HomeMy WebLinkAbout13-7459 Supreme Co ' Z Pennsylvania
COu r f-CQHlIY10 leas For Prothonotary Use Only:
Cl I:oYEl�s�l:e t Docket No: sf
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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 knv or rules of court.
Commencement of Action:
S ❑ Complaint Writ of Summons ❑ Petition
13 Transfer from Another Jurisdiction ❑ Declaration of Taking
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Lead Plaintiff's Name: Lead Defendant's Name:
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T , �"Q ` GuaVcl► l cl�- Ca�'� } �arrut� Cornmur,i Fy Se v�� ,
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Dollar Amount Requested: ❑ within arbitration limits
I Are money damages requested? [Yes ❑ No (check one) ❑outside arbitration limits
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N Is this a Class Action Suit? 0 Yes �(No Is this an MDJAppeal? ❑ Yes "o
4
F A Name of Plaintiff /Appellant's Attorney: Lld&do s W - M a yl ;&r — TV'-, �S 4 LLt V2
0 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 ❑ Board of Assessment
❑ Motor Vehicle ❑ Debt Collection: Other ❑ Board of Elections
❑ Nuisance ❑ Dept. of Transportation
❑ Premises Liability ❑ Statutory Appeal: Other
S ❑ Product Liability (does not include
mass tort) ❑Employment Dispute:
E 13 Slander/Libel/ Defamation Discrimination
C E3 Other: 11 Employment Dispute: Other ❑Zoning Board
T 13 Other:
I ❑ Other:
O MASS TORT
❑ Asbestos
N ❑ Tobacco
❑ Toxic Tort - DES
❑ Toxic Tort - Implant REA PROPERTY MISCELLANEOUS —
❑ Toxic Waste ❑ Ejectment ❑ Common Law /Statutory Arbitration
❑ Other:
B ❑Eminent Domain/Condemnation ❑Declaratory Judgment
❑ Ground Rent ❑ Mandamus
❑ Landlord/Tenant Dispute ❑ Non - Domestic Relations
❑ Mortgage Foreclosure: Residential Restraining Order
PROFESSIONAL LIABLITY ❑ Mortgage Foreclosure: Commercial ❑ Quo Warranto
y ❑ Dental ❑ Partition ❑ Replevin
❑ Legal ❑ Quiet Title ❑ Other:
Medical ❑ Other:
❑ Other Professional:
Updated 1/1/2011
e f
R. J. MARZELLA & ASSOCIATES, P.C. Attorney for
BY: Charles W. Marsar, Jr., Esquire Jeff Bouder, Individually,
Pennsylvania Supreme Court I.D. No. 86072 and as Administrator of the
35 North Front Street Estate of Gail Louise Bouder
Harrisburg, PA 17110
Telephone: (717) 234 -7828
Facsimile: ( 7�i- 4 -6883
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
Jeff Bouder, Individually, DOCKET NO. 1 - 3 - '7yS (Ud
and as the Administrator of the Estate
of Gail Louise Bouder PROFESSIONAL MEDICAL
NEGLIGENCE
Plaintiff,
V.
Guardian Elder Care Home and Community: Cn
Services, LLC T /D /B /A Forest Park Health
Center
Route 219 Brockway /Dubois Rd. ' " r;, 4'
Box 2
Brockway, PA 15824
Defendant JURY TRIAL DEMANDED
PRAECIPE FOR WRIT OF SUMMONS
TO THE PROTHONOTARY OF SAID COURT:
Please issue Writ of Summons in the above - captioned action.
1 Writ of Summons shall be issued and forwarded to (X) Attorney ( ) Sheriff
7
Cha rles W. Mar sar, Jr•• Esq uire C�f a� • Gr p Cv�ie- ��
3513 North Front Street _ Signature of Attorney
Harrisbu PA 17110_
(717) 2 _ Supreme Court ID No. 860
Names /Address/Telephone No. Date: _ /P_ /
of Attorney
WRIT OF SUMMONS
TO THE ABOVE NAMED DEFENDANTS:
YOU ARE NOTIFIED THAT THE ABOVE -NAMED PLAINTIFF HAS COMMENCED
AN ACTION AGAINST YOU.
i
Prot onotary
Date: / a �� Z3 by
Deputy
( ) Check here if reverse is used for additional information.
CERTIFICATE OF SERVICE
I, Enjoli Neely, hereby certify that a true and correct copy of the foregoing
document was served upon counsel of record this 1_7th day of December 2013, by
depositing said copy in the United States Mail at Harrisburg, Pennsylvania, postage
prepaid, first class delivery, and addressed as follows:
Guardian Elder Care Home and Community Services, LLC
T /D /B /A Forest Park Health Center
Route 219 Brockway /Dubois Rd.
Box 240
Brockway, PA 15824
R. J. MARZELLA & ASSOCIATES, P.C.
BY:
ENJOLI NE Y, PARALEGAL