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HomeMy WebLinkAbout95-00766 ,c. ..J.. ....'" - - en , . , . '~ " ; ".'" ,... t ~. F- a ~-,,,.,, ~. ..!3J ~ \ ~) . ," DAVID CAMPBELL, plaintiff IN THE COURT OF COMMON PLEAS OF v, CUMBERLAND COUNTY, PENNSYLVANIA NO. 95-766 CIVIL TERM BILL'S WELDING, and LARRY RUNK Defendant To: Bill's Welding Date of Notice: March 9, 1995 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO TAKE ACTION REQUIRED OF YOU IN THIS CASE, UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP: COURT ADMINISTRATOR, 4TH FLOOR CUMBERLAND COUNTY COURTHOUSE CARLISLE, PENNSYLVANIA 17013 TELEPHONE NUMBER: (717) 240-6200 ~k( 11,. bel~-8.... Ja Muller-Peterson Attorney for Plaintiff Legal services, Inc. a Irvine Row carlisle, PA 17013 (717) 243-9400 DAVID CAMPBELL, Plaintiff IN THE COURT OF COMMON PLEAS OF v. CUMBERLAND COUNTY, PENNSYLVANIA NO, 95-766 CIVIL TERM BILL'S WELDING, and LARRY RUNK Defendant PROOF OF SERVICE I hereby certify that I am this 9th day of March, 1995, serving a true copy of the foregoing written notice of intention to file a praecipe for entry of default judgment upon the person and in the manner indicated below: Service by first class mail addressed as follows: Date ':1Jj AA-dL.. '1 I qtu;- I Bill's Welding 254 East North Street Carlisle, PA 17013 ~1~Qzu;....V"\- Ja Muller-Peterson Attorney for Plaintiff Legal Services, Inc. a Irvine Row Carlisle, Pa 17013 (717) 243-9400 ~ -- .- .' - ~:-: ,:"1, '/."'::;;.- '.~ ,.., ~ -. ~~ .' Cl 1 o >n . , ~ ~ ~ :.:.: ,- . j \ ~j;;; ;......... en 0= d = ,-, DAVID CAMPBELL, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTV, PENNSVLVANIA NO. 95-766 CIVIL TERM v. BILL'S WELDING, and LARRV RUNK Defendant To: Larry Runk Date of Notice: March 9, 1995 IMPORTANT NOTICE yOU ARE IN DEFAULT BECAUSE VOU HAVE FAILED TO TAKE ACTION REQUIRED OF YOU IN THIS CASE. UNLESS VOU ACT WITHIN TEN DAVS FROM THE DATE OF THIS NOTICE, A JUDGMENT MAY BE ENTERED AGAINST VOU WITHOUT A HEARING AND YOU MAY LOSE VOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE, IF VOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP: COURT ADMINISTRATOR, 4TH FLOOR CUMBERLAND COUNTY COURTHOUSE CARLISLE, PENNSYLVANIA 17013 TELEPHONE NUMBER: (717) 240-6200 .Jill ' J1,..oO..;J?~- Ja Muller-Peterson Attorney for Plaintiff Legal Services, Inc. a Irvine Row Carlisle, PA 17013 (717) 243-9400 " ~, .:. ';" " :.,,', '!:' ,.', ' ,..:. . .., ..... . .." . . C//.~. r~ '.. DAVID CAMPBELL, Plaintiff v. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 95-766 CIVIL TERM BILL'S WELDING, and LARRY RUNK Defendant PROOF OF SERVIC~ I hereby c~rtify that I am this 9th day of March, 1995, serving a true copy of the foregoing written notice of intention to file a praecipe for entry of default judgment upon the person and in the manner indicated below: Service by first class mail addressed as follows: Date 'tt-l,t.L~-l...... q . /(,'i,r , Larry Runk 254 East North Street Carlisle, PA 17013 ~~lt,c.Q~h_-(]~"""" ~e Muller-Peterson Attorney for Plaintiff Legal Services, Inc, 8 Irvine Row Carlisle, Pa 17013 (717) 243-9400 " L/") l:" E o Ln - en l>: ~ )- >- ~r ~ ;:;r 011.;':"'" ~~ ~ .~ :~7 ...-. ...>"- ~.) .'- ,lJ; '1' .r j<jl....:,r ,'jt.., ;: :!:..... lI.Z? ~, ;l , . DAVID CAMPBELL Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA Y. BILL'S WELDING, AND LARRY RUNK, Defendants 95-766 CIVIL TERM PRAECIPE TO EN'\'ER AN APPEARANCE TO: Lawrence E, Welker, Prothonotary Please enter my appearance on behalf orthe Defendants In this case. Date: March 24th, 1995 Respectfully Submitted, BY: CERTIFICATE OF SERVICE I, Marcus A. McKnight, III, Esquire, do hereby certify that I have served a true and correct copy of my entry of appearance in this case upon the Plaintiff by First Class United States Mail, postage prepaid in Carlisle, Pennsylvania, upon the following: Jane Muller-Petterson, Esquire LEGAL SERVICES, INC. 8 Irvine Row Carlisle, PA 17013 Attorn 'Y for the Plaintiff David Campbell March 24th, 1995 , , "~. r l.r> !?> ,','1"\' 1;!(}:~ .'Ii,1d '~j-t}i rq :(, ;"t' i! .,j l\ ., " ~, .1".... . .. I '.~' ,::.:: - ,~. . ("...Li ..., ,q . ",' ~..~ -. C<1 '" ., :::: .... ~.~' ""-I Il . I'l '". l~ . . ,~ "I> ~ ~ ~ i ~!i III . , . '~ ~~ :~ ell>< u~ ~~ ~'. ,~.I ti l' .J .~, ~ " . e 't lr~a~ :: . ~. ~~ ~~~~t. ~~()). J ~J ,U;; . . f ...l . ' '. ' ..,. ,~. S !j; .' ' ,,; r'" .f: >' .,' ~' " '..' , .'.,.' , Ii " , , . <~,..1jl'-W ~~~'j!.-\Ti~~ DAVID CAMPBELL, Plaintiff v, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO, 95- 7/.!.tl' CIVIL TERM BILL'S WELDING, and LARRY RUNK Defendant MQl!Q.!.;, You have been sued in court. If you wish to defend against the claims set forth in the fOllowing pages, you must take action within twenty (20) days after this Complaint and Notice are served, -by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you, and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the plaintiff, You may lose money or property or other rights important to you, YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. COURT ADMINISTRATOR, 4TH FLOOR CUMBERLAND COUNTY COURTHOUSE CARLISLE, PENNSYLVANIA 17013 TELEPHONE NUMBER: (717) 240-6200 DAVID CAMPBELL, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 95- 7 leL, CIVIL TERM v. BILL'S WELDING, and LARRY RUNK Defendant COMPLAINT Plaintiff David Campbell sets forth his complaint as follows: PARTIES 1. Plaintiff David Campbell is an individual residing in the single Room Occupancy Program at Safe Harbour, 102 W. High street, Room 216, Carlisle, Cumberland county, Pennsylvania, 17013. 2. Plaintiff was in the Harrisburg School District's special education program from 1955 to 1966. 3. Plaintiff is the owner of a 1973 Dodge van, 4. Defendant Bill's Welding is a company whose principal place of business is at 254 East North street, carliSle, Cumberland County, Pennsylvania, 17013. 5. Defendant Larry Runk is the owner of Bill's Welding and directed, controlled and participated in the activities of Defendant Bill's Welding described below. COUNT I FRAUD 6, On or about September 20, 1993, at Plaintiff's request, Defendant Bill's Welding towed Plaintiff's 1973 Dodge van to 254 East North street in carlisle, Pennsylvania, to install a motor provided by Plaintiff. See a copy of the towing bill attached hereto as Exhibit "A" and incorporated herein by reference. 7. Defendants did not provide Plaintiff with an estimate of repairs before beginning the motor work, B. On or about october 25, 1993, Plaintiff began making payments to Defendant Larry Runk towards motor work which was not completed at that time. 9. Without obtaining plaintiff's authorization, Defendants put a different motor into the van, not the one provided by Plaintiff, and told Plaintiff the charge for the motor was $600.00. 10. On a later invoice, that same motor was listed as costing $900.00. See copy of the invoice dated December 20, 1993, attached hereto as Exhibit "B" and incorporated herein by reference. 11. As of about July 29, 1994, Plaintiff had paid Defendants $l,OBO.OO. See copy of receipts attached hereto as Exhibit "c" and incorporated herein by reference. 12. On an invoice dated December 20, 1993, attached as Exhibit "B," but including work done through August 1994, Defendant Larry Runk indicated that Plaintiff paid only $1,000.00 knowing this to be untrue and intending that Plaintiff rely on it to his detriment. 13. From September 1993 to october 1994, Defendant Larry Runk periodicallY showed Plaintiff invoices for used parts and labor but failed to provide Plaintiff with a copy of any repair invoice despite repeated requests by Plaintiff. 14. Plaintiff believes and therefore avers that prices were changed from the original invoices shown to him to the invoices later given to him, Defendants intended to deceive plaintiff, and intended in each instance when a price was shown him, to have him rely on its accuracy to his detriment. 15. In or around mid-August 1994, Plaintiff applied for a $1,000.00 loan with PNC Bank. Plaintiff indicated to Ms. Beth Ann Eppley, an employee of PNC Bank, that he needed the money to fix his van, 16. Since Ms, Eppley did not wish to finance only a portion of the van repairs, upon learning from Plaintiff that the " $1,000.00 was for certain specified repairs such as tires, Ms. Eppley telephoned Defendant Larry Runk and asked him to verify the final payoff amount necessary to completely repair the van. 17. The following day, Defendant Larry Runk telephoned Ms. Eppley and informed her that the cost of completely fixing the van would be around $3,500.00. 18. On or about August 22, 1994, Ms. Eppley issued a check payable to Defendant Bill's Welding in the amount of $3,516.38, See a copy of the receipt attached hereto as Exhibit "0" and incorporated herein by reference. . . '~" .. ....e. . . , .' . _ _, .-_ " , ,. ~---#'- -~~~..... ..-.-........,...- ~ ' " , ' -,.-___=,..-. r....' ~ , ,. . , '. . ' 19. Plaintiff took the check to Defendant Bill's Welding, 20, Defendant Larry Runk indicated on Plaintiff's invoice dated December 20, 1993, attached as Exhibit "B," that only $3,316.38 had been paid, knowing this to be untrue and intending that plaintiff rely on it to his detriment. 21. In or around the end of August 1994, Plaintiff went to Defendant Bill's Welding to pick up his van at which time Defendant Larry Runk informed Plaintiff that the van could not be driven because it could not pass state inspection. 22. Defendant Larry Runk informed plaintiff that the repairs, including tires, needed to enable the van to pass state inspection would cost an additional $2,200.00. 23, Plaintiff did not authorize any further repairs. 24. Plaintiff applied for a second loan with PNC Bank and was denied. Believing that Plaintiff had been taken advantage of by Defendants, Ms, Eppley suggested to Plaintiff that he seek legal help. 25, As of october 11, 1994, Defendant Bill's Welding had not given Plaintiff an invoice for any repairs, 26. on or about October 11, 1994, a representative of Legal services, Inc. telephoned Defendant Larry Runk and requested a copy of all repair invoices. 27, Defendant Larry Runk said he would not be able to provide a copy of any repair invoices until on or about october 12, 1994, at which time plaintiff could pick up a copy, 28. On or about October 12, 1994, as agreed, Plaintiff went to Defendant Bill's Welding to obtain a copy of the repair invoices, but no one was there, 29. On or about October 13, 1994, a representative from Legal Services, Inc. accompanied Plaintiff to Defendant Bill's Welding's place of business where they obtained a copy of the repair invoice dated December 20, 1993, attached as Exhibit "B." 30. plaintiff's van is no longer on the property of Defendant Bill's Welding, and plaintiff does not know where it is. 31. plaintiff has been damaged in the amount of all sums expended toward the repair of the van. 32. Defendants' acts of crediting Plaintiff's account for less than the amounts he paid, arbitrarily increasing the prices of items on invoices, withholding repair invoices from Plaintiff, and insisting that Plaintiff pay an additional $2,200.00 in repairs before the van could be driven after assuring plaintiff and a bank employee that the van would be fixed for the amount of the bank loan were outrageous and demonstrate Defendants' evil motive or reckless indifference to Plaintiff's rights. COUNT II UNCONSCIONABILITY 33. Plaintiff repeats and incorporates by reference all of the preceding averments in this complaint. 34. Defendants charged Plaintiff excessive prices for used parts and labor without regard for actual costs incurred for parts or the amount of labor expended. a. The market value of the motor for which Plaintiff was charged $900,00 is $250.000, b. Defendants charged Plaintiff twice for a battery tray. See invoice dated December 20, 1993, attached as Exhibit "B" and invoice dated October 28, 1994, attached as Exhibit "E" and incorporated herein by reference, 35, Defendants charged Plaintiff for parts not provided and labor not performed. 36. Defendants have taken $4,686,48 from Plaintiff and have not given Plaintiff a van in drivable condition. COUNT I II VIOLATIONS OF THE UNFAIR TRADE PRACTICES AND CONSUMER PROTECTION LAW 37, Plaintiff repeats and incorporates by reference all of the preceding averments in this complaint, 38. Defendant Bill'S Welding is engaged in "trade or commerce" as defined by the Unfair Trade Practices and consumer Protection Law, 73 P,S. 5201-1 et sea. 39. Defendant Bill's Welding is a repair shop as defined in the regulations governing Automotive Industry Trade Practices, 37 Pa. Code 5301.1 et sea" and is subject to those regulations, 40, Defendants have violated the Unfair Trade Practices and Consumer protection Law, 73 P.S. 5201-1 et sea., and the regulations promulgated thereto, by engaging in unfair methods of competition and unfair or deceptive acts or practices in the conduct of trade or commerce, as follows: a. Defendants violated 37 Pa. Code 5301.5(2) in failing to provide an estimate of repairs prior to commencing repairs. b. Defendants violated 37 Pa. Code 5301.5(3) in charging Plaintiff for repairs which were not authorized in writing. c. Defendants violated 37 Pa. Code 5301.5(8) in failing to provide Plaintiff with a written invoice upon completion of the repairs, d, Defendants violated 73 P.S. 5201-3 in showing Plaintiff an invoice and later increasing the prices of an item on that invoice. e. Defendants violated 37 P,S. 5301.5(9) in charging Plaintiff for repairs which had not been performed. f. Defendants violated 73 p,s, 5201-3 in removing Plaintiff's van from 254 East North street, Carlisle, Pennsylvania without Plaintiff's consent and without informing him of the vehicle's whereabouts, DAMAGES WHEREFORE, the plaintiff requests the following relief: 1. On Count I, Fraud, actual damages in the amount of $4,686.48 plus punitive or exemplary damages. 2. On Count II, Unconscionability, actual damages in the amount of $4,686.48, I I I , , ,1 , 3. On Count III, violations of the Unfair Trade Practice and Consumer protection Law, $4,686.48 trebled pursuant to 73 P,S. 5201-9.2, making the total $14,059.44, plus reasonable attorney's fees. 4. Such other and further relief as this Court may deem reasonable and just, Respectfully submitted, o.L- L..J!~ -.Q l.~ Jan Muller-Peterson Attorney for Plaintiff LEGAL SERVICES, INC. 8 Irvine Row Carlisle, PA 17013 (717) 243-9400 ,. The above-named Plaintiff, David Campbell, verifies that the statements made in the above Complaint are true and correct. Plaintiff understands that false statements herein are made subject to the penalties of 18 Pa, C.S. S4904, relating to unsworn falsification to authorities. Date: d- -IO-9S- ~(h'-~O J ~~ Q-~" fkfQ David Campbell, PI intiff 8Hur No, OF -Hlns ESTIMATE OF REPAIRS ..u. ~ \~ ~l'/"I J\-- 0 I ~ ./3.....\\rv\np I~ ~.I~I ~ I /oCDIIlIUI I LleIH.. HU".'" ""LUOr. -'''O'ON NO. ~~a.o-q3- .r."tAL NO. I I IHIUI'lID IV ~DJUITU ,HI,.ICTO" .....OHI HO'" aUI'I'Hr.. OlY, DESCRIPTION OF REP"IRS AHO REPLACEMENTI' PARTS NUMDEn "'MOUNT LAnON AMOUNT "AINT AMOUNT TOTAL AMOUNT \o~'''''\'''''' \J .... lY'.Y'I ) --- "- <'\\AH) . I, f' l\~tl ({D,lllJ ... ~ I ...D "2 G -AI ,oJ ~ ^ vc. ;:::,!!. -' \.../ - --- tAX ~~~ 5(0 INSURED MYS I INS. CHECK PAy"m TO INS, CO. PAY. R. O. No_ TOTALS h .~ I. U 1,lImlt" baled ell CUlt IUllldio" 8IId dOl' not rover addltlollll plrh or labor dlldl "'II., bt Nqltl"d . t., 'h, ,,"01' I..t bnll .I.ned. All" wel. hu ."rted, Ill' worn, brdu or dlm,qed Plrt' ..hie" If' dlICowr.d 'lid .,.. not ,,,id,nt 0" fi,.. IIH~Clio". .. 'I"I'VI 11'11 tlOht 10 ,ni.1 'hi. ,lIim", by proaf. '.uu.. 01 ftlll th ,bo.,. print are not Qlllfllllltdb"d .,. 'or l""",dl.t. tcnpl.Kt1 OIIly, All '1110'.11011I 08 pam aad labo, .,. ~,""I 'lid III lief t. d,tQ,. WIlECICU SUYICE STORAGE CHG'S EST"^E- TOTALOF ,... D .0 ESTIMATE :::~z,';~~~~DI=.-9-;;;1I-93 Exhibit "A" '101/0 r- e"llT Ho, or -Uln. 1=\ ESTIMA11: I 'OF REPAIRS , Aol. ' d-Ib. =:., ~)\~ C~~'(-~~\f~ \.\'- .... - , If(~,~.\\\(.\\\ 0-\ ,,( ~(I\I;Jo==iTi - 7.o-'~3 N....'... ~ \CIO 15:2 '~'r.4J '........'0.... .,,,... i , 1100.0. .0, "''',. '0, . 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'" 111 '('t~C) H \~ Re-~'\.' ~"O, lff\S \...u~ l ~..~\S 'Rt.~Qu - "'" n 1\ .\L\(\~\,~,K~~ ~ ""\"\r ri>. \ ~. W' - ,,~, l . '. .e.,~L~ ~ I "....., .i~.D" :.. ~ (',~~ol..\...,It1 _ '=~. .A, ,'ll 1\. \.. ,(?~. '\- \.. eL. ~ ' , ~15 He) ,...". - I( .1 '() rl. RI2 \ L^C"<:t\1,:...~ ~&. ~I\,-==' ,~WO f{, \\\"5C. W~ ~~ ' . i=~, ~- 0 t:A . (_ 'V'. EA. ~p . ___ , I '\.nol \--.0"'"1/ or AA. r~1r ,"^ 'V'\ ~. --k ="-l' ~ f'(' ,- \ T .. "Y) !:l.t ~, r---" 0. 'Y' 4, ~ . -;c.-. OO~ 4-"5 Cb \t:::)G9 i 4.,~ i '~::.---~~ ' I~- \ fl~'~~ ~~ \I~QD "Kloo I ~3Q.~ru 13 ~O I! ---~ _"1 i - I ~ ., ~ "L .l=- /' ,.. ,.....1:... "n....I. .....11..." I.,...c&l,. ..4 ..... ...1 ~..., ,""111...1 p.,h .. I,.,., · MIl(' ..., ~.lt... .f... IN .." .,. ..... ,h,I,4. All" ".f' h. 1''''"'. .., ...... ..,...., '! .. "MM,.II ,.riII ..Id. It. III...,.".. .a4 .,. ... ."Id.., .. Un' I...nll... ... ,.It"" I'. ''':1::.-::-'' .... ........ br ...... ....... ,1111', ,.. ...... .,1,.. .,. H' ,,,,nl,,tI, .... ~. 1,...41... .......,.... ...... "" ...1.11... .. ,..ft_ .... I.... .,. urn" ,.11....,,,. WUC." ''''lel - I . 1 In 05! - I 100 6"- ' -I , INSURED MYS' INS. co. MY~ 'NS, CHECK MYAILE TO ~O./l._ TOTALS . lAll noli.ol't.in ~.,. EST MAD. r, TOT A ~ 0 F . , ISTlI.IATI AlIlIOIlLlnOft nl MAlI. T......~ ~..~' "".... --..""..-...... .,~, SIGNED~~~ ()~.J MI..../'.. /1) -).Y' - ~ I ""'- . ' "xhlhlt "I''' 1.\\ " : JK;l.Q 01 i I . I 9C/ " .' ..I 8! ~ ,.,"""'_ .' DAVID LEE CAMPBELL, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 95- 7f..r,l... CIVIL TERM V. BILL'S WELDING, and LARRY RUNK, Defendants PRAECIPE TO PROCEEP IN FORMA PAYfgB~ To the Prothonotary: Kindly ~llow, DAVID LEE CAMPBELL, Plaintiff, to proceed in forma Qauoeris. I, Jane Muller-Peterson, attorney for the party proceeding in forma RftMQeris, certify that I believe the party is unable to pay the costs and that I am providing free legal services to the party. The party's affidavit showing inability to pay the costs of litigation is attached hereto, --:) - k .cr ,~-C:tc.....~ Ja Muller-Peterson Attorney for Plaintiff LEGAL SERVICES, INC. a Irvine Row Carlisle, PA 17013 (717) 243-9400 DAVID LEE CAMPBELL, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v, NO. 95- CIVIL TERM BILL'S WELDING, and LARRY RUNK, Defendants AFFIDAVIT IN SUPPORT OF PETIJlQtl LOR LEAVE TO PROCEED IN FORMA PAUPERIS 1. I am the plaintiff in the above matter and because of my financial condition am unable to pay the fees and costs of prosecuting, defending, or appealing the action or proceeding. 2, I am unable to obtain funds from anyone, including my family and associates, to pay the costs of litigation, 3. I represent that the information below relating to my ability to pay the fees and costs is true and correct. (a) Name: David Lee Campbell 102 West HiQh Street ,.-AI1t. 216 Carlisle. Pa 17013 social Security Number: 162-36-9623 Address: (b) If you are presentlY employed, state Employer: Western Si~~ler /Embers convention Center Address: __G.arlisle pike_, Carlisle, PA 17013 -~---,------ Salary or wages per month: __~~A~~QO Type of work: -p~shw~she1J~~JUtor - Western Sizzler __DLs_hwa s D_El.L-'=._!:mb_e.l:s If you are presently unemployed, state Date of last employment: _N.9.D!L Salary or wages per month: None Type of work: _ None (c) Other income within the past twelve months Business or profession: None Other self-employment: --HQne Interest: None Dividends: None Pension and annuities: -lLone Social Security benefits: None Support payments: None Disability payments: None Unemployment compensation and supplemental benefits: ___~9ne Workman's compensation: None Public Assistance: None ., Other: None (d) Other contributions to household support (Wife)( Husband) Nama: None If your (husband) (wife) is employed, state Employer: J/A Salary or wages per month: -HLA Type of work: --HLA Contributions from children: ___~ (e) Property owned Cash: _$_Q..,9.!L--______ Checking Account:_$-L~g_ " i I Savings Account:__$~.OO Certificates of Deposit: _N~ Real Estate (including home): NOLLe Motor vehicle: Make __~~gle Year 1983 Cost _$-?9JhQ.0 Amount owed 0.00 Stocks; bonds: None Other: None (f) Debts and obligations Mortgage: None Rent: _~50. OO/mo. Loans: PNC_~$108.00 MonthlY Expenses:_Mont-9oml'!J:Y_W!!rcL...::j18,OO, gas- $60.00 TransnuLssioJLJihop~~t9_~.OO. car insurance - $28.00. -9.uLc_esi...e.1L.::.._$"':~Q-,_OQ,_QJgJ hing-=-$l 0.00. Stor-Mor-$30. 00 AAA - $3. Qo..."s_!!Llis_le_!:!Ql>pi..t..JII - $1.9,..9.0..._ (g) Persons dependent upon you for support (Wife) (Husband) Name: None Chi ldren. if any: Name: ...J'!,9D.lL.___ Age: None 4, I understand that I have a continuing obligation to inform the court of improvement in my financial circumstances which would permit me to pay the costs incurred herein. 5. I verify that the statements made in this affidavit are true and correct, I understand that false statements herein are ~ h ...... . I ~ . t t' 'I I' I" ",:. ... ' '.. ", ~_' '.. , .... .' made sUbject to the penalties of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. Date: d..-/~'Cj5' [)O-.~Q d ~Q Cb..~~.Q..QQ David Campbell, plaintiff I I \, J ,.n \t en (~ (,j Ii' ? , , "' '---J ',." lU ,~