HomeMy WebLinkAbout05-6783
IN RE: WILLIAM BERNOSKI, a
minor, by LOUISE WAGGONER,
Petitioner
IN THE COUR'r OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
0""- I. 7)'3 0.;;,) (u-
NO. J'
CIVIL ACTION - LAW
PETITION FOR APPROVAL OF MINOR'S l:::OMPROMISE
PURSUANT TO Pa,R,C,P, 2039
1. Petitioner is LOUISE WAGGONER, the natural mother of
WILLIAM BERNOSKI (age 15).
2. Both LOUISE WAGGONER and WILLIAM BERNOSKI reside at
316 3rd Street, New Cumberland, Cumberland County, PA 17070.
3. On May 31, 2005, William Bernoski was injured as the
resul t of a "one-car" automobile accident in which he was a
passenger.
4. Mr. Bernoski broke a bone in his left wrist. He also
had pain in his left shoulder and left shin following the accident,
but the pain has subsided.
5. Mr. Bernoski is no longer being treated for any of
his injuries.
6. Nationwide Insurance Company has offered to settle
this matter for $14,000.00. Nationwide's insured is Ms. Sierra
Gonse, the owner of the car.
7. Undersigned counsel believes this is a fair amount
and in line with what William could expect to receive at trial.
8. All medical bills have been paid by insurance; there
are no liens or claims.
9. Louise Waggoner requests the Court to permit her to
sign the Release (copy attached as Exhibit ",1\" hereto) to resolve
this matter.
10. Petitioner requests the funds be handled as follows:
a) $2,855.50 to Kenneth F. Lell1is, Esq. ($2,800.00
representing a 20% fee as per the parties' written fee agreement;
and $55.50 representing costs advanced for the filing of this
petition); and
b) the remaining $11,144.50 to be placed in an interest-
bearing account with sovereign Bank, such account to comply with
Pa.R.C.P. 2039, including a provision that nc> withdrawal shall be
made from the account until the minor attains majority or by a
prior Order of Court.
WHEREFORE, Petitioner requests the Court to approve of
the settlement as described herein.
Respectfully submitt:ed,
DATE: /2-/Z-.~)05
KEN ETH F. LEWIS, ESQUIRE
I. . #69383
1101 N. Front st.
Harrisburg, PA 17102
(717) 234-3136
Attorney for Petitioner
VERIFICATION
I hereby verify that the statements made in the foregoing
document are true and correct. I understand that false statements
herein are made subject to the penalties of 18 Pa.C.S. Section
4904, relating to unsworn falsification to authorities.
Dated: /J-' :2f-{XJ-
/:f]O( A ~ ~j ~ iJ~)u/) /
LOUISE WAGGONER, er of
WILLIAM BERNOSKI
RELEASE OF ALL CLAIMS
CLAIM NUMBER: 5837 D 7773630531200501
FOR ANI) IN CONSIIlERA TION OF the payment to me/us the sum of ($ 14,000.00 ) dollars, and other good and valuable consideration. IIwe.
being of lawful age, have released and discharged, and by these presents do for myself/ourselves, illY/Our heirs, executors, administrators and assigns,
release, acquit and forever discharge Sierra Gonse. Chris Begardus, Nationwide Insurance Company, and any and all other persons, firms and
corporations, whether herein named or referred to or not, of and from any and all past, present and future actions, causes of action, claims, demands,
damages, costs, loss of services, expenses, compensation, third party actions, suits at law or in equity, including claims or suits for contribution
and/or indemnity, of whatever nature, and all consequential damage on account of, or in any way growing out of any and al1 known and unknown
personal injuries, death, and/or property damage resulting or to result from an accident that occurred on or about 05-31~2005 at or near LEWfSBURY
17339 YORK,
IIwe hereby declare and represent that the injuries sustained may be permanent and progressive and that recovery therefrom is uncertain and
indefinite, and in making this release and agreement it is understood and agreed that I/we rely wholly upon my/our own judgment, belief and
knowledge of the nature, extent and duration of said injuries, and that I/we have not been influenced to any extent whatever in making this release by
any representations or statements regarding said injuries, or regarding any other matters, made by the persons, firms or corporations who are hereby
released, or by any person or persons representing him or them, or by any physician or surgeon by him or them employed.
I/wc understand that this settlement is the compromise of a doubtful and disputed claim, and that 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.
It is further understood and agreed that J am responsibre for the payment of any lien or charges ag.ainst the settlement sum, including but not limited
to Worker's Compensation liens, liens of the Department of Public Welfare or liens arising out of any other form of public assistance. Should any
person or entity make a claim for payment of any liens or charges against the released parties, J hereby agree to indemnify and hold harmless the
released parties, from any and all liens, charges, fees, attorney's fees, cost, interest and other sums.
It is agreed that distribution of the above sum shall be made as follows: as court order reQuires
This release contains the ENTIRE AGREEMENT between the parties hereto, and the terms of this release are contractual and not a mere recital.
rlwe further state that J/we have carefully read the foregoing release and know the contents thereof, and Jjwe sign the same as my/our own free act.
WITNESS
hand and seal this; _ day of
20
In the presence of:
CAUTION' READ BEFORE SIGNING
Name
Your Signature
(SEAL)
Address
Your Signature
(SEAL)
Name
^ ddrcss
State of
, County of
On this __ day of
,20 _' Before me personally appeared
to mc known to be the person...described herein, and who executcd the foregoing instrument and he/she acknowledged that
he/she voluntarily executed the same.
My tefm expires
.20_
Notary Public
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 insurancll act, which is a crime and SUbjects such a
person to criminal and civil penalties.
EXHIBIT '/1)1
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IN RE: WILLIAM BERNOSKI,
a minor, by LOUISE WAGGONER,
Petitioner
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: 05.6783 CIVIL
ORDER OF COURT
""'
AND NOW, this" day of January 2006, IT IS ORDERED:
1. Approval of the settlement of this minor's claim for $14,000.00 for William
Bernoski, a minor, born July 2, 1989, IS GRANTED.
2. From the settlement, a counsel fee of $2,800.00 for Kenneth F. Lewis, Esquire IS
APPROVED,
3. Costs of$55.50 are approved to he paid to petitioner's counsel for the filing fee,
4. The net proceeds of $11,144.50 shall be placed by Louise Waggoner in a restricted
federally insured interest bearing account in the name of William Bernoski,
5, The account shall contain the following notation: "'''0 WITHDRAWAL CAN BE
MADE PRIOR TO WILLIAM BERNOSKI, BORN JULY 2, 1989, OBTAINING
HIS MAJORITY EXCEPT BY AN ORDER OF A COURT OF COMPETENT
JURISDICTION."
6, Louise Waggoner is authorized to sign any release necessary to effectuate this
settlement, and to then settle and satisfy the docket
7. Attorney for Petitioner, Kenneth F. Lewis, Esquire, shall file with the Prothonotary,
and forward a copy to this chambers, proof of compliance with this order.
By the Court
~1
M. L. Ebert, Jr.
~nneth F, Lewis, Esquire
For Petitioner
has
c.
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IN RE: WILLIAM BERNOSKI, a
minor, by LOUISE WAGGONER,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Petitioner
NO. 05-6783 CIVIL
PROOF OF COMPLIANCE
1. By Order of
attached), the undersigned
Compliance with such Order.
Court dated January 6,
was ordered to file
2006 (copy
a Proof of
2. Attached hereto are copies of the bank records
indicating that a Certificate of Deposit was set up, with Louise
Waggoner, as the guardian in the amount of $11,144.50 and that the
certificate is subject to the January 6, 2006 Order of Court.
I hereby verify that the statements made in the foregoing
document are true and correct to the best of my knowledge,
information and belief. I understand that false statements herein
are made subject to the penalties of 18 Pa.C.S. section 4904,
relating to unsworn falsification to authorities.
Respectfully submitted,
DATE: 1/27/06
KE NET F. LEWIS, ESQUIRE
1101 N. Front st.
HarriSburg, PA 17102
(717) 234-3136
LD. #69383
IN RE: WILLIAM BERNOSKI,
a minor, by LOUISE WAGGONER,
Petitioner
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: 05.6783 CIVIL
ORDER OF COURT
""'
AND NOW, this" day of January 2006, IT IS ORDERED:
I. Approval of the settlement of this minor's claim for $14,000,00 for William
Bernoski, a minor, born July 2, 1989, IS GRANTED.
2. From the settlement, a counsel fee of $2,800.00 for Kenneth F, Lewis, Esquire IS
APPROVED.
3. Costs of$55.50 are approved to be paid to petitioner's counsel for the filing fee.
4, The net proceeds of$1 1,144.50 shall be placed by Louise Waggoner in a restricted
federally insured interest bearing account in the name of William Bernoski.
5, The account shall contain the following notation: "NO WITIIDRA W AL CAN BE
MADE PRIOR TO WILLIAM BERNOSKJ, BORN JULY 2, I 989, OBTAINING
HIS MAJORITY EXCEPT BY AN ORDER OF A COURT OF COMPETENT
JURISDICTION. ..
6. Louise Waggoner is authorized to sign any release necessary to effectuate this
settlement, and to then settle and satisfY the docket.
7. Attorney for Petitioner, Kenneth F. Lewis, Esquire, shall file with the Prothonotary,
and forward a copy to this chambers, proof of compliance with this order.
By the Court
~1
M. L. Ebert, Jr.
Kenneth F, Lewis, Esquire
For Petitioner
bas
Page: 1 Document Name: untlt1ed
rDDHOLDS
Time Deposit Display Holds
6017
01/27/06
Acct 0775540099
Alpha key WAGGOLA.02
Nhr of holds . . . . 1
Product T513
ACTIVE
Amount of holds. . . . . . 11,144.50
Seq
Amount
Descrlptlon
Eff Date
Term Date
Opr
001
11,144.50 01/19/06
COURT ORDER 05-6783 BR 077 NEW CUMB DJP
07/02/07
021
TDDMAIN
Only one page of lnformatlon.
COMMAND ==>
TDDINT
TDCMISC
TDDHIST
TDDHISTMONEY
GN20000IO'1
F2=Retrieve F3=Exit
F4=CRFwindow
F6=Togg1e
Date: 1/27/2006 Time: 10:56:10 AM
overeign Bank
Certificate of Deposit Receipt
This receipt is issued to:
I!XJISE A ~ GUAR
316 3RD STREE:I'
NEW cnlBERlAND PA 17070
The account evidenced by this receipt is subject to and further explained in the terms and
conditions as contained in the deposit account agreement and the certificate of deposit disclosure.
Account Number: 0775540099
IRA Account:
DYes [XJ No
Date Opened: 01/19/2006
AJnount:$11,144.50
Term:T513/13-17 Months
Maturity Date: 02/19/2007
Interest Rate: 4 . 04\
Interest Disbursement:
Interest Payment Frequency: Monthly at End of Month
This account is not negotiable and not transferable.
Effective 12/02
BankefS Systems, Inc., 51. Clood, MN MDF. EPACOR
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