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.IZ. 1.'"~C. GIOI1., . OIVZL .01101 - La.
Dafl.'a. . JUlY 'IZAL DaNAXD.D
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AI>> 10. com.. tha Plaintitt, cindy W. Fr.et, by har attornlY
~wrancI J. N.ary, Ilquir. and r.lpeottully r.pr'llnt. al tolloWI.
1. The Plaintitf, cindy w. Frllt, .lI an adult individual
radding at 403 South Inola Drive, Inola, cumberland County,
Plnn.ylvania 17028.
2. The D.fandant, Iria In.uranc. Group, 11 an inlurance
company lioan..d to tran..ct bu.ina.. in the COllllllonwl.lth of
Plnn.ylvania with . branch of tic I located at 4901 Loubl Driva,
ROllmoynl Bu.ina.. Canter, po.t OfficI Box 2013, Meohllnic.burq,
Cumberland county, pann.ylvania 17088-0710,
3, On May 19, 1991, Plaintitt waa involvad in a motor vahicle
accident in which .ha .u.tained par.onal injurie.,
4. Prior tharato, Detendant i..uad an automobile in.urance
polioy to the Plaintitf, policy number Q09-1704881-8, which wa. in
atteot on May 19, 1991, thl datI of the accident.
8. Pur.uant to the term. and condition. of .aid policy,
Plaintiff wa. the namad in.urad and the policy providad for One
Hundred Thou.and ($100,000.00) DOllar. in fir.t party medical 10'.
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bendit. 1n aooordanoe w1th the Penn.ylvani. Motor Vehicle
'1nancbl ae.pondbility Law. A oopy of the Deolaration Pave of
..ld polioy b attached hereto and .arked au Ixhibit A.
6. A. a re.ult of the accid.nt, plaintiff Buttered varlou.
injurie., inolud1nq h.adache., a left .houlder oontu.ion, left
ehoulder pain and neak paj,n, tinq1inq and nulllbne.. in both Brill', a
herniated cervioal diso at the C5-6 level, a bulqing di.o at the
C4-5 lev.l, .evere lIIu.ole etrain with Thoracio Outl.t syndrome and
r..ul tant .urqery and TMJ syndrome and re,ul tant .urg.ry. Some or
all of which may be p.rmanent in nature.
7. A. a turther re.ult ot .aid accident, Plaintiff ha. been
obliqed to received and underqo m.dical treatment and care and to
exp.nd variou. .um. for whioh medioal benefit. are payable and may
be obl1q.d to continue to expend variou. .um. for an indefinite
time in the future.
8. The Detendant ha. paid the mediclll bUll for variou.
treatment. for the injurie. .uttered in an amount in exo... of
Thirty-Nine Thou.and Two Hundred Fifty-Four and 84/100 ($39,251.84)
with the Ixception of the medical billa incurred related to the TMJ
syndrome which have not been paid,
9. At variou. time., plaintiff ha. reque.tld that the
Defendant pay the medical bill. related to the TMJ Syndrome and
.urqery which re..ain unpaid and .aid medical bill. ar. .. follow..
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~. Oentral Penn KRI
a. We.t Shore Ane.the.ia
3. Grandview surgical center
.. Mechanic.burg Rehab Ho.pital
5. Robert J. Beaudry, OND
TOTAL
A copy of .aid invoice. are attached h.r.to
B.
'.711.00
'360.00
$a,747.00
$1,1119.65
"3,883.50
$9,0211.15
and marked a. Ilxhibit
10. Def.ndant, punuant to the penn.ylvania Motor V.hicl.
Financial R.spon.ibility Law on or about Octob.r 28, 1991, notified
Dr. Rob.rt J. Beaudry, the Plaintiff'. primary phy.ician for the
TMJ problem, that the Peer R.view proc... was going to be utili.ed
to det.rmine it the tnatment he provided, "contom. to the
profe..iond standa1.'ds ot car., is m.dically nec..sary and i.
causally relat.d to the accident". A copy of said notice is
attach.d hereto and marked as Exhibit c.
11. On or about December 13, 1991, a copy of the Peer R.view
R.port dated November 29, 1991 wall provided to all partie. and .aid
r.port stated that it was the opinion ot the review.r that the TMJ
injury was not causally related to the acoident. The is.ue ot
whether the tr.etment contorm. to the prof...ional .tandards ot
oar. or i. m.dioally nec.s.ary was not addr....d. A copy of ..id
notice and report i. attach.d h.r.to and mark.d a. Ilxhibit O.
4
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12. Th.r.aft.r, on or about January 10, 1993, a l.qu..t tor
R.con.iet.zoation wa. maet. anet wa. confirm.et a. e.t forth in the
con..pond'ne. dat.et January 17, 1993, a copi.e of which are
attaoh.d h.r.to and mark.et a. Exhibit E.
13. On r.bzouuy 18, 1993, plaintiff WAl advb.d that the
recon.ietezoation perform.d by Dr. H.rb.rt L. Goldb.rq, etateet
rebzouary 7, 1992, confirm.d the earli.r opinion that the treatment
for TNJ wa. not cau.aUy related to the automobila aceid.nt. A
copy of .aid notic. and report ar. attached hereto and mazoked a.
Exhibit ...
14. Ther.after., by corre.pond.nce dat.d s.pt.mber 21, 1993
dir.ct.d to the Mill.r Oral Surqery and Central Penn.ylvania Mal
c.nter, the Defendant once aqain d.clined to pay for the
out.tandinq medical bill. a. ft re.ult of the lack of a direct and
cau.al r.lation.hip to the accident, A oopy of .aid notic.. are
attach.d her.to and mark.d a. Exhibit G.
111. Th. D.f.ndant, contrary to the providon. of Section
1797(b) (1) h.. att.mpted to u.e .aid Peer Revie" organization to
determine the caued conn.ction bet"een the accident and the
alleged injurie..
16. Th. Def.ndant, b..ed upon the Peer Revi." Report .et
forth abov., ha. refu..d to pay for pa.t and future tzoaatll\.nt
r.qardinq the TMJ injury.
II
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17. It i. av.rred that all lIl.cUcal bill. incurr.cS, both
b.ro~e.lnd art.~ the PI'~ Review, .~. r.i~ In4 re..onable .n4 th.t
.aid t~..tlll.nt wa. m.dic.lly n.c....ry .nd ~.l.t.d to th. .ccid.nt.
lB. A.. re.ult of D.f.ndant'. r.fu..l to p.y .aid .edioal
8xp.n..., Plaintiff ha. b..n required to hire the .ervio.. of an
attorney to initiate .uit to obt.in p.yment of the .edio.l bill.
due and Plaintiff i. entitled to her .ttorney fe.., in the event
th.t the Defend.nt b found to have acted in .n unre..on.ble .anner
in refu.ing to pay the benefit. when due.
19. A.. re.ult of .aid r.fu.al, the Defend.nt i. required to
p.y intere.t .t the rate of TWelve (lU) Percent on .ny unpaid
balanoe for which the Defendant i. found to be liable for payment.
20. Defendant ha. undertakln a cour.e of aotion which ha.
b..n de.igned to refu.e the clailll for lIle4ical benefit. and cau.e
tbe Plaintiff to be penonally r..ponaibl. for .edioal bill.
arilinq out of the lIlaintenance or u.e of a 1Il0tor vehicle, in
contradiction of the ten. of the contraot, penn.yl v.nia Motor
Vehicle Pin.noial Re.ponlibility LaW and the c..e law of the
COlDlllonwealth of penn.ylvania and Plaintiff i. .ntitled to tr.ble
dallla91..
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I, CINDY If. PRlIT, hereby acknowledge tha~ I a. a Plaintiff in
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the fOl'e9oin9 action, t,hat I have read the toreqoinq co.plaint and
the etat...nt. .ad. therein ar. true and correct. I und.l'~tand
that tal.. .tat..ent. herein ar. .ade ,ubjeot to the penaltie. of
11 Pa.C.S. Slction U04 relatinq to un.worn faleification to
authoriti.. .
Datal
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2 N I NHOL IR D LITED
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~Q dayeot the PRO's initial determination.
Sincerely,
-
Jodi L. Spahr
Medical Manaqement Special1.t
(717) 795-2208
JLSlbjw
001 cindy Freet
40~ S. .nola Dr,
.nola, fA 17026
001 Lawrence Neary
Attorney at Law
P.O. Box 963
Harrisburg, PA 17108
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Connelly, Reid' spade
P.O. lox 963
H.rri.b~r9, fA 17108
January 17, 1992
Our Claim No. I
Our In.uredl
Qate ot LOlli
Your Patient I
170225689
cindy Freet
5/20/91
Cindy Freet
Dear Mr. Neary I
We are in receipt of your January 10, 1992 correspondence in which
you reque.t a reoonsideration of the PEER Review performed by
Medimax re9arding your client, cindy Freet, We have forwarded
your request to Medimax so that they can start the reoonsideration
procesl.
Auto in.urance regulations have now been approved that the in.ured
or their representing attorney may request reconsideration
directly from the PEER Rsview Organization, If Dr. Beaudry has
additional information that would be pertinent to the
reoonsideration process, please forward this information directly
to the PEER Review Organization.
Plea.e feel free to contact Medimax with any questions regarding
the reoonsideration or if you have any questions. Their addr...
i. Medimax, 1 OXford Valley, suite J18, Langhorns, PA 19047,
telephone (215) 752-75JO. Please contact me with any concerns or
problem. that may arise in regards to this reconsideration,
Sincerely,
t
,
JLS/V'fA
001 FUe
OCI Miller Oral Surgery
400 Nationwide Drive
Harri.burg, PA 17110
COI Cindy Freet
4035 Enola Drive
Enol., PA 17025
COI Medimax, Ino.
1 Oxford Valley, Suite J18
Langhorne, PA 19047
I ERIE INSURANCE GROUP
The ER'e ,. Above Allin SEflV'CE. , S"". 1/)26
Jodi L. Spahr
Medical Management Speaiali.t
(717) 795-2208
.
Al, ~I~III""" ..",', ,., ,_., ,j ,~''''~. I "'" "'~Ilt"HII,,1o ~",,""ILJ"
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MY A. NELL, Ale
VI" P,"III'rM ifill IflOl;I\CltIrN MINett
ERIE INSURANCE GROUP
February 18, 1992
Connelly, R~id & Spade
P. 0, Box 963
Harrisburg, PA 17108
'RF.,
ERn: Claim No.
ERIE Insured
Dat\'l of Loso
Patient NflIlle
170225689
Cindy Freet
May 20, 1991
Cindy Freet
Dear Mr. Neary,
In compliance with the re~ulations of the Pennsylvania Insurance
Department, enclosed is a copy of the reconsideration of the Peer
Review Or~anizatiol\, Medimax.
Based on this reconsideration, we are unable to
payment of your bills for the followin~ reasonl
not casually related to the accident.
consider further
The treatment is
Sincerely,
,Jodi L, Spahr
Medical Management Special1s t
JLSlmg
, ,
enclosure
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CCI FHe
Cindy Freet
~lller Oral Sur~ery
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Miller Oral Surqery Inc.
400 Nationwide Drive
Harrisburq, PA 17110
Attentionl Billinq Dept.
eeptember 21, 1~93
Our, claim No. r
Our Insuredr
Date of Lossr
'lour Pat ient r
170225689
Charles Freet
5/19/91
Cindy Freet
Gentlemen t
We must re.peotfully decline payment of the attached bills, After
careful consideration, my Supervisor, steve Granoff, has informed
me we will not be covering TMJ bills for cindy Freet due to the
lack of a direct and causal relationship to the auto accident of
May 19, 1991, His decision was based on a Peer Review and a Peer
Review Reconsideration, both of. which indicated there is the lack
of a direct al.:1 causal relationship to the accident,
Please consider submitting the attaohed billing to the patient's
private health insurance carrier,
Thank you for your cooperation in this matter, If you have any
questions, please feel free to call me at the number below,
Sincerely,
Victoria Phillips
Medical Management Speoialilt
(717) 795-2208
VP/kmb
Enolosure/bill
oOlfil,
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I ERIE INSURANCE GROUP
The ERIE 18 Above Allin SERViCE, . S,nce 19~&
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BHf:/lH'l'" B HI::'l\JflN
~.F\L111 OF PF.NNSvrNT\NIA,
coomv Of' CU"ll3BRIJlNll
In The Court of Common Plees of
Cumberland County, Pennsylvania
No. 652 civil Term 1994
Complaint in Civil Action Law
Notice to Pefend and Claim Rights
C j,ndy W, F'ree t
vs
Erie InBurance Group
Michael Barrick
, B~~ Deputy Sheriff of
Cunberland County, PennBylvania, who being duly Bwom according to law, Bays,
that he Berved the within CO.!!!Elllint
and claim
upon Erie InBurance Group
in civil Action Law Notice to Defend
Rights -
, tho defendant, at .~~~_ o'clock
P ,M, EST I IlDfJJX on the _,_2j____ day of l'ebruaEL-_, 19~at
4901 I.9JJiBe DrjveJ MechanicBburg , CUnoorland County,
Pennsylvania, by handIng to ,John safBtr.ol!.!L_Adu~_J.n Chllrge of the Claims
Departmen t
a true dlld atteated copy of thl\1
Complaint in Civil. FIction Law Notice to ,Defend
,lOci ClaIm RightB
hia attention to the contentB thereof' and
am at the salf(l t!me directing
the "NoUce to Plead" endorsed thereon,
Sheriff'a Costal
Pocket ing
Sorvice
Af fidav it
Surchal:Yjo
14.00
7,84
2,00
23.84 I'd, by Atty,
2-25-94
So anaworal
:r~--.l~~
11. 'rhcJllaa Kline, SherIff
b ~/' ,&' ,J
Y' .
~<f, "'.,~~. ' ~
,/ I~puty Sheriff
SWom ,md subscr.ibed to hefore me
this 'I U
, day of ]JJ_J~J","--
19_'L1_ A,O.
-'::..'~i.!-J.i.'-:::uu!.Ji", 'JJt4,
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Prothonotary
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CINDY w. rRIIT,
Pla1nUft
IN THI COURT or COMMON PLIAS
or CUMBERLAND OCUNTY, PENNSYLVANIA
No. 852 Civil 1994
CIVIL ACTION - LAW
JURY TRIAL DIMANDID
NOTICE TO PLIlAD
v..
IRII INSURANCI GROUP,
Defenclnat
TOI CINDY w. rRIET and LAWRENCE J. NEARY, ESQUIRE,
her attorney
You are hereby notified to plead to the enalo.ed Defendant'.
An.wer with New Matter within twenty (30) day. from .erviae
hereof or a default judqment may be entered aqain.t you.
MoNEES, WA~LACI . NURIC~
By (J AJ oj ,A ~~L~
~rol AW~r
100 pine street
~,O. Box 1166
Harriaburq, PA 17108-1166
(717) 333-8000
Attorney. for Iri. Inaurana. Group
Dated I ~
(If(9~1
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CINDY W. rltll'J' ,
'ldntUf
I XN THI COURT or COIIMON 'LP.
I or CUNIIRLAND COUNTY, '.NNSYLVANXA
I
I No. 85a Civll le94
I
I CIVXL ACTION - LAW
,I JURY TRIAL DIlMANDID
v.
"XI XN'l1IWfCI GROUP,
Defendant
D..mmAlftt'. ~811" 1II!rH ..-, 1D.'l"l'D.
foIiSWD
1. Admitted, upon intormation and belief.
a. Admitted.
3. Admitted in part, d.nied in part. It i. adaitted that
Plaintiff wa. involv.d in a motor vehiol. aooident on Hay 19,
1991. Aft.r r.a.onable inve.tiqation, Defendant i. without
knowl.dql or information .Uffioilnt to form a b.lilf a. to the
truth of the r.maininq averm.nt. of paraqraph 3 of the Complaint,
.nd the .... .r. thlrefore deni.d.
4. Ad.ittld.
5. Ad.itt.d in part, d.nied in part. It i. Idmitt.d th.t
the polioy provid.d for one hundrld thou. and dollar.
(.100,000.00) in fir.t party ..dioal 10... To the extent th.t
the.e aVlrment. are an eftort to oharaot.riz. or paraphra.e thl
tera. of the doou.lnt, th... aver..nt. are denied .inoe the
doouaent .peak. for it.elt.
6.- 7. Denied. After rea.onabl. inve.tiqation, D.fend.nt
ie without knowl.dql or intormation .uffioient to torm . beli.t
1
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a. to the t~uth of the aVe~.ent. of P'~aqraph. 6 and 7 of the
complaint, and the .a.e a~e therefore denied.
.. Admitted.
e. Admitted in part, denied in part. It i. ad.itted that
Plaintiff ha. a.ked Defendant to pay the .ediaal bill. related to
the te.poromandibular joint eyndro.e (IITHJII), and that Defendant
hae ~afu.ed to pay .aid billa. To ~he extent that the.e
aver.ent. are an effort to characterize or paraphra.e tbe term.
of the dooument., th..e averment. are denied .inol the document.
.peak fo~ the..elve.. After rea.onable inve.tiqation, Defendant
i. without knowledge or information ,uffiaient to form a belief
.. to the t~uth of the rem.ininq averment. of par.qr.ph 9 of the
co.plaint, and the .ame ara therefore denied.
10. Admitted in part, denied in part. It i. admitted that
Defendant notified Dr. Robert Beaudry that it would utili.e the
Peer Review P~oo... to determine wheth.r the treat.ent he
provided to Plaintiff oonform.d to the profe..ional .tanda~d. of
aare, wa. ..dio.lly n.o....ry and we. a.u.ally rel.ted to the
aoaident. To the extent that the.. .verment. are .n effort to
aharaoteri.e or p.r.phr..e the term. of the dooument, the.e
averment. .re denied .inoe the dooument .pe.k. for it.elf.
11. Admitted in p.rt, denied in part. It i. .d.itted that
the peer review report aonoluded that the TMJ injury alleqed by
Plaintiff Wa. not aau..lly relat.d to the .ooident, To the
:2
.xt.nt that th..e aver.ent. are an effort to charact.ri.. or
paraphra.. the ter.. of the document., the.e aver.ent. are deni.d
.inc. the docum.nt. .peak for them.elve..
12. Admitted in part, denied in part. It i. admitted that
plaintift made a reql~e.t tor recon.ideration, To the extent that
the.e averment. are an ettort to characteri.e or paraphra.. the
t.r.. of the document, the.e averment. are denied .ince the
document .peak. for it.elt.
13. Admitted in part, denied J.n p4rt. It i. admitted that
Dr. Goldberg aleo conoluded that the TMJ treatment wa. not
cau.ally related to the aooident. To the extent that the..
av.raent. ar. an ettort to oharaoterize or paraphra.e the ter..
of the docu.ent, th... averment. are d.ni.d .ino. the docu..nt
.peak. tor it..lf,
14. Admitted in part, denied in part. It i. admitted that
Detendant declined to pay for the m.dioal bill. related to the
treatment for TMJ. To the ext.nt that th... averment. are an
.ttort to oharaoterize or paraphrae. the term. of the document,
th... av.rment. are denied .inc. the docum.nt .p.ak. for it..lt.
15. Admitted in part, d.nied in part. It i. admitt.d that
O.t.ndant has u..d the Peer Review Proce.. to determine the
cau.al connection between the acoident and the injurie.. It i.
d.nied that thi. u.e of the Peer R.view proce.. i. cont.rary to
the provi.ion. of 75 Pa.C.B.A. S 1797(b)(1).
3
16. A4mitt.d.
17. D.nied. Def.nd.nt deni.. th.t th.,..dio.l bill. ar.
..dioally n.o....ry, .nd furthor deni.. th.t the ..dio.l bill.
.r. o.u..lly r.l.t.d to the .ccid.nt. Aft.r re..onabl.
inv..tiq.tion, Def.nd.nt i. without knowledq. or intor.ation
,uftioiant to form . b.li.f a. to the truth of the r.maininq
av.r..nt. of p.ragr.ph 17 of the compl.int, .nd the .... are
th.r.fore d.ni.d.
11. D.ni.d. Plaintiff i. not antitlod to b' r.i.bur.ed for
attorn.y" f.e. pur.uant to 7~ Pa.C.S.A. S 1797(4) and (6)
b.oau.. Def.ndant hat ohall.nqed the rea.onablen... .nd n.oe..ity
of the .edio.l tr.atm.nt for TMJ b.for. . pe.r R.vi.w
orq.ni..tion. By w.y of further answer, D.fend.nt d.ni.. th.t it
i. raquired to pay .ny attorney" t... b.oau.. the m.dical bill.
ar. not medically n.c....ry and ar. not r.lat.d to the acoid.nt.
Aft.r r.a.onable inv..tiqation, Det.ndant i. without knowl.dga or
informaticn .ufficient to torm . belief a. to the truth ot the
re..i~in9 averment. of paragr.ph 18 of the complaint, .nd the
.ama .ra ther.for. d.niad.
19. D.niad. Th. av.rment. ot p.ragr.ph 19 of plaintiff"
complaint .tate oonclu.ion. of law to whioh no r..pon.. i.
r.quir.d. If it i. d..m.d th.t a r..pon.e i. n.c....ry,
D.f.ndant i. not r.quir.d to pay intere.t pur.uant to 7~
P..C.S.A. I 1797(4) and (6) becau.. Defendant ha. chall.ng.d the
4
rea.onablene.. and neoe..ity ot the .edical treat.ent for TMJ
blfore a Peer Review organi.ation. Sy way of further an.wer,
Defendant d.nie. that it i. required to pay any intere.t baoau.e
the .edioal bill. are not medioally neoe..ary and are not related
to the aooident.
20. Denied. The avermente of Paragraph 20 of Plaintiff/.
Complaint etate oonolueion. ot law to whioh no r..pon.. i.
r.quir.d. If it i. d..med that a r.epon.. i. n.o....ry,
D.f.ndant d.ni.. that the action. it ha. tak.n contr.dict the
t.rlll. of the oontraot, the Penneylvan!.a Motor Vehicle Finanoial
Re.pon.ibility Law and the ca.e law ot Pennsylvania. It i&
furth.r .p.oifically denied that Plaintiff i. entitl.d to tr.bl.
d'lII.g.. b.oaue. Detendant'. aotion. do not con.titut. "w.nton"
beh.vior.
WHERBFORE, Detendant Erie In.urance Group re.p.ottully
requ..t. that thi. Honorable Court diemiss Plaintiff" COlllplaint,
and award it costs of .uit.
HI!W MA'l'T1R
21. p.t.ndant incorporate. herein by r.ference Paragraph.
1-20 of it. Answer to Complaint, a8 it set torth fully.
22. The TMJ about which Plaintitt complains i. not cau.ally
r.lat.d to the motor vehicle aocident which occurred on M.y 19,
1991.
15
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33. Th. tre.tment which Plaintiff ha. reoeiv.d for THJ w..
and i. not ..dioally n.c....ry.
34. Th. tr.at..nt for the a11eq.d TMJ injurie. i. not
cov.red by Plaintiff'. automobile in.urana. policy.
a&. plaintiff i. not .ntitl.d to tr.bl. d..aq.. pur.u.nt to
7& pa.C.8.A. . 1797(4) b.cau.. D.fendant ha. chall.nq.d the
r.a.onablen... and n.c...ity of the ..dical tre.t..nt for THJ
before a p..r Review orqani..tion.
26. plaintiff i. not entitled to treble damaq.. pur.uant to
7& Pa.C.8.A. I 1797(4) beoau.e Defendant'. aonduot ha. not been
and i. not wanton.
27. plaintiff i. not entitled to intere.t, attorney'. fe..
and oo.t. pur.uant to 7& Pa.C.S,A. S 1797(4) and (6) b.cau..
Defendant ha. ch.l1enqed the rea.onablene.. and neoe..ity of the
..dioal tr.atment for TMJ before a Peer Review orqani.ation.
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WHI~lrORI, D.f.ndant Iri. In.urana. G~oup r..p.otfully
~.~..t. that thi. Honorabl. Court di..i.. Plaintiff'. coaplaint,
and award it ao.t. ot .uit.
McN118, WALLACE . N~IC~
-.a J J~'"~
By f !i' l'l{ Ii' ,- '/..tn~)
vty Fre. nil
Attorn.y I.D. No. 33153
carol A. at.inour
Attorn.y I.D. No. 55'6'
100 pin. stre.t
P. O. Box 1166
Harri.bur9, PA 17108.'1166
(717) 3 3a~.000
Attorn.y. for Defendant Iri.
In.uranaa Group
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Slllljqct t<'l tne pel'llll~i'l:.' (')( III Pol, r:.8.
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to Unl!lwrH'n tlllalficlItion to .'t.lh"It'Lt \'h'., 1\,11.',,1,1' '!()I.'~jtl' t:ha~ I
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Am /I Litigation Specialist I)f f:r iI, /.1'1,' "1".11':., ',ll.""IP, i'lt,llrm'
_.. ..........-....-.......,.-...-....
for th__, [)(lfen','dtlts I.n thn within .,,':ll,,),., ,11101 tiVlt [ M,l ,\lItll"ll'I.7.':)c\
to verify t:hi~ lI'luw.~r with NI;!"' M,\I.'.t". ',lil LU; ~\r,h;tll,
t 1'\1 t" hll\.'
certify t.hat r have ~e4d ~,hll t:'Jr'i'I':"'Vj '\113'"(,, with Ih:"1 M~I'I:>H' <1I1d
that thp. fl;lCt.8 set forth liUll'('Ln 'It"" t,,"II" .In,; ,;":n, ',:1. lr) 11",." bo,)t
of my kllOwlQdg!), IIHormatl,)rl .1'l,J h"lld.
_~..-.-1.~.:~/tJ~. ,_
Tom lTI'ffr;
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CIRTIPICATI or SIRVICI
Tha undar.i9nad haraby cartifia. that a true and correct
copy of the fora9oin9 docum.nt wa. .erv.d upon aoun.el li.tad
below by u.s. fir.t-cla.. mail, po.ta9a prepaid.
Lawran.ca J. Naary, I.quira
108-112 Walnut stra.t
P.O. Box 963
Harri.burq, PA 17108
e~ /1 AI a:-
ll--1(t ~tl'(-F>
Carol l. Sour
Date. April 14, 1994
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