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12-4426
3 N -v Q r- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVI f^"` cJ? CIVIL DIVISION 3W n Plaintiff(s) & Address(es) ZC:) Audrey Bloom as Administratrix of the Estate of Ezekiel Bingaman 441-A Valley Road Marysville, PA 17053 !?, Case No. Civil Term VS. Civil Action Law Defendant(s) & Address(es) Edward Yeager, 5 Red Fox Lane, Mechanicsburg, PA 17050 & Samantha : Benner c/o Mifflin County Jail, 103 W. Market St., Lewistown, PA 17044 PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY/CLERK OF SAID COURT: Cd W co -4 s-' ^Y i c3 In A ?e Issue summons in the above case Writ of Summons shall be issued and forwarded to Attorne Sheriff %eaw Circle choice Date : 7/13/2012 Signature of Attorney Print Name: Scott B. Cooper, Esq., SCHMIDT KRAMER PC Address: 209 State Street Harrisburg, PA 17101 Telephone #• 717-232-6300 Supreme Court ID Number: 70242 • • • • • WRIT OF SUMMONS TO: Edward Yeager & Samantha Benner YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFF(S) HASH E COMMENCED AN ACTION AGAINST YOU. '( , ? je_z? Prothonotary/Clerk, Civil Division Date: r7 17) 19 b Deputy ctrl???1c3.?S? Q 1 Gc.a alllol ?? a7 $0(09 SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff Jody S Smith Chief Deputy Richard W Stewart Solicitor T F- PRO THONO 1 t , •i: HI-2 AUG -7 AM 9: 0'2 'CUMBERLAND COUNTY PENNSYLVANIA ?$?tit+tr ai ?u?ybrrt?,?$ C?. QFfl C4,,-,F THE _°?ERIFF Audrey Bloom vs. Case Numbe Edward Yeager (et al.) 2012-4426 SHERIFF'S RETURN OF SERVICE 07/19/2012 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent sear and inquiry for the within named defendant, to wit: Samantha Benner, but was unable to locate her in i bailiwick. He therefore deputized the Sheriff of Mifflin County, Pennsylvania to serve the within Writ of Summons according to law. 07/23/2012 01:22 PM - Mifflin County Return: And now July 23, 2012 at 1322 hours I, Chris Shade, Sheriff of Miffl r County, Pennsylvania, do hereby certify and return that I served a true copy of the within Writ of Summons, upon the within named defendant, to wit: Samantha Benner by making known unto herself personally, at Mifflin County Correctional Facility, 103 W. Market Street, Lewistown, Pennsylvania 1704, its contents and at the same time handing to her personally the said true and correct copy of the same 07/27/2012 06:32 PM - Ryan Burgett, Deputy Sheriff, who being duly sworn according to law, states that on July 27, 2012 at 1832 hours, he served a true copy of the within Writ of Summons, upon the within named defendant, to wit: Edward Yeager, by making known unto himself personally, at 5 Red Fox Lane, Mechanicsburg, Cumberland County, Pennsylvania 17050 its contents and at the same time handing t him personally the said true and correct copy of the same. RYAN BURGETT, SHERIFF COST: $63.00 SO ANSWERS, August 03, 2012 RONNY R ANDERSON, SHERIFF (c) CeuntySuite Sheriff, Teleosoft, Inc. Christopher S. Shade, Sheriff Laurie J. Kozak, Chief Deputy Charles L."Bump" Angney, Deputy James R. "Joe" Bell, Deputy Terri D. Rupert, Deputy Ronald E. Fisher, Deputy SHERIFF'S OFFICE MIFFLIN COUNTY 20 North Wayne Street Lewistown, PA 17044 (717) 242-1105 " (717) 242-1808 Fax: (717) 248-2907 Plaintiff: Audrey Bloom as Administratrix of the Estate of Ezekiel Bingaman Defendant: Edward Yeager & Samantha Benner Serve At Name: Samantha Benner ) Address: Name: J Address: Daniel Z. Sear Solicitor (71) 242-5250 Court Number: 4426-12 County: Cumberland Type of Writ or Complaint: Writ Writ Of Summons ? [ ] Complaint Mifflin County Jail 103 W. Market St. Lewistown, PA 17044 Indicate Unusual Service: ? Comm. of Pa. ? Deputization ? Other Now 20 , I, SHERIFF OF MIFFLIN COUNTY, PA. do hereby deputize the Sheriff of County to execute this Writ and make return thereof according to law. This deputization is made at the request and risk of plaintiff. X Sher' of Mifflin Co. Special Instructions or other information that will assist in expediting service: Attorney or other Organization requesting service: Telephone No: Date F led: Cumberland County Sheriffs Office (717) 240-6390 7/17/201 1 ackn ge receipt oft Writ or Complaint as indicated above: Date Received: Exp. D te: X 7/20/2012 8/16/201 I hereby CERTIFY and RETURN that I W have personally served. ? have legal evidence of serviceas shown in "Remarks", ? have executed as shown in "Remarks", the Writ or Complaint described on the individual, company, corporation, etc. at the address shown above or on the individual, company, corporation, etc., at the address inse ed below, handing a TRUE and ATTESTED copy thereof. ? 1 hereby certify and return a NOT FOUND because I am unable to locate the individual, company, corporation, tc., name above. See Remarks below.) Name and Title of individual served: ? A person of suitable age and d cretion Served Samantha Benner. then residing at the defendant' usual place of abode. Address where served (complete only if different than shown above) I Date of Service: ime: 7117 N 4 if Attempts Date Miles Dep.lnt. Date Miles Dep.lnt. • ?•? Date • Miles 1 - r 1V1 ep.lnt. 1 7/23/2012 4 TDR Advance Costs Service Costs Mileage Postage Surcharge Notary Total Refund $95.00 $18.00 $15.00 $1.00 $0.00 $5.00 $39.00 $56.00 wala) val,al a71VG? Sworn to and subscrib9d before me this Notary tAltllCllt A: NON, ti1N? t?Mt Lemstol n tieA, WrA Notarial Seal My Commission Expires Mw h 31, "IS So Answers: Deputy Sher' Terri D. Rupert 12412012 X ?. 2U /,2 Sheri Chri stop de /24/2012 X ? SCHMIDT KRAMER PC ~ .~ ._ st'~ ~ ~' n Cj t t ~ ~ ' ~ ~' ' By: Scott B. Cooper, Esquire . r r . ~ , , I.D. No. 70242 , , il,'f~ ~~~ -~ i~ (); 209 State Street Harrisburg, Pa 17101 ~~M $ERl,~,rdD ~~~~~~~~ (717) 232-6300 ~ ENtVSYLVA,~Ir~, (717) 232-6467 Fax scoope~a schmidtkramer.com Attorney for Plaintiff IN THE COURT OF COMMON PLEAS Audrey Bloom as CUMBERLAND COUNTY, Administratrix of the PENNSYLVANIA Estate of Ezekiel Bingaman Plaintiff v. Edward Yeager and Samantha Benner CIVIL ACTION -LAW JURY TRIAL DEMANDED Defendants NO. 2012-4426 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 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, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 AVISO USTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las demandas que se presentan mas adelante en las siguientes paginas, debe tomar accion dentro de los proximos veinte (20) dias despues de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objecciones a, las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar accion como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Usted puede perder dinero o propiedad u otros derechos importantes para usted. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. CUMBERLAND COUNTY BAR ASSOCIATION 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 3 r ~ SCHMIDT KRAMER PC By: Scott B. Cooper, Esquire I.D. No. 70242 209 State Street Harrisburg, Pa 17101 (717) 232-6300 (717) 232-6467 Fax scooper@schmidtkramer.com Attorney for Plaintiff IN THE COURT OF COMMON PLEAS Audrey Bloom as CUMBERLAND COUNTY, Administratrix of the PENNSYLVANIA Estate of Ezekiel Bingaman Plaintiff v. Edward Yeager and Samantha Benner : Defendants CIVIL ACTION -LAW JURY TRIAL DEMANDED NO. 2012-4426 COMPLAINT AND NOW, comes Plaintiff, AUDREY BLOOM, as Administratrx of the Estate of EZEKIEL BINGAMAN, by and through her attorney, Scott B. Cooper and Schmidt Kramer PC, and avers the following: 1. Decedent, Ezekiel Bingaman ("Decedent"), was an adult individual with an address of 422 South Enola Drive, Enola, Pennsylvania 17025. 2. Plaintiff, Audrey Bloom, is the surviving mother of Decedent and Administratrx of the Estate of Ezekiel Bingaman, Letters of Administration having been granted by the Register of Wills for Cumberland County on September 6, 2011. 4 3. Plaintiff, Audrey Bloom, is an adult individual with a permanent address of 441-A Valley Street, Marysville, Pennsylvania 17053. 4. Defendant, Edward Yeager, is an adult individual with a last known address of 5 Red Fox Lane, Mechanicsburg, Pennsylvania 17050. 5. Defendant, Samantha Benner, is an adult individual with a last known address of 38R Lancaster Avenue, Enola, Pennsylvania 17025. OPERATIVE FACTS 6. The facts and occurrences that gave rise to this cause of action took place on March 2, 2011 at approximately 2:45 a.m. at 4250 Wertzville Road, Enola, Pennsylvania 17025. 7. At all relevant times hereto, Defendant, Edward Yeager, was the owner of a 2010 Chevrolet Impala registered in the Commonwealth of Pennsylvania. 8. At all relevant times, Defendant, Samantha Benner, was the operator of the above mentioned 2010 Chevrolet Impala, which was owned by Defendant Edward Yeager. 9. At approximately 2:45 a.m., Defendant Samantha Benner was operating the vehicle with the Decedent as a passenger and was traveling at about 97 mph on Wertzville Road in Enola, Pennsylvania. 5 10. At the aforesaid time and place, Defendant Samantha Benner lost control of the vehicle which left the roadway, struck a residence, and landed upside-down at 4250 Wertzville Road. 11. Police responded to the scene at approximately 2:50 a.m., and found Defendant Samantha Benner in the front driver's area of the vehicle and Decedent was found in the rear passenger's side of the vehicle. 12. Decedent was pronounced dead at the scene of the accident. COUNT I SURVIVAL ACTION AUDREY BLOOM V. StAMANTHA BENNER NE(3~LI(3~ENCE 13. Paragraphs 1 through 12 of this Complaint are incorporated herein by reference and made a part thereof as if set forth in full. 14. Plaintiff brings this action under the Pennsylvania Survival Statute, 42 Pa.C.S.A. X8302 and pursuant to 20 Pa.C.S.A. ~ 3373. 15. The accident at issue was caused solely by the negligence, carelessness and recklessness of Defendant Samantha Benner as set forth below and was in no way caused or contributed to by the Plaintiff. 16. Defendant's negligence, carelessness and recklessness consisted of the following: a) Failure to maintain proper and adequate control of a vehicle; b) Operation of a vehicle at excessive speeds; 6 c) Reckless and careless operation of a motor vehicle; d) Operation of a vehicle so as to create a dangerous situation for passengers; e) Operation of a motor vehicle while under the influence of alcohol; and fl Failure to abide by the motor vehicle laws of the Commonwealth of Pennsylvania. 17. As a direct and proximate result of the accident and of the Defendant's conduct, Decedent suffered serious and fatal injuries, which resulted in his death, including, but not limited to, the following: a) Blunt impact of the head; b) Blunt impact of the torso; and c) Multiple fractures. 18. As a direct and proximate result of the injuries sustained in the motor vehicle accident, Decedent has suffered a loss of wages and may have suffered an impairment of his future earning power and capacity, and thus, a claim for these losses is made. 19. Plaintiff claims on the behalf of the Estate of Ezekiel Bingaman all damages suffered by the Estate by reason of the death of the Decedent, as well as for pain and suffering experienced by the Decedent prior to his death. 7 20. Plaintiff, the Administratrix of the Estate Ezekiel Bingaman, further claims any other damages recoverable under the Pennsylvania Survival Statue and case law. WHEREFORE, Plaintiff, Audrey Bloom, as Administratrix of the Estate of Ezekiel Bingaman, respectfully requests your Honorable Court grant judgment in her favor and against the Defendant, Samantha Benner, in an amount in excess of the amount requiring compulsory arbitration. COUNT II AUDREY BLOOM V. SAMANTHA BENNER WRONGFUL DEATH 21. Paragraphs 1 through 20 are incorporated herein by reference and made a part thereof as if set forth in full. 22. Plaintiff, Audrey Bloom, Administratrix of the Estate of Ezekiel Bingaman, has standing to bring the following Wrongful Death Action on behalf of the wrongful death beneficiaries under the Pennsylvania Wrongful Death Statute, 42 Pa.C.S.A. ~ 8301 and pursuant to Pa.R.C.P. § 2202 (a) against Defendant Samantha Benner. 23. The persons entitled by law to recover wrongful death damages as a result of the death of Ezekiel Bingaman, the Decedent are: a) Elijah Bingaman, Son - 535 Harman Rd., Halifax, PA 17032. b) Audrey Bloom, Mother - 441-A Valley Street, Marysville, PA 17053. 8 c) Nehemiah Bingaman, Son - 535 Harman Rd., Halifax, PA 17032. 24. At no time during his life did Ezekiel Bingaman, deceased, bring an action to recover for his personal injuries and no other action has ever been brought to recover damages for his death. 25. As a result of the death of Ezekiel Bingaman, the individuals identified in paragraph 28 above, have suffered a pecuniary loss and claim all damages for Wrongful Death permitted by Pennsylvania statute, rules or case law, including past and in the future services, support, assistance, companionship, comfort, society and contribution that the Decedent would have rendered to said beneficiaries, but for his death. 26. Plaintiff demands payment for funeral and burial expenses incurred as a result of the death of Ezekiel Bingaman, the Decedent. 27. Plaintiff further demands payment for all economic losses suffered by the Decedent's survivors, including the costs of Administration and other expenses reasonably associated with the Decedent's death and not otherwise specifically stated herein. WHEREFORE, Plaintiff, Audrey Bloom, as Administratrx of the Estate of Ezekiel Bingaman, respectfully requests your Honorable Court grant judgment in her favor and against the Defendant, Samantha Benner, in an amount in excess of the amount requiring compulsory Arbitration. 9 COUNT III AUDREY BLOOM V. 8AMANTHA BENNER PUNITIVE DAMAGE8 28. Paragraphs 1 through 27 of this Complaint are incorporated herein by reference and made a part thereof as if set forth in full. 29. At the time of the accident, it is believed and averred that the Defendant, Samantha Benner, was operating the vehicle while under the influence of alcohol. 30. Defendant Samantha Benner knew or should have known that her negligent conduct set forth above involved a high degree of probability that substantial harm would result to Decedent, her passenger. 31. The actions, conduct, and negligence of Defendant Samantha Benner set forth above display a wanton and reckless indifference to the health, safety, rights, and interests of others. 32. The aforementioned accident and injuries and damages to the Decedent are the direct and proximate result of the egregious behavior and outrageous conduct of Defendant Samantha Benner as set forth herein. WHEREFORE, Plaintiff, Audrey Bloom, as Administratrix of the Estate of Ezekiel Bingaman, respectfully requests your Honorable Court grant judgment in her favor and against the Defendant, Samantha Benner, in an amount in excess of the amount requiring compulsory Arbitration. 10 COUNT IV SURVIVAL ACTION AUDREY BLOOM V. EDWARD YEAGER NEGLIGENT ENTRUSTMENT 33. Paragraphs 1 through 32 of this Complaint are incorporated herein by reference and made a part thereof as if set forth in full. 34. Plaintiff brings this action under the Pennsylvania Survival Statute, 42 Pa.C.S.A. §8302 and pursuant to 20 Pa.C.S.A. § 3373. 35. Defendant, Edward Yeager, negligently and recklessly entrusted his vehicle to Defendant Samantha Benner who he knew, or should have known, was intoxicated, did not have a license to operate a motor vehicle which was valid, and would drive in a dangerous and reckless manner, would not follow the PA Motor Vehicle Laws, and would present a danger to passengers of the vehicle. 36. As a direct and proximate result of the accident and of the Defendant Edward Yeager's negligent entrustment of his vehicle to Defendant Samantha Benner, Decedent suffered serious and fatal injuries, which resulted in his death, set forth above. 37. As a direct and proximate result of the injuries sustained in the motor vehicle accident, Decedent has suffered a loss of wages and may have suffered an impairment of his future earning power and capacity, and thus, a claim for these losses is made. 38. Plaintiff claims on the behalf of the Estate of Ezekiel Bingaman all damages suffered by the Estate by reason of the death of 11 the Decedent, as well as for pain and suffering experienced by the Decedent prior to his death. 39. Plaintiff, the Administratrix of the Estate Ezekiel Bingaman, further claims any other damages recoverable under the Pennsylvania Survival Statue and case law. WHEREFORE, Plaintiff, Audrey Bloom, as Administratrix of the Estate of Ezekiel Bingaman, respectfully requests your Honorable Court grant judgment in her favor and against the Defendant, Edward Yeager, in an amount in excess of the amount requiring compulsory Arbitration. COUNT V AUDREY BLOOM V. EDWARD YEAG4ER WRONGFUL DEATH 40. Paragraphs 1 through 39 of this Complaint are incorporated herein by reference and made a part thereof as if set forth in full. 41. Plaintiff, Audrey Bloom, Administratrix of the Estate of Ezekiel Bingaman, has standing to bring the following Wrongful Death Action on behalf of the wrongful death beneficiaries under the Pennsylvania Wrongful Death Statute, 42 Pa.C.S.A. ~ 8301 and pursuant to Pa. R. C. P. ~ 2202 (a) against Defendant Edward Yeager. 42. The persons entitled by law to recover wrongful death damages as a result of the death of Ezekiel Bingaman, the Decedent are: a) Audrey Bloom, Mother - 441-A Valley Street., Marysville, PA 17053. 12 b) Nehemiah Bingaman, Son - 535 Harman Rd., Halifax, PA 17032. c) Elijah Bingaman, Son - 535 Harman Rd., Halifax, PA 17032. 43. At no time during his life did Ezekiel Bingaman, deceased, bring an action to recover for his personal injuries and no other action has ever been brought to recover damages for his death. 44. As a result of the death of Ezekiel Bingaman, the individuals identified in paragraph 42 above, have suffered a pecuniary loss and claim all damages for Wrongful Death permitted by Pennsylvania statute, rules or case law, including past and in the future services, support, assistance, companionship, comfort, society and contribution that the Decedent would have rendered to said beneficiaries, but for his death. 45. Plaintiff demands payment for funeral and burial expenses incurred as a result of the death of Ezekiel Bingaman, the Decedent. 46. The aforementioned accident and injuries and damages to the Decedent are the direct and proximate result of the egregious behavior and outrageous conduct of Defendant Edward Yeager as set forth herein. WHEREFORE, Plaintiff, Audrey Bloom, as Administratrix of the Estate of Ezekiel Bingaman, respectfully requests your Honorable Court grant judgment in her favor and against the Defendant, Edward Yeager, in an amount in excess of the amount requiring compulsory Arbitration. 13 COUNT VI AUDREY BLOOM V. EDWARD YEAGER PUNITIVE DAMAGES 47. Paragraphs 1 through 46 of this Complaint are incorporated herein by reference and made a part thereof as if set forth in full. 48. At the time of the accident, it is believed and averred that the Defendant, Edward Yeager, voluntarily permitted Defendant Samantha Brenner to drive his vehicle when he knew or should have known that she was under the influence of alcohol. 49. Defendant Edward Yeager knew or should have known that her negligent conduct set forth above involved a high degree of probability that substantial harm would result to Decedent. 50. The actions, conduct, and negligence of Defendant Edward Yeager set forth above display a wanton and reckless indifference to the health, safety, rights, and interests of others. 51. The aforementioned accident and injuries and damages to the Decedent are the direct and proximate result of the egregious behavior and outrageous conduct of Defendant Edward Yeager as set forth herein. 14 WHEREFORE, Plaintiff, Audrey Bloom, as Administratrix of the Estate of Ezekiel Bingaman, respectfully requests your Honorable Court grant judgment in her favor and against the Defendant, Edward Yeager, in an amount in excess of the amount requiring compulsory Arbitration. Respectfully Submitted, 3CHMIDT KRAMER, PC By: Scott B. Cooper I.D. No. 70242 209 State Street Harrisburg, PA 17101 (717) 232-6300 (t) (717) 232-6467 (fl }-, scooper~a~schmidtkramer. com Date: j ~ G, / ~, Attorney for Plaintiff 15 VERIFICATION I, Audrey Bloom, hereby verify that the statements set forth herein are true and correct to the best of my knowledge, information and belief. I understand that intentional false statements herein are made subject to the penalties of 18 Pa. C.S. X4904 relating to unsworn falsification to authorities. Date: ~ a~ a~ ~ Aud y loom CERTIFICATE OF 8ERVICE AND NOW, this ~ day of November 2012, I, D. Joseph Chapman, Esquire, hereby certify that I have this day served a true and correct copy of the foregoing Complaint by depositing a copy of the same in the United States Mail, postage prepaid, at Harrisburg, Pennsylvania, addressed to: Edward Yeager 5 Red Fox Lane Mechanicsburg, PA 17050 Samantha Benner c/o Dauphin County Prison State ID # 251 29 09 1 FBI #646368RC8 501 Mall Road Harrisburg, PA 17111 Respectfully submitted, 8CHMIDT KR.AMER PC By: ~ Zo~tst9 D. Joseph Ch p , Esqu e I.D. No. 20951 209 State Street Harrisburg, PA 17101 (717) 232-6300 Date: ~Uc ~. ~, 7.~ ~ L Attorney for Plaintiff IN RE: ESTATE OF EZEKIEL : IN THE COURT OF COMMON PLEAS BINGAMAN, Deceased, by CUMBERLAND COUNTY, AUDREY BLOOM AS PENNSYLVANIA, ADMINISTRATRIX OF THE : ti) ESTATE, CIVIL ACTION - LAW -0 3 rr;co e�s rn m r Petitioner No. 2012-4426 (n1 . c- PETITION FOR COURT APPROVAL OF r,, WRONGFUL DEATH AND SURVIVAL ACTION SETTLEMENTS' AND NOW, comes Petitioner, AUDREY BLOOM, as Administratrix of the Estate of EZEKIEL BINGAMAN, Deceased, through her attorney, Scott B. Cooper and Schmidt Kramer PC, and respectfully petitions this Court for settlement of the Wrongful Death and Survival Action claims pertaining to the death of Ezekiel Bingaman. This Petition is made pursuant to 20 Pa.C.S.A. § 3323 as follows: 1. Petitioner Audrey Bloom is currently a resident of 441-A Valley Road, Marysville, Pennsylvania 17053 and at the time of the accident resided at 422 South Enola Drive, Enola, Pennsylvania 17025. 2. On March 2, 2011 at approximately 2:45 a.m., Ezekiel Bingaman ("Decedent") and son of the Petitioner was a passenger in a vehicle that was being operated by Samantha Benner with the permission of its owner Edward Yeager and was traveling on Wertzville Road, Enola, Pennsylvania. 3. Although hotly contested it is believed that Ms. Benner was negligently entrusted with the vehicle and operated the vehicle at an roadway, struck a residence, and landed upside-down at 4250 Wertzville Road causing the death of the Decedent at the scene. (See, Police Report attached hereto as Exhibit A and Death Certificate attached hereto as Exhibit B). 4. Decedent is survived by his mother, Audrey Bloom, Administratrix of the Estate and his two minor children Nehemiah Bingaman and Elijah Bingaman. 5. Letters of Administration were granted to Audrey Bloom by the Register of Wills for Cumberland County on September 6, 2011. (See, Short Certificate attached hereto as Exhibit C). 6. This Petition concerns settlement of both third party and underinsured motorist coverage claims. 7. At the time of the accident, Edward Yeager, the owner of the vehicle that Ms. Benner was believed to be driving, had automobile insurance with Erie Insurance with liability limits of said policy are ONE HUNDRED THOUSAND DOLLARS ($100,000.00). Mr. Yeager had no other insurance available at the time of the accident. (See, Affidavit of Mr. Yeager attached hereto as Exhibit D.) 8. Erie Insurance has offered the amount of SEVENTY-FIVE THOUSAND DOLLARS ($75,000.00) as settlement of the third party claim. (See, Erie Insurance Release attached hereto as Exhibit E). 9. At the time of the accident, Decedent was insured under an automobile insurance policy with Progressive Insurance Company 2 providing underinsured motorist coverage with the limit of TWENTY-FIVE THOUSAND DOLLARS ($25,000.00). 10. Progressive Insurance Company has offered the amount of TWENTY THOUSAND DOLLARS ($20,000.00) as settlement of the underinsured motorist claim. (See, Letter from Progressive Insurance Company and Release attached hereto as Exhibit F and Progressive Insurance Company Declaration Sheet attached hereto as Exhibit G). 11. Audrey Bloom, Administratrix of the Estate of Ezekiel Bingaman, Deceased, wishes to accept the total amount provided by the carriers is the sum of NINETY-FIVE THOUSAND DOLLARS ($95,000.00) to avoid any further litigation. 12. The proposed allocation between the wrongful death and survival actions is 50% to the survival action and 50% to the wrongful death action. 13. The wrongful death and survival action beneficiaries are Nehemiah Bingaman (age 6) and Elijah Bingaman (age 4), Decedent's surviving children who reside with their mother Jessica Bowman (Peck). 14. The Decedent died intestate and as such, the proceeds of the survival action portion of the settlement are payable to Audrey Bloom, as Administratrix of the Estate of Ezekiel Bingaman, to be distributed in accordance with the laws of intestacy which, since there are no creditors to the Estate, will be distributed to the minor children equally and deposited into restricted accounts. 3 15. The wrongful death action proceeds shall be distributed among both surviving minor children as follows to be deposited into restricted accounts: Nehemiah Bingaman 50% Elijah Bingaman 50% 16. The Petitioner, Audrey Bloom, as Administratrix of the Estate of Ezekiel Bingaman, Deceased, engaged the services of Schmidt Kramer PC to pursue all claims on behalf of the Petitioner under a Fee Agreement. Said agreement provides for a rate fee of 33 1/3 % plus costs of all funds recovered as a result of services rendered by SCHMIDT KRAMER PC in securing a settlement of these claims without litigation, plus incurred costs. (See, Fee Agreement of SCHMIDT KRAMER PC attached hereto as Exhibit H). However, Petitioner's counsel has agreed to reduce its fees in this matter to 25% plus costs. 17. The total attorney fees per this agreement are TWENTY- THREE THOUSAND SEVEN HUNDRED AND FIFTY DOLLARS ($23,750.00)1. 18. In pursuing the claim on behalf of Petitioner, Schmidt Kramer PC incurred $2,790.26 in costs and expenses. (See, itemized Schmidt Kramer expenses accounting attached hereto as Exhibit I). 19. The Petitioner, Audrey Bloom, as Administratrix of the Estate of Ezekiel Bingaman, Deceased, is personally seeking reimbursement for 'A referral fee of one-third will be paid to a referring lawyer out of the fees paid to Schmidt Kramer PC. 4 funeral expenses. The Petitioner, Audrey Bloom, as Administratrix of the Estate of Ezekiel Bingaman, Deceased, received $1,500.00 from the first- party insurance company for funeral expenses. The funeral service invoice was for the amount of $1,795.00, the flowers for the service were in the amount of $200.00 and the cost of the urn was in the amount of $775.00. Therefore, the unreimbursed amount beyond the payment of $1,500.00, due to the Petitioner totals $1,270.00. (See, Funeral Expense receipts attached hereto as Exhibit J.) 20. The Petitioner, Audrey Bloom, as Administratrix of the Estate of Ezekiel Bingaman, Deceased, is also accepting an Administratrix Commission Fee at 5% from the Survival Action. The Administratix Commission Fee totals $2,375.00. 21. There will also be reservations in the amounts of $1,500.00 for the Estate attorney fees for the PA Inheritance Tax Return and Inventory preparation and the filing and closing of the Estate, $100.00 for the probate and filing fees for the PA Inheritance Tax Return and Inventory, and $1,236.81 for PA Inheritance Tax for the net proceeds payable to the children (4.5%). 22. Petitioner requests that the settlement of damages be allocated as follows: A. SURVIVAL ACTION (50%): Schmidt Kramer PC Attorney fees $11,875.00 5 Schmidt Kramer PC Attorney costs $1,395.13 Remainder to Audrey Bloom, Administratrix of the Estate of Ezekiel Bingaman: Unreimbursed funeral expenses $1,270.00 (To Audrey Bloom) Administratrix Fee $2,375.00 JSDC Law Offices $1,500.00 Estate attorney fees for PA Inheritance Tax Return and Inventory preparation and filing and closing of Estate Register of Wills, Cumberland County $100.00 Additional probate fee & filing fees for PA Inheritance Tax Return and Inventory Register of Wills, Agent $1,236.81 PA inheritance tax for net proceeds payable to children (4.5%) Mid Penn Bank, 349 Union Street, Millersburg, PA 17061 to be deposited in separate federal insured accounts, CDs and/or trusts marked as follows: "Jessica Bowman (Peck), as Parent and Natural Guardian of Nehemiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before May 12, 2019, except by Order of this Court" $13,874.03 "Jessica Bowman (Peck), as Parent and Natural Guardian of Elijiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before February 23, 2023, except by Order of this Court" $13,874.03 Total (50% of$95,000) $47,500.00 6 B. WRONGFUL DEATH ACTION (50%): Schmidt Kramer PC Attorney fees $11,875.00 Schmidt Kramer PC Attorney costs $1,395.13 Mid Penn Bank, 349 Union Street, Millersburg, PA 17061 to be deposited in separate federal insured accounts, CDs and/or trusts marked as follows: "Jessica Bowman (Peck), as Parent and Natural Guardian of Nehemiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before May 12, 2019, except by Order of this Court" $17,114.93 "Jessica Bowman (Peck), as Parent and Natural Guardian of Elijiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before February 23, 2023, except by Order of this Court" $17,114.94 Total (50% of$95,000) $47,500.00 23. The Petitioner requests that your Honorable Court approve the distribution of the payment of the $95,000.00 representing the aforementioned third party and underinsured settlements. 24. The Pennsylvania Department of Revenue has reviewed the contents of this Petition and has no objection to the apportionment. (See, Letter from Department of Revenue attached hereto as Exhibit K). 25. The Petitioner, Audrey Bloom, as Administratrix of the Estate of Ezekiel Bingaman and Jessica Bowman (Peck), the mother of the 7 Decedent's two minor sons, have reviewed this Petition and the content thereof and joins in this Petition. (See, Joinder of Audrey Bloom attached hereto as Exhibit L and Joinder of Jessica Bowman (Peck) attached hereto as Exhibit M). WHEREFORE, Petitioner, Audrey Bloom as Administratrix of the Estate of Ezekiel Bingaman, Deceased, respectfully requests that this Honorable Court enter the Order attached hereto approving the foregoing compromised settlements and directing the distribution of proceeds as set forth herein. Respectfully submitted, SCHMIDT KRAMER PC By: ,j) frj Scott B. Cooper, Esquire I.D. No. 70242 209 State Street Harrisburg, Pa 17101 (717) 232-6300 (717) 232-6467 Fax scooper@schmidtkramer.com Date: C)) j /013 Attorney for Petitioner 8 EXHIBIT A r. r ' Print CRS W0204633 Page 1 of 6 MICE COMMONWEALTH PORK YRM �N(fUl ��{NIUJ dathNumber 1 Case 4epoml>laara6h WO204633 . a9211 .3 M.5001 0Yys 0 N OYes ONo lill luddent xumbie Pella Aya Petrel ngr tan. a [14'40110300050 I!21103 I . Agengr dame Precinct Invatl Won Data MM•DD-YYYY} It I Hampden Township I 03 -I�-2011 1 aide Ttnu r Anlval Time(mD) 1 star badge Number 8 0250 I F 0255 1 CPL SHAWN FULLERTON 11 1907 1 leviewer Bad,a Number •• .vil Data ( D•YYYY) RICHARD J NULTY 1909 03 - 07 -I VII ii County Name mu I Idtmidpalky Name DiX.of lYmedt iI ® ICumberiand 1 103 ampden Township 10 sun 0 Thu Cash DateIMM•DO- *ads lime LI) No of Units a—le in wed led' 'nsel 0 Man 0 Fd 1 03 - 02 - 2011 0250 1 2 1 1 Fans F'' ao� O I Sal Welcome, Co410,1.1lta O Ye No om am 0 Ye O No eehooi mar O Yes O ND N PBI,w.DOTO Yos O No u�T a .t 1 ! 0 a way Intersection O'Y`lntertedlon 0 MIda 0 ON Ramp 0 ROW Crowing , r'•"7 0 M 4** 01'IntaNed ion O IVA A�ba�ttt O an Rim 0 crossover O OUtr *so onol w+ i Rout*Number ant Optional) Trivet lane S aid hint 0 FInrdn Nause Number appttca 0641 02 13S 1 0 sown 1 4250 a Streatham skeet Endkia O fast rat MN•htodcmime use J W RTZVr�1lE J RD O west Cotio par +red *sate 1---`..._._��.�.... O WIka= Petyd'k is liust+s tiff Deem o Pat"?`maix .0"Ike 0 spulUnrita 0 say O ear o tril ituad o o Uinkrmwcn Bout*Number Segment(OpSonel) Dave;Lanes S Umlt 0 Nacdc t! O South Shat Nana I ( fhiat Snag 0 Soft �■ i f O west• O Women A Vos•O t eeauoa 0 nun 0 Turnpike a stele 0 County 0 tool Reed a o Wed 1 A OvotTop* i� Spur fllSios y Rid «sleet Road Unknown Intersecting Minim Or PAID Post OrSa�ym*ntMtrkes _ I an. .•1Lintess.cth,gsvLLum. I.°I If n.❑ • 9 tawny* K stattttlin9 let Num Or MS.Post 0r Saym■t Fl Orin ro DiMrt*e Rom GisA °jDtlo° l S I t t �.❑I St Seat sera a lantuwk t artwk r l I Landmark a r rem Minutes Seconds Degree Names Seconds r 0�Latitedst 40 cii: 08 000 iaeglandet— Ea 58 , 14 Fri t Rellkilealogamdct O,dew Am 0 Pea OPkerer Irliaritwing a A O Net Appnawe 0 Trefrc Stoll 0 Crossing 00 M"type TCD O No e«�ba� 0 ` erdsS O ;w ' J imis and Appocim e n,teitum teas am O O N or °O EaO s■■O wo dY soO 0 u w w An South, A + 0 West O East and West ME) 1111.211211 moms 0 0 O 001.3 his 036 ha 06.9km Os9hoax Ounkma n %O ap tQ 0 d ': O Wdmowe* aaraaawpsnoB MENNOOT COPY I Received Date: 07/02/2011 1 . Print CRS W0204633 Page 2 of 6 t .J POLICE CRASH R CRTIK FORM R 11111111 't i c.&Plumber J Pagel AA 500 2 1 P'6".odr 1 Ell' W0204633 I ——MIX"varde in la O ltampoR 0 lit&Run V$Me C)OeOally Palled 0 Lod*Parked 0 Noe-Mulched Comnserdet Wilda Padastrlae op Sat , Mubled From O Yes 0 No .11 fat O Pededdon 0 in wheeithe tc Pedu pub O TIAN O Fhasdem*hide (If 1bs eonpkn Pone q ' , f1:pollostrfan•or'PedeiUlan on Skater,k Wheekha i arc•,Complete Rom A4 Sadao 2&) , Volt No Plat Name 11I Date of BirthedPAM01)-YYYY) 0i 1 SAMANTHA I 3 08 03 1982 Dekde7 � o behen pd'er 0 1 BENNER 1 17174610344 $ 38 R LANCASTERAVENUE ENOLA PA 1 17025 1 : Mono Number S- ass _.. - 60908 1 i I Alcohol/Mom Sum*, DrANt missi sffids AVS n tnf taadlrbn O No 0 thgaltee0 0*Magee 0 Wei O Sri Drug 0 O Merolla' `'I 0 Alcohol 0 Aoki and Ono O unknown a�dBeen 0 sick 0 Mao 0 Whew I Akrhoil1at'rms C)Boa Not Ghoo O smash O other fl exile tRoieUot ` CAW 0 Blood p Uwe t7 Msi IDUI !0 vas 0 No ptmhef Yost Rrubr OTestRefined 0 WttierOperued Mkt NedStese f�- 0 TCawardlnated ReMi S t i 2cPIo D e Onmeolkirm OO.Not Appilcable •0■ bate vehicle lint 04atete Pedro Vhde 07.MeddpSt PeAe Mt O/•Fedara Goevh °' °wn<dd, o>� OWN*I0 I M M ov t Vehicle 99.4.1rOmown Sam es Owner gust tame Owner test Name er Bust Name et Pedestrian,skip th&Section) °1^"r 0 tEliARD F I I YEAGER Address/Gtr/Voce/tip Vehicle Mate *Make Cade 5 RED FOX LN MECHANICSBURG PA 17050 `I Chevrolet I NM Modal Veer Wilde Model beeorllay) 2111 WB5EN6A1126125 2010 1 IMPALA I Manse Plne Reg•state in,Speed Yehidt_Tewed ?Owed* I PD 1521T I E2111 999 O ves O Ne I ROADSIDE AUTO R I _ O YeS O MI 0 , ERIE Q012303013 I r,:c Idaco1ag Pass Vas 461obil&Moduar Ibnw 7.emi-TaMr w 0(277 Yaeger ht 111 ; y' 6. 0 2Toabg Task 6•Camper !.Other 3.11mbp UMIyTtakr NulTraaar R.tfiknown _�p>n Heide. 00 12:Cornme/dal XtbicliAlif 11110-B21 06.Yekw 014Wtonab/e 00544.2 e�AIY VIGO 07 07oNlver 01 02•Mmorode 97.Yea 21•0t orPadakyde Stlibtglicabla 13.Trictor DB.Gokl Oohs 1044 asnobee 22.Itorr a lumactor nalla Oloillue tgegtee 9e.ete Trek 11.Con and 23.Hone8Alden 08.OtlW E oMple m OQRIad Wert ere Fran 1>��t Equip �� mown Tula of.2r 0,.21.,*not, 1peee9B 1100 Tamped 90•UnWtowt O lads 99.0 wn rum,at San 20 Mink lype SpVeh 90, . 01 00.Iton{olton MoUndanaiage I MoTimed UM 1441flof 1." doSottom ofd 0113+Para 9941ekown © 9dltdalown 24FM 9•Un�knounl © 9•4.Iaknaxn serem►amtssarP PENNDOT COPY . mimnemi Received Date: 07/02/2011 r . Print CRS W0204633 Page 3 of 6 PO C£Ll CRASH OR IN FOR86VAAIfA EMI a ■ M t ' O Number AA 600 3 I7bi0t Us*" I ® W0204633 ' A ow D gaBragfengepp000pird E Mg g/not i. G emn bar 20 oesengr Mofiry- vq / ro-Staines► ioNot� • 7oFidestrun O2.Fsau Stet NM.Petition 02•lap Bee Used Woolly*atd B•Other 03■Piont Sat Right Side 03dap And Belt Used Wordily ed . 9'Uflknown a4 and v-ten Side Or Okada Sa HSe used 0.Ultiata m O'Sd�kow�Position B�hnetUnd 11!.11.. 06.B idimde 07�iFdrdRawwor-Ggnair- ti■ChddSe filAodlmfaopedy °t.j h5 D000r� M° o ia,warc acer- Used Improperly op 2■lteal9h Side Window =tom MiddlePoadon 9 eya 11g0UghB� d Ipa1! 0_-�Ta�lwrd Row Or Greater- _ 1lta'� nod Door Opening of 1- '"- � �p D Right Side ion OO rw�ed fixliab F O Afr lag (For This Seal) �RaDf D 1■1fi4d Pampar Or CargoMea 02•Stde Air Bag, ed THs WO 7= Paa (Comerhhia Jort�JiXy 1hP Pack 0I 4.Ball GI�Mn1l�pkM ury 13<Troeh+yUnit deEps - �d w�r Wilding On Yihide Interior �Weedn •,• ' --, 1 t hgery VX Mks Now 1O=Air Bag Mot Employe S , ,On I rj ,p�yd BB■Other 11■*Bag Not De • Switch ON %Unknown if 99•Untaawtt 12,-.0 Bap .., Welled Medsedal Means IllFiV mewled Mewls S3�A* 5wiltmov4I_dorToCrasia - �a K Ai kg Deployed B•1kFmown 1$ no Aoeety;I-1IA11TPDEN EMS Medal. !UMW I HERSHEY'MEDICAL CENTER I . Unit No Mao No • • of 06pt DAM AID- A it C D P H 1 t Delete >. 01 01 p 08 - 03 - 1982 DE 3 01 I 01 nil I tn Name lAddress 1 Mono • ❑ r IBENNER,SAMANTHA L 38 R LANCASTER AVENUE ENOLA PA 17025 _ 0 Yet O WS Transport Unit No Person Died 01 02 t� O 02 ��- 1989 ED 103 00E 01 F - 3 L LL Nemo I Address/P11one 11616 Transport ❑ r'EZEKIEL$INGIAMAN 422 SOUTH ENOLA DRIVE ENOLA FA 17025 71 I Ova No - - o Li II I-I COOEDL1 F GP 00 ' Name I Address/Phone IBIS Transport 0p°peI I OYes 0 N Unit °- DOW Di),. nDDD HaaaJ Address/nom MIN llonsPorl •© I 1 O Yee Otto "11111 10 °:�--1 000 r 1 I F 000 Nemo/Address/Phone DAB Transport orl I Oft ONe El a ~C i-r COD=EN ADO❑MI EMS Taanpwt Gfa Ova QN1 A■emme Irmo, • taastaa+eopeaD PBNNDOT COPY I. • .. • . , w.. - ... •■..• r..••••inMM.w••M•w• 9us 1,14161 1 I Received Date: 07/02/2011 I 1 . Print CRS W0204633 Page 4 of6 Pam PENNSYLVANIA 1111111 I cant 1 REP AA 500 4 l'obuncoi. ...._r____1 rill W0204633 D� O4424Cdadon 2lleadOn $.An4e 0•8fd5andpe 8ilcNoonan Wow Cad 8. t d1 t (*cat Undo) ) R 1 Lytton m xo+dtwv e 1-00 Toil Lana a wdbn 6a0cmde Dalian/ More(amp lalariscko4 2.Shouldor 4aRoad1d/ Us Par1r g Lane Oatlakoowa orig 2.1g1,artbulman4Wm"1"....0 04 thiralkir41 i jive maw I �.2.REI env kaRakt4wa _ • `!latafeftdefem o 1 "AK a r R s &Odor • M D 00 s ,o of r. ,p) r' ,,. -- .�......� EN 3 A 1 a r r td�Bba.YWl 01 QIRIA►2 .+ — 004 181 4 ttrOrAt*ioot 0 I I 1 � r Ot txr alt ❑ o aa�Frottra,Aae,at Oa 3/41 Other N0a O !Won SIWill Woo WO t MOO Wood 'n) ❑ oI i �Br i T rk rd x € b•UnB3 4241 Sum Bank Kann beat 1/R PAW Ugly toGNenrhar 1�1 Unit 5 �4�Cge�rdon 1 I I be Tree OrSMeh Oak 4H.14d qwt 111111 0 22.401_ - ❑ o I I 24o16t Aa hlNry 51• • ^rihrarnr Or Wig iB�3 ❑ ol �`r'ePall>rld o : �4 n ❑ o I I t hrh °Berrflr �kroin Yak ale Warm avant Unit N. Harm 6vant 9 i rAalfon for INCade/Or tlaod �Wr�l O1 i l:lll:: 0l t4kHo C tag Adbn 9 On _do mil!f �� a�)�1 ry. iMSM o.ataaNCtllMoertsia,+avalaod q�UiplReePkon! t>�MztbI9 pp� __ I 00 2= ' - a', tick, I hw 1 11oodCanddorepdallrne.d yyp 2faCa Q�C/r9Forb 1��iotOnBoedvrlr 04. Ace �P turn d Cardktoas 13+fothoRa doaa_, -14.4TT�r��opkin *NW Prima t h Owke F 16r�Ceoffers 946.OIIIet/ colIn is... 9+.taahenglFador' Off ;lit loud on n� ��ppr��OalCf �maf11dded >b.IJn1J10W1 t �tane .iaYa.TO SPad d p >&Odw*proper Wog Odin 92wAfiedad By Pimlai Condition ! i lerWdr/..Paihnle.bhiun I ,� =Vibe wivogii Olallfe ommiasyston i 014V11111g SySIN 1� thAlebags 01 t a - 3[ s- OfoonarTmfi 1 ramie Nitlatt CU 1 00 2 2k��ObdhCe[y �a sNatd ? = t I1 = g 4-ItiktidaddiaidE No - I WNW ' Ot.Npo�neF d�Or Cmelrq At Vikla hs k.*,RiueRdar I1ldkNa Fedor ODdN 0=1oW% uaa"ts .a Ot 123 I Imisinowm aitr v a P vratne 01 - vdt14e= 0 0 0 0 p I type. Wit//a Wiat reamemaaiaaae — PENNOOT COPY ....m.... • 1.44.../1._.—.A..at.a.6,...,....,/.......—pad..a....��../V...IR:t..»01A1 tMCAOv A1'I A f0ICA9Ail4.. 4/0NtA11 IMAM Received Date: 07/02/2011 Pat CRS W0204633 Page 5 of 6 r PO CE CAASK REPOR'ING FA IA 11111111 4I ',i II aaskNembas m5005. woweooM" © W0204633 MEMMEMEMMUMMEMONIMMOMMUMME 1111■■■■ ■■■� 1111■■ 1111■■■ u■■■■■■■■■■■11 ■1111■■■■1111■■ ■■11■■■■■■■■1111■■■■1111■■■ ■■ ■■■■1111■■■■■ ■11 ■■11 ■ ■■■■■■■■■■ ■■■■■■■11■1111■■ ■■■■■11■■■■■■ ■a ' I■■■■■■■r11■■1111■■11■■■■■■■■1111■■■ %1111■■■■■■■n■■11111111■■■■■11■1111■■■ ii i■■a■■ii■iiii ■■■11i■■■1111■1111■, ■■■ ■■■■■■■ ■■ ■ ■ ■1111■■ ■■■�, 11■■■■■■■t■■■ ■■1111■■r■■■■■■■ - ■■11■11■■1111■■1111■■■■ 1111■■■■11 ■ ■■■■11■■■■■■■■1111■■1111■■■■■■■■■R ,iiiiii1111110 Ad&ess mon 7 Nimbi and additional witness= Accident InvestlgaCon Notiftcation Iuusd?0 Proputy Wage See Ctenbedand Canty Accident Reconstruction Nacritive. • • I I . nmommiwal PQIINOOTCOPY Received Date: 07/02/2011 Print CRS W0204633 . Page 6 of 6 Pap AA 600 F Omni W0204633 6 0 badmntion tteedstatiaenm+a 0SidorWork 0Ott kadgiaisliAa O law 0otor okra ow M 0 0 ova* 0� a O other 0 :Zone 0 Indlw karma 0 arty 0 Unwsoatt O National art 0 a. elVai 0 lidam Please •. . Ustt tnfomutioa for oath unk Wired is a Natrads.Do sat •eat the bdomuNoa in theft/Ads Atm on multi. • ,a. WAND 1 AitYletlegati 01 °Ombr/on O 1 O in • 0 coRtritpaiditialivatk ortzposylvirda OTop Q`,�I O lb ft- O UrcapO ma O " Ntl °`" Wq APP w ne 0' �1 . O NO • - 0/4allwa O�dUnit , . 0 06• '=Mita d tmopi< :Aft 0 trarPOIUSAMItit 0L iagos 0 None tai" 0 p P0O Unlaces" Avoidance de No Avoidance O p O wimp.thin. O WO g of or 0 OtirAaa Ertdis Maneuver 'Caen ONatttequlradfor O Oak If Cot or 0 M 0 eep ' 0 kxoadcske YeMde Ci Cmt tiequind . 0 forte,UMW 0 Orlwreillyinlal O& i 0�or d 0 vah. • 0 Not Licensed O Itaanefor ©UNelwwa gderxrde Usd w%No .ft ire?tit O mood 0 Other No thcdea 0 lde or p Compartment 0 orerrlde mwWilda o Not 0 Ors p If Tat pato Dot -Mite rimvOxrhd O itsert�mers 0 a 0 Ondo tar Oa No TatMvet 0 IA ❑ Attcuutos Mamba- DeiMrlafs 1.No Om 6■� 22■ wq * !s Orypt�Tut 0 ❑ O army' C)sacs soa.u� 0 biome pl, 1—.1 O Nmtamdoct � �Q C)1,Air O' E 0ava OootaPennyMnia 0Top • OCh O O O 0oRatialow amplledvp = 1Np4nie� O .._ i O 0toned Unit_, 0' qe. '.0 Milartated 0 -wilt 0 mfiuerwilvada 0Whom 0 O tlareIeptad�Goap+Atsoe O a NoAvoidance Compliance O Ibduoaen 0 mamma, O m► �°d"r O attuvffhPaidantO 0Vdcke O�� 0 tadt i d aO . 0lhtaKhmmw 0 Not meow OwidrY Rd lioe reltw 0 kn n9 ran 4 O u,Ni O Wang O linknown akar 0 a 0Oiloarm tusiTa 0 or O Nos 0 w'. kRalitilYi P ralea.uYd O other O NU* vadwAfaMikity al No O rldeor 0 0 Mde a O r s Linden/de. Muslim Odom if O CoromCllselt s e t O Conga 0 o a mtt radon Wanton Mown babe O.Milne tb 5•gratarnints D❑ ❑Otkr *Manus ad stl2Or. f ndmoaITae El ❑ O be In " O tghlef6sdy O ttstasa nd I=Opiates mg 0 siren Winding 0 Odom 0 marstaamoveraa PINGED Received Date: 07/02/2011 • . , . . Cash Reporting System Page 1 of 2 Print ( Clesewindow 1 Synopsis ®quoit/Assurance Synopsis 0 Report Crash Synopsis created 03/0812011 for Crash Nwmber W0204633 WebGroup:OA Police Agency Dela The crash report was recorded by police agency 21103•Ha mpden Township under Incident number HA 20110300050.The dispatch data was 03/07)2011,the dispatch time was 0250 hours,the investigation date was 03102/2011,the arrival time was 0255 hours.The Investigator was CPI.SHAWN FULLERTON,badge number 1607.The report was approved by RICHARD J NULTY,hedge number 1606 on 03/0712011. Crash Data: This lea hit Bed object cash wormed in Cumbadamd in the munidpailly of Hampden Township,on Wednesday,OS11)2/201 1 at 0250 haws. The Semblance at the time of the crash was dark with no street lights.The 1-unit crash involved 2 people with 1 Injury.There was 1 fatally as a result of this crash.This is a reportable crash.Hrbway maintenance was not notified.The crash was not school bus related.The crash was not school zone related.There was PennDOT property damaged.The cash did not occur Ina wwkzena,The Blacktop roadway surface was dry.Weather conditions included No adverse coadelons.A not icatton of an accident Investigation was Issued.The Indicated pdme r this crash was a driver's a IJ n(Speeding)foruni 101.The firstandmostharmfulavantforlidscashwas butunit1ha another Bred object. Type Laminar This was a m id lock(non Intersection)crash,which occurred at no spedal location. Principal Roadway. Cumberland Comely,route 0841,Ms orientation of the roadway was East,Mere were 02 travel lane(:),the speed Omit was 36 Mph,with a state highway route signing. GPS: • The polka-entered Latitude was 4014:08.000 and the police-ardered Longitude was 76 5614.000 Tcce Traiflc Control Devine:no traifio control device,No controls. Workroom Type of Work Zone:not awork zone. Lane Cowrie Futydose&Lane closure direction East and West Trans detoured yes.Estimated hours dosed 34 horaa UNIT INF0RMATION:1 Unit Number 1 was a motorveldcle In transport.The unit was owned by YEAOER,EDWARD F Address:8 RED FOX LN MECHANICSBURG PA 17050.This 2010 Chevroletlderdled by VIN:2011W135ENSA1128I28 was registered in PA with Liamse P1)15217. Travel s :Unknown.Unit insured:vehicle has insurance,insurance Company:ERIE.Ilte Unit was towed by ROADSIDE AUTO Thews note commercial vehicle.This Una was an automobile,Vehicle colon Sliver,Special Usage:Not applicable.The Initial Impel pelotas';at I*lock,Damage indicator:Disabling(severe•not driveable),Vehicle role:hit another lbred object.Vehicle pceition:lo the curb lane right.Direction of trivet East,Movement Negotiating are-left,Gradient uphill,Afigament Curve. Other/Unknown Person Type lnbmaatIon: Unknown 01:BENNNER,SAMANTHA L,Address:36 R LANOASTER AVENUE ENOLA PA 17026.Telephone 717-451-0344.DOR 0840311982.Age:28.Sex Female.Seat pour:delves seat Primary safety equipment None used l Not applicable.Secondary safety equipment:Front air bag deployed(for this seeq.illy+severity:Major Injury.Ejection;Not ejected. Received Date: 07/02/2011 Gash Reporting System Page 2 of 2 O herdUn mown'Perean Type Information: Unknown 02:EZEKIEL BINGAMAN.Address:422 SOUTH ENOLA DRIVE ENOtA PA 17025.Telephone:717.379-1287.DOB:o2J08/9s8A. Front Sex: Rant e safely equipment None used!Not applicable.8eoanduy safety equpmet h d laded. Print CloseWtndow .. ..._ _ . . . . . • - .. Received rate: 07/02/2011 EXHIBIT B , . .. .,„,„....„.,,,.........„,....„..„., ,. . . . ... ..... ..... „. ..... „ . „. .,....„,„,,..,..„,...,-,..-....„..--,..--....--,......,........„.„,-. ••,,,..•,.,•,,,•-••.,„...-,•,..„.- H105.805 REV(01/07) LOCAL REGISTRAR'S. CERTIFICATION OF DEATH WARNING: It Is illegal to duplicate this copy by photostat or photograph. . ••• ".• •-• •••••- • - - - •-: : .,-,.....,:. ", .,,, ....,. .:, :. - Fee for this' ertifiOat0,:$0.:1:10,..'.,,•?. - • •••••• this is ti certify that the information here given is .. .,.. ..,.: ....... F I* -:..-"' eariectVcopied.from an original Certificate Death 4/.1), t. 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Pa. 17050 mixabourna No. 0 6,i 0/ EXHIBIT C pnn COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE COUNTY OF CUMBERLAND , A.li Off' IlVf I, GLENDA FARNER STRASBAUGH Register for the Probate of Wills and Granting • Letters of Administration in and for • • CUMBERLAND County, do hereby certify that on • t�; the 6th day of September, Two Thousand and � Eleven, Letters of ADMINISTRATION in common form were granted by the Register of said County, on the estate of EZEKIEL A BINGAMAN , late of EAST PENNSBORO TOWNSHIP First.Middle,Cosa in said county, deceased, to AUDREYMBLOOM First,Middle,Last) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 6th day of September Two Thousand and Eleven. File No. 2011- 00943 PA File No. 21- 11- 0943 Date of Death 3/02/2011 S.S. # 180-70-9384 Jj rLda Uatt .atAa. egister Ct)1-iru n i)"L . Deputy J NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL EXHIBIT D AFFIDAVIT OF NO OTHER INSURANCE • My name is Edward Yeager and I reside at 5 Red Fox Lane, Mechanicsburg, PA 17050. On 3/2/2011, I was insured under a policy of automobile insurance issued to me by Erie Insurance Company, Policy No. Z01 2303013. As of the date of the accident, I owned no other motor vehicles in my own name. As of 3/2/2011, I was covered by no other insurance policies that would apply to the automobile accident which occurred on 3/2/2011. As of 3/2/2011, there was no person residing with me in my household who would have covered me under an insurance policy to apply to the automobile accident that occurred on 3/2/2011. I understand that the statements made herein are made subject to the penalties of 18 Pa. C.S.A. §4094, relating to unsworn falsifications made to authorities. 4, Date: L/ / ) 3 Edward Yeager 551326 22740-3042 EXHIBIT E GENERAL RELEASE OF ALL CLAIMS KNOW ALL PERSONS BY THESE PRESENTS, that I, AUDREY BLOOM, Individually and as Administratrix of the Estate of Ezekiel Bingaman, intending to be legally bound hereby, and in consideration of the payment of Seventy Five Thousand ($75,000.00) Dollars, receipt whereof is hereby acknowledged, have remised, released and forever discharged, and by these presents do for ourselves, our successors, agents, assigns, heirs and insurers hereby remise, release and forever discharge Edward Yeager, his insurers, administrators, personal representatives, successors, agents, assigns, officers, directors, workmen, employees (hereinafter "Releasees"), and all other persons, firms, corporations, associations or partnerships, of and from all actions, causes of action, claims, suits, wrongful death claims, survival action claims, punitive damages claims, controversies, trespasses, damages, judgments, and demands in any form whatsoever, at law or in equity, arising from or by reason of any and all known or unknown, foreseen or unforeseen bodily or personal injuries, death or property damage sustained by Ezekial Bingaman as a result of a motor vehicle accident that occurred on March 2, 2011, near 4250 Wertzville Road, Enola, Cumberland County, Pennsylvania. Said incident and claim is the subject of a civil action currently pending in the Court of Common Pleas of Cumberland County, Pennsylvania, docketed to No. 2012-4426 in which it is claimed that Edward Yeager and Samantha Benner are legally liable for said accident and injuries, which liability was and is expressly denied by Edward Yeager. The aforesaid civil action will be discontinued of record contemporaneously with the execution of this Release. In further consideration of the above payments, the undersigned will indemnify and hold harmless Releasees from any and all liability arising from liens or subrogation claims, including any workers' compensation or medical liens or payments due or claimed to be due under any state or federal law, regulation or contract. It is understood and agreed that this is the compromise of a doubtful and disputed claim, and that this Release and payment is not to be construed as an admission of liability on the part of the parties released, and that the Releasees deny liability therefor and intend merely to avoid further litigation and buy their peace. It is further understood that the terms of this settlement and Release are to be kept strictly confidential and are not to be disclosed to anyone. The undersigned declares and represents that no promise, inducement or agreement not stated herein has been made to the undersigned and that this Release contains the entire agreement between the parties hereto, and that the terms of this Release are contractual and not a mere recital. THE UNDERSIGNED HAS READ THE FOREGOING RELEASE, HAS HAD AN OPPORTUNITY TO DISCUSS IT WITH HER ATTORNEY, AND FULLY UNDERSTANDS IT. IN WITNESS WHEREOF, and intending to be legally bound, I have hereunto set my hand and seal this day of , 2013 WITNESS: AUDREY BLOOM Individually and as Administratrix of the Estate of Ezekial Bingaman 548007 22740-3042 COMMONWEALTH OF PENNSYLVANIA • : SS. COUNTY OF On the day of , 2013, before me, the subscriber, a Notary Public in and for said Commonwealth and County, personally came the above named herein, and who executed the foregoing Release and has acknowledged to me that she voluntarily executed the same. In Testimony Whereof, I have hereunto set my hand and my seal. Notary Public (SEAL) EXHIBIT F PROGRESSIVE CLAIMS ��� 3950 Hartzdale Dr. PROGRESSIVE} Ste 150 /" Camp Hill,PA 17011 Underwritten By: Progressive Specialty Insurance Company Claim Number: 11-1526507 SCHMIDT KRAMER Loss Date: March 2,2011 SCOTT COOPER Document Date: March 27,2013 209 STATE ST Page 1 of 1 HARRISBURG,PA 17101 clai ms.progressive.com Track the status and details of your daim, e-mail your representative or report a new claim. Claim Information Your Client: Estate of Ezekiel Bingaman This will confirm our agreement of settlement in the amount of$20,000 for your client's underinsured motorist daim. Upon receipt of the court approval of settlement and the enclosed completed release,we will forward the settlement payment to you. Upon receipt of the appropriate documents to review consent to settle and waiver of subrogation,we will review and reply accordingly. Should you have any questions, kindly contact the undersigned. TYEDDIE WILLIAMS Claims Department 1-717-730-1592 1-800-PROGRESSIVE(1-800-776-4737) Fax: 1-717-730-1409 Form Z587 XX(01/08)-PA UNDERINSURED MOTORIST RELEASE &INDEMNITY AGREEMENT Page 1 of 2 KNOW ALL BY THESE PRESENTS: That the undersigned, Estate of Ezekiel A. Bingaman(hereinafter "Releasor"), for the sole consideration of Twenty Thousand and 00/100($20,000), receipt of which is hereby acknowledged,has remised,released, and forever discharged and covenant to hold harmless Progressive Specialty Insurance Company, its agents, employees, subsidiaries and affiliates (hereinafter "Releasee") and Releasee's successors and assigns, from any and all claims, actions, and causes of action, demands, costs, and expenses arising under policy number 66041423-1 for bodily injury or damages of any kind sustained,or that may be hereafter sustained by or on behalf of the undersigned,on account of or in any way arising out of an accident caused by an underinsured motorist at or near Wertzville Rd., Cumberland County, PA, on or about 3/2/11. To procure the payment of the stated consideration,the Releasor hereby declares: that no representations about the nature and extent of the said injuries, disabilities or damages made by any physician, attorney or agent of Releasee, nor any representations regarding the nature and extent of legal liability or financial responsibility,have induced the Releasor to make this Release; that this Release is entered into in consideration of all known and unknown injuries, disabilities and damages, and also the possibility that the injuries sustained may be permanent and progressive and recovery therefrom uncertain and indefinite, so that consequences not now anticipated may result from the said accident. Releasor agrees to indemnify and hold harmless said Releasee from any additional sum of money that Releasee may hereafter be compelled to pay on account of the injuries to said Releasor because of said accident. The Releasee is hereby authorized to take any action which may be desirable or necessary in law or in equity, either in the name of the Releasee or in the name of the Releasor, against any person or organization who may be liable for such injuries or damages who has not been heretofore released with Releasee's written consent. The Releasor covenants and agrees to cooperate fully with the Releasee in the presentation of such claims and to furnish all papers and documents necessary in such proceedings, submit to such physical or testimonial examinations as may be required in such proceedings, and to attend court and testify if the Releasee deems it to be necessary. to UNDERINSURED MOTORIST RELEASE & INDEMNITY AGREEMENT Page 2 of 2 I have read this release and understand it. Signed: Witness date Audrey M. Bloom date Administrator of Estate of Ezekiel A. Bingaman Witness date date State of: County of: On this day of , 2 ,before me personally appeared , to me known to be the person(s)who executed the foregoing instrument, and acknowledged this as a free act and deed. IN TESTIMONY WHEREOF, I have hereto subscribed my name and affixed my seal this day of , 2 My commission expires Notary Public Claim Number: 111526507 EXHIBIT G WILLIAM PRESSLEY INS PROGREll/UE® 100 S THIRTEENTH ST OR/Vr/nsurance HARRISBURG,PA 17104 Policy number: 66041423-1 Underwritten by: Progressive Specialty Insurance Co AUDREY M BLOOM August 19,2010 421 SUU I H ENOLA DR Policy Period:Sep 26,2010-Mar 26,201 1 ENOLA,PA 1/025 Page 1 of 2 717-233-1079 WILLIAM PRESSLEY INS Contact your agent for personalized service. gre Auto Insurance pro Online Seageetcom Coverage Summary Make payments, information check billing sstatus iof a claim. policy information or check sttu of a claim. This is your Renewal 800-274-4499 To report a claim. Declarations Page The coverages,limits and policy period shown apply only if you pay for this policy to renew. Your coverage begins on September 26, 2010 at 12:01 a.m. This policy expires on March 26, 2011 at 12:01 a.m. Your insurance policy and any policy endorsements contain a full explanation of your coverage. The policy contract is form 9610A PA(05/06). The contract is modified by forms 4884 PA(08/07)and Z445 PA(03/07). COLLISION COVERAGE FOR RENTAL VEHICLES IF THIS POLICY PROVIDES COLLISION COVERAGE,IT WILL APPLY TO VEHICLES YOU RENT,BUT NOT TO VEHICLES RENTED FOR 6 MONTHS OR MORE. Underwriting Company Progressive Specialty Insurance Co P.O. Box 6807 Cleveland, OH 44101 800-876-5581 Drivers and household residents Additional information AUDREY M BLOOM First Named insured Outline of coverage 1999 Ford Escort ZX2 Cool/Hot VIN 3FAKP1138XR147119 Limits Deductible Premium Liability To Others $237 Bodily Injury Liability $25,000 each person/$50,000 each accident Props ty Damage Liability $25,000 each accident First Party Benefits 61 Medical Expenses $5,000 each person Income Loss $1,000 each month/$5,000 maximum 10 Funeral Benefit $1,500 each person 1 Accidental Death $5,000 3 Uninsured Motorist-Stacked $25,000 each person/$50,000 each accident 12 Underinsured Motorist-Stacked $25,000 each person/$50,000 each accident 26 Total 6 month policy premium $350 Form 6489 PA(04/07) Continued Policy number: 66041423-1 AUDREY M BLOOM Page 2 of 2 Premium discounts Policy 66041423-1 continuous insurance:silver and electronic funds transfer(EFT) Vehicle 1999 Ford Escort ZX2 Cool/Hot airbag Tort Option This policy provides limited tort insurance. Notice of Available Premium Discounts You may be eligible for discounts mandated by Act 6 of 1990: • on first party benefits coverage if your car is equipped with a passive restraint system • on comprehensive coverage if your car is equipped with a passive anti-theft device • if all named insureds are 55 or older and have successfully completed a motor vehicle driver improvement course approved by PennDOT. If you have any questions about your eligibility,please contact your agent. Company officers PoZOd‘:1— President Secretary Form 6489 PA(04/07) EXHIBIT H CONTINGENT FEE AGREEMENT THIS AGREEMENT entered into the 20th day of May, 2011, by and between SCHMIDT KRAMER PC and Audrey Bloom, Ind. and as Admnistratrix of the Estate of Ezekial Bingaman, Deceased, hereinafter referred to as "Client." WITNESSETH: The law firm of SCHMIDT KRAMER PC, will act as Client's attorney in negotiating for a settlement, and in bringing a claim against Samantha Benner arising out of an accident which occurred on March 2, 2011. In addition, SCHMIDT KRAMER PC, will pursue all claims for underinsured or uninsured motorist benefits to which the Client may be entitled under his/her insurance policy. In return, the Client will: 1. Promptly supply accurate information, as requested by SCHMIDT KRAMER PC, and cooperate fully, including making myself available for meetings with attorneys and for legal proceedings. Client promises all information supplied will be truthful and accurate. 2. (a) In any claim brought on Client's behalf, to pay to SCHMIDT KRAMER PC, for its services an amount equal to thirty-three- and-one-third percent (33-1/3%) of all funds or property accruing to Client as a result of SCHMIDT KRAMER PC's services in securing a settlement of these claims after a suit has been filed; and an amount equal to forty percent (40%) if such funds or property are secured after L a start of trial or as a result of verdict or judgment. Trial begins at the Pre- Trial Conference, or when testimony is taken for trial, whichever occurs first. In any matter submitted to arbitration, suit is filed when the arbitrators are appointed or when a Petition to Appoint Arbitrators is filed, whichever first occurs. In any matter submitted to arbitration, trial starts the first day the arbitrators have convened to hear testimony. (b) Client agrees not to settle or negotiate the above claim or any proceedings based thereon. (c) If Client terminates this Agreement before recovery, Client agrees that SCHMIDT KRAMER PC, shall be entitled to a fee based upon work done and benefit conferred. (d) Client agrees to read and follow SCHMIDT KRAMER PC's "Client Instruction Manual". 3. Client agrees to reimburse SCHMIDT KRAMER PC, out of any recovery, in addition to attorneys' fees, all costs and expenses incurred on Client's behalf in order to make the claim. All such costs and expenses will be advanced by SCHMIDT KRAMER PC as they are incurred. Such costs and expenses include, but are not limited to, filing fees, cost of medical records, copying costs, fax costs, long distance telephone costs, expert witness fees and sheriffs service costs. In the event there is no recovery, the Client will not be responsible for any costs or interest charges. Costs will be repaid to SCHMIDT KRAMER PC, out of any funds or property collected either by settlement or judgment. 4. Claims for first party medical benefits and income loss benefits are separate items. SCHMIDT KRAMER PC, will help you process these claims. A separate agreement will have to be entered into for fees if a major dispute occurs requiring the filing of suit for these benefits. The Client has read and does understand this Agreement. Signed the day and year set forth above. WITNESS: Client: "k Audrey Bloo /Ind and Adm Estate of Ezekial Bingaman Approved: SCHMIDT MER PC By: I have received a copy of this Contingent Fee Agreement. Initials CONTINGENT FEE AGREEMENT THIS AGREEMENT entered into the 0th day of Ma , 2011, by and between SCHMIDT KRAMER PC and Audrey Bloom, Ind. and as Admnistratrix of the Estate of Ezekial Bingaman, Deceased, hereinafter referred to as "Client." WITNESSETH: The law firm of SCHMIDT KRAMER PC, will act as Client's attorney in negotiating for a settlement, and in bringing a claim against Samantha Benner arising out of an accident which occurred on March 2, 2011. In addition, SCHMIDT KRAMER PC, will pursue all claims for underinsured or uninsured motorist benefits to which the Client may be entitled under his/her insurance policy. In return, the Client will: 1. Promptly supply accurate information, as requested by SCHMIDT KRAMER PC, and cooperate fully, including making myself available for meetings with attorneys and for legal proceedings. Client promises all information supplied will be truthful and accurate. 2. (a) In any claim brought on Client's behalf, to pay to SCHMIDT KRAMER PC, for its services an amount equal to thirty-three- and-one-third percent (33-1/3%) of all funds or property accruing to Client as a result of SCHMIDT KRAMER PC's services in securing a settlement of these claims after a suit has been filed; and an amount equal to forty percent (40%) if such funds or property are secured after start of trial or as a result of verdict or judgment. Trial begins at the Pre- Trial Conference, or when testimony is taken for trial, whichever occurs first. In any matter submitted to arbitration, suit is filed when the arbitrators are appointed or when a Petition to Appoint Arbitrators is filed, whichever first occurs. In any matter submitted to arbitration, trial starts the first day the arbitrators have convened to hear testimony. (b) Client agrees not to settle or negotiate the above claim or any proceedings based thereon. (c) If Client terminates this Agreement before recovery, Client agrees that SCHMIDT KRAMER PC, shall be entitled to a fee based upon work done and benefit conferred. (d) Client agrees to read and follow SCHMIDT KRAMER Pr's "Client Instruction Manual". 3. Client agrees to reimburse SCHMIDT KRAMER PC, out of any recovery, in addition to attorneys' fees, all costs and expenses incurred on Client's behalf in order to make the claim. All such costs and expenses will be advanced by SCHMIDT KRAMER PC as they are incurred. Such costs and expenses include, but are not limited to, filing fees, cost of medical records, copying costs, fax costs, long distance telephone costs, expert witness fees and sheriffs service costs. In the event there is no recovery, the Client will not be responsible for any costs or interest charges. Costs will be repaid to SCHMIDT KRAMER PC, out of any funds or property collected either by settlement or judgment. 4. Claims for first party medical benefits and income loss benefits are separate items. SCHMIDT KRAMER PC, will help you process these claims. A separate agreement will have to be entered into for fees if a major dispute occurs requiring the filing of suit for these benefits. The Client has read and does understand this Agreement. Signed the day and year set forth above. • TNESS: , 'lient: Marl diP drey Bloo Ind and Adm S CC-. -eC�( state of Ezekial Bingaman 4-(6/1/1-.Cirt Approved: t� ' 'I ( t'& SC IDT MER PC 7o a By: �/7 f7l I have received a copy of this Contingent Fee Agreemen n' ias EXHIBIT I 8:57 AM SCHMIDT KRAMER PC 07/25/13 Client Cost Report Accrual Basis All Transactions Type Date Num Source Name Memo Amount Bingaman, Estate of Ezekial A. 222923 Check 7/21/2011 18360 Appalachian Investigative Services 222923/Ezekial A.Bingaman/Investigative servic... 481.90 Check 11/14/2011 19219 James,Smith,Dietterick&Connelly,... 222923/Ezekial A.Bingaman/Inv.#179761/mgs 1,864.42 General... 4/11/2012 Bingaman,Estate of Ezekial A.:222923 LexisNexis Charges/Feb&Mar 11.42 Check 7/16/2012 21161 Cumberland County Prothonotary's 0... 222923/Ezekial A.Bingaman/Writ fee/mgs ASAP 103.75 Check 7/16/2012 21163 Cumberland County Sheriffs Office 222923/Ezekial A.Bingaman/Service of Process... 100.00 Check 7/16/2012 21164 Mifflin County Sheriffs Office 222923/Ezekial A.Bingaman/Service of Process... 95.00 Deposit 8/9/2012 Return of Costs/Cumberland Co Sheriff -37.00 Deposit 8/9/2012 Return of Costs/Mifflin Co Sheriff -56.00 General... 12/11/2012 Bingaman,Estate of Ezekial A.:222923 LexisNexis Charges/Nov 2012 1.77 General... 6/7/2013 Bingaman,Estate of Ezekial A.:222923 Admin Costs 225.00 Total 222923 2,790.26 Total Bingaman,Estate of Ezekial A. 2,790.26 TOTAL 2,790.26 Page 1 EXHIBIT J Charges are only for those items that you selected or that are required.If we are required by law or by a cemetery or crematory to tr-11 f yT use any items,we will explain the reasons in writing below. 51 N.5;30)2 Dr. I/you selected a funeral that may require embalming,such as a P6 nsylvar_,17025 funeral with viewing,you may have to pay for embalming.You do not M7)732- yG have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial.If we charged for embalming,we will explain why below. fis lg l rvt ;9,72,4 ii. 3 /Z /'o /z /f,,/ Funeral Services for No. Date of Death Date of Statement 1.Professional Services: ❑Forwarding remains to: ❑Receiving remains from: Basic Services of Funeral Director&Staff { Embalming /• Other preparation of body -' Immediate Burial ---- - t I , Direct Cremation ) 79:c.16 t x ry Other.. ,d!ti._(.il l.tt1{� 2.Facilities,Equipment&Staff: TOTAL OF SPECIAL CHARGES ' $ Use of Facilities&Staff for Viewing/Visitation... Use of Facilities&Staff for Funeral Ceremony..: ( TOTAL FUNERAL HOME CHARGES (A+B+C).$` ' Use of Facilities&Staff for Memorial Service.... I (This total does not include Cash Advances) Use of Equipment&Staff for Graveside Service.. Use of Equipment&Staff for Church Service.... 1 Certified Copies of Death Certificate G$ 4.u'a each $ .2..II1 .. 3.Transportation: Clergy j Transfer of Remains to Funeral Home � Hearee - II; Musician Limousine - 1 Sedan Paid Newspaper Notice Service/Utility Vehicle f,.l 6 Cemetery 4.Other Services/Facilities/Equipment: Other {1 r` `{ TOTAL CASH ADVANCES $ iv A s1 `J 4.. ......... _ We charge you for our services in obtaining:(specify;cash advance hems). TOTAL OF SERVICES SELECTED $ I"41 C a Casket(or other receptacle) S; Material Total Funeral Home Charges $)77T-fa Color Local Sales Tax(if applicable) $--'---"' Outer Burial Container State Sales Tax(if applicable) $ NameMo. Total Cash Advances $ Materiel GRAND TOTAL $ .-- Acknowledgement Cards Less Credits,Pa � yments,and Assignments from Register Book :7;P. Memory Folders/Prayer Cards. ""L./J C $ Clothing a.. $ Cremation Urn _ TOTAL CREDITS $ TOTAL OF MERCHANDISE SELECTED. $ �r /LANCE DUE► 175 0.0 AIY 34—,1 DISCLOSURES f/ 6F If any law,cemetery or crematory requirements have required the purchase of any Items listed,the law or requirement is explained below.f .3 If you selected a funeral that may require embalming,such as a funeral with viewing,you may have to pay for embalming.You d fiot have to pay for ballnin$,you did npt approve ; if you selected amangements such as a direct cremation or immediate burial.If we charged for embalming,we will explain why bdlow. �„� tit r Reason for Embalming: ACKNOWLEDGEMENT AND AGREEMENT '4 I hereby acknowledge that I have the legal right to arrange the final services for the deceased,and I authorize this establishment to perform services,furnish goods,and incur outside # charges specified on this Statement.I acknowledge that I have received the General Price List and the Casket Price List and the Outer Burial Container Price List. Terms of Payment: Full Payment is due no later than .If any payment is not paid when due,an unanticipated LATE CHARGE of %per month (ANNUAL PERCENTAGE RATE %)on the unpaid balance will be due.I agree to pay the Balance Due listed on this Statement,plus any Late Charge.In the event I default in payment to this funeral establishment,I agree to pay reasonable attorney's fees and court costs in addition to any Late Charge applicable.I understand and agree that I am :% assuming personal liability for the charges set forth in this Statement and that this is in addition to the liability imposed by law upon the estate of the deceased.By my signature below, I hereby agree to all of rarflackkrwledge receipt of a copy of this Statement. Signed X ly/s, ^- / Dated - `^ jl Social Security Number Signed X Dated Social Security Number ACCEPTANCE This funeral establishment agrees to provide all services,merchandise and cash advances indicated: 4k.C"n✓t. G;.� 't9 dk g.r r ADDITIONAL ITEMS ORDERED LATER: .1,ri H-,) :-H) r) Qibi,,c ,) NI E .1 .--i (--. ---. H L (1. g . _ , , , , , v 1 _ \f„ fsl j ,,_._.i ... 3 , ..-t ,--,,,A ,___F „.... . . L) .---__ 4 . ,....__________ C2 0 (..) 3 -1-- — 2 j .in -± v i ce r, 6' 0 = ao G LL Q 4. pNu • v V a N° J g p LL • • ( IN 4 e 0 c~s aZ 9 AI 3 `TJ F 11 : 1 ry 05 W' k%, � ;e. 5 o 1.t11 - -` — n....... ,=k SECURITY AGREEMENT FOR CEMETERY SERVICES AND MERCHANDISE ILH.D., Inc., t/a William Howard Day Cemetery ❑Pre Need f]At Need ALDWIN CEMETERY • 801 Lincoln Street' Steelton, PA 17113 Contract No: I 492 HONE: (717) 939-9809 • FAX(717)939-0354 Purchaser's Phone: '7 ri !`° ' ` -.'` - /ebsite :www.eternal-memories.com E-mail: -IS AGREEMENT is made the `.'t , day of P,{,:, ,':'.'I 20 t by and between you the Buyer, 'td us the Seller,W.H.D.,INC.,801 LINCOLN STREET,P.O.BOX 7276,STEELTON,PA 17113-0276. i _ AGREEMENT OF SALE ubject to the terms and conditions hereof, we agree to sell and provide, and you agree to purchase, the burial space, cemetery merchandise and/or ineral merchandise specifically enumerated below. Seller intends to assign this Agreement to the Assignee named on reverse side. A.. BENEFICIARY /e shall deliver the burial space and/or merchandise enumerated below only upon your death unless you designate otherwise below, in which event such urial and/or merchandise shall be delivered only upon the death of such designee: (Name of Designee, if any) Social Security# (Name of Designee, if any) Social Security# or the purpose of this Security Agreement,the term"Beneficiary"shall mean the person upon whose death such burial space is to be used and/or merchandise re/is to be delivered,whether such person is Buyer or Buyer's designee: BURIAL RIGHTS QTY ITEMIZATION OF AMOUNT FINANCED: RESERVED FOR: 1. CASH SALE PRICE $ —7—/C �V Ground Mausoleum Cremation 2. DOWN PAYMENT(Paid in cash or by check) $ i t t U.,, ,( Sect Lot Space 3. AMOUNT FINANCED $ Sect Lot Space Prep Care$ Price$ FEDERAL TRUTH-IN-LENDING DISCLOSURES Total$ Annual Percentage Rate FINANCE CHARGE MEMORIALJMONUMENT See Design Form Price includes installation cost $ and memorial care of$ The cost of your Credit as a yearly rate. The dollar amount your Credit will cost you. And cost of Monument/Memorial. Price$ % $ If installed at another cemetery these costs indicate Maximum coverage Seller will provide AMOUNT FINANCED TOTAL OF PAYMENTS TOTAL SALE PRICE INSTALL STORE TOTAL# The amount of credit provided The amount you will have paid The total cost of your purchase _OT OWNER'S NAME OR NAME OF CEMETERY IF OTHER THAN W.H.D.,INC. to you or on your behalf after you have made all payments on credit, including your down as scheduled payment of$. it I..: ti: M. VAULT(S)/URNS ':'0 ,, 1<,?i ce_, k t1(, z,i j,;.,' • € $ $ $ Quantity J 1 4 `f{0 r't"F I Your payment schedule will be: Y ) Standard Oversized , , Number of Amount of When Payments Are Due Material_ {r -: !. t'` ,' _>,-`. Payments Payments Price ($ Each) $ tr., I On the day of each month beginning CASKET FOR Standard Oversized Late Charge: If any payment is not paid on the due date thereof or within*10 days thereafter, you will be charged a late charge of$5.00 or 5% of the unpaid $ Price portion of the payment,whichever is less,but not less than$1.00. t'ASKFT F(1R Prepayment: If you pay off early,you may be entitled to a refund of part of the • _• III IdnUe Uldlye. Standard Oversized See the General Provisions of this Agreement for additional information about non- Price $ payment, default, required payment in full before the scheduled due date and PROFESSIONAL SERVICE $ prepayment rebates and penalties. OTHER $ ATTORNEY IN FACT AND TRUST FUNDS LESS TOTAL TRADE-IN ALLOWANCE (CREDIT) $ Buyer hereby appoints Seller as his agent and attorney in fact for the purpose of creating an IRREVOCABLE Trust with part of the funds to be paid hereunder as provided in the CASH SALE PRICE $ General Provisions hereof and for taking all proper, convenient, necessary or expedient actions incidental thereto. This IRREVOCABLE Trust shall be for the benefit of Buyer and Beneficiary, as their interests may appear, and shall be created pursuant to an SERVICE FEE: For Document Processing IRREVOCABLE Trust Agreement with Bank. Buyer empowers and directs Seller to deal and Administration,Buyer agrees to pay a with and handle this IRREVOCABLE Trust,and to change trustees,as permitted by such non-refundable fee of$100.00 upon this IRREVOCABLE Trust and income from this IRREVOCABLE trust as provided in such Security Agreement $ ;._•,- IRREVOCABLE Trust Agreement, and Seller shall have the right to withdraw principal and income from this IRREVOCABLE Trust as provided in such IRREVOCABLE Trust TOTAL SALE PRICE AND Agreement. This power of attorney shall not be affected by Buyer's subsequent death, SERVICE FEE $ w i�'tm disability or incapacibility. Signature(s)of Buyer(s) I(WE),THE BUYERS(S),HEREBY AGREE THAT IN CONSIDERATION OF THE . GOODS AND/OR SERVICES TO BE DELIVERED,THAT BUYER(S)INDIVIDU- ALLY AND JOINTLY IS (ARE)HEREBY OBLIGATED TO PAY ALL AMOUNTS OWING AND SHOULD BUYERS) DEFAULT IN THE AGREEMENT WITH SELLER, IN ACCORDANCE WITH THE TERMS OF THE CONTRACT GENERAL-PROVISIONS-BUYERS AND SELLER RIGHTS AND OBLIGATIONS BETWEEN BUYER(S)AND SELLER, BUYER(S) HEREBY AGREES)TO PAY ARE PRINTED'ON REVERSE SIDE.PLEASE REVIEW BEFORE SIGNING: ALL COLLECTION COSTS,REASONABLE ATTORNEY FEES AND COURT W.H.D.,INC. COSTS UPON COMMENCEMENT OR INITIATION OF ANY COLLECTION .' EFFORTS OR LEGAL PROCEEDINGS. By: (Authorized:Representative) A Real Estate Recovery Fund exists to reimburse any person who has obtained a Accepted By Title final civil judgement against a Pennsylvania real estate licensee owing to.fraud, rlo� rgaen,e,doneit in real estate transaction and who has been unable Date- ' to collect the judgement after exhausting all legal and equitable remedies. For IN WITNESS WHERE OF,Buyer and Seller have executed this Security Agreement for complete details about the Fund,call(717)783-3658. Cemetery Services and Merchandise,the day and year first above wilt-ten.We also assign this Agreement to the"Assignee"named below, intending to be.legally bound YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR hereby at TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS BUYER;ACKNOWLEDGES RECEIPT OF A COMPLETELY FILLED-IN AND EXECUTED COPY HEREOF TRANSACTION. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR SUBJECT TO THE GENERAL PROVISIONS OF.THIS AGREEMENT ON REVERSE SIDE. AN EXPLANATION OF THIS RIGHT. '-'• (Signature of Buyer) - (bate of Birth) (Signature of Buyer,if more than one) (Date of Birth) NOTICE OF CANCELLATION DATE OF TRANSACTION You may cancel this transaction,without penalty or obligation,within 3 business days from the above date.If you cancel,any property traded in,any payments made by you under the Contract or sale,and any negotiabl instrument executed by you will be returned within 10 business days following receipt by the Seller of your Notice of Cancellation,and any security interest arising out of the transaction will be cancelled.If you cancel,you mut make available to the Seller at your residence, in substantially good condition as when received, any Goods delivered to you under this Contract or sale;or you may if you wish,comply with the instructions of the Sell( regarding the return shipment of the Goods at the Seller's expense and risk. N you do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation,you may retain of dispose of the Goods without any further obligation. If you fail I make the Goods available to the Seller,or if you agree to return the Goods to the Seller and fail to do so,then you remain liable for performance of all obligations under the Contract. To cancel this transaction mail or deliver a signed and dated copy of the Notice of Cancellation or any other written notice,or send a telegram to: W.H.D.,Inc. al 801 Lincoln St.,P.O.Box 7276,Steelton,PA 17113-0276 (Name of Seller) (Address of Seller's place of business) not later than midnight of .I HEREBY CANCEL THIS TRANSACTION. (Date) (Date) (Buyer's Signature) (Date) (Buyer's Signature) Buyer acknowledges receipt of completed duplicate copies of"Notice Cancellation." (Buyer's Signature) (Buyer's Signature) Any Co-Signer must receive and read a copy of this detachable notice before becoming obligated to this Contract ORIGINAL-WHITE BUYER'S COPY-CANARY BANK-GOLD DEALER-PINK EXHIBIT K Rpennsylvania DEPARTMENT OF REVENUE July 10,2013 Scott B. Cooper,Esquire Schmidt Kramer 209 State Street Harrisburg,PA 17101 Re: Estate of Ezekiel Bingaman File Number 2111-0943 Court of Common Pleas Cumberland County Dear Mr. Cooper: The Department of Revenue has received the Petition for Approval of Settlement Claim to be filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action. It has been forwarded to this Bureau for the Commonwealth's approval of the allocation of the proceeds paid to settle the actions. Pursuant to the Petition,the 22 year old decedent died as a result of a motor vehicle accident. Decedent is survived by his two children. Please be advised that,based upon these facts and for inheritance tax purposes only,this Department has no objection to the proposed allocation of the net proceeds of this action, $35,625.00 to the wrongful death claim and$35,625.00 to the survival claim. Proceeds of a survival action are an asset included in the decedent's estate and are subject to the imposition of Pennsylvania inheritance tax. 42 Pa.C.S.A. §8302; 72 P.S. §9106, 9107. Costs and fees must be deducted in the same percentages as the proceeds are allocated. In re Estate of Merryman, 669 A.2d 1059(Pa. Cmwlth. 1995). I trust that this letter is a sufficient representation of the Department's position on this matter. As the Department has no objections to the Petition,an attorney from the Department of Revenue will not be attending any hearing regarding it. Please contact me if you or the Court has any questions or requires anything additional from this Bureau. Sinc ly, n E.Baker Trust Valuation Specialist Inheritance Tax Division Bureau of Individual Taxes I PO Box 280601 I Harrisburg, PA 17128 1 717.783.5824 I shabaker @pa.gov EXHIBIT L revel q` 1%/ 13 GP JOINDER OF AUDREY BLOOM I, AUDREY BLOOM, as surviving mother of EZEKIEL BINGAMAN, Deceased, hereby state that I have read the foregoing Petition for Approval of Wrongful Death and Survival Action Settlements and reviewed it with my attorney, Scott B. Cooper, Esquire, and that I understand, agree, and approve the contents thereof and join in the Petition. / / �.?►�`_it �udr,. B .om Surviving Mother of Ezekiel Bingaman, Deceased EXHIBIT M rCA a(15/i3 JOINDER OF JESSICA PECK I, JESSICA BOWMAN (PECK), as mother of surviving children to EZEKIEL BINGAMAN, Deceased, hereby state that I have read the foregoing Petition for Approval of Wrongful Death and Survival Action Settlements and reviewed it with my attorney, Scott B. Cooper, Esquire, and that I understand, agree, and approve the contents thereof and join in the Petition. 4 .� r P G i essica Bowman Peck) Mother of Surviving Children of Ezekiel Bingaman, Deceased IN RE: ESTATE OF EZEKIEL : IN THE COURT OF COMMON PLEAS BINGAMAN, Deceased, by CUMBERLAND COUNTY, AUDREY BLOOM AS : PENNSYLVANIA, 2 ADMINISTRATRIX OF THE : rn o -: ESTATE, ORPHANS' COURT DIVISIONS r Petitioner No. <C) -T, IA ORDER AND NOW this day of , 2013, it is leray ORDERED and DECREED as follows: 1. That the settlement terms as set forth in the foregoing Petition for Court Approval of Wrongful Death and Survival Action Settlements are hereby approved. 2. The Court approves the total third party and underinsured motorist settlements of NINETY-FIVE THOUSAND DOLLARS ($95,000.00) as follows: A. SURVIVAL ACTION (50%): Schmidt Kramer PC Attorney fees $11,875.00 Schmidt Kramer PC Attorney costs $1,395.13 Remainder to Audrey Bloom, Administratrix of the Estate of Ezekiel Bingaman: Unreimbursed funeral expenses $1,270.00 (To Audrey Bloom) , Administratrix Fee $2,375.00 JSDC Law Offices $1,500.00 Estate attorney fees for PA Inheritance Tax Return and Inventory preparation and filing and closing of Estate .: , Register of Wills, Cumberland County $100.00 Additional probate fee 85 filing fees for PA Inheritance Tax Return and Inventory Register of Wills, Agent $1,236.81 PA inheritance tax for net proceeds payable to children (4.5%) Mid Penn Bank, 349 Union Street, Millersburg, PA 17061 to be deposited in separate federal insured accounts, CDs and/or trusts marked as follows: "Jessica Bowman (Peck), as Parent and Natural Guardian of Nehemiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before May 12, 2019, except by Order of this Court" $13,874.03 "Jessica Bowman (Peck), as Parent and Natural Guardian of Elijiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before February 23, 2023, except by Order of this Court" $13,874.03 Total (50% of$95,000) $47,500.00 B. WRONGFUL DEATH ACTION (50%): Schmidt Kramer PC Attorney fees $11,875.00 Schmidt Kramer PC Attorney costs $1,395.13 Mid Penn Bank, 349 Union Street, Millersburg, PA 17061 to be deposited in separate federal insured accounts, CDs and/or trusts marked as follows: "Jessica Bowman (Peck), as Parent and Natural Guardian of Nehemiah Bingaman, a Minor, 2 held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before May 12, 2019, except by Order of this Court" $17,114.93 "Jessica Bowman (Peck), as Parent and Natural Guardian of Elijiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before February 23, 2023, except by Order of this Court" $17,114.94 Total (50% of$95,000) $47,500.00 3. The law firm of Schmidt Kramer PC shall oversee the directives set forth in the preceding paragraphs and will file an Affidavit confirming the deposit of the estate's money within sixty (60) days of receipt of the settlement funds. . BY TH OURT: J. Thomas A. Placey Common Pleas Judge Cz?L'es abl( � s . 131444,- icyq/i3 - f17t 3 :liar t 0 2 3 SCHMIDT KRAMER PCrL�±LAv'i1 C 't1NT"' By: Scott B. Cooper, Esquire g' ,, SYLVANIA I.D. No. 70242 209 State Street Harrisburg, Pa 17101 (717) 232-6300 (717) 232-6467 Fax scooper@schmidtkramer.com com Attorney for Plaintiff IN THE COURT OF COMMON PLEAS Audrey Bloom as CUMBERLAND COUNTY, Administratrix of the PENNSYLVANIA Estate of Ezekiel Bingaman, Plaintiff CIVIL ACTION - LAW V. Edward Yeager and Samantha Benner JURY TRIAL DEMANDED Defendants : NO. 2012-4426 PRAECIPE TO SETTLE, DISCONTINUE AND END PLEASE mark the above-captioned action settled, discontinued and ended, with prejudice. Respectfully submitted, SCHMIDT KRAMER PC By: Scott tKCooper, Esq. I.D.# 70242 209 State Street Harrisburg, PA 17101 (717) 232-6300 Date: 1 J J)3 Attorney for Plaintiff CERTIFICATE OF SERVICE L AND NOW, this _. day of November 2013, I, Scott B. Cooper, Esquire, hereby certify that I have this day served a true and correct copy of the foregoing Praecipe to Settle, Discontinue & End depositing a copy of the same in the United States Mail, postage prepaid, at Harrisburg, Pennsylvania, addressed to: John A. Statler, Esq. Johnson Duffle 301 Market Street PO Box 109 Lemoyne, PA 17043 Attorney for Defendants Respectfully submitted, SCHMIDT KRAMER PC By: Scott B. Cooper, Esquire I.D. No. 70242 209 State Street Harrisburg, PA 17101 (717) 232-6300 Attorney for Plaintiff IN RE: ESTATE OF EZEKIEL : IN THE COURT OF COMMON PLL$S BINGAMAN, Deceased, by CUMBERLAND COUNTY, c-- AUDREY BLOOM AS PENNSYLVANIA, c`s► `.'t ADMINISTRATRIX OF THE : ce• .t, ;-, ESTATE, CIVIL ACTION - LAW � =' - . Honorable Thomas A. Placey r. Petitioner No. 2012-4426 MOTION TO REOPEN AND AMEND ORDER FOR WRONGFUL DEATH AND SURVIVAL ACTION SETTLEMENTS AND NOW, comes Petitioner, AUDREY BLOOM, as Administratrix of the Estate of EZEKIEL BINGAMAN, Deceased, through her attorney, Scott B. Cooper and Schmidt Kramer PC, and respectfully petitions this Court to Amend the Order for settlement of the Wrongful Death and Survival Action claims pertaining to the death of Ezekiel Bingaman. This Motion is made pursuant to L.R. 208.3(a) as follows: 1.) The Petitioner filed a Petition for Court Approval of Wrongful Death and Survival Action Settlements on September 20, 2013. 2.) An Order approving the Wrongful Death and Survival Action Settlements was entered on October 4, 2013 and signed by the Honorable Judge Thomas A. Placey. 3.) A Praecipe to Settle, Discontinue and End for this case was entered on November 4, 2013. 4.) The Petitioner is filing this Motion to Re-Open and Amend Order as to amend the dates the minor children, Nehemiah Bingaman and Elijiah Bingaman reach majority. 5.) Minor Nehemiah Bingaman's birthdate is May 12, 2007 and the date he will reach majority is May 12, 2025. 6.) Minor Elijiah Bingaman's birthdate is February 23, 2009 and the date he will reach majority is February 23, 2027. 7.) The Amended Order will be revised as the following: A. SURVIVAL ACTION (50%): Schmidt Kramer PC Attorney fees $11,875.00 Schmidt Kramer PC Attorney costs $1,395.13 Remainder to Audrey Bloom, Administratrix of the Estate of Ezekiel Bingaman: Unreimbursed funeral expenses $1,270.00 (To Audrey Bloom) Administratrix Fee $2,375.00 JSDC Law Offices $1,500.00 Estate attorney fees for PA Inheritance Tax Return and Inventory preparation and filing and closing of Estate Register of Wills, Cumberland County $100.00 Additional probate fee & filing fees for PA Inheritance Tax Return and Inventory Register of Wills, Agent $1,236.81 PA inheritance tax for net proceeds payable to children (4.5%) Mid Penn Bank, 349 Union Street, Millersburg, PA 17061 to be deposited in separate federal insured accounts, CDs and/or trusts marked as follows: "Jessica Bowman (Peck), as Parent and Natural Guardian of Nehemiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before May 12, 2025, except by Order of this Court" $13,874.03 "Jessica Bowman (Peck), as Parent and Natural Guardian of Elijiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before February 23, 2027, except by Order of this Court" $13,874.03 Total (50% of$95,000) $47,500.00 B. WRONGFUL DEATH ACTION (50%): Schmidt Kramer PC Attorney fees $11,875.00 Schmidt Kramer PC Attorney costs $1,395.13 Mid Penn Bank, 349 Union Street, Millersburg, PA 17061 to be deposited in separate federal insured accounts, CDs and/or trusts marked as follows: "Jessica Bowman (Peck), as Parent and Natural Guardian of Nehemiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before May 12, 2025, except by Order of this Court" $17,114.93 "Jessica Bowman (Peck), as Parent and Natural Guardian of Elijiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before February 23, 2027, except by Order of this Court" $17,114.94 Total (50% of$95,000) $47,500.00 WHEREFORE, Petitioner, Audrey Bloom as Administratrix of the Estate of Ezekiel Bingaman, Deceased, respectfully requests that this Honorable Court enter the Amended Order attached hereto approving the foregoing compromised settlements and directing the distribution of proceeds as set forth herein. Respectfully submitted, SCHMIDT K R PC By: 7' Scott B. Cooper, Esquire I.D. No. 70242 209 State Street Harrisburg, Pa 17101 (717) 232-6300 (717) 232-6467 Fax Ada) scooper@schmidtkramer.corn Date: `, Attorney for Petitioner IN RE: ESTATE OF EZEKIEL : IN THE COURT OF COMMON PLEAS BINGAMAN, Deceased, by CUMBERLAND COUNTY, � r-,> -t; AUDREY BLOOM AS PENNSYLVANIA, -U3 -n z ADMINISTRATRIX OF THE r. , � M- . ESTATE, CIVIL ACTION - LAW U„r- r -<A o Y. Honorable Thomas A. Placey ° �_, Petitioner No. 2012-4426 ORDER AND NOW, this day of Y , 2014, it is hereby ORDERED and DECREED as follows: 1. That the settlement terms as set forth in the foregoing Petition for Court Approval of Wrongful Death and Survival Action Settlements are hereby approved. 2. The Court approves the total third party and underinsured motorist settlements of NINETY-FIVE THOUSAND DOLLARS ($95,000.00) as follows: A. SURVIVAL ACTION (50%): Schmidt Kramer PC Attorney fees......................................................... $11,875.00 Schmidt Kramer PC Attorney costs......................................................... $1,395.13 Remainder to Audrey Bloom, Administratrix of the Estate of Ezekiel Bingaman: Unreimbursed funeral expenses............................. $1,270.00 (To Audrey Bloom) Administratrix Fee.................................................. $2,375.00 JSDC Law Offices......:............................................ $1,500.00 Estate attorney fees for PA Inheritance Tax Return and Inventory preparation and filing and closing of Estate Register of Wilts, Cumberland County ....... $100.00 Additional probate fee & filing fees for PA Inheritance Tax Return and Inventory Register of Wills, Agent........................................... $1,236.81 PA inheritance tax for net proceeds payable to children (4.5%) Mid Penn Bank, 349 Union Street, Millersburg, PA 17061 to be deposited in separate federal insured accounts, CDs and/or trusts marked as follows: "Jessica Bowman (Peck), as Parent and Natural Guardian of Nehemiah Bingaman, a Minor; held in trust not to be redeemed, withdrawn, . negotiated or in any way alienated, except for the renewal in its entirety before May 12, 2025, except by Order of this Court"............................... $13,874.03 "Jessica Bowman (Peck), as Parent and Natural Guardian of Elijiah Bingaman, a Minor, held in trust not to-be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before February.23, 2027, except by Order of this Court"............................... $13,874.03 Total (50% of$95,000)..................................... $47,500.00 B. WRONGFUL DEATH ACTION (50%): Schmidt Kramer PC Attorney fees:.......................... .............................. $11,875.00 Schmidt Kramer PC Attorney costs..........................................................$1,395.13 Mid Penn Bank, :349 Union Street, Millersburg, PA 17061 to be deposited in separate federal insured accounts, CDs and/or trusts marked as follows: "Jessica Bowman (Peck), as Parent and Natural Guardian.of Nehemiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, . negotiated or in any way alienated, except for the renewal in its entirety before May 12, 2025, except by Order of this Court"............................... $17,114.93 "Jessica Bowman (Peck), as Parent and Natural Guardian of Elijiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for- the renewal in its entirety before February 23, 2027) except by Order of this Court".......I I...............:........ $17,114.94 Total (50% of$95,000)..................................... $47,500.00 3. The law firm of Schmidt Kramer PC shall oversee the directives set forth in the preceding paragraphs and will file an Affidavit confirming the deposit of the estate's money within sixty (60) days of receipt of the settlement funds. BY THE O RT:. J. Tho s A. Placey .Common Pleas Judge Co n2 y SCHMIDT KRAMER PC By: Scott B. Cooper, Esquire I.D. No. 70242 209 State Street Harrisburg, PA 17101 (717) 232-6300 (717) 232-6467 Fax scooper@schmidtkramer.com HE PRO THON0 TR): 2014 MAR -If PM 1: 11 CUMBERLAND COUNTY PENNSYLVANIA Attorney for Petitioner IN RE: ESTATE OF EZEKIEL : BINGAMAN, Deceased, by : AUDREY BLOOM AS ADMINISTRATRIX OF THE : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA, ESTATE, : CIVIL ACTION - LAW • Petitioner No. 2012-4426 Honorable Thomas A. Placey AFFIDAVIT OF DEPOSIT OF MINORS' FUNDS The undersigned, counsel for Audrey Bloom as Administratrix of the Estate of Ezekiel Bingaman, hereby certifies that the net settlement amounts of $13,874.03 and $17,114.93, as set forth in this Court's Order dated February 10, 2014 and attached hereto as Exhibit "A", was deposited by Nicole Heim of Mid Penn Bank, into a restricted, federally insured account, marked as follows: "Nehemiah Bingaman & Jessica Bowman Peck as Parent and Natural Guardian." The sum of $13,874.03 was deposited in accordance with the Court's February 10, 2014 Order into Account Number 318000019. (See Mid Penn Bank's Certificate of Deposit attached hereto as Exhibit "13".) The sum of $17,114.93 was deposited in accordance with the Court's February 10, 2014 Order into Account Number 318000020. (See Mid Penn Bank's Certificate of Deposit attached hereto as Exhibit "C".) The net settlement(s) were deposited into the above-referenced accounts on February 28, 2014. Respectfully submitted, SCHMIDT KRAMER PC By: Date: 9 h )/i/ Scott B. Cooper, Esquire I.D. No. 70242 209 State Street Harrisburg, PA 17101 (717) 232-6300 (717) 232-6467 Fax scooper@schmidtkramer.com Attorney for Petitioner IN RE: ESTATE OF EZEKIEL : IN THE COURT OF COMMON PLEAS BINGAMAN, Deceased, by : CUMBERLAND COUNTY, CD AUDREY BLOOM AS : PENNSYLVANIA, (7.) r-s:■ -1-. ADMINISTRATRIX OF THE : ,„.. -c-- ---i ESTATE, : CIVIL ACTION - LAW rrtqC/ I'l▪ l ▪ If-z--- co 7 rr 0 r- Honorable Thomas A. Placey -<> c) , >C-) Petitioner : No. 2012-4426 -z- c) ( ) -.4 > AND NOW, this Iv day o and DECREED as follows: 1 That the settlement terms as set forth in the foregoing Petition for 0 ER , 2014, it is hereby ORDERED Court Approval of Wrongful Death and Survival Action Settlements are hereby approved. 2. The Court approves the total third party and underinsured motorist settlements of NINETY-FIVE THOUSAND DOLLARS ($95,000.00) as follows: A. SURVIVAL ACTION (50%): Schmidt Kramer PC Attorney fees ..... ..... ......... ..... ....... $11,875.00 Schmidt Kramer PC Attorney costs $1,395.13 Remainder to Audrey Bloom, Administratrix of the Estate of Ezekiel Bingaman: Unreimbursed funeral expenses....... .. .. ...... ......... $1,270.00 (To Audrey Bloom) Administratrix Fee $2,375.00 JSDC Law Offices $1,500.00 Estate attorney fees for PA Inheritance Tax Return and Inventory preparation and filing and closing of Estate Register of Wills, Cumberland County $100.00 Additional probate fee 85 filing fees for PA Inheritance Tax Return and Inventory Register of Wills, Agent $1,236.81 PA inheritance tax for net proceeds payable to children (4.5 %) Mid Penn Bank, 349 Union Street, Millersburg, PA 17061 to be deposited in separate federal insured accounts, CDs and /or trusts marked as follows: "Jessica Bowman (Peck), as Parent and Natural Guardian of Nehemiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before. May 12, 2025, except by. Order of this Court" $13,874.03 "Jessica Bowman (Peck), as Parent and Natural Guardian of Elijiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before February 23 except by Order of this Court" Total (50% of $95,000) 2027, $13,874.03 $47,500.00 B. WRONGFUL DEATH ACTION (50 %): Schmidt Kramer PC Attorney fees $11,875.00 Schmidt Kramer PC Attorney costs $1,395.13 Mid Penn Bank, 349 Union Street, Millersburg, PA 17061 to be deposited in separate federal insured accounts, CDs and /or trusts marked as follows: "Jessica Bowman (Peck), as Parent and Natural Guardian of Nehemiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before May 12, 2025, except by Order of this Court" $17,114.93 "Jessica Bowman (Peck), as Parent and Natural Guardian of Elijiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before . February 23, 2027, except by Order of this Court" $17,114.94 Total (50% of $95,000) $47,500.00 3. The law firm of Schmidt Kramer PC shall oversee the directives set forth in the preceding paragraphs and will . file an Affidavit confirming the deposit of the estate's money within sixty (60) days of receipt of the settlement funds. BY THE J. Tho' . s A. Pinney Common Pleas Jud9e TRUE COPY FROM RECORD In Testimony whereof, there unto set my hand and the of said p8 t Cahiste. Pa. _ _ This •16�' y:of , 20.1.1F1— • Prothonota MID PENN BANK Certificate of Deposit Receipt This receipt is issued to: NEHEMIAH BINGAMAN JESSICAN BOWMAN PECK AS PARENT AND NATURAL GUARDIAN 233 STONE HILL RD LYKENS, PA 17048 By the following institution: MID PENN BANK 349 UNION ST MILLERSBURG PA 17061 Account Number 318000019 Amount $ 13,874.03 Date Opened 02/28/2014 Term 60 Term Code Months Maturity Date 02/28/2019 Interest Rate .85% Annual Percentage Yield .85% 0 Bump Up Certificate FID -Court Ordered Trust Account Ownership Type The account evidenced by this receipt is subject to and further explained in the terms and conditions contained in the account agreement and account disclosures. The account is Not Negotiable and Not Transferable. Only the items checked apply. Interest will be: Mailed to the owner(s). Frequency of Interest Paid Sent'onxivalw Added to principal (compounded). Paid to Account No. 0 X Fixedlnterest Rate Automatically Renewable 0 Variable Interest Rate Single Maturity (not automatically renewable) Revised 07/13 EXHIBIT i MID PENN BANK Certificate of Deposit Receipt This receipt is issued to: NEHEMIAH BINGAMAN JESSICAN BOWMAN PECK AS PARENT AND NATURAL GUARDIAN 233 STONE HILL RD LYKENS, PA 17048 By the following institution: MID PENN BANK 349 UNION ST MILLERSBURG PA 17061 Account Number 318000020 Amount $ 17,114.93 Date Opened 02/28/2014 Term fi0 Term Code Months Maturity Date 02/28/2019 Interest Rate .85% Annual Percentage Yield Bump Up Certificate .86% FID -Court Ordered Trust Account Ownership Type The account evidenced by this receipt is subject to and further explained in the terms and conditions contained in the account agreement and account disclosures. The account is Not Negotiable and Not Transferable. Only the items checked apply. Interest will be: Mailed to the owner(s). Frequency of Interest Paid Semiannually Added to principal (compounded). Paid to Account No. o X Fixedlnterest Rate Automatica IlyRenewa ble Variable Interest Rate 0 Single Maturity (not automatically renewable) Revised 07/13 SCHMIDT KRAMER PC By: Scott B. Cooper, Esquire I.D. No. 70242 209 State Street Harrisburg, PA 17101 (717) 232-6300 (717) 232-6467 Fax scooper@schmidtkramer.com CF THE PRO THONO 2014 friAR —la PM 1:10 CUMBERLAND COUNTY PENNSYLVANIA Attorney for Petitioner IN RE: ESTATE OF EZEKIEL : BINGAMAN, Deceased, by : AUDREY BLOOM AS • ADMINISTRATRIX OF THE : ESTATE, Petitioner IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA, CIVIL ACTION - LAW Honorable Thomas A. Placey No. 2012-4426 AFFIDAVIT OF DEPOSIT OF MINORS' FUNDS The undersigned, counsel for Audrey Bloom as Administratrix of the Estate of Ezekiel Bingaman, hereby certifies that the net settlement amounts of $13,874.03 and $17,114.94, as set forth in this Court's Order dated February 10, 2014 and attached hereto as Exhibit "A", was deposited by Nicole Heim of Mid Penn Bank, into a restricted, federally insured account, marked as follows: "Elijah Bingaman 86 Jessica Bowman Peck as Parent and Natural Guardian." The sum of $13,874.03 was deposited in accordance with the Court's February 10, 2014 Order into Account Number 318000017. (See Mid Penn Bank's Certificate of Deposit attached hereto as Exhibit "B".) The sum of 17,114.94 was deposited in accordance with the Court's February 10, 2014 Order into Account Number 318000018. (See Mid Penn .Bank's Certificate of Deposit attached hereto as Exhibit "C".) The net settlement(s) were deposited into the above-referenced accounts on February 28, 2014. Respectfully submitted, SCHMIDT KRAMER PC By: Date: Scott B. Cooper, Esquire I.D. No. 70242 209 State Street Harrisburg, PA 17101 (717) 232-6300 (717) 232-6467 Fax scooper@schmidtkramer.com Attorney for Petitioner IN RE: ESTATE OF EZEKIEL : BINGAMAN, Deceased, by : AUDREY BLOOM AS ADMINISTRATRDE OF THE : ESTATE, Petitioner IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA, CIVIL ACTION — LAW : Honorable Thomas A. Placey • : No. 2012-4426 =1 rn 9? „--Vex AND NOW, this W day o ORDER 2014, it is hereby ORDERED and DECREED as follows: 1. That the settlement terms as set forth in the foregoing Petition for Court Approval of Wrongful Death and Survival Action Settlements are hereby approved. 2. The Court approves the total third party and underinsured motorist settlements of NINETY-FIVE THOUSAND DOLLARS ($95,000.00) as follows: A. SURVIVAL ACTION (50%): Schmidt Kramer PC Attorney fees $11,875.00 Schmidt Kramer PC Attorney costs $1,395.13 Remainder to Audrey Bloom, Administratrix of the Estate of Ezekiel Bingaman: Unreimbursed funeral expenses .$1,270.00 . (To Audrey Bloom) Administratrix Fee $2,375.00 JSDC Law Offices $1,500.00 Estate attorney fees for PA Inheritance Tax Return and Inventory preparation and filing and closing of Estate Register of Wills, Cumberland County Additional probate fee 85 filing fees for PA Inheritance Tax Return and Inventory Register of Wills, Agent ...... .. .. ............... .... $1,236.81 PA inheritance tax for net proceeds payable to children (4.5%) $100.00 Mid Penn Bank, 349 Union Street, Millersburg, PA 17061 to be deposited in separate federal insured accounts, CDs and/or trusts marked as follows: "Jessica Bowman (Peck), as Parent and Natural Guardian .of Nehemiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before May 12, 2025, except by. Order of this Court" $13,874.03 "Jessica Bowrnan (Peck), as Parent and Natural Guardian of Elijiah Bingaman, a Minor, held, in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before February 23, 2027, except by Order of this Court" $13,874.03 Total (50% of $95,000) $47,500.00 B. WRONGFUL DEATH ACTION (50%): Schmidt Kramer PC Attorney fees $11,875.00 Schmidt Kramer PC Attorney costs.... ...... ......... ............. ..... ...... . ...... $1,395.13 Mid Penn Bank, 349 Union Street, Millersburg, PA 17061 to be deposited in separate federal insured accounts, CDs and/or trusts marked as follows: "Jessica Bowman (Peck), as Parent and Natural Guardian of Nehemiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for the renewal in its entirety before May 12, 2025, except by Order of this Court".. ......... ..... . ...... $17,114.93 "Jessica Bowman (Peck), as Parent and Natural Guardian of Elijiah Bingaman, a Minor, held in trust not to be redeemed, withdrawn, negotiated or in any way alienated, except for- the renewal in its entirety before February 23, 2027, except by Order of this Court" $17,114.94 Total (50% of $95,000) ...... . ..... ................ ......... $47,500.00 3. The law firm of Schmidt Kramer PC shall oversee the directives set forth in the preceding paragraphs and will file an Affidavit: confirming the deposit of the estate's money within sixty (60) days of receipt of the settlement funds. J. Tho A. Placey Common Pleas Judge TRUE COPY FROM RECORD In Testimony whereof. I here unto set my hand and the :se of said -Carlisle, Pa. This iifP'Ney ot ,2o 1 Prothonota MID PENN BANK Certificate of Deposit Receipt This receipt is issued to: EUJAH BINGAMAN JESSICAN BOWMAN PECK AS PARENT AND NATURAL GUARDIAN 233 STONE HILL RD LYKENS, PA 17048 By the following institution: MID PENN BANK 349 UNION ST MILLERSBURG PA 17081 Account Number: 318000017 Amount $ 13,874.03 Date Opened 02/28/2014 Term H0 Term Code Months Maturity Date 02/28/2019 Interest Rate .86% Annual Percentage Yield .85% Bump Up Certificate FID -Court Ordered Trust Account Ownership Type The account evidenced by this receipt is subject to and further explained in the terms and conditions contained in the account agreement and account disclosures. The account is Not Negotiable and Not Transferable. Only the items checked apply. Ixedlnterest Rate AutomaticallyRenewable Variable Interest Rate Single Maturity (not automatically renewable) Interest will be: Mailed to the owner(s). Frequency of Interest Paid Semiannually Added to principal (compounded). Paid to Account No. 0 Revised 07/13 EX BIT ,APIP1P MID PENN BANK Certificate of Deposit Receipt This receipt is issued to: ELIJAH BINGAMAN JESSICAN BOWMAN PECK AS PARENT AND NATURAL GUARDIAN 233 STONE HILL RD LYKENS, PA 17048 By the following institution: MID PENN BANK 349 UNION ST MILLERSBURG PA 17061 Account Number 318000018 Amount $ 17,114.94 Date Opened 02/28/2014 Term 60 Term Code Months Maturity Date 02/28/2019 Interest Rate .85% Annual Percentage Yield .85% [Bump Up Certificate FID -Court Ordered Trust Account Ownership Type The account evidenced by this receipt is subject to and further explained in the terms and conditions contained in the account agreement and account disclosures. The account is Not Negotiable and Not Transferable. Only the items checked apply. Interest will be: Mailed to the owner(s). Frequency of Interest Paid Added to principal (compounded). Paid to Account No. 0 1 1 1 CFixedlnterest Rate AutomaticallyRenewa ble Variable Interest Rate Single Maturity (not automatically renewable) Semiannually Revised 07/13 EXHIBIT Co•