HomeMy WebLinkAbout95-01619
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CHERYL F. CERK, Individually
and as Administratrix of the
Estate of THOMAS E. CERK
deceased, on behalf of said
Estate and on behalf of all
of those entitled to recover
for the death THOMAS E. CERK,
deceased,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
NO.
v.
KIMBERLY S. GORDON,
Defendant
PETITION FOR APPROVAL OF COMPROMISE AND
SETTLEMENT OF WRONGFUL DEATH AND SURVIVAL CLAIM
AND NOW, comes Cheryl F. Cerk, Administratrix of the Estate
of Thomas E. Cerk, deceased, on behalf of said estate and on
behalf of all persons entitled to recover for the death of Thomas
E. Cerk, deceased, seeking court approval of compromise and
settlement as follows:
1. This action is a wrongful death and survival claim
arising from a vehicle accident which resulted in the death of
Thomas E. Cerk.
2. Thomas E. Cerk was born on May 1, 1961, was married to
the petitioner, Cheryl F. Cerk and was the natural father of
Christopher Cerk, a minor.
mother of Christopher Cerk.
3. On December 16, 1994, Thomas E. Cerk died as a result
Cheryl F. Cerk is also the natural
of injuries received in a motor vehicle accident.
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4. At the time of death, the decedent resided at 34
Hamilton Road, Boiling Springs, Cumberland County, Pennsylvania,
having the same address as your petitioner.
5. Thomas E. Cerk was intestate (without a will). His
next of kin are the petitioner, Cheryl F. Cerk, his wife, and his
son, Christopher Cerk, 34 Hamilton Road, Boiling Springs,
Cumberland County, Pennsylvania.
6. Your petitioner was appointed Administratrix of the
Estate by a grant of letters of administration through the Office
of Mary C. Lewis, Register of wills, Cumberland County, on March
22, 1995. See Letters of Administration attached hereto as
Exhibit "A".
7. The aforesaid motor vehicle accident occurred on Route
997 in Chambersburg and involved a vehicle driven by Kimberly S.
Gordon, on which vehicle there was liability insurance coverage
in the amount of $15,000.00 as evidenced by the declarations page
of Progressive Casualty Insurance Company as set forth in Exhibit
"B" hereto.
8. Decedent's occupation was that of data processor at the
time of the accident which resulted in his death.
9. All funeral and medical expenses have been paid and
petitioner is not aware of outstanding bills of creditors whose
claims have not been settled.
10. Considering the age and work habits of decedent and
other pertinent factors, this settlement is fair and reasonable
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and petitioner desires to accept the same.
11. Also considering the age and work habits of decedent
and other pertinent factors, the petitioner desires the allocate
the $15,000.00 as follows:
a. To the wrongful death action, 100% or $15,000.00;
b. To the survival action, 0% or $0.
12. If your Honorable Court approves this settlement, your
petitioner desires to be bound by the release of all claims
against Kimberly s. Gordon and Progressive companies relating to
this incident, said release being attached hereto as Exhibit "C"
and your petitioner hereby certifies that she has not previously
settled any claims with any persons or parties relating to this
matter and further that there is no under insured motorists
carrier or other carrier with any subrogation interest whose
approval must or should be obtained before entering into this
settlement, in order to protect Kimberly S. Gordon and her
insurance carrier. petitioner avers that the underinsured
motorist carrier, Erie Insurance Company has consented to this
settlement.
WHEREFORE, petitioner request your Honorable Court to enter
an order approving the settlement agreed upon by petitioner and
by those acting on behalf of Kimberly S. Gordon, authorizing the
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Exhibit A
7/0u/1- (7-2 .;~ N, ..((,' "J1 ~ /};1y.
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Register
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SHORT CERTIFICATE
estate of CERK THOMAS E
I~A~~, t~K~~, M~UU~~)
I, MARY C. LEWIS
Register for the Probate of Wills and Granting
Letters of Administration &c. in and for said
County of CUMBERLAND do hereby certify that on
the 22nd day of March A.D.,
one thousand nine hundred and ninety five.
Letters of ADMINISTRATION
in common form were granted by the Register of
said County, on the
, late of SOUTH MIDDLETON TOWNSHIP
in said county, deceased, to
CHERYL F CERK
ILA~~, t~K~~, M~UU~~)
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand
of said office at CARLISLE, PENNSYLVANIA, this 22nd day
A.D., one thousand nine hundred and ninety five.
File No. 1995-00230
PA File No. 2195-0230
Date of Death 12/16/1994
S.S. # 207-46-6089
and affixed the seal
of March
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
Exhibit B
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03/2J/9S THU 09:~ ;~\.!J7 891 8938
PROGRESSIVE
PkOG~SSIVE HE DIVISIoN
11J003
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PLUg; ~1AD'IlUA_ I'OUcr"""'RI 52-'''-2''0-1
TWo 11oo10,_ '....- _... _ ...~ 111. ....,., jaooo,ldtollilooj ~ ... _ ... ..'.... ... ""''''''" ....p",.. ... _ ...._ ....or
,............".--- 526"2400 '....10""P. u 1091 LlltlTED TORT PIIDfOl37
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~NAMEDINSUR&D
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P
I STRICKLER AGCY INC
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'KIIIBERLY 5 GORDON
ELltER LEE GORDON
5398 GREINvILL.aE RD
CHAIIBERSBURG PA 17201
_PI!.100'2.~' A.M n._.on..e'TTH! '_!ISOI'THI ~!DINSU""Asn"T2lI~ellClN
FRO" SEP 08. 199" TO liAR 08. 1995
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1I0UHTA1N LAUREL ASSURANCE COKPANY
'IN ....,... .h....,....'" w1'h _, .. -.... .. _ 01 lilt '''-'- ___.... _I" wtl~ _ .. _ ...."........._ Tlla "".01 '...
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DR tL PLCT FPB COIIP
YR TRADE BODr TYPE SERIAL NO. CL PT TA SYH DISC DISC DISC
82 DATSU IIAXIIIA 40 JNIHUOISgCT03S505 F5 0 23 80 1St
80 DODGE WIOO 4XltPK WI"JNASI2"715 F5 0 23 18 15t
COVERAGE AND LIIIITS DF LIABILITY FULL TE~ PREIIIUII CHARGE
VEH.-I VEH.-2 VEH.-3 VEH.-4
BODILY INJURY & PROPERTY DAIIAGE LIABILITY 5129 5129
515.000/530.000/$5.000
UNINSURED 1I0tORIST REJ. REJ.
UNDERINSURED 1I0TORIST REJ. REJ.
FIRST PARTY BENEFITS
IIEDICAL BENEFITS 55.000 PER PERSON
ATTACHIIENT5 IDENTIFIED BY FOR" NO. PREIIIUII BY VEHICLE
9330 (0292)
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51"8
51g
SI48
TOTAL POLICY PREIIIUK
52.96
IF YOU HAVE PURC~ASED COLLISION COVERAGE, THIS POLICY COVERS COLLISION DAIlAGE
TO RENTAL VE~ICLES WHEN THE RENTAL LOCAT ON IS 100 DR HORE HILES FROH YOUR
PRINCIPAL RESIDENCE.
NO SURCHARGE HAS BEEN ADDED TO THIS PREIIIUK
ISSUED AT NORTHEAST REGIONAL PROCESSING CTR
P.O. 101 946U
CLEVELAND OH ~~101
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STRICKLER AGCY INC OOOODHO 9"257 o~ 080
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11.93
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f.hibit c
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FULL REI ~4SE OF ALL CLAIMS WITH INDEMNITY
I-d& -CJ€l_
Date
KNOW ALL BY THESE PRESENTS, THAT c.htrVI P, ~ert.. J Adn'1"M~fraf.i nf Thunas E,t!t:rLe-9~/e.
for and in consideration of the payment of EfIelI'1 ..fhOu. ~(J nd dn 110..1'6 tJ1Jd.oo!tM- (SIS: 1JtJ(). ~),
lhe receipt and sufficlency 01 which Is hereby acknowledged, does (do) hereby for myself (ourselves) and for my (our)
heirs, executors, administrators, successQrs, assigns and any and all other persons, firms, employers, corporations.
associations, or partnerships release. acquit and forever disc:harge K,'m bt, 1'1 f) . eOI'd./HI t/
.pmt),ff.ftStVl. ~''eP and his, her, their or Its agents. servants. successors. heirs, executD~, adminlstra1crs,
isSijjIis and all other persons, finns. corporalions. aSS()l'i~'lS or partnerships of. and from any and all claims, aclions,
...... - B 5 of actions, demands. rights, damages, costs, loss of wages, expenses, hospital and medical expenses, loss
of consortium, loss of service, and any compensation whatsoever, which the undersigned now hasIhave or which may
hereafter lICClUe on account of or In any way growing out of an accident which occurred on or about fu umbtr I u, (qqL{.
atornear Rt qq1 '. CiJambuJv..rg. -P/l
It Is understood and agreed that this setllement Is in full compromise 01 a doubtful and disputed claim as to both questions
of liability and as to the nature and extent of the injuries and damage, and that nelther this release, nor the payment
pursuant thereto, shall be construed as an admission of Dabiilty, such being denied.
The undersigned hereby cIeciare(s) and represenl(s) that the injuries are or may be permanent and that recovery therefrom
is uncertain and Indefinite and In making this release, It is understDcxl and agreed that the undersigned reIy(ies) wholly
upon the undersigned's judgment. belief, and knowledge of the nature. extent. eIIed and duration of said Injuries and
IiabUIty therefor and is made without reIlance upon any statement or represen1ation of the party or parties being releawd.
ortheirrepres6,llcdi.es. or by anyphyslclan or surgeon by them employed.
In consideration of the payment of the sum ~ above. the undersigned further agrees to indemnify the above
released parties and save them hannJess from any and all further liability. loss, damage, claims of subrogation and
expense. arising because 01 any injuries and damages, and, if necgsury in order to save them so hannless, to satisfy
on their behalf any judgment against them 8J1s1ng in any way out of the aforesaid accident.
The undersigned further decIare(s) and repreSerrt(s) that no promise, inducement or agreement not herein expressed
has been made to the undersigned, and that this release contains the entire agreement between the parties hereto.
and that the terms 01 this release are conu-aduaI and not a mere rec:ItaI.
THE UNDERSIGNED HAS READ'THE FOREGOING RELEASE AND FULLY UNDERSTANDS IT.
Witness
Date
y CVu"u.. x-tt C OA 1'2
Signed ~
1/&/95'"
Date
Witness
Date
Signed
Date
Fcnn No. 2115(5-931
Copy 1 - Original to be Signed and Relumed; Copy 2 . File (ClaImant or AIIomey): Copy 3 . File (legal or ClaIm)
."
VERIPICATION
I, Cheryl F. Cerk, hereby certify that I have read the
foregoing Petition for Approval of Compromise and Settlement of
Wrongful Death and Survival Claim and believe it to be true and
correct to the best of my knowledge, information, and belief. I
understand that false statements herein are made subject to the
penalties of 18 Pa. C.S.A. 54904 relating to unsworn
falsification to authorities.
Date :
~
(Y\M.M9-::j- ~J\2.
Cheryl F. c~rk
-7-
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Commonwealth of Pennsylvania
County of Cwnberland
Ch~ryl F. Cerk. Individually
and as Administratrix of the
Estate of Thomas E. Cerk
deceased. on behalf of said
Estat~ and on behalf of all
of thos~ entitled to recover
for the death Thomas E.
Cerk. deceased.
Court or Conunoll Pleas
vs.
No.
95-1619 Civil
~------------------------------------
19____
Kimberly S. Gordon
In ____~_~y_~!__~~_~}_~~__:__~~~_______________
Kimberly S. Gordon:
"fo _____________________________________________
You are hereby notified that Cheryl F. Cerk. individually & as Administratrix of
of the Estate of Thanos E. Cerk, deceased. on healf of said Estate and on behalf of all
of thosE -eri1:iUt!(J-tci-feceiver-T6f - l:lie-at.i:iffi'l'l'ii'iiiiis-"E;- ~erK~--decei:isea'------ ----- - ------ -----
th PI 0 orr h d . 0 Summons - Civil Action - LaW
e alnn S avecommence an aChon In _..___..____.._____...._________________.._____..___...._________
against you which you are required 10 derend or a derault judgment may be entered against you.
(SEAL)
Dale -______l-:!~E~_':_f_~.!____m____ 19_.?_~
LAWRENCE E. WELKER
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CHERYL F. CERK, Individually
and as Administratrix of the
Estate of THOMAS E. CERK
deceased, on behalf of said
Estate and on behalf of all
of those entitled to recover
for the death THOMAS E. CERK,
deceased,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
.
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1-5- Iv If
NO.
(I ~A'-\. C 0lA.t'Y'--/
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Plaintiffs
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.
v.
XIMBERLY S. GORDON,
Defendant
.
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WAIVER OP SERVICE AND APPEARANCE
I accept service of the Writ of Summons on behalf of
Defendant Ximberly S. Gordon, consenting to the jurisdiction of
the court and waiving service of process. I also hereby appear
on behalf of defendant.
R chard B. Dr
Attorney I.D.
P.O. Box 93
Harrisburg, PA 17108-0093
(717) 238-8187
Date: March rJr
, 1995
K1M~lJy S 0o("ell'71
.5Y1J (! I't.o\vdlt< J ti
(I k~ 6t 15~LtJ (JCL 17).0/
CHERYL F. CERK, Individually I
and as Administratrix of the
Estate of THOMAS E. CERK,
deceased, on behalf of said :
Estate and on behalf of all I
of those entitled to recover
for the death of THOMAS E.
CERK, deceased,
Plaintiffs
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
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XIMBERLY S. GORDON,
Defendant
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I NO. 95-1619 CIVIL TERM
c..n
U"I
IN RE: PROCEEDING TO BE CONTINUED GENERALLY
ORDER OF COURT
AND NOW, this 10th day of May, 1995, upon
consideration of the Petition for Approval of Compromise and
Settlement of Wrongful Death and Survival Claim, and following
a proceeding in Court in which the Plaintiff indicated that she
would like to consult with an attorney regarding the settlement
prior to completion of the proceeding, the request to do so is
granted, and this proceeding is .continued generally. At such
time within the next two weeks as Plaintiff files a motion for
action by the Court, the Court will consider such motion and
will approve the settlement if that is what Plaintiff wishes
following consultation with an attorney.
By the Court,
Cheryl F. Cerk
Pro Se
34 Hamilton Road
Boiling Springs, PA 17007
Richard B. Druby, Esquire
Counae1 for Defendant
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William P. Dougl.., Esq.
Suprtn'" Court I.D. *37926
DOugla., Douf.'.' (:I Dougl..
27 W. Higl. S .
C.,Ii,'e, I'll 17013
Telephone (717) 243.1790
Cheryl F. Cerk, Individually and as
Administratrix of the Estate of Thomas
E. Cerk, deceased
In the Court of Common Pleas of
Cumberland County, Pennsylvania
Cheryl F. Cerk, on behalf of all
individuals entitled to recover for the
wrongful death of Thomas E. Cerk,
deceased
Petitioners/Plain tiffs
No. 95-1619 Civil Tenn
vs
Kimberly S. Gordon and Erie
Insurance Companies
Responden ts/Defendants
Civil action law
Settlement Approval
Praecipe to Issue a Writ of Summons
Dear Mr. Welker:
Please issue a writ of summons against Erie Insurance Companies.
date: June 7,1995
,
· 1 ·
DOUGLAS. DOUGLAS & DOUGLAS
ATTORNEYS AT LAW
27 W. HIGH STREET
R O. DOl( zel
CARLISLE, PENNSYLVANIA
17013-0281
~UH 7 Lj 09 PH '95
., ',Li U, OiFlC~
OF 1H: ri(.TlfOHiTA~'t
CtP",!F.k'.t.~D C(-V:Uy
PtNt, S:Yt 'it"h~
Commonwealth of Pennsylvania
County of Cumberland
Cheryl F. Cerk, Individually and as
Administratrix of the Estate of Thomas
E. Cerk, deceased
In the Court of Common Pleas of
Cumberland County, Pennsylvania
Cheryl F. Cerk, on behalf of all
individuals entitled to recover for the
wrongful death of Thomas E. Cerk,
deceased
Peti tioners/ Plain tiffs
No. 95-1619 Civil Term
vs
Civil action law
Settlement A roval
Writ of Summons
To: Erie Insurance Companies
You are hereby notified that Cheryl F. Cerk,
Individually and as Administratrix of the Estate of
Thomas E. Cerk, deceased
and
Cheryl F. Cerk, on behalf of all individuals entitled to
recover for the wrongful death of Thomas E. Cerk,
deceased, has brought an action against you.
'j7'~ ~ ~~ro~~ry
June 7,1995
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DOUGLAs, DOUGLAS & DOUGLAS
ATTORNEYS AT LAW
27 W. HIGH STREET
R 0. DOX 101
CARLISLE, PENNSYLVANIA
17013-0281
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William P. DouglAs. Esq.
5uprtn'" Court/.D. 137926
DoUg/4S. Doug/... & Doug/4s
27 W. High 5/:
C4,/iJ~, PI. 17013
Tt~ont (717) 24J.1790
Cheryl F. Cerk, Individually and as
Administratrix of the Estate of Thomas
E. Cerk, deceased
In the Court of Common Pleas of
Cumberland County, Pennsylvania
Cheryl F. Cerk, on behalf of all
individuals entitled to recover for the
wrongful death of Thomas E. Cerk,
deceased
Peti tioners/ Plaintiffs
No. 95-1619 Civil Term
vs
Kimberly S. Gordon and Erie
Insurance Companies
Respondents/Defendants
Civil action law
Settlement Approval
Petition for Approval of Minor's Settlement
1. Your Petitioner, Cheryl F. Cerk, is the parent and guardian of Christopher
Cerk, a minor, the aforesaid reside at 100 Campus Drive, Box 2621, Grove City,
Mercer County, Pennsylvania, 16127.
2. The minor child, Christopher Cerk, was born on June 14, 1994.. His Social
Security Number is 206-74-1155.
3. The respondent is Kimberly S. Gordon.
4. The respondents, Erie Insurance Companies and Progressive Insurance
Companies, are corporations licensed to do business in the Commonwealth of
Pennsylvania.
5. On December 16, 1994, Thomas E. Cerk was killed in a motor vehicle
accident. At the time of his death he was married to Cheryl F. Cerk, and had one
minor child, Christopher Cerk.
6. Chery F. Cerk was appointed the administratrix of the estate of Thomas E.
Cerk on March 22, 1995, by Mary C. Lewis, the Register of Wills of Cumberland
County.
"....T."..'~
7. There are no outstanding bills or creditors claims whose claims have not
been paid.
8. The respondent Kimberly S. Gordon is covered by a policy of automobile
liability insurance in the amount of $15,000.00. Said policy was issued by the
Progressive Insurance Company.
9. Progressive Insurance Company has agreed to pay the full policy amount
of $15,000.00, as the result of the death of Thomas E. Cerk.
10. At the time of Thomas E. Cerk's death he and his wife had two vehicles
insured with the respondent, Erie Insurance Companies, with coverage for under
insurance on two vehicles, which can be stacked.
11. Each underinsurance policy is in the amount of $250,000.00, for a total of
available insurance in the amount of $500,000.00, issued by Erie Insurance
Companies.
12. Erie Insurance has agree to pay the full $500,000.00 to settle the claim for
the wrongful death of Thomas E. Cerk.
14. All sums set forth above constitute damages on account of personal
injury/wrongful death, arising from the occurrence, within the meaning of ~
104(a)(2) of the Internal Revenue Code of 1986, as amended.
15. It is requested that Two Hundred Seventy Two Thousand Five Hundred
Dollars ($272,500.00) be paid to Cheryl Cerk for the Wrongful Death of her late
husband.
15, Your petitioners request the Court direct that Two Hundred and Forty
Five Thousand Dollars ($242,500.000) be placed in a Federally Insured savings
account or certificate of deposit, to marked, "Not to be withdrawn until age 18, or
further Order of a Court."
16. Your Petitioners further requests that the Court direct that the Federally
Insured Bank or Savings Institution be permitted to pay federal and state income
tax on the income earned on behalf of the minor in the said account/accounts.
WHEREFORE, your Petitioners pray that the settlements be approved.
~q~
William P. Douglas, Esq.
Attorney for parties
William P. Douf/ns. Esq.
Suprtnle Cour' .D. .37926
Doug/as, Doug/as & Doug/as
27 W. High Sf.
CAr/isk, PA 17013
Ttkphont (717) 243.1790
Cheryl F. Cerk, Individually and as
Administratrix of the Estate of Thomas
E. Cerk, deceased
In the Court of Common Pleas of
Cumberland County, Pennsylvania
Cheryl F. Cerk, on behalf of all
individual entitled to recover for the
wrongful death of Thomas E, Cerk,
deceased
Petitioners/Plain tiffs
No. 95-1619 Civil Term
vs
Kimberly S. Gordon and Erie
Insurance Companies
Respondents/Defendants
Civil action law
Settlement Approval
AFFIDAVIT
I hereby swear or affirm that the Foregoing is true and correct to the best of my
knowledge and/or information and belief.
This is made subject to the penalties of 18 Pa.C.S. ~4904 relating to unsworn
falsification to authorities.
I.i.B.:- ~ ~
William P. Douglas, Esq.
Attorney for Parties
Date: June 5,1995
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"ci'iU'i:yn.. Cerk, 'irnTi'\;i~fuii'jjy"(iii(f:1s ".
Adlllinislrnlrix of the Estnlc of Tholllns
E. Cerk, deccnsed
In the Court of Common Plens of
Cumberlnnd County, Pennsylvnnia
Cheryl F. Cerk, on behnlf of nil
individunls en lit led to rct:Ovcr for Ihe
wrongful death of 1'hOl11ns E. Ccrk,
decensed
I'd il illllC/'S/l'lllillt ills
No, 95-1619 Civil Term
I",
.1
Kimberly 5. Gordon and Eric
Insurance Companies
".""_.""""...."""..............,,.!~~~l~~!!!~!~:!!,t,::l.QC.l!:.!.I!!!.'!!!}..
"
Civil nclion law
._...,,_..._.. Settlement APP~~EL__...'
~.
ORDER
AND NOW. to wit this Ihe 'i'!3< day Ill' Junc, 1995. a hearing having previously
heen held in this mailer. it is helehy older that the selllemcnt in the amount of Five
Hundred Fifteen Thousand Dollals ($515,000.00) for the wrongful death of Thomas E.
Celk is appHJveu.The prol:ccds are to be dil'ided as follows;
Cheryl F. Cerk
$272,500.00
$242,500.00
Cheryl F. Cerk, as parent and natural
guardian of Christopher Cerk
Thc procccds of thc selllclllcnt for thc minor child are lO be dcposited in a fcderully
insulcd savings aCCllunt and/Ilr ccrtificatc of deposit. marked "Notlo bc wilhdrawn until
age 18 or further Ordcr of a Court".
The minor l:hild. Christopher Cerk. WilS born on Junc 14, 1994.
(lis Sodal Sccurily Numbcr is 206 - 74 - 1155.
All sums set forth abovc constitutc damages on ilccount of pcrsonal injuries, arising 1'1'0::1
thc Ol:ClllTCnCe, within the locaning of ~ 10.1(01)(2) of the Intc1'l1al Reve:lUe Codc of 1985,
as amcndcd.
IT IS FURTHER OHDEHEllthatlhe instiullion in which snid funds arc dcposited is
hcrcby granted pcrmission to usc such income from said funds lhat is neccs~ary to ;'lay
incomc tax which may bCl:omc duc am] payablc as a result of the said funds bcing on
dCJll1sit inlhcir institution.
TIlE GUARDIANS shall pmvidc a certificate 10 the Prothonotary setting forth thc pi,lCC
of dcposit, nccount oUlnbcr, in cOll1pliance with the above provision. .
THUE COPY FRO;";; FIECOHD
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USAA"
USAA fEDERAL SAVINGS BANK
August 11, 1995
Cheryl F. Cerk
11964 N. Seven Pines Rd.
Northport, Mi. 49670-9710
Re: Account #5031888
To Whom It May Concern:
This letter is ill response to your telephone request for written
verification on the above referenced account.
Our records indicate this account was opened as a custodial account
for Christopher Cerk on 07/24/95. Per court order in file f~nds
are no~ to be withdrawn until age 18 or further Order of a Cocrt.
If we can be of further assistance, please call me at
1-800-531-2265 extension 6-8040.
~~~(~.
Norma Davila
Deposit Sales & Svcs Representative
USAA Federal Savings Bank
/nd
USM fedorol Sa..:ng. Bank
10750 McDormon Freewav
San Anlonio. TX 7~288.0544
18001531.22651210/498.2265
FDIC INSURED
USAA Relocation Se",a', Inc.
10750 McDormon frce.vay
San Antonio. TX 7B~8i:',j553
12101498.7657
C>-.
8037G~
Ml'lIIltl'f
FDIC
~It)f.,lilin ~11t.":f
1\(1. n.,1l1(';
Tlhull. Nl'\\ H:1I1l1,~llln.'l','!UH'jlI7
FI RST DEPOSIT
AilliOlIll//klllk
II /'RO\'/f)/AN CtllII/JlIII)'
I.HOO.HII.Wol9
Septembcr 21, 1995
Chcryl F. Ccrk
11964 N. Scvcn Pincs Roud
Northport, MI 49670
To Whom It May Concern:
OUllincd bclow is infornllllion flcrtaining 10 an accounl currcntly maintained at First Deposit
National Bank.
Christopher E. Cerk. UGMA
Chcryl F. CCl'k. Custodian
Account Number: 57007228
~.
Account Owncr(s):
Typc of Account: Certilicale of lJcposit
AccQunt Opcn Date: 08121/95
Opcning Balancc: $95,000.00
Verification Dale: 09/21/95
Pcr thc court order wc havc on filc, funds may not be withdrawn until the clnor is age 18
or furlhe.' Ordcr of 1I Cllnrt.
Sincercly,
JtVvnUt1macA{j}MU
Carmcn Macisaac
Retail Deflosits Specialist
.'
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WiII",1n P. Douglaf, f.fIj.
Su~ Cour' 1.0. 137926
Douglaf, Douglm {:; Douglas
27 W. High 51;
Clrlifk, PA 17013
Ttkphont (717) 243-1790
Cheryl F. Cerk, Individually and as
Administratrix of the Estate of Thomas
E. Cerk, deceased
In the Court of Common Pleas of
Cumberland County, Pennsylvania
Cheryl F. Cerk, on behalf of all
individuals entitled to recover for the
wrongful death of Thomas E. Cerk,
deceased
Petitioners/Plain tiffs
No. 95-1619 Civil Term
vs
Kimberly S. Gordon and Erie
Insurance Companies
Respondents/Defendants
Civil action law
Settlement Approval
Praecipe to Mark Docket Settled and Discontinued
Dear Mr. Welker:
Please mark the above captioned matter settled and discontinued.
date: (., I ~o {q rs
. ~
William P. Dougl Esq.
Attorney for Cheryl . erk
Indlvfdually and as G Ian
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