HomeMy WebLinkAbout11-26-13 �� __ _
� 150561014�
REV-1500 �` �°,_,°,
PA Department of Revenue ��-USE ON�Y
Bureau of Individual Taxes Couniy Code Year File Number
�o�oX 2so6o� INHERITANCE TAX RETURN 2 1 1 1 0 1 3 6
t�arriseur�,PA 17128-0601 RESlDENT DECEDENT
ENTER DECEDENT INFORMATION BEL01M
Sociai Security Number Date of Death MMDDYYYY Date of Birth MMDDWYY
1 1 1 8 2 0 1 0 0 7 2 2 1 9 6 8
DeoedenYs Last Name Suffix Deoedent's First Name MI
WE V 0 D A U D A V I D A
(If Applicable)Enter Sunriving Spouse's Information 8elow
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Retum � 2.Supplementai Retum � 3.Remainder Retum(date of death
prior to 12-13-82)
� 4.Umited Estate � 4a.Future Interest Compromise(date of � 5.Federal Estate Tax Retum Required
death after 12-12-82)
� 6.DeoedeM Died Testate ❑ 7.Deoedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of�II) (Attach Copy of Trust)
� 9.Utigation Prooeeds Received � 10.Spousal Prnrerty Credit(date of death � 11.Eledion to tax under Sec.9113(A)
betw�een 12-31-91 and 1-1-95) (Attach Sch.Q�
CORRESPONDENT-THIS SECTION MUST BE CO�LETED.ALL CORRESPONDENCE AND CONFIDENTUIL T FORMATION�UL�E TED T0:
Name Dayl�'�q�,'�l�lephone t„�i_rnbe�j, �
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R 0 G E R B • I R W I N , E S Q U I R E 7 �n'i � c-� �1 � � 5 3
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First line of address � � � � '� �
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I R W I N & M c K N I G H T , P - � • ` —�
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Second line of addness � � �
6 0 W E S T P 0 M F R E T S T R E E T
City or Post Oifice State ZIP Code DATE FlLED
C A R L I S L E P A 17 D 1 3
comespondsnt's e-n,al�address: ---
Under penaiEies of perjury,I dec�ar�e that i have examined this rotum,induding aa�ompanying sc��edules and sts�emenffi,and to the best ot my knowledge and belief,
it is true,cortdct and c�mpletie.Dedaratlon of pr�epar�er ott�than the persohal nepresernativve is based on all intortnation of which pr�eparer has any knowled�e.
SIGNA OF PE N�ESPONSI E FOR FILIN RETURN DATE
��
ADDR
55 AGARO ROAD ENOLA PA 17025
SIGNA O PREPARER THER T REPRESENTATNE t �
1 �/ La /3
A RESS '
;
60 WEST P MFRET STREET CARLISLE ' PA 17013
PLEASE USE ORIGINAL FORM ONLY
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Oh20'C9S0S2 r
Ev-�s�o Ex+(o�-o�)
pennsylvania SCHEDULE G
DEPARTN�NT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITMICE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
- _ - - - —
___ ---:
STATE OF ___ __ __ . _ -- FILE NUMBER
�AVID A.WEVODAU 21 11 0136
This schedule must be c�omple�and filed if the answer fio any of questions 1 th�ugh 4 on page three of the REV-1500 is yes. �
_ --- -—. _____ __ __
DESCRIPTION OF PROPERTY
ITEM INq.UDE THE NMiE OF THE TRA�ff,TFBR RBATIONSHIP TO DEC�ENT AND DATE OF DEATH 96 OF DECD'S EXCLUSION TAXABLE
�NIBER TFE DATE OF TRANSF�.AITACH A COP1(OF TFE D�FOR REAL ESTATE. VALUE OF ASSET INTEREST pF�uc�e�q VALUE
-- - -- _ _
i. WRONGFUL DEATH ACTION 50,000.00 100.00 50,000.00 0.00
PETITION AND FINAL DECREE ATTACHED
NON-TAXABLE
--_ -- -
__ _ -
TOTAL Also enter on Une 7,Recapitulation � 0.00
if more space is needed,use�diianal sheet�of paper of the same size.
:EV 1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATNE COSTS
RESIDENT DECEDENT
=-- __ __ _- ---
STATE OF -.. — FILE NUMBER
-�AVID A.WEVODAU 21 11 0136
DecedenCs debts must be reporbed on Schadule I.
__ -- __
ITEM
NUMBER DESCRIPTION AMOUNT
-- __ __ _ -- -
;. FUNERAL EXPENSES:
1. RICHARDSON FUNERAL HOME, INC. 1,535.00
. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Rep�sentative(s)
Street Add�ss
��y State ZIP
� . Year(s)Commission Paid:
2, Attomey Fees: IRWIN&McKNiGHT, P.C. 1�,500.00
3. Family Exemption:(If dec�denYs address is notthe same as daimanYs,aitach explanation.)
Claimant
ShBet At��ss --
��y State ZIP
Relafionship of Claimant to Decedent
4. probate Fee.s: REGISTER OF WILLS 53.50
5 A000untant Fees:
6. Tax Retum Prepa�er Fees:
7. REGISTER OF WILLS-FILING FEE 30.00
8. CUMBERLAND LAW JOURNAL-ESTATE NOTICE 75.00
9. THE SENTINEL-ESTATE NOTICE 187•�
10. NOTARY FEES 5.00
11. JOHN CHRONISTER-INVESTIGATION 350.00
TOTAL(Also enter on Line 9,Rec�itulation) S 14 736.04
- -- --- -- -- - -_
If more space is needed,use additional sheets of paper of the same size.
-V-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
____-
- — -
_ _
STATE OF: - . FILE NUMBER:
�AVID A.WEVODAU 21 11 0136
-- _ --
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
!UMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do No#List Truatee(s) OF ESTATE
----
I. TAXABLE DISTRIBUTIONS pndude�g ht I distributions and transfe�s under
Sec.91'T6(a (1.2).]
1. DEREK PHILIP WEVODAU Lineal 17,631.98
1/2 REMAINDER
2. KAYLA CELESTE WEVODAU Lineal 17,631.98
1/2 REMAINDER
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II, NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
_.__ .
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. �
___ -- _
If more space is needed,use additional sheets of paper of the same size.
� �
b
IN RE: ESTATE OF DAVID A. : IN THE COURT OF COMMON PLEAS OF
WEVODAU, Deceased : CUMBERLAND COUNTY,PENNSYLVArTIA
� : ORFHAN'S COURT DIVISION
:
: No. 21 -11—0136
FINAL DECREE
. AND NOW, this �day of , 2013, upon consideration of the
attached Petition for Court Approval of Compromise of Wrongful Death Action Involving
Minors as Interested Parties, settlement between and among the Esta.te of David Wevodau wlth
Encompass Insurance for $50,000.00 is approved. Based upon the Petitioner's belief that the
death was instantaneous and the facts involving the death as outlined in the attached Petition,the
settlement is attributable to the Decedent's wrongful death.
From the settlement insurance proceeds, attomey fees of 25%, or $12,500.00, are
awarded to Irwin & McKnight, P.C. The balance of the insurance proceeds, $37,500.00 are
awarded to Jack C. Wevodau, Administrator of the Estate of David A. Wevodau for the payment
of any Pennsylvania inheritance taxes, and the costs of the administration of the Esta.te, including
but not limited to advertising, filing fees, funeral expenses, and administration fees, with the
resulting net funds to be administered and held by Jack C. Wevodau in savings accounts or
certificates of deposit at a. federally insured banking institution for the sole benefit of the
Deced.ent's two minor children, Derek Philip Wevodau and Kayla Celeste Wevodau, and no
withdrawals therefrom shall be made until the minors reach majority without Order of Court
1,� � .c-
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� ��= `�' �= A TRUE COPY FROM RECORD
:-; `_`.a, �~� � In Testimony whsrof�1 tia J.
�•: ;,; � �? ='_ �..� set my hand And th�s soe{ �
�:. . �:-;:-: �,� m ��c�.�c��,pxr omas A. Placey .
:..r ....' \.. J � �p �
�a �-,1�. �� ° � ��,,, mon Pleas �udge�
-- ,
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a�«d�n. �
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IN RE: ESTATE OF DAVID A. : IN THE COURT OF CO Q�T PLE�O� r�
WEVODAU, Deceased : CUMBERLAND COiTNT �NSY�,VA►N��
• ORPHAN'S COURT��TOI���� � '���'
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: No. 21-11—0136 �., � =�� ��, ��::�. ��-�
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PETITION FOR COURT APPROVAL OF COMPRONIISE �? ` `-`�
OF WRONGFUL DEATH ACTION
IlWOLVING MINORS AS INTERESTED PARTIES
TO THE HONORABLE, TI�JUDGES OF THE SAID COURT:
This Petition is filed under Section 3323 of the Probate,Estates and Fiduciaries Code, 20
Pa.C.S. § 3323, and Ru1e 2206 of the Pa. Rules of Civil Procedure by Jack C. Wevoda.u,
Administrator of the Estate of David A. Wevodau, deceased, by and through his attorneys, Irwin
&McKnight, P.C.
1. David A. Wevodau died on November 18, 2010, as a result of an automobile
accident wherein David A. Wevodau (the "Decedent") was a passenger in a vehicle driven by
Jodi L. Shina.ult. A true and correct copy of the Death Certificate for David A. Wevodau is
attached hereto as Exhibit"A."
2. Decedent died intesta.te, a resident of Cumberland County, Pennsylvania. He was
divorced and is survived by two minor children, Derek Philip Wevodau and Kayla Celeste
Wevoda.u.
3. Decedent's father, Jack C. Wevodau, has qualified as Administrator of his estate
and a true and correct copy of his appointment and Grant of Letters of Administration is attached
hereto and incorpora.ted herein as Exhibit"B."
4. The motor vehicle accident occurred late in the evening on November 18, 2010,
in the Borough of Marysville, Peny County, when the vehicle driven by Jodi L. Shinault
attempted to negotiate a left turn onto Park Avenue, and instead left the roadway and struck the
Specialty Bakers building at the intersection of U.S. Routes 11/15 and Park Avenue. A true and
correct copy of the Pennsylvania State Police crash report is attached hereto and incorporated
herein as Exhibit"C."
5. According to Exhibit "C," the Decedent was not wearing a seatbelt, multiple
airbags in the vehicle were deployed, and both the Decedent and the driver of the vehicle were
pronounced dead at the scene.
6. Also according to Exhibit "C," the Perry County Coroner determined the deaths
of both Decedent and the drive to be from multiple traumatic injuries,blunt force impact, and the
vehicle into a structure.
7. Based upon the investigation by the Pennsylvania Sta.te Police and the resulting
crash report,it is believed and therefore averred that the Decedent's death was instantaneous.
8. The insurance cazrier for the driver of the automobile, Jodi L. Shinault, is
Encompass Insurance,vvhich offered the maximum policy limit of$50,000.00.
9. Upon information and belief after making reasonable inquiries and conducting an
investigation,the Decedent did not have any vehicle or personal insurance coverage.
10. Decedent did not possess a driver's license or own a vehicle and had no
automobile insurance. A true and correct copy of the Affidavit of No Insurance signed by the
Petitioner is attached hereto and incorporated herein as Exhibit"D."
2
11. Upon further information and belief after making reasonable inquiries and hiring
a private investigator, there is no other insurance coverage applicable to the motor vehicle
accident in which Decedent was involved.
12. Petitioner therefore executed a Release of All Claims with Encompass Insurance .
for the policy limits of $50,000.00. A true and correct copy of the fiilly signed Release is
attached hereto and incorpora.ted herein as Exhibit"E."
13. Petitioner has been informed and therefore believes that Jodi L. Shinault has no
. assets.
14. Petitioner believes that the amount offered by the insurance carrier is fair and
reasonable as it represents the maximum amount for which the company is liable.
15. The entire settlement amount is distributable to the Administrator of the Estate of
David A. Wevodau.
16. Whether awarded under a survival action or a wrongful death action in this
matter, the entire insurance proceeds of $50,000.00 has been paid to the Estate of David A.
Wevodau, and the net proceeds thereof, after fees and expenses, are to be distributed for the
benefit of the Decedent's two minor children, Derek Philip Wevodau and Kayla Celeste
Wevodau. �
17. Based upon the Petitioner's belief that death was instantaneous, Petitioner
suggests and therefore avers that no portion of the limited insurance funds be atlributa.ble to a
survival action, but that instead the insurance funds be attributed to the Decedent's wrongful
death.
3 �
18. The investigation of the accident and negotiations with the insurance company
were undertaken on behalf of Petitioner and the Estate of David A. Wevodau by the law firm of
Irwin&McKnight,P.C.
19. In addition, the law firm of Irwin & McKnight, P.C. is handling the
administration of the Estate of David A. Wevoda.u, and all associated forms and filings in that
matter.
20. Pennsylvania inheritance tax will not be due on the net insurance proceeds, on the
basis that Decedent died instantaneously and did not survive from the impact of the motor
vehicle into a building.
21.� The minor children's net cash settlements are to be deposited in their individual
names of Derek Philip Wevodau and Kayla Celeste Wevodau, with David A. Wevodau as
guardian/custod.ian, in savings accounts or certificates of deposit at a federally insured banking
institution and no withdrawal therefrom sha11 be made until the minors reach maj ority without
prior Order of Court.
WHEREFORE, Petitioner requests that the Court approve settlement with the insurance
carrier, Encompass Insurance, as above-described, approve the attomey's fees for the personal
injury and estate administration in the amount of twenty-five percent (25%) of the insurance
proceeds, and award the balance of Thirty-Seven Thousand Five Hundred and no/100 Dollars
($37,500.00) to Jack Wevodau, Administrator for the Esta.te of David A. Wevodau for the
payment of any Pennsylvania inheritance taxes and costs of administration of the Estate and
completion of the administration of the said Estate, with the resulting net funds to be
administered and held by the Petitioner in savings accounts or certificates of deposit at a
4
federally insured banking institution for the sole benefit of the Decedent's two minor children,
Derek Philip Wevoda.0 and Kayla Celeste Wevodau.
Respectfully Submitted,
IRWIN&McI�TIGHT,P.C.
�
Douglas G ' er,Esquire
Supreme C urt I.D.No. 83776
West Pomfiret Professional Building �
60 West Pomfret Street
Carlisle,PA 17013-3222
(717)249-2353
Date: August 22, 2013 Attorney for Petitioner
5
VERIFICATION
The foregoing document is ba.sed upon information which has been gathered by my
counsel and myself in the preparation of this action. I have read the statements made in tlus
document and they are true and correct to the best of my knowledge, information and belief. I
understand that false statements herein made are subject to the penalties of 18 Pa.C.S.A. Section
4904,relating to unswom falsification to authorities.
� �, �
���i�C
JAC VODAU,Administrator of the Estate
of D WEVODAU
Date: �8�t 22� 2013
EXHIBIT "A"
�
EXHIBIT "B"
- -- , -� . . ' � �+
. .
REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVAIVIA ADMINISTRATION
No. 2011- 00136 PA No. 21- 11- 0136
� Es ta te Of: DA VlD A WEVODAU
. /Rrs�Mkk6�et.Lastl
La te Of: EAST PENNSBORO TOWNSHIP
CUMBERLAND COUNTY
Deceased
Soci al Securi ty .No:
WH�REAS, DA V/D A WEVODA U
���
late of EAST PENNSBORO TOWNSHIP CUMBERLAND COUNTY
di ed on the I 8 th day of November 2 O10 and,
WHEREAS, the gran t of Le t ters of Admini s tra ti on
i s required for the admini s tra ti on of the es ta te.
THEREFORE, I, GLENDA FARNER STRASBAUGH , Regi s ter of Wi 11 s in and
for CIII�ERLAND County, in the Commonweal th of Pennsylvania, have
this day granted Letters of Administration to:
JACK C WEVODAU
who has duly qualified as ADMINISTRATOR(RIX) of the estate
of the above named decedent and has agreed to administer the estate
according to law, all of which fully appears of record in my office at
CUMBERLAND COUNTY COURT HOUSE, CARL/SLE, PENNSYL VANIA.
IN TSSTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the �nd day of Feb�uary 2011.
e.o s
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epu
**NOTE** ALL NAMES A.BOVE APPEAR (FIRST, MIDDLE, LAST)
EXHIBIT "C"
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Commonw�ealth of Pennsylvania P�� �
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PA BTATE POLICE-NEYYPORT YE8 41 11l`18/Z010
Dap�ch 7'hne � Tine � B�dpe Number
23:�0 � Z3:60� 81�VE,TODD A 110�6
D�le Ravie� . Revie�Bad�e Number
01/�011 . LLO�YD.EDWARD R JR 06367 •
os�s ac�, orcxs�n oay an,e w� c�oesa�on
��nerm�o zs:ZO �. . THUR8DAY s�sv�(sr►�o�cr�o��
counq►
PERRY MAR1fSVILLE BORO
� VMeei�CondfUor�s R�Iton 1�F�o�dwsy
Ho Acv�coNOmoHS oN n�►va.uNEs
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OOZ 004 000 002 MARY8VILI.E NONE
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NO NO YES "T"INTERSECTION NOT APPLIC/1BLE .
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1Jsed M LOCAL ROAD�t STREET T000 02 36�H EA8T
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p �� 40 � ; 18 ■ 002 �� • 76 56 ; ST � 364
� rsAlc CoMrol Dsvb� Co�r�d FunctioMnp
NOT APPLICABLE NO CONTROLS
� Lans Cloesd Lane Ciosu�e Oire�on Ttal�c Dstiourad E�ebd Time Cbsad
PARTIALLY SOUTH YES 3-6 HRS
Em►irorWr�tsl/R�dNray Po�sntlN Fictors(EIR) .
Fac�or.E Fac�or 2 . Fac�ot 3
MvN
F�st H�unM�Evs�t tn tl�e Crash Most Hannful Evsr�t in the Crssh
u001�� I�'T UNR Z Uni�Number HR EBtJIL�DING
001
Indicaled P�ime Fsclor Un�N� Prime Fac�or D�iver Aalion
DRIVER ACTION 001 FAN.URE TO MAqrTA�l PROPER SPEED
� Prime Facto�EnvinomentallRoadway Pfine Fac�V�hide Fa�xe P�kne Fac�Pedeatrian Ac�a►
Buc�'� �sPJ c-�c�u�sac�
� P�inbd A�PA�e Polke-Newport 011Z51Z01108:38/IM Psg�1 Fom��:HOa-18e6s07
�'�0°"` Commonw�ealth of Pennsyivania �P"� Z
Incidsnt Numbsr: H06-1� i .
crasr�imron�.s: Police Crash Report r�r�c�+ .
O� O F.a�qr O��a�� O co�«ar v.� O s�Pono.v.n�. p �•��•v.n�
O WA O wo�z� O AN O s�wn�o�. O Co�onwa�Vehia. O t.�•�c�►V.nta.
Unit Number tMit Co�nnsrdal Vehide
001 Mobor VN�ide in Tr�ar�port ' No
Fi�st N�me MI L.aat Name Sullbt OOB e�phone Nurnber
JODI L BHMIAULT ���0
Strsst A�dd�s � Sta�e Zip Ccds
�WA�$T�� PA 1TOZ6
t3ender lioeme N� lioe�e St�e Class Owne�/D�iwr
pEMALE Z31�4843 PA C OeH7/Z013 PRNATE VEHIaE ONMEDJLEA3ED BY DRNER '
D�Proesnoe Physical Con�ton P�rw�►Vbhide Cade Viol�tlon . ��0"��°d .
DRNER OPERATED VEHICI.E APPARENTLY NORMAL 3J61 ' �
� T�� Test Results
UNKNO�NN TEST NOT GIVEN .
�� FA�.URE TO MAWTA�1 PROPER 8PEED
Pads�ian A�tion Pede�rian Sip�s. Pedsarian Ciolhins P�rian locatbn
1 st FIartMW Evsnt LeR or Ri�t Side Most Hennful U�il�l Pate Number �
�uN�r z No
2nd FIa�mNl EvsM LeR or Ri�t Side Most Ham�ul Ut�ty Pole Nwnber
HR Bu�� � �
3�d Ham�ful Event LaR or Rf�ht Side Most H� tl�lY Pols Number
41h HarmNl Event LeR or Rtght S'ide Most Hartnfld Ut�iq►Pde Number
Ownsr Ftrot Name Ownsr MI Owne�L�t Neurie or 8t�s Name
.IODI L BHINAULT �
Sh�et Add�s C�► S�s �P�
ZO'1 WAYNE 8TREET ENOLA PA 170?,6
GovemmeM EquipmeM Ntanber
�� � NOT APPLICABLE
Modsl Yeer Nlake Model ehide Cobr N
�� c� �ro� a cou�Y v� � �
fo�se Phbe Rep.Stsbe Est.Spesd To�w�ed awed By
HDN88� PA 999 YES PI"��L�S
na�no° �a,rano°ca'y�" �a E�ation os�e
� �� 03M3/Z011
of Ttav�sl Po�tion V�et�icie Mo�nent Mitled imp�ct Point
�atTM �r uNE Ncu�N ooa�s�►� 11 O'CLOCK
p��p� {tosd ABpnm�t P�o�ibie Vehide F�lu�s
o�►eu�c3 �va. sn�►�3�rr uNKaoMM
i �cf tJn�s 'Type UMt 1 ag Number Tag Ye�r Ta9�
�� '0
� Unit Nlake � Unit Owner
� T State
�' �2 T�Number T�Y�r ao
�
~ Unit Make ��
��� � ����. �� D�iver Educ�tion?
� priv�e�t�et Type Helmet S�ay�ed On? DOT/SneN Designa�ion� Eye ProMc�ion� Long Sle�? L.o�9 Pan�? r Mlde Boots?
Helmet'fype Hetmet Stayed On? OOT/SneN Deaigna�on? Eye P�dion� long Sleeves? Long Pants? Over Anlde Boo�a?
P� Helmet?
Head t.ights? R�r Reflectas9
P�inEad/►t:PA Stabe PoNce-NewPort 011Z5IZ01108:38 AIA Page 2 Fom��:H05-1886807
`"�0°T" Commonw�alth of Pennsylvania F 1'�
IncitNnt Number: H06-1� � .
c�i��: Police Crash Report �T��"
O� O F�ey O��a�+ O co�aa v.nka O ��oa�.vaa�a Q ��Pak �
O w� O wo�zono O�TV O snowmodw O commom�th ven�c�e O �oca�oov v.�e �..__`.
un�Numbsr uNC . commen�l venide
OOZ Mobor V�in Transport �'1O
F�at Name MI L.a�t N�ne S�dPoc DOB e1ep�� .
8EAN MA MCCALEB 10A6/1987 C11��T1
3trest Add� ' � � ��
�uNC�►s�Ave. PA ��ozs
ci�d� uo�ae� uoen�e s�s c� o�
MALE 27969401 PA C 10�1l011 PRNATE VEf11CLE NOT OWNEDA.EASED BY DRNER
DrNsr P�nae Phy�toM Conditlon Prtrtah►lhtdc�e Cade Viol�iion P��
DRNER OPERATED.VEHICLE APPARENTLY NORMAL I�IE �
� Teat Type Test ResWls
NQ TEST NOT GNEI�I
Oriver Acfion NO CONTRIBUTII�K3 ACTiON
Ped�rian Aclion Pedestrian S�nals Pade�ian C.loih�p P�n Lacetion
1st Hsnnh�l Evet� � Ldt or Ri�bide AAost HamMul Ud�►Pole Number
8TRUCK BY UNIT 1 �
2nd Ham�Event Left or RigM Side Most Flatmt�ul Ut�y Pde Numb�
3rd Hamntul Event LNt or Right S'ide Most Hamnful tJtNilY Pole Number
41h HartMul Event LeR or Ri�M 8ide Most FIart�W Ut�q►Po1e Nw�nber .
Own�Fi�st Wame Owner� Ownsr I.ast trarrie ar Bu�n�s Hiame .
SEAN � ��
Stros�t addrsaa � � ��
4!6 LANCA8TER AVE. ENOLA PA 170Z6
Vehk�e lype �� �
Govemment 6quipmsnt Nun�er
AUTOMOBILE NOT APPLICABLE
Modsl Y�t M�ke Model ehide Cdor N
1996 V�OI.K�BWAGD�1 � JETTA BLACK SWVTD81H7TM07583Z
PN�e Rsp.Sta�e Est.Speed TaMed Towad�y .
H�c� PA oso ao
ns�x�nae 1�anoe compar�r � Po�►I�axr�r E�au°"°�te
YE8 PROORE88NE 660T589�-0 04N 9�IZ010
of Trev�sl ProeNion 1�ef�ide�Ao� Inidal Impact Point
HORTH RK3HT LANE"CURB" �STRAK�HT S O'CLOCK
p�����p� Road qiignment Po�eible Vehide F�u� �
II�NOR LEVEL STRAK3HT NONE
�ot Un�s lype UNt 1 ag Number Tap Y� Ta��e
� 0
� � Unit Ma�ce Unit Owne�
� Unit 2 � a9 Nun� ag Year Tag State
�
~ Unit Mske � Unit Owner
Engbie S'ize Passenger? Sad�e Bag/Tnmk? ra�? Driver Educatbn�
x
� Driver Hehnst Type Helmet Stayed On� DOT/SneM 0�►tion? Eye Pro�ac�bn? �ong S'Iseves7 �9 Par�a? Oveir Mlc�Boat�s?
asseng�Heknet Type Helmet Stayad On� DOT/Snell Designa�? Eye Pro�dion? Long Sles�es4 Long Panta? Ove�Anids Boots?
� p� �� .
� Head Lights? R�r ReRec�ors?
�
Printed At:PA�e PoNce-Nawport 01/251�1108:38 AM Page 3 Form�:H05-188680T
�0°T" Commonw�ealth of Pennsylvania P"°E 4
Incident Numbsr: H06-1886lOT �
c�n.��: Police Crash Report �*��
Q oa Q F,e�r Q��a� O co�v.� . O ��.va�ia. Q �.i��va��.
O w� O w�o�z��. O��nr O s�owmoww O co�onwwua�v.nia. O �.o�•�ca�►v.n�.
Unit� Drivsr Ra�rk�bns Compli�noe Oriver Endo�t CompN�oe ���0�0°
01 UNKNONYN CO�L.IANCE �� UNKNOVYIr COMPUIINCE VAL�t:ICENSE FOR CLAS8
�P�ipal pnp�Ct P�oMt v�oidanoe� lJnd�Ride p�abr
��o�a.ocic u�aawN No uN��at ov��e
Teet ResuNs
I�T MI E�ER�iENCY USE NONE � NO TEST GIVE�1 .
Unit# Driwr�ora CompMnoe D�Ner�Cort� Dfi�Lben�e Con�pNenae
02 RESTRICTIONS CO�LJED WITH NONE REQUIRED VALID UCEN8E FOR CLA8S
�P�p�l Impsct I�t v�oid�noe Menauver Under Ride�
a act.ocic s�-�oR u�v�sTArEU No uao�oR ov�e
" E��y�e pnq T�t Type Drup Test� "
NOT MI�CY l�E .NOHE NO TEBT GIVEN �
Un�� Person No. Flrst Name L.�t Nsme StilPoc DOB
pp1 pp� �ppj L SHINAULT OeM6/'19`l0
Addre� Cih► � ��°
Z01 WAYHE 8TREET p�p�.A PA 170�
Phone Number E�AS Transport Psrson Type f3er� �Y��Y
� p�R PEMALE KM.LED
Ss�t PoWqon �h►��
DRIVER-A'LL VEHK�.ES NONE U8ED/NOT APPLICABLE
�Y�2 Exbi�i°"
�lLTI�LE AIR8AO8 DEPLOYED � EXTRICATED BY MECHANICAL MEANS
� E�tion Patli
I�T EJECTED . HOT EJECTE�IOT APPLICABLE �
Un�� Pereon No. First Nenr�e MI t.adt N�ne SuAbc DOB
OOZ 00� SEAN M MCCALEB 10/�06H987
� � Zip Code
4�6 LANCA8TER AVE. �„p PA 1 TOZB
Phone Niunber E1AS Ttansport Person 1'ype � ��Y�
(71�443-66T1 NO DRIVER MALE I�T INJURED
Se�t Poatlon �Y E4��
DRNER-ALL VEHICLES LAP AND SHOULDER BELT UBED
S�►6qu�t 2 � Extric°d°"
AIR BAG NOT DEPLOYED-SWITCH OH NOT EXTRIC�►TED
� Ejsc�lo�Patl�
NOT EJECTED NOT E.lEGTEDINOT APPLIC�►BLE
U�R* Prr�on No. FNst Nams l.aat Narrie 3utPoc DOB
002 003 JAME8 L EARLY 40J�1'1�8T
Add�s . � � �Y ��
Z76 8U8QUEHANNA AVE. ENQLA PA 170Z8
Phone Nwnbsr EMS Ttansport Person Type Gender ��Y�Y
(T17�73Z-72l1 NO PA8SENGER MALE :NOT INJURED
Seat Po�iMon ���
FRONT SEAT R�iH'T SIDE LAP AND SHOULDER BELT USED
���Z � . Extrk�ti°" �
AIR BAG NOT DEPLOYED-SWITCH ON NOT EXTRICATED
� qedbn Palh
NOT EJECTED NOT EJECTEDINOT APPLICABLE
Pri�ed/1t:PA 8t�e Police-Newport 01/Z51201108:38 AM Page 4 Fonn S:H05-1886807
��0°T" Commonw�ealth of Pennsylvania PAGE S
Indd�nt Number. H�-1986�0T �
c�n in�oM.s: _ Police Crash Report �T�c�as�+ .
O� O F�wqr O wt�a� O co�a.i vaw� O �Po�•v.n�a. Q ���•v.n�.
O w� O wo�zo�� O ATV O sno,�o�n. O c�nn v.h�a O �i oo�►v.�
Unit� Perwn No. Fkat Narie MI Last Narrie SuAbc DOB
oo� 004 a�v� A v�oae►u o7r�nsas
� c�yr s�e z�code
AZ6 TONYER ROiAD ENOLq PA 170Z5
Phone Nunbsr EAAS.Traneport Parson Type . � ��Y�
(T17f 73Z-?Z7! NO �PAB�SENGER MALE KH.LED
Ss�t Potltlon �q►��
FRONT 8EAT RIOHT SIDE IrONE USED/NOT APPLIGABLE
�Y�� � . � -
�J�TIPLE AIRBA�3S DEPLOYED EXTRICATED BY�IANICAL�ANS
� Eje�don Patl�
NOT EJECTED . NO?EJECTEQMOT APPLICABLE
� SuIPoc Phone�
.�lO�IN�� A �PIOT�RO�YY8KI (717��67-Z131
Str�st A�ddross CUy 5t�s Cods
450 80UTM 8TATE STREET MARY8VIU.E PA 1T063
P�b�
B�AKERY FAqUTY�DiAMAGE FROM CRASH
Pe�son�&a�s�Not�isd ��� �°� �
! PA DOT Cr1'1�582-Z'191 11M9rZ010 ��hrs.
- Re�san 1�ar NoWicstlon
= TRAFFIC t�NTROL
P�fnb4d At:PA State Police-Newport 01/2SfZ01108:38 AM P�ge S Form�:1�5-1886807
-�0°"` Commonw�ealth of Pennsylvania PAGE 6
IncidMt NumbK: H06-1�7 �
c�,��: Police Crash Raport ���+
Q� OO r.�r O�e aa� O com�aa w�a. O ��wn�a p ��•v�•
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Whtle in tha ares af Enola,on SR11/1S,The 1Z ociock portion of Unit 1 sduck the 6 oclock portion of Unit Z while
both uni�s wrrs northbound on SR 11/1S. Both Un�s co�rtinuad No�thbound fntio Marysville Boro,with Un�1 cio:ely
followin�Unit Z. Unit Z ne�iat,ed a lal�tum onfi�Paric Avenw. Whita doi�so,Unit 1 also at�smpfied to turn lef�
strikiny ths�rt roar of Unit Z at th�5 oclock posistion. Unit 2 cor�tinuad onto Psrk Avenus,and Unit 1 failed to
ne�o�iab tha tN�turn,�oir�straight o�'f the nosdway. Unit 1 then s�uck the building that houses Speaciafty
Bakers.Bo�h occupents af Unit 1 were pronounced dead at tl�e scene.
�w
Whtle in tha aroa of Enola,on SR11/15,the 1Z ociock portion of Unit 1 struck the 6 oclock portion o�f Unit Z while
bo�h un�s wrro northbound on SR 11/15. Both Unita continued I�orthbound Ir�to Marllsvi�le Boro,w�h Unit 1
closaly iolio�Unit Z. Unit Z negotiated a lef�t�rn onto Park Avenue. While doin�so,Unit�1 also at�smpbd�o
�rn Ie1�sb�Nd�tl»�ht�r of Unit Z. Unit 2 continued onto Park Avenue,and Unit 1 failed to n�e�fis th�le�
turn,9oi�9 straiylrt o�f the roadway. Unit 1 then struck the building that houses Speacialty Bakers.Both occupen�s
of Unit 1 were pronounced dead at the scene.
Upon anival l observed Unit 1 at flnai rest against Specialy Bakers facility. Unit 2 was psrked in the adjacent bank
parking I�with both occupan�s standing near .
P�inbed At:PA 8bte Polke•Newport 01/Z51�11�:38 AM Page 8 Fornn*:HO&1886807
'$0°"` Commonw�ealth of Pennsyivania PaaE '
Incident Nurnber. H05-18�80T ► .
c�i�: Police Crash Report� ���"
O� O F.e�r . O�ac�a� O co�w w�. O saa�.v.hia. p �Po�•v.n��
� �WA O W'oMc Z�on� O AN � 8no�wmobiN O Commonw�h VNdcN O �Oov VNdcN
it uninjurod. There were numerous rescua and ems uei�s on scene at�emPti�'�9�o at�e�d t°Unit 1. Unit 1�was in an
unstabl�location�partialiy r�estin9 syair�st tl�e baicery facNity and p�rtially tlrrough the r+oof o�a utility room
b�lon�in��th�bakery. Pl�sical damage fi�Unit 1 consi�bd of senrere firont��:$���Bak�rs f,�ciUty
d�m�a to Untt Z consisbd of dan�s to the rar bumpsr and right rear ta i� bhl P�
included darna�s�o ths.flay Pole,f�or�t Por�ch.walls at tl�faci�ty,roat�o a utlitty r+oom, trvac/exhaust equiprr�snt
and inbrior productlon�ns tquiprnan� At the in�srsectlon af SR 11M6 and Park drive thare w�ere pisces o�f broken
tail li�ht I�r�s trom Unit Z lying on the YYesbrn skle af SR 11MS. There was 40'9"of tlre yaw ma�la fron�Unit Z
stsrtin�in ths Southbound lane of SR 11/15 and continuing orrto Park Drive,con�istant of Unit Z making the lef�
onto Park Drive. .
An employBe of Speclalty Bakers recehied minor injuries from the impact intio the facility as he was working in the
room were Unit 1 struck. The employses infiom�ation is:
Albuth MOEUN of 2942 Chestnut Rd,Elizabetlttown,PA 17022,PH#717-lZ6-2571
Physical measurenients from the scene are as follows:
SR 11/15 er�tire width of rosdway SO' .
SR 11/'la Esst Bern� 4' � �
SR 11M5 North Bou�d Lane 1Z'
SR 11/1s�ddlo turning lane • 12'
3R 11M5 Southbound lane 11'4"
SR 11/1a Wist Barni 10'Z"
Park Avenua Width 38'6"
Park Avsnus Op�nin�width
against SR 11M6 curb to curb 79'11" �
Yaw mark from Unit#2 40'9" .
North edge of Park Drive to
Speciaity Bakers side�walk 48' .
Sidewalk b�fh�pole 70'
Fl�pole to o�Ce porch 16'6"
Offlce porch to 1st impsct with
building 35'
1st buNding impact to 2nd
building impact 54'
Operator Z was infisrvlewad 11118/10�2351 hrs.on sca�e and said he pulled out from Susquehanna Rd.�PCN
benk on�o SR 11M5 North when he noticad Unit 1 corne from b�ind hbn from what looked tio be a hish spsed.
Opera�or Z said hs wss approaching a red light at the Surroco in Enola and as he began to slaw dawn hs no�icsd
Unit 1 flyin�up on his rear er�i. Open�or 2 said ths light turnad 8rosri bsfore ha came�O a comPfabs s�P��he
st��ted Uo sp�sd up he was stnick in t�rear by Unit 1. O��a�Or a sa�d�r��s�ck he spsd up���aY
from Unit 1 bscause he thought the person was drunk snd did not want�o get sbn�ck again. As Opera�or Z sp�d up
to try tio�t away trom Unit 1 he no�iced Unit 1 kapt folloMriny him at a close pac.�oO�n�1���r 2
attemp#iny�o�s#away irom Unit 1 stili traveling Northbow�d he reached sPeeds
said as h0 cams intio Marysville Boro he stow�ed tio make a quick leit onto Park Drive in an attsmpt tio gat avi►a�l irom
Un1t 1. Opera�or Z said as he was making tha�he w�struck in the rear by Unft 1 and as he continusd onto Park
Drive he said he kn�ww Unit 1 had crashed in�o the Bakery• 4pe�or Z said ha�e�ca11ed tO��P��e crash.
PriMed At:PA State Police-Nwivport 011ZS/�01106:38 AM Page 7 Fomn�:i�5-1886807
�0°T" Commonvirealth of Pennsyivani8 PAOE 8
IncidNft Nurr�r: H05-1986Y07 �
c�n��: Police crash Report �T�c�+
O� 0 F�r O wr�a� O co�va�a. O ��o�•v.hia. p ���•v.n�.
O w� O vMo�z�. O�TV O s�w� O co�h v.n� O �.i c;o�►v.�aa.
ppe�Z was asked what provoked Unit 1 to chase you,Ope�or Z said he did nat knoMr what Unit 1's problem
was. Opsra�or Z said he did not recogni�e the vehkle that wss chasing him or the occupsnts.
P�ssen�ar Z was irrbarvie�red 11118M0�approx?358 hrs at the�ena of the cr�h and said he remembor's b�1�9
ne�r�ths 8unoco in Enola when tl�air vshicla wss struck fr+om behind 6y Unit 1.Pas�snper Z sakl theY sPsd up in an
at�mP��o�t awa�i from Unit 1 because thay tl�o�t the d�iver was dnink. Passenger Z said thay contlnusd.North
on SR 11/15 snd Unit 1 was folloMring vory close tio the�n as ti�l n�ached high sPeads• P�sssnysr 2 said h�ireind
made a quick turn or�to Park Dri�re�o try and lose Unit 1 and he rw�d Unit 1 th�n go thr+ou�h the paricing lat and
strike tha buNdin�. P�r Z said Opsra�or 1 th�n caNed to report the crash that just,happsnsd. VVhsn askad,
was there a reason iar Unit 1 to chase you or did you know ths ax.�pants oi Unit 1,he repiied no.
Ope�Z was ro-in�ervieMred on 11M9M0�approx Z3Z0 hrs via phone. Ope�2 was asked if he knew�e two
occupanb o�Unit 1 that were killed in the crash and rapliad that he did learn who tlte occupen�s were and that he
did not know them.
Passenger 2 was re-ir�tisrview�ed on 11/18/10�approx 2330 hra.via phone.Passenger 2 wa�asked if he knew tfie
two occupan�s at Unit�2 that w�eirs kilied in the cr�h. Passenger 2 said he dkl n�knorv either o�the two that were
killed and never have heard of them.
'Greiner Industries ofi Mount Joy,PA PH#717-653-8111 assisted on scene with the use of a 70 ton c�ne�remove
Unit 1 from tho building.
Perry County Coroner Mike Shalonis pronounced Driver(1�Shlnault and Passenger(1)Wevodau dead on scene�
11:13pm,11/18/10� .
Perry County Cononers office noti�ed me a toxicology analysis would be perfonr�ed on Shinauit, results wiil be
supplamsr�d to this report.
Perry County Coroner Mike Shalonis took into possesion the license of both deceased Persons involved.
On 11/18/10 at 1ZOS Hrs.Death notlflcation w�made for the dece�ed(Wevodau)to Jack Cook Wevodau
On 11/18/10 at 1008 Hrs.Desth notification was made for the decessed(Shinault)to Ashley Loper
11/Z0/10 Incider�t was added to the PSP Fatal Crash System
11/Z1M0 Perry Co.Coroner de�rmined the deaths of the two occupants from Unit 1 to be from:
A.Multiple Traum�tic Injuries
B.Blunt Fon:s Impa�t �
C.Vehicle into s structure �
ph�ographs from tl��scene w�ere taken by Tpr.Todd A.SHIYE.i viewed the images and they accura�y represent
the scerw.l burn�d the digital im�ges,without alteration,to a non-ravvritable CD.
Aerial phabopraphs o�the scene ww�enre takan by Tpr.l�ew FRAMPTON.Reference Supplemental crash
investigatlon e�mpl�d by Tpr.FRAMPTON fior details.
All phabos are rotained in the crash attachment file located at PSP Newport
PrinEed At:PA St�e Polke-Newport 01/25/Z01108:38 AM Page 8 Fonn�:H08-1886807
'�0°T" Commonw�lth�of Pennsylvania PA� g
;Incident Humbsr H06-19Q6807 +
' cr.:n�o�ss: Pollce crasn Report ��«�
O� O F�r O�ac,�a�, O co�v.� O ��va�ki. p ��.v.�
O w� O v�zo� O�TV � � s�o�w� O co�o�w�n v.h� O �c;o�►v.h�u.
Assisting offlcers on scene: Tpr.Michael BROWN,Cpl.Brian KNORR,Tpr.Stephen GRIFFITH and Tpr.Michael
TERESKA. �
1'he following has baan flled irrto the c�h attachment flle:
Fatal Crash S'ys�em repo�t
Cononsrs rsport 1br both Ope�1 and Passen�r 1
Copy of hlotivanl�ae .
Pho�os from t�ash FSU#H70-0335 �
Prfnbd At:PA�s�e Police-Newport 01f26fZ01108:38 AM Pag�9 Form*:H05-198680T
� '�`'S0°"T" Commonw�ealth of Pennsylvania � �
- . ,
��N��: �-�� Police Crash Report . .
Supplemental Narrative
���� • ��p� Baclpe Nwnber
� PA 8TATE POLICE-NEYYPORT SHNE.TODD A � 110Alj
Ir►v�ipWon.Dats Otiptrq�p Apsr�l �
1 t/ZS12010 PA STATE POLICE-NEVYPORT ��A•��
� Revb+�er Reviswe�Bsdge Num� �°
LLOYD,EDWARD R JR pg�T 1M1/Z091 .
Warrative
This inv�tigatlon vin�conducfied by Tpr.Barry Caihoun with the sssistance of Tpr.Steven Bradney.
On 11/?3I10 at approxi�na�ei�l OSSO via tielephone�71T-73Z-4848)1 interviewad Chass ZIM,dob 1?�O7/40,69yoa.He
relatsd that hs dpes ths Rumots b�r.Ho recali�d thst SHINAULT was st Rumors and was sittfr�g on a 8�sva
DILLEI�S�p.SHINAULT had 1 cMink and fiook�it ou�skle.Thsy brought her back in and thsn=he lef�becAUSe she
could n�gat senred.ZIM doas nat have a conta�t number ior Christine,DILLER,a'Gesna(bsr maid�.
On 11/Z3/10 at appr+o�dmatiehl 1015 hours I ar�ived at the Sunoco A Plus Mini Markst Mcated at 611 Enola Drive,
Enola PA 1T0��717-73Z-1SOOj.I apol�e with a reladva of the o�.Hs rela�ed that he did nat kno�w I�ow�
o p e r a fi e t h e s u n re i l i a n c s e q u i p n�e r�t a r K!t h a t h i s b r o t h e r A n g ad Sii n gh NAGRA(570-412-03Z1)w�uld be available
siter 1400 hours on 11/ZS/10.
On 111?.3/10 at approxMnatiely 10Z61�oura I an�ived at Bniners,607 North Er�ola Road,Enola PA 17025
(717-TSZ-2�18).1 Alan I.��wnence BRUNER,w/n-m,dob 1?JA0�6Z,47 yoa.Ha rola�ed that�couid bok at
��UN�Il�l1f���!dOeR fi0�k11aMl hO�W�O Op9f��.Up011 V�AMI�I'1��N iYN�11afIC0�Mfai t�rlll���th6
sys�sm clock vv�approximafialy 1Z-13 minutes slow.Du�in�ths obsarvation ai this digital vidso it vv�s Isarned
that unit Z p�d tl�subj�t arw�at approxiima�ely?�19:57.Unit 1 then p�ssd tl�e subject aroa at a�roxNna�ely
Z3Z0:.This tlrn�was approximafiely Z�saconds ap�rt.Thelr reb��na speed appe�red avan�e when oomp�rod to
other traific Pa��b�/.A�s tha uni�s pas�d by tl�e subject a�+�a going from south tio north It was apparent that
both uni�s ww�s apph►in�thsir brakas as bo�h unit's braka lamps w�re lit as theji approachad tl�e subja�t vide
as indicatiad i�ths��al in .There is a Z1 day n�ention period of this survaiilance ioo�e
systiem requins that tl�e 1�oo�age be transfierred to a thumb drive.This w�s not done due�o the Iack of a thumb
drive during this ir�fien�w. �
On 11/Z3/10 at spproxitna�ehl 1119 hours at Nathan's Cai�,Z01 North Enola Rd.,Enola PA 170?5 717-TZ8-TSZ6,I
intenriewed Gn�ory Niei APQ�1R,w/n-m,dob 111'03/SZ,58 yoa.He rels�ed that I�is the awner oparator of
Nathan's Cal�.Hs nla�sd that he was talking with his bar maid,Laslie LAMP(71T-385-2870�,snd shs h�ad rolated ,
Co him tluit 8l�HAt�.T was in Hathan�on 11/18r10 at approximately Z000-Z100 hours a�d la�(�t.at approxtmatehl
2200 hours.SH�IAULT ws�with Steve DILLER(71T-�WE5-0069)af Rumors.8he was alao with har boyf�isnd
WEVODAU.8HMIAULT at a�e point was sittlng on DILLER'S lap.SHINAULT and WEVODAU appsarod�o be
arguing that ni�ht APG�1R had haard that 8HINAULT and VYEVODAU were involved in an al�arcatlon so�ne�where
else but did not know wh�r+e.SHINAULT and her boyfriend came in together.They w�ere not a problem.Th�l had a
dMnk and wwrt tio Rumors.They all sat at the bar.There was no one ha�assing tt�m.His ber maid Lasiie will be at
wo�lc on 11/23M0 at approximately Z000 hours.it was nofied that none af the subjects involved in th�crash were
seen on survsillance.
P�intad At:PA State Police-Nevvport 01/251Z01108:38 AM Page 7 Form�:H05-1896807
��` . � Commonw�ealth of Pennsylvania � +
��N� �-�� Police Crash Report
� Suppiemental Narrative
s�qsme�no onros��«�► sw�p��� � �°�
� PA 8TATE POLICE-I�INPORT CHEWNMIG�DONALD L ��
��� ��►
11�010 PA STATE POLICE-NEMMPORT TROOPER TODD A.SHNE
� Revisw�x I�evie�ws�gadps N�n�ber I De�e
tIA�AAR,D�AV�A OTOOZ 1�010
�
INTERVIEW o�f Jaanaa(Gins)PIZZINO,WAWF,9/2SR5,618 West College Street,York,Pa,17047,717-654-7515:
O�11/?3/10,1810h�s,1 infisrvisw�sd PIZZINO at Rumor"a Bar and Night Club,Z51 North Enola Road,Enola,Pa
170?.�. PI�10 ni�bd that shs was bairbandi�on 11/18M0 at Rumo�'s. She relatad that SHiNAULT and
WEVODAU carrN�rbo th�bar throu�h tha fron�door. PIZZtNO stated that she knew the SHINAULT caused
probiems in ths ba�bsf�ore arul w�avvare of I�er history.
PIZZINO stabd that she s�ved SHIN�4ULT one bser in a plastic cup bacause she had broken a bo�de before•
PIZZINO stabd th�t WEAVODAU had a biack 0ya and he was not drinldng. PIaINO sta�sd that both of t�m were
talking�o Stiws DILLER who is a�ular petron at the bar.
PIZZINO stated that DILLER rr�ay haw b�en with
ano�hsr wonn�n. PRZINO atatsd that she was unsure ff they all came in toge#her but probably came in around the
�same time fi�ama af�er ZZOOhrs.
PITZINO�tabd�at SHMIAULT and YYEAVODAU w�ere no�flghting during thair visit at the bu.SHINAULT walked
out the front door with tl�s!�r snd poured it on tl�s floor as she wa�leaving ths bar. PI�10 stabd that
SHINAULT c�bacic insid�and shs rofi,�d fio sarve her additional aicohol. WEAVODAU t�isd�pet PIa1N0 to
sonre SHINAULT anot�d�irrk,but she ro�ia0d to do so. PIZZINO stated that th�l eventually Isft tha b�r without
incic�r�t. PIZZINO vlawad pho�ographs of IMcCALEB snd EARLY and sta�ed that she had na�rer seen them bs�fiore
at Rumor"�. .
INTERVIEIN of Lasl�Edan LAMP,WMIF,1?J�3J81,111 Herman Ave,Lemoyne,Pa 717-385-Z970:
On 11/Z3/10,1�Ohrs,i infierviervad LAMP at Nathan's Ca�e,Z07 North Enola,Road,Erbla,Pa 170Z5, whsro she
�employed�a barber�der, SI�roisbd that on 11/18/10,SHINAULT and YVEAVODAU camo into tha I�ar and sat in
the back n�ar tl�s b�thr+oom. Shs sta�ed that sha had naver seen thern b�fore in the bar and idsntifisd thom b�l
their viewing the PA OLN pho�ographs. LAMP stated that she had seen SHINAULT out befone�t did nat la�ow
her. �
LAII�P relatied that tl�ey starbed arguir�and it was not a pie�sant conversation. She st�ted th�t SHINAULT had a
Jini Boam ar�d Cok��nd WEAVODAU had a Busch Poundar(Baer). LAMP sta�ed that SHINAULT had sav�l
tattoos and tfat NIEAVODAU had a black eye. LAMP stat�d�at they can�e in around Z'100hra. LAMP sta�d that
they rnst up wt#h�v�DILLER�nd w�ere there for about 30 minuties. LAMP statied tl�t they calmsd doMnt af�
th�j/st��ted t�Ndr��DILLER. LAMP stated that they said they were going to I�umor"s and tt�y Idt't tha bar
Nrithout Incid�nt, LA�viev�ed pho�ographs af�CA�EB and EARLY and stated that she had never seen them
beiore at Nathan's Cafie.
Surveilisnce Video at Runor's ar�d Sunoco Mart viewed:
Rumor"s: 1 observed SHINAULT and WEVODAU arrived 2018:56 with a unknovm female. They I�out th�side
door and�air mini-van was observed leaving the parking lot after talkin8 with a male in front of Rumo�'s at
2307hrs. The times on the .
Printed At:PA Stabe PoNce-Newpo�t 011Z5/201108:A0 AM Page 1 Fam�:H05-1886807
�` • - Cor�nmonw�ealth of Pennsylvania � z
.�N��: �-�� Police C�h Report
Supplemental Narrative
Rumo�'s video could be off 5-8 minutes from tha Sunoco Mart Video. .
g�noco; �obssnnd what appe�r�ed�o ba a Wack ssdan and mini�ran passir�the Sunoco on Route 11/1 S �
northbound lan�at Z301:01:3Z. Ths s�dan was flrat with van tra�in�tt at an incre�ed speed.There was nothing
alanriin�or art ofi tl�e unusual. No broaldng was obssnred. A voluntieer fireman's bvck with ligh�s activa�sd vvas
obsarvsd travelin�northbound on Rt 11M5 iri front af the Sunoco at 2318hrs.
Prit�ted At:PA Sbte Police-Ne�rport OUZ5/Z01108:�0 IW Page 2 Form#:1�5-18a680T
�` � � � Commonw�eaith of Pennsylvania � �
,ident Numbsr: H06-1s�so7 ,Polioe Crash Report
.
Supplementai Narrative
���,�„�, - s�,�s�r�.,a,na on� ea�e r�n�
� PA 8TATE POLICE•HARRISBURG FRA�T�N.MATTHEW D 07a7S
���� � OQioer
11Ml1�010 PA 8TATE POLICE-NEINPORT �D SHNE
� Revisw�er ��� � .
MOYNtEY,WILI.IAM M 05389 11/Z1/Z0'10
Narraiiv�s --_ - -- _
On 11/18�010,1 was taking asrial pho�togra�s o�f a differsnt fatal crash scene,cio�e to this fatal crash scene. I
dacided b�tak•a�isl pho�ographs af this fatal crash scane,whicle 1 was in the srea.
On 11/19/Z010 at appx.12�0 hra.,l an�ivad at the scane,in a Departme�halicoptier pilo�ed by Cpl.Jeff BRAID.
Tha scene was locatied on SR0015 at Park Drive,Marysvii�Borough,Perry County.
On 1�119/Z010 at appx.1241-1?�14 hrs.,l pho�ographecl the scene using a Nikon D3 digital camera and a Nikon
241 ZOmm Isns. 1 cap�ured iorty�'ive(45)digital images.
On 11/19/Z010 at appx.1245 hrs.,l de�rted the scene.
On 111ZOJ�010 at appx.l�7 hrs.,I doMmlo�dod the d�ital imagas�o a�rtment com�. I reviewed�e
ima�s,and�accurafisiy neprsson�sd the f��raPhed. On 11/ZO�IZ010 at appx.2119 hrs,I burnecl the
digital in�ges,without albration,to a non-rewritabla CD. I labalad the CD as a"Allsst�r Copy". It vWll be�tained �
at the Troop H Forenslc 8srvic�Unit. 1 also upbad•d tt�e digital Nnages fi�the PSP Bureau of For+ensic Sarvicss'
: SAN servsr. i mada one copy af the CD,which 1 fonMarcisd�Tpr.SHNE,via Troop maii.
�
�
, �
:
Pri�d At:PA Stabe Police-Harti�burg 01f251Z01108:40 AM Page 1 Form�:H05-1986807
'T" • � � Commonw�esith of Pennsylvania � � �
.��c N��: �-+�07 Police Crash Report
Supplementai Narrative
����� � S�� Bad�e Nu�
� PA BTATE POLK�.I�YYPORT DUDDY,DAV�J � 10Z84
��� ��►
��n�rm�o PA STATE POLICE-N�T ��r000 sHnre
� ��� io�e
� HAMMAR�QAVID A p70pZ 1?J5/Z010
Nana�ve '
On 11/19M0 at 1Z06 hrs.,Tpr.TERESKA,PSP Newport,and 1 delhrered a daath no�ificatlon to Jack Cook
VYEVODAU,WIN M,a�70,DOB a�J'ZZI�O,of�Mayaro Rd.,Enola,PA 1702a,phone(717)7SZ�2T8. Jack is the
fath�r of ths d�d Davkl YYEVODAU. Jack w�also given informatlon so that he could contact P�y Count�l
Coroner Mike SHALONI3.
Printed 11t:PA St�e Polke-Newport 01/251Z01106:40 AM Page 1 Fonn�:H05-1866807
AFFIDAVIT OF NO INSURANCE
Jack Wevodau, Administrator of
I, the Estate of David Wevodau of 201 Wayne Street, Enola, PA 17025
(Full�ddress on accident date)
N/A .
(Home and Employer telephone number)
was involved in an accident on 1 I/I8/10 at 450 South State Road, Marysville, PA
(Date) �Exact locati�of accident)
when I was a passenger
(Driver/Passenger(where seated�Pedestrian)
in a vehicle,or in contact with a vehicte,owned/operated by Jodi Shinault, 201 Wayne Street, Enola, PA 17025
(Name/Address of Owner/Operator)
As a t�sult uf this�x[ddit,i sustained petsutixl injury. On the above�,I dicl�o�own�r icase a not�:veh;cle,�o;di��F��li��irilill
any relative who ovmed or leased a motor vehicle.
List nll residents of your household by name,age,and relationship
. (Use additional sheet if necessary) •
j�g � Relationshin Ovm or Lease �I�Yes.Insurer Po�
. Of Birth �Vg��Z Number
Jodi Shinault 8/16/70 friend .. Yes % �No,. Encompass . .US 240.408549�. .
. . . . . . . : • � Yes No ' � ' • � � .
� � Yes No ' •
Yes No
� Yes No
I make this statement to compel Citizens United Reciprocal Exchange to pay me personal injury prot�ction or medical expense
benefrts. I understa�►d that any person who knowingly files a statett►ent of claim containing any false or mislead'uig infonnation is
subject to criminal and civil pe,nalties. I hereby request an application for PIP or medical expense benefits.
� � -,
•t � • � �
(X) -�� �.. '.� � > '(..• ��''�L�'Z���'�'� —
,
r �
Driver�Licens�#: N/A State:
(If none,so indicate)
, .
s�o �'�nS �11��a
� /
County of rJ, f . � , �
On this day of� /Y ° 20 1/ ,before me personally appeared L �,��.� � L�--
to me known to be the person described herein,and who executed the foregoing instrument and
acknowledged that �7 �„ voluntarily executed the same.
�
r .� .:�
No Public
My term expires ,
_�.�....�._
Kar+art S.NoN,Nat�y i�c
C�SIe B�xo,t�mb�nd GouMY
� Ooc.�,7Ali
MEMB�t,P�II�ISYl.YMqA ARIES
� c.la�n,Number: zolss5ss Hp►
� Insuring Compaay. Eacompass Home and Auto
Insurance CompaaY
Date of Loss: Navember 18,2010 �
Claimant Name: David Wevodau
RELEASE OF ALL CLAIMS
This Indenture Witnesseth that, in considerafion of the sum of Fifty Thousand Dollars
($50,000.00),for myself and for my heirs� personal representatives and assigns, I do hereby
release and forever discharge Jodi Shinault, Terrence Shinault, Encompass,.its affiliates and its
subsidiaries and any other person,firm or corporation charged or chargeable with responsibility�or
liability, their heirs, representatives and assigns,from any and all daims, demands, damages,
costs, expenses, loss of servic�s, actions, and causes of acdon whatsoever and any daims for
pre-and p�t�udgment interest and any daims for attomey fees, arising from any act or
occ��rrence up to the present time and particularly on acx;ount of ali personal injury, disability,
property damages, loss or damages of any kind already sustained or that I may heneafter sustain
in consequence of or ar�ing out of an accident that occurred on or about November 18, 2010 at
or near Route 11-15, Marysville, RA.
To procure payment of the said sum, I hereby dedare: that I am more than 18 years of age;that
no�representation about the nature and extent of said injuries,disabilities or damages made by a
physiaan, att�ney or agent of any party hereby released, nor any representafion regarding the
nature and extent of legal►liability or financial responsibility of any of the parties hereby released,
have induc�d me to make this settlemen�that in determining said sum there has been taken into
considera�on not only the ascertained injuries, disabil'rties and damages, but also the possibility
that the injuries sustained may be permanent and progressive and recovery therefrom unc�rtain
and inde�inite, so that consequences not now anticipated may result from the said acadent.
The undersigned further covenant to indemnify and hold harmless the said party or parties from
and against all daims and demands whatsoever on account of or in any way arising out of the
said occurrence or its results both to person and property. This provision applies, but is not
limited to, subrogation daims by any other party.
I hereby agree that, as a further consideration and inducement for this compromise setaement,
this setdement shali apply to all unknown and unantiapated injuries and damages resulting or
arising from said accident, casualty or event, as well as to those now disclosed.
I understand that the parties hereby released admit no liability of any sort by reason of said
accident and that said payment and settlement in compromise is made to terminate further
controversy respecdng all daims for damages that I have heretofore asserted or that I ar my
personal re�xesenta�ve might hereafter assert because of the said accident.
I further understand that such liability as I may or shall have incurred, directly or indirecdy, in
connection with or for damages arising out of the accident to each person or organization
• released and discharged of liability herein, and to any other person or organ'iza�, is expressly
reserved to each of them, such liability not being waived, agreed upon, discharged not settled by
this release.
The undersigned expressly covenants and warrants that all Medicare, Medicaid, hospital� medical
provider, health care provider, medical supplier and other medical liens, subrogation rights, rights
of payment, rights of reimbursement and daims of any nature whatsoever, arising now or in the
future, as a result of heaith care services provided to the undersigned have been or will be
satisfied� settled, compromised or paid by express�agreement with Medicare, Medicaid, each
insurance carrier and each hospital, health care provider, medical provider or medical supplier by
the undersigned prior to finai disbursement of the settlement proceeds. The undersigned
covenants and warrants that all such daims, liens, payment obiigations and assignmer�ts have
been disctosed in writing to the parties reteased prior to settlement. The undersigned agrees to
Page 1 of 2
My person who knawingly and with intent to iojure or defraud�y insurer flles an appiicatlon ar claim contaiMng sny fatse,
incompla�e or mislea�ng ir�fiom�adon shall,upon conWction,be subject to�nprisonment for up to seven years and the
payment of a ftne of up to S1S,000.
qaim Ntxnber: Z0169569 HA
" ��g�P�Y Eacompsss Home sad Auto
Insurance Company
Date of Loss: Nove�mber 18,2010
Claimaat Name: David Wevodau,
indemnify, defend and hold harmless the parties released for any and all losses, daims, demands
or causes of ac�tion, and any damages,judgments, fees, expenses, costs(induding interest)of
any nature whatsoever paid and incurred as a re.sult af any breach of these warranties and
covenants. The undersigned understands and agrees that the parties released have relied on
these material representations as part of the consideration and inducement for this settlement.
The undersigned understands and agrees that such liability as he/she may or shall have incurred,
arising now or in the future, as a result of health care servic�s provided to the unclersigned, is
expt�essly reserved to each�and every heaith care provider or payor based on such servic�s, such
liability not being in any way waived, agreed upon, discharged or setded by this release. This
specificelly indudes, but is not limited to, any liabilifiy the undersigned may have to any hospital,
health catre provider, medical provider, medicel supplier, Medicare or Medicaid. if any
subrogation daims, liens or rights to payment of any kind against these settlement proceeds do in
fact e�d�t,the undersigned shall distribute these funds in acxord with such daims, liens or right�s to
payment.(or shall direct his/her attomey to do so). The undersigned agrees to indemnify, defend
and hold h�rmless the parties released for any and all iosses, daims, demands or causes of
ac�on, and any damages,judgments,fees, expenses, costs(induding interest)of any nature
whatsoever paid and incurred as a resuit of any breach of these agreements a�d covenants. The
undeirsigned understands and agrees that the parties released have relied on these materiai
representations as part of the consideration and inducement for this settiement.
Signed and sealed this � 31st day of J�Y ,�12
Witn�sed by: Bsrers oF n�svrD a. �
, �-- W � SEAL
� )
J C. �iSV�AII, �IS�
(SEAL)
STATE OF SS �0l�l0�Li'S oF PBI�iSYLVa�IIA :
COUNTY OF � �F ; SS
.
On this 31st day of Jo�.Y , 2012 , before me persa�ally �
qppeared J� C. ii8�0�eII , to me known to be the person who executed the
faregoing instrument, and adcnowledged that L�- executed the me as�free act and
deed. __
My commission expires
N ARY U L C
�wEa.TM oF Pe�r�vMaa
��
�e N0�'aun"�"°°°�"a' .
� �a,m�s
���sna,a�,�ssoa� Nor�es
Page 2 of 2
Any psison who knawin�ly and with i�tent to injure or defraud any insurer flies an applicatlon or claim containing any false,
incomplete or misl�ng infonnation sh�l,upon conviction,be subject to�nprisonment for up�seven y�ears and the
payment of a flne of up to=15,000.
iRwir` . .
./ .
�iC�r�Of1 unGf" a�sov��or.�n�uvs
�J � �J`G ome nc.
V ENOLA.PA 17i0ffi
� � t71�T99G0687
��gMtJRRAY
STA OF FUNBRAL GppD3 AND�3BRVICBS 3BL8CTED
Cl�a m o�!�a tLou�elat�ou.elec�ed or t6�c aoe�eqdrea.tf w�e m e�oq�irea bp la�►a���a«y«
p����� a�uacf to u�e�n1'Ite�.w�e wW
Itlron t�lecocd i l�asa�t d�t m�e�equire�soc6�alMneral whh�le�,lon m�'Mre co Ea
Pn' �Yoa do noR hrn to pa�Eoc�
f'an�d oot�ro�ne tf l�os ukc�ed� emem�mc6�a dkeu c�Naa a�a tiar�l.tf we ch�e�ed far emb�,we w�esp6h w6�r bebw.
For tl�e Senla at �Ocs�..r/ ��l�� li��.i�n a/� �, D�e ct De�q� //,/g—�•-:�
C6�e�oc -�4 N� 1.[/P•�f!c.�e.c-� �S'SZ /�9cr�aia /�� ��.r��� � �/7c�-� �� -
Addteu Cit�' Shte
A.CBA�t',E�OR�iR1►R�3B.1C1'� a��
1. �1WF�tONAt geR11IC� _
Ser�ioa of lmeal Dlrector/Std�....f =
��•��..........: �mn. .es �......i���
/e
� -__
� :�____
.............. ........... � � e �'.! s.-
SiID-7�OTAL OF li0A�i0i�/AL�YIC�......... AI i /'�e�J r' ��'1� :�,p v
.
2.FACILI77B3 AND SBRV[CBS T����CY'aD..................B S_,.,T
IJse of ficll�a�od tesnioes tot C.�AL C`BA�6BS:
��fdoe).........i �af�to
[be of bdWies�nd ravloa i
f�r timeat aarmon�............i (�Home)
tJ�e oI�d�p�md�n►ioa far �of��am
MemaeW Senlce ......... .f (�p�) _
Ute of aquipma�t md ser�foes ..... Immedi�e Hurf�l.................i
foa�ri�ide�enloe..... ...... = Dlrect Ce�nntion.................:
Od�er we of bciNda i
SUD-]�OTAL OF SlBdAL CB11lGES................C=
. D.CA3H ADVANCBp
� ............................... i Opad�Gtrn ..................i�_
SU�-TO?AL Ol�I�AqLiTI�IaQUIl1�'1'...........A2 i �6qa�menE..............:__...
3.AUTOMOTIVB� Lot md Deed....................t
Vd�kle ro am�6a camhit co Punaai E�a�. �Notices—Loail.........i
Lacs�l...........................: �Nodc�--Onaof-town....i
E�e(C�rlat Coach) T��Tde� ...........:
Loal................ Air6oe......................... i
...........i ���..............i�
L°c�t�''''.........'............. i .. Ce�i�fied Ccpiea af dx Deuh.......i
Ffmil�qc .. _ . . . � ; .�'-J7/c�.-. r J
Piower cor a fLont�po�ion......i ���vtts�..................... :—� .
� Lad ar/cler�►pr................ i Vwlt Service Charge.............. _-�_
Laai...........................i :
Cu foc p�bqras =—T
�...........................i =
Om of to�ro tempoetnion........._�_ :—
i i
: 3W-?07'AL OF ADVi�I�......:................ D i
SOa-'i'0�1"AL Ol�AtTl�OMpttYE�QOQYMIT........ A3 i We ch�r�e you fa au senica in abmido`:
'roTi►t Ol��!O!�lO1�AL��5� l�,h canb a�oa�t.n aaa�ta�wpj
FAClLTAES AND A�11�l111E
� ................................... A :•
s�narsav oF ca�cBs
D.CBARGE FOR 1�A1�IDI�E�.RCTE� A.Pr�!Seniea.F9ciliti��nd
��....................._ � �,md Autanoti�e........i f?3�. � v
B.M�t.....................i�i ., o
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�) D.C�h Ad�aooa...................i�. a � .
'1�OTAL OF AI1 aECTIONS.. .......... .....�,:�.^.�.�`
Onta butbi co�.............: !Am AT TII�OF O��IOL TO.
�) A�ANGEI�TS....�-�',�! ��.,r,0!.,��.i�aG• �v
Adu�u�rled� ........... �DpB. �• V ' : I U
cu� : B��JyJ 6 ,'�v/ Gj�,�jn� /f�s c,
�a b°°�°(�) .................i f.�=�— ofo �� .�
foldets . '
P�ay�Cuds.....................i of m��listed�drc�rrqnir��n�ed ehe�
is ez�ioed
7'��a�rker...........i �
Bnri91 clothi� .................. i � �_
I�tre dmt I hsre maietd the imo�af�ood�md xnioa sdocled�boMe md�ound dKm ro be cacrect aad�otordiog to drc�I bave c�eque�ted.1
md�sa�vica�.a��� of Poeeti fioodt md Set�lca Sdecoed.�thg[ �t tmd�s�ble fot p��ment of d1e arb pcioe Eot�*�
si�below.A ble c6�ere af�_a��:—'— � �o�be joind�wd x�r�r N�bk•wit�.wrooe ef�e wla
c�om m�a�te of mi� .�wN�o �.m�d"a�°'nd"t�o ra rar be�p�iea�o dk�d n�aoe b� ✓ Q�rs
pry�o the.!°uoa�l Dlt�ector tll re�orobie aoqs pMd b�tbe Fnnmi Dii�coor to oo�ea�ow�I o�rt aodec tlds
7'hou coqs mir�Mtpeer�lpu.oouR ooqt md od�a ooW.Au�addidoml tenloa a merdandise o�dered or reqpmood�tba t6e due af dds�pa�iWil
� � �ad t6e co�t w�be re8ected on du l�al bW or snoanait. .
(� � � .��o2f �,���
. � ,�. (1�)
($q�� •L,,,,,iy � �,[�iµ?' ��^' • .
o►�rnaoa r�naa�ora�as�.oa�n wx�re�u� �w� �.
form-600 Reviaed 4/94