HomeMy WebLinkAbout95-01519
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VS.
~A"~ ~~t'-d
lM~~J :hj,.
Court of Common Pleas
Cumbo Co.
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CIVIL COMPLAINT
COMMONWEALTH OF PENNSYLVANIA
Moglslellal DlsHlcl Number 'Sll-=:--T:::-I52---
OJ Nome: Hon, .........T>... 1'lT'T>t'
Address: .-.-"".. -...
1'.0. 1!OX 5S
!lUlUlIWl, P... 17009
Telepheno No. (71~ 248-2607
,----.. I1J~.';';lliOO-'-'-'
COMPLAINT NUMBER: CYI_4_R4
DATE FILED:, ~
PLAINTIff:
[Nom"
~d'h""
tww10tawn Uoop1ta1
400 IlJ.cblBDd AVltIUII
Lev1!ltown, 1'a. 17ow.
DEfENDANTIS):
VS,
FILING COSTS S
SERVICE COSTS S
J.C,P, S
~~
m
0-1 N;lmll
D^ lE PAID Addross
h"A...n] b"tol tmll
11264 OUerp1ne 5obool lload
JlelIburg, 1'a. 17240
tlIlltl1D :i'tol bas
11261~ OUerp1Do Sohool BoIl4
lifJlIbarrr, Pa. 17240
0.2 rjamo
^ddfoi'l
TOTAL S
90.00
-
TO THE DEFENDANT: The ebove named plaln!:"(s) Rsk. Judgment ngoinsl yeu for $ 4:1$0.00 logelher wllh cosls upon
lho loUclwing clalln (Civil rilles must Include cUalion of tho 5tolulO or ordinance v!olated)~
'J.'be a1Iove Baud DetIlDdant(e) aM/or the.lr depand~ie d14 _1va nrdoee
%'liMned at tM Ledstow RoqUal 7/1/94 tb1u 7/4/94.
I, SJLW Jl. lU.&lOliI lOR L&WIll'l'UWlf lU)5PI'fAL . vellly thOllhe Incla a.llorlh
In this complaint are true and correcllo lhe bosl 01 my knowlodge, hlform3lion, and bf~lief. This tilnlemtlnt ls'm~ti subject to Iho penollies of
Section 4904 ollhe Crlmos Code (10 Pa. C.SA. ~4904) related 10 unsworn lalsllicalion 10 Dulhorilins. ,~'
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, (Signature of Plainlllt or Authorized Agontl
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Plaintiffs
Allomey:
Address:
i
Te'ppnont': .-.
HEARING IS SCHEDULED BY DISTRICT JUSTICE AS FOLLOWS:
YaAGEllTOVR PLAZA
310 SOUTH MAtH STOET. YRACKR'rOUIl. Ph 170']!1 OlIC!:UBc:::.,5.19tl.4 10.30 Atl
LocaUon
Dahl-'.'''''-''';' ',,"_~'T__' Time
IF YOU INTEND TO ENTER A DEFENSE TO THIS COMPLAINT. NOTIFY THIS OFFICE IMMEDIATELY AT
THE ABOVE TELEPHONE NUMBER, YOU MUST APPEAR AT THE HEARING AND PRESENT YOUn
DEFENSE, UNLESS YOU DO, JUDGMENT WILL BE ENTERED AGAINST YOU BY DEFAULT,
IF YOU HAVE A CLAIM ogalnsllhe plainll" which Is wllhln dislrlct lushco jU"'dlCllon nnd '"hlcn you Inlend to assert alll10
hearing, you musllile lion a complllll1llorm at Ihls ollIC" at leasl15) days bel or. Iho ~"I. sol lor the hell'ing, II ;'ou ha\'~ a
claim againEllhe plainlill whICh Is nOI wilhin dlSlrlct jushco JUrisdiction, you moy reqllesllnlormalion hom Ihl~ office as 10 IIlJ
procedures you may foilow,
Service of Process
-llJ D~
;'h N ReOl5toll'dlCnr!i1lOd Mall
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11 /1'1 Rf!llnnml Rocolpt ^lInr:hf!r1
-,9' PJ
f\J 1'\1
^ 01
K D?
01 D?
1-1 (-j Nut Served
Proof 01 Gl'rVl(tl AU,lCher1 f~ r~lll-'-:l
U,T
c 1I,II,Cll( 8"~.,.,,,,.\~
Onlo ~lf'fvfl{l ".--- - -~. _-.-~
II'II'lII,;:J_( lLM'"
D.llo S'n',,",,1
p.", JLA,I:f:~
I: Dl n..,,,,O" _,____,._.
D:~ Il'Hl','Hl
NJPr: :JOU . un
1';1 \j);1 < 'H
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OEFENOENT 1 (0'1)
"
o Oelondnnt intnnds to doll'IHt !OAH~)
o Plainhfl so nolihod IDA 1 E) . .... . .- ,.--.
IKI HI'uJiog w,," hold "n tDATE _IlJlCEIIBE R_()"...I () 9 'I
UehJl\dnnt l1PIll'tHcd 01 hOllnng:
[J I\eprnsuntm! hy _ -.--
--------_...~
[1 Not Ruprcscnted
IX Oofondant lhd not lIpponr
XI Pln;"l"l d,d KX"PI'OOf
---_._-,._--~
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Renllllks:
o Judgmont nnll cost ~hhsfiCHt
--------..-
--_._----~--- ,~-,,- ,---,~-"."-_.-'-
DATE
BY WHOM NOTlnED
.. _..._--.--_._-,~-'---.--,.- --.-.
1I10'AUf..;: ..~-.... "~~S";"S~~I;~--" .,-.- - "\
" Pla,n"fIInn"o), I',E,I!,I,S'rll.1l"_HOS1'XI'/\L:
Jtld!l'tll'nl'o, I ' EMANUAL S'l'OI.TZI'US
t [,) Ooltlndnn\ tnilnlr)) -.---.----.------'---...-
Amoutll S .. II.....a.:g; gg--
COats $ -.--..--.' --...-.--
XlIlIllCX
S'II;9S-!r:-Oo--
S ..,...._.._,___
DEClmBER 6, 1994
DECEMBER }_;-'-!.?91~
,JCP.
TolDI
Ju{j~]IlHJI\1 PillerI'd 011 IDA IE) -- . ---~.
tlOlltll ('lllIdnrnl'nt (jlo'l!r\ on (DA'E; .
rl OI:iflll'S".lll .....IHloul prejudice (DAlE} .-------..
\ t-l lrnll~;lt'rrf1d It! (D/\lEI .___._m______
i-J Cnlltinllud It> (DArE f. TIME) ___h___'_"__ ---..-------
\ i~ rjt.M::e oll;on .'IHlilnce u,vcn I)" (DArt:) -- ---'--" ,-
":,;,' ;~:~~"t:,D;;~.-- d(Z7ad -------
l \,'.1do by "1"'-- _,,'/?la.. . . ~
DL..trlcl Justlco
.. ,- -_.-.' .' - .---.., -'" ----- -_._'- _._-------'~
OEFENOENT 2 (0-2)
o D.lon:~nl inlend~;: <101",'<1 ;~~;~';--~,~,~~--:._'~'::_-\
o Plainllll so nor,liod (DATE) ----------.. ,-'. -, -' ,
tJ HUDflng was hold on (DATE _,_.__ ~_ __.. ________.u ._--
DofendAnt appealed at ht!nrlnQ:
o RtJpresonlcd LJy ----.------------~~.--..-
-------_._._,---_.~-~.._--"'-.---
o Not ReplescnttJd
~ Odfcndallt dId nol ilppHlf
X.I
Plamtltl Gld X.X.nl'rH!;iI
--,---.----'-
__ .__._________~'___,._..._~'__.,___.__ ,_.u
Rernurkr.:
[} Jlldomonr ,"d tOC' "",,1",,'
J . __==yAT~=,-~~__, :-~,..:~_\'::IK'f~;I'iOl Hi. D.
,~:'HJ:\Il\1A1tY OF TI':~TI ""0':"
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DISPOSITION
PI^'''l'fll''""h.).J.!l,W..!.STOWN_.!!.OSPITAL
SUSAN STOLTZFUS
Dl~'r!ndanl (n~'"tJ) _----
Arnount $ .JI...8.9.!L..O-O_
Cn!il~ $ _._..~Jl..!JLQ__
11"1'
J.C,P, S
TolDI S _!t,..2.!!~t,.Q..O__
DECEIIBER 6, 1994
Judgnwnl ,"'/lhHct1 OP (DATE) _._------------
rlol"cO nl jud,]monl ~I'\'"'' on (DAiE) J1ECg,lli!!!.R...'?,,_J1.?!!.-
rl Dlsrni:;:s;:I1 Wllt1UUt prtlJUdiCll (DAlE) .._-~---_._------~-
11 Tfiw'.;I<::rlil.llo lGATE) --. ----,--------.------.- -----
Cl''ltilwod I" (DATE &. TIME) .-- ...---.--- ..--------
f:;111(:P 01 {unlirllFtnCe gp/lm oIIIDt,TE., _u~___ ---,.---.
h:';" I~::~:"'cl ~~ ~;IJI. - t -;' - /Y/i,--; -- ,---
r,'~11~!".' rM:_tu"4_ a-.";__/~G-- ---
DISIII!,;t JU':Itlce
-~_. ---' -- -- -' _...--,--- ~-,--------
IJEI'AULT 1'.
.Iudqrucnl 101 ( .
. ll1
I, UARBARA A. CLARE, IJISTRICT JUSTICE IN
AND I'OR DISTRICT NO. 58-3-02, MIFFLIN
COUNTY, PENNSYLVANIA, DO HEREBY CERTIFY
TilE WITHIN TO BE TRUE AND CORRECT COPY
OF THE ORIGINAL I'ILED IN MY OFFICE.
WITNESS UV BAND AND T~l)l 01'l'lci.A2 SEAL
, , . #4 ,I /. _, t
01' HY,OI"1'lCIl TillS ~1i DAY Oil! i / 1995..
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DISTRfCT JUSTICE