HomeMy WebLinkAbout06-1986
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
In Re: Estate of John A. Crider,
Deceased
Civil Action - Law
No. Ol- - /'tf>b
(! iu ,1.. ~~
PRAECIPE
To the Prothonotary:
Please file the enclosed Petition to Approve Settlement of Wrongful Death and Survival
Claims, and present it to the Court at your earliest convenience. Once the Court has signed the
Order, please return a file-stamped, true and attested copy to me in the enclosed self-addressed,
stamped envelope. Please also contact me with any questions or concerns this may cause.
Respectfully submitted,
Date: ils /0(,
\
"JC~n 7JJ. ~"--
James M. Stein, Attorney for Petitioners
Dick, Stein, Schemel, Wine & Frey, LLP
13 West Main Street, Suite 210
Waynesboro, Pennsylvania 17268
(717) 762-1160 P A Bar No. 84026
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
In Re: Estate of John A. Crider,
Deceased
Civil Action - Law
No. 0(0 - /'1/(.,
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PETITION PURSUANT TO SECTION 3323 OF
THE PROBATE, ESTATE AND FIDUCIARIES CODE
TO APPROVE SETTLEMENT OF WRONGFUL DEATH AND SURVIVAL CLAIMS,
TO DESIGNATE PERSONS ENTITLED TO RECOVER DAMAGES, AND
TO APPROVE AGREEMENT FOR PAYMENT OF ATTORNEY FEES & EXPENSES
COME NOW the Petitioners set forth below, by and through their undersigned attorney,
and for their Petition to settle wrongful death and survival claims in this matter state to the Court
as follows:
1. The Petitioners are as follows:
A. Vera J. Rice, widow of the Decedent;
B. Ken Hartman, co-executor of Decedent's estate; and
C. Marie Ann Fitzgerald, co-executor of Decedent's estate.
2. Both Executors have been duly appointed by the Register of Wills for Cumberland
County, Pennsylvania on June 27, 2005. A copy ofthe Certificate of Appointment is attached
hereto and by this reference made a part hereof, labeled as Petitioners' Exhibit "A."
3. Both Executors are stepchildren of the Decedent, and Vera J. Rice is the widow of the
Decedent. A copy of Decedent's Last Will and Testament is attached hereto and by this
reference made a part hereof, labeled as Petitioners' Exhibit "B."
4. The Decedent, John A. Crider, died testate on April 22, 2005 as a result of injuries he
sustained from a motor vehicle accident. Mr. Crider was a pedestrian in front of his home when
he was struck by a vehicle operated by Elizabeth Loomis and owned by Franklin Hansen. A
.
copy of the Pennsylvania State Police Accident Report is attached hereto and by this reference
made a part hereof, labeled as Petitioners' Exhibit "C."
5. At the time of his death, the Decedent was married to Vera J. Rice and was survived
by her.
6. Following the occurrence ofthe accident set forth above, Vera J. Rice, acting on her
own behalf, and Ken Hartman and Marie Ann Fitzgerald, in their capacities as co-executors of
the estate of John A. Crider, entered into a Contingent Fee Agreement with the law firm of Dick,
Stein & Schemel, LLP, to advise, represent, and assist them in prosecuting the claim for damages
against the responsible party, and to make a claim for underinsured motorist benefits. Copies of
said Agreements are attached hereto and by this reference made a part hereof, labeled as
Petitioners' Exhibits "0," "E" and "F."
7. Prior to entering into the above referenced Contingent Fee Agreements, undersigned
counsel, along with William S. Dick, Esquire, advised all three (3) clients that there could be a
potential for competing claims in this matter, and that both the co-executors of the estate and Ms.
Rice, as the Decedent's widow, had a right to seek independent counsel with regard to the
ultimate settlement ofthe matter. All parties declined to do so.
8. The party responsible for the accident, Elizabeth Loomis, was insured under a
commercial automobile policy with the Maryland Automobile Insurance Fund (MAIF), that
provided single limit liability coverage of $20,000.00. A certificate of coverage from MAIF
verifYing its liability limit of $20,000.00 is attached hereto and by this reference made a part
hereof, labeled as Petitioners' Exhibit "G."
-2-
9. Franklin Hansen is the owner of the vehicle which struck Mr. Crider. Mr. Hansen was
insured under a commercial automobile policy with Allstate Insurance Company that provided
single limit liability coverage of $1 00,000.00. A certificate of coverage from Allstate Insurance
Company verifYing its liability limit of $1 00,000.00 is attached hereto and by this reference made
a part hereof, labeled as Petitioners' Exhibit "H."
10. At the time of the accident, the Decedent, John A. Crider, owned an underinsured
motorist policy through Nationwide Insurance, which policy contained a $50,000.00 (stacked)
coverage, for a total of $1 00,000.00 of underinsured motorist coverage. A copy of the certificate
of coverage from Nationwide Insurance Company verifYing its liability limit of $1 00,000.00 is
attached hereto and by this reference made a part hereof, labeled as Petitioners' Exhibit "I."
I L As a result of the efforts of the law firm of Dick, Stein & Schemel, LLP, and through
their negotiations with all of the above referenced insurance companies, an agreement has been
reached whereby MAIF will pay its full policy limit of $20,000.00 to settle the liability claims of
the Petitioners, Allstate Insurance Company will pay its full policy limit of $1 00,000.00 to settle
the liability claims of the Petitioners, and Nationwide Insurance Company will pay a total of
$25,000.00 to settle the underinsured portion ofthe Petitioners' claims. This represents a total
settlement to the Petitioners in the amount of $145,000.00.
12. The Petitioners propose to allocate fifty (50%) percent of the settlement, i.e. the sum
of $72,500.00, to the settlement of the survival claim; and fifty (50%) percent of the settlement,
i.e. the sum of $72,500.00, to the settlement of the wrongful death claim.
-3-
13. The Pennsylvania Department of Revenue has authorized this allocation of proceeds.
A copy of the Department of Revenue's letter dated March 28,2006 is attached hereto and by
this reference made a part hereof, labeled as Petitioners' Exhibit "J."
14. Medicare has a reimbursement claim arising out of this accident against any proceeds
recovered in this matter in the amount of $33,455.07.
15. The Petitioners will allocate the repayment of this lien such that fifty (50%) percent of
the lien, i.e. the sum of$16,727.54, will be paid by the settlement proceeds received on the
survival claim; and fifty (50%) percent of the lien, i.e. the sum 01'$16,727.53, will be paid by the
settlement proceeds received on the wrongful death claim.
16. Vera J. Rice, widow ofthe Decedent, is the only person entitled to recover damages
under the wrongful death claim pursuant to 42 Pa. C.S.A. S 8301(b). Due to a Prenuptial
Agreement, however, Vera J. Rice is not entitled to any portion of the survival claim because she
has disclaimed any interest in the Decedent's estate. A copy of said Prenuptial Agreement is
attached hereto and by this reference made a part hereof, labeled as Petitioners' Exhibit "K."
17. The Petitioners believe that this settlement is in the best interests of both Ms. Rice
and the Estate. They agree that the allocation of settlement proceeds between Vera J. Rice and
the Estate of John A. Crider is fair. The settlement represents the maximum amount of insurance
available from the driver of the vehicle and owner of the vehicle, and represents a negotiated
settlement with the underinsured carrier.
18. The Petitioners have been advised by counsel and understand that, should this
settlement be approved, there will be no future or further payments from Elizabeth Loomis or
-4-
Franklin Hansen, individually, or from MAIF, Allstate Insurance, or Nationwide Insurance for
claims against them arising out of the Decedent's death.
19. The Petitioners have been advised by counsel and understand that they will be
required to execute releases totally and fully discharging Elizabeth Loomis and Franklin Hansen,
individually, and all of the insurance companies referenced above, from any obligation to pay
additional sums with respect to the death of the Decedent.
20. The fee agreement between the Petitioners and counsel provides for a thirty-three
(33%) percent attorney fee which, in this case, totals $48,333.33. The Petitioners agree that the
fee charged in this case is fair and reasonable. The attorney fee will be allocated fifty (50%)
percent, i.e. the sum of$24,166.66 to the settlement of the survival claim, and fifty (50%)
percent, i.e. the sum of$24,166.66 to the settlement of the wrongful death claim.
21. The attorneys for the Petitioners have incurred the following litigation expenses in
prosecuting the claim:
Postage Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $14.34
Records Expenses ............................... $228.80
Notary Expenses .................................. $9.00
Total ......................................... $252.14
Petitioners agree to reimburse the law firm of Dick, Stein & Schemel, LLP, for those
expenses from the proceeds of settlement with fifty (50%) percent of the litigation expenses, i.e.
the sum of$126.07, being allocated to the survival claim and fifty (50%) percent of the litigation
expenses, i.e. the sum of$126.07, being allocated to the wrongful death claim.
-5-
22. There are no individuals entitled to recover under the above referenced statute other
than the Petitioners.
WHEREFORE, the Petitioners respectfully request that the Court:
A. Approve the settlement of the survival claim pursuant to Section 3323 of the
Probate, Estate and Fiduciaries Code, which allocates $72,500.00 to the settlement of the
survival action and $72,500.00 to the settlement of the wrongful death claim;
B. Approve the agreement for payment of counsel fees and expenses, with fifty
(50%) percent allocated to the survival claim and fifty (50%) percent allocated to the
wrongful death claim;
C. Designate Vera 1. Rice as the sole person entitled to share in the net proceeds
of settlement allocated to the wrongful death action pursuant to Pa. R.c.P. 2206(b); and
D. Grant leave to Petitioners to execute all necessary instruments to effectuate the
settlement as set forth in the Petition.
Respectfully submitted,
Date: %~b
;
,J Cq~'-lj) 717 :ti:~,--
James M. Stein, Attorney for Petitioners
Dick, Stein, Schemel, Wine & Frey, LLP
13 West Main Street, Suite 210
Waynesboro, Pennsylvania 17268
(717)762-1160 PABarNo.84026
-6-
<
VERlFICA nON
I verify that the statements made in the foregoing pleading 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.
Date: il'!/t'b
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M . e Ann Fitzgerald, P' toner
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Date: '0/ /
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Ken Hartman, Petitioner
Date: 3/3/ /u:.
~0/Uu 9. R~'--" /
Vera J. Rice, Petitioner
-7-
----
REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
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No. 2005-00579
Estate Of: JOHN A CRIDER
PA No. 21-05-0579
(First, Middle, Last)
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Late Of:
NORTH NEWTON TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Security No: 201-18-5913
WHEREAS, on the 27th day of June 2005 an instrument dated
May 22nd 2002 was admitted to probate as the last will of
JOHN A CRIDER
(First-Middle, Last}
la te of NORTH NEWTON TOWNSHIP, CUMBERLAND County,
who died on the 23rd day of April 2005 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
KENNETH R HARTMAN and MARIE ANN FITZGERALD
who have duly qualified as EXECUTOR(RIXj
and have agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 27th day of June 2005.
I . t
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. Register of Ills ,
:Yr r CD Cl"nt
Deputy
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
.
WEast ~il1 atW 'Q}tstatttcttt
I, JOHN A. CRIDER. of 6968 Hades Church Road, Chambersburg,
Franklin County, Pennsylvania, 17201, being of sound mind and memory, do
make, publish and declare this my Last Will and Testament, hereby revoking and
declaring null and void any and all wills and codicils by me at any time heretofore
made.
FIRST: I direct my Executors to pay any debts which I may owe
which are not barred by the statute of limitations and are considered just by my
Executors, the expenses of my last illness, and my funeral expenses.
SECOND: I give, devise and bequeath all of my estate, of whatsoever
nature and wheresoever situate, to my wife, Betty Mae Crider, if she survives me.
Should my wife, Betty Mae Crider, fail to survive me, I give,
devise and bequeath all of my aforesaid estate, in equal shares, to her children:
Samuel J. Hartman, Paul E. Hartman, Kenneth R. Hartman, and Marie Ann
Fitzgerald, if they survive me. Should any of my wife's children fail to survive me,
his or her share shall be distributed to his or her issue, per stirpes, surviving me.
THIRD: I direct my Executors to payout of the principal of my estate,
all federal estate, state inheritance, estate and succession taxes imposed upon
or with respect to my estate or any property in which I may have an interest,
including any property not forming a part of my testamentary estate, but included
in my gross estate for tax purposes, in such manner as my Executors, in their
sole discretion, shaH deem advisable; and no such taxes or any portion thereof
Page 1 of a Three-Page Will
--
so paid shall be collected from or paid by any other person, persons, or
corporations by way of reimbursement, proration, apportionment or otherwise.
FOURTH: I name and appoint my stepchildren, Kenneth R. Hartman
and Marie Ann Fitzgerald, Co-Executors of this, my Last Will and Testament.
I direct that my Executors shall not be required to post bond
for the faithful performance of their duties in this or in any other jurisdiction.
IN ~TNESS WHEREOF, I have hereunto set my hand and seal this~
day of /~/ ,2002.
WITNESS:
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J. n A. Crider
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Page 2 of a Three-Page Will
--~---,"!'''-'- -'- \
COMMONWEALTH OF PENNSYLVANIA
:S8.
COUNTY OF FRANKLIN
We, John A. Crider, Richard K. Hoskinson, and
~-... tj, ~...,,-Jtt , the Testator and the witnesses,
respectively, whose na es are signed to the attached or foregOing Instrument,
being first duly affirmed, do hereby declare to the undersigned authority that the
Testator signed and executed the instrument as his Last Will and that he signed
willingiy, and that he executed it as his free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the presence and hearing
of the Testator, signed the Will as witness and that to the best of their knowledge
the Testator was at that time eighteen years of age or older, of sound mind and
under no constraint or undue influence.
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J . n A Cnder. Testator
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Richard K. Hoskinson, Witness
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() Witness
Subscribed, affirmed, and acknowledged before me by JOHN A. CRIDER,
Testator, and subscribed and affirmed before me by Richard K. Hoskinson and
Y-~,..,;'"'. :f!. ~od~ , witnesses, this ;Q".jday of
'l/'f )1/ , 2002.
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o
o
Both Uglrts .nd
Siren
Unknown
000
01~11 12 01020
_ 09 03 0
008 040
07 06 050
o 0
l-
o Braking. Other
Evidence
o Steering. Evidence
or Driver Stated
o Other Avoidance
Maneuver
o Inconclusive
o Steering and Braking 0 Unknown
Evidence or Stated
Underride. No
o Compartment
Intrusion
Underride.
o Compartm.nt
Intrusion Unknown
o Override. Other
Vehide
Unknown if
o Underride or
Override
o Liglrts Fla.hing
o Siren Sounding
o Both Uglrts and
Siren
o Unknown
'-
. Motor Vehicle in 0 Hit & Run Vehicle 0 Illegally Parked 0 Legally Parked 0 Non - Motorized
Transport
O Pdt. 0 Pedestrian on Skates, 0 Disabled From 0 Train
e es: nan In Wheelchair, etc Previous Crash
(If .Pedestrian- or -Pedestrian on Skates, in Wheelchair, etc., Com lete Form M, Section 28)
First Narne M1 Date of Birth (MM.DD-VYYY)
~ [QEJ Gill] [Jillili]
Tek!phone Number
!(4/D)8.;l<1-lfS.:l8 1
z'
I~
FAT' ~ '
".J COMI\IlOi\l\J1/IEALTGl OLl' i'lEi\li\l5VLVAi\lIA
i'OUCIE CMSi<l L'tIEPOL'tll'Di\lG Ll'ORM
AA 500 2 1'01",",,001, HD;;J.-fi.!7lf96<1
i
,. -
~
~
:>
Tn!!.
Unit
Unit No
[Q]I]
Delete?
o
c
o
;l
..
E
~
:s
AlcohoVDruas Susoected
. No 0 Illegal Drugs
o Alcohol 0 Alcohol and DllJgs
o Breath
o Urine
a Test Refu5ed
O Test Given,
Contaminated Resulu
Page:
10131
11'111111\111111I11I111~lm
P0746755
Crash Number
-,
Commercial Veil/de
o Yes . No
o Phantom Vehicle
(If Yes. Complete Form 0
State Class
IMIDII C
o Med:cation
o Unknown
Driver or Pedestrian PhYsical Condition
_ Apparently 0 Illegal Drug
Normal Use
O Had Been 0 S' k
Drinkin ,C
Fatigue
o
o
Unknown
o
Medication
c
.
"1
l~
'.
. 1= Alcohol Test TVDe
: B . Test Not Given
. w'
"g I 0 Blood
:c
~, Alcohol Test Results
: I
Ii II [QJ. IT]
~l; i'[ OwnerlDriver OO=Not APP.licable O.2..=private Vehicle Not 04=State Police Vehicle 07=MUllrcipal Police Veh 09=Federal Gov Veh
J ~ 01=Prlvate VehIcle Owned/ Owned/Leased by Driver Q5:;::PENNDOT Vehicle- 08:::Other Muniopal 98:::0ther
~ Leased by Driver 03=Rented Vehide 06~ther State Gov Veh Government VehIcle 99=Unknown
-f~~';'e~:; -Owner First-Name-'--=---'--:~~--'--===-=-==---o;~sr last Name or Busin-ess'Name (If Pedestr;;m, sk;p this Sedionf== =--
Driver 0
o Asleep
o Other
O Unknown If
Test Given
Unknown
o Results
Primary Vehide Code Violation Charged?
I OEEI>/ E~ Ib l1W'f'/c.CMiRD 0€.Y4 . Yes 0 No
Driver Presence
1 =Driver Operated
VehIcle
2""No Driver
OJ
3=Driver Fled Scelle I
4=Hit and Run ....J....
9=Unknown
Vehicle Make -Make COde
II VOU<SWAGE~ 113 ~
Vehicle Model (see overlay)
H "- S fIA. 0 0 G, ;). 5 b ~ I JeTiA I
Reg. State Est. Speed vehicle Towed Towed By
[EJ]J 1015181 . Yes 0 No I hlYER'S ful>Y S-Hop I
Policy No
II geI4L/3:2/.fO I
APOLLO. PA /5fo/3
Insurance Company
o ~~~n I ALLSTA:TE
Insurance
c I
", _Ye, 0 No
""
m,
~ II Trallina
12 i;1 ~ No., .of [Q]
- Trailing
~ Units:
:l!
~ Direction of I.. I!
!BY!!!. IoV
Vehicle Color
06=Yellow
07=Silver
08.Gold
09:::Brown
10=Orange
, J=Purple
12=Other
99;::Unknown
~ 1=Towing Pass. Veh
Unit 0 2=TowlOg Truck
- 3;Towing Utiilty Trailer
'Vehic/e Position [QII]
V~hlde TVQe
~O I o,.Au'omobile
~ 02=Motorcycle
03:::Bus
04=Small Truck
(If "02", Complete Form
M, Section 26)
(tf"20"or "21", Comple~
Form M, Section 27)
[QB]
01::Blue
ObRed
03=White
04=Green
05=Black
'nitiallmDact Po;nt
I r-QfIll OO=Noll-Collision
~ 01-12=Clock Points
I 'J.Top
14:::Undercarriage
15=Towed Unit
99=Unknown
FORM it AA-500 (12lO2)
Model Year
4=MobileIModulaf Home
S==Camper
6=Full Trailer
7=Seml-Trailer
8:::Other
9=Unknown
'Movement IQJID
'See
Overlay
05=Large Truck
06=SUV
07=Van
1D:::Snowmobile
11 =Farm EqUip
11=Construction Equip
13=ATV
18=Other Type Spec Veh
19;::UIlk., Type Spec Veh
20=Unicyde. Bicycle.
Tricycle
21 =Other Pedalcycle
22=Horse & Buggy
23=Horse & Rider
24=Tralll
25= Trolley
9S,Other
99=Unknown
Gradient
f3l '=level
~ 2=Uph,1I
Damaae Indicator
~ O=None 2=Functional
t.JJ 1 ===Minor 3=Oisabling
9=Unknown
:>Et.!NDDT COPY
-
Tag No
I
Tag Year
II
Tag St
ID
SDecial Usaae
[Q]Q]
12=Commereial
Passenger
Carrier
13=Taxi
21 = Tractor Trailer
22=Twtn Trailer
23:Triple Trailer
31 =Modifred Veh
99=Unknown
OO=Not Applicable
01 :Fire Veh
02=Ambulance
03""Polke
08=Other EmergellCY
VehIcle
11 :::Pupil Transport
3=Downhlll
4:::8ottom of Hill
S:Top of Hill
9=Unknown
Road Alignment
I .., I 1.Straight
.t.. 2.Curved
9=Ullknown
'.J
FA,.
OO:1Rllf.@~n.lI'OI O~ LOiEOONsnVAMDA
~DCIE mA$OII.tIEPOI.t111:~G ~iOI.tM
AA 500 2
Page: L/
I [{lID
. New
IIllmll~IUII~lllwm
Crash Number
--,
Unit No
@m
I """llieonlyHa;1._llJ74f(' I{
o Motor Vehicle in 0 Hit & Run Vehicle 0 Illegally Park.ed 0 Legally Parked 0 Non - Motorized
Transport
. p--' 0 Pedestrian on Skates. 0 Disabled From 0 0 Ph t V h' I
. ~estflan in Wheelchair, etc Previous Crash Train an om e IC e
(If -Pedestrian- or -Pedestrian on Skates, in Wheelchair, etc., Comp/~te Form M, Section 28)
First I\!ame MI Dote of Birth(MM.DD-YYYY)
~ !iliJ IQlil ~
TeleDhone Number
lem) 77"-S~S5" I
Z-
I~
I
o Change'
Continuation
"'~-
I~
."
I
I
I
~
Unit
Commercial Vehide
o Yes . No
(If Ye~ Complete Form C)
State Oas5
[E]A] I c
o MedlCdton
o Unknown
Driver or Pedestrian Phvsical Condition
o ~~~ntly 0 ~U'"I Drug 0 Fatigue
o H,'d Been 0 SI~' 0 A5le~
Dnnil:,Jl". "I"
o Medication
. Unk,nown
,-
~ ~~It:J;jol '7est Tv'!J3
K . Te!.t Not G:ven
o
y. 0 Blood
'd
., Alcobol ;Om :mu103
[Q]. OJ
Tt"!lt Refu~cd
Test Given,
C ontam natrd RI.'..,ults.
OOH~r'
O Unknown it
Tpst GlVE'n
O Um.nown
Re...ults
Primary Vehide Cod:! Violation
ndrl;ed'
o y", 0 ~o
06,"'th
o Urine
o
o
Driver Presence
~
1 ""::>~IV('f Operated
Ven,de
2 ",No Dny('1"
3.,."Dnver F!ed Scene .....L
4=Hlt and Run
9,=",Unknown
OwnerlDrhler OO-..."Not Applicdble
CD 01 =PrNate VehIC~ Ownedl
Leased by Dnver
Ob.Pnvate VehlC~e Not
OwnedILeased by Onver
03=Rented Vehicle
04=State Police Vehicle
OS"PENNDOT VehICle
Q6=Other ~tate (JOY Veh
07=Munldpal Policl:' Veh
08=:Other Municipal
CJovernment vehicle
09=F€'deral Gay Veh
98=Other
99=Unkno....m
Si:~ts
OJiverO
.. Addre.. , City I Smte , Zip
J
;1 VI~
Owner last N~m~ or Business Name (If Pi!destrian. t:,I,'? thit Ssci.1on)
Vehicle Ma!te
II
Vehicle Model
I
Towed By
I
*iV'!.8:te Cede '
IITJ!
(see ....rfay)
Iii
I
1:\
I
"
o
:e':O
'I
I:
12 ~
o
'tl
:<:
~I
,I
Model Year
ITITI
Reg. State Est. Speed Vehide Towed
ITJ ITJJ Oy" ONo
Policy No
II
I
~ lkense Plate
o Yes 0 No
Insurance Company
DUn- I
xnO\'Vn
Insurance
TrailinQ
Umt No. of D
- Trailing
UniK
~
Unrt
t.=Towing Pa5s. Vch
D 2...Towmg Truc:<'
3= Towing Utilfty T raller
4=Mob:tpjModuldr Homp
~=C dmppr
6=Ful! Trdller
7~Sefm.Trcliier
8=Other
9z:Unknown
Tag i\!o
I
Ta~ Yur Tag St
II ID
Direction of 0 "Vehicle Position CD "Movement CD '5.. SJJecialUsafle
Travel Overlay IT]
Vehid@ Color Vehide TVDe OS=large TrueX 20=Unlcycle. Bicycle, 12=(ommercial
CD 06=Yellow ~ 01=Automobile 06-SUV T ncycle Passenger
07=Silver 02=Motorcyde 07=Van 21....0ther PedalcycJe OO=Not Applicable Carrier
08=Gold 03=Bus 10=Snowmobtle 22=Horse & Buggy Dl=Fire Veh 13=Taxi
01=61ue 09=Brown 04=Small Truck 11:-Farm EqUip 23=Horse & Rider 02:::Ambulance 21... Tractor Trailer
02_Rod l0=0range (If .or, Complete Form 12""Constructlon EqUIp 24:-:Tram 03",Police 22=Twln Trailer
03=White tt=Purple M, Section 26) 13=AN 2S=Trolley 08=Other Emergency 23,."Tnple Trailer
()4:.:Green 12=<Jther ls...Other Type Spec Veh 98.,."Qther VehIclE' 31 =ModjfjE'd Veh
OS=Blacx 99=Unknown (If .20. or -21., Complete t9=Unk. Type Spec Ve" 9g""Unknown 11 =Pupil Transport 99=:Unknown
Form M, Section 27)
Initia.l/mI1an Faint
Itl OO:~on"COthSlOn
LLL-J 01-12=CioO:. Pomts
t3=Top
~:::.. .'.".':~;w(~
14,..,.UndercdmClgc
lS...Towt'd Un.t
99.,.,.UnknO'....n
Damaoe lndlGJtor
D O::None 7=fu'1ctloncll
l'"'"I''''.oor 3=Dlsabh~g
9=U"kr.ovm
Gradient
Dl::leve-:
2=Uph:1I
3,..DownhIJ' I Roed AliGnment
4..8otto'TI of H,~j D l.::Stra<qht I
S""Top of Hill I 2:oCurvro._ I
9=Unknown 9=Un(n~~
::.L.:..~::'" ;:;:::".'
FA. ~,
.. I COMMONWEALTH OF ~YLVANIA
---l POLICE CRASH REPORTING FORM
AA 500 3 I Poi,,,",, 001, Ro.J. -11./71./ 9b 4
~
A P@.r<;on Tvnl":
l_Driver
2=Passen~er
7:o:Pedestnan
8=Other
9=Unknown
!)Pat Po<;ition:
D aD_Not A Passenger/Occupant
01 "'Dnver ~ All Vehides
02=Front Seat Middle PosItion
03=Front Seat Right Side
04=Second Row - Left SIde Or
Motorcycle passenger
05=Second Row . Middle Position
06=Second Row . Right Side
07= nurd Row Or Greater -
left Side
08= Third Row Or Greater -
Middle Position
09= Third Row Or Greater ~
Right Side
10=Sleeper Section of Truckcab
11 =In Other Enclosed
Passenger Or Cargo Area
12=ln Open Area
(Back Of Pickup, Etc.)
13= Trailing Unit
14=Rldlng On Vehicle Exterior
1 S=Bus flassenger
98=Other
99=Unknown
Page S
I~
'lafptv FnuinmPnt One:
E OO-None Used I Not Applicable
01 =Shoulder Belt Used
02=lap Belt Used
03=lap And Shoulder Belt Used
04.Child Safety Seat Used
OS:;Motorcycle Helmet Used
06=Bicycle Helmet Used
10=Safety Belt Used Improperly
11 ",Child Safety Seat Used Improperly
12=Helmet Used Improperly
90=Restralnt Used. Type Unknown
99=Unknown
)iifptv FnuiDm~nt Two:
F CO_None Used I Not Applicable
01=Front Air Bag Deployed (For This Seat)
Q2.Slde Air Bag Deployed (fOl Th~ Seat)
03=Other Type Air Bag Deployed
04=Multiple AIr Bags Deployed
05=Motorcycle Eye Protection
06:;;;Bicyclist Wearing ElbowlKn~ads
10=Air Bag Not Deployed, SWitch On
11 =Air Bag Not Deployed. SWitch Off
12=Air Bag Not Deployed,
Unk SWitch Settmg
13=AIT Bag Removed (Prior To Crash)
19=Unknown If Air Bag Deployed
99=Unknown
1111111111111111111~n
~
Po 74(:;7SS
--,
c
o
i
~
g
.s
, -,
, D.I
; II
,
~:
B f _female
M=Male
U ""Unknown
Crash Number
W1kl!J.'
G 0 Not Applicable
1 =Not Ejected
2=Totallv Ejected
3=Partially Ejected
9=Unknown
H F;prtion Path:
O-Not Ejected / Not Applicable
1 = Through Side Door Opening
2= Through Side Window
3= lnrough WIndshield
4:!!!Through Back Door
5= Through Back Door Tallgate Opening
6=Through Roof Opening (SunroofJ
Convertible Top Down)
7=Through Roof Opening (Convertible
Top Up)
9=Unknown
~
Extrication:
O=Not Applicable
1 =Not Extricated
2:;:Extncated By Mechanical Mean<j
3...Freed By Non. Mechamcal Means
8""Othef
9=Unknown
il
'I
Ii
:i
EMS Agency: IIIJeWV/I.L.E Am8Ul-ANce 1 Medical Facility: 1 ~L.ISL€ AGGIDIJAL. I\{C;OIcA-L ~ \::
Unit No Person No I Date of Birth IMM.DD-VYYYI ABC D E f G HI:
14] @]J] ~ Ad:~e~ pgJ-OJ - DID OJ [E] [Q][Q]l] [Qli] [ZB] ITJ [Q] [!J I
I EMS Transport
!81 Same as I 0 Ye~ . No
I Operator
i Unit ~;~-'o.~rs';;'-N~.--- DatO of Blrtt, (MM-DlJ.YYYYj - - = - -AS . c - -.~-D~ - f ~ - ~ F - G H 1 - "i
I [ill] [QE] D~el [Qff] - ~ - u:JIJill ~ ~ [Q] [ill] @:ill (IE] ITJ [gJ [lJ I
I n Sa~ Name I Address / Phone EMS Transport
~~:~, IJONATHA.'" A. l>UWDE 47~ R.a.m::'" APo/.J..O, PA tS"f3 (401) 't5;1-0H/t I Dves . No
rn ~nlNr D~el ID~tel~rr~M~rr;1 'f I... ~[]~-cblolo 110 10"11010 II;-I~~ I
Name I Address I Phone EMS Transport
l D~p~~a~r~"~CRl~/051)~S"~~.~~l!1=. M~7~lfl(;n?77~-S-'IS"~_1 ~YesDNol
. CD ITrDc;~l rn~ITrEDTIDDDcbrndJ-D-DD~
Name I Address I Phone E"S T I
1 I 1\'1 ransport
D~meM ~
I Operator 0 Yes 0 No
,1.___. __~_u ~~_______~-"_..---_____._____._________--
,~un~IND I ED De~el [jj:cIrITIooDodJdJ-dJoDD
Name I Address I Phone EMS T
I ransport
D ~':"::r I 0 Yes 0 No
I _'u~._, _" _ ._~
IEfJrn D~tel [jj~IT~rD=oJDDDdJdJdJDDI[]l
I Name I Address I Phone E"'S T I
. I IV! ransport
o ~me as I "
L Ope",to' 0 Ves D No I
FORt.:: II AA.500 (12J02) P;:i\!i\!DOT CO?'!
Iniwv fievpritv:
C O=Not Inlured
hKilled
2=MaJor InjUry
3=MOderate
InjUry
4=Mmor Injury
8=lnjury, Unk
SeverIty
9=Unknown If
InjUry
"
J
FAT <:e~ '
.~ COMMONWEALTH OF PENNSYLVANIA
POUCE CRASH REPORTING FORM
AA 500 4 I ""'U~"'" f.ta,;-''t7 4 9b4
Page ~
~
~lllllnlmlmlln
P0746755
Crash Number
I
Crash Dticril1tion rnJ Q=;Non-CoJlision 2=Head On 4"Angle
~ ~ 1 =Rear End 3=~O Rear 5=~~desWIBe
( Ing) ame ireclion)
~f Relation to Roadwav OJ 1=On Travel Lanes &:-Median 5::Outside Trafficway
E
.e 2:::Shoulder 4=Roadside 6=ln Parking Lane
15 Sf Illumination IT] 1 =Daylight 3=Dark . Street 5=Dawn
'" "
es 2=:gark - No Lights 6=Dark - Unknown
v N treel L' his 4=Dusk Roadway U hlin
_ 0 1 ~~ A~verse
.. . WeiJther Conditions ~ 5=Fog
~ ~ 3=31..1 (Hall)
~ . ndltions
I Iii g 2~Rajn 4=Snow 6=Rain & Fog
"'" OJ 2=~and, Mud, Dirt,
I Road Surface Conditions O::.Dry II 4=Slush
l=Wet 3=Snow Covered 5=100
n-- Unit NO-~ r~-qT 0 M:1
il . [Q]JJ2 UJ 0 0
[]JOO
4ITJOO
Please Put :3
Events in
Sequential
Order
c:
o
0';:;,
. ,",
E
o , Harm Event L/R
~.~ 1 []J 0
I ;;: Unit No
':iii[]J2 ITJ 0
f.., PleasePutl []J 0
I' Events In
, ;: Sequential
, :: Order 4 []J D
7 I
J
11
!
i
I
Firsr
Harmful
Event In
l1ii7fiSh
Unit No Harm Event
!QIT] [ill]
Utility pole Number -
CIIIIIIJ
CIIIIIIJ
CIIIIIIJ
CIIIIIIJ
Most? Utility Pole Number
o CIIIIIIJ
o CIIIIIIJ
o CIIIIIIJ
o CIIIIIIJ
lI'I..t
Harmful
Event In
tnelJiih
Unit No Harm Event i
[QIJ] [QIi]
OOl\Ot~lthlloll1form<rtlOnonmtAlopl(>poage1
Environmental I Roadwav
Poten"ar Factors ([/If) 1
OO=None
01=Windy ConditIOns
02=Sudden Weather Conditions
03::::0ther Weather Conditions
04::Deer In Roadway
05:::0bstacle On Roadway
06:::0ther Animal In Roadway
18 ,OhGlare
, c " 08:o:Work Zone Related
o'
;1 ".g ,I Ponible Vehicle Failures (V)
E OO:::None 06=Exhaust
.s: I 01zTires 07=Headlights
.5 I OhBrake System 08=S&gnalllghts
g' 03=5teenng System 09=Other lights
+' 04==Suspemion 10""Horn
~ OS::Power Train 11=Mirrors
8 ~~ [Qli] 1 [Q]Q] 2 OJ
I
~~It rn ' IT] 2 IT]
,
"
Indicated Pri",. Factor
00 not rtpeat thl~ mlormallOl1 Or'l
multiplepa!J5,
,IR V
o 0
o
.
,.
o
FORM' .u.-sco (121tl2)
[ill] 2 OJ 1 CD
11=SIIPPery Road Conditions (IcelSnow)
12=Substance On Roadway
13=Potholes
14=Broken Or Cracked Pavement
15=TCD Obstructed
16=Soft Shoulder Or Shou~der Drop Off
28=~herRoadwdyFactor
29=~her Environmental Factor
99=Unknown
12=Wiperi
13=Dnver SeatlnglControl
14=Bodv. Doors. Hood. Etc
lS=Trai[er Hitch
16=Whee~
17 =i\Jrbags
1S""Trailer Overloaded
19=UnsecuretShifted
Trailer Load
20=lmproper Towing
21 =Obstructed Windshield
99=Unknown
Unit No Factor Code
[QEJ 1~131
If fiR is the Prime Fador
Type. leave Unit No blank
Harmful Events (Harm Event'
01=Hit Unit 1
02=Hit Unit .2
03=Hrt Umt l
04=Hit Unit 4
OS=Hit Unit 5
06=Hlt Other Traffic Unit
07=Hlt Dee-r
08=Hlt Othe' Animal
09=Co~hslon Vlith Other Non
f.xPd OblE'et
1 h:Strudr. By U!1lt 1
11=Strud By Unit 2
13=Struck By Unit 3
14=StriJck By Unit 4
t S=Strud:. By Unit 5
16=Struck By Other TraffiC Unit
21=Hrt Tree Or Shrubbery
22=Hlt Embankment
23=Hlt Utill!y Pole
24=Hit TraffIC Sign
25=Hit Guard Rail
26=Hlt Guard Rail End
27=Hit Curb
28=Hit CO!1crete Or
longitudinal Barner
29=Hit Ditch
Driver Action (DJ
OQ=No Contributing Action
01=Driver Was Distracted
02=Dnllrng USing Hand Held Phone
03=Dnving Usmg Hands Free Phone
04=Makmg Ulegdl U-Turn
OS=lmproper/Careless Turning
06=TurnmgFrom Wrong Lane
07=Proceedlng W/O
Clearance After Stop
08=Running Stop Sign
09=Running Red light
10=Failure To Respord To
Other Traffic C antral Dev.ce
11::.Tai!gatLng
12=Sucden SlowlnQ/Stoppng
ll=lllegal~ Slop""a On Road
14=(areless PaS$lflg Or Lane
Change
15=Pasmg In No Passing Zone
16=Drivlng The Wrong Way On
l-WayStreet
~~~ [Q]] 1
6=Sideswipe 8=Hit Pedestrian
(Opposite Direction)
7=Hit Fixed Object 9=Other!Unknown
1=Gore (Ramp IntersectIOn)
9=Unknown
8=Other
7=Slool & Fog
8=OIher
6=100 Patches
7=Water, Standing
or MaVin
9=Unknown
6=Qther
30=Hit Fence Or Wall
31=Hit Building
32=Hit Culvert
33=Hit Bridge Pier Or Abutment
34=Hit Parapet End
35=Hlt Srid~e Rail
36=Hlt Sou der Or Obstacle
On ROddway
37=Hlt Impact Artenuator
38=Hlt Fire Hydrant
39=HIt Roadway EQUlpml'Ot
4O=HIt Ma.' Box
41=Hlt Traffic Island
42""Hlt Snow Bank
43=HIt Tempordry Construction
Barner
48=Hit Other Fixed Ob.ect
49=Hit Unknown Fixed Object
SO=OvertumIRo!l Over
51=Struck By Thrown Or Falling
Object
52=Pot Holes Or Other
Pavement Irregularities
53=Jacknife
54=Fire In VehIcle I
SS=~her Non.Collislon j
99=Unknown Harmful Ev~nt _. ~=
17=Careless Or IIleg.ll
Socking On Roadway
18=DrlVmg all The Wrong
S,de Of Road
19=Making Improper
Entrance To Highway
20=Mak.lng Improper EXit
From HIghway
21 =C.lreless parklllglUnparKlng. --i
22=OverlUnder
Compensation At Curve
ll=$peed,ng
24=Drlvlng Too Fast For ConditiOns
25=Failure To Malntam Proper Speed
26:=DrNff FJeE'lIlg PoJJce (Pol Chase)
27=Drlver Inexperienced
28=Fdilure To U~ $pedalized Equip
92=Affected By PhYSICal Condition
98=Other Improper Dnvmg Action~
99=Unknown
:1
!1
Ii
I[
I
I
[ill] 2 CD 1 CD 4[]J
~~Il ITJ 1 CD 2 CD 1 CD 4ITJ
Pedestrian Action (II)
aa-None
01 =Entering Or Crossing At
Specified Location
02=Walking, Running, Jogging.
Or PlaYing
II
UnltNo~
[QJIJ
PEIIIIIIDOT COPY
03=Worklng
04=PUShlOg Vehtc~
OS=Approad1ing Or leaving Vehide
06=Working On VI!~h;de
07:..Standing
98=Other
99=Unknown
Unit No []J
[]J
,. I .
. ~ .
F1fT ,.Q ,
COMMONWEALTH OF ~YLVANIA
POLICE CRASH REPORTING FORM Pago 7
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Accldent Investigation Notification Issued? Property Damage 0
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L"OLICIE ~Dl ~lPOmuNG fOC4M
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Crash Number
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Continuation
Narrative and addhional witnesses:
22
RI::::::O~:~
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Incident Number
~t\oi..-I
<! Agency Name Precinct ~i'gion Date (MM-DD-YYYY)
~ I ~....... C;;__~.--..;;: ~l-,J;c:.< II C-~\...rS'-,,", 10 l.\ -~-~
1 : ~ Arrival TIme (miQ Investigator ~r
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n .~ 0 W.idblocx 0 or IntersoctJo" 0 Traffic (Irdel 0 On Ramp 0 Crossover
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F'A-T ~
COMMONWEALTH OF PE YLVANIA
POUCE CRASH REPORTING FORM
Case Closed Reportable Cra.h
o y", _ No . Yes 0 No
o CIIangel
Continuation
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AA 500 1
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I
Crash Number
~ Patrol Zone
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Crash Number !
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Continuation
22
Narrative and additional witnesses;
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COMMONW~J;' OF ~LVAIIIIA
POLICE CRASH REPORTING FORM
ea.e Closed Reportable Cra.h
o Yes . No . Yes 0 No
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Continuation
1'1I1111111111111111111111
Crash Number
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AA 500 1
~~
:! - L ~ L..!..LLL.J
o A~ency Name Precinct ~ion Date (MM-DO-YVYY)
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1 .. Dispatch Timo (m,l) Arrival Time (m,l) Investigator ~
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Municipality Name
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LUI
Crash Date (MM-DD-YYYY)
ITJ-
Dav of Wef!lk
o Sun 0 Thu
OMon OFri
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Complete
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Form M Section 29) Related Mamtenance
'f" Interse<tlon Type 04 Way Inte"ecti~n -0 'Y' Intersection 0 Multi-leg 0 Off Ramp 0 Ra,lroad cr~s;'ng-~;~~~~T--n-- I III
3\ ~ . Intersectlon ~.
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..-.. Route Number - -- -Dent {oPtiona'i OJTravel Lanes OJspeed Urnlt 0 North House Number (if appl:cable) -;;
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I'!:. Street Name Street Ending ~ a East I For M:d-bloc~ Cfa!>h6 only Use I
41 ~, OJ 'o~ 0 West postal Hou~ N....mb('l',a'"ld m,ake sure I
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~I ~ ~ ITIJ 0 80 North Feet
, 11 ~ LL..LLJ" ~ 0 South CLIIIJ
: 1 II 1) Ple.se ~ Or Intersecting Street Name []]S1 Ending ~ g East Or Miles
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I ~" ;;; for BOTH
· , ell 'landmarks ,lnteFig Rl NUj ITIJor Mile Post . 0 Or Segment Marker ;
"0 : ~ If USing t'ol '8 0 North Distance From (rash
't:. ~ Th,s Opt on ~ 5: 0 South Sc.ene to landmark 1
'. il' 51 E Or Intersectln Street Name 51 Ending::) 0 (For Crash between
I is . :1 -g IT] East Landmark 1 and I
: . .s ~ 0 West landmark 2) ,
7i~~a:i:=:[[]rn:rn.rn~~~ng~~de:- CD--rn';rn"~rn"~=~=~ ~l
'I 'i Traffic Control Devic@ 0 Yield 5'gn 0 Pohee Officer or 1m ~unction~
110 0 Not Applicable 0 TraffiC 5'gnal 0 ActIVe RR Crossing 0 ~~~;;~pe TeD 0 No Controls a ~~~~~~ctioning 0 ~~:~~~~
" ~ T ff Controls Signal
o Flashmg ra JC 0 Stop Sign 0 PasSive RR 0 DeVIce Not 0 Device Functlomng 0
I SIgnal Crossing Controls a Unknown Functioning Properly Unknown
1!11 Lane rh>...d (If "Not Applicable', skip rest of the Lane C/osure section) Lane CIasute 0 North 0 East 0 North and South 0 All
~s I 0 Not Applicable 0 Part'ally 0 Fully 0 Unknown Di1J1$Ii<IIJ. 0 South 0 West 0 East and West (N,S,E,W)
, i'\)I,
!!II ~ Yes 0 NoO F<ti 11....
~ ; Detoured Unknow_~_O f1Dsf11I. 0 < 30 Min. 0 3D-GO Min. 0'.3 hI) 0 3-6 hrs a 6-9 hrs 0 > 9 hours a Unknown
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FOR"..1# AA-800l (12102)
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Crash Number
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Continuation
Narrative and additional witnesses:
22
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EXHU11T
D
CONTINGENT FEE CONTRACT
THIS AGREEMENT is made in duplicate original, this ~ /)l. I day of
~ -U~ ,2005, at Waynesboro, Franklin County, Pennsylvania, between Vera J. Crider,
her' after ferred to as the "Client," and James M. Stein, of Dick, Stein & Schemel, LLP, 13 West
Main Street, Suite 210, Waynesboro, Franklin County, Pennsylvania, 17268, hereinafter referred to
as the "Attorney."
In consideration of the mutual promises contained in this agreement, the parties agree as
follows:
1. PurDose of ReDresentation. The Client ret!lins and employs the Attorney to sue for and
recover all damages and compensation to which the Client may be entitled, as well as to compromise
and settle all claims arising out of the death of Client's husband, John A. Crider, due to an accident
which took place on April 22, 2005.
2. Attornev's Fee. The Attorney will be compensated for services rendered only if a
recovery is actually obtained for the Client. The fee to be paid the Attorney will be one third (l /3)
of the remaining balance of the recovery after litigation costs and expenses.
If the fee allowed to the Attorney for the above claim and cause of action is set by law, the
fee shall be limited to the maximum allowed by law.
Client also understands and authorizes the Attorney, in advimce of any litigation, to seek a
structured settlement in regard to Client's claim through the use of deferred, periodic payments as
to the Client's claim and, at Attorney's sole discretion, Attorney's fees; and Client also agrees that
the legal fee must be based upon the cost of such negotiated structured settlement.
3. ADDroval Necessary for Settlement. No settlement of any nature shall be made for any
of the above claims of Client without the explicit approval of the Client, and all offers of settlement
shall be communicated to the Client. The Client shall not obtain any settlement on the above claim
without the knowledge of the Attorney.
4. Association with other Attorneys. The Attorney may, at the sole discretion and expense
of the Attorney and with the consent of the Client, associate with any other attorney in the
representation of the above claim of the Client.
5. Litie:ation Costs and EXDenses. The costs of litigation, which are to be borne by the
Client and advanced by the Client include, but are not necessarily limited to: court filing fees, costs
of investigation, costs for medical examination for litigation purposes, expert witness fees,
consultants fees, costs for taking and transcribing deposition testimony, and any other costs of
obtaining and presenting evidence. Litigation expenses include, but are not necessarily limited to,
telephone expenses, mailing expenses, reasonable attorney travel expenses, photocopying charges
and notarial fees. For the convenience of the Client, these costs and expenses may be advanced by
the Attorney. Either the Attorney or the Client or both, whichever has advanced litigation costs and
expenses, shall be reimbursed out of the gross recovery for any such advances and the Attorney shall
thereafter receive the percent of the remaining balance as set forth in paragraph 2 above. The Client
shall remain liable for these costs and expenses in the event that a settlement or judgment is not
obtained in this matter. The parties acknowledge that, as of the date of this agreement, Client had
deposited the sum of$O.OO towards future expenses.
6. Coo Deration of Client. The Client shall keep the Attorney advised of Client's
whereabouts at all times, shall appear on reasonable notice at any and all depositions and court
appearances, and shall comply with all reasonable requests of the Attorney in connection with the
preparation and presentation of the above claim and cause of action of the Client.
7. Termination. This Agreement will continue in effect until the services to be performed
under it have been completed or until either party cancels it by giving thirty (30) days prior written
notice to the other at the address stated above or at an address chosen subsequent to the execution
of this Agreement and duly communicated to the party giving notice.
If the Client terminates this contract, without reasonable cause, at any time before a
settlement has been negotiated or before a settlement is in hand, the Client shall compensate the
Attorney for the reasonable value of the services rendered prior to the termination. The Client shall
also reimburse the Attorney for any costs and expenses advanced or required to be advanced by the
Attorney. The parties agree that the reasonable value of the Attorney's services is the Attorney's
regular billing rate for personal injury work which is currently $145.00 per hour; and that the
reasonable value of the personal injury paralegal's services is currently $75.00 per hour. If the Client
tenninates this contract, without reasonable cause, at such time as a settlement has been substantially
negotiated or is in hand, the Client shall compensate the Attorney at a figure which is a reasonably
expected or anticipated value of settlement times the appropriate percentage as set forth in paragraph
2 above which figure shall not be less than the number of hours thus far expended by the Attorney
times $ I 45.00 per hour and the number of hours thus far expended by the paralegal times $75.00 per
hour.
Client understands that Attorney will investigate Client's claim, and if at any time thereafter
it does not appear to have merit, then Attorney shall have the right to terminate this Agreement.
8. Medical EXDenses. All medi~al expenses an.d charges of any nature made by physicians
and health-care providers in conjunction with the above mentioned claim are not litigation costs and
will be paid by Client. In the event of a recovery, Client agrees that Attorney may pay any of these
bills from Client's share of the recovery. Should Client recover nothing, it is understood that
Attorney is not bound to pay any of these medical bills, and Client shall be liable for all such bills.
9. Governinl! Law. This Agreement shall be construed under and in accordance with the
laws of the Commonwealth of Pennsylvania, and all obligations of the parties created under this
Agreement are performable in Franklin County, Pennsylvania.
10. Parties Bound. This Agreement shall be binding on and inure to the benefit of all the
contracting parties and their respective heirs, executors, administrators, legal representatives,
successors and assigns, where permitted by this Agreement.
-2-
.
11. Lel!al Construction. In case anyone or more of the provisions contained in this
Agreement shall, for any reason, be held to be invalid, illegal, or unenforceable in any respect, the
invalidity, illegality or unenforceability shall not affect any other provision of it, and this Agreement
shall be construed as if the invalid, illegal, or unenforceable provision had never been contained in
it.
12. Prior Al!reements SUDerseded. This Agreement constitutes the sole and only
Agreement of the contracting parties and supersedes any prior understandings or written or oral
agreements between the parties respecting its subject matter.
13. Power of Attornev. The Attorney is authorized to obtain all information and reports
relative to Client's medical condition including, but not limited to, information and reports related
to examinations, diagnoses, treatments, prognoses, X -rays, costs, and any other matters concerning
the subject matter of this Agreement. The Attorney is also authorized to obtain all information and
reports relative to the subject matter of this Agreement other than those related to medical matters
including, but not limited to, police and other investigative reports, witness statements, employment
information, and other evidentiary materials.
Executed on the day and year first written above, with intent to be legally bound.
Witness:
~~~~~1~9";('~-<
Vera J. Crider, Client
James M. Stein, Attorney
-3-
CONTINGENT FEE CONTRACT
THIS AGREEMENT is made in duplicate original, this ~. _ day of
j 41~ ,2005, at Waynesboro, Franklin County, Pennsylvania, between Ken Hartman
and Mane Ann Fitzgerald, heremafter referred to as the "Client," and James M. Stem, of [lIck, Stem
& Schemel, LLP, 13 West Main Street, Suite 210, Waynesboro, Franklin County, Pennsylvania.
17268, hereinafter referred to as the "Attorney."
In consideration of the mutual promises contained in this agreement, the parties agree as
follows:
1. Puroose of Reoresentation. The Client ret.ains and employs the Attorney to sue for and
recover all damages and compensation to which the Client may be entitled, as well as to compromise
and settle all claims arising out of the death of John A. Crider, due to an accident which took place
on April 22, 2005.
2. Attornev's Fee. The Attorney will be compensated for services rendered only if a
recovery is actually obtained for the Client. The fee to be paid the Attorney will be one third (113)
of the remaining balance of the recovery after litigation costs and expenses.
If the fee allowed to the Attorney for the above claim and cause of action is set by law, the
fee shall be limited to the maximum allowed by law.
Client also understands and authorizes the Attorney, in advance of any litigation, to seek a
structured settlement in regard to Client's claim through the use of deferred, periodic payments as
to the Client's claim and, at Attorney's sole discretion, Attorney's fees; and Client also agrees that
the legal fee must be based upon the cost of such negotiated structured settlement.
3. Aooroval N ecessarv for Settlement. No settlement of any nature shall be made for any
of the above claims of Client without the explicit approval of the Client, and all offers of settlement
shall be communicated to the Client. The Client shall not obtain any settlement on the above claim
without the knowledge of the Attorney.
4. Association with other Attornevs. The Attorney may, at the sole discretion and expense
of the Attorney and with the consent of the Client, associate with any other attorney in the
representation of the above claim of the Client.
5. Litil!ation Costs and Exoenses. The costs oflitigation, which are to be borne by the
Client and advanced by the Client include, but are not necessarily limited to: court filing fees, costs
of investigation, costs for medical examination for litigation purposes, expert witness fees,
consultants fees, costs for taking and transcribing deposition testimony, and any other costs of
obtaining and presenting evidence. Litigation expenses include, but are not necessarily limited to,
telephone expenses, mailing expenses, reasonable attorney travel expenses, photocopying charges
and notarial fees. For the convenience of the Client, these costs and expenses may be advanced by
the Attorney. Either the Attorney or the Client or both, whichever has advanced litigation costs and
expenses, shall be reimbursed out of the gross recovery for any such advances and the Attorney shall
thereafter receive the percent of the remaining balance as set forth in paragraph 2 above. The Client
shall remain liable for these costs and expenses in the event that a settlement or judgment is not
obtained in this matter. The parties acknowledge that, as of the date of this agreement, Client had
deposited the sum of $0.00 towards future expenses.
6. Coooeration of Client. The Client shall keep the Attorney advised of Client's
whereabouts at all times, shall appear on reasonable notice at any and all depositions and court
appearances, and shall comply with all reasonable requests of the Attorney in connection with the
preparation and presentation of the above claim and cause of action of the Client.
7. Termination. This Agreement will continue in effect until the services to be performed
under it have been completed or until either party cancels it by giving thirty (30) days prior written
notice to the other at the address stated above or at an address chosen subsequent to the execution
of this Agreement and duly communicated to the party giving notice.
If the Client terminates this contract, without reasonable cause, at any time before a
settlement has been negotiated or before a settlement is in hand, the Client shall compensate the
Attorney for the reasonable value of the services rendered prior to the termination. The Client shall
also reimburse the Attorney for any costs and expenses advanced or required to be advanced by the
Attorney. The parties agree that the reasonable value of the Attorney's services is the Attorney's
regular billing rate for personal injury work which is currently $145.00 per hour; and that the
reasonable value of the personal injury paralegal's services is currently $75.00 per hour. If the Client
terminates this contract, without reasonable cause, at such time as a settlement has been substantially
negotiated or is in hand, the Client shall compensate the Attorney at a figure which is a reasonably
expected or anticipated value of settlement times the appropriate percentage as set forth in paragraph
2 above which figure shall not be less than' the number of hours thus far expended by the Attorney
times $145.00 per hour and the number of hours thus far expended by the paralegal times $75.00 per
hour.
Client understands that Attorney will investigate Client's claim, and if at any time thereafter
it does not appear to have merit, then Attorney shall have the right to terminate this Agreement.
8. Medical Exoenses. All medical expenses and charges of any nature made by physicians
and health-care providers in conjunction with the above mentioned claim are not litigation costs and
will be paid by Client. In the event of a recovery, Client agrees that Attorney may pay any of these
bills from Client's share of the recovery. Should Client recover nothing, it is understood that
Attorney is not bound to pay any ofthese medical bills, and Client shall be liable for all such bills.
9. Governinl!: Law. This Agreement shall be construed under and in accordance with the
laws of the Commonwealth of Pennsylvania, and all obligations of the parties created under this
Agreement are performable in Franklin County, Pennsylvania.
10. Parties Bound. This Agreement shall be binding on and inure to the benefit of all the
contracting parties and their respective heirs, executors, administrators, legal representatives,
successors and assigns, where permitted by this Agreement.
-2-
11. Lel!:al Construction. In case anyone or more of the provisions contained in this
Agreement shall, for any reason, be held to be invalid, illegal, or unenforceable in any respect, the
invalidity, illegality or unenforceability shall not affect any other provision of it, and this Agreement
shall be construed as if the invalid, illegal, or unenforceable provision had never been contained in
it.
12. Prior Al!:reements SUDerseded. This Agreement constitutes the sole and only
Agreement of the contracting parties and supersedes any prior understandings or written or oral
agreements between the parties respecting its subject matter.
13. Power of Attornev. The Attorney is authorized to obtain all information and reports
relative to Client's medical condition including, but not limited to, information and reports related
to examinations, diagnoses, treatments, prognoses, X-rays, costs, and any other matters concerning
the subject matter of this Agreement. The Attorney is also authorized to obtain all information and
reports relative to the subject matter of this Agreement other than those related to medical matters
including, but not limited to, police and other investigative reports, witness statements, employment
information, and other evidentiary materials.
Executed on the day and year first written above, with intent to be legally bound.
Witness:
~;.~
Marie Ann Fitzgerald, Client
James M. Stein, Attorney
-3-
CONTINGENT FEE CONTRACT
THIS AGREEMENT is made in duplicate original, this to day of
~ ,2005, at Waynesboro, Franklin County, Pennsylvania, between Ken Hartman
an arie Fitzgerald, hereinafter referred to as the "Chent," and James M. Stem, 01 DIck, Stem
& Schemel, LLP, 13 West Main Street, Suite 210, Waynesboro, Franklin County, Pennsylvania,
17268, hereinafter referred to as the "Attorney."
In consideration of the mutual promises contained in this agreement, the parties agree as
follows:
1. Puroose of Reoresentation. The Client retains and employs the Attorney to sue for and
recover all damages and compensation to which the Client may be entitled, as well as to compromise
and settle all claims arising out of the death of John A. Crider, due to an accident which took place
on April 22, 2005.
2. Attornev's Fee. The Attorney will be compensated for services rendered only if a
recovery is actually obtained for the Client. The fee to be paid the Attorney will be one third (113)
of the remaining balance of the recovery after litigation costs and expenses.
If the fee allowed to the Attorney for the above claim and cause of action is set by law, the
fee shall be limited to the maximum allowed by law.
Client also understands and authorizes the Attorney, in advance of any litigation, to seek a
structured settlement in regard to Client's claim through the use of deferred, periodic payments as
to the Client's claim and, at Attorney's sole discretion, Attorney's fees; and Client also agrees that
the legal fee must be based upon the cost of such negotiated structured settlement.
3. A\>oroval Necessary for Settlement. No settlement of any nature shall be made for any
ofthe above claims of Client without the explicit approval of the Client, and all offers of settlement
shall be communicated to the Client. The Client shall not obtain any settlement on the above claim
without the knowledge of the Attorney.
4. Association with other Attornevs. The Attorney may, at the sole discretion and expense
of the Attorney and with the consent of the Client, associate with any other attorney in the
representation of the above claim of the Client.
5. Litil!8tion Costs and Exoenses. The costs of litigation, which are to be borne by the
Client and advanced by the Client include, but are not necessarily limited to: court filing fees, costs
of investigation, costs for medical examination for litigation purposes, expert witness fees,
consultants fees, costs for taking and transcribing deposition testimony, and any other costs of
obtaining and presenting evidence. Litigation expenses include, but are not necessarily limited to,
telephone expenses, mailing expenses, reasonable attorney travel expenses, photocopying charges
and notarial fees. For the convenience of the Client, these costs and expenses may be advanced by
the Attorney. Either the Attorney or the Client or both, whichever has advanced litigation costs and
expenses, shall be reimbursed out of the gross recovery for any such advances and the Attorney shall
thereafter receive the percent of the remaining balance as set forth in paragraph 2 above. The Client
shall remain liable for these costs and expenses in the event that a settlement or judgment is not
obtained in this matter. The parties acknowledge that, as of the date of this agreement, Client had
deposited the sum of$O.OO towards future expenses.
6. Cooperation of Client. The Client shall keep the Attorney advised of Client's
whereabouts at all times, shall appear on reasonable notice at any and all depositions and court
appearances, and shall comply with all reasonable requests of the Attorney in connection with the
preparation and presentation of the above claim and cause of action of the Client.
7. Termination. This Agreement will continue in effect until the services to be performed
under it have been completed or until either party cancels it by giving thirty (30) days prior written
notice to the other at the address stated above or at an address chosen subsequent to the execution
of this Agreement and duly communicated to the party giving notice.
If the Client terminates this contract, without reasonable cause, at any time before a
settlement has been negotiated or before a settlement is in hand, the Client shall compensate the
Attorney for the reasonable value of the services rendered prior to the termination. The Client shall
also reimburse the Attorney for any costs and expenses advanced or required to be advanced by the
Attorney. The parties agree that the reasonable value of the Attorney's services is the Attorney's
regular billing rate for personal injury work which is currently $ I 45.00 per hour; and that the
reasonable value of the personal injury paralegal's services is currently $75.00 per hour. If the Client
terminates this contract, without reasonable cause, at such time as a settlement has been substantially
negotiated or is in hand, the Client shall compensate the Attorney at a figure which is a: reasonably
expected or anticipated value of settlement times the appropriate percentage as set forth in p:ll'agraph
2 above which figure shall not be less than' the number of hours thus far expended by the Attorney
times $145.00 per hour and the number of hours thus far expended by the paralegal times $75.00 per
hour.
Client understands that Attorney will investigate Client's claim, and if at any time thereafter
it does not appear to have merit, then Attorney shall have the right to terminate this Agreement.
8. Medical Expenses. All medical expenses and charges of any nature made by physicians
and health-care providers in conjunction with the above mentioned claim are not litigation costs and
will be paid by Client. In the event of a recovery, Client agrees that Attorney may pay any of these
bills from Client's share of the recovery. Should Client recover nothing, it is understood that
Attorney is not bound to pay any of these medical bills, and Client shall be liable for all such bills.
9. Governinl!: Law. This Agreement shall be construed under and in accordance with the
laws of the Commonwealth of Pennsylvania, and all obligations of the parties created under this
Agreement are performable in Franklin County, Pennsylvania.
10. Parties Bound. This Agreement shall be binding on and inure to the benefit of all the
contracting parties and their respective heirs, executors, administrators, legal representatives,
successors and assigns, where permitted by this Agreement.
-2-
11. Lel!:al Construction. In case anyone or more of the provisions contained in this
Agreement shall, for any reason, be held to be invalid, illegal, or unenforceable in any respect, the
invalidity, illegality or unenforceability shall not affect any other provision of it, and this Agreement
shall be construed as if the invalid, illegal, or unenforceable provision had never been contained in
it.
12. Prior Al:reements Superseded. This Agreement constitutes the sole and only
Agreement of the contracting parties and supersedes any prior understandings or written or oral
agreements between the parties respecting its subject matter.
13. Power of Attornev. The Attorney is authorized to obtain all information and reports
relative to Client's medical condition including, but not limited to, information and reports related
to examinations, diagnoses, treatments, prognoses, X-rays, costs, and any other matters concerning
the subject matter ofthis Agreement. The Attorney is also authorized to obtain all information and
reports relative to the subject matter of this Agreement other than those related to medical matters
including, but not limited to, police and other investigative reports, witness statements, employment
information, and other evidentiary materials.
Executed on the day and year first written above, with intent to be legally bound.
Witness:
Ken Hartman, Client
4~x~
~~~~~.~~
Marie Ann Fitzgerald, C lent'
James M. Stein, Attorney
-3-
DEC-15-2005 THU 02:47 PM MAIF,CASUALTY UNIT
..
FAX NO, 41,0 269 8162
p, 03
fl.. 'Ra~rJ
k,tf,,,~ y~/.f 01"
Maryland Automobile Insurance Fund
Sol.dad l.eJarraga
r::la;ms Spoelalist
1750 Forest Drive
Annapolis, MD 21401-4294
(BOO) if.O:.il.71:20 X4D3~ or (410) 2Q9-.l932 Phone
(410) 269-4988 Fax
Soledad. Lejarraga@:emaif.com
December l.5, 2005
Dick, ~tein & Schemel
Attn. James M. Stein
13 Wt;st Main ~t
Suite 210
WaynesboL'U, FA 17:<bl:l
R",: Claim Number: TB45739
MAIF Insured : Elizabeth Mary Loomis
Dat", uf ~oss: 04/22/05
Claimant: Estate of John A. Crider
Dear Mr. Stein:
The Maryland Automobile Insurance Fund offers to pay the policy
limit of $20.noo_oo to settle any and all ~laims of Kenneth R.
Hartman and Marie Ann Fitzgerald as Executors of the Estate of
John A. Crider, and th.. wrongful death claim of Verd J. Rice.
Payment will be made in excha.nge of aD executed release.
If you have any questions please call me.
Si:;pZ ~
SOle~ad ~~-
Cc:
Member Company af the Natlonilllnsurance Crima Bureau
ITY: Baltimore/Annapolis Ar... (410) 269-4355
Tall r-ft;:ll;l S~lvJCI!l Frcrn Other ML) Areas 1-800-765-2340
~ PITTSBURGH
~ 1 721 COCHRAN ROAD
~ Allstate'PITTSBURGH PA 15220-1002
You're In good hands.
1",111.,.1.,1,1,11"1"1,,,,11,\,1,,,.111,.,11,1,,1,1".1,,11
JAMES M. STEIN, ESQUIRE
DICK, STEIN & SCHEMEL, LLP
13 W MAIN ST STE 210
WAYNESBORO PA 17268-1517
November 14,2005
INSURED: FRANKLIN HANSEN
DATE OF LOSS: April 22, 2005
CLAIM NUMBER: 2425777303 B09
Your Client: Estate of John Crider and Vera Rice
MAlF Claim Number: T845739
PHONE NUMBER: 800-726-8990
FAX NUMBER: 412-306-7375
OFfICE HOURS: Mon - Fri 8:00am - 5:30pm
Dear Mr. Stein,
Pursuant to our conversation this morning, this letter is to confirm our offer of $100,000.00 to settle the claims presented by
the Estate of John Crider and Vera Rice. This amount represents the bodily injury policy limits of Franklin and Valerie
Hansen's Allstate Automobile Policy. Maryland Automobile Insurance Fund is the excess liability camer in this matter(they
insure Elizabeth Loomis) and this claim is being handled by Ms. Soledad Lejarraga. Her phone number is (410)269-4932.
Upon receipt of this letter, please provide me with consent to settle and Underinsured Motorist waiver from Mr. Crider's
automobile insurance carrier. Also, please forward a letter indicating the parties and wording on the release.
Should you have any questions, please call me at (412)388-5124. Thank you for your courtesy in this matter.
Sincerely,
Cliristoplier L. CCausen
Christopher L Clausen
412-388-5124
Allstate Property and Casualty Insurance Company
Copy: SOLEDAD LEJARRAGA
GENIOO!
2425777303 B09
lCJ.,.r.......~-."'.^....
~ I
, I:
I
.. O'
1001 Hector Street, Suite 300 * Conshohocken, PA 19428 * *
June 8, 2005
Dick, Stein and Schemel
James Stein
M & T Bank Building
13 West Main Street
Waynesboro, PA 17268
OUR INSURED: John A Crider
OUR CLAIM NUMBER: 58 37 B 0962930422200501
YOUR CLIENT: John A Crider
DA TE OF LOSS: 04-22-2005
Dear Mr. Stein:
Enclosed is a copy of our declaration sheet and underinsured motorist authorization forms. The
available underinsured motorist coverage for this loss is 100,000 (50,000 stacked by two
vehicles). I have also enclosed an Affidavit of No Additional Insurance for the driver of the
vehicle, Elizabeth Loomis, to sign to confirm she does not have additional liability insurance to
provide coverage for this loss.
Please provide a copy of the accident reconstruction report when you receive it If you have any
questions. please contact me at 610-234-2726. Thank you for your cooperation.
NATIONWIDE MUTUAL INSURANCE COMPANY
'{
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 a person to criminal and civil penalties.
03/27/2005 23:15
717-783-3457
INHERITANCE TAX
PAGE 02/02
BUREAU OF INDIVIDUAl T =
INHER.\TN1CE. TAX O\VlS1C)1IJ
PO 60X 260601
HA~RIS'U"", PA 17126.0601
COMMONWEALTH IF PENNSYLVANIA
DEPARTMENT OF REVENUE
WEB AOO~e:SS WNW.state.oa.us
MarCil 28, 2006
James M. Stein, Esq.
13 W. Main St., Ste. 210
Waynesboro, PA 17268
Re: Estate of John A Crider
File Number: 2105-0579
Court Number:
Dear Mr. Stein:
The Department of Revenue has received the Petition for Approval of Settlement Claim to
be filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action.
It has been forwarded to this Bureau for the Commonwealth's approval of the allocation of thl'!
proceeds paid to settle the actions.
Pursuant to the Petition, the decedent died as a result of a pedestrian/motor vehicle
accident. Decedent is survived by his spouse and adult children.
Please be advised that, based upon these facts and for inheritance tax purposes only, this
Department has no Objection to the proposed allocation of the proceeds of this action, 50% to the
wrongful death claim and 50% to the survival claim. Proceeds of a survival action are an asset
included in the decedent's estate and are subject to the imposition of Pennsylvania inheritance tax.
42 Pa. CS A 91<302; 72 P.S. ~99106. 9107. Costs and fees must be deducted in the same
percentages as the proceeds are allocated. In re Estate of MefTVman, 669 A,2d 1059 (Pa.
Cmwlth. 1995).
I trust that this letter is a sufficient representation of the Department's position on this
matter. As the Department has no objections to the Petition, an attorney from the Department of
Revenue will not be attending any hearing regarding it. Please contact me if you or the Court has
any questions or requires anything additional from this Bureau. Finally, the approval of this
allocation is limited to this estate and does not reflect the pOSition that the Department may take in
any other proposed distribution of proceeds of a wrongful death/survival action.
Sincerejy,
[bJ, MCC~-ocet
Holly A McClintock
Trust Valuation Specialist
Inheritance Tax Division
Bureau of Individual Taxes
PHONE: 717.767-1794 . FAX: 717-783-3467 . "MA": hmccLintoc@state.Da.us
ANTENUPTIAL AGREEMENT
THIS AGREEMENT, Made this :l?> day of November, 2004, by and between Vera J. Rice,
of I 050 Greenspring Road, Newville, Cumberland County, Pennsylvania, 17241, and John A. Crider,
of Hades Church Road, Greencastle, Franklin County, Pennsylvania, 17225.
WHEREAS, the parties hereto are contemplating marrying each other; and
WHEREAS, the parties enter into this agreement with love for each other and with the desire to
define the interest which each of them may have in the property of the other during and after their
marriage to each other and in the estate of the other after the death of one of them, and
WHEREAS, the parties have disclosed to each other the nature and extent oftheir various property
and linancial interests and the sources of income and financial liabilities of each, and
\'lIEREAS, the parties guarantee to each other individual 0' . !lership in and to all property and
estate which each now owns or subsequently may acquire, and
WHEREAS, the parties have agreed and will hereinafter further agree with each other that each
is economically financially independent of the other, and
WHEREAS, the real and personal property owned by each of the partij:s is set forth in Exhibits
"A" and "8", attached hereto and made a part of this agreement, and
WHEREAS, both parties have been afforded the opportunity to retain, advise and consult with
counsel of their choice. Vera J. Rice has been represented by Paul T. Schemel, Esquire of the law
firm of Dick, Stein and Schemel, LLP, and John A. Crider has chosen not to be represented by an
attorney.
NOW, THEREFORE, in consideration of the marriage of the parties hereto, and intending to
be legally bound, the parties agree as follows: I
I. All property and estate of the parties hereto of every nature and wheresoever situate and all
property and estate hereafter acquired by each of the parties shall be and remain forever the individuar
property and estate of the party so owning and acquiring it and neither of the parties shall acquire
any interest in the individual property and estate of the other because of the marriage relationship;
and each shall hold and possess all such property and estate as ifhe and she had remained unmarried.
2. Each of the parties hereby disclaims all right, title and interest in all property and estate
now owned or hereafter acquired by the other, renouncing forever all claims to the separate estate
of the other including all right of dower, curtesy, family exemption, to elect against the will or
conveyances, or to receive a share of the estate under the intestate laws.
3. Each of the parties agree to join in any deed, or in the execution of any paper necessary
to effect the sale of real estate or to assist the other in the administration or sale of his or her individual
property and estate.
4. Nothing herein shall be construed as preventing either of the parties from giving any
of his or her property or estate to the other by deed, gift, will or otherwise.
5. The parties agree that each is financially and economically able to sustain themselves
whether or not married; therefore each agrees that neither support nor alimony will be asked or accepted
in the event of any separation of the parties after marriage or of any dissolution of the marriage for
any reason whatsoever. Both parties agree that in the event that anything is owned jointly as of the
time of separation, that that property will be divided equally between the parties. Neither party shall
have any other rights to property individually titled to the other, even though it might be deemed "marital
property" under any divorce law.
6. This agreement is entered into in Pennsylvania and shall be construed under and in
accordance with the laws of Pennsylvania and shall in no way be affected by any change in domicile
of either party.
7. This agreement shall bind and inure to the benefit of the respective parties, their heirs,
legatees, devisees, personal representatives and assigns, notwithstanding the extent or size of the parties'
individual estates at the time of the execution of this agreement or subsequently.
8. John A. Crider declares that he fully unders-.a'1c1s thetenns and provisions of this agreement
and that he has been fully informed of his legal rights and liabilities and that he believes the provisions
of the agreement are fair, just and reasonable and that he signs this agreement freely and voluntarily.
9. Vera J. Rice declares that she fully understands the terms and provisions of this agreement
and that she has been fully informed of her legal rights and liabilities and that she believes the provisions
of the agreement are fair,just and reasonable and that she signs this agreeme!lt freely and voluntarily.
10. Should any provision of this agreement be found, held, or deemed to be unenforceable,
voidable or void, as contrary to law of public policyunderthe laws of Pennsylvania or any other competent
jurisdiction, the parties intend that the remaining provisions of this agreement shall nevertheless continue
in full force and be binding upon the parties, their heirs, personal representatives, executors and assigns.
11. This agreement contains the entire understanding of the parties. There are no
representations, warranties, promises, covenants or undertakings, oral or otherwise, other than those
expressly set forth herein. I
12. This agreement shall become effective only upon the marriage of the parties.
.
IN WITNESS WHEREOF, and intending to be legally bound hereby, the parties have hereunto
set their hands and seals the day and year first above written.
Wi3+~C-;~d
~"' Cd C~j
,.
~A.tJ- C1.. 'iZr';'--P~ (SEAL)
Vera J. Rice 0
9J:!~der;J; ,()~N (SEAL)
- 2 -
STATE OF PENNSYLVANIA
COUNTY OF yJ iJ
SS
On thisa dayofNovember, 2004, before me, aNotary Public, the undersigned officer, personally
appeared Vera 1. Rice, known to me or satisfactorily proven to be the person whose name is subscribed
to the within instrument and acknowledged the due execution hereofforthe purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
[PI ~~ J
//Zl:J~ t.~ ~
.J Notary Public
COMMONWEALTH OF PENNSYLVANIA
NoIarlaI Seal
Usa A Dupert, Nolafy Public
NewWle Bao. Cumberland County
My Corm1Ission Expires Apr. 6. 2008
Member, Pennsylvania Association Of Notand..
STATE OF PENNSYL VANIA
COUNTY OF FRANKLIN
SS
)' I}
On this )3 day ofNovember, 2004, before me, aNotary Public, the undersigned officer, personally
appeared John A Crider, known to me or satisfactorily proven to be the person whose name is subscribed
to the within instrument and acknowledged the due execution hereof for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
COMMONWEALTH OF PENNSYLVANIA
NoIanal Seal
Usa A Dupert, Notary Public
NewIIIIe Bao. CumOeltand County
My Corm1Ission El<pires Apr. 6. 2008
Member. Pennsylvania AS8~allon Of Notaries
- 3 -
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
\f:~ri'-i"'-"-.1-GF,D
i t>.?R 1 G L006
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Civil Action. Law L-,-
No. Ill. -/9Pb f.L~L tS'2-~
In Re: Estate of 10hn A. Crider,
Deceased
ORDER OF COURT
'\1>.
NOW on this '1 day of
I\~~',\
, 2006, the Court, having reviewed the
foregoing Petition to Approve Settlement of Wrongful Death and Survival Claims, and being
fully advised in the premises, FINDS that the requested relief is appropriate.
The Court therefore ORDERS that the requested settlement is approved, which total
settlement equals $145,000.00. The settlement proceeds shall be allocated such that fifty (50%)
percent ($72,500.00) is allocated to settlement of the survival action and fifty (50%) percent
($72,500.00) is allocated to settlement of the wrongful death claim. The Court further approves
payment of counsel fees and expenses such that fifty (50%) percent of said fees and expenses are
allocated to the survival claim and fifty (50%) percent of said fees and expenses are allocated to
the wrongful death claim. The Court designates Vera 1. Rice as the sole person entitled to share
in the net proceeds of the settlement allocated to the wrongful death action pursuant to
Pennsylvania Rule of Civil Procedure 2206(b). The Petitioners are hereby granted leave to
execute all necessary instruments to effectuate the settlement as set forth in the Petition and this
Order.
IT IS SO ORDERED.
By the Court,
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