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HomeMy WebLinkAbout13-1052Law Offices of James P. Carfagno, LLC ~ ' James P. Carfagno, Esquire ~ :_~ ~ ~~ ~ ~ ~ ,4 ~`~. ,., , P.O. Box 2688 Vincentown, NJ 08088 ~+~"~~ _i+ ~., ; ~;. ~ : ; (609)388-4012 F E ~ ~~ S Y! ,,. ; ~ : , ; ; Facsimile: (609)388-4013 Attorney for Plaintiff Selective Way Insurance Company a/s/o S & A Homes, Inc. SELECTIVE WAY INSURANCE COMPANY a/s/o S & A Homes, Inc. Plaintiff(s) :COURT OF COMMON PLEAS :CUMBERLAND COUNTY DOCKET NO.: ! 3 - vs. JENNIFER CLIFTON CHRISTOPHER CHAMBERS Defendant(s) PRAECIPE TO DOCKET THE JUDGMENT TO THE PROTHONOTARY: Please docket a Judgment in favor of Plaintiff, Selective Way Insurance Company a/s/o S & A Homes, Inc., and against Defendants Jennifer Clifton and Christopher Chambers . 1. On January 8, 2013, Judgment was entered against Defendants Jennifer Clifton and Christopher Cambers in the amount of $12,233.46. See The Certified Copy of the District Court Judgment against Jennifer Clifton and Christopher Chambers, attached hereto as Exhibit "A". ~3 /~ ~S 1'~ e~ ~s7 ~, ~ 1.,~ ~~ _ rr,.z. ~ ~~, 2. Court costs to transfer the Judgment from District Court to the Court of Common Pleas of Cumberland County is $31.25. 3. A Certification of addresses is attached hereto. Law Offices of.,,kynes P. CarFagno, LLC Dated: February 15, 2013 _. ~``~ ,. James P. Carfagno CERTIFICATION OF ADDRESSES OF PARTIES I, James P. Carfagno, Attorney for Plaintiff, hereby verify that the addresses of the parties stated below are true and correct to the best of my knowledge, information, and belief. I understand that false statements are subject to the penalties of 18 PA.C.S. Section 4904, relating to falsification of authorities. PLAINTIFF Selective Way Insurance Company P.O. Box 763 Branchville, NJ 07826 DEFENDANT Jennifer Clifton 122 Virginia Avenue Carlisle, PA 17013 Christopher Chambers 223 Center Street Everett, PA 15537 Law Offices o es P. Carfagno, LLC Dated: February 15, 2013 James P. Carfagno EXHIBIT A CQ M NWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Plaintiff Selective Way Insurance Co Selective Way Insurance Co Mag. Dist. No: MDJ-09-2-01 MDJ Name: Honorable Paul M Fegley Address: 2260 Spring Road, Suite 3 Carlisle, PA 17013 Telephone: 717-218- 52 50 James P. Carfagno, Esq. Law Offices of James P. Carfagno, LLC P.O. Box 2688 Vincentown, NJ 08088 Disposition Summary MJ-09201-CV-0000126-2012 MJ-09201-CV-0000126-2012 Judgment Summary Participant Christopher P Chambers Jennifer Clifton Selective Way Insurance Co Notice of JudgmentlTranscript Civii Case Selective Way Insurance Co v. Jennifer Clifton, Christopher P Chambers Defendant Jennifer Clifton Christopher P Chambers JointlSeveral Liability $12,233.46 $12, 233.46 $0.00 Individual Liability $0.00 $0.00 $0.00 Docket No: MJ-09201-CV-0000126-2012 Case Filed: 10!22/2012 o~ Disposition Date Default Judgment for Plaintiff 01 /08/2013 Default Judgment for Plaintiff 01/08/2013 Amount $12,233.46 $12,233.46 $0.00 Judgment Detail ("Post Judgment) In the matter of Selective Way Insurance Co vs. Jennifer Clifton; Christopher P Chambers on 1/08/2013 the judgment was awarded as follows: Judgment Component JointlSeveral Liability Individual Liability Deposit Applied Amount Civil Judgment $11,161.20 $0.00 $11,161.20 Attorney Fees $838.80 $0.00 $838.80 Filing Fees $163.00 $0.00 $163.00 Server Fees $70.46 $0.00 $70.46 Grand Total: $12,233.46 ANY PARTY HAS THE RIGHT TO APPEAL WITHIN 30 DAYS AFTER THE ENTRY OF JUDGMENT BY FILING A NOTICE OF APPEAL WITH THE PROTHONOTARYICLERK OF COURT OF COMMON PLEAS, CIVIL DIVISION. YOU MUST INCLUDE A COPY OF THIS NOTICE OF JUDGMENT/TRANSCRIPT FORM WITH YOUR NOTICE OF APPEAL. E)FCEPT AS OTHERWISE PROVIDED IN THE RULES OF CIVIL PROCEDURE FOR MAGISTERIAL DISTRICT JUDGES, IF THE JUDGMENT HOLDER ELECTS TO ENTER THE JUDGMENT IN THE COURT OF COMMON PLEAS, ALL FURTHER PROCESS MUST COME FROM THE COURT OF COMMON PLEAS AND NO FURTHER PROCESS MAY BE ISSUED BY THE MAGISTERIAL DISTRICT JUDGE. UNLESS THE JUDGMENT IS ENTERED IN THE COURT OF COMMON PLEAS, ANYONE INTERESTED IN THE JUDGMENT MAY FILE A REQUEST FOR ENTRY OF SATISFACTION WITH THE MAGISTERIAL DISTRICT JUDGE IF THE JUDGMENT DEBTOR PAYS IN FULL, SETTLES, OR OTHERWISE COMPLIES WITH THE JUDGMENT. ` l S Date Magisterial District Judge Paul M Fegley .,f#~H.I ~~\ ~,`~t tury,^~M1rr C t~. .. .. .... ^.~ i certi y t at t is is a rue an correct copy o t e recor o t e procee ings ~rnng t e lu gment. r Date Magisterial Di rict Judge MDJS 315 Page 1 of 2 Printed u2/1112013 3:35:48PM Selective Way Insurance Co ' v. Jennifer Clifton, Christopher P Chambers Participant List Plaintiff(s) Selective Way Insurance Co a/s/o S & A Homes, Inc. Po Box 763 Branchville, NJ 07826 Defendant(s) Christopher P Chambers 223 Center St. Everett, PA 15537 Jennifer Clifton 122 Virginia Ave Carlisle, PA 17013 Complainant's Attorney(s) James P. Carfagno, Esq. Law Offices of James P. Carfagno, LLC P.O. Box 2688 Vincentown, NJ 08088 Docket No.: MJ-09201-CV-0000126-2012 MDJS 315 Page 2 of 2 Printed: 02/11/2013 3:35:48PM MAILING CERTIFICATION I, James P. Carfagno, of full age, hereby certify as follows: I am employed by Law Offices of James P. Carfagno, LLC, counsel for Plaintiff, and on February 15, 2013, I mailed a copy of Plaintiffs Praecipe to Transfer Judgment against Defendants via certified and regular mail, to the following: Jennifer Clifton 122 Virginia Avenue Carlisle, PA 17013 Christopher Chambers 223 Center Street Everett, PA 15537 Law Office James P. Carfagno, LLC Dated: February 15, 2013 - "~ James P. Carfagno OFFICE OF THE PROTHONOTARY COURT OF COMMON PLEAS-CUMBERLAND COUNTY One Courthouse Square Carlisle, PA 17013 SELECTIVE WAY INSURANCE COMPANY a/s/o S & A Homes, Inc. Plaintiff(s) vs. JENNIFER CLIFTON CHRISTOPHER CHAMBERS COURT OF COMMON PLEAS CUMBERLAND COUNTY DOCKET NO.: Defendant(s) NOTICE Pursuant to Rule 236 of the Supreme Court of Pennsylvania, you are hereby notified that Selective Way Insurance Company a/s/o S & A Homes, Inc. has caused a Judgment to be entered against you in the above proceeding as a result of the transfer of the Judgment Court 09-2-01 in the amount of $12, on January 8, 2013 in District ~,z. DA D. BUELL, PROTHONOTARY If you have any questions concerning this notice, please contact: Law Offices of James P. Carfagno, LLC James P. Carfagno, Esquire P.O. Box 2688 Vincentown, NJ 08088 (609)388-4012 Facsimile: (609)388-4013 R Law Offices of James P. Carfagno, LLC 3� O TH0740 T'AR Y James P. Carfagno, Esquire P.O. Box 2688 2013 APP 29 PM 4, 2 Vincentown, NJ 08088 CUMBERLAND COUNTY(609)388-4012 , Facsimile: (609)388-4013 E'ENN5 l.YANlA Attorney for Plaintiff Selective Way Insurance Company a/s/o S &A Homes, Inc. SELECTIVE WAY INSURANCE COMPANY a/s/o S &A Homes, Inc. :COURT OF COMMON PLEAS :CUMBERLAND COUNTY Plaintiff(s) DOCKET NO.: 13-1052 vs. JENNIFER CLIFTON CHRISTOPHER CHAMBERS Defendant(s) PRAECIPE TO CERTIFY THE MOTOR VEHICLE JUDGMENT TO THE PROTHONOTARY: Please certify a motor vehicle Judgment form DL-201 in favor of Plaintiff, Selective Way Insurance Company a/s/o S &A Homes, Inc., and against Defendants Jennifer Clifton and Christopher Chambers. 1. On January 8, 2013, Judgment was entered against Defendants Jennifer Clifton and Christopher Cambers in the amount of$12,233.46. See The Certified Copy of the District Court Judgment against Jennifer Clifton and Christopher Chambers, attached hereto as Exhibit "A". e , � a�vq Ll 2. 1 hereby swear to and affirm that this judgment derives from a motor vehicle accident that occurred on July 20, 2007. Jennifer Clifton was the driver and Christopher Chambers was the owner of the vehicle. Please see the affidavit of James P. Carfagno, Esquire and the Police Report attached hereto as Exhibit "A" and Exhibit "B" respectively. Law Offices of J P. Carfagno, LLC Dated: April 26, 2013 James P. Ca o EXHIBIT A AFFIDAVIT OF JAMES P. CARFAGNO, ESQUIRE I, James P. Carfagno, Attorney for Plaintiff, hereby affirm under oath the following as true and correct to the best of my knowledge, information, and belief. I understand that false statements are subject to the penalties of 18 PA.C.S. Section 4904, relating to falsification of authorities. 1. On July 20, 2007, Jennifer Clifton, driving a vehicle owned by Christopher Chambers was involved in an accident with a vehicle owned by S & A Homes, Inc. 2. S &A Homes, Inc. was insured by Selective Way Insurance Company as a result of this accident. Selective Way Insurance Company paid S &A Homes, Inc. for the property damage and became subrogated to the rights of S & A Homes, Inc. 3. Jennifer Clifton and Christopher Chambers agreed to reimburse Selective Way Insurance Company for the damage caused by the motor vehicle accident of July 20, 2007. 4. A judgment was entered against Jennifer Clifton and Christopher Chambers in District Court 09-2-01 on January 8, 2013 as a result of the property damage deriving from the motor vehicle accident and the breach of an agreement by Jennifer Clifton and Christopher Chambers to reimburse Selective Way Insurance Company for the property damage caused by the aforementioned motor vehicle accident. 5. The Judgment from District Court 09-2-01 was Docketed into the , , t Court of Common Pleas of Cumberland County on February 25, 2013, and it does derive from the property damage sustained in the motor vehicle accident of July 20, 2007. 6. 1 have attached hereto a Certification of Motor Vehicle Judgment, Pennsylvania Department of Transportation Form DL-201 after 60 days has expired and that this motor vehicle judgment has not been satisfied by the Defendants. 7. 1 swear that the aforementioned paragraphs are true and correct and that this judgment entered against Jennifer Clifton and Christopher Chambers is a judgment that was entered as a result of a motor vehicle accident. Law Offices of Ja . Carfagno, LLC Dated: April 26, 2013 ames P. Carfagno EXHIBIT B COMMONWEALTH OF POLICE CIIASH REPORTING FORM PENNSYLVANIA Aelq CA"Closed Reportable Crash PagQ AA 500 1 ft Yes ONo MYes ONO P 12231-3- 5 Inddcnt Number Police Agency Patrol zone N4 s- I —I / I&I a I S-1 ij Agency Name Precinct investigation Date(MM-Wri'Yl) � S r* -- Z Ns tCit Time OWP Arrival Time(Mil) lnvestieatr Badge Number –T F Raviswor Badge MUftd:t*r Approval Date (MM-DD-YYYY) lele. 10 I's-la F ry County Ncot Cetwity Name Municipality MunIcIpalky Name D&VALMed Oil 0 Sun 0 Thu Crush D" 0 Mon 10 Fri rash Date JMM-00-yyyy) Crash Time(n* No of Units People injured.7 Kfllad* •1f!-VV cornpiete Formf (=)Wed C:)Unk I IOUs CD Yes is, Workrane 29)C:) Yes M No I samol zone (:) Yes M No Notify PEN1100TO YO& M NO orrn No*Iwirt-d -- ­ "ReliFted Maintenance larnrsGCNnn-TJM CD 4 Way Intersection CD 'y'Inlerwtion C--),Mn,'e'1t=9 4 06 Midbiock C) 'T' Intersection 0 Traffic CirclR/ on 0 off Ramp C)Railroad Crossing Round About 0 on camp 0 Crossover (0 Other 3 Route Number� "t toptionao Travel Lanes Speed Limit C) North J40uso Numt- applicable) 1013(7- CD South ( Ij 1 -1 1 1 Street Name El ne Street Ending CD East For mid-block craW a#*.Use E= 4D VVM postal Home Number and make sure EETT j C:) unknovm Principal Roadway Street Name is filled in if ustriq this option ke StAW CD C Road c) Other! C) interstate County C3 Local (Not Turnpike) 0 (1=1to CD CD Private 1=0 or Street Po3d unknown Route Number S."ment(2p Travel 1.3nu speed Limit CD North j CD South Street Net" Street Ending CD Em J F 1 L—L—L I C) West Unknown Roure St Interstate Turnpike C:) Turnpike CD State c—) Local Road c) Private (D Citherl (Not Turnpike) VaWvftst) Spur Highway C3 Road or or Street Road Vnkncwm Intet"ClIng lit Num Or Mile Pot 10-t Segment Marker Feet a C)North El 171= C)South 4 Car Street Name St E dt M Please mo C:l Ea" Or Mlles % f nler f�West iftonation =T T7 for BOTH Loadmarks iniarsecth,111 Rt Nam Or Mile Post or Snent Marker Distance From Crash a rimption -11 0(D North Scene to Landmark I M.1 9R C)South Or intersecting Street Name (For Crash trervywrit '"g'B C:)Cast Larldirlark I Rnd St End# (D 1Nc5t Landmark 2) Degreft Minutes Second% Degrees Mout" Seconds r Latitude; kcrng1td.: _j Treff k faatadJZuft 0 Yield Sign CD Police Officer or ctioning (:) Eiymrgeqcy Flagman 4D No Controls C:) Preem 46 Not Applicable C:)Traffic Signal C)Active RR Crc&sing C3 01bef Type TCO Mvt= ynve Controls 5ign 0 flashing Traffic CD o S4o 'R DevIce Not Device Functioning CD Unknown Signal = unknown FunctionIA9 Property Lgoli­Aawd jif'Not Applicable.skip rest of the Or*Cimure seftril) I WWjamn (Z) North 0 e3st 0 North and South 0 All CD Not Applicable ID ParfiOHY C::)Fully (D.Unknown I Dimd6W (:--) South 0 Wm 40 East sod West (N,S,LW) of-to, Y C:)<30 Min. 40 30-60 Win. C:)1.3 hrs C)3.6 hrs 0 6-Ij hrs 0>9 hours CD Unknown V- U FORM it AA•500(IZ'ftV PENNDOT COPY CGPAPA0imwr_-ALTm oF PENNSYLVAND POLICE CRA519 REPOffIlING R)RM A Page' cr*sh Numb" AA 500 2 1 Pol-�� P1223135 otor vehicle In (Z) Hit&Run Vehicle Illegaliy Parked CD Legally Parked Non-momrized commarria C I Vehicle C CD Pedestrian Pedestrian on Skates.C) Disabled From CD Train CD Phantort,Vehicle do No :) CD in Wheelchair,ex Previous Crash to'Pedestrian*or'Pedeszrian on SkWft In Wheelchair,etc*,2==e4forn)W,Section 28i (if yes, Complete Form Q F�Unft No First Name h4l Date of 8jrt:h(MWE3D-YYYY) 1,19 IS I Lut Name TelenhjgM Number Wele? C) Address I ri I state Z, 1 1 12 Driver license Number state class -C I C AlcohoWnmx 5asoected Wryer orPoidgWa Physka(Qw4kj:m tr C:) No C:) Illegal Drugs CD medication 0 NA gnytly 1U1:gaIDoq (:D Fatigue CD Medication 40 Alcohol C:)AlcoW and Drugs Q Ur1knwin a Md� " C S'ct Asleep _ Unknoym nk Alcohol T'ast Ei.: Prfmw Vehkie Qft J n Charged? W 0 Test Not Given C) Breath CD Other _WftL MAn it 0 Blood CD Urine CD TUe-,', 4 y #0 yes C:)14D Eve,Pnxwnc* }=Driver operated 3--Dfiver Fled Scene I Afrohal Test t Rettised 0 xunk n es,'r C) TCS t, Test Given. Vehicle 4--Kh and Rup ME= (Z) Contaminated Results 2�_Nrj Drnier 9-_U4,nc#vvn 4w eryFrluer 0&--WI.Applicable 02-Private vehicle Not 04=5talti Police Vehicle 07=1hAurlicipalPoticeVeh, 09=Fedcral Goy Vefh 01=P(ivate Vehicle Ownedf Ow wdlteased by Driver 05-PENNDOT Vehicle 08-0ther Municipal 96=0ther Leased by Drive 03--Rented Vehicle 08-Other State Gov Veh Government Vehkle 99-Unknown Sane as owner First Name Owner Last Name or ausine"Name(if eedestrian,skip this Section) airi­CD I —7 it - �f-I 11-1 r- Is I r 1 0 1� P1.1 I dfifF6 1107 16 ja I A-1 Address I City I State/Zip Vehicle Make 'Make Code VIM Modest Year Vehicle Model Lee overlay) 1.1cense Plate Rep.State ESL Spored Volticit,Tavvrd Towed by W $ C3 A 4 2 d IN Yes (:D No Insurance insurance Company Palley Na 0 yes CD No (::) Un- Lnown fOGsiZd ced, ro 1=T*W.,,g Paz.Veh 4--M*WWodAa,Ho. 7-Semi-Trailer Tag No Tag Year Tag 5t ,2 TYPL Tra, 2-Touting TIUCk S-C"er 9�.OTJILW Ilin (jair tin t5.9 3=TovVjng Utility Trailer S=Full Trailer 9-Unknown Direction 0 *VCWI,&.SLV__ L-M *MavalmAr UM *S- Spacial Vehcle Color vehicle rm 05-Large Truck 20a1jrfqde,Blcyde, 06 Passenger --yellow 0fi--SUV T -131 Iver 01--Van 03 Fie Veh Carrier 07-Si oz�motcirqyde 21=0wedalcycle 00=;Not Applicable F6 1 ,311 13=T" 03--r-old 03=0U3 10--Snowmobila 22�Horse&B:r o2=Ambulance zt=Tractioi'trailer 01=61ue 09=arown 04=Small Truck I lufarm Equip 23=HoW-&Wi I 03-Police 22-Twin'trailer 02=Red 7"- ra (ff 102",Complete form 12-Construction Equip 24-Train 03-WRe 11-Purr, M,se0o,,26) 13=ATV 25=Tropq 08--QuIrver Emergency 23=Triple Trailer Vehicle 31=1viodilied Veh 04--Green 12--Other (ff*20'or 11* Complete I8--C +er Type Spec Vdh 98-01het 11--Pupil Trarg.port 99-Unknown 05=01ack 99--Unknown i 1-orm M_SeLwn 77) 19=Unk-Type Spec Veh 'J4_-Unknown initial mlerr Lott- DaMaqt Indl-Lor _ - dvrle»r 3-Downhili AWAknm 00--Non-Collision 4=Undercarriage 0=111-Jone 2-Furtcttortal 4�11clxom of Hill l4traight I 1=minor 3--Disabling lictevel of Hill 2-Curved W-12.Clock Points 15�Tovved U 2-uphili _T If] � 0 13=Top 99=Unknown 9--mknown 9-U,,,PknovA% 9=Unknovvn 4F0ft##AA-M0(1M PF_NND01f COPY COMPA01MEAL OF PEWSYLVAMA POUcE CRASH RTH EPORTIFOG FORM Parge- Crash Number AA 500 2 P1223135 TI hide in C:) Hit&Aun Vehicle CD Illegally Parked 0 LQgally Pa*ed C:) Non-Motorized coyranemw vehifie -1. ret CD Pedestrian on Sates,CD Disabled from 0 Yes Milo Q Pedestrian In WheoiChoir,etc Previous Crash (:D Train 0 Phantom Vehicle Cif"Pedestrian"or "Pedestrian on skates, in WheE4chalr,=:,CaT&et,-For-_I.W Section 28) (if ye,Complete Form C) Unit Na First Name Ml loatelof Birth(MNI-DD-YYM re—] [ 1 2-1 Delete? Lasiffame Telephone Number CD If V Address I CAV I stale zip I /o/ A 'P'f'4-'4 ta A 0, six ?,e 4 Driver UteftSe Number sate Vass LLElij / 1,5-12 k2 = akoholmruwampmw or Pedasvfan Physical ConditLan ti 0 No (::) Illegal Drugs CD Medication Apparently C) Illegal Drug Q fatigue 0 MedlcaVon 0 Alcohol CD Alcohol and D(u93 CD unknown Normal Use 0 HDO aid Been C) Sick C:) Asleep C) U4nown Astaire)rest Dupe — Ing- ary Whithr Q*Walation 40 Test Not Glyon CD Breath C:)othet Charged7 CD Yes IM No 13 0 Blood CD Urine 6 Tupkino=,nif F Akb.1 Test ftadu CD Test flefusect CD RU'nknovvn orhfar vnpf r 4 i-Driver Operated 3-Dfiver Fled Scene Test Given, Vehicle 4=1­11t:and Run CD CordamInated Remits ID 2qN0 Driver 9,--UnkrKtvvn OwnerlDrnrer 00=Not Applicable 02--Private Vehicle Not 04-State Pollee Vehicle 07mMunicipal Police Veh 09-Faderat Go-i Veh 01 mPrivate Vehicle Ovnedt 0vvnodU%ed by Driver 05�NNDOY vehicle 08---Other MuntdpAl 90-Other Leased IN Driver 03--Rented Vehicle 06=01her State GovVeh Government Vehicle 99=Vnknown Sam,,as I Owner First Name Owner Last Name or Business Noma(it ftd"tr;*n skip this Section) Oliver CD TT ir-14 Address I Oty f State I Zip Vehicle Make NfAako GGod VIIN model Year V,-hkk Wdel (see cAporlay) FIF-0 IT,] I License Picts Req.State Est Speed VaNife,Towed Towed By FP71 [� a Yes Q No r., atom 1/v I Insurance Company Polity No fa Yes ONO (M Un- 4er known W 5; ' "-q 3 No of 1=YoMng Pass,Veh *tMobr1aFModufar Home 7=Seml•TralW Tag No Tog Year Tag St 2=ToNvinu Truck 5--Camoer 8-Other T 3--Towing U104 Trailer 6=Full Trailer 9=Unkn"n F U t'q Obection of T Vok.A.Jrjon E]j] -A.v..t ) see SpedalUvae rave F overlay VOW@ 05=Large T"x 20=Un;cyde.Bicycle, 12-Commercial 06-Yellow 01-Automobile DGeSUV Tricycle 00--Nol Applicable 07=SiKW 02.motorcycle 07-Van 21--Otlher Pedalcycle 014ire Veit 13cTaxi 08---Gold I 0=5novnitobils, 22ZH01W 80 y 02--Ambulance 21 wTractoc Yezilat 01=6!ue 09-Brown 04-Small I A-fillrn Equip 23=Hcfte RZ 02=Aed 10-Orange 41f-a2"complete form 12-Constructiop Equip 24-Train 03=police 22=T%-An Trailer rp4a JW,Se"101)76) 13=ATV 25=Trok-y velIale, 31-Modified Veh 03-White 1Ix:Pu 08--Other Emergency Z3-Tiiple Trailer 04=Green 12-Other (if'Zo'or 121',Complete 18=Mer Type Spec Veto 9&_-Other I lz.Npo Transport 99=Unitr*vvn 05-81ack 99-Unknown Fv.Y,Section 27) 19=unk,Type Spec Veh 99-Unknv,M thitial lrtipact Point Damage Indicator girad_wnt 3mDownhiii Road 69emont 00=14or-Collision t"Underto O-Nona 2-Functional 4wBotWm of Hill t=Straight I Winor 3--D13abling lulevel 5=-rop of"a M7, 01-12mClock Points IS-illowed 2-Uphill I3=10P 99�Unknovvn 9--Ur)knmvn R=Unknown 9=Unknown FORM#AA,6do4tzAx0 PENNOOT COPY COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM page CnasinNumbiw AA 500 3 1,`* P 1223135 s I 2E iZw t ---N one Used I Not APP11(ablO 2=Passenger 03—Driver rA,,g pa, G Mpkable 01=Shoulder Bell Used 1-2Qotjjec�d kd,,tnat% 02--+ront Seat Middle Position GZ--tap Befit Used To Cecld W=Front Seat Right Side 03--tap And Shoulder Belt Used 3':Par ti.T�9-L,t.d tictz�wn Q4--<N1d Safety Seat Used 9 D4--Smnd Row-Left Side,Or 3=Uoknown Moto er 05-MOtor4tie Hoirnet Used Middle PoSalon 21 0 5--5 e con7RC JoewpT Msa% 0634icyde Helmet Used Improperly H .-_y: 06-Second Row-Right Side 10=Safety Belt Lhecl F -:Female 07 Third Row Or Greater- 11=ChIld Safety Seal Used improperly Ejected I Wt ApplitWe m-Mote Left Side , 12,He"ql Used trnproperly I Through Side VOW Openinl; U Unknown 08•Thlrd Row Or Greater- 9D--Repra-ml Used,Type Unknown 2=Through Side Vilrulow Middle Position 99-Unknq&n .3=Tt)rough WindsNeld 09--Thlrd Raw Or Greater- 4=Through Flat*Door Right Side 2: S=Th(ovgh Back Door Tailgate Opening I ftf��Uldf nln &-Tirwougn ka, Applicable Mot Pwin wr�v Mli=Section of Trtxtc;ib F )=ftne sed I not Too/ CO-Not injured r Endozed 0 1-Ront Air Sag Deployed(For ibis Seat) Convertible Top D;P 1=101ied Passenger Or Cargo Area 0Z=$idP Air Sag ;JoyW(for This Seat) 7=Through Roof Opening(ConvertiW Z--Major injury 12=in Open Area 03.Other Type Zr a Top Up) 3=Moderale (Bad-Of FiCkup,Etcj 04-Multiple Air BMcloyed e In' ry 13-Ttalling Unit 05=Motorcyde Eye otedion 4--mor Injury 14-lVding On Vehicle Exterior 06--fliryclist Wearing Elbow/oee/Pads S-Anj".Unk t5-gvs Patseagec WmAlr Sag Not Deployed,Switch On Severity 98-Other I I-4ir Bag Not Deployed,SvA"Off _N01A licable 9=unicnown if 99%Unknown 12-ASv Bag W Deptood, ID-Not 4,picirtd Injury Ur*Switch Setting 2=E<tdcated By lvttchanicai Means 13--6jr Bag Removed(Prior To Clash) 3--Freed By Non-Mechani!W Means 19.JJnknown W Air Bag Deployed B-Other 99zurvknown 9=t Mknawn EMS Agency L-PNI, Medical Facility. .......P-C� Unit No Person No Palate? Data of girth (M"O-yyyy) A 8 C H fol I 1 0 w Fp�r FL41 EE E, I ro-1 P-1 Same,as Name J A EMS Transport operator= Unit No person No Delete? Date of Birth (MM.DD-YYYY) A B C D F RJM C) Fo-T-7-1 FEF01 ElSame as Name I Address/,Phone ea- 3 5" f C� EMS Transport operator f cwrA43 71451 Yes 0 No , E Unit no porson,No Delete? batev Birth (MM-DD-YYYY) A C 1)---F� F (5 Name I Address I Phcw%s EMS Transport Saone as C:,Yes a No Unit No Person No 0*14ft? Date of Birth (MM-00-YYV'6 A B C D H I WE 0 M Fo-I D Name I Address/Phone 0 Same 03 EMS Transport operator 01D6r Yes wo Unit No Person No Dvlete7 Date of (MM-Do-yy" A D r_ D Name!Address!PAOne 0 FIFIFT—IFT�==OFID Operator[ CDYes CD No Unlit No Person No Date a Wh- (1�jm-co-yyyy) A 1) -G IH I = 0 ELIFX] Same as Narne/Address I Phone 0 IEW Transport operator F 6y" 0 N FORM#AA-00(711= PENNUOT COPY + • 1 COMMONWEALTH OF PENlYWIVANIA POLICE CRASH REPORTING FORM Page Crash Number AA 500 4OP onn P 1223135 ,; fruhh 0=14on-collsion 2=Hoed On 6=510"w AFaq Vail-lit Peclgrtrtan '='fir" End 3' of by F3ear 5= wr C Oppon ) t�i3on9] SSamti�irrecUpn) G1 Fx9 �OthedUMnown Refatlon to Roadwy 1�On Travel Lane% ,A,-Mvdi&n SrrOtittride T M1110W0 7, o � Y GtNe(Flclwn)4-Roadside tli=ln Perking Lana 9=UnkymwtzDayOpht perk-3taet 5=Dawn 8-01her 2`Dark-N° U9hts B--Dark•Unknown �t L has 4-Ousk Roadw L Unt W�ether Conrf/tfont a '"N�— 3-Steer(HaA) 5.Fog pleat&FD 2�aN 4=Snow 6�din�Fog U=Mer t Unl°tdvJn Roach Conrti[1 O�ry 2 nd.Mum.Dill. 4=ugh v 1--wat 7=Wgtsr- t3�ther 9aSnow Covered 5=ice or MovirUtr Po e u r ffarmkd E~ft fFlarm Aggil 30 Vlall Unit No t 2 D ® 01=Kit Unit i 31=H4 8uitdUtg _ 02=Hit Unit 2 32eHit CUbert Z j�j— i © �—.T 004-Rh Unit 3 33=Hh Bridge Pier Or Abutment t 1 1 i f Hh Unit 4 34oHk Parapet End OS=Hit Unit 5 3SW44 Bridge Rail Please Par 'r�J—�- fT'�t - V-A+ Other Traffic rUnh 36=Hit&wider Or Obstacle Events in 3 07=1411 Deer On Roadway 08w14if Daher ANma.' 37d-Ht Impact Atten.ratzx' SeQut'niia! 09--Collision vAth Other Non 38=Hr1 Are Hydrant cUlr�ger Fixed Object 39sHil Roadway Equipment o a O 11_Shuck By Unit 1 40cHh Mail IkA �6 12=5truck By Unit 2 41 rWrrt Traffic island 13--Struck By Unit 3 42-Hi:Snow Bank Harm Event L/R Mvst7 UUetY Pole Number 14=Smxk By Unit 4 43,Hil Tornpoiary Construction 1 S=Stnxk 81 Unit 5 Barrier Unit 11b 1 © 16a5truck 8y Other Traffic Unit 48F1tit Otherfixed Object 21-Rt Tree Or Shrubbery 49=Hit Unknown Fora Object 22=Mt Embankment SO.-Ouertuin toll Over 23-Hit 11,! Pole StaStiudt 8y Thrown Or Falling 6 Zz � � o 2SHit G Sig Ob)eGt Pees.Put 52 Or Nolen Or Other 26-Wit Guard Rail End Pavement Idegularitifs Eyerrts in 3 © 27_Hlt Curb 53:lacknlle 5equenr 28--Hit gConerve Or 54-Fire In Vehicle Order 4 �'�'j O E=j j l 29--Hit Ditch nal Barrier gq{jnk Own Hanrtful Event n flrsl Unit Na I Hem Event ar u! Unlit N_ol Na.Tn v; Driver Action!O) I - areless Or Inegal �armfuf t 6 J f 2 0 1 cW-1do CattrtM,tirrg action Reding On Roadway 9 O1-Driver Was Dlitracmd 1k-DnvirrQ On The Wron ao rm'rP.n r, ;,r ,,;�on rwt,*NPs 02�Drivinp Using Hand Held Phone Side Of Road O-._Llrrvin thing He Free Phone 19=Making improper Emfro nniental/Roedwpy T f7a snaking(pegal V-Tum fnirande To Highway Potenriaf factors(ERs} t a l' 2�.1.� 3 05_knproperlCaralm Turning 20'emaking Improper Exit tt��__LL__J 06=Turrfingg From Wrong Lane From Highway 00 None i II&Ppery Road Conditions ace/Snow) 07=Pracee0Ing W/0 It=Careless Pannng/unparlang 01=vVindy Ctxxiit ons 12-Subnance On Roadvv Clearance After$top 22=OverlUnder 02--Sudden Weather Conditions 13-Potholes 09a-Running Stop Siggn Comoerdation At Curve 03=Other Weather Condtions 14-Brgken Or Cracked Pavement 09.Rfmninq Red Llk 23.Speet{Ing 04-Deer in Roadway 0=Failure To R and To T Y 15=TCO Obstrucud 24aDrivirg oo Fan For Conditions 05=Obstr Aim Rnadvva /(YSoh Shudder Or Shuu6=r D o Off Other Traffic ntrol Devitt 25422vre To Maintain Prs;,er Speed F }1=Tai;ggaatin9 06tOther Anima!In floe vay 28�ther Roadway Factor 12=Sudden Stowm�$to in :Cz.Drrver Fleeing Pot ce(PW Cha tp 07--Glare 29--Other frnironmental Factor 13=illegally Stopper]onpRoag 27=Drkr hetperiaMd c 083WorL Zone R @laced 99cUnknrrNn 14=Caeless Passing Or pane Z6,--Failure To Use Specialized£qujP Chan 92=Affeeted 8 j E Otl=NOrre tFeidde faiksrsu(Y} 12=Wipers change in No Passing Zone 98=Other JMp of iving Aalprtis 06=Extvust 13=Driver 5eating/Control 16_DriAng The Wrong vyay On 99-Unknown F 01=1 r� 07-HetdfigW 14��y Doors H000,Et 1-Way Street 02=Brake System 08 5r'ryynal tights 15=Trailer Hitch 03rStearing System og=Otlter lights 'F='> ce►s rU 1p"h t7-Aid3ap5 G t t O ' 2 O ,s 3 a p 7 04m5uspenson }6=Nom +�GL• [�� jl .a US=Power Train }'=Mirrors 18.Traiter Overloaded ✓m 19=UnsecureShihed Unit --r--1 AID t7 1 ' O 2 L 1 i hailer toad No ROT t 2 ' i j 3 ��"") 4 20=Irrtprrriter TowMg t�L.J I I I 21=06stNtttstf Windsfiiekl NUnit 2 99_Jnknown Pvdettrian,409a a 03--Working 00-None 04-:Pushing Vehicle D1-Enuring Or Crossing At OS=Approach ng Or Leaving Vehicle fndieated Prime rater Vhk No Fatter to Speciifed Location 06-Working On Vehicle 19 °oon-* tfih i.—IN6 non Unit Gm--W a ing,Running.Jugging, 07=Si tiering E/R V D P 99-Unknown 0 CD 40 O If EfR h the Prime Factor Unit No p MOO Llnit No f D I�j Type,leaye Unit No blank t�l. t— ► -t roaW V AA-600(1 VM RENNOOT COPY COMMONWEALTH OF PENNSYLVANIA POLICE CRASH RXPORTINFG FORM Page Crash Number AA 500 5 P kos 8 P 1223135 _ i _ , Tez ucK t S t27 'j - -_ .-_ .. _.+.. --•}-._... � 7 7 i 7 I_.—.__,......��._.�.._..._.�f.H1�i:R,h/_!1Iq'F.ti?._: a i � i � i i � � r I I I i r •I e s i i t { i.. —1... r ! 1 _.t % �s I 1 ....._.__..._... ...__,__....... ...__.._.._...u...L........,...�_._.._.�.. e „tNamrramlva u c�Kf ress Phone /Y G r , c- 414-additional witnesses Accident Investigation NvUfitation issued?Q Property Damage O z�Pm� 'LPL-urG r_fw-.t s F.4,��, �.e.+.tr �.3.Yy.�.acfd�4s"•>�. T� G ~,ro ZLW4 Y o H QI�T ._/tom S�✓[J ,�'!� 1�.Si4lS" �dllr.'t - 'O CAR+SNi7iA-.r �.{�p �{�j._ z u�rCa •a u s r n'tR LvJC Y G s .wsd 7 _.._Ta�c.r�,IfcSC .rsr FORM d A4'!OD(1&67) PENNOOT COPY COMMOWWEAJ.TH OF PEPOISYLVANIA POLICE CRASH REFORMG MRM Page am New Crash Number AA 5W N Pd"U'r C) channel Continuallod Narrative and additional witnesses: 22 44,AZ7 7WP�J. A /Ze Am C &W Sri F014M•AA40IN(WO" PENNOOT COPY MAILING CERTIFICATION I, James P. Carfagno, of full age, hereby certify as follows: I am employed by Law Offices of James P. Carfagno, LLC, counsel for Plaintiff, and on April 26, 2013, 1 mailed a copy of Plaintiffs Praecipe to Certify the Motor Vehicle Judgment against Defendants via regular mail, except a copy of the DL-201 form was sent only to the appropriate individual defendant, to the following: Jennifer Clifton 122 Virginia Avenue Carlisle, PA 17013 Christopher Chambers 223 Center Street Everett, PA 15537 Law Offices es P. Carfagno, LLC Dated: April 26, 2013 James P. Carfagno Law Offices of James P. Carfagno, LLC James P. Carfagno, Esquire P.O. Box 2688 Vincentown, NJ 08088 (609)388-4012 Facsimile: (609)388-4013 Attorney for Plaintiff Selective Way Insurance Company a/s/o S & A Homes, Inc. THE P OTHUNO IR 2014 SEP -2 PH9 2: 55 CUMBERLAND COUNTY PENNSYLVANIA SELECTIVE WAY INSURANCE COMPANY a/s/o S & A Homes, Inc. :COURT OF COMMON PLEAS :CUMBERLAND COUNTY Plaintiff(s) : DOCKET NO.: 13-1052 vs. JENNIFER CLIFTON CHRISTOPHER CHAMBERS Defendant(s) PRAECIPE TO MARK THE JUDGMENT SATISFIED AS TO DEFENDANT CHRISTOPHER CHAMBERS ONLY TO THE PROTHONOTARY: Please mark the judgment satisfied in full as to Defendant Christopher Chambers only. Please note that the filing of this Praecipe does not release the judgment that was entered against Defendant Jennifer Clifton. 1. so:?(L.,A! .11 ct(# 4P-9 CLS fel_ 2/G S/8 Dated: August 28, 2014 Law Offices of ames P. Carfagno, LLC James P. Carfagno MAILING CERTIFICATION I, James P. Carfagno, of full age, hereby certify as follows: I am employed by Law Offices of James P. Carfagno, LLC, counsel for Plaintiff, and on August 28, 2014, I mailed a copy of Plaintiffs Praecipe to Mark the Judgment Satisfied as to Defendant Christopher Chambers only via regular mail to the following: Dated: August 28, 2014 Jennifer Clifton 122 Virginia Avenue Carlisle, PA 17013 Christopher Chambers 1361 Menchtown Road Everett, PA 15537 Law Offices of James P. Carfagno, LLC James P. Carfagno