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Home My WebLink About94-02633 o C \... <[ ~ '. \ E ~ - '- , \f) r<) -9i (lS IN RE: TINA ARNOLD, A Minor, By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs : IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA AMICABLE ACTION . . v. NO. 94-2633 CIVIL TERM TIMOTHY LEE PIERCE, Defendant AND NOW, this ~L~ o R D E R day of July, 1994, upon consideration of the Supplemental Petition for Approval of Minor Plaintiff's Compromised Settlement and Distribution of Proceeds, it is hereby ORDERED and DECREED that the Petition is granted and payment of the fund due to the minor Plaintiff Tina Arnold set forth in the Court's Order of May 19, 1994 is hereby directed to be made as follows: (1) $300.00 to be paid to the minor Plaintiff on a monthly basis until she turns age 18 (eighteen) to purchase clothing and other necessities; (2) $1,200.00 to be paid to the minor Plaintiff to pay for a class trip to Disney World; and The remainder totaling to be deposited in a minor's trust account established with the restription that no withdrawals can be made until after the .~lnor Plaintiff Tina Arnold turns age 18, except as aut~~rized by the Court. ~ (3) G... -, Co' , .......... w J. " . RICIIAHD C. ANOINO LAW OJTICDI ANGINO & ROVNER. P.C. NIUL I. ROVNIaI ".AX I71n aa-aelO TUllY" nYIUN W.CHAaL IL KOBIK CATlnUUN.... WAHADY~mr DAVID" WUlNDKI "ICHAKL I. NAVlT8KY LAWRENCS r. BAilON. J06&P1I N. MELILLO DAVID l... LUTZ PAMELA o. tUlUIlAN RICIlA"D A. BADLDCK NUOLE c. OLSON RODIN I. MARZELLA DAWN L. "UNINOH 0&&0.1 NOIITIIII'RONT BTIUtlCT HARRIBBURO, PENNA. ,7no 1'I17113M7I1 July 12, 1994 RAND DELl:VERED The Honorable George E. Hoffer c/o cumberland County Courthouse 1 Courthouse Square South Hanover Street Carlisle, PA 17013 RE: Tina Arnold, A Minor, By and Through Her Parents and Natural Guardians, Percy Arnold and Mary M. Fornwalt v. Timothy Lee pierce CUmberland Countv - Amicable Action - No.: 94-2633 civil Dear Judge Hoffer: Enclosed is an Order which I have drafted in the above- referenced case following yesterday's hearing on this matter. Should you have any questions pertaining to this order, please contact me. Thank you. MEK/dmr Enclosure 47224/DMR IN RE: TINA ARNOLD, A Minor, : By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs : IN THE COURT OF COMMON PLEAS, CUHBERLANDCOUNTY, PENNSYLVANIA AMICABLE ACTION v. : NO. 94-2633 CIVIL TERM TIMOTHY LEE PIERCE, Defendant . . . . . . PROOF OF DEPOSIT In accordance with Pennsylvania Rule of civil procedure 2039, attached is a photocopy of the Gavings account from the Mellon Bank, to Tina Arnold, a Minor, as proof of deposit of the settlement proceeds. No withdrawal can be made from any such account until the Minor attains majority, except as authorized by a prior order of Court. n alt, Parent and Guardian Dated: 7/1491 ~~- 717/;]I-~b'~ 48946/MLS ,6 ~~ ace owYti:. &tp~~ ,I Codes on reverse_ide TransDction Codcl Account Number Uecelpt Dnte Number Amount :1 ~ oa.Ol~o6~7 ~:.:1:1):(1~0.~, ~~,-;~ ... ",'. : . I . .'. I. : ~ T1!.20ll Rev. 19m) LC.(4!l1l PD lNl ":>" C7') ~ - - n:: .." ;'"1 ..''./ c--, -, -~ -, ... 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I'DI'd] ~,r:I,:"'ICE 1.I1'I.f'I~;Ur.'I:.i) OOTI1I' '.'LllleLL ~-;r tIC I~ T t!li IH!II!.::If!:..II/IFU rilrlnr. Vr:111CI..L ',I:,LI: un; P[().lll, Dr '~;rU. rHJ I '- u~.)~) or ~; I Gill I.. 1M If~; lOO/~]O()/ I 00 ~;EMI'ANNLJAL rHEMIUM '~3'?? I.:t '11 ()O~)()() t :~~.:J 0 0 .t;~:JI}:.)O fir'.: ()CI." ~11I.3D,OJ '1'3,0:1 $2tl, :~:J 101,' ':l():,! '~1 0., ,":' '1,:~U'7. 0:.' '1<:1. f,() 'HO,~iO I O(),o;:~O() $:16, lO .t;~()I)') ~ 1. Oi) '!Ol(,r: cr /, rimlTl1 I'llCtlIWl rllWTHI..Y 1'!'!.MIUr1 (:;L1~','F:r: ('!IM!l'I: flU I lrli:LUDEU) M'I'I.lC(d.ll.l_ Uli_;CUUtll~;: ,'!ili. II C;\I,' UII',CUUln 'J.?'? 1 , j :..~ 'I. I. 6~:; , 1 !} T II i', 1. .; d !.Ji"l.(.'f t'xanll,lc ni' ;nlnC: 'J!" !! I '" Ill,) t d 0 i ,. T' ,)( I. t. 1"1 C. h.i n.l. C'.l II (\; :J fJ C' :', ..! if d 1 i HI .i. 't.:". 11111 it:: II :1 Y' to' or C0'/C'l',I'jC; nor i\ reCtlHlTllC'fl ,___,ui! JL'~, I, I, ,) lilt: I Qrm~ and \'!;.!.,r'I'Hlf:tl!.';, It' ':.'1111 h:,',/p i-\ll'l d:i! ::"11 or r ;J'-.'t'j"d'l,', Iii 1 t. t.: \". '1' I ",I '::. - ;) r c.' .1:1:_,l_i'_'lI:_ r.lJrd._.i.ncd 'll tL ,"'li'.:-,- ..lfi 11[, '!,ifill. p!I-.:'.__i\:' c(.n"l....ict T1(i "fl'lee', .. . IN RE: TINA ARNOLD, A Minor, : By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs IN THE COURT OF COMMON PLEAS, CUMBF.RLANDCOUNTY, PENNSYLVANIA AMICABLE ACTION . . v. NO. 94-2633 CIVIL TERM TIMOTHY LEE PIERCE, Defendant . . o R D E R AND NOW, this day of July, 1994, upon consideration of the Supplemental Petition for Approval of Minor Plaintiff's compromised Settlement and Distribution of Proceeds, it is hereby ORDERED and DECREED that the Petition is granted and payment of the fund due to the minor Plaintiff Tina Arnold set forth in the Court's Order of May 19, 1994 is hereby directed to be made as follows: (1) (2) paid for the purchase of a car; $300.00 to be paid to the minor Plaintiff on a. monthly basis until she turns age 18 (eighteen) to purchase insurance, clothing, and other necessaries; and (3) The remainder totaling to be deposited in a minor's trust account established with the restriction that no withdrawals can be made until after the minor Plaintiff Tina Arnold turns age 18, except as authorized by the Court. BY THE COURT: J. , " .. IN RE: TINA ARNOLD, A Minor, By and Through Her Parents and Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, Plaintiffs IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA AMICABLE ACTION . . v. NO. 94-2633 CIVIL TERM TIMOTHY LEE PIERCE, Defendant . . SUPPLEMENTAL PETITION FOR APPROVAL OF MINOR PLArNTIFF'S COMPROMISED SETTLEMENT AND DISTRIBUTION OF PROCEEDS The Supplemental Petition of Tina Arnold, a Minor, by Percy Arnold and Mary Fornwalt, her parents and natural guardians, respectfully represents: 1. The Petitioners had previously filed a Petition for Approval of the Minor's Compromised Settlement with this Court on May 18, 1994. Exhibit "A". A copy of the Petition is attached hereto as 2. The Court of Common Pleas of Cumberland county, pursuant to an Order signed by the Honorable George E. Hoffer, dated May 19, 1994, approved the settlement, providing that: $5,400.00 be paid to Angino & Rovner, P.C. for fees and expenses; $2,068.01 be allocated for the purchase of a computer; and the remaining $12,531.99 be placed in an interest-bearing Federally insured account, pursuant to Pa, R.C.P. 2039. A copy of the Court's Order is attached hereto as Exhibit "B". 4BSB3/MLM . 3. plaintiffs have reached a settlement with Nationwide Insurance company on behalf of Timothy Lee pierce with attorney's fees of $5,400.00 being paid to Angino & Rovner, P.C. and $2,068.01 being allocated for the purchase of a computer. 4. The remaining $12,531.99 check from Nationwide has not been deposited pending the Court's determination of whether any additional allocations can be made for the purchase of a car and further consideration of the type of account wherein the funds will be deposited. 5. Tina Arnold, the minor plaintiff, is the daughter of Percy Arnold and Mary Fornwalt herein, Tina Arnold is now 16 years old with her date of birth on June 16, 1978. 6. Minor plaintiff Tina Arnold has received her permit to obtain a Pennsylvania driver's license from the Commonwealth of Pennsylvania and plans to take the test for her license within one month, possibly before the hearing set for July 11, 1994. ,See copy of the permit attached hereto as Exhibit "C". 7. The car currently owned by the minor Plaintiff's parents is a standard shift car which the minor plaintiff is not capable of driving and she has been forced to borrow a relative's car to practice her driving. 2 . 8. Minor Plaintiff Tina Arnold wishes to purchase a car with an automatic transmission to use for driving herself to school and possible part-time employment. 9. Petitioners had previously requested permission from the Court to purchase an automobile which the minor Plaintiff selected from Forbes Chevrolet in Camp Hill. 10. Minor plaintiff Tina Arnold would like to purchase with part of the proceeds of the settlement a 1990 Geo Prism which had been valued at $7,300.00, as set forth in the receipt from Forbes Chevrolet, attached to the original Petition as Exhibit "F". 11. Petitioners Percy Arnold and Mary Fornwalt believe that the purchase of the automobile would be a reasonable use of the settlement proceeds and are agreeable to permitting the minor Plaintiff Tina Arnold to purchase the car if approved by the Court. 12. Minor Plaintiff Tina Arnold currently receives supplemental security income assistance benefits because of a learning disability, which benefits total $478.40 per month. 13. Petitioners Percy Arnold and Mary Fornwalt also receive public assistance and food stamps, as well as housing assistance credit from the Cumberland County Housing Authority. 14. Petitioners are concerned that the settlement proceeds even if placed in a restricted trust account will currently, as in 3 v I L . the future, adversely affect their right to continue receiving these public assistance benefits. 15. petitioners are requesting the Court to tailor how the settlement proceeds are received and spent so as not to jeopardize the benefits which the minor Plaintiff and her family are currently receiving. 16. Minor plaintiff Tina Arnold maintains that if the money is placed in trust until she turns age 18, the establishment of the trust could possibly jeopardize current benefits and definitely would result in her and her family becoming ineligible for some assistance benefits when she turns 18. 17. Petitioners are concerned that the proceeds of the personal injury settlement would not ultimately benefit the minor Plaintiff and actually jeopardize her right to receive the benefits which the family is currently receiving. 18. Even if the settlement proceeds are placed in a restricted trust until the minor Plaintiff turns age eighteen, the restricted trust would be considered a "resource," and when she turns age 18 and receives the money, it will become income which in either case will result in the loss of benefits which the family receives. 19. Minor plaintiff Tina Arnold maintains that with the Court's approval, expenditure of some of the funds within the 4 . limits provided by the various pUblic Assistance agencies at the present time will not jeopardize her benefits and will result in a net benefits to the minor Plaintiff. 20. Minor plaintiff Tina Arnold believes the Court's approval of the purchase of a car would be a reasonable use for the settlement proceeds, which is permitted by law for someone receiving the public assistance benefits and food stamps outlined above. 21. Petitioners are obtaining a quote for insurance on the car which the minor Plaintiff wishes to purchase and have received an estimate for coverage similar to those which Petitioners currently have on their own vehicle. The estimate just to insure the minor Plaintiff on Petitioner's own car would result in an increase of $51.96 premium per month. See estimate attached as Exhibit "D". petitioners hope to have available at the hearing a quote for the car the minor Plaintiff wishes to purchase.. 22. Petitioners Percy Arnold and Mary Fornwalt would also request the Court to consider allowing $1,200 of the money to be used to permit the minor Plaintiff to participate on a class trip to Disney World in Florida on September 19, 1994. The cost of the trip is $900.00 and $300.00 is requested for additional expenses. 23. Petitioners Percy Arnold and Mary Fornwalt would be unable to pay for the class trip but believe it would be a good use 5 . of the settlement proceeds and represents a unique one-time opportunity for the minor Plaintiff. 24. Minor Plaintiff Tina Arnold would also like the remaining money to be placed in an interest-bearing, tax-free trust over which she would have no direct control until after she turns age 18, so it will not be considered to be income, a resource or an asset of her family which also would directly affect their right to receive public housing assistance, food stamps, and Social security benefits. 25. Petitioners Percy Arnold and Mary Fornwalt maintain that by permitting them to place money in a tax-free restricted trust would permit the monies which were received from the personal injury settlement to be used to the minor Plaintiff's advantage, rather than resulting in a disqualification from Public Assistance benefits, which would result in no net gain to the minor Plaintiff. 26. In order to maximize the benefit to the minor Plaintiff Tina Arnold, Petitioners would request the Court to approve a monthly withdrawal for the trust in the amount of $300.00 to be used by the minor Plaintiff for the purchase of clothing and other personal care items. Petitioners maintain that the monthly withdrawal would not affect the minor Plaintiff's right to benefits and would be a good use of the settlement proceeds. 6 ~ WHEREFORE, Petitioners request your Honorable Court to grant the Supplemental Petition for Approval of Minor plaintiff's compromised settlement and Distribution of Proceeds, and payment of the money due to the minor Plaintiff Tina Arnold is hereby directed to be made as follows: (1) (2) paid for the purchase of a car; $300.00 to be paid to the minor plaintiff on a monthly basis until she turns age 18 (eighteen) to purchase insurance, clothing, and other necessaries; and (3) The remainder totaling to be deposited in a minor's trust account established with the restriction that no withdrawals can be made until after the minor Plaintiff Tina Arnold turns age 18, except as authorized by the Court. chael E. oS1k, Esqu re I. D. No. 36513 4503 North Front street Harrisburg, PA 17110-1799 (717) 238-6791 Counsel for plaintiffs Dated: IN RE: TINA ARNOLD, A Minor, By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA AMICABLE ACTION . . v. NO. TIMOTHY LEE PIERCE, Defendant PETITION FOR APPRO~ OF MINOR PLAINTIFF'S COMPROMISED SETTLEMENT AND DISTRIBUTION OF PROCEEDS The Petition of Tina Arnold, a Minor, by Percy Arnold and Mary Fornwalt, her parents and natural guardians, respectfully represents: 1. Tina Arnold, the minor plaintiff, is the daughter of Percy Arnold and Mary Fornwalt, Petitioners herein. Tina Arnold is 15 years old, having been born on June 16, 1978. 2. On October 25, 1993 at 4:48 p.m., Tina Arnold sustained injuries, including a laceration, with resulting scarring, above her right eye, as well as a contusion to her left ankle and lower leg as a result of being involved in an automobile accident. 3. At the time of the accident, Tina Arnold was a right front passenger in a 1994 Chevrolet Geo Metro driven by Timothy L. Pierce. 4. The pierce vehicle was traveling south on Magaro Road in East pennsboro Township, cumberland County, Pennsylvania. 5. At that time and place, Defendant Timothy Pierce lost control of his vehicle, striking the quardrail along the edge of o .--....... .' ..- ";-.- ----.;....... .. - -.",,\ .- . the southbound lane before crossing the highway and striking a parked vehicle, resulting in the injuries to the minor Plaintiff Tina Arnold. A copy of the Police Accident Report is attached hereto as Exhibit "A". 6. As a result of the accident, a claim was brought against Defendant Timothy Pierce as a result of the injuries that minor Plaintiff Tina Arnold sustained. 7. At the time of the accident, Defendant Timothy Pierce was insured through Nationwide Insurance Company. 8. The minor Plaintiff Tina Arnold received treatment for the ankle injury by her family physician, Dr. H. Robert Gasull, Jr., at Perry Health Center, who had referred her for physical therapy at Polyclinic Medical Center. 9. The minor Plaintiff Tina Arnold received physical therapy from December 14, 1993 through January 26, 1994, when she was released from treatment. A copy of the Physical Therapy Discharge Summary is attached hereto as Exhibit "B". 10. The minor Plaintiff Tina Arnold's scarring of her right eyebrow has been evaluated by Dr. John P. stratis, M.D., a plastic surgeon who anticipates performing surgery on Tina's eyebrow closer to the one-year anniversary of the accident. 11. Dr. stratis anticipates that the scarring over the eyebrow will improve with the surgery, but believes that it will be to some extent permanent. A copy of Dr. stratis' January 7, 1994 report is attached hereto as Exhibit "C". Photographs of the minor Plaintiff Tina Arnold's scarring as of April 18, 1994 are attached hereto as Exhibit "D". 12. Defendant Timothy pierce, through his insurance company, has agreed, subject to the approval of your Honorable Court, to compromise the claim of minor Plaintiff Tina Arnold for the sum of $20,000.00. 13. In view of the uncertainty of securing a verdict in excess of the amount of $20,000.00, your Petitioners believe that it is in the best interests of minor plaintiff Tina Arnold that the proposed settlement be accepted and approved. 14. Should the Court deem it necessary to schedule a hearing to approve the settlement, and if a hearing is scheduled, minor plaintiff Tina Arnold and petitioners herein, parents of the minor Plaintiff, and plaintiffs' counsel will be present at the hearing. 15. Your Petitioners have retained the law firm of Angino & Rovner, P,C. to prosecute this action and have entered into a contingency fee agreement with said attorneys, whereby said attorneys are to receive, for professional services, 25% of any amount recovered after filing suit. 16. Petitioners have agreed, subject to approval of your Honorable Court, to pay Angino , Rovner, P.C. the sum of $5,000.00 for legal fees. 17. Peti tioners have agreed, 8ubj ect to approval of your __..__ ~__ - -0 ._.. ___._'..._ .... .___... Honorable Court, to reimburse Angino & Rovner, P.C. the sum of $461. 65 for out-of-pocket expenses lncurred in prosecuting this claim. 18. Petitioners have agreed, subject to the approval of your Honorable Court, to reimburse Angino & Rovner, P.C. the sum of $400.00 for out-of-pocket expenses, which represents an amount which has been compromised or reduced by Angino & Rovner, P.C. 19. The minor Plaintiff Tina Arnold requests the Court to grant permission for her to purchase a computer from Radio Shack, located in the Summerdale Plaza in Enola, PA, The computer which the minor Plaintiff Tina Arnold wishes to purchase is described on the proposal from the Summerdale Radio Shack Store, attached hereto as Exhibit "En. The total purchase price of the computer is $2,068.01. The proposal is only valid for a period of fifteen (15) days from May 12, 1994, and a slightly increased price may apply. 20. The minor Plaintiff Tina Arnold anticipates receiving her driver's license in the near future and has selected a car at Forbes Chevrolet in Camp Hill, PA, which she would like to purchase with part of the proceeds of the settlement. Petitioners have obtained a price on the 1990 Geo Prism of $7,300.00, as set forth on the receipt from Forbes Chevrolet attached hereto as Exhibit "F". 21. Petitioners Percy Arnold and Mary Fornwalt believe that the purchases would be reasonable uses of the settlement proceeds and are agreeable to permitting the minor Plaintiff Tina Arnold to purchase the computer and car, if approved by the Court. 22. The minor Plaintiff Tina Arnold believes that the purchase of the computer, which would assist her in her academic efforts, and the purchase of the car, which she believes to be a reasonable use of the settlement proceeds, would be good purchases for which she seeks the Court's consent. 23. Petitioners Percy Arnold and Mary Fornwalt would also request permission from the Court to invest the remainder of the settlement proceeds, totaling $5,231.99, in an annuity which they would purchase in the name of minor Plaintiff Tina Arnold, rather than placing the money in a Federally insured, interest-bearing account in a local bank. 24. Petitioners believe that the return on the investment from the annuity would be greater than that which would be received from a normal savings account in a local bank, and the security of the annuity is reasonable, especially given the amount that would be invested. WHEREFORE, Petitioners request your Honorable Court to approve the minor's compromise settlement and authorize the payment of attorney'. fees from the fund due the minor plaintiff Tina Arnold; direct payment of $2,068.01 for the purchase of a computer from Radio Shack; direct payment of $7,300.00 for the purchase of a car from Forbe. Chevrolet; and the remainder totaling $5,231.99 to be deposited in an annuity purchased by the Guardians with the restriction that the annuity be set up as a trnst, and no withdrawals could be made from the annuity until after the minor Plaintiff Tina Arnold turns age 18, except as authorized by the Court. .chael E. Kos k, I. D. No. 36513 4503 North Front street Harrisburg, PA 17110-1799 (717) 238-6791 Counsel for plaintiffs Dated: ~/I1Jq~ "'....~ .. . ".' - ---. ~ . COMMONWEALTH OF PENNSYLVAlyJA....l.j.;..".~,.; ~~~~:e~~C,f;:.~~~::~~OM ~, I. )l~~:' ACCIDENT LOCATION 20, COUNTY 3' -'- :-.. '\...~vl,t. S.~LJT~'(..J - . "1'''' oJ!;, ...., :,\ J; '~~~.,:,..-' - . . ~REFEM TO OVEFlI..AV SHEe7S POLICE INFORMATION l c'-\ - ~::, I', INCIOENT I ~lUM8ER ,2.AGEIICY-::."..- r'I_ ,...c:l.....OC.-1 .,0 ok c..'" j NAME n':'>" r'~'-l..........,~..... '-'"'. I ~ ~ : 3. STATlONI _ . I ^ ^ I. ?AT~OL .,..., 1 ?REClNCT l=... NO........' in. =ONE c; 15. INVESTIGATOR .) _ . ,._ ~ . 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OWNER i AOORESS ~ \.\..~\':\.l2.i\ $"i"", 1"2. CITY. STAT. - L^ ^ ...,,; i . ;:IPCOOE I::. NU , .. I..... . \. L C '-::> I"J. YEAR \ C\, qLi 144 MAKE( HI::.\..I,.<..Ol....L:.,- !.S.~gg;'r;.~N~T 6--:0 _,^"..:::i..<..0 1.51~~B"'"NO UNKO ,r~!)~~; a 2. i 46. ~~~~'~e 0 149. ~~~~~~HIP I 50 ~~;~ATL IMPACT \ 2.. i~~~~~~E 0 1(3)~~~~~L {&~~~,~,~~T I i~~:~VSEE';,CE I I I 155. g~~g~'ON \ 156. ~~~~~R;;;"3 ~ 7 Q ~ I 151. ST~. !56.~~~~R ~lA-'\clt-. l,-=.c I \':..x.c.'C.- 159.CRIVER \3 Ilv..^.'"' ~ 1 ADQRESS r\ ~~~~'- v I . 50. CITY. STAre ....""., 1-' A ',", . .IPcooe = "" u ~-,. 161.SEXtY\ 152.~~T~oF\l-3-<O~ i64. COMM. VEH.16S. ORIVER __ 156. ORIVER I YC N ! CLASS "- SS- i 67. CARRIER 166. CARRIER "-OQRESS 169. CITY, STATE 1 ZIPCOOE \70. USOQT f ~VEH. I CONFIG. is. NO. OF ,,-xLES AA.....~ (1192) I\...UC ,,~ 1"""3' , I ~ 1~8.~~ ICC~ \PUC ~ 174. GVVlR I n. REe~SE GL "4. ~A.r.. . VU NU UNKU 17J.1CARGO 1 '-'3oov TYPE Q!)HAZAROOUS I YA TERIALS .. ~.,~, J '.J I . I 21. ~.'UNIC:PAW~ .... -.-;:), - IUJ. COOE '2..1 COOE '. I . t (j , rEJ.-'JJ5.&~I~CJ PRINCIPAL ROADWA Y INFORMA TION M/\ So,", .Q..C R6, ~TYP. I ~IGHWAY 0 INTERSECTING ROAD: 22. ~OUTE NO. OR STREET ~IAME 23. SPEE.O - C'M.T 2 ~ II~ACCESS CONTROL 26. ROUTE I/O. OR STREET NAME 27. SPEEO LIMIT I~TYPE HICHWAY I' 29. ACCESS CO~ITRCL IF NOT A T INTERSECTION: C.eSc.,(S ('t)~ 0R, FT. 2;; 0 '." ~ 30. CROSS SiP.E::T OR SEGMENT MARKEil 31. OIAECTION .:;::;OM SITE N 5 J JJ. OISTANCS: "0..5 E W 132. ~ISTANCe... ~~OM SITe: MEASURED 0 :~TRAFF1C 1 CONTROL OE'IICE ESTlMA TEO PAINC:PAL [QJ INTEilSE071NC ~ 1 I '----' ~CONSTRUC710N ZONE i c; i 1.--1 UNIT 1# 2 136. 'B~ I (:-\ 36. L.GALL Y Y "137. REG. 'l. 3 c.. I (>, _ '.- ~ARKeo'? S G .::ll,.A TE ., ... " t'"" 39. PA TITLE OR - -37 " '"I,5'~ ''''I 7 ~/ 0 / OUT.OF.STATE 'IIN :;;4'::;'''''''c:;r ,o.oWNER v\Aau -I.) I::- ,~.<..L.~dl....i) S"R ... ~6';R~Rss '"t c \It A.G.A K.-t.: Rd., 42. Cln. STAlE r- I)' "\ l.""o ' 0..;. ! .IPCOOE t:..uU ~ ..., ' .. ~ . ~ r-S .J. .,EAR ~ Ci<g"6 144 MAKE Fc.<.U .S. MOOEL .,NOT,- ., ,,". .-,,..,,., n _ !) 14B. INS_ 300Y TYPE! v-' '"'" V o.:;s.,'-...... ...00:......... y!B" N 0 UNK C .7 600Y '-0 148.1SPEClAL " . 49. VEHICLE TYPE .::) I'-J' USAGE '-' I OWNE lSHIP SO. INITIAL IMPACT ") IS1.lVEHICLE I '1'52.1TRAV". .:JOINT \ '- 1'-..:7 STATlJS . '\;.J spee~ 53. VEHICLE ~ORIVER I -, :'-1 I~ORIVER GRADIENT I ;:II:~ESENCE C. CONOITION SQ, JAIVEM 157. STATE NUMBER 58. CRIVER NAME 59. ORIVER AOORESS 60. CITY, 5T ATE ! .,PCOOE 61. SEX 162. DATE OF 31RTH 64. COMM. vErt. 165. OAIVER 166. ORIVER YC NC! C.....SS 5S' 67. CARRIER ~~..r::C:;-"IC'o":t)G or.... .r..,......~ e8. C,,",RAIER . - , f AOORESS I I B9. CITY. S"1':'" / ! .IPCOOE 70. USOOT .. \ CO i6J.P~. Jfoq"f IPUC~ IN. aVWR \17. REt,;.:\SE 2E HAZ ~,~ vU NU UNKL ceNTER FOR HIGHWAY SAFETY 72.lVEH. ::ONFIG. 75. :~o. OF J.XLES lice' {73.)CARGO l'-3oov TVPE 5.)HAV,FlOOUS '..tA TE~IALS . . :tAOE I 0883253 ~"'ft II ~ -....... -\ :"3,::ES;':O,C11,G2.',IS,l,GE."C'( E.~')l l-:;..\,,;.....j.:e..:...:... ;~~.\.,)\.l.~AL'l.'.: ,~..;'::>L-C. .'~~E.;IC,1.L F,.\C:LI"N. l-l.: Ul.V ') ~\ .~ l,. r" t-ro~ i.J ~ 1'";; L ,dO.)PEOPL.~ ,.1F,Jr,':':1ATlON . \':( 3 C 0 E F Q N,1ME ",OORESS 1111 !,\\!z~1 12.1 d o~';:,~\Ci'- o~ U,0\'- L I Liz I I:: I i513 12. i 01 7/....' ,'1 IV, 1.z..VC-t.J) le'f WA )J';' 1 1 1 I I I i I I 1 1 I I I I I I Ii'H':;DENr ..., ACCIDENT DATE: \ U -t - -~..j IG --~-q --~,... . P-l ' L., ,.. J K L M _-I-frS! 2!AI,o II it",,:. ,;;,u1.l11 3 I 2 12J..A I 0 I J I,' '- 1,...-1 I /1 I I ~! "'-. I I I I I li 1B5._;;%RIPTI~~~ 'IT::AGED PROPERTY .....v/ ,f . ,.y/ ". ~' ~ <:: /"'\ / ..- ,7/ . ~)<\ ............ ...... ;;i f.... .:';~::. ... ,~e?~ ... /~'>":.:, - ... .... .... ........ ,... "# y. \ ( ;' ~ // ~; \... \ ' '-../ I::a~;~,"~"~ ;;... ...... ...... ... i! :::' ~ -" .......................... ..... 1",!."C~'~2 ; ~97'tu" I .......... ,K . .... ...... . ...... .. ... \87. NARRATIVE, IDENTIFY PRECIPITATING EVENTS. CAUSATION FAC70RS, SEOUENCES OF .'1ENTS, ,WITNESS STATEMENTS. AND PROVIDE AODITIONAL DETAILS. LIKE INSURANce INFORMAnON ,\NO lCCATlON OF Toweo VEHICLES. iF 1(NOWN. I I Uj..j~ \" 1. .,,\-S -;-:Z).,.vt.\...;_.. .:5()L.I.~ c;J .tt. ..;-.<..'0 ,~. c.-t Cu.J u..uK.vlJuJi..-' I sPa:!) L_J,t,.,; 10-'2.( o-;;',~rL b. IL....I~Iv'. U,v,f:L -r".b.J ,S7'/2.t.,tc../ c..,,) I i'L c:.vL...3i ~I i)i ".,. -ft"'L 4,/9 .,..;;1 '-f[>-l.AJ ~.J.'-l c,..;cl ti,f.. LQ.j1' of -tiz.l.! u.jtY..'z.~ (..t_1I/ :..,. ,;; f1',k,,-, t.(.n/, -r ..;:. _ ON. a.' I ~"vc~; A c.s c.,.e,'jl t I o;c:Mto/? 1 'lot. S....vi..ev'lU '* ~4'l-,SS ".r s,~!1 Il"hv, ;~~.-l' "i,/t"e,t, ,co.,v C\.c,2.0SS ,rtu... l::ba:.d I"V' +20",,"1 0 f . I ..vv .5 t..-VlJet;.z..) O-,vd !aJl'" Q7,v,-;2(! I a,A./. Lt.'v" -r .;2 , INSURANCE ICOMPA""Y' , ' ,,- - /. INFORMATION K}A-I~Cr-Jll..:.\J'~ ....N'5, ~o. U~'T I P~.,uOCY ,- ~~ - 7 tclc "6 'I 88, NAME 77)J A ;. .<.N 0'- 0 WITNESSES NAME "I. C ,.c"SI"UAlz/l. 0141" 89. VIOLAnONS INDlCATEO 88. OIAGRAM I"" ~2' .~ r7-l '~ILLUMINATlON ~ ~WEATHEM I 0 I \@ROADSURFACE m ~ 84. PENNSY~VANIA SCHOOL DISTIlICT IIF APPLICABLE) I INSURANCE COMPANY U. 5 ,:-" - L /" INFORMA nON . . ",- . -r- \.::j I 1 U~'T 1 PONUDCY P ,~- L 0:5 '3Tl Co 'g' CO rO J..{c'>'D~GA-.eo , z,u()i4., It. -7''f!.~/c:'97 53~RED ..~N:::' ~I uJ(}~~"f'lS,:JcL.e.f PHr~E937"; 190. secnoN NUMBERS IONL.Y IF CHAAGEO) TC NTC oc OC ~PR08A8LE uSE ~TYPE I TEST e:JRESULTS 0 NO TEST I ~PR08A8u;. I ,., FU ~ use O'__~'o~ He,. u~~ I UNIT 2! 192.1TYPE 193.lRESULTS 0 NO TEST I 1'-'" TEST 1'-'" 90&. INVEST1GA TION O 01. 0 REFUSE COMPLErE? .__.00 UNK yes ~ NO L CENTER FOR HIGHWAY SAFErY UNIT I .I..A~511192' 0883~68 ?AGE;_ ..,.. -. , ' . CLINICAL SERVICES DIVISION PHYSICAL THERAPY DEPARTMENT (717) 782-2344 FAX (717) 782-4200 ~ ~~,. 2001 NOrTh fhllO Stleer Hornscu'g, Pennsylvania 17110 ~elecnone (717) 782..1141 TO: R.obut 6aSL({! 1M, D. FROM: Kef/V nuft! 1 f, (. DATE: /.;)./:;.~ /q 3 RE: "TinCt A-r(l(,.1(d.., DX: (9 a"1J:..Ce SprlLl..n DISCRARG~:~ _. =-- S~Y~) ~.' PATIENT STATUS: PI: h(J..f a. -/leJ1CUtL W 5C(.wL~&J Vr.$ / Is '.:5Ihc.", kr inrhoJ e,va.{tfL)/?f:1V d'1 /~I/'Ilq;, T'itcdnurri htta ./7..c.Cu.d.ul ;(011/ rJNJl .sfr.J,i19f'NIII~1j lrJ..!UYl (0,,- 'It\/. (f) ~&... / Aent.t- pl-7Jfjml7( /L1jld. ia h 'ftl.l (j;; ()At.UJ, To do}( I (/) o-l'l~Jh..., M.oA4 h M i 11 CA . c/ , er;( I (f) C!--il,!t-[t s/-f.ln3i'/1 IW;J ill CI'r..eM.u< ) 4L r C"..c.lJ7..ct.:nc71 i5 € Ii In 1/7t"lIr:t:L (J....uL jtkf- /"1 CLS' Ilrr.pY(PI.u/, ,of, Yii"!ds 'k ().lfLt,t,.(,~ f"i/i'fh dt.c/uc~ tuelJh1 /xtu-;/'!.J C'VL 'fit;: (;: !Jt,d- is a,f;1..t:. fo' COTroL&r 'HtuJ c,0l'fh d-l..US . " RECOMMENDATIONS: Cevd P T O.S 0- bdVc .- ~€Jll(. Je.l-~ f r T~RAPIS~'S SIGNATURE ~ 11/3 II , CLINICAL SERVICES DIVISION PHYSICAL THE?~PY DEPART~ENT (717) 782-2344 FAX~ 782-4200 ~ ~~.. ':::;01 ~lcn~ ;"nlrc Srr~er --::ms::::'..Jrc. .='9'nrsvl'ICr'!!'= . ~ ~ .: .~'e:::::"'cr~' .... .~: .;.'~~ January 26, 1994 H. Robert Gasull, Jr., M.D. Perry Health Center P.O. Box 913 Loysville, PA 17047 RE: Tina Arnold SS~: 172-60-2363 Diagnosis: Severe sprain left ankle; status post MVA 10/25/93. DISCHARGE SUMMARY: Following the Initial Evaluation on December 14, 1993, t~is patient was scheduled for Outpatient Physical Therapy Services three times per week. The patient attended 16 out of 20 scheduled treatment sessions. . The treatment program has consisted of modalities as needed to decrease inflammation including cold packs and electrical muscle stimulation. The oacient has also received therapeutic exercises to improve the strengch, range of motion, and proprioception of the left lower extremity. The patienc has parcicipated in a home exercise program. Subjectively the patienc reports that the left ankle "really hurts" when she is :-unning. Observation of the patient during running, jumping, and advanced gait activities indicates thac the patient does not demonstrate an antalgic gait and does not demonstrate any observable signs of pain or discomfort. PROBLEM AREAS NOTED ON INITIAL EVALUATION: 1. Subjective complaints of pain and giving ouc with walking. 2. Impaired gait pactern i~cluding decreased toe off ~nd decreased heel scrike. 3. Increased girch of 1.1 cm. on the right for the figure eight method. 4. Decreased active range of motion for the left ankle. 5. Decreased strengch of the left ankle. 6. Positive tibia/fibula compression test on the left. PROGRESS TOWARD SHORT TERM GOALS: Goal Achieved - (A) Progress Made - (P) No Change - (N) 1. (A) - Decrease subjective complaints of pain with activity to less than 6/10. __'.__0 .... ...., DISCHARGE SUMMARY TINA ARNOLD PAGE 2 ~ 3 . 4. (A) (A) _ Increase left ankle strength as indicated by an increase of 1/3 manual muscle test grade. The patient'S left ankle strength is within normal limits for all motions. _ Improve left ankle proprioception. The patient is able to maintain single leg stance for 60 seconds. Enable the oatient co oer::orm an indeoendent home exercise program. The patient has been given a written home exercise program which she is able to per::orm independently, however her compliance is questionable. 2 . (A) PROGRESS TOWARD LONG TEID4 GOALS: Goal Achieved - (A) Progress Made - (P) No Change - (N) 1. (A) - Maximize the patient'S function for activities of daily living. 2. (P) - Return to school including physical education class cain-free and without restrictions. This oatient has demonstrated the abilitv to oerform various advanced gait activities and running activities without difficulty. It is my recommendati~n that this patient is able to oarticioate in ohvsical education class as tolerated. - . - - 3. (A) - Independence with a home exercise program. The patient has a written copy of the exercise program however compliance is questionable. COMMENTS: Although this patient reports subjective complaints of pain with activities, she does not demonstrate any observable signs of pai~ or discomfort., The, P'7t~enc, has ,?-~monstrated the. ability to per-or~ ad"a"~Q~ -~,t ac-'v'c'OC 'n~luc'"~ 'a~a~~l chu-~les c-oss _ _... J ____ ':2-- ~ -- - --- -. -- -..--: - --- '-- -...- 1- over~, jumping, a.n~ ;,unning. Th: ?a~,ienc ,is able to 'tolerate =unn~ng on a ~=ea~~~l~ a~ 4.0 mph :or =~ve ~~nutes. PLAN: This patient has been discharged from Outoatient Phvsical Therapy Services. If you have any further questions or recommendations regarding this patient please feel free to contact me at the above number. Again, thank you for this referral. Sincerely, .~{h. - '1'1,1.-4--<. .'_f.' '.. ~.-I mr... Michelle Mikan~wicz, P.T./A.T.C. l1M/cal -. . AESTHETIC AND RECONSTRUCTIVE SURGERY OF CENTRAL PENNSYLVANIA, P.C. 816 Belvedere Street Carlisle. Pennsylvania 17013 717.249.0100 WILLIAM p, GRAHAM. III. M.D. JOHN p, STRATIS, M.D. January 7, 1994 Michael Kosik Angina & Rovner, P.C. 4503 N. Front st. Harrisburg, Pa. 17110 RE: Tina Arnold Dear Mr. Kosik: This letter is in followup to my evaluacion of Tina Arnold and your request for information regarding the patient. Please excuse the delay in sending my report. Apparently your first letter did not make it to the patients chart when I initially saw her. This patient is a 15 year old white female who was involved in a motor vehicle accident in October of 1993. she came in on December 29, 1993 for consultation regarding the scar of her right forehead. Apparently she '"as seen in the Emergency Room at Holy spirit Hospital where her laceration of the right forehead was repaired. Apparently there has not been a history of infection or hematoma during the healing process. The patient and her parents felt that the scar was quite visible and there was eyebrow asymmetry present. On examining the patient, she has a 3 em. scar extending from the mid forehead on the right side in curvilinear fashion through the eyebrow area itself. The scar is quite evident currently because of the redness in it. It is approximately 2 mm. in width. At the junction of the scar of the eyebrow the patient has loss of eyebrow hair. I do not believe that there is an actual mismatch in the edges of the injury at the area of the eyebrow. I believe that the apparent mismatch is actually secondary to the location of the scar in the eyebrow and the lack of eyebrow hair in that area. I have advised continued observation of this scar, use of cocoa butter and protection from sunlight using sun block. I have asked the patient to return to see me in three months and would not proceed with scar revision at this point in time. I have seen the patient only this one time. She made indeed require additional treatment in the future, either with scar revision or dermabrasion or both. The surgical cost of this future treatment would be approximately 52,000.00 with reasonable degree of medical ~ I'{' II Tina Arnold ,January 7, 1994 Page 2 certainty I feel that the patients current injury and the treatment I am providing are directly related to her automobile accident. If you have any additional questions, please feel free to contact me. Sincerely, ~/~r:: M.D. JPS/klp Enclosure , ! -:. :::ADiO SHAC.X 1)1-:::1:,53 ENOLH-SUr'!~~~F:C~L~ SUW'lE:ED"L:: 2'_':W=4 4,>5 II ::~.OL:~ RD ~NGL~. ;:'A 17(1:5 (7171 7J1-~~i::''+ ------------------------------------------------------------------------------------- A:::cwr::t F.JFN\.jAL T, MARY 1 (14 '..JP'(i.'E AVE. :::.IGi..~. ~:~ t 71)2~ stecH :.!o. Oeser:' ~~ ion aty. Price 26(1-1)288 6'PC9L 25PIN-!BM 1 11. 99 :6(1-28SI) D~IP21)3 P!=:!Nj'EF. 1 1~9.99 260-,)134 1M 9.5Xil ::'011 60W 1 11. 99 :::60-0349 cASIC S?Ii{E " au-;- 1 1....:;9 261)-(1431 1\1-'3.511 HD DISKS 1 13.'19 SYSTEM - 149<? f)() ::51)-1641 TANDY W~PC NOD '::0 1 1399.1)(1 2'5li-tc)Q6 ~!PC SPEAKER/A~!P 1 79.99 250-4091 'IGM390 (1.39 SVGA 1 399.99 36 ~10NTfi COMPUTER CARRY ~i'I is? FOR 25')-1641 TANDY MMPC "00 2(1 1 199.00 SUBTOTAL TAX TOTAL ISSUE DATE: 05/12/94 THIS PROPOSAL IS VALID FOR: 15 DAYS MONTHLY RSVP PAYMENT 63.1)0 THIS MONTHLY PAYMENT AMOUNT MAY VARY DEPENDING ON YOUR ACCOUNT BALANCe:. . ~ lIE II Page I or : -.--.----..--.....- ." 11.99 199.99 11.99 14.99 13.99 .499.(11) 199.00 1950.95 lli.l)b 21)68.01 ]1')16 AOAnlSD .11l1l1.,.n, ~TJrFi CHEVROLET. INC. 3400 Hartzdale Orive at Capital City Mall Orive CAMP HILL. PA 17011 . SAl.lS co. Phone: (717) 761-0600 l.tcUl. '.:J'l\,u,ur'M". . \ ~~ .u.c....... ..... o A)r,,,\-0l- EV\oLo-.. ) "'u, '..'fa. ';lff F\V.ll- . \ 7 02.s ,url 'NV. . 1II1S. 'MOMI IUS. '''OMI S"LF.SI.4"'N'~ HA"4r~ ___ OIM- PLEASE EtHER MY ORDER FOR. MODel. DR\)..,. BODY SERIES 1""{ ,--=eM TYPE OOTHER DED~~18 100,0 MAKE ~~~~R R- 9 s ~ p.. SER\\(r~ KSY."L\- L ~ \ 44 '1 \ 2- PUfch..., agr..s tMI this Order includ.. all a. the terms end conditions on both the 'ac .nd rav.rs. side hereo'. thllt this Order cane.' and supersede' any prior agr.ement end 8S of the data hareof CDmprisas the ~1'la and ."clusive Slatarnent of the terms of the agr.,mer ralatinQ to tha subject mallan cOY"llrad hereby. and that THIS ORDER SHALL ~'OT BeCOMe BINDING UNTIL ACCEPTED BY DEALER OR HI AUTHORIZED REPftESENTATI~_ P\m:Msor by his a..~tion of thiS Order certifies he IS a. malorltY 89' and adc.nowledqes that he hes re. Its N~ "nd conditions and he. ...eeiv"d a tn.Ht COPY of this Order. THE F ACTOAY WARAAHTY CONSTITUTES ALL Oil THE WARRAHT WITH RESPECT TO THE SALt: OF THIS ITEl.6/ITEMS. THE jELli.Q UfSlf8Y EXPRESSL.Y DISCLAIMS ALL WARRANTIES. EITHER EXPRESS 'MPLIED 'HCLUDING ANY IMP~'ED WARRANTY OF ~ERCHAHr AdlLIIY eR FITHE~S FOR. PARTICULAR PURPOSE. AND THE SEL .......u."_..........." .'''''' ."T",,,"'TCO: awV r\T"'CO pco",nN Tn H~U"E FOR_IT ANY I.IABILITY.IH COHHECTIOH WITH THE SALE OF . - _ _7.:...--.- .' .------ ~. TO BE DELIVERED ON OR ABOUT CASH DELIVERED PRICE OF UNIT ACCESSORIES CASH SALE PRICE OF DesCRIBED MOTOR VEHICLE STATE AND LOCAL TAXES DOCUMEHTARY FEE LICEHSE. LICENSE TRAHSFER. TITLE REGISTRA TICH FEE 1. TOTAL PRICE OF UNIT 2. DOWN PAYMENT: consisting of 5 in cash anellOI' 5 net trad~in al- lowance on trad~in: see statement In right hand calunn lor details. 3. UNPAID CASH BALANCE DUE ON DELIVERY S (difference between Items 1 and 21 G~ 19 s 15t:lte that odometer maleaSc on thc VEHICLE ON ORDER dc:,- cribcd abovc i5 3'l . ~ at timc of tt3n5(er (elt.de ,n. lollDwln9 .rar."...."r. II appllcobl.; 01 Curther 5tate that the actual milcace dirfers hom the odOOle t reedin, (ot relSons other than odomcter calibration error and lh the actual mile'lc is unknown. I further state th.t thla vehicle w.. not involved In flood water!: s x S,...Ar","1l 0' fIU".,e_o_ taCAl.lllll 0'" A",rMO_I'1l0 ....1."" o...rr. F<<J."., ,.gularionr lYQu;,. tit. odo".."" mil.~' to b. Irarrd upon "anI of oWfMrdtip. An in*xu"." It.c.nwnr may mata th. t"aml.fo,. J/MJI. , d.m#9" to rh. r,..ml'rH. pUfsuant to .-ction .,csr.) 01 th. Mora,. V.hi. InfoflfNrion .nd COlt S,lfingl Act of '912. Public L,W' 92-513. . "'-USED ,VEHICLETRADE:INiANDI.OIfOTHER CREDITS '" \.AST ,\.ATC MOQU. laDY ~.Y.l. HO. I .tate that odome.er milea&e on the USED VEHICLE TR^DF.- describcd above is at time of transk (Ch.ck rh. 'aUowin9 .tar.m."'. ;I applleab/.) o (further Itate that the actual milease differs from the odome feadine ror reasons other than odometer calibration error and t: the actual mile_Ie is unknown. [ further at.te tb.t thla vebJ.clo w.. aot lnvoh'ed in nood ..t. I I s bB \ b . 409., I X B I BALANCE OtIED TO ADDRESS 2..\ USED TRADE-IN ALlOWANCE I BALANCE OtIED ON TRADE-IN I NET AllOWANCE ON USED TRADE'IN I DEPOSIT OR CREDIT BALANCE OOWNiPAYMENr1lTransiio;leftCal.):. . . . .. ' . REMARKS I'&NAf"''''' 0" .",.eM".CS ""AN...t:sallll 0" """OIl.'Nt o",t: s s s $ $ i I I 3Do.lcoi " VERIFICATION We, PERCY ARNOLD and MARY rORNWALT, as parents and natural guardians of ainor plaintiff TINA ARNOLD, have read the foregoing PBTITIOK roa APPROVAL or HINOR PLAINTIrp's COMPROMISED SETTLEMENT AND DISTRIBUTION or PROCEEDS and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of our knowledge, information and belief. We understand that this Verification is made subject to the penalties of 18 Pa. C.S. 54904, relating to unsworn falsification to authorities. ?:1!--'1ZI ~ ~fjt~~N-o'~ MARY T DATED: -s;/ I) ( q 4 ~ lit!.,", \ l,lj ,......... .V'J 'QJ'/ IN RE: TINA ARNOLD, A Minor, : By and Through Her parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : plaintiffs IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA v. : AMICABLE ACTION NO. qlj -.;J t., 3-3 eaJ ~f.;11,t : TIMOTHY LEE PIERCE, Defendant : . . ORDER AND NOW, this '9 tf,. day of -rn a...a ' 1994, upon consideration of the Petition for Approval of Minor plaintiff's compromised Settlement and Distribution of Proceeds, it is hereby ORDERED and DECREED that the Petition is granted and payment of the $20,000.00 due to the minor Plaintiff Tina Arnold is directed to be made as follows: (1) $5,400.00 paid to Angino & Rovner, P.C. for attorney's fees and expenses; (2) $2,068.01 for the purchase of a computer from Radio Shack; ~.t'\-\'rJ:~:-~:~~.Al.- p<U.wRaee- of' --a-<="(" from. F~ "'/.1,53/.'l1 ;.......~~ (4) The remainder totaling $S,I31.3~ to be deposited ift aft ~.~ a- u''o~ ",'" I. _.1:1 bY' 'oh~ 811111.11 __.8 with the restriction that u._ &Rauit.y 8e _GL ~.. alii il .~.1I1\!., A...lo no withdrawals could be made ErQIII "In _ ._.:. \!.y until after the minor plaintiff Tina Arnold turns age 18, except as authorized by the Court. BY THE COURT: TRUE CO?y r~:;"\ ?EC:iRD I T. .' I . d n \:~t.m~:",y ....n:r:Oi, :~Zi::C :;~to ~t my nan and the s.al oi s3id C~crt Jf CJri:sie. Pa. 45652/0.Jris .../..9.:!.'::-... day of ..J.:h.~...L. 19..9..~. ..............~...(.L..,..:e.,.!.."fk:..<...- ~n Prothonotary /oS / ~()"-- l.. )..k~ J. .'",.' OL.180"29)1 APPLICATION FOR INITIAL NON.COMMERCIAL LEARNER'S PERMIT/DRIVER'S LICENSE PRINT ALL INFORMAT'ON IN FULL IN BLACK OR BLUE INK 0285307 . . ~o RIVER 5 LICENSE '.UloteERJI 0 NUMBER I LASTt,"'I,If jA lYe 19 I ;-7r;'/1 tJ -ii,'1 I I ~ I I !I I I I I I I L.- I. . . "IIS''''''I,I! ...'00\.1........1 '-1'1 l' I ./ i /J I ! I I I I I I /111 I I I I : OATE OF el~TH 'GE ,,"l(j,lOt SOCI"'~ SlCl"IRI', ...villelA ". "0'''. '" ... /~ .,.. / 2l-?J. I f. I 0 IT. L"7. I ? 1.3 r ()~ I 1(. I 7~ tJ _ _~LJJ'~ J -? ._~ . ;/..:; EYlCOLOR,PIH,."'KIrOM): :::d.aLUI QeROWN i:JORUH OHAlEL l..lPINK CJIL...CK .WaRAY C10ICHROWATIC WOTHE.R SfRUT"'COIlUS 1 C,f" F....r/ c) L. "j """ .f1 ! llfleooi' ,,-.' I{)L/ W".,./:.,o' .....1.//: /.. ?? c1 ~ [: EXAM REPORT CHECK Applicable lIems Below Enter Fee For Eech VISION SCREENING lIem Checked .I Check One YES NO k........ PERMIT(S) DESIRED FEE . '. 2<YTO VISIon or less In bener eye W1tn correction.. .::1 A, / 0 CLASS A 55.00 Repon 01 Eye Examination allacheo... .......::1 .; :...J CLASS B 55.00 Quehlleo ... ...... .. .............. ....-d ...I 2i CLASS C 55.00 i; '-''' COMPLETE ONLY WHEN NECESSARY I Uncorrected Corrected I :..::J CLASS M 57.00 201 I R'ght Eye , 201 '. ; ..LICENSE REQUIRED..;::.;!I.: .. .~ .,..... ';"FEE:'. ." '. 201 I LeU Eye ' 201 il 4.Year PholO 522.00 :.),;/ ~ v , 201 Both Eyes 201 I - ~ ....1 2.Year PholO Age 65 & Over 512.00 ~ r , R L i F,elds R L ~ tP7C1L' ::J Must wear correctIve lenses TOTAL FEES $ I Paid by: :J Check pMoney Order -. ~ Olherrestrlctlons_ .. ~'" ----~ II-'~ - .'..... . ALL' QUESTIONS MUST BE ANSWERED VERIFICATION OF BIRTHDATE AND IOENTITY - -- .I Chick Applicable Block YES NO / ~ S,nh Cen,IIcate 1. Have you ever held or possessed a PA Driver's License/' l.I a Other Learne~s PermiUPhoto Idanlilicalion Card? .............................. .....':) TEMPORARY LEARNER'S PERMIT FOR 60 DAYS 2. Is your \'9ht to apply lor a license or your privilege 10 ThiS is to certlly Iha1lhe above applicant has applied for operate a vehicle in th,s or any other slale currenliy :1' and passed the SIgns and knowledge exammatlon lor a '"~'r " ......' .. ...............,................. .... .... ..' .::J PennsylvanIa Non.CommerClal Learner's Perml!. II yes. Ive state _ dale____________. :::l Unable to delermlne vIsion/medical Qualifications '" and re on . Temporary Learner's Permit cannot be ,ssued. 3. Have y u been arrested or c,leO ,n Ih's slate or any other ::I Currenlly suspendedlrevokeO. Temporary stale 10 any viola lion wnlch carnes a poss'ble penalty 01 . .- Learner's Permit cannot be issued. suspen$lon 01 your driver'S license? ...................................................:l ~( PHYSICAL DATE: i Men'h Oa, Year It yes. give state___________ Oale _______. i 05 i Ol/ I 97 and reason - ! II /,.,.-') , CERTIFICATION (Sign) . ,.... .-----/ I - . c ". .~._.., . /:-./~ J t~,.(";...., X t(.... / ....It...'-......___ , . ,._~/ X ../ ISIgnature 0' E.xammlfJ / tOLE No.) . . . . I I,., .. EJam'lssue Dale I I ,APP/I"''''' S'grq'ur. '" Inlf) Month Day Vear e.am Cenler I hereby aC~OWledge thiS day thai I have leceived nollce ollhe prOVISions of Section 3709 01 the "ehlele COde (se, back fOf prOVISIons). WARNING: Milltatement 01 lac I (Ji.; ! .-" , ~it./ I CARLISLE IS a mlsde"leanOI of Ihe Ihlld degre8 pUnishable bV a, line 01 up 10 52.500 and/or ,--/ imprlsonmet\t up 10 1 year (18 PA C S, Section 4904Ib)). . J . , . :~ '. .. '. .... . ..... ." ."'" ., . THIS IS YOUR TEMPORARY NON.CpMMERCIAL LEARNER'S PERMIT THIS FORM IS NOT VALID. ROR TESTING PURPOSES . 'I .. - 2. APPLICANT / :. ., I I I J This temporary iearne,'s pe,mlt ent,tles the person to whom It was Issued to drive vehicles and comblp;Ulqns 01 vehicles 01 the classlos) specllled, bul only wh,le the holder 01 the perm't 's accompanlod by end under the immediate s~parvls'on 01 a person who is at least 16 years 01 aga and whO: IS licensed In this Commonweatlh to drive veh'cles 01 the class than boing driven by the holder 01 the learne"s permit: and is actually occupying a seal bes,de the holder of the learner's perm,l unless the vehicle is a motorcycle. . Final approval ollhls application lor Pennsylvania Non-Commarclal Driver's Parmllle aUbjectto'verlllcatlon at the appllcanl's paat driver record hlalory, Should verlllcatlon dlaclo.e outslandlng vlolatlona In any Stale or Jurisdiction, Ihe application will be denied end alll..ued Pennsylvania Driver's Llcens../Psrmlls are subjecllo cancellation and recall. . ilia Unlawtul tor any peraon: To exhib,l, cause, or permil 10 be exhibiled 0' have ,n possession any recalled, cancelled, suspanded, revoked, Iictitious or' Iraudulently allered drive,'s IIcense/permil. To lend a driver's license/perm' I to any other person or permil the use Ihareol by another. To exhibll or represont 88 one's own any dnver's Iicenso/permll not issued 10 (he person. i To lall or reluse 10 surrender to the Deparlment upon lawlul demand a recalled, cancelled, su~pended, revoked, ticlilious. or.,... Iraudulently altered driver's license/permil. Oil l J Any persons v'olatlng any 01 the above IS guiily 01 a summery olfense end shall, upon conviction, be sentenced 10 pay a line 01 5100 The Department may cancel any driver's license upon determining Ihat Ihe licensee was not ent,tiad to the issuance or Ihal the person lailed to give the ,eqUlled or correct Inlormation or committed Iraud in making the application or in obtaining Ihe IIconse or the lee has not been paid. ' Any Pennsylvan,a driver who IS convicted 01 any 01 the abova olfenses shall be assessed 3 points as ollhe dale 01 violation. . A PERSON IS GUILTY OF A MISDEMEANOR OF THE FIRST DEGREE IF THE PERSON. WITH FRAUDULENT INTENT, HAS' POSSESSION OF, SELLS OR ATTEMPTS TO SELL, USES OR DISPLAYS A DRIVER'S LICENSE, KNOWING IT TO HAVE BEEN. ALTERED, FORGED OR COUNTERFEITED, Any person comm'ting this olfense is, upon conviction, subjecllo imprisonment lor a term 01 up to 5 years. The Department shall revoka tha drlver's'licansa privilega 01 any driver lor ana year upon rece,ving a carllliad record 01 the driver's convict,on 01 this-olfanse. PENALTIES AND SANCTIONS ... '.' SECTION 3709 OFTttE VEHICLE CODE Section 3709 provldas lor a IIna 01 up to 5300 lor dropping, thrOWing or daposiUng, upon any h'ghway, or upon any other public or. private property w'thout the consent 01 Ihe owner thareol or into or on the waters 01 Ihls Commonwealth, Irom a vehicle, any waste paper. sweepings, ashes, household wasta, gtass, metal, reluse or rubbish or any dangerous or detrimental substance, or permllting any 01 the preceding Without Imme!llately removing such items or causing their removal. For any v,olat,on 01 Section 3709, I may be subject to a line 01 up to 5300 upon conviction, including any violation rasulling Irom the conduct of any olher persons present Within any veh,cle 01 which I am the driver. ( '-= ) The Department IS raquired to obtain tha Licensee's Social Security Number, height and eye color undar the provisions 01 Sections 15tO(a) and/or 1609(a)(4) ollhe Pennsylvania Vehicle Coda. This Inlormat'on will be used as identllylng information In an altempt 10 m,nlmlze driver license Iraud. Federal law perm,ts Iho use of tne Soc,al Security Number by state licensing olliclals 'or purposes 01 Identification. SOCIAL SECURITY NUMBER INFORMATION t...... . Is valid on the day i~5ued. You must be 16 years ot ag9 or older to apply . Must be validated and signed by the Driver License Examiner . Must be signed by you .Is valid only when you are accompanied by and undllr the immediate supervision ot a licensed driver who IS at' least 18 years ot age . Must be In your possession at all times while driving a motor vehicle . Is valid only for the classas Iistad . Is valid for up to sixty (60) days trom the dale issued . . Is not transferable or renewable and becomes invalid if altered or changed in any manner, . Is not valid if your driving privilege is currently suspended or. revoked . Is not valid for taking your driving test (. . Will not be extended . Is void and must be destroyed upon your receipt of a Pennsylvania Learner's Permit I .~ ,~. -~tate rarm ~ells Llte insurance. . - . S1040MCEUI( snt, IJISl:OUtlT f'lIJTO QUOTE I 2 1986 SUDAbu "GL" lrRH:037 IRG:012 CL:4F, . Pfll ii DIPD 100/::l00/10() 't>290, 1'\ FULL TORT ,J;J.OOO(JO 't>2500 't>~;OOO FULL ~~500 11ED F ~l; .l.O'i . ,I,:~ ~1.2 t JO -, .. .tl~-!O. .... '! 't.41, J'1 '~1171 ~I~'I CUI1P COLI.. EHS U W Y OED '~3. ,',I) !t,10. ,;,". ~n3l) . ,I',' 11)0/300. l.00/300 '1;5001) HE r P HEt1 IlII! TlJT()L. PREMl.ut'l 'J;t. n'.' 'tf,..,O, eG 't6J\O,I'C .'5:?- - )~ -= ..... C;;: IICltITIIL Y PP.EMIUM 'HOb ,I' 1 ,JUL Y 01, .I. ~Jl/4 RATE qUOTE STO DISCOUNT *QUOTE I l. 1906 SUBARU "GL" kIlW:OI2 CL:10 * BIPD 100/300/100 * FULL TORT .~ ME 0 $1<)0000 k I" 't.2500 A' Z 't.5000 k COHP FULL "COLL $500 OED k ERS k U .k W * Y '" ,1>: 100/30\) lOO/300 $5000 NET PHEMIUt1 TOTAL PREtllUM MOIlTHL Y PREMIUM IF3-HOOIFY HATE QUOTE ~) - TERR:03? PI~EM $14() ,32 $::;1 . ~J6 'H,12 't.9. ,'6 't>19,36 $55.20 $3,60 $10,50 $36,10 'H,QO $329.12 't.~9,.l.2 , - $54.85 ACCEPT TO CONTINUE . - .. . . ~ -. VERIFICATION We, PERCY ARNOLD and MARY FORNWALT, as parents and natural guardians of minor Plaintiff TINA ARNOLD, have read the foregoing SUPPLEMENTAL PETITION FOR APPROVAL OF MINOR PLAINTIFF'S COMPROMISED SETTLEMENT AND DISTRIBUTION OF PROCEEDS and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of our knowledge, information and belief. We understand that this Verification is made subject to the penalties of 18 Pa. C.S. 54904, relating to unsworn falsification to authorities. 2lI~~ DATED: ~7'~':-. -.....-.... '~:""~,~~~.~...\,,,......_, . IN RE: TINA ARNOLD, A Minor, By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs : IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA AMICABLE ACTION v. : NO. 94-2633 CIVIL TERM TIMOTHY LEE PIERCE, Defendant SUPPLEMENTAL PETITION FOR APPROVAL OF MINOR PLAINTIFF'S COMPROMISED SETTLEMENT AND DISTRIBUTION OF PROCEEDS The Supplemental Petition of Tina Arnold, a Minor, by Percy Arnold and Mary Fornwalt, her parents and natural guardians, respectfully represents: 1. The Petitioners had previously filed a Petition for Approval of the Minor's compromised Settlement with this Court on May 18, 1994. Exhibit "A". A copy of the Petition is attached hereto as 2. The Court of Common Pleas of Cumberland County, pursuant to an Order signed by the Honorable George E. Hoffer, dated May 19, 1994, approved the settlement, providing that: $5,400.00 be paid to Angino & Rovner, P.C. for fees and expenses; $2,068.01 be allocated for the purchase of a computer; and the remaining $12,531.99 be placed in an interest-bearing Federally insured account, pursuant to Pa. R.C.P. 2039. A copy of the Court's Order is attached hereto as Exhibit "B". 48S83/HLH 3. Plaintiffs have reached a settlement with Nationwide Insurance company on behalf of Timothy Lee pierce with attorney's fees of $5,400.00 being paid to Angino & Rovner, P.C. and $2,068.01 being allocated for the purchase of a computer. 4. The remaining $12,531.99 check from Nationwide has not been deposited pending the Court's determination of whether any additional allocations can be made for the purchase of a car and further consideration of the type of account wherein the funds will be deposited. 5. Tina Arnold, the minor Plaintiff, is the daughter of Percy Arnold and Mary Fornwalt herein, Tina Arnold is now 16 years old with her date of birth on June 16, 1978. 6. Minor plaintiff Tina Arnold has received her permit to obtain a Pennsylvania driver's license from the Commonwealth of Pennsylvania and plans to take the test for her license within one month, possibly before the hearing set for July 11, 1994. See copy of the permit attached hereto as Exhibit "C". 7. The car currently owned by the minor Plaintiff's parents is a standard shift car which the minor Plaintiff is not capable of driving and she has been forced to borrow a relative's car to practice her driving. 2 8. Minor Plaintiff Tina Arnold wishes to purchase a car with an automatic transmission to use for driving herself to school and possible part-time employment. 9. Petitioners had previously requested permission from the Court to purchase an automobile which the minor Plaintiff selected from Forbes Chevrolet in Camp Hill. 10. Minor Plaintiff Tina Arnold would like to purchase with part of the proceeds of the settlement a 1990 Geo Prism which had been valued at $7,300.00, as set forth in the receipt from Forbes Chevrolet, attached to the original Petition as Exhibit "F". 11. Petitioners Percy Arnold and Mary Fornwalt believe that the purchase of the automobile would be a reasonable use of the settlement proceeds and are agreeable to permitting the minor Plaintiff Tina Arnold to purchase the car if approved by the Court. 12. Minor Plaintiff Tina Arnold currently receives supplemental security income assistance benefits because of a learning disability, which benefits total $478.40 per month. 13. Petitioners Percy Arnold and Mary Fornwalt also receive public assistance and food stamps, as well as housing assistance credit from the Cumberland County Housing Authority. 14. Petitioners are concerned that the settlement proceeds even if placed in a restricted trust account will currently, as in 3 the future, adversely affect their right to continue receiving these public assistance benefits. 15. petitioners are requesting the Court to tailor how the settlement proceeds are received and spent so as not to jeopardize the benefits which the minor plaintiff and her family are currently receiving. 16. Minor plaintiff Tina Arnold maintains that if the money is placed in trust until she turns age 18, the establishment of the trust could possibly jeopardize current benefits and definitely would result in her and her family becoming ineligible for some assistance benefits when she turns 18. 17. Petitioners are concerned that the proceeds of the personal injury settlement would not ultimately benefit the minor Plaintiff and actually jeopardize her right to receive the benefits which the family is currently receiving. 18. Even if the settlement proceeds are placed in a restricted trust until the minor Plaintiff turns age eighteen, the restricted trust would be considered a "resource," and when she turns age 18 and receives the money, it will become income which in either case will result in the loss of benefits which the family receives. 19. Minor plaintiff Tina Arnold maintains that with the Court's approval, expenditure of some of the funds within the 4 limits provided by the various Public Assistance agencies at the present time will not jeopardize her benefits and will result in a net benefits to the minor Plaintiff. 20. Minor Plaintiff Tina Arnold believes the Court's approval of the purchase of a car would be a reasonable use for the settlement proceeds, which is permitted by law for someone receiving the public assistance benefits and food stamps outlined above. 21. Petitioners are obtaining a quote for insurance on the car which the minor Plaintiff wishes to purchase and have received an estimate for coverage similar to those which Petitioners currently have on their own vehicle. The estimate just to insure the minor Plaintiff on Petitioner's own car would result in an increase of $51.96 premium per month. See estimate attached as Exhibit "0". Petitioners hope to have available at the hearing a quote for the car the minor Plaintiff wishes to purchase. 22. Petitioners Percy Arnold and Mary Fornwalt would also request the Court to consider allowing $1,200 of the money to be used to permit the minor Plaintiff to participate on a class trip to Disney World in Florida on September 19, 1994. The cost of the trip is $900.00 and $300.00 is requested for additional expenses. 23. Petitioners Percy Arnold and Mary Fornwalt would be unable to pay for the class trip but believe it would be a good use 5 of the settlement proceeds and represents a unique one-time opportunity for the minor Plaintiff. 24. Minor Plaintiff Tina Arnold would also like the remaining money to be placed in an interest-bearing, tax-free trust over which she would have no direct control until after she turns age 18, so it will not be considered to be income, a resource or an asset of her family which also would directly affect their right to receive public housing assistance, food stamps, and Social Security benefits. 25. Petitioners Percy Arnold and Mary Fornwalt maintain that by permitting them to place money in a tax-free restricted trust would permit the monies which were received from the personal injury settlement to be used to the minor Plaintiff's advantage, rather than resulting in a disqualification from Public Assistance benefits, which would result in no net gain to the minor Plaintiff. 26. In order to maximize the benefit to the minor Plaintiff Tina Arnold, Petitioners would request the Court to approve a monthly withdrawal for the trust in the amount of $300.00 to be used by the minor Plaintiff for the purchase of clothing and other personal care items. Petitioners maintain that the monthly withdrawal would not affect the minor Plaintiff's right to benefits and would be a good use of the settlement proceeds. 6 WHEREFORE, Petitioners request your Honorable Court to grant the Supplemental Petition for Approval of Minor Plaintiff's Compromised Settlement and Distribution of Proceeds, and payment of the money due to the minor Plaintiff Tina Arnold is hereby directed to be made as follows: (1) (2) paid for the purchase of a car; $300.00 to be paid to the minor Plaintiff on a monthly basis until she turns age 18 (eighteen) to purchase insurance, clothing, and other necessaries; and (3) The remainder totaling to be deposited in a minor's trust account established with the restriction that no withdrawals can be made until after the minor Plaintiff Tina Arnold turns age 18, except as authorized by the Court. ANGINO & ROVNER, P.C. a~. I. D. No. 36513 4503 North Front street Harrisburg, PA 17110-1799 (717) 238-6791 Counsel for Plaintiffs Dated: IN RE: TINA ARNOLD, A Minor, By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA AMICABLE ACTION v. . . NO. . . TIMOTHY LEE PIERCE, Defendant PETITION FOR APPROVAL OF MINOR PLAINTIFF'S COMPROMISED SETTLEMENT AND DISTRIBUTION OP PROCEEDS The Petition of Tina Arnold, a Minor, by Percy Arnold and Mary Fornwalt, her parents and natural guardians, respectfully represents: 1. Tina Arnold, the minor Plaintiff, is the daughter of Percy Arnold and Mary Fornwalt, Petitioners herein. Tina Arnold is 15 years old, having been born on June 16, 1978. 2. On October 25, 1993 at 4:48 p.m., Tina Arnold sustained injuries, including a laceration, with resulting scarring, above her right eye, as well as a contusion to her left ankle and lower leg as a result of being involved in an automobile accident. 3. At the time of the accident, Tina Arnold was a right front passenger in a 1994 Chevrolet Geo Metro driven by Timothy L. Pierce. 4. The pierce vehicle was traveling south on Magaro Road in East pennsboro Township, CUmberland County, Pennsylvania. 5. At that time and place, Defendant Timothy Pierce lost control of his vehicle, striking the guardrail along the edge of .__...__........_-_.--":-.-~.--_._..... .~ -- ','.-- ._---;..~., - .- the southbound lane before crossing the highway and striking a parked vehicle, resulting in the injuries to the minor Plaintiff Tina Arnold. A copy of the Police Accident Report is attached hereto as Exhibit "A". 6. As a result of the accident, a claim was brought against Defendant Timothy Pierce as a result of the injuries that minor Plaintiff Tina Arnold sustained. 7. At the time of the accident, Defendant Timothy Pierce was insured through Nationwide Insurance Company. 8. The minor Plaintiff Tina Arnold received treatment for the ankle injury by her family physician, Dr. H. Robert Gasull, Jr., at Perry Health Center, who had referred her for physical therapy at Polyclinic Medical Center. 9. The minor Plaintiff Tina Arnold received physical therapy from December 14, 1993 through January 26, 1994, when she was released from treatment. A copy of the Physical Therapy Discharge summary is attached hereto as Exhibit "B". 10. The minor Plaintiff Tina Arnold's scarring of her right eyebrow has been evaluated by Dr. John P. stratis, M.D., a plastic surgeon who anticipates performing surgery on Tina's eyebrow closer to the one-year anniversary of the accident. 11. Dr. stratis anticipates that the scarring over the eyebrow will improve with the surgery, but believes that it will be to some extent permanent. A copy of Dr. stratis' January 7, 1994 -'" ,.~- -.-;--- ~~r-''''''.-~ .-.-.. . .. --"':...-:-- report is attached hereto as Exhibit "C". Photographs of the minor Plaintiff Tina Arnold's scarring as of April 18, 1994 are attached hereto as Exhibit "0". 12. Defendant Timothy Pierce, through his insurance company, has agreed, subject to the approval of your Honorable Court, to compromise the claim of minor Plaintiff Tina Arnold for the sum of $20,000.00. 13. :In view of the uncertainty of securing a verdict in excess of the amount of $20,000.00, your Petitioners believe that it is in the best interests of minor Plaintiff Tina Arnold that the proposed settlement be accepted and approved. 14. Should the Court deem it necessary to schedule a hearing to approve the settlement, and if a hearing is scheduled, minor Plaintiff Tina Arnold and Petitioners herein, parents of the minor Plaintiff, and Plaintiffs' counsel will be present at the hearing. 15. Your Petitioners have retained the law firm of Angino & Rovner, P.C. to prosecute this action and have entered into a contingency fee agreement with said attorneys, whereby said attorneys are to receive, for professional services, 25% of any amount recovered after filing suit. 16. Petitioners have agreed, subject to approval of your Honorable Court, to pay Angino & Rovner, P.C. the sum of $5,000.00 for legal fees. 17. Petitioners have agreed, subj Bet to approval of your Honorable court, to reimburse Angino & Rovner, P.C. the sum of $461. 65 for out-of-pocket expenses incurred in prosecuting this claim. 18. Petitioners have agreed, subject to the approval of your Honorable Court, to reimburse Angino & Rovner, P.C. the sum of $400.00 for out-of-pocket expenses, which represents an amount which has been compromised or reduced by Angino & Rovner, P.C. 19. The minor plaintiff Tina Arnold requests the Court to grant permission for her to purchase a computer from Radio Shack, located in the Summerdale Plaza in Enola, PA. The computer which the minor plaintiff Tina Arnold wishes to purchase is described on the proposal from the Summerdale Radio Shack store, attached hereto as Exhibit "E". The total purchase price of the computer is $2,068.01. The proposal is only valid for a period of fifteen (15) days from May 12, 1994, and a slightly increased price may apply. 20. The minor plaintiff Tina Arnold anticipates receiving her driver's license in the near future and has selected a car at Forbes Chevrolet in Camp Hill, PA, which she would like to purchase with part of the proceeds of the settlement. Petitioners have obtained a price on the 1990 Geo Prism of $7,300.00, a3 set forth on the receipt from Forbes Chevrolet attached hereto as Exhibit "F". 21. petitioners Percy Arnold and Mary Fornwalt believe that the purchases would be reasonable uses of the settlement proceeds and are agreeable to permitting the minor Plaintiff Tina Arnold to purchase the computer and car, if approved by the Court. 22. The minor Plaintiff Tina Arnold believes that the purchase of the computer, which would assist her in her academic efforts, and the purchase of the car, which she believes to be a reasonable use of the settlement proceeds, would be good purchases for which she seeks the Court's consent. 23. Petitioners Percy Arnold and Mary Fornwalt would also request permission from the Court to invest the remainder of the settlement proceeds, totaling $5,231.99, in an annuity which they would purchase in the name of minor Plaintiff Tina Arnold, rather than placing the money in a Federally insured, interest-bearing account in a local bank. 24. Petitioners believe that the return on the investment from the annuity would be greater than that which would be received from a normal savings account in a local bank, and the security of the annuity is reasonable, especially given the amount that would be invested. WHEREFORE, Petitioners request your Honorable Court to approve the minor's compromise settlement and authorize the payment of attorney's fees from the fund due the minor Plaintiff Tina Arnold; direct payment of $2,068.01 for the purchase of a computer from Radio Shack; direct payment of $7,300.00 for the purchase of a car from Forbes Chevrolet; and the remainder totaling $5,231.99 to be '--,..--.-.--... '. -.....-:. ...----~... 'f "-.. -.. ".....-~-_., -:---t.--..... -~ . ~~, ~ deposited in an annuity purchased by the Guardians with the restriction that the annuity be set up as a trust, and no withdrawals could be made from the annuity until after the minor Plaintiff Tina Arnold turns age 18, except as authorized by the Court. chael E. KosJ.k, :t. D. No. 36513 4503 North Front street Harrisburg, PA 17110-1799 (717) 238-6791 Counsel for Plaintiffs Dated: Ut1/qJ.j ~ . '1--' ~:( ); . "~'-:-:-'~" COMMONWEAL TH OF PENNSYL VAi'fJA..;d:..... ,. ~,j ;..f'?'( I I . POLICE ACCIDENT REPORT ( I. 1 I:. =1E?CRT,.\61.: Z 'ICt~ ;;lE?C;::::!iA8L:: ,- f:!I)~ IV ~:t.t 1/7, 1 (C I - I J6. 3"'i"r;.tE 36. LS.GALL Y , 'I 137 ;::l:EG 'l. 3. G l C:l _ ' r-- ,'-'". ='ARKEO? g c! ?tATE -." -C- 39 'A T1TLECR - -< 7 .) '"\5 ' .", 7""" .\ / CUT.OF.Si..\TE "IN "..I "':1""'",,". vc::::7' / C 'OOWNER v'vlau.~ t:- A.<.Io..~dt...i) <:rK. .. ~;O",.~~S ~ (:) 1,:\ ,.f'G..A K..C Pd., 42. CIOf. S.A.: c: , "It,) l.....;\.. ' .J, . l. t.O z-o..:..- !. ZIPeoce ~_..J '3. VE"R l <; "65 !" MAKE Fc.:tu 45. MOOEL . ,NO._ .,,,.. C.,"'" ., ^ _ ') 1'6. INS...... _ 300YiYPEl t..-"~..) ~,-..........~...._v'--J vGa'" NL.1 'JNKL '7 BOOV ~O \:VspeCIAL 0 49. VEHICLE Of Pc ......, I uSAGE I OWNERSHIP 50. INITIAL 'MPAC. ') ISllVEHiCLE I '52.11'RAVEL :I0lNT \ ~ j'-' ST~ruS j'-J" SPEED 53. vEHICLE ,~OR'VER I -, 'I~ORIVER fJr;..\Ole~r ! ::1I:~eSENCE C. ,; CONDITION S6. iJAIVER 137. STATE NUMBEil I 58. DAIVER .'lJAME 59. OR'VER 'OORESS 60. CITY. STATE: ! ':IPCOOE 61. SEX l,02.0ATEOF 31ATH 64. COMM. '/EH. 165. DRIVER 1 ci6. ORIVER va .'0 cuss I SS' 67. CARRIER C'::';~.r:::;-~~~r--. II . " .., .CO .c.":~~...~~nl 6a. CARRIER ,-' . 'I ' AOORESS I i 69. CITY. S.A ~ / 1 ~ ZIPcooe 70. usoor . i ICC . 72.lVEH ,~C)'RGO ::CNFIG. I _DOY T'VPE : n. QEl.;.:,5E Q.f.. "'lA, ,,'AT 75. .'.0 OF ~lHAz..H~OOU5 1 v W ~J U IjNK LJ JoXlES ! 'AA re~IAlS O 8 8::?~, Q rl1 . L . d~~~ J-'I I "-'-.....;v ~ 'f1 - \Q)~EFER TO O'JE~l,o\Y S~E:.i'S POLICE INFORMATION I' '''C:OENr " L I (\ '2 "UMBE" l v -. - -\ ~ : 2. "GE"C'( -:::. ," - ()_ '. '.<: :l.,,~ ~ , -. ,0 U", . .:: i N:'ME t:?\,:,)\"'..:...'-J~'""""-'''''<.c.; \\,.V. I '-II.-...\oL- ;3.S"':;0'" _ . 11\ U^ i4:ArRCL:2 I PRE",:Ncr I=.. ~O......, , ' n. . _CNE 15. iNVESTIGATOR,) _ . '.- 1 I L. ,<:5 3AOGE \. l,._e/l , K.~t',..".....'c:..'"'t"'"1........ \l"""\..."'-..J \,jUMBER Ui "'1. i!S. APP~OVEr-o Y 3ACCiE . 0 ,i. (1.. G 0 '-' _ tl NUMBER I b 0 I..j .7. '''',n1'lGA TlCN l 2 - q ,', '6. ARRIVAL I' .::: '1. t 1<5. , OAr: 0 - :;, -:> I "','E '"' o...J v V\ I ACCIDENT INFORMATION ,9. "CC:OENr ..,- ('. 1'0. OAY CF w~;(" d ! OA1'E \0 ~,-;:)- '"\, vV\ONu.i"t'l ,':'~~~~CF \ kJ'-t"il. ~-<.-; 1'2.~~~~;;s l\..uC ;'3.,CS:O 114..7t~E8 11S.~~~~;~P. .,0 'j~ 16. 010 'JErolClE. ~A__:. 70 BE REMCvE!J 17. "EHICL; OAt.1AGE '==CM ':"nE SC:::~jE' , ) " NONE UNIT' utUT 1 UNIT Z I I . LIGHT ' Z. ~ICOE?AiE v GJ N 0 V 0 "G:r i l . SEVE?E UNIT 2 13: i 2. I i 18. HAZARDOUS I .',1A TE~IAlS O r.:;r 119, ?ENNCOT v \I ~ 1 :)~CP:E;::;TY vO ~J j/ UNIT ~ 1 '36. LEGALL'! ., '" 37. ilEG. A' ) ,"1 _ ,..:;' I () , .~:"RKEO' r r: I ~LAiE K I",\..J 0 ; :9. :I" TITLE OR . " 'OU..OF.S.ATE'''N i~O' 11..oJ,::>'\ "';"'I~C I~O.OWNER - _;_ . 0 ' 1"- l L W\() I " t..... : \. .;.......'-.::. '.1.1. OWNER AOORESS ~ 1...\.,,1,'\.\2.,/\ 57", :'2. CITY s.ArE _ '\ I" -" J : ! ZIPCOCE \- NU L-h ,'-'l' \. ~ C <-;) : "3. VEAil \ r. r" I 144. MAKE/, 1.' - ,., '--I , "'\ '-t"\ ~ t..,..l::.\....."..-....U .....~-=- i '5. MOOEL. ,.N01' 1'::"'-.., ,I - -~U" ','d. INS_./' 0 - I SODY iVPE) \",J ,='-" "V" c- \ '" I v 1.kf 'j UNK U I")BOOV ,", ') :148.1SPECIAL 0 {49JVEHICLE i'- T'YPE U Co- 1\,;,Jo USAGE \'-..:.1 CWNE~SHIP ~'NITIAL :MPAC7 .., 151 \VEH'C~E 0 .152.1.ilAVEl I '::OINT \ c...1~ STATtJS I......... 5;:11==0 IreJ~~~~,~;11' i\bl~:~vE~;'CE i I :~g~~g~,o" , : ,d. ~~~~~R ,;J. 3 <g 7 0 &, / 157S.~ , I 58. DRIVER --- .-.-. i ~AME I \ IN '\0 ' v-..-f l \~.c ,\ '::.x.c...:.. : 59. DRIVER 3 I I i AOORESS \ ;-t u....V\.~t. S'7", '60. CITY. S.ATE -.,,' iA '("\ ! :IPCOOE e,,-, '-' '- ,-,. ! 61. SEX IY\ Id2. ~~'.e,. OF \ l - '3 - <c '! 104. COMM. -JEH.165. DRivER c:::::... 1 tS6. QRIVER : VI N ! CLASS 55- i 67. C;.RFHER ACCIDENT LOCATION :0. :OU:jf'( . Ll..:.d..t1.3 :2....~L?rt.--~~ 21. .'.'UNIClP~~ '" . _, , -- ~r1::>' , ,;)..}#J5~Ul~() I U), COOE '2.1 COOE '. I . tc:, PRINCIPAL ROADWA Y INFORMA TION M/\ ~.-\ /<.0 R.6 . ~)r(?: i ~IGHWA'f 0 INT:=F1SECTlNG ROAD: 22. MOUTE ~lO. eR 5T;::\E:7 '-lAME 23 SPE=~ 25 .!~.lIT i~lACCESS , CONTROL 26 ROUTE NO. OH STi=lEET NAME 27 SPEED 1.lMIT ~OfPE I HICHWA'f 29. ACCESS I -=O~ITRCL IF NOT A T INTERSECTION: Ci2SE.K.S~i)-::' 0fZ. E N 'l2. ~'S.ANCE 2// S ' : ~=10M SITE FT. i'l G ,'.'1 '.IEASUREO 0 =S1'IMA.EO 0' J4)CONSTMUC-:-ION ~TRAF~lC ~RINC:?Al INTEr;SEC7INC ~ ;ONE i u: I CONOROL ' 0 I I,~ OE'IICE L ~O. CA.OSS 57? == I OR SEOME~n .''''ARKER 31. JIAEC"iION ;:::!CM SITE N 33, JIS'i ANC2 ':/;..3 UNIT 1/ 2 i38. 'B~ I l:"" \ CO -- l. 1<:,) 2..::> 163. 'HONE -G/ 7. c:.- l.::l 6<.> 168. CARR'ER I .J..OORESS 169. Clrt'. SiATE I 1. ZIPCODE 170. uSDaT f .~veH ; CONFIG. I ;"5. ~jO. OF .lXl.ES .:..A-l.511l921 IPUC f I'CO. (73.ICARGO !"--3,OOY rvP'E ~HAZAROOUS I \tA reFIIAlS 174. aVWA I i63.P~_ /(,/i'/ IPUC of ! 74, GVWA I i1 .=lE~SE Q.E HAZ ~.l~ I .., L.: ,'j L.! UNK L CENTER FOA HIGHWAY S~FETY .... ..-,,"- I ~'\- ':;E:::~(:~,C:IIG ~-.'.;5 ~GE:.C:( E.;--:, I 1........;.~.....J .-~~-=...:..' .-1~.\.I") 1..1. \,Ai...' (.\.: 7']. ...1E'OIC~L F~C:LlrY l~ulv "") r--\ ~ \,. (' t-Tc~:..J ~ -;-;; 1.- I""":"J':>i.:C, li'H.';;IJ:::"l i ~:' ACCiOENT OA TE: '10'"1 - ~~.J U,) -~:::.-q I 0_, .- ll. ,'-" , I .,z...;c..",1) Ie 'I .:L ~#'" H L -- J to( L M :'3' ! -5! 21 A I 0 I I dO,IPECFl..:: ".FOh':':1ArlON :'-i 3 C 0 E ;: a I I i I iI'"12.41 i 2.! cl L ! 2! I:: i \513 i 2. i 01 ! I I I I I I I I I I I I I ~JAMe I~." " 0;<..'-,... IC,,- 7/.1..','-\ IVI. .\CO~E~S : ~_ r--i 1@ILLuMINAnoN ~ (glWEATHER ~ '@ROAO SURFACE m I 184. PENNSYL'/ANIA SCHOOL OIST;;ICi (IF APPLICABLE) I IS6. ClAGRAM 11.-',41)...:':; A,,'I:' l~tJt . '. i 65Gg~RIPn~~~ 'LtAGEO PROPE;;ry I ---, : ! - im(~,\:,E.L": \'-' \:.,. M....:c;\..J) ~. I ~'~,. :AO~Z; vLl.-'r'-,t.~ pd, I - L. "),, ~ I I 1;::,'-'(: ''t, i., ~1.()L.:. I [PHONE /. 32. l b9~ I ,d" d" . 187, ,"ARRA TI"E . iCENTlFY PREC:PITA TINQ EVE!'ns. CAUSATiON F.l.C7CRS. SE~UENces CF :"/ENTS. 'wITNESS SiA TSMENTS. "'NO PROVIDe ....OOITlONAL j DETAILS. LIKE INSU':fANce tNFO~MAnON AND LCCATION CF ToweD VEHICLES, IF i(NO\'YN I I . I . 1"\' I .../ I U~" I 1. 7":Z;"'\"'l..L-~_' so....!. ~ C ~ .Lt,,. ,~'Zl ,~. ctr c.....; U.vivviJW L': I -- . I . ..; t ~. , SP2."~ c. ~.",Yi""''''; +c ,\.:2.,' 01 :,.} 'Ii.... a.. 1u..~A.J, U;I..,,'I .:.- I~""" I .Si72..w:.1 -t1..o.J... c;'l.l.u;d. /(Co I c.'''; I. /'L !.vL-11 .)11)1.. "7" -f-{~L iL.d.,"';! I +t--<."j c...a;~:5l 'ti,i, Lul,-lf a,Jel ,-,,-,<..~f rJ -tt,f... c..c:<..jl' t uL of' Y1o...l A:..qd<../c~ Cl..II../ct "l.,;-,,' -tiz.LJ d.2..I./i,-CN'~j u.."~,~~ Ltlv,'. r ,;; /...I.H..S /tb.~ ;:; , t.1.L/:/j fi.k.1.J Co/. ld U,v:"1'.::2 U/!{..) pc.."Ji.l. \. aul ~"tI..~. \ \.."1..1- /Ii. s....vi..,E.I.I'l.O -to ~~,..ss ...r s.~~11 ,c.o...v CLC.ecSS -t'L~l.- l!p",.) 1',1/' +20",-;"'" 0 f lz. ,1..'/ . /3o..cx' O-Ivd 10:''1'" Ct7Ni"'A1l et...ve;i .5/"7J"c.I{ , -- ." '<./l/I I ,'">- Co. I INSURANCE ICOMPANY L.L <.: .-=- -I- /" INFORMATION ....J. "'. \.::i I I U~IT IPO,~CYp ,4- Lo:5$L'1 ~~COlC J..!c.c~1t.~GA-.<c Ad, Z,ud.4. H. -i3'"!.~ 1~9'7 -5 .3~RE1J ..:9-':> ~-;- WI.l.GLlifys,J<.t,e.f p~r-e q S 7<1 190. SEC':10N NUMBERS {ONLY IF CHARGEOl TC ,\Ire 68. WITNESSES UNIT' DC 01 UNIT Z ~PROIlABl.E I use UNIT 1 I AA45 (1/921 ~TYPE I reST I e;~eSUt..iS I ' NO TEST I ~~~CBABLE ! = REFUSE L--! use O.__J'o;=; UNK I UNIT ~ : ,~IT'I'pe I ,"ST 19J.jRESU<.TS ., NO reST I "-' -- 9-4 INveSTlG.\nON ! 'J 0 ~eFUSE I COMPLETE,? 0.__ 100 UNK YES I~ NO i- CENTER FOR H'GHWAY SAFETY" 0883268 ,:tAGE. -=-- CLINICAL SERVICES DIVISION PHYSICAL THERAPY DEPARTMENT (717) 782-2344 FAX (717) 782-4200 . ~~,. 2001 NCrTh rhlta Srteer Harnscurg. Pennsvlvan,a 17110 .,,'ecnone(717) 782.J141 TO: R..okrt 6051,(({, f.;f.D. FROM: Kef/V Rukl, f,r. DATE: I''J.!:;'~ /q"3 RE: "TiflC\ A'('(1()lt~ OX: (9 a,.1Lf..e Sf"cUn DISCRARG~::: _. ~ S~Y''') .-/' PATIENT STATUS: PI: hCLS a. -lie I 1CLt.r1. ~ sc(.1..C.tL~l..d V(~I Is '.5/nc.c..- Ju, inrhQ.J e,va.{{,.(f)):lrfrL, dn /;;;'/1'I/1~ Iftcdnut71 htw '/1cCud.ul 1(011I Cl/l.UI .5fr.ti1~f'NIII~1j t.,.(t.:~ (0", 'Hv. ([) ~f.t-. I A~ profril./JL a-wJ. i CL -1-0 'ftlL (j;; ()...~Ltu . To daJ< I (6) {)..rI,,th.... MflA4 n iW i fl C/I...t..C{,U.rJ... I (t) (;UCfU_ts!-r.ln3ih ht0 i 11 CkeClA~.d ) 0lfC"c{Q7..cdc.C7'7 is dltnl/lt'dr:t:L cuttL jtJ.../...1- j'lClS /f"/l.py(P("u/. ,of, '-ft.yul..s 'fa fl''J1..{'iA.i.//-k t,iJ;'fh ~cuc~ tueljht /xtr..r;/1.j ~l 1ft,:,; (b: bt-d- i5 ai;i..t. fv corr.t..c.-I- 'Htw c..0t'1'h (]..{..u:S, RECOMMENDATIONS: c.evd t. T o.s 0. br/'ve. .' k€Jllf. Jt.t/-J- ~ T T~PIS~'S SIGNATURE ~"13 II I . --.. ~_.. .-.. .. . CLINICAL SERVICES DIVISION PHYSICAL THE?~PY DEPART~ENT (717) 782-2344 F.llJC# 782-4200 . ~Iinic ~'CAL CaNT1lR" '::01 I'ICrT:-'l Trmc Sfr03er -c:rIS:::l.:fG. :l'l?rH"iS',jI'lC:"I'":: . ~! ~: ..~'eC:"'c~e' ..... "~:..;...:.; January 26, 1994 H. Robert Gasull, Jr., M.D. Perry Health Center ?O. Box 913 Loysville, ?A 17047 RE: Tina .~rnold SS#: 172-60-2363 Diagnosis: Severe sprain left ankle; status post MVA 10/25/93. DISCHARGE SUMMARY: Following the Initial Evaluation on December 14, 1993, t~is patient '"as scheduled for Outpatient Physical Therapy Services three times per week. The patient attended 16 out of 20 scheduled treatment sessions. The treatment program has consisted of modalities as needed to decrease inflammation including cold packs and electrical muscle stimulation. The oatient has also received therapeutic exercises to improve the strength, range of motion, and proprioception of the left lower extremity. The patient has participated in a home exercise program. Subjectively the patient repor':s that the left ankle "really hurts" when she is running. Observation of the patient during running, jumping, and advanced gait activities indicates that the patient does not demonstrate an antalgic gait and does not demonstrate any observable signs of pain or discomfort. PROBLEM AREAS NOTED ON INITIAL EVALUATION: 1. Subjective complaints of pain and giving out with walking. 2. !~peired gait pettern including decreased toe off and decreased heel strike. 3. Increased girth of 1.1 em. on the right for the figure eight method. 4. Decreased active range of motion for the left ankle. 5. Decreased strength of the left ankle. 6. Positive tibia/fibula compression test on the left. PROGRESS TOWARD SHORT TERM GOALS: Goal Achieved - (A) progress Made - (P) No Change - (N) 1. (A) - Decrease subjective complaints of pain with activity to less than 6/10. DISCHARGE SUMMARY TINA ARNOLD ?AGE 2 ~ 2 . ( .:\.) _ Increase left ankle strength as indicated by an increase of 1/3 manual muscle test grade. The patient'S left ankle strength is within nor.nal limits for all motions. _ Improve left ankle proprioception. The patient is able to maintain single leg stance for 60 seconds. Enable the oatient to oer::or.n an indeoendent home exercise program. The patient has been given a written home exercise progrum which she is able to perform independently, however her compliance is questionable. 3 . 4. (A) (A) PROGRESS TOWARD LONG TEm~ GOALS: Goal Achieved - (A) ?rogress Made - (P) No Change - (N) 1. (A) - Maximize the patient'S function for activities of daily living. 2. (P) - Return to school including physical education class oain-free and without restrictions. This oatient has demonstrated the ability to perfor.n various advanced gait activities and running activities without difficulty. It is my recommendation that this patient is able to participate in physical' education class as tolerated. 3. (A) - Independence with a home exercise program. The patient has a written copy of the exercise program however compliance is questionable. COMMENTS: Although this patient reports subjective complaints of pain with activities, she does noe demonstrate any observable signs of oain or discomfort. The oatient has demonserated the abilitv to O.er~o~- adva"~C~ ~D;t ac-'.v'-;ce 'n~lua';n~ 'a-e~Dl ehu~~les c~oss .. - _.04 ___~ ':r-_. __ _'-___ - .-- - -: --... -1;;;,- - "'-- ,.... overs, jumping, and running. . The patient is able to . tolerate =unning on a t=ea~~ill a~ 4.0 mph tor five mi~utes. PLAN: This patient has been discharged from Out?atient ?hysical Therapy Services. If you have any further questions or recommendations regarding this patient please feel free to contact me at the above number. Again, thank you ::or this referral. Sincerely, .~\. '",,~-l.."_""'" il;liIo'L Michelle Mikanewicz, P.T./A.T.C. I1M/cal AESTHETIC AND RECONSTRUCTIVE SURGERY OF CENTRAL PENNSYLVANIA, P.C. 816 Belvedere Street Carlisle. Pennsylvania 17013 717'249.0100 WILLIAM P. GRAHAM. III. M.D, JOHN P. STRATIS. M.D. January 7, 1994 Michael Kosik Angina & Rovner, P.C. 4503 N. Front St. Harrisburg, Pa. 17110 RE: Tina Arnold Dear Mr. Kosik: This letter is in followup to my evaluacion of Tina Arnold and your request for information regarding the patient. Please excuse the delay in sending my report. Apparently your first letter did not make it to the patients chart when I initially saw her. This patient is a 15 year old white female who was involved in a motor vehicle accident in October of 1993. She came in on December 29, 1993 for consultation regarding the scar of her right forehead. Apparently she was seen in the Emergency Room at Holy Spirit Hospital where her laceration of the right forehead was repaired. Apparently there has not been a history of infection or hematoma during the healing process. The patient and her parents felt that the scar was quite visible and there was eyebrow asymmetry present. On examining the patient, she has a 3 cm. scar extending from the mid forehead on the right side in curvilinear fashion through the eyebrow area itself. The' scar is quite evident currently. because of the redness in ic. It is approximately 2 mm. in width. At the junction or the scar of the eyebrow the patient has loss of eyebrow hair. I do not believe that there is an actual mismatch in the edges of the injury at the area of the eyebrow. I believe that the apparent mismatch is actually secondary to the location or the scar in the eyebrow and the lack of eyebrow hair in that area. I have advised continued observation of this scar, use of cocoa butter and protection from sunlight using sun block. I have asked the patient to return to see me in three months and would not proceed with scar revision ac this point in time. I have seen the patient only this one time. She made indeed require additional treatment in the future, either with scar revision or dermabrasion or boch. The surgical cost of this future treatment would be approximately $2,000.00 with reasonable degree or medical ~ I'C' II Tina Arnold ,January 7, 1994 Page 2 certainty I feel that the patients current injury and the treatment I am providing are directly related to her automobile accident. If you have any additional questions, please feel free to contact me. Sincerely, ~/Ilstwt- ~n P. stratis, M.D. JPS/klp Enclosure ...- ~;";:~-.~~-~'~.~._..~. . - ..0.. '--;'.".,.-~r-_, "J"":'. ~.. . .- - r.J:....:~.,.....,. _.W ~ ~.....~ :. ~ ("f". / ' . ~. ~ ' , , '. ~ ~ c!jJ4L~t 'V II ':. :'::ADiO SHAC:~ .)1-2(;53 ENOLH-SUtl!j'llE~C~L~ su~t:"1E;:.D:~LS 'i-'LA lA 4'+5 II ::NiJL:~ RD E:NGL~~ PA 170::; (i17) 7J1-.~7:~ :=aF~l~;AL T ~ MARV 104 1..J~,(i.:E A\IE. ::NOi..:='. ~:~ 1 71)2~ Stc~k :.!o. Des::ri~ticn aty. PriC!! A::lCl:r.~ ------------------------------------------------------------------------------------- 26(1-0288 :::60-::881) 261)-.)134 ::60-0349 26(1-(1431 6'PC9L 25PIN-!BM D~IP21)3 ?~:!NiE;:, 1M 9.5Xll ::'0:1 60W EASIC SPIKE 6 aUi 10-3.5" HD DISKS 1 11.99 1 1',9.99 1 11.99 ! 1... ..9 I 13.99 14'~9. f)l) 1 t399.00 1 -Q -:1'2 ,... , I 399.99 1 199.00 SUBTOTAL TAX TOTAL 11.99 199.99 11.99 14.99 13.99 4499. (It) SYSiEM 25(l-164! 25t)- \ ()Q6 250-4091 ;ANDY M~PC MOD ::1) NPC SPEAKERiP~!P VGM390 0.39 SVGA 36 ~10NTfi CONPUTER CAF.RY !N T::P FOR 250-1641 TANDY MMPC "00 2(1 199.00 1950.95 11;.06 21)68.01 ISSUe: DATE: 05/12/94 THIS PROPOSAL IS VALID FOR: 15 DAYS MONTHLY RSVP PAYMENT 63.00 THIS MONTHLY PAYMENT AMOUNT MAY VARY DEPENDING ON YOUR ACCOUNT BALANCe:. . ~ lIE II Page 1 or : -( ]'916 AU"",SD _11111..,.,,, ~OT~~ L(lUL =M'U'UU"O' . \ I..\: ~Wu"'....... .'w, o ('J~I.~ EV\()let... ) "'''\ ....fa "'"' P\V.<L. \70Z~ stAft INY. . CHEVROLET. INC. 3400 Hartzdale Drive at Capital City M.111 Drlve CAMP HILL. PA 17011 . HoUS co. Phone: (717) 761-0600 .IS. ""0..1 IUS. ""ON( SAl.ESM."N"'i N.AME: O~ l PLEASE ENTER MY ORDER FOR: MODa O!f\l. BODY I I 1\ SERIES -n ~~ TYPE ~ TO BE DELIVERED ON OR ABOUT CASH DELIVERED PRICE OF UNIT 19 OOTHER DEU~~"iE \Qc\'O MAKE ~~~'k ~9ss:~ SER\',(rS KSY-"L\- L:C \ 44 '1 \ 2- G)Lu s 1 stilte tt'lat odometer mileage on the VEHICLE ON ORDER de.' cribed abovc is 3'1 , ct:;O at time u( tfilnsre' feh.clc lit. (ollowin9 Slal."i'".nr, 11 appllcobl.J 01 Curther 'late that the actual mileage di(fers (rom the odOnlel reading (or reno"s other than odometer calibr:uion error ",od th the actual mileaKc is unknown. I lurther stale that this vehlele was not involved in nood w.ter~ ACCESSORIES s x ~IG.ATU"1l 0" ,.....s'c.o,. 101l"''-1l'' 0" "'U'.O"IIIlO .0:01l"" O.'1l Ftd.r.1 rwgul.lion$l?Qu,,. rh. odorrNr.r mil.~. co b. Jr.rtd uDon rr.ns of oWrNn/llp. An ;n*XUnre Jr.r.rrwnr may male. th. trlnrl.ror lI.of" I d.m~$ to ch. crlnrl.rH. pu(w.nt to SlKt;on 409t.J 01 ch. Mocor V,hl Informat;on .nd COJt Sa~lng$ Act of 1912. Pub".,; Law 92.513. . .':USED .vEHICLETRADE:IN:ANDI.OIr OTHER CRfDITS YR. LAST '~Al'r; l.400[~ IOCT "'.V.I.HO. CASH SALE PRICE OF DESCRIBED MOTOR VEHICLE I state that odometer mileage on the USED VEHICLE TR^OE- described above is at time or trans I.. len.ele ,11. lollowin9 $Iot.m.nt. il oppllca&I.J 01 Curther !tatc that the actual milc31c dirfcts Cram the odome readine for reasons other than odometer caHbrlltion error and t the .ctual mileacc is unknown. I further atate Ib.t Ibia veblclc wa. Qot lnvolyec11n nood ",.t I X I I S1.....rt".1l 0" .U..C......Il" ""........1l:.0. 0'" T....OIl...' S bB \ b . R81 BALANCE OWED TO l ( rO. I ADDRESS "t'U~I' 2., USED TRADE-IN ALLOWANCE I BALANCE OWED ON TRADE-IN I. NET AllOWANCE ON USED TRADE-IN S DEPOSIT OR CREDIT BALANCE S DOWN.PAYMENrfcrrans;;io>l:8ft.CQI~I:. . . . ,- . REMARKS DA'Il: STATE AND LOCAL TAXES S OOCUMEHTARY FEE LICEHSE, LICENSE TRANSFER. TITLE REG5TRA TIOH FEE 1, TOTAL PRICE OF UNIT 2, DOWN PAYMENT: S S consisting of S in cash and lor S net trade-in al- lowance on trade-in: see statement in right hand column lor details. 3. UNPAID CASH BALANCE DUE ON DELIVERY S 3{)D. Icol . . II II I (difference between Items 1 and 2) , Purchaser l!!I......s thet this Order includes .11 of the terms and conditions on both the fae and reverse sid. hereof. thet this Order cBncel and supers.oes any prior .......ment and 8S ot 11M dale h.reof compriseS the ~1.le and exclUSIVe slatement of the terms 0' the ogr.emer relaling 10 the subject matters covered hereby. and thai THIS ORDER SHALL Nor BECOME BINDING UNTIL ACCEPTED BY OEALER OR HI AUTHORIZED REPRESENTATIVE. Purchaser by his .,u.c:ution of thIS On1er con.ties he IS of m8lorlly 1lIQ11 and adtnowledge5 ttutt he has ",& its l1mM "nd conditions IInd has rwceived. rrue COPy of this Order. THE FACTORY WARRANTY CONSTITUTES Al.L OF THE WARRAHTI WITH RESPECT TO THE SALE OF THIS ITEW/1TE~S. THe ~ELLc.Q ftfl\fBY EXPRESSLY DISCLAIMS AL.L WARRAHTlES. EITHER EXPRESSt' 'MPLIEO IHCLUO'HC AHY IMPlIED URRAHTY OF "ERCHAHTAH'L1lY OR FITHE5S fOR A PARTICULAR PURPOSE. AHa THE SELL ..-..........,. ...to"'.... .."',. 4UTloln.,l.,u 4WV nTI,U:p p~D~nN Tn .~5UME FOR_IT ANY LIAeILlT"( .IH CC?HHEC::!IO"!.-.!~T.!f.. !.H_~_SALE OF T VERIFICATION We, PERCY ARNOLD and MARY FORNWALT, as parents and natural guardians of minor Plaintiff TINA ARNOLD, have read the foregoing PETITIOK FOR APPROVAL OP HINOR PLAINTIFF'S COMPROMISED SETTLEMENT AND DISTRIBUTIOH OP PROCEEDS and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of our knowledge, information and belief. We understand that this Verification is made subject to the penalties of 18 Pa. C.S. 54904, relating to unsworn falsification to authorities. ~1iV ~ /11~~~ MARY ALT '. DATED: ~/ /) / q It ( (.... l'tlhi l',j l,ji,;-rQY IN RE: TINA ARNOLD, A Minor, : By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA AMICABLE ACTION NO. C;l/ ..JG,3-3 &i,,J ~ v. : TIMOTHY LEE PIERCE, Defendant . . ORDER AND NOW, this /9 J:I,. day of -nl d ' 1994, upon consideration of the Petition for Approval of Minor Plaintiff's Compromised Settlement and Distribution of Proceeds, it is hereby ORDERED and DECREED that the Petition is granted and payment of the $20,000.00 due to the minor Plaintiff Tina Arnold is directed to be made as follows: (1) $5,400.00 paid to Angino & Rovner, P.C. for attorney's fees and expenses; (2) $2,068.01 for the Shack; ):\.t.\.\-(~. purchase of a computer from Radio r~ G.R.3.se __ of' a ~,. :rcm . F~ (4) ~ -$/.2,53/.'1'1 .;.....~ The remainder totaling $5,131.33 to be deposited 1ft aft 11- '1:~...' 1. __~ byo.-eftl5. SI1l!._ll uS with the restriction that t:l._ allll',ity se. _..L ~... all il "~II'e., ~.~.l. no withdrawals could be made f;rglll till __._H.... until after the minor plaintiff Tina Arnold turns age 18, except as authorized by the Court. BY THE COURT: TRUE CO?y FR:J~/\ ;:.ECQRD In Ttst:m';,., \'.h:r:of, I i1~r" tJ,tJ ~",t my hand and the seal of said Court at Cari:s:e. Pa. 45652/D.Jris ...I..q..~~.. day of ")):)'~"'L.. 19..9..~ .......,......~...Cl..,..:f'.,,(.~~.._ ~ Prothonotary (oS / ~;)"-' c.. ~ f-~ J. ,-..' .' . DLIBOII,O)I APPLICATION FOR INITIAL NON.COMMERCIAl lEARNER'S PERMIT/DRIVER'S LICENSE PR'NT ALL 'NFORMA T'ON IN FULL IN ULACK OR BLUE 'NK ORlVER S LICENSE 'IUI,lBERJI 0 NuueER rCJ JJRS,...U,ll ::n -, !- "l<G'" ...0"'" J(' '....( ~. '. LU! Q BROWN :J GREEN .:J HAZEL J..'fJ J I' ({ t.Y! COLOR (PIN'. eneer 011.': STMU'.I.:::::PUS /V'/ 1_1.,'/~ U"J':~.' 0285307 r e," ...JSLACK {'...f/r) t. " '.J DICHAOWA TIC --' ?~ ":' Enter Fee For Each Item Checked FEE : EXAM REPORT VISION SCREENING .I Check One 2000 VISIon or less In bener eye Wltt'l correctIon Report 01 Eye ExamInation al1acheo ".. Ouallllea YES .::l ::I ,. .-a ::l I COMPLETE ONL V WHEN NECESSARV I Uncorrectea Corrected 1201 RI9ht Eye 201 , 201 Lell Eye I 201 : 20'-- Bolh Eyes 20/ , R L Fields R L ::1 Must wear correctIve lenses ~ Othenestrlcuons._ ...........--.. ~ , VERIFICATION OF BIRTH DATE AND IDENTITY .f) SInh Cenlflcals ::l Olher TEMPORARY LEARNER'S PERMIT FOR 60 DAYS This is to certIfy that the above applicant has applied lor and passed me s'gns and knowledge examination lor a Pennsylvania Non-CommerCial Learner's PermIt. ::l Unable to determine vISion/medical qualifications - Temporary Learner's PermIt cannot be Issued. .::l Currently suspendedirevoked. Temporary Learner's Permit cannot be Issued. PHYSICAL DATE. Mentn i (,/'5 Do I ()'/ " " 7 Year /-'-'), .,.... ----/ , . ,~.._.. , X ((.... / A<...;..,._......-- (S'gnarvrr 0' EX'rrlll1efl ,;' e.am'lssue Dale Mon:n Daf fear F-/(,J rOLE No) E lam Cenler ,,'I.' ~'!./ ~ (id , , CARLISLE CHECK Applicable Ilema Below PERMIT(S) DESIRED / Cl CLASS A 55.00 Cl CLASS B 55.00 21 CLASS C 55.00 :.:J CLASS M $7.00 . LICENSE REQUIRED''':;';:'':' ':: ~ 4.Ycar PhOIO 522.00 -(0' .~ '''.' ..J 2-Year Pholo Age 65 & Over 512.00 ~ I .'..,. , TOTAL FEES ~ $ ;;7VL I Paid by: .J Check Money Order ALL QUESTIONS MUST BE ANSWERED .I Check Applicable Block . YES NO 1. Ha....e you e....er held or possessed a PA Driver's Licensel Learne~s PermIVPholo Idenl,hcalion Card? ........... 2. Is your 1'9h"O apply for a license or your privilege 10 operate a vehicle In this or any other slale currently suspe4ed or re....oked? . ... . ............ . If yes. Ive slale _ dale__________________. and re on . 3. Have Y1u been arresled or Clled on this slale or any other stale fOl any ....Iolatlon wnlch carnes a possible penally 01 suspension 01 your driver's hcense? ................................................ If yes, 9,ve slale____________ dale _____.___ ___, and reason '::I .-.{ ./ :J :1 / ...J 2( CERTIFICATION (Sign) X ':71. .t...... .'. ...,;/ _ . . II..,l., 1 (Appllea"f, S'gNh". In Imo I hereby ac~owtedge It'lIs day Ihal I have received notice 01 Ihe provisions 0' Secllon 3709 01 Ihe flehlCle Code (S8e bacJc for provIsIons). WAR,NINO: Misstatement ot lact IS a mlsde"1eanor 01 lhe ttmd degree ounlshable by a tine of up 10 52.500 and/or ,mCrlSonmen,1 uc 101 year (18 PA C S. Secllon 49041b)) . .... ,. . . '. _'... OJ'" THIS IS YOUR TEMPORARY NON.CpMMERCIAL LEARNER'S PERMIT THIS FORM IS NOT VALID F.OR TESTING PURPOSES 1\ ~. APPLICANT " . APPLICANT INFORMATION . ., . f I. This temporary learner's perm't ent,lIes lhe person to whom It was ,ssued to drive vehicles and comblnallons of vehicles 01 the class(es) speCified, but only wh,le the holder of tho perm't 's accompanied by and under the immediate s~pervlsion of e person who Is at least 18 years of age and who: '5 licensed in this Commonwealth to drive vehicles of the class then being driven by Ihe holder 01 the learner's permil; and is actually occupying a seat beside the holder of the learner's perm't unless Ihe vehicle Is a motorcycle. . Flnel approval 01 this application lor Pannsylvanla Non-Commercial Drlver'a Permllla aublectto'verlllcatlon 01 the applicant's past driver record hlatory. Should nrlflcatlon disclose outstanding violations In any State or Jurisdiction, the application will be denlad and alllssuod Ponnaylvanla Driver's Llconses/Permlls are sUbJoct to cancellation and recall. . Ills Unlawlullor any person: To exhibit, ceuse, or permit 10 be exhibited or have ,n possession any rocalled, cancelled, suspended, revoked, IIctitious or' fraudulenlly altered driver's IIcense/permll. To lend a driver's Iicense/permillo any other person or permit Ihe use lhereof by another. T~ exhibit or represent 8S one's own any driver's license/permit not Issued to lhe person. i To fail or refuse to surrender to the Department upon lawful demand a recalled, cancelled, su~pended, revoked, tiCtitiOU8. or.. ,.,. Iraudulenlly allered driver's IIcense/permlt. 1 I J Any persons v'olallng any of the above .s guilty 01 a summary olfense and shall. upon convicl,on, be sentenced to pay a fine 01 5100. The Department may cancel any driver's license upon determining that the licensee was not enlilled to the Issuance or that the person failed 10 give the reqUIred or correct information or committed Iraud in making the application or In oblalnlng the license or the fee has not been paId. . Any Pennsylvan'a driver who is conviCled of any 01 the above ollenses shall be essessed 3 points as 01 the date 01 violation. . A PERSON IS GUILTY OF A MISDEMEANOR OF THE FIRST DEGREE IF THE PERSON, WITH FRAUDULENT INTENT, HAS' POSSESSION OF, SELLS OR ATTEMPTS TO SELL, USES OR DISPLAYS A DRIVER'S LICENSE, KNOWING IT TO HAVE BEEN ALTERED, FORGEO OR COUNTERFEITED. Any person comm,ling Ihis olfense is, upon conviction, subject to imprisonment for a term of up to 5 years. The Deparlment shalt revoke the driver's'license privilege of any driver for one year upon rece,ving a certified' record of the dnve(s conviction 01 thiJl'offense. PENALTIES AND SANCTIONS [ ] SECTION 3709 OFTHE VEHICLE CODE . Section 3709 provides lor a line 01 up to $300 for dropping, Ihrowlng or deposiling, upon any highway, or upon any olher public or. prlvale property Without Ihe consent of the owner thereof or into or on Ihe waters of th.s Commonweatth, Irom a vehicle, any wasle paper, sweepings. ashes, household waste, glass, metal, refuse or rubbish or any dangerous or detrimental substance, or permitting eny of the preceding wilhout immeplately removing such items or caus,ng lhelr removal. For any vlolalion of Section 3709, I may be subjecl to a line of up 10 $300 upon conviction. including any violation resulting from the conduct of any other persons present w,thln any vehicle of whiCh I am the driver. ( '= J The Department IS required 10 obtain lhe Licensee's Social Security Number, no'ght and eye color under the provisions 01 Seclions 1510(a) and/or 1609(a)(4) of the Pennsylvania Vehicle Code. This Informal,on will be used as identifying Information In an attempt to minimize driver license fraud. Federal law permits the use 01 the Social Security Number by state licensing officials for purposes of ,dentlllcatlon. SOCIAL SECURITY NUMBER INFORMATION THIS TEMPORARY. DRIVER'S PERMIT ] 1-- . Is valid on the day I~sued. You must be 16 years of age or older to apply . Must be validated and signed by the Driver License Examiner . Must be signed by you . Is valid only when you are accompanied by and undvr the immediale supervision of a licensed driver who IS at' . leasl 18 years of age . Must be in your possession at all times while driving a motor vehicle 'Is valid only for the classes IIsled ..~ . Is valid fo, up to sixty (60) days lrom the date issued , . Is not transferable or renewable and becomes invalid iI altered or changed in any manner ~ . Is not valid If your driving privilege is currenlly suspended or. revoked . . Is not valid for taking your driving test (. . Will not be extended . Is void and must be destroyed upon your receipt of a Pennsylvania Learner's Permit ,~~ .State rarm ~ells Lite insurance. JULY 01, 19'/4 RATE qUOTE STO DISCOUNT .QUOTE t 1 1986 SUOARU "GL" 'hIRGIOI2 CL:I0 . BIrD 100/300/100 . FULL TORT .N ML:U HOOOOO h F 't.:~500 " Z $5000 h COMP FULL h COLL $500 OED . EIHl .. U h W . Y 'k Gl048,)(',CEUI( snl U1l3Cmnn ,'tHO qUOTE t 2 1986 SUHAhu "GL"IFRR:037 IRG:Ol~~ CL:4F. . 1'111 ii HII'll 100/300/100 $298. I'~ FUl.L TORT 'to 1. OOO()O 'I;;~::;()O 't-5000 \CIJI..L '1'50') OEU MEll F It> J. o <i- . .I.': ~l>2. ;')0 't. ;..!() . ..' '~ "' .. CUMP COLI.. r~rl!3 LJ W Y 't.41 , J'1 I~ 1 J. 7 . ~:~n 't.3,,"0' !t,10. I;,. '~36. I',' 't.:L. rU.1 't/J,10. en tt,iH). t'n ."54- - )'/ -= .,. ... 100/;~OO 1.00/300 '1;5000 NET PREM!U11 TOTAL P"EtUUM 100/300. 1.00/300 't-5000 I'IE r P"EtHUll TOTAl. f' rlErn UtI c... ilCltITIIL Y PREMIUM .1;.L06,".1 MOtlTIILY PREMIUM I FS-MOOIFY RATE QUOTE ?- ) - TERRI037 I' REM $140.32 $51.36 U.12 $9.76 $19.36 $55,20 .t.3,60 $10,50 $36.10 'H ,80 $:129.12 $~9,1.2 , - $54,85 ACCEPT TO CONTINUE . .. . .... VERIFICATION We, PERCY ARNOLD and MARY FORNWALT, as parents and natural guardians of minor plaintiff TINA ARNOLD, have read the foregoing SUPPLEMENTAL PETITION FOR APPROVAL OF MINOR PLAIHTIJ'I" S COMPROMISED SETTLEMENT AND DISTRIBUTION OF PROCEEDS and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of our knowledge, information and belief. We understand that this Verification is made subject to the penalties of 18 Pa. C.S. 54904, relating to unsworn falsification to authorities. ~h%/I DATED: < >, C - .c ...J z 0 VJ VJ< z <> s..'Oex: I..L.. UJ ...J oe:< ex:I..L..C e,) ...J >- e:<c 0-2: Ii; 0 Cl- VJ .~ >- v> LLt-<:Vl - "" Ev>u ..... .... 7- C a: w - ~ ... Z2 ::;: ....ex: ..... e: ~-t-W ri - o UJ ex: n:Je:UJ .~ <c O<X:ZUJ ;;; ::;:Cl- UJ Q) Cl- I- .... '0 --JWU III W ... .;, ::;: I- -s.. ...J e: e: 1-0.:::0 w Z Z Z ... 0 C<c -< .~ UJ Q) - UJ ex: u ~ 0 Z lD U >- ...J -J c.V)~ <c u ..... I-~-'a.. il: a: w cD I- - 0 e:Z ~ ex: Q) -01- ... ... 0.. M LLZZ> ZS-ltJO: Cl- UJ C UJ2:I-Lt.. 0 a: ci N O=:lO_ 0: OJ 'r- 0 - a..-UJO ~ all :I: ~ O-U <C.c"CLL. 0_ ::;: VJ Ii: a: :> - Ul- s.. ...J Z 0 0 m !:: u"" <..c:<c UJ <L.a..OO Z z III C<"" Z Ol::l, UJ .....CH.LJ_ Ci M a: Z "" -::> OJ ...J Z VJ I- 0 a: ct: UJN 1-0 >- UJ-1-::> Z III <( ...J...J I ....~ex: >- ~<~CO ct ... :I: ex: CO "" ....c: to <C :I: W>O_ UJ<Ol W+-Jt..:E > I- ...JOo:a::: rou ex: ::> 0 a.. 0: a.. t- ::- '0.... '0 :;: a..a..z=V') =>ZO Zc:rcc - :::>a..O_ Uct:Z -rcc:l't1 I- V)c:(Uo . . .. . .I I ~ ~ ..... i1~. .... .., 10.,. '0 'lI ". . '.. .11 ';',. '0 ()t" "..". . "'.., ~ '." l' I, '.'. "0 . '. JOL 08 19S1t I . \' ;';1L/ . .r~ . IN RE: TINA ARNOLD, A Minor, By and Through Her Parents and Natural Guardians, PERCY ARNOLD, and MARY M. FORNWALT, plaintiffs IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA v. AMICABLE ACTION NO. <il./ - dto3-3 ~~ TIMOTHY LEE PIERCE, Defendant ~ AND NOW, this J q upon consideration of the : : ORDER ~~ day of ~ petiti~n for Approval , 1994, of Minor plaintiff's Compromised Settlement and Distribution of Proceeds, it is hereby ORDERED and DECREED that the Petition is granted and payment of the $20,000.00 due to the minor Plaintiff Tina Arnold is directed to be made as follows: (1) $5,400.00 paid to Angino , Rovner, P.C. for attorney's fees and expenses; (2) for the purchase of a computer from Radio ~ h pur h 0 sa-- '~IS"'" ,'t (4) The remainder totaling $i.iill1 gg to be deposited .... _I. ...---'~" I ___a 1>.1 ~I.a _l",~dlc!l.._ with the restriction that -V- -Rnllity- 1I L ..., IIiI .. tlI . J .ld no withdrawals could be made ,_ ..1.... IluF'tt.. until after the minor Plaintiff Tina Arnold turns age 18, except as authorized by the Court. I. 1":," I J. ~bl \!" \.-;: q t~11 ~\ "'\\ 4S6S2/DMR IN RE: TINA ARNOLD, A Minor, : By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : plaintiffs : IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA AMICABLE ACTION . . v. : NO. . . TIMOTHY LEE PIERCE, Defendant . . IIB'rITIOII I'OR apPRoVMr 01' MINOR PLaIN'l'II'I"S eoKPROMISED SETTLEMENT AND DISTRIBUTION 01' PROCEEDS The Petition of Tina Arnold, a Minor, by Percy Arnold and Mary Fornwalt, her parents and natural guardians, respectfully represents: 1. Tina Arnold, the minor Plaintiff, is the daughter of Percy Arnold and Mary Fornwalt, Petitioners herein. Tina Arnold is 15 years old, having been born on June 16, 1978. 2. On October 25, 1993 at 4:48 p.m., Tina Arnold sustained injuries, including a laceration, with resulting scarring, above her right eye, as well as a contusion to her left ankle and lower leg as a result of being involved in an automobile accident. 3. At the time of the accident, Tina Arnold was a right front passenger in a 1994 Chevrolet Geo Metro driven by Timothy L. pierce. 4. The Pierce vehicle was traveling south on Magaro Road in East Pennsboro Township, cumberland County, Pennsylvania. 5. At that time and place, Defendant Timothy pierce lost control of his vehicle, striking the guardrail along the edge of the southbound lane before crossing the highway and striking a parked vehicle, resulting in the injuries to the minor Plaintiff Tina Arnold. A copy of the police Accident Report is attached hereto as Exhibit "A". 6. As a result of the accident, a claim was brought against Defendant Timothy Pierce as a result of the injuries that minor plaintiff Tina Arnold sustained. 7. At the time of the accident, Defendant Timothy Pierce was insured through Nationwide Insurance Company. 8. The minor Plaintiff Tina Arnold received treatment for the ankle injury by her family physician, Dr. H. Robert Gasull, Jr., at Perry Health Center, who had referred her for physical therapy at POlyclinic Medical Center. 9. The minor plaintiff Tina Arnold received physical therapy from December 14, 1993 through January 26, 1994, when she was released from treatment. A copy of the Physical Therapy Discharge summary is attached hereto as Exhibit "B". 10. The minor plaintiff Tina Arnold's scarring of her right eyebrow has been evaluated by Dr. John P. stratis, M.D., a plastic surgeon who anticipates performing surgery on Tina's eyebrow closer to the one-year anniversary of the accident. 11. Dr. stratis anticipates that the scarring over the eyebrow will improve with the surgery, but believes that it will be to some extent permanent. A copy of Dr. stratis' January 7, 1994 report i. attached hereto as Exhibit "C". Photoqraphs of the minor Plaintiff Tina Arnold's scarrinq as of April 18, 1994 are attached hereto a. Exhibit "D". 12. Defendant Timothy pierce, throuqh his insurance company, has aqreed, subject to the approval of your Honorable Court, to compromise the claim of minor Plaintiff Tina Arnold for the sum of $20,000.00. 13. In view of the uncertainty of securinq a verdict in excess of the amount of $20,000.00, your Petitioners believe that it is in the best interests of minor Plaintiff Tina Arnold that the proposed settlement be accepted and approved. 14. Should the Court deem it necessary to schedule a hearinq to approve the settlement, and if a hearinq is scheduled, minor Plaintiff Tina Arnold and Petitioners herein, parents of the minor Plaintiff, and Plaintiffs' counsel will be present at the hearinq. 15. Your Petitioners have retained the law firm of Anqino , Rovner, P.C. to prosecute this action and have entered into a continqency fee aqreement with said attorneys, whereby said attorneys are to receive, for professional services, 25' of any amount recovered after filinq suit. 16. Petitioners have aqreed, subject to approval of your Honorable court, to pay Anqino , Rovner, P.C. the sum of $5,000.00 for leqal fees. 17. Petitioners have aqreed, subject to approval of your Honorable Court, to reimburse Anqino II Rovner, P.C. the SUID of $461.65 for out-of-pocket expenses incurred in prosecutinq this claim. 18. Petitioners have aqreed, subject to the approval of your Honorable court, to reimburse Anqino II Rovner, P.C. the SUID of $400.00 for out-of-pocket expenses, which represents an amount which has been compromised or reduced by Angino II Rovner, P.C. 19. The minor Plaintiff Tina Arnold requests the Court to grant peraission for her to purchase a computer from Radio Shack, located in the SUIIlIIlerdale Plaza in Enola, PA. The computer which the minor Plaintiff Tina Arnold wishes to purchase is described on the proposal from the Summerdale Radio Shack store, attached hereto as Exhibit "E". The total purchase price of the computer is $2,068.01. The proposal is only valid for a period of fifteen (15) days from May 12, 1994, and a slightly increased price may apply. 20. The minor Plaintiff Tina Arnold anticipates receivinq her driver's license in the near future and has selected a car at Forbes Chevrolet in Camp Hill, PA, which she would like to purchase with part of the proceeds of the settlement. Petitioners have obtained a price on the 1990 Geo Prism of $7,300.00, as set forth on the receipt from Forbes Chevrolet attached hereto as Exhibit "F". 21. Petitioners Percy Arnold and Mary Fornwalt believe that the purchases would be reasonable uses of the settlement proceeds and are agr.eabl. to permitting the minor Plaintiff Tina Arnold to purchas. the computer and car, if approved by the Court. 22. The minor Plaintiff Tina Arnold believes that the purchase of the computer, which would assist her in her academic efforts, and the purchase of the car, which she believes to be a reasonable use of the settlement proceeds, would be good purchases for which she seeks the Court's consent. 23. Petitioners Percy Arnold and Mary Fornwalt would also request permission from the Court to invest the remainder of the settlement proceeds, totaling $5,231.99, in an annuity which they would purchase in the name of minor Plaintiff Tina Arnold, rather than placing the money in a Federally insured, interest-bearing account in a local bank. 24. Petitioners believe that the return on the investment from the annuity would be greater than that which would be received from a normal savings account in a local bank, and the security of the annuity is reasonable, especially given the amount that would be invested. WHEREFORE, Petitioners request your Honorable Court to approve the minor'S compromise settlement and authorize the payment of attorney's fees from the fund due the minor Plaintiff Tina Arnold; direct payment of $2,068.01 for the purchase of a computer from Radio Shack; direct payment of $7,300.00 for the purchase of a car from Forbes Chevrolet; and the remainder totaling $5,231.99 to be deposited in an annuity purchased by the Guardians with the restriction that the annuity be set up as a trust, and no withdrawals could be made from the annuity until after the minor Plaintiff Tina Arnold turns aqe 18, except as authorized by the Court. chael E. Kos k, I. D. No. 36513 4503 North Front street Harriaburq, PA 17110-1799 (717) 238-6791 Counsel for Plaintiffs Dated: ~ft7Jq,-/ L ')/I/7-'} f1 J. '/ I ") v - - . . " :00' ........ - . COMMONWEALTH OF PENNSYLVA,,!J;g"i.~').'J;,J ;, n - (.;')REF~R TO OV'ERLAV SHEETS . I POLICE ACCIDENT REPORT ~y ).1 .ft: ,ill!;/..... :J.iJIC{t ~ ..' REPORT ABLE i:8:l '1011. REPORT ABLE D '..~.' POLICE INFORMATION ACCIDENT LOCATION !I I ,. INCIDENT 'C'-\-L\~ 20 COUNTV (\Av~t.3e.~I...A~'u CODE '2.1 NUMBER 2.AaENCV~A~~-- Q~..J5eoRc'..u9 t-6k.c.e. 21. MUN'CIP~ S i Pr:J..JIJ:;&/~.O MpCOOE to I NAME j \ 3. ST AnON! E ~o l..A Pr.>... .. ?A TAOt :2 PRINCIPAL ROADWA Y INFORMA TION PRECINCT ZONE 5.'NVEsnOATOR 1(,- O,_~ l,.\.u.SS BAOGE Il:,oq 22. ROUTE NO. OR M/\ g.A ,Q..o R.~o "'-I..J~~ NUMBER STREET NAME 8. APPROVE~V" BAOGE 23. SPEED 2S i~;VPE 0 I~~CCESS I o ,~ (L 7" Gov'_o NUMBER I b 0 '-I LIMIT HIGHWAY CONTROL 7~:[EsnGAT'ON IO-25-Q3 18. ARRIVAL 1<"5~ IARS INTERSECTING ROAD: TlME ACCIDENT INFORMATION 28. ROUTE NO. OR STREET NAME 9. ACCIDENT z.5 c;, ~ 10. ~<<~F 1~'\ y 27 SPEED i~~PE I~~ccess DATE \ Q - - y ON LIMIT I H,CHWAV CO~ITROL 11. nMC:OF 11oL-i"a "'R5 112. NUMBER I\..UC IF NOT A T INTERSECTION: DAY OF UN'TS 13. , Kc-sED 1'4. · INJURED 15. PRIV. PROP. vO N[);] 30. CROSS STREET OR C .e€. c K. S L'i).z. ~R, Tt..WG ACCIDENT SEOMENT MARKER 'B. 0'0 VEHICLE HAVE TO BE REMOVED ". VEH'CLE DAMAOE 31 OIRECTlON N(S)e w 132. DISTANCE FT. 2;; (; FROM THE SCENE' O-NONE UNIT t [ID FROM SITE FROM S'TE '" UNIT 1 UN'T 2 1. LIGHT 33. O'STANCE WAS 0 g 2. MODERATE ~ MEASUREO EST'MATED v0' NO vO NGa' 3. SEVERE UN'T2 ~;ONSTRUCTION @J I~TRAFFIC PRINCIPAL 'NTERSECTlNG ZONE CONTROL [Q] D lB. HAZARDOUS vO N0 19 PENNDOT vO NIZI DEV'CE MATERIALS PROPERTY UNIT # 1 UNIT # 2 38. LEOALL V V NIl 37. REO. A K I~ -5 ct I <z 138.~~ 36. LEGALLY v ~ 137. REG. '13'\lQ- C ~ 1J8'~q PARKED? 00 PLATE -. PARKED? :ill 0 PLATE 39. P4 TITLE OR I~OI A\J AI t...A1"1-:.L..:.. 39. PA TITLE OR _ "37;).d.,sL-d770 / OUT.OF.STATE V'N OUT.OF.STATE V'N 40. OWNER _ _\.... i,..., p. -~c.-=- 40, OWNER t.M lSl...u ~ IJ - A .<.~1d l...b .Jl< l l W\<.)' 'w ..~:... ~ l::- oll. OWNER l~ L-\. ~\.~\I\.I2.I1... $\. 41. OWNER '-\i::l J\I\ ..+G.A K.4.: Pd.. ADDRESS ADDRESS 42. CITY. STATE E NO L-/\ {J.; . ... 42. C'TY. STATE Euui...A. 1fI:'\ 0 t. "to 2...'5' & Z'PCODE \. /. (;) L:) & Z'PCODE 43. VEAR \ Q, ct/.{ 144. MAKE( L+E.\...l...~(j I...L";."" 43. YEAR I Q'if5 144 MAKE Fc.~u 45. MODEL' INOT 6E _ .vt..:::r.:t u 146 'NSIB""" UNKO 45. MODEL. 'NOT(;: z.s ~ ~ - .a!46.INSaa- 0 BODV TYPE} _0 v NO BODV TYPE) . '" - "''''=- Y N UNKC ~~ODY 02 eJ~PEC'AL 0 ~~EHICLE \ ~~ODV 50 I~SPECIAL C> '~~EHICLE I TYPE USA~E I OWNERSHIP TVPE USA~E OWNERSHIP ~~N'TIAL 'MPACT \ 2.. ~~EH'CLE 0 ~:RAVEL 30 ~~NlTIAL 'MPACT l ') ~~EHICLE I J 8':RAVEL CO POINT STATUS I SPEED POINT L.- I STATUS _. SPEED ~~EHICLE I ~~R'VER nI ~~RIVER \ ~~EH'CLE I ~DR'';ER r2I ~DRIVER - GRAD'ENT PRESENCE CONDITION GRADIENT PRESENCE COND'T'ON 58. DRIVER ,;2.33~70~1 157.ST~ . 50. DRIVER 157. STATE NUMBER NUMBER 58.DR'VER '\ '~'f \ -:: r- \-J\ ':.K.c. \C.. 58. DR'VER NAME \ iA-'\O I NAME 59. DR'VER \3 l4 ll..V\~'l S-;-. 59. DRIVER ADDRESS ADDRESS 60. CITY. STATE 6l\JoLA l-JA. t. 10 L'5" 60. CITY. STATE & ZIPCODE & ZIPCODE 61. SEXM 162. g~~ OF \l- '3 - <0 ~ 83 ~~~NE -~ G: 81. SEX 162. DATE OF 83.P~~. 1"'97 7,G.-J::J . BIRTH 64. COMM. VEH~165. DRIVER C. 16&. DRIVER 64. COMM. VEH. 165. DRIVER 166. DRIVER V CJ N 61. CLASS SS. va NO CLASS SS_ 67. CARRIER 6? CARR'ER lrlr,.r;C;;;~~E;Q J '..~ .r~~.~. S': n 68. CARRIER 68. CARR'ER 1f:I Ii h.-jt Oil 11 ADDRESS ADDRESS C;..... 89. C'TY. STATE 69. C'TY. STA I & Z'PCODE & ZIPCODE 70. USOOT . Ice. IPUC · 70. USOOT . IICC. jPuc. '~VEH. ~ CARGO 74. GVWR ~)~EH ~~AROO 74 GVWR CONF'O. ODV TYPE CONFIG. ODV TYPE 75. NO. OF I~ HAZARDOUS n RELtJSE OHAZ MAT 75. NO OF '~~AZARDOUS 177 RE'tj"SE 0 HAl MA T AXLES MATERIALS v N UNKO .\XLES I MATERIALS v N UNK C ,u-4S 11/921 :JA,GE I CENTER FOR H'GHWAV SAFETV 0883253 ~ ''/t'l 176 RESPO"OI~GEI~IS AGENCY E.1:) T '.;.0,<::)Q:)1::o . ,.\, (AI..'l.;: .r;;;ME'O;CAL FACILITY L~ol ') 1". ~ ,1" \:\-o~ l-'. I ,; L \~.~)PEOPL.'" li-lFOFf.'l1ATlON INCIDENT #: ACCIDENT DATE: - ADDRESS H , J K L M B C 0 E F G NAME I I \'1\ 2.~ ~ 2.1 d oll';:AToi,- ool- .- 1- 3 s. 2- A 0 1 U\\.J\ . I L Z 1= is 3 2- 0 7/1-1,4 ;11/. JI,Z'VU;,.(5 10,/ WA'f)J.:i A,,',~ I:=>> () t 3 2 2- .A 0 j , , ,~ I, I , ',' , , I :;z;r~ ~ I ..., /, ..... ! @ @WEATHER [Q] 68. DIAGRAM , "--. t €)ILLUM'NA TlON .. , ~ / , @ROAO SURFACE CO ,j/ ...r/~\' , 84. PENNSYLVAN'A SCHOOL O,sm,CT '-,: " " ~' , I~ . ~ ) (IF APPLICABLE) ."... ,.. ......-.. ~ ;' . . ,"7. . : 7~ /~. -. .........,.... 8S~~~RIPTI~~~ 'if AGED PROPERTY i ,i '\ ( ;' z.~,/ ~.' ~ I . ...... ..... .... ; i ~------. ...................,..,..,. ....... OW/Vli{'a ' N~()(......i:l .;it. \J~v ," . - , AO~~ vt.t,-\-'-.\.'to pd. K !2{...lCLJ\ , \-",:\ , 10 t.:;; I .. ... .. ...... . ' ...............,................ ....... PHONE 732. lb9"7 67, NARRAT'VE .'OENTlFY PREC'PITATlNG EVENTS. CAUSATION FACTORS. SEQUENCES OF EVENTS..wITNESS STATEMENTS. AND PROV'OE AOOITlONAL OETA'LS, LIKE INSURANCE 'NFORMATlON AND LOCATION OF TOWED VEH,CLES.,F KNOWN. " UioJ" 1. I, h"t-'i> 7";Z),.V~l-;_" q' .~O'-l. '"""- c:J . t t ,...c,,;.,a. ~ !<.d. aT C~ u..vK,vow lJ' SP2."-"i) t....J-t....; ~ -:\;.; -n. A..-'2.( ..... h Il..<..~ A), U ...... ;L ~"" u <I c:.."",? . ,.... 0, "",, L. Q Jl.l' , .'51l2. U Co I( -ttL2... y/.l.fl:J- I~'/ 0,-0 Iirt'L - '- 5' vi. o-t -fI.",-- IL_ t; I. ,vA y ':'v L..-S f a, vel '-li..[. IV f, "~"[6 +l"l... h.tjL~u.f.-l y o,t.!c . .... t.,.H -tt,f.. L~ i"' c-,u' '" ~6....'1 'i t uL of' '-11..;. ~I){<d L./ c" y Q#'v-;;t ,l:rt;" -tiLL d.2.. v.z..W"ly' uilJ<.. .z.~ , fbcKl'o , a,v: Ii .L fi.k ,'-' col/.d{d cv . ,-t, --;1.. u.lvi'1 ,;} '--uc<s Lt''''1 f . flr.q.J .. ON. CA.. v:-r' .:::2 L-v~ pl..'Jt'l~ f;io.J< ~L'/C"?.dS · v"-c A qCtS I' I ~ C/~I "/I d'l >V\(iQ,",,,, q, " 7 I -, sa.vU_ , , t o /iM (u .R. 1. JrA-7"i Q ';"/;._"l. {- /tJ L S ...v(j!.vI v -tv ,;Mt..sS A- 5.14,,;-11 r'/-Iu I ~ ~L,+ j. l,,/./t... c. t, ,eo-,v CLC.eOSs .HLl_ ,{d;;q, d , -1-20,,,,-( of h '~L'J , I'V 1ft ;.fIc..t N 5 ,,-v~(. (,. i ~ 8a..c;( o.",d I()Jr CClM,"7!(I! a..A./d S/-.8" c.lf - .;2. LL'v" 1 'NSURANCE COMPA,\" " .. . .. -r; '<j CO. 'NSURANCE COMPANY l).. 'S. F.+G. 'NFORMATlON f() A- I ~ C "-..:u.;. ,i),;.. -N. . INFORMATION UNIT PQUCY :-; ~ c.. - 7tcfc ~yq UNIT PO,l-i,CY PP.4 - Lo:5''t;'L'1 (.,"6CO~ 1 NO . . 2 88. NAME 77 JJ A I~ .<iVoJ... ~_ 4 cAoo,.1f.SJ,.GA-Ko ;I(d ,8ud.4, /-t. -i'Ift~ I ~ 97 WITNESSES NAME -;- el,.c,'s/vP!ti1? J{OA1'" s .1~REt; ...;r:;;, :)" uJ().eL"~vs,J""ef "'7P~r-EC;S7Y , 89. VIOLATIONS INDICATED go, SECTION NUMBERS (QNL Y IF CHARGElJI TC NTC UNIT I OD UNIT 2 OD '~P~OBABLE I~TYPE I~RESULTS 0 NO TEST ~~PROBABLE I~)TYPE I~RESUL TS 0 NO TEST USE TEST USE TeST 94. INVESTIGATION UNIT 1 o 0'00 REFUSE UNIT 2 o 0'00 REFUSE COMPLETE" '--' 0 UNK, i '--' 0 UNK YES rgr NO r "-'\-15 (1/921 ~ 0 .:::. CENTER FOR H'GHWAY SAFETY 08832b8 ,A.GE_ CLINICAL SERVICES DIVISION PHYSICAL THERAPY DEPARTMENT (717) 782,...2344 FAX (717) 782-4200 .. 2001 North Th"C Streer M.OICAL. C.NnIlll HCrtlsc\Jrg. PennSylvan,a 17110 '..'echOne (717) 7R~.J1J' TO: Kobut 6051/..(1, M.D. FROM: Kef/V reuld, f,T DATE: /9.!;J.~ /q 3 RE : Ii (let A- rtl "I t-L DX: (9 a.11:.f.t sr~ ___-..==_ DISCHARG~RESS S~Y"~ --"" PATIEN'1 STATUS: pt hu.s a. -{./e'1tU.tL ~ sdud..u...Ld VIS, Is '5IhC.,- lur inrhaJ e,va{t@.i?{;ft(.., dn /;;J./ly/q;, lftcd7'luni htto .ltcCud-al 1(0111 fJAA..d .sfr.tn~i1t1I/(~1.j t.(}.:~ lOt"' 'ltv.. <0 ~&.- J At:ml..f- '?J'Z1!,i1l1f.. lL~ld iCL 10 ~t1L (j; fMt.I:.U. To da.k I (j;) r;",...liL MiJM hew in UI...LCw.erJ..., (f.J C!-ic((...c_ts/-T.ln!jf/) ht0 ill c"u!aa.u< ) 4lfC(,~U7..CI..fz.c77 is dlfnll1tdr:d- cuu:L gad- j'lCiS' 1f-rt.pytJy.u,l. ff. '/iY!tl.s Yo ,z,x./"/,i...Wr t,1Ii'fh dt. C1..lc~ tueljht /xtr.r;,"1 ~L IftLL (;: bt..i.:f- i5 a.b4:. fc; Corr:t.c..f- 'HtuJ u;,y--t, (!.t..{.iS. RECOMMENDATIONS: C. e7tc..t f. T o. S 0. bdVC .' 14.€..elf. J.t..I..W- f T TuERAPIS~'S SIGNATURE \ I . ! ~/811 CLINICAL SERVICES DIVISION PHYSICAL THERAPY DEPARTMENT (717) 782-2344 FAX# 782-4200 ~. ~t01 Ncnh Thlfd StreeT ....cmscurq. ?ennSVIVOnIQ 1 ~ 1 '8 .''?'i!'C:'''GnA.' ~.'" "~2.~~.:~ January 26, 1994 H. Robert Gasull, Jr., M.D. Perry Health Center P.O. Box 913 Loysville, PA 17047 RE: Tina Arnold SS#: 172-60-2363 Diagnosis: Severe sprain left ankle; status post MVA 10/25/93. DISCHARGE SUMMARY: Following the Initial Evaluation on December 14, 1993, this patient was scheduled for Outpatient Physical Therapy Services three times per week. The patient attended 16 out of 20 scheduled treatment sessions. The treatment program has consisted of modalities as needed to decrease inflammation including cold packs and electrical muscle stimulation. The patient has also received therapeutic exercises to improve the strength, range of motion, and proprioception of the left lower extremity. The patient has participated in a home exercise program. Subjectively the patient reports that the left ankle "really hurts" when she is running. Observation of the patient during running, jumping, and advanced gait activities indicates that the patient does not demonstrate an antalgic gait and does not demonstrate any observable signs of pain or discomfort. PROBLEM AREAS NOTED ON INITIAL EVALUATION: 1. Subjective complaints of pain and giving out with walking. 2. Impaired gait pattern including decreased toe off and decreased heel strike. 3. Increased girth of 1.1 ern. on the right for the figure eight method. 4. Decreased active range of motion for the left ankle. 5. Decreased strength of the left ankle. 6. Positive tibia/fibula compression test on the left. PROGRESS TOWARD SHORT TERM GOALS: Goal Achieved - (A) Progress Made - (P) No Change - (N) 1. (A) - Decrease subjective complaints of pain with activity to less than 6/10. DISCHARGE SUMMARY TINA ARNOLD PAGE 2 ~ 2. (A) - Increase left ankle strength as indicated by an increase of 1/3 manual muscle test grade. The patient's left ankle strength is within normal limits for all motions. - Improve left ankle proprioception. The patient is able to maintain single leg stance for 60 seconds. - Enable the patient to perform an independent home exercise program. The patient has been given a written home exercise program which she is able to perform independently, however her compliance is questionable. 3. 4. (A) (A) PROGRESS TOWARD LONG TEro~ GOALS: Goal Achieved - (A) Progress Made - (P) No Change - (N) 1. (A) - Maximize the patient's function for activities of daily living. 2. (P) - Return to school including physical education class pain-free and without restrictions. This patient has demonstrated the ability to perform various advanced gait activities and running activities without difficulty. It is my recommendation that this patient is able to participate in physical' education class as tolerated. 3. (A) - Independence with a home exercise program. The patient has a written copy of the exercise program however compliance is questionable. COMMENTS: Although this patient reports subjective complaints of pain with activities, she does not demonstrate any observable signs of pain or discomfort. The patient has demonstrated the ability to perform advanced gait activities in~luding lateral shuffles, cross overs, jumping, and running. The patient is able to 'tolerate running on a treadmill at 4.0 mph for five minutes. PLAN: This patient has been discharged from Outpatient Physical Therapy Services. If you have any further questions or recommendations regarding this patient please feel free to contact me at the above number. Again, thank you for this referral. Sincerely, ..:,h A~-t.,'_r.,.: irltrr"L Michelle Mikan~wicz, P.T./A.T.C. MM/cal I ~ , . ~. ' , AESTHETIC AND RECONSTRUCTIVE SURGERY OF CENTRAL PENNSYLVANIA, P.C. 816 Belvedere Street Carlisle, Pennsylvania 17013 717. 249' 0100 WilLIAM P. GRAHAM, III, M.D. JOHN P. STRATIS, M.D. January 7, 1994 Michael Kosik Angina & Rovner, P.C. 4503 N. Front St. Harrisburg, Pa. 17110 RE: Tina Arnold Dear Mr. Kosik: This letter is in followup to my evaluation of Tina Arnold and your request for information regarding the patient. Please excuse the delay in sending my report. Apparently your first letter did not make it to the patients chart when I initially saw her. This patient is a 15 year old white female who was involved in a motor vehicle accident in October of 1993. She came in on December 29, 1993 for consultation regarding the scar of her right forehead. Apparently she was seen in the Emergency Room at Holy Spirit Hospital where her laceration of the right forehead was repaired. Apparently there has not been a history of infection or hematoma during the healing process. The patient and her parents felt that the scar was quite visible and there was eyebrow asymmetry present. On examining the patient, she has a 3 cm. scar extending from the mid forehead on the right side in curvilinear fashion through the eyebrow area itself. The scar is quite evident curre~tly because of the redness in it. It is approximately 2 rom. in width. At the junction of the scar of the eyebrow the patient has loss of eyebrow hair. I do not believe that there is an actual mismatch in the edges of the injury at the area of the eyebrow. I believe that the apparent mismatch is actually secondary to the location of the scar in the eyebrow and the lack of eyebrow hair in that area. I have advised continued observation of this scar, use of cocoa butter and protection from sunlight using sun block. I have asked the patient to return to see me in three months and would not proceed with scar revision at this point in time. I have seen the patient only this one time. She made indeed require additional treatment in the future, either with scar revision or dermabrasion or both. The surgical cost of this future treatment would be approximately $2,000.00 with reasonable degree of medical ~ lie II ,. .. =:AD 1 0 SHACK ,) 1-:2(;53 ENOLf.-SUl~~~IOF:OhLc SU~HEED;:;LE r'LHl.... 4~5 N E~.OL~~ RD ~i\:GLA. fA 17l)::'~ (7,7) /3:2--,7:2" ~'JF~:l.oj~L T! MARY t 04 ~JAYj.:E A....E. ~NG;..~. ;::~ t 7(12':: Sto=k ~!o. Descri::t iCrl Oty. Price ~bo~r.t ------------------------------------------------------------------------------------- 260-0288 -:'60--~83() 26(.-1) 134 :::60-()349 26('-(1431 6'PCBL 25PIN-!BM D~lP2('::! PO:! Ni'E~ 1M 9.5Xl1 ::'011 60W EASIC SPIKE 6 aUi' 1(1-3.5" HD O;:;I(S I 11. 99 I 1',9.99 1 11. 99 I 14.99 I 13.99 . 1499. ')0 1 131.?9.0(1 ! 7Q.99 1 399.99 1 199.00 SUBTOTAL TAX TOTAL 11.99 199.99 11.99 14.99 13.99 S'(SiEM ::5(1-1641 25,)-\.)Q.r, 25('-4091 ~ANDY M~oC MOD ::0 MPC SPEAKER/A~!P VGM390 (I. 39 SVGA 1499.(1) 36 MONTM COMPUTER CARRY .N TSP FOR 250-1641 TANDY MM;:C "01) 21) 199.00 1950.95 117. ('6 2068,,)1 .ISSUE DATE: 05/12/94 THIS PROPOSAL IS VALID FOR: 15 DAYS MONTHLY RSVP PAYMENT 63. :)0 THIS MONTHLY PAYMENT AMOUNT MAY VARY DEPENDING ON YOUR ACCOUNT BALANCE. >> ~ lIE II Oage I of : 31918 ADAms u . ""1.''''11 LEOAL F\\J.SL. \702!;; ""'1 ~~ .OCI CHEVROLET. INC. 30100 Ha,lzdalo Orivo 01 Capitol CitV Mall Drive CAMP HILL, PA 17011 . ULU co. Phone: (7171761-0600 SALESMAN'S NAME: OIM- PLEASE ENTER MY ORDER FOR. MODa olfil.. BODY SERIES 11 t~ TYPE IH'I. . \ 4 L "UItCH"SIIt', H"MI o A.J u . . ,--.JL. _EV\olo... ) ....., AOO'Pa. CUf ~ "II. f'HOHI IUS, "MOHI DOTHER DEt1~IB 11-." _ , MAKE 0' .>'-4-0' ~~~~ R-'1S~~ 19 .Ei~(rS KSY-G,L\- L:C \ 4-4 "1 \ 2- TO BE DELIVERED ON OR ABOUT CASH DELIVERED PRICE OF UNIT s 1 slate that odometer mile Ole on the VEUICLE. ON ORDER dc:'l~ cribed above is 3'7 . U)() al lime or Irnn!lrer. (eh.cJc ,h. lollowlng .,o'.';.n', "oppllcabl.} 01 rurther stale that the actual mile_Ie direcrs rrom the ooomct(" rcadinl Cor reasons olher than odometer calibration crror and thn the actual mileBRG is unknown. J further at ate that this vehicle 'Ill.. not involved In nood waters ACCESSORIES s x .1.~AfU"" or 'iIIA~.rl"O" 10CALI" Oil AU'MO'UJID AGUH' 0.'1. F<<1.r.1 twgvl.r/on, rwqu/tw the odoma,., mil.. to b. Itatftl upon trantf. 01 oWMnhlp. An ;n.xur." It.,.".,.nr may m... the tramf.for /1.,,'. (r damat/fl. to rh. rramf'rH. purlU.nt to ~tlon 409taJ of the Motor V.hiel InfofrNr/on .nd CO" Saving, Acr 0' 1972. Public L~ 92.513. . USED VEHICU:'TRAOE.-IN'ANDI.OR 0l1iER CRfDITS YA. MODU 100'( LAST PL"'[ ....V.I. NO. l..a'e ,ha, odomeler milea,e on ,he USED VEIllCLE TRADE-I' dcscribed above is al time oC transf~1 (Ch.ck ,h. followln9 .,a'.m.n', 11 oppllcabl.' or Curthcr state that the actual mileale dilCers from the odomc" readinl Cor rcasons other than odometer calibration crror and th the actual mileale is unknown. I further .tate th.t lbi. vehlel. wa. Dot lnvol.ed In flood ..ter X .I~MA'UIIC or ,.UIICMA.IIIl 1'''AN.rellO'' or '''Aoe-INI 0.'1 STATE AND LOCAL TAXES DOCUMENTARY FEE LICENSE, LICENSE TRANSFER. TITLE REGIlTRA TION FEE 1. TOTAL PRICE OF UNIT 2. DOWN PAYMENT: consisting of $ in cash andlOl' $ net trade-in al- lowance on trade-in: see statement in right hand column for details. 3. UNPAID CASH BALANCE DUE ON DELIVERY S (difference between Items 1 and 2) $bBlc. 4CA. BALANCE OWED TO ADDRESS USED TRADE-IN AllOWANCE BALANCE OWED ON TRADE-IN NET ALLOWANCE ON USED TRADE-IN DEPOSIT OR CRfDIT BALANCE DOWN PAYr.ENT':jTrana.to. Left Col.) REMARKS s CASH SALE PRICE OF DESCRIBED MOTOR VEHICLE s s 3DD.cx) " Purcha..r agre.. thait this Order include. all 0' the terms end condition. on both the 'ac and r.v..... side hereof. that this Ord.r cancels and super.ede. any prior agr..ment and a. 0' the de,e hereo' a>>mprises th. ~Ie'e and exclu.lv. .tatement 0' the 'erms of the sgreemenl rala,lng to tha aubjac. meUa.. co.arad hereby, and that THIS ORDER SHALL NOT BECOME BINDING UNTIL ACCEPTED BY DEALER OR HIS AUTHORIZED REPRESENTATIVE. Purcha..r by his execution of this Ordar cenUies he is of majority age and acknowledges that he has read It I tenn. "nd condlt'ana end hils ,.celved .. true copy of this Order. THE FACTORY WARRANTY CONSTITUTES ALL OF THE WARRANTI! WI1N RESPECT TO THE SALE OF TNISIHIl/ITEIlS. THE IElLF.R IIFHOY EXPRESSLY OISCLAIMS ALL WARRANTIES, EITHER EXPRESS 0 IMPLIED INCLUDING AHY IMPLIED WARRANTY OF MERCHANtAOILltY OR FITNE$S FOR A PARTICULAR PURPOSE, AND THE SELLE .......u"'" U"IU~.~ ~.,..,. ... "U"''\~I'n'~ &wv nTWI:'D PI:!nnN Tn ,UIUMe ItOR IT AMY LIABILITY IH CONNECTION WITH THE SALE OF THI ... VERIPICATION We, ,BaCY ARROLD an4 MARY .ORRWALT, a. parent. an4 natural quar4iana of ainor 'laintiff TIKi aaKOLD, have read the foreqoinq ,nITIO. .oa U'RovaL O. III.OR 'LAIftU.'8 COJI1IROHI8BD 8BT'l'LBJUDIT un DIITRIBU'fIO. O. IROCBBDI and do hereby swear or affirm that the facts set forth in the foreqoinq are true and correct to the best of our knowledqe, information and belief. We understand that this Verification is made subject to the penalties of 18 Pa. C.S. 54904, relatinq to unsworn falsification to authorities. z:uu ~ 'J/1a;i~~H-d~ MARY ALT DATED: -:r/ /) I q 4 ( 1- . IN RE: TINA ARNOLD, A Minor, : IN THE COURT OF COMMON PLEAS, By an~ ~hrough Her Parents and : CUMBERLAND COUNTY, PENNSYLVANIA Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs : AMICABLE ACTION TIMOTHY LEE PIERCE, Defendant . NO. . . . . . : 0 R D E R AND NOW, this day of July, 1994, upon consideration of the Supplemental Petition for Approval of Minor Plaintiff's compromised Settlement and Distribution of Proceeds, it is hereby ORDERED and DECREED that the Petition is granted and payment of the fund due to the minor Plaintiff Tina Arnold set forth in the Court's order of May 19, 1994 is hereby directed to be made as follows: (1) (2) paid for the purchase of a car; $300.00 to be paid to the minor Plaintiff on a. monthly basis until she turns age 18 (eighteen) to purchase insurance, clothing, and other necessaries; and (3) The remainder totaling to be deposited in a minor's trust account established with the restriction that no withdrawals can be made until after the minor Plaintiff Tina Arnold turns age 18, except as authorized by the Court. BY THE COURT: J. IN RE: TINA ARNOLD, A Minor, By and Through Her Parents and Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, Plaintiffs . . IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA . . AMICABLE ACTION . . v. NO. 94-2633 CIVIL TERM TIMOTHY LEE PIERCE, Defendant . . SUPPLEMENTAL PETITION FOR APPROVAL OF MINOR PLAINTIFF'S COMPROMISED SETTLEMENT AND DISTRIBUTION OF PROCEEDS The Supplemental Petition of Tina Arnold, a Minor, by Percy Arnold and Mary Fornwalt, her parents and natural guardians, respectfully represents: 1. The Petitioners had previously filed a Petition for Approval of the Minor's Compromised Settlement with this Court on May 18, 1994. Exhibit "A". A copy of the Petition is attached hereto as 2. The Court of Common Pleas of cumberland County, ~ursuant to an Order signed by the Honorable George E. Hoffer, dated May 19, 1994, approved the settlement, providing that: $5,400.00 be paid to Angino & Rovner, P.C. for fees and expenses; $2,068.01 be allocated for the purchase of a computer; and the remaining $12,531.99 be placed in an interest-bearing Federally insured account, pursuant to Pa. R.C.P. 2039. A copy of the Court's Order is attached hereto as Exhibit "B". 4BSB3/MLM 3. Plaintiffs have reached a settlement with Nationwide Insurance company on behalf of Timothy Lee Pierce with attorney's fees of $5,400.00 being paid to Angino & Rovner, P.C. and $2,068.01 being allocated for the purchase of a computer. 4. The remaining $12,531.99 check from Nationwide has not been deposited pending the Court's determination of whether any additional allocations can be made for the purchase of a car and further consideration of the type of account wherein the funds will be deposited. 5. Tina Arnold, the minor Plaintiff, is the daughter of Percy Arnold and Mary Fornwalt herein, Tina Arnold is now 16 years old with her date of birth on June 16, 1978. 6. Minor Plaintiff Tina Arnold has received her permit to obtain a Pennsylvania driver's license from the Commonwealth of Pennsylvania and plans to take the test for her license within one month, possibly before the hearing set for July 11, 1994. .See copy of the permit attached hereto as Exhibit "C". 7. The car currently owned by the minor Plaintiff's parents is a standard shift car which the minor Plaintiff is not capable of driving and she has been forced to borrow a relative's car to practice her driving. 2 8. Minor Plaintiff Tina Arnold wishes to purchase a car with an automatic transmission to use for driving herself to school and possible part-time employment. 9. Petitioners had previously requested permission from the Court to purchase an automobile which the minor Plaintiff selected from Forbes Chevrolet in Camp Hill. 10. Minor Plaintiff Tina Arnold would like to purchase with part of the proceeds of the settlement a 1990 Geo Prism which had been valued at $7,300.00, as set forth in the receipt from Forbes chevrolet, attached to the original Petition as Exhibit "F". 11. Petitioners Percy Arnold and Mary Fornwalt believe that the purchase of the automobile would be a reasonable use of the settlement proceeds and are agreeable to permitting the minor Plaintiff Tina Arnold to purchase the car if approved by the Court. 12. Minor Plaintiff Tina Arnold currently receives supplemental security income assistance benefits because of a learning disability, which benefits total $478.40 per month. 13. Petitioners Percy Arnold and Mary Fornwalt also receive public assistance and food stamps, as well as housing assistance credit from the Cumberland county Housing Authority. 14. Petitioners are concerned that the settlement proceeds even if placed in a restricted trust account will currently, as in 3 the future, adversely affect their right to continue receiving these public assistance benefits. 15. Petitioners are requesting the Court to tailor how the settlement proceeds are received and spent so as not to jeopardize the benefits which the minor Plaintiff and her family are currently receiving. 16. Minor Plaintiff Tina Arnold maintains that if the money is placed in trust until she turns age 18, the establishment of the trust could possiblY jeopardize current benefits and definitely would result in her and her family becoming ineligible for some assistance benefits when she turns 18. 17. Petitioners are concerned that the proceeds of the personal injury settlement would not ultimately benefit the minor Plaintiff and actually jeopardize her right to receive the benefits which the family is currently receiving. 18. Even if the settlement proceeds are placed in a restricted trust until the minor Plaintiff turns age eighteen, the restricted trust would be considered a "resource," and when she turns age 18 and receives the money, it will become income which in either case will result in the loss of benefits which the family receives. 19. Minor Plaintiff Tina Arnold maintains that with the Court's approval, expenditure of some of the funds within the 4 limits provided by the various Public Assistance agencies at the present time will not jeopardize her benefits and will result in a net benefits to the minor Plaintiff. 20. Minor plaintiff Tina Arnold believes the Court's approval of the purchase of a car would be a reasonable use for the settlement proceeds, which is permitted by law for someone receiving the public assistance benefits and food stamps outlined above. 21. Petitioners are obtaining a quote for insurance on the car which the minor Plaintiff wishes to purchase and have received an estimate for coverage similar to those which Petitioners currently have on their own vehicle. The estimate just to insure the minor Plaintiff on Petitioner's own car would result in an increase of $51.96 premium per month. See estimate attached as Exhibit "0". Petitioners hope to have available at the hearing a quote for the car the minor Plaintiff wishes to purchase. 22. Petitioners Percy Arnold and Mary Fornwalt would also request the Court to consider allowing $1,200 of the money to be used to permit the minor Plaintiff to participate on a class trip to Disney World in Florida on September 19, 1994. The cost of the trip is $900.00 and $300.00 is requested for additional expenses. 23. Petitioners Percy Arnold and Mary Fornwalt would be unable to pay for the class trip but believe it would be a good use 5 of the settlement proceeds and represents a unique one-time opportunity for the minor Plaintiff. 24. Minor Plaintiff Tina Arnold would also like the remaining money to be placed in an interest-bearing, tax-free trust over which she would have no direct control until after she turns age 18, so it will not be considered to be income, a resource or an asset of her family which also would directly affect their right to receive public housing assistance, food stamps, and Social Security benefits. 25. Petitioners Percy Arnold and Mary Fornwalt maintain that by permitting them to place money in a tax-free restricted trust would permit the monies which were received from the personal injury settlement to be used to the minor Plaintiff's advantage, rather than resulting in a disqualification from Public Assistance benefits, which would result in no net gain to the minor Plaintiff. 26. In order to maximize the benefit to the minor Plaintiff Tina Arnold, Petitioners would request the Court to approve a monthly withdrawal for the trust in the amount of $300.00 to be used by the minor Plaintiff for the purchase of clothing and other personal care items. Petitioners maintain that the monthly withdrawal would not affect the minor Plaintiff's right to benefits and would be a good use of the settlement proceeds. 6 WHEREFORE, Petitioners request your Honorable Court to grant the Supplemental Petition for Approval of Minor Plaintiff's compromised Settlement and Distribution of Proceeds, and payment of the money due to the minor Plaintiff Tina Arnold is hereby directed to be made as follows: (1) (2) paid for the purchase of a car; $300.00 to be paid to the minor Plaintiff on a monthly basis until she turns age 18 (eighteen) to purchase insurance, clothing, and other necessaries; and (3) The remainder totaling to be deposited in a minor's trust account established with the restriction that no withdrawals can be made until after the minor Plaintiff Tina Arnold turns age 18, except as authorized by the Court. Dated: ANGINO & ROVNER, P.C. a~. I. D. No. 36513 4503 North Front Street Harrisburg, PA 17110-1799 (717) 238-6791 Counsel for Plaintiffs IN RE: TINA ARNOLD, A Minor, : By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA . . AMICABLE ACTION NO. v. : TIMOTHY LEE PIERCE, Defendant PETITION FOR APPROVAL OF MINOR PLAINTIFF'S COMPROMISED SETTLEMENT AND DISTRIBUTION OF PROCEEDS The Petition of Tina Arnold, a Minor, by Percy Arnold and Mary Fornwalt, her parents and natural guardians, respectfully represents: 1. Tina Arnold, the minor Plaintiff, is the daughter of Percy Arnold and Mary Fornwalt, Petitioners herein. Tina Arnold is 15 years old, having been born on June 16, 1978. 2. On October 25, 1993 at 4:48 p.m., Tina Arnold sustained injuries, including a laceration, with resulting scarring, above her right eye, as well as a contusion to her left ankle and lower leg as a result of being involved in an automobile accident. 3. At the time of the accident, Tina Arnold was a right front passenger in a 1994 Chevrolet Geo Metro driven by Timothy L. Pierce. 4. The pierce vehicle was traveling south on Magaro Road in East pennsboro TownShip, cumberland county, Pennsylvania. 5. At that time and place, Defendant Timothy pierce lost control of his vehicle, striking the guardrail along the edge of -.-._~' --._........--....._._~~...--~--- . . .... the southbound lane before crossing the highway and striking a parked vehicle, resulting in the injuries to the minor Plaintiff Tina Arnold. A copy of the Police Accident Report is attached hereto as Exhibit "A". 6. As a result of the accident, a claim was brought against Defendant Timothy Pierce as a result of the injuries that minor Plaintiff Tina Arnold sustained. 7. At the time of the accident, Defendant Timothy pierce was insured through Nationwide Insurance Company. 8. The minor Plaintiff Tina Arnold received treatment for the ankle injury by her family physician, Dr. H. Robert Gasull, Jr., at Perry Health Center, who had referred her for physical therapy at Polyclinic Medical Center. 9. The minor Plaintiff Tina Arnold received physical therapy from December 14, 1993 through January 26, 1994, when she was released from treatment. A copy of the Physical Therapy DisCharge Summary is attached hereto as Exhibit liB". 10. The minor Plaintiff Tina Arnold's scarring of her right eyebrow has been evaluated by Dr. John P. Stratis, M.D., a plastic surgeon who anticipates performing surgery on Tina's eyebrow closer to the one-year anniversary of the accident. 11. Dr. Stratis anticipates that the scarring over the eyebrow will improve with the surgery, but believes that it will be to some extent permanent. A copy of Dr. Stratis' January 7, 1994 '. .. report is attached hereto as Exhibit "C". Photographs of the minor Plaintiff Tina Arnold's scarring as of April 18, 1994 are attached hereto as Exhibit "0". 12. Defendant Timothy Pierce, through his insurance company, has agreed, subject to the approval of your Honorable Court, to compromise the claim of minor Plaintiff Tina Arnold for the sum of $20,000.00. 13. In view of the uncertainty of securing a verdict in excess of the amount of $20,000.00, your Petitioners believe that it is in the best interests of minor Plaintiff Tina Arnold that the proposed settlement be accepted and approved. 14. Should the Court deem it necessary to schedule a hearing to approve the settlement, and if a hearing is scheduled, minor Plaintiff Tina Arnold and Petitioners herein, parents of the minor Plaintiff, and Plaintiffs' counsel will be present at the hearing. 15. Your Petitioners have retained the law firm of Angino & Rovner, P.C. to prosecute this action and have entered into a contingency fee agreement with said attorneys, whereby said c.ttorneys are to receive, for professional services, 25% of any amount recovered after filing suit. 16. Petitioners have agreed, subject to approval of your Honorable Court, to pay Angino & Rovner, P.C. the sum of $5,000.00 for legal fees. 17. Petitioners have agreed, subject to approval of your Honoraele Court, to reimDurse Angino & Rovner, P.C. the sum of $461.65 for out-of-pocket expenses incurred in prosecuting this claim. 18. Petitioners have agreed, sueject to the approval of your Honoraele Court, to reimDurse Angino & Rovner, P.C. the sum of $400.00 for out-of-pocket expenses, which represents an amount which has eeen compromised or reduced ey Angino & Rovner, P.C. 19. The minor plaintiff Tina Arnold requests the Court to grant permission for her to purchase a computer from Radio Shack, located in the Summerdale Plaza in Enola, PA. The computer which the minor plaintiff Tina Arnold wishes to purchase is descrieed on the proposal from the summerdale Radio Shack store, attached hereto as Exhieit "E". The total purchase price of the computer is $2,068.01. The proposal is only valid for a period of fifteen (15) days from May 12, 1994, and a slightly increased price may apply. 20. The minor Plaintiff Tina Arnold anticipates receiving her driver's license in the near future and has selected a car at Forbes Chevrolet in Camp Hill, PA, which she would like to purchase with part of the proceeds of the settlement. Petitioners have obtained a price on the 1990 Geo Prism of $7,300.00, as set forth on the receipt from Forbes Chevrolet attached hereto as Exhieit "F". 21. Petitioners Percy Arnold and Mary Fornwalt eelieve that the purchases would ee reasonaele uses of the settlement proceeds .__"._ _._.____._._ 0__'" _--. __ __~"'-'-'-.'.. _ ~ -or-""l - W'. .r~ . .~ ..-............... and are agreeable to permitting the minor plaintiff Tina Arnold to purchase the computer and car, if approved by the Court. 22. The minor Plaintiff Tina Arnold believes that the purchase of the computer, which would assist her in her academic efforts, and the purchase of the car, which she believes to be a reasonable use of the settlement proceeds, would be good purchases for which she seeks the Court's consent. 23. petitioners Percy Arnold and Mary Fornwalt would also request permission from the Court to invest the remainder of the settlement proceeds, totaling $5,231.99, in an annuity which they would purchase in the name of minor Plaintiff Tina Arnold, rather than placing the money in a Federally insured, interest-bearing account in a local bank. 24. Petitioners believe that the return on the investment from the annuity would be greater than that which would be received from a normal savings account in a local bank, and the security of the annuity is reason3ble, especially given the amount that would be invested. WHEREFORE, Petitioners request your Honorable Court to approve the minor'S compromise settlement and authorize the payment of attorney's fees from the fund due the minor plaintiff Tina Arnold; direct payment of $2,068.01 for the purchase of a computer from Radio Shack; direct payment of $7,300.00 for the purchase of a car from Forbes ~evrolet; and the remainder totaling $5,231.99 to be chael E. Kosik, :t. D. No. 36513 4503 North Front street Harrisburq, PA 17110-1799 (717) 238-6791 counsel for plaintiffs deposited in an annuity purchased by the Guardians with the restriction that the annuity be set up as a trust, and no withdrawals could be made from the annuity until after the minor plaintiff Tina Arnold turns aqe 18, except as authorized by the court. Dated: !i/I1/q~ ~ ' "IJ:"-' :t "\ ',.\ / "~~~.':/ COMMONWEALTH OF PENNSYLVANM;~J"' .";..; ;In ' ~~;~~~ ~c,f;;'~~:~:e~~RT ~;1 i. k;;:'.j \PUC" 17.1. GVWR I n. REL~SE QE.. "tAZ MAT I vU NU UNKO 0883263 ~:"R'I -. ~;::!eF~M TO OV.E~~AY SHEETS POLICE INFORMATION i l. Il'lC:OENT , ,....... L1 (\ "'1. i NUMBE" '\ V, - -~...) !2.~~~~CV-::',o..57' ?-:~...:s2::0.QC lu)'? ,Ok,c..::. 3.S.ATIONl ...;-.,. I ^ ^ 14?AT"0~"'" ?QEC:NCr L::.. ."O......"l ", . ZONE G 5.'NVESTlGATOR;) _ . ,.---i I L ''''5 BAOGE 'l i_Or; Kloo.lV\..\:::..''''- .......,-....., "UMBE" <!j I 1 a. APPRove~v r. BAOGE , 0 It t\.. - ...r 0 v '_ " "UMBE" I b 0 '-I i7:;z[t'GATlONtO_25_Q3 la~~tAL \1.,5:) '-'I<S. ACCIDENT INFORMATION 9. ACCIOENT , .,.:; r. 1'0. OAV C?F W~~ \l OATE Iu-<-",-"\, vV\ONUli'. '1'" 7::':" CF \ I. I...l '" I. 1'2. NUMBE" --: " OAV IQ.' e ",-'<."i'. OF UNITS I ,-UC 1:1. 'Kl leD 114. ~ INJURE!! 1'5. ?RIV. ?!=IOP. 0 m 7t,\"j G .o\CC:OENT '( N ~ 16. OrO VEr.1Ct.E I-!AIJ: 70 ae FlEMOVEO 11,7. VEHICLE OAMAGE----, ;:'riOM THE SCE~e1 0 . NONE UNIT 1 I 3 ! UNIT 1 UNIT 2 1 . LIOHT L--..-..; z. MCOERATE I2l V 0' '" 0 v 0 ." c;;r I 3.SE'IERE UN'TZ ~ O Q' 1'9. ?ENNCOT 0 Y N L=:.J =Flope;:;yy Y N 118. riAZARCOUS I MA TEFUALS ! UNIT;; 1 rJ6.lEGAlLV v N 137. "F.G. A; ) I" _.",,"' I C : ?ARKE01 C 0 PLATE "'" I",,\..J U : J9. .. TITLE OR . _"\ . ,\ - !OUT.QF.STATE'I'N 1\\0 I :....0 !~\ L-.rll~'" 140. OWNER - _,-i_ . O. - '1.:. ~ , l lV\lI.ul '" \....., "\:,,,",,-"- 1'41. OWNE" , c-- 400RESS ~ I..I.~I/\.E-;.....J I , ! 4~. ~I~CS~~~E \=- NO U\ I ~ . I. 'l. Co 2--$ 43. VEAR \ 0. q4 ''''' MAKE( L+'=-I..l..-<-C: L'~'- '5. MOOE~.\NOT /':"-0' " _ _,.. 14a. INS........... 300V TYPE! '-P::O .",,1::-\ "'-v v I1<:f NO . 47)BOOV a ") I' 48.ISPECIA~ 0 ~VEH'C~E ! TYPE '- USAGE 'I OWNE"SHIP i SO ~~;~'i-L :MPACT \ 2.. 1\V~~~ii,~E 0 I~l~~~~~~ II&~~~'~'~~T I !~~:~vS~';.CE i111~g~~~~'ON l'Sa.'OR,ve" "3 0::; 701 / IS.. ST , I ~M~R ~ 0 ~ I 156. ORIVER --- --' \.... ~ --: .'> - NAME \ ,"'-'\0 I "" ~ \ .~c.'C.. I 59. ~~6'::SS \ 3 H tA..V\~1. s-;- , 60. C'TY. STATE =".' iA '^ ~ ZIPCOOE = "-' u...... ,-,. 161.SEXM 162.~~T~oF\l_ '3-<'o~ I. 64. COMM. ',EH'165. ORIVE" .- 166. QRIVER vC V , CLASS '-- SS- i 67. CARR'E" 68. C;.ARIER 400RESS 169. CITV. STATE 1 zlPcooe 170. USOOT , ~VEH. I CON Fla. is. ~O. OF ~XLes u~s 11/921 IJB. .r.)',1'E /-."\. Ice.. ,(7J.)CARGO I ""-aOOY TYPlS ~HAZAROOUS I MA TER'ALS ACCIDENT LOCATION 20. COUNTY 'Ll,iI\.t,3-=..~LA6--'U 21. '.'UNIC:P~~-~ . _ (_, j. ~., -...-17), I J;::J-1J54;)(JI...V CCOE '2. I --rc; COOE t (: I PRINCIPAL ROADWA Y INFORMA TION Mi\ g..-t /<..0 ,0....6. 1rc>~~~WAV 22. AOUTE ~jO. OR STREET NAME 23. SPEED 2 c: ~lMIT -J I~ACCESS . ceNTROL o INTERSECTING ROAD: 2a. "cure NO. OR STREET NAME 27. SPEEO LIMIT I~TYPE HICHWAY 'I~ACCESS C~~ITRCL IF NOT A T INTERSECTION: C.eSCKS~'D..z. ~[Z., 21- FT. I'tl..J '.'1 ~ :30. Ci=\OSS STREET OR SEGME~jT ~.1ARKER 31. DIRECTION F"OM SITE N S E 33. DISTANCe: 'liAS 'N t 32. OIST ANce I F"OM SITE ',IEASURED 0 : 35. TRAF~IC I CONTRO~ I eE'/ICE ESTIMATED ?AINCIPAL 101 INTE"SEC7ING I I 34 CONST"UC710N ZONE r-- i ui UNIT;; 2 36. L=GAU.Y '~ ~ 137. .=IEG. ..RKED? Z w ?lATE 39. ?A Tine OR _ OUT.OF-S'. A TE '/IN 010. OWNER :JB.~~ 1 \:-\ . 'l. 3 ~ ~ q- '~ 37d-d.SGd770 / vV\,..sL-.U 'lJ t::.. .14.<.~;cLi) .::J:< 41 ~;;Re:SS '-\ c> \i\ ,.t-G-A K..C Pd.. 42. C:iY. STArE - \ "" HIPCOOE l:::..uuL.../.... :'t, 43. VEA" l q <g'"S 144 MAKE Fe .~U 45. MOOEL . I NOT,..- "".. .-...."., ~ _ "46.'NS,.,..~ 30QVT'YPEl ",-"'~0 ~.-.......,.lr"wo:.."""'" Vl.t::::J NO UNKL 47. BOOV '-0 /48.1SPECIAL . 49. VEH'CLE TYPE () 1'-.:.1 USAGE 0 ! OWNe"SH'p so. ~~;;:TL IMPAC, \ 2. :~~~~:'0~E I. I~~~~~~L 53. VEHIClE ~OR'VE" I 2 ."-1 I~ORIVE" GRAQIENT ! F1cESENCE , CONDITION SQ. iJAIVEA j 57. STATE NUMBE" I 58. ORIVER NAME 59. OR'VE" AOORESS 60. CITY. STATE ~ ZIPCOOE 61. SEX 1"2-0ATEOF 3'RTH 64. COMM. '.lEn. 165. DRIVER 166. CAIVER va .NO ClASS S S- 67. CARR'ER e=!"l:~=~ Ir!}~,'r":C'7::~~~1~ 68. CA"R'ER ,-' . II i .OORESS ' 69. CITY. ST"\~ ~ ZIPCOOE 70. USOOT . Lt..bL'3) I co i6J.P~. ;{,fj'; jPUCI 174. aVWR In. RE!&,SE QE HAZ ,,~ vU NU UNKL CENTER FOR HIGHWAV SAFE1'Y 72.IVEH. CON FIG. 75. ~o. OF .\,XLES lice · (73.}CARGO I'-Soov TYPE 6.IHAVROOUS ! 'AA TERIALS -...- ~3 ":;t=;:'~I,"':':i(:' l:::,I"; .,,-iC',,> 1:=.; 'J I I'~":'~"" F -~-... .~t.\',', I...L\Af... '-...: -;;~E'O'C'\L F.\CiUn l~ur:;--:) ~\ ~ ~ (---~~~-~'"';;-L--~--- .dO}PEOP,-~ ,i~FClh~A TlCN ~ 3 C 0 E ~ Q ~IM.1E ,l,CORES:) i II I il,\ :2.~1 312.: CI o,~.::,.\\c.~ c f. lV":\-: Illzi\::II:5i312.loi '"1'/.,-,,\ ,vi. A<>;r..'_o le,/ n IIIII I I I I I I I I I I ,.~ ../.;..'-L, li'j~;tJc:"Ji .;. . 0~ - '-~.,j . '.... (.. 3 lu ~-...,- ACCIDENT DATE: 1- ~ ,L. 'OJ K L M :31S121Aloll ,:::;';iJil 3 i 212-JAI'o II I 1,--[ I I I I /1 I I I I I '~I I I I "~'lt u.-'A i)..''';' It,,"::' , I ~ - ;@'LLUM'''ATlON ~ @WEA;HE;l i o! i@ROAO SURFACE OJ 84. PENNSYLVANIA SCHOOL O'S~'C; (IF APPLICABLEl 186. ellAGRAM I I i ;/:/'"' -i ~/..,..". .;"";,/" ' ...-: , // ' .-' . j/ j/~.. '\ " ,>':jt 1""\ '\"<.t(i /€; ;//.d \ . '. . I --...; ~S;-. ~. '" , 1Il5G~%RIPTlG-~: tt:AGEO PROPE;lTY I I iO{tlvEi{'av,0 ;::. A,..?...::c;t.J) ~. ~., IAO~~ vLl"\'(..,\,~ pd, 'I - ., ,)" 1 0 } .. e.""c......'t, I ~.. L ....,- I PHONE 7. 32.. I b 9'7 ! 187. NARRATIVE. IOENTIFY PRECIPITATING C:VENTS. C~USAnON F.J.C":'CAS. SECUENCES OF :-/ENTS.,'NITNESS SiATEMENTS. ANO PROVIOE AOOITIONAl.. OEi.o\.ll..S. uKE INSUR.o\.NCE INFOFlMATION ANO l..CC~TION OF rowED VEHICLES.:F KNOWN. I i Ur.;~\ 1. ,',)",,"0;. 7":Z;"',-'~L-;-'~:;O....,-~ cJ .Ll.'r4,~'D ,~. c,+ .:u-; u..u;.GVOWL.-' ! SP2,'-0 L.....J-c.....; c.7IZ......y-;-,:.,;<i -+c: A..'2.('o'-".~rL 10.. tv...R.A...', u,v,f.:L -tf...::,.,... I .s172.w:.,/< -n.0... QI.(..+./d- lfit, / c.-v IJ.;-t'L c...v;,..1')1 i)L (.17' -fi.~L. /.L''9/"..J;I(' I .....;i...[,."j c.2L.:~:;l -H~l... Lul.4 c,vel <......-i:....f <J' -t1'L LQ..j1' I t uL A:.e. a.......d- "l-;-,-' -ttz.Ll .2.. 1../i..CdIJ:/ u..,t~.z..'i.. L.t..1t),'1 ,;J .~40, tj,l/,Ii t1.k,,-, col. (.J q.J - ON, U,I/ ,"7.::) tA./ ({.j P"'JtLE.'. nu' ~"vc,,' c..-'?,'!! ,t.."",. ,',v' sa,z..l:i., ' \ I O;Z.M/c:J..'( ~1 J/"A-1>.() y.-f\.q"r At.. So,..;../e-,E..t/'ll:> -fc .~,ss ,.r s.l/I....rl! I ,4,/.11 ;~'L.+,.L ,-,vl..c.t, ,c.o..,o.J CLC.2.C'S.s i'LLL. ,i::bC!d ,',v' +~'o./-;- 0 f h,..d. HL '-I1<.t.N 5' ....va c.'l. ~ 13 c<.c;{ 0.,1/ d 1057 Ct7N."'2d ( Ct..,l./~ .sr;l1"c.l{ d2. - .' ,<-.v" ,.,. CCJ. I';:;~~'::A~~" ICOMPANY LL. S. F. -\- G, I U~'T IPC;bCY p ,~~ lo:5 $ l'1 Co 'l cO ~ J.{c.o~~~rl.<.c Ad, z.uc.t4.. H. 'f3cg~ /4:J97 -5 3~REi5 ...y -.;) '5-;-' uJU~~/h'l5,Jt.L,e.f P':!r'.E Cj.s 7'1 ! 90. SEC":1QN NUMBeRS ,ONLY IF CHARGED) TC NTC OC! on UNIT I I IUN'T ~ ~?~OBABLE USE UNIT' I AA....S (1/92) ~RESUl..rS CNO reST 1 ~;:U:~caABlE. 1 ,- ;lEFUSE L....-.-! uSE I O.__''o;=:; I UNIT< I ~ _ UNK, ~lNPE I 1"ES7 i ,9J.1RESULTS 0 0 res; I I........." N 9.. JNVESTlGA nON O '" CJ REFUSE COMPLETE? I .__,00 UNK yES g NO r CENTER FOR H'CHWAY SAFE7Y' ~r<PE i"EST 0883~68 .;3AGE:_ -f. .. - ~- CLINrCAL SERVICES DIVISION PHYSICAL THERAPY DEPARTMENT (717) 782-2344 FAX (717) 782-4200 ~ ~~. ~C01 North rhuC Streef Hcmscurg. Pennsylvanlo 17110 'i!!ecnone (717) 782..1141 TO: R.o bu t 6 a s~(( I I foil. D . FROM: Kef! V r?.u/d I f, T- DATE: I';;'/:;'~ let :; RE : 1i (lCl It,. (l c.t It/..., DX: (9 a;.1!:.U Sr~ ----.--. ---. DISCHARG~RESS S~Y) PATIENT STATUS: PI; h(j..S a. -IIe"cutC % ~.d1.,(_cLu..CuJ v('sds '.:5IhC.i.., /u.., in,.haJ e,va.{utVzlrfrL, 11'1 /;;'/I'I/tJ?, 7?tcd7/uni hlUJ .ltc-Cud-al tf.OIll CI4oJ,( .sfr.tn~f'N 1/ 11'j t rt.: u..;.t 10 ". 'f!:: Q ~&- J A tmu.... ?rtJg-rW7r.. a/~ld. iCL to 'fit[ (j;; ().,f1./:.U. 10 daj( I rJ;) o-I',~/:.J!L Mf)A-l nM in U1...!..Cw.R.c/..., (fJ f::u..Jr:.J_t s/-T.lr1j"f/l At~ ill c/'r..eM.t.d ) au c"..c.lJ7..cdz.c71 i 5 € INn 1I1/;t.icd.. (J..;!.t:(- j()...(,f- /'1 Ci.S" if"fl.pMY..ul. II, *,y:tls fa a'iLf/~i,&...h: f,lIi'fh dt.C1..tc~ tuelJhf /xtu-;t7.J C'VL 'flu. (;: bt.,(;f- /5 a.64:. fo Corr.{..~f- 'Htu.; c,01'fh t!~'....iS . RECOMMENDATIONS: Cevd o_s 0.- be/Ve. .' t- ./. ~te.l(. J.l..~ f T T!JER,APIS'l!" S SIGNATURE ~/I!3 II. I .. CLINICAL SERVICES DIVISION PHYSICAL THE?~PY DEPART~ENT (717) 782-2344 F.l\.X# 782-4200 ~ ~~. '::01 l'ICrT:"\ ;nlrc Str~er -cms=ur=;.::J~nn5"IVCnIC!:'"t-: ~~'-=:::"'c:;e' .... .~:-..;,~..:~ January 26, 1994 H. Robert Gasull, Jr., M.D. Perry Health Center P.O. aox 913 Loysville, PA 17047 RE: Tina Arnold SS#: 172-60-2363 Diagnosis: Severe sprain left ankle; status post MVA 10/25/93. DISCHARGE SUMMARY: Following the Initial Evaluation on December 14, 1993, this patient was scheduled for Outpatient Physical Therapy Services three times per week. The patient attended 16 out of 20 scheduled treatment sessions. . The treatment program has consisted of modalities as needed to decrease inflammation includina cold oacks and elec~rical muscle stimulation. The oatient has aiso received therapeutic exercises to improve the strengt:h, range of motion, and proprioception of the left lower extremity. The patient has participated in a home exercise program. Subjectively the patient reports that the left ankle "really hurts" when she is running. Observation of the patient during running, jumping, and advanced gait activities indicates that the oatient does not demonstrate an antalgic gait and does not demonstrate any observable signs of pain or discomfort. PROBLEM AREAS NOTED ON INITIAL EVALUATION: 1. Subjective complaints of pain and giving OUt with walking. 2. I~paired gait patter~ i~cludir.g decreased toe off and decreased heel strike. 3. Increased girth of 1.1 em. on the right for the figure eight method. 4. Decreased active range of motion for the left ankle. 5. Decreased strengt:h of the left ankle. 6. Positive tibia/fibula compression test on the left. PROGRESS TOWARD SHORT TERM GOALS: Goal Achieved - (A) Progress Made - (P) No Change - (N) 1. (A) - Decrease subjective complaints of pain with activity to less than 6/10. DISCHARGE SUMMARY TINA ARNOLD l?AGE 2 ~ 2 . - Increase left ankle strength as indicated by an increase of 1/3 manual muscle test grade. The patient's left ankle strength is within normal limits for all motions. - Imorove left ankle orocrioceotion. The oatient is able to maintain single "leg stance for 60 seconds. Enable the oatient to oer:orm an indeoendent home exercise program. The pacient has been given a written home exercise program which she is able to perform independently, however her compliance is questionable. (:\0) 3 . 4. (:\0) (A) PROGRESS TOWARD LONG TEm~ GOALS: Goal Achieved - (:\0) Progress Made - (P) No Change - (N) 1. (A) - Maximize the patient'S function for activities of daily living. 2. (P) - Return to school including physical education class oain-free and without restrictions. This oatient has demonstrated the ability to per:orm various advanced gait activities and running activities without difficulty. It is my =ecommendati~n chat this patient is able to participate in physical education class as tolerated. 3. (:\0) - Independence with a home exercise program. The oatient has a written copy of the exercise program however compliance is questionable. COMMENTS: Although this patient reports subjective complaints of pain with activities, she does not demonstrate any observable signs of cain or discomfort. The oatient has demonstrated the abilitv to O'er~or~ ad~.~"~O~ -~;t ac-~-v't;oe ;nrlu~;n- '~~o~al chu~~les c~oss .. - -.... ~----- '::l'--~ -- - --- ---- .....-...':: -~--- -.... -- ,... overs, jumping, and running. The patient is able to 'tolerate rUl1ni!lg on a t=eaci..'l1ill aT.: 4. O' mph for :.:.ve :nin.u~es. .' PLAN: This patient has been discharged from Outoatient Phvsical Therapy Services. If you have any further questions or recommendations regarding this patienc please feel free to contact me at the above number. Again, thank you for this referral. Sincerely, ,4\. <\,W.-<...._r..... r-.-Irr.'e- Michelle Mikanawicz, P.T./A.T.C. I1M/cal -~--_. ~-~_. .-,-.-- AESTHETIC AND RECONSTRUCTIVE SURGERY OF CENTRAL PENNSYLVANIA, P.C. 816 Belvedere Slreel Carlisle, Pennsylvania 17013 717'249'0100 WilLIAM P. GRAHAM, III, M,O. JOHN P. STRATIS. M.O, January i, 1994 Michael Kosik Angina & Rovner, P.C. 4503 N. Front St. Harrisburg, Pa. 17110 RE: Tina Arnold Dear Mr. Kosik: This letter is in followup to my evaluation of Tina Arnold and your request for information regarding the patient. Please excuse the delay in sending my report. Apparently your first letter did not make it to the patients chart when I initially saw her. This patient is a 15 year old white female who was involved in a motor vehicle accident in October of 1993. she came in on December 29, 1993 for consultation regarding the scar of her right forehead. Apparently she was seen in the Emergency Room at Holy Spirit Hospital where her laceration of the right forehead was repaired. Apparently there has not been a history of infection or hematoma during the healing process. The patient and her parents felt that the scar was quite visible and there was eyebrow asymmetry present. On examining the patient, she has a 3 cm. scar extending from the mid forehead on the right side in curvilinear fashion through the eyebrow area itself. The' scar is quite evident currently because of the redness in it. It is approximately 2 mm. in width. At the junction of the scar of the eyebrow the patient has loss of eyebrow hair. I do not believe that there is an actual mismatch in the edges of the injury at the area of the eyebrow. I believe that the apparent mismatch is actually secondary to the location of the scar in the eyebrow and the lack of eyebrow hair in that area. I have advised continued observation' of this scar, use of cocoa butter and protection from sunlight using sun block. I have asked the patient to return to see me in three months and would not proceed with scar revision at this point in time. I have seen the patient only this one time. She made indeed require additional treatment in the future, either with scar revision or dermabrasion or both. The surgical cost of this future treatment would be approximately 52,000.00 with reasonable degree of medical ~ I'C' II Steck :.!o. Descr:.::ticn F"JF:~;~;~L T! t 1)4 ~JAY~.:E: ::~'IGL,". ?::l :!M-02BS 261)-288') 26')-.)13.. :::60-i)349 261)-(1431 SYSTEM ::51)-1641 251)-1.)Q6 25(1-4091 .:~ ~:AD r 0 SHAC:'" ,) 1-~(iS3 ENOLA-SUI'!~:Ei';C>.LC;: SUW'lE:F,D::lL:: c'!.HlA 445 ~i :NOL:~ RD ~NGL~. PA 17(r':~ (71 7) 73'::-.:~ i:<.t MARY H\IE. ~ 7(\::~ Oty. Price A::lCL:r.~ 6'PCSL 25?IN-,BM D~IP21):; P~:!Ni'ER 1M 9.5Xll ::'011 SOW EASIC SPIKE 6 aUi' 1('-3.5" HD DiSKS TANDY ~MPC MOD ::0 MPc SPEAKER/A~!P VGM390 0.39 SVGA I 11.99 I 1~9.99 1 11. 99 1 14. '99 I 13.99 . 1499. r)l) 1 13S:9. (Il) 1 -Q ~~ ,... . 1 399.99 1 199.00 SUBTOTAL TAX TOTAL 1950.95 117.06 2')68.01 11.99 199.99 11.99 14.99 13.99 1499."1) 36 ~10NTfi COMPUTER CAF,RY iN TSP FOR 25(1-1641 TANDY M:~FC "00 20 199.00 ISSUe: DATE: 05/12/94 THIS PROPOSAL IS VALID FOR: 15 DAYS MONTHLY RSVP PAYMENT 63..,0 THIS MONTHLY PAYMENT AMOUNT MAY VARY DEPENDING ON YOUR ACCOUNT BALANCE. . ~ lIE II Page 1 or : _.'__'__h. ...... 31118 AUAmsu _,It'I'"'''' ~T~~ 'DC I l.UAL I II L "U"CHASC"'S HA"'I ~O'"t _J...Jeu J \~ t:V\nlc,- ) no.., ....~a CI" P\\/ .~. \ 7 02~ nArc IH'I. . CHEVROLET. INC. 3400 Hartzdale Drive at Capital City Mall O"'Ie CAMP Hill, PA 17011 . SALU co Phono: (717) 761-0600 SALESMAN'S NAME.: OIM- , PLEASE ENTER MY ORDER FOR: MaDa OR\l..I-=>". . BODY SERIES "'r{ I.-="~ TYPE IUS. ""OMI IUS, "MOIIC / DOTHER DE U1EIB n.,. _ , IClQa MAKE C5............... ~~~~R R- 9 s s;- p.. SER\\(rS KS'-tG,Lt L:C \ 44 -1 \ 2- ~. TO BE DELIVERED ON OR ABOUT CASH DELIVERED PRICE OF UNIT 19 s I St3tc that odomctcr mllc3&e on the VEHICLE ON ORDER dc' cribcd 3bovc is ',3r1 . \r.IJ at timc of ltBns( e (CI1.ck ,h. lolla..,in9 .,a,.m'.n', 1/ appllcabl.J 01 rurther suite that the actual milea&c diCCers from the odome' readine fOf roasons other th3n odometer clIHbrDtion error and II: the actual mileale is unltnown. I further state that thi_ vehicle ....s not involved in flood ....tcr~ ACCESSORIES s x .1C1.....'\l1I1 Of' ,..a..."IIIOII lallllo'" 0" A,,'"Ollllla a.a.." OArl F<<i.r.1 ,.gu'.tion, f'ft1u,,.. tit. odo".,.,..r mil..g. to b. 'f.ttd upon rr.m 01 owtNnhip. .An ;nMXUnre ,t.c.rrwnr may malt. t/J. rranttafor Ii.ol. d'm~. to th. ".ntt.rH. pursu,nt to .-ctio" 4U!1f.J of th. Motor V.h, Intortmc;on .nd Co.t S.~jng. .Act ot '912. Public L,w 92,5' 3. . f'.usa> .VEHICLETRADE:INiAND/OR'OTHER; CREDITS T.. LAST '1.Af[ ,",DOlL lOOT ....'1.1. MO. t state that odometer mileace on the USED VEH1CLE TR^OF..- described abovc is at time of transf. rCh.ck ,n. lollowin9 sla,.m.n', if oppllcab/.J 01 rurther uatc that the actual milease difrers from the odome fcadine for felSons other than odometer calibration error and t the actual mile_IG is Wlknown. I rurther atate that thla veb.icle ...... a.ot lnvohed in Rood .....t s ~B t b . 409, x \ tl_"...TUIIC 0" .UIIC"asc:. IT"A"."C:"O" or '..AOC.I"' BI BALANCE. OWED TO ADDRESS 2- USED TRADE-IN ALl.OWANCE I BALANCE OWED ON TRADE-IN I NET AllOWANCE ON USED TRADE-IN DEPOSIT OR CREDIT BALANCE DOWN,PAYMENtlcrrans~io>uiftC'a"I:; . . . .' . REMARKS s aA'C: CASH SALf PRICE OF DESCRIBED MOTOR VEHICLE s STATE AND LOCAL TAXES DaCUMENTARY FEE L!:ENSE. L!:ENSE TRANSFER. TITLE REGISTRA TJON FEE 1. TOTAL PRICE OF UNIT 2. DOWN PAYMENT: consisting of S in cash andlOl' S net trade-in al- lowance on trode-in: see statement in right hand column lar details. 3. UNPAID CASH BALANCE DUE ON DELIVERY S (difference between Items 1 and 21 s s s 30D.lcoi /I Purcha.., 1I~.e. thee this Order includes all of the terms and conditions on both the tac and reverse side helreo', thllt this Order cancel and supersede. anv prior agreement and as of the d.lte het'eo' comprises the COCTIPlele and exclusive statement of the terms 0' the agre."..r ,ola.lng to the subJ.c. ....n.rs co..rod h.r.by. .nd ma. THIS ORDER SHALL NOT BECOME BINDING UNTIL ACCEPTEO BY OEALER OR HI AUTHORIZED t'lEPRESENTATtVE. P'ureheser by his e.ecutlon 0' this Order cenif...s he is of rNllOt1tY a9& and acknowledges tl'\8t he has re. Its r.nns IInd conditions and 1\1I. receiwd a true copy of this Order. THE FACTORY WARRAHTY COHSTITUTES ALL OF THE WARRANT WITH RESPECT TO THE SALE OF TNIS ITEM/ITEIlS. TNE $ELLoR ,m;[8Y EXPRESSLT DISCLAIMS ALL WARRANTIES. EITHER EXPRESS' IMPLIED INCLUDING AHY IMP~IF.D ....RRANTT OF ~ERCHANI Ad'LITY GR FITNESS FOR A PARTICULAR PURPOSE. AND THE SEL~' ""D ."D<n.. Tn ASSUIIE FO IT ANY LIABILITY .IN CON.HEc;,!IO~~T~ !.H.~_SALE OF .. , VERIFICATION We, PERCY ARNOLD and MARY ~ORNWALT, as parents and natural quardians of minor plaintiff TINA ARNOLD, have read the foregoing PBTITION ~OR APPROVAL O~ ~NOR PLAINTI~~'S COMPROMISED SETTLEMENT AND DISTRIBUTION O~ PROCEEDS and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of our knowledge, information and belief. We understand that this Verification is made subject to the penalties of 18 Pa. C.S. 54904, relating to unsworn falsification to authorities. Lf-ffV ~ 'JJ1~~'lH-d~ MARY T '. DATED: -s;/ /) ( q " ~ ::J 6 ;:0 a: Iltl..,1 ~ I; iV';"()Y , IN RE: TINA ARNOLD, A Minor, : By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA AMICABLE ACTION NO. c;l/ -.,') (., 3-3 euJ ~ v. TIMOTHY LEE PIERCE, Defendant : ORDER AND NOW, this 11 tJ... day of '-7>1'd ' 1994, upon consideration of the Petition for Approval of Minor Plaintiff's Compromised Settlement and Distribution of Proceeds, it is hereby ORDERED and DECREED that the Petition is granted and payment of the $20,000.00 due to the minor Plaintiff Tina Arnold is directed to be made as follows: I I i I (2) $2,068.01 for the Shack; ! ~,t'\.\-(~7))..3'OO.(tli t:z:sF'~. ! .~~ (1) $5,400.00 paid to Angino & Rovner, P.C. for attorney's fees and expenses; purchase of a computer from Radio rtooUo \;"h3.se __ of' .f=U'l"" from. F~ a (4) ..Q..o.......- <is 1.2, 5 3/ .<1 '1 ;...... c.t.ec.:n.cL The remainder totaling $S,!31.33 to be deposited 1ft aft a--u'~~ . ,...1. __: bi"'-ehe St1!!i_l':' ..s with the restriction that t:i._ &RR'lity Be w..L ~.. as il tilNlI4!., ~...a. no withdrawals could be made kgll "AI ___._lby until after the minor Plaintiff Tina Arnold turns age 18, except as authorized by the Court. BY THE COURT: TRIll: C('\::lY -!;)'"'q ":i:r-.nD _'- 'J.. r.\.~" t. :'_...'-vt". I T. .. I . , d n c.=t.m~;",'r' \'.n:r::Oi, :1.:i:: .;~tJ ~..;t rrr/ nan and the seal oi ~3id C:~rt 31 Cilri:s;a, Pa. This ...1..9..-!.'::-... day of .J:n.~..., 19..~.~ 4S6S2/D~......,.....~..CL..,..~~:......_ ,Qn Prothonotary H / ~<);Lo ~. ~ fftAJ J. .~." DL.IAD "'931 APPLICATION FOR INITIAL NON-COMMERCIAL CEARNER'S PERMIT/DRIVER'S LICENSE PRINT ALL 'NFORMATlON IN FULL IN BLACK OR BLUE 'NK . .' 0285307 rlJORIVER 5 liCENSE ~UI.lOER" 0 NUJ.ABER l.'srl,u,l' ---r' 7H )7T~~1 () I !--l.or I II I I ~ I I I- I --1 I I I , I UIOOl.E ........E i ! I I I l i /10/ I I I I I SOC"\L\lC'JJ.I.h"'lJt,IIIR ". .A Efe I , JIA5"I.....1 : ! ! .--(1 J' i ,V" : /J OATE OF MHH AGE UON'" OAf 'EAA J}~. ' JL ~ '/([ I IG EYE COLOR (PIN" Clift" OII.J: ~LUE "1'C..r .~.' i~i. , I I ? I 7-1 . J t I 0 I - 1;, J~ r? I 3 CJUROWN :JGRE!N ':JHAZEL I..lPINK ,.JULACK WORAY ~DICHRO"'AtlC WOTHER IS'ATl.~ FA/c)" .7 , I;?J r tv,.,./:,,./., ...;?.. 'I:: !C1h I/,peoot J. ,....... I /??~'':J Enter Fee For Each Item Checked FEE [: S"llP"'CClollU .lv'/ EXAM REPORT VISION SCREENING ,ICheckOne YES NO V',;"'''' PERMIT(S) DESIRED 20170 v,s,on Orless ,n Oenereyewllhcorrecl'on.... .:1 2r. /0 CLASS A Repon 01 Eye Exam,nallon allacheo. ..........:1,.:1 :I CLASS B OU."',eo ..... . ......... .....<:J..J 21 CLASS C , i :.:J CLASS M 57.00 i . :. LICENSE REQUIRED'''::''''': I 11 4. Year PholO 522.00 ---..------ L I .J 2-Year PholO Age 65 & Over 512.00 , TOTAL FEES ~ $ tP71:/" I Paid by: ::l Check .;a.Money Order -..,---- 1i'I-'- .'. ~. ALL QUESTIONS MUST BE ANSWERED CHECK Applicable Items Below S5.00 55.00 55.00 t:; (..,eJ -- COMPLETE ONLY WHEN NECESSARY Uncorrocteo Corrected 201 I R'ghl Eye ; 201 I Lell Eye r 20"--- BOlh Eyes , i A L i F'elds ::J Must wear correCllve lenses ':,: 'r".' .;. FEE;' 201 I 201 201 ." .. ,:/,/ <- v R ~ Olher-restnCtlcns.. VERIFICATION OF BIRTHDATE AND IDENTITY .fI Birth Cenlllcale o Olher TEMPORARY LEARNER'S PERMIT FOR 60 DAYS This is to certlly that the above appllea"1 has applied for and passed the signs and knowledge eXamination lor a Pennsylvania Non-Commercial Learner's Permit. .:J Unable 10 delermlne vISion/medical qualifications. Temporary Learner's Permit cannol be Issued. ::! Currently suspended/,evoked. Temporary Learners Permit cannol be Issuod. ---- YES NO / . d.. ':J:.f ,I Check Applicable Block 1 Have y~u ever held or possessed a PA Driver's Licensel Learne~s Permit/PholO Identification Card? ............... ... ......... 2. IS your l,gh' 10 apply 'or a hcense or your privilege 10 operate a vehicle in this or any other slate currently SUSPOjOO or revoked? . ... ... .... . ........ .. , II yes, ove slale _ dale________________... and ro on . 3. Have Y U been arrested or Cited In thiS slate or any olher state 10 any Violation wnlch carnes a pOSSible penally of suspenSIon of your driver's license? ............................... ........."".. II yes. gove slale____________ dale _____._____, and reason ..-- , ...:::J ~ ,. .,j ::( PHYSICAL DATE : Monlh Oay : t/,j ,()'/ Vear I ;;;1' I I.:lI CERTIFICATION (Sign) , . ......~.-/ , /,,/ ~./ I ( . .<-.._-. . X . (.... /' ....{(.........-......- fS,gnar,'fe 0' EXlJt'fllflefl ~/ J F./t-J tOtE NO) X -'/(, .c~ -, . , ,::..~/ ; (AD"/Icant's StgNtUf. In Ink} I hereby ac~owledge 1t'1I5 day thai I have received notice ollhe prOVISions 01 Sec1lQn 370901 the ~ehlcle Coas (see blck fOf prOVISIonS). WARNING: Misstatement of lacl IS a mlsae"1oanor 01 the lhlrd degree punIshable by a line 01 up 10 $2.500 ana/or Impnsonmsf\t up to 1 year (18 PA CS SectIon 4904(bll. exam'lssue Oale Mon!n Oaf (ear e..am Center Ct.' 1 '";"/ J . 'It.l , , CARLISLE .... , .. ......" .,. .. THIS IS YOUR TEMPORARY NON-COMMERCIAL LEARNER'S PERMIT .\ THIS FORM IS NOT VALID F.OR TESTING PURPOSES , ~ :r;.-: ~, APPLICANT ( ~ I J APPLICANT INFORMATION This temporary'learner's perm,l entilles the pe'son 10 whom It was issued to drive vehicles and cOn!bln.a,tio~s of vehicles 01 Iha class(es) specIfied, but only while the holder of ttie permit Is accompanied by and under Ihe immediate slJpervlslon 01 a person who Is at least 1 B years of ago and who: IS licensed in this Commonweallh to dnve vehicles of Ihe class Ihanbelng driven by Ihe holder 01. .' the learner's permit; and Is actually occupying a seat be~lde the holder of Ihe learner's permit unless the vehicle Is a motorcycla. . Final approval 01 Ihll application lor Pannlylvanla Non.Commerclal Drlver'l Permit II lublecllo'verlllcetlon 01 the appllcant'l palt driver record hlllory. Should verification dllclole outltandlng vlolatlona In any Stale or Jurlldlctlon, Ihe application will be danlad and allll8ued Pennlylvanla Drlver'e Llceneel/Permlta Ire aublecllo cancellation and recall, . Ilia Unlawful lor any pereon: To exhibil, cause, or permll to be exhibited or have In possession any recalled, cencelled, suspended, revoked, fictitious or~ traudulenlly altered driver's IIcense/permll. To lend a driver's license/perm't to any other person or permll the use thereol by another. T~ exhibit or represent as one's own any driver's license/permit not issued 10 the person. ' I To lall or refuse to surrender to the Depar1menl upon lawful demand a recalled, cancelled, su~per\ded, revoked, fictitious. or.....,. fraudulenlly aile red driver's license/permlt. 1 l J Any persons v,olal,ng any of the above 's guilty 01 a summary ollense and shall, upon convlclion, be sentenced to pay a fine of S 1 00. The Departmenl may cancol any driver's license upon delermlning that Ihe licensee was nol entilled 10 Ihe Issuance or Ihat the person lolled 10 give the required or correct Inlormatlon or committed fraud In making Iha application or In obtaining Ihe license or the lee has not been paid. . Any Pennsylvania driver WhO is convicted 01 any 01 the above offenses shall be assessed 3 pain Is as ollhe date of violation. . A PERSON IS GUILTY OF A MISDEMEANOR OF THE FIRST DEGREE IF THE PERSON, WITH FRAUDULENT INTENT, HAS' POSSESSION OF, SELLS OR ATTEMPTS TO SELL, USES OR Of SPLAYS A DRIVER'S LICENSE, KNOWING IT TO HAVE BEEN: ALTERED, FORGED OR COUNTERFEITED, Any person commlting this offense Is, upon conviction, subject to Imprisonment for a term of up 10 5 years. The Departmant shall revoke tho dnver's'lIcense privilege of any driver lor one year upon receiving a cer1l1led' record 01 the dnver's conviction of thi~offense. PENALTIES AND SANCTIONS SECTION 3709 OF .. Section 3709 provides for a fine of up 10 5300 for dropping, throwing or depositing, upon any h'ghway, or upon any olher public or' pnvate property wlthoul Ihe consent of the owner thereof or into or on Ihe walers 01 this Commonwealth, from a vehicle, any waste paper, sweepings. ashes, household waste, glass, metal, rafusa or rubbish or any dangarous or dalrimental substanca, or permitting any ollha preceding withoul imme~lately removing such Ilems or causing their removal. For any violation 01 Sect,on 3709, I may be subject to a fine 01 up to 5300 upon conviction, Including any vlolalion resulting Irom Ihe conduct of any olher persons present within any vehicle of which I am Ihe driver. ( = J The Department is required 10 oblain the Licensea's Soclel Security Number, hei9ht and eye color under the provisions of Seclions 1510(a) and/ar 1609(a)(4) ollhe Pennsylvania Vehlcla Code. This Informal,on will be used as Identifying Information In an attempllo minimIZe driver licensa fraud. Feaeral law permits tha use 01 the Social Securily Number by state licensing officials lor purposes of, identillcaflon. SOCIAL SECURITY NUMBER INFORMATION 1'- . Is valid on Ihe day Issued. You musl be 16 years of ags or older to apply . Must be validated and signed by the Driver License Examiner . Musl be signed by you . Is valid only when you are accompanied by and undlJr the immediate supervision of a licensed driver who Is at' , ieasl 18 years of age . Must be in your possession at all times while driving a motor vehicle . Is valid only for the classes Iisled .- . Is valid for up to siXly (60) days from the date Issued; . Is not transferable or renewable and becomes invalid if allered or changed in any manner ~ . Is nol valid if your driving privilege is currently suspended or revoked . Is not valid for taking your driving test ~. . Will not be exlended . Is void and must be destroyed upon your receipt of a Pennsylvania Learner's Permit . -.." ... .. . VERIFICATION We, PERCY ARNOLD and MARY FORNWALT, as parents and natural guardians of minor plaintiff TINA ARNOLD, have read the foregoing SUPPLEHEN'rAL PETITION FOR APPROVAL OF MINOR PLAIN'rIFF'S COMPROMISED SETTLEMEN'r AND DISTRIBUTION OF PROCEEDS and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of our knowledge, information and belief. We understand that this Verification is made subject to the penalties of 18 Pa. C.S. S4904, relating to unsworn falsification to authorities. DATED: -. .. ... .'-- ..--~.-.... --....'-......:- [..,...:.;.."",,~. "','J."-'j"'"'''' ','-, " ,,;,'" ,.,'~..-' .....,. :.J' ..~. ?i1:l",. .'->, -, ~,"""...'.,! IN RE: TINA ARNOLD, A Minor, By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs : IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA . . AMICABLE ACTION NO. 94-2633 CIVIL TERM v. TIMOTHY LEE PIERCE, Defendant : ,ok ORD~ AND NOW, this l-L- day of cons'der,"on of .h. supp'...n..;p.., n for , 1994, upon Approval of Minor Plaintiff's compromised Settlement and Distribution of Proceeds, is hereby ORDERED and DECREED that permission is GRANTED for the withdrawal of $7,300.00 for the purchase of a car from the restricted minor's trust account which has been set up a Mellon Bank. BY THE COURT: J. pu. h\ l'l 11 L~ ~{~ IN RE: TINA ARNOLD, A Minor, : By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs : IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA . . AMICABLE ACTION NO. 94-2633 CIVIL TERM v. TIMOTHY LEE PIERCE, Defendant . . SUPPLEMENTAL PETITION FOR APPROVAL OF MINOR PLAINTIFF'S COMPROMISED SETTLEMENT AND DISTRIBUTION OF PROCEEDS The Supplemental Petition of Tina Arnold, a Minor, by Percy Arnold and Mary Fornwalt, her parents and natural guardians, respectfully represents: 1. The Petitioners had previously filed a Petition for Approval of the Minor's compromised Settlement with this Court on May 18, 1994 and a Supplemental Petition for Court Approval on July 8, 1994. 2. The Court of Common Pleas of Cumberland County, pursuant to Orders signed by the Honorable George E. Hoffer, dated May 19, 1994 and July 12, 1994, approved the settlement, providing that: $5,400.00 be paid to Angina & Rovner, P.C. for fees and expenses; $2,068.01 be allocated for the purchase of a computer; $300.00 per month be permitted to be withdrawn by the minor Plaintiff; $1,200.00 be paid to the minor Plaintiff to pay for a class trip to Disney World; and the remainder of the money totaling $11,031.99 be 49227/DHR placed in an interest-bearing Federally insured account, pursuant to Pa. R.C.P. 2039. A copy of the Court's Orders are attached hereto as Exhibit "A" and "B" respectively. 3. As part of the previous Petition, Petitioners had requested the Court to approve the purchase of an automobile with proceeds from the settlement fund, specifically $7,300.00 to purchase a 1990 Geo Prism from Forbes Chevrolet. 4. The Court, at the time of signing the original Order and at the time of the hearing on July 11, 1994, indicated that once the minor Plaintiff Tina Arnold obtained her license, the Court would consider approving the money to purchase a car from the proceeds of the settlement. 5. On July 15, 1994, the minor Plaintiff Tina Arnold took the driver's portion of the examination, which was the final portion of the examination which she had to complete before obtaining a driver's license, and at that time, she passed the examination. A copy of the driver's license, stamped passed and approved, is attached hereto as Exhibit "C". 6. Petitioners have checked with Forbes Chevrolet and was advised that the 1990 Geo Prism which they had previously selected has since been sold, however, a comparably equipped and priced car is available, and Petitioners are now again requesting the Court to approve the purchase of a car for the minor Plaintiff in the amount of $7,300.00. il I I MAY.la i8~'t 'oY '. . . " r IN RE: TINA ARNOLD, A Minor, : By and Through Her Parents and : Natural Guardians, PERCY ARNOLD,: and MARY M. FORNWALT, : Plaintiffs : IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA AMICABLE ACTION NO. c)i/ -,;}G,3.3 W ~ v. TIMOTHY LEE PIERCE, Defendant ORDER AND NOW, this /9 J;i.. day of '""7?'d ' 1994, upon consideration of the Petition for Approval of Minor ; Plaintiff's Compromised Settlement and Distribution of Proceeds, it is hereby ORDERED and DECREED that the Petition is granted and payment of the $20,000.00 due to the minor Plaintiff Tina Arnold is directed to be made as follows: (1) $5,400.00 paid to Angino & Rovner, P.C. for attorney's fees and expenses; (2) $2,068.01 for the Shack; ! ~.t.\o\-(~. purchase of a computer from Radio rtu.. cl:l3se __ of A,A1"" frCllll . F~ a (4) .......xt:i.......Q.c......>- oi$/.J,s3/.'11 .:;......~ The remainder totaling $5,131.33 to be deposited ~B aR a- 't~....), __.J by tlh~ Stllu11 uS with the restriction that ll._ &RR',i<sy se _..L ~~ ail a 'II_Ill!., C.l;,a. no withdrawals could be made f'!E'QlII tin. ___1"-./ until after the minor Plaintiff Tina Arnold turns age 18, except as authorized by the Court. BY THE COURT: TRUE COpy FROM REC0RD In Tcst:mony \'.h:r:of, I hEro u~to ~t my hand and the seal of said Court ilt Carlisle, Pa. 45652/DJhiS ...I..9..~.. day of..l:h.~...l.. 19..9..~ ..............~....Q..,..:e~..._ ~ Prothonotary /oS/ ~~, ).kf~ J. .. !>', 1>- . .a....,.. .' ..' ~:,~ .'/ 's..,..;..,.,., . ,".,; Q:..., '. '"'''j-''' .-. ~~:.~~-~ ~"'>-"" . .;....,..,..~:"~- . ~-' ......;...:-.:-..;..~....-=,.._....t.....:~~---- ,- .J......... . ~..-........ ~ ,'. . i,to .. ,..... <,-",....' ,',0 ,:-... ". ~' ,'......,..(..J.....r,..!- A .~~.;" . ,.".' '.;, "" ~~'," ..'~ . I. " ~~.J. ".i"~l. )0 ,"'_ """ ......~'~._,. ',-' . . , :..... ....;..-... :.:{iii,::.' r~.,.,~::;{':~~..f:Z.",":.:[ . ....... .~ ~.'~~)... ':'"~ . :.:.' '.~ ..~.. .' .."...... '~':~';~;.~~.~;:~?::' .~ .' ":''-.' .:.' .'! ..> -,.'~ . - .... .~. . \ . .... ',' .:.:.;,...~:5.,;:~~.;:;""..,..~.:;.::.:. .::~~.:'~~:, )::' ,,'..' ,,,....;,..../.:... :" ....8!.:t........,~.s.,,~.. ~..~ ..r.;{:;.J~V:?J;;;j{'$:"-:&1 . . .(...,....... '~'r .,.... -.-..y;,:; ~~ '" ~-:1 ...,........ . ....-...... ".. ii(, ,-". .~.. ...'"_.~':......:..~ ~f:,.....,..",,-" .-.......:". :,;:oz..,;... ....;..;-~,'-": , ~ '':.. '-. "- -'. ....~' .;" '. : :. . ,./".' .. .' . ' ',. .. .' ." ,....'.:--. : )p~~~:f~~~~~~.~ .. .'.... ". ~"; ....5"..~;:~~~1>~U~~~56:'7.~{~'it;r.r~;,;;~~~~M.. . "'. '. ." ';'." ":,,'~'_" ".'''' ..,...~~.;j..,..::~ r~,i:...~ .':.' .,.,',.. -. ~.. ."'. '. -:~..: . , .. ~~':'. . ..... ...... . .' - ... ..~....;.~!4~;:;... .... ...:-;...... .., .,',;'; , ..... ""I ~ ,. T')tP) ~J; (e.. Dale ~-~ ~~~~ ~.' "~-, - ,..-y' , ...... ~ I .\ a. ,~ ~ CJJI'f · -_-."l;'" , , ~ " .... ';". ,''':''',,' ,/.'~"'.:...:.::,1..~.. ,.--<'r.' ,.,,':,,'.'~.:L._',1.~. :'" '-'.-1'" .,....- !.. .(". ,<"p~"" ~. ....... ~ --..,~. -... " : ~. -, 'I: 't-.' '" ,....-'.t..: , . .. ~ " ....':..-:.'\o....1Jf '.. -~..,I, ...-....,' .....~:....../(,...., . .-<; \.. ,~~~f~1~:~'1-~,~ . ~ - "" .~ .. ., ...-,....". _,. .. ~..:--'~'~.::~:<~:~~.~.~,i~.;.1-',~ . ',.,,~.~~~' ;~t; '.;;...- " ~ I . , ':!~:,,?' :...... "';~ ; ,,~. .~;. , ~ ".":c'; , _d' . ....". '<;." ," . ~ .1",1.. ...... - From the desk of GEORGE E. HOFFER Judge .~,:.;. wJA Gl: ';'" 'H' ~'7': ;\, ".1, ~," '- ." -.. "-';- ... _,~.H . :,l!'~ '~'. , .'~ " :.r:. ~.:' .._of... ,1'.;':: ,...,..:'-'.....-,....... . -I' ",~".,... . -~.. .. :.~':~,-.~+.~.,~.~.~~;<. -- iYffi5;J!~(,??:~. - ..t.'.~,.-...~. ' . .,~ ..._"~;~2r..:". <-, '. :.t .; ''':'ii.~ ~~.:~ .-:;.... ~i:-, ..;~~,; '.' ~ ';' -: ! ".>., . .' "'-".,,:, hr'" '. " ., ,- I IN RE: TINA ARNOLD, A Minor, By and Through Her Parents and Natural GUlirdians, PERCY ARNOLD,: and I~Y M. FORNWALT, Plaintiffs IN THE COURT OF ~OMMON PLEAS, CUMBERLAND COmITY, PENNSYLVANIA AMICABLE ACTION v. NO. 94-2633 CIVIL TERM TIMOTHY LEE PIERCE, Defendant AND NOW, this , ~L1'-\ o R D E R day of July, 1994, upon consideration , I I j' i I of the Supplemental Petition for Approval of Minor Plaintiff's Compromised Settlement and Distribution of Proceeds, it is hereby ORDERED and DECREED that the Petition is granted and payment of the fund due to the minor Plaintiff Tina Arnold set forth in the Court's Order of May 19, 1994 is hereby directed to be made as follows: $300.00"~o be paid to the minor basis until she turns age 18 clothing and other necessities; (2) $1,200~00 to be paid to the minor Plaintiff to pay for a class trip to Disney World; and (1) Plaintiff on a monthly (eighteen) to purchase (3) The remainder totaling to be deposited in a minor's trust account established with the restriction that no withdrawals can be made until after the .~nor Plaintiff Tina Arnold turns age 18, except. as aut~~ized by the Court. ~ , c..., -.... c-..' TRUE COPY FROM RECORD In T a..'1imoll't wtl.;raol. I h:!ra lint" set my hand and tho 3...".11 at said Court at Colrll~. Pa. Thin 1.3 -;;t; d:1!.,!:!A" _ 19 91/ . ~"iJlfl.. ,.{"- . _.. '. . _'. . Prothonotary ._ n ..... - ...-.- ---.. J. . ;. ",. , .:::....: ~.. . . . . ..... ';. ,>~~ij~;<~~~~:/:, '-;~.,:.;;.<:::':~.. ;~\:,'j':, :,. "'>;.: '. ,', : ;:).::.~:~.~:;..~~\~i;4':f~":.~i;il~i'~~~.~;:::;::1~:ji\ ;t'....~ l"~~~',""~~.~-If.. -.~~tlo~"'~'.~....r:..."_",.....,s,,. ..''''i~:\''':''\. ''';-;' ".~l;..:l"_)' t:....')r,~-....~ . ,".. .~:.~-:''''''':'"':'"''_~:~''':'~~'^t..lJ;~~,..j ~~~'" .. ~..-.' h, '.~,-.~.. 'oIY~wy.~4.-A..-..........t.,'.., '~'.. _ ._.:-.". " ..-........ .-. ''''-'.'''/-' ........,.........v...'....;.. .......~.o:':.-:;;:;""-.:z:~. .~':. ll".-......-.I r"....-"....,~..,.r,pro.:. ~'1r'P"G";.""",,,,,-,, 'J", '.., ....'._'.'.!.~....... __"M:"....."......,. .__"--.... ..... ....., ........ ."...... 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TINA M ARNOLD ,104 WAYNE AVENUE IENOLA PA 17025 /m:% ... ~/-::"0--0:2~mr 94182-8210-00697-3-001 SEE REVERSE FOR INSTRUCTIONS , CHll,l"ll USE ONLY .----~;;~.::.-li~5r.~~S~(nC U~f C'.l'" '''IlUllES PASS. I EXAM TYPE ;, ; DRIVER EXAM 00 0: :0: '~U~.-L5~.~LlCARL1SLi!L .J::/J]r;J 0_0' .~ - - ____.____--.1) 0 0 0 n 0 0: i.Qj :00 Oi :01 ....... 000' loi o 0 0: 'IT 000 0 " , ....-.,--.-- . .. '; . ~"'.. . '. p.. ........ '-.-...~.... . ::'~:~":~..~_:"'~':'~-;;"~~~~~G~9~:;';~r.?-~;.:'~-":;j_'-:_; . ....,;~':fo. --. ,'. "~~~'''',' ~~....~ ..:*:-.....;::: .J". .'-. . .,..:' .._......~. "'.-Ir..-.',-- ..~_ ._.... ' ..:~.r-.:~.;~S:c .,.~-_.,u~-__.~.;' ~~_...... ~:~.. .' '.' 1~~'~"~.'...~';,;:;;':";';~'I."'4\"'~'I~'';:'''''"':~~..I'''''-i:ii:~'' ....... .~,.,.~...\;.. .,.-_.,..~v...~.iW~""~~""""~'":~':"'!"~""'- ,.......,..,..,....~. - _'II . .. _.. ..' '..;:".' . _. ",....;J;.f) ~...,....". ..~......._ A..............1;.C. . :'.::0=' .A' "'-..,.:::...~~~ . ..,..J r.; 'cJe ~.t:~-~.;:... ,.~.... . 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