Loading...
HomeMy WebLinkAbout13-4780 Supreme C � ®� - � nsylvania COui' O4I11mo y leas For Prothonotary Use Only. ' C Docket No: CS�A l Cu er and � County — p The information collected on this form is used solely for court administration purposes. This form does not supplement or replace the filing and service ofpleadings or other papers as required by law or rules of court. Commencement of Action: S I@ Complaint © Writ of Summons ® Petition ® Transfer from Another Jurisdiction ® Declaration of Taking E C Lead Plaintiff's Name: Lead Defendant's Name: Susanne Jacobs Bernice J. Bourne T Dollar Amount Requested: (within arbitration limits I Are money damages requested? 0 Yes © No (check one) ®x outside arbitration limits O N Is this a Class Action Suit? 01 Yes 12 No Is this an MDJAppeal? 0 Yes J No A Name of Plaintiff /Appellant's Attorney: Peter M. Villari, Esquire ® Check here if you have no attorney (are a Self- Represented (Pro Sel Litigant) Nature of the Case Place an "X" to the left of the ONE case category that most accurately describes your PRIMARY CASE. If you are making more than one type of claim, check the one that you consider most important. TORT (do not include Mass Tort) CONTRACT (do not include Judgments) CIVIL APPEALS ® Intentional ® Buyer Plaintiff Administrative Agencies ® Malicious Prosecution ® Debt Collection: Credit Card 0 Board of Assessment Motor Vehicle ® Debt Collection: Other ® Board of Elections © Nuisance ® Dept. of Transportation © Premises Liability El Statutory Appeal: Other S ® Product Liability (does not include E mass tort) [3 Employment Dispute: ® Slander/Libel/ Defamation Discrimination Mj C ® Other: Employment Dispute: Other © Zoning Board � Other: , I M Other: O MASS TORT ® Asbestos N ® Tobacco ® Toxic Tort - DES 13 Toxic Tort - Implant REAL PROPERTY MISCELLANEOUS Toxic Waste ® Other: 17 Ejectment 0 Common Law /Statutory Arbitration B 0 Eminent Domain /Condemnation 0 Declaratory Judgment © Ground Rent ® Mandamus 0 Landlord/Tenant Dispute © Non - Domestic Relations Mortgage Foreclosure: Residential Restraining Order PROFESSIONAL LIABLITY ® Mortgage Foreclosure: Commercial © Quo Warranto 0 Dental ® Partition © Replevin Legal © Quiet Title ® Other: ® Medical 0■ Other: © Other Professional: Updated 111/1011 " (M1 VILLARI, BRANDES & GIANNONE, P.C. si4t By: Peter M. Villari, Esquire 47 ; 3 s 1'0 Theresa L. Giannone, Esquire / '7 R �; Nicole T. Matteo, Esquire C U1119ERL 1{ lF�� COl i� r Attorney ID Nos. 26875, 77148 & 206156 �s Y * � � , � � Y 8 Tower Bridge, Suite 400 A 161 Washington Street Conshohocken, PA 19428 (610) 729 -2900 Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION Susanne Jacobs, individually, and as parent and natural guardian of Kylee Jacobs, a minor Docket No.: C y 1325 Christopher Street Johnstown, PA 15905 Plaintiffs Jury Trial Demanded vs. Bernice Bourne 4433 Peterboro Street Apartment A3 Vernon, NY 13476 -3643 Defendant NOTICE TO DEFEND 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 AN 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 PROCEEDWITHOUT 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. 9rD 3 , 7 pq /7 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 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 REDUECED FEE OR NO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 1- 800 - 990 -9108 717 - 249 -3166 AVISO USTED HA SIDO DEMANDADO /A EN CORTE. Si usted desea defenderse de las demandas que se presentan mds adelante en las siguientes pdginas, debe tomar acci6n dentro de los pr6ximos veinte (20) dias despu6s de la notificaci6n 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 reclamaci6n o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mds 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 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 1- 800 - 990 -9108 717 - 249 -3166 VILLARI, BRANDES & GIANNONE, P.C. By: Peter M. Villari, Esquire Theresa L. Giannone, Esquire Nicole T. Matteo, Esquire Attorney ID Nos. 26875, 77148 & 206156 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 (610) 729 -2900 Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION Susanne Jacobs, individually, and as parent and yo natural guardian of Kylee Jacobs, a minor Docket No.: �3 ,lC - 1325 Christopher Street Johnstown, PA 15905 Plaintiffs Jury Trial Demanded VS. Bernice Bourne 4433 Peterboro Street Apartment A3 Vernon, NY 13476 -3643 Defendant COMPLAINT Plaintiffs, Susanne K. Jacobs, individually, and as parent and natural guardian of Kylee Jacobs, a minor, by and through their attorneys, say the following by way of Complaint against the Defendant: 1. Plaintiff, Susanne K. Jacobs, is an adult individual residing at the address above - captioned. 2. Plaintiff, Kylee Jacobs, is a minor individual residing at the address above - captioned with her parent and natural guardian, Susanne K. Jacobs. 3. Defendant, Bernice J. Bourne, is an adult individual residing at 4433 Peterboro Street, Apartment A3, Vernon, New York. 4. At all times material hereto, Defendant, Bernice J. Bourne, a New York resident, was the owner of a 2004 Ford F350 which was involved in the collision hereinafter more fully described. 5. On September 18, 2011, Plaintiff, Susanne K. Jacobs was operating 2001 Ford F350 pulling a horse trailer and travelling west on the Pennsylvania Turnpike approximately ten miles east of Carlisle. 6. At said date and time, Plaintiff, Kylee Jacobs, a minor, was a passenger in the front seat of the vehicle driven by Plaintiff, Susanne K. Jacobs. 7. At the same time and place aforesaid, Defendant, Bernice J. Bourne, was also travelling west on the Pennsylvania Turnpike. 8. At said date and time, Plaintiff was travelling in the right lane when Defendant, Bernice J. Bourne, then traveling in the left lane, caused the vehicle that she operated to collide with Plaintiff's horse trailer. 9. The force of the impact from Defendant's vehicle caused Plaintiff's vehicle to violently swerve and move about the highway, which caused Plaintiff to lose control of her vehicle and horse trailer it was towing to collide with Plaintiffs 2001 Ford F350. 10. Defendant, Bernice J. Bourne, then proceeded to strike the median. 11. As Defendant's vehicle is registered in another state, Plaintiffs are legally subject to the full tort election pursuant to 75 Pa. C.S. §1705(d)(1)(ii). 12. As a direct and proximate result of the aforesaid incident, Plaintiff, Susanne K. Jacobs, sustained injuries in and about her body and extremities, which injuries are or may be serious and /or permanent, including but not limited to: injuries to her head, neck, back, collarbone, chest and body, including whiplash, muscle spasms, rib discomfort, headaches, and neck pain; pain in her lumbar, thoracic and cervical spines; numbness in her hands and feet, and exacerbation of preexisting conditions of the aforesaid areas of her body that were otherwise non - disabling and asymptomatic, as well as anxiety and emotional distress, as a result of which she has experienced and may continue to experience pain and suffering, limitations of her activities, loss of enjoyment of life's pleasures, embarrassment and humiliation and /or disfigurement. 13. As a direct and proximate result of the aforesaid incident, minor - Plaintiff, Kylee Jacobs, sustained injuries in and about her body and extremities, which injuries are or may be serious and /or permanent, including but not limited to: injuries to her head, neck, back, collarbone, chest and body, including headaches, neck pain, arm pain, tingling in her fingers and arms, pain in her lumbar, thoracic and cervical spines, shoulder pain and abdominal pain; and exacerbation of preexisting conditions of the aforesaid areas of her body that were otherwise non - disabling and asymptomatic, as well as anxiety and emotional distress, as a result of.which she has experienced and may continue to experience pain and suffering, limitations of her activities, loss of enjoyment of life's pleasures, embarrassment and humiliation and /or disfigurement. 14. As a further direct and proximate result of the aforesaid incident, Plaintiffs have been and may in the future be obliged to incur expenses for medicines and medical attention in trying to treat and cure said injuries. 15. As a further direct and proximate result of the aforesaid incident, Plaintiffs have been and may in the future be prevented from attending to their usual and daily occupation and daily duties, thereby suffering a loss of earnings and /or impairment of earning capacity. 16. As a further direct and proximate result of the aforesaid incident, Plaintiffs, have suffered or may suffer a loss because of expenses which have been or may be reasonably incurred in obtaining ordinary and necessary services in lieu of those which Plaintiffs would have performed, not for income, but for themselves if they had not been injured by Defendant. COUNT I — NEGLIGENCE Plaintiff, Susanne K. Jacobs v. Defendant, Bernice J. Bourne 17. Plaintiffs incorporate by reference all of the preceding paragraphs as if fully set forth herein at length. 18. The aforesaid collision and the resultant injuries and damages were directly and proximately caused by the negligence of Defendant, Bernice J. Bourne, as follows: a. Failing to observe and /or obey traffic markers, signs and /or signals; b. Failing to stay within her designated lane of travel; c. Changing lanes unsafely, improperly, without looking and in violation of applicable traffic laws; d. Violating applicable traffic laws of the Commonwealth of Pennsylvania; e. Failing to maintain proper control over the operation of her vehicle; f. Failing to maintain an adequate and proper lookout; g. Failing to know and /or abide by the "Rules of the Road" as set forth in 75 Pa. C.S. §3301 et seq.; h. Failing to know and /or abide by 75 Pa. C.S. § §3303 and /or 3304; i. Being an incompetent and/or inattentive driver; j. Driving while talking, dialing or texting on a cell phone or other such device; k. Operating her vehicle without being able to stop within an assured clear distance ahead; 1. Failing to operate her motor vehicle within the posted speed limit; m. Failing to sound the horn of her vehicle prior to colliding into Plaintiffs' vehicle; n. Disregarding the rights and safety of persons and /or vehicles lawfully on the road; o. Operating her vehicle in such a manner to create a dangerous condition of which she knew, or in the exercise of reasonable care, should have known; p. Operating her vehicle at an unsafe speed given the traffic, road and /or weather conditions prevailing during the relevant time; q. Failing to properly and/or adequately apply her vehicle's brakes; r. Operating her vehicle when she knew or reasonably should have known that it was not equipped with proper and /or properly operating signals, safety devices, warning devices, tires and /or brake systems; s. Carelessly driving her vehicle; t. Driving her vehicle while being inattentive and /or too tired to safely do so; u. Recklessly operating her vehicle. 19. As a direct and proximate result of Defendant's negligence, Plaintiff, Susanne K. Jacobs, sustained the injuries and damages as set forth in paragraphs 11, 13 -15, supra. WHEREFORE, Plaintiff, Susanne K. Jacobs, demands compensatory damages in an amount above $50,000.00 be awarded in her favor and against Defendant, Bernice J. Bourne together with such other relieve as this court deems just. COUNT II — NEGLIGENCE Plaintiff, Kylee Jacobs, a minor, by and through her Parent and Natural Guardian, Susanne Jacobs v. Defendant, Bernice J. Bourne 20. Plaintiffs incorporate by reference all of the preceding paragraphs as if fully set forth herein at length. 21. The aforesaid collision and the resultant injuries and damages were directly and proximately caused by the negligence of Defendant, Bernice J. Bourne, as follows: a. Failing to observe and /or obey traffic markers, signs and /or signals; b. Failing to stay within her designated lane of travel; c. Changing lanes unsafely, improperly, without looking and in violation of applicable traffic laws; d. Violating applicable traffic laws of the Commonwealth of Pennsylvania; e. Failing to maintain proper control over the operation of her vehicle; f. Failing to maintain an adequate and proper lookout; g. Failing to know and /or abide by the "Rules of the Road" as set forth in 75 Pa. C.S. §3301 et seq.; h. Failing to know and /or abide by 75 Pa. C.S. § §3303 and /or 3304; i. Being an incompetent and /or inattentive driver; j. Driving while talking, dialing or texting on a cell phone or other such device; k. Operating her vehicle without being able to stop within an assured clear distance ahead; 1. Failing to operate her motor vehicle within the posted speed limit; m. Failing to sound the horn of her vehicle prior to colliding into Plaintiffs' vehicle; n. Disregarding the rights and safety of persons and /or vehicles lawfully on the road; o. Operating her vehicle in such a manner to create a dangerous condition of which she knew, or in the exercise of reasonable care, should have known; p. Operating her vehicle at an unsafe speed given the traffic, road and /or weather conditions prevailing during the relevant time; q. Failing to properly and /or adequately apply her vehicle's brakes; r. Operating her vehicle when she knew or reasonably should have known that it was not equipped with proper and /or properly operating signals, safety devices, warning devices, tires and /or brake systems; s. Carelessly driving her vehicle; t. Driving her vehicle while being inattentive and /or too tired to safely do so; u. Recklessly operating her vehicle. 22. As a direct and proximate result of Defendant's negligence, Plaintiff, Kylee Jacobs, a minor, by and through her parent and natural guardian, Susanne Jacobs, sustained the injuries and damages as set forth in paragraphs 12 -15, supra. WHEREFORE, Plaintiff, Kylee Jacobs, demands compensatory damages in an amount above $50,000.00 be awarded in her favor and against Defendant, Bernice J. Bourne together with such other relieve as this court deems just. Respectfully submitted, VILLARI, BRANDES & GIANNONE, P.C. Dated: 1 113 By: ��� )L� er M. Villa Esquire Nicole T. Matteo, Esquire Attorneys for Plaintiffs JURY DEMAND Plaintiffs hereby demand a jury trial as to all of the above claims. Respectfully submitted, VILLARI, BRANDES & GIANNONE, P.C. Dated: 4 7 1 11 By: I�eter M. Villm"f, Esquire Nicole T. Matteo, Esquire Attorneys for Plaintiffs e VERIFICATION Susanne K. Jacobs, individually and as parent and natural guardian of Kylee Jacobs, a minor, hereby states that she is the Plaintiff herein and that the facts set forth in the foregoing Complaint in Civil Action are true and correct to the best of her knowledge, information and belief and are based upon information which she has furnished to her counsel and information which has been gathered by her counsel in preparation of the lawsuit. The language in the Complaint is that of counsel and not of Plaintiff. Plaintiff has read the Complaint and to the extent it is based upon information she has given to her counsel, it is true and correct to the best of her knowledge, information and belief. To the extent the contents of the Complaint are that of counsel, Plaintiff has relied upon counsel in making this verification. This verification is made subject to 18 Pa.C.S.A. § 4904 which provides for certain penalties for making false statements. Susanne K. Jacobs, individually and as parent and natural guardian of Kylee Jacobs, a minor VILLARI, BRANDES & GIANNONE,P.C. ' "� = t3P,O T{'Cllu 7,Ar By: Peter M. Villari, Esquire 20j3 OCT ,� Theresa L. Giannone, Esquire Pi 10. 5q Nicole T. Matteo, Esquire CUMBERLAND COUNT Attorney ID Nos. 26875, 77148 & 206156 PENNSYLVANIA 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 (610) 729-2900 Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION Susanne Jacobs, individually, and as parent and : natural guardian of Kylee Jacobs, a minor : Docket No.: 13-4780 1325 Christopher Street • Johnstown, PA 15905 • Plaintiffs • Jury Trial Demanded • vs. • • Bernice Bourne • 4433 Peterboro Street • Apartment A3 • Vernon, NY 13476-3643 • Defendant • PRAECIPE TO REINSTATE COMPLAINT TO THE PROTHONOTARY: Kindly reinstate the Complaint in the above-captioned case, a true and correct copy of which is attached hereto. Respectfully submitted, VILLARI, BRANDES & GIANNONE, P.C. Dated: 10/ 1/ l3 By: I ._Ii i II L I 1.0 .-r M. Villari, "squire Nicole T. Matteo, Esquire Attorneys for Plaintiffs .1SPAt ala VILLARI, BRANDES & GIANNONE, P.C. f 3 By: Peter M. Villari, Esquire ` ( _7 �, Theresa L. Giannone, Esquire Nicole T. Matteo, Esquire CUMBERLAND COUNTY Attorney ID Nos. 26875, 77148 & 206156 PENNSYLVANIA 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 (610) 729-2900 Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION Susanne Jacobs, individually, and as parent and • natural guardian of Kylee Jacobs, a minor • Docket No.: 13-4780 1325 Christopher Street • Johnstown, PA 15905 • Plaintiffs • Jury Trial Demanded vs. • • Bernice Bourne • 4433 Peterboro Street • Apartment A3 • Vernon,NY 13476-3643 • Defendant • PRAECIPE TO REINSTATE COMPLAINT TO THE PROTHONOTARY: Kindly reinstate the Complaint in the above-captioned case, a true and correct copy of which is attached hereto. Respectfully submitted, VILLARI, : '. : S & ANNONE,P.C. Dated: i%0 I / 3 By: "IP/ Peter M. Villari, squire Nicole T. Matteo, Esquire Attorneys for Plaintiffs 611.7 Cl FOSI Eyf 1.f VILLARI, BRANDES & GIANNONE, P.C. �� By: Peter M. Villari, Esquire JAN 13 PM 3, 14 Andrew C. Rimol, Esquire Ct1P9 ER(,tiNo * Y Attorney ID Nos. 26875 & 205809 p NNS�, COUNT 8 Tower Bridge, Suite 400 �-VANIA 161 Washington Street Conshohocken, PA 19428 (610) 729-2900 Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION Susanne Jacobs, individually, and as parent and • natural guardian of Kylee Jacobs, a minor • Docket No.: 13-4780 1325 Christopher Street • Johnstown, PA 15905 • Plaintiffs • Jury Trial Demanded vs. • • Bernice Bourne • 4433 Peterboro Street • Apartment A3 • Vernon,NY 13476-3643 • Defendant • PRAECIPE TO REINSTATE COMPLAINT TO THE PROTHONOTARY: Kindly reinstate the Complaint in the above-captioned case, a true and correct copy of which is attached hereto. Respectfully submitted, VILLARI, BRANDES & GIANNONE, P.C. 2 Dated: P By: er M. Villari, Esquire 4P Andrew C. Rimol, Esquire Attorneys for Plaintiffs aWA II.�Spa CL35 —. - LANK___iY--._i 31n 4 .aYltil;. -,,it �laiC., ti_ VILLARI,BRANDES & GIANNONE, P.C. ' Ci } "gyp ' By: Peter M. Villari, Esquire 2014 Attorney I.D. No. 26875 12 10: 2? -and- CUMBERLAND Andrew C. Rimol, Esquire PEN jS I9UN T" Y Attorney I.D. No. 205809 8 Tower Bridge 161 Washington Street, Suite 400 Conshohocken, PA 19428 Telephone- (610) 729-2900 Facsimile - (610) 729-2910 Attorneys for Plaintiffs SUSANNE JACOBS, Individually, : IN THE COURT OF COMMON PLEAS and as Parent and Guardian of : OF CUMBERLAND COUNTY KYLEE JACOBS, a minor, : CIVIL ACTION—LAW Plaintiffs -vs- : Docket No. 13-4780 BERNICE J. BOURNE • Defendant. • PLAINTIFFS' MOTION FOR ALTERNATE SERVICE Plaintiffs, by and through their undersigned counsel, Villari, Brandes & Giannone, P.C., hereby file the foregoing Motion for Alternative Service. Pursuant to Pa.R.C.P. 430, Plaintiffs respectfully move before this Honorable Court for an Order directing an alternate method of service for original process upon defendant, Bernice J. Bourne, and in support thereof aver the following: 1. Plaintiffs, Suzanne and Kylee Jacobs (hereinafter "Plaintiffs"), initiated this civil action against defendant, Bernice J. Bourne (hereinafter"Defendant" or"Ms. Bourne"), with the filing of a Complaint on August 12, 2013, for injuries and damages arising from a motor vehicle accident occurring on September 18, 2011, in the westbound lanes of the Pennsylvania Turnpike, approximately ten miles east of Carlisle, Pennsylvania. A true and correct copy of the Complaint is attached hereto as Exhibit"A". 2. Defendant, Ms. Bourne, was the registered owner and driver of a 2004 Ford F350 that struck Plaintiffs' vehicle and caused the injuries and damages alleged by Plaintiffs. 3. According to the Commonwealth of Pennsylvania — Non-Reportable Crash Record (hereinafter "Police Report") completed by officers from the Pennsylvania State Police, on the date of the accident, Ms. Bourne's mailing address was P.O. Box 775, Vernon, New York 13476. A true and correct copy of the Commonwealth of Pennsylvania—Non-Reportable Crash Record is attached hereto as Exhibit"B". 4. An examination of New York Voter Registration records indicated that the residential address associated with the mailing address identified for Ms. Bourne in the Police Report was 4433 Peterboro Street, Apartment A3, Vernon, New York 13476. A true and correct copy of the New York Voter Registration record is attached hereto as Exhibit"C". 5. Thus, on August 7, 2013, a copy of the Complaint was sent, via certified mail, return receipt requested, to Ms. Bourne at 4433 Peterboro Street, Apartment A3, Vernon, New York 13476. 6. On September 5, 2013, a time-stamped copy of the Complaint was also forwarded to Government Employees Insurance Company("GEICO"), Ms. Bourne's motor vehicle liability carrier on the date of the accident at issue herein. 7. Via correspondence dated September 11, 2013, Joseph R. D'Annunzio, Esquire, confirmed that GEICO was Ms. Bourne's automobile insurance carrier and provided coverage to Ms. Bourne on the date of the accident. Attorney D'Annunzio also stated that he would be representing Ms. Bourne in this matter. A true and correct copy of said correspondence is attached as Exhibit"D". 8. On September 12, 2013, the certified mailing sent to 4433 Peterboro Street, Apartment A3, Vernon, New York was returned with a notation from the postal authorities indicating "No Mail Receptacle" at the address where the Complaint had been mailed. Proof of same is attached hereto as Exhibit"E". 9. On the same date, Plaintiffs sent a copy of the Complaint to Ms. Bourne, via certified mail, return receipt requested, at the mailing address identified for Ms. Bourne in the Police Report, i.e., P.O. Box 775, Vernon,New York 13476. 10. On October 7, 2013, the certified mailing sent to P.O. Box 775, Vernon, New York was returned with a notation from the postal authorities indicating "Not Deliverable as Addressed Unable to Forward". The U.S. Postal Service Track & Confirm record for this certified mailing indicates that Ms. Bourne"Moved, Left no Address". Proof of same is attached hereto as Exhibit"F". 11. On September 12, 2013, Plaintiffs also sent a copy of the Complaint, via certified mail, return receipt requested, addressed to Ms. Bourne at 4600 Country Club Road, Apt. 108, Morehead City, North Carolina 28557. This address was identified as Ms. Bourne's current address pursuant to a search of public records using LexisNexis' "Public Records: Locate a Person (Nationwide)" search feature. A copy of the search results are attached hereto as Exhibit 12. On October 3, 2013, the certified mailing sent to 4600 Country Club Road, Apt. 108, Morehead City, North Carolina was returned with a notation from the postal authorities stating: "Return to Sender", "Not Deliverable as Addressed" and"Unable to Forward". The U.S. w�a Postal Service Track & Confirm record for this certified mailing indicates that Ms. Bourne "Moved, Left no Address." Proof of same is attached as Exhibit"H". 13. Under cover dated October 8, 2013, Plaintiff's counsel contacted the Postmasters of Vernon, New York and Morehead, North Carolina requesting information regarding Ms. Bourne's current address. Copies of said correspondence are attached as Exhibit"I". 14. On October 10, 2013, the Postmaster of Vernon (NY) responded that that Ms. Bourne was "Long gone" from both addresses in Vernon, New York. No other information was provided. Copies of the Postmaster's responses are attached as Exhibit"J". 15. On November 15, 2013, the Postmaster of Morehead City(NC) indicated that Ms. Bourne was "Not known at [the] address given" and "Gone more than two y[ea]rs." A copy of the Postmaster's response is attached as Exhibit"K". 16. On November 20, 2013, Plaintiffs' counsel utilized Accurint's "Drivers License Search" feature to search its driver's license database and examine motor vehicle records from multiple states in an effort to find a current address/location for Ms. Bourne. As a result, Plaintiffs' counsel found a current address listed for Ms. Bourne of 4600 Country Club Road, Morehead City, North Carolina 28557, and a historical address for Ms. Bourne of 117 Countryside Court, Newport, North Carolina 28570. A copy of the Accurint Driver's License Search results is attached as Exhibit"L". 17. On November 20, 2013, Plaintiffs' counsel also conducted a search of Accurint's public records and commercially available data database to find the current location/address of Ms. Bourne where service of process could be made. The search results indicated a "Probable Current Address" for Ms. Bourne at 117 Countryside Court, Newport, North Carolina 28570. A copy of the Summary Report from the search is attached as Exhibit"M". 18. Plaintiffs' counsel's previous search of public records using LexisNexis' "Public Records: Locate a Person (Nationwide)" also indicated an address for Ms. Bourne at 117 Countryside Court, Newport, North Carolina 28570, in addition to the addresses already identified herein. See, Exhibit"G". 19. Thus, on November 20, 2013, Plaintiffs sent a copy of the Complaint, via certified mail, return receipt requested, addressed to Ms. Bourne at 117 Countryside Court, Newport, North Carolina 28570. 20. Additionally, on December 6, 2013, Plaintiffs engaged the services of Guaranteed Subpoena Service, Inc., a professional process server, to effectuate personal service of the Complaint on Ms. Bourne at 117 Countryside Court,Newport, North Carolina 28570. 21. On December 10, 2013, the certified mailing sent to 117 Countryside Court, Newport, North Carolina, was returned with a notation from the postal authorities stating: "Return to Sender", "Not Deliverable As Addressed" and "Unable to Forward". The U.S. Postal Service Tracking Information related to this certified mailing indicates that Ms. Bourne"Moved, Left no Address." Copies of proof of same are attached as Exhibit"N". 22. On December 16, 2013, Guaranteed Subpoena Service, Inc., advised Plaintiffs' counsel that it was unable to serve Ms. Bourne at 117 Countryside Court, Newport, North Carolina. In a follow up e-mail dated December 23, 2013, Guaranteed Subpoena Service, Inc., explained that their Process Server attempted to personally serve the Complaint on December 7, 2013, December 9, 2013 and twice on December 10, 2013, but was unable to make contact with Ms. Bourne and was unsuccessful. Copies of said documents from Guaranteed Subpoena Service, Inc., are attached as Exhibit"0". 23. Thereafter, on December 23, 2013, Plaintiffs again utilized Guaranteed Subpoena Service, Inc., to attempt to effectuate service of process on Ms. Bourne at 7563 State Road 7, Lake Worth, Florida 33449 — an address identified on the Accurint Summary Report as current for Ms. Bourne as of September 2013. See, Exhibit"M". 24. On or about December 30, 2013, Guaranteed Subpoena Service, Inc., notified Plaintiffs that it was unable to serve Ms. Bourne at 7563 State Road 7, Lake Worth, Florida 33449, for the reason that Ms. Bourne was "[u]nknown at address." A copy of Guaranteed Subpoena Service, Inc.'s Status Report evidencing same is attached as Exhibit"P". 25. While attempting to locate and serve Ms. Bourne, Plaintiffs' counsel periodically forwarded the Complaint to the Prothonotary for reinstatement and it was reinstated on October 5, 2013, November 7, 2013 and, most recently, on January 14, 2014. A copy of the Praecipe to Reinstate Complaint filed January 14, 2014, is attached as Exhibit"Q". 26. Pennsylvania Rule of Civil Procedure 404 provides, in pertinent part, that "[o]riginal process shall be served outside the Commonwealth . . . (1)by a competent adult in the manner provided by Rule 402(a); [or] (2) by mail in the manner provided by Rule 403." Pa.R.C.P. 404(1) and(2). 27. Pursuant to Pa.R.C.P. 403, "[i]f a rule of civil procedure authorizes original process to be served by mail, a copy of the process shall be mailed to the defendant by any form of mail requiring a receipt signed by the defendant or his authorized agent." Service is deemed complete"upon delivery of the mail." 28. However, when servicing original process by mail, "[i]f the mail is returned with notation by the postal authorities that it was unclaimed, the plaintiff shall make service by another means pursuant to [the Rules of Civil Procedure]." See, Pa.R.C.P. 403(2). 29. Pa.R.C.P. 430(a) states: If service cannot be made under the applicable rule the plaintiff may move the court for a special order directing the method of service. The motion shall be accompanied by an affidavit stating the nature and extent of the investigation which has been made to determine the whereabouts of the defendant and the reasons why service cannot be made. 30. Thus, a plaintiff wishing to use alternate methods of service to serve a defendant must show that "good faith efforts" were made "to locate and serve the defendant." See, Romeo v. Looks, 369 Pa. Super. 608, 535 A.2d 1101, 1106 (Pa. Super. 1987); Grove v. Guilfoyle, 222 F.R.D. 255, 256 (E.D. Pa. 2004). 31. Examples of the "good faith effort to locate the defendant" required by Rule 430(a) include inquiries of postal authorities; inquiries of relatives, neighbors, friends and employers; and searches/examinations of local telephone directories, voter registration records, local tax records, and motor vehicle records (i.e., public records). See, Pa.R.C.P. 430(a), note; City of Philadelphia Water Revenue Bureau v. Towanda Properties, Inc., 976 A.2d 1244, 1248 (Pa. Cmmw. Ct. 2009). 32. In the instant matter, Plaintiffs' counsel has undertaken a diligent and good faith effort to locate and serve Ms. Bourne in a manner set forth by the Rules of Civil Procedure as required by Pa.R.C.P. 430(a). 33. As described herein, Plaintiffs have examined motor vehicle records and voter registration records; conducted multiple searches through both Accurint and LexisNexis, which utilize comprehensive, up-to-date databases comprised of not only public records but all publicly available information; and made inquiries of the postal authorities for information related to Ms. Bourne's current address/location. 34. Despite the effort undertaken by Plaintiffs' counsel to locate and serve Ms. Bourne, Plaintiffs have been unsuccessful in obtaining a current confirmed address or forwarding address for Ms. Bourne to be able to effectuate service of process on Defendant by way of one of the methods authorized by the Rules of Civil Procedure. 35. As such, Plaintiffs seek an Order directing that service may be made upon Ms. Bourne by mailing a Certified Copy of the reinstated Complaint to GEICO — Ms. Bourne's automobile liability insurance carrier for the time period at issue — c/o Joseph D. Annunzio, Esquire, the attorney who will be representing Ms. Bourne in this matter on behalf of GEICO; and by publication of Notice, one time in a newspaper of general circulation in Carteret County, North Carolinas, and a newspaper of general circulation in Vernon, New York. WHEREFORE, Plaintiffs respectfully request that this Honorable Court grant Plaintiffs' Motion for Alternative Service and enter the proposed Order submitted herewith. Respectfully submitted, VILLARI, BRANDES& GIANNONE,P.C. Dated: Feb. 11, 2014 By: 4 Ter M. Villari, Esquire Attorney ID No. 26875 -and- Andrew C. Rimol, Esquire Attorney ID No. 205809 Attorneys for Plaintiffs ' Carteret County,North Carolina encompasses both Morehead City and Newport. SUSANNE JACOBS, Individually, : IN THE COURT OF COMMON PLEAS and as Parent and Guardian of : OF CUMBERLAND COUNTY KYLEE JACOBS, a minor, : CIVIL ACTION—LAW Plaintiffs -vs- : Docket No. 13-4780 BERNICE J. BOURNE Defendant. AFFIDAVIT OF GOOD FAITH IN SUPPORT OF PLAINTIFFS' MOTION FOR ALTERNATIVE SERVICE Andrew C. Rimol,having been duly sworn according to law, hereby states: 1. I am an associate attorney at Villari, Brandes & Giannone, P.C., attorneys for Plaintiffs, Suzanne Jacobs, individually and as parent and natural guardian of Kylee Jacobs, a minor, in the above-captioned action, and submit this Affidavit in support of Plaintiffs' Motion for Alternate Service. 2. I have been directly involved in and have personal knowledge of Plaintiffs' attempts to locate Defendant, Bernice J. Bourne, and make service of original process upon Ms. Bourne. 3. At my direction, an investigation was conducted into the whereabouts of the defendant, Bernice J. Bourne. 4. The statements set forth in Plaintiffs' Motion for Alternate Service detailing the effort and investigation undertaken to locate Ms. Bourne and effectuate service of process, are true and correct to the best of my personal knowledge, information and belief. 5. Plaintiffs have been unable to find/locate a current address for Ms. Bourne where service of process can be made. 6. The statements of fact in the foregoing Motion for Alternate Service and the Exhibits attached thereto, are true and correct to the best of my personal knowledge, information and belief. Dated: 2/11/14 ew C. Rimol, Esquire Sworn to and Subscribecl,before me on thi / ay of f a , 2014 COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL LINDA A.VONDERCRONE.,Notary Public Towamencin Twp.,Montgomery County My Commission Expires December 22,2016 Supreme Co icv t nnsylvania 4 11. Con „..'"i , t c I q leas For_Prothonotary Use Only: Docket No: Cu It, - i, ' : County W i Kb . /-3 ‘--- nu The information collected on this form is used solely for court administration purposes. This form does not supplement or replace the filing and service of pleadings or other papers as required by law or rules of court. Commencement of Action: Complaint 0 Writ of Summons 0 Petition .,.e,4;-1 0 Transfer from Another Jurisdiction 0 Declaration of Taking Lead Plaintiff's Name: Lead Defendant's Name: ;*•44', Susanne Jacobs Bernice J. Bourne Dollar Amount Requested: °within arbitration limits Are money damages requested? 11 Yes 0 No (check one) Kt outside arbitration limits N Is this a Class Action Suit? 0 Yes M No Is this an MI)J Appeal? 0 Yes El No .<'':::,•'i)4 Name of Plaintiff/Appellant's Attorney: Peter M.Villari, Esquire 0 Check here if you have no attorney(are a Self-Represented [Pro Sc] I,itig,ant) Nature of the Case: Place an"X"to the left of the ONE case category that most accurately describes your PRIMARY CASE. If you are making more than one type of claim,check the one that you consider most important. TORT(do not include Mass Tort) CONTRACT(do not include Judgments) CIVIL APPEALS O Intentional 0 Buyer Plaintiff Administrative Agencies O Malicious Prosecution 0 Debt Collection:Credit Card 0 Board of Assessment rj Motor Vehicle 0 Debt Collection:Other 0 Board of Elections O Nuisance 0 Dept.of Transportation „...., 0 Premises Liability : . 0 Statutory Appeal:Other 0 Product Liability(does not include 0 Employment Dispute: Et mass tort) Discrimination [3 Slander/Libel/Defamation C 0 Other: 0 Employment Dispute:Other 0 Zoning Board T 0 Other: I 0 Other: 0 MASS TORT 0 Asbestos N, 0 Tobacco Et Toxic Tort-DES Q Toxic Tort-Implant REAL PROPERTY MISCELLANEOUS Et Toxic Waste 0 Ejectment 0 Common Law/Statutory Arbitration 0 Other: 0 Eminent Domain/Condemnation 0 Declaratory Judgment 0 Ground Rent 0 Mandamus O Landlord/Tenant Dispute 0 Non-Domestic Relations O Mortgage Foreclosure:Residential Restraining Order PROFESSIONAL I JABI,ITY 0 Mortgage Foreclosure:Commercial 0 Quo Warranto r71 Dental 0 Partition 0 Replevin O Legal 0 Quiet 1 itle 0 Other: O Medical 0 Other: O Other Professional. _ ....._ (iodated 1/1/2011 VILLARI,BRANDES &GIANNONE, P.C. By Peter M. Villari, Esquire 203 ivy 1 2 ‘..) 4-. Pi : Theresa L. Giannone,Esquire i 2 I f i Nicole T. Matteo, Esquire rUMBErt i ,,,.._, Attorney ID Nos. 26875, 77148 &206156 twtNNSYLVANii I A 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 (610) 729-2900 Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION Susanne Jacobs, individually, and as parent and : natural guardian of Kylee Jacobs, a minor . Docket No.: 3 --i 7 r i L"i / 6 1325 Christopher Street • Johnstown,PA 15905 • Plaintiffs : Jury Trial Demanded • vs. ' • Bernice Bourne • 4433 Peterboro Street . Apartment A3 - Vernon, NY 13476-3643 . Defendant : NOTICE TO DEFEND 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 AN 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. -mut:: COPY FROM RECORD In 1-,,-diehony whereof, 1 here unto.sot toy hand and the'eAof saie Coo t Cart sie,Pa...? This i'4 d of __3 ,20 4) og— I /I" ir- thonotary 4144-Net, c 1 7 Air 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 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 REDUECED FEE OR NO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET CARLISLE,PA 17013 1-800-990-9108 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 0 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 0 BAJO COSTO A PERSONAS QUE CUALIFICAN. CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 1-800-990-9108 717-249-3166 VILLARI,BRANDES &GIANNONE, P.C. By: Peter M. Villari,Esquire Theresa L. Giannone, Esquire Nicole T. Matte°,Esquire Attorney ID Nos. 26875, 77148 &206156 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 (610) 729-2900 Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA CIVIL ACTION Susanne Jacobs, individually, and as parent and : natural guardian of Kylee Jacobs,a minor Docket No.: 1325 Christopher Street • Johnstown,PA 15905 Plaint iffi Jury Trial Demanded • vs. Bernice Bourne • 4433 Peterboro Street Apartment A3 • Vernon, NY 13476-3643 Defendant • COMPLAINT Plaintiffs, Susanne K. Jacobs, individually, and as parent and natural guardian of Kylee Jacobs, a minor, by and through their attorneys, say the following by way of Complaint against the Defendant: 1. Plaintiff, Susanne K. Jacobs, is an adult individual residing at the address above- captioned. 2. Plaintiff. Kylee Jacobs, is a minor individual residing at the address above- captioned with her parent and natural guardian, Susanne K. Jacobs. 3. Defendant, Bernice J. Bourne, is an adult individual residing at 4433 Peterboro Street, Apartment A3, Vernon, New York. 4. At all times material hereto, Defendant, Bernice J. Bourne, a New York resident, was the owner of a 2004 Ford F350 which was involved in the collision hereinafter more fully described. 5. On September 18, 2011, Plaintiff, Susanne K. Jacobs was operating 2001 Ford F350 pulling a horse trailer and travelling west on the Pennsylvania Turnpike approximately ten miles east of Carlisle. 6. At said date and time, Plaintiff, Kylee Jacobs, a minor, was a passenger in the front seat of the vehicle driven by Plaintiff, Susanne K. Jacobs. 7. At the same time and place aforesaid, Defendant, Bernice J. Bourne, was also travelling west on the Pennsylvania Turnpike. 8. At said date and time, Plaintiff was travelling in the right lane when Defendant, Bernice J. Bourne. then traveling in the left lane, caused the vehicle that she operated to collide with Plaintiff's horse trailer. 9. The force of the impact from Defendant's vehicle caused Plaintiff's vehicle to violently swerve and move about the highway, which caused Plaintiff to lose control of her vehicle and horse trailer it was towing to collide with Plaintiffs 2001 Ford F350. 10. Defendant, Bernice J. Bourne, then proceeded to strike the median. 11. As Defendant's vehicle is registered in another state, Plaintiffs are legally subject to the full tort election pursuant to 75 Pa. C.S. §1705(d)(1)(ii). 12. As a direct and proximate result of the aforesaid incident, Plaintiff. Susanne K. Jacobs, sustained injuries in and about her body and extremities, which injuries are or may be serious and/or permanent, including but not limited to: injuries to her head, neck, back, collarbone, chest and body, including whiplash, muscle spasms, rib discomfort, headaches, and neck pain; pain in her lumbar, thoracic and cervical spines; numbness in her hands and feet, and exacerbation of preexisting conditions of the aforesaid areas of her body that were otherwise non-disabling and asymptomatic, as well as anxiety and emotional distress, as a result of which she has experienced and may continue to experience pain and suffering, limitations of her activities, loss of enjoyment of life's pleasures, embarrassment and humiliation and/or disfigurement. 13. As a direct and proximate result of the aforesaid incident, minor-Plaintiff, Kylee Jacobs, sustained injuries in and about her body and extremities, which injuries are or may be serious and/or permanent, including but not limited to: injuries to her head, neck, back, collarbone, chest and body, including headaches, neck pain, arm pain, tingling in her fingers and arms, pain in her lumbar, thoracic and cervical spines, shoulder pain and abdominal pain; and exacerbation of preexisting conditions of the aforesaid areas of her body that were otherwise non-disabling and asymptomatic, as well as anxiety and emotional distress, as a result of which she has experienced and may continue to experience pain and suffering, limitations of her activities, loss of enjoyment of life's pleasures, embarrassment and humiliation and/or disfigurement. 14. As a further direct and proximate result of the aforesaid incident, Plaintiffs have been and may in the future be obliged to incur expenses for medicines and medical attention in trying to treat and cure said injuries. 15. As a further direct and proximate result of the aforesaid incident, Plaintiffs have been and may in the future be prevented from attending to their usual and daily occupation and daily duties, thereby suffering a loss of earnings and/or impairment of earning capacity. 16. As a further direct and proximate result of the aforesaid incident, Plaintiffs, have suffered or may suffer a loss because of expenses which have been or may be reasonably incurred in obtaining ordinary and necessary services in lieu of those which Plaintiffs would have performed,not for income, but for themselves if they had not been injured by Defendant COUNT I—NEGLIGENCE Plaintiff, Susanne K.Jacobs v. Defendant,Bernice J.Bourne 17. Plaintiffs incorporate by reference all of the preceding paragraphs as if fully set forth herein at length. 18, The aforesaid collision and the resultant injuries and damages were directly and proximately caused by the negligence of Defendant, Bernice J. Bourne, as follows: a. Failing to observe and/or obey traffic markers, signs and/or signals; b. Failing to stay within her designated lane of travel; c. Changing lanes unsafely, improperly, without looking and in violation of applicable traffic laws; d. Violating applicable traffic laws of the Commonwealth of Pennsylvania; e. Failing to maintain proper control over the operation of her vehicle; f. Failing to maintain an adequate and proper lookout; g. Failing to know and/or abide by the "Rules of the Road" as set forth in 75 Pa. C.S. §3301 et seq.; h. Failing to know and/or abide by 75 Pa. C.S. §§3303 and/or 3304; i. Being an incompetent and/or inattentive driver; j. Driving while talking, dialing or texting on a cell phone or other such device; k. Operating her vehicle without being able to stop within an assured clear distance ahead; 1, Failing to operate her motor vehicle within the posted speed limit; m. Failing to sound the horn of her vehicle prior to colliding into Plaintiffs' vehicle; n. Disregarding the rights and safety of persons and/or vehicles lawfully on the road; o. Operating her vehicle in such a manner to create a dangerous condition of which she knew, or in the exercise of reasonable care, should have known; p. Operating her vehicle at an unsafe speed given the traffic, road and/or weather conditions prevailing during the relevant time; q. Failing to properly and/or adequately apply her vehicle's brakes; r. Operating her vehicle when she knew or reasonably should have known that it was not equipped with proper and/or properly operating signals, safety devices, warning devices, tires and/or brake systems; s. Carelessly driving her vehicle; t. Driving her vehicle while being inattentive and/or too tired to safely do so; u. Recklessly operating her vehicle. 19. As a direct and proximate result of Defendant's negligence, Plaintiff, Susanne K. Jacobs, sustained the injuries and damages as set forth in paragraphs 11, 13-15, supra. WHEREFORE, Plaintiff, Susanne K. Jacobs, demands compensatory damages in an amount above $50,000.00 be awarded in her favor and against Defendant, Bernice J. Bourne together with such other relieve as this court deems just. COUNT II—NEGLIGENCE Plaintiff,Kylee Jacobs, a minor, by and through her Parent and Natural Guardian, Susanne Jacobs v.Defendant,Bernice J. Bourne 20. Plaintiffs incorporate by reference all of the preceding paragraphs as if fully set forth herein at length, 21. The aforesaid collision and the resultant injuries and damages were directly and proximately caused by the negligence of Defendant, Bernice J. Bourne, as follows: a. Failing to observe and/or obey traffic markers, signs and/or signals; b. Failing to stay within her designated lane of travel; c. Changing lanes unsafely, improperly, without looking and in violation of applicable traffic laws; d. Violating applicable traffic laws of the Commonwealth of Pennsylvania; c. Failing to maintain proper control over the operation of her vehicle; f. Failing to maintain an adequate and proper lookout; g. Failing to know and/or abide by the "Rules of the Road" as set forth in 75 Pa. C.S. §3301 et seq.; h. Failing to know and/or abide by 75 Pa. C.S. §§3303 and/or 3304; i. Being an incompetent and/or inattentive driver; j. Driving while talking, dialing or texting on a cell phone or other such device; k. Operating her vehicle without being able to stop within an assured clear distance ahead; 1. Failing to operate her motor vehicle within the posted speed limit; in. Failing to sound the horn of her vehicle prior to colliding into Plaintiffs' vehicle; n. Disregarding the rights and safety of persons and/or vehicles lawfully on the road; o. Operating her vehicle in such a manner to create a dangerous condition of which she knew, or in the exercise of reasonable care, should have known; p. Operating her vehicle at an unsafe speed given the traffic, road and/or weather conditions prevailing during the relevant time; q. Failing to properly and/or adequately apply her vehicle's brakes; r. Operating her vehicle when she knew or reasonably should have known that it was not equipped with proper and/or properly operating signals, safety devices, warning devices, tires and/or brake systems; s. Carelessly driving her vehicle; t. Driving her vehicle while being inattentive and/or too tired to safely do so; u. Recklessly operating her vehicle. 22. As a direct and proximate result of Defendant's negligence, Plaintiff, Kylee Jacobs, a minor, by and through her parent and natural guardian, Susanne Jacobs, sustained the injuries and damages as set forth in paragraphs 12-15, supra. WHEREFORE, Plaintiff, Kylee Jacobs, demands compensatory damages in an amount above $50,000.00 be awarded in her favor and against Defendant, Bernice J. Bourne together with such other relieve as this court deems just. Respectfully submitted, VILLARI,BRANDES & GIANNONE,P.C. Dated: _a/7/ By: t ,Q, er M. Villa Esquire Nicole T. Matteo,Esquire Attorneys for Plaintiffs JURY DEMAND Plaintiffs hereby demand a jury trial as to all of the above claims. Respectfully submitted, VILLARI, BRANDES & GIANNONE, P.C. • Dated: V7/i3.. ....._. BY t ter M. Villa ",Esquire Nicole T. Matteo, Esquire Attorneys for Plaintiffs VERIFICATION Susanne K. Jacobs, individually and as parent and natural guardian of Kylee Jacobs, a minor, hereby states that she is the Plaintiff herein and that the facts set forth in the foregoing Complaint in Civil Action are true and correct to the best of her knowledge, information and belief and arc based upon information which she has furnished to her counsel and information which has been gathered by her counsel in preparation of the lawsuit. The language in the Complaint is that of counsel and not of Plaintiff. Plaintiff has read the Complaint and to the extent it is based upon information she has given to her counsel, it is true and correct to the best of her knowledge, information and belief. To the extent the contents of the Complaint are that of counsel, Plaintiff has relied upon counsel in making this verification. This verification is made subject to 18 Pa.C.S.A. § 4904 which provides for certain penalties for making false statements. *73 Susanne K. Jacobs, individually and as parent and natural guardian of Kylee Jacobs, a minor MO Non-Reportable Crash RecordtArt r-Azr>7 CzAli' INCIDENT NUMBER tit �/ T05-5033033 PA STATE POLICE-NEWVILLE (717)776-3135 3a,_ Ofd I T- 752-. DATE OF CRASH TIME OF CRASH DAY OF WEEK COUNTY MUNICIPALITY 09/18/2011 15:00 hrs. SUNDAY CUMBERLAND WEST PENNSBORO TWP ROUTE# SEGMENT# STREET STREET ENDING 6000 0000 PA TURNPIKE PIKE PATROL ZONE INVESTIGATOR t INVESTIGATOR SIGNATURE BADGE NUMBER 14 MORROW,ANTHONY L 06370 REVIEWER REVIEWER BADGE NUMBER APPROVAL DATE Latitude: 40� i2 es : 1 Decimal Longitude:= Degrees Minutes - : 5S52 Seconds Decimal Location: MILEPOST 216.8 WB SR 76/PA TURNPIKE UNIT# DRIVER'S LAST NAME FIRST NAME MI SUFFIX- DOB GENDER PHONE NUMBER 001 BOURNE BERNICE J 10/23/1958 FEMALE (252)646-5333 STREET ADDRESS CITY STATE ZIP CODE P 0 BOX 775 VERNON NY 13476 LICENSE NUMBER LICENSE STATE CLASS EXPIRATION DATE 377679121 NY D 10/23/2013 ' INSURANCE COMPANY POLICY NUMBER POLICY EXPIRATION DATE m GEICO 4097936258 11/29/2011 - OWNER'S LAST NAME OR BUSINESS NAME FIRST NAME MI SUFFIX • BOURNE BERNICE J z C STREET ADDRESS CITY STATE ZIP CODE P O BOX 775 VERNON NY 13476 VEHICLE YEAR MAKE 'MODEL 2004 FORD F150 XLT VIN LICENSE PLATE# STATE VIOLATIONS(INCLUDING SECTION NUMBERS): DRIVER CHARGED? 1FTRX12W94NA77906 ELK2932 NY DRIVING ON ROADWAYS LANED FOR TRAFFIC YES UNIT# DRIVER'S LAST NAME FIRST NAME MI SUFFIX DOB GENDER PHONE NUMBER 002 JACOBS SUSANNE K 11112/1961 FEMALE (814)421-7490 STREET ADDRESS CITY STATE ZIP CODE 1325 CHRISTOPHER ST JOHNSTOWN PA 15905 LICENSE NUMBER LICENSE STATE CLASS EXPIRATION DATE 19649632 PA C 11/13/2013 u INSURANCE COMPANY POLICY NUMBER POUCY EXPIRATION DATE m YOUNG INS CO PP20049728 01/20/2012 >- OWNER'S LAST NAME OR BUSINESS NAME FIRST NAME MI SUFFIX JACOBS SUSANNE K In STREET ADDRESS CITY STATE ZIP CODE 1325 CHRISTOPHER ST JOHNSTOWN PA 15905 VEHICLE YEAR MAKE MODEL 2001 FORD F350 XLT VIN LICENSE PLATE# STATE VIOLATIONS(INCLUDING SECTION NUMBERS): DRIVER CHARGED? 1FTSX31L71EA67617 YJW1439 PA NONE NO FIRST NAME MI LAST NAME SUFFIX PHONE NUMBER JEANNE E WIRICK (814)248-5655 _5 STREET ADDRESS CITY STATE ZIP CODE *+ 431 LOUELLA DR MINOSER PA 15963 Remarks‘Nates This crash occurred as both units were travelling westbound on the Pennsylvania Turnpike. In this area is a long term construction zone with a posted 55 mph speed limit. Unit 1 was in the left lane and unit 2 was in the right lane. Unit l's right front struck the left rear of unit 2. Operator 1 stated she was going 65 mph in the left lane when the other vehicle cut her off causing her to strike the vehicle in the rear. Operator 2 stated she was going 50 mph in the right lane when she was struck from behind. .....(..a.16 si si SI _ -1 1 3' - 416 q 3 SP 7 U099TX-Non Repeatable Commonwealth of Pennsylvania Non-Reportable Crash Record INCIDENT NUMBER T05-5033033 PA STATE POLICE-NEWVILLE (717)776-3135 Witness stated that at no time did she observe unit 2 swerving into the left lane. 5' i 1 ''-f" No injuries reported in this crash. C l� , d/-//V 7 Assisted by Newville maintenance personnel&John's Mobile Repair Service. ss - g j / / F C- gtq 94 7 41/3 / / LL - 6"4 5"S 4„, Page 1 1 OF 1 RECORD(S) Voter Registrations 1. New York Voter Registration Registrant Information Name: BOURNE, BERNICE J Residential Address: 4433 PETERBORO ST APT A3 VERNON, NY 13476-3643 ONEIDA COUNTY Mailing Address: PO BOX 775 VERNON, NY 13476-0775 ONEIDA COUNTY Home Phone: 2526465333 SSN: 169-52 400X Date of Birth: 10/1958 Gender: Female Voter Information Registration Date: 01/05/2009 Last Vote Date: 11/06/2012 Party Affiliation: REPUBLICAN Active Status: ACTIVE Town: 060 District: 002 • Special District 1: 001 Precinct 1: 000 Precinct 2: 000 State House District: 121 State Senate District: 047 U.S. House District: 022 General Election 2006: VOTED General Election 2005: VOTED Important: The Public Records and commercially available data sources used on reports have errors. Data is sometimes entered poorly, processed incorrectly and is generally not free from defect. This system should not be relied upon as definitively accurate. Before relying on any data this system supplies, it should be independently verified. For Secretary of State documents, the following data is for information purposes only and is not an official record. Certified copies may be obtained from that individual state's Department of State. Your DPPA Permissible Use is: I have no permissible use Your GLBA Permissible Use is: I have no permissible use Copyright © 2013 LexisNexis, a division of Reed Elsevier Inc. All Rights Reserved. 1E1 LAW OFFICE OF JOSEPH R.D'ANNUNZIO ATTORNEYS AND SUPPORT ASSOCIATES ARE EMPLOYEES OF GOVERNMENT EMPLOYEES INSURANCE COMPANY 4309 Linglestown Road, Suite 211 Harrisburg, PA 17112 Telephone: 717-901-5002 Facsimile: 717-901-5012 September 11, 2013 Nicole Matteo, Esquire Villari, Brandes & Giannone, P.C. 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 RE: Jacobs v. Bourne Dear Nicole: Thank you very much for our telephone conversation of September 11, 2013. I am the managing attorney for the GEICO Staff Counsel Office in Harrisburg. GEICO provides automobile insurance for Bernice J. Bourne, the Defendant in your action. Please mark your file to reflect that I will be representing Bernice Bourne in this case. If circumstances develop where you need to take a judgment, I ask that you please contact me first before doing so. Thank you for your courtesy and cooperation in this matter. Very truly yours, Joseph R. D'Annunzio JRD/ks cc: Evelyn Cropp - Claim #0324730680101061 ,-..,...... . --(--_ , , cosj —1 ------P'" 1 r ,C--- - (I...,.‘ —1 1"-- c3t..■i 1.••■ •"....1; i3 6 til • *7,....„, , ....................., 4......., , ---- tr., ------------■---•-•'._....__.._,__,... zci —ri 0 ',4■1174 VI --a Zw.t• co. ",.4 4 ., tri tilco 4> co -1--u-11:335 ''''..."."'"*.°".":"1.1.-------------- ------ -....."...............--"0"1" ."..•••••-•-.....„,,„........,__.....---.....---________ --:;:1,..........h.a. (.11 - CD 1:1,-1.2 1.11111.1111.111.111.1.11. ...-,•••• 00......._,............................. ......,__- I-7 'Z 5 tg in C., u.) cr r.-4 (1..) % _ • Cr\ — 4.‘ i "a: .c-'• _ liVts“V'.t ---. . ... .. . . .z.-.: ... ... ...,.... -,,,.., .... 0. v k V a ... %- 1.= ... ... ........ ... _. socol 1/4 ...... to ,..);,,:,. -.... -...„.... .A, ‘,—.3......0, , i . ,c- --..„ (3 r 1■ '1Ø tt ili V t 0 n 1.?irlii"-Y ti,() alt4.::*441140t - 0 4, ct a 1 z 133 4 11! trk —...-"- -----__;.-................."" ill . , z •?-1 - ,3) 0 1 IL".;":" --... .---'..."....---.1".."..'....--j."°- ''"°1-n-*'"°"."'".-----------------""..."----:..■.,..- -'.____.....-..............- ..—,--.....„___:11117-1. .............■ ci , , ;I ..................---........:..—...---...•-•....... ---, ril r4 i, r"1 , l'Y 4,1, 4. `t- b• * 2, 1- Q p -9? 41 b I 47. cn if .1.ad lot c7s14. -Eet; 6. r;ç Z, 1.•••"1 Ca Cc 47 4t) Fr, 47 (../ ,..: c:a 0 `C 44 ?..--■••"''''......."-------"--".-------- Andrew C. Rimol From: US_Postal_Service @usps.com Sent: Wednesday, November 20, 2013 10:59 AM To: Andrew C. Rimol Subject: U.S. Postal Service Track&Confirm email Restoration - 70111570000309471033 This is a post-only message. Please do not respond. Andy Rimol has requested that you receive this restoration information for Track&Confirm as listed below. Current Track&Confirm e-mail information provided by the U.S. Postal Service. Label Number: 70111570000309471033 Service Type: Certified Mail" Shipment Activity Location Date &Time Delivered CONSHOHOCKEN PA 19428 October 7, 2013 12:06 pm Processed through USPS Sort Facility PHILADELPHIA PA 19176 October 2, 2013 9:18 pm Processed through USPS Sort Facility ROCHESTER NY 14692 September 22, 2013 9:51 am Depart USPS Sort Facility ROCHESTER NY 14692 September 20, 2013 Processed through USPS Sort Facility ROCHESTER NY 14692 September 20, 2013 11:38 am Moved, Left no Address VERNON NY 13476 September 14, 2013 9:30 am Arrival at Unit VERNON NY 13476 September 14, 2013 7:15 am Processed through USPS Sort Facility SYRACUSE NY 13220 September 14, 2013 4:31 am Processed through USPS Sort Facility SYRACUSE NY 13220 September 13, 2013 11:27 pm Depart USPS Sort Facility SYRACUSE NY 13220 September 13, 2013 Depart USPS Sort Facility PHILADELPHIA PA 19176 September 13, 2013 Processed through USPS Sort Facility PHILADELPHIA PA 19176 September 12, 2013 9:45 pm USPS has not verified the validity of any email addresses submitted via its online Track&Confirm tool. For more information, or if you have additional questions on Track&Confirm services and features, please visit the Frequently Asked Questions (FAQs)section of our Track&Confirm tool at http://www.usps.com/shipping/trackandconfirmfaqs.htm. 1 VB viLLARi BRANDES OGGIANNONE ATTORNEYS AT LAW September 12, 2013 VIA CM#7011 1570 0003 0947 1033, RRR AND REGULAR MAIL Bernice Bourne P. 0. Box 775 Vernon,NY 13476 Re: Susanne Jacobs, individually and as parent and natural guardian of Kylee Jacobs, a minor v. Bernice Bourne Cumberland County Court of Common Pleas Our File No. 217485 Dear Ms. Bourne: Enclosed please Plaintiffs' Complaint filed against you in the above-captioned case. Please be guided accordingly. Sincerely, - —7 June Boualam Legal Secretary U.S. Postal Serviceu, CERTIFIED MAIL, RECEIPT m (Domestic Mail Only;No insurance Coverage Provided) Er:_13 For delivery information visit our website at www.usps.com, OFFICIAL USE Restage $ Crtifd Fee m Postmark CO Return Roostot Fee ,3 :unurununt ReqrCd) Cu EMI LF) 'Total Postage&Fees r-q Sent To , _ D Street,Apt.No.; _Ac Mart;Brantles&Giannone, or PO Sox No. 1-) , City,State,Z1P+4 „-- 1 Washington Street,Suite 400•Conshohocken,PA 19428 :72 Cr A lone 610-729-2900 0 Fax 610-729-2910 PS Fenn 3800.August 2006 S e Reverse for Instructions ram eardaw.com _ 1E1 Page 1 Search: Public Records : Locate a Person (Nationwide) Terms: last-name(Bourne) state(ALL) radius(30) dob(10/XX/1958) No. Full Name Address/Phone SSN 2. BOURNE,BERNICE J 117 COUNTRYSIDE CT 169-52-XXXX BOURNE,BERNIE J NEWPORT,NC 28570-9002 (PA:1973-1975) (DOB:10/1958) CARTERET COUNTY ,SSN linked to multiple (Age:55) (08/1999-Current) people 252-223-6188 BOURNE DAVID F LexID(sm):001007515872 (08/1999-Current) 3. BOURNE,BERNICE JOANNE 4600 COUNTRY CLUB RD APT 108G 169-52-XXXX BOURNE,BERNICE J MOREHEAD CITY,NC 28557-6224 (PA:1973-1975) BOURNE,BERNICE CARTERET COUNTY r SSN linked to multiple BOURNE,GROTKOWSKI (12/2009-11/2013) people BOURNE,BERNIECE J BOURNE,BERNIECE PO BOX 775 LexID(sm):000246195877 GROTKOWSKI BOURNE,BERNICE VERNON,NY 13476-0775 (Gender:Female) ONEIDA COUNTY (DOB:10/1958) (11/2012) (Age:55) 252-646-5333 Phone&ZIP code conflict 181 COATES WAY FAYETTE CITY,PA 15438-1041 FAYETTE COUNTY (06/2011-11/2011) 550 ROSTRAVER RD BELLE VERNON,PA 15012-1954 WESTMORELAND COUNTY 4600 COUNTRY CLUB RD 6PT 1 1 ) MOREHEAD CITY,NC 28557-6232 CARTERET COUNTY (01/2010-06/2011) 252-727-9090 Phone may be disconnected 117 COUNTRYSIDE CT NEWPORT,NC 28570-9002 CARTERET COUNTY (08/1999-06/2011) 252-223-6188 BOURNE DAVID F (Current Listing Name) 245 CEDAR CREEK RD NEWPORT,NC 28570-3709 CARTERET COUNTY (02/2010-02/2010) 4433 PETERBORO ST APT A3 VERNON,NY 13476-3643 ONEIDA COUNTY (02/2009-09/2009) 252-646-5333 Phone&ZIP code conflict 128 SHIPMAN RD HAVELOCK,NC 28532-1745 CRAVEN COUNTY Page 2 No. Full Name Address/Phone SSN (09/1995-12/1995) 58 HOLLY AVE LANGHORNE,PA 19047-5318 BUCKS COUNTY (12/1994-12/1994) 58 HOLLYBROOKE DR LANGHORNE,PA 19047-5752 BUCKS COUNTY (09/1994-09/1994) PO BOX 1927 NEWPORT,NC 28570-1927 CARTERET COUNTY Search: Public Records : Locate a Person (Nationwide) Terms: last-name(Bourne)state(ALL)radius(30)dob(10/XX/1958) Date/Time: Wednesday, November 20,2013 1:20 PM Permissible Use: DPPA - I have no permissible use GLBA - I have no permissible use Copyright©2013 LexisNexis, a division of Reed Elsevier Inc.All Rights Reserved. IIIII • ::::74 r..,z O t^7 t L1i � rn O .................. ....1 O ■ _ •■• t i LU .rte- 0 0 n ■ nows . ' CD 0(--, CD ■■ .... ,°-' 0 rA - , l n fir_ 2 (.4'' 0- PC) " . 0 F J /r +{ T7 D.) C3 11 ty Ill zr4rn U rt wmC rtt' ,O m )i2 CO x CV CV -Ir7-1 III t+) n.4 ti i-$# apt;* hA SF 1— .i A.k,"•.•*r.; V 770 07 2 ' Q • Nil:, % ' r Ua X xs/1" . ' . *13 UNIT col 73 m N bw� r �4 l 15) 'n N ffi f71 11 Y V) C; tV N ► 'a c O ! Q fn .N� III r . .ui3 Andrew C. Rimol From: US_Postal_Service @usps.com Sent: Wednesday, November 20, 2013 10:56 AM To: Andrew C. Rimol Subject: U.S. Postal Service Track&Confirm email Restoration - 70111570000309471040 This is a post-only message. Please do not respond. Andy Rimol has requested that you receive this restoration information for Track&Confirm as listed below. Current Track&Confirm e-mail information provided by the U.S. Postal Service. Label Number: 70111570000309471040 Service Type: Certified Mail TM Shipment Activity Location Date&Time Depart USPS Sort Facility PHILADELPHIA PA 19176 September 27, 2013 Processed through USPS Sort Facility PHILADELPHIA PA 19176 September 27, 2013 4:53 pm Processed through USPS Sort Facility RALEIGH NC 27676 September 23, 2013 4:34 pm Depart USPS Sort Facility RALEIGH NC 27676 September 19, 2013 Processed through USPS Sort Facility RALEIGH NC 27676 September 19, 2013 6:54 pm Moved, Left no Address MOREHEAD CITY NC 28557 September 17, 2013 9:59 am Sorting Complete MOREHEAD CITY NC 28557 September 17, 2013 9:08 am Arrival at Unit MOREHEAD CITY NC 28557 September 16, 2013 9:50 am USPS has not verified the validity of any email addresses submitted via its online Track&Confirm tool. For more information, or if you have additional questions on Track&Confirm services and features, please visit the Frequently Asked Questions (FAQs) section of our Track&Confirm tool at http://www.usps.com/shipping/trackandconfirmfags.htm. 1 v. B VILLARI BRANDES OGGIANNONE ATTORNEYS AT LAW Nicole T.Matteo,Esquire Email:nmatteo@villarilaw.com October 8, 2013 Postmaster Post Office Vernon,NY 13476 Re: Bernice Bourne P.O. Box 775, Vernon,NY 13476 Dear Sirs: Please be advised that this office represents the Plaintiff in the action against the above referenced Defendant. This request is made pursuant to the Administrative Support Manual Section 352.44(f)(2)(a) which exempts attorneys involved in actual or prospective litigation from the prohibition against providing names and addresses of postal customers. *Our client's records indicate that the Defendant receives mail at the post office box set forth above. In order to serve the Defendant with legal process, it is necessary to ascertain the physical address of his residence. *This request comes pursuant to a civil suit which this office has instituted against the Defendant verified by the docket number indicated above. The information provided will be used solely for the purpose of facilitating our efforts to locate the Defendant in order to make service of process. Accordingly, kindly provide the information requested on the enclosed postal form for the above referenced Defendant at your earliest convenience. I have enclosed a self-addressed stamped envelope for your convenience. I hereby certify that the information set forth above is true and correct to the best of my knowledge, information and belief. Thank you for your attention to this matter. If you have any questions, please do not hesitate to contact me. Very truly yours, a m3 Nicole T. Matteo, Esquire Mari,Brandes&Simone,P.C. 8 Tower Bridge •161 Washington Street,Suite 400•Conshohocken,PA 19428 Phone:610-729-2900•Fax:610-729-2910 www.villarilaw.com Request for Change of Address or Box holder Information Needed for Service of Legal Process Postmaster Please furnish the new address or the name and street address (if a box holder) for the following: Name: Bernice Bourne Address: _ P. O. Box 775, Vernon, NY 13476 (Note: The name and last known address are required for change of address information. The name, if known,and post office box address are required for box holder information.) The following information is provided in accordance with 39 CFR 265.6(d)(6)(ii). There is no fee for providing box holder information. The fee for providing change of address information is waived in accordance with 39 CFR 265.6(d)(1) and (2) and corresponding Administrative Support Manual 352.44 a and b. 1. Capacity of requester is ATTORNEY'S OFFICE. 2. Statute or regulation that empowers me to serve process is not required when requester is an attorney. 3. The names of all known parties to the litigation: Jacobs v. Bourne 4. The Court in which the case has been or will be heard: _Cumberland County, PA 5. The docket or other identifying number(if one has been issued): _2013-4780 6. The capacity in which this individual is to be served is Defendant. WARNING:The submission of false information to obtain and use change of address information or box holder information for any purpose other than the service of legal process in connection with actual or prospective litigation could result in criminal penalties including a fine of up to $10,000.00 or imprisonment or(2)to avoid payment of the fee for change of address information of not more than five years, or both (Title 18 U.S.C. § 1001). I certify that the above information is true and that the address information is needed and will be used solely for service of legal process in connection with actual or prospective litigation. N T. Matteo, Esq re For Post Office Use Only New Address or Box holder's Postmark/Name and Street Address No change of address order on file. Not known at address given. Moved, left no forwarding address. No such address. VmVILLAPI BRANDES G B GIANNONE ATTORNEYS AT LAW Nicole T.Matteo,Esquire Email:nmatteo@villarilaw.com October 8, 2013 Postmaster Post Office Vernon,NY 13476 Re: Bernice Bourne 4433 Peterboro Street, Apt. A-3, Vernon,NY 13476-3643 Dear Sirs: Please be advised that this office represents the Plaintiff in the action against the above referenced Defendant. This request is made pursuant to the Administrative Support Manual Section 352.44(f)(2)(a) which exempts attorneys involved in actual or prospective litigation from the prohibition against providing names and addresses of postal customers. *Our client's records indicate that the Defendant receives mail at the address set forth above. In order to serve the Defendant with legal process, it is necessary to ascertain the physical address of his residence. *This request comes pursuant to a civil suit which this office has instituted against the Defendant verified by the docket number indicated above. The information provided will be used solely for the purpose of facilitating our efforts to locate the Defendant in order to make service of process. Accordingly, kindly provide the information requested on the enclosed postal form for the above referenced Defendant at your earliest convenience. I have enclosed a self-addressed stamped envelope for your convenience. I hereby certify that the information set forth above is true and correct to the best of my knowledge, information and belief. Thank you for your attention to this matter. If you have any questions, please do not hesitate to contact me. Very truly yours, TLU , i Ia z Nicole T. Matteo, Esquire Mari,Brandes&Giannone,P.C. 8 Tower Bridge •161 Washington Street,Suite 400•Conshohocken,PA 19428 Phone:610-729-2900•Fax:610-729-2910 www villarilawcom Request for Change of Address or Box holder Information Needed for Service of Legal Process Postmaster Please furnish the new address or the name and street address (if a box holder) for the following: Name: Bernice Bourne Address: _ 4433 Peterboro Street, Apt. A-3, Vernon, NY 13476-3643 (Note: The name and last known address are required for change of address information. The name, if known,and post office box address are required for box holder information.) The following information is provided in accordance with 39 CFR 265.6(d)(6)(ii). There is no fee for providing box holder information. The fee for providing change of address information is waived in accordance with 39 CFR 265.6(d)(1) and (2) and corresponding Administrative Support Manual 352.44 a and b. 1. Capacity of requester is ATTORNEY'S OFFICE. 2. Statute or regulation that empowers me to serve process is not required when requester is an attorney. 3. The names of all known parties to the litigation: _Jacobs v. Bourne 4. The Court in which the case has been or will be heard: _Cumberland County, PA 5. The docket or other identifying number(if one has been issued): _2013-4780 6. The capacity in which this individual is to be served is Defendant. WARNING:The submission of false information to obtain and use change of address information or box holder information for any purpose other than the service of legal process in connection with actual or prospective litigation could result in criminal penalties including a fine of up to $10,000.00 or imprisonment or(2)to avoid payment of the fee for change of address information of not more than five years, or both(Title 18 U.S.C. § 1001). I certify that the above information is true and that the address information is needed and will be used solely for service of legal process in connection with actual or prospective litigation. marrio Nicb4 T.Matteo, Es ire For Post Office Use Only New Address or Box holder's Postmark/Name and Street Address No change of address order on file. _ Not known at address given. _ Moved, left no forwarding address. No such address. Nicole T.Matteo,Esquire Email:nmatteo@villarilaw.com October 8, 2013 Postmaster Post Office Morehead City,NC 28557 Re: Bernice Bourne 4600 Country Club Road, Apt. 108 G, Morehead City, NC 28557-6224 Dear Sirs: Please be advised that this office represents the Plaintiff in the action against the above referenced Defendant. This request is made pursuant to the Administrative Support Manual Section 352.44(f)(2)(a) which exempts attorneys involved in actual or prospective litigation from the prohibition against providing names and addresses of postal customers. *Our client's records indicate that the Defendant receives mail at the address set forth above. In order to serve the Defendant with legal process, it is necessary to ascertain the physical address of his residence. *This request comes pursuant to a civil suit which this office has instituted against the Defendant verified by the docket number indicated above. The information provided will be used solely for the purpose of facilitating our efforts to locate the Defendant in order to make service of process. Accordingly,kindly provide the information requested on the enclosed postal form for the above referenced Defendant at your earliest convenience. I have enclosed a self-addressed stamped envelope for your convenience. I hereby certify that the information set forth above is true and correct to the best of my knowledge, information and belief. Thank you for your attention to this matter. If you have any questions,please do not hesitate to contact me. Very truly yours, Nicole T. Matteo, Esquire .v 4 Atli* Request for Change of Address or Box holder Information Needed for Service of Legal Process Postmaster Please furnish the new address or the name and street address(if a box holder)for the following: Name: Bernice Bourne Address: _ P. O. Box 775, Vernon, NY 13476 (Note: The name and last known address are required for change of address information. The name,if known,and post office box address are required for box holder information.) The following information is provided in accordance with 39 CFR 265.6(d)(6)(ii). There is no fee for providing box holder information. The fee for providing change of address information is waived in accordance with 39 CFR 265.6(d)(1) and (2) and corresponding Administrative Support Manual 352.44 a and b. 1. Capacity of requester is ATTORNEY'S OFFICE. 2. Statute or regulation that empowers me to serve process is not required when requester is an attorney. 3. The names of all known parties to the litigation: Jacobs v. Bourne 4. The Court in which the case has been or will be heard: Cumberland County, PA 5. The docket or other identifying number(if one has been issued): 2013-4780 6. The capacity in which this individual is to be served is Defendant. WARNING:The submission of false information to obtain and use change of address information or box holder information for any purpose other than the service of legal process in connection with actual or prospective litigation could result in criminal penalties including a fine of up to $10,000.00 or imprisonment or(2)to avoid payment of the fee for change of address information of not more than five years,or both(Title 18 U.S.C.§1001). I certify that the above information is true and that the address information is needed and will be used solely for service of legal process in connection with actual or prospective litigation. Ni a T.Matteo,Esq re For Post Office Use Only New Address or Box holder's Postmark/Name and Street Address No change of address order on file. Not known at address given. Moved, left no forwarding address. No such address. Request for Change of Address or Box holder Information Needed for Service of Legal Process Postmaster Please furnish the new address or the name and street address(if a box holder)for the following: Name: Bernice Bourne Address: _ 4433 Peterboro Street, Apt. A-3, Vernon, NY 13476-3643 (Note: The name and last known address are required for change of address information. The name,if known,and post office box address are required for box holder information.) The following information is provided in accordance with 39 CFR 265.6(d)(6)(ii). There is no fee for providing box holder information. The fee for providing change of address information is waived in accordance with 39 CFR 265.6(d)(1) and (2) and corresponding Administrative Support Manual 352.44 a and b. 1. Capacity of requester is ATTORNEY'S OFFICE. 2. Statute or regulation that empowers me to serve process is not required when requester is an attorney. 3. The names of all known parties to the litigation: _Jacobs v. Bourne 4. The Court in which the case has been or will be heard: _Cumberland County, PA 5. The docket or other identifying number(if one has been issued): _2013-4780 6. The capacity in which this individual is to be served is Defendant. WARNING:The submission of false information to obtain and use change of address information or box holder information for any purpose other than the service of legal process in connection with actual or prospective litigation could result in criminal penalties including a fine of up to $10,000.00 or imprisonment or(2)to avoid payment of the fee for change of address information of not more than five years,or both(Title 18 U.S.C. § 1001). I certify that the above information is true and that the address information is needed and will be used solely for service of legal process in connection with actual or prospective litigation. utt, , Nic e T.Matteo,Es Yire For Post Office Use Only New Address or Box holder's Postmark/Name and Street Address No change of address order on file. Not known at address given. Moved,left no forwarding address. No such address. IIIII Nov 15 2013 3: 50PM HP LASERJET FAX p. 1 • r Request for Change of Address or Box holder Information Needed for Setvice of Legal Process Postmaster Please furnish the new address or the name and street address(if a box holder)for the following: Name: — Bernice Bourne Address: _ 4600 Country Club Road,Apt. 10813, Morehead City, NC 26557-6224 (Note: The name and last known address are re:Mired far change of address information. The name,if known,and post office box address ere required for box holder information.) The following Information is provided In accordance with 39 CFR 265.6(d)(6)(il). There is no fee for providing box holder information. The fee for providing change of address information Is waived in accordance with 35 CFR 285.8(dx1)end(2)and ocrrespondtne Administrative Support Manual 352,44 a and b. 1. Capacity of requester is ATTORNEY'S OFFICE. 2. Statute or regulation that empowers me to serve process is not required when requester is an attorney,_____ 3. The names of all known parties to the litigation: _Jacobs V. Bourne 4. The Court In which the case has been or will be heard: _Cumberland County. PA 5. The docket or other Identifying number(If one has been issued): _2013-4780 6. The capacity in which this individual is to be served is Defendant. Zg� yVARNINO:The submission of raise information to obtain and use change of address information or box holder information for any purpose other than the service of Legal process In connection with actual or prospective litigation could result in criminal penalties including a fine of up to$10,000,00 or imprisonment or(2)to avoid payment of the fee for change of address information of not more than Ave years,or both(Title 18 U.S.C.§1001). I certify that the above information Is true and that the address Information is needed and will be used solely for set tea~` ,�;•. -ss in connection with actual or prospective litigation. ' • `�' j11t03 / . !1 ' ,fII ' , ittC T.Matted,E" ire For Post Office Use Only New Address or Nos holder's Postmark I Name and Street Address No change of address order on fife. X Not known ataddress given. Moved,taft no forwarding address. _ No such address. &otJ MoCG-44:10-i Gh�Offs. £OCIE0071 A'Z O16Z6et019 XVd t£ 1Z It'd EZOZ/BL/11 Driver Licenses Search Page 1 of 2 24/7 Search and Technical Assistance 1-S66-277-8407 HOME i PRINT i CONTACT US ` LIVE CHAT I HELP i SIGN OUT My Accurint People Business Assets Licenses Phones Courts Recent Searches Mysccount Driver Licenses Professional Licenses FAA Pilots Hunting/Fishing Licenses More Searches t DLSeefdS BOURNE BERN Person Sea,.. B BOURNE 10 Last Name First Name Middle Name SSN Person Sea... B BOURNE 10 •BOURNE BERNICE Person Sea... B BOURNE 10 Coverage ffep% Street Address City State.A Zip • important:The Public R C FL :ante data ssurrs used ,his system n yr:ors. All Recent Searches» License Number DOB(mm/dd/yyyy) t t -t r y.p ti .ee fro.e.0,5ect.Read I Use of Permissible l Searches is bons. to „-- o”"I°and la generally nu. your Permissible Use selections. More Note:Not all of the Information contained in these • • ,t -R results is derived from governmental agencies. Include similar sounding names 3i Some information may have been enhanced ov Security News Include Non-Governmental Sources IA f., +c=ti-r 3I so�r<es. • New Security Center! •_........ ___...__. -CLICK HERE ,. Reference Code: Security Tip#7 €......................._..................................................................................................................................................................................................................................................................................................................................................................... Do not install any programs or software from the Internet if you do not 100%trust the source of the program or software. show All Security Tips Driver Licenses Search Results <_._s:I to 10 or 10 Search Terms Used- Last Name:BOURNE;First Name:BERNICE;State:FL; ^o'Edit Search New New Search :;':''':Print Results slj Export to Excel All License Information Reports The following are potential[Driver Licenses Records of the subject searched: j, Name:BERENICE C BOURNE License Number:exae-xxx-xx-xxx-x Other Re ports •-•Address:460 E OCEA A1�1E,LANTANA FL 3 346 2-33 50 License Type:DUPLICATE REPLACEMENT late:FLORIDA � License Class:Non-Commercial-Regular Operator Address Report County:PALM,BEACH License II al Potential S1 :199-18-xxxx Record Type:Current DOB xx,1923 Exp.Date:Sep 29,2014 der:lMnale Issue Date Aug 05,2008 Ethnicity:INN 5., Restrictions-Corrective Lenses Height:4'11" t Data Source-Governmental ....._.. .__. ..__.._.._.___.. 2. 2#c Name: :2391 SW BOURNE License Number Type:RENEWAL NE xxxx-xxx-xx-xxx-x Other Reports Address:2391 SW 9TH AVE, NTON BEACH FL 33426-5313 License Type:RENEWAL State:FLORIDA License Class:Non-Commercial-Regular Operator tLl Address Report •..unty:PALM BEAC License 18� Po-,;al SSN�4�`x99.18-xxxx Record Type:Historical DOB: l• :1923 Exp.Date:Sep 29,2014 Gende-.-••-In Issue Date:Aug 05,2008 city: Restrictions-Corrective Lenses Height:411" 's,.-,-4. Data Source-Governmental 3. 5'", Name:BERENICE C BOOR License Number:xxxx-xxx-xx-xxx-x (-fit Other Reports Address:2391 SW 9TH A -;BOYNTON BEACH FL 33426-5313 License Type:RENEWAL w -te:FLORIDA Record Type:Historical &Address Report •-•ty:PALM:- H Exp.Date:Sep 29,2008 Potent,: • :199-1 6-moot Issue Date:Aug 09,2002 DOE!. F 3 Restrictions-Corrective Lenses Female thnicity:WHITE Height.4'11" Data Source-Governmental 4. -_yam- Name:BERENICE C B••-NE License Number:xxxx-xxx-xx-xxx-x :nr Other Reports Ad•�s:2397 SW AVE,BOYNTON BEACH FL 33426-5313 License Class:MOn-Commercial-Regular Operator State:_,OR!r.• License County:•:-4 BEACH Record T ype:Historical Address Report Poteryda SSN •- 99-18-xxxx Exp.Date:Sep 29,2002 D9B:Sep xx,1923 Issue Date:Aug 29,1996 :Gender:Female Restrictions-Corrective Lenses �//Ethnicity:WHITE Height 411" Data Source-Governmental E, "' Name:BERNICE JOANNE BOURNE Ucense Number.xxxxxxxxxxxx 51 Other Reports Address:4600 COUNTRY CLUB RD,MOREHEAD CITY NC 28557-6224 License Class:CLASSIFIED ififi State:NORTH CAROLINA Record Type:Current Address Report County:CARTERET Exp.Date:Oct 23,2016 p Potential SSN d:169.52-xxxx Issue Date:Feb 08,2010 DOB:Oct xx,1958 Restrictions-CORRECTIVE LENSES Gender:Female Data Source-Governmental 5, ".. Name:BERNICE JOANNE BOURNE License Number:xxzxxxxzxxxx �j1 Other Reports =r7 Address:117 COUNTRYSIDE CT,NEWPORT NC 28570-9002 License Class:CLASSIFIED w State:NORTH CAROLINA Record Type:Historical a Address Report County:CARTERET Exp.Date:Oct 23,2016 Potential SSN J:169-52-xxxx Issue Date:Oct 10,2008 DOB:Oct xx,1958 Restrictions-CORRECTIVE LENSES Gender:Female Data Source-Governmental 7. °tl Name:BERNICE J BOURNE Record Type:Historical r Other Reports Address:43400 TWP 246,POMEROY OH 45769 State:OHIO Address Report ap County:MEIGS https://secure.accurint.com/app/bps/misc 11/20/2013 Ell Summary Report Page 1 of 2 Important: The Public Records and commercially available data sources used on reports have errors. Data is sometimes entered poorly, processed incorrectly and is generally not free from defect. This system should not he relied upon as definitively accurate. Before relying on any data this system supplies, it should be independently verified. For Secretary of State documents, the following data is for information purposes only and is not an official record. Certified copies may be obtained from that individual state's Department of State. The criminal record data in this product or service may include records that have been expunged, sealed,or otherwise have become inaccessible to the public since the date on which the data was last updated or collected. Accurint does not constitute a "consumer report"as that term is defined in the federal Fair Credit Reporting Act, 15 USC 1681 et seq. (FCRA).Accordingly,Accurint may not be used in whole or in part as a factor in determining eligibility for credit, insurance,employment or another permissible purpose under the FCRA. Your DPPA Permissible Use: Civil,Criminal,Administrative,or Arbitral Proceedings Your GLBA Permissible Use: Use by Persons Holding a Legal or Beneficial Interest Relating to the Consumer Summary Report Date: 11/20/13 Subject Information AKAs indicators (Best Information for Subject) (Names Associated with Subject) Name:BERNICE J BOURNE BERNICE J GROTKOWSKI Bankruptcy:No Date of Birth:10/xx/1958 DOB: 10/xx/1958 Age:55 SSN: 169-52-xxxx Property:No Age:55 BERNIE J GROTKOWSKI Corporate Affiliations:No SSN: 169-52-xxxx issued DOB:10/xx/1958 Age: 55 SSN: 169-52-xxxx in Pennsylvania between 1/1/1973 and BERNIE J BOURNE 12/31/1975 DOB: 10/xx/1958 Age:55 SSN: 169-52-xxxx Others Associated with SSN: (DOES NOT usually indicate any type of fraud or deception) BERNICE J BOURNE DOB:10/xx11958 Age:55 BERNICE JOANNE BOURNE DOB:1959 Age:54 BERNICE BOURNE DOB:10/xx11958 Age:55 BERUICE BOURNE DOB:10/xx/1958 Age:55 GROTKOWSKI BOURNE DOB:10/xx/1958 Age:55 BERNICE J GROTKOWSKIBOURNE DOB:10/xx/1958 Age:55 BERNIECE BOURNE DOB:10/xx/1958 Age:55 BOURNE BERNICE GROTKOWSKI DOB:10/xx/1958 Age:55 BERNICE JOANNE GROTKOWSKI DOB:10/xx/1958 Age:55 BERNIECE J BOURNE DOB:10/xx11958 Age:55 BERNICE GROTKOWSKI BOURNE DOB:10/xx/1958 Age:55 BERNICE GROTOWSKI DOB:10/xx/1958 Age:55 BOURNE B GROTKOWSKI DOB:10/xx/1958 Age:55 BERNICE J GROTKOWSKI DOB:1959 Age:54 BERNICE GROTKOWSKI DOB:10/1958 Age:55 DENISE BOURNE Age: Address Summary (.1-Probable Current Address) 4/117 COUNTRYSIDE CT,NEWPORT NC 28570-9002,CARTERET COUNTY(Mar 1998-Mar 2011) Phone at address:252-223-6188 -EST BOURNE DAVID F https://secure.accurint.com/app/bps/report 11/20/2013 Summary Report Page 2 of 2 Phone at address:252-223-6188 -EST BOURNE DAVID F Neighborhood Profile(2010 Census) Average Age:34 Median Household Income:$63,451 Median Home Value:$143,534 Average Years of Education: 12 7563 STATE ROAD 7,LAKE WORTH FL 33449-6716, PALM BEACH COUNTY(Oct 2011 -Sep 2013) Neighborhood Profile(2010 Census) rl fl- 7/461 777 AI L; CFA]' . Average Age:44 Median Household Income:$101,786 Median Home Value:$525,773 Average Years of Education:15 181 COATES WAY, FAYETTE CITY PA 15438-1041,FAYETTE COUNTY(Jun 2011 -Dec 2011) Neighborhood Profile(2010 Census) Average Age:47 Median Household Income:$47,463 Median Home Value:$86,645 Average Years of Education: 13 N> 4600 COUNTRY CLUB RD APT 115C,MOREHEAD CITY NC 28557-6232,CARTERET COUNTY(Jan 2010-Jun 2011) Neighborhood Profile(2010 Census) Average Age:47 Median Household Income:$55,093 Median Home Value:$192,857 Average Years of Education: 13 128 SHIPMAN RD,HAVELOCK NC 28532-1745,CRAVEN COUNTY(Jun 1995) Neighborhood Profile(2010 Census) Average Age:24 Median Household Income:$38,088 Median Home Value:$132,250 Average Years of Education: 13 58 HOLLYBROOKE DR,LANGHORNE PA 19047-5752,BUCKS COUNTY(Nov 1994) Neighborhood Profile(2010 Census) Average Age:33 Median Household Income:$100,469 Median Home Value:$223,611 Average Years of Education: 13 3880 LIMA AVE APT 1595, FEASTERVILLE TREVOSE PA 19053-7920, BUCKS COUNTY(May 1993) Neighborhood Profile(2010 Census) Average Age:35 Median Household Income:$88,208 Median Home Value:$233,269 Average Years of Education:13 608 JUDY LN,LEXINGTON KY 40505-1716, FAYETTE COUNTY(Dec 1989-Dec 1992) Neighborhood Profile(2010 Census) Average Age:44 Median Household Income:$51,330 Median Home Value:$104,290 Average Years of Education: 12 RUTH ST,VERNON NY 13476,ONEIDA COUNTY(Sep 1992) [No Data Available] 4073 N LAKE ORLANDO PKWY APT,ORLANDO FL 32808-2200,ORANGE COUNTY(Feb 1992) Neighborhood Profile(2010 Census) Average Age:31 Median Household Income:$36,871 Median Home Value:$193,118 Average Years of Education:12 64 CHANCERY RD,LANGHORNE PA 19047-1916,BUCKS COUNTY(Jan 1991) Phone at address:215-752-4030 -EST GROTKOWSKI JOANNE 215-750-6099 -EST BALENT JOHN Neighborhood Profile(2010 Census) Average Age:40 Median Household Income:$127,241 Median Home Value:$430,362 Average Years of Education:15 \ 1905 LEE RD,ORLANDO FL 32810-5703,ORANGE COUN Sep 1988) /' Neighborhood Profile(2010 Census) Average Age:55 Median Household Income:$21,983 Median Home Value:$187,891 Average Years of Education: 12 3051 KIRKLEVINGTON DR APT 58, LEXINGTON KY 40517-2437,FAYETTE COUNTY(Sep 1988) Neighborhood Profile(2010 Census) Average Age:25 Median Household Income:$35,820 Median Home Value:$125,595 Average Years of Education:14 131 COUNTRYSIDE CT,NEWPORT NC 28570-9002,CARTERET COUNTY(Oct 2009) Phone at address:252-223-5914 -EST CLOUD DEBORAH Neighborhood Profile(2010 Census) Average Age:34 Median Household Income:$63,451 Median Home Value:$143,534 Average Years of Education: 12 PO BOX 775,VERNON NY 13476-0775,ONEIDA COUNTY Neighborhood Profile(2010 Census) Average Age:42 Median Household Income:$57,576 Median Home Value:$114,315 Average Years of Education:13 Run Flr14er Repo> Report Comitieher h►e rt https://secure.accurint.com/app/bps/report 11/20/2013 1111 ,.,,.... r 44 C..1). -- kl„ *.....'....ci ' rianifit ' 0 Ja ,......''.0..'"...__....;006*........1111 tZt Vk ...s_.• ••---0 0 0...a...1._,■--- rt St'; i...ltr'' ".1 •-"-- -----...... .°....°.'s0.°"°. M'i ',IP rii' As' SI)T.3 (17, .....a ,, % ..°°°..."--„,..■"'`...'"*.-----01. 1001.1. .. r."'';'' 4i.. c 3 0 tl..1 ,•-t ,,..., Aso.1;3 ............._11.....00•00.. al. ...g;:i "*"....."-....... . ...... Or, .n,... ... —.•"--%------------ . -,-, —.• ,,, '°.*°001. 1.° °61.°. Cgi .............................. 7,,t; AP -7,n, n ■.-.3 : . ,•• z ,f2 , ,. •,2 ,c, ,..„, , ir, •••••A ,,:::•-•••:•,,o• .2 1 •-:-..-. p 0 .....) ..„ • -::: 0 0•-,k ... .,„ ' ..r. : . .. t *- * 4411'. \ ""'"-: ass S—'20'.•,,, I • a ..4 IgttZeitla,0111... '- 0 I-a 7 .°.' Nit ' :foci • ." * a . . '''''--...•,..,„0 03.„at oa t§t. / 4. . * • O%11 t'' ''',..... -:-. * -F,... Gt -•13 t) ...a 4, '`...,':.•::;.tt, """0-71 9,. c.P ' 4) 0 aSs. . -- , ...-....,- USPS.com® - USPS TrackingTM Page 1 of 2 English Customer USPS Mobile Register/Sign In Service US P S.COM Search USPS.com or Track Packac Quick Tools Track Ship a Package Send Mail Manage Your Mail Shop Business Solutions Enter up to 10 Tracking Wind Find USPS Locations Buy Stamps Customer Service Cal d'a Tracking TM Have questions?We're here to help. Fin a ZI Code Hold Mail Change of Address Tracking Number:9171999991703238980211 Expected Delivery Date:November 23,2013 Product & Tracking Information Available Options Postal Product: Features: First-Class Mail® Certified Mail'" Return Receipt Electronic December 10,2013, Processed 5:10 am through USPS PHILADELPHIA,PA 19176 Sort Facility December 9,2013, Processed 1 e b through USPS PHILADELPHIA,PA 19176 Sort Facility December 7,2013, Processed December m through USPS RALEIGH,NC 27676 Sort Facility December 5,2013, Processed December m through USPS RALEIGH,NC 27676 Sort Facility December 3,2013 Depart USPS RALEIGH,NC 27676 Sort Facility December 3,2013, Processed 1:15 pm through USPS RALEIGH,NC 27676 Sort Facility November 25,2013, Moved,Left no HAVELOCK,NC 28532 1:33 pm Address November 25,2013, Out for Delivery HAVELOCK,NC 28532 10:28 am November 25,2013, Sorting Complete HAVELOCK,NC 28532 10:18 am November 23,2013, Arrival at Unit HAVELOCK,NC 28532 10:47 am November 22,2013, Processed 11:19 pm through USPS FAYETTEVILLE,NC 28302 Sort Facility November 22,2013 Depart USPS FAYETTEVILLE,NC 28302 Sort Facility November 21,2013 DSort Facility epart USPS PHILADELPHIA,PA 19176 November 20,2013, Processed at 10:53 pm USPS Origin Sort PHILADELPHIA,PA 19176 Facility November 20,2013, Accepted at CONSHOHOCKEN,PA 19428 9:38 pm USPS Origin Sort Facility https://tools.usps.com/go/TrackConfirmAction!input.action?tRef qt&tLc=... 12/23/2013 USPS.com® - USPS TrackingTM Page 2 of 2 Electronic November 20,2013 Shipping Info Received Track Another Package What's your tracking(or receipt)number? Track It LEGAL ON USPS.COM ON ABOUT.USPS.COM OTHER USPS SITES Privacy Policy> Government Services> About USPS Home> Business Customer Gateway> Terms of Use> Buy Stamps&Shop> Newsroom> Postal Inspectors> FOIA> Print a Label with Postage> USPS Service Alerts> Inspector General> No FEAR Act EEO Data> Customer Service> Forms&Publications> Postal Explorer> Delivering Solutions to the Last Mile> Careers> Site Index> EB fS,p5COM Copyright©2013 USPS.All Rights Reserved. https://tools.usps.com/go/TrackConfirmAction!input.action?tRef qt&tLc=... 12/23/2013 IIII .. Fax Server 12/16/2013 6:00: 15 PM PAGE 1/002 Fax Server Guaranteed Subpoena Service, Inc. P.O. Box 2248 - UNION, NJ 07083 Phone: (908) 687-0056 Toll free: (800) 672-1952 Fax: (908) 688-0885 Tax ID 22-2393485 Web: www.Served.com - Email: Info @Served.com £1�1' Iii` 1i Your Process 20131206162708Was01 OT SERVED! ° 3 t'll1H 8!3 , Ili,s Iliii!ii,li... i£. „sillfilila;;u,.. !' 'i'Iilliill niilli!�i� NOT Served Upon: ERNICE BOURNE ;;: i!i 1i NOT Served Date/Time: 121/0/2013 2:13:00PM ,,;" HNlil lyiNllilli° At HOME: 117 COUNTRYSIDE COURt NEWPORT NC 28570 ,;:, Visit us at www.1 RVD"nom to get the latest st!atus'°ifiyour process. Your firn f!iI it€ I..iiiiilmii ii,i!..i.:.:,,..,I, 3!!I. ii!b" i 3£!1111!lil !ii , diL. 1 111!£1£!':!ii,£,a IDis 9 ,,„!,�' Y p ii!r 11111 :,!I!£il'.�.::m,u•,IR!EiiPE ,11111ui£i!iri!ilii:,:=i,:,,!, !!!!!i!i!?!i!i!i!!!i!i!i!it£:£!8 In the Case/Docket: 1.3::.4780 Claim. dilly” iii 1 iiiii 1111 Plaintiff: iii: SIX-ANNE JACOBS, IN(V. 1 1 1 I ;f1; ;iii; iiii Defendant: BEtNICE BOURNE iiii ,1 i!iUili�E i iilliiiiiliinllliil 1=1.,, =,iltiGw.,.:.: .i::,i3 Attorney: .......... TER M. VILLARI, ESQ. Frione: 6107292900 Fax: 6107292910 Email: Firm: VILLARI, BRANDES & GIANNME, P.C. £!EIGHT TOWER BRIDGE'4TI !'FL:ZOR 161 WASHINGTON" REET £111!1,' X11! iiii! Iifli■:,... !II CONSHOHOCKEN, PA 1:9428 Hl£11111'sli4iiii£!iii3i£ii"'s'£i£i ''3i!itimli Oni„r ,,,ii£iiilil:: WE MAY BE ABLE TO SERVE YOUR PROCESS IFWEHAVE HAVE YOUR AUTHORIZA1 dNIO FURTHER INVESTIGATE THIS MATTERI !iii' :i£i£' .,::£:. ,,, li ,111 k!i F '1i; li E! I , { € 111 m::au:,,,,in :1111 Ilil� �� �l,I !(iik„y:;:.:.:.:.:::.:lit!Jld�°II i£f£ il!gi rl (iiwaannsai,:,ii,s£. AUTHORIZATION FOR"�AD1 NCED SEARCH Note:alliinvestigative work is performed bySpart'an Detective Agency, NJ License 2392 To order search check desired box,sign authorization andix!I> ck to us Immediately at 800-0” 4-4405 'PLEASE BE ADVISED THAT IF THE SOCIAL SECURITY NUMBER 014 TAX ID IS 4EDED FOR A SEARCH THERE WILL A! ifF l£: £iiii) ��}1 III( a££!i£!uiiVdi!8ni£Ri !i£!! I IIIIi Ili£,; [ J Social Security Search:00 find o no find " [XrAffidtivit of Due Diligence$35 N lionly,!$50 other states Iiii i!,=i pi !ill! £iii!, iiii` Al „', [X]Skip Search'$75 no fell ;silo pajs£` I ]Corporate Search$75 anywhere ....U.. MM.".t.11:111M111111 ,.,, ! ill! [ ]Postal Forwarding$30`ariytivWltef�in U.S. i [ ] take i�ut-Hours: „ !",':Stake oUil$75/hour NJ only, $125/houri teth=er states iii [ ] DMV-MVC$50 NJ only, $1,i.0 other states i 1:1`1::1 / !!!! "''AUITIMIIZING SIGNATURE DATE Iiili Hu; „ PLEASE FAX SIGNED'AUTH9EVATI;(1 TO(888)224-4405 1{1£; !11 i ! !, i£OR CALL(877)SDA-2009 TO REA AN DETECTIVE AGENCY 2 CALL(800)672-1952 TO REACH G IARA EED SUBPOENA SERVICE w, 311'1 Ill 11111 * REASON FOR FAILURE TO SERVE IS AVAILABLE FROPROCE1$S SERVER IN AFFIDAVIT FORM,SIGNED AND NOTARIZED FOR$30 IN NJ ONLY AND$50 OTHER STATES.CHECK ABOVE AND RETURN FOR AFFIDAVIT. Fax Server 12/16/2013 6:00: 15 PM PAGE 2/002 Fax Server WE ARE UNABLE TO SERVE YOUR PROCESS FOR THE FOLLOWING REASON: [ ]POSSIBLE VACANT-POSSIBLY VACANT AND ABANDONED---- N.J.S.A.2A:50-73 May Apply $100 SUMMARY FORECLOSURE AFFIDAVIT.Call 1-800-672-1952 For Details. [ ]MOVED [ 1 UNABLE TO MAKE CONTACT [ ]ADDRESS DOES NOT EXIST [ ] DECEASED [ ]EVADING [ ]INCARCERATED [ ] UNKNOWN AT ADDRESS [ ]IN COLLEGE [ ]CANCELLED ON: [ ]RETIRED Guaranteed Subpoena Service utilizes "real time status". Our process servers communicate with our computers via a PDA through a menu. The categories above are what our process servers view and click in cases where process cannot be served. Our process server did go to the address you provided to make the declared determination. Fuel, time and wear and tear are involved. A "Due Diligence" Affidavit is available at a nominal cost upon request. Our no-serve/no-charge policy does not extend to special requests. We feel that this is fair and are confident that you agree. Should you have any questions please feel free to call our office at 1-800-672-1952 Andrew C. Rimol From: Linda A.Vondercrone Sent: Monday, December 23, 2013 4:54 PM To: Andrew C. Rimol Subject: FW:Jacobs From: Casey [mailto:00SPending @served.coml Sent: Monday, December 23, 2013 4:48 PM To: Linda A. Vondercrone Subject: RE: Jacobs WE WERE UNABLE TO MAKE CONTACT AT THE ADDRESS AFTER NUMEROUS ATTEMPTS,WE HAD ATTEMPTED ON THE DECEMBER 7TH,9TH,AND 10TH TWICE. IF YOU NEED THE AFFIDAVIT OF NON SERVICE WE CAN MAIL THAT OUT TO YOU FOR A FEE OF$50 Casey Nicholls Guaranteed Subpoena Service, Inc. Voted Best Process Server New York, Connecticut, New Jersey, Pennsylvania "IF WE DON'T SERVE IT,YOU DON'T PAY"ANYWHERE IN THE USA 2009 Morris Avenue Union, NJ 07083 908-687-0056 ext#137 From: infoftserved.com [mailto:info@iserved.com] Sent: Monday, December 23, 2013 4:39 PM To: OOSPENDING©SERVED.COM Subject: FW: Jacobs From: Linda A. Vondercrone [mailto:LVondercrone(avillarilaw.com] Sent: Monday, December 23, 2013 4:32 PM To: info@served.com Subject: FW: Jacobs Thank you for the attached . However,you did not indicate on Page 2 what the reasoning of non-service was. Normally, we wouldn't ask but we are in the process of drafting a Motion for Alternative Service&we are certain the Courts will ask. Thank you, Linda From: Tracey A. McDermott Sent: Tuesday, December 17, 2013 9:38 AM To: Linda A. Vondercrone; Jeanine M. Villari; Peter Villari Subject: re:Jacobs 2 III Page 1 of 1 Your process has been NOT SERVED Guaranteed Subpoena Service,Inc. P.O.BOX 2248,UNION,NJ 07083 Phone:(800)672-1952 Fax:(908)688-0885 Tax ID:22-2393485 Email:Info@Served.com www.Served.com GSS# 20131223143443 DocketlCase# 13 4780 Claim/File# Plaintiff SUSANNE JACOBS,INDIVIDIVUALLY,AND AS PARENT AND NATURAL GUARDIAN OF KYLEE JACOBS,A MINOR Defendant BERNICE BOURNE Entity BERNICE BOURNE THIS IS NOT AN AFFIDAVIT OF DUE DILIGENCE Address: 7563 STATE ROAD 7 LAKE WORTH FL 33449 Court Date: Due Date: 12/30/2013 12:00:00 AM Attorney PETER M.VILLARI,ESQ. Process Server: *SOUTH FLORIDA Serving: HOME Documents: PRAECIPE TO REINSTATE COMPLAINT,NOTICE TO DEFEND,COMPLAINT, .................................._..............._..........VERIFICATION ._.. We were unable to serve your process for the following reason(s): THIS IS NOT AN AFFIDAVIT OF DUE DILIGENCE [J Evading [x] Unknown at address []Address does not exist []Moved []Cancelled We may be able to serve your process if we have your authorization to further investigate this matter.Please select one of the options below. NOTE:ALL INVESTIGATIVE WORK PERFORMED BY SPARTAN DETECTIVE AGENCY.NJ LICENSE 2392 [x]WE RECOMMEND SEARCH: AUTHORIZATION FOR ADVANCED SEARCH [x]Skip Trace-$75.00-No Find,No Pay [x]Affidavit of Due Diligence $35 NJ Only,$50 Other States []Postal Forwarding-Call(877)SDA-2009 []Stake Out-For Hours []DMV-MVC-Call(877)SDA-2009 []Corporate Search Authorizing Signature: Date / / To order search please check desired box,sign and fax back to us immediately at:(888)224-4405 https://www.served.com/Not%20Served.aspx?gssno=20131223143443 2/7/2014 e• : t 1I . PRO HO ©Tf VILLARI, BRANDES & GIANNONE, P.C. By: Peter M. Villari, Esquire 2014 JAN 13 p)4 3: 14 Andrew C. Rimol, Esquire CUMBER���� COUNTY COU��� Attorney ID Nos. 26875 &205809 NLA,NO 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 (610) 729-2900 Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION Susanne Jacobs, individually, and as parent and . natural guardian of Kylee Jacobs, a minor Docket No.: 13-4780 1325 Christopher Street • Johnstown, PA 15905 Plaintiffs • Jury Trial Demanded • vs. Bernice Bourne • 4433 Peterboro Street • Apartment A3 • Vernon, NY 13476-3643 • Defendant • PRAECIPE TO REINSTATE COMPLAINT TO THE PROTHONOTARY: Kindly reinstate the Complaint in the above-captioned case, a true and correct copy of which is attached hereto. Respectfully submitted, VILLARI, BRANDES & GIANNONE, P.C. Dated: IP))/44 By 4,1 -r Esquire Andrew C. Rimol, Esquire Attorneys for Plaintiffs SUSANNE JACOBS, Individually, : IN THE COURT OF COMMON PLEAS and as Parent and Guardian of : OF CUMBERLAND COUNTY KYLEE JACOBS, a minor, : CIVIL ACTION—LAW mai -T Plaintiffs : =; -vs- : Docket No. 13-4780 Nr "`' BERNICE J. BOURNE : 1' • Defendant. : --± r, ORDER AND NOW, this 1,0 , day of t0 r vac , 2014, upon consideration of Plaintiffs' Motion for Alternate Service; and it appearing that Plaintiffs have made a diligent and good faith effort to locate and serve defendant, Bernice Bourne, in accordance with the Pennsylvania Rules of Civil Procedure, it is hereby ORDERED and DECREED that Plaintiffs' Motion is GRANTED. Accordingly: Service of process upon defendant, Bernice J. Bourne, may be made by sending a Certified Copy of the reinstated Complaint, along with this Order, to Government Employees Insurance Company ("GEICO") — defendant's automobile liability insurance carrier for the time at issue—care of Mr. Joseph R. D'Annunzio, Esquire, GEICO staff counsel assigned to represent defendant in this matter; and by publication of Notice, in the form set forth in C.C.R.P. 1009-1, one time in a newspaper of general circulation serving Carteret County, North Carolina, and in a newspaper of general circulation serving Vernon, New York. 4ej s `'. BY THE COURT: .I'ANNu/J-Z-1d \‘\\\;\J FAL/ P, , J. ,././aopq a Joseph R. D'Annunzio, Esquire I.D. No. 23384 4309 Linglestown Road, Suite 211, Harrisburg, PA 17112 Attorney for Defendant, (717) 901-5002 Bernice Bourne Fax: (717) 901-5012 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Susanne Jacobs, Individually and • t� as Parent and Natural Guardian of Kylee Jacobs Plaintiffs : NO. 13-4780 cr7, cp • v. : CIVIL ACTION - LAW °, • ,ter i i Bernice Bourne, • JURY TRIAL DEMANDED 77 { f • N Defendant PRAECIPE TO ENTER APPEARANCE TO THE PROTHONOTARY: Kindly enter my appearance on behalf of Defendant, Bernice Bourne, in the above-captioned matter. LAW OFFICE OF JOSEPH R. D'ANNUNZIO Date: co-dev1�/ z� /`19 BY: Joseph R. D'Annunzio, Esquire Attorney for Defendant CERTIFICATE OF SERVICE I hereby certify that I am this day serving a copy of the foregoing document upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States Mail, first-class postage prepaid, addressed as follows: Nicole Matteo, Esquire Villari, Brandes & Giannone, P.C. 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 • Date: A ", 'L€ 1 Kimb ly Stielper Stiel p BY:Joseph R.D'Annunzio Law Office of Joseph R.D'Annunzio Identification No.23384 4309 Linglestown Road, Suite 211 Attorney for Defendant,Bernice Bourne Harrisburg,PA 17112 (717)901-5002 (717)901-5012(Fax) -r; } jdannunzio @geico.com IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA SUSANNE JACOBS, INDIVIDUALLY AND AS -� - PARENT AND NATURAL GUARDIAN OF KYLEE JACOBS, Plaintiff • NO. 13-4780 v. • CIVIL ACTION - LAW BERNICE BOURNE, JURY TRIAL DEMANDED Defendant • NOTICE TO PLEAD TO: Susanne Jacobs& Kylee Jacobs c/o Nicole Matteo, Esquire Villari, Brandes & Giannone, P.C. 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 You are hereby notified to file a written response to the enclosed Answer and New Matter of Defendant to Plaintiff's Complaint within twenty(20) days from service hereof or a default judgment may be entered against you. LAW OFFICE OF JOSEPH R. D'ANNUNZIO Date: ��� �� 2e7/ By: . Joseph R. D'Annunzio, Esquire Attorney for Defendant BY:Joseph R.D'Annunzio Law Office of Joseph R.D'Annunzio Identification No.23384 4309 Linglestown Road,Suite 211 Attorney for Defendant,Bernice Bourne Harrisburg,PA 17112 (717)901-5002 (717)901-5012(Fax) jdannunzio@geico.com IN THE COURT OF COMMON PLEAS FOR CUMBERLAND COUNTY, PENNSYLVANIA SUSANNE JACOBS, INDIVIDUALLY AND AS PARENT AND NATURAL GUARDIAN OF KYLEE JACOBS, Plaintiff NO. 13-4780 v. : CIVIL ACTION - LAW • BERNICE BOURNE, JURY TRIAL DEMANDED Defendant ANSWER AND NEW MATTER OF DEFENDANT,BERNICE BOURNE,TO PLAINTIFF'S COMPLAINT 1. Admitted only upon information and belief. 2. Admitted only upon information and belief. 3. Admitted that the Defendant is Bernice J. Bourne. 4. Admitted. 5. Admitted. 6. Admitted only upon information and belief. 7. Admitted. 8. Denied as stated. It is admitted only that on September 18, 2011 a collision occurred between the vehicle operated by the Defendant, Bernice J. Bourne and the vehicle with trailer operated by the Plaintiff, Susanne K. Jacobs. 9. Denied. After reasonable investigation the answering Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in this paragraph. Accordingly, the averments are deemed denied and strict proof is demanded. 10. Admitted. 11. Denied as a conclusion of law to which no responsive pleading is required. 12. Denied that the Defendant was negligent or that her conduct in any way caused or contributed to any injuries or damages allegedly sustained by the Plaintiff. After reasonable investigation the answering Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in this paragraph regarding injuries and damages. Accordingly, the averments are deemed denied and strict proof is demanded. 13. Denied that the Defendant was negligent or that her conduct in any way caused or contributed to any injuries or damages allegedly sustained by the Plaintiff After reasonable investigation the answering Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in this paragraph regarding injuries and damages. Accordingly, the averments are deemed denied and strict proof is demanded. 14. Denied that the Defendant was negligent or that her conduct in any way caused or contributed to any injuries or damages allegedly sustained by the Plaintiff After reasonable investigation the answering Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in this paragraph regarding injuries and damages. Accordingly, the averments are deemed denied and strict proof is demanded. 15. Denied that the Defendant was negligent or that her conduct in any way caused or contributed to any injuries or damages allegedly sustained by the Plaintiff. After reasonable investigation the answering Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in this paragraph regarding injuries and damages. Accordingly,the averments are deemed denied and strict proof is demanded. 16. Denied that the Defendant was negligent or that her conduct in any way caused or contributed to any injuries or damages allegedly sustained by the Plaintiff. After reasonable investigation the answering Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in this paragraph regarding injuries and damages. Accordingly,the averments are deemed denied and strict proof is demanded. I. NEGLIGENCE Susanne K.Jacobs v. Bernice Bourne 17. The answers to paragraphs 1-16 are incorporated by reference as if fully set forth herein. 18. Denied generally as conclusions of law to which no responsive pleadings are required. It is denied specifically that the Defendant was negligent or that her conduct in any way caused or contributed to any injuries or damages allegedly sustained by the Plaintiff. 19. Denied as a conclusion of law to which no responsive pleading is required. WHEREFORE, Defendant, Bernice Bourne, demands that judgment be entered in her favor. II. NEGLIGENCE Kylee Jacobs, a Minor through her Parent and Natural Guardian, Susanne K. Jacobs v.Bernice Bourne 20. The answers to paragraphs 1 through 19 are incorporated by reference as if fully set forth herein. 21. Denied generally as conclusions of law generally to which no responsive pleadings are required. It is denied specifically that the Defendant was negligent or that her conduct in any way caused or contributed to any injuries or damages allegedly sustained by the Plaintiff. 22. Denied as a conclusion of law to which no responsive pleading is required. WHEREFORE, Defendant, Bernice Bourne, demands that judgment be entered in her favor. NEW MATTER 1. The answers to paragraphs 1 through 22 are incorporated by reference as if fully set forth herein. 2. The injuries and damages allegedly sustained by the Plaintiff may have been caused by occurrences that happened before the date of this motor vehicle accident and so pre- existed the date of this motor vehicle accident. 3. The injuries and damages allegedly sustained by the Plaintiff may be caused by occurrences that happened after the date of the motor vehicle accident and so were caused by events which are subsequent to the date of the motor vehicle accident. 4. The direct and proximate cause of the motor vehicle accident that forms the basis of this lawsuit was the negligence, carelessness and recklessness of the Plaintiff, Susanne Jacobs in the operation of her motor vehicle. Said negligence consisting of the following: a. The Plaintiff failed to have her truck and trailer under reasonable and adequate control. b. The Plaintiff failed to have due regard for the rights, safety and position of other vehicles on the highway. c. The Plaintiff failed to adjust her driving to reflect that the area in which she was traveling was under construction and that the road lanes of travel were narrowed due to that construction. d. The Plaintiff moved her vehicle into a vehicle into a lane of traffic when it was unsafe for her to do so. e. The Plaintiff failed to keep a proper lookout for other vehicles on the highway. 5. The Plaintiffs claims are barred from recovery by virtue of the contributory negligence of Plaintiff, Susanne K. Jacobs which was the direct and proximate cause of this motor vehicle accident. 6. The Plaintiffs are barred and/or limited by the comparative negligence of the Plaintiff, Susanne K. Jacobs which negligence was greater than any negligence that can be attributed to the conduct of the Defendant, Bernice J. Bourne. WHEREFORE, Defendant, Bernice Bourne, demands that judgment be entered in her favor. Respectfully submitted, Date: /;�dv,--d L7 zip/ By:ht C,'!° ` Y Joseph R. D Annunzio, Esquire Attorney for Defendant VERIFICATION The undersigned, being duly sworn according to law, deposes and says that he is counsel for the party or parties indicated on the preceding page as being represented by said counsel, that he has examined the pleadings and the entire investigative file made on behalf of said party or parties, that he is taking this verification to assure compliance with the pertinent rules pertaining to timely filing of pleadings and other documents described by said rules; and that the facts set forth in the foregoing document are true and correct to the best of his knowledge, information and belief. The undersigned understands that the statements therein are made subject to the penalties of 18 PA C.S. SECTION 4904 relating to unsworn falsification to authorities. Date: d��o—y BY: G Joseph R. D'Annunzio, Esquire I a BY:Joseph R.D'Annunzio Law Office of Joseph R.D'Annunzio Identification No.23384 4309 Linglestown Road, Suite 211 Attorney for Defendant,Bernice Bourne Harrisburg,PA 17112 (717)901-5002 (717)901-5012(Fax) jdannunzio@geico.com IN THE COURT OF COMMON PLEAS FOR CUMBERLAND COUNTY,PENNSYLVANIA SUSANNE JACOBS, INDIVIDUALLY AND AS PARENT AND NATURAL GUARDIAN OF KYLEE JACOBS, Plaintiff • NO. 13-4780 • v. • CIVIL ACTION - LAW BERNICE BOURNE, • JURY TRIAL DEMANDED Defendant CERTIFICATE OF SERVICE I, Kimberly Stielper, do hereby certify that on this--7J day of F-e'vr-- , 2014, I caused a true and correct copy of Defendant, Bernice Bourne's, Answer and New Matter Addressed to Plaintiff, Susanne JacobsKylee Jacobs ,to be served upon the following person listed below via first class United States mail, postage prepaid: Nicole Matteo, Esquire Villari, Brandes &Giannone, P.C. 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 LAW OFFICE OF JOSEPH R. D'ANNUNZIO r BY: �1�� Kimberl ielper, Legal Secretary BY:Joseph R.D'Annunzio n r« n ° ' ' I: Law Office of Joseph R.D'Annunzio ' + t fA,i 4 Identification No.23384 ;;,k t. 4309 Linglestown Road, Suite 211 Attorney for Defendant;Be �5' J 1X1 1 Harrisburg,PA 17112 (717)901-5002 (717)901-5012(Fax) jdannunzio@geico.com IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA SUSANNE JACOBS, INDIVIDUALLY AND AS PARENT AND NATURAL GUARDIAN OF KYLEE JACOBS, Plaintiff • NO. 13-4780 • v. • CIVIL ACTION - LAW • BERNICE BOURNE, • JURY TRIAL DEMANDED Defendant • NOTICE TO PLEAD TO: Susanne Jacobs & Kylee Jacobs c/o Nicole Matteo, Esquire Villari, Brandes & Giannone, P.C. 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 You are hereby notified to file a written response to the enclosed Motion to Compel Neuropsychological Evaluation within twenty (20) days from service hereof or a default judgment may be entered against you. LAW OFFICE OF JOSEPH R. D'ANNUNZIO 3 J By: Date: rr,4 Joseph R. D'Annunzio, Esquire Attorney for Defendant BY:Joseph R.D'Annunzio Law Office of Joseph R.D'Annunzio Identification No.23384 4309 Linglestown Road, Suite 211 Attorney for Defendant,Bernice Bourne Harrisburg,PA 17112 (717)901-5002 (717)901-5012(Fax) jdannunzio@geico.com IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA SUSANNE JACOBS, INDIVIDUALLY AND AS PARENT AND NATURAL GUARDIAN OF KYLEE JACOBS, Plaintiff NO. 13-4780 • v. : CIVIL ACTION -LAW • BERNICE BOURNE, JURY TRIAL DEMANDED • Defendant • MOTION TO COMPEL NEUROPSYCHOLOGICAL EXAMINATION 1. On February 20, 2014, the Honorable M. L. Ebert, Jr., issued an order regarding a Motion for Alternative Service in this case. 2. On August 12, 2013, The Plaintiff, Susanne Jacobs, individually and as parent and natural guardian of Kylee Jacobs, filed a Complaint in this matter seeking to recover money damages for personal injuries sustained in a motor vehicle accident that occurred on September 18, 2011. 3. On February 12, 2014,the Plaintiff filed a Motion for Alternative Service in this matter. 4. On February 20, 2014, Judge Ebert granted the motion and directed that service of process upon the Defendant could be made by alternative means. 5. The Defendant, Bernice J. Bourne, through her attorney, Joseph R. D'Annunzio, Esquire, has filed an Answer and New Matter in this case. 6. Plaintiff, Kylee Jacobs is a minor whose date of birth is August 21, 1999. 7. The Plaintiffs contend that in the motor vehicle accident Kylee Jacobs struck her head on the windshield of the car causing her to sustain neurological injuries. 8. The Plaintiffs have submitted a report prepared by Dr. Harry Bramley,the Medical Director at the Penn State Concussion Program at the Milton S. Hershey Medical Center in which Dr. Bramley disclosed that Kylee Jacobs has been having post- traumatic headaches. 9. The Defendant believes that the physical condition of Kylee Jacobs is in controversy as it relates to being proximately caused by the motor vehicle accident. Accordingly, the Defendant requests that Kylee Jacobs submit to a neuropsychological evaluation to determine the causation for the headaches. 10. The Defendant wishes to retain Dr. Reed Goldstein, a neuropsychologist at Pennsylvania Hospital, to conduct the neuropsychological evaluation. 11. The Defendant has requested of the Plaintiff that Kylee Jacobs submit to the neuropsychological evaluation and has agreed to pay the costs of transportation for Kylee Jacobs and her mother to travel to Philadelphia for this evaluation. 12. Because Kylee Jacobs is a student, Dr. Goldstein has agreed to conduct his evaluation on either a Saturday or a Sunday to minimize interruption of Kylee's school life. 13. The Plaintiffs cancelled the appointment that had been made with Dr. Goldstein for February 1, 2014 and have refused to reschedule an appointment with Dr. Goldstein. 14. Pursuant to Pennsylvania Rule of Civil Procedure 4010, the Defendant requests that this Honorable Court issue an order directing that Kylee Jacobs shall submit to a physical examination conducted by Dr. Reed Goldstein at Pennsylvania Hospital at such time as shall be determined with the examination to take place within 30 days of the date of the order. WHEREFORE, the Defendant, Bernice Bourne asks this Honorable Court to direct that Kylee Jacobs, a minor, submit to a neuropsychological evaluation with Dr. Reed Goldstein at Pennsylvania Hospital. Respectfully submitted, Date: Arcs By:A4 Joseph R. D'Annunzio, Esquire Attorney for Defendant CERTIFICATE OF SERVICE I hereby certify that I am this day serving a copy of the foregoing document upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States Mail, first-class postage prepaid, addressed as follows: Nicole Matteo, Esquire Villari, Brandes & Giannone, P.C. 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 Date: Kimberly Stielper SUSANNE JACOBS, : IN THE COURT OF COMMON PLEAS OF INDIVIDUALLY AND AS : CUMBERLAND COUNTY, PENNSYLVANIA„ PARENT AND NATURAL (.= GUARDIAN OF KYLEE JACOBS, -ox -- PLAINTIFF =rri yam V. BERNICE BOURNE, 41- C) E5 DEFENDANT : NO. 13-4780 CIVIL ORDER OF COURT AND NOW, this 7th day of March, 2014, upon consideration of the Plaintiff's Motion to Compel Neuropsychological Examination; IT IS HEREBY ORDERED AND DIRECTED that: 1. A Rule shall issue upon Susanne Jacobs to show cause why the relief requested by the Defendant should not be granted; 2. Susanne Jacobs shall file an Answer to the Motion on or before March 28, 2014; 3. If no answer to the Rule to Show cause is filed by the required date, the relief requested by Petitioner shall be granted upon the Court's receipt of a Motion requesting Rule be made Absolute. 4. Should the Plaintiff file an Answer, the Court will determine the necessity for hearing and/or oral argument. By the Court, Matteo, Esquire Attorney for Plaintiff Joseph R. D'Annunzio, Esquire Attorney for Defendant bas 0...briz 'Es P2z4 3/1 iy VILLARI, BRANDES & GIANNONE, P.C. By: Peter M. Villari, Esquire Attorney I.D. No. 26875 -and - By: Andrew C. Rimol, Esquire Attorney I.D. No. 205809 8 Tower Bridge 161 Washington Street, Suite 400 Conshohocken, PA 19428 Telephone - (610) 729 -2900 Facsimile - (610) 729 -2910 TlOi Ti O1411MR IN At ill: 31 CUf 3ERLAND COUNT'( PENNS YLVANIA Attorneys for Plaintiffs SUSANNE JACOBS, Individually, and as Parent and Guardian of KYLEE JACOBS, a minor, Plaintiffs -vs- BERNICE J. BOURNE Defendant. : IN THE COURT OF COMMON PLEAS • OF CUMBERLAND COUNTY • CIVIL ACTION — LAW Docket No. 13 -4780 Vil PLAINTIFFS' REPLY TO NEW MATTER Plaintiffs, Susanne Jacobs and Kylee Jacobs, by and through their undersigned counsel, , Brandes & Giannone, P.C., file this Reply to the New Matter of Defendant, Bernice J. Bourne, and hereby say as follows: 1. Paragraphs 1 through 22 of Plaintiffs' Complaint are incorporated by reference as if same were set forth at length in their entirety herein. 2. Denied. It is denied that the injuries and /or damages alleged by Plaintiffs were caused by any incident or occurrence taking place prior to the subject motor vehicle accident or that said injuries and/or damages otherwise pre- existed the motor vehicle accident. To the contrary, as alleged in Plaintiffs' Complaint, each and every allegation of which has been incorporated by reference herein, Plaintiffs' injuries and damages are the direct and /or proximate result of the September 18, 2011 motor vehicle accident with Defendant. Strict proof of Defendant's allegation is demanded. 3 Denied. It is denied that the injuries and/or damages alleged by Plaintiffs were caused by any incident or event taking place after the subject motor vehicle accident or that said injuries and/or damages otherwise occurred subsequent to the motor vehicle accident. To the contrary, as alleged in Plaintiffs' Complaint, each and every allegation of which has been incorporated by reference herein, Plaintiffs' injuries and damages are the direct and/or proximate result of the September 18, 2011 motor vehicle accident with Defendant. Strict proof of Defendant's allegation is demanded. 4. Denied generally as conclusions of law to which no response is required. Notwithstanding, it is denied that, at anytime relevant hereto, Plaintiff Susanne Jacobs acted negligently, carelessly or recklessly or otherwise caused or contributed to the happening of the motor vehicle accident or the injuries, damages and/or losses Plaintiffs sustained as a result thereof. To the contrary, at all times relevant hereto, Plaintiff Susanne Jacobs proceeded carefully, cautiously, prudently and with due regard to the rights and safety of herself and others. Strict proof of Defendant's allegations is demanded. 5. Denied as a conclusion of law to which no response is required. Notwithstanding, it is denied that Plaintiff Susanne Jacobs was comparatively or contributorily negligent or otherwise caused or contributed to the happening of the motor vehicle accident or the injuries, damages and/or losses sustained by Plaintiffs as a result thereof. To the contrary, at all times relevant hereto, Plaintiff Susanne Jacobs proceeded carefully, cautiously, prudently and with due regard to the rights and safety of herself and others. Strict proof of Defendant's allegation is demanded. 6. Denied as a conclusion of law to which no response is required. Notwithstanding, it is denied that Plaintiff Susanne Jacobs was comparatively or contributorily negligent or otherwise caused or contributed to the happening of the motor vehicle accident or the injuries, damages and /or losses sustained by Plaintiffs as a result thereof To the contrary, at all times relevant hereto, Plaintiff Susanne Jacobs proceeded carefully, cautiously, prudently and with due regard to the rights and safety of herself and others. Strict proof of Defendant's allegation is demanded. WHEREFORE, Plaintiffs Susanne Jacobs and Kylee Jacobs, respectfully request that judgment be entered in their favor and against Defendant as set forth in the Complaint and any amendments thereto. DATED: March 17, 2014 By: Respectfully submitted, VILLARI, BRANDES & GIANNONE, P.C. C. RIMOL Attorneys for Plaintiffs VERIFICATION I, Andrew C. Rimol, Esquire, hereby certify and say that I am an associate at Villari, Brandes & Giannone, P.C., attorneys for Plaintiffs, Susanne and Kylee Jacobs, in the above- captioned civil action and that the statements of fact set forth in Plaintiffs' Reply to New Matter are true and correct to the best of my personal knowledge, information and belief. I understand that the statements made herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. DATED: March 17, 2014 By: VILLARI, BRANDES & GIANNONE, P.C. ANDREW C. RIMOL Attorneys for Plaintiffs VILLARI, BRANDES & GIANNONE, P.C. By: Andrew C. Rimol, Esquire Attorney I.D. No. 205809 8 Tower Bridge 161 Washington Street, Suite 400 Conshohocken, PA 19428 Telephone - (610) 729-2900 Facsimile - (610) 729-2910 Attorneys for Plaintiffs SUSANNE JACOBS, Individually, and as Parent and Guardian of KYLEE JACOBS, a minor, Plaintiffs -vs- BERNICE J. BOURNE Defendant. : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : CIVIL ACTION — LAW Docket No. 13-4780 CERTIFICATE OF SERVICE I hereby certify that Plaintiffs' Reply to New Matter was served upon the following in accordance with Pa. R. C.P. 440, by mailing a true and correct copy of same to defendant's counsel of record this 17th day of March 2014, via U.S. First Class Mail, postage prepaid, addressed as follows: DATED: March 17, 2014 Joseph R. D'Annunzio, Esquire Law Office of Joseph R. D'Annunzio 4309 Linglestown Road, Suite 211 Harrisburg, PA 17112 Attorney for Defendant, Bernice Bourne By: VILLARI, BRANDES & GIANNONE, P.C. C. RIMO Attorneys for Plaintiffs VILLARI, BRANDES & GIANNONE, P.C. By: Peter M. Villari, Esquire Attorney I.D. No. 26875 -and - Andrew C. Rimol, Esquire Attorney I.D. No. 205809 8 Tower Bridge 161 Washington Street, Suite 400 Conshohocken, PA 19428 Telephone - (610) 729 -2900 Facsimile - (610) 729 -2910 iti t tL 20 MAR 28 P11 2; 51 CUMBERLAND COUNTY PENNSYLVANIA Attorneys for Plaintiffs SUSANNE JACOBS, Individually, and as Parent and Guardian of KYLEE JACOBS, a minor, Plaintiffs -vs- BERNICE J. BOURNE Defendant. : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : CIVIL ACTION — LAW : Docket No. 13 -4780 PLAINTIFFS' RESPONSE TO MOTION TO COMPEL NEUROPSYCHOLOGICAL EXAMINATION Plaintiffs, by and through their undersigned counsel, Villari, Brandes & Giannone, P.C., hereby file the foregoing Response to Defendant's Motion to Compel Neuropsychological Examination, and in support thereof aver the following: 1. Admitted that on February 20, 2014, the Honorable M. L. Ebert, Jr., issued an Order granting Plaintiffs' Motion for Alternative Service. 2. Admitted. 3. Admitted. 4. Admitted. 5. Admitted. By way of further response, Plaintiffs filed a Reply to New Matter on March 18, 2014. 6. Admitted. 7. Denied as stated. Plaintiffs allege that Kylee Jacobs struck her head during the car accident and sustained a traumatic brain injury as a result of which she now suffers from post- traumatic headaches. 8. Admitted. 9. Denied. After reasonable investigation, Plaintiffs are unable to determine what Defendant "believes" regarding the physical condition of Kylee Jacobs. 10. Admitted, upon information and belief 11. Denied as stated. Plaintiffs reside in Johnstown, Pennsylvania, which is a 4 -5 hour drive to Philadelphia, Pennsylvania. Contrary, to Defendant's assertion, Defendant has not "agreed to pay the costs of transportation for Kylee Jacobs and her mother to travel to Philadelphia for [the neuropsych] evaluation." Defendant has offered to purchase Plaintiffs a round -trip train ticket from Harrisburg to Philadelphia for an evaluation to take place on a Saturday or Sunday. Such an arrangement would require Plaintiffs to wake up extremely early, drive 2 -3 hours to the Harrisburg train station, then take a 2 hour train ride into Philadelphia, attend a 4 -6 hour neuropsychological evaluation, take another 2 hour train ride back to Harrisburg and finally another 2 -3 hour drive back home, resulting in a 16 hour roundtrip. Defendant refused to pay for lodging so that Plaintiffs could arrive for the evaluation the night before and have refused to pay for anything other than a round trip train ticket from Harrisburg. Thus, Defendant's statement that it has agreed to pay for transportation is inaccurate and /or misleading. 12. Admitted that Defendant has offered to schedule the evaluation for a Saturday or Sunday. 13. Denied. It is denied that Plaintiffs have refused to reschedule an appointment with Dr. Goldstein. Plaintiffs have offered to submit to an evaluation in proximity to where they reside or within proximity to where this matter is venued, i.e. Cumberland County. Furthermore, Plaintiffs have agreed to explore having the IME take place in Philadelphia if more appropriate and less burdensome arrangements can be made. 14. Denied. Pursuant to Pennsylvania Rule of Civil Procedure 4011 no discovery shall be permitted which would cause unreasonable annoyance, embarrassment, oppression, burden or expense to any person or party. It is submitted that ordering the minor, Kylee Jacobs to submit to a neuropsychological examination in Philadelphia under the arrangements proposed by Defendant would violate Rule 4011. While Plaintiffs do not dispute Defendant's right to conduct a neuropsychological examination of Kylee Jacobs, Plaintiffs do object to Defendant's current proposal to compel Ms. Jacobs and her mother to travel to Philadelphia for a lengthy neuropsychological examination while offering only to pay for a roundtrip train ticket from Harrisburg. WHEREFORE, Plaintiffs respectfully request that this Honorable Court deny Defendant's motion to compel Kylee Jacobs to submit to a neuropsychological examination in Philadelphia, Pennsylvania. Dated: March 27, 2014 By: Respectfully submitted, VILLARI, BRANDES & GI ONE, P.C. lamer M. Villari, Esquire Attorney ID No. 26875 -and - Andrew C. Rimol, Esquire Attorney ID No. 205809 Attorneys for Plaintiffs VILLARI, BRANDES & GIANNONE, P.C. By: Andrew C. Rimol, Esquire Attorney I.D. No. 205809 8 Tower Bridge 161 Washington Street, Suite 400 Conshohocken, PA 19428 Telephone - (610) 729 -2900 Facsimile - (610) 729 -2910 Attorneys for Plaintiffs SUSANNE JACOBS, Individually, and as Parent and Guardian of KYLEE JACOBS, a minor, Plaintiffs -vs- BERNICE J. BOURNE Defendant. : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : CIVIL ACTION — LAW : Docket No. 13 -4780 CERTIFICATE OF SERVICE I hereby certify that Plaintiffs' Response to Defendant's Motion to Compel Neuropsychological Examination was served upon the following in accordance with Pa. R.C.P. 440, by mailing a true and correct copy of same to defendant's counsel of record this 27th day of March 2014, via U.S. First Class Mail, postage prepaid, addressed as follows: Joseph R. D'Annunzio, Esquire Law Office of Joseph R. D'Annunzio 4309 Linglestown Road, Suite 211 Harrisburg, PA 17112 Attorney for Defendant, Bernice Bourne DATED: March 27, 2014 By: VILLA ! BRANDES & GL4NNONE, P.C. W C. ', OL orneys for Plaintiffs BY: Joseph R. D'Annunzio Law Office of Joseph R. D'Annunzio Identification No. 23384 4309 Linglestown Road, Suite 211 Harrisburg, PA 17112 (717) 901-5002 (717) 901-5012 (Fax) jdannunzio@geico.com Attorney for Defendant, Bernice Bourne IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA. SUSANNE JACOBS, INDIVIDUALLY AND AS PARENT AND NATURAL GUARDIAN OF KYLEE JACOBS, Plaintiff v. BERNICE BOURNE, Defendant NO. 13-4780 CIVIL ACTION - JURY TRIAL DEMA IDI PRAECIPE TO WITHDRAW MOTION TO COMPEL NEUROPSYCHOLOGICAL EXAMINATION TO THE PROTHONOTARY: Kindly withdraw the Motion to Compel Neuropsychological Examination previously filed with the Court. The names and addresses of all opposing counsel/pro se litigants are as follows: Date: J/, Zj 1'4/44 Andrew Rimel, Esquire Villari, Brandes & Giannone, P.C. 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 BY: Joseph R. D'Annunzio, Esquire Attorney for Defendant Jt CERTIFICATE OF SERVICE I hereby certify that I am this day serving a copy of the foregoing document upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States Mail, first-class postage prepaid, addressed as follows: Andrew Rimel, Esquire Villari, Brandes & Giannone, P.C. 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 Date: /=))/ Kirly Stielper VILLARI, BRANDES & GIANNONE, P.C. BY: Peter M. Villari, Esquire Andrew C. Rimol, Esquire PA Attorney ID No.'s 26875 / 205809 Eight Tower Bridge 161 Washington Street, Suite 400 Conshohocken, PA 19428 (610) 729-2900 ' r(:tri-O FiCL -° TATE PROTHONOTARY 2814 OCT 10 'P 1 2: 24 CUMBERLAND COUNTY PENNSYLVANIA ATTORNEYS FOR PLAINTIFFS SUSANNE JACOBS, Individually, and as Parent and Guardian of KYLEE JACOBS, a minor, Plaintiffs -vs- BERNICE J. BOURNE Defendant. : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : CIVIL ACTION — LAW : Docket No. 13-4780 PETITION FOR APPROVAL OF SETTLEMENT OF MINOR'S CLAIM AND ALLOCATION/DISTRIBUTION OF SETTLEMENT PROCEEDS Pursuant to Pennsylvania Rule of Civil Procedure 2039, Susanne Jacobs, mother and natural guardian of Kylee Jacobs, the minor -plaintiff herein, by and through her attorneys, Villari, Brandes & Giannone, P.C., hereby petitions this Honorable Court for an order approving the proposed settlement of the minor -plaintiff's claim and distribution of the settlement proceeds, and in support thereof avers the following: 1. Plaintiffs are Kylee Jacobs, a minor, by Susanne Jacobs, her parent and guardian, and in her own right (i.e., individually). 2. Susanne Jacobs is the mother and natural guardian of the minor -plaintiff, Kylee Jacobs, who was born on August 21, 1999, and who is currently fifteen (15) years old. 3. Kylee Jacobs, resides at 1325 Christopher Street, Johnstown, Pennsylvania, with her mother, Susanne Jacobs. 4. The minor's father is David L. Jacobs, who resides at 1068 Mount Hope Road, McVeytown, Pennsylvania. 5. The defendant in this action is Bernice J. Bourne. 6. Plaintiffs assert in their Complaint, inter alia, as follows: On September 18, 2011, Susanne Jacobs was the owner and operator of a 2001 Ford F350 pickup truck that was pulling a horse trailer west on the Pennsylvania Turnpike, approximately ten miles east of Carlisle, Pennsylvania. The minor -plaintiff, Kylee Jacobs, was a front seat passenger in her mother's vehicle. On said date, Defendant, Bernice J. Bourne, was the registered owner and operator of a 2004 Ford F350 pickup truck that was also traveling west on the Pennsylvania Turnpike, approximately ten miles east of Carlisle, Pennsylvania. On the date of the accident, Susanne and Kylee Jacobs were in the right lane on the westbound side of the Turnpike when defendant's vehicle, then traveling in the left lane of the westbound side of the Turnpike, struck the horse trailer being towed by Plaintiffs' vehicle. The force from this collision caused the Plaintiffs' vehicle to move and swerve about the highway causing Mrs. Jacobs to lose control of the vehicle and the horse trailer she was pulling to strike/hit the Plaintiffs' truck. As a result of this accident, Kylee's head was thrown about and struck the passenger side window of the vehicle. Kylee was taken by ambulance to the Carlisle Regional Medical Center where she complained of headaches, was diagnosed as suffering from an acute, non-specific headache and later discharged. 7. Following the accident, Kylee treated with her pediatrician, Jean M. Reams, D.O., who, on September 23, 2011, diagnosed Kylee with cephalgia (i.e., headaches), cervical strain and right should pain. Dr. Reams recommended a course of physical/occupational therapy which, Kylee regularly attended between October 25, 2011 and June 14, 2012. By June 14, 2012, Kylee was discharged from therapy with her physical therapist noting that Kylee had "made excellent progress with the occupational therapy program for the treatment of cervical neck strain" and had "achieved all long-term goals with the OT program at this time." See - Report of Timothy L. Leventry, OTR/L, attached hereto as Exhibit "A". 8. Thereafter, due to continuing, intermittent cervical pain as well as headaches, Kylee was evaluated by David A. Andreychik, M.D., a board certified orthopedic surgeon, on November 12, 2012. Dr. Andreychik's assessment of Kylee was that she was still suffering from a whiplash type injury (cervical strain) sustained in the aforementioned motor vehicle' accident. Dr. Andreychik noted that whiplash type injuries can take some time to fully resolve but observed that Kylee did seem to be improving. Dr. Andreychik did not see the need for Kylee to have any further orthopedic intervention. A copy of Dr. Andreychik's orthopedic evaluation/assessment from November 12, 2012, is attached hereto as Exhibit "B". 9. On May 16, 2013, Kylee was evaluated by Harry Bramley, D.O., the medical director of the Penn State Concussion Program, in relation to continuing complaints of headaches following the aforesaid motor vehicle accident. Dr. Bramley diagnosed Kylee with post- traumatic headaches as a result of striking her head on the window of her vehicle during the accident. Dr. Bramley observed that Kylee's headaches were improving but noted that they could be very disabling. Dr. Bramley stated that it was reasonable to expect Kylee to make a full recovery but that a full recovery could take between 3-5 years. Dr. Bramley also found that Kylee was at an increased risk of suffering a future head/brain injury. A copy of Dr. Bramley's report is attached hereto as Exhibit "C". 10. On September 26, 2013, Kylee was seen again by Dr. Bramley, who observed that since her last visit, Kylee appeared to be doing quite well, requires no accommodations at school and that "her headaches [were] close to being completely resolved." Dr. Bramley also noted that Kylee and her father had no concerns with regard to her concentration, short term memory or problem solving. Dr. Bramley's assessment, at this time, was that Kylee's post-traumatic headaches seemed to be resolving and that once resolved, the risk of any recurring symptoms was minimal. Dr. Bramley noted that Kylee's risk of suffering a further concussion was "probably increased" but that her risk of suffering a catastrophic brain injury had not increased. Dr. Bramley medically cleared Kylee to participate in cheerleading and discharged her from his care with instructions to return only if needed. A copy of Dr. Bramley's September 26, 2013 assessment/evaluation is attached hereto as Exhibit "D". 11. Following negotiations between counsel and representatives of defendant's liability insurer, defendant's insurance company has offered to settle the minor-plaintiff's claims against the defendant for the gross amount of Twenty-seven Thousand Five Hundred Dollars ($27,500.00). 12. In prosecuting this action on behalf of the minor-plaintiff, counsel has advanced the following costs, to date (totaling $1,468.07), for which reimbursement is sought: Experts (Harry Bramley, D.O.): $ 400.00 Court Filings: $ 69.50 Medical records: $ 708.84 Xeroxing/Postage/UPS $ 289.73 Travel Expenses (Mileage, Parking, Tolls) $ 00.00 Total Expenses: $1,468.07 13. With respect to the settlement proceeds, counsel requests a fee of one-third (1/3) of the net recovery after the deduction of costs/expenses, pursuant to the Contingency Fee Agreement. Accordingly, counsel requests a fee of $8,677.31. 14. The fee requested by counsel is fair and reasonable for the following reasons: Prior to initiating suit, counsel worked diligently to prove and substantiate the minor -plaintiff's injuries and/or damages. Examples of the extent of the work performed and skill brought to bear by counsel, as well as the results thereof, are evident in the previous paragraphs. In addition, the defendant, Bernice J. Bourne, could not be found. Thus, Plaintiffs' counsel expended a significant amount of time conducting a detailed and exhaustive search to locate the defendant so that plaintiffs could effectuate service of process. Finally, when counsel's efforts to locate the defendant proved unsuccessful and it was apparent that the defendant could not be found, counsel prepared a Motion for Alternative Service, which was granted by the Court. As such, per the applicable law, counsel respectfully requests that the proposed attorney fee and reimbursement of costs be approved by the Court as reasonable under the circumstances presented herein. See e.g., In Re Trust Estate of LaRocca, 431 Pa. 542, 246 A.2d 337 (1968) (holding that the factors to be considered when determining the reasonableness of the counsel fees to be paid from a settlement include, but are not limited to, the amount of work performed; the character of the services rendered; the difficulty of the problems involved; the importance of the litigation; the amount of money in question; the degree of responsibility incurred; whether the involved fund was 'created' by the attorney; the professional skill and standing of the attorney in his/her profession; the results he/she was able to obtain; and the ability of the client to pay a reasonable fee for the services rendered); see also, Stecyk v. Bell Helicopter Textron, Inc., 53 F.Supp. 2d 794, 801 (E.D. Pa. 1999) (applying Pennsylvania law). 15. There are no potential or actual claims or liens against the minor -plaintiff by the Department of Public Welfare, and neither counsel nor Plaintiffs, have been put on notice of any claim or lien by any other medical provider or governmental entity. 16. The net settlement to be paid to the minor -plaintiff, Kylee Jacobs, after the deduction of costs and counsel fees, is $17,354.62, 17. The net settlement proceeds of $17,354.62 due to the minor -plaintiff, Kylee Jacobs, will be deposited into an interest bearing savings account, in the name of the minor only, in a bank or credit union insured by a Federal governmental agency, with a provision and/or instructions that the funds are not to be withdrawn until the minor attains majority, except as authorized by a prior order of the court. See, Pa.R.C.P. No. 2039(b)(2). 18. Counsel is of the professional opinion that the proposed settlement and distribution represents a full and fair settlement of the minor -plaintiff's claims, is in the best interest of the minor, and adequately compensates the minor for the injuries she suffered. As a result of the motor vehicle accident, the minor -plaintiff suffered a whiplash type injury (cervical strain) and post-traumatic headaches from striking her head on the passenger side window of her vehicle. Kylee has made a very good recovery from her accident -related injuries and she is no longer under the care of any medical professional for any injury related to the September 18, 2011 motor vehicle accident. 19. Counsel is further of the opinion that the proposed settlement is reasonable in light of the uncertainties of trial and jury verdicts, the expenses associated with bringing this case to trial, and the minor -plaintiff s good recovery and prognosis. In addition, both counsel and the minor's parents want to ensure that a settlement is secured that will provide a financial benefit to the minor that will become available as she finishes high school, with the hope that the settlement proceeds are used to pursue a college education. It is the opinion of counsel that the settlement proposed herein furthers this objective. 20. Verifications from the minor's mother (Susanne Jacobs) and father (David Jacobs), certifying the physical and mental condition of their daughter, together with their approval of the proposed settlement and allocation/distribution of funds, are attached hereto as Exhibit "E". 21. As stated herein, the minor -plaintiff, Kylee Jacobs, resides with her mother in Johnstown, Cambria County, Pennsylvania, approximately 2.5 hours and over 120 miles from the Court. Given Kylee's school schedule, along with the schedules of her parents, Plaintiffs respectfully request that the Court dispense with a hearing to approve this settlement and accept the Affidavits from Kylee's parents attached hereto as Exhibit "F", in lieu of a hearing. WHEREFORE, Plaintiffs respectfully request that this Honorable Court grant the within Petition and enter an Order approving the proposed settlement of the minor -plaintiffs claims and the allocation/distribution of funds as detailed herein and in the attached Order. DATED: 10)/c?/1 Lf BY: VILLARI, BRANDES & GIANNONE, P.C. 13E R M. VILLA , ESQ ft(e-- :LUIRE ANDREW C. RIMOL, ESQUIRE Attorneys for Plaintiffs/Petitioner Corrective Therapy Solutions 1397 Eisenhower Blvd. Suite 304 Johnstown, PA 15904 814-262-4236 Fax 814 - 262 - 4237 Patient: Kylee Jacobs Diagnosis: cervical strain DOB: 08/21/99 Physician: Dr. Reams Number of visits: 06 Treatment: ADLs, therapeutic exercise, therapeutic activities, MET, manual therapy. Progress report: The patient has made excellent progress with the occupational therapy program for the treatment of cervical neck strain. On the initial evaluation The patient stated that her pain was rated at 4 -- 7/10 of the cervical neck and left shoulder area. The patient stated that pain and decreased active range of motion compared her ability to perform ADLs, grooming, home tasks, school activities, and sleep patterns. The patient now states that her pain is rated at 1 -- 2/10 in the cervical neck area with full active range of motion through all planes of movement. The patient has no significant increase in signs or symptoms of pain at this time with any activities. The patient has achieved all long-term goals with the OT program at this time. D/C O.T. At this time. Occupational Therapist recommendations: Physician recommendations: D/C O.T. At this time. Thank you for the referral on this patient. Occupational the pist: Timothy L. Leventry OTRJL Date: 06/14/12. Please sign date and return to corrective therapy solutions. Jacobs, Kylee S.(MR # 5136181) Patient Information DOB: 08/21/1999 Jacobs, Kylee S [5136181] DOB 08/21/1999 Female 1068 MOUNT HOPE RD Home Phone 717-250-4739 MC VEYTOWN, PA 17051 Work Phone Contact Information Name Relation Home Work Mobile JACOBS,SUSANNE VVEYANDT,MERLE — Patient History Report Mother 814-255-4817 Other 814-239-5835 814-421-7490 Kylee S Jacobs (MRN 5136181) Obstetric History Obstetric History The patient has not been asked about pregnancy. Allergies (Not on File) Immunization Summary Kylee S Jacobs (MRN 5136181) Patient Information Patient Name MRN Gender DOB Jacobs, Kylee S 5136181 Female 8/21/1999 Immunizations as of 1/9/2013 Never Reviewed No immunizations on file. Allergies as of 1/912013 Never Reviewed Not on File PCP and Practice Primary Care Provider Jean M Reams Devita, DO [7400] Practice Name Jean Reams Lewistown Phone 717-248-3002 Immunothe apy njection Summary Kylee S Jacobs (MRN 5136181) Patient Information Patient Information Patient Name MRN Jacobs, Kylee S 5136181 Gender Female DOB 8/21/1999 Immunotherapy History Immunotherapy Injections as of 1/9/2013 No Immunotherapy Injections on file for this patient. Printed 1/9/13 2:46 PM Geisinger Allergies Page 1 Jacobs, Kylee S (MR # 5136181) Allergies (continued) Allergies as of 1/9/2013 DOB: 08/21/1999 Never Reviewed, Not on File PCP and Practice Primary Care Provider Practice Name j Phone Jean M Reams Devita, DO [7400] Jean Reams Lewistown 717-248-3002 Medication Injection Summa Kylee S Jacobs (MRN 5136181 Patient Information Patient Information I Patient Name 1 MRN Gender 1 DOB Jacobs, Kylee S 5136181 Female 8/21/1999 Injected Medica ions Injected Medications as of 1/9/2013 No Injected Medications on file for this patient. Allergies Allergies as of 1/912013 Never Reviewed Not on File PCP and Practice Primary Care Provider Practice Name 1 Phone Jean M Reams Devita, DO [7400] Jean Reams Lewistown 717-248-3002 Medication Kylee S Jacobs (MRN 5136181) Meds Comments as of 11/13/2012 Medications taken for digestion(umknown ) miralax Medication Review Info 1 User [Not Reviewed] Allergies as of 1/9/2013 Date and Time 1/9/2013 2:46 PM Never Reviewed Not on File MyGeisinger Messaging Kylee S Jacobs (MRN 5136181) Printed 1/9/13 2:46 PM Geisinger Page 2 Jacobs, KyleeS(MR #513G1B1) DOB: 08/21/1999 Kylee S Jacobs 11N3120128:38AM Office Visit MRN: 5136181 Dapartrn Ortho Spine Descripti 13 year old female \ ent: Surgery Danville on: Encounte 1211,03197 David A r #: Andreychik, MD | Progress Notes No MyGeising_er Activity for Patient: JACOBS,KYLEE S Note Initiated By Status Last Editor Updated Melinda Pick, RN Signed Melinda Pick, RN 11/13/2012 8:59 AiV1 Addended by: PICK, MELINDA on: 11/13/2012 08:59 AM Modules accepted: Orders Note Initiated By Status Last Editor Updated David A Andreychik, MD Signed David A Andreychik, MD 11/13/2012 8:50 AM Please see dictated note for documentation on this encounter EPIC ENCOUNTER NUMBER: 121103197 David A Andreychik, MD 11/13/2012 8:50AM Transcription Type ID Date 'and Time ` ` Author Outpatient Clinic Note GMC27958 11/13/2012 9:04 AM David A Andreychik, MD 419 Signed by David A Andreychik, MD on 11/19/12 at 1525 Document Text CLINIC NOTES Geisinger Medical Center 100 North Academy Avenue Danville, Pennsylvania 17822 JACOBS, KYLEE S MR# 5120181 DOB` 08/21/I999 ORTHOPAEDIC SURGERY OUTPATIENT NOTES 11/13/2012 This patient is 13 years old, referred by Dr. Reams-Devita for evaluation of neck pain as well as beadaobeo' She was apparently involved in a motor vehicle accident in the middle of September of last year, and since that time has complained of intermittent cervical pain as well as headaches. Despite physical therapy she continues to have symptoms. A workup including a Cr scan of her head as well as a cervical MRI was Jacobs, Kylee S (MR # 5136181) DOB: 08/21/1999 .'• No _Patient: performed. She is here to see me for orthopaedic evaluation. She occasionally gets tingling in her fingers but this does not appear to be related to any activity. She denies any lower extremity weakness, any bowel or bladder abuormaIitiea' The patient is healthy otherwise with the exception of gastrointestinal polyps. Patient's growth and development have been normal. On questioning review of systems she has had a recent significant weight loss. She apparently had a 30-year-uld brother who died in August which did seem to prompt this. CLINICAL EXAMINATION: Today reveals cervical motion to be full and pain free. Examination of her thoracolumbar spine revealed normal sagittal coronal alignment. She had no focal neurologic deficits. No pathologic reflexes. Her gait was normal. I reviewed plain radiographs of her cervical spine. There were no abnormalities. She had reports of a CT scan of her head as well as an MRI of her -cervical spine, which were within normal limits. ASSESSMENT: I believe that the patient probably has a cervical strain. In layman's terms that would be consider whiplash. It has been going on for slightly over a year and in a young girl that takes quite an extensive period of time to get better. She does feel like she is improving so I would not recommend any orthopaedic ioterveotloo right now. From the standpoint of her headaches, these are mostly anterior and lateral. They did not appear to be related to her cervical spine, so I am going to see if z can get Pediatric Neurology to see her. z will see her back as needed. David A Andreychik, MD Spine Surgery, Scoliosis Surgery Adult and Pediatric DAA/LLB D: 11/13/2012 09:04:15 T: 11/13/20I2 I6:88:33 Doc0: 279584I9/4046736 , Patient Information owsheet pata (011 recorded All ` ��`�� ^—��•i 8ow,Namme: Office Visit .. 11113/2012 imOrthopaedics Spine Surgery, Danville Patient Identification Pt identified using two identifiers by: Self -KT Pain Evaluation Is the pt having No -KT any pain related to today's visit? Fall Evaluation Does pt have a history of falls in the Iast month? WiH any of the medications or procedures this patient may Printed 1/9/ 3 2:46 PM Geisinger Jacobs, Kyiee S (MR # 5136181) DOB: 08/21/1999 r---'----�—�---' ll Ar -----�—�—�' Patient Information (continued) Row Name Office Visit from 11/1312012 in Orthopaedics Spine Surgery, Danville encounter during their visit put them at increased risk of a fail? Does this pt demonstrate any physical impairment or altered mental status that places them at increased risk of fall? No -KT Fall precautions Yes -KT in place: Do any of the — medications you are currently taking make you fee lightheaded or dizzy? User Key (r) = User Recd, (t) = User Taken, (c) = User Cosigned Initials Name KT Kevin Tersavge, TECH Visit Disposition / Disposition Provider Type Return if symptoms worsen or fail to improve, for if symptoms worsen or fail to improve.. Referral Referring Provider Self Patient Instructions None Allergies usoYi1U3/2V12 Never Reviewed Not on File Meds Comments as of 11/13/2012 Medications taken for > miralax 'Medication Administration History: |AU administrations No administration data available Intervention summary for Jacobs Kytee S Printed 1/9/13 2:46 PM Geisinger Page 5 Jacobs, Kylee S (MR # 5136181) DOB: 08/21/1999 Intervention summary for Jacobs, Kylee S (continued) Open Interventions ! Type Status Opened By Opened Respons Outcome On None Closed Interventions Type Status Opened By Opened Respons Outcome On None Intervention Detail (There are no med orders for this encounter) Diagnoses Visit Diagnoses • Headache [784.0] Neck pain [723.1B] All Orders CERVICAL SPINE AP & LATERAL [2237584151 Final result Ordering User: Kevin Tersavige, TECH 11/13/12 0822 Authorized by: David A Andreychik, MD Electronically Kevin Tersavige, TECH 11/13/12 0822 signed by: Electronically David A Andreychik, MD 11/16/12 1419 for Ordering cosigned by: Class: To Radiology Lab status: Final result Diagnoses: NECK PAIN [723.113] Comments: Ordering Provider: Frequency: Quantity: Specimen: Kevin Tersavige, TECH Routine 11/13/12 - 1 11/13/12 0832 W.C./N.F. : Not Applicable SPECIAL VIEWS REQUIRED: AP and Lateral RIGHT, LEFT OR BILATERALLY?: Not Applicable (Spine) SPECIAL INSTRUCTIONS: No special instructions IS THERE ANY POSSIBILTY THAT YOU ARE PREGNANT: Not Asked PATIENT LOCATED IN: Exam Room #: 425 PT HX: Patient presents with: EVALUATION - neck pain/post MVA 2011 PEDS NEURO REFERRAL OP [223763632] Ordered Ordering User: Authorized by: Electronically signed by: Electronically cosigned by: Class: Diagnoses: Questions: Comments: Headaches Lives in mifflin county Melinda Pick, RN 11/13/12 0859 David A Andreychik, MD Melinda Pick, RN 11/13/12 0859 Ordering Provider: Frequency: David A Andreychik, MD 11/16/12 1419 for Ordering Melinda Pick, RN Within 28 days 11/13/12 - Referral Quantity: 1 HEADACHE [784.0] Referral Priority Within 28 days CERVICAL SPINE AP & LATERAL [72040 (CPT®)] (Order 223758415) Results Status: Final result 11/13/2012 1:16 PM Result Information Status Provider Status Final result (11/1312012 1:16 PM) Reviewed Collection Information Collection Date Collection Time Printed 1/9/13 2:46 PM Geisinger Page 6 Jacobs, Kylee S (MR # 5136181) DOB: 08/21/1999 Collection Information (continued) Collection Date Collection Time 11/13/2012 8:32 AM Entry Date 11/13/2012 Transcription Type ID Date and Time Author Diagnostic imaging R8983+45 11/13/2012 11:19 AM Faruq Mahmud, MD Signed by Faruq Mahmud, MD on 11/13/12 at 1316 ' - Document Text CERVICAL SPINE - I1/13/2012 HISTORY: Neck pain post MVA. FINDINGS: Upright AP and lateral radiographs show that there is slight straightening Of the cervical spine which may be due to muscle spasm or opraio. There is no fracture or dislocation seen. The intervertebral disk spaces are intact. No bony abnormality is identified. IMPRESSION: As above. Reviewed by List ANDREYCHIK, DAVID on Mon Nov 19, 2012 3:18 PM Reason for Visit EVALUATION Patient Information neck pain/post MVA 2011 Jacobs, Kylee S [5136181) DOB 08/21/1999 Female 1068 MOUNT HOPE RD Home Phone 717-250-4738 MCVEYTDVVN.PA17051 Work Phone Visit Information Provider Department Encounter # 11/13/2012 8:30 AM David A Andreychik, MD Ortho Spine Surgery Danville 121103197 PCP and Practice I Primary Care Provider 'Practice Name Phone Jean MReams Dovba.DO[74OV] Jean Reams Lewistown 717-248'3002 [ / Administrative Information Administrative Information Printed 1/9/13 2:46 PM Geisinger Page 7 Jacobs, Kylee S (MR # 5136181) Administrative Information (continued) r4EncountervC assificatfbn s n1ii11Str1Ye o irIP' ;coni1n DOB: 08/21/1999 None eferrttgProuider SELF Advance Directives Advance D rectives On File? No Level Of Service ast,nd,cato Highmark Indicator Date: C2 OFFICE CONSULT,LEVEL2 [99242] Authorizing Provider David A Andreychik, MD [7978] Document List Patient/User Signed Documents - This Encounter There is no document attached to this encounter. Encounter Information Encounter Number: 121103197 Status: Closed by ANDREYCHIK, DAVID on 11/13/12 at 8:50 AM SMS Billing Number: 5514092640 Learning Assessment None Education Notes No noteipresent for this japtient. Annotated Images None Printed 1/9/13 2:46 PM Geisinger Page 8 Jacobs,, S (MR # 5136181) r Kylee S Jacobs 11/13/2012 10:26 AM Scan Encounter MRN: 5136181 DOB: 08/21/1999 Departm Ortho Spine Descripti 13 year old female ent: Surgery Danville on: Encounte 121211870 Provider: David A r #: Andreychik, MD Patient Information Patient Information Jacobs, Kylee S [5136181] DOB 08/21/1999 Female 1068 MOUNT HOPE RD Home Phone 717-250-4739 MC VEYTOWN, PA 17051 Work Phone Encounter Information Visit Information 1 Provider Department Encounter # 11113/2012 David A Andreychik, MD PCP and Practice Ortho Spine Surgery Danville 121211870 1 Primary Care Provider Jean M Reams Devita, DO [7400] Practice Name Jean Reams Lewistown Scanned Documents - See Attached Patient Instructions Phone 717-248-3002 None All Orders No orders found Order -Level Documents: There are no order -level documents. Meds Comments as of 11/13/2012 Medications taken for digestion(umknown ) miralax Medication Review Info 1 User Date and Time [Not Reviewed] Allergies as of 11/13/2012 1/9/2013 2:46 PM Never Reviewed Not on File Administrative Information Administrative Information Encounter Classification(s) Refernng Provider I Visit Indicator None Advance Directives Advance Directives On File? No Printed 1/9/13 2:46 PM Geisinger None None Power of Attorney On File? No Page 9 Jacobs, KvieeS(MR #5136181> Encounter Information DOB: 08/21/1999 Encounter Number: 121211870 Status: Closed by INTERFACE, TRANSCRIPTION on 9/25/12 at 10:26 AM Annotated Images None Encounter -Level Documents '11M3/2012: Scan on11/13/2O1212:0UAMbyDavid AAndmynhik.MD: ACCESS CENTER ORTHOSPINE SURGERY DANV|LLE(below) Printed 1/9/ 3 2:46 PM Geisinger Page 10 Jacobs, Kylee S (MR # 5136181) ative Information (COtltiAu Encounter -Level Documents -11/13/2012: (continued) (00:+10-1W9) Wti9£:6 Z1OZ/9Z/60 JEAN M. REAMS, D.O. h� 16 NORTH BROWN STREET �n‘/ LEWISTOWN, PA 17044 61b' ; (717)248-3002 FAX (717)248-3017 TO 4 . 226 DOB: 08/21/1999 AUG 102012 FROM ,, �f?Jtu_ DATE 1)16/1 V 1 g/1/ PAGES MESS,A- ,0lltitet 1 (INCLUDING COVER PAGE) 3 a/ 99 a.? appr. PLEASE SIGN, DATE, AND RETURN THIS COVER SHEET AS CONFIRMATION OF RECEIVING THIS FAX. THANK YOU. (SIGNATURE) ***Confidentiality Notice*** (DATE) The documents accompanying this telecopy transmission contain confidential information, belonging to the sender that is legally privileged. This information is intended only for the use of the individual or entity named above. The authorized recipient of this information is prohibited from disclosing this information after its stated needed has been fulfilled. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of these documents is strictly prohibited. If you have received this telecopy in error, please notify the sender immediately to arrange for return of these documents. e6ed Printed 1/9/13 2:46 PM Geisinger L60£-BPZ-LLL o0`sweaa W ueapxed dH WH££;60 ZIOZ SZ daS Page 11 Jacobs, Kylee S (MR # 5136181) ACItI1uslavww 1i7!PAPA Q Ill Qr11ia#Io►1 �iCt?t� it1 1 Encounter -Level Documents -11/13/2012: (continued) taa +10-1w9) Wti9£ : 6 Z GOZ/SZ/60 DOB: 08/21/1999 AI c»iNfmr LAUREL HIGHLANDS ADVANCED IMAGING JUN 11 2012 i13Y: 1 atient Nam.= JACOBS, KYLEE S M.R.N. 000435513 JielerrintPhYsickn: REAMS, JEAN, MD 1450 Scalp Avenue, Suitc 001 Tel (814) 262.7290 Johnstown. PA 15904 Fan (814)262.7653 Exam Date: 0610812012 Account #:9662131 DOB: 821/1999 Eauipment: 1.5 Testa C0. Sigma rax with TwtnSpeed gradients INDICATION: MVA 0911 An t. Posterior neck pain. MRI OF ILIE CERVI] AL SPINE: The vertebral alignment is anatomic in the sagittal plane. The vertebral body heights and dsc space heights are maintained. Axial images demonstrate no disc pmuusion. disc czwzion or ccotrai stentMla. The neural foramina arc widely patent, The spinal cord is normal in caliber acid Signal Intensity, The eraniovertebrrl junction is unremarkable. The anterior end posterior longitudinal ligaments, ligarnenruni flavum, interspinous, supraspinous and nuchal ligaments ail appear 1MPRFSSZON: Unremarkable MRI OFthe cervical spine and spinal card. Dictated By: GOLDEN, STANLEY. MD Transcribed: 06/082012 HZ Electronically Signed: GOLDEN. STANLEY. MD 6/8/2012 3:07:40PM a abed Printed 1/9/13 2:46 PM Geisinger Ll0£-84Z-LLL O0'sweay W uearned dH 14tl££:60 Z1.0Z SZ deS Page 12 Jacobs, Kylee S (MR # 5136181) 12121111111,1111,47,1111111111Witifiiiii41611ArtiNte$: , Encounter -Level Documents - 11113/2012:(contit) ued (00:110-1W0) WUH:6 ZWU5Z/60 • Memorial 4-6-ww Medical Center klianbeF Caner...WI Heahh Sygern Patient: JACOBS, KYLEE S Final Report DOB: 08/21/1999 (TH BROWN STREET 1STOWN. PA 17044 Radiologic Interpretation Location: C4// Exam: 4191900 CT HEAD UNENHANCED Referring Physician: REAMS, JEAN Attending Physician: Copy to Physician: Reason: ha slp trauma DX: Consulting Physician: Admitting Physician: Accession: 01336674 Exam Date: 11/4/2011 11:50:OOAM INDICATION: FRONTAL HEADACHES. MOTOR VEHICLE ACCIDENT ON 09/18/11. • 4ID CT UNENHANCED he ventricles are normal in size and shape. There is no acute intracranial bleed. No midline shift, „lass effect, mass lesion or acute ischemic infarct is detected. The gray -white matter interface is well demarcated and symmetric bilaterally. The skull is intact at bone windows without evidence of a calvarial fracture. IMPRESSION: 1. Negative unenhanced head CT. 2. Should this patient's symptoms continue and/or progress MR imaging of the brain may be helpful in further evaluation. TIME OF DICTATION: 1255 ' ated By. WILLIAM HERBICK MD It/4/2011 12:58:OOPM '--otiscribed by: KM 11/4/2011 1:50:14PM .ectronically Signed: WILLIAM HERBICK MD 11/4/2011 3:01:20PM Patient: JACOBS, KYLEE S MRN: 000435513 Account #: 9159239 Copy to Physician: Attending Physician: DOB: 8/21/99 12Y Location: C4// Accession: 01336674 Pri 11/4/2011 3:03:23PM 1086 Franklin Street, Johnstown, PA 15905 (P) 814.534.9166 (F) 814,534.3242 320 Main Street, Johnstown, PA 15905 (P) 814.534.6010 (F) 814.534.6024 Pagel of 1 E a6ed Printed 1/9/13 2:46 PM Geisinger Ll0E-842-L11 Odsweed W uearxeJ dH WVE£:60 1,0Z SZ daS Page 13 Jacobs, Kylee S (MR # 5136181) ,„-.5y- minis trat!ve Encounter -Level Documents -11/13/2012: (continued) rmatlong (con tinu DOB: 08/21/1999 (00:110-1149) WH9£ 6 Z LOZ/5Z/6.0 asalr page t ort LEWISTOWN HOSPITAL Patient: Jacobs, Kylee S MRN: 104922 Financial #: 20111402051 DOB/Age/Sex: 08(21/1999 12 years Female Location: LH XR Patient Type: Outpatient Lewistown Hospital 400 Highland Avenue Lewistown, PA 17044 Admit Date: Discharge Date: Attending: Ordering: Consulting: Primary Care: Client Name: 09/23/2011 09/23/2011 Reams, Jean M Reams, Jean M Reams, Jean M Lewistown Hospital Diagnostic Radiology XR Spine cervical NGnimum 4 Views XR-11-0036637 Exam Date/Time 09/23/2011 12:13:00 EDT Report INDICATION: Pain status post motor vehicle accident. FIVE VIEWS. FINDINGS: There is mild straightening of the normal cervical lordosis. Vertebral body heights and intervertebral disc space heights are intact. Facets are normally aligned. Prevertebral soft tissues are normal. Neural foramina are widely patent bilaterally. Open-mouth odontoid view demonstrates intact odontoid with normal alignment of the lateral masses of 01 on the body of 02. Craniocervical alignment is within normal limits. IMPRESSION: Normal exam. Dictated: 09/24/11 20.13:00 Embry , Joseph Signed (Electronic Signature): 09/27/11 09:22:28 Transcribed by: DL 09/26/201 1 10:16 am Reams. Jean M 16 N. Brown Street Lewistown. PA 17044 q a6ed Printed 1/9/13 2:46 PM Geisinger 4 -27 -It 71/4r) -61)L -Q - Chart Request ID: 5274455 Print Date/Time: 09/27/2011 10:04 Page 1 of 1 ' L1.0E-8PZ-LLL 0a`sweaa W uearxeJ dH WVEE60 ZLOZ 9Z daS Page 14 Jacobs, Kylee S (MR # 5136181) p .Vi=m , :. rAclrn is ra de Iri &Aid o {continuer Encounter -Level Documents -11/13/2012: (continued) DOB: 08/21/1999 (00:fi0-1W9) WV9£:6 Z60Z/93/6O XR Spine Cervical Minimum 4 Views • Final Report' Result type: XR Spine Cervical Minimum 4 Views Result date: 23 September 2011 12:13 EDT Result status: Modified Result title: XR Spine Cervical Minimum 4 Views Performed by: Embry , Joseph on 24 September 2011 20:13 EDT Verified by. Embry , Joseph on 27 September 2011 09:22 EDT Encounter info: 20111402051, LH, Outpatient, - 09/23/11 Final Report * Reason For Exam S/P MVA / Neck pain Jacobs, Kylee S - 104922 Interpretation INDICATION: Pain status post motor vehicle accident. FIVE VIEWS. '''FINDINGS: There is mild straightening of the normal cervical lordosis. Vertebral body heights and intervertebral disc space heights are intact. Facets are normally aligned. Prevertebral soft tissues are normal. Neural foramina are widely patent bilaterally. Open-mouth odontoid view demonstrates intact odontoid with normal alignment of the lateral masses of C1 on the body of C2. Craniocervical alignment is within normal limits. IMPRESSION: Normal exam. Signature Line — Final Dictated: 09/24/11 20:13:00 Embry , Joseph Signed (Electronic Signature): 09/27/11 09:22:28 Transcribed by: DL 09/26/2011 10:16 am Completed Action List: 'Order by Reams. Jean M on 23 September 2011 11:42 EDT . Perform by Ream, Cheryl S on 23 September 2011 12:13 EDT VERIFY by Embry , Joseph on 27 September 2011 09:22 EDT Printed by: Printed on: Bumgardner , Denise Page 1 of 1 09/27/11 12:55 EDT (End of Report) g a6ed LLOE-84E-LLL OO`sweaa N uearxed dH WVEE:60 ZLOZ gZ daS Printed 1/9/13 2:46 PM Geisinger Page 15 Jacobs, Kylee S (MR # 5136181) minis ra`tiueetlnformation' DOB: 08/21/1999 Encounter -Level Documents -11/13/2012: (continued) Scan on 11/13/2012 12:00 AM by David A Andreychik, MD : ACCESS CENTER ORTHO SPINE SURGERY DANVILLE (below) (O0:tt0-1W9) WdZZ:+t ZIOZ/SZ/60 JEAN M. REAMS, D.O. 16 NORTH BROWN STREET 3 alk' LEWISTOWN' PA 17044 311Y (717)248-3002 FAX (717)248-3017 TO . / - 0226 AUG 1 ¢ 2092 FROM Qi DATE A6 -74-771--i ciia.51/.z PAGES `=PC's- c 7W- - ya l Ro (INCLUDING COVER PAGE) 1268= FS1-99 an a.frperei PLEASE SIGN, DATE, AND RETURN THIS COVER SHEET AS CONFIRMATION OF RECEIVING THIS FAX THANK YOU. (SIGNATURE) (DATE) ***Confidentiality Notice*** The documents accompanying this telecopy transmission contain confidential information, belonging to the sender that is legally privileged. This information is intended only for the use of the individual or entity named above. The authorized recipient of this information is prohibited from disclosing this information after its stated needed has been fulfilled. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of these documents is strictly prohibited. If you have received this telecopy in error, please notify the sender immediately to arrange for return of these documents. abed LWE-817Z-LLL Od'sweaa W uearxed dH Wd66170 Z60Z 6Z da5 Printed 1/9/13 2:46 PM Geisinger Page 16 Jacobs, Kylee S (MR # 5136181) min1S.'1('nforma#io Encounter -Level Documents -11/13/2012: (continued) DOB: 08/21/1999 (00:ti0-1W9) WdZZ:+i ZL0Z/5Z/60 LAUREL HIGHLANDS ADVANCED IMAGING 1450 Scalp Avenue, Suitc 001. Tel (814) 262-7290 JUN 11 2012 Johnstown, PA 15904 Fax ($14)262-76; (BY' Patient Name: JACOBS, KYLEE S MRN: 000435513 Referring Ph , iciare REAMS, JEAN, MD Exam Date: 06/08/2012 Account #19662131 DOB: 8/21/1999 );nuip_ment: 15 Tesla GE Signe H Dx with TwiaSpeeci gradients JNOICA770N: MVA 09/18/11. Posterior neck pain. MRIOF THE CERVICAL SPINE: The vcncbratalignment is anatomic in the sagi tal plant - lb c lant_The vertebral body heights and disc space heights are maintained. Axial images demonstrate no disc pmtrusion. disc extrusion or central stenosis. The neural foramina arc widely patent. The spinal cord is normal in caliber and signal intensity. 'The craniovertebral junction is unremarkable. The anterior and posterior longitudinal ligaments. ligamentum flavum interspinous, supraspinous and nuchal ligaments all appear iniad. IMPRESSION: Unremarkable MRI of the cervical spire and spinal cord. Dictated By: GOLDEN, STANLEY. MD Transcribed: 06/08/2012 AZ Electronically Signed: GOLDEN. STANLEY, MD 6/6/2012 3:07:40PM Z abed L1.0£-8t'Z-L1L O0`swead W uearxed dH Wd61:40 ZI.OZ 6Z deS Printed 1/9/13 2:46 PM Geisinger Page 17 Jacobs, Kylee S (MR # 5136181) Aitlmiristratt�e Encounter -Level Documents -11/13/2012: (continued) o ma't1o�n (contmu DOB: 08/21/1999 (00:+t0-1149) WdZZ:1 Z1.0Z/SZ/60 Memorial Medical Center Memo, Conemailsh Heel. Spleen Final Report Mt1tJ <TH BROWN STREET ..1STOWN, PA 17044 Radiologic Interpretation Patient: JACOBS, KYLEE S Exam: 4191900 CT HEAD UNENHANCED Referring Physician: REAMS, JEAN Attending Physician: Copy to Physician: Reason: ha s/p trauma DX: Location: C4/1 Consulting Physician: Admitting Physician: Accession: 01336674 Exam Date: 11/4/2011 11:50:OOAM INDICATION: FRONTAL HEADACHES. MOTOR VEHICLE ACCIDENT ON 09/18/11. 4D CT UNENHANCED he ventricles are normal in size and shape. There is no acute intracranial bleed. No midline shift, .,lass effect, mass lesion or acute ischemic infarct is detected. The gray -white matter interface is well demarcated and symmetric bilaterally. The skull is intact at bone windows without evidence of a calvarial fracture. IMPRESSION: 1. Negative unenhanced head CT. 2. Should this patient's symptoms continue and/or progress MR imaging of the brain may be helpful in further evaluation. TIME OF DICTATION: 1255 r sted By: W ILLiAM HERBICK MD 11/4/2011 12:58:OOPM -'- tftscribed by. KM 11/4/2011 1:50:14PM ,ectronicatly Signed: WILLIAM HERBICK MD 11/4/2011 3:01:20PM Patient: JACOBS, KYLEE S MRN: 000435513 Account*: 9159239 Copy to Physician: Attending Physician: DOB: 8/21/99 12Y Location: 0411 Accession: 01336674 F Printed: 11/4/2011 3:03:23PM 1086 Franklin Street, Johnstown, PA 15905 (1') 814.534.9166 (F) 814.534.3242 320 Main Street, Johnstown, PA 15905 (P) 814.534.6010 (F) 814.534.6024 Page 1 of 1 £ .e5ed LL0£-84Z-LLL OO`sweaa I„1 uearxed dH Wd61.470 2102 gZ da5 Printed 1/9/13 2:46 PM Geisinger Page 18 Jacobs, Kylee S (MR # 5136181) DOB: 08/21/1999 Administrative Information (continued) l Encounter -Level Documents -11/13/2012: (continued) 00:h0 -1W9 WdZZ•+t ZLOZ/5Z/60 '9/272011 10.'06:52 AAI Lewistown Hospital 7172485411 Page 1 of 2 LEWISTOWN HOSPITAL Patient: Jacobs, Kylee S MRN: 104922 Financial it: 20111402051 DOB/Age/Sex: 08/21/1999 12 years Female Location: LH XR Patient Type: Outpatient 4II Lewistown Hospital 400 Highland Avenue Lewistown, PA 17044 Admit Date: Discharge Date: Attending: Ordering: Consulting: Primary Care: Client Name: 09/23/2011 09/23/2011 Reams. Jean M Reams, Jean M Reams, Jean M Lewistown Hospital XR spine Cervical MFnimum 4 Views Re 'o INDICATION: Pain status post motor vehicle accident. Diagnostic Radiology XR-11-0036637 Exam Date/Time 09/23/2011 12:13:00 EDT FIVE VIEWS. 1 FINDINGS: There is mild straightening of the normal cervical lordosis. Vertebral body heights and intervertebral disc space heights are intact. Facets are normally aligned. Prevertebral soft tissues are normal. Neural foramina are widely patent bilaterally. Open-mouth odontoid view demonstrates intact odontoid with normal alignment of the lateral masses of C1 on the body of C2. Craniocervical alignment is within nor:nal limits. IMPRESSION: Normal exam. Final Dictated: 09/24/11 20:13:00 Embry , Joseph Signed (Electronic Signature): 09/27/11 09:22:28 Transcribed by: DL 09/26/2011 10:16 am Reams, Jean M 16 N. Brown Street Lewistown. PA 17044 t, a6ed Printed 1/9/13 2:46 PM Geisinger q_a7 ,/ 11/L6 y1 5 9'tsZ Chart Request ID: 5274455 Print DatefTime: 09/27/2011 10:04 Page 1 of 1 LL0E-817Z-LLL og`sweaa W uearxed dH Wd6Lt'0 21.0? 9Z daS Page 19 Jacobs, Kylee S (MR # 5136181) mnsfa° Encounter -Level Documents -11/13/2012: (continued) info',Ymat�on�(cotl n ur DOB: 08/21/1999 (00:+10-1W9) WdZZ:fi ZIOZ/5Z/60 XR Spine Cervical Minimum 4 Views Final Report' Result type: XR Spine Cervical Minimum 4 Views Result date: 23 September 2011 12:13 EDT Result status: Modified Result title: XR Spine Cervical Minimum 4 Views Performed by: Embry , Joseph on 24 September 2011 20:13 EDT Verified by: Embry , Joseph on 27 September 2011 09:22 EDT Encounter info: 20111402051, LH, Outpatient, - 09/23/11 * Final Report * Reason For Exam S/P MVA / Neck pain Jacobs, Kylee S - 104922 Interpretation INDICATION: Pain status post motor vehicle accident. FIVE VIEWS. FINDINGS: There is mild straightening of the normal cervical lordosis. Vertebral body heights and intervertebral disc space heights are intact. Facets are normally aligned. Prevertebral soft tissues are normal. Neural foramina are widely patent bilaterally. Open-mouth odontoid view demonstrates intact odontoid with normal alignment of the lateral masses of C1 on the body of C2. Craniocervical alignment is within normal limits. IMPRESSION: Normal exam. Signature Line *'""' Final '•"" Dictated: 09/24/11 20:13:00 Embry , Joseph • Signed (Electronic Signature): 09/27/11 09:22:28 Transcribed by: DL 09/26/2011 10:16 am Completed Action List: ` Order by Reams, Jean M on 23 September 2011 11:42 EDT Perform by Ream, Cheryl S on 23 September 2011 12:13 EDT ' VERIFY by Embry , Joseph on 27 September 2011 09:22 EDT Printed by: Printed on: Bumgardner , Denise 09/27/11 12:55 EDT g a6ed Page 1 of 1 (End of Report) LtOE-842-Ll.L 00`sweaa I„I uearxad dH Nd61:40 ZiOZ SZ daS Printed 1/9/13 2:46 PM Geisinger Page 20 Jacobs, Kylee S (MR # 5136181) �.°� � ��� Admlralstratve;� Encounter -Level Documents -11/13/2012: (continued) ormation ntinke DOB: 08/21/1999 (00:+10-1W9) WdZZ: fi n03/53/60 AUG -2 _' F A. NeD AUG - 2 2012 Corrective Therapy Solutions 1397 Eisenhower Blvd. Suite 304 Johnstown, PA 15904 814 - 262 - 4236 Fax 814 - 262 - 4237 JUL e16 Patient: Kylee Jacobs DOB: 08/21/99 Physician: Dr. Reams Diagnosis: cervical strain Number of visits: 06 Treatment: ADLs, therapeutic exercise, therapeutic activities, MET, manual therapy. Progress report: The patient has made excellent progress with the occupational therapy program for the treatment of cervical neck strain. On the initial evaluation The patient stated that her pain was rated at 4 -- 7/10 of the cervical neck and left shoulder area. The patient stated that pain and decreased active range of motion compared her ability to perform ADLs, grooming, home tasks, school activities, and sleep patterns. The patient now states that her pain is rated at 1 -- 2/10 in the cervical neck area with full active range of motion through all planes of movement. The patient has no significant increase in signs or symptoms of pain at this time with any activities. The patient has achieved all long-term goals with the OT program at this time. DIC O.T. At this time. Occupational Therapist recommendations: Physician recommendations: DIC O.T. At this time. Thank you for the referral on this patient. Occu ational the pist: Timothy L. Leventry OTRJL Date: 06114/12. Please sign date and return to co Printed 1/9/13 2:46 PM Geisinger ve therapy solutions. 01) - g abed Ll0£-8t6Z-LLL 00'sweed ueatxed dH Wd61.:170 ZIOZ 6Z daS Page 21 / Jacobs, Kylee S (MR # 5136181) DOB: 08/21/1999 Printed 1/9/13 2:46 PM Geisinger Page 22 Jacobs, Kylee S (MR # 5136181) Kylee S Jacobs 11/13/2012 8:00 AM PCP/Clinic Change MRN: 5136181 DOB: 08/21/1999 Description: 13 year old female Department: Encounter #: 123042411 Patient Instructions None Allergies as of 1/9/2013 Never Reviewed, Not on File Meds Comments as of 11/13/2012 Medications taken for digestion(umknown ) miralax 'Medication Administration History: I I All administrations No administration data available Intervention summary for Jacobs, Kylee S Open Interventions Type Status Opened By Opened Respons Outcome On None Closed Interventions Type Status Opened By Opened One None Intervention Detail Respons 1 Outcome (There are no med orders for this encounter) All Orders No orders found Patient Information Jacobs, Kylee S [5136181] DOB 08/21/1999 Female 1068 MOUNT HOPE RD Home Phone 717-250-4739 MC VEYTOWN, PA 17051 Work Phone Visit Information I Department I Encounter # 11/13/2012 8:00 AM PCP and Practice Primary Care Provider 123042411 Practice Name Jean M Reams Devita, DO [7400) Jean Reams Lewistown Phone 717-248-3002 Administrative Information Administrative Information Encounter Classification(s) None Printed 1/9/13 2:46 PM Geisinger Referring Provider None Visit Indicator None Page 23 Jacobs, Kylee S (MR # 5136181) Advance Directives LV &l 41, DOB: 08/21/1999 Ivance�tJi�ecitves�,�.� MAIL rr x� �w. On Fite? No Document List On File? No Patient/User Signed Documents - This Encounter There is no document attached to this encounter. Encounter Information Encounter Number: 123042411 Status: Open Learning Assessment None None Education Notes No notes present for this patient. Annotated Images None END OF REPORT Printed 1/9/13 2:46 PM Geisinger Page 24 PENNSTATE HERSHEY LET Milton S. Hershey 1410 Medical Center Harry Bramley, D.O. Assistant Professor and Medical Director Concussion Program and Pediatric Rehabilitation Tel: 717-531-6824 Fax: 717-531-0245 Matthew Silvis, M.D. Assistant Professor Primary Care Sports Medicine Concussion Program Tel: 717-531-5638 Fax: 717-531-0983 June 12, 2013 I have been asked by Peter M. Villari to provide a medical opinion regarding one of my patients by the name of Kylee Jacobs (DOB: 8/21/1999). Mr. Villari represents Kylee for injuries she suffered in a motor vehicle accident in September of 2011. I have been the medical director of the Penn State Concussion Program and one of the pediatric rehabilitation physicians at Penn State Hershey Medical Center for the past eight years. Currently, approximately 80% of my medical practice consists of patients with traumatic brain injury. I evaluated Kylee on May 16, 2013 with her father. They indicated that Kylee was involved in a motor vehicle accident in September of 2011. She does recall striking her head on the window during the accident. Since the accident she has suffered from headaches. They indicated she missed approximately 20 days of school since the accident due to headache. Headaches do seem to be improving, but noise, studying and reading continue to provoke a headache. During this visit I diagnosed Kylee with post-traumatic headache, provided treatment strategies of ibuprofen and imitrex for when she gets a headache, and arranged a follow up visit. With a very high degree of medical certainty, Kylee is suffering from post-traumatic headache as a direct result of the motor vehicle accident which occurred in September of 2011. Post- traumatic headache is a result of traumatic brain injury. This type of headache can last for many years, and can be very disabling, as is the case with Kylee. The multiple days of school missed are a direct result of the post-traumatic headache. Kylee's risk of future brain injury has increased due to the injuries sustained during the motor vehicle accident. If Kylee were to strike her head again, she is at risk of further brain injury and a more prolonged recovery. Individuals with a history of brain injury are more vulnerable for future injury, as is the case with Kylee. Penn State Milton S. Hershey Medical Center • Penn State College of Medicine • Penn State Hershey Children's Hospital Penn State Concussion Program, Mail Code H085, 500 University Drive, P.O. Box 850, Hershey, PA 17033-0850 An Equal Opportunity University While there is a chance that Kylee's injury may persist indefinitely, based on her current condition and her response to the recommended treatment, it is reasonable to expect her to make a full recovery at this time. However, as is the case for many of my patients with post- traumatic headache, this can take years. I would therefore not be surprised if Kylee continues to suffer from post-traumatic headaches and associated disabilities for an additional three to five years. Har P. Bramley, D.O. PENNSTATE HERSHEY WTI Milton S. Hershey RP Medical Center Patient Name: MRN: Date of Birth: Patient Gender: JACOBS, KYLEE S 2138313 8/21/1999 Female RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: September 26, 2013 Name: JACOBS, KYLEE S HMC Number: 2138313 DOB: 08/21/1999 Date of Service: 09/26/2013 Jean Reams DO 16 North Brown Street Lewistown, PA 17044 Dear Dr. Reams: Penn State Hershey Tel: (717) 531-8055 Milton S. Hershey Medical Center Health Information Services, HU24 500 University Drive PO. Box 850 Hershey, PA 17033-0850 Visit Number: 19772869 Visit Type: Clinic Patient Location: PC07 Outpatient Letter Final Outpatient Letter Bramley,Harry P (9/27/2013 11:27 EDT) I had the opportunity to see Kylee Jacobs and her father in follow up in the Penn State Concussion Program on 09/26/13. I last saw Kylee back on 05/16/13. During that visit, Kylee was suffering from posttraumatic headache which was direct result from a motor vehicle accident which occurred back in September of 2011. During that visit, I suggested p.r.n. ibuprofen and Tylenol and also prescribed Imitrex 25 mg for the more severe headaches. It did appear that visit that headaches were improving and so did not opt to provide a preventive medication. Since that time, she appears to be doing quite well. She did well over the summer and currently is doing quite well at school. There are no accommodations in place for school and headaches are essentially fairly minimal for her. She did not utilize the Imitrex over the last few months, her headaches are close to being completely resolved. She has stopped horseback riding, but would like to participate as a cheerleader this upcoming winter. She indicates that she has been sleeping well. Mood and personality are good and dad indicates that she does appear to be very stable from an emotional standpoint and she indicates that her grades are A's and B's and has no concerns in regards to her concentration, short-term memory or solving problems. On exam, she looks well, she is in no apparent distress, pleasant and appropriate. Her HEENT exam is unremarkable. Mucous membranes are moist. She has good air movement. She is well perfused. Neurologically, she is grossly intact. Date/Time Printed: 1/29/2014 06:19 EST Page 1 of 10 Printed By: Tice,Cindy L PENN HERSHEY lizTi Milton S. Hershey %Pi Medical Center Patient Name: JACOBS, KYLEE S Outpatient Letter MRN 2138313 ASSESSMENT: Kylee is a 14 -year-old status post motor vehicle accident back in September of 2013. She does seem to be resolving her posttraumatic headache. RECOMMENDATIONS: At this point point in time, 1 did indicate that once headaches and other symptoms resolve in most cases they continue to stay away. In regards to participating in cheerleading, | did indicate that at this time, | think that is very reasonable. | did ind\cate, however, that the risk of further concussion has probably increased because of the motor vehicle accident back in 2011; however, I do not think that risk of catastrophic brain injury has increased. 1 did indicate that being a flyer to be the higher risk of positions while cheerleading and would consider other positions if possible. Because Kylee is doing quite well, I did not schedule a foliowup appointment, but did tell her father that he could contact me at any time with questions. Thank you for aliowing me to partcipate in the care of one of your patients. Please contact me with questions. #11U5529 Electroriic Signature on File CC: Jean M Reams, DO 16 North Brown Street Lewistown PA 17044 Sincerely, Harry P Bramley, DO Author Signature Dt/Tm: 09<27%20/3 11:27 AM HPB/N7S DO: 09/26/13 DT- 09/27/13 01:00 Dote/Time Printed: 1/2S%2014UO18EST Page 2 of 10 PENNSTATE HERSHEY PPM Milton S. Hershey my Medical Center Patient Name: JACOBS, KYLEE S Allergy History MRN 2138313 Substance Pollen Recorded Date/Time Recorded By 2/8/2013 10:45 ESTC' Parsons,Trisha M Reaction Status Active; Allergy Type Allergy; Reviewed By Lutz,Lisa M; Reviewed Date/Time 9/26/2013 12:54 EDT; Recorded On Behalf Of Parsons,Trisha M C1: 2/8/2013 10:45 EST; Parsons, Trisha M; seasonal allergy Date/Time Printed: 1/29/2014 06:19 EST Page 3 of 10 Printed By: Tice,Cindy L PENNSTATE HERSHEY W Milton S. Hershey Medical Center Patient Name: JACOBS, KYLEE S Measurements Recorded Date Recorded Time Recorded By 9/26/2013 12:56 EDT SYSTEM 9/26/2013 12:54 EDT Lutz,Lisa M Procedure. Units Height cm 170 Height (inches) inch 66.9 Patient Weight Patient Weight (lbs kg lb 64.1 141.3 Body Mass Index kg/m2 22.18 BMI Percentile 78.15 Body Surface Area m2 1.74 Mandatory Intake Measurements Yes MRN 2138313 Date/Time Printed: 1/29/2014 06:19 EST Page 4 of 10 Printed By: Tice,Cindy L PENNSTATE HERSHEY IFET1 Milton S. Hershey Medical Center Patient Name: JACOBS, KYLEE S MRN 2138313 �..............w................................ , ..w.......,.............,,,,,.,..... Vital, Signs,.......,,,,,,,,,..,,,,, ,.................,,....................,....,,,,....,......,....................,....,,,...... Recorded Date 9/26/2013 Recorded Time 12:54: EDT Recorded By Lutz Lisa .M rocedure nits Temperature DegC 36.7 Temperature (Deg F) DegF 98.06 Heart Rate bpm 80 Respiratory Rate br/min 20 Systolic Blood Pressure mmHg 108 Diastolic Blood Pressure mmHg 64 Date/Time Printed: 1/29/2014 06:19 EST Printed By: Tice,Cindy L Page 5 of 10 PENNSTATE HERSHEY PRETI Milton S. Hershey RIP Medical Center Patient Name: JACOBS, KYLEE S Pain Assessments Recorded Date 9/26/2013 Recorded Time 12:54 EDT Recorded By Lutz Lisa M Procedure Units Pain Intensity Outpt MRN 2138313 Date/Time Printed: 1/29/2014 06:19 EST Page 6 of 10 Printed By: Tice,Cindy L PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: JACOBS, KYLEE S PsychoSocial Ped Documentation Recorded Date .::,9/26/20.13 Recorded Time 12:54 EDT Recorded By Lutz,Lisa:M Procedure Units Felt Down or depressed over as 2 weeks 0 Little Interest in doing things No MRN 2138313 Date/Time Printed: 1/29/2014 06:19 EST Page 7 of 10 Printed By: Tice,Cindy L PENNSTATE HERSHEY ilizr Milton S. Hershey go Medical Center Patient Name: JACOBS, KYLEE S Routine Care Documentation MRN 2138313 • Recorded Date Recorded Time Recorded. By • 9/26/2013 12:54 EDT. Lutz,Lisa M Procedure Units Mandatory Health Literacy Documentation Yes Health Literacy Communication Barriers Never Educational Needs Assessed one year Barriers to Learning one year Yes None evident Learning Preferences one year Verbal Explanation Mandatory Intake Health Habits Yes Mandatory Intake Vital Signs Yes Mandatory Intake Education Mandatory Emotional Assessment 13 above Yes Yes Mandatory Intake Measurements Yes Mandatory Intake General Nurse Station Requisition Print Default Yes Default Cigarette smoker Tobacco Product Use Never smoked cigarettes See Below 1-1 Textual Results T1: 9/26/2013 12:54 EDT (Tobacco Product Use) Never used other tobacco products Date/Time Printed: 1/29/2014 06:19 EST Page 8 of 10 Printed By: Tice,Cindy L PENNSTATE HERSHEY WTI Milton S. Hershey Medical Center Patient Name: JACOBS, KYLEE S Problems MRN 2138313 Problem Name:: SPLENOMEGALY.. Last Updated: 3/8/2013 10:24 EST; Weaver,Jennifer L Classification: Medical; Confirmation: Confirmed; Code: 789.2; Course: ; Onset Date: ; Prognosis: ; Persistence: Recorder: Weaver,Jennifer L; Responsible Provider: Life Cycle Date: 3/8/2013 Life Cycle Status: Active Date/Time Printed: 1/29/2014 06:19 EST Printed By: Tice,Cindy L Page 9 of 10 PENNSTATE HERSHEY W1 Milton S. Hershey Medical Center Patient Name: JACOBS, KYLEE S Height /Weight Measurements Height Recorded Date 9/26/2013 Recorded Time 12:54 EDT Recorded By Lutz,Lisa M Procedure Units Height cm 170 Weight Recorded Date 9/26/2013 Recorded Time 12:54EDT Recorded By Lutz,Lisa M Procedure Units Patient Weight kg 64.1 MRN 2138313 Date/Time Printed: 1/29/2014 06:19 EST Page 10 of 10 Printed By: Tice,Cindy L VERIFICATION I, Susanne Jacobs, mother and natural guardian of the minor -plaintiff, Kylee Jacobs, state that I have reviewed the Petition for. Approval of Settlement of Minor's Claim and Allocation/Distribution of Settlement Proceeds, and hereby certify that I understand and agree with each of the requests in the Petition and verify that the statements made therein are true and correct upon personal knowledge or to the best of my information and belief. I hereby also certify that, for the reasons stated in the Petition, it is my opinion that the proposed settlement and distribution is fair, reasonable, in the best interest of my daughter and recommend that it be approved by the Court. I have also reviewed the records/reports from Doctors Andreychik and Bramley attached as exhibits to the Petition and verify that they accurately reflect the current physical and mental condition of my daughter. I understand that the statements I have made herein are subject to the penalties of 18 Pa. Cons. Stat. Ann. § 4904 relating to unsworn falsification to authorities. COMMONWEALTH OF PENNSYLVANIA Notarial Seal Elaine H. Fisher, Notary Public Granville Twp., Mifflin County My Commission Expires Feb. 14, 2018 MEMBER., PLNNSYLVANIA ASSOCIATION Of NOT Al. I - VERIFICATION I, David Jacobs, father of the minor -plaintiff, Kylee Jacobs, state that I have reviewed the Petition for Approval of Settlement of Minor's Claim and Allocation/Distribution of Settlement Proceeds, and hereby certify that I understand and agree with each of the requests in the Petition and verify that the statements made therein are true and correct upon personal knowledge or to the best of my information and belief. I hereby also certify that, for the reasons stated in the Petition, it is my opinion that the proposed settlement and distribution is fair, reasonable, in the best interest of my daughter and I recommend that it be approved by the Court. I have also reviewed the records/reports from Doctors Andreychik and Bramley attached as exhibits to the Petition and verify that they accurately reflect the current physical and mental condition of my daughter. I understand that the statements I have made herein are subject to the penalties of 18 Pa. Cons. Stat. Ann. § 4904 relating to unsworn falsification to authorities. DATEDgr3E4 Jaa(-4.) COMMONWEALTH OF PENNSYLVANIA Notarial Seal Elaine H. Fisher, Notary Public Granville Twp., Mifflin County My Commission Expires Feb. 14, 2018 MEMBEIA,PENAISYWANIA ASSOCIATION Of NOTARIES VILLARI, BRANDES & GIANNONE, P.C. BY: Andrew C. Rimol, Esquire PA Attorney ID No.: 205809 Eight Tower Bridge 161 Washington Street, Suite 400 Conshohocken, PA 19428 (610) 729-2900 ATTORNEYS FOR PLAINTIFFS SUSANNE JACOBS, Individually, and as Parent and Guardian of KYLEE JACOBS, a minor, Plaintiffs -vs- BERNICE J. BOURNE Defendant. IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : CIVIL ACTION — LAW : Docket No. 13-4780 CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of Plaintiffs' Petition for Approval of Settlement of Minor's Claim and Allocation/Distribution of Settlement Proceeds, was served upon the following in accordance with Pa. R.C.P. 440, by mailing a true and correct copy of same to defendant's counsel of record this 9th day of October 2014, via U.S. First Class Mail, postage prepaid, addressed as follows: DATED: Oct. 9, 2014 Joseph R. D'Annunzio, Esquire Law Office of Joseph R. D'Annunzio 4309 Linglestown Road, Suite 211 Harrisburg, PA 17112 Attorney for Defendant By: VILLARI, BRANDES & GIANNONE, P.C. ANDREW C. Rimo Attorneys for Plaintiffs SUSANNE JACOBS, Individually, and as Parent and Guardian of KYLEE JACOBS, a minor, Plaintiffs -vs- BERNICE J. BOURNE Defendant. : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY- : CIVIL ACTION — LAW : Docket No. 13-4780 Commonwealth of Pennsylvania: County of ,,c(p,c4A) . AFFIDAVIT S.S. BEFORE ME, the undersigned Notary, 3.1-1- Gr y J, < a ,L� on this ` day of 0p to_O--c_ -c.) , 2014, Susanne Jacob person _ly appeared, known to me to be a credible person and of lawful age, who being by me first duly sworn, on her oath, deposes and says: 1. I am Susanne Jacobs, mother and natural guardian of Kylee Jacobs, a minor. 2. I commenced the above -captioned action against the defendant as guardian of my daughter, the minor -plaintiff, Kylee Jacobs. 3. I have agreed to settle my daughter's claims for the gross amount of $27,500.00. 4. I had the opportunity to consult with my attorneys, Villari, Brandes & Giannone, P.C., before deciding to accept the proposed settlement. 5. I agree that the gross settlement amount is fair and reasonable. 6. I had an opportunity to review the Petition for Approval of Settlement of Minor's Claim and Allocation/Distribution of Settlement Proceeds and discuss it with my attorneys. 7. I understand the requests that have been made in the Petition. Page 1 of 3 8. I understand that Villari, Brandes & Giannone, P.C., has advanced certain monies in prosecuting this action on behalf of my daughter, such as for court filing fees, medical records, experts and the like. 9. I understand those costs currently total $1,468.07. 10. I understand that Villari, Brandes & Giannone, P.C., is seeking reimbursement of those costs from the proceeds of the gross settlement. 11. I agree that the costs are fair and reasonable. 12. I understand that Villari, Brandes & Giannone, P.C., is also seeking counsel fees in the amount of $8,677.31, which represents one-third (1/3) of the settlement amount after the deduction of costs/expenses, pursuant to the contingency fee agreement. 13. I agree the fee requested by counsel is fair and reasonable. 14. I, along with my daughter, Kylee, entered into a contingency fee agreement with Villari, Brandes & Giannone, P.C., that provides for an attorney fee of one-third (1/3) of the settlement amount. 15. I agree with payment of $8,677.31 out of the net settlement figure after payment of costs. 16. I am satisfied with the work done by Villari, Brandes & Giannone, P.C. in litigating my daughter, Kylee Jacob's, claims against the defendant and in reaching a settlement on her behalf. 17. I understand that the net settlement amount payable to my daughter, Kylee Jacobs, after deduction of costs and attorney's fees is $17,354.62. 18. I understand that the settlement proceeds due to my daughter, Kylee Jacobs, will be placed into an interest bearing savings account at a bank or credit union insured by a Federal governmental agency, in the name of Kylee Jacobs only, with a provision and/or Page 2 of 3 instructions that the funds are not to be withdrawn before Kylee Jacobs attains majority or upon prior Order of Court. 19. I understand that I, as Kylee's guardian and mother, have the right to reject the settlement that has been proposed and proceed to trial to have my daughter's claims decided by a jury. 20. I understand that by agreeing to settle I am giving up the right to a jury trial. 21. I understand that I could reject the proposed settlement and instead proceed to trial but I have nevertheless decided to accept the settlement that has been proposed. 22. I understand that the settlement is for all claims my daughter, Kylee Jacobs, may have against the defendant in relation to this lawsuit. 23. I understand that by accepting this settlement, neither I, nor my daughter, can ask for more money at a later time or bring suit against the defendant for any claim relating to this accident. SWORN TO AND SUBSCRIBED before me, this 3 day of Q 0- , 2014.. COMMONWEALTH OF PENNSYLVANIA Notarial Seal Elaine it; Fisher, Notary aCPublli Granville Twp., Mifflin ty My Commission Expires Feb. 14, 2011 NSYLVANIA ISSOC:*non of NOTARI SUSANNE JACOBS 1325 Christopher Street Johnstown, PA 15905 Page 3 of 3 SUSANNE JACOBS, Individually, and as Parent and Guardian of KYLEE JACOBS, a minor, Plaintiffs -vs- BERNICE J. BOURNE Defendant. Commonwealth of Pennsylvania: County of '41iLvvL) BEFORE ME, the undersigned Notary, --DO. , on this `3 day of Q , 2014, David Jacobstpersonally appeared, known to me to be a credible person and of lawful age, who being by me first duly sworn, on her oath, deposes and says: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY CIVIL ACTION — LAW Docket No. 13-4780 AFFIDAVIT S.S. rw na. 1 I am David Jacobs, father of the minor, Kylee Jacobs. 2. I have agreed to the settlement of my daughter's claims for the gross amount of $27,500.00. 3. I had the opportunity to consult with an attorney and/or speak with the attorneys at Villari, Brandes & Giannone, P.C., prior to agreeing to the proposed settlement on behalf of my daughter. 4. I agree that the gross settlement amount is fair and reasonable. 5. I had an opportunity to review the Petition for Approval of Settlement of Minor's Claim and Allocation/Distribution of Settlement Proceeds and to consult with an attorney and/or speak with the attorneys at Villari, Brandes & Giannone, P.C., regarding the Petition. 6. I understand the requests that are made in the Petition. Page 1 of 3 7. I understand that Villari, Brandes & Giannone, P.C., has advanced certain monies in prosecuting this action on behalf of my daughter, such as for court filing fees, medical records, experts and the like. 8. I understand those costs currently total $1,468.07. 9. I understand that Villari, Brandes & Giannone, P.C., is seeking reimbursement of those costs from the proceeds of the gross settlement. 10. I agree that the costs are fair and reasonable. 11. I understand that Villari, Brandes & Giannone, P.C., is also seeking a counsel fee in the amount of $8,677.31, which represents one-third (1/3) of the settlement after the deduction of costs/expenses, pursuant to the contingency fee agreement entered into by Kylee and Kylee's mother, Susanne Jacobs. 12. I agree that the fee requested by counsel is fair and reasonable. 13. I understand that my daughter, Kylee, and her mother, Susanne, signed a contingency fee agreement with Villari, Brandes & Giannone, P.C., that provides for an attorney fee of one-third (1/3) of the settlement amount. 14. I agree with payment of $8,677.31 out of the net settlement figure after the payment of costs. 15. I am satisfied with the work done by Villari, Brandes & Giannone, P.C. in litigating my daughter, Kylee Jacob's, claims against the defendant and in reaching a settlement on her behalf. 16. I understand that the net settlement amount payable to my daughter, Kylee Jacobs, after deduction of costs and attorney's fees is $17,354.62. Page 2 of 3 17. I understand that the settlement proceeds due to my daughter, Kylee Jacobs, will be placed into an interest bearing savings account at a bank or credit union insured by a Federal governmental agency, in the name of Kylee Jacobs only, with a provision and/or instructions that the funds are not to be withdrawn before Kylee Jacobs attains majority or upon prior Order of Court. 18. I understand that 1, as Kylee's father, have the right to object to the settlement that has been agreed by Kylee and her mother, Susanne Jacobs. 19. I understand by agreeing to the proposed settlement I am giving up the right to object to same. 20. I understand that I have the right to object to the proposed settlement and Petition the Court to not approve it. 21. I understand that the settlement is for all claims my daughter, Kylee Jacobs, has against the defendants relating to this lawsuit. 22. I understand that by agreeing to the proposed settlement, neither I, nor my daughter, Kylee, can ask for more money at a later time or bring suit against the defendant in relation to this accident. SWORN TO AND SUBSCRIBED before me, this d day of 0CJD , 2014.. Page 3 of 3 DAVID JACOBS 1068 Mount Hopekoad McVeytown, PA 17051 COMMONWEALTH OF PENNSYLVAN Notarial Seal p Elaine H. Fisher, Notary ota Pc ubublili Granville Twp., ty My Commission Expires Feb. 14, 2018 IATION OE NOTARIES E E SYLYANIA SUSANNE JACOBS, Individually, IN THE COURT OF COMMON PLEAS and as Parent and Guardian of OF CUMBERLAND COUNTY KYLEE JACOBS, a minor, C, C-) CIVIL ACTION-LAW c !I Plaintiffs -vs- Docket No. 13-4780 z M `-)- x� Nr- c BERNICE J. BOURNE Defendant. :&C:; cv : . ORDER t� AND NOW, this 5 day of 2014, upon consideration of the Petition for Approval of Settlement of Minor's Claim and Allocation/Distribution of Settlement Proceeds, it is hereby ORDERED that the proposed settlement of the minor-plaintiffs claims for the gross amount of Twenty-seven Thousand Five Hundred Dollars ($27,500.00) is hereby approved; and it is further ORDERED that the proceeds of the settlement be allocated and distributed as follows: (a) TO: Villari, Brandes & Giannone, P.C. $ 1,468.07 (Reimbursement of Costs) (b). TO: Villari, Brandes & Giannone, P.C. $ 8,677.31 (Counsel Fees) (c) TO: Kylee Jacobs, a minor, the sum of $17,354.62 to be deposited into an interest bearing savings account in a bank or credit union insured by a Federal governmental agency, in the name of Kylee Jacobs only, with provisions/instructions that no withdrawal may be made from said account until Kylee Jacobs attains majority or upon prior order of the court. BY THE COURT: Pv_+er &p y ft,'l rcl to l p lj y p1/, VILLARI, BRANDES & GIANNONE, P.C. By: Peter M. Villari, Esquire Andrew C. Rimol, Esquire Attorney ID Nos. 26875 & 205809 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 (610) 729-2900 Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION Susanne Jacobs, individually, and as parent and natural guardian of Kylee Jacobs, a minor 1325 Christopher Street Johnstown, PA 15905 Plaintiffs vs. Bernice Bourne 4433 Peterboro Street Apartment A3 Vernon, NY 13476-3643 Defendant Docket No.: 13-4780 Jury Trial Demanded PRAECIPE TO SETTLE, DISCONTINUE AND END TO THE PROTHONOTARY: Please mark this matter "settled, discontinued and ended" with payment of your costs only. VILLARI, BRANDES & GIANNONE, P.C. Dated: 105/31 31 /14 BY: eter M. Villar% Esquire Andrew C. Rimol, Esquire Attorneys for Plaintiff VILLARI, BRANDES & GIANNONE, P.C. By: Peter M. Villari, Esquire Andrew C. Rimol, Esquire Attorney ID Nos. 26875 & 205809 8 Tower Bridge, Suite 400 161 Washington Street Conshohocken, PA 19428 (610) 729-2900 Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION Susanne Jacobs, individually, and as parent and natural guardian of Kylee Jacobs, a minor 1325 Christopher Street Johnstown, PA 15905 Plaintiffs vs. Bernice Bourne 4433 Peterboro Street Apartment A3 Vernon, NY 13476-3643 Defendant Docket No.: 13-4780 Jury Trial Demanded CERTIFICATE OF SERVICE I, Andrew C. Rimol, Esquire, Attorney for Plaintiff, hereby state that a true and correct copy of Plaintiffs Praecipe to Settle, Discontinue & End, was served upon all parties through their counsel by first-class mail, postage prepaid and email addressed as follows: Joseph R. D'Annunzio, Esq GEICO Staff Counsel Office 4309 Linglestown Road, Suite 211 Harrisburg, PA 17112 VILLARI, BRANDES & GIANNONE, P.C. Dated: (0/31A+ /(+ BY: ndrew C. Rimol, Esquire Attorney for Plaintiff VILLARI, BRANDES & GIANNONE, P.C. By: Peter M. Villari, Esquire Attorney I.D. No. 26875 -and- By: Andrew C. Rimol, Esquire Attorney I.D. No. 205809 8 Tower Bridge 161 Washington Street, Suite 400 Conshohocken, PA 19428 Telephone - (610) 729-2900 Facsimile - (610) 729-2910 32 LI", Attorneys for Plaintiffs SUSANNE JACOBS, Individually, and as Parent and Guardian of KYLEE JACOBS, a minor, Plaintiffs -vs- BERNICE J. BOURNE Defendant. : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : CIVIL ACTION — LAW . Docket No. 13-4780 AFFIDAVIT I, Andrew C. Rimol, Esquire, hereby certify that pursuant to the Order of October 15, 2014, a copy of which is attached as Exhibit "A" Suzanne Jacobs, custodial parent and natural guardian, received and deposited $17,354.62 on November 28, 2014. A copy of the transaction receipt from USSCO Credit Union is hereto attached as Exhibit "B." VILLARI, BRANDES & NE, P.C. BY: drew C. Rimol/Esquire Attorney for Plaintiff/Petitioner SWORN TO AND SUBSCRIBED before me, COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL MARCIA M BROWN Notary Public CONSHOHOCKEN BORO.. MONTGOMERY CNTY My Commission Expires Oct 21. 2017 VILLARI, BRANDES & GIANNONE, P.C. By: Peter M. Villari, Esquire Attorney I.D. No. 26875 -and- By: Andrew C. Rimol, Esquire Attorney I.D. No. 205809 8 Tower Bridge 161 Washington Street, Suite 400 Conshohocken, PA 19428 Telephone - (610) 729-2900 Facsimile - (610) 729-2910 Attorneys for Plaintiffs SUSANNE JACOBS, Individually, and as Parent and Guardian of KYLEE JACOBS, a minor, Plaintiffs -vs- BERNICE J. BOURNE Defendant. : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : CIVIL ACTION — LAW . Docket No. 13-4780 CERTIFICATE OF SERVICE I, Andrew C. Rimol, Esquire, attorney for Petitioners, hereby certify that a true and correct copy of the Affidavit of Deposit has been forwarded to all interested parties listed below by first class mail, postage prepaid, on this 5th day of December, 2014: Dated: 1 Zf 5/ Joseph R. D'Annunzio, Esquire GEICO STAFF COUNSEL OFFICE 4309 Linglestown Road Suite 211 Harrisburg, PA 17112 BY: VILLARI, BRANDES & INE, P.C. e , rew C. Rimol, quire Attorney for Plaintiff/Petitioner VILLARI, BRANDES & GIANNONE, P.C. By: Peter M. Villari, Esquire Attorney I.D. No. 26875 -and- By: Andrew C. Rimol, Esquire Attorney I.D. No. 205809 8 Tower Bridge 161 Washington Street, Suite 400 Conshohocken, PA 19428 Telephone - (610) 729-2900 Facsimile - (610) 729-2910 Attorneys for Plaintiffs SUSANNE JACOBS, Individually, and as Parent and Guardian of KYLEE JACOBS, a minor, Plaintiffs -vs- BERNICE J. BOURNE Defendant. : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : CIVIL ACTION — LAW Docket No. 13-4780 I, ANDREW C. RIMOL, ESQUIRE, of full age, hereby certifies and says: 1. I am an attorney licensed to practice law in the State of Pennsylvania and am an associate with the firm of Villari, Brandes & Giannone, P.C., attorney for minor Plaintiff, Kylee Jacobs, by and through her parent and natural guardian, Suzanne Jacobs. 2. I make this Certification in support of the Affidavit of Deposit of Minor's Funds. I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment. Dated: (2.- 5 - I4 By: Respectfully submitted, VILLARI, BRANDE. GIANNONE, P.C. A'drew C. Rimol, Esquire Attorney for Plaintiffs SUSANNE JACOBS, Individually, and as Parent and Guardian of KYLEE JACOBS, a minor, Plaintiffs -vs- BERNICE J. BOURNE Defendant. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY : CIVIL ACTION — LAW Docket No. 13-4780 c=a —0 ira Z . ZQ (.lz z Gam' 29 C7:_1(..1." ORDER AND NOW, this /S `day of D(, , 2014, upon consideration of the Petition for Approval of Settlement of Minor's Claim and Allocation/Distribution of Settlement Proceeds, it is hereby ORDERED that the proposed settlement of the minor -plaintiff s claims for the gross amount of Twenty-seven Thousand Five Hundred Dollars ($27,500.00) is hereby approved; and it is further ORDERED that the proceeds of the settlement be allocated and distributed as follows: TO: Villari, Brandes & Giannone, P.C. (Reimbursement of Costs) TO: Villari, Brandes & Giannone, P.C. (Counsel Fees) $ 1,468.07 $ 8,677.31 TO: Kylee Jacobs, a minor, the sum of $17,354.62 to be deposited into an interest bearing savings account in a bank or credit union insured by a Federal governmental agency, in the name of Kylee Jacobs only, with provisions/instructions that no withdrawal may be made from said account until Kylee Jacobs attains majority or upon prior order of the court. TRUE COPY FROM RECORD in Testimony whereof, 1 here unto set my hand and the seal of said Court a�Carlisle, Pa. This %S_ day of ,20 _ _, 201 Prothonotary k. j BY THE COURT: J / ter - . e 9 , J. A . Advanta g • (0082058279) - • Member Nurnber 0082058279 Kylee S. Jacobs Utma (P) Susanne K Jambs Custodian Johnstown. PA 15905 Score: New Ittembe Sean:41: .1 VATiffit ‘4P SZ1 I kAoSelect SSN: 194-78-0183 DOB: 08/21/1999 Opened: 11. COrnalcere; 0 Payroll: 0 Plastics: 0 c.ornments: 0 'Joints: 0 Misc Codes; 0 Applications- 0 Relations 0,54 Balances Inquiryl Non Financial Financial Loans i Member Documents1 Financial Task List Eriterthange 5 Out Apply Funds Take/Trander Funds CeVflcate, New Certificate,. Wandrawal Certificate. Addion Certificate, Renew Certificate, Adjustment Loan Advance Loan Payment fAiscallaneous Funds In Miscellaneous Funds Out Journal Adiustments Bond Purchase Bond Redemption Summary of Actions 50.00 0A 50.00 r 6i" 7,T57-1 50.00 D S0.60 Shares for Total of S17,354.621 Available ' a°as!,, Hold .HL ID ' Description ', Rle . Balance . Balance • i i • I51 i Primary Share 01 ...,_ 0.150% : 517,354.62i S0.00 i 01 :, Member... i 517,354.62 i ._ . 0 Loans for Total of 50.00 ID 4 Description ; Balance Available Payrnent Freq • Method atDue I Ding Status 1 De I Amt • Certificates for Total of 50.00 4 ber Desofiption Balance MulYe Rate , Eain Date , lytn Bat . , • , , , • • . ' . ,' • Keyboard Tran Mode:OTC' ! 63 • ARsaia Production! 11/28%2014 !:,:5:52 Pfri1. •TT208' j USSCO FEDERAL CREDIT UNION