HomeMy WebLinkAbout12-1539
THE LAW OFFICE OF
GREGORY A. SMITH LLC
By: Gregory A. Smith, Esquire
Atry ID #: 84189
123 S. Broad Street, Suite 1920
Philadelphia, PA 19109
MIRANDA RODRIGUEZ, Individually and as
Parent and Natural Guardian of JAYDEN
RODRIGUEZ, a Minor
99 Salem Church Road, Unit C
Mechanicsburg, PA 17050
vs.
BUILDING BLOCKZ ACADEMY
5023 E. Trindle Road
Mechanicsburg PA 17050
Attorney for Plaintiffs
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND
COUNTY
NO..
NOTICE
YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claim set forth
against you 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 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 default 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 THIS
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
CUMBERLAND COUNTY BAR ASSOCIATION
Lawyer Referral Service
Two Liberty Street
Carlisle, Pennsylvania 17013
1-800-990-9108 CaM'i??os 7s? /
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THE LAW OFFICE OF
GREGORY A. SMITH LLC
By: Gregory A. Smith, Esquire
Atty ID #: 84189
123 S. Broad Street, Suite 1920
Philadelphia, PA 19109
for Plaintiffs
MIRANDA RODRIGUEZ, Individually and
as Parent and Natural Guardian of
JAYDEN RODRIGUEZ, a Minor
99 Salem Church Road, Unit C
Mechanicsburg, PA 17050
VS.
BUILDING BLOCKZ ACADEMY
5023 E. Trindle Road
Mechanicsburg PA 17050
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND
COUNTY
NO..
AVISO
USTED HA SIDO DEMANDADO EN LA CORTE. Si usted desea defenderse de las
quejas expuestas en las paginas siguientes, debe tomar acci6n dentro de veinte (20) dia s a partir de
la fecha en que recibi6 la demanda y el aviso. Usted debe presentar comparecencia escrita en
persona o por aboga y presentar en la Corte por escrito sus defensas o sus objeciones a as
demandas en su contra. Se le avisa que si no se defiende, el caso puede proceder sin usted y la
Corte puede decidir en su contra sin mas aviso o notificaci6n reclamados por el Demandante.
USTED PUEDE PERDER DINERO, O PROPRIEDDES U OTROS DERECHOS
IMPORTANTES PARA USTED.
LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE.
SI USTED NO TIENE O NO CONOCE UN ABOGADO, VAYA O LLAME A LA OFICINA
EN LA DIRECCION ESCRITA ABAJO PARA AVERIGUAR DONDE P11EDE
OBTERNER ASSISTENCIA LEGAL.
CUMBERLAND COUNTY BAR ASSOCIATION
Lawyer Referral Services
Two Liberty Street
Carlisle, Pennsylvania 17013
(717) 249-3166
1-800-990-9108
THE LAW OFFICE OF
GREGORY A. SMITH LLC
By: Gregory A. Smith, Esquire
Atty ID #: 84189
123 S. Broad Street, Suite 1920
Philadelphia, PA 19109 Attorney for Plaintiffs
MIRANDA RODRIGUEZ, Individually and as IN THE COURT OF COMMON
Parent and Natural Guardian of JAYDEN PLEAS OF CUMBERLAND
RODRIGUEZ, a Minor COUNTY
99 Salem Church Road, Unit C
Mechanicsburg, PA 17050
NO..
VS.
BUILDING BLOCKZ ACADEMY
5023 E. Trindle Road
Mechanicsburg PA 17050
CIVIL ACTION COMPLAINT
Plaintiff Miranda Rodriguez, Individually and as Parent and Natural Guardian of
Jayden Rodriguez, a Minor, is an adult individual and citizen of the Commonwealth of
Pennsylvania residing at 99 Salem Church Road, Unit C, Mechanicsburg PA 17050.
2. Minor Plaintiff Jaden Rodriguez is a citizen of the Commonwealth of Pennsylvania
residing at 99 Salem Church Road, Unit C, Mechanicsburg PA 17050.
3. Defendant Building Blockz Academy is, on information and belief, a corporation
or other entity existing under and by virtue of the laws of the Commonwealth of Pennsylvania
involved in the provision of child care with a principal place of business located at 5023 E.
Trindle Road, Mechanicsburg PA 17050.
4. At all times material hereto. Defendant Building Blocks Academy acted and/or
failed to act by and through its duly authorized agents, employees, servants, workmen, owners
and/or officers.
At all times material hereto defendant Building Blocks Academy was licensed by
the Commonwealth of Pennsylvania as a day care facility.
6. At all times material hereto, defendant Building Blockz Academy employed
persons who dial not have a GED or High School diploma.
7. At all times material hereto Jayden Rodriguez, date of birth March 20, 2009, was
attending Building Blockz Academy.
8. At all times material hereto, Building Blockz Academy stood in loco I)arentis to
Jayden Rodriguez.
9. On or about June 23, 2011, Jayden Rodriguez was in the playground at Building
Blockz Academy.
10. The particular playground in which Jayden was permitted to play was restricted to
older children, since the equipment on that playground was far too advanced for toddlers of
Jayden's age.
11. Despite the fact that the playground was restricted from use for younger children,
the Building Blockz Academy employees who were supposed to be watching Jayden permitted
him to play on the equipment for use by only older children.
12. Jayden climbed on one of the pieces of equipment, unsupervised, and fell off,
striking his forehead, which began to bleed.
13. Jayden's mother Miranda Rodriguez was employed as a cook at Building Blockz
Academy.
14. When Mrs. Rodriguez learned that her son fell, hit his head and was bleeding, she
reported this to Summer Greer, the owner of Building Blockz.
15. Mrs. Rodriguez told Greer that she needed to take her son to the doctor to treat his
head injury.
16. Greer told Mrs. Rodriguez that she should take Jayden to her husband., whom she
identified as a doctor.
17. Mrs. Rodriguez took Jayden to see Summer Greer's husband, who is, in fact, a
podiatrist.
18. Louis Greer DPM owns, maintains and/or controls a business called .Advanced
Podiatry Service LLC, with a principal place of business located at 4230 Crums Mill Road,
Harrisburg PA.
19. Dr. Greer stitched Jayden Rodriguez' head, partially closing the wound.
20. In an effort to be paid by Jayden Rodriguez' insurance carrier for this service, Dr.
Greer billed the insurance plan for placement of a stitch in Jayden's foot, not his head.
21. As a direct and proximate result of the negligence, carelessness and/or recklessness
of defendant, Minor Plaintiff Jayden Rodriguez suffered injuries including, but not limited to, a
head injury and prominent scar on his forehead, to his great detriment and loss.
COUNTI
MIRANDA RODRIGUEZ, INDIVIDUALLY AND AS PARENT AND NATURAL
GUARDIAN OF JAYDEN RODRIGUEZ, A MINOR, v. BUILDING BLOCKZ ACADEMY
22. Paragraphs 1-21 are incorporated by reference as if fully set forth herein.,
23. The negligence, carelessness and/or recklessness of defendant Building Blockz
Academy included the following:
a. Failing to appropriately and adequately supervise Minor Plaintiff,
b. Failing to have Minor Plaintiff under observation at all times;
C. Failing to appropriately and adequately monitor Minor Plaintiff,
d. Failing to properly inspect the premises for dangerous conditions;
e. Maintaining a dangerous condition;
f. Maintaining an attractive nuisance;
g. Failing to have counselors within an appropriate distance from the
children;
h. Failing to prevent Minor Plaintiff from being injured;
i. Failing to prevent Minor Plaintiff from going into the playground
for older children;
j. Failing to warn;
k. Permitting Minor Plaintiff to go onto the playground;
1. Failing to tell Minor Plaintiff not to go onto the playground;
M. Failing to recognize and/or appreciate a dangerous condition;
n. Failing to fix the dangerous condition;
o. Failing to properly train its employees/agents;
P. Failing to have adequate numbers of counselors to supervise the
children;
q. Failing to follow appropriate policies, procedures and/or protocols;
r. Failing to have appropriate policies, procedures and/or protocols;
S. Failing to remove the dangerous conditions;
t. Failing to warn of a known, dangerous condition;
U. Failing to use due care under the circumstances;
V. Failing to regularly inspect the premises;
W. Telling Mrs. Rodriguez to take her son to a podiatrist to be stitched.
24. As a direct and proximate result of the negligence, carelessness and/or recklessness
of defendant, Minor Plaintiff Jayden Rodriguez suffered injuries including, but not limited to, a
closed head injury, laceration of his forehead, scarring, pain, suffering, loss of enjoyment of life,
embarrassment and humiliation and the inability to perform his usual and daily activities, to his
great detriment and loss.
25. As a direct and proximate result of the negligence, carelessness and/or recklessness
of defendant, Minor Plaintiff Jayden Rodriguez underwent painful medical treatment and may
require additional medical treatment and/or surgery in the future, to his great detriment and loss.
26. As a direct and proximate result of the negligence, carelessness and/or recklessness
of defendant, Plaintiff Miranda Rodriguez has in the past and may in the future have to expend
various amounts of money for medical care and treatment, to her great detriment and loss.
WHEREFORE Plaintiff, Miranda Rodriguez, Individually and as Parent and Natural
Guardian of Jayden Rodriguez, a Minor, demands judgment be entered in their favor and against
defendant in an amount not in excess of Fifty Thousand ($50,000.00) Dollars, together with
interest, costs, delay damages and any other amounts that this Honorable Court deems appropriate.
Respectfully submitted,
THE LAW OFFICE OF
GREGORY A. SMITH LLC
BY:
A. ITH, ESQUIRE
Plaintiffs
DATE: March 6, 2012
VERIFICATION
I, Miranda Rodriguez, individually and as Parent and Natural Guardian of Jayden Rodriguez,
a Minor, hereby verify that I am the plaintiff in this matter and that the facts set forth in this Complaint
are true and correct to my knowledge, information and belief. I understand that this Verification is
subject to the penalties of 18 Pa.C.S.. § 4904 relating to unsworn falsification to authorities.
?f
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c 1
Date:
IRANDA RODRI Z
SHERIFF'S OFFICE OF CUMBERLAND COUNTY
Ronny R Anderson
Sheriff
Jody S Smith
Chief Deputy
Richard W Stewart
Solicitor
Miranda Rodriguez
vs.
Building Blockz Academy
.0, 19 APR -5 F11 L,.
. V t 1111 A
1-?s
Case Number
2012-1539
SHERIFF'S RETURN OF SERVICE
03/29/2012 02:12 PM - Stephen Bender, Deputy Sheriff, who being duly sworn according to law, states that on March
29, 2012 at 1412 hours, he served a true copy of the within Complaint and Notice, upon the within named
defendant, to wit: Building Blockz Academy, by making known unto Summer Green, Owner of Building
Blockz Academy at 5023 E. Trindle Road, Mechanicsburg, Cumberland County, Pennsylvania 17050 its
contents and at the same time handing to her personally the said true and correct copy of the same.
STEPHEN BE DER, DEPUTY
SHERIFF COST: $38.00
March 30, 2012
SO ANSWERS,
RON R ANDERSON, SHERIFF
File
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THE LAW OFFICE OF ZZ P,
a
GREGORY A. SMITH LLC / H
By: Gregory A. Smith, Esquire
Atty ID #: 84189
123 S. Broad Street, Suite 1920
Philadelphia, PA 19109 Attorney for Plaintiffs
MIRANDA RODRIGUEZ, Individually and as ; IN THE COURT OF COMMON
Parent and Natural Guardian of JAYDEN i PLEAS OF CUMBERLAND
RODRIGUEZ, a Minor COUNTY
VS.
NO.: 2012-1539
BUILDING BLOCKZ ACADEMY
PETITION FOR SETTLEMENT AND DISTRIBUTION OF
PROCEEDS OF A MINOR'S CLAIM
Plaintiff Miranda Rodriguez, as parent and natural guardian of Jayden Rodriguez, a minor,
by and through their attorneys the Law Office of Gregory A. Smith LLC, respectfully request that
this Honorable Court enter the attached Order granting this Petition for Settlement and
Distribution of Proceeds of a Minor's Claim, and in support thereof state and aver the following:
1. Plaintiff Miranda Rodriguez("Parent Petitioner"), is an adult individual residing at
99 Salem Church Road , Unit C, Mechanicsburg, PA 17050
2. Parent Petitioner is the parent and natural guardian of Jayden Rodriguez, ("Minor
Petitioner"), date of birth March 20, 2009.
3. On or about June 23, 2011, Jayden Rodriguez was in the playground at Building
Blockz Academy.
4. The particular playground in which Jayden was permitted to play was restricted to
older children, since the equipment on that playground was far too advanced for toddlers of
Jayden's age.
5. Despite the fact that the playground was restricted from use for younger children,
the Building Blockz Academy employees who were supposed to be watching Jayden permitted
him to play on the equipment for use by only older children.
6. Jayden climbed on one of the pieces of equipment, unsupervised, and fell off,
striking his forehead, which began to bleed.
7. Jayden's mother Miranda Rodriguez was employed as a cook at Building Blockz
Academy.
8. When Mrs. Rodriguez learned that her son fell, hit his head and was bleeding, she
reported this to Summer Greer,the owner of Building Blockz.
9. Mrs. Rodriguez told Greer that she needed to take her son to the doctor to treat his
head injury.
10. Greer told Mrs. Rodriguez that she should take Jayden to her husband, whom she
identified as a doctor.
11. Mrs. Rodriguez took Jayden to see Summer Greer's husband,who is, in fact, a
podiatrist.
12. Dr. Greer stitched Jayden Rodriguez' head, partially closing the wound.
13. As a direct and proximate result of the negligence and/carelessness of defendant,
Minor Plaintiff Jayden Rodriguez suffered injuries including,but not limited to, a head injury and
scar on his forehead, to his great detriment and loss.
14. Undersigned counsel attempted to resolve the matter prior to suit being filed.
However, the defendants were not cooperative,thus necessitating the filing of the underlying
action.
15. It was learned through discovery that Building Blockz had a commercial general
liability policy, however, coverage for this matter was denied.
16. Accordingly, all funds for this case have been and will be paid from the personal
assets of the owners of Building Blockz, Summer Greer and Louis Greer.
17. The Greers,through their personal counsel,have offered to resolve Minor
Petitioner's claim by a payment of$20,000.00.
18. The proceeds from such compromise will be used to pay Parent Petitioners'
attorneys' fees and case costs, with the balance of the proceeds being deposited into a special
needs trust for the benefit of Minor Petitioner.
19. Parent Petitioner is aware that accepting the offer of settlement will result in a
waiver of the right to a jury trial and a waiver of the right to recover any further damages on
behalf of the Minor Petitioner which may arise out of this incident in the future.
20. Considering the nature and extent of the Minor Petitioner's injuries and the extent
of his recovery,with the fact that any and all settlement funds are from the personal assets of the
Greers,Parent Petitioner believes that this settlement is fair and reasonable and in Minor
Petitioner's best interest.
21. Parent Petitioner has fully discussed this settlement with counsel, Gregory A.
Smith,Esquire, and has agreed that the proposed settlement is in the best interests of her child. (A
true and correct copy of the Affidavit of Miranda Rodriguez is attached as Exhibit"X').
22. Petitioner has agreed to pay counsel an amount equal to thirty-three and one
third (33 1/3rd olo)percent of any recovery or award made,plus any costs or expenses advanced
on behalf of Minor Plaintiff.
23. Miranda Rodriguez, as Parent and Natural Guardian of Jayden Rodriguez, also
respectfully requests that this Honorable Court disburse Four Thousand($4,000.00)Dollars to use
immediately for the benefit of Minor Plaintiff, in order to purchase items for her son to have a
play room, which will include educational toys and books.
24. Miranda Rodriguez, as Parent and Natural Guardian of Jayden Rodriguez, also
respectfully requests that this Honorable Court disperse the amount of Five Hundred($500.00)
Dollars to the Law Office of Debra K. Wallet, as the attorney fee for preparation of the irrevocable
special needs trust agreement.
25. It is the desire of plaintiff to place the settlement proceeds into a Special Needs
Trust which will allow plaintiff to receive Supplemental Security Income (SSI) and Medical
Assistance benefits if otherwise eligible.
26. If a Special Needs Trust is not established for plaintiff, he may become ineligible
for the above-described public benefits.
27. The Petitioner has retained Debra K. Wallet, Esquire, to draft the attached
Special Needs Trust to protect plaintiff's entitlement to SSI and Medical Assistance benefits, and
to preserve some limited assets for his special needs which are not expected to abate in any
material manner in the near future.
28. Under the Medical Assistance law as amended in the Omnibus Budget
Reconciliation Act of 1993, disabled individuals such as plaintiff who receive Medical Assistance
benefits may be the beneficiary of a trust that is established for his benefit, and which provides
services and funds to the extent that necessary services are not provided through Medical
Assistance funds. 42 U.S.C. Section 1396p(d)(4).
29. The transfer of monies into the attached Trust Agreement fully complies with
federal and state law and furthers the public policy of allowing disabled individuals to maintain
some level of financial independence; moreover, upon the death of plaintiff, any sums in the trust
will be available to the Commonwealth of Pennsylvania and/or Social Security Administration to
repay these agencies for expenditures made through the Medical Assistance Program for her in the
manner and extent prescribed by law. (A true and correct copy of the Trust Agreement is attached
as Exhibit"B").
30. Under the Social Security Act,42 U.S.C. §1396p(d)(4)(A), a special trust may be
created by the disabled beneficiary's parent, grandparent, court-appointed guardian, or a court.
Plaintiff parent has created this Trust, and plaintiff submits the attached Trust to the Court for
approval as part of the settlement.
31. Inasmuch as the subject of this Petition is a minor,court approval for expenditure
of principal is required under Pennsylvania's Probate,Estate and Fiduciary Code. 20 P.C.S.A.
§5164. In light of the disabilities of the minor, it can reasonably be anticipated that expenditures
of principal will be required on an annual basis in order to meet the habilitative, educational,
rehabilitative,therapeutic,medical and physical needs to this individual. Such expenditures can
reasonably be expected to include those which are noted in the Special Needs Trust which is
attached to this Petition, and a reasonable likelihood exists that in future calendar years,the
income from the Trust may be inadequate to pay for such services,programs, or materials.
32. If the compromised settlement is approved,Petitioners hereby request the
following distribution:
a. The sum of$6,666.67.00 to the Law Office of Gregory A. Smith LLC for
attorney fees;
b. The sum of$203.75 to the Law Office of Gregory A. Smith LLC as
reimbursement for advanced costs and expenses (See Exhibit"C");
C. The sum of$4,000.00 made payable to Miranda Rodriguez to be used for
school/educational expenses of Minor Plaintiff Jayden Rodriguez;
d. The sum of$500.00 to the Law Offices of Debra K. Wallet as the attorney
fee for preparation of the irrevocable special needs trust agreement; and
e. The sum of$8,629.58 to be placed in The Jayden Rodriguez Self-Funded
Special Needs Trust, as articulated in the attached Special Needs Trust
Agreement", administered through Marcia Hoffinan, grandmother of minor
plaintiff.
WHEREFORE, Petitioners respectfully request this Honorable Court to enter an Order
approving the compromise and distribution as above stated.
Respectfully submitted,
THE LAW OFFICE OF
GREGORY A. SMITH LLC
BY:
G GO A./SMITH, ESQUIRE
Attorney or Plaintiffs
DATE: April 18, 2013
VERIFICATION
The undersigned hereby verifies that the facts set forth in the foregoing Petition for
Settlement and Distribution of Proceeds of a Minor's Claim are true and correct to the best of his
knowledge, information and belief, and further states that false statements herein are made subject
to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities.
THE LAW OFFICE OF
GREGORY A. SMITH LLC
BY:
G orne G Y A SMITH, ESQUIRE
A for Plaintiffs
DATE: April 18, 2013
EXHIBIT A
THE LAW OFFICE OF
GREGORY A. SMITH LLC
By: Gregory A. Smith, Esquire
Atty ID#: 84189-
123 S. Broad Street, Suite 1920
Philadelphia, PA 19109 Attorney for Plaintiffs
MIRANDA RODRIGUEZ, Individually and as IN THE COURT OF COMMON
Parent and Natural Guardian of JAYDEN PLEAS OF CUMBERLAND
RODRIGUEZ,a Minor COUNTY
VS.
NO.: 2012-1539
BUILDING BLOCKZ ACADEMY
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
Miranda Rodriguez, being duly sworn according to law, depose and states that she is the
Parent and Natural Guardian of jayden Rodriguez, a Minor,that she has read the foregoing
Petition for Court Approval of Minor's Compromise;that the averments contained in the
foregoing Petition are true and correct to the best of her knowledge, information and belief;that
she believes the acceptance of the offer of settlement was in the best interests of the minor
plaintiff,Jayden Rodriguez,that she is satisfied with the attorney's fee in this matter on the
minor's claim set forth as an express terms of the signed Contingency Fee Agreement executed
with counsel of record in this matter at the outset of the minor's representation; that she is
satisfied with the terms of distribution of the settlement funds and the allocation of those funds
and that she hereby authorizes the settlement of the foregoing personal injury action in accordance
with the terms of the Petition for Court Approval of Minor's Compromise and the form of Order
submitted therewith.
Seal
MIRA A DRIGUEZ
Sworn to and Subscribed
CC3MMCi`airiI�ALTH C?�PENNSYLVANIA
Before me this 15-� Day NOTARIAL SEAL
of Ail L- ,2013 JASON WIRTH,Notary Public
Camp bill Boro,Cumberland County
My Commission Expires August 16,2015
u
EXHIBIT B
Apr 03 2013 13: 44 Debra K. Wallet 717-761.5319 p. 2
IRREVOCABLE SPECIAL NEEDS TRUST AGREEMENT
FOR THE BENEFIT OF JAYDEN RODRIGUEZ
THIS AGREEMENT OF TRUST, is made on the day of
, 2013, by and between Miranda C. Rodriguez, mother and legal
guardian of Jayden Rodriguez, of New Cumberland, York County, Pennsylvania, hereinafter
referred to as °Settlor", and Marcia Hoffman, of Camp Hill, Cumberland County,
Pennsylvania, hereinafter referred to as "Trustee" who, in consideration of the mutual
agreements hereinafter contained., and intending to be legally bound hereby, do hereby agree as
follows:
WHEREAS, Settlor recognizes that her minor son, Jayden Rodriguez, hereinafter
referred to as "Beneficiary", has limitations which will likely impair his ability to handle
money and to engage in financial decisions throughout his lifetime and that he will have special
needs that may not be met without the creation of this Trust; and
WHEREAS, Settlor desires to establish and fiord this trust to ensure that the money
received from a personal injury settlement which will be used to fund this trust will be used for
the purposes hereinafter set forth and not as a trust for the primary support of Beneficiary;
WHEREAS, Settlor desires to establish this Trust intending it to conform to the
requirements of 42 U.S.C. §1917(d)(4)(A) as a Medicaid Payback Trust under the Social
Security Act and under the provisions of 62 P.S. §1414(b)(4), as amended from time to time,
and applicable state rules or statutes which create an en exception to the treatment of trust
assets of disabled. individuals;
Apr 03 2013 13: 44 Debra K. Wallet 717-761-5319 p. 3
NOW,THEREFORE, Settlor does hereby establish THE IRREVOCABLE TRUST
FOR THE BENEFIT OF JAVDEN RODRIGUEZ with Trustee and does hereby grant and
convey unto Trustee the sum of One Dollar($1.00), receipt of which is hereby acknowledged
by Trustee, in trust, to hold, administer and distribute the same, and any other property, real
or personal, that may be added to the trust (such sum, additions and any accumulation of
income thereon being hereinafter called principal), and any income thereon or proceeds
therefrom, IN TRUST, as follows:
FIRST:
A. For the duration of the life of Beneficiary, the Trustee may pay or apply for
said Beneficiary's sole benefit, such amounts from the net income of this Trust as the Trustee
in the exercise of the Trustee's absolute discretion,deems advisable for the welfare of
Beneficiary. The Beneficiary shall have no entitlement to the income or principal of the Trust,
except as the Trustee, in her sole, complete, and unfettered discretion, elects to disburse.
In making such distributions to or for the benefit of Beneficiary, the Trustee shall take
into consideration all other resources available, including any benefits to which Beneficiary is,
or may be, entitled through Social Security, public assistance,medical assistance, or from any
other governmental or other resources. No part of the principal or income of this Trust shall
be considered available to the Beneficiary and no part shall be used to supplant or replace
public assistance benefits of any county, state, federal or governmental agency. The Trustee
may hold and retain any or all of the income and principal of this trust as the Trustee, in the
exercise of the Trustee's absolute discretion, shall deem advisable for the uses and purposes
herein set forth.
Apr 03 2013 13: 44 Debra K. Wallet 717-761-5319 p. 4
So long as Beneficiary remains a minor, no payment of any Trust principal shall be
made by Trustee without the approval of the Orphans' Court Division of the Court of Common
Pleas of Cumberland County.
B. In exercising the discretionary powers herein conferred on the Trustee, the
Trustee shall be guided by the following statement of Settlor's purposes and intentions. It is
Settlor's expectation that the trust income and principal will not be made available to provide
primary support for Beneficiary. Therefore, the Trustee is directed to investigate other sources
of support available to Beneficiary and to take whatever steps necessary to enroll Beneficiary
i for such benefits or assistance. The Trustee is authorized to make trust distributions to or on
Beneficiary's behalf in such a way that Beneficiary's life will be enriched and made more
enjoyable, including providing recreational and vacation opportunities for Beneficiary. The
Trustee is authorized to expend the trust estate to procure more sophisticated medical, dental,
ophthalmological, and other similar treatment, psychiatric/psychological services, recreational
therapy, occupational therapy, physical therapy, vocational therapy, durable medical needs,
dietary needs and supplements, prosthetic devices, special rehabilitative services or equipment,
and programs of training, education, and the like than may otherwise be available to
Beneficiary and to seek private rehabilitative and related services. Settlor desires that
Beneficiary be able to maintain contact with family members, and the Trustee is authorized to
expend trust income and other principal for transportation costs for Beneficiary to facilitate
such contact. The Trustee is authorized to expend such reasonable amounts of income and
principal as are reasonably related to the needs of the Beneficiary and which shall enable
Beneficiary to achieve his maximum potential and to lead as comfortable a life as possible. To
that end, it is Settlor's desire, without it being legally binding, that the Trustee may expend the
Apr 03 2013 13; 44 Debra K. Wallet 717-761-5319 p. 5
income and principal of this Trust in ways that shall protect, enforce and expand the rights of
Beneficiary. Settlor desires the Trustee to exercise the discretionary power conferred on the
Trustee hereunder in a manner which will provide flexibility in the administration of the trust
under conditions from time to time existing, and in exercising such powers, the discretion of
the Trustee shall be conclusive as to the advisability of any distribution of income or principal,
and as to the person to or for whom such distribution is to be made. Furthermore, the Trustee
is authorized to expend such amounts of income and principal for the benefit and to last the life
of Beneficiary as shall best provide for his comfort and happiness without regard to the effect
that such distributions might have upon the interest of the takers of the remainder of this trust.
C. This trust shall terminate upon the death of Beneficiary; and upon such
termination, the Trustee shall distribute all remaining principal and accrued income to the
following and in the following order:
(1) Pennsylvania Department of Public Welfare to reimburse for any
Medicaid benefits paid on behalf of the Beneficiary. If more than one state is entitled to
reimbursement for Medicaid expenditures, each state shall receive its proportionate share of
the total amount of Medicaid to be reimbursed;
(2) Miranda. C. Rodriguez, her heirs or assigns.
D. In the event this Trust will be considered by any governmental agency or
other provider as an asset or resource of Beneficiary in determining the contribution to be
made by or for Beneficiary for any benefits, services or care to be provided by such entity to
Beneficiary, or there is a change in the law applicable to this Trust, the Trustee shall have the
right to amend the Trust to conform to these changes. If, in the sole discretion of the Trustee,
it is deemed impracticable to continue to administer this trust, the Trustee is hereby authorized
npr 03 2013 13: 44 Debra K. Wallet 717-761-5319 p. 6
and empowered to terminate this trust with the approval of the Court of Common Pleas of
Cumberland County. Upon such termination, the Trustee shall make distributions to the
Pennsylvania Department of Public Welfare to reimburse for any Medicaid benefits paid on
behalf of the Beneficiary. If more than one state is entitled to reimbursement for Medicaid
expenditures, each state shall receive its proportionate share of the total amount of Medicaid to
be reimbursed. Only then shall all remaining principal and accrued income of this trust be
distributed to Beneficiary, if Beneficiary is living at the time of such distribution, is of legal
age, and is competent to receive these funds, and if he is not living, then unto those persons
named in Paragraph FIRST, C, (2) above.
SECOND: In the event the named Trustee hereunder is or becomes unwilling or
unable to serve as Trustee hereunder for any reason, Settlor does hereby nominate, appoint and
confirm her father, Douglas Hoffinan, of Camp Hill, Cumberland County, as and to be the
Successor Trustee hereunder, whereupon Successor Trustee shall administer this Trust and
shall have the duties and powers of Trustee as herein set forth, subject at all times to any
decree of the Orphans' Court.Division of the Court of Common Pleas of Cumberland County.
In the event the named Trustee and.named Successor Trustee hereunder are or become
unwilling or unable to serve as Trustee for any reason, Settlor does hereby nominate, appoint
and confirm the person named by the Successor Trustee to continue the Trust and to serve as
Trustee subject at all times to any decree of the Orphans' Court Division of the Court of
Common Pleas of Cumberland County.
THIRD: This Trust shall not be subject to anticipation or to voluntary or involuntary
alienation.
--." Apr 03 2013 13: 45 Debra K. Wallet 717-761-5319 p. 7
FOURTH: Trustee shall have the following powers in addition to those vested in her
by law and by other provisions of trust, applicable to all property, whether principal or
income, exercisable without court approval, and effective until actual distribution of all
property:
A. To hold and retain any or all of the assets of this trust, real or personal,
without regard to any principal of diversification or risk;
B. To sell at public or private sale, to exchange, or to lease for any period of
time, any real or personal property, and to give options for sales, exchanges or leases, for such
prices and;upon such terms or conditions as Trustee deems proper;
C. To allocate receipts and expenses to principal or income or partly to each as
Trustee from time to time thinks proper in Trustee's sole discretion; and
D. To compromise any claim or controversy.
FIFTH: Settlor has had explained to her the consequences of an irrevocable trust and
Settlor does hereby declare that she intends this Trust to be, and the same shall be, irrevocable.
SIXTH: Subject to the approval of Trustee, anyone may add property, real or
personal, to the principal of this Trust by Deed, Will or otherwise. In the event the same
should be or-includes life insurance or annuity proceeds payable to this Trust or the applicable
Trustee of this Trust under the terms of any life insurance policy or annuity, said proceeds
shall be paid, in trust, to the then serving Trustee hereof by the applicable life insurance
company or annuity without liability or further responsibility on the part of such life insurance
company or annuity.
SEVENTH: The Trustee shall be entitled to receive compensation for service
hereunder, which compensation shall be charged against or payable from both principal and
Apr 03 2013 13: 45 Debra K. Wallet 717-761-5319 P. 8
income of this Trust, at such rates as may be reasonable and customary. Unless required by
the Orphans' Court or any Court of competent jurisdiction, the Trustee or Successor Trustee
shall not be required to post a bond.
EIGHTH: The situs of this Trust for administrative and accounting purposes shall be
in the Countyof Cumberland and Commonwealth of Pennsylvania, and all questions pertaining
to the construction or validity of the provisions of this instrument shall be governed by the
laws of the Commonwealth.
NINTH: The Trustee hereby accepts the Trust created by this Agreement and agrees to
carry out the provisions hereof according to the best of the Trustee's ability.
IN VVrMSS WHEREOF, the parties hereto do hereby execute this instrument on the
date and year first above written.
Miranda C. Rodriguez, Settlor
Marcia Hoffman, Trustee
_
Apr 03 2013 13: 45 Debra K. Wallet 717-761-5315 p. 8
ACKNOWLEDGMENT
Commonwealth of Pennsylvania
County of e0,"6Ln,1 A-)fl
I, Miranda C. Rodriguez, Settlor, whose name is signed to the attached instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed
the instrument as an Irrevocable Special Needs Trust; that I signed it willingly; and that I
signed it as my free and voluntary act for the purposes therein expressed.
r
Miranda C. Ro guez
Sworn or affirmed to and subscribed before me by the Setdor, this /5day of
2013_
Not b is
LOM )NWE-AL"I H OF PENN6YLVANIA
NOTARIAL SEALPubIiC
SON WIRTH,Notary
p Hill Boro,Cumberland County
mmission Expire s August 16,2015
EXHIBIT C
CASE COSTS -RODRIGUEZ v. BUILDING BLOCKZ ACADEMY
CUMBERLAND COUNTY CCP NO: 2012-1539
Prothonotary of Cumberland County: $103.75
Sheriff of Cumberland County: $100.00
TOTAL: $203.75
CERTIFICATE OF SERVICE
I, Gregory A. Smith,Esquire do hereby certify that on this day a true and correct copy of the
within Petition for a Minor's Compromise has been forwarded to the individuals listed below via
first-class mail:
Ms. Miranda Rodriguez
99 Salem Church Road , Unit C
Mechanicsburg, PA 17050
Todd R. Bartos, Esquire
Stevens &Lee, P.C.
51 South Duke Street
Lancaster, PA 17602
Debra K. Wallet, Esquire
24 N. 32nd St.
Camp Hill, PA 17011
By:
GREGO YA. kTVIFVH, ESQUI
Atto y for intiff
Date: April 18, 2013
IILED-OFFICE,-
THE LAW OFFICE OF 01- 1 HE PRO 7 HONO Tp , ,(
GREGORY A. SMITH LLC 200 HAY —2
By: Gregory A. Smith, Esquire AN 9-- 46
Atty ID#: 84189 CUMBERLAND COUNTY
123 S. Broad Street, Suite 1920 PENNSYLVANIA'
Philadelphia,PA 19109 Attorney for Plaintiffs
MIRANDA RODRIGUEZ, Individually and as 1 IN THE COURT OF COMMON
Parent and Natural Guardian of JAYDEN PLEAS OF CUMBERLAND
RODRIGUEZ, a Minor COUNTY
VS.
NO.: 2012-1539
BUILDING BLOCKZ ACADEMY
AND NOW this A(,V4 , day of {`2,r 2013, upon consideration of
the within Petition for Settlement and Distribution of Proceeds of a Minor's Claim, it is hereby
ordered and decreed that a hearing on the Plaintiffs'Petition is scheduled for the day
of 2013, at a.m/N The injured party and her natural
guardian shall appear at that hearing together with their attorney.
BY THE :
J.
Orl- FE PROT;ED-OFFICE
THE LAW OFFICE OF iOH ONOTARY
GREGORY A. SMITH LLC 201MY20 PM 1: 19
By: Gregory A. Smith,Esquire
Atty ID#: 84189 CUMBERLAND COUNTY
123 S. Broad Street, Suite 1920 PENNSYLVANIA
Philadelphia,PA 19109 Attorney for Plaintiffs
MIRANDA RODRIGUEZ,Individually IN THE COURT OF COMMON
and as Parent and Natural Guardian of
PLEAS OF CUMBERLAND
JAYDEN RODRIGUEZ, a Minor
COUNTY
VS.
NO.: 2012-1539
BUILDING BLOCKZ ACADEMY
MOTION FOR CONTINUANCE
Counsel for Plaintiffs, Gregory A. Smith, Esquire respectfully requests that this
Honorable Court enter the attached Order and grant a Continuance of the Minor's Compromise
Hearing scheduled for Thursday,June 6, 2013 and alleges the following:
1. The underlying matter concerns injuries suffered by minor Plaintiff,Jayden
Rodriguez,who was injured on a piece of playground equipment on or about June 23, 2011.
2. Agreement was reached between the parties to resolve the matter for$20,000.00,
pending court approval.
3. To that end, a Petition for Minor's Compromise was filed with this Honorable
Court.
4. A hearing on that Petition was scheduled for June 6, 2013 at 11:00 a.m.
5. However,undersigned counsel is attached for trial that day in the Superior
Court of Essex County New Jersey,in the case Melendez v. The Port Authority ofNew York and
New Jersey, et al. Superior Court of New Jersey,Law Division, Docket No.: ESX-L-7745-1 1.
6. Accordingly,undersigned counsel respectfully requests that the hearing on the
Petition for Minor's Compromise be continued and rescheduled.
7. Undersigned counsel is also attached for trial in the Superior Court of Hudson
County New Jersey, in the case Dan and Nancy McGovern v. Zova Enterprises Inc et al
Superior Court of New Jersey, Law Division, Docket No.: L-1914-12 beginning June 17, 2013.
8. Therefore, to the extent that this Honorable Court grants the within Motion for a
Continuance, it is respectfully requested that the hearing not be rescheduled the week of June
17`".
WHEREFORE Plaintiff respectfully requests that this Honorable Court enter the attached
Order.
Respectfully submitted,
THE LAW OFFICE OF
GREGORY A. SMITH LLC
BY: Ax��,
=G R . S ITH, ESQUIRE
Atto ey fo laintiffs
DATE: May 17, 2013
THE LAW OFFICE OF
GREGORY A. SMITH LLC
By: Gregory A. Smith, Esquire
Atty ID#: 84189
123 S. Broad Street, Suite 1920
Philadelphia,PA 19109 Attorney for Plaintiffs
MIRANDA RODRIGUEZ,Individually IN THE COURT OF COMMON
and as Parent and Natural Guardian of PLEAS OF CUMBERLAND
JAYDEN RODRIGUEZ, a Minor COUNTY
VS.
NO.: 2012-1539
BUILDING BLOCKZ ACADEMY
MEMORANDUM IN SUPPORT OF THE MOTION FOR CONTINUANCE
The underlying matter concerns injuries suffered by minor Plaintiff,Jayden Rodriguez,
who was injured on a piece of playground equipment on or about June 23,2011. Agreement was
reached between the parties to resolve the matter for$20,000.00,pending court approval. To that
end, a Petition for Minor's Compromise was filed with this Honorable Court
A hearing on that Petition was scheduled for June 6, 2013 at 11:00 a.m. (A true and
correct copy of the Order is attached as Exhibit"A").
However, undersigned counsel is attached for trial that day in the Superior Court of Essex
County New Jersey, in the case Melendez v. The Port Authority offew York and New Jersey, et
al. Superior Court of New Jersey,Law Division,Docket No.: ESX-L-7745-1 1.
Accordingly,undersigned counsel respectfully requests that the hearing on the Petition
for Minor's Compromise be continued and rescheduled.
Undersigned counsel is also attached for trial in the Superior Court of Hudson
County New Jersey, in the case Dan and Nanck McGovern v. Zoya Enterprises Inc., et al.
Superior Court of New Jersey, Law Division,Docket No.: L-1914-12 beginning June 17,2013.
J
Therefore,to the extent that this Honorable Court grants the within Motion for a Continuance, it
is respectfully requested that the hearing not be rescheduled the week of June 171h
WHEREFORE Plaintiff respectfully requests that this Honorable Court enter the attached
Order.
THE LAW OFFICE OF
GREGORY A. SMITH LLC
BY:
GRT O A. MI H, ESQUIRE
A orney r Plaintiffs
DATE: May 17, 2013
0
CERTIFICATE OF SERVICE
I, Gregory A. Smith,Esquire do hereby certify that on this day a true and correct copy of the
within Motion for Continuance has been forwarded to the individuals listed below via first-class
mail:
Ms. Miranda Rodriguez
99 Salem Church Road, Unit C
Mechanicsburg, PA 17050
Todd R. Bartos, Esquire
Stevens& Lee, P.C.
51 South Duke Street
Lancaster, PA 17602
Debra K. Wallet, Esquire
24 N. 32nd St.
Camp Hill, PA 17011
By:
AGRER S ITH, ESQU IRE
aintiff
Date: May 17,2013
f
EXHIBIT A
PROJ�E�rrti�OTAR I I THE LAW O FFICE Of` THE OF Y
GREGORY A. SMITH LLC 201.3 MAY -2 AV, 9 LG
By: Gregory A. Smith, Esquire '
,4tty ID 4: 84189
CUMBERLAND COUNTY
123 S. Broad Street,'Suite 1920 P"ENNSYLVANIA
Philadelphia, PA.19109 Attorney for Plaintiffs
MIRANDA RODRIGUEZ, Individually and as IN THE COURT OF COMMON
Parent and Natural Guardian of JAYDEN PLEAS OF CUMBERLAND
RODRIGUEZ, a Minor COUNTY
VS.
NO.: 2012-1539
BUILDING BLOCKZ ACADEMY i
AND NOW this A(00 -, day of 14)*191fo 2013, upon consideration of
the within Petition for Settlement and Distribution of Proceeds of a Minor's Claim, it is hereby
ordered and decreed that-a hearing on the Plaintiffs' Petition is scheduled for the day
Of
2013, at a.m/p. The injured party and her natural
guardian shall appear at that hearing together with their attorney.
BY THE
J.
a
MIRANDA RODRIGUEZ, Individually and as ; IN THE COURT OF COMMON
Parent and Natural Guardian of JAYDEN PLEAS OF CUMBERLAND
RODRIGUEZ, a Minor COUNTY
VS.
NO.: 2012-1539
BUILDING BLOCKZ ACADEMY
ORDER
AND NOW THIS AA Nat day of MA / 2013 upon consideration
of the attached Motion for Continuance of the June 6, 2013 Minor's Compromise Hearing, it is
hereby ordered as follows:
L� Motion for Continuance is GRANTED and the matter is rescheduled for
day of X2013 at �' /p.m.
❑ Motion for Continuance is DENIED.
BY THE COURT:
J.
C
141 MW "' i•r•r�-
CDP
Cn
11'�
1=ILEO-OF fC
THE LAW OFFICE OF OF THE{E PRO THON MR`r`
GREGORY A. SMITH LLC
By: Gregory A. Smith, Esquire 2013 JUN -5 AM 11: 15
Atty ID #: 84189 CUMBERLAND COUNTY
123 S. Broad Street, Suite 1920 PEtdNIMANIP
Philadelphia, PA 19109 Attorney or Plaintiffs
MIRANDA RODRIGUEZ, Individually. IN THE COURT OF COMMON
and as Parent and Natural Guardian of PLEAS OF CUMBERLAND
JAYDEN RODRIGUEZ, a Minor COUNTY
VS.
NO.: 2012-1539
BUILDING BLOCKZ ACADEMY I
MOTION FOR CONTINUANCE
Counsel for Plaintiffs, Gregory A. Smith, Esquire respectfully requests that this
Honorable Court enter the attached Order and grant a Continuance of the Minor's Compromise
Hearing scheduled for Thursday, June 21, 2013 and alleges the following:
1. The underlying matter concerns injuries suffered by minor Plaintiff, Jayden
Rodriguez,who was injured on a piece of playground equipment on or about June 23, 2011.
2. Agreement was reached between the parties to resolve the matter for$20,000.00,
pending court approval.
3. To that end, a Petition for Minor's Compromise was filed with this Honorable
Court.
4. A hearing on that Petition was initially scheduled for June 6, 2013 at 11:00 a.m.
5. However,undersigned counsel is attached for trial that day in the Superior
Court of Essex County New Jersey, in the case Melendez v. The Port Authoriu of New York and
New Jersey, et al. Superior Court of New Jersey, Law Division, Docket No.: ESX-L-7745-11.
6. Accordingly, undersigned counsel requested that the hearing on the Petition for
Minor's Compromise be continued and rescheduled.
7. Undersigned counsel also requested that the hearing not be scheduled for the
week of June 17", 2013 because he is attacked for trial in the Superior Court of Hudson
County New Jersey, in the case Dan and Nancy McGovern v. Zova Enterprises Inc., et al.
Superior Court of New Jersey, Law Division, Docket No.: L-1914-12 beginning June 17, 2013.
8. Unfortunately,the hearing was rescheduled for that week, specifically, June 21
2013.
9. As undersigned counsel is scheduled for trial that week, it is respectfully
requested that the hearing not be rescheduled the week of June 17"
10. Undersigned counsel is also scheduled to be on a pre-paid, family fishing trip
from June 17"through July 3`d. Therefore it is also respectfully requested that the hearing not be
rescheduled during that time period.
WHEREFORE Plaintiff respectfully requests that this Honorable Court enter the attached
Order.
Respectfully submitted,
THE LAW OFFICE OF
GREGORY A. SMITH LLC
BY:
GRE OR . S TH, ESQUIRE
Att rney fo lai tiffs
DATE: May 31, 2013
THE LAW OFFICE OF
GREGORY A. SMITH LLC
By: Gregory A. Smith, Esquire
Atty ID#: 84189
123 S. Broad Street, Suite 1920
Philadelphia, PA 19109 Attorney for Plaintiffs
MIRANDA RODRIGUEZ, Individually IN THE COURT OF COMMON
and as Parent and Natural Guardian of PLEAS OF CUMBERLAND
JAYDEN RODRIGUEZ, a Minor ; COUNTY
VS.
NO.: 2012-1539
BUILDING BLOCKZ ACADEMY
MEMORANDUM IN SUPPORT OF THE MOTION FOR CONTINUANCE
Plaintiff relies upon and incorporates by reference the attached Motion as if fully set forth
herein.
WHEREFORE Plaintiff respectfully requests that this Honorable Court enter the attached
Order.
THE LAW OFFICE OF
GREGORY A. SMITH LLC
BY: hrim, qv��
GRE OR S ITH, ESQUIRE
Atto ey forJPlaintiffs
DATE: May 30, 2013
CERTIFICATE OF SERVICE
I, Gregory A. Smith,Esquire do hereby certify that on this day a true and correct copy of the
within Motion for Continuance has been forwarded to the individuals listed below via first-class
mail:
Ms. Miranda Rodriguez
99 Salem Church Road , Unit C
Mechanicsburg, PA 17050
Todd R. Bartos, Esquire
Stevens &Lee, P.C.
51 South Duke Street
Lancaster, PA 17602
Debra K. Wallet, Esquire
24 N. 32nd St.
Camp Hill, PA 17011
By:
GRE R S ITH, ESQUIRE
Atto ey fo laintiff
Date: May 30, 2013
EXHIBIT A
MIRANDA RODRIGUEZ, individually and as ; IN THE COURT OF COMMON
Parent and Natural Guardian of JAYDEN ; PLEAS OF CUMBERLAND
RODRIGUEZ, a Minor COUNTY
V5.
NO.: 2012-1539
BUILDING BLOCKZ ACADEMY
ORDER
AND NOW THIS d.A Not day of 2013 upon:consideration
of the attached Motion for Continuance of the June 6, 2013 Minor's Compromise Hearing, it is
hereby ordered as follows:
Motion for Continuance is GRANTED and the matter is rescheduled for
day of 2013 at �'`�7 4r*p.m.
Cl Motion for Continuance is DENIED.
BY THE COURT:
J.
fY
Cam.
3
MIRANDA RODRIGUEZ, Individually and as ; IN THE COURT OF COMMON
Parent and Natural Guardian of JAYDEN PLEAS OF CUMBERLAND
RODRIGUEZ, a Minor COUNTY
VS.
NO.: 2012-1539
BUILDING BLOCKZ ACADEMY
i1 ORDER
AND NOW THIS �~ day of , 2013 upon consideration
of the attached Motion for Continuance of the June 21, 2013 Minor's Compromise Hearing, it is
hereby ordered as follows: Q
❑ Motion for Continuance is GRANTED and the matter is rescheduled for T
day of 2013 at f&p.m.
❑ Motion for Continuance is DENIED.
BY THE COURT:
J.
�u L&
C71
'�7� �v
R-I- C
��'11
F11 ED-OFFICE
THE LAW OFFICE OF "' PROTHONOTA;i
GREGORY A. SMITH LLC 2013 JUN { 7 P i 2: 37
By: Gregory A. Smith, Esquire
Atty ID#: 84189 CUMBERLAND COUNTY
123 S. Broad Street, Suite 1920 PENNSYLVANIA
Philadelphia, PA 19109 Attorney for Plaintiffs
MIRANDA RODRIGUEZ, Individually and as ; IN THE COURT OF COMMON
Parent and Natural Guardian of JAYDEN ; PLEAS OF CUMBERLAND
RODRIGUEZ, a Minor COUNTY
VS.
NO.: 2012-1539
BUILDING BLOCKZ ACADEMY
PRAECIPE TO WITHDRAW
Kindly withdraw plaintiff's Motion for Continuance filed with the Court on June 5, 2013.
THE LAW OFFICE OF
GREGORY A. SMITH LLC
BY: cdaov 24;
GRE A. SMITH, ESQUIRE
Attorney for Plaintiff's
DATE: June 13, 2013
s
MIRANDA RODRIGUEZ, IN THE COURT OF COMMON PLEAS OF
Individually and as CUMBERLAND COUNTY, PENNSYLVANIA
Parent and Natural
Guardian of JAYDEN
RODRIGUEZ, a Minor,
Plaintiff '
BUILDING BLOCKZ ACADEMY, _' ZK r r'
Defendant NO. 2012-1539 „ cv cr '
ORDER OF COURT
AND NOW, this 29th day of July, 2013 , after
hearing, we approve the settlement of this case on behalf of
Jayden Rodriguez in the amount of $20 , 000 . 00 . Mother Miranda
Rodriguez may sign a release settling said case for
$20, 000 . 00 , which sum shall be held in escrow by her counsel
until further Order of this Court .
The Order of Court will deal with approving
the Special Needs Trust which we have requested have two
additional provisions :
1 . That any distribution before Jayden Rodriguez
reaches the age of 18 must have Court approval .
2 . That the Trustee be limited to investments in
FDIC insured instruments until the child reaches the age of
18 years .
We are also reluctant to approve the $4 , 000 . 00
requested distribution to Mother for the purchase of
educational toys . We may authorize the purchase of specific
k
items if a list and cost of said items are provided to this
Court along with an explanation as to why Mother cannot
purchase them from her own funds .
Attorney fees and costs may be disbursed prior
to our final Order in this matter.
By the Court,
Edward E. Guido, J.
Gregory A. Smith, Esquire
At orney for Plaintiff
Todd R. Bartos, Esquire
Attorney for Defendant
Debra K. Wallet, Esquire
srs
C
!/a
THE LAW OFFICE OF
GREGORY A. SMITH LLC
By: Gregory A. Smith, Esquire
Atty ID #: 84189
123 S. Broad Street, Suite 1920
Philadelphia, PA 19109
L' ii -C = FJCE
-t£ PRO I OHO TA
201 4 FEAR I I PH 3: 15
CUMBERLAND COUNTY
PENNSYLVANIA
Attorney for Plaintiffs
MIRANDA RODRIGUEZ, Individually and as
Parent and Natural Guardian of JAYDEN
RODRIGUEZ, a Minor
vs.
BUILDING BLOCKZ ACADEMY
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND
COUNTY
NO.: 2012 -1539
ORDER
AND NOW this day of "A , 2014, upon presentation of
the within Petition for Settlement and Distribution of Proceeds of a Minor's Claim and after due
consideration of the Petition and the exhibits thereto, this Court, being satisfied with the
propriety of the compromise as above stated, hereby orders and decrees that:
1. The Twenty Thousand ($20,000.00) Dollar settlement as described in the Petition
is a fair and reasonable compromise of this claim, and that such a compromise is
in the best interest of the minor Petitioner.
2. Settlement shall be distributed as follows:
a. The sum of $6,666.67.00 to the Law Office of Gregory A. Smith LLC for
attorney fees;
b. The sum of $203.75 to the Law Office of Gregory A. Smith LLC as
reimbursement for advanced costs and expenses;
c. The sum of $500.00 to the Law Offices of Debra K. Wallet as the attorney
fee for preparation of the irrevocable special needs trust agreement; and
d. The sum of $12,629.58 to be placed in The Jayden Rodriguez Self - Funded
Special Needs Trust, as articulated in the attached Special Needs Trust
Agreement ", administered through Marcia Hoffman, grandmother of
minor plaintiff.
4BY THE COU •
J.
pt
19441 srnt4k
044-y
'8wAtos
3/il� /'
i
THE LAW OFFICE OF
GREGORY A. SMITH LLC
By: Gregory A. Smith, Esquire
Atty ID #: 84189
123 S. Broad Street, Suite 1920
Philadelphia, PA 19109
THE PROTHONOTARY
2iI14SEP -8 P1112: 50
CUMBERLAND COUNTY
PENNSYLVANIA
Attorney for Plaintiffs
MIRANDA RODRIGUEZ, Individually and
as Parent and Natural Guardian of JAYDEN
RODRIGUEZ, a Minor
vs.
BUILDING BLOCKZ ACADEMY
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND
COUNTY
NO.: 2012-1539
AFFIDAVIT OF COMPLIANCE
I Gregory A. Smith, Esquire, hereby state and affirm that as counsel for plaintiffs in this
matter, I have complied with the Order issued on March 11, 2014, by the Honorable Edward E.
Guido (attached as Exhibit "A") as follows:
1. By Order dated March 11, 2014, the Honorable Edward E. Guido approved the
Petition for Court Approval in the above matter. (See Exhibit "A").
2. The sum of $12,629.58 was deposited in Wells Fargo Bank on March 24, 2014. A
copy of the account deposit is attached here to as Exhibit "B".
I verify that the statements made in the Affidavit are made subject to the penalties of 18 Pa.C.S.
§ 4904 relating to unsworn falsification to authorities.
//hid
GREG • ' Y 1 SMI H, ESQUIRE
Attorn-y for Plaintiffs
Dated: 9' 1
Exhibit "A"
THE LAW OFFICE OF
GREGORY A. SMITH LLC
By: Gregory A. Smith, Esquire
Atty ID #: 84189
123 S. Broad Street, Suite 1920
Philadelphia, PA 19109
Puc tut,
2inliMAR H 1 Phi y: I5
CUMBERLAND COUNTY
PENNSYLVANIA
Attorney for. Plaintiffs
MIRANDA RODRIGUEZ, Individually and as
Parent and Natural Guardian of JAYDEN
RODRIGUEZ, a Minor.
vs.
BUILDING BLOCKZ ACADEMY
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND
COUNTY
NO.: 2012-1539
ORDER
AND NOW this / { day of PA
, 2014, upon presentation of
the within Petition for Settlement and Distribution of Proceeds of a Minor's Claim and after due
consideration of the Petition and the exhibits thereto, this Court, being satisfied with the
propriety of the compromise as above stated, hereby orders and decrees that:
1. The Twenty Thousand ($20,000.00) Dollar settlement as described in the Petition
is a fair and reasonable compromise of this claim, and that such a compromise is
in the best interest of the minor Petitioner.
2. Settlement shall be distributed as follows:
a. The sum of $6,666.67.00 to the Law Office of Gregory A. Smith LLC for
attorney fees;
b. The sum of $203.75 to the Law Office of Gregory A. Smith LLC as
reimbursement for advanced costs and expenses;
c. The sum of $500.00 to the Law Offices of Debra K. Wallet as the attorney
fee for preparation of the irrevocable special needs trust agreement; and
d. The sum of $12,629.58 to be placed in. The. Jayden Rodriguez Self -Funded
Special Needs Trust, as articulated in the attached Special Needs Trust
Agreement", administered through Marcia Hoffman, grandmother of
minor plaintiff.
J.
TRUE COPY FROM RECORD
In Testimony whereof, I here unto Set rny hand
utt the s:e I of said Court at CatJisie, Pa. '
.:is.11day of./72 .a.C.j ..20.
Prothon • = ry
Exhibit "B"
Wells Fargo StoreVision Platform Page 1 of 1
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Bank FLORIDA ( 287 )Detail I Address I History I Statements I Stoo Payments I Holds/Pledges
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Deposit Detail
Deposit Date 03/24/2014
Deposit Amount $12,629.58 View Deposit Slip
Deposit Summary
Category Amount
Cash $0.00
Checks (1 item) $12,629.58
Less Cash $0.00
Total $12,629.58
Deposited Items
Checks
Item # Account # Check # Amount
1 XXXXXX8021 689 View $12,629.58
Total Checks $12,629.58
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Deposit Slip Detail
Deposit Date 03/24/2014
Deposit Amount $12,629.58
Item # Account # Check #
1 XXXXXX8021 689
Amount
$12,629.58
Page 1 of 1
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The Law Office of Gregory A. Smith LLC
Penns).hares it/LTA
123 S. Broad Street, Suite 1920
Philadelphia, PA 19109
Jayden Rodriguez trust
PNC Bank, N.A.
Phitadelphia, PA 020
3-5-310
1188-11
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DATE AMOUNT
PAY
TO THE
ORDER
OF,
Mar 19,
rwelve Thousand Six Hundred Twenty -Nine ar.d 58/100 Dollars
Hoffman, Marcia 077004 of' JA$0144S A44,4 0'-
2392 Tuttle Lane
Cantonment, FL 32533
USA
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CERTIFICATE OF SERVICE
I, Gregory A. Smith, Esquire do hereby certify that on this day a true and correct copy of
the within Affidavit of Compliance has been forwarded to the individuals listed below via first-
class mail:
The Honorable Edward E. Guido
Cumberland County Court
of Common Pleas
1 Courthouse Square, Suite 100
Carlisle, PA 17013
Ms. Miranda Rodriguez
99 Salem Church Road , Unit C
Mechanicsburg, PA 17050
Todd R. Bartos, Esquire
Stevens & Lee, P.C.
51 South Duke Street
Lancaster, PA 17602
Debra K. Wallet, Esquire
24 N. 32nd St.
Camp Hill, PA 17011
By:
Dated: q,2
ZEgiikti SAL d
GREGO Y A. it MIT '
Attom for Plaintiffs
• ▪ 'r
THE LAW OFFICE OF
GREGORY A. SMITH LLC
By: Gregory A. Smith, Esquire
Atty ID #: 84189
123 S. Broad Street, Suite 1920
Philadelphia, PA 19109
Attorney for Plaintiffs
MIRANDA RODRIGUEZ, Individually and
as Parent and Natural Guardian of JAYDEN
RODRIGUEZ, a Minor
vs.
BUILDING BLOCKZ ACADEMY
IN THE COURT OF COI'VIQ.N
PLEAS OF CUMBERLAgD
COUNTY
NO.: 2012-1539
c : coo
Fri
-7x
AFFIDAVIT OF COMPLIANCE
I Gregory A. Smith, Esquire, hereby state and affirm that as counsel for plaintiffs in this
matter, I have complied with the Order issued on March 11, 2014, by the Honorable Edward E.
Guido (attached as Exhibit "A") as follows:
1. By Order dated March 11, 2014, the Honorable Edward E. Guido approved the
Petition for Court Approval in the above matter. (See Exhibit "A").
2. The sum of $12,629.58 was deposited in Wells Fargo Bank on March 24, 2014. A
copy of the account deposit is attached here to as Exhibit "B".
I verify that the statements made in the Affidavit are made subject to the penalties of 18 Pa.C.S.
§ 4904 relating to unsworn falsification to authorities.
411111 ,
GREG•`' Y SMI H, ESQUIRE
Attorn=y for Plaintiffs
Dated: 9-2-114
THE LAW OFFICE OF
GREGORY A. SMITH LLC
By: Gregory A. Smith, Esquire
Atty ID #: 84189
123 S. Broad Street, Suite 1920
Philadelphia, PA 19109
t�!t:iii�i;i,Jir,,.
2 RKAR 1 ! Pit ,: 15
CUMBERLAND COUNTY
PENNSYLVANIA
Attorney for Plaintiffs
MIRANDA RODRIGUEZ, Individually and as
Parent and Natural. Guardian of JAYDEN
RODRIGUEZ, a Minor
vs.
BUILDING BLOCKZ ACADEMY
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND
COUNTY
NO.: 2012-1539
ORDER
AND NOW this f (4^ day of giAta,CP , 2014, upon presentation of
the within Petition for Settlement and Distribution of Proceeds of a Minor's Claim and after due
consideration of the Petition and. the exhibits thereto, this Court, being satisfied with the
propriety of the compromise as above stated, hereby orders and decrees that:
1. The Twenty Thousand ($20;000.00) Dollar settlement as described in the Petition
is a fair and reasonable compromise of this claim, and that such a compromise is
in the best interest of the minor Petitioner.
2. Settlement shall be distributed as follows:
a. The sum of $6,666.67.00 to the Law Office of Gregory A. Smith LLC for
attorney fees;
b. The sum of $203.75 to the Law Office of Gregory A. Smith LLC as
reimbursement for advanced costs and expenses;
c. The sum of $500.00 to the Law Offices of Debra K. Wallet. as the attorney
fee for preparation of the irrevocable special needs trust agreement; and
d. The sum of $12,629,58 to be placed in The Jayden Rodriguez Self -Funded
Special Needs Trust, as articulated in the attached Special Needs Trust
Agreement", administered through. Marcia Hoffman, grandmother of
minor plaintiff.
BY THE COU
J.
TRUE COPY FROM RECORD
in Testimony whereof, ( here unto set my hand
;cr the 2s2.el of said Court at Ca isle, Pa.
,is / day of _/�`..dfic. u .90
Prothon
Exhibit "B"
Wells Fargo StoreVision Platform
Search I Sales I Banker Toolbox I Administration I Main I Sign Off
Account
Quick Profile 1
El Clear List
Customer List (0) 1
Wells Fargo Value Checking 5241215655
Bank FLORIDA ( 287 )Detail 1 Address 1 History 1 Statements 1 Stop Payments 1 Holds/Pledges
Overdraft/NSF Fees I Service Fees
Check Orders 1 Transfers 1 Customer Event History
Deposit Detail
Deposit Date
Deposit Amount
03/24/2014
$12,629.58 View Deposit Slip
Deposit Summary
Category Amount
Cash $0.00
Checks (1 item) $12,629.58
Less Cash $0.00
Total $12,629.58
Deposited Items
Checks
Item # Account # Check # Amount
1 XXXXXX8021 689 View $12,629.58
Total Checks $12,629.58
Search I Sales I Banker Toolbox I Administration I Main I Sign Off
Page 1 of 1
cci-al-appl 3/prodsvp_256.0.3 i
cci-al-app13/prod svp 256.0,3_1
ahLdepositDetails
https://al-site l.salesandservice.wellsfargo.com/svp/accountHistoryDepositDetails.do?itemse... 6/6/2014
Wells Fargo StoreVision Platform
Deposit Slip Detail
Deposit Date 03/24/2014
Deposit Amount $12,629.58
Item # Account # Check #
1 XXXXXX8021 689
Amount
$12,629.58
Page 1 of 1
Pnnt
The Law Office of Gregor/ A. Smith LLC
PennsyNana 101.TA
123 S. Broad Street, Suite 1920
Ftniade1prna, PA 19109
Jayden Rodriguez trust
PNC Bank, N.A.
Philadelphia, PA 020
3-5-310
DATE
0689
AMOUNT
PAY
TO THE
ORDER
OF.
Mar 19, 2014
******"**512,629.58
Twelve Thousand Six Hundred TwentY-Nine and 58/100 Dollars
Hoffman, Marcia 11.5Tf Oat ef' .1140.1044S /LP 1 ' 4 61.-- 65
2392 Tuttle Lane
Cantonment, FL 32533 d54aa
USA
e000689e I0310000S3': 8E2211838(32 le
318b2522/15
https://al-sitel.salesandservice.wellsfargo.com/svp/accountHistoryDepositImage.do?type=d... 6/6/2014
CERTIFICATE OF SERVICE
I, Gregory A. Smith, Esquire do hereby certify that on this day a true and correct copy of
the within Affidavit of Compliance has been forwarded to the individuals listed below via first-
class mail:
The Honorable Edward E. Guido
Cumberland County Court
of Common Pleas
1 Courthouse Square, Suite 100
Carlisle, PA 17013
Ms. Miranda Rodriguez
99 Salem Church Road , Unit C
Mechanicsburg, PA 17050
Todd R. Bartos, Esquire
Stevens & Lee, P.C.
51 South Duke Street
Lancaster, PA 17602
Debra K. Wallet, Esquire
24 N. 32nd St.
Camp Hill, PA 17011
By:
Dated: c/ 2 ,
JIL4.r L.
GREGOY A.1. MIT '
Attorn; for Plaintiffs
Gregory A. Smith t
tAlso licensed in New Jersey
The Law Office of Gregory A. Smith, LLC
1515 Market Street
Suite 1360
Philadelphia, PA 19102
Telephone: 215-546-1690
Facsimile: 215-546-2005
www.gsmithesquire.com
September 5, 2014
Prothonotary
Cumberland County Court
of Common Pleas
1 Courthouse Square, Suite 100
Carlisle, PA 17013
Shannon B. Stewart
Re: Miranda Rodriguez, Individually and as Parent and Natural Guardian of
Jayden Rodriguez, a minor v. Building Blockz Academy
Cumberland County Court of Common Pleas
No.: 2012-1539
Dear Sir or Madam:
This office represents plaintiff in the above -referenced matter. I am enclosing one
original and one copy of the Affidavit of Compliance. Would you kindly accept the original for
filing and return a time -stamped copy in the self-addressed stamped envelope provided.
Thank you for your kind assistance.
GAS/ls
Enclosures
Very truly yours,
cc: The Honorable Edward E. Guido (w/Enclosure
Ms. Miranda Rodriguez (w/Enclosure)
Todd R. Bartos, Esquire (w/Enclosure)
Debra K. Wallet, Esquire (w/Enclosure)
210