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JUDGMENT NOTE /7(1,.1;) I' Y ~":; y'
~..i-w'~_ , Pennsylvania, r 7, /'?.J. ,$ ~ lJ-78.. p..p
(pl~ (date) (amount)
FOR VALUE RECEIVED, I/we promise to pay to the order of ~
~ C~
the sum of t14U ..7tt~~ ~ ~~.A~ ~.Arollars,
.J'I I..t I" "I", _ r 101l II If AAAI/I" frQ'" !. .. :, said sum to be payable as
y -~ V. ~. '-
follows: ,:we'9' 7',U"'f: d .......,,'...' --. dollars, ($.2S;~
on the _~ ..,f day of ()F!-~Z 197.2. and
T~. ~~(,F'" d- ~ ---- dOllar.s,..~$.:.ls" DO)
on theY~- day of each and every .............--...rA /1 .
r<.R.~ ~ <-;j I, ~7<'?, ~~ ~_ R 04'''
thereafter until the
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on which date the entire balance of the principal then unpaid shall become due and payable.
UPON FAILURE to make any payments as herein agreed, this note shall, at the option of
Its holder, become Immediately due and payable, without demand or notice.
AND FURTHER, IIwe do hereby authorize and empower the Prothonotary or any attorney
of any Court of Record of Pennsylvania or elsewhere, to appear for and confess judgment
for the sum due and payable hereon. with or without declaration, with costs of suit, release
of error.s~ without stay of execution; and also waive the right of Inquisition on any real
estate that may be levied upon to collect this note; and do hereby voluntarily condemn
the same and authorize the Prothonotary to enter said VOluntary condemnation upon any
Fieri Facias that may be Issued to coilect said judgment; and further agree that said estate
may be sold on a Fieri Facias, and do hereby waive and release all relief from any and
all appraisement, stay of execution, exemption or bankruptcy laws of this or any other
state now In force or hereafter to be passed.
Gm.y 9. .j~#~
(L.S.)
This note Is given and executed without duress or coercion and with full and complete
understanding that upon failure to make payment as agreed, that my operating privileges
may be suspended.
Further, I Q9 hereby acknSlwledge that the damages incurred In the accident of
~ ~ , 19 7/ for which this note Is given resulted from my negligence
an(! fl.lult, and I do hereby acknowledge and waive my right to any hearing or trial on that
issue.
ORIVER OA TE OF BIRTH /.) -[ 7 - 7~)
ORIVER OPERATOR NUMBER;) d (fJ) tj U I
OWNER DATE OF BIRTH l,j' t I ,/ d
I ) (1 '\ ,::)..- 1.11 '.\
OWNER OPERATOR NUMBER 0 ~ ..I v
O'hL'!J rf 4<:tZU{f{;(i~.)
(L.S.)
..:AI.L,. r"'~'~~"AlI: 4-
rJ \.: I i~,..., J..J' l. fI'1~I.J, )./. / Ie) )-{'
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A",y :1, S'i,.....AlIlt.d)4..t....
.51. f.r1."" SH......
(",..,,'...,_. r~. ,1~'.J
RAY A NELL, Ale
VI"J nltGld"l1ll1nd BrW1r.h Cllllm~ MonIlQIr
ERIE INSURANCE GROUP
ERIE.
Branch OlllctJ . 4!}Ollr)UIS~1 Or . H06';olr1oVnu B~sitlt)ti6 Cenl"r J PO, 80)( 2013 . MuchBnlcl!oburg, PA 17060..0710
(717)796-9200' ToU Frelo'Fm!T1 Pt/flntiyIVl.tflluOnly 1"000-382-1304 I Fu)l. (717) 796.2316
eu.berland County Prothonotary
Cuaberland County Court Houae
I Courthou.e Square
Carliale, PA 17013
1-3-95
Our cu.. No. : 000170227454
Our In.urad: Tina Myers
Da te of Loss: 6-4-91
Defend.nt: /wy Schwartzbauer
No. & Term: 94-6155
Dear Sir:
I certify that the above-captioned judgment i. a, a re.ult of a ~tor
vebicle accident.
Sincerely,
~-a~
Deb Jacobs
Subro,ation Specialiat
. DJ/jlp
rrie' ERIE Is All'we Allin SERVICF:. . Silica 192',
000170227454 DJ
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In the Court of Common Pleas of
Cumberland County, Pennsylvania
...."."'y._~.~.IlUU.z.\l.llY.l! r.. .__ou '.'-/S.<'- ..--
..,
J d . I I PI' ", Jan.uarv 9, 1992
u gment an Q"or 0 alnu on H....~uu{.._....n_.._
1478.44
........._._.___..____..__...... lor $........
No __~~::(>J5~ ctvi L...____..__ Term, 19~.~___
EnLmd _q':'_t.'!~~.~.E,_.________...._..___ 19..~~__
._._.. .....li.t i,. . I Mllr.ll.lJ''l_ .C9J1lR.nx _ __._. _ _.. __...... ........ .'..n..n....... __ ___ _.... un" Plalntifl
in the abo\'~ Judgm(,:nl, do .lplJl"ar and i&cknowl~dse that
this d:1Y ha'..e had and received mnd
Irolll ... _.._ _ _ ~!'!r __~~~)i,~ ~_t.~ !>!'X'!!_. ___ __..... _. __ _ _ ___. ._.. .___.._. _. __. "n_ __ _n._ _. _.. _ _..... "_n..
the de:~ndJnt in the Olbovc Jud!;a:':nt, full pi\yment and ~,ab(:lcdon of the S:lr.le. with interest and casu, and de.ired thot
aadslaction I.herdorc sha.lI be entered upon the records thereof.
do hmby ,uthorl" >od empow.. ______~~.!.t.!.~,.~;._~,~!'_~...._.,........n._..nn_
And lurther, 1
rneProthonotJry of solid Court, to appear ...fAt__lD.A..........nun___............n___........__......._
.nd in my
n3me and m,d to en"r lull ,awlaction upon the record 01 ,aid Judgment, as fully and effeclually, to all
intents and purpose'J ilS I
could were
1 personally pre'enl in porson 10 do '0. And for '0 doing thil "'aU be
your lulfkit.mt warrant or authority.
10 lalimooy wheroof,
haH hereunto set our hands and seals this _____}_!..9_!..uu......u_..__u.......____
day of ....___-!!1,!.L.._._....m...............m..' A.D, ".3.QP,IYt_. f)
.'-'-'1Iie.v~t\:l: er-"-
.1la.Lr.i ..bu.r~_Ar.Ao..ch._.c.l
. __.. iStal)
.KOA' gINal)
SlalO of Pennsylvaaia
County 01 Cumberland,
}
.. .oo..._._.. ___ n.__ 'n. ._.. noo _ _.. ____.. n_ (Stal)
Personally appeared beforo me, tho .ubscribcr, .....__.S.t~y.'!!'._.~~..!I.~t~l.'!.r___.......... .._._._....n_...
..._-..__._...._--..__............._--_...._~--.._---~_..__.........._--_..-.._--..~...._...._---......-..-.._-_...._-..............._-..-......-..--_..-
..----.....-....--------........--------.....--........-..-......-....---..---......-----........--..................----..........----
'_n.._.__.._ _.. _.n_...__......... .___oo.. .__..n.n _ _.___...._u __.. ..______ n___.__._ tho Plaintiff in tho
abov~ Judrm.n., and in due fonn 01 law acknowltd.od tha within and loregoing Power of A'lornoy 10 ,awly the Judg.
nlont '0' forth, 10 be a n act and deed, and d.,i"d that th~ '''.Ie ,11,11 be filod of record in tho offico 01 tho Prothon.
obry of the Courl 01 Common Plea, 0' .aid County.
I
In ,uIlmony whereol,l hovo hereunto '01 my h,nd and ,eal thi, u___..,'II_L__.u_____.___.___...._ .__.
day ol_....___._,!.\!J.L_.__u_____..______....____. A. D zr}~ '. :ul,L..
-----....--- ______.__eIOT IJ.l.S __._____ Sui,
r,l\ TFliCI.i\ J ~H0h~I~l.O, j\infltry PubUc
. . _ . . _ _ . . _ _.. M~rJAJ'~ ~~r~w..~.qar9". .9JJm~~rJ~ ~,~ntY
Mv COrr1l11t~,rlJ' I "'-'PIlGS ncll'J~ 31. 2COS
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CUM8U(L,,:',tJ cCUNlY
PENNSYLVANIA
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