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Home My WebLink About04-5434 TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER 1. D. 1/60267 22nd Fl.,1845 Walnut Street Phila., PA 19103 (215) 569~S050' P1alnlifJ(s) THE MILTON S. HERSHEY MEDICAL CENTER P.O. Box 853 Hershey, PA 17033 () ATTORNEY FOR Plaintiff vs Defendanls(s) TONY L. HURLEY, JR. & BETH A. HURLEY 321 N. East Street Carlisle, PA 17013 COURT OF COMMON PLEAS DIVISION CUMBERLAND COUNTY TERM. ) tJ4- JY'1L{'~ No. IIOT I CE COMPLAINT - CIVIL ACTION AVISO You have been sued ,in court. If you wish to defend against the claims:tet 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 ff ling 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 reL ief 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 BELOII. 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 DR NO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717)249-3166 (800)990-9108 Le han demandado a usted en la corte. Si usted qui ere defenderse de estas demandas expuestas en Las paginas siguientes, usted tiene ve;nte (20) dies de pLaza aL partir de La fecha de La demandanda y La notificacion. Hace faL ta asentar una comparencia escrita 0 en persona 0 con un abogado y entregar a la corte en for escrita sus defensas 0 sus objeciones 8 Las demandas en contra de su persona. Sea avisado que S1 usted no se defiende, La corte tomara medidas y puede continuar La demandanda en contra suya sin previo aviso 0 notificacion. Ademas, la corte puede decidir a favor del demandante y requiere que usted cumpLa con todas las provisiones de esta demanda. Usted puede perder dinero 0 sus propiedades u otro$ derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADD INMEDIATAMENTE, 51 USTED NO TIENE ABOGADO, VAYA PERSONALMENTE 0 LLAME POR TELEFONO A LA OFICINA MENCIONADA A CONTlNUACION, ESTA OFICINA LE PUEDE PROVEER LA INFORMACION NECESARIA PARA CONTRATAR A UN ABOGADO. 51 USTED CARECE DE LOS MEDIOS NECESARIOS PARA CONTRATAR A UN ABOGADO, DICHA OFICINA LE PUEDE SUMINISTRAR LA INFORMACION NECESARIA ACERCA DE AQUELLAS AGENCIAS QUE OFRECEN SERVICIOS LEGALES A LAS PERSONAS QUE TIENEN DERECHO A RECIBIR TAL AYUDA GRATIS 0 A UNA CUOTA REDUCIDA, CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717)249-3166 (800)990-9108 COMPLAINT - CIVIL ACTION COUNT I THE MILTON S. HERSHEY MEDICAL CENTER VS. TONY L. HURLEY, JR. 1, Plaintiff is a non-profit corporation located at the address indicated in the caption hereof. 2, Count I defendant is an individual who resides at the address indicated in the caption hereof, 3, As the result of a certain medical condition, Count I defendant was treated at the plaintiff hospital on June 25, 2003 thru June 30, 2003, 4. The amounts, quantities and nature of the medical care rendered, the date on which said medical care was rendered, and the charges therefore are set forth in Exhibit "A," which is incorporated herein as if set forth at length, 5, Said medical care was commensurate with the condition of Count I defendant and was necessary for the health and welfare of Count I defendant. 6. At or about the time of Count I defendant's treatment at the plaintiff hospital, implied, constructive and oral contracts arose between Count I defendant and plaintiff by the terms of which Count I defendant became obligated to pay plaintiff the charges incurred for the medical care rendered by plaintiff to Count I defendant, THIS DOCUMENT IS BEING USED TO COLLECT A DEBT AND THE INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. 7, Count I defendant refuses to pay the balance due although plaintiff has made demand that Count I defendant do so. 8. As a result of the foregoing, there is due and owing from Count I defendant to plaintiff the sum indicated in Exhibit "A,II WHEREFORE, plaintiff demands judgment against Count I defendant for the sum of $25,496,25 plus six percent (6%) interest per annum from the date of discharge to the date of judgment, record costs and non-record costs, COUNT II THE MILTON S. HERSHEY MEDICAL CENTER VS. BETH A. HURLEY 9, The foregoing paragraphs are incorporated herein as if set forth at length, 10. Count II defendant is an individual who resides at the address indicated in the caption hereof, 11, At all times material hereto, Count II defendant was the mother of Count I defendant, 12, In consideration for the care and treatment of Count I defendant by plaintiff, at the time of Count I defendant's admission to the plaintiff hospital, Count II defendant agreed in writing to be responsible for the charges incurred. A copy of said agreement is attached hereto as Exhibit "E" and is incorporated herein as if set forth at length, THIS DOCUMENT IS BEING USED IN CONNECTION WITH THE COLLECTION OF A DEBT; ANY INFORMATION OBTAINED MAY BE USED FOR THAT PURPOSE. 13. Count I defendant is indigent. 14. Count II defendant is financially able to pay for the medical care of Count I defendant, 15. Count II defendant has been unjustly enriched by plaintiff's discharge of Count II defendant's duty to support Count I defendant, which duty Count II defendant failed to perform. 16, By virtue of the Act of 1937, June 24, P,L, 2045, ~3, as amended, 62 Pa. Cons. Stat, Ann, ~1973 and all other appli- cable statutes, laws and ordinances, Count II defendant has a duty to support Count I defendant, 17, Count II defendant refuses to pay the balance due,al- though plaintiff has made demand that Count II & defendant do so, 18. As a result of the foregoing, there is due and owing from Count II defendant to plaintiff the sum indicated in Exhibit "A," WHEREFORE, plaintiff demands judgment against Count II defendant for the sum of $25,496,25 plus six percent (6%) interest per annum from the date of discharge to the date of judgment, record costs and non-record costs. TABAS & ROSEN, P,C, ~;s C'~FFER' :;;IRE Attorney for Plaintiff THIS DOCUMENT IS BEING USED TO COLLECT A DEBT AND THE INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/25/04 at 03:20 PM PAGE: 1 Guarantor: HURLEY TONY L JR 321 N EAST STREET CARLISLE, PA 17013-0000 Patient: HURLEY TONY L JR Visit #: 3533664 Date I Svc Code I Description I Units I Debits Credits -----r------------------------------------------------------------------------~- 06/25/03 06/25/03 02/29/04 02/29/04 711107 711108 980090 980091 AIR AMBULANCE TRANSPO AIR AMBULANCE MILEAGE HOSPITAL BAD DEBT W/O HOSPITAL BAD DEBT PLA 1 26 -1 1 4601.00 2314.00 6915.00- 6915.00 * - Not posted Balance: 6915,00 I rd MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/25/04 at 03:20 PM PAGE: 1 Guarantor: HURLEY TONY L JR 321 N EAST STREET CARLISLE, PA 17013-0000 '. Patient: HURLEY TONY L JR Visit #: 24841 --~----------------------------------------------------------------------------- I Svc Code I ! Unitsl Description Date Debits Credits -----r-------------------------------------------------------------------------- 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 10277 16502 46061 46121 46122 46126 46472 46479 46486 46487 46630 46673 46694 46696 46697 46699 4671 7 101003 101004 101005 104002 104009 104042 104060 104106 104111 104129 104131 104145 104156 104433 104711 105037 105052 105059 105656 106011 109104 245206 245475 245483 245553 7 PEDS PRIVATE RM ADULT LEVEL II TRAUMA IV SOLUTION URINALYSIS DIPSTIX PR HEMOCCULT, STOOL SKIN STAPLE EMERGENCY VISIT, LEVE CLOSED DRAIN SYSTEM S SUTURING SUPPLIES WOUND TX SUPPLIES ARTERIAL PUNCTURE BLADDER CATH, SIMPLE ADMIN VACCINE, SINGLE IV INFUSION TX 0-1 HR IV INF TX,EA ADDL HR THERA/DIAG INJECTION NONINVAS PULSE OX, MU ABO BLOOD GROUP ANTIBODY SCREEN RH TYPE ALCOHOL (ETOH), BLOOD AMYLASE, BLOOD CREATININE, BLOOD GLUCOSE, BLOOD MAGNESIUM BLOOD GAS PANEL W/02 PHOSPHORUS, BLOOD POTASSIUM (K), BLOOD SODIUM (NA) , BLOOD SGPT (ALT) BASIC METABOLIC PANEL DRUG SCREEN, URINE HEMOGLOBIN PARTIAL THROMBOPLAS T PROTHROMBIN TIME CBC W/PLT AUTO URINALYSIS-BASIC & MI MARIJUANA CONF LIDOCAINE 10MG/ML GENTAMICIN 40MG/ML DEXTROSE 5% 50ML LIDOCAINE 1 ML 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 2 2 1 930.00 2400.00 10,00 7.00 7.00 20.00 478,00 17.00 87.00 22,00 43.00 39.00 5.00 338.00 84,00 74,00 77.00 17.00 30,00 16.00 42.00 36.00 10.00 9.00 40.00 124.00 10.00 10.00 10.00 11.00 34.00 79.00 14.00 30.00 19.00 50.00 18.00 43.00 2.10 12.50 7.20 4.15 - Continue ~ A'd- MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/25/04 at 03:20 PM Guarantor: HURLEY TONY L JR 321 N EAST STREET CARLISLE, PA 17013-0000 Date 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/25/03 06/26/03 06/26/03 06/26/03 06/26/03 06/26/03 06/26/03 06/26/03 06/26/03 06/27/03 06/27/03 06/27/03 06/27/03 06/27/03 106/27/03 06/27/03 06/27/03 06/27/03 06/27/03 06/27/03 06/27/03 06/27/03 I Svc Code I 246021 247786 272987 273686 305611 305621 307069 307101 307205 307220 307310 310501 310519 310567 310641 310694 621054 622023 667231 670330 670334 10277 246706 272987 273686 621033 621053 621054 622023 245710 24571 7 246162 246182 246316 246705 246706 246708 250577 272425 272661 272987 307069 PAGE: 2 I Units I 1 1 2 6 1 1 1 1 1 1 1 1 1 1 1 1 2 2 1 1 1 1 6 5 4 1 2 1 1 1 1 2 2 1 1 1 1 1 1 1 1 1 , Patient: HURLEY TONY L JR Visit #: 24841 - Continue - AJ Debits Credits Description BACITRACIN 15 GM MORPHINE SULFATE 10 M CEFAZOLIN 1 GM PRE-MI PENICILLIN GK 2MU PRE WRIST 1-2 VIEWS RIGHT KNEE 1-2 VIEWS RIGHT PANOREX TEETH/ORTHOPA CHEST 1 VIEW C-SPINE 2-3 VIEWS PELVIS 1-2 VIEWS KNEE 1-2 VIEWS LEFT CT HEAD UNENHANCED CT ABDOMEN ENHANCED CT PELVIS ENHANCED CT LOCM 300-399 MG CT TRAUMA SPINE RECON I V LACTATED RINGERS IRRIGATION SOD CHL 0, SLING ARM ADULT IV INFUSION SET, UNIV IV INFUSION SET, UNIV 7 PEDS PRIVATE RM MORPHINE SULFATE 2 MG CEFAZOLIN 1 GM PRE-MI PENICILLIN OK 2MU PRE I V DEXTROSE 5%-,45 S I V LACTATED RINGERS I V LACTATED RINGERS IRRIGATION SOD CHL O. BUPIVICAINE 10 ML DEXAMETHASONE 4 MG/ML FENTANYL CITRATE 5 ML GLYCOPYRROLATE 0.2 MG NEOSTIGMINE 10 ML MORPHINE SULFATE 4 MG MORPHINE SULFATE 2 MG MEPERIDINE ECL 25 MG PROPOFOL 20ML MIDAZOLAM 1MG/ML 2ML ROCURONIUM BROMIDE 10 CEFAZOLIN 1 GM PRE-MI PANOREX TEETH/ORTHOPA 8,60 2.10 17.10 39.30 92,00 114.00 105,00 98,00 125.00 128.00 114,00 612.00 876.00 994.00 105,00 462,00 12.00 12,00 6.00 16.00 8.00 930.00 12.60 42.75 26.20 6.00 12,00 6.00 6.00 4.65 2,10 2.10 4.20 10.95 2.30 2.10 2.10 28.75 2.10 117.75 8.55 105.00 ~-------------------------~----------------------------------------------------- MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/25/04 at 03:20 PM Guarantor: HURLEY TONY L JR 321 N EAST STREET CARLISLE, PA 17013-0000 Date I Svc Code I ---------------~-------~-------------------------------------------------------- 06/27/03 06/27/03 06/27/03 06/27/03 06/27/03 106/27/03 06/27/03 06/27/03 02/29/04 02/29/04 410032 410051 422004 502000 600510 622023 665670 670334 980090 980091 * - Not posted Description O.R, TIME @ 15MIN INC BASIC SET-UP, ROUTINE 1/2 TO 1 HOUR-RECOVER ANESTHESIA TIME-HOSP PULSE OXYMETER SENSOR IRRIGATION SOD CHL O. WATER PICK IV INFUSION SET, UNIV HOSPITAL BAD DEBT W/O HOSPITAL BAD DEBT PLA A c~ PAGE: 3 , Patient: HURLEY TONY L JR Visit #: 24841 I Unitsl 7 1 1 7 1 1 1 1 -1 1 Debits Credits 1484,00 653.00 291.00 476.00 13.00 6.00 65.00 8,00 13592,25- 13592,25 Balance: 13592,25 I PENN STATE !5l The Milton S. Hershey Medical Center .. The College of Medicme 'iii IF ANY QUESTIONS, PLEASE CONTAcT: MSHMC PATIENT FINANCIAL SERVICES DATE PROCEDURE DIAG QTY DESCRIPTION CODE CODE ))) PATIENT: TONV L JR HURLEV 1328836 3&B934 24841 PERFORMED BV, DIY of EMERG RDOH PLACE OF SYC: EMERGENCV ROOH CRITICAL CARE FIRST HR BALANCE TRANSFER TO GUAR INSERT TEMP BLAD CATHISIM BALANCE TRANSFER TO GUAR PERFORMED BV, DIY PLASTICRECllNST SURG . PLACE DFSYC, INPATIENT INITI AL INPT CllNSULTATIDN BALANCE TIlANSFERTO GUAR PERFORMEDBV: DIY OF DIAGRADIOLDSY CTHEAD lHNHANCED BALANCE TRANSFER TOGUAR CTCOlIoNALSAGtTTALOBLlq 8At 4N!:E TR:ANSf'ERTD GUAR oRTHDPANTOGRAM BALANcE tRANSfER to GUAR CHEST 1 YIEH BALANcE TRANSFER TO GUAR SPINECERYIC'.ANt/POS: tAt BAL4N!:EtRAN$fl!RJO GUAR PELYXs ANrERPOStER 8ALANCE TRANSFER TOGUAR KNEE l1l'lIIED 8ALANcE TRANsfER TO GUAR Kl4El! WInED BALANCE TRANSFER TO GUAR HRIST ANTEROPOSTE LATERAL BALANCE TRANSFER TO GUAR PERFORMED BV, TRAUMA sURGERV DIY INITIAL HOSPiIAL CARE BALANCE TRANSFER TO GUAR PERFORMED Bf' DIY OF DIAG RADIOLOGV PLACE OF SYC, EMERGENCV RDOH C T ABDOMEN ENHANCED 8ALANCE TRANSFER TO GUAR CT PELVIS ENHANCED BALANCE TRANsFER TO GUAM PERFORMED 8V, DIY OF ANESTHESIA OFFICE CONSULTATION BALANCE TRANSFER TO GUAR PERFORMED BV: DIY OF DIAG RADIOLOGV PLACE OF SYC, INPATIENT ORTHOPANTOGRAM BALANCE TRANSFER TO GUAR PERFORMED BY, DIY PLASTIC RECONST SURG FRAC MANDIBULAR OPEN H MA BALANCE TRANSFER TO GUAR 06/25/03 99291. 25 850.5 10/201ll3 06/25/03 51702.GC 850.5 10/20/03 06/25/03 99253.57 B02.20 10/20/03 06/25/03 7045026 959,01 10/20/03 06/25/03 7637526 959.01 10/20/03 06/25/03 7035526 802.20 lU120/03 06/25/03 7101026 959.1 10120/03 06/25/03 7204026 959;1 10/20/03 06/25/03 7117026 959.1 10/20/03 06/25/03 7356026 959.1 10/20/03 06/25/03 7356026 959,1 10/20/03 06/25/03 7310026 959,1 10/20/03 06/25/03 99222 959.8 101Z0/03 06/25/03 7416026.GC lU/20/03 06/25/03 7Z19326.GC 10/Z0/03 789,00 789.00 061Z5/03 10/20/03 99243 959,8 06/27/03 7035526 10/20/03 Y54,19 06/27/03 10/20/03 802.20 l1453 TONY L JR HURLEY 321 N EAST STREET CARLISLE PA 17013.2008 ACCOUNT # 1328836 1 or 3 STATEMENT DATE: 02124/04 LAST STATEMENT DATE: 02116104 FED TAX 10 # 251857035 INS (:HARGE PAYMENTI GUARANTOR , ADJUSTMENT BALANCE CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK A-~ PENNSTATE !$l The Milton S. Hershey Medical Center . The College of Medicme TONY L JR HURLEY 321 N EAST STREET CARLISLE PA 17013-2008 PAGE 2.r 3 ACCOUNT # 1328836 STATEMENT DATE: 02/24/04 lAST STATEMENT DATE: 02/16/04 FED TAX 10 # 251857035 INS ~HARGE PAVMENTI GUARANTOR ADJUSTMENT BALANCE .El IF ANY QUESTIONS, PLEASE CONTACT: MSHMC PATIENT FINANCIAL SERVICES DATE PROCEDURE DIAG QTV DESCRIPTION CODE CODE PERFORMED BY, DIV OF ANESTHESIA PLACE OF SVC: SURGERY - SHORT STAY 06/27/03 21453,AA 802.20 11 TAT OPN MAND FRAC HlHANIP 10/20/03 BALANCE TRANSFER TO GUAR 825.00 825.00 06/30/03 99213 959.8 06/30/03 06/30/03 MAHCV 959.8 11/05/03 11/05/03 11/05/03 354m8 PERFORMED BY: TRAUMA SURGERY DIV PLACE OF SVC: OP PHYSICIAN OUTPATIENT VISIT EST OUTPATIENT VISIT EST PLACE OF SVC: OP HOSPITAL HOSP OUTPT CLINIC VISIT APPLIED TO DEDUCTIBLE MEDICAID CONtRACTUAL AOJ BALANCE AFTER INS* BALANCE: TONV L JR HURLEV $4989.00 IF VOU HAVE ANY QUESTIONS ABOOT TIlE .AHDlM' V[l\)JlINSURANCE COMPANY PAID, CONTACT THEM DtRECTLV. FOR ANY OTHER QUESTIONS REGARDING YOUR BALA~, PLEASE CONTACT ollR OFFICE.. IF PAYMENT HAS BEEN MADE, THANK YOU AND DISREGARD THIS BILL. PLEASE FORMARD TO CNRIGHT, CUST SERV A-K THANK YOU FOR USING HSHMC PHYSICIANS GROUP fOR VOlJR PHVSICIAN SERVICES. IF YOU HAVE ANV QUESTIONS REGARDING THIS BIll, PLEASE CONTACT US AT 717-531-5069 OR 800-254-2619, BETWEEN 8:00AM AND 5:30PM MONDAY THROUGH NEDNESDAY OR BETI'lEEN 8:00AM AND 4,30PM THURSDAY AND FRIDAY. 60,00 60.00- 0.00 74.00 0;00 34.00- 40.00 CHECK BOX AND ENTER ANV ADDRESS OR INSURANCE CORRECTIONS ON BACK A -~ PENN STATE !5:! The Milton S. Hershey Medical Center . The College of Medieme TONY L JR HURLEY 321 N EAST STREET CARLISLE PA 17013.2008 PAGE 3 of 3 STATEMENT DATE: 02124/04 LAST STATEMENT DATE: 02/16/04 FED TAX ID # 251857035 'CHARGE PAYMENT/ CUARANTOR , ADJUSTMENT BALANCE ACCOUNT # 1328836 18 IF ANY QUESTIONS, PLEASE CONrACT: MSHMC PATIENT FINANCIAL SERVICES DATE PROCEDURE DIAG nTY DESCRIPTION CODE CODE '" INS i)AlANCE SUI1I1ARY RESPONSIBLE PARTY """ GUARANTOR RESPONSIIlIlITY polXCY " TOTAL t 4989.00 ________~_~______________~____1~!~.e..Qkr6Mtt!':..'"_~~;fl..€ll~lAfftA1JP-f{'irp'-'!fj_l!-'lr1J!M.f.QBJ-'P...IJ~gf..PX~JJ]~ll:t!_'!f../J..Jj-'{9J!.!LeAtMrltcl__~..___.._____________________ STATEM~NT DATE: GUARANTOR RUJ'lONSlBIL1TY: MtNlMUM PAYM~N1 02/24/04 $ 4989,00 $ 4989.00 BF6 MSHMC PHYSICIANS GROUP BILLING SERVICES P O.1l0X 854 HERSHEY PA 17033,0854 00001328836 UP 0000000000498900022404 ""11,1.1",1,1.11",1"1,,11..,11...,11..11.,,,1,,,11,'.,1,1 M~ MSHMC PHYSICIANS &ROUP To 1",11I..,111"",.11..11.,.1,111...11,..1,.1".1.1.,,11.1,1,1 PO BOX 643313 PITTSBURGH PA 15264-3313 TONY l JR HURLEY 321 N EAST STREET CARLISLE PA 17013-2008 He , F61l0 TYP, DMND CARDHOLDER NAME (PRINT) $%mw~IJ:Jffir,~al~W_~ 1328836 a'1l;!i" ,J -~ $ 4989.00 03/16/04 ~:ll~ .:._....;/lkr..CHF.CIC\lI.ll.\WABf..,To:Y.'",.., ,. .". MSHMC PHYSICIANS GROUP OFFICE USE ONJ.Y .; CHECK ONE FOR CRfOrr CARD F'AYMENT, PLEASE FILL IN INFORMATION BElOW _Mle _VISA IIII II lllllllllll CARD NUMBER EXP DATE CREDIT CARD SIGNATURE o CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK A " PEi'l N STATE !S:l Milton $, Hershey Medical Center ., College of Medicine AUTHORIZATION FOR BENEFIT ASSIGNMENT AND INFORMATION RELEASE NAME: HURLEY TONY L J~ Me: CHEAAY ROBERT A IAR#: 1.328836 008: 04/1611982 ,INs: SELF PAY !..oc; SURG 00811: 3542978 MO#: 20313 SEX: M VIS!T DATE: 06/3012003 , I hereby assign any benefits payable to The Milton S. Hershey Medical Center for providing medical services. I understand that I am responsible for any balance in excess of the benefits/contract payable by this plan. The Milton S. Hershey Medical Center may disclose information about me and the treatment I am receiving, including copies of my medical record for purposes of treatment, payment and medical center operations as described in our Privacy Notice. I acknowledge that I have been offered the Hershey Medical Center Privacy Notice. :~~" ~P~'"ornt;" ~-\A\lAi?\\ ~o 0:~'I\ 0 ~ Date ~\~ Print Name \\\~U\~, Relationship to Patient Privacy Notice Offered - Patient Unable to Sign Privacy Notice Offered - Patient Declined to Sign Other DO NOT COpy THIS FORM. ORDER FORMS FROM HMC STORES, CAT. #83012 MR 889 (5/03) h HURLE~, TONY L. JR. f,il328836 $20,507.25 4,989.00 (Hasp) (Phys) VERIFICATION LINDA SCHLADER hereby states that she is the Super- visor of Financial Counselors and Collection of Milton S, Hershey Medical Center, The Pennsylvania State University and verifies that the statements made in the foregoing pleading are true and correct to the best of her knowledge, information and belief, The undersigned understands that the statements therein are made subject to the penalties of 18 Pa, C,S, ~4904 relating to unsworn falsification to authorities, ~~ DATE: C1~"H)Y ~,~ -fj-..... "....J -SI 2; -J C/'l.:J 81\ ~ c!f U'; <?'I~ ~ ~ j" :~: ,," ,....., ::':'"' (.~ );.... {'''~ ~i:: n., -< (") (~; rd ~' 'I' I n ..... ~ 0 ..,.. -n o " -~ ", CO ::;J:!l ni~ ~~ -0 =r :tl ::.;;:: ~~C5 ~ (')m :::-i ~'O c.: o -J ~ . , TABAS & aOSEN, P.C. BY: LEWIS C. 'l'RAtJI"FER, ESQUIRE ID No.: 60267 1845 Walnut Street, 22nd Floor Philadelphia, PA 19103 (215) 569"5050 . THE MILTON S. HERSHEY MEDICAL CENTER P~O. BOX 853 HERSHEY, PA 17033 COURT OF COMMON PLEAS CUMBERLAND COUNTY VS. TONY L. HURLEY, JR. & BETH A. HURLEY 321 NORTH EAST ST., CARLISLE, PA 17013 ORDER FOR JUDGMENT FOR WANT OF AN ANSWER AND ASSESSMENT OF DAMAGES NO.: 04-5434 TO THE PROTHONOTARY: Kindly enter judgment in the sum of $ 27,734.52 in favor of the Plaintiff(s) in the above entitled matter for failure of the Defendant(s) to file an Answer 'to Plaintiff(s) Complaint in Civil Action and assess Plaintiff(s) damages as follows: Amount of Claim: $ 25,496.25 Interest at 6% per annum from date of discharge Total 2,238.27 $ 27,734.5,2 '-- /~ -- ~ Ie::::> At~ney fo Plaintiff(s) I assess damages~ove f:;;~:o7L 0 I....~...::::~................,~y certify that th~ 10 day letter '~~~"R.C.P.R. 237.1 was forwarded t04 TONY L. HURLEY, JR. & Oef.endant BETH A,. HURLEY 321 NORTH EAST STREET Ad4t~ CARLISLE, PA 17013 8M. R~QEMDE~ 30, 2004 I""~:'::~- _ :-........-:?............ 'certit} that the above names are correct and th~ Precrise Residence ~.ddress of the Judgrmmt creditor Is Ad d.ress ..,......,.... _......... e.?-m~......, ............ .:... ...._.... Address of ,1p-ff!hiants ....................s.AUle....................__ THE MILTON S. HERSHEY ~EDICLA'CENTER COURT OF COMMON PLEAS VB TONY' L. HURLEY, JR. & BETH HURLEY CUMEB~RLAND COUNTY NO. 04-5434 AFFIDAVIT OF NON MILITARY SERVICE COMMONWEALTH OF PA ~ COUNTY OF PHILADELPHIA LEWIS C. TRAUFFER being legally swornr deposes and says: (a) that the defendant(s) is/are not in the Military or . Naval Service of the United States or of its allies, or otherwise within the provisions of the Soldiers' and Sailors' . Civil relief action of Congress of 1940. as amended; (b) that defendant TONY L. HURLEY is over 21 years of age and resides at 321 NORTH EAST STREET, CARLISLE, PA 17013 and is employed in Private Business. that defendant BETH A. HURLEY is over 21 years of age and resides at 321 NORTH EAST STREET, CARLISLE, PA 17013 and is employed in Private Business. ( c) Affiant has ascertained the foregoing information by inquiry and belief and makes this Affidavit with due authority. LE~~FFER, ES~RE Attorney for the Plaintiff COMMONWEALTH OF'PENNSVLVANIA NOTARIAL SEAL KENNETH C. SLOV'TSKY, Notary Public City of Philadelphia. Phila, County My Commission Expires Nov~mber 17, 2008 TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER, ESQUIRE ID No.: 60267 1845 Walnut Street, 22nd Floor Philadelphia, PA 19103 (215)569-5050 The Milton S. Hershey Medical Center P.O. Box 853 Hershey, PA 17033 COURT OF COMMON PLEAS CUMBERLAND COUNTY VS NO. 04-5434 Tony L. Hurley, Jr. & Beth A. Hurley 321 North East Street Carlisle, PA 17013 NOTICE OF INTENTION TO TAKE DEFAULT JUDGMENT TO: Tony L. Hurley, Jr. 321 North East Street Carlisle, PA 17013 DATE OF NOTICE/FECHA DEL AVISO: NOVEMBER 30, 2004 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE, A JUDGEMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. 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 or (800) 990-9108 AVISO IMPORTANTE USTED SE ENCUENTRA EN ESTADO DE REBELDIA POR NO HABER PRESENTADO UNA COMPARECENIA ESCRITO CON ESTE TRIBUNAL SUS DEFENSAS U OBJECTIONES A LOS RECLAMOS FORMULADOS EN CONTRA SOYO. AL NO TOMAR LA ACCION DEBIDA DENTRO DE DIEZ DIAS DE LA FECHA DE ESTA NOTIFICATION, EL TRIBUNAL PODRA, SIN NECESIDAD DE COMPARECER USTED EN CORTE U OIR PREUBA ALGUNA, DICTAR SENTENCIA EN SU CONTRA Y USTED PODRIA PERDER BIENES U OTROS DERECHOS IMPORTANTES. USED DEBE LLEVAR ESTE AVISO A UN ABOGADO ENSEGUIDA. SI USTED NO TIENE ABOGADO, VAYA PERSONALMENTE o LLAME POR TELEFONO A LA OFICINA MENCIONADA A CONTINUACTION. ESTA OFICINA LE PUEDE PROVEER LA INFORMACION NECESARIA PARA CONTRATAR A UN ABOGADO. SI USTED CARECE DE LOS MEDIOS NECESARIOS PARA CONTRATAR A UN ABOGADO, DICHA OFICINA LE PUEDE SUMINISTRAR LA INFORMACION NECESSARIA ACERCA DE AQUELLAS AGENCIAS QUE OFRECEN SERVICIOS LEGALES A LAS PERSONAS QUE TIENEN DERECHO A RECIBIR TAL AYUDA GRATIS 0 A UNA CUOTA REDUCIDA. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 or (800) 990-9108 LEWIS C. TRAUFFER, ESQUIRE ATTORNEY FOR THE PLAINTIFF THIS CORRESPONDENCE IS BEING USED TO COLLECT A DEBT AND THE INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER, ESQUIRE ID No.: 60267 1845 Walnut Street, 22nd Floor Philadelphia, PA 19103 {215}569-5050 The Milton S. Hershey Medical Center P.O. Box 853 Hershey, PA 17033 COURT OF COMMON PLEAS CUMBERLAND COUNTY VS NO. 04-5434 Tony L. Hurley, Jr. & Beth A. Hurley 321 North East Street Carlisle, PA 17013 NOTICE OF INTENTION TO TAKE DEFAULT JUDGMENT TO: Beth A. Hurley 321 North East Street Carlisle, PA 17013 DATE OF NOTICE/FECHA DEL AVISO: NOVEMBER 30, 2004 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE, A JUDGEMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. 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 or (800) 990-9108 AVISO IMPORTANTE USTED SE ENCUENTRA EN ESTADO DE REBELDIA POR NO HABER PRESENTADO UNA COMPARECENIA ESCRITO CON ESTE TRIBUNAL SUS DEFENSAS U OBJECTIONES A LOS RECLAMOS FORMULADOS EN CONTRA SOYO. AL NO TOMAR LA ACCION DEBIDA DENTRO DE DIEZ DIAS DE LA FECHA DE ESTA NOTIFICATION, EL TRIBUNAL PODRA, SIN NECESIDAD DE COMPARECER US TED EN CORTE U OIR PREUBA ALGUNA, DICTAR SENTENCIA EN SU CONTRA Y US TED PODRIA PERDER BIENES U OTROS DERECHOS IMPORTANTES. USED DEBE LLEVAR ESTE AVISO A UN ABOGADO ENSEGUIDA. SI USTED NO TIENE ABOGADO, VAYA PERSONALMENTE o LLAME POR TELEFONO A LA OFICINA MENCIONADA A CONTlNUACTION. ESTA OFICINA LE PUEDE PROVEER LA INFORMACION NECESARIA PARA CONTRATAR A UN ABOGADO. SI USTED CARECE DE LOS MEDIOS NECESARIOS PARA CONTRATAR A UN ABOGADO, DICHA OFICINA LE PUEDE SUMINISTRAR LA INFORMACION NECESSARIA ACERCA DE AQUELLAS AGENCIAS QUE OFRECEN SERVICIOS LEGALES A LAS PERSONAS QUE TIENEN DERECHO A RECIBIR TAL AYUDA GRATIS 0 A UNA CUOTA REDUCIDA. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 or (800) 990-9108 LEWIS C. TRAUFFER, ESQUIRE ATTORNEY FOR THE PLAINTIFF THIS CORRESPONDENCE IS BEING USED TO COLLECT A DEBT AND THE INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. ~If( F ~ ~ ~ ~ ~ r: R ~ it ;a o ~~ -~ -L... . ~ " \ . ~... i" .. ~:. - ~ r-..' (") C'::^,) C';") -'",1 .,. r~' ~_. ~ -', I i ' . " () t --n , i ~, 1 \ :) (:'" '~ .' i ,- j --\"', .-. - --' , - i , C.) ", ':--- r....,) > L " . -<. TABAS & ROSEN, P,C. BY: LEWIS C. TRAUFFER I,D. #60267 22nd Fl,,1845 Walnut Street Philadelphia, PA 19103 (215)569-5050 Attorney for Plaintiff THE MILTON S. HERSHEY MEDICAL CENTER COURT OF COMMON PLEAS CUMBERLAND COUNTY VS TONY L. HURLEY, JR, & BETH A, HURLEY NO, 04-5434 and COMMERCE BANK, Garnishee PRAECIPE TO DISSOLVE WRIT OF ATTACHMENT TO THE PROTHONOTARY: Kindly dissolve the Writ of Attachment regarding the above captioned case against COMMERCE BANK, Garnishee, ------.-'^~ ~~~ ----. LEWIS C, T FER, ESQUIRE Attorney fo~ Plaintiff ,~~ ;D ('- ~kJ ~~ l-J\ ~ s~, c; ('~;:.> -n d' "" rn o \ - -- .' (Jl .~::~ - . . ..... SHERIFF'S RETURN - REGULAR CASE NO: 2004-05434 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND MILTON S HERSHEY MEDICAL CENTE VS HURLEY TONY L JR ET AL SHANNON SHERTZER , Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE HURLEY TONY L JR DEFENDANT was served upon the at 321 N EAST STREET , at 2120:00 HOURS, on the 9th day of November, 2004 CARLISLE, PA 17013 TONY HURLEY by handing to a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 18.00 3.70 .00 10.00 .00 31.70 Sworn and Subscribed to before liP me this..f'"...--/' day of ~ c1.tW/ A.D. I Ch /) 'v..' A Oi'i-j~ . 'A..t. ~ LL Intl,fu) 'T-J othonotary , So Answers: ~~~ R. Thomas Kline 11/10/2004 TABAS B:' ROS~ k c;jj;;. Deputy Sherif SHERIFF'S RETURN - REGULAR CASE NO: 2004-05434 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND MILTON S HERSHEY MEDICAL CENTE VS HURLEY TONY L JR ET AL SHANNON SHERTZER , Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon HURLEY BETH A the DEFENDANT , at 2120:00 HOURS, on the 9th day of November, 2004 at 321 N EAST STREET CARLISLE, PA 17013 by handing to TONY HURLEY, ADULT IN CHARGE a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge So Answers: 6.00 .00 .00 10.00 .00 16.00 ~. y '.' 'r~~~f:j6~-< ,~~ R. Thomas Kline 11/10/2004 TABAS & ROSEN Sworn and Subscribed to before By: me this .5'::: day of q~ ~tV,1 A.D. Ck~~htd2~~AJ;4 ...' It, ...., SHERIFF'S RETURN - GARNISHEE CASE NO: 2004-05434 P COMMONWEALTH OF PENNSLYVANIA COUNTY OF CUMBERLAND MILTON S HERSHEY MEDICAL CENTE VS HURLEY TONY L JR ET AL And now HAROLD WEARY ,Sheriff or Deputy Sheriff of Cumberland County of Pennsylvania, who being duly sworn according to law, at 0010:05 Hours, on the 25th day of January , 2005, attached as herein commanded all goods, chattels, rights, debts, credits, and moneys of the within named DEFENDANT HURLEY TONY L JR in the hands, possession, or control of the within named Garnishee COMMERCE BANK 65 ASHLAND AVE CARLISLE, PA 17013 Cumberland County, Pennsylvania, by handing to TRACY MORIN ASST BRANCH MANAGER personally three copies of interogatories together with 3 true and attested copies of the within WRIT OF EXECUTION and made the contents there of known to Her . Sheriff's Costs: Docketing Service Affidavit Surcharge .00 .00 .00 .00 .00 .00 County 00/00/0000 Sworn and subscribed to before me this .:< ~ day of dpi,.". A. ,;LtC .5 A. D . 7 ~ /I \r. 7 .- . (.I!, n1<-.[C-IJ, I\~~ P 0 honotary ) By 71al lJ",~ . Deputy eriff ..... -.. SHERIFF'S RETURN - GARNISHEE CASE NO: 2004-05434 P COMMONWEALTH OF PENNSLYVANIA COUNTY OF CUMBERLAND MILTON S HERSHEY MEDICAL CENTE VS HURLEY TONY L JR ET AL And now HAROLD WEARY ,Sheriff or Deputy Sheriff of Cumberland County of Pennsylvania, who being duly sworn according to law, at 0010:05 Hours, on the 25th day of January , 2005, attached as herein commanded all goods, chattels, rights, debts, credits, and moneys of the within named DEFENDANT HURLEY BETH A , ln the hands, possession, or control of the within named Garnishee COMMERCE BANK 65 ASHLAND AVE CARLISLE, PA 17013 Cumberland County, Pennsylvania, by handing to TRACY MORIN ASST BRANCH MANAGER personally three coples of interogatories together with 3 true and attested copies of the within WRIT OF EXECUTION and made the contents there of known to Her . Sheriff's Costs: Docketing Service Affidavit Surcharge ~,_#!", .00 .00 .00 .00 .00 .00 R. Thomas Kline Sheriff of Cumberland County 00/00/0000 Sworn and subscribed to before me thi.s ~ /1l-,?{ day of..1 ~'7 .;2ro::.. A.D. gJfo;oti?r;U1f~ ~ By COMMONWEALTH OF PENN,~YLVANIA COUNTY OF CUMBERLAND MILTON S. HERSHEY MEDICAL CENTER VS TONY L. HURLEY, JR. & BETH A. HURLEY COURT OF COMMON PLEAS NO. 04-5434 PRAECIPE FOR WRIT OF EXECUTION TO THE PROTHONOTARY: Issue writ of execution in the above matter, directed to the Sheriff of Cumberland County: (1) against TONY L. HURLEY, JR. & BETH A. HURLEY 321 North East Street Carlisle, PA 17013 defendant(s) and (2) against COMMERCE BANK 65 Ashland Avenue Carlisle, PA 17013 (3) AMOUNT DUE INTEREST FROM 6/03 AT 6% PER ANNUM $ 25,496.25 garnishee(s). (COSTS TO BE ADDED) $ 2,238.27 $ $ TABAS & ROSEN, P.c. L~~fer, ES~, 1845 Walnut Street, 22nd Floor Philadelphia, PA 19103 (215) 569-5050 1/60267 Attorney for Plaintiff ~ "t. ~ N~ ~ ~ ~ 1J-e> <0 \).J ~ -C ..c:. ~....J ~ lJ-..l ~ ~ 'fr- '(S. (. \i ~ ~ ~ - en '" \,;. \> f~ -\,g. -"" - V\_wV\ w ll>...oV\~-:-' \>." ~-tll'\ '~ ~ ~ 0 ~ v ~J \ \ , ~: \r _: ~- ":---~-:f- - ~ (<.~ .- ....-,... ~,:.; c.n. ,~', ......) WRIT OF EXECUTION andlor ATTACHMENT COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND) TO THE SHERIFF OF CUMBERLAND COUNTY: To satisfy the debt, interest and costs due MILTON S. HERSHEY MEDICAL CENTER, NO 04-5434 Civil CIVIL ACTION - LAW Plaintiff (s) From TONY L. HURLEY, JR. & BETH A. HURLEY, 321 NORTH EAST STREET, CARLISLE, PA 17013 (1) You are directed to levy upon the property of the defendant (s)and to sell (2) You are also directed to attach the property of the defendant(s) not levied upon in the possession of COMMERCE BANK, 65 ASHLAND AVENUE, CARLISLE, PA 17013- INTERROGATORIES GARNISHEE(S) as follows: and to notify the garnishee(s) that: (a) an attachment has been issued; (b) the garnishee(s) is enjoined from paying any debt to or for the account ofthe defendant (s) and from delivering any property of the defendant (s) or otherwise disposing thereof; (3) If property of the defendant(s) not levied upon an subject to attachment is found in the possession of anyone other than a named garnishee, you are directed to notify hirnlher that helshe has been added as a garnishee and is enjoined as above stated. Amount Due $25,496,25 L.L. $,50 Interest FROM 6/03 AT 6% PER ANNUM - $2,238.27 Atty's Comm % Atty Paid $130.20 Plaintiff Paid Due Prothy $1.00 Other Costs Date: JANUARY 14, 2005 CURTIS R. LONG (Seal) , ProthO:;Z: ~ a-,. , p ~~ 4 _ It.- .r--------~ Deputy REQUESTING PARTY: Name LEWIS C. TRAUFFER, ESQUIRE Address: TARAS & ROSEN, p,c. 1845 WALNUT STREET, 22NO FLOOR PHILADELPHIA, PA 19103 Attorney for: PLAINTIFF Telephone: 215-569-5050 Supreme Court In No. 60267 TABAS & ROSEN, P.C, BY: LEWIS C, TRAUFFER, ESQUIRE I.D, #60267 22nd FI, 1845 Walnut Street Philadelphia, PA 19103 (215) 569-5050 Attorney for Plaintiff MILTON S. HERSHEY MEDICAL CENTER COURT OF COMMON PLEAS CUMBERLAND COUNTY vs TONY L, HURLEY, JR, & BETH A, HURLEY, h/w NO, 04-5434 PRAECIPE TO SATISFY JUDGMENT TO THE PROTHONOTARY: please mark the Judgment entered in the above matter against Tony L. Hurley, Jr. and Beth A. Hurley, h/w, satisfied. ~ ~ ------- LEWIS C, UFFER, ESQUIRE Attorney for Plaintiff Ci C':' Milton S. Hershey Medical Center VS Tony L. and Beth A. Hurley Writ of Execution Docket No. 2004-5434 Civil Term F~L.E(.t-try i~"~F OF T!-{F P"~~'~C?"~~TARY 209 SAP i I ~!~ 8~ ~~ i'~1~1, v;~'~ ~..V~P~,;t~ R. Thomas Kline, Sheriff, who being duly sworn according to law, states this writ is returned ABANDONDED. No action has been taken in the last six months. Sheriff s Costs: Docketing $18.00 Surcharge 30.00 Garnishee 9.00 Levy 20.00 Mileage 3.70 Prothonotary 1.50 Poundage 1.64 , `~ / 9' 1y ~ 0~ `~` $83.84 So Answers: ~~~ R. Thomas Kline, Sheriff BY Serge t j ~, (?,,. v ~ '~ 5 C~ 7l ~ ~3