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Home My WebLink About14-66167.VAlj1/40\1 14 1'6 1.. 05 r,:,01‘ABERL A.1.10 COU10.. EtAtASY AW P. P. Richard Wagner, Esquire Wagner & Spreha I.D. #23103 2233 North Front Street Harrisburg, PA 17110 (717)234-7051 Attorney For: Petitioner ZACHARY SNYDER, a Minor, by KATHY J. SNYDER and JOSEPH SNYDER, his Guardians, V. Petitioner IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO:/y_,6/, PETITION FOR COURT APPROVAL OF A COMPROMISE AND SETTLEMENT AND NOW, comes Zachary Snyder, by Kathy J. Snyder and Joseph Snyder, his guardians, and files the following Petition pursuant to Rule 2039 for compromise and settlement of an action for motor vehicle injury: 1. The Petitioners herein are the natural parents of Zachary Snyder, a minor, born May 12, 2001. 2. The aforementioned guardians and Zachary Snyder were involved in an automobile accident on May 6, 2012. 3. The aforementioned automobile accident was investigated by the police and it was determined that the party causing the accident was the driver of an automobile for whom Allstate Insurance Company provided coverage. 4. Allstate Insurance Company has as address 3810 Market Street, Camp Hill, Pennsylvania, 17011. C#16Vo a0/3Vf? 5. As a result of the aforementioned automobile accident, the minor child sustained injuries where were diagnosed as some neck discomfort and a concussion. 6. As a result of the aforementioned automobile accident, there were medical expenses in the amount of $5,014.52 paid by the first party carrier. 7. As a result of the aforementioned automobile accident, a claim was filed against the driver of the vehicle who is insured by Allstate Insurance Company. 8. Allstate Insurance Company has tendered an offer of settlement which was accepted by the Petitioners herein, natural guardians of the aforementioned minor child. 9. A copy of said Release is attached hereto, incorporated herein by reference, made a part hereof, and marked as Exhibit A. 10. On behalf of the minor child, the natural guardians executed a Contingency Fee Agreement with the law firm of the undersigned providing that one-third (1/3) of the proceeds would be payable as a legal fee, however, all costs would be included within that one-third (1/3). 11. The natural guardians hereto, as parents of the minor child, believe the resolution of this case is fair, appropriate, and is in the best interests of the minor child. 12. The natural guardians hereto, as parents of the minor child, intend to place the net proceeds from this settlement in an account for the benefit of the minor child, to be used exclusively for the health and well-being, and educational well-being of the child. 13. Petitioners herein, natural guardians of the minor child, pray this Court to grant relief in the form of approving the Compromise and Settlement, approving distribution in the form of one-third (1/3) to the undersigned attorney, with the two-thirds (2/3) payable unto the guardians of the minor child. 14. The Respondent, Allstate Insurance Company, seeks only Court approval and agrees with this settlement. WHEREFORE, Petitioners, the natural guardians of the minor child, pray this Court to grant the relief as requested. Date: //ft/it/ Respect ly Submitted, Wagnerpreha card Wagner, Esquire .D. # 23103 2233 North Front Street Harrisburg, PA 17110 Attorney for Petitioners 4 VERIFICATION I verify that the statements made in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. §4904, relating to unswom falsification to authorities. Date: 1/ VERIFICATION I verify that the statements made in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. §4904, relating to unsworn falsification to authorities. Date: ///////If PARENT(S) RELEASE AND INDEMNITY AGREEMENT CLAIM # 0243994076 Inconsideration of the payment, to the undersigned, of the sum of Thirty Five Thousand and 00/100 Dollars ($35,000.00) the receipt of which is hereby acknowledged, the undersigned parent(s) Kathy Snyder and/or guardian(s) Kathy Snyder of, ZACHARY SNYDER a minor, do/does forever release, discharge and covenant to hold harmless Keri Martinez and David Martinez, and any other person, firm or corporation charged or chargeable with responsibility or liability, their heirs, administrators, executors, successors and assigns. from any and all claims, demands, damages, costs, expenses..loss of services, actions and causes of action, belonging to the said minor or to the undersigned arising out of any act or occurrence up to the present time, and particularly on account of all personal injury, disability, property damage, loss or damages of any kind sustained or that may hereafter be sustained by the said minor or by the undersigned, in consequence of an accident that occurred on or about the 6th day of May, 2012 at or near 72 SOUTH, LANCASTER, PA. The undersigned do/does hereby bind ourselves and our heirs, administrators, executors, successors and assigns to repay to the said, Keri Martinez and David Martinez and to any other person, firm or corporation charged with responsibility or liability, their heirs, administrators, executors, successors and assigns, any additional sum of money that any of them may hereafter be compelled to pay on account of the injuries to said minor because of,the said accidenL. To procure the payment of the said sum, I/we hereby declare: that no representations about the nature and extent of the said injuries, disabilities or damages made by any physician, attorney or agent of any party released, nor any representations regarding the nature and extent of legal liability or financial responsibility of any of the parties released, have induced me/us to make this release and indemnity agreement; that in determining the amount of the said sum there has been taken into consideration not only the ascertained injuries, disabilities and damages, but also the possibility that the injuries sustained may be permanent and progressive and recovery there from uncertain and indefinite, so that consequences not now anticipated may result from the said accident. The undersigned agree(s), as a further consideration and inducement for this release and indemnity agreement, that it shall apply to all unknown and unanticipated injuries and damages directly and indirectly resulting from the said accident, as well as to those now disclosed. The undersigned understand(s) that the parties hereby released admit no liability of any sort by reason of said accident and that said payment in compromise is made to terminate further controversy respecting all claims for damages that said minor or the undersigned have heretofore asserted or might personally or through personal representatives hereafter assert because of said accident. Uwe further understand and agree that this Release is inclusive of any and all present and future liens or claims for subrogation against the payments to he made in accordance with this Release. Uwe understand and agree that Uwe 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 includes, hut is not limited to. medical expense liens, workers' compensation liens, ERISA liens, liens asserted by any federal, state. or local governmental entity or agency or any health care benefit claim. Should any person or entity make claim for payment of any liens or charges against Allstate Fire and Casualty Insurance Company, Uwe agree to indemnify and hold harmless Allstate Fire and Casualty Insurance Company from any such liens, charges, fees, claims, attorney fees, costs, interest and any other sum. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. y ` Signed and sealed this 3� day of f\{ (1i 1�i�� ,20 6 ` t . (Seal) --o=--..O0rA tt ih r 1 i (Seal) STATE OFittn,WanitSS 1 COUNTY OF Cebailc r On this )(�e� day of �,..p ,(Yib�.Q., 010tt-4 , before me personally appeared } S11 ' 2 p STI �,`fo me known to be the person S who executed the foregoing instrument, and acklrowle ed that executed the same a.s\-i-hete free act and deed.�,-�{� . My commission expires - 3(t3 is (aviR . (.rf1p 1 ! f \O ) NOT • sj • UBLIC Name printed (Relationship to minor) N - i/L I,,✓S'tln (SEAL) (SEAL) C106-4 0243994076 U33 COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Cheryl L. Major, Notary Public City of Lebanon, Lebanon County My Commission Expires June 22, 2018 MEMBER. PENNSYLVANIA ASSOCIATION OF NOTARIES P. Richard Wagner, Esquire Wagner & Spreha I.D. #23103 2233 North Front Street Harrisburg, PA 17110 (717)234-7051 Attorney For: Petitioner IN RE: ZACHARY SNYDER, a Minor, by KATHY J. SNYDER and JOSEPH SNYDER, his Guardians, • ;LED -0F i=Cr-- THE PROTHCHQ AF Y 2014 NOV 24 PSI 13 CUMBERLAND COUNTY Y PENNSYLVANIA : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA NO: Iv- 6/6 ORDER AND NOW, this 2 Li da of N m y 1( , 20 , upon Petition of the Guardians, the Petition is hereby granted and the proceeds of the compromise are to be distributed as set forth herein in said Petition. Said proceeds shall be deposited by the guardians in a bank in the name of the minor further providing that no withdrawals can be made therefrom for any amount until the minor attains majority except as authorized by any Order of Court until thereof. BY THE COURT: Distribution: _ P. Richard Wagner, Esq., 2233 N. Front St., Harrisburg, PA 17110 6T� %�- ///D// &y _/C (i'