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HomeMy WebLinkAbout14-5506 Supreme C,o lansylvania Cou , o in mleas o For Prothonotary Use Only: 11 C ,Hgery; Docket No:Cum County The information collected on this fibrin is used solely for court administration purposes. This form does not supplement or replace thefiling and service of pleadings or other papers as required ky law or rules of court. Commencement of Action: [3Complaint El Writ of Summons 0 Petition S E3Transfer from Another Jurisdiction Declaration of Taking E c Lead Plaintiff s Name: Lead Defendant's Name: David Sledzinski Eric S. Jacobs T I Ar;emoney damages requested? El Yes E3 No Dollar Amount Requested: nX within arbitration limits 0 (check one) noutside arbitration limits N Is this a Class Action Suit? [3 Yes [9 No Is this an MDJAppeal? 0 Yes El No A Name of Plaintiff/Appellant's Attorney: David H Rosenberg E3 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 0 Intentional Buyer Plaintiff Administrative Agencies 0 Malicious Prosecution Debt Collection:Credit Card [3 Board of Assessment 1@ Motor Vehicle n Debt Collection:Other [3 Board of Elections [3 Nuisance Dept.of Transportation 0 Premises Liability 8 Statutory Appeal:Other S Product Liability(does not include E3 Employment Dispute: E mass tort) Discrimination Slander/Libel/Defamation C [3 Other: Employment Dispute:Other [3 Zoning Board T 0 Other: I [] Other: O MASS TORT [3 Asbestos N E] Tobacco Toxic Tort-DES Toxic Tort-Implant REAL PROPERTY MISCELLANEOUS n Toxic Waste [I Ejectment n Common Law/Statutory Arbitration B Other: n Eminent Domain/Condemnation E] Declaratory Judgment 0 Ground Rent Mandamus [3 Landlord/Tenant Dispute BNon-Domestic Relations 0 Mortgage Foreclosure:Residential Restraining Order PROFESSIONAL LIABILITY ID Mortgage Foreclosure:Commercial 0 Quo Warranto Q Dental n Partition 0 Replevin M Legal 13 Quiet Title 11 Other: Medical Other: Other Professional: Updated I/1/2011 0 Til ONO TA David H Rosenberg Attorney ID#20569 ° SEP 16 Pl, t. 17 HANDLER,HENNING&ROSENBERG, LLP CUMBERL 4h'D 1300 Linglestown Road �'Etd 'S'tL , ��UNTY Harrisburg, PA 17110 Telephone: (717)238-2000 Attorney for Plaintiff(s) Fax: (717)233-3029 E-mail: Rosenberg@hhriaw.com IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY,PENNSYLVANIA No.2014 ^S .U t Civil Action- Law David L. Sledzinski Eric S.Jacobs 1310-A S Market Street 58 Creek Rd Mechanicsburg, PA 17055 Dillsburg, PA 17019 vs Adam Todd Kanter 5623 Moreland Court Mechanicsburg, PA 17055 Plaintiff(s)&Address(es) Defendant(s)&Address(es) PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY OF SAID COURT: Please issue Writ of Summons in the above-captioned action. Writ of Summons shall be issued and forwarded to( )Attorney(XX)Sheriff. David H Rosen rg Supreme Co rt ID No.20569 Date: 9/11/2014 . �� 311151 David H Rosenberg Attorney ID#20569 HANDLER,HENNING&ROSENBERG, LLP 1300 Linglestown Road Harrisburg,PA 17110 Telephone: (717)238-2000 Attorney for Plaintiff(s) Fax: (717)233-3029 E-mail: Rosenberg@hhrlaw.com DAVID L. SLEDZINSKI IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff ( ! �� C(U I versus NO. I 1 ERIC S.JACOBS and ADAM TODD KANTER CIVIL ACTION -LAW Defendant(s) WRIT OF SUMMONS TO THE ABOVE NAMED DEFENDANT(S): YOU ARE HEREBY NOTIFIED THAT THE ABOVE-NAMED PLAINTIFF(S) HAS/HAVE COMMENCED AN ACTION AGAINST.YOU. Date: 01 Prothonotary Deputy HANDLER, HENNING & ROSENBERG LLP David H Rosenberg (PA 20569) Laurie J. DeBarr (PA 204374) 1300 Linglestown Road, Suite 2 Harrisburg, PA 17110 Ph. 717.238.2000 Fax 717.233.3029 Rosenberg@hhrlaw.com debarr@hhrlaw.com OF THE: PROTHONO TA 2014 OCT —5 "11 t CUh1ts e -" -;,',!D A 1, COUNTY '� PE/NS YL V Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA David L. Sledzinski, Plaintiff, CIVIL ACTION — LAW v. NO.: 2014-5506 Civil Eric S. Jacobs and Adam Todd Kanter., Defendants. MOTION FOR DISCONTINUANCE AS TO DEFENDANT ADAM TODD KANTEER Plaintiff, David L. Sledzinski, by and through his attorneys, Handler, Henning & Rosenberg, LLP, hereby moves this Court to voluntarily discontinue this action against defendant, Adam Todd Kanter pursuant to Rule 229 of the Pennsylvania Rules of Civil Procedure, stating in support thereof as follows: I 1. Plaintiff, David L. Sledzinski ("Mr. Sledzinski"), commenced this action by Writ of Summons filed on September 16, 2014, for personal injuries Mr. Sledzinski sustained as a result of a motor vehicle collision that occurred November 5, 2012, in Upper Allen Township, Cumberland County, Pennsylvania (the "Collision"). 2. The Police Crash Reporting Form ("Police Report") documenting the Collision listed Eric S. Jacobs as the driver of the at -fault vehicle and Adam Todd Kanter as the owner of the at -fault vehicle. A copy of the original Police Report is attached as Exhibit A. 3. Based upon the information provided in the original Police Report, both Eric S. Jacobs and Adam Todd Kanter were named as defendants in the writ. 4. Subsequent to the filing of the writ, Mr. Sledzinski learned that the original Police Report mistakenly contained Mr. Kamter's vehicle information due to a typographical error made by the investigating officer. 5. Mr. Sledzinski was unaware that a corrected Police Report had been prepared, which documented that the at -fault vehicle involved in the Collision was driven and owned by Defendant Jacobs. Page 2 of the corrected Police Report faxed to the undersigned's office on September 30, 2014, is attached as Exhibit B. 6. Mr. Kanter was not involved in the Collision and Defendant Jacobs will not be prejudiced by a voluntary, discontinuance of the action against Defendant Kanter. 7. Pursuant to Local Rule 208.2(d), counsel for Defendant Kanter concurs in the filing of this Motion. To date, counsel for Defendant Jacobs has not entered an appearance. 8. Pursuant to Local Rule 208.3(a), no judge has ruled on any issue in this matter. 2 WHEREFORE, Plaintiff, David L. Sledzinski, respectfully requests that this Honorable Court grant him leave to voluntarily discontinue this action against Defendant, Adam Todd Kanter, only. Respectfully submitted, HANDLER, HENNING & ROSENBERG, LLP Dated: /a 6-(1 y By: David H Rose . erg {PA 20569) Attorneys for plaintiff Print CRS W0310125 2 3 4 6 7 e e COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM Case Closed Reportable Crash 0 Yes 0 No 0 Yes 0 No AA'500 1 Page 1111111 OI 111111111I W0310125 Page 1 of 7 Crash Number �I a Incident Number Police Agency Patrol Zone ff UAT20121100133 21104 01 1 Agency Name Precinct Investi.ation Date (MM-DD-YYYY) Upper Allen Township - 05 - 2012 Dispatch Time (mil) Arrival Time (mil) Investigator Badge Number 1402 1406 MICHAEL KEISTER 2304 Reviewer Badge Number Approval Date (MM-DD-YYYY) ANDREW D PARSONS 2309 11 = 07 - 2012 County County Name Munici • lity Municipality Name pa a of !Wets 21 Cumberland 104 Upper Allen Township 0 Sun 0 Thu Crash Date (MM-DD-YYYY) Crash Time (mil) No of Units People Injured Killed" *If > 00 0 Mon 0 Fri 11 - 05 - 2012 L402 2 2 2 0 FocompleteF O Wed Dunk Workzone r� Y� Complete Form )vl Section 29) ©Yes O No School iki Related ©Y� O N0 School Zone Related 0 Yes O No Not) PENNDOT Malrt�tenance O Yes 0 No I °� SO Intersection tiwt 0 4 Way 0 "Y'. Intersection 0 Multi -Leg 0 "Spada! ,Location 00 O Midblock Intersection 'T" Intersection Traffic Circle/ Intersection Oft Ramp O Round About 0 On Ramp 0 Crossover 0 Railroad Crossing Q Other tr See l ° I aStreet Ti k Route Number Segment (Optional) Travel Lanes S • - • Limit 0 N°rth House Number (if applicable) 02 c 0 South Name • Street Ending 2 O East For Mid-block crashesonly. Use GETTYSBURG PK o O Unknown °r1 dp House postal �yh Street Name i surer and make filled in if using this option Route Interstate Slam Q (Not Turnpike Turnpike) Q (East/West) O Turnpike State County Spur 0 Highway O Road Local Road O or Street Private O Road Other/ O Unknown V Route Number Segment (Optional) Travel Lanes Speed Limit O North c ° O South i Street Name Street Ending O East 4 O O West 0 Unknown . BQ1dte O Interstate Slgnino (Not 0 Turnpike Turnpike) (East/West) a Turnpike O State 0 County Spur Highway Road O local Road or Street Q Private Q Other/. Road Unknown Distance Tram Landmark Use For Mid • Block Crashes �a:�ogmv Ea -'so g 0 Intersecting Rt Num Or Mile Post Or Segment Marker x a ❑ p s 0 North 0 South 100 g. Or Intersecting Street Name St Endin.. J O Fast Or Miles GRANTHAM RD E 0 west C Intersecting R4 Num Or Mile Post Or Segment Marker1.1 Distance From Crash Scene to Landmark 1 Crash between Landmark 1 and Landmark 2) i „ O North O South Or Intersecting Street Name se Ending(For 0 East ° O West a Degrees Minutes Seconds Degrees Minutes Seconin ds Latitude: 40 09 : 24 ° 000 Longitude: — 77 00 - 26° 000 Traffic Control DevicePolice Officer or 0 Sign 0 l Fundi°n►no Yield 0 Not Applicable 0 Traffic Signal Active RR Crossing Flagrrlan 0 Controls 0 Other Type TCD Flashing Traffic O Signal O Stop Sign O Passive RR 0 Unknown Crossing Controls O No Controls 0 Device Functioning , Emergency Improperly p Signal Q Device Not 0 Device Functioning O Unknown Functioning Properly $ lane -Closed Of °Not Applicable”, skip rest of the Lane Closure section) 0 Not Applicable 0 Partially O Fully 0 Unknown lane Cbsuce O North 0 East Q North and South C) All Direction (N,S,E,W) 0 0 South Q West 0 East and West Traffic Yes 0 No Q �` peto°rad Unknown C) Ell -rim 0 < 30 Min. C) 30-60 Min. Q 1-3 hrs 0 3.6 hrs Q 6-9 his Q > 9 hours 0 Unknown FORM R M-096 (12/02) https ://www. dot6. state.pa.us/crs ap Print CRS W0310125 10 11 1 (CORfil(nfil®NW(EALTRI CIF PENNSYLVANIA PUKE CRASH REPORVONG FORA AA 500 2 Police Use Only Page: 2 Page 2 of 7 III IINI IOIIiIIIIIIIIII Crash Number W0310125 o e a, Motor Vehicle in Type O Transport O Hit & Run Vehicle Q Illegally Parked O Legally Parked Q Non - Motorized Unit O pedestrian O Pedestrian on Skates, O Disabled From O Train Q Phantom Vehicle in Wheelchair, etc Previous Crash (If "Pedestrian" or "Pedestrian on Skates, in Wheelchair, etc", Complete Form M, Section 28) Commercial Vehicle 0 Yes Q No (If Yes, Complete Form C) 0 e I 6 d 0 d g y Unit No First Name MI Date of Birth (MM-DD-YYYY) 01 ERIC • S 07 12 ' 1970 Last Name Telephone Number Delete? O JACOBS 7178021957 Address / City / State • Zip 58 CREEK RD DILLSBURG PA 17019 Driver License Number State Class 22159166 PA C Alcohol/Drugs Suspected Driver or Pedestrian Physical Condition Q No 0 Illegal Drugs Q Medication 0 Alcohol 0 Alcohol and Drugs 0 Unknown O omrael O Had Drinking ntly O Illegal Drug OFati Fatigue Q Medication Been 0 sick O Asleep 0 Unknown Alcohol Test Type Test Not Given Q Breath 0 Other Primary Vehide Code Violation Charged? Q Q Blood 0 Urine O Test ow nif 3714 A.CARELESS DRIVING 0 Yes O No Alcohol Test Results Test Refused Resultwn Driver Presence 1=Driver Operated 3=Driver Fled Scene 0 0 � Test Given, O — 1 Vehicle 4=Hit and Run • Contaminated Results 2=No Driver 9=Unknown Owner/Driver 00=Not Applicable 02=Private Vehicle Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh Owned/Leased by Driver 05=PENNDOT Vehicle 08=Other Municipal 98=Other 02 01=Private Vehicle Owned/ Leased by Driver 03=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown o 2 E np c o Ti 4.1 Same Owner First Name Owner Last Name or Business Name (If Pedestrian, skip this Section) as Driver C) ADAM TODD KANTER Address / City / State / 2ip Vehicle Make *Make Code 5623 MORELAND CT MECHANICSBURG PA 17055 Hyundai • 55 VIN Model Year Vehicle Model (see overlay) 5NMSKDAG5AH346603 2010 SW License Plate Reg. State Est. Speed Vehicle Towed Towed By FINT0837 PA 025 0 Yes O No ZIMMERMAN'S AUT insurance Insurance Company Policy No Q Yes 0 No O kr own AMICA 930137-20UL Trailing Type 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No Tag Year Tag St Unit No.. ofUnit Trailing 0 2=Towing Truck 5=Camper B=Other 3=Towing Utility Trailer 6=Full Trailer 9=Unknown Direction of (m "Vehicle Position 01 *Movement 01 *See Special Usage ra W — ` � Overlay Vehicle Color Vehicle Type 05=La e Truck 20=Unicycle, Bicycle, 00 12=Commercial 01 06=Yellow 07=Silver 07 01=Automobile 06=SUV Tricycle 02=Moto RY cle 07=Van 21=Other Pedalcycle 22=Horse & Buggy. Carrenger 01=Not Applicable Carrier 01=Fire Veh 13=Taxi 08=Gold 01=Blue 09=Brown 02=Red 10=Orange 03=White 11=Purple 04=Green 12=Other 05=Black 99=Unknown 03=Bus 10=Snowmobile 04=Small Truck 11=Farm Equip 23=Horse & Rider (If "02", Complete Form 12=Construction Equip 24=Train M, Section 26) 13=ATV 25=Trolley (ft "20" or "21", Complete 18=Other Type Spec Veh 98=Other Form M, Section 27) 19=Unk. Type Spec Veh 99=Unknown 02=Ambulance 21=Tractor Trailer 03=Police 22=Twin Trailer 08=Other Emergency 23=Triple Trailer Vehicle 31=Modified Veh 11=pupil Transport 99=Unknown Initial Impact Point Damage indicator Gradient 3=Downhill Road Alignment 12 00=Non-Collision 14=Undercarriage 01-12=Clock Points 15=Towed Unit 3 0=None 2=Functional C 1=Minor 3=Disabling 3 — 1 -Level 4=Bottom of Hill 5=Top of Hill 2=Uphill 1 1=Straight 2Curved 13=Top 99=Unknown 9=Unknown 9=Unknown 9=Unknown :ORM N RA -500 (12/02) PENNDOT COPY https://www.dot6.state.pa.us/crsapp/PrintImages/XmlFiles/2012110785201303271315441... 3/27/2013 Print CRS W0310125 10 11 COMMONWEALTH OF PENNSYLVANIA I OUCEc SIS G FORM 1 AA 500 2 Police Use Only Page: I I I Page 3 of 7 IIUI�I� Gash Number W0310125 oMotor g rn Vehicle in Tyce Transport 0 Nit & Run Vehicle Q Illegally Parked O Legally Parked Q Non - Motorized UnitPedestrian on Skates, Disabled From 0 Pedestrian Qin Wheelchair, etc O Previous Crash Q Train 0 Phantom Vehide (If 'Pedestrian' or 'Pedestrian on Skates, in Wheelchair etc', Com • Iete Form M, Section 28) Commercial Vehicle 0 Yes 0 No (If Yes, Complete Form C) Vehicle Driver / (Pedestrian information Unit Na First Name Ml Date of Birth (MM -DD YYYY) 02 DAVID L 05 09 1957 Last Name Telephone Number Delete? 0 SLEDZINSKI 7178025236 Address / Gty / State Zip 10 GEORGE CIRCLE MECHANICSBURG PA 17055 Driver License Number State Class 21104952 PA C Alcohol/Drugs Suspected Driver or Pedestrian Physical Condition 0 No 0 Alcohol O Illegal Drugs 0 Medication 0 Alcohol and Drugs O UnknownHad NorntlyOUgDrugO nal0 Fatigue 0 Medication Been 0 Drinking O Sick 0" Asleep 0 Unknown Alcohol Test Type 0 Test Not Given 0 Breath 0 Other Primary Vehide Code Violation Charged? 0 Blood 0 Urine 0 trigtoverrtd N/A . O Yes Q No Alcohol Test Results 0 Test Refused O Unknown Driver Prexetrce 1—Driver Operated 3=Driver Fled Scene O Test Given, O Vehide 4=1 -lit and Run • Contaminated Results 2=No Driver 9=Unknown Owner/Driver 00=Not Applicable 02=Private Vehicle Not 04=State Police Vehicle 07=Munidpal Poke Veh 09=Federal Gov Veh Owned/Leased by Driver 05=PENNDOT Vehicle 0B=Other Municipal 01 01=Private Vehicle Owned/ Leased by Driver 03=Rented Vehicle 98=Other 06=Other State Gov Veh Government Vehicle 99=Unknown a E Same as Owner first Name Owner Last Name or Business Name (If Pedestrian, skip this Section) Driver 0 RANDAL L HOLLINGER Address / City / State / Zip Vehide Make *Make Code 1327 N STRICKLER RD MANHEIM PA 17545 Chevrolet 20 VIN Model Year Vehide Model (see overlay) 1GCGD3450GF353059 1986 TK License Pete Reg. State Est. Speed Vehicle Towed Towed By YZC0073 PA 010 0 Yes 0 No insurance Insurance Company Policy No 0 Yes O No , O known ERIE INSURANCE EX Q05 08 30583 TrailingType 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No Tag Year Tag St Unit No. Trailing Units: of Unit _„_ 2=Towing Truck 3=Towin9 Utility Trailer S=Camper B=Other 6=Full Trailer 9=Unknown Direction of *Vehide Position 01 *Movement 01 *See Special Usage Travel Overlay Vehicle Color Vehicle Type 05=Large Truck 20=Unicycle, Bicycle, 00 12=Commercial 01 06=Yellow 07=Silver 04 01=Automobile 06=SUV 02=Motorcycle 07=Van Tricycle00Jot ., 21=Other Pedalcyde Passenger Applicable Carrier 01=Fire Veh 13=Taxi OB=Gold 01=Blue 09=Brown 02=Red 10=Orange 03=White 11=Purple 04=Green 12=Other 05=Black 99=Unknown 03=Bus 10=Snowmobile 04=Small Truck 11=Farm (ff "02", Complete Form 12=Construction M, Section 26) 13=ATV (If "20" or 21 ", Competa 18=Other Form M, Section 27) 19=Unk. 22=Horse & Buggy Equip 23=Horse & Rider Equip 24=Train 25=Trolley Type Spec Veh 98=Other Type Spec Veh 99=Unknown yP P OZ=Ambulance 21=Tractor Trailer 03=Police 22 Twin Trailer 08=pther Emergency 23=Triple Trailer PupiVehl Transport 31=Modified Veh 11=Pupil 99=Unknown Initial Impact Point Damage Indicator Gradient 3=Downhill Road Alignment 06 00=Jon-Collision 14=Undercarriage 01-12=Clock Points 15=Towed Unit 1 0=None 2=Functional 1=Minor 3=Disabling "'—" 3 4=Bottom of Hill 1=Level 5=To of Hill (1 1=Straight I 2=Curved 13=Top 99=Unknown — unknow — 2=Uphill k known 9=Unknown FORM Y AA -500 (12102) PENNDOT COPY https://www.dot6.state.Da.usiersann/PrintimaPesNm1Files/9n1711 n7R57n1'tfl1')71'41 Can 1 .•2 /I/ /1/11 Print CRS W0310125 1 t COMMONWEALTH OF PENNSYLVANIA —E POLICE CRASH REPORTING FORM AA5003 Police Use Only, Page 4 Page 4 of 7 III IIIIIIIIIIIIIIIIIIIIIIJ Crash Number n W0310125 a ® S a ® w E, o a. Person Tyne: Soar Position _ Safe?), Equipment One: Eiection: A 1=Driver D 00=Not A Passenger/Occupant E 00=None Used / Not Applicable G O=Not Applicable 2=Passenger 01=Driver - All Vehides 01=Shoulder Belt Used 1=Not Ejected 7=Pedestrian 02=Front Seat Middle Position 02=Lap Belt Used 2=Totally Ejected 8=Other 03=Front Seat Right Side 03=Lap And Shoulder Belt Used 3=Partially Ejected 9=Unknown 04=Second Row - Left Side Or 04=Child Safety Seat Used 9=Unknown Motorcycle Passenger 05=Motorcycle Helmet Used 05=Second Row - Middle Position 06=Bicycle Helmet Used H Ejection Path: 06=Second Row - Right Side 10=Safety Belt Used Improperly : O=Not Ejected / Not Applicable 07=Third Row Or Greater - 11=Child Safety Seat Used Improperly B F =Female Left Side 12=Helmet Used Improperly 1=Through Side DoorOpening M=Male 2=Through n Window ow Type Unknown U =Unknown 08=Third Row Or Greater - 90=Restraint Used, 3=Through Windshield • Middle Position 99=Unknown 4=Through Back Door 09=Third Row Or Greater - 5=Through Back Door Tailgate Opening Right Side Safety Eauinment Two: 6=ThroughoRoofTOpening (Sunroof/ Iniuty Seyeriiv: 10=Sleeper Section of Truckcab F 00=None Used / Not Applicable Convertible Top Down) CO=Not Injured 11=ln Other Enclosed . 01=Front Air Bag Deployed (For This Seat) 7=Through Roof Opening (Convertible 1=Killed Passenger Or Cargo Area 02=Side Air Bag Deployed (For This Seat) Top Up) 2=Major Injury 12=1n Open Area 03=Other Type Air Bag Deployed 9=Unknown 3=Moderate (Back Of Pickup, Etc.) 04=Multiple Air Bags Deployed Injury 13=Trailing Unit 05=Motorcycle Eye Protection 4=Mmor Injury 14=Riding On Vehicle Exterior 06=Bicyclist Wearing Elbow/Knee/Padsparkatiort 8=Injury, link 15=Bus Passenger , 10=Air Bag Not Deployed, Switch On � O=Not Applicable Seventy 98=Other 11=Air Bag Not Deployed, Switch Off 1=Not Extricated 9=Unknown if 99=Unknown 12 Air Bag Not Deployed, 2=Extricated By Mechanical Means Injury 13=Airnk BSw Reh Setting moved (Prior To Crash) 3=Freed By Non - Mechanical Means =Otr 19=Unknown If Air Bag Deployed 9=UUnknown • 99=Unknown • EMS Agency: N/A Medical Facility: N/A • Unit No Person No Date of Birth (MM-DD-YYYY) A 8 C D E F G H I 0 O No Delete? � � 01 01 p 07 — 12 — 1970 1 M ' 01 03 01 (" 10 Name / Address / Phone ' EMS Transport • Operator Same as JACOBS, ERIC S 58 CREEK RD DILLSBURG PA 17019 7178021957 O Yes Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E. F G H I j I 0 No Delete? Fill -V-11 (� 02 01 O 05 — 09 — 1957 • 4 01 03 12 0 Fri Name / Address / Phone EMS Transport R Same as SLEDZINSKI, DAVID L 10 GEORGE CIRCLE MECHANICSBURG PA 17 Operator 0 Yes Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H I Li O No Delete? , o — — LE , Name I Address I Phone EMS Transport Same as Operator O Yes Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H I n 0 No Delete? 0 - - n Name / Address / Phone EMS Transport O Same as Operator 0 Yes Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H I Delete? { 0 — — I Name / Address / Phone EMS Transport O No Same as Operator 0 Yes 0 Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H I O No Dena? nn ,nnc Name / Address / Phone EMS Transport is Same as Operator O Yes FORM # AA -500 (12/02) PENNDOT COPY httes://www. dot6.state.na.us/crsann/PrintImages/XmlFiles/2012110785201303271315441... 3/27/2013 Print CRS W0310125 COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM AA 500 4 Polite Use only . Page 5 Nml W0310125 Page 5 of 7 Crash Number u Crash Description Non -Collision 2=Head On 1=Rear End 3=earto Rear (Bearing) 4 -Angle 5=$ldaaeswmmeiilBe ((SS 6-Sideswipe 8=Hit Pedestrian (Opposite Direction) 7 -Hit Fixed Object 9=OthertUnknow Relation to Roadway 1=On Travel Lanes 3=Median 2=Shoulder 4=Roadside S= Outside Trafflcway 7=Gore (Ramp Intersection) 6=In Parking Lane 9 -Unknown Illumination 1 1=Daylight 3=Dark - Street .Lights 2 Street Lights 4=Du k S=Dawn 8 O her Roadway Light Weather Conditions 1 1.No Adverse Conditions 2=Rain 3=Sleet (Hall) 5=Fog 4=Snow 6=Raln & Fog Road Surface Conditions 1=W 2 end, Mud, DLA, 4=Slush 3=Snow Covered mice 7 -Sleet & Fog 8=Other 6=Ice Patches 7=Water - Standing or Moving 9=Unknown B=Olher 0 is c 17 1 Unit No 01 2 Please Put 3 Events in Sequential Order 4 Harm Event LIR 02 }Nast? Utility Pole Number 0 0 0 0 • Harm Event LIR Most?. Utility Pole Number 1 Unit No 02 2 Please Put Events in 3 Sequential Order 4 11 LI 0 0 0 0 Harmful Events (Harm Event) 01=Hit Unit 1 02=Hit Unit 2 03=Hit Unit 3 04=Hlt Unit 4 05=1 -lit Unit 5 06 -Hit Other Traffic Unit 07=Hit Deer 08=Hit Other Animal 09=Colliision With Other Non Fixed Object 11=Struck By Unit 1 12=Struck By Unit 2 13=Starck By Unit 3 14=Struck By Unit 4 15=Struck By Unit 5 16 -Struck By Other Traffic Unit 21=Hit Tree Or Shrubbery 22 -Hit Embankment 23=Hit Utility Pole 24=Hit Traffic Sign 25=Hit Guard Rail 26=Hit Guard Rail End 27=Hit Curb 28= -Hit Concrete Dr Longitudinal Barrier 29=Hit Ditch 30=Hit Fence Or Wall 31=Hit Building 32=Hit Culvert 33=Hit Bridge Pier Or Abutment 34 --Hit Parapet End 35=Hit Bridge Rail 36=Hit Boulder Or Obstacle On Roadway 37=Hit Impact Attenuator 38=Hit Fire Hydrant 39=Hit Roadway Equipment 40=Hit Mail Box 41=Hit Traffic island 42=Hit Snow Bank 43=Hit Temporary Construction Barrier 48=Hit Other Fixed Object 49=Hit Unknown Fixed Object 50=Overturn/Roll Over 51. --Struck By Thrown Or Falling Object 52 -Pot Holes Or Other Pavement Irregularities 53=Jacknife 544ire In Vehide 58=Other Non -Collision 99=Unknown Harmful Event First 1nnful Event In the Gash Unit Poo 01 Harm Event Most Unl FraTinful Event in the Crash this Int ion m mark Pages 02 Do no No 01 arm Even 02 4 m o` S m c 19 Environmental/ Roadway Potential Factors (E/R) 00=None 01=Windy Conditions 02 -Sudden Weather Conditions 03=Dther Weather Conditions 04 Deer In Roadway 05 -Obstacle On Roadway 06=Other Animal In Roadway 07 -Glare 08=Work Zone Related 00 2 3 11=SIppery Road Conditions (Ice/Snow) 12=Substance On Roadway 13=Potholes 14=Broken Or Cracked Pavement 15=TCD Obstructed 16=Soft Shoulder Or Shoulder Drop Off 28=Other Roadway Factor 29=Other Environmental Factor 99=Unknown Possible Vehide Failures (V) 03=None 06 -Exhaust 01=Tires 07=Headlights 08=S' nal Lights 09=Other Lights 10 -tont 11=Mirrors 02=Brake System 03=Steering System 04=Suspension 05=Power Train Unit No Unit No 01 1 00 02 1 00 2 2 12=Wipers 13=Dever Seating/Control 14 -Body, Doors, Hood, Etc 15=Trailer Hitch 16 -Wheels 17=Airbags 18=Trailer Overloaded 19=Unsecure/Shifted Trailer Load 20 -_Improper Towing 21 -Obstructed Windshield 99=Unknown Driver Action (D) OO=No Contributing Action 01=Driver Was Distracted 02=Driving Using Hand Held Phone 03=DrMng Using Hands Free Phone 04=Making Illegal U -Turn 05=Improper/Careless Turning O6=Turning From Wrong Lane 07 -Proceeding W/O Clearance After Stop 08=Runnimngg Stop Sign Dounn10=failure To RReesppond To Other TrafficControllowing/Stping Device 13Ilegaliy Stopped OnpRoad 14=Careless Passing Or Lane Change -15-Passing In No Passing Zone 16=Driving The Wrong Way On 1 -Way Street Unit No Unit No 01 02 1 01 25 2 2 17=Careless Or Illegal Backing On Roadway 18=Driving On The Wrong Side Of Road 19 -Making Improper Entrance To Highway 20=Makingg Improper Ext From Highway Park ng/Unparking 22-Over/Under Compensation At Curve 23=Speeding 24=Driving Too Fast For Conditions 25 -Failure To Maintain Proper Speed 26=Driver Fleeing Police (Pol Chase) 27 -Driver Inexperienced 28=Failure To Use Specialized Equip •92=Affected By Physical Condition 98=Other Improper Driving Actions 99=Unknown 3 .4 4 Indicated Prime Factor Do not repeat this information on muhipic Pages E/R V D P 0 0 0 0 Unit No Factor Code 01 01 If E/R is the Prime Factor Type, leave Unit No blank Pedestrian Action (P) 00=None 01 ----Entering Or Crossing At Specified Location 02=Walking, Running, Jogging, Or Playing Unit No PENNDOT COPY 01 03=Working 04=Pushing Vehicle 0505 ---Apps ingOn Vehide ie Vehide 07=Standing 98=Other 99=Unknown Unit No 02 https ://www.dot6.state.pa.usicrsapp/PrintImagesamlFiles/20 1 21 1 07852013 0 3271 31 5441 1/270(11' Print CRS W0310125 20 21 2 COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM AA 500 5 Police Use Only Page 6 Page 6 of 7 11 11111011111111111111111 Crash Number W0310125 Ej al m i ! • 4 t I t • i : f I ' I I a .. a a a m; I a Iii I Witness Name Address Phone 1 a Narrative and additional witnesses: Accident Investigation Notification Issued? 0) Property Damage 0 Unit 1 and Unit 2 were both travelling north on Gettysburg Pk when a single vehicle automobile accident occured in the southbound lanes. Unit 1 and Unit 2 were both distracted by the accident and Unit 2 slowed in the lane. When Unit 1 realize that Unit 2 had slowed he applied his brakes, but was unable to bring his vehicle to a stop. Unit 1 sustained damage to the front, Unit 2 to the it's rear, and both driver's reported minor injuries but refused EMS. . i FORM a AA -500 {12102) PENNDOT COPY https://www.dot6.state.pa.us/crsapp/PrintImages/XmlFiles/201211078520130327I 315441... 3/27/2013 Print CRS W0310125 Crash Number: W0310125 Incident Number: UAT20121100133 •TO LZ Page 7 of 7 Unit:2• Unit 1 . 0 II Getfysburg Pk https://www.dot6.state.Da.us/crsanD/PrintImaees/XmlFil es/20121107R5201 1 0177111 5441 Vi77i'ni g F,,ROM:UPPER ALLEN POLICE DEPT TO:233-3020 00/30/2014 10:12:06 #26795 P.001/002 TO: UPPER ALLEN TOWNSHIP POLI 100 GETTYSBURG PIKE MECHANICSBURG, PA 17055-5604 (717)795.2445 FAx (717) 7909410 FAX COVER SHEET FROM: DATE: PAGES: RE: JAMES ADAMS Chief of Police 2 (INCLUMG COVER SHEET) If you do not receive all of the pages being sent, please contact the sender, CONFIDENTIALITY STATEMENT This message is intended only for the use of the addressee and may contain information that is privileged and confidential. If you are not the intended recipient, you are hereby notified that any di semination of this communication is strictly prohibited. Any violation may subject you to criminal p secution and/or civil penalties. If you have received this communication in error, please notify us injmediately by telephone. Thank you. TACOMMON1Fax Coversheeldoc FROM:UPPER ALLEN POLICE DEPT TO:233-3029 09/30/201410:12:18 #26795 P.002/002 "hint CRS W0310125 ComFi1A enem te OF PENNSYLVANIA POLICE CRASH REPORTING FORM AA 500 2 Motor Vehicle Transport © Pedestrian K -Pedestrian" Page: Page 2 of 7 11110111111111 u....1 W0310125 O Hit & Run Vehicle Q illegally Parked 0 Legally Par en Pedestrian on Skates, Disabled From in Wheelchair, etc Previous Crash Q Train "Petfestrlan on Skates, in Wheekheir, err, Complete form M Unit Ni 01 Delete? Address ► Feat Name ERIC Name JACOBS S Q Phantom Vehicle C) Yes • No two2W� — MI (If Yes, Complete'O►m c Hata of Birth (MM"DD"YYYY) 1970 07 22159166 i No CD Illegal Drugs C) Meditation { Alcohol Q Akohol and Drugs Q Unknown kohol Teat type Test Not Given © Breath Q Blood Q Urine 02 Same as Driver 0 Q Test Refused Test Gwen, 0 Contaminated Results © Other a Unknown if Fest Gi Unk Rest ently Normal mal © Had Been Drinnkux9 Primary Vehicle G State 12 Telephone Number 7178021957 PA Dass IP 17019 3714 A CARELESS DRIVING OO=Not Applicable O2.Ptivate Vehicle Not 01=Priwate Vehicle Owned/ Owned/teased by Driver Leased by Driver 03.Rented Vehicle ERIC S & JENNIF Owner Last! JACOBS 1.Driver Operated Vehicle 2 -No Driver Q Medication CD Unknown Charged? © Yes • No 3 -=Driver Fled Scene 4.Hit and Run 9=Unknown 04=State Police Vehicle 07=Municipal Police Veh 05ePENNPOT Vehicle 08=Other Municipal 06.Other State Gov Veh Government Vehicle s Name Of 09=Federal Gow Veh 9P -..Other 99•Unknown estriarb skip this Section) gess / C / State I TJ Code 8 CREEK RDD€LLSBURG PA 17019 5FNRL38726B059952 Model Year L2006 Vehicle Model (see overlay) Reg. state Est Speed Mktg Towed HNT0831 AMICA 1. Yes © No Policy No 930137-20UL ZIMMERMAN'S AUT No, of € Trailing 0 Units: t=Towing Pass. Veh d=Mobile/Modu 2-Towring Truck S=Camper 3..Towing Utility Trailer 6 -Fut Trailer r Horne 7•5emrTrailer Tap No B --Other 9 -Unknown Year Tap St 'Vehicle Position 01 *Movement 101 .Soo Ovs,ey Vehicle C 01 01+Blue 02=Red 03=Whhe 04= -Green 05 Black 06 -Yellow 07sdver 09 or Gold 0 n 10=Orange 11=Prrple t2■OHter 99.Unknown Vehicle Tyne ! 7 OteAutomobile 02=Motorcyde 03mBus 04=Small Truck (If '02', Complete Form M, Section 26) (if -20' or'2r , Complete rano M, Section 271 06•Sw Truck 07sVan 10 -Snowmobile 11.Ferm Equip 12.Coostruction Equip 13.ATV 18..ther type Spec Veh 19.4.ink, Type Spec Veh 20•Unicycle, Bicycle. Tricycle 21 -Other Pedakyde 22=Horse & Buggy 23=Horse & Rider 24=Train 25=Trolley 9B=Other 99=Unknown Pod Usage 00 12 -Commercial Passenger OO.Nat Applicable Carrier 01=Fire Veh 13=Taxi 02.Arnbulance 210Tractor Trailer 03 -Police 22 -Twin Trailer OB.Other Emergency 23.Triple Trailer Vehicle 31 -Modified Veh 11 ■Pupil Transport 99.Unknown kdNal Impact Point 12 I 00=Non-Collision 01-12..Clock Points 13 -Top 14=Undetcarriage lS.Towed Unit 99=Unknown oleos Wicator OENNone 2 -Functional I -Minor 3=Disabling 9 -Unknown Gridi'•hrf 3=DownhilJ 4.Botto m of Hill 1.Lewel %Top of Hill 2.Uph4ll 9■Unknown FO'ev a AAEW h cps://www.dot6.state.p I WOO PENNDOT COP AMMery I -Straight Z•Curved 94Lhlknown a, us/crsapp/Printlmages/Xm 1Files/201211078 52014093009412 84... 9/30/2014 David H Rosenberg Attorney1D# 20569 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road Harrisburg, PA 17110 Telephone: (717) 238-2000 Fax : (717) 233-3029 E-mail: Rosenberg@hhrlaw.com Attorney for Plaintiff(s) IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DAVID L. SLEDZINSKI, Plaintiff(s) 2014-5506 v. Civil Action - Law ERIC S. JACOBS and ADAM TODD KANTER, Defendant(s) CERTIFICATE OF SERVICE On, October 3, 2014, I hereby certify that a true and correct copy of Motion for Discontinuance as to Defendant Adam Todd Kanter was served upon the following by depositing same in the United States Mail, in Harrisburg, Pennsylvania: Tamara L. Fox, Esq. Attorney at Law P.O. Box 60532 Harrisburg, PA 17110 Eric S. Jacobs 58 Creek Road Dillsburg, PA 17019 HANDLER, HENNING & ROSENBERG, LLP David H Rosen erg IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA David L. Sledzinski, Plaintiff, CIVIL ACTION — LAW v. NO.: 2014-5506 Civil Eric S. Jacobs and Adam Todd Kanter., Defendants. ORDER 0 AND NOW, this tO day of October, 2014, upon consideration of Plaintiff's Motion for Discontinuance as to Defendant Adam Todd Kanter, it is hereby ORDERED that Plaintiffs Motion is GRANTED and the civil action docketed at 2014-5506, is discontinued as to Defendant Adam Todd Kanter. Co-Ds'es• P2;1 la JL ni-k( PPOss4 erx.;r_ J Distribution: David H Rosenberg, Esq. Laurie J. DeBarr, Esq. Handler, Henning & Rosenberg, LLP 1300 Linglestown Road, Suite 2 Harrisburg, PA 17110 Attorneys for plaintiff Tamara L. Fox, Esq. Attorney at Law PO Box 60532 Harrisburg, PA 17110 Attorney for Adam Todd Kanter Eric S. Jacobs 58 Creek Road Dillsburg, PA 17019 Defendant 2 SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny RAnderson 'lLED-OFFICE Sheriff t' THE PROTHONOTARY Jody S Smith Chief Deputy Richard W Stewart Solicitor TF C :F THE a4.FFIFF 2014 OCT 24+ PIl 3: 35 CUMBERLAND COUNTY PENNSYLVANIA David L Sledzinski (et al.) vs. Eric S Jacobs (et al.) Case Number 2014-5506 SHERIFF'S RETURN OF SERVICE 09/17/2014 Sheriff Ronny R Anderson, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Eric S Jacobs, but was unable to locate the Defendant in the Sheriffs bailiwick. The Sheriff therefore deputizes the Sheriff of York, Pennsylvania to serve the within Writ of Summons according to law. 09/24/2014 Ronny R Anderson, Sheriff, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Adam Todd Kanter, but was unable to locate the Defendant in his bailiwick. The Sheriff therefore returns the within requested Writ of Summons as "Not Found" at 5623 Moreland Court, Lower Allen, Mechanicsburg, PA 17055. Deputies were advised by the defendant's father that he moved to 6005 Sommerton Drive, Mechanicsburg, PA 17055. 09/24/2014 11:20 AM - The requested Writ of Summons served by the Sheriff of York County upon Jennifer Jacobs, Wife, who accepted for Eric S Jacobs, at 58 Creek road, Dillsburg, PA 17019. Richard P. Keuerleber, Sheriff, Return of Service attached to and made part of the within record. 10/14/2014 08:12 PM - Deputy Shawn Harrison, being duly sworn according to law, - o• the re. -; sted Writ of Summons by "personally" handing a true copy to a person representing ve o b- the Defendant, to wit: Adam Todd Kanter at 6005 Sommerton Dr., Hampden Twp., M .' r•, PA 7055. SH N HARR ON, 1 TY SHERIFF COST: $107.20 SO ANSWERS, October 21, 2014 RON2R ANDERSON, SHERIFF (c) CountySui;a Sherif!, Te!easoft, Richard P Keuerleber Sheriff Michael S. Hose Chief Deputy, Operations SHERIFF'S OFFICE OF YORK COUNTY PETER J. MANGAN, ESQ. Solicitor Richard E Rice, II Chief Deputy, Administration DAVID L. SLEDZINSKI vs. Case Number ERIC S. JACOBS 2014-5506 CIVIL SHERIFF'S RETURN OF SERVICE 09/24/2014 11:20 AM - DEPUTY SHANE KAUFFMAN, BEING DULY SWORN ACCORDING TO LAW, SERVED THE REQUESTED WRIT OF SUMMONS (WOSM) BY HANDING A TRUE COPY TO A PERSON REPRESENTING THEMSELVES TO BE JENNIFER JACOBS, WIFE, WHO ACCEPTED AS "ADULT PERSON IN CHARGE" FOR ERIC S. JACOBS AT 58 CREEK ROAD, DILLSBURG, PA 17019. SHERIFF COST: $44.28 SO ANSWERS, September 30, 2014 RICH RD P KEUERLEBER, SHERIFF COMMONWEALTH OF PENNSYLVANIA Notarial Seal Sheila E. Cook, Notary Public City of York, York County My Commission Ex.lres Feb. 1, 2017 ,,EMCER, PENNSYLVANIA ASSOCIATION OF NOTARIES Affirmed and subscribed to before me this 30TH day of SEPTEMBER NOTARY 2014 (c) CounlySuile Sheriff, Telecsoft, Inc.