 717-697-2201 Michael Botti 6 Victor Lane Mechanicsburg, PA 17050 Docket No: MJ-09304-CV-0000248-2011 Case Filed: 4/25/2011 Disposition Summary Docket No Plaintiff Defendant Disposition Disposition Date MJ-09304-CV-0000248-2011 Pamela Lucas Michael Botti Default Judgment for Plaintiff 06/23/201 Judgment Summary Joint/Several Liability Individual Liability Amount Participant Michael Botti $0.00 $972.50 $972.50 Judgment Detail (*Post Judgment) In the matter of Pamela Lucas vs. Michael Botti on 6/23/2011 the disposition is Default Judgment for Plaintiff and judgment was awarded as follows: Judgment Component Joint/Several Liability Individual Liability Deposit Applied Amount Civil Judgment $0.00 $880.00 $880.00 Filing Fees $0.00 $86.50 $86.50 Costs $0.00 $6.00 $6.00 Grand Total: $972.50 ANY PARTY HAS THE RIGHT TO APPEAL WITHIN 30 DAYS AFTER THE ENTRY OF JUDGMENT BY FILING A NOTICE OF APPEAL WITH THE PROTHONOTARY/CLERK OF COURT OF COMMON PLEAS, CIVIL DIVISION. YOU MUST INCLUDE A COPY OF THIS NOTICE OF JUDGMENT/TRANSCRIPT FORM WITH YOUR NOTICE OF APPEAL. EXCEPT AS OTHERWISE PROVIDED IN THE RULES OF CIVIL PROCEDURE FOR MAGISTERIAL DISTRICT JUDGES, IF THE JUDGMENT HOLDER ELECTS TO ENTER THE JUDGMENT IN THE COURT OF COMMON PLEAS, ALL FURTHER PROCESS MUST COME FROM THE COURT OF COMMON PLEAS AND NO FURTHER PROCESS MAY BE ISSUED BY THE MAGISTERIAL DISTRICT JUDGE. UNLESS THE JUDGMENT IS ENTERED IN THE COURT OF COMMON PLEAS, ANYONE INTERESTED IN THE JUDGMENT MAY FILE A REQUEST FOR ENTRY OF SATISFACTION WITH THE MAGISTERIAL DISTRICT JUDGE IF THE JUDGMENT DEBTOR PAYS IN FULL, SETTLES, OR OTHERWISE COMPLIES WITH THE JUDGMENT. Date a true ana correct copy 0- 6-)'&C'47 A- Placey L '&I .3 -4E Date Magisterial Pamela Lucas V, Michael Botti Thomas A. Placey i"- AL Y MDJS 315 Page 1 of 2 Printed: 06/23/2011 10:23:54AM O THELPROTHONOTAR) 2011 JUL 22 PM 3: 23 CUMBERLAND COUNTY PENNSYLVANIA PROOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE COMPLAINT (This proof of service MUST BE FILED WITHIN TEN (10) DAYS AFTER filing of the notice of appeal. Check applicable boxes.) COMMONWEALTH OF PENNSYLVANIA COUNTY OF ss AFFIDAVIT: I hereby (swear) (affirm) that I served ? a copy of the Notice ofApp??e..((al, Common Pleas , upon the District Justice designated therein on (date of service) ?r 11 1 2011 by personal service ? by (certified) (registered) mail, sender's receipt attached hereto, and upon the appellee, (name) C,vl,?t A L? L? S on J 20 ) ?L ? by personal service (Xby (certified) (registered) mail, sender's receipt attached hereto. IRMED) AND Sri .1 UB CRIBED BEFORE 0R?/ME (SWORN) (A? THIS DAY OF Z:? in 4z?r-__ Signature of official befa whom atidavit was made Title of official My commission expires on /ti/`4?kyof ?t.?, 20,,1 Signature of affrant rc.? ??-' J L70 jT 0 J4 'ad 60 wmmvnvrcAL t h Ur PENNSYLVANIA COURT OF COMMON PLEAS Judicial District, County Of NOTICE OF APPEAL FROM DISTRICT JUSTICE JUDGMENT COMMON PLEAS No. - NOTICE OF APPEAL Notice is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the District Justice on the date and in the case referenced below. art ? ----- oRESS OF APPELLANT TE OF JUDGMENT CITY THE CASE OF (PlaintAf) J} OK.NA i unt of APPELLANT OR ATTORNEY OR AGENT This block will be signed ONLY when this notation is required under Pa. If appellant was Claimant (see Pa. R.C.P.D.J. No. 1001(6) in action R.C.P.D.J. No. 1008B. This Notice of Appeal, when received by the District Justice, will operate as a before a District Justice, A COMPLAINT MUST BE FILED within twenty SUPERSEDEAS to the judgment for possession in this case. (20) days after riling the NOTICE of APPEAL. Signature of Prothonotary or Deputy PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE (This section of form to be used ONLY when appellant was DEFENDANT (see Pa.R.C.P.D.J. No. 1001(7) in action before District Justice. IF NOT USED, detach from copy of notice of appeal to be served upon appellee. PRAECIPE: To Prothonotary Enter rule upon ?..,,e„e?r ? . (Common Pleas No. Name of appellees) • « ) within twenty (20) days after service of rule or suffer entry of judgment of non pros. Signature of appellant or attomey or agent RULE: To appellee(s) Name of appellees) (1) You are notified that a rule is hereby entered upon you to file a complaint in this appeal within twenty (20) days after the date of service of this rule upon you by personal service or by certified or registered mail. (2) If you do not file a complaint within this time, a JUDGMENT OF NON PROS MAY B ???NST °vOU. (3) The date of service of this rule if service was by mail is the date of the mailing. Date: ! a 20 I t Signature of Prothonotary or eputy YOU MUST INCLUDE ACOPY OF THE NOTICE OF JUDGMENT/TRANSCRIPT FORM WITH THIS NOTICE OF APPEAL. AOPC 312-02 COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS Judicial District, County Of NOTICE OF APPEAL FROM DISTRICT JUSTICE JUDGMENT COMMON PLEAS No. NOTICE OF APPEAL Notice is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the District Justice on the date and in the case referenced below. NAME OF APPELLANT. - MAG. D,IST. NO. NAME OF D.J. CITY DATE OF JUDGMENT IN THE CASE OF (PlamUll) (Oelendanr) DOCKET No. 51GNATUKL OF APPELLAN 1 UK A] 1 UKNE Y UK AGEN I r. This block will be signed ONLY when this notation is required under Pa. If appellant was Claimant (see Pa. R.C.P.D.J. No. 1001(6) in action R.C.P.D.J. No. 1008B. This Notice of Appeal, when received by the District Justice, will operate as a before a District Justice, A COMPLAINT MUST BE FILED within twenty SUPERSEDEAS to the judgment for possession in this case. (20) days after filing the NOTICE of APPEAL. Signature of Prothonotary or Deputy WHITE -COURT FILE TO BE FILED WITH PROTHONOTARY GREEN - COURT FILE YELLOW- APPELLANT'S COPY PINK -COPY TO BE SERVED ON APPELLEE GOLD -COPY TO BE SERVED ON DISTRICT JUSTICE ¦ Complete items 1, 2, and 3. Also complete Item 4 R Restricted Delivery is desired. ¦ Print your name and address on the reverse so that we can return the card to you. ¦ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: AB L Lvc& ?egenc.?l (?c>?st ,J??Ir a6 3. Agent Received by ( C. Date of Delivery different from item 1? ? Yes y add ress below: ? No ??ified Mail r ? ' 0 Registered ? Insured Mail 4. Restricted Delive 2. Article Number 9568 511] 6 (Tr&Mdbrfrwn: 7011 0470 0DUU PS Form 3811, omestic Return Receipt ? Express Mail OVetum Receipt for Merchandise ? C.O.D. pry? (Extra Fee) ? Yes .-1 G8 6 102585-02-M-1540 (A L. LL (CCC S vs" MI(hat ?"XA4-1 CoArl C ?,rnv;,t:r lira t? COY Ak, I I - ICU v rn ? ?i r. ? + 2 ?.?r t e....,y ?..,1 ^ mp Kin C(l , On '?- 5 - 2010 rn i C-hW oaf,! ?rO?L ??- fit, i n -Turn G?r? ? , ?Gct ttiSi a CQ m# Mvsclr) RUSPYAOet(CWrjC LUVWS ) 'el N'*r) Wla? f1t, r4ill 4aorz?e5 dav Irc ou Car. tar k- s (101 t. reatize- 44v ca-v de4l no ?t Kbor PIL4S-4h-e tTU t-j fig- J?ry I ) Ord Pol"(X re rje DA-IC m ORDER NO: WHEN PROMISED t YEAR. MAKE M D __._. • O EL . SERIAL NO. - -- No ' L , NO. ICEFiSE NSi OQOMETER - - WRITTEN BY > T##A ?t WFF. ? WAM -- a CIO OTAL PARTS i GALS. GAS LABOR ONLY PARTS ' OtL M& GREASE TOfAL GAS ACCESSORIES GAS. OIL, & GREASE ; & OIL & MISC. MERCHANOISE GREASE SUBLET REPAIRS RETAIN PARTS DIDESTROY PARTS OTAL cc?sscriEy TAX TOTAL R aAtc;?_m ruc.?t - ,;r, ,-c ner.r,..a! t., StwesNS?abhw?nq mire veu!ryh rep?a. U194EMJ 7U CPERP7E THE ?Ai;, TFIk;% OR MF.#A"..E Hf4" 7ESCRBrp ON PU-W WA YOJR S6w!!h?F_SW4 ?nMYNC. Btt +?. r'GY Ef!c C hE c'TdtAiE Yl' Fa'JPY !.? STR?tTo hY_?'MAl`P3 (Rt EtIiFAFIEgE FCA TSB H7AP06E CG iEy'T!h0.; 4hT10e? YOMFF,FW4 F 2('leeaeP?d?Kgt%ut cat:w OSiwa t'd3'L:7rLYt AA fYP7f£S-3 IAE(7V,t7tC5 Lt£N G ,rR&BL` HIiEfK Ei DNN T a7 uaTu4° k ° "?Bxpn Aix Gio?esJ$ . f mOr?? 7AtiGh -YEi ,.E Ti y? s n .Ri?E 9; xhwC'NRTAR iANY14L5c Y7t?tr! TO DA ? _?N'ic"7i 1.:,?1h?Q•e Axis hIEF#T0. . r_;-;?AUTM:#?,. IN. ?k VlCE.; f',t 'xO, drab aantanae N. a . aTSa OF Th 04TF 3gtt'N ALrrO REPAIR ORDER AuTo REPAIR ORDER Print CRS W0165056 Page 1 of 6 COMMOMWEALTH of ft*NMV1 v POIJa CRA SH YtEPWITM FORM Crash Number paw Ak •500 1 Q Yts ® p Yes Q 1 W0165056 Can Chmed Womble Crash Mddmt Nuaeber -Agmy Paw Zone HAW0100700172 21103' 10 Army 0 Name Pr*dnd' DO YYM H ampden Township ' Thee Arth?t Tfeeea ( 07 - 05 - 21 I U Badoo Number 0211 0217 PT I.M. MATTHEW GRUNDEN 29 24 RWWW*r Nuarbar AM" .TEFFREYASNYDER 19-11 07 12 26 D :j caufft Coca Naam Nerrne Ilav of is 21 Cumberland 103 ampden Township Q sun Q Thu R YYYY) 1 fie (?[ ' - 'if.:00 Q Mon Q Fn 07 OS - 2010 i 0 0 Q Tue . C )sat CQ' Uri: worlcions(?orrn Q Yes OW Sdeoof a- Form F C:) Wed L&"_*ion Related Q Yes Q No ZWWOyes ONO TQ Yes Q No _ Q 4 Way'kl;ersettion (:3 'Y' Intersection Q Q Off gamy Q Raikoad cro" Q Midblock Q .T. intersection o Traffic Circlet Q On Ramp Q Crossover Q Other Round About Route Number 'Sam TraW Lam Speed Urnit Q North tkoulfu'NURk6- ? Of a iCW*) INP Q Sour Name 4 Street D Q West Pa" House Wu and malt are N&M Q Unblown Pmxpal aOft #0trnet NW* Is fbd in, 4 option © IrItOrstae 'w wnpke) Q? Turr O Turnpike Q Q Q Q e Q Other Numb (Optionai? Trivet tangy r Speed Un* 02 O North --- r ©SouUt SUVK NMW a .1"N1'r11FER St%et © East CR z Q West - o Q I V'WIKWjn . O ( InterStale lot Turrip" Q ?u Q O may Q o= Q oor Road sueett O fnialite © tun4kn/ unknown hdorsectft Rt alum or Moe fast or ' at tYhr#et ..?. ? Q North Feet i sweet Name . ? Q south ease E 5t Er? , oWet nter wee• or mow Inforrimbon Landrnaft rr"s option . Q O North Distance From Crash or i street Name O soul Scene to tandrmrk t St Q East (For Crash between ar Q West LNXW lc t and - .c ? Z) Degrees Minutes Aiiireutrs Seour? ' tarjeude 40 14 51 • 000 76 58 •.40? - 000 or ?2?----? Q Yield sign, 4 ftim ° Q Not Applicable Q Traffic Signal Q Active RR Cro-wrig Q No Controls Q [)eA??, lite Functioning Errargen4 Traffic Controls Q Other Type TCD Q f?reemp" ©s O stop sg, Q e Rc unknown O Q wnctbnin9 O Signl,wn of ftt © ; s* resr af *w conk ooxNe mcdoro ynecue Q North Q East 0 North and South Q An Q Not Applicable ly Q R* Q Unknown DiNWOR ° Q South Q West Q East and West (N,S,E,IAq Daft Yes Q No Q IOLUM Unknown Q Q <30 Mn. d 30.60 Min. Q 1-3 hrs Q 3-6 hrs Q 6-4 hrs Q a 9 hours Q Unknown P OOT COPY ---- http://www.dot6.state.pa.us/asapp/Printhnap-es/)(rnlFilect00if IIATI'zc')nt MAg4y „o1,, 0 „ft,.,,,,... Print CRS W0165056 Page 2 of 6 J C0M 8.5(4'0 OF PEWSYLVANIA Crash Number 8 FORM Page, AA 500 2 Pwice use ony --71 ELI W0165056 l' O MTransport 0 oto Vehicle in O Hit & Run Vehicle Q illegally parked O Legally Parked 0 Non - Motorized Commercial Vehicle Pedestrian on Skates Disabled From O Train p Phantom Vehicle m 0 pedestrian O in Wheelchair, etc O Previous Crash (if Yrrs, Complete Form C) (!f 'Pedestrian' or •P riart on Skates in Wheettteir etc-, OM!M Form M, Section 28) - VWV% Unlit First Nance a O1 MICHAEL D last Mamie Delete? O BOTTI 6 VICTOR LN MECHANICSBURG PA ?ft ucense Humber. 28470061 tt Q No O 1e?1 Drugs O Medication O O Alcohol O Alcohol and Drugs O Ur nawn O O U Drug O Fatigue Q Medication Q Sick p Asap 0 Unknown lkotra 11101, Pritmw VehkAo Code 19irr(att _ Charged? 0 Test Not Given p Breath p other Q Yes Q No p f t>od 0 Urine D Ynk wit DRIVING UNDER THE INFLUEN C 5,t lPe:r to O Test Refused O Resin ftyfM-W Dr4w 7= Vehicle 3=Driver Red Scene Test Given, Vehicle 4 --Hit and Run O Contaminated Results o 2=No Driver 9=Unknown Own_eA9!LW- 0D=Not Applicable 02=Private vehicle Not 04--State Poke Vehicle 07=Municpal Police Veh 09-Federal Gov Veh 01 =Private Vehicle owned/ ownedlLeased by Driver OS=PENNDUT Vehicle 08=Other Municipal 98-0thcr 0z Leased by Driver 03=Rented vehicle 06 Other State Gov Veh Govemment vehicle 99=Unknown r 1 ;.-j ? ;; eueness Name of Pedestrian, skip this 5er ttort) Same as Driver O PAMELA L LUCAS Address l CKY l Slats l zip - Vehwe Mall m sane 12 REGENCY WOODS N CARLISLE PA 17015 Ford d Model Year ay) (see ave Vehicle Model vlN 1995 ESCORT 3FASP13J3SR100486 ucertse Ph" Rag, Sta" EsL Speed V Towed Towed HJD8535 PA 999 0 yes Q No PRIVATELY insurance Company Policy PIo Assurance - MMG INSURANCE CO O Yes Q No Q k AC10956448 n 1¢TOw+ng Pass. Veh 4=WbbilelFAoduiar Horne 7=Semi-Trailer o of 11 ? 2=To+a+ng Truck 5--Camper 8--Other t T Ho Tag Year Too St ra !7ing 3=Toveng Utikty Trader 6=FuM Tra lei 9 Unknown U nits: L a>+am 07 t 12 Dirt s?oa-c-?-tt tlcaats 1 OO 1 92=Commercial ye" Color i,£ebA* rvve 05=iarge Truck 20=Unicycle, Bicycle, Td L?J Passenger r C iz 06=Yetkow 07=SiWer Q1;AuUUntabile 06=SW 01 02=Motorcycle 07=Van 21-0ther Pedakyde e & Bu g Hor 2 ome W=rN.t Applicable Ohre Veh 13=Taco il T 08=Gold 03=8us 1 D=Snowmobile Small Truck 11-Farm Equip 04 g y = s 2 23=Horse & Rider er ra 02=Ambutance 21=Tractor 03=Poke 22=Twin Trailer 01=81ue 09=Brown 02=Red 1 0--Orange = (if '02' Complete Form 12.Construction Equip AN 24=Train 25=Tro1ley 08=Other Emergency 23=Triple Trailer Modified Veh 31 03=White 11=Purple 04=Green 12=0ther M, Section 24) 13= (if -20' or "21' Complete 18=Other Type Spec Veh 98=10ther = Vehicle 11 =Pupil Transport 99=Unknown 05=8lack 49=Unknown Form t4 27) 19=Unk. Type Spec Veh 99=Unknown fnitbl npatt Poirti 00=Non-Collision 14=Undercarriage nmwae Mdlcator 0=None 2-Functional bli 3 i Gradknt 1 1=Level 3=Dr'-hill Rwd Atlo t 4=Bottom of Hill ? 1=Straight S= To of Hill 1 2=Curved 12 Ot-12=Ckxk Pants 15=Towed Unit ng sa 1=Minor 3=D 2=Uphill p 9=Unknown k U nown n g= Sate of 1"Um %MM-DD 0z Zz r989 T N 717661590 17050 sta,be PA Print CRS W0165056 COA8R8oNWMTH OF PE14NSYLVANIA PONCE CRASH REPORTING FORM AA 500 3 !x use ono Page 3 of 6 INIM' Crash Number W0165056 tom: A 1?Dr d A cupa t E / i t A l G A 2>npassenQer ?fin 01=06%w - Ali vowes 02.&Omt seat Mddk Pa"on pp pp ic" 01=Shoulder Belt Used t-Not Ejected t>2?tap seat Used 2=To E B--Ckher 9=Unknown 03-front Seat Right We 04=Second Row - Left Side Or 03cLap And Shoulder Belt Used Sap ? j 06-Child Safety Seat Used 9=Unknown as=s1Noec R w r 05-Motor Helmet Used _ 06?Second Row - Rat Side u a 10=sa Papetiy Belt Used lr H ? B F =? M=Maie 07=Third Row Or Greater - Left Side No I Not Appliwbte 11=[fted 5 atery Seat t%d,rly. 1 - 12=Helmet Used ra sp 1=Through ? Dow Opening U =Unknown 0H=M ddle Now Or r Posrdm 90= Restraint Tj 16known Through 5 3- Windshield 99-Unknown 09-Third Row Or Greater - ftht Side S i f 4=Throta? Back Door . Throug h back Door 7ais 6 Throu h Root awn F ft?W C on o eR Trutktab 11=1n Mw Endorsed s g unanoft sed Sea#} Cornrer?le Top Down 01-Front Air Bag Deployed (for This 1 altiNed 2njury =, PawW or Cargo Area t Quin Open Area . .00W Jlk C 02=dg Ap) (J pr This Sego 7°Thrm* Roof Opening (Cormeftle 0 plr peP{ TO k t?P , te I (Bade Of FdruP, Etc.) y f Vehicl E i t iiFE"# P _ 0,5 njury "ury, Unk e e or xter 1 10-Afr sag ti ploy On E Seventy 92Mkriown H Injur 98 99=Unknown 11-Air Bag Nat Deployed, Swiuh Off 1 Extr 12-Aw Big Not UN lo*, 2 ated By"MechanicW Means Svw h s w y tc e 3-Freed MKh8niC8l 13=Air Bag RemovedIPrior TO Crash) By [fin ' Means 19=Unkridnm if Air Hag Mooyed 9 k U = n nown 99-Unknown - EARS Agency:" N/A ? Asedlcal ftow. N/A Unit No Person No O1 01 dNe1 s7 Data of (MM4X)-y" A B C D E F G N I 0 02 _ z2 _ 1989 Qacl of 03 10 0?0 1 Moran 1 Address / Phone ? SO" M BOTTI, MICHAEL D 6 VICTOR LN MECAANICSBURO PA 17050 7177 EMS Transport Yes ONO Unft No ftnan No Delete? Daps of RiAh (MMd)11 YYYY) A B C D E F G H T Mme / Address ! Phone 13 SNM as Y Trawpors r Q Yes 0 No unit No , ftrsw NO Delete? Dale of M-DD-rrYY) A B C D E F Q ??[ Mane ! Address 1 Phase ' 0 soft a: ?s Transport EPeao Q Yes Q No 11Frkr ° YYYY} A G ii I F Nam ! Address ! Rwm ? saw Operator O Y, ONO Unit No Fw"n No Delete;! Dete of 1111kth (Mhf-DD-YYYr7 A n8(C?D? E?` T G H I ( O MFI ??? Name, i Address 1 Phom ? t?.....Jl. l Same EMS Transport Operator 0 Yes 0 No Unit No Perri No Delete? of Bkth (MM-DA-YYYY) A 8 C D E, F G H I -? ?MM Name Address /.Phone Same EMS Transport Operator CD Yes 0 No PENNDO'T COPY httn://www.dot6.state.taa.us/crsaDD/PrintIm eesfXm Filesf2(1 00633352011042511181118... 4/2512011 Print CRS W0165056 I COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM P AA 500 4 PdKe use Only Page 4 of 6 low Gash Number 7 W0165056 Crash Desrriation 7 O-Non-Coffision 2 On 4=Jingle 8ftM P'ed f 1=Rear End 3= &? Rsar Direction } t>3nstion) 7=Hit Fined O*d 9?41tllerNnivtom Belalion to Roadwav 4 ? 1=0n Travel L.a ne$ 3 r kig Tief avay 7-Gom (Ramp intersection) c 2=Shoulder 4=RoadNde 84n Paeidng Lane 9-unIewwn 3 ? 14"Ilgldo Ong ?s et o n ?- Miller - She* Ughts 4=O!>sic y ff g Mather C-Wft ns 1'hIC ? 3=Steel (HaI) 5=F09 7=Sleet & Fog - - 9-Unknown 2=Rain y 44now, 6=FWin & Fog 8=01her Road Sm w Cwxft= a O=Dry 2=8r, Wad, Dirt, 4-Shalt 6_lce Patches -- 8=Other 1=Wet 3=5now Cowered 5=1ce 7ZY> _ Standing n..w.a vvxar rwa wwwww 1'tilR?fi? EYR'/!tS t7flrrerEtherrt Urdt N 1 27 CD 0 $ U 2 o Q i 2 ? ?_ it 03=Hit Unit 3 04-M Unit 4 05 Hit Unit 5 Please Put 3 06=ifit Other Traffic Unit 07=Hit Deer Evtnts in 5e?ueertda! O d o 08=CdHot6Othser Animal 09.,ron 1Mrth Other Non r er 4 ? 0 Fowd 11=St ruckOBy Unit I 12 5t = n+ck By Unit 2 13=5truck By Unit 3 Harm Event LIR Most? Utility Pole Number 14=Struck By Unit 4 11 5=Sumk By i# 5 1 0 16*Sbucit BY Other Traffic Unit Ur9t No 21=Ht Tree Or Shrubbery 22=h4t Embankment 2 0 23=Hit Utility Pole T T 24 ht fi rat = t c Sogn 25=Hh Guard Rail Please An 3 Events in O 26=Hit Guard Rail End 2 it Curb Segrrcntial -H it Concrete Or OrrMr 4 ? 0 Barrier 29?NLwg&xkW tt Ditch Unh No Harm Event u* No Harm Event 11 'r kh" 01 27 h O1 27 oo na depart 9?s i+(aoan onoPk plods 3 ? ff/Rf ? 2 rl?Jt i;titxts (tcet5now} Randorxadv~ay 1 =tee 1121! I 01=Windy Conditions On C Ro 02=Sudden Weather Conditions 134othotes t 03=000 Weather Conditions 14=Broken Or Cracked Pavement 04=Deer In Roadway tS=TCD vx r on Roadwa 16-soft . SF?O+rkter t 'Ulf 06=0ther Animal In Roadway 28=Other Roadway Factor ,s 07=Glare 29=Qatar Environmental factor C 08-Work Zone Related 99=Unknown M vowk M 12-1Mpers 13=0river SeatingKontrol 006=Exhaust 14=8ody Doors yotat Etc 5 02-Brake System 0a1=5gts 15-Trio Hitch 03 Steering System 09wOther Lights 16--ovels 05=POwar fi ain 11? Rots 18=Trader Ov&ioaded T.s 19-UnsecurelShifted c unit Trail No 01 1 2 Weir Lead 20=lrnixpper rcwvin Id unit 49=tinknoNrWindshie No i 2 ba"Wfts)Wtor Unit No Fadw Code i =V$pf %*InWGnn on O 1 92 1 7 EIR V D P 7 Q 000 N Ell? is the Prime Factor Tym leave Unht No blank 11 ODk* ConUibuting Action 01-Dever was Onstracted 02-Driving Using Hand Held Pltone 03=Drving Using Hands Free Phone O4-AAaking Negal U•Turn 05?rr+properACareless Turn' rsg 06?TumIng From Wnmg Lane 07?roceeding Wl0 Cleararxe After Stop 08-?Running Step 5ign 04=Runninq Red tight 10=Failure To R?spund To Other Traffic Cornrol Device r 1?T 12=5 n n 13=I1legally St On Road 14=Camkws Passing Or Lane Change 1-Way Street 15=Passing In No Passing Zone f6=.Driving The Wrong Way On 30=Htt Fence Or Wall 31=Hit Bu iT 32=Hit Culvert 33=Hit Bridge Pler Or Abutment 34=Hit Parapet End 35=Hit 111 Rail 36--Hit Boulder Or Obstacle On Roadway 37--Hit Impact Attenuates 38-Hit Fire Hydrant 39=Hit Roadway Equipment 40=Htt Mail Box 41--Hit Traffic Island 42=Hit Snow Bank 43--9arriTemporary Construction er 48=Flit Other Fixed 49=liit Unknown ?t)bject Over =StrUck By Thrown Or Palling 52=Pot Hiles Or Other 53..Jat Irregularities 54- ire to Vehicle 58=Other Non Collision 99-Unknown Hamnful Event i Side Of Road 19=Making Improper Entrance To Highway 20=Makirrg knilroper Exit From t4ighway 21 --Careless ParkkrryUnparking 22=OvedUnder 2375p eI' Curve 24=Dewing Too Fast For Condltwrs 25-Fakire T Pt1?E N"DI(?} 27=1>r Inexperienced 28=Fad= To Use Specialized Equip 92-Affected By Physical ConcHon known toper DrMN Actions No 01 12 2? 3 ?$ .4 m Noll 111 l2? 3? 41 00-a lone Anon -rte 03-Working ?Vehide 01=Ernering Or Crossing At 5 fled Location 02=Wal g Running, Jogging, Or Playin Unit No O 1 05-App in9 Or Leaving Vehicle M=Woetnng On Vehicle 07 `mg 99--Unknown Unit NO I f tunes 0 AAdee fit" PENNDOT COPY f C WC )'.65056 COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM pop AA 500 5 Cyr" use L" 5 Page 5 of 6 I Illipm Crash Nmber -? wnlFSnsa rem"U 7T COPY http:llwww.dot6.state pa.us/ersapp TfintImages/XmIFilesl24l0063335201102511181118... 4/25/2011 Page 6 of 6 print CRS W0165056 Crash Number: VV0165056. Incident Number: HAM20100700172 A Q iY W LL Of 20 w N 5127 J?er C1T, FRANKS DR. 07/05/2010 0200 HOURS FRANICS DR. AND : BtEN IFER CIR. UNIT 1 NO INJURIES UNIT 1 TOWED PRIVATELY Crash Reporting System Page 1 of 2 Synopsis -) Quality Assurance Synopsis ) Report Crash Synopsis Created 04!25!2011 for Crash Number W0165056 WebGroup: REPT Police Agency Data: Pont Glose?nd The crash report was recorded by police agency 21103-Hampden Township, patrol zone -100, under incid dispatch date was 0710512010, the dispatch time was 0211 hours, the investigation date was 07 5=10t number MI time as 021 72. hours. The investigator was PTLM. MATTHEW GRUNDEN, badge number 19-24 The !, the arrival timews 0217 report was approved on 07!1212010. Crash Data: This is.a hit fixed object Crash occurred in Cumberland In the This i9A hi at the time of the crash was dark with street lights, of Hampden Township, on Monday, 0710512010. This is a on at portable Crash. fights, The 1 -unit crash involved 1 person with no in at were no hours. The Highway maintenance was not notified. The Crash was not school bus Juries. There were no fatalities. related. The crash did not occur in a work zone. The roadway surface was dry. Weather related' The crash was not aeonsl zone ons notification of an accident investigation was issued. The Indicated or y cortwas a included No adverse rmrmd phys. A this crash condition) for unit 01. The first and most harmful event for this crash was that unit 1 hit as curb was a driver's action (affected b Y physical Type Location: This was a a "r intersection crash, which occurred at no special location. Principal Roadway: Cumberland County, FRANCIS Drive, the orientation of the roadway was Unknown, there were 02 travel lane(s), time speed limit was Not posted, with a local road or street route signing. Intersecting Road: Cumberland County, JENNIFER Circle, the orientation of the roadway was Unknown, there were 02 travel Lane(s), the speed limit was Not posted, with a local road or street route signing. GPS: The police-entered Latitude was 4014:51.000 and the police-entered Longitude was 76 58:40.000 TCD: Traffic Control Device: no traffic control device, No controls Wark zone: Type of Work Zone: not a work zone. Lane Closure: Not applicable. UNIT INFORMATION: 1 Unit Number ! was a motor vehicle in transport The unit was owned by LUCAS PAMELA L. Address: 80 REGENCY WOODS N CARLISLE PA 17015. This 19$5 Ford identified by VIN: 3FASP13J3SR100486 was registered in PA with License HJD8535. Travel s Unit insured: vehicle has insurncq, France Company-. . NNNG INSURANCE aommerdai vehicle. This Unit arc was an automobile, Vehicle color. an ottie rCO. The Unit was towed PRNA : was nfct a 12 o'clock, vehi Indic Special Usa by TELY• This was not a Direction of travel East ator DI I Turning (severe ` not driveable), Vehicle role: hit a curb. Vehicle epP : in an The i lmpa ? point was at g loft, Gradient: on a Level roadway, Alignment: Straight. mn an oncoming traffic lane. Driver Information: http://www.dot6.state.pa,us/cr ,P/gene,aeSvnonsig.do?methQa=:exerm Crash Reporting System Page 2 of 2 The driver of this unit was MICHAEL D BOTTI. Address: 6 VICTOR LN MECHANICSBURG PA 17050. Telephone: 717-766-1590, Drivers License #: 284-10661, State: PA. DOB: 02/22/1989. Age: 21. Sex: Male. Seat position: driver's seat. Primary safety equipment: lap and shoulder belt were used. Secondary safety equipment: Air bag not deployed, switch on. Injury severity: Not injured. Ejection: Not elected. Alcohol/Drugs Suspected: Alcohol, Alcohol Test Type: a blood, Alcohol Test Results: Result = 0.09. Dr'iver's action(s), 1 affected by physical condign, 2 driving too fast for conditions, 3 making.an improper / careless turn. The individuars condition had been drinking. Vehicle code DRIVING UNDER THE INFLUENCE OF ALCOHOL was violated. Citation was written. Print ( CloseWindow DavidD. (ueC Prothonotary Office of the Prothonotary Cum5erfancf County, Pennsylvania �irkS. Sohonage, ESQ Solicitor S4 w CIVIL TERM ORDER OF TERMINATION OF COURT CASES AND NOW THIS 28TH DAY OF OCTOBER, 2014, AFTER MAILING NOTICE OF INTENTION TO PROCEED AND RECEIVING NO RESPONSE.— THE ABOVE CASE IS HEREBY TERMINATED WITH PREJUDICE IN ACCORDANCE WITH PA R.C.P.230.2. BY THE COURT, DAVID D. BUELL PROTHONOTARY One Courthouse Square Suite100 ® Carcth , (PA ® (Phone 717 240-6195 e Far 717 240-6573