HomeMy WebLinkAbout14-7044 Supreme Court.cif Pennsvlvania WWR# 20623734 C Y Jer HOH
Courtof Common:Pleas
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rvi Cos'e�;�he� ForProtkonovan°Use(3ntt
CUMBERLAN a,,tr,',` , Count} DocketNo: 1r.
The information collected on this form is used solely for- court administration purposes. This form does not
supplement or replace the filing and service ofpleadings or other papers as required by late or rules of court.
Commencement of Action:
S la Complaint ❑ Writ of Summons ❑ Petition
n Trnn.fer from Another Jurisdiction Declaration of Taking
E
C Progressive Northern Lead Defendant's Name:
T Insurance Company MARY GALITSY
0 Are money damages requested? ® Yes ❑ No Dollar Amount Requested: ® within arbitration limits
N (check one) [3outside arbitration limits
Is this a Class Action Suit? ❑ Yes W No Is this an NWJ Appeal? ❑ Yes El No
A
Benjamin W. Lawrence, 209032
Name of Plaintiff/Appellant's Attorney:
❑ Check here if you have no attorney(are a Self-Represented (Pro Se]Litigant)
Nature of the Case: Place an "X" to the left of the ONE case category that most accurately describes your
PRIMARY CASE.If you are making more than one type of claim,check the one that
you consider most important.
TORT(do not include Mass Tort) CONTRACT(do not include Judgments) CIVIL APPEALS
❑ Intentional ❑ Buyer Protection Administrative Agencies
❑ Malicious Prosecution ❑ Debt Collection: Credit Card ❑ Board of Assessment
❑ Motor Vehicle ❑ Debt Collection:Other ❑ Board of Elections
❑ Nuisance ❑ Dept.of Transportation
S ❑ Premises Liability ❑ Statutory Appeal: Other
E ❑ Product Liability(does not include [3Employment Dispute
Mass torn Discrimination
Clander/Libel/Defamation C3 Employment Dispute: Other C3 Zoning Board
T Other: ❑ Other:
I 5(J rJl'�7 c d vt
❑ Other:
O
N MASS TORT
❑ Asbestos
B ❑ Tobacco REAL PROPERTY MISCELLANEOUS
❑ Toxic Tort-DES ❑ Ejectment ❑ Common Law/Statutory Arbitration
❑ Toxic Tort—Implant ❑ Eminent Domain/Condemnation ❑ Declaratory Judgment
❑ Toxic Waste E3 Ground Rent11 ❑ Mandamus
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PROFESSIONAL LIABILITY ❑ Quiet Title ❑ Other:
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❑ Other Professional:
Undated 1/1/2011
LU
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL DIVISION
Progressive Northern
Insurance Company n
Plaintiff NO: cv ( t
VS . COMPLAINT IN CIVIL ACTION
MARY GALITSY
Defendant FILED ON BEHALF OF I
Plaintiff
COUNSEL OF RECORD OF
THIS PARTY:
Benjamin W. Lawrence, 209032
WELTMAN, WEINBERG & REIS Co. , L. P.A.
325 CHESTNUT STREET SUITE 501
PHILADELPHIA, PA 19106-2614
215-599-1500
FAX: 215-599-1505
20623734 C Y Jer HOH
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WEINBERG&REIS CO.,L.P.A. \
WELTMAN, Attorney for Plaintiff(s)
BY: Benjamin W. Lawrence, Esquire
Pa. Identification No.209032
325 Chestnut Street, Suite 501
Philadelphia, PA 19106
Phone: 215.599.1500
Fax: 215.599.1505
File #20623734
PROGRESSIVE NORTHERN
INSURANCE COMPANY Court of Common Pleas
CUMBERLAND County
vs.
MARY GALITSY NO.
CIVIL ACTION —COMPLAINT
1. Plaintiff is a business organization licensed and authorized to conduct
business in the State of Ohio with a place of business located at 5920 LANDERBROOK
DR, MAYFIELD HTS, OH 44124.
2. Defendant is an adult individual who at all times pertinent hereto resided
at 301 NORMAN RD, CAMP HILL, PA 17011.
3. Plaintiff issued a policy of motor vehicle insurance whereby Plaintiff
agreed to insure the motor vehicle involved in this incident("Insured Vehicle"), owned by
Plaintiff's insured.
4. On or about October 12, 2013 Defendant was the operator of a motor
vehicle which vehicle did negligently, recklessly and/or carelessly collide with the Plaintiff
Insured's vehicle at or near Trindle and Brian Road, Hampden, Pennsylvania.
5. The negligence and/or carelessness of the Defendant consisted of the
following:
a. Failing to have his motor vehicle under such control as the situation
warranted;
b. Operating his motor vehicle in complete disregard of the point and
position of Plaintiff's vehicle;
c. Failing to keep a proper lookout;
d. Traveling too fast for conditions;
e. Disregarding traffic control devices;
f. Failing to abide by the Rules of the Road and the Motor Vehicle Code of
Pennsylvania;
g. Being otherwise negligent under the circumstances; and,
h. Being negligent as a matter of law as may be relevant through discovery
and/or at the time of trial.
g. As a direct and proximate result of Defendant's negligence, the Plaintiff
Insured's vehicle sustained property damage and/or incurred rental charges in the total
amount of $5,510.93. See attached as Exhibit 1" a copy of the damage documentation
which documents Plaintiff further intends to introduce at the arbitration in this matter.
7. Pursuant to the insurance policy issued by Plaintiff and as a result of the
aforesaid payment, Plaintiff became subrogated to the claim of its Insured against
Defendant.
WHEREFORE, Plaintiff demands Judgment against Defendant in the amount of
$5,510.93 plus interest and costs.
WELTMAN, WEINBERG & REIS, CO., L.P.A.
Benjamin W. La ence, Esquire
PA I.D. #2090
325 Chestnut treet
Suite 501
Philadelphia, PA 19106
(215) 599-1500
WW R#20623734
EXHIBIT I
October 01, 2014, 11 : 41 :_2_$.....
&h) &f PASSPORT&b&D, &
.............. . ......... ..
41
P A C M A N OCT 01 14 - 11 :
CMSD3011 /CMSM3011 TERMID: ?OOH
OPID: TXH0081 SALVAGE INFORMATION REVISE POL# : 57046176 -9
INSD: KISKIS, SUSAN F
DOL :, OCT 12 13 PA-AL CLM: 135147065
ACTIVE REP : J GUYER
FMZA51453BA55819
PROP: 03, FORD, WINDSTAR LXES
PROP OWNER: KISKIS, SUSAN F
SALVAGE STAT* C VEHICLE TYPE* 01 AUTOMOBILE
- SALVAGE METHOD* A POOL POOL STOCK NUMBER: 12078975@
SALVAGE VENDOR* 1148 IAA - HARRISBURG, PA INITIAL STORAGE ENDED: OCT 15 13
INITIAL STORAGE BEGAN: OCT 12 13
DATE TITLE ORDERED: OCT 22 13 TITLE RECD/TYPE* ARVALUEDABLE OR GENERA GENERAL
PRE TAX ACV: 5, 171 . 63 TAX,TAG,TITLE: TOTAL SALE PRICE 600 .00
DATE SOLD: NOV 13 13
SALVAGE END BUYER: CHAZ ' S USE
TEXT:
L/COV DESC L/COV TOTAL FEES NET RECOVERY
COLL 2103 629 .00 -29 .00
COMMAND: SALREV F4=RECADD FS=SALFEA F10=SALREC F13=SALFEE
Page 1 of 1
Progressive Group of Insurance Companies
Settlement Summary
Claim Information
Claim Number: 13-5147065-01 Coverage Type of Loss: Collision
Policy Number: Loss Date: 10/12/2013
Owner: KISKIS,SUSAN Reported Date: 10/12/2013
Valuation Report ID: 1003994324
Vehicle Information
Loss Vehicle: 2003 FORD WINDSTAR LX PSNGR VAN 3.81-6 Location: PA 17055
Cyl Gas A 2WD
VIN: 2FMZA51453BA55819 Exterior Color: Lgt Parchment Gold Metallic
Mileage: 96,206 miles License Plate:
Title History: Unknown Title History Comments:
Loan Information Payment Information
Lien Holder Payoff: $0.00 Lien Holder Payment(s): $0.00
Loan/Lease Payoff Coverage: $0.00 Net to Owner: $5,231.93
Settlement
Stated Amount: $0.00
Actual Cash Value: $5,171.63
Base Value: $5,171.63
Title History Adjustment: -$0.00
Refurbishment Adjustment: $0.00
After Market Parts Adjustment: $0.00
Condition Adjustment: $0.00
Prior Damage Adjustment: -$0.00
Market Value: $5,171.63
Settlement Adjustment(Pre-Tax): $0.00
Fees: $0.00
Taxes: $310.30
Company Obtains: $0.00
Net Settlement: $5,481.93
Settlement Adjustment(Post-Tax): $0.00
Deductible: $250.00
Other Adjustments: $0.00
Total Settlement: $5,231.93
Adjuster License#:
Comments:
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Claim Payment Detail Page 1 of 1
Clainh Payment Detail 13-5147065 )
Payment Information
Disbursement Number: 479898400 Total Amount: $5,231.93
EFT Trace Number: Invoice Number:
Paid To: SUSAN F KISKIS,ONLY***************************************
Mailing Address: 212 EAST PORTLAND STREET
MECHANICSBURG, PA 17055 USA
In Payment Of: FULL/FINAL SETTLE-03 FORD WINDSTAR-250 DED-PROG OBTNS SALV
Vendor Information
Name: 1099 Required:
Type:
Reviewed Summary
Issuing Rep: JSGO022 Approved By: BJR0002
Issue Date: 10-18-13 Review Date:
Last Updated Rep: JSGO022 Reviewed By:
Bank Information
Type: Loss Bank Code: AS2
Stop Reason: Cleared: 10-22-13
Stop Date:
Exposure Detail:COLL
Party Name: KISKIS,SUSAN F Amount Paid: $5,231.93
Property Description: 03 FORD WINDSTAR LXES Deductible Taken: $250.00
Payment Type: FINAL PAYMENT Property Damage: $0.00
Rental: $0.00
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Mitchell WorkCenter-Estimate: 13-5147065-01 Page 1 of 4
Exception Summary
Compliance
Result: Warning %of ACV(from estimate): 157.07% Profile: PA Profile 05 01 2013
TUSR1F5
Line Severity Description Actual, Guideline. Variance
(Warning POI missing 01 01 0
Estimate: 13-5147065-01
Admin Information
Service Provider: PRESTON PAUL Date Received: 10/17/2013
Estimate ID: 13-5147065-01 Estimate Version: 0
Claim#: 13-5147065-01 Loss Type: Property
Policy#: Loss Date: 10/12/2013
Insured/Claimant: Loss Designation: Total Loss
Assigned Reviewer:
Vehicle Information: 2003 Ford VanWgn 3.81- Inj 6 Cyl
VIN: 2FMZA51453BA55819 Mileage: 96206 miles
License Plate: Exterior Color: GOLD
Vehicle Location: IAA HARRISBURG(17372) Condition:
Admin Comments
Line Operation Description Parts Price Labor Amount
Type Quantity; Unit, Extended Hours'
Cost°
1 IREMOVE/INSTALL I Frt Bumper Assy 1.61 $76.80 $76.80
2 IREPAIR Frt Bumper Cover JEX 1 ( $0.001 $0.00- { 3.0* 1$144.001 $144.00
3 REFINISH Frt Bumper Cover I ( iI C 2.71 $129.60 1 $129.60
4 REMOVE/REPLACEI
L Front Combination AM 1 $92.31 I $92.31 0.3 $14.40 $106.71
{{ Lamp Assembly I III III 1111 III !! I
5 CHECKIADJUST I Headlamps # , 1 0.41 $19.201 $19.20
6 REMOVE/INSTALL 1 R Fog Lamp 1 0.21 $9.601 $9.60
7 1REMOVE/INSTALL 1L Fog Lamp 1 0.21 $9.601 $9.60
8 IREPAIR ,L Fender Panel JEX 1 1 1 $0.001 $0.00* 1 2.0111 $96.00 1 $96.00
9 1 REFINISH I L Fender Outside ( C 2.01 $96.00 1 $96.00
10 1REMOVE/INSTALL 1L Frt Fender Mudguard ! 0.2 1, $9.601 $9.60
11 IREMOVE/REPLACEIL Floor Sidemember-S 1NW ( 1 1 $219.921 $219.921 5.0 1$240.001 $459.92
12 IREFINISH L Frt Add For Jambs I I ( ( C 1 0.5 1, $24.001 $24.00
13 IREPAIR 1L Frt Door Repair Panel lEX 1 ( $0.001 $0.00* 1 3.0* 1$144.00 $144.00
14 I REFINISH L Frt Door Outside C 2.11 $100.80 $100.80
15 REMOVE/INSTALL L Frt Door Mirror 0.21 $9.601 $9.60
16 1REMOVE/INSTALL 1L Frt Otr Belt Moulding 0.21 $9.60 $9.60
17 REMOVE/INSTALL (L Frt Door Upper EX 1 $0.00 $0.00 0.3 I $14.40 $14.40
1111 (`Moulding III 1
18 REMOVE/INSTALL L Frt Door Adhesive I EX 1 $0.00 $0.00 0.2 $9.60 $9.60
Moulding I!
! S ! 1 1 !
i S i
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Mitchell WorkCenter- Estimate: 13-5147065-01 Page 2 of 4
19• IREMOVE/INSTALL 1L Frt Door Trim Panel ( INC 1 $0.00
20 IREMOVE/INSTALL 1L Frt Otr Door Handle ( 1 0.61 $28.801 $28.80
21 IREMOVE/INSTALL L Frt Door Glass Run 1EX 1 ( $0.001 $0.00* 1 0.2- 1 $9.601 $9.60
22 N Loosen for Refinish [ ! ! $0.00
23 IBLEND R Side Door Outside f C 1 1.01 $48.001 $48.00
24 REFINISH L Add For Jambs& C 1 0.5- 1 $24.00 $24.00
Interior 1 _
25 IREMOVE/INSTALL L Side Door �_ INC $0.00
R&I for Qtr RR,Outer
26 Panel Seperating from $0.00
Shell
27 IREPAIR IL Side Door Shell 1EX 1 $0.001 $0.00* 3.0* 1,$144.00 $144.00
28 REFINISH L Side Door Outside � i� C 1.91 $91.20 !i $91.20
29 REMOVE/INSTALL (R Side Door Adhesive EX 1 I $0.00 $0.00 0.2 $9.60 I $9.60
Moulding III
30 REMOVE/INSTALL LSide Boor Adhesive (EX 1 ! $0.00 $0.00 02 $9.60 I $9.60
31 IREMOVE/INSTALL IR Door Trim Panel )) 1III ((E 111 INC 1i1� _$0.00
32 JREMOVE/INSTALL [L Door Trim Panel [ INC $0.00
33 IREMOVE/INSTALL 1R Side Door Handle 1 1 0.61 $28.801 $28.80
34 IREMOVE/INSTALL L Side Door Handle 1 0.61 $28.801 $28.80
35 REPAIR lGlass
R Side Door Stationary EX 1 $0.00 $0.00'K 0.2* $9.60 $9.60 f
36REPAIR IGlass L Side Door Stationary !EX ( 1 $0.00 $0.00' 0.2* $9.60 $9.60
f t
37 I Refinish Time to Mask fro ( ( $0.00
1
38 1REPAIR 1R Van Side Panel EX 1 !1 0.001 $0.00' 1s 3.0* $144.00 $144.00
39 1 REFINISH R Van Side Panel Outside I 1
I C 2.31 $110.40 $110.40
40 IREMOVE/REPLACE I L Van Side Panel JNW 1 $1,822.55 j$1,82155 1 13.8 1$662.40 1$2,484.95
41 REFINISH L Van Side Panel Outside ( C 2.11 $100.80 $100.80
42 REFINISH L Van Side Panel Edge ( C 1 0.51 $24.00 j $24.00
43 REFINISH ' L Add For Pillar ( C 0.51 $24.00 1 $24.00
44 IREMOVE/INSTALL L Rear Quarter Glass INC tI 1 $0.00
45 REPAIR R Rear Qtr Glass (EX 1 $0.001 $0.00' 0.3- 4 $14.40 $14.40
I IStationary I
46I I Repair Time to Mask for I ( ) I
Refinish �� I $0.00
1
47 REMOVE/REPLACEILiftgateShell ILK 1 1 $150.00 $150.00* 1 4.71$225.60 1 $375.60
48 REFINISH Liftgate Outside C 1 2.51 $120.00 $120.00
49 REFINISH Add For Jambs&Interior C 1 1.51 $72.00 $72.00
50 LINE MARKUP Line Markup%25.00 1 $37.501 $37.50 1 l $37.50
51 REMOVE/INSTALL Lamp r Combination 0.2 $9.60 $9.60
52 I
REMOVE/REPLACE�LRear Combination �AM 1 $58.29 $58.29 INC $58.29
Lamp Assembly III I
53 JOVERHAUL I Rear Bumper Cover Assy I I I 1 1 0.61 $28.80 ( $28.80
54 REMOVE/REPLACERear Bumper Cover ILK I 1 1 $150.001$150.00* 1 INC1 1 $150.00
55 REFINISH Rear Bumper Cover J. I C1 2.6 $124.80 1 $124.80
56 EE LINE MARKUP Line Markup%25.00 $37.501 $37.50 1 1 1 $37.50
57 [ADD'L COST DISPOSAL RDOUS WASTE $3.00 $3.00 $3.00
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Mitchell WorkCenter-Estimate: 13-5147065-01 Page 3 of 4
58 ALIGN ISETUP&MEASURE JEX f 11 $0.001 $0.00* ( 2.0* 1$100.00 1 $100.00
59 REPAIR UNIBODY N REAR I EX 1 $0.00 $0.00* 4.0* $200.00 $200.00
60 ( Pull to L Sidemember,
Rear Body,L Qtr i $0.00
61 JADD'L OPR Clear Coat 1 $0.001 $0.00 4.9 1$235.20 (((1 $235.20
62 I
ADD'L LABOR (CORROSION SL 1 $15.00( $15.00* 0.2* 11 $9.60 $24.60
PROTECTION 1
63 JADD'L LABOR IWELD THRU PRIMER ISL ( 1 1 $8.001 $8.00' 1 0.2- 1 $9.601 $17.60
64 JADD'L LABOR (CAR COVER ISL 1 I $4.001 $4.00* 1 0.2- 1 $9.601 $13.60
65 IREMOVE/REPLACE1 FLEX ADDITIVE ISL 1 1 $8.001 $8.00* C 0.0- 1 $0.001 $8.00
66 JADD'L LABOR SEAM SEALER ISL 1 1 $12.001 $12.00- 1 0.0- 1 $0.001 $12.00
NOTE:THIS ESTIMATE
67 REMOVE/REPLACE IS NOT ALL INCLUSIVE, JNW 1 $0.00 $0.00* 0.0* $0.00 $0.00
1IT
IS ONLY WITTEN TO
68 REMOVE/REPLACE THE POINT OF A TOTAL NW 1 $0.00 $0.00* 0.0* $0.00 $0.00
LOSS.
69 JADD'L COST (Paint/Materials $560.00 ( $560.00 1 $560.00
C-included in clear coat talc *-judgment item
Labor Subtotals $4,093.93
Hours hate Add? Sublet Total
Body: 45.5 $48.00 1 $0.00 $39.001 $2,223.00
Bdy-S: ( 01 $48.001 $0-001 $0.001 $0.00
Refinish: ( 27.61 $48.001 $0.001 $0.001 $1,324.80
Glass: 0.31 $48.001 $0-001 $0.001 $14.40
Frame: 6.01 $50.001 $0.001 $0.001, $300.00
Mechanical 01 $52.00 1 $0.001 $0.00 1 $0.00
Taxable Labor: $3,862.20
Labor Tax: 1 6.00% 1 $231.73
Non-Taxable Labor: ( $0.00
Part Subtotals $2,730.63
Rate Total
Taxable Parts: $2,501.07
Parts Adjustments: $75.00
Glass Adjustments: $0.00
Sales Tax: 6.00% $154.56
Non-Taxable Parts: $0.00
Parts Adjustments: $0.00
Glass Adjustments: $0.00
Additional Costs $596.78
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Mitchell WorkCenter Estiiriafe:"13-5147065-01 Page 4 of 4
MOMMI MEN*
Rate < Total
n Taxable Costs: $563.00
Sales Tax: 6.00% ( $33.78
Non-Taxable Costs: $0.00
Gross Total: $7,421{.34
Estimate-adjustments ($250.00)
Walto
Ot
Betterment: $0.00..
Insurance Deductible: ($250.00)
Insurance"Prepaid Amount: $0.00
Appearance Allowance: ( $0.00.: .
Related Prior,Damage: ( $0.00
�tW
Net Total: $7,171.34
https://progressive.mymitchell.coin/CARR/PrintPreviewFrame.aspx?Url=%2FCARR%2F... 10/1/2014
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VERIFICATION
I, Benjamin W. Lawrence, Esquire, attorney for the Plaintiff(s) do hereby swear
and affirm that the averments in the attached Complaint are true and correct to the best
of my knowledge, information and/or belief. These averments are made subject to the
penalties of 18 Pa.C.S.A. §4904 relating to unsworn falsification to authorities.
Benjamin Lawrence
Date
SHERIFF'S OFFICE OF CUMBERLAND COUNTY._ _
Ronny R Anderson ;- ; ` ' +1 • -,'•,.-,‘
Sheriff 1 E�>IZ() nu
ktV1�n d�RtifC,l"/cpu
Jody S Smith Q 3' 23
Chief Deputy t. ��
Richard W Stewart �. `� f•uM6ERLA
Solicitor orHC -PIK VERIFF p Et4s_SY LV fahl A
Progressive Northern Insurance Company
vs.
Mary Galitsy
Case Number
2014-7044
SHERIFF'S RETURN OF SERVICE
12/11/2014 06:49 PM - Deputy Jamie DiMartile, being duly sworn according to law, served the requested Complaint &
Notice by "personally' handing a true copy to a person representing themselves to be the Defendant, to
wit: Mary Galitsy at 301 Norman Road, Lower Allen Township, Camp Hill, PA 17011.
IE DIMARTILE, DEPUTY
SHERIFF COST: $44.95 SO ANSWERS,
December 12, 2014 RONNY R ANDERSON, SHERIFF
(c) CountySuite Sheriff, Teleosoft, Inc.