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Home My WebLink About06-0665 TAB AS & ROSEN, P.C. BY: LEWIS C. TRAUFFER LD.I/60267 22nd Fl.,1845 Walnut Street Phi la. PA 19103 (215) 569-5050 Plainlif/(s) THE MILTON S. HERSHEY MEDICAL CENTER P.O. Box 853 Hershey, PA 17033 ATTORNEY FOR Plaintiff vs D~fendants(s) KAREN J. CHASE 1308 Kelton Road Camp Hill, PA 17011 COURT OF COMMON PLEAS DIVISION CUMBERLAND COUNTY TERM, No ex. - !-IS C(0~ CT ER..~ NOTICE COMPLAINT - CIVIL ACTION AVlSO You have been sued in court. If you wish to defend against the claims set forth in the following 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 forth against you. You are warned that if you faiL 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 rel i ef requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. I F YOU DO NOT HAVE A LAIIYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOII. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO NIRE A LAWYER, TNIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABDUl AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 (800)990-9108 Le han demandado a usted en la corte. Si usted qui ere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene veinte (20) dias de pLazo al partir de la fecha de (a demandanda y la notificaeion. Haee falta asentar una eomparencia escrita 0 en persona 0 con un abogado y entregar a la corte en for escrita sus defensas 0 sus objeeiones alas demandas en contra de su persona. Sea avisado que si usted no se defiende, La corte tomera medidas y puede continuar la demandanda en contra suya sin previa aviso 0 notificacion. Ademas, la corte puede decidir a favor deL demandante y requiere que usted cump(a con todas Las provisiones de esta demanda. Usted puede perder dinero a sus propiedades u otras derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE. SI USTED NO TIENE ABOGADO, VAYA PERSONALMENTE 0 LLAME POR TELEFONO A LA OFICINA MENCIONADA A CONTlNUACION. ESTA OFICINA LE PUEDE PROVEER LA INFORMACION NECESARIA PARA CONTRATAR A UN ABOGADO. SI USTED CARECE DE LOS MEDIOS NECESARIOS PARA CONTRATAR A UN ABOGADO, DICHA OFICINA LE PUEDE SUMINISTRAR LA INFORMACION NECESARIA ACERCA DE AQUELLAS AGENCIAS QUE OFRECEN SERVICIOS tEGALES A LAS PERSONAS QUE T1ENEN DERECHO A RECIBIR TAL AYUDA GRAlIS 0 A UNA CUOTA REDUCIDA. CUMBERLAND COUNTY BAR ASSOCIATION 2 Liberty Avenue Carlisle, PA 17013 (717)249-3166 (800)990-9108 COMPLAINT - CIVIL ACTION THE MILTON S. HERSHEY MEDICAL CENTER VS. KAREN J. CHASE 1. Plaintiff is a non-profit corporation located at the address indicated in the caption hereof. 2. Defendant is an individual who resides at the address indicated in the caption hereof. 3. As the result of a certain medical condition, defendant was treated by the plaintiff on Sept. 24, 2002 thru July 1, 2003. 4. The amounts, quantities and nature of said medical care, the dates on which said medical care was rendered, and the charges therefore are set forth in Exhibit "A" which is incor- porated herein as if set forth at length. 5. Said medical care was commensurate with the condition of defendant and was necessary for the health and welfare of defendant. 6. At or about the time of defendant's treatment by plain- tiff, implied, constructive and oral contracts arose between defendant and plaintiff by the terms of which defendant became obligated to pay plaintiff the charges for the medical care rendered by plaintiff to defendant. 7. Defendant refuses to pay the balance due although plaintiff has made demand that defendant do so. 8. As a result of the foregoing, there is due and owing from defendant to plaintiff the sum indicated in Exhibit "A". WHEREFORE, plaintiff demands judgment against defendant for the sum of $27,700.29 plus six percent (6%) interest per annum from the date of discharge to the date of judgment, record costs and non-record costs. TABAS & ROSEN, P.C. c -:-C::~ LE~S C. T UFFER, ESQUIRE Attorney for Plaintiff ~ , MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 11/25/03 at 10:07 AM PAGE: 1 Guarantor: CHASE KAREN J 1308 KELTON RD CAMP HILL, PA 17011-0000 Patient: CHASE KAREN J Visit #: 2803367 -------------------------------------------------------------------------------- Date I Svc Code I Description I Units I Debits Credits -------------------------------------------------------------------------------- 09/24/02 46470 EMERGENCY VISIT, LEVE 1 152.00 09/24/02 249402 CYCLOBENZAPRINE 10MG 1 2.10 09/24/02 250092 OXYCODONE APAP 1TAB 2 4.20 09/24/02 307205 C-SPINE 2-3 VIEWS 1 125.00 09/24/02 307209 T-SPINE 2 VIEWS 1 125.00 09/30/03 980090 HOSPITAL BAD DEBT W/O -1 408.30- 09/30/03 980091 HOSPITAL BAD DEBT PLA 1 408.30 * - Not posted Balance: 408.30 I A - \ PAGE: 1 MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 11/25/03 at 10:22 AM Guarantor: CHASE KAREN J 1308 KELTON RD CAMP HILL, PA 17011-0000 Patient: CHASE KAREN J Visit #: 2833210 -------------------------------------------------------------------------------- I unitsl I Svc Code I Credits Debits Description Date -------------------------------------------------------------------------------- CBC W/PLT AUTO 1 URINALYSIS-BASIC & MI 1 PRE/POST CARE 0-1 HRS 1 PRE/POST CARE 4-6 HRS 1 LVL3 SURGICAL PATHOLO 1 CEFAZOLIN SODIUM INJ 100 EPHEDRINE 50MG/ML AMP 1 SODIUM CHLORIDE INJ 3 60 BACITRACIN INJ 50000 1 DIPRIVAN INJ 10 MG/ML 40 DIPRIVAN INJ 10 MG/ML 300 VERSED SOL IMG/IML IN 1 FENTANYL INJ 5CC 75 GEL FOAM SPONGE (DEVI 1 LIDOCAINE/EPINE 0.5% 50 THROMBIN 1 MORPHINE SULFATE 2 MG 1 MORPHINE SULFATE 10 M 1 OXYCODONE APAP ITAB 4 C-SPINE 2-3 VIEWS 1 FLUORO MORE THAN ONE 1 SPACER/GRAFT ACF 1 PLATE, CERVICAL VAR A 1 O.R. TIME @ 15MIN INC 18 MAJOR SET-UP, ADD. SUP 1 ELECTROCAUTERY 1 BIPOLAR CAUTERY 1 MICROSCOPE 1 PLATING SYSTEM 1 1/2 TO 1 HOUR-RECOVER 1 PASTE/PUTTY,DBX/DBM, 1 1 MICROSCOPE DRAPE CONT 1 14MM POSTS 2 IRRIGATION TUBING SET 1 SCREW, VARIABLE AXIS 4 SCREW, EXPANSIONHEAD 1 LOCKING SCREW 4 SURGICEL-ALL SIZES 1 SCD KNEE SLEEVE PER P 1 NEURO PACK 1 SOMATOSENSORY;UPPER L 1 MOTOR EVOKED RESP/POT 1 25.00 18.00 90.00 179.00 60.00 6.00 4.25 4.20 5.05 42.00 315.00 4.25 8.25 33.05 68.50 55.25 2.10 2.40 8.40 125.00 245.00 1369.00 1574.00 3816.00 1084.00 26.00 37.00 376.00 34.00 291.00 240.00 29.00 206.00 59.00 1520.00 318.00 208.00 67.00 71.00 105.00 293.00 377.00 10/04/02 10/04/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 10/09/02 105656 106011 47132 47135 191022 230346 231434 231469 231748 232025 232027 232296 232297 232418 232546 232987 246706 247786 250092 307205 307551 392125 392130 410032 410052 410060 410061 410067 410075 422004 457019 462015 462198 462380 462683 464481 464947 469172 469330 469973 479001 479003 - Continue - '1d-- , MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 11/25/03 at 10:22 AM PAGE: 2 Guarantor: CHASE KAREN J 13 0 8 KELTON RD CAMP HILL, PA 17011-0000 Patient: CHASE KAREN J Visit #: 2833210 Date I Svc Code I Description I Units I Debits Credits 10/09/02 479007 INTRAOP MONITORING EA 4 1304.00 10/09/02 479019 SOMATOSENSORY;LOWER L 1 293.00 10/09/02 502000 ANESTHESIA TIME-HOSP 18 1103.00 10/10/02 503129 BAIR HUGGER LOWER BOD 1 34.00 01/29/03 902040 AUTO/WORK COMP PAYMEN -1 847.21- 09/30/03 980090 HOSPITAL BAD DEBT W/O -1 15287.49- 09/30/03 980091 HOSPITAL BAD DEBT PLA 1 15287.49 * - Not posted Balance: 15287.49 I fl-3 I MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 11/25/03 at 10:23 AM PAGE: 1 Guarantor: CHASE KAREN J 1308 KELTON RD CAMP HILL, PA 17011-0000 Patient: CHASE KAREN J Visit #: 2874005 -------------------------------------------------------------------------------- Date I Svc Code I Description I Units I Debits Credits -------------------------------------------------------------------------------- 10/22/02 09/30/03 09/30/03 307205 980090 980091 C-SPINE 2-3 VIEWS HOSPITAL BAD DEBT W/O HOSPITAL BAD DEBT PLA 1 -1 1 125.00 125.00- 125.00 -------------------------------------------------------------------------------- * - Not posted Balance: 125.00 I A'if MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 11/25/03 at 10:23 AM PAGE: 1 Guarantor: CHASE KAREN J 1308 KELTON RD CAMP HILL, PA 17011-0000 Patient: CHASE KAREN J Visit #: 2984153 -------------------------------------------------------------------------------- Date I Svc Code I Description I Units I Debits Credits -------------------------------------------------------------------------------- 12/03/02 09/30/03 09/30/03 307201 980090 980091 SPINE 1 VIEW ANY LEVE HOSPITAL BAD DEBT W/O HOSPITAL BAD DEBT PLA 1 -1 1 111.00 111.00- 111. 00 * - Not posted Balance: 111. 00 I at:; MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 11/25/03 at 10:23 AM Guarantor: CHASE KAREN J 1308 KELTON RD CAMP HILL, PA 17011-0000 Date I Svc Code I 01/07/03 09/30/03 09/30/03 307201 980090 980091 * - Not posted Description SPINE 1 VIEW ANY LEVE HOSPITAL BAD DEBT W/O HOSPITAL BAD DEBT PLA ,1'l, PAGE: Patient: CHASE KAREN J Visit #: 3063722 I Units I 1 -1 1 Debits 111.00 111.00 Balance: 1 Credits 111.00 - 111. 00 I MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 11/25/03 at 10:23 AM PAGE: 1 Guarantor: CHASE KAREN J 1308 KELTON RD CAMP HILL, PA 17011-0000 Patient: CHASE KAREN J Visit #: 3151264 Date I Svc Code I Description I Units I Debits Credits 02/24/03 200032 O.R. TIME @ 15MIN INC 9 1908.00 02/24/03 200052 MAJOR SET-UP, ROUTINE 1 1084.00 02/24/03 200067 MICROSCOPE 1 376.00 02/24/03 200099 PHACO EMUL SYSTEM 1 47.00 02/24/03 202000 ANESTHESIA TIME-HOSPI 9 590.00 02/24/03 207132 PRE/POST CARE 0-1 HR 2 180.00 02/24/03 232429 PHENYLEPHRINE HCL SOL 1 4.75 02/24/03 245477 GENTAMICIN 40 MG/1 ML 1 2.10 02/24/03 245568 LIDOCAINE 1 ML 1 3.50 02/24/03 245725 BUPIVICAINE 10 ML 1 9.25 02/24/03 245933 TETRACAINE 1 ML 1 4.25 02/24/03 245960 EPINEPHRINE 1 ML 6 12.60 02/24/03 245990 ACETYLCHOLINE CHLORID 1 58.95 02/24/03 246024 SODIUM CHLORIDE 15 ML 2 10.10 02/24/03 246493 DEXAMETHASONE 4 MG/ML 1 2.10 02/24/03 246836 FENTANYL CITRATE 2 ML 2 18.90 02/24/03 247831 ACETAMINOPHEN 325 MG 3 6.30 02/24/03 247841 SODIUM CHLORIDE 500 M 2 26.70 02/24/03 247896 TROPICAMIDE 2ML 1 28.95 02/24/03 248212 DEX/NEOM/POLY 3.5G 1 4.45 02/24/03 250577 PROPOFOL 20ML 2 47.80 02/24/03 272194 HYALURONATE SODIUM O. 1 147.70 02/24/03 272425 MIDAZOLAM 1MG/ML 2ML 1 2.10 02/24/03 273680 DUOVISC INJ OPHTH 1 264.00 02/24/03 390161 OPHTHALMIC DYE INJECT 1 110.00 02/24/03 393019 C270BD LENS 1 101.00 02/24/03 463079 ERASER MENTOR 18 GAUG 1 13.00 02/24/03 463090 RETRACTOR FLEXIBLE IR 1 140.00 02/24/03 463145 CANNULA, IRRIGATING, 1 11.00 02/24/03 463150 KIT PHACO 1 110.00 02/24/03 469976 EYE PACK 1 93.00 09/30/03 980090 HOSPITAL BAD DEBT W/O -1 5417.50- 09/30/03 980091 HOSPITAL BAD DEBT PLA 1 5417.50 * - Not posted Balance: 5417.50 I Ii 7 MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 11/25/03 at 10:24 AM PAGE: 1 Guarantor: CHASE KAREN J 1308 KELTON RD CAMP HILL, PA 17011-0000 Patient: CHASE KAREN J Visit #: 3316305 -------------------------------------------------------------------------------- Date I Svc Code I Description I Units I Debits Credits -------------------------------------------------------------------------------- 04/08/03 09/30/03 09/30/03 307201 980090 980091 SPINE 1 VIEW ANY LEVE HOSPITAL BAD DEBT W/O HOSPITAL BAD DEBT PLA 1 -1 1 111.00 111.00- 111.00 -------------------------------------------------------------------------------- * - Not posted Balance: 111. 00 I ~S' PENN STATE !5l The Milton S. Hershey Medical Center . The College of Medicme KAREN J CHASE 546 BRIDGE STREET APT 1 NEW CUMBERLAN PA 17070-1957 ACCOUNT # 1266938 1 0' 2 H IF ANY QUESTIONS, PLEASE CONTACT: MSHMC PATIENT FINANCIAL SERVICES PROCEDURE DIAG DATE CODE CODE >>> PATIENT: KAREN J CHASE QTY 1266938 DESCRIPTION INS STATEMENT DATE: 09/04/03 LAST STATEMENT DATE: 09/03103 FED TAX 10 # 251857035 CHARGE PAYMENTI GUARANTOR ADJUSTMENT BALANCE 09/24/02 7204026 723.1 01/29/03 09/24/02 7207026 723,1 01/29/03 10/09/02 7204026 V45,4 01/29/03 12/03/02 7202026 723,1 01/29/03 01/07/03 7202026 722.0 01/29/03 02/19/03 7651926,LT 366,20 04/08/03 99213 722,10 02/24/03 66982,LT 366,17 02/24/03 66982 366,17 02/19/03 92004 366,19 02/19/03 7651926,LT 366,19 2803367 PERFORMED 8Y: DIV OF DIAG RADIOLOGY PLACE OF SVC: EMERGENCY ROOM SPINE CERVIC ANT/POS LAT 8ALANCE TRANSFER TO GUAR SPINE THOR ANTIPOS LATER 8ALANCE TRANSFER TO GUAR 59.00 59,00 59,00 59.00 2833210 PERFORMED 8Y: DIV OF DIAG RADIOLOGY PLACE OF SVC: SURGERY - SHORT STAY SPINE CERVIC ANT/POS LAT 8ALANCE TRANSFER TO GUAR 59,00 59.00 29&1153 PERFORMED 8Y: DIV OF DIAG RADIOLOGY PLACE OF SVC: OP HOSPITAL SPINE SING VIEH ANY LVL 8ALANCE TRANSFER TO GUAR 40,00 40,00 3063722 PERFORMED 8Y: DIV OF DIAG RADIOLOGY PLACE OF SVC: OP HOSPITAL SPINE SING VIEH ANY LVL 8ALANCE TRANSFER TO GUAR 40,00 40,00 3121179 PERFORMED 8Y: DEPT OF OPHTHALMOLOGY PLACE OF SVC: OP PHYSICIAN A - SCAN POH CUCU 15f+,OO 154,00 3141534 PERFORMED 8Y: DIV OF NEURO SURGERY PLACE OF SVC: OP PHYSICIAN OUTPATIENT VISIT EST 60,00 60.00 3151264 PERFORMED 8Y: DEPT OF OPHTHALMOLOGY PLACE OF SVC: SURGERY - SHORT STAY EXTRACAP CAT REMV COMPLEX PERFORMED 8Y: DIV OF ANESTHESIA 16 EXTRACAP CAT REMV COMPLX 4050.00 4050,00 1200,00 1200,00 3175969 PERFORMED 8Y: DEPT OF OPHTHALMOLOGY PLACE OF SVC: OP PHYSICIAN OPHTH EX & EVAL COMPR NEH A - SCAN POH CALCU 150,00 154,00 150,00 15f+,OO 3316305 D CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK PENNSTATE 5 The Milton S. Hershey Medical Center .. The College of Medicme KAREN J CHASE 546 BRIDGE STREET APT 1 NEW CUMBERLAN PA 17070-1957 ACCOUNT # 1266938 2 of 2 STATEMENT DATE: 09/04/03 LAST STATEMENT DATE: 09/03/03 FED TAX 10 # 251857035 CHARGE PAYMENTI GUARANTOR ADJUSTMENT BALANCE H IF ANY QUESTIONS, PLEASE CONTACT: MSHMC PATIENT FINANCIAL SERVICES DATE PROCEDURE DIAG QTY DESCRIPTION CODE CODE PERFORMED BY: DIV OF DIAG RADIOLOGY PLACE OF SVC: OP HOSPITAL 04/08/03 7202026 722,0 SPINE SING VIEH ANY LVL INS 40,00 40.00 07/01/03 99213 366,45 3535877 PERFORMED BY: DEPT OF OPHTHALMOLOGY PLACE OF SVC: OP PHYSICIAN OUTPATIENT VISIT EST BALANCE: KAREN J CHASE $6129.00 64,00 64.00 IF YOU HAVE ANY QUESTIONS A8lIUT THE AMOUNT YOUR INSURANCE COMPANY PAID, CONTACT THEM DIRECTLY, FOR ANY OTHER QUESTIONS REGARDING YOUR BALANCE, PLEASE CONTACT OUR OFFICE. IF PAYMENT HAS BEEN MADE, THANK YOU AND DISREGARD THIS BILL. RAT4 THANK YOU FOR USING MSHMC PHYSICIANS GROUP FOR YOUR PHYSICIAN SERVICES. IF YOU HAVE ANY QUESTIONS REGARDING THIS BILL, PLEASE CONTACT US AT 717-531-5069 OR 800-254-2619, BETWEEN 8:00AM AND 5:30PM MONDAY THROUGH HEDNESDAY DR BETWEEN 8:00AM AND 4:30PM THURSOAY AND FRIDAY, BALANCE Sl.tIMARY RESPONSIBLE PARTY *-* GUARANTOR RESPONSIBILITY POLICY . TOTAL $ 6129,00 _______________~_____________jl_[~~Q~_t~~ttf_~~~~_~_Qg!_4~!f~~g_fl_~rY_~~_~_~r!_Q~~Q~JClq~_9J:~_t~I_~~JL~I_~IJC~_Y9_~~_~~_y~~~_t_jl_____________________________ STATEMENT DATE: GUARANTOR RESPONSIBILITY: MINIMUM PAYMENT 09/04/03 $ 6129.00 $ 6129.00 BF6 MSHMC PHYSICIANS GROUP BilLING SERVICES POBOX 854 HERSHEY PA 17033.0854 00001266938 UP 0000000000612900090403 1",11,1,1",1,1,11",1"1"11",11,,,,11,,11,,,,11,,11,1,,1,1 Mail MSHMC PHVSICIANS GROUP To: 1",111",111",1",111"""111.1",1,1.1,,,1,1,,1,11",,11.1 PO BOX 643313 PITTSBURGH PA 15264-3313 KAREN J CHASE 546 BRIDGE STREET APT 1 NEW CUMBERLAN PA 17070-1957 "FFICE USE ONL Y .; CHECK ONE FOR CREDIT CARD PAYMENT, PLEASE FILL IN INFORMATION BELOW M/C _VISA 1266938 xwr:@0 CARD NUMBER EXP DATE 6129.00 09/25/03 HC: F6BO TYP: DMND CARDHOLDER NAME (PRINT) /Ii' o CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK CHASE, KAREN J. 111266938 $21,571.29 (Hasp) 6,129.00 (Phys) ,. VERIFICATION LINDA SCHLADER hereby states that she is the Team Manager, Customer Service of the Milton S. Hershey Medical Center and verifies that the statements made in the foregoing pleading are true and correct to the best of her knowledge, information and belief. The undersigned understands that the statements therein are made subject to the penalties of 18 Pa. C.S. ~4904 relating to unsworn falsification to authorities. II i: I J<) ,.~~ (g':LIJ..fJ DATE: l/i/0~ , f-J t P io. 7"~ ~ "'0 tI\ 6~~ ~~ B . ',l ~n ~ ~',l~ VJ . "In , -'.~7 /")(i., :.';, :f~ -0 )('S ;.~jrn <..,J _~ (.r1 "):J (./1 .< SHERIFF'S RETURN - REGULAR CASE NO: 2006-00665 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND HERSHEY MILTON S MEDICAL CENTE VS CHASE KAREN J MICHAEL BARRICK Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon CHASE KAREN J the DEFENDANT , at 2006:00 HOURS, on the 2nd day of February 2006 at 1308 KELTON ROAD CAMP HILL, PA 17011 by handing to RONALD SNELL ADULT IN CHARGE a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge So Answers: 18.00 14.08 .00 10.00 .00 42.08 rfh?~r'<~J R. Thomas Kline me this '" 7~ day of 02/03/2006 TABAS & ROSEN i ' .-'-7 By: ----/ /i~~J/ Af--~:' Deputy Sheriff Sworn and Subscribed to before .. TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER, ESQUIRE lD NO.: 60267 1845 WALNUT STREET, nND FLOOR PHILADELPHIA, PAl 9103 215-569-5050 The Milton S. Hershey Medical Center P.O. Box 853 Hershey, PA 17011 COURT OF COMMON PLEAS CUMBERLAND COUNTY VS. Karen J. Chase 1308 Kelton Road Camp Hill, P A 17011 NO.: 06-665 CIVIL TERM ORDER FOR JUDGMENT FOR WANT OF AN ANSWER AND ASSESSMENT OF DAMAGES TO THE PROTHONOTARY: Kindly enter judgment in the sum of $ 32,452.74 in favor of the Plaintiff(s) in the above entitled matter for failure of the Defendant(s) to file an Answer to P1aintiff(s) Complaint in Civil Action and assess P1aintiff(s) damages as follows: Amount of Claim: $ 27,700.29 Interest at 6% per annum from date of discharge 4/8/03, 7/1/03 $ 4,752.45 Total: $ 32,452.74 ~ /-~1f ~ Attorney fo P1aintiff(s) I assess damages as above Pro Prothonota- ~ ~# ---- 1........ .............. . .................hereby certify that the 10 day letter under R.c.P.R. 237.1 was forwarded to Defendant Karen J. Chase '-. -c:.-~~ .. :h~h~~~' ~~~~.~;.;.~~~;;~:r:::i the Precise Residence Address of the Judgment creditor is Address 1308 Keltou Rd, Camp Hill, PA 17011 Address: Same Date February 23, 2006 Address of Defendants: Same .. MILTON S. HERSHEY MEDICAL CENTER COURT OF COMMON PLEAS VS. CUMBERLAND COUNTY KAREN J. CHASE No.: 06-665 CIVIL TERM AFFIDAVIT OF NON MILITARY SERVICE COMMONWEALTH OF PA COUNTY OF CUMBERLAND LEWIS C. TRAUFFER being legally sworn, deposes and says: (a) that the defendant (s) is/are not in the Military or Naval Service of the United States or or of its allies, or otherwise within the provisions of the Soldiers' and Sailors' Civil relief action of Congress of 1940 as amended; (b) that defendant Karen 1. Chase is over 21 years of age and resides at: 1308 Kelton Road, Camp Hill, P A 17011 and is employed in Private Business. (c) that defendant is over 21 years of age and resides at: and is employed in Private Business. Affidavit has ascertained the foregoing information by inquiry and belief and makes this Affidavit with due authority. ~~~U::"ESQUIRE Attorney for the Plaintiff Sworn to and subscribed before me on this 7~ day of ""'ARc.)--\, . "waG (:O"'MONWEA~lH OF 'PENN VANIA NOTARIAL SEAl. KtM'lfTH C. SLOVITSKY, NOlar,..P.!lbHc (:Ilyof Phit8delphia,1'hila:-\::O\jIIIy COrllmission Expires Novi'mlier 17. 2008 TABAS & ROSEN, P.C. BY, LEWIS C. TRAUFFER, ESQUIRE ID No.: 60267 1845 Walnut Street, 22nd Floor Philadelphia, PA 19103 (215)569-5050 The Milton S. Hershey Medical Center P.O. BOX 853 HERSHEY, PA 17033 COURT OF COMMON PLEAS CUMBERLAND COUNTY VS NO.' 06-665 CIVIL TERM KAREN J. CHASE 1308 KELTON ROAD CAMP HILL, PA 17011 NOTICE OF INTENTION TO TAKE DEFAULT JUDGMENT TO: KAREN J. CHASE 13 0 8 KELTON ROAD CAMP HILL, PA 17011 DATE OF NOTICE/FECHA DEL AVISO, FEBRUARY 23, 2006 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO TAKE ACTION REQUIRED OF YOU IN THIS CASE. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 or (800) 990-9108 AVISO IMPORTANTE USTED ESTA EN REBELDIA PORQUE HA FALLADO EN TOMAR LA ACCION EXIGIDA DE SUP PARTE EN ESTE CASO. A MENOS DE QUE USTED ACTUE ENTRO DE DIEZ DE LA FECHA DE ESTE AVISO, SE PUEDE REGISTRAR UNA SENTENCIA CONTRA USTED SIN EL BENEFICIO DE UNA AUDIENCIA Y PUEDE PERDER SU PROPIEDAD 0 DERECHOS IMPORTANTES. USTED DEBE LLEVAR ESTE AVIOS A UN ABOGADO ENSEGUIDA. SI US TED NO TIENE UN ABOGADO Y NO PAGAR POR LOST SERVICIOS DE UN ABOGADO, DEBE COMUNICARSE CON LA SIGUIENTE OFICINA PARA AVERIGUAR DONDE PUEDE OBTENER AYUDA LEGAL. Cumberland County Bar Association 2 Liberty A venue Carlisle, PA 17013 (717) 249-3166 or (800) 990-9108 LEWIS C. TRAUFFER, ESQUIRE ATTORNEY FOR THE PLAINTIFF THIS CORRESPONDENCE IS BEING USED TO COLLECT A DEBT AND THE INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. c ](J () "B- ~ -0 it. ' ' -..\ 1- \) , ' ," \) , ~ --- ~ ~ r lI{ ) ~~ !If ( ~ r ~~ t ~ ,."-- \...~ ' r ~ --------- -- 1& OFFICE OF THE PROTHONOTARY CUMBERLAND COUNTY COURT HOUSE ONE COURTHOUSE SQUARE CARLISLE, PA 17013 TO: Karen J. Chase 1308 Kelton Road Camp Hill, P A 17011 CUMBERLAND COUNTY . No.: 06-665 CIVIL TERM The Milton S. Hershey Medical Center P.O. Box 853 Hershey, PA 17011 VS. Karen J. Chase NOTICE Pursuant to Rule 236 of the Supreme Court of Pennsylvania, you are hereby notified that a Judgment has been entered against you in the above proceeding s indicated belo X JUDGMENT BY DEFAULT MONEY WDGMENT JUDGMENT IN REPLEVIN JUDGMENT FOR POSSESSION JUDGMENT ON A WARD OF ARBITRATION TRANSFER OF JUDGMENT IF YOU HA VB ANY QUESTIONS CONCERNING THIS NOTICE, PLEASE CALL: ATTORNEY LEWIS C. TRAUFFER. ESOUlRE AT THIS TELEPHONE NUMBER: 215-569-5050 - COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND THE MILTON S. HERSHEY MEDICAL CENTER P.O. Box 853 Hershey, PA 17033 VS KAREN J. CHASE 1308 Kelton Road Camp Hill, PA 17011 COURT OF COMMON PLEAS NO. 06-665 CIVIL TERM PRAECIPE: FOR WRIT OF EXECUTION TO THE PROTHONOTARY: Issue writ of execution in the above matter, directed to the Sheriff of Cumberland County (1) against KAREN J. CHASE 1308 Kelton Road Camp Hill, PA 17011 defendant(s) and (2) against M & T Bank One West High Street Carlisle, PA 17013 (3) AMOUNT DUE INTEREST FROM4/03 & 7/03 AT 6% PER ANNUM $27,700.29 gamishee(s). (COSTS TO BE ADDED) $ 4,752.45 $ $ TABAS & ROSEN, P.c. ~~ ~ Gewls C. ~ auffer, Esq. , 1845 Walnut Street, nnd Roar Philadelphia, PA 19103 (215) 569-5050 1160267 Attorney for Plaintiff c [:I. -+- ~ ~ ~ L (\. l. tJ VI ~ r---. fJ (J \t-1t ~ ~ (I-- t: ~ r ~ i>Q.~ 0{ \) C' \) f~ ~ -I.q. (~ ..1::. --- 90 .l0 ....0 0 !G .lI'\ ..t::. '. , . V[ c; Ire D "\ ~0cC~C> I I I I p~ ":::::::::v, n ~ -t- +-- ' :::. ::.:. ~ C:L c-.' I,,/.) WRIT OF EXECUTION and/or ATTACHMENT COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND) NO 06-665 Civil CIVIL ACTION - LAW TO THE SHERIFF OF CUMBERLAND COUNTY: To satisfy the debt, interest and costs due THE MIL TON S. HERSHEY MEDICAL CENTER, Plaintiff (s) From KAREN J. CHASE, 1308 KELTON ROAD, CAMP HILL, PA 17011 (I) You are directed to levy upon the property of the defendant (s)and to sell (2) You arc also directed to attach the property of the defendant(s) not levied upon III the possessIOn ofM & l' BANK, ONE WEST HIGH STREET, CARLISLE, PA 17013 - SERVE INTERROGATORIES GARNISHEE(S) as follows: and to notify the garnishee(s) that: (a) an attachment has been issued; (b) the garnishee(s) is enjoined trom paying any debt to or for the account of the defend.nt (s) and from delivering any property of the defendant (s) or otherwise disposing thereof: (3) If property of the defend.nt(s) not levied upon an subject to attachment is found in the possession of anyone other than a named garnishee, you are directed to notify him/her that he/she has been added as a garnishee and is enjoined as above stated. Amount Due $27,700.29 L.L. $.50 Interest FROM 4/03 & 7/03 AT 6% PER ANNUM - $4,752.45 Atty's Comm % Due Prothy $1.00 Other Costs Ally Paid $124.58 Plaintiff Paid Date: APRIL 6, 2006 CURTIS R. LONG (Seal) Prothonotary p ~., ~ ~O., ~ .., /74._._17./ Deputy REQUESTING PARTY: Name LEWIS C. TRAUFFER, ESQUIRE Address: TABAS & ROSEN, P.c. 1845 WALNUT STREET, 22ND FLOOR PHILADELPHIA, PA 19103 Attorney for: PLAINTIFF Telephone: 215-569-5050 Supreme Court ID No. 60267 I\- - rAPR J 6 200& LEWIS C. TRAUFFER, ESQUIRE TARAS & ROSEN, P.C. Attorney I.D. 60267 1845 Walnut Street, 2200 Floor Philadelphia, PA 19103 (215) 569-5050 THE MILTON S. HERSHEY MEDICAL CENTER: P.O. Box 853 Hershey, PA 17033 vs. KAREN J. CHASE 1308 Kelton Road Camp Hill, PA 17011 and M & T BANK One West High Street Carlisle, PA 17013 You are hereby notified to plead to the enclosed Interrogatories within 20 days from service hereof or default judgment may be entered against you. Lewis C. Trauffer, Esquire Attorney for Plaintiff CUMBERLAND COUNTY COURT OF COMMON PLEAS TRIAL DMSION NO, 06-665 CIVIL TERM TO: INTERROGATORIES IN ATTACHMENT M & T BANK You must :file with the Court answers to the following interrogatories within twenty (20) days after service upon you. Failure to do so may result in a default judgment being entered against you. A copy of said answers niust be served on the undersigned. If your answer to any of the foregoing interrogatories is af/irmative,specify the amount, value and/or nature of the subject property. (Garnishee) 1. At the time you were served or at any subsequent time, did you Owe the defen- dant(s) any money or were YQU liable to defendant(s) on any negotiable or other written instrument, or did defendant(s) claim that you owed any moneMT'f'~to defendant(s) for any reason? HAS NO OPEN ACCOUNTS 2. At the time you were served or at any subseqfJ.;?~Q.\{I'~~JAur posses- sion, custody or control or in the joint possession, custody or control of yourself or one or more other pel_ _3 any property of any nature owned solely or in part by the defendant(s)? 3. At any time you were served or at any subsequent time, did you hold legal title to any property of any nature owned solely or in part by the defendant(s) or in which defen- dant(s).held or claimed any interest? 4. At any time you were served or at any subsequent time, did you hold as a fiduciary any property in which the defendant(s) had an interest? 5. At any time before or after you were served, did the defendant(s) transfer or deliver any property to you or to any person or place pursuant to your direction or consent and, if so, what was the consideration therefor? 6. At the time you were served or at any subsequent time did you pay, transfer or deliver any money or property to thedefendant(s) or to any person or place pursuant to the direction of defendant(s) against you? .... j - M & TBANK HAS NO OPEN .t\CCOUNT~ , . "FOR ABOVE Nt.MFn ,7.. At the time you were served or at any subsequent time, did you, have or share any safe-deposit boxes, pledges, documents of title, securities, notes, coupons, receivable, or collat- eral in which there was an interest claimed by defendant(s)? 8. Identity every account (not previously noted), titled in the name of defendant(s) of in which you believe defendant(s) have an interest in whole or part, whether or not styled as a payroll account, individual retirement account, tax account, lottery account, partnership account, joint or tenants by entirety account, insurance account, trust or escrow account, attorney's account or otherwise. i;rwr~ ~U;:;- ESQUiRE Attorney for Plaintiff II :[ d I I HdV qUOl Vd ').1r11/0,) ONI11U38~n:J .:I.:IleJ3HS 3Hl .dO 3:11.:1.:10 """ r-.' = = cro ::iT:. ::.~ I - -G :J: r:? \".0 SHERIFF'S RETURN - GARNISHEE CASE NO: 2006-00665 P COMMONWEALTH OF PENNSLYVANIA COUNTY OF CUMBERLAND HERSHEY MILTON S MEDICAL CENTE VS CHASE KAREN J And now MARK CONKLIN ,Sheriff or Deputy Sheriff of Cumberland County of Pennsylvania, who being duly sworn according to law, at 0012:00 Hours, on the 13th day of April , 2006, attached as herein commanded all goods, chattels, rights, debts, credits, and moneys of the within named DEFENDANT CHASE KAREN J , in the hands, possession, or control of the within named Garnishee M & T BANK 1 WEST HIGH ST CARLISLE, PA 17013 Cumberland County, Pennsylvania, by handing to HEIDI DEAGOSTINO (MANAGER) personally three copies of interogatories together with 3 true and attested copies of the within WRIT OF EXECUTION and made the contents there of known to Her . Sheriff's Costs: Docketing Service Affidavit Surcharge .00 .00 .00 .00 .00 .00 S'-' ~~~_ ~ ~ '"~~4 R. Thomas Kline Sheriff of Cumberland County this ~..ftt day of M.-fM/ JOO du.~' proFfiono1~ry 7 By 04/17/2006 Sworn and subscribed to before me R. Thomas Kline, Sheriff, who being duly sworn according to law, states this Writ is returned ABANDONED, no action taken in six months. Sheriff's Costs: Docketing Poundage Advertising Law Library Prothonotary Mileage Misc. Surcharge Levy Post Pone Sale Certified Mail Postage Garnishee TOTAL ~ ~ ~ Ll.L. Bd... cg 18.00 1.66 .50 1.00 4.40 30.00 20.00 9.00 84.56 V Advance Costs: 150.00 Sheriffs Costs 84.56 65.44 Refunded to Atty on lO/25/06 c:. "- \ ~ C' 0'\ Ilb.3-0~~~~~ R. ~oras Klin~, She~ . By~(1lLl1-1 L I :f d I I HdV qODZ ~ ~ ~ \1.1- Y- ~ Vd 'A1NnOJ Wfl/ -lcl38Wfl3 .:LmElHS 3Hl _iO 3JI.:L:JO ,SU tit.. ,Sl..,l q 0 ~ 18sn1\ WRIT OF EXECUTION and/or ATTACHMENT COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND) NO 06-665 Civil CIVIL ACTION - LAW TO THE SHERIFF OF CUMBERLAND COUNTY: To satisfy the debt, interest and costs due THE MILTON S. HERSHEY MEDICAL CENTER, Plaintiff (s) From KAREN J. CHASE, 1308 KELTON ROAD, CAMP fiLL, PA 17011 (1) You are directed to levy upon the property of the defendant (s)and to sell (2) You are also directed to attach the property of the defendant(s) not levied upon in the possession ofM & T BANK, ONE WEST HIGH STREET, CARLISLE, PA 17013 - SERVE INTERROGATORIES GARNISHEE(S) as follows: and to notify the garnishee(s) that: (a) an attachment has been issued; (b) the garnishee(s) is enjoined from paying any debt to or for the account of the defendant (s) and from delivering any property of the defendant (s) or otherwise disposing thereof; (3) Ifproperty ofthe defendant(s) not levied upon an subject to attachment is found in the possession of anyone other than a named garnishee, you are directed to notify him/her that he/she has been added as a garnishee and is enjoined as above stated, Amount Due $27,700.29 L.L. $.50 Interest FROM 4/03 & 7/03 AT 6% PER ANNUM - $4,752.45 Atty's Corom % Atty Paid $124.58 Plaintiff Paid Date: APRIL 6, 2006 Due Prothy $1.00 Other Costs CURTIS R. LONG (Seal) Profu"2 ~ 7fc . "---..fu: (J"'l <6.. ~. :e/?4~ /' Deputy REQUESTING PARTY: Name LEWIS C. TRAUFFER, ESQUIRE Address: TABAS & ROSEN, P.C. 1845 WALNUT STREET, 22ND FLOOR PHILADELPHIA, PA 19103 Attorney for: PLAINTIFF Telephone: 215-569-5050 Supreme Court ID No. 60267