HomeMy WebLinkAbout05-0331
SHIPPENSBURGI
SOUTH HAMPTON MANOR, LP
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO, 2005- .331
CIVIL TERM
JUDITH DEVOE,
Defendant
CIVIL ACTION-LAW
NOTICE
You have been sued in court. If you wish to defend against the claims set forth in the
following pages, you must take action within twenty (20) days after this complaint and notice are
served, by entering a written appearance personally or by 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 ajudgment may be entered against you
by the court without further notice for any money claimed in the complaint or for any other claim
or relief requested by the plaintiff. You may lose money or property or other rights important to
you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION
ABOUT HIRING ALA WYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAYBE ABLE
TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER
LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.
Cumberland County Bar Association
32 South Bedford Street
Carlisle, Pennsylvania 17013
(717) 249-3166
SHIPPENSBURGI
SOUTH HAMPTON MANOR, LP
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
v.
NO. 2005- .n I
CIVIL TERM
JUDITH DEVOE,
Defendant
CIVIL ACTION-LAW
COMPLAINT
NOW, comes Shippensburg/South Hampton Manor, L.P. ("Shippensburg Health Care"),
by and through its attorneys, O'BRIEN, BARIC & SCHERER, and files the within Complaint
and, in support thereof, sets forth the following:
L Shippensburg/South Hampton Manor, L.P. is a Maryland limited partnership duly
authorized to conduct business in the Commonwealth of Pennsylvania,
2, Shippensburg/South Hampton Manor, L.P, owns and operated a skilled nursing
facility ("facility") located at 121 Walnut Bottom Road, Shippensburg, Cumberland County,
Pennsylvania.
3. Defendant, Judith Devoe, is an adult individual residing at 12696 Cumberland
Highway, Orrstown, Pennsylvania 17244,
4. On or about July 12,2004, Judith Devoe sought to be admitted to the facility.
5. In connection with seeking admission to the facility, Judith Devoe executed an
Admission Agreement. A true and correct copy of the Admission Agreement is attached hereto
as Exhibit "A" and is incorporated by reference,
6. On or about luly 12,2004, Judith Devoe became a resident of the facility.
7. On October 16, 2004, Judith Devoe was discharged to home from the facility.
8, As of the date of her discharge, there existed an outstanding balance due of
$7,036.00 for the costs of care provided to Judith Devoe by Shippensburg Health Care.
9. A true and correct statement of the amount due and owing is attached hereto as
Exhibit "B" and is incorporated by reference.
1 O. Demand has been made upon Judith Devoe to pay the amount due and owing.
11, The Admission Agreement provides, in relevant part, as follows: "If you or your
representative do not pay the money you owe us and we hire a collection agency or attorney, you
agree to be liable for their fees and court costs."
COUNT 1- BREACH OF CONTRACT
SHIPPENSBURG HEALTH CARE v. JUDITH DEVOE
12, Plaintiff incorporates by reference paragraphs one through eleven as though set
forth at length,
13, All conditions precedent to recovery under the Admission Agreement have been
fulfilled,
14, Judith Devoe is obligated to pay for the costs of care provided to her by
Shippensburg Health Care,
15. The amount due and owing is not covered by a third party payor.
16, Judith Devoe has breached the Admission Agreement by and failing and refusing
to pay for the costs of care provided.
17, Late fees for on the balance due began to accrue as of December 1, 2004 at a per
diem rate of$ .96. Late fees to January 15,2004 are $44,16.
WHEREFORE, Plaintiff requests judgment in its favor and against Defendant for the sum
of $7,036 plus late fees, costs and expenses and attorney fees to the date of award,
COUNT II-QUANTUM MERUIT
SHIPPENSBURG HEALTH CARE v. JUDITH DEVOE
18, Plaintiff incorporates by reference paragraphs one through seventeen as though set
forth at length,
19, During the period of her residency at the facility, Judith Devoe enjoyed the benefit
of care and services provided to her by Shippensburg Health Care.
20. Judith Devoe has failed and refused to pay for the costs of her care and services as
provided by Shippensburg Health Care.
21, Judith Devoe has been unjustly enriched by her use and enjoyment of the services
and care provided by Shippensburg Health Care without making payment therefor.
WHEREFORE, Plaintiff requests judgment in its favor and against Defendant for the sum
of$7,036.00 plus late fees, costs and expenses and attorney fees,
Respectfully submitted,
David A. Baric, Esquire
1.D, # 44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
Attorney for Plaintiff
dab.dirlshcc/devoe/complain t. pld
01/13/2005 14:01
7172495755
DBS
PAGE 05
VERIFICATION
The statements in th.e foregoing Complaint are based upon information which has been
assembled by my attorney in this litigation. The language of the statements is not my own. I
have read tl1e statements; and to the extent that they are based upon information which 1 have
giveu to my counsel, they are true and correct to the best of my knowledge, information and
beUef. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. ~
4904 relating to unsworn falsifications to authorities.
DATE:
~/jJ~)
5f; /) /47 ~
V Larry Cottle
Administrator
FROM :Shippensb~rg Health Care Ctr
FAX NO. :7175308304
Jan_ 10 2005 03:53PM P9
~~$kN~
~~ HHALTH CARE CllNTER
121 Walnut Rottom Road
ShippensbUl"g, Pennsylvania
17257.9005
(717) 530-8300
FAX (7l7) 530-K304
TTY 1-800.654-S'l84
ADMISSION AGREEMENT
This Agr~~:lleAi~ between S. hippensburg Health Care Center (the "Facility" or "we" and)
~\LI_.be: \l.!' ~ (the "Resident" or "you") and, if you or the court have
designated an individual to act 011 your behalf, or there is another individual to act on your
behalt~ or operation of law, ,..,___.__....... __ ("your representative"). A
checklist of the rights and responsibilities applicable to your representative is listed in Exhibit 1
and is incorporated into this Agreement.
l'arillg for Yom' Clll-e
If you are applying to d.ns facility as a private-pay resident, you must provide all linancial
infonnation requested by &s, If we later tind that the inli,rmation YOll or YOllr representative
provided was incomplet~ or inaccuratE'; we will consider that as a breach of t1ti~ Agreement
which gives U~ the right to purSUe all legal remedies against you or your repre~entative.
WhoJ;;'9.E Be RCQuh'ed to Pav fill' Yom:..Care
Only you and your insurer can be required to pay for YOllr care, No other person, (i,e. II family
member, thend, neighbor, legal representative or guardian) can be required to pay trom tbeir
own filnds for your care, although he or she may knowingly and voluntarily agree to guarantee
payment for the cost of your care. We require the person responsible for making payments on
your behalf to pay for your care under the terms of this contract in a timely manner.
tf you are a benefi<;iury of Medicare, Medicaid or any other third. party payment plan, your
representative agrees to make all necessalY payments from your funds. Your representative
could face a civil penalty for intentionally failing to pay required amounts from your funds and
could face a criminal penalty for abusing your fimds,
Private Pay Residellts
The items and sel>'ices illcluded in our daily rate is basic room, board and general nllrsing care as
reqllired by your medi';al condition. Payment for items and services that are included in the
daily rate and is payable one month in advance and due on the first of each month, Items and
services included in your daily rate are listed in Exhibit 2,A,
You will be charged separately for additional items and sel>'ic:es not included in our daily rates
sllch as special nursing care, special equipment, pharmacy charges, laboratory charges, medical
transportation and additional services such as telephone expense, dry cleaning, beauty and barber
sel>'ices and newspapers, Items and services for which you will be charged are listed in Exhibit
2,B. Payment for these additiooal items and services are clue after you have requested them, and;
you have received and have been billed for them. Within 30 days of receiving an item or service,
EXHIBIT "A"
FR8M :Skippensburg Health Care Ctr
FAX NO. :7175308304
Jan. 10 2005 03:54PM P10
'--
you have the right to a~k us for an itemized financial statement that briefly but clearly describes
each item and the amount charged for it. You will be given an updated listing of services llnd
related charges, including any charges lor services not covered tinder Medicare or by the
facilities basic per diem charges, annually on or about January 1 of each year,
Medicare Residents
We participate in the Medicare Program, Medicare may pay for some or all of your nursing
home care, For information on Medicare, see Exhibit 3, If you are eligible for Medicare, you
have thc right to have claims for your nursing home care submitted to Medicare,
Medicaid Residents
We participate in the Medicaid program, For information on Medicaid, see Exhibit 3, You are
not required to give up any of your rights to Medicaid benefits to be admitted or to stay here, If
your private funds are used up dllring YOllr stay here and YOll are eligible for Medicaid; we will
accept Medicaid payments alth9~gh Medicaid may require you to pay Some amount in addition
to what Medicaid pays for your care. If you are planning on applying to Medical Assistance
later, you may want to find out now if your are "medically eligible" for nursing home payment
by Medicaid, :
.I
You are responsible fOT ap~lying for and obtaining Medicaid benefits and we will assist YOIl. We
Illay not charge, ask for, accept or receive any gift, money, donation or consideration other than
Medicaid reimbursement as a condition of your admission or continued stay here except that
Medicaid may require you to pay certain amollnts from your private funds,
If you receive Medicaid, most of your nursing home charges such as room, board, and general
nursing care are covered, For a list of services covered by Medicaid, see Exhibit 4,A. The local
Board of Assistance will tell YOll whether you have to pay part of the charge for your care and, if
so, how much, Some of the items and services that we offer are not covered by Medicaid. If you
want any items or selvices, which are 1I0t covered by Medicaid, YOll or. your representative will
have to pay for them. .A list of the items and services not covered by Medicaid and the charges
for them are in Exhibit 4.B. Payment for items and services that are not covered by Medicaid is
due after you have requested them, and; have received and have been billed for them, Within 30
days of receiving the item or service, you have the right to ask us for an itemized statement that
briefly but clearly describes each item and the amount charged for it.
Increases in Charl!e.~ and Fees
Any time we increase a fee or charge for item or service or add a new item or service, we will
provide you and your representative with 30 days advance written notice,
Penalties
We may not charge you interest if you pay your bill in time. Your payment is on time if it is
made within 45 days of the date the bill is post marked, or 30 days after the end of the billing
period. whichever is later The penalty we charge is 5% of the amount due, calculated on a per
day basis.
FRGM :Skippensburg Health Care Ctr
FRX NO, :7175308304
Jan. 10 2005 03:54PM Pll
,
(f you or your representative do not pay the money you owe us and we hirc a collection agcney
or attorney, you agree to he liable lilr their fees and COUlt costs.
Priv:lte Duty Nurses Geriatric Aides
If you want a private duty nurse or a private dllty geriatric aide, you lire responsible for selecting
a person licensed and! or certified according to PClUlsylvania laws and regulations, You are also
responsible for paying him or her and for letting us know that YOll have hired one. The person
you hire is not an employee or agent of the facility, but he or she must meet our standards and
follow our policies and prOCedl\res. Employees of the Facility may not serve as private duty
nllrses or private duty geriatric aides.
Holditll! Your Bed if You l..cave the Facilitv
If you are hospitalized or on leave fi'om thc Facility, we will hold your bed for you as follows:
A. If you arc privatc-pay resident, or are receiving inpatient care reimbursed under Medicare
Program (and you are,not covered under Medicaid), unless you notifY us othelwise, we
will hold your bed for as long as you pay for it at the daily rate you are currently being
charged, '
.
I
B. If Medicaid pays .for part or all of your nursing home care and you need to he
hospitali:r.ed, we will hold your bed for up to the maximum number of days required by
this state, currently 15 days, If you leave for any other reason, we will hold your bed for
up to the maximum number of days required by this state, cllrrently 18 days. You have a
right to be readmitted to the facility to the first available appropriate bed, While we are
holding your bed, you are still required to pay the Facility any amount for whieh you are
liable as determined by the Medicaid Program.
C, If you have applied for Medicaid, your bed will be reserved in accordance with Paragraph
B . However, if you are found to be ineligible for Medicaid, then. you arc required to pay
for the bed as a private pay resident as described in Paragraph A.
D, Other third-party payers mayor may not have a bed hold policy, We will discuss this ifit
applies to you.
YOUI" Ril!ht to Make Comrlaints and SUl!l!est Challl!:es in Policies and Services
As a nursing home resident, you have many rights according to State and Federal law, These are
described in detail in Exhibit 6, which is attached and is part of this Contract.
You may make complaints about your care irl the Facility and you may also suggest changes in
the policies and services of the Facility. You wiJl not be harassed or discriminated against for
making a complaint or suggesting a change in a policy or service, You may present your
complaints to facility, management company or to onc of the following State agencies:
.FR~M :5kippensburg Healtk Care Ctr
FAX NO, :7175308304
Jan. 10 2005 03:55PM P12
Larry D. Cottle, LNHA
Administrator ,
Shippensburg Health Care Center
121 Walnut Bottom Road
Shippensburg, P A 17257
717-530-8300
Peter E, Perini, Sr,
President
Magnolia Management, Inc,
1710 Underpass Way
Hagerstown, MD 21740
301-745-8700
Ombudsman
Office of Aging
16 West 81gb Street
Carlisle, P A 17013
717-240-6110
717-532-7286 Ext. 6110
Department of Health
100 North Cameron Street
2nd Floor
Harrisburg, PA 17101
717-783-3790
"
Y 011I' Ril!ht to Make Decisions
You have the right to make yPur own medical decisions and to manage your personal affairs. If
you become disabled, it may/be necessary for someone else to make decisions for you. For tllis
reason, we l'econmlend that you have a Jiving will and/or advance directive for medical decisions
and a financial Power of Attorney but you are not required to do so, See Exhibit 7 for a
description ofyoUl' legal rights to decide about Yl)Ur future medical treatment.
"'-~
Tl'ansfer. Relocatiollllnd Dischlll'fl;C
You have the right to remain here, and you may not be transferred, relocated or discharged
against your will, except for the following reasons: (1) A medical reason (i.e, the facility cannot
provide the kind of care that you need, your condition has improved so that you no longer need
Ihe care we provide, or a medical emergency arises; (2) Vour we1!are or the welfare of other
residents or staff; (3) Nonpayment fot' a stay, or (4) the Facility ceases to operate,
If we decide that you should be transferred or discharged, we will noti(y you, and an immediate
family member or legal representative, by letter 30 days in advance, If YOll are transferred
because of an emergency situation, we will provide the required notice as soon as practicable,
The letter will contain the reasons for the transfer or discharge and its effective date. The letter
will also tell YOll how you can appeal our decision to transfer or discharge you,
If you lire discharged involuntarily, we will attempt to make other appropriate arrangements for
your care, However, if other arrangements are not available, your representative agrees to accept
you into his or her custody ifit is medically appropriate.
Your Riebt to End This Contract
If you decide to end this Contract and leave the Facility, you must pay your bill before yc.u leave,
You must give us five (5) days written notice to terminate this contract. If you leave before the
end of that time, you must still pay for each day of the required notice,
FROM :Skippensburg Healtk Care Ctr
FAX NO, :7175308304
Jan. 10 2005 03:55PM Pl3
In the event you die while a resident of the facility, your representative is responsible for making
th(J funeral arrangements, We will notify your representative immediately. If we are unable to
reach your representative, we will contact the funeral home of your choice to facilitate
arratlgement~.
Additional Documents
It is not possible to cover everything that is important to your stay in our Facility in the body of
this Contract. Therefore, we have included additional importatlt documents a.~ Exhibits, These
Exhibits are part of this Contract. Please verifY that you received the Exhibits and that the
contents of the Exhibits were explained to YOll by placing your initials on the line next to the
description of each Exhibit,
~... .__ Exhibit 1 Rights.and ~b,ligations ofRcpresentatives,
..~ Exhibit 2. For Pnvate-Pay Residents:
(a) Items and selvices covered by daily rate.
(b) Items and';$ervices not covered by daily rate,
-* Exhibit 3. How to ~PPlY For and Use Medicare and Medicaid Benefits,
~ Bxhibit 4. (a) Items and Services Covered by Medicaid.
-rJ"-'" (c) Items and Services Not Covered by Medicaid,
~EXhibjt 5,
__~ Exhibit 6,
_.,~Exhibit 7,
~xhibit 8.
Clw.ttees in .Law
Phy~icians Who Practice at the Facility,
Legal Rights ofPenllsylvania to Decide Future Medical Treatment.
Policies and Procedures Concerning Your Personal I:unds and Your
Per~onal Property,
Services Provided by Outside Health Care Providers,
Any provision of this Contract that is fOllnd to be invalid or unenforceable as a result of a change
in State or Pederal law will not invalidate the remaining provisions of this Contract, If there are
services we have agreed to provide that are later found to be impossible to render as a result of a
change in State or Federal law, it is agreed that to the extent possible, the Resident and the
Facility will continue to fulfill our respective obligations under this Contract consistent with the
law,
FROM :Shippensburg Health Care Ctr
FAX NO. :7175308304
Jan. 10 2005 03:55PM P14
IN ~SS WHE~O~hoe,rrties have executed this Contract on this {kt1f-:day of_
By:~
Lany D, Cottle, Administrator
Shippensburg Health Care Center
Witness
",jJ
,
,
.~o. ~~~~_
e Ident
.I
If th Resident has heen adjudicated disabled or the Resident's dootor determines that the
Resident is incapable of understanding or exercising hig or her rights and responsibilities, the
Facility may require the signature of another person on this contract. The other person may be:
(1) An appointed healthcare agent under an advance directive for medical care; (2) A guardian or
Power of Attorney of the pcrson; (3) A surrogate Dr family member
Witness
Responsible Party (Name)
Title; Indicate whether you are (I), (2) or (3)
FROM :Shippensburg Health Care Ctr FRX NO. :7175308304
Jan. 10 2005 03:52PM P4
STATEMENT
SHIPPENSBURG HEALTH CARE eTR
121 WALNUT BOnOM RD
SHIPPENSBURG, PA 17257
Facility Phone: 717.530,6300
Resident: JUDITH DEVOE
Statement Date: 11/30/04
JUDITH DEVOE
12696 CUMBERLAND HWY
ORRSTOWN, PA 17244
Date Service Through Qty Description Amount
Charaes
11/01/04 08/13104 OB/31/04 19 Co.lnsurance 2,080,50
09/30/04 09/01/04 09/30/04 30 Co-Insurance 3,265.00
10/15/04 10/01/04 10/15/04 15 Co-Insurance 1,642.50
Sub Total 7,008.00
Balance 7,008.00
~ash Receipts/Adiustments
07/23104 07/19/04 07/19/04 Payment -7.00
09/27/04 08109/04 OB/09/04 Payment -8.25
09/23/04 09123/04 09/23/04 Payment -40.00
Sub Total -55.25
Balance 8,952.75
Ancillarv/Other Charaes
11/01/04 07/12/04 07/26/04 2 Barber & Beauty 16.50
07/19/04 07/19/04 07/19/04 1 CABLE 7,00
08/09/04 06109/04 08/09/04 1 Barber & Beauty 8.25
11/01/04 09/13/04 09/27/04 2 Barber & Beauty 43,25
11/01/04 10/04/04 10/04/04 1 Barber & Beauty 6.25
Sub Total 83.25
Balance as of: 11/30/04 7,038.00
Total Amount DUll 7,036.00
EXHIBIT "B"
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
SHIPPENSBURG/
SOUTH HAMPTON MANOR, LP
: No: 2005-331 Civil Term
Plaintiff
: Civil Action - Law
vs.
JUDITH DEVOE
Defendant
ANSWER
1.
Admitted
2.
Admitted
3.
Denied Judith DeVoe does not reside at 12696 Cumberland Highway,
Orrstown, Pennsylvania.
4.
Admitted
5.
Admitted
6.
Admitted
7.
?
8.
Denied after reasonable investigation Defendant is without knowledge or
information sufficient to form a belief as the truth of the matter averred. Defendant
further assures that she had not been supplied with an itemized list of the services
provided and the amounts charged.
9.
Denied Defendant is without knowledge or information sufficient to form a
belief as to the truth of the matter averred. Defendant further answers that the
"statement" attached as Exhibit B has never been delivered to her.
10,
Denied, demand for the amount stated in the complaint has never been made
upon Defendant.
11.
Admitted
12.
The answers to paragraphs 1 through 11 are incorporated herein by reference
as fully as if set forth at length.
13.
Denied, the Plaintiff has not fulfilled the contract provisions which would allow
a claim for payment.
14.
Admitted to the extent that Plaintiff has fulfilled its contractual obligation to
Defendant.
15.
Denied, Defendant is covered by Medicare Part A & B number 182-32-4671
and by Federal Blue Cross-Blue Shield # R18992657-104 both of which should have
made payment for and on behalf of Judith A. DeVoe.
16.
Denied, the Plaintiff did not fulfill its contracted obligation with the Defendant
and further the Defendant has not refused payment.
17.
The answers to paragraph one through sixteen are incorporated herein by
reference as fully as if set forth herein at length.
18,
Admitted
19.
Denied, Defendant has not had demand made upon her for service and
believes and therefore avers that no demand was made for payment on Federal Blue
Cross, Blue Shield.
20.
Denied, Judith DeVoe stands ready to make payment for services rendered to
her when as if Plaintiff fulfills it contract.
Wherefore, Defendants prays judgment be entered in her favor.
Respectfully
~~~-
H. nt any Adams
Attorney for Defendant
49 West Orange Street
Shippensburg, Pa. 17257
Supreme Court 10 # 25502
VERIFICATION
I verify that the statements made in this answer are true and correct. I
understand that false statements herein are made subject to the penalties of 18
Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Date: \, ,\.:;j~tJ5
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J H DEVOE
Date:
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SHIPPENSBURGI
SOUTH HAMPTON MANOR, LP
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO, 2005-331 CIVIL TERM
JUDITH DEVOE,
Defendant
CIVIL ACTION-LAW
PETITION FOR APPOINTMENT OF ARBITRATORS
TO THE HONORABLE, JUDGES OF SAID COURT:
David A. Baric, Esquire, counsel for the Plaintiff in the above-captioned action,
respectfully represents that:
1. The above-captioned action is at issue,
2. The claim of the Plaintiff in the action is $7,036.00,
The following attorneys are interested in the case as counsel or are otherwise disqualified
to sit as arbitrators:
H. Anthony Adams, Esquire, 49 West Orange Street, Shippensburg, P A 17257
II
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WHEREFORE, your petitioner prays your Honorable Court to appoint three (3)
arbitrators to whom the case shall be submitted.
Respectfully submitted,
/
r ' OmRIEN, BARIC & SCHE~R
"
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David A. Baric, Esquire
I.D. # 44853
19 West South Street
Carlisle, PA 17013
(717) 249-6873
Attorney for Plaintiff
il.
..
CERTIFICATE OF SERVICE
I hereby certifY that on March 1,2005, I, David A. Baric, Esquire of O'Brien, Baric &
Scherer, did serve a copy of the Petition For Appointment Of Arbitrators, by first class U.S. mail,
postage prepaid, to the party listed below, as follows:
H. Anthony Adams, Esquire
49 West Orange Street
Sh'p",",'"'. """"1,,,,. 172d 4
David A, Baric, Esquire
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SHIPPENSBURGI
SOUTH HAMPTON MANOR, LP
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v,
NO, 2005-331 CIVIL TERM
JUDITH DEVOE,
Defendant
CIVIL ACTION-LAW
ORDER OF COURT
AND NOW, this ;I /fad day of /1 fa /J -c j) ,2005, in consideration ofthe
foregoing petition,>i#<.~ .A1LdelJ/ , Esq" r01~k ALY , Esq.
and (70. tu.a-fi..~ ~ n-v;-v , Esq, are appointed arbitrators in the above-captioned
action as prayed for,
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SHERIFF'S RETURN - OUT OF COUNTY
CASE NO: 2005-00331 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SHIPPENSBURG SOUTH HAMPTON MAN
VS
DEVORE JUDITH
R. Thomas Kline
, Sheriff or Deputy Sheriff who being
duly sworn according to law, says, that he made a diligent sea ch and
and inquiry for the within named DEFENDANT
, to wit:
DEVOE JUDITH
but was unable to locate Her
deputized the sheriff of FRANKLIN
in his bailiwick. He therefo e
County, Pennsylvan'a, to
serve the within COMPLAINT & NOTICE
On February 22nd, 2005 , this office was in receipt of he
attached return from FRANKLIN
Sheriff's Costs:
Docketing
Out of County
Surcharge
Dep Franklin Co
18.00
9.00
10.00
41.60
.00
78.60
02/22/2005
OBRIEN BARIC
Sworn and subscribed to before me
this q day of 7/f-tkL..
i.YgoJ- A.D.
~ut. - .~_. 1_-"'9 -- ~
II' ... /'~o-;hJ;:;tary/V
So answers:
.-.Y~
R. Thomas Kline
Sheriff of Cumberland Count
SCHERER
.
/' In The Court of Common Pleas of Cumberland County, Penns lvania
Shippensburg South Hampton Manor LP
VS.
Judith Devoe
No.
05-331 civil
Now,
January 19. 2005
, I, SHERIFF OF CUMBERLAND COUNTY P A, do
hereby deputize the Sheriff of
County to execute this rit, this
Franklin
deputation being made at the request andrisk of the Plaintiff.
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Sheriff of Cum her land County, P
Affidavit of Service
Now,
JAAJujO,(L'f 7..7
,20<9S"' ,at z: sa o'clock P. M. s rved the
within
C o IM-\? L!4-, u ~
upon
J (..( ~u TN b~\JofE
at
1 '-Hz... ,4tJTH,,~~'f f.k 6o.+w....y
(J (). a"{ s- s-
If W.~7
t<.,,vCy PA
by handing to
J0/)lll-l vli-vOE.
a
,. rZ-ua: A'" I> A rrb!T~0
copy ofthe original
COM'f'Li4 NI
and made known to
~R.
the contents th reof.
So answers,
~(j..l(,l.(, of p"".
~of~,.
ounty, PA
'sheriff of
Sworn and subscribed before
me this nTl'day of ff"R~tV2.'( , 20 I ~
fL4~~~
I
COSTS
SERVICE
MILEAGE
AFFIDA VIT
$
~.HJ
(/: {eo
if, 0-0
Notarial:>eat
Richard D. McCa;ty. Notary Public
Chambersburg Born. Franklin County
My Commission E'(pire" ':tn. 'N, 2007
$
<.jf.(Po
1
.
SHIPPENSBURG/
SOUTH HAMPTON MANOR, LP
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
v,
NO. 2005-331 CIVIL TERM
JUDITH DEVOE,
Defendant
CIVIL ACTION-LAW
PRAECIPE TO DISCONTINUE
TO THE PROTHONOTARY:
Please mark the above-captioned action as having been settled and discontinued without
prejudice,
Respectfully submitted,
~il1,
I
II
I,
I
I
I
I
I
i
David A. Baric, Esquire
I.D. 44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
dab.dirlshcc/devoe/discontinue. pra
II.
-...
CERTIFICATE OF SERVICE
I hereby certifY that on April 12, 2005, I, David A. Baric, Esquire of O'Brien, Baric &
Scherer, did serve a copy of the Praecipe To Discontinue, by first class U.S, mail, postage prepaid,
to the party listed below, as follows:
H, Anthony Adams, Esquire
49 West Orange Street, Suite 3
sru~~~.Z?:; !? tl
David A. Baric, Esquire
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SH IPPENSBU RG/ SOUTH
HAMPTON MANOR, LP.
V.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
05-331 CIVIL TERM
JUDITH DEVOE
IN RE: ARBITRATION
ORDER OF COURT
AND NOW, April 26, 2005, the Court having been informed that the
above-captioned case has been settled prior to hearing, the panel of
arbitrators previously appointed is vacated, and Samuel L. Andes, Esquire,
Chairman of the Arbitration Panel, shall be paid the sum of $50.00.
By the Court,
Samuel L. Andes, Esquire
525 North Twelfth Street
PO Box 168
Lemoyne, PA 17043
~
/}'VI...IA,jd.... 't..:n. () <
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Court Administrator
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