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HomeMy WebLinkAbout05-0515 Ira H. Weinstock, Esquire Pa.l.D. No. 01602 IRA H. WEINSTOCK, P.C. 800 North Second Street Harrisburg, P A 17102 Phone: 717-238-1657 Fax: 717-238-6691 Attorney for Petitioner INRE: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. ESTATE OF LARRY E. JOHNSON NO. oS- .i' I{ {l~..j J;.... PETITION TO APPROVE SETTLEMENT AND DISTRIBUTION OF FUNDS IN THE WRONGFUL DEATH OF LARRY E. JOHNSON TO THE HONORABLE, THE JUDGES OF SAID COURT: The Petition of Margaret A. Johnson, Administratrix of the Estate of Larry E. Johnson, deceased, by and through her attorneys, Ira H. Weinstock, P.C., respectfully requests: I. Petitioner is Margaret A. Johnson who was appointed Administratrix of the Estate of Larry E. Johnson, deceased, on May 5, 2004 by the Register of Wills in and for the County of Cumberland. A copy of the Short Certificate granting Lette.Ts of Administration is attached hereto as Exhibit "A". 2. The decedent died on June 26, 2003 as a result of injuries sustained from a motor vehicle accident that occurred on June 26, 2003. 3. The decedent was 58 years old at the time of his death and had a date of birth of May 23,1945 and a Social Security Number of241-78-8116. Decedent did not have a Will. 4. Decedent was married and had two children at lLhe time of his death. 5. Pursuant to Pa. R.C.P. 2206, Petitioner served a copy of this Petition on the intestate heirs of decedent who are as follows: David L. Johnson Paul E. Johnson Son 41670 Lawson Circle, Temecula, CA 92592 Son 315 South 3'd Avenue, Lebanon, PA 17042 6. The Department of Public Welfare does not have a claim or lien against the Petition, the Estate or any wrongful death beneficiary. 7. At all times relevant hereto, the decedent was insured by Allstate Insurance Company. The applicable policy limits for the policy covering the decedent, issued by Allstate Insurance Company, is Five Hundred Thousand ($500,000.00) Dollars. 8. The Petitioner has negotiated a settlement directly with Allstate Insurance Company and has agreed to settle, upon Court approval, all und,:rinsured motorist claims arising out of this motor vehicle accident for the total sum of Five Hundred Thousand ($500,000.00) Dollars, in exchange for a Release to be executed in favor of Allstate Insurance Company. 9. A copy of the proposed Release is attached hereto and marked as Exhibit "B". 10. Counsel is of the professional opinion that the proposed settlement is reasonable given that it represents the full policy limits due under the aforestated policy of insurance. 11. Petitioner is of the opinion that the proposed settlement is reasonable. See attached Verifications of Petitioner, Margaret A. Johnson, and intestate heirs. 12. In procuring said settlement with Allstate Insurance Company's undcrinsured motorist liability coverage, Petitioner engaged Ira H. Weinstock, Esquire, and entered into a contingency fee agree (see Exhibit "COO, attached hereto), and has agreed that: 2 (a) Ira H. Weinstock, Esquire, should be paid the sum of One Hundred Fifty Thousand ($150,000.00) Dollars of the aforesaid settlement regarding the Estate of Larry E. Johnson, which represents a reduced fee of the contingent fee of thirty-three and one-third (33 1/3%) percent of the payment of Five Hundred Thousand ($500,000.00) Dollars. If approved by Your Honorable Court, the sum of Five Hundred Thousand ($500,000.00) Dollars shall be apportioned and distributed as follows: Ira H. Weinstock, P.C. Margaret A. Johnson TOTAL $ 150,000.00 $ 350,000.00 $ 500,000.00 13. The reason for the requested allocation is as follows: The pecuniary loss suffered by the Petitiom~r far exceed the policy limits available. 14. Pursuant to the Wrongful Death Statute (42 Pa. C.S. S 8301), the beneficiary of the Wrongful Death Claim, and the portion of her interest, is as follows: Margaret A. Johnson $ 500,000..00 15. The pecuniary loss suffered by the beneficiary listed in Paragraph 13 is as follows: Petitioner relied upon the decedent for maintenance, services and gifts and intended to rely upon the decedent for same in her elder years. Decedent also provided the Petitioner with companionship and comfort which she looked forward to in her elder years as well. The loss of the decedent's maintenance, services, gift, companionship and comfort is immeasurable. 3 WHEREFORE, Petitioner requests that she be permitted to enter into the settlement recited above, and that the Court enter an Order of Distribution as :follows: Ira H. Weinstock, P.C. $ 150,000.00 Margaret A. Johnson $ 350,000.00 Respectfully Submitted IRA H. WEINSTOCK, P.C. 800 North Second Street Harrisburg, PA 17102 Phone: 717-238-1657 By: ~ 1 ~ fl. LJ() i }cllc'Y'f)___ IRA H. WEINSTOCK Attorney LD. No. 01602 4 VERIFICATION I, Paul E. Johnson, hereby verifY that I am an intestate heir ofthe decedent in this action. 1 have received a copy of the Petition for Approval of Settlement and Distribution of Funds. I have no objection to the proposed settlement or distribution. /7, /At/ I C. J:;~S-0'7-7 PAUL E. JOHNSON DATED: c>/ ~ 3' ~.s--- VERIFICATION I, David L Johnson, hereby verify that I am an intestate heir of the decedent in this action. I have received a copy of the Petition for Approval of Settlement and Distribution of Funds. I have no objection to the proposed settlement or distribution. DATED: }- (q- 2oo~ STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I, GLENDA FARNER STRASBAUGH estate of JOHNSON LARRY E Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 5th day of May, Two Thousand and Four, Letters of ADMINlSTRA TfON in common form were granted by the Register of said County, on the , la te of HAMPDEN TOWNSHIP (Last, First, Middle) in said county, deceased, to JOHNSON MARGARET A (Last, First, MicJdJeJ and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 5th day of May Two Thousand and Four. File No. 2004-00440 PA File No. 21-04-0440 Da te of Dea th 6/26/2003 S.S. # 241-78-8116 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL EXHIBIT "A" NOV. 4.2004' lO:2~"""ALLSTATE INS. H~g. Pa. 17112 l!?J ALLSTATE INSUAANCE COMPANY (hereinafter referred to H A1lslute) o ALLStATe INDeMNITY COMPANY (hereinafter referred to.. Allstate) o ALLSTATE NEW JERSEY INSURANCe COMPANY (hereinafter reffllTed to as Allstate) RECEIPT AND RELEASE UNDER o UNINSURED MOTORIST INSURANCe - Coverage SS C!SI UNPERINSURED MOTORIST INSURANCE - Coverage SU SUBROGAnON AGREEMENT NO, '761 ClAIM. 1S5477041~27 1. In conslderallon of the payment of Five Hundred Thousand Dollare I'Y Allstate. the receipt of whloh Is hereby acknowledged, the undersigned hereby for~er rele,ases and discharges Allstate from any and allllab~ity and from any and all contrac\ual obligations whlllSoever under the OllVeragl! designated above of Policy No. 008138320 issued to Lanv E. Johnson by Allstate and arising out of 181 bodily Injuries, 0 properly d..mages sustained by Estate of Lany E. Johnson due to an acoIdent on or about the MIll day of.!WJt,~. 2. The undersigned hereby asslgns. transfers and 5el3 over to Allstate any and all claims or ceuses of adton fOr bodily Injury and/or properly damage which thll under5igned now has, or may herelilt!er have, to recover against any person or persons as thll result of said BCCident and loss abOve staled to the extent of the payment above made; i/le undersigned agl'ee$ lhet Allstate may enforce the same In such manner as shall be neces!;ary.or appropriate for the use ;md benllllil of A1\$tate, either In Its own name or In the name of the undersigned; that the undersigned will furnish such papers, Information or evidence as shall be within the undersigned's pllSSM$ion or control for the purpose of enforcing 9UCh claim, demand or cause of action; that the undersigned wm do whatever else is necessary to seoure such righ18 of rect:rl/ery on behalf of Allstate and do nothing Il1ler loss to prejudice them; and 3. The undersigned covenants that no release or selllement of any such claim, demand or cause of action ha$ been made. IN WITNESS WHEREOF I have hereunto set my hand this ~ ~ Wl\nesses: I. I C58O-a, SS-SU RocoIp\ & P.oIeaso-Subro Agreement Pllpe 1 Of 1 day of (Seal) rev.06/21l100 P. 2/2 EXHIBIT liB II POWER OF ATTORNEY AND CONTINGENT FEE AGREEMENT KNOW ALL MEN BY THESE PRESENTS: that I, Margaret A. Johnson, 3924 Brookridge Dr., Mechanicsbmg, PA 17050, do hereby make, constitute and appoint IRA H. WEINSTOCK, P .C., of Harrisburg, Dauphin County, Pennsylvania, my true, lawful, sole and exclusive attorneys, in law and in fact, to institute and maintain for me and in my name, an action against ABF Trucking and to conduct said action and! award in as speedy manner as the said attorneys reasonably can; AND in their sole judgment and discretion, to compromise and settle said claim without suit; AND to conduct the prosecution of said action or suit so to be brought and to use all effectual ways and means in my name therein, in as full and effectual a manner as I could do if personally present; HEREBY ratifying and confirming whatsoever my said attorney, in the said claim, whether by litigation or compromise touching the prosecution thereof, may do according to law in the premises. It is understood that no costs or expenses shall be advanced by the said attorneys, and that I(we) shall be responsible for advancing all costs including, but not limited to filing fees, sheriff's fees, medical record reproduction fees and expert fees. I understand that said Attorneys shall be entitled to receive, based upon and from the gross sum of such recovery secured 33 % thereof in th(: event that such recovery is obtained with or without the institution of suit, but prior to trial, or compulsory or policy-mandated arbitration, and 40% thereof in the event that such recovery is received after comm.encement of trial, or compulsory or policy -mandated arbitration; and further said attorneys shall be entitled to payout from the residue before turning over the balance any witness fees, and any other expenses which may have been incurred incident to the preparation for or conduct of litigation. In addition, it is expressly understood that if an appeal results after a decision of the lower Court, the fee arrangement will be subject to further negotiation. In consideration ofthe foregoing, said attorneys agree to act diligently and in the best interests of the said claimant in the assertion, negotiation and, if necessary, litigation in hislher behalf of any claims which may exist. I understand that if said attorneys are unwilling to act as my legal representative at any time during the course ofthis matter, that they are hereby authorized to withdraw from this case upon ten (10) days written notice. Executed and delivered in duplicate this q~ day of I u.t , 2003, the undersigned hereby acknowledging receipt of one copy hereof. ~ ~ fa tt; I c. (,L _- 'JJ-..tv\..) Itness '~~J{) ~ (Seal) MA GARET .. JOHNSON IRA H. WEINSTOCK, P.C. By: (Seal) IRA H. WEINSTOCK EXHIBIT "CII CERTIFICATE OF SERVICE ".1;-/1, / \ AND NOW, this :::L-- day of ~iLfLLLLL'-'J"52005, I, Ira H. Weinstock, Esquire, attorney for Petitioner, Margaret A. Johnson, hereby c(:rtity that I served the within PETITION FOR APPROVAL OF SETTLEMENT AND DISTRIBUTION OF FUNDS this day by depositing the same in the United States mail, postage prepaid, in the post office at Harrisburg, Pennsylvania, addressed to: By First Class Mail: David L. Johnson 41670 Lawson Circle Temecula, CA 92592 Paul E. Johnson 315 South Third Avenue Lebanon, PA 17042 By: t~~ ;-(. C~{\L rieL IRA H. WEINSTOCK - ~ JI ~f\ " % tt.. ~ & ~ )v c ~ "'<I lft. ~ . \ (y I ~J r,; ~"~,,; C-) " "^~:) ..: iI ,:../1 '- '~j ?~': j';'l ';P -rJ:'1'l f'-.' ~'<~ (;1 --..I ~'j() - _-~ J () ITl C,j C~) \3 IN RE: ESTATE OF LARRY E. JOHNSON IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -. LAW NO. 05-515 CIVIL TERM ORDER OF COURT AND NOW, this 2nd day of February, 2005, upon consideration of the Petition To Approve Settlement and Distribution of Funds in the Wrongful Death of Larry E. Johnson, a hearing is scheduled for Monday, April 4, 2005, at 9:30 a.m., in Courtroom No. I, Cumberland County Courthouse, Carlisle, Pennsylvania. IT IS FURTHER ordered and directed that Petitioner shall give notice of the above hearing to all intestate heirs and to the Pennsylvania Department of Revenue. BY THE COURT, .;r(H. Weinstock, Esq. 800 North Second Street Harrisburg, PA 17102 Attorney for Petitioner 1 ftps O:l-03-()5 :rc ~~ jO~USON /\\. . uQy,d jo\,jjsoJ C,C :7 _.j ...1 U,,,\ ;.-;..J Z - fEL:-; :Oil :le -------- Ira H. Weinstock, Esquire Pa. J.D. No. 01602 IRA H. WEINSTOCK, P.c. 800 North Second Street Harrisburg, PA 17102 Phone: 717-238-1657 Fax: 717-238-6691 Attorney for Petitioner INRE: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. ESTATE OF LARRY E. JOHNSON NO. 0 s: ')15 {1;,.,J -c.... PETITION TO APPROVE SETTLEMENT AND DISTRIBUTION OF FUNDS IN THE WRONGFUL DEATH OF LARRY E. JOHNSON TO THE HONORABLE, THE JUDGES OF SAID COURT: The Petition of Margaret A. Johnson, Administratrix of the Estate of Larry E. Johnson, deceased, by and through her attorneys, Ira H. Weinstock, P.C., respectfully requests: I. Petitioner is Margaret A. Johnson who was appointed Administratrix of the Estate of Larry E. Johnson, deceased, on May 5, 2004 by the Register of Wills in and for the County of Cumberland. A copy of the Short Certificate granting Letters of Administration is attached hereto as Exhibit "A". 2. The decedent died on June 26, 2003 as a result of injuries sustained from a motor vehicle accident that occurred on June 26, 2003. 3. The decedent was 58 years old at the time of his death and had a date of birth of May 23,1945 and a Social Security Number of241-78-8116. Decedent did not have a Will. 4. Decedent was married and had two children at thf: time of his death. 5. Pursuant to Pa. R.C.P. 2206, Petitioner served: a copy of this Petition on the intestate heirs of decedent who are as follows: David L. Johnson Paul E. Johnson Son 41670 Lawson Cirde, Temecula, CA 92592 Son 315 South 3'd Avenue, Lebanon, P A 17042 6. The Department of Public Welfare does not have a claim or lien against the Petition, the Estate or any wrongful death beneficiary. 7. At all times relevant hereto, the decedent was insured by Allstate Insurance Company. The applicable policy limits for the policy covering the decedent, issued by Allstate Insurance Company, is Five Hundred Thousand ($500,000.00) Dollars. 8. The Petitioner has negotiated a settlement directly with Allstate Insurance Company and has agreed to settle, upon Court approval, all undt:rinsured motorist claims arising out of this motor vehicle accident for the total sum of Five Hlmdred Thousand ($500,000.00) Dollars, in exchange for a Release to be executed in favor of Allstate Insurance Company. 9. A copy of the proposed Release is attached hereto and marked as Exhibit "B". I o. Counsel is of the professional opinion that the proposed settlement is reasonable given that it represents the full policy limits due under the aforestated policy of insurance. II. Petitioner is of the opinion that the proposed settlement is reasonable. See attached Verifications of Petitioner, Margaret A. Johnson, and intestate heirs. 12. In procuring said settlement with Allstate Insurance Company's underinsured motorist liability coverage, Petitioner engaged Ira H. Weinstock, Esquire, and entered into a contingency fee agree (see Exhibit "C", attached hereto), and has agreed that: 2 (a) Ira H. Weinstock, Esquire, should be paid the sum of One Hundred Fifty Thousand ($150,000.00) Dollars of the aforesaid settlement regarding the Estate of Larry E. Johnson, which represents a reduced fee of the contingent fee of thirty-three and one-third (33 1/3%) percent of the payment of Five Hundred Thousand ($500,000.00) Dollars. If approved by Your Honorable Court, the sum of Five Hundred Thousand ($500,000.00) Dollars shall be apportioned and distributed as follows: Ira H. Weinstock, P.C. Margaret A. Johnson TOTAL $ 150,000.00 $ 350,000.00 $ 500,000.00 13. The reason for the requested allocation is as follows: The pecuniary loss suffered by the Petitioner far exceed the policy limits available. 14. Pursuant to the Wrongful Death Statute (42 Pa. C.S. S 8301), the beneficiary of the Wrongful Death Claim, and the portion of her interest, is as follows: Margaret A. Johnson $ 500,000.00 15. The pecuniary loss suffered by the beneficiary listed in Paragraph 13 is as follows: Petitioner relied upon the decedent for maintenance, services and gifts and intended to rely upon the decedent for same in her elder years. Decedent also provided the Petitioner with companionship and comfort which she looked forward to in her <elder years as well. The loss of the decedent's maintenance, services, gift, companionship and comfort is immeasurable. 3 WHEREFORE, Petitioner requests that she be permitted to enter into the settlement recited above, and that the Court enter an Order of Distribution as follows: Ira H. Weinstock, P.C. $ 150,000.00 $ 350,000.00 Margaret A. Johnson Respectfully Submitted IRA H. WEINSTOCK, P.C. 800 North Second Street Harrisburg, P A 171102 Phone: 717-238-1657 By: ~ 1 IX fl. el)(J i >~dc-y..{)__ IRA H. WEINSTOCK Attorney J.D. No. 01602 4 VERIFICATION I, Paul E. Johnson, hereby verify that I am an intestate heir of the decedent in this action. I have received a copy of the Petition for Approval of Settlemllnt and Distribution of Funds. I have no objection to the proposed settlement or distribution. ~/' c-. :J: ~ S"<77? PAUL E. JOHNSON DATED: ~//3'~~ VERIFICATION I, David 1. Johnson, hereby verify that I am an intestate heir of the decedent in this action. I have received a copy of the Petition for Approval of Settlement and Distribution of Funds. I have no objection to the proposed settlement or distribution. ~ 10 L. JOHNSON -- DATED: J- f q- ;20DS-- STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I, GLENDA FARNER STRASBAUGH estate of JOHNSON LARRY E Register for the PrQbate of wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 5th day of May, Two Thousand and Four, Letters of ADMINISTRA TlON in common form were ~Jranted by the Register of said County, on the , la te of HAMPDEN TOWNSHIP (Last, First, Middle) in said county, deceased, to JOHNSON MARGARET A (Last, First, Middle) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 5th day of May Two Thousand and Four. File No. 2004-00440 FA File No. 21-04-0440 Date of Death 6/26/2003 S. S. # 241-78-8116 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL EXHIBIT "A" .,",_.,-.""",.~ NOV. 4,2004 10:29AM ALLSTATE INS, Hbg, Pa, 17112 181 ALLSTATE INSURANCE COMPANY (hereinafter referred to lI$lUlstate) o AlLSTATE INDEMNIlY COMPANY (hereinllfl<< referred to lIS Allstate) o ALLSTATE NEW JERSEY INSURANCE COMPANY (hereinafter referred to lIS Allstate) RECEIPf AND RELEASE UNDEFt o UNINSURED MOTORIST INSURANCE - COy.....g.. ss 181 UNDERlNSURED MOTORIST INSURANCE - Coverage SU SUBROGAnON AGREEMENT NO, '761 CLAIM' 155477041Nl27 1. In consideration of the payment of Five Hundred Thousand Dollars by Allstate. the receipt of which Is hereby acknowledged, the undeflligned hereby forever r,eleases and discharges Allstate from any and allliabili\y' and from any and all contnlelual obligations whatsoever under the ooverage designated above of Policy No. 008138320 issuad IXI L8ITV E. Johnson by Allstate and arising out of 181 bodily Injuries, 0 property damage'; sustained by Estate of L.arrv E. Johnson due to en accldenl on or about the ~ day of~,~. 2. The undersigned hereby assigns, transfers and sets over to Allstate any and all claims or ceuses of adlon for bodily Injury and/or property damage which the undersigned now has, or may hereafter have, to recover against any parson or parsons a's the result of said accident and Io!ls above stated to the extent of the payment above made; the undersigned agrees that Allstate may enforce the same In such manner as shall be nece!lsary.or appropriate for the use .and benlll'it of Allstate, either In Its own name or In the namEI of the undersigned; that the undersigned will furnish such papers, Infonnallon or evidence al: shall be within the undersigned's possession or conlrQI for the purpose of enforot"l;1 such claim, demand or cause of acllon; that the undersigned wHI do whatever else is necessllry to seoure such rights of recovery on behalf of Allstate and do nothing after loss to prejudice them; and 3. The llndersigned covenants that no release or sl!Jltlement of any such olalm. demand or cause of acIIon hilS been made. IN WITNESS WH~R~OF I have hereunto set my hand this ~ ~ Witnesses: ;, C~. SS-SU Receipt & Reloaso-8ub<o Agreement Page 1 of 1 day of (Seal) rev.06I28100 P, 2/2 EXHIBIT liB" POWER OF ATTORNEY AND CONTINGENT FEE AGREEMENT KNOW ALL MEN BY THESE PRESENTS: that I, Margaret A. Johnson, 3924 Brookridge Dr., Mechanicsburg, PA 17050, do hereby make, constitute and appoint IRA H. WEINSTOCK, P.C., of Harrisburg, Dauphin County, Pennsylvania, my true, lawful, sole and exclusive attorneys, in law and in fact, to institute and maintain for me and in my name, an action against ABF Trucking and to conduct said action and award in as speedy manner as the said attorneys reasonably can; AND in their sole judgment and discretion, to compromise and settle said claim without suit; AND to conduct the prosecution of said action or suit so to be brought and to use all effectual ways and means in my name therein, in as full and effectual a manner as I could do if personally present; HEREBY ratifying and confirming whatsoever my said attorney, in the said claim, whether by litigation or compromise touching the prosecution thereof, may do according to law in the premises. It is understood that no costs or expenses shall be advanced by the said attorneys, and that I(we) shall be responsible for advancing all costs including, but not limited to filing fees, sheriffs fees, medical record reproduction fees and expert fees. I understand that said Attorneys shall be entitled to receive, based upon and from the gross sum of such recovery secured 33 % thereof in the event that such recovery is obtained with or without the institution of suit, but prior to trial, or compulsory or policy-mandated arbitration, and 40 % thereof in the event that such recovery is received after commencement of trial, or compulsory or policy-mandated arbitration; and further said attorneys shall be entitled to payout from the residue before turning over the balance any witness fees, and any other expenses which may have been incurred incident to the preparation for or conduct of litigation. In addition, it is expressly understood that if an appeal results after a decision of the lower Court, the fee arrangement will be subject to further negotiation. In consideration of the foregoing, said attorneys agree to act diligently and in the best interests of the said claimant in the assertion, negotiation and, if necessary, litigation in hislher behalf of any claims which may exist. I understand that if said attorneys are unwilling to act as my legal representative at any time during the course of this matter, that they are hereby authorized to withdraw from this case upon ten (10) days written notice. Executed and delivered in duplicate this 1'1-1\. day of I" 0 _,2003, the undersigned hereby acknowledging receipt of one copy hereof. ~ ~At1;d'r, J ltness '~1ii{) ~ (Seal) MA CARET . JOHNSON IRA H. WEINSTOCK, P.C. By: (Seal) IRA H. WEINSTOCK EXHIBIT lie" CERTIFICATE OF SERVIC:~ AND NOW, this :::n-lh day of /-fcIUL<L"L~y2005, I, Ira H. Weinstock, Esquire, attorney for Petitioner, Margaret A. Johnson, hereby certifY that I served the within PETITION FOR APPROVAL OF SETTLEMENT AND DISTRIBUTION OF FUNDS this day by depositing the same in the United States mail, postage prepaid, in the post office at Harrisburg, Pennsylvania, addressed to: By First Class Mail: David L. Johnson 41670 Lawson Circle Temecula, CA 92592 Paul E. Johnson 315 South Third Avenue Lebanon, P A 17042 By: \:~Lc- H. (tltU: L,l rick IRA H. WEINSTOCK - ::;::::::,~ , -- liS- ~ J }- ~ -c:> ~ ) St::, Q ..J:: Q <>\\ ('~'. () ""i' (._ Cj -,., :(t~ r',I"o'- .:~ -:2~i~) ~ ~. ~ i..}, , --- -..-\ (./J- C) lJ \ '=) Ira H. Weinstock, Esquire Pa. J.D. No. 01602 IRA H. WEINSTOCK, P.C. 800 North Second Street Harrisburg, PA 17102 Phone: 717-238-1657 Fax: 717-238-6691 Attorney for Petitioner INRE: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. ESTATE OF LARRY E. JOHNSON NO. 05 - 515 Civil Term AFFIDAVIT OF SERVICE Ira H. Weinstock, Esquire, being duly sworn according to law, deposes and says that he mailed a true and correct copy of the Order of Court dated February 2, 2005 signed by the Honorable J. Welsey Oler, Jr. upon the intestate heirs and the Pennsylvania Department of Revenue on February 7, 2005, by depositing it in the United States mail, regular first class delivery, addressed as follows: ~s.~argaretJohnson 3924 Brookridge Drive Mechanicsburg, PA 17050 ~r. David L. Johnson 41670 Lawson Circle Temecula, CA 92595 Mr. Paul E. Johnson 315 South Third Avenue Lebanon, PA 17042 Department of Revenue Bureau ofIndividual Taxes Inheritance Tax Division Department 280601 Harrisburg, PA 17128-0601 Attention: J. Paul Dibert I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of I 8 Pa.C.S. ~4904 relating to unsworn falsification to authorities. ~ ~f'l fl. IA lfJ.lffi-J-!c~ IRA H. WEINSTOCK r...,,) <..;, 'IT ...-1 -(. ,i'j .1 ''':::,,1 , CJ f\,) Ira H. Weinstock, Esquire fa. J.D. No. 01602 IRA H. WEINSTOCK, P.c. 800 North Second Street Harrisburg, PA 17102 Phone: 717-238-1657 Fax: 717-238-6691 'Y JAN 2 B ZDD5 Attorne~ for Petitioner I INRE: IN THE COURT OF OMMON PLEAS CUMBERLAND COU TY, PENNA. ESTATE OF LARRY E. JOHNSON ,/ ./ NO. uj -/ ,50 ~~ ORDER AND NOW, this ~day Of~, 2005, upon considera ion of the foregoing Petition to Approve Settlement and Distribution of Funds in the wrong I death of Larry E. I. The settlement of the claim of Petitioner, Margaret A. Johns n, Administratrix of Johnson, it is hereby ORDERED and DECREED as follows: the Estate of Larry E. Johnson, for the sum of Five Hundred Thousand ($5 0,000.00) from the underinsured motorist claim with Allstate Insurance Company is approved. 2. Margaret A. Johnson, as Administratrix of the Estate of hereby authorized to effect such settlement from the underinsured motorist claim with Allstate Insurance Company and accept the sum of Five Hundred Thousand ($500,0 0.00) Dollars as set forth in the foregoing Petition in full payment and settlement of the afo esaid claim, which amount shall be distributed as follows: Ira H. Weinstock, P.C. $ 150,00 .00 Margaret A. Johnson $ 350,00 .00 4. The maximum amount of recovery IS Five Hundred Tho and ($500,000.00) Dollars from the underinsured motorist benefits with Allstate Insurance Com any. 5. Margaret A. Johnson, as Administratrix of the Estate of ljarry E. Johnson, is authorized to execute and deliver a good and sufficient release of the u4derinsured motorist claim. 6. The payment of the underinsured motorist claim shall con~titute evidence and complete satisfaction of all underinsured motorists claims and demands of hatsoever kind and nature arising out of the motor vehicle accident that occurred on June 26, 20 3. BY THE COURT: J. (; \) ---u fI'\ i.n -v ~ \) v (lJ r----... ,.----, ( .~ ..t ~ ~ - tt -i_ C'/ .?2 ~..~ ('\ G t/> r5..~ r~ '. (. ..\ C c/-