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HomeMy WebLinkAbout06-7171 SEYMOUR LEVINE and TIFFANY LEVINE, parents of Robert Levine, Deceased, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. (}'-,--- NO. 0 (,. '1 J '7 I ~ , b- MARK SHEELY and ANNETTE SHEELY PETITION FOR MINOR'S COMPROMISE OF WRONGFUL DEATH AND SURVIVAL ACTION OF DECEDENT MINOR PLAINTIFF AND NOW comes Petitioners, Tiffany and Seymour Levine, parents and natural guardians for decedent minor Plaintiff Robert (Robbie) Levine and through counsel for Defendants Mark and Annette Sheely, by and through their carrier, Foremost Insurance Group, files this Petition for Minor's Compromise and in support thereof avers as follows: 1. Petitioners, Seymour and Tiffany Levine, are the parents and natural guardians of minor decedent Plaintiff, Robert (Robbie) Levine, and reside at 198 Rose Hill Drive, New Cumberland, Pennsylvania 17070. 2. Minor decedent Plaintiff Robert (Robbie) Levine was four years of age at the time of the tragic accident which underlies this claim which occurred on May 28,2006. 3. Petitioners Seymour and Tiffany Levine do not currently have counsel, however, have agreed to permit the undersigned counsel, as the attorney for the Defendants and Foremost Insurance Company, their carrier, to present this Petition as evidenced by the execution of this document. 4. Defendants Mark and Annette Sheely are adult individuals who maintained a residence at the time of this incident at 330 North 30th Street, Camp Hill, Pennsylvania 17011. They are now divorced. 5. On or about May 28,2006, minor decedent Plaintiff, Robert (Robbie) Levine, was a guest at the home of the Sheelys, 6. On the aforementioned date minor decedent Robert (Robbie) Levine fell into the swimming pool at the Sheely residence and tragically drowned. 7. Cumberland County Coroner Michael L. Norris issued a Certificate of Death dated May 31, 2006 listing the immediate cause of death as drowning. (A true and correct copy of the Certificate of Death is attached hereto and identified as Exhibit "A"). 8. Any and all medical bills related to this tragic accident have been paid by insurance monies and there are no outstanding medical bills or otherwise with respect to minor decedent's tragic death. 9. Petitioners have chosen to settle this case without counsel and again have agreed to permit Defendants' and Defendants' carrier's counsel to present this Petition. 10. The parties have agreed to a settlement for the policy limits of the Defendants' homeowner's insurance policy through Foremost Insurance Group which totals $300,000.00. (A true and correct copy ofthe formal claim worksheet for Foremost Insurance Company listing the $300,000.00 liability limits is attached hereto and identified as Exhibit "B"). 11. Petitioners have executed the appropriate Release which is attached hereto and identified as Exhibit "C". 2 12. The Defendants at the time of this incident had no other applicable insurance or umbrella policies as evidenced by the attached Affidavit of No Other Insurance attached and identified as Exhibit "D". 13. Indeed Petitioners sought advice of personal counsel who concluded that there was no other applicable insurance to this matter, including the business policy of Defendant Mark Sheely for his construction business and therefore Petitioners are satisfied with this settlement and compromise. 14. The pool where this tragic accident occurred was in its existing state at the time Defendants purchased the home. 15. Petitioners request that this Court approve the compromise settlement of this wrongful death and survival claim without a formal hearing if possible. 16. There are no unpaid expenses associated with this claim. 17. Petitioners have consulted with their financial advisor/accountant and have agreed based on his advice to the classification of the payments under the wrongful death and survival actions presented in this matter as follows: (a) 90% or $270,000.00 payable under the wrongful death claim; and (b) 10% or $30,000.00 payable under the survival action. 18, The Pennsylvania Department of Revenue in past cases has approved this division of settlement proceeds for purposes of any and all applicable estate taxation issues. 42 Pa.C.S.A. ~8302; 72 P.S. ~~9106, 9107; In re Estate of Merryman, 669 A.2d 1059 (Pa. Cmwlth. 1995). 19. Petitioners are aware that accepting this offer of settlement will result in the waiver of the right to a jury trial and a waiver of the right to recover any further damages on 3 behalf of the decedent minor Plaintiff arising out of the accident underlying this Petition in the future. 20. Since the settlement is for the policy limits of the applicable insurance policy, Defendants, Defendants' carrier, Foremost Insurance Group, undersigned counsel and Petitioners believe the settlement is fair and reasonable and in their best interests. 21. Petitioners understand and appreciate that by executing this Petition they are attesting to their knowledge and consent of the settlement and the effect of this compromise. 22. There are no legal fees pending in this case on behalf of Petitioners. 23. All parties to this action concur with the filing of the Petition and seek approval of the minor's compromise under the settlement terms set forth herein. WHEREFORE, the Petitioners respectfully request that this Honorable Court approve the Petition to Seek Minor's Compromise in this wrongful death and survival action so that the proceeds can be promptly paid to the decedent's surviving parents. DATE: (r..-l ()5 00 Matthew . Owens, Esquire LD. No. 76080 4200 Crums Mill Road Harrisburg, P A 17112 (717) 651-3501 Attorneys for Mark and Annette Sheely 4 DATE: jJ-jg-x, DATE: \ L\ \<0 \ ~\, \ \ \05_ A \LlAB\MLOWENS\LLPG\240360\ACZILLA \06091 \00733 eymour Levine Petitioner and Parent and Natural Guardian of Decedent Minor Plaintiff Robert (Robbie) Levine Tiff!~ ~~ Petitioner and Parent and Natural Guardian of Decedent Minor Plaintiff Robert (Robbie) Levine 5 I:>.MU~ 1llI~ 1/(" This is to certify thaI the Information here given is correctly copted from an original certificate of deatb duly filed with me as loc?al Regi.su:ar. The original certificate will be forwarded to the Stale Vital Records Office for pemlanent 'filing. WARNING: It Is Illegal to dupliclte this copy by photostat or photograph. Fcc for this certificate, $6.00 No. -t.~..~...~~ Local cgjstroT P 12593951 1f13~ .2 w(. Dale I II I COIIIlIIONMALnt OF I'ENHllyt,\I~1A . IlEPARTIIENT 01' Hl!ALlH . V1fA&. RIiCOROS CERTIFICAte OF PJ;ATH fCORONER) *W4IEV_ lYI'I'...'1I =' UO-2S2 t R_ol_N_"'WIIoI Robert , ,."..........,. 4 s Le'Vine . . - .,.. ClIlI'" I l-...,,"'" Hay 28. %01;16 CALlIE au... .-......... ....' NlIT. .................._.............-........_.._IllTIICIf___IUlII.__ ---..---.............. .....--..-... _,._.1wI_.. _ --'.--' , ~~ . -.... ==...-- lliII"IP"'__'" . :--- iOnllt....... ~ . o . __I 0'" JIt'- - ........ _f'lllII__ "C-II_r C ,.. Clio - [1- C- )1.- C-_. 0- C-.....- ... -- - Coroner 2006 II> Printed as of: Aug-04-2006 Worksheet for Claim 773-7006 Unit 1: Status Opened Closed Family: Selected: Total Loss: Model Year: Unit Length: Unit Width: CCs: Power Type: Horsepower: Engine Count: Incl Vessel Amt: D Fuel Type: Motor Type: Unit Location: Page 2 of 13 Risk: ~ D 1960 o o Unit Added: D Existing Damage: D Make/Model: Serial Number: Purchase Price: $0 Purchase Date: Unit Type: Vessel Name: Hull Material: Racing Flag: D Layup Period: Waters Navigated: 330 N 30TH ST CAMP HILL, PA 17011 Loss Comp Pers Liab BI CPL Med Pay Dwelling 381 Adj Structures Personal Property Addl Living Exp 381 Comp Pers Liab PO Medical Payments Repl Cost Contents Limit Deductible Added Loss Reserve 300,000 0 0 300,000 0 1,000 179,010 500 0 17,901 500 0 89,505 500 0 35,802 0 0 0 1,000 0 0 89,505 0 0 002988-MOLD EXCEPTION 003434-REPL COST PER PROP 005257-HOMEOWNERS POLICY 006979-REQUIRED CHANGE - PA Manuscripts: D EQUITY ONE INC ISAOA PO BOX 57043 IRVINE, CA 92619-7043 First Mortgagee o Added D May Not Be Applicable THE JUNIATA VALLEY BANK PO BOX 66 MIFFlINTOWN, PA 17059-0066 Second Mortgagee D Added D May Not Be Applicable - RELEASE AND SETTLEMENT AGREEMENT KNOW ALL MEN BY THESE PRESENTS: THIS RELEASE AND SETTLEMENT AGREEMENT ("Release") is made and entered into by and between Seymour Levine and Tiffany Levine, Parents of Robert Levine, Deceased, ("Plaintiffs") and Annette Sheely and Mark Sheely and Foremost Insurance Group ("Defendants"). WHEREAS, the Plaintiffs have presented a claim against Defendants arising out of an accident which occurred on May 28, 2006, at 330 North 30th Street, Camp Hill, Cumberland County, Pennsylvania. WHEREAS, the Plaintiffs and Defendants desire to settle the matters raised in the Lawsuit, together with any and all other matters pertaining to the parties named herein and the above noted incident that might have been raised, that could be raised, that could have been raised, or that might be raised in the future, and WHEREAS, all parties to the Lawsuit wish to make a full, complete, and final settlement of all those matters. NOW, THEREFORE, with the foregoing background being incorporated herein by reference and made part hereof, Plaintiffs, for and in consideration of the total sum and sole consideration of Three Hundred Thousand Dollars ($300,000.00), receipt of which is hereby acknowledged, do hereby remise, release, and forever discharge, and by these presents, do for themselves, their successors, administrators, assigns, heirs and executors, remise, release, and forever discharge Defendants and their respective past, present, and future officers, directors, stockholders, insurers, attorneys, agents, servants, representatives, employees, subsidiaries, affiliates, partners, predecessors, and successors in interest and assigns, and any and all other persons, finns, or corporations with whom any of the fonner have been, are now, or may hereafter be affiliated, together with any and all other persons, finns or corporations, of and from any and all past, present, or future claims, demands, obligations, actions, causes of action, liens, rights, damages, costs, expenses, and compensation of any nature whatsoever, whether based on a tort, contract or other theory of recovery, and whether for compensatory or punitive damages, which the Plaintiffs now have, or which may hereafter accrue or otherwise be acquired, on account of, or in any way growing out of, or which are the subject of the Lawsuit (and all related pleadings) including, without limitation, any and all known or unknown claims for bodily and personal injuries to Plaintiffs, and the consequences thereof, which have resulted or may result from the alleged negligent or intentional acts or omissions of the Defendants. This Release on the part of the Plaintiffs shall be a fully binding and complete settlement between the Plaintiffs, the Defendants and all parties represented by or claiming through the Plaintiffs save only the executory provisions of this Release and Settlement Agreement. Each party hereto shall bear all attorney's fees and costs arising from their actions or . the actions of their co\UlSel in connection with the Complaint, this Release and Settlement Agreement and the matters and documents referred to herein and all related matters. The Plaintiffs hereby acknowledge and agree that the Release set forth hereinabove is a General Release, and they further expressly waive and assume the risk of any and all claims for damages which exist as of this date, but which the Plaintiffs do not know of or suspect to exist, whether through ignorance, oversight, error, negligence, or otherwise, and which, if known, would materially affect their decision to enter into this Release and Settlement Agreement. The Plaintiffs further agree that they have accepted payment of the sums specified herein as a complete compromise of matters involving disputed issues oflaw and fact, and they fully assume the risk that the facts or the law may be otherwise than they believe. Counsel for Plaintiffs will deliver to Counsel for Defendants an executed Stipulation of Dismissal with prejudice and/or an Order to Settle, Discontinue and End with prejudice of the Lawsuit described hereinabove. The Plaintiffs represent and warrant that no other person or entity has or has had any interest in the claims, demands, obligations, or causes of action referred to in this Release and Settlement Agreement; that they have the sole and exclusive right to receive the sums specified in it; and, that they have not sold, assigned, transferred, conveyed, or otherwise disposed of any of the claims, demands, obligations, or causes of action referred to in this Release and Settlement Agreement. The Plaintiffs agree and acknowledge that they accept payment of the sums specified in this Release and Settlement Agreement as a full and complete compromise of matters involving disputed issues; that neither payment of the sums by the Defendants nor the negotiations for this settlement (including all statements, admissions or communications) by the Defendants, or their attorneys or representatives shall be considered admissions by any of the said parties; and that no past or present wrongdoing on the part of the Defendants shall be implied by such payment or negotiations. Plaintiffs agree to indemnify and hold harmless the Defendants from any and all claims or liens presently existing against the Plaintiffs on the settlement fund herein by any person, entity, or corporation. This Release and Settlement Agreement contains the entire agreement between the Plaintiffs and the Defendants with regard to the matters set forth in it and shall be binding upon and inure to the benefit of the executors, administrators, personal representatives, heirs, successors, and assigns of each. There are no other understandings or agreements, verbal or otherwise, in relation thereto, between the Plaintiffs and Defendants. In entering into this Release and Settlement Agreement, the Plaintiffs represent that they have not relied upon the legal advice of an attorney and have not secured counsel to represent them, but that the terms of this Release and Settlement Agreement have been completely read and explained to them and that those terms are fully understood and voluntarily accepted by them. 2 The parties hereto enter into this Release and Settlement Agreement in the Commonwealth of Pennsylvania, and said document shall be construed and interpreted in accordance with its laws. Plaintiffs, intending to be legally bound..9Y the terms ~f t?is Release and Settlement Agreement hereunto, set their hand and seal this -.; \ " day of ftV(fM-1 , 2006. CAUTION: READ BEFORE SIGNING. TIDS IS A RELEASE. WITNE SEYMOUR LEVINE, Individually and as Par t 0 Robert Levine, Deceased WITNESS Sworn to and subscribed , />7 before me this ~ ----aay of ~-6r- ,2006. . ~\ - NOT Y PUBLIC COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL MICHAEL R. CARANCI, Notary Public Lemoyne Bora. Cumberland County \ My Commission Expires June 15,2010 3 SEYMOUR LEVINE and TIFF ANY LEVINE, parents of Robert Levine, Deceased, v. MARK SHEELY and ANNETTE SHEELY AFFIDAVIT OF NO OTHER INSURANCE 1. Affiant is Mark Sheely, an adult individual competent to make this Affidavit. 2. On May 28, 2006, I was the owner of a residential property located at 330 N. 30th Street, Camp Hill, P A and resided at this property on this date. 3. Robert (Robbie) Levine died tragically at my home when he fell into my swimming pool on May 28, 2006. 4. The only Policy of Insurance which I maintained concerning the above-described residence is a homeowner's Policy of Insurance issued to me by Foremost Insurance Group. 5. As of the time of the May 28, 2006 accident, neither I nor my wife, Annette Sheely, had any other insurance including, but not limited to, other homeowners insurance, a personal liability umbrella policy (pLUP) or any other possible insurance or coverage for this incident/accident. 6. I did maintain a liability policy for my business trading as Mark Sheely Builder, Inc., however, this policy is not a homeowner's policy and to my knowledge provides no coverage or protection for liability claims at my residence. rrltJAl ~~ Mark Sheely I (j.-;g-ab Sworn to and Subscribed before me this ~ day of ~ ,2006. ~~~ NOTAR~IC COMMONWEALTH OF PENNSYLVANIA Notarial Seal K1mberty A. Bauer, NotaJy Public Lower Paxton Twp.. Dauphin County My Commission Exp\fes Dec. 12, 2007 Member. Pennsylvania AssoclalIon of NolarIe8 SEYMOUR LEVINE and TIFF ANY LEVINE, parents of Robert Levine, Deceased, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLV ANIA v. NO. MARK SHEELY and ANNETTE SHEELY AFFIDAVIT OF PARENT AND NATURAL GUARDIAN SEYMOUR LEVINE 1. I am Seymour Levine. 2. My date of birth is 6- $- ~ 3. My social security number is '2..:1'{ - ~O.. ~rl 4. I was the parent and natural guardian together with my spouse of Decedent Minor Robert (Robbie) Levine. 5. My son Robert (Robbie) Levine was killed in a tragic accident on May 28, 2006. I presented a claim against the homeowners, Mark and Annette Sheely, and their homeowner's insurance company, Foremost Insurance Group. 6. I have settled the claim for $300,000.00 which represents the policy limits of the Foremost Insurance Policy of Defendants. 7. I did not retain counsel for this claim and I do not now have an attorney representing me for this settlement. 8. I have met with Matthew L. Owens, Esquire, counsel for Defendants Mark and Annette Sheely and for their carrier, and understand that he is not my attorney but that he represents the interests of the Sheelys and their insurance company. 9. I did consult with my own personal counsel on the settlement and distribution of the settlement proceeds and am satisfied with the settlement and compromise. 10. I fully understand the effects of executing a Release consummating the settlement resolution of this matter, which I have done so, and further, fully understand the effects of executing the Petition for Minor's Compromise of Wrongful Death and Survival Action of DATE: Jj-/g-oC Decedent Minor Plaintiff and for accepting the settleme w&u<.~ '" &:->-- ~ Sworn to and subscribed before me this day of , 2006. - <'"'"'\ "- .;;::,. Y't"'<"'t"-'- -:s-~s NOTARY PUBLIC ~ I J./{, <W;./~ . 2 SEYMOUR LEVINE and TIFF ANY LEVINE, parents of Robert Levine, Deceased, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. NO. MARK SHEELY and ANNETTE SHEELY AFFIDAVIT OF PARENT AND NATURAL GUARDIAN TIFFANY LEVINE 1. I am Tiffany Levine. 2. My date of birth is ( 3. My social security number is .78' -5"8'- <-Ic SS:- . 4. I was the parent and natural guardian together with my spouse of Decedent Minor Robert (Robbie) Levine. 5. My son Robert (Robbie) Levine was killed in a tragic accident on May 28,2006. I presented a claim against the homeowners, Mark and Annette Sheely, and their homeowner's insurance company, Foremost Insurance Group. 6. I have settled the claim for $300,000.00 which represents the policy limits of the Foremost Insurance Policy of Defendants. 7. I did not retain counsel for this claim and I do not now have an attorney representing me for this settlement. 8. I have met with Matthew L. Owens, Esquire, counsel for Defendants Mark and Annette Sheely and for their carrier, and understand that he is not my attorney but that he represents the interests of the Sheelys and their insurance company. 9. I did consult with my own personal counsel on the settlement and distribution of the settlement proceeds and am satisfied with the settlement and compromise. 10. I fully understand the effects of executing a Release consummating the settlement resolution of this matter, which I have done so, and further, fully understand the effects of executing the Petition for Minor's Compromise of Wrongful Death and Survival Action of Decedent Minor Plaintiff and for accepting the settlement of $ 00,000.00 in this case. DATE: \ ') \ \'1, \ Cl~ , \ 0- Sworn to and subscribed w~> .,-- L ;:~~ 9-"' ---:::-- before me this day of , 2006. ~ - . (J... VV'vt"'V" ~ ~ .~ ~v--JLj '9~~ I '2.-( I ~l o(p NOTARY PUBLIC 2 SEYMOUR LEVINE and TIFF ANY LEVINE, parents of Robert Levine, Deceased, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. NO. MARK SHEELY and ANNETTE SHEELY CERTIFICATE OF SERVICE I, Angela Zilla, an employee of Marshall, Dennehey, Warner, Coleman & Goggin, do hereby certify that on this \ ~~ day of December, 2006, I served a copy of the foregoing via First Class United States mail, postage prepaid as follows: Seymour and Tiffany Levine 198 Rose Hill Drive New Cumberland, P A 17070 r ~Lct~w lla c:::> 11 ~ Cl 1'-1 ("') ~ t- ]\ CO ...... boo ....) ...~,- V\ .. ...c. ~ r,', ...c ~ .I,~ V-, THE ESTATE OF ROBERT S. LEVINE, SEYMOUR LEVINE and TIFFANY LEVINE, parents of Robert Levine, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 06-7171 CNIL TERM MARK SHEELY and ANNETTE SHEELY PETITION FOR MINOR'S COMPROMISE OF WRONGFUL DEATH AND SURVIVAL ACTION OF DECEDENT MINOR PLAINTIFF AND NOW comes Petitioners, Tiffany and Seymour Levine, parents and natural guardians for decedent minor Plaintiff Robert (Robbie) Levine and through counsel for Defendants Mark and Annette Sheely, by and through their carrier, Foremost Insurance Group, files this Petition for Minor's Compromise and in support thereof avers as follows: 1. Petitioners, Seymour and Tiffany Levine, are the parents and natural guardians of minor decedent Plaintiff, Robert (Robbie) Levine, and reside at 198 Rose Hill Drive, New Cumberland, Pennsylvania 17070. 2. Minor decedent Plaintiff Robert (Robbie) Levine was four years of age at the time ofthe tragic accident which underlies this claim which occurred on May 28, 2006. 3. Petitioners Seymour and Tiffany Levine do not currently have counsel, however, have agreed to permit the undersigned counsel, as the attorney for the Defendants and Foremost Insurance Company, their carrier, to present this Petition as evidenced by the execution of this document. 4. 'Defendants Mark and Annette Sheely are adult individuals who maintained a residence at the time ofthis incident at 330 North 30th Street, Camp Hill, Pennsylvania 17011. They are now divorced. 5. On or about May 28,2006, minor decedent Plaintiff, Robert (Robbie) Levine, was a guest at the home of the Sheelys. 6. On the aforementioned date minor decedent Robert (Robbie) Levine fell into the swimming pool at the Sheely residence and tragically drowned. 7. Cumberland County Coroner Michael L. Norris issued a Certificate of Death dated May 31, 2006 listing the immediate cause of death as drowning. (A true and correct copy of the Certificate of Death is attached hereto and identified as Exhibit "A"). 8. Any and all medical bills related to this tragic accident have been paid by insurance monies and there are no outstanding medical bills or otherwise with respect to minor decedent's tragic death. 9. Petitioners have chosen to settle this case without counsel and again have agreed to permit Defendants' and Defendants' carrier's counsel to present this Petition. 10. The parties have agreed to a settlement for the policy limits of the Defendants' homeowner's insurance policy through Foremost Insurance Group which totals $300,000.00. (A true and correct copy of the formal claim worksheet for Foremost Insurance Company listing the $300,000.00 liability limits is attached hereto and identified as Exhibit "B"). 11. Petitioners have executed the appropriate Release which is attached hereto and identified as Exhibit "C". 2 12. The Defendants at the time of this incident had no other applicable insurance or umbrella policies as evidenced by the attached Affidavit of No Other Insurance attached and identified as Exhibit "D". 13. Indeed Petitioners sought advice of personal counsel who concluded that there was no other applicable insurance to this matter, including the business policy of Defendant Mark Sheely for his construction business and therefore Petitioners are satisfied with this settlement and compromise. 14. The pool where this tragic accident occurred was in its existing state at the time Defendants purchased the home. 15. Petitioners request that this Court approve the compromise settlement of this wrongful death and survival claim without a formal hearing if possible. 16. There are no unpaid expenses associated with this claim. 17. Petitioners have consulted with their financial advisor/accountant and have agreed based on his advice to the classification of the payments under the wrongful death and survival actions presented in this matter as follows: (a) 90% or $270,000.00 payable under the wrongful death claim; and (b) 1 0% or $30,000.00 payable under the survival action. 18. The Pennsylvania Department of Revenue in past cases has approved this division of settlement proceeds for purposes of any and all applicable estate taxation issues. 42 Pa.C.S.A. S8302; 72 P.S. SS9106, 9107; In re Estate of Merryman, 669 A.2d 1059 (Pa. Cmwlth. 1995). 19. Petitioners are aware that accepting this offer of settlement will result in the waiver of the right to a jury trial and a waiver of the right to recover any further damages on 3 behalf of the decedent minor Plaintiff arising out of the accident underlying this Petition in the future. 20. Since the settlement is for the policy limits of the applicable insurance policy, Defendants, Defendants' carrier, Foremost Insurance Group, undersigned counsel and Petitioners believe the settlement is fair and reasonable and in their best interests. 21. Petitioners understand and appreciate that by executing this Petition they are attesting to their knowledge and consent of the settlement and the effect of this compromise. 22. An estate was opened by the Court; however, there is no tax liability. 23. There are no legal fees pending in this case on behalf of Petitioners. 24. All parties to this action concur with the filing of the Petition and seek approval of the minor's compromise under the settlement terms set forth herein. 25. The letter of approval from the Pennsylvania Department of Revenue attached hereto and marked as Exhibit "E". WHEREFORE, the Petitioners respectfully request that this Honorable Court approve the Petition to Seek Minor's Compromise in this wrongful death and survival action so that the proceeds can be promptly paid to the decedent's surviving parents. Respectfully submitted, MARSHALL, DENNEHEY, WARNER, COLEMAN & GOGGIN DATE: 12/t..7 (" { BY: o t.t-I-4.. "'"' , Matthew L. Owens, Es uire LD. No. 76080 4200 Crums Mill Road Harrisburg, P A 17112 (717) 651-3501 Attorneys for Mark and Annette Sheely 4 DATE: \~ \.:Li l o~ DATE: \.;2- \ J- 1 I"" \05 _A \LIAB\MLOWENS\LLPG\240360\ACZILLA \06091 \00733 Seymour Levine Petitioner and Parent and Natural Guardian of Decedent Minor Plaintiff Robert (Robbie) Levine Ti fany L. vi Petitioner and nt and Natural Guardian of Decedent Minor Plaintiff Robert (Robbie) Levine 5 1~."1I~ KIl~ 1/11:1 This is to certify that the infonnation here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the Stale Vital Records Office for permanent 'filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fcc for this certificate. $6.00 No. -t~.......~.,.., Local cgisU'af P 12593951 "11:.1' 31, ;l dtJ 4. Dale 1111~REV_ l'II'E,..,tl =' nO-2S2 I M...._i'I'IL_...""" Robert '......IIIIIlorI 4 ~ ~ COIIMQNWIiAl.nt OF I"ENHlIYl.VIINIA . ElEPARTIIIEHT OF HEAL 1H . Y1fA&. RtCOfU)S CERTIFICATE OF DJ;ATtlICORONER) s Levine . ... r,. IlIirIIloll I l!I I 01_ a .".. -t-.....1'IIl 9156 A. M May 28. 2006 t.<o_OI' _111 __. _........1 ...~, 1'Ml. _...lNiIIl....._........_......._.._IlOIIOf.....__Iudl..__ __..___.....III......Ilo....._.._1M _1I_f~__.. _ --"'--' . ~"'___I", It, &;'J.:';;",,::AE .............. =':'='L'T"....r. If __ .__,_.._.-... )Q,. C... ,.,"'.....-~.- ......-........,.,.-.....,..., .,- :---- ;.....- I . . _\llt___l IJ hi D".." 01100- lNI..rwo.......,.,...,.., "" -.. 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PA 170:10 11IM 0tI_1 Worksheet for Claim 773-7006 Unit 1: Status Opened Closed Family: Selected: Total Loss: Model Year: Unit Length: Unit Width: CCs: Power Type: Horsepower: Engine Count: Incl Vessel Amt: D Fuel Type: Motor Type: Unit Location: Printed as of: Aug-04-2006 Page 2 of 13 Risk: ~ D 1960 o o Unit Added: D Existing Damage: D Make/Model: Serial Number: Purchase Price: $0 Purchase Date: Unit Type: Vessel Name: Hull Material: Racing Flag: D Layup Period: Waters Navigated: 330 N 30TH ST CAMP HILL, PA 17011 Loss Comp Pers Liab BI CPL Med Pay Dwelling 381 Adj Structures Personal Property Addl Living Exp 381 Comp Pers Liab PO Medical Payments Repl Cost Contents Limit Deductible Added Loss Reserve 300,000 0 D 300,000 D 1,000 179,010 500 D 17,901 500 D 89,505 500 D 35,802 0 D D 1,000 0 D 89,505 0 D 002988-MOLD EXCEPTION 003434-REPL COST PER PROP 005257-HOMEOWNERS POLICY 006979-REQUIRED CHANGE - PA Manuscripts: D EQUITY ONE INC ISAOA PO BOX 57043 IRVINE, CA 92619-7043 First Mortgagee D Added D May Not Be Applicable THE JUNIATA VALLEY BANK PO BOX 66 MIFFLlNTOWN. PA 17059-0066 Second Mortgagee D Added D May Not Be Applicable . RELEASE AND SETTLEMENT AGREEMENT KNOW ALL MEN BY THESE PRESENTS: THIS RELEASE AND SETTLEMENT AGREEMENT ("Release") is made and entered into by and between Seymour Levine and Tiffany Levine, Parents of Robert Levine, Deceased, ("Plaintiffs") and Annette Sheely and Mark Sheely and Foremost Insurance Group ("Defendants"). WHEREAS, the Plaintiffs have presented a claim against Defendants arising out of an accident which occurred on May 28, 2006, at 330 North 30th Street, Camp Hill, Cumberland County, Pennsylvania. WHEREAS, the Plaintiffs and Defendants desire to settle the matters raised in the Lawsuit, together with any and all other matters pertaining to the parties named herein and the above noted incident that might have been raised, that could be raised, that could have been raised, or that might be raised in the future, and WHEREAS, all parties to the Lawsuit wish to make a full, complete, and final settlement of all those matters. NOW, THEREFORE, with the foregoing background being incorporated herein by reference and made part hereof, Plaintiffs, for and in consideration of the total sum and sole consideration of Three Hundred Thousand Dollars ($300,000.00), receipt of which is hereby acknowledged, do hereby remise, release, and forever discharge, and by these presents, do for themselves, their successors, administrators, assigns, heirs and executors, remise, release, and forever discharge Defendants and their respective past, present, and future officers, directors, stockholders, insurers, attorneys, agents, servants, representatives, employees, subsidiaries, affiliates, partners, predecessors, and successors in interest and assigns, and any and all other persons, firms, or corporations with whom any of the former have been, are now, or may hereafter be affiliated, together with any and all other persons, firms or corporations, of and from any and all past, present, or future claims, demands, obligations, actions, causes of action, liens, rights, da.TIlages, costs, expenses, and compensation of any nature whatsoever, whether based on a tort, contract or other theory of recovery, and whether for compensatory or punitive damages, which the Plaintiffs now have, or which may hereafter accrue or otherwise be acquired, on account of, or in any way growing out of, or which are the subject of the Lawsuit (and all related pleadings) including, without limitation, any and all known or unknown claims for bodily and personal injuries to Plaintiffs, and the consequences thereof, which have resulted or may result from the alleged negligent or intentional acts or omissions of the Defendants. This Release on the part of the Plaintiffs shall be a fully binding and complete settlement between the Plaintiffs, the Defendants and all parties represented by or claiming through the Plaintiffs save only the executory provisions of this Release and Settlement Agreement. Each party hereto shall bear all attorney's fees and costs arising from their actions or . the actions of their counsel in connection with the Complaint, this Release and Settlement Agreement and the matters and documents referred to herein and all related matters. The Plaintiffs hereby acknowledge and agree that the Release set forth hereinabove is a General Release, and they further expressly waive and assume the risk of any and all claims for damages which exist as of this date, but which the Plaintiffs do not know of or suspect to exist, whether through ignorance, oversight, error, negligence, or otherwise, and which, if known, would. materially affect their decision to enter into this Release and Settlement Agreement. The Plaintiffs further agree that they have accepted payment of the sums specified herein as a complete compromise of matters involving disputed issues of law and fact, and they fully assume the risk that the facts or the law may be otherwise than they believe. Counsel for Plaintiffs will deliver to Counsel for Defendants an executed Stipulation of Dismissal with prejudice and/or an Order to Settle, Discontinue and End with prejudice of the Lawsuit described hereinabove. The Plaintiffs represent and warrant that no other person or entity has or has had any interest in the claims, demands, obligations, or causes of action referred to in this Release and Settlement Agreement; that they have the sole and exclusive right to receive the sums specified in it; and, that they have not sold, assigned, transferred, conveyed, or otherwise disposed of any of the claims, demands, obligations, or causes of action referred to in this Release and Settlement Agreement. The Plaintiffs agree and acknowledge that they accept payment of the sums specified in this Release and Settlement Agreement as a full and complete compromise of matters involving disputed issues; that neither payment of the sums by the Defendants nor the negotiations for this settlement (including all statements, admissions or communications) by the Defendants, or their attorneys or representatives shall be considered admissions by any of the said parties; and that no past or present wrongdoing on the part of the Defendants shall be implied by such payment or negotiations. Plaintiffs agree to indemnify and hold harmless the Defendants from any and all claims or liens presently existing against the Plaintiffs on the settlement fund herein by any person, entity, or corporation. This Release and Settlement Agreement contains the entire agreement between the Plaintiffs and the Defendants with regard to the matters set forth in it and shall be binding upon and inure to the benefit of the executors, administrators, personal representatives, heirs, successors, and assigns of each. There are no other understandings or agreements, verbal or otherwise, in relation thereto, between the Plaintiffs and Defendants. In entering into this Release and Settlement Agreement, the Plaintiffs represent that they have not relied upon the legal advice of an attorney and have not secured counsel to represent them, but that the terms of this Release and Settlement Agreement have been completely read and explained to them and that those terms are fully understood and voluntarily accepted by them. 2 The parties hereto enter into this Release and Settlement Agreement in the Commonwealth of Pennsylvania, and said document shall be construed and interpreted in accordance with its laws. Plaintiffs, intending to be legally boundj>y the terms ~this Release and Settlement Agreement hereunto, set their hand and seal this 7, \ .' day of F ' 2006. CAUTION: READ BEFORE SIGNING. TIDS IS A RELEASE. WITNE SEYMOUR LEVINE, Individually and as Par t 0 Robert Levine, Deceased WITNESS Sworn to and subscribed - if before me this ~ /-aay of ~6r-- ,2006. . ~i n 'NOT "PUBLIC '~ COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL MICHAEL R. CARANCI, Notary Public Lemoyne Boro. Cumberland County I My Commission Expires June 15,2010 3 SEYMOUR LEVINE and TIFFANY LEVINE, parents of Robert Levine, Deceased, v. MARK SHEELY and ANNETTE SHEELY AFFIDAVIT OF NO OTHER INSURANCE 1. Affiant is Mark Sheely, an adult individual competent to make this Affidavit. 2. On May 28, 2006, I was the owner of a residential property located at 330 N. 30th Street, Camp Hill, P A and resided at this property on this date. 3. Robert (Robbie) Levine died tragically at my home when he fell into my swimming pool on May 28, 2006. 4. The only Policy of Insurance which I maintained concerning the above-described residence is a homeowner's Policy of Insurance issued to me by Foremost Insurance Group. 5. As of the time of the May 28, 2006 accident, neither I nor my wife, Annette Sheely, had any other insurance including, but not limited to, other homeowners insurance, a personal liability umbrella policy (PLUP) or any other possible insurance or coverage for this incident/accident. 6. I did maintain a liability policy for my business trading as Mark Sheely Builder, Inc., however, this policy is not a homeowner's policy and to my knowledge provides no coverage or protection for liability claims at my residence. 1YltJtJt .M~~ Mark Sheely I~-Ig-ao Sworn to and Subscribed before me this ~ day of ~d,v ,2006. y~~~ NO;Aiy PuILIC COMMONWEALTH OF PENNSYLVANIA Notarial Seal Kimberly A. Bauer, Notary Public Lower Paxton Twp., Daupliln County My Commission Expires Dec. 12. 2007 Member. Pennsylvania AssoclatIon of Notarlee SEYMOUR LEVINE and TIFFANY LEVINE, parents of Robert Levine, Deceased, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. NO. MARK SHEELY and ANNETTE SHEELY AFFIDAVIT OF PARENT AND NATURAL GUARDIAN SEYMOUR LEVINE 1. I am Seymour Levine. 2. My date of birth is 6/ ~ /6S 3. My social security number is 2?l- 90-4~{ 4. I was the parent and natural guardian together with my spouse of Decedent Minor Robert (Robbie) Levine. 5. My son Robert (Robbie) Levine was killed in a tragic accident on May 28,2006. I presented a claim against the homeowners, Mark and Annette Sheely, and their homeowner's insurance company, Foremost Insurance Group. 6. I have settled the claim for $300,000.00 which represents the policy limits of the Foremost Insurance Policy of Defendants. 7. I did not retain counsel for this claim and I do not now have an attorney representing me for this settlement. 8. I have met with Matthew L. Owens, Esquire, counsel for Defendants Mark and Annette Sheely and for their carrier, and understand that he is not my attorney but that he represents the interests of the Sheelys and their insurance company. 9. I did consult with my own personal counsel on the settlement and distribution of the settlement proceeds and am satisfied with the settlement and compromise. 10. I fully understand the effects of executing a Release consummating the settlement resolution of this matter, which I have done so, and further, fully understand the effects of executing the Petition for Minor's Compromise of Wrongful Death and Survival Action of DATE: )2- /t-oG Decedent Minor Plaintiff and for accepting the settlement of Sworn to and subscribed W\~,S. ...~~: ~ , before me this day of , 2006. - \ - ,.- 1 ~~ ~ OY'-c:'~ - NOTARY PUBLIC ~~ I L{ l C{ /oCp " 2 SEYMOUR LEVINE and TIFFANY LEVINE, parents of Robert Levine, Deceased, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. NO. MARK SHEELY and ANNETTE SHEELY AFFIDAVIT OF PARENT AND NATURAL GUARDIAN TIFFANY LEVINE 1. I am Tiffany Levine. 3. My social security number is 2. My date of birth is 4. I was the parent and natural guardian together with my spouse of Decedent Minor Robert (Robbie) Levine. 5. My son Robert (Robbie) Levine was killed in a tragic accident on May 28,2006. I presented a claim against the homeowners, Mark and Annette Sheely, and their homeowner's insurance company, Foremost Insurance Group. 6. I have settled the claim for $300,000.00 which represents the policy limits ofthe Foremost Insurance Policy of Defendants. 7. I did not retain counsel for this claim and I do not now have an attorney representing me for this settlement. 8. I have met with Matthew L. Owens, Esquire, counsel for Defendants Mark and Annette Sheely and for their carrier, and understand that he is not my attorney but that he represents the interests of the Sheelys and their insurance company. 9. I did consult with my own personal counsel on the settlement and distribution of the settlement proceeds and am satisfied with the settlement and compromise. 10. I fully understand the effects of executing a Release consummating the settlement resolution of this matter, which I have done so, and further, fully understand the effects of executing the Petition for Minor's Compromise of Wrongful Death and Survival Action of DATE: Tiffany Levin Sworn to and subscribed ~J~4J -~~ before me this day of ,2006. ~hJ,........r ".....- J (f;...J-;) NOTARY PUBLIC ~~ ! 2-/" 'i'/o& 2 12/22/2006 12:24 717-772-1459 OFF CHIFF OOUNSFL PAGE ai/Ell D.~22-2006 01:08pm 'rQl~ T"OIO P.OOI/OOI F-III Jim Millar, Esqub:e Pennsylvania Dc1)8l1men\ of Revenue Office of Chief COUDSel F~;717-712-J459 Geoffrey Mcinroy, Esquire Marshall, Dennehey, Warner, Coleman &. Goggin 4200 Crums Mill Road, Suite B Hmi,buTg, P ^ 17112 RE: Eatate ufRoticrt LevlDe DocketNumber: Q6..7171 civil term, Cumberland County, PA Your Fl~o. 06091-00733 Dear Mr. McInroy: On December 22, 2006 I spoke with you with regard to settlement in the above- referenced matter. We discussed a settlement at the li~ts of Foremost's po1i~y ($300,000.00). We discussed the distribution of$270,OOO.00 in the wrongful deatIl claim and $30,000.00 in tbe survival claim. We also discussed the minor decedent, Robbie Levine and the fact that he died this past summer at the younl8lc of 4-yeus"old. We also discussed that the settlement funds would. be payable to the parents afme now deceased Robbie Levine. This letter is to confirm that this department has no objection to the proposed allocation of the proceeds in this action. . Millar. Esquire Office of Chief Counsel A.J~~' llc.J fJ. SS~~ SEYMOUR LEVINE and TIFFANY LEVINE, parents of Robert Levine, Deceased, v. MARK SHEELY and ANNETTE SHEELY IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-7171 CIVIL TERM CERTIFICATE OF SERVICE I, Angela Zilla, an employee of Marshall, Dennehey, Warner, Coleman & Goggin, do hereby certify that on this day of December, 2006, I served a copy of the foregoing via First Class United States mail, postage prepaid as follows: Seymour and Tiffany Levine 198 Rose Hill Drive New Cumberland, P A 17070 Angela Zilla f'-.,,'\- C) II C) --4 1'"'-'1 C) t-.,) -..I -.. ~ .. ..,::.- :;~ 1- - ~:a LJ .< THE ESTATE OF ROBERT S. LEVINE, SEYMOUR LEVINE and TIFFANY LEVINE, parents of Robert Levine, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 06-7171 CIVIL TERM MARK SHEELY and ANNETTE SHEELY ORDER AND NOW, this 2? llaay of ----1>~. , 2006, upon presentation of the within Petition and after due consideration of the Petition for Minoris Compromise of Wrongful Death and Survival Action of Decedent Minor Plaintiff and exhibits thereto, this Court, being satisfied with the propriety ofthe compromise as above stated, hereby ORDERS and DECREES that: 1. The settlement as described in the Petition is a fair and reasonable compromise of this claim, and that such a compromise is in the best interest of the Petitioners. 2. Settlement shall be distributed as follows: Payment of $300,000.00 policy limits: (a) 90% or $270,000.00 payable under the wrongful death claim; and (b) 10% or $30,000.00 payable under the survival action. BY THE COURT: r :2 -c:J ~ ~ ~ -<' ,-p "'-<. ~ ts .. , ~~ r t- i ftP~ r l-t- f3 f z:,.. ....... ~ fJ N f ~~ C) c::.,,::) -..., ~=r'" .- .-1 o , 01 f'~11 ("":. \"",) , --~ V ....;,:"'" 1"'0 - r..::