HomeMy WebLinkAbout05-0576
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Gregory R, Reed, Esquire
3120 Parkview Lane
Harrisburg, P A 17111
(717) 238-0434
E-mail: lawortlce(i1epix.net
ETHEL TAYLOR, Executrix
of the ESTATE OF MARY M
KAUFFMAN a/k/a MARY E.
KAUFFMAN, DECEASED,
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
Plaintiff
v,
NO. Oj~ ~ S-7 <;
C;vl
AUSTIN 0, MAKOWSKL
Defendant
JURY TRIAL DEMANDED
r-iOTICE TO DEFEND ANI) CLAIM RIGHTS
YOU HA VE BEEI'\ SUED IN COURT. If you wish to defend against the claims set
torth in the lollowing pages, you must take action within twenty (20) days after this Complaint
and Notice are served. by entering a written appearance personally or by attorney and filing in
writing with the Court your defenses or objections to the claims set torth against you, You are
wamed that if you Elil to do so the case may proceed without you and a judgment may be entered
against you by the court without further notice for any money claimed in the Complaint or for
any other claim or relief requested by the Defendant. 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 HA VE A LA WYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW.
THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LA WYER,
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE
TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MA Y OFFER
LEGAL SERVICIC:S TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.
Cumberland County Bar Association
32 S, Bedford Street
Carlisle. P A 17013
(717) 249-3166
(800) 990-9108
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A VISa
USTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las
demandas quese prcsentan mas adclante en las siguientes paginas, debe toma accion dentro de
los proximos vcintc (20) dlas dcspues dc la notiticacion de esta Oemanda y Aviso radicando
personalmentc 0 por mcclio de un abogado una comparecencia escrita y radicando en la Corte
por escrito sus dci'cnsas de, y objeccioncs a, las dcmandas presentadas aqui en contra suya. Se Ie
advicrte de que si ustcd falla de tomar accion como se describe anterionnente, el caso puede
proceder sin usted y un t~lllo por cualquier suma de dinero reclamada en la demanda 0 cualquier
otra reclamacion 0 rcmedio solicitado por el demandante puede ser dietado en constra suya por la
Corte sin mas aviso adiclona!. Usted puede pcrder dinero 0 propiedad u otros derechos
importantes para ustcd,
usn:D DE BE LLEVAR ESTE DOCUMENTO A SU ABOGADO
JNJVlEDJATAt\lE~TE. SI USTED NO TIENE UN ABOGAOO, LLAME 0 VA YA A LA
SIGUIENTl: OFICli\A, ESTA OFICINA PUEOE PROVEERLE INFORMACION A CERCA
DE COMO CONSEGUIR UN AI30GADO.
Date:a~() ~ ~<.XlS
~---
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1Jregory R. Reed, Esquire
Attorney for Plaintiffs
3120 Park view Lane
Harrisburg,PA 17111
(717) 238-0434
Attorney LO. No. 23705
SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES
POSlI3LE QUE ESTA OFlCINA LE PVEDA PROVEER INFORMACION SOBRE
AGENClAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO 0 BAJO COSTO A
PERSONAS QUE CUALlFlCAN,
Cumberland County Bar Association
32 S, Bedford Street
Carlisle, P A 17013
(717) 249-3166
(800) 990-9108
.'
ETHEL TAYLOR, Executrix
of the ESTATE OF MARY M
KAUFFMAN a/k/a MARY E.
KAUFFMAc-:, [lECI,i\SI,[),
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYL VANIA
Plaintiff
v.
NO.
AUSTIN D. MAKOWSKI,
Defendant
JURY TRIAL DEMANDED
COMPLAINT
COMES NOW Ethel Taylor, the executrix of the Estate of Mary M, Kauffman a/k/a
I. Ethcl Taylor (hc{'einatter referred to as "Plaintit1) is executrix of the Estate of Mary
Mary E. Kauftimll1, deceased. by and through her attorney Gregory R, Reed, Esquire and for her
causes of action alleges:
M. Kauffman a!k!a Mary [, Kauffinan, deceased (hereinafter referred to as "Decedent") by
virtue of Letters Testamentary granted to her on August 13,2004, by the Register of Wi Us of
Cumberland County. Pennsylvania (Estate No. 21-04-0751).
2. Ethel Taylor presently resides at 228 Birch Lane, Carlisle, Cumberland County,
Pennsylvania 17013,
3, Austin D. Makowski (hereinafter referred to as "Defendant"), is a minor who
presently resides at 39 Half Mile Drive, Gardners, Adams County, Pennsylvania,
4. The fi,cts and occurrences hereinafter related took place on or about August 1, 2004
on State Route 34 in Me Holly Springs Borough, Cumberland County, Pennsylvania at
approximately 1:43 p,m.
..
5, At aboutlhat time and place Ethel Taylor was the operator of a 1995 Oldsmobile
Cutlass and was traveling South on State Route 34.
6. At aboutlhat time and place Defendant was the operator ofa 1998 Honda Civic and
was traveling North on Stale Route 34,
7. At abmlt that time and place the vehicle operated by Defendant was caused or
allowed to travel across the double yellow line into the southbound lane crashing into the vehicle
driven by Ethel Taylor and occupied, as a li'ont seat passenger, by Decedent.
8. As a direct rcsult of the aforesaid collision Decedent sustained severe,
painful and disabling injuries which resulted in her death on August 6, 2004.
9. The aforesaid collision and all the hereinafter mentioned injuries and damages
sustained by Decedent arc the direct result of the negligence, carelessness and recklessness of
Defendant as follows:
(a) In Eliling to keep alert and maintain a proper lookout for
the presence of other motor vehicles on the highway;
(b) In fai ling to keep proper and adequate control of his vehicle;
(c) In failing to stop his vehicle from colliding with Plaintiffs vehicle;
(d) In l~liling to exercise the degree of care required when operating
a vehicle on a rural route with two lanes separated only by a
double yellow line;
(c) In allowing or causing his vehicle to cross the center double
yellow line:
(I) In operating his vehicle without due regard for the rights,
safety and position of Plaintit1's vehicle at the time and place
of the aloresaid collision;
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(g) In tililing to maintain a proper lookout for traffic;
(h) In biling to yield the right of way to Plaintiffs vehicle;
(i) [n t:liling to apply his brakes in time to avoid striking
PlaintiJrs vehicle; and
(j) In t:liling to take measures to avoid striking Plaintiffs vehicle.
CLAIM I
WRONGFUL DEATH ACTION
3
10. Paragraphs I through 9 inclusive of this Complaint are incorporated herein by
reference as though fully set forth herein,
II, PlaintitThl'ings this action to recover damages therefore under and by virtue of the
Aet of 1976, .luly ~, P.L. 5~6, No. 142 S 2,42 Pa, C.S.A. S8301 and Pa. R.C.P. No. 2202(a),
12, Decedent did not bring an action for her injuries during her lifetime,
13. As a result of the aforesaid injuries and death of Decedent, Plaintiff has incurred
medical, funeral and burial expenses and other special damages, and claim is made therefore.
WHEREFORE, I'laintifl~ Ethel Taylor, executrix of the Estate of Mary M. Kauffman
a!k!a Mary E. Kauffman, Decedent, claims judgment against the Defendant, Austin D.
Makowski, for compensatory damages in an amount, exclusive of interest and costs, in excess of
any jurisdictional amount requiring compulsory arbitration in Cumberland County,
Pennsylvania.
"
CLAIM II
SURVIVAL ACTION
14, Paragraphs I through 13 inclusive of this Complaint are incorporated herein by
reference as though fully set forth herein,
15. Plaintitlbrings this action under and by virtue of the Act of 1976, July 9, P.L. 586,
No. 142, ~ 2,42 Pa, C.S,A. 9 8302,\
4
\6, As a direct and proximate result of Defendant's aforesaid acts of negligence,
Decedent suffered and Defendant is liable to Plaintiff for the following damages:
(a) Decedent's pain and suffering between the time of her
injuries and the time of death;
(b) Decedent's loss ofretirement and Social Security income;
(c) Decedent's other linanciallosses suffered as a result other death; and
(d) Decedclll's loss ofcnjoymcnt of life,
WHEREFORE. Plaintill Ethel Taylor, exeeutrix of Estate of Mary M. Kauffman
a/k/a Mary E. Kauftinan, Decedent, claims judgment against the Defendant, Austin D,
Makowski, for compensatory damages in an amount, exclusive of interest and costs, in excess of
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any jurisdictional amount requiring compulsory arbitration in Cumberland County,
Pennsylvania.
Date; ~l/~o~t
Pzf712
6regory R, Reed, Esquire
Attorney for Plaintiff
3120 Parkview Lane
Harrisburg, P A 17111
(717) 238-0434
Attorney ID #23705
5
. ....
VERIFICATION
!, ETHEL TAYLOR, Executrix of the Estate of Mary M, Kauffman a/k/a Mary E.
Kaut1inan. dcccased. hereby vcrifies that the statements in the foregoing Complaint are based
upon information which I have providcd to my attorney. ! have read the Complaint and the
allegations are true and correct to thc best of my knowledge, information, and belief. However,
the languagc of tbe COlllplaint is that of counsel, and not my own, To the extent that the contents
of this Complaint arc that of my attorney, I have relied upon them in making this verification. !
undcrstand that the statemcnts therein arc made subject to the penalties of 18 Pa.C.S.A. Section
4904, relating to unsworn Ellsitication to authorities,
Date: L-- / I / 0 S-
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Ethel Taylor, Executrix of the state of
Mary M. Kauffman a/k/a Mary E.
Kauffman, deceased
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SHERIFF'S RETURN - REGULAR
CASE NO: 2005-00576 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
TAYLOR ETHEL EXEC OF EST MARY
VS
MAKOWSKI AUSTIN D
VALERIE WEARY
Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE
was served upon
MAKOWSKI AUSTIN D
the
a true and attested copy of COMPLAINT & NOTICE
together with
DEFENDANT
, at 1129:00 HOURS, on the 9th day of February, 2005
at 39 HALF MILE DRIVE
GARDNERS, PA 17324
by handing to
DAVID MAKOWSKI, FATHER
and at the same time directing His attention to the contents thereof,
Sheriff's Costs:
Docketing
Service
Out of County
Surcharge
So Answers:
18.00
7.40
9.00
10,00
.00
44,40
?'~~~
R. Thomas Kline
me this 1'I!f'
day of
02/09/2005
EST OF MARY KAUFFMAN
(~~ty ~ff
By:
Sworn and Subscribed to before
J~ d(MS A.D.
C ).1t' - t2 'Yn~i~/. , A ~
I rothonotary'
ETHEL TAYLOR, Executrix
of the ESTATE of MARY M.
KAUFFMAN a/k/a MARY E.
KAUFFMAN, DECEASED,
Plaintiff
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYL VANIA
v.
NO. 05-576
AUSTIN D. MAKOWSKI,
Defendant
PETITION FOR APPROY AL TO COMPROMISE
WRONGFUL DEA TH/SURYIY AL CLAIMS
AND ALLOWANCE OF COUNSEL FEES
Pursuant to Pennsylvania Rule of Civil Procedure No. 2206, Ethel Taylor,
Executrix of the Estate of Mary M. Kauffman a1k/a Mary E. Kauffman, by and through
her attorney, Gregory R. Reed, Esquire, petitions your Honorable Court to approve a
compromise settlement of the wrongful death and survival actions and allow counsel fees
and in support thereof represents the following.
I. Your Petitioner is Ethel Taylor, Executrix ofthe Estate of Mary M. Kauffman
a/k/a Mary E. Kauffman, deceased.
2. On August 6, 2004 Mary M. Kauffman alk!a Mary E. Kauffman, then ninety
nine (99) years of age, died in the Carlisle Hospital after being injured in an automobile
accident on August 1,2004 when a 1998 Honda Civic driven by Defendant, Austin D.
Makowki, was allowed to travel across the double yellow line into the southbound lane
crashing into the vehicle in which Decedent was a front seat passenger.
3. On or about February 1,2005, your Petitioner filed the instant Wrongful
Death and Survival Actions on behalf of beneficiaries of the Estate of Mary M. Kauffman
a/kla Mary E. Kauffman, deceased.
4. The Decedent had been unmarried for many years, had no surviving parents
and had never had any children, natural or adopted.
5. The only beneficiary of any ofthe proceeds of this proposed settlement is your
Petitioner in her capacity as the Executrix ofthe Decedent's estate.
6. All of the beneficiaries named in the Last Will and Testarnent and Codicil of
Decedent are religious charities which are exempt from income taxation under Section
501(c)(3) of the Internal Revenue Code, as amended, and exempt from Pennsylvania
Inheritance and Estate taxes (a copy of Decedent's Will and Codicil is attached hereto,
marked Exhibit "A" and incorporated herein by reference).
7. Plaintiff and Defendant reached a compromised sl~ttlement of the Wrongful
Death and Survival Actions whereby Defendant has agreed to pay Plaintiff the sum of
Forty Thousand and 00/100 ($40,000.00) Dollars in exchang'~ for a release of all claims
and discontinuance of the case with prejudice to Plaintiff (a copy of the proposed release
is attached hereto, marked Exhibit "B" and incorporated herein by reference).
8. Petitioner and counsel for Petitioner believe it is in the best interest of said
Estate for the court to approve this settlement in lieu of the risks of a trial before a jury on
the issue of damages since Decedent was ninety-nine (99) years of age, she had a
minimal retirement income, she had an extremely short life expectancy and she
2
knowingly and intelligently refused significant medical treatment after the accident
because of her advanced age.
9. The following is an itemization of out-of-pocket expenses incurred by
Petitioner's counsel as a result of pursuing the Wrongful Death and Survival Actions:
August 17,2004
- Commonwealth ofPA
Police Report
$ 8.00
September 10, 2004 - West Shore Emergency Medical - 22,1 I
Services - Medical Records
February I, 2005
- Prothonotary of Cumberland
County (Filing Fee)
55.50
February 9, 2005
Cumberland County Sheriff
(Service)
44.40
April 8, 2005
- Belvedere Medical Center
Medical Records
33.23
TOTAL
$ 163.24
10. Petitioner entered into a contingency fee agreement with Gregory R. Reed,
Esquire, whereby she agreed to pay thirty-three and one-third (33 1/3%) percent fee for
his representation in the Wrongful Death and Survival Actions (a copy of said Agreement
is attached hereto, marked Exhibit "c" and incorporated herein by reference).
II. Petitioner's counsel is willing to reduce his fee to twenty-five (25%) percent
and waive reimbursement of expenses.
12. A complete copy of this Petition for Approval to Compromise Wrongful
Death! Survival Claims and Allowance of Counsel Fees is being served
3
contemporaneously on all residuary beneficiaries of the Estate of Mary M, Kauffman
a/kla Mary E. Kauffman and the Attorney General of the Commonwealth of
Pennsylvania.
WHEREFORE, Petitioner prays your Honorable Court to issue an Order
providing for the following:
A. Approval of the compromise settlement as fair and equitable and
authorizing Petitioner to settle the action for the sum of
Forty thousand and 00/100 ($40,000.00) Dollars;
B. Authorization to your Petitioner to execute said release and
any other documents necessary to effectuate said compromise
settlement; and
C. Distribution ofthe Forty thousand and 001100 ($40,000.00)
dollar proceeds as follows:
a. Estate of Mary M. Kauffinan alk!a
Mary E. Kauffman--------------------------------..------$ 30,000.00
b. Counsel Fee of 25%____________________________-.--_____ 10,000.00
?;;}!b5
Date
~~
Gregory R. Reed, Esquire
3120 Parkview Lane
Harrisburg, PA 17111
(717) 238-0434
Attorney 1.0. 23705
4
VERIFICATION
I, Ethel Taylor, Executrix ofthe Estate of Mary M. Kauffman alk!a Mry E. Kauffman,
Deceased, hereby verifY that the statements in the foregoing Petition for Approval to
Compromise Wrongful Death!Survival Claims and Allowance of Counsel Fees are based upon
information which I have provided to my attorney. I have read the Petition for Approval to
Compromise Wrongful Death!Survival Claims and Allowance of Counsel Fees and the facts
alleged in the foregoing Petition for Approval to Compromise Wrongful Death!Survival Claims
and Allowance of Counsel Fees are true and correct to the best of my knowledge, information,
and belief. However, the language of the Petition for Approvali:o Compromise Wrongful
DeathlSurvival Claims and Allowance of Counsel Fees is that of counsel, and not my own. To
the extent that the contents of this Petition for Approval to Compromise Wrongful
DeathlSurvival Claims and Allowance of Counsel Fees are that of our attorney, I have relied
upon him in making this verification. I understand that the statements therein are made subject
to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities.
Date: 9- ~ 3-d S'
~ ;L/t-LL ~.w'""7 &~
Ethel Taylor
contemporaneously on all residuary beneficiaries ofthe Estate of Mary M. Kauffman
a1kla Mary E. Kauffman and the Attorney General of the Commonwealth of
Pennsylvania (...b"" C.....l:i;""...l:...I.l......f 0_ .L: tt l: 21.1.t" , lU_&",J E.<h~b~1. 'If" WIU~
.
~ll"O.L 1-"-'J. akd hvH;;~U by 1 ,",&U!Fl9~).
WHEREFORE, Petitioner prays your Honorable Court to issue an Order
providing for the following:
A. Approval of the compromise settlement as fair and equitable and
authorizing Petitioner to settle the action for the sum of
Forty thousand and 001100 ($40,000.00) Dollars;
B. Authorization to your Petitioner to execute said release and
any other documents necessary to effectuate said compromise
settlement; and
C. Distribution ofthe Forty thousand and 00/100 ($40,000.00)
dollar proceeds as follows:
a. Estate of Mary M. Kauffinan alkla
Mary E. Kauffman-------n------------------------------$ 30,000.00
b. Counsel Fee of 25%------------------------------------ 10,000.00
Gregory R. Reed, Esquire
3120 Parkview Lane
Harrisburg, PA 17111
(717) 238-0434
Attorney I.D. 23705
Date
4
LAST WILL AND TESTAMENT OF MARY M. KAUFFMJIN
KNOW ALL MEN BY THESE PRESENTS, That I, MARY M. KAUFFMAN, of
the Borough of Carlisle, County of Cumberland and State of
Pennsylvania, do hereby make, publish and declare this instrument
to be my Last Will and Testament, hereby r,~voking and making void
any and all former Wills by me at any time heretofore made.
FIRST - I direct the Executrix hereof to pay all my just
debts, funeral expenses and costs of administration as soon as
conveniently may be done after my death. I further direct the
Executrix hereof to pay all inheritance, estate, transfer and
succession taxes which may be levied or assessed upon any
property which is included as part of my gross estate for the
purpose of any such tax.
SECOND - I give and bequeath the sum of One Thousand Dollars
and 00/100 ($1,000.00) to CHILD EVANGELISM FELLOWSHIP OF
CUMBERLAND COUNTY, PENNSYLVANIA.
THIRD - I give, devise and bequeath all the rest, residue
and remainder of my estate, both real and personal, as follows:
(a) One-third(1/3) thereof to CHAPEL POINT,
Carlisle, Pennsylvania;
(b) One-third (1/3) thereof to THE FRIENDS
OF ISRAEL GOSPEL MINISTRY, INC., Bellmawr,
New Jersey; and
(c) One-third (1/3) thereof to BACK TO THE
BIBLE, INC., Lincoln, Nebraska.
EXHIBIT "A"
m.m ?l.
FOURTH - I appoint my friend, ETHYL TI\YLOR, to be the
Executrix of this, my Last Will and Testament. I do hereby give
to the Executrix hereof full power, discretion and authority at
any time or times to sell, at private or ptilllic sale, mortgage,
lease, pledge, exchange or otherwise deal \-Tith or dispose of the
property comprising my estate upon such terms as deemed best, to
settle and compound any and all claims in f'avor of' or against my
estate as deemed best and, for any of the foregoing purposes, to
make, execute and deliver any and all deeds, mortgages,
contracts, leases, bills of sale or other instruments necessary
or desirable therefor.
LASTLY - I direct that no fiduciary appointed by this, my
Last Will and Testament, shall be required to give Bond and that
if, notwithstanding this direction, any Bond is required by any
law, statute or rule of court, no Surety shall be required
thereon.
IN WITNESS WHEREOF, I have set my hand and seal to this, my
Last Will and Testament, consisting of three (3) pages on the
IYJ. m. ')(
margin of which (except this page)
. d.t. fJt~
thl.s :1..", day of ()
I have affixed my initials
, A.D. 1997.
~1~'~~-.'J
Ma y M K uf aIJ6
(SEAL)
Signed, sealed, published and declared by Mary M. Kauffman,
the above named Testatrix, as and for her I,ast Will and
Testament, in the presence of us and each of us, who at her
request, and in her presence, and in the presence of each other,
have hereunto subscribed our names as attesting witnesses.
~ /7
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ACKNOWLEDGMENT
STATE OF PENNSYLVANIA
:ss
COUNTY OF DAUPHIN
I, MARY M. KAUFFMAN, the testatrix whose name is signed to
the attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; and that I signed it
willingly and as my free and voluntary act for the purposes
therein expressed.
Sworn to or affirmed and
acknowledged
.u.l:I. day of
before me by MARY M.
KAUFFMAN, the testatrix, this
~u~k
, 1997.
~fl?~'7Y~
Y KAUF N estatrix
~~~
Notary P lic
NOTARIAL SEAL
GREGORY R. REED, Notary Public
Hanisbu11l, t'auphln COuIl!y
My Commission E:qllres Mar. 19, 2001
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
:ss
COUNTY OF DAUPHIN
We, L..a.UM.. /J1. /?c.we7f and :r4~'" O<cthta...sfc.,'N ,the
witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw the~testatrix sign and execute
the instrument as her Last Will; that the testatrix signed
willingly 2and executed it as her free and voluntary act for the
purposes therein expressed; that each subscribing witness in the
hearing and sight of the testatrix signed the will as a witness;
and that to the best of our knowledge the testatrix was at that
time 18 or more years of age, of sound mind and under no
constraint or undue influence.
Sworn
L<tu"",- f}J.
witnesses,
1:9, or affirmed and subscribed to before me by
I((;wett and :Tol..... I&tbe...sfe.lN ,
this ~ day of ~".sr , 1997.
//OTARIAL SEAL
GREGORY R. REED. Notary Public
Harrisburg. Dauphin County
My Commission hplres Mar. 19,2001
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GENERAL RELEASE
For the consideration of Forty Thousand Dollars ($40,000,00), receipt of whk:h is hereby acknowledged, I/we release and
discharge, and for myself/ourselves and for my lour heirs, representatives, executors, administrators, successors and assigns,
do hereby remise, release and forever discharge David S. Makowski, Ramona A. Makowski, and Austin Makowski
hereinafter referred to as the releasee(s), hislher/their/its heirs, executors, administrators, insurers, successors and assigns, and
any and all other persons, firms, corporations, associations, of and from any and all causes of action, suits. rights, judgments.
claims and demands of whatsoever kind, in law or in equity, known and unknown, which I1we now have or may hereafter
have, especially the claimed legal liability of releasee(s), arising from or by relll'.on of any and all bodily or personal injuries
and/or property damage known and unknown, foreseen and unforeseen which hen~tofore haslhave been or which hereafter may
be sustained by me/us arising out of the accident on or about August 1, 2004, at or near Route 34, Mount Holly Springs, in the
County of Cumberland, in the State of Pennsylvania, which liability releasee(s) expressly deny(ies).
IIWe agree that the consideration set forth above is specifically applicable to ard paid to me/us with respect to any and all
damage to any property, either real or personal, of mine/ours and with respect to any and all personal or bodily injury of
mine/ours, whether presently known or unknown, foreseen or unforeseen or which may subsequently develop and the
consequences thereof, all as arising out of the aforementioned accident
IIWe further agree that the consideration set forth above is specifically applicable 1:0 and paid to melus with respect to any right
of contribution that I1we may have against the releasee(s), hislher/their/its heirs, executors, administrators, insurers, successors
and assigns relative to claims of others that may be brought against melus by reason of said accident
IIWe further agree that the consideration set forth above is specifically applicable to mylour agreement that I1we will not join
nor attempt to join the releasee(s), hislher/their/its executors, administrators, insurers, successors and assigns in any capacity,
in any action that may be brought against me/us arising out of said accident
IIWe warrant for myself/ourselves and mylour heirs, representatives, executors, administrators, successors and assigns that
I/we have received no money or other valuable consideration from any other person or persons by reason of any causes of
action, suits, covenants, agreements, judgments, claims and demands of whatsoever kind, which I/we now have or may
hereafter have. for injuries to mylour person or property or for the other matters for which this release is given.
I1we further understand and agree that this Release is inclusive of any and all prest~nt and future liens or claims for subrogation
against the payments to be made in accordance with this Release. I1we understand and agree that I/we are responsible for the
payment of any liens or charges against the payments to be made hereunder should any such liens, subrogation, claims or
claims for expenses and charges be asserted, This inclndes, but is not lin:rited to, medical expense liens, workers'
compensation liens, ERISA liens, liens asserted by any federal, state or local governmental entity or agency or any medical
expense claim. Should any person or entity make claim for payment of any liens Olt charges against The ERIE or their counsel,
I/we agree to indenmify and hold harmless The ERIE and their counsel from any and all such liens, charges, fees, claims,
attorney fees, costs, interests and any other sum.
I/we understand that this settlement is the compromise of a disputed claim, and tlJ.at the payment is not to be construed as an
admission of liability on the part of the persons, firms and corporations hereby released by whom liability is expressly denied,
Intending to be legally bouOO thereby, WITNESS my/our band(s) and seal(s) this
day of
NOTICE:
Any person who knowingly and with intent to defraud any insurance company Olr other person f1les an application for insurance or
statement of daim containing any materially false informalioo or conceals for tbe purpose of misleading, information cooceming
any fact material thereto commits a fraudulent insurance act, whidt is a crune and subjects the person to c:rlminaJ and c:ivil
penalties. .
WITNESS
(Seal)
(Seal)
Claim #010170762071
C. Marshall:tam
REU 12/04
Page 1
1177528_ LDOC
EXHIBIT "B"
CONTINGENT FEE AGREEMENT
It is agreed between ETHEL TAYLOR, individually and ETHEL TAYLOR,
Executrix of the Estate of MARY M. KAUFFMAN alk!a MARY E. KAUFFMAN,
(hereinafter known as "Plaintiffs") and GREGORY R. REED, ESQUIRE, (hereinafter
known as "Attorney"), as follows:
1. Plaintiff(s) engage Attorney to represent (him, his, her, their) claim against
AUSTIN DAVID MAKOWSKI and any related uninsured or lmderinsured claims.
2. The Attorney agrees to devote his best efforts to the: damages for injuries
sustained in the above claim on behalf of the Plaintiffl:s).
3. For services to be rendered by the Attorney and in the event Attorney obtains
a settlement or verdict in favor ofPlaintiff(s), Plaintiff(s) agree to pay to the Attorney a
contingent fee of thirty-three and one-third (33 1/3%) percent.
4. The Plaintiff(s) agree to be responsible for all costs incurred in the litigation
which shall include but not be limited to court costs, witness fees, medical reports and
testimony, photographs, photocopies, long-distance telephone calls, postage, etc.
Photocopy, long-distance telephone calls, and postage are billed monthly.
5. In the event that the Plaintiff(s), after the Attorney has instituted court action,
for whatever reason, discharges the Attorney, retains other counsel to prosecute the
action, and receives a settlement or verdict, the Attorney shall be entitled to charge the
Plaintiff(s) the time the Attorney has spent working the case on an hourly basis or twenty
percent of any settlement or verdict the Plaintiffls) receive, whichever is the greater sum
or amount.
6. Although the Attorney shall utilize his best effort on behalf of
the Plaintiffl:s), the Attorney cannot and does not guarantee any result favorable to the
Plaintiff(s).
7. In the event that the PlaintiffZs) do not cooperate with. the Attorney
to Attorney's satisfaction, the Attorney shall have the right to cancel the within
Agreement. In the event that the Attorney cancels this Contingent Fee Agreement,
retains other counsel to prosecute the action, and receives a settlement or verdict, the
Attorney shall be entitled to charge the Plaintiff for time the Attorney has spent working
on the Plaintiffl:s)' case on a hourly basis or twenty percent of any settlement or verdict
the Plaintiff(s) receive whichever is the greater sum or amount.
EXHIBIT "C"
IN WITNESS WHEREo~es hereto have hereunto set their hands and
seals the ~ day of ... , 2004.
t.L4d-~r">i-~
Ethel Taylor
to~ ~~. G:,;4v-
Ethel Taylor, Exel~ut
Gre~{.
I, ETHEL TAYLOR_ hereby acknowledge receipt ofa copy of the above Contingent
Fee Agreement dated the <it!- day of ~~ .2004.
~~ ..ddY.-bv
CERTIFICATE OF SERVICI~
AND NOW, this 23rd day of September, 2005, I, Gregory R. Reed, Esquire,
Attorney for Plaintiff, do hereby certify that I have this day served by first class mail a
copy ofthe attached, Petition For Approval To Compromist: Wrongful DeathlSurvival
Claims and Allowance of Counsel Fees to the following address:
Tom Corbett, Esquire
Attorney General
Strawberry Square 16th Floor
Harrisburg, PA 17120
Chapel Pointe of Carlisle
770 South Hanover Street
Carlisle, P A 17013
The Evangelization Society
of Philadelphia, Inc.
P.O. Box 11527
Philadelphia, PA 19116
Back to the Bible
6400 Comhusker Highway
Lincoln, NE 68507
G,~fJ
regory . ee:, sqUire
3120 Parkview Lane
Harrisburg, P A 17111
(717) 238-0434
Attorney 1.0 23705
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ETHEL TAYLOR, Executrix
of the EST ATE OF
MARY M. KAUFFMAN alk/a
MARY E. KAUFFMAN, DECEASED,
Plaintiff
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
PENNSYL VANIA
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ORDER
AUSTIN D. MAKOWSKI,
Defendant
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AND NOW, this ::10' day of J;o~ ,2005, upon consideration ofthef ·
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written Petition for Approval to Compromise Wrongful Death!Survival Claims and
Allowance of Counsel Fees, it is hereby ORDERED AND DECREED that:
1. The compromise settlement described in the within Petition is approved as
being fair and equitable and the parties may compromise these actions upon said terms.
2. Distribution of the $40,000.00 proceeds shall be as follows:
(A) Counsel Fee of 25%------------------------------------ $ 10,000.00
(B) Estate of Mary M. Kauffman a1kla
Mary E. Kauffman under the-------------------------- 30,000.00
3. It is further ordered and directed that the settlement as herein approved shall
be in full settlement ofthe liability of the Defendant, Austin D. Markowski, and his
insurer for all causes of action or claims that the Plaintiff or any other person or party
have or may have as a result ofthe death of Mary M. Kauffman a1k1a Mary E. Kauffman
on August 6, 2004 which are more fully described in the aforesaid Petition and that
counsel for the Plaintiff, upon payment of the total sum of Forty thousand and 001100
($40,000.00) Dollars as directed hereinabove, shall enter a full satisfaction of the within
action upon the docket of this court. Petitioner is authorized to execute a release and any
other documents necessary to effectuate the receipt of said sums of money and to
terminate with prejudice to Plaintiffthe aforesaid Survival and Wrongful Death Actions.
By the court,
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Gregory R. Reed, Esquire
3120 Parkview Lane
Harrisburg, PAl 7111
(717) 238-0434
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ETHEL TAYLOR, Executrix
of the ESTATE OF MARY M
KAUFFMAN a1k1a MARY E.
KAUFFMAN, DECEASED,
Plaintiff
v.
AUSTIN D. MAKOWSKI,
Defendant
To: Curt Long
Prothonotary
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYL VANIA
NO. 05-576 Civil Term
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JURY TRIAL DEMANDBij)
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PRAECIPE
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Please mark the above referred to case "settled, satisfied and discontinued."
Date: M~ ~, ~<l..::;
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Gregory R. Reed, Esq.
Attorney for Plaintiff
3120 Parkview Lane
Harrisburg, P A 17111
(717) 238-0434
Attorney 1.0. #23705
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