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IIAJUlY A. DOIlTIIAL, .SQUIIlB
'a. Supr... COu~ I.D. No. 55672
IlBYNOLDS " KAVAS
101 'ine St:reet:
.oat: Office Box 932
Barriaburg, 'eDDayl.aDia 17108-0932
~elephoDel (717) 236-3200
rax. (717) 236-6863
At:t:orney for .eapoDdeDt:1
CIIl'IIU.IlS II. ICADDIN
CINDY VANKIRK ROACH and
THOMAS A. VANKIRK as Parents
and Natural Guardians of
ASHLEY VANKIRK, a Minor,
Petitioners
v.
CHARLES M. MADDEN,
Respondent
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. fJt, - 3~3 U;~e"'f
CIVIL ACTION - LAW
AND NOW, this
ORDBR
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day of ,\ L.,\..I..\(.\..) 19~ upon
VanKirk Roach and Thomas
consideration of the Petition of Cindy
A. VanKirk, as Parents and Natural Guardians of Ashley VanKirk, a
Minor, it is HEREBY ORDERED AND DECREED that the Petition for
Minor's Compromise and Settlement in the amount of $1,500.00 is
granted, that $500.00 of the settlement proceeds shall be paid to
Barbara Sumple-Sullivan, Esquire, pursuant to a Contingent Fee
Agreement, and that the remaining $1,000.00 shall be paid to
Petitioners, as guardians of aforesaid Minor. Petitioners shall
deposit the settlement monies in an interest bearing saving
account for the benefit of Minor, where it shall remain until
Minor obtains the age of majority. Petitioners are authorized to
execute a Release, in favor of the insurance carrier, State Farm
Mutual Automobile Insurance Company, and Respondent, Charles M.
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Madden. The Release shall be in the form of a Release attached
to petitioners' petition as Exhibit "C".
BY T E COURT:
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JllUUty A. KIlOJITIIAL, B8QUIRB
'a. 8upr... COurt I.D. Mo. 55672
RBYJlOLDI .. SAVAS
101 'iae street
'oat Office lox 932
Barriaburg, 'eDDarlVaaia 17108-0932
Telepboael [717J 236-3200
Fax I [717J 236-6863
AttOrDer for .eapoadeatl
CIIA.'tLll8 II. IlADDIDf
CINDY VANKIRK ROACH and
THOMAS A. VANKIRK as Parents
and Natural Guardians of
ASHLEY VANKIRK, a Minor,
Petitioners
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
:
: NO.
: CIVIL ACTION - LAW
v.
CHARLES M. MADDEN,
Respondent
.
.
.
.
AND NOW, this
ORDBR
day of
, 1995, it
is HEREBY ORDERED AND DECREED that a hearing on the Petition of
Cindy VanKirk Roach and Thomas A. VanKirk, as Parents and Natural
Guardians of Ashley VanKirk, a Minor, is hereby scheduled for
o'clock on
, 1995, in Courtroom No.
of the Cumberland County Courthouse, 1 Courthouse Square,
Carlisle, Pennsylvania, at which time, all interested parties
shall appear and be heard.
BY THE COURT:
J.
IIAJUlY A. DOIlTllJlJ., a.ouI..
Pa. aupr..a COurt I.D. No. 55672
RBY1IOLDa . aVAIl
101 Pina straat
Poat Offioa lox 932
.arriaburg, panoayl.ania 17108-0932
Talaphona. (717) 236-3200
rax. (717) 236-6863
Attornay for Raapondantl
CllARLB8 II. MADDIIII
CINDY VANKIRK ROACH and
THOMAS A. VANKIRK as Parents
and Natural Guardians of
ASHLEY VANKIRK, a Minor,
Petitioners
v.
CHARLES M. MADDEN,
Respondent
IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
NO.
CIVIL ACTION - LAW
PBTXTXON OF PBTXTXONBRS,
CXNDY VANltXRK ROACH AND THOJIAS A. VANltXIUt,
AS PARBNTS AND NATURAL GUARDXANS OF ASHLBY VANltXIUt, A MXHOR,
FOR MXNOR'S COMPROMXSB AND SBTTLEMBNT
AND NOW, comes Petitioners, Cindy vanKirk Roach and
Thomas A. VanKirk (collectively referred to as "Petitioners"), as
Parents and Natural Guardians of Ashley VanKirk, a Minor
("Minor"), and file this Petition for Minor's Compromise and
Settlement, averring the following in support thereof:
1. petitioner, Cindy VanKirk Roach is an adult
individual currently residing at 125-B Umberto Avenue, New
Cumberland, Cumberland County, Pennsylvania, 17070.
2. petitioner, Thomas A. VanKirk is an adult
individual currently residing at 755 Halfway Drive, Myerstown,
Lebanon County, Pennsylvania.
3. Petitioners, who are the parents and natural
guardians of Minor, were formerly husband and wife, but are now
divorced. However, Petitioners share legal custody of Minor.
,<
~ Separation and property Settlement Agreement, a copy of which
is attached hereto, made a part hereof and marked as Exhibit "A".
4. Minor currently resides with Petitioner, Cindy
VanKirk Roach at her above-referenced address.
5. On August 26, 1994, the Minor was involved in an
automobile accident. Specifically, the vehicle in which Minor
was a passenger was traveling on Highway 17, in Garden City,
South Carolina, when it was struck in the rear by a vehicle being
driven by Respondent, Charles M. Madden ("Respondent"), an
insured of State Farm Mutual Automobile Insurance company ("state
Farm") .
6. Minor was taken by ambulance to the Georgetown
Hospital, in Garden City, South carolina, where she was
subsequently treated and released on the same day with the
diagnosis of a cervical strain.
7. As a result of the aforementioned motor vehicle
accident, Minor sustained a cervical strain and minor headaches,
both of which have resolved at this time.
8. Minor was born on March 7, 1985, and is currently
10 years old. At the time of the accident, Minor was under the
care, custody and control of Petitioners.
9. Petitioners have made a careful and diligent
inquiry in investigating and ascertaining the facts surrounding
the accident, the responsibility therefor and the nature and
extent of Minor's injuries.
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10. state Farm has agreed to compromise Minor's claims
in the amount of $1,500. The aforementioned settloment has been
explained at length to Petitioners and Petitioners have indicated
that they understand same and have voluntarily agreed to enter
into the settlement.
11. Petitioners have been represented throughout this
matter by Barbara sumple-Sullivan, Esquire.
12. On or about November 22, 1994, Petitioner, cindy
VanKirk Roach executed a Contingent Fee Agreement in favor of Ms.
Sullivan, in which she agreed to pay Ms. Sullivan one-third (1/3)
of the settlement proceeds. A copy of the contingent Fee
Agreement is attached hereto, made a part hereof and marked as
Exhibit "B".
13. Accordingly, the settlement proceeds will be
divided as follows: (1) $1,000.00 to Minor; and (2) $500.00 to
Ms. Sullivan.
14. The settlement is in no way to be construed as an
admission of liability on the part of Respondent, State Farm, or
any other persons or entities.
15. Petitioners believe that the compromise is fair
and in the best interest of Minor.
16. Respondent hereby request Petitioners to give him
and state Farm a General Release in the form that is attached
hereto, made a part hereof and marked as Exhibit "c".
.
17. Petitioners fully intend to invest the proceeds of
this settlement as provided by Chapter 73 of the Decedents,
Estates and Fiduciaries Code, and to make such distribution of
the income received by them in accordance with 28 Pa. Cons. stat.
55164 for the ongoing, necessary, and reasonable expenses for the
care, maintenance and education of Minor.
WHEREFORE, Petitioners, Cindy VanKirk Roach and
Thomas A. VanKirk, as Parents and Natural Guardians of Ashley
VanKirk, a Minor, pray this Honorable Court enter an Order
approving the Minor's Compromise.
Attorneys for Respondent,
CHARLES M. MADDEN
DATE: '/(1(9)"
REYNOLDS & HAVAS
~_~::~ss~al Corporation
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By' '---
C B~ . KRONTHAL
Att6rney 1.0. #55672
101 Pine Street
Post Office Box 932
Harrisburg, PA 17108-0932
(717) 236-3200
3209/MISC26
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VBRII'ICATION
I, CINDY VANKIRK ROACH, As Parent and Natural Guardian of
ASHLEY VANKIRK, hereby acknowledge that I have read the foregoing
document; and that the facts stated therein are true and correct
to the best of my knowledge, information and belief.
I understand that any false statements herein are made
subject to penalties of 18 Pa.C.S.A. section 4904, relating to
unsworn falsification to authorities.
DAj" 4 Y'
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(/II,t'.,~-/?d'lJt:< ,--.c. dIL-rl. t:. ~
, CIN;DY VANKIRK ROACH, as Parent
and'Natural Guardian of
ASHLEY VANKIRK
VBRII'ICATION
I, TBOKAS A. VANKIRK, a. Parent and Natural Guardian of
ASBLBY VANKIRK ,hereby acknowledge that I have read the foregoing
document; and that the facts stated therein are true and correct
to the best of my knowledge, information and belief.
I understand that any false statements herein are made
subject to penalties of 18 Pa.C.S.A. Section 4904, relating to
unsworn falsification to authorities.
DATE: /0 JIlIJ 9~
~~~ent
and Natural Guardian of
ASHLEY VANKIRK
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SEPARATION AND PROPERTY SETTLEMENT AGREEMENT
THIS AGREEMENT is made this ~D
ofJ,kL
day
1993, by and between THOMAS A. VANKIRK. now P.O. Box 95, Ono,
Lebanon County. Pennsylvania 17077. hereinafter referred to as
"Husband" .
. AND -
CINDY LOU VANKIRK. presently of 126-B Umaberto Avenue. New
Cumberland. Cumberland County, pennsylvania 17070. hereinafter
referred to as "Wife".
WITNESSETH:
WHEREAS. Husband and wife were lawfully married on November
26, 1979; and
WHEREAS. one child was born of this marriage. Ashley Anna
VanKirk, Date of Birth March 7. 1985; and
WHEREAS. diverse unhappy marital difficulties have arisen
between the parties causing them to believe that their marriage
is irretrievably broken, as a result of which they have separated
and now live separate and apart from one another, the parties
being estranged due to such marital difficulties with no
reasonable expectation of reconciliation; and the parties hereto
are desirous of settling fully and finally their respective
financial and property rights and obligations as between each
other, including, without limitation by specific~tion: the
settling of all matters between them relating to the ownership of
real and personal property; the settling of all matters relating
to the custody and support of their minor child. and in general
the settling of any and all claims and possible claims by one
against the other or against their respective estates,
particularly those responsibilities and rights growing out of the
marriage relationship.
NOW, THEREFORE, in consideration of the premises and of the
promises. covenants and undertakings hereinafter set forth and
for other good and valuable consideration. the receipt of which
is hereby acknowledged by each of the parties hereto. Husband and
Wife, each intending to be legally bound hereby. covenant and
agree as follows:
1.
SEPARATION.
It shall be lawful for each party, at
all times hereafter, to live separate and apart from the other,
at such place or places as he or she may. from time to time,
choose or deem fit. Each party shall be free from interference,
authority or contact by the other. as fully as if he or she were
single and unmarried, except as may be necessary to carry out the
provisions of this Agreement. Neither party shall molest the
other or attempt to endeavor to molest the other. nor compel the
other to cohabit with the other, or in any way harass or malign
the other. nor in any way interfere with the peaceful existence,
separate and apart from the other.
Should a decree. jUdgment or order of separation or divorce
be obtained by either of the parties in this or any other state,
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country or jurisdiction. each of the parties hereby consents and
agrees that this Agreement and all of its covenants shall not be
affected in any way by any such decree. judgment. or order of
separation or divorce; and that nothing in any such decree,
jUdgment. order or further modification or revision thereof shall
alter. amend or vary any term of this Agreement, whether or not
either or both of the parties shall remarry. it being understood
by and between the parties hereto that this Agreement shall
survive and shall not be merged into any decree, judgment, or
order of divorce or separation. It is specifically agreed,
however. that a copy of this Agreement or the substance of the
provisions thereof. may be incorporated by reference into any
divorce. judgment or decree. This incorporation, however. shall
not be regarded as a merger. it being the specific intent of the
parties to permit this Agreement to survive any decree. judgment,
or order of separation or divorce. and to be forever binding and
conclusive upon the parties.
2. EFFECTIVE DATE. The effective date of this
Agreement shall be the "date of execution" or "execution date",
defined as the date upon which it is executed by the parties if
they have each executed the Agreement on the same date.
Otherwise, the "date of execution" or "execution date" of this
Agreement shall be defined as the date of execution by the party
last executing this Agreement.
3. DEBTS AND OBLIGATIONS. Husband represents and
warrants to Wife that since January 31. 1990. he has not, and in
the future he will not contract or incur any debt or liability
for which Wife or her estate might be responsible and shall
indemnify and save Wife harmless from any and all claims or
demands made against her by reason of such debts or Obligations
incurred by him since the date of said separation, except as
otherwise set forth herein.
wife represents and warrants to Husband that since January
31, 1990, she has not, and in the future she will not contract or
incur any debt or liability for which Husband or his estate might
be responsible and shall indemnify and save Husband harmless from
any and all claims or demands made against him by reason of such
debts or obligations incurred by her since the date of said
separation, except as otherwise set forth herein.
Husband and Wife acknowledge that Husband paid the sum of
$3.314.66 in full satisfaction of marital debts and warrant that
to the best of their knowledge no other debts are outstanding.
4. MUTUAL RELEASES. Husband and Wife do hereby mutually
remise. release, quit-claim or forever discharge the other and
the estate of such other, for all time to come, and for all
purposes whatsoever, from any and all rights, title and interest,
or claims in or against the estate of such other, of whatever
nature and wherever situate. which he or she now has or at any
time hereafter may have against such other, the estate of such
other or any part thereof, whether arising out of any former
acts, contracts. engagements or liabilities of such other or by
way of dower or curtesy. of claims in the nature of dower or
curtesy, or widow's or widower's rights, family exemption or
similar allowance or under the intestate laws; or the right to
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take against the spouse's will; or the right to treat a lifetime
conveyance by the other as testamentary or all other rights of a
surviving spouse to participate in a deceased spouse's estate,
whether arising under the laws of Pennsylvania, any state,
commonwealth or territory or the United States, or any other
country; or any rights which either party may now have or at any
time hereafter have for past. present or future spousal support
or maintenance, alimony, alimony pendente lite, counsel fees,
costs or expenses, whether arising as a result of the marital
relation or otherwise, except and only except all rights and
agreements and obligations of whatsoever nature arising or which
may arise under this Agreement or for the breach of any provision
thereof. It is the intention of Husband and Wife to give to each
other by the execution of this Agreement a full. complete and
general release with respect to any and all property of any kind
or nature, real, personal or mixed, which the other now owns or
may hereafter acquire. except. and only except. all rights and
agreements and obligations of whatsoever nature arising or which
may arise under this Agreement or for the breach of any provision
thereof.
5. DIVISION OF HOUSEHOLD AND PERSONAL PROPERTY. The
parties hereto mutually agree that they have effected a
satisfactory division of the furniture, household furnishings,
appliances and other household personal property between them.
The parties mutually agree that Wife shall, from and after the
date hereof, be the sole and separate owner of all such tangible
personal property presently in her possession. and that Husband
hereby releases and relinquishes any right, title or interest he
may have had in the past or now has in the aforesaid tangible
personal property in Wife'S possession. The parties further
agree that Husband shall, from and after the date hereof, be the:J .
sole and separate owner of all such tangible personal property
presently in his possession, and that Wife hereby releases and
relinquishes any right, title or interest that she may have had
in the past, or now has, in the aforesaid tangible personal
property in Husband's possession.
6. PENSIONS AND RETIREMENT ACCOUNTS. The parties hereto
expressly waive and relinquish any rights. claim, title or
interest in any pension. individual retirement accounts or in any
other savings or retirement plans in which the other has any
interest.
Wife expressly waives and relinquiShes any rights, Claim.
title or interest in the Husband's pension resulting from his
employment and memberShip with the National Guard and/or the
Department of the Army.
7. CUSTODY. Husband and Wife will share joint legal
custody of Ashley Anna VanKirk, Born March 7. 1985. The wife
shall have physical custody of Ashley. Husband shall have
reasonable visitation as the parties will agree. Nothing in this
Agreement shall prevent either party from amending this provision
by filing a separate custody action.
8. SUPPORT. Husband agrees to pay the minimum of the sum
of Four Hundred ($400.00) Dollars per month for the support of
Ashley for as long as he maintains his current employment.
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Husband will provide medical insurance coverage of the type and
amount as his employer shall provide on Ashley for as long as the...
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pOlicy allows such coverage. Husband will continue to provide '<'''''),.):''1
medical insurance coverage for Wife of the type and nature
provided for Ashley. until the effective date of the divorce
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between the parties. Extraordinary medical bills for Ashe1y will
be shared by Husband and Wife in proportion to the income of each.
party.
. ,
Husband shall be entitled to claim Ashely as a personal
exemption on his income tax for the tax years 1993. 1994 ~~
to enable Husband
~ 1995.
yf)J to take
Wife will sign any documents necessary
such exemption.
9.
CASH SETTLEMENT.
Husband agrees to pay to Wife the
sum of Six Thousand ($6,000.00) Dollars at the signing of this
Agreement as an equitable distribution of the marital assets.
10. COUNSEL FEES. Each party individually covenants and
agrees that he or she will individually assume the full and sole
responsibility for legal expenses for his or her attorney and
Court costs in connection with the pending divorce action and
shall make no claim against the other for such costs or fees.
11. ADVICE OF COUNSEL. The provisions of this Agreement
and their legal effect have been fully explained to Husband, by
his counsel. James L. Walsh, Esquire. and to Wife by her Counsel,
Barbara Sumple-Sullivan. Esquire. Husband and Wife each
covenants that he or she has made a full financial disclosure to
the other of his and her property and hOldings. Husband and Wife
each acknowledge that each fUlly understands the facts of the
.
agreement and has been fully informed as to her or his legal
rights and obligations and each party acknowledges and accepts
that this Agreement is, in the circumstances, fair and equitable
and that it is being entered into freely and voluntarily, with
such knowledge and that execution of this Agreement is not the
result of any duress or undue influence and that it is not the
result of any collusion or improper or illegal agreement or
agreements.
12. ADDITIONAL INSTRUMENTS. Each of the parties shall,
from time to time at the request of the other, execute,
acknowledge and deliver to the other party any and all further
instruments or documents that may be reasonably required to give
full force and effect to the provisions of the Agreement.
13. MODIFICATION AND WAIVER. A modification or waiver of
any of the provisions of this Agreement shall be effective only
if made in writing and executed with the same formality as this
Agreement. The failure of either party to insist upon the strict
performance of any of the provisions of the Agreement shall not
be construed as a waiver of any subsequent default of the same or
similar nature.
14. ENTIRE AGREEMENT. This Agreement contains the entire
understanding of the parties. and there are no representations,
warranties, covenants or undertakings other than those expressly
set forth herein.
15. DESCRIPTIVE HEADINGS.
herein are for convenience only.
The descriptive headings used
They shall have no effect
~
whatsoever in determining the rights or obligations of the
parties.
16.' INDEPENDENT SBPARATE COVENANTS. It is specifically
understood and agreed by and between the parties hereto that each.
paragraph hereof shall be deemed to be a separate and independent
agreement.
17. BREACH. If either party breaches any provision of
this Agreement, the other party shall have the right, at his or
her election, to sue for damages for such breach or seek such
other remedies or relief as may be available to him or her, and
the party breachinq this contract shall be responsible for
payment of leqal fees and costs incurred by the other in
enforcing their rights under this Agreement, or in seeking such
other remedies or relief as may be available to him or her.
18. APPLICABLE LAW. This Agreement shall be construed
under the laws of the Commonwealth of Pennsylvania.
19. VOID CLAUSES. If any term, condition, clause or
provision of this Agreement shall be determined or declared to be
void or invalid in law or otherwise. then only that term,
condition, clause or provision shall be stricken from this
Agreement, and. in all other respects, this Agreement shall be
valid and continue in full force, effect and operation.
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IN WITNESS WHEREOF, the parties have hereunto set their
hands and ..a1. the day and year,first above written.
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CINDY .~u VANKIRK
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ACKNOWLEDGMENTS
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COMMONWEALTH OP. PENNSYLVANIA
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COUNTY OP~~~.d_ :
On tb" "'oa.1J day Of~kt
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, 1993,
before me, the undersigned officer, personally appeared Thomas A.
VanKirk known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within Agreement and acknowledged
that he executed the same for the purposes ~ in contained.
Notary Public
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COMMONWEALTH OP PENNSYLVArfJA
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COUNTY OP ~ a
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On this the G D day of ....!&h2'1ft? 1993.
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before me, the undersigned officer, personally appeared Cindy
Lou
VanKirk known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within Agreement and aCknOwledged
that she executed the same for the
containec!.
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NolnI S8II ~ Pl.I*: _
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Notary Public
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LAW O'FlCE.
BARBAAA SUMPLE,SULLlV AN
54i eRIDOI ST"IIT
NEW CU....IRLAND, PINNIYLVANIA 17070
.
PHON" (7171 77.'I.Y I,
.
I'AI (7171 77.'7058
November 14, 1994
CONTINGENT FEE AGREEMENT
I, Cindy Lou VanKirk as legal guardian for Ashley VanKirk,
hereby retain the Law Office of Barbara Sumple-Sullivan as my
attorney to represent me in all actions arising from lhe Auto
Accident on August 26, 1994, and to process, negotiate and/or
litigate all claims arising from said accident.
In consideration of Barbara Sumple-Sullivan's promise to
represent me in connection with all rights, actions and claims
which I now have or which may arise in the future as a result of
the above, I agree:
1. To supply promptly, truthfully
information, data and materials requested
Sullivan, Esquire as necessary and useful for
claimsl
and completely all
by Barbara Sumple-
furtherance of these
2. To
litigation or
such as costs
incurredl
pay all costs
negotiations of
and expenses by
and expenses incidental to any
settlement undertaken on my behalf,
Barbara Sumple-Sullivan as they are
3. To pay Barbara Sumple-Sullivan, in addition to the
foregoing costs and expenses, an amount equal to one-third (1/3) of
all funds or property accruing to me as a result of her services in
settlement of these claims with or without litigationl
4. It is further understood that the counsel fee payable as
provided above ooes nnt include services in any appeal after trial:
and if an appeal should occur, the charge for such appeal shall be
as is mutually agreed upon by me and my attorneYl
5. I authorize my attorney to payout of my share of any
settlement or trial any unpaid balances for treatment or services
made necessary by the injuries sustained in the accident in
question and such amount as will cover my attorney's fee as
described hereinl
6. 1 agree not to settle or adjust the above claim or
proceeding based thereon without first consulting my attorney and
obtaining her consentl
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.
.
,
.
Barbara Sumple-Sullivan, Esquire
contingent Fee Agreement
Page 2
7. I agree to fully cooperate with my attorney in the
prosecution of this claim. This includes but is not limited to
making myself available for legal proceeding, for consultations
with my attorney, and keeping my attorney informed of my current
address and phone number; and
8. I warrant that the information which I have supplied and
will supply during the course of these legal proceedings is true
and accurate and has not been obtained through fraud or illegal
activities.
I further state that I am at least eighteen (18) years of age,
that I have read and understand this Agreement, and that I intend
and agree that it shall be fully binding on me, my heirs,
executors, successors and aSSign:~. .
Signed this ~ day of ~ , 1994.
Wllness
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,tAlll.ll/.~ 7 UJJ::.~
c ely LoU VanKirk, as Legal Guardian
for Ashley VanKirk
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PULL AND PIN~L RELE~BE
FOR AND IN CONSIDERATION of the sum of One Thousand
Five Hundred Dollars ($1,500.00) paid to the undersigned, cindy
VanKirk Roach and Thomas A. vanKirk, as parents and natural
guardians of Ashley VanKirk, a Minor, and other good and valuable
consideration the receipt and sufficiency of which is hereby
acknowledged, the undersigned agrees fully to release, discharge
and hold harmless and indemnify Charles M. Madden , state Farm
Mutual Automobile Insurance Company, and all other persons,
associations and corporations whether or not named herein, their
heirs, executors, administrators, successors, assigns and
insurers, and their respective agents, attorneys, servants and
employees, from any or all causes of action, claims and demands
of whatsoever kind on account of all known, and unknown injuries,
losses and damages allegedly sustained by the Minor on August 26,
1994, and, specifically from any claims or joinders, for sole
liability, contribution, indemnity or otherwise as a result of,
arising from, or in any way connected with injuries sustained by
the Minor, on account of which a Legal Action was instituted by
the undersigned in the court of Common Pleas for Cumberland
County, pennsylvania, at Docket No. , and the
defense and handling thereof from the inception of the claim
until the date of this Full and Final Release. The undersigned
understands and agrees that the acceptance of said sum is not an
admission of liability by any party named herein.
. 1 .
It is expressly understood and agreed that this Release
and settlement is intended to cover and does cover not only all
now known injuries, tosses and damages, but any further injuries,
losses and damages which arise from or are related to the
occurrences set forth in the Legal Action noted above and the
handling and defense thereof.
It is further understood and agreed that this is the
complete Release agreement, and that there are no written or oral
understandings or agreements, directly or indirectly connected
with this Release and settlement that are not incorporated
herein. This agreement shall be binding upon and inure to the
successors, assigns, heirs, executors, administrators and legal
representatives of the respective parties hereto.
The undersigned hereby declares that he is of legal
age; that the terms of this settlement have been completely read;
that he has discussed the terms of this settlement with legal
counsel of choice; and that said terms are fully understood and
voluntarily accepted for this purpose of making a full and final
compromise, adjustment and settlement of any and all claims on
account of the injuries and damages above-mentioned, and for the
express purpose of precluding forever any further or additional
Page 2 of 3
. .' .
suits, administrative proceedings or any other claims for relief
arising out of the aforesaid claim.
IN WITNESS WHEREOF, and intending to be legally bound
hereby, I have hereunto set my hand and seal this
, 1995.
day of
WITNESS:
(SEAL)
CINDY VANKIRK ROACH and
THOMAS A. VANKIRK, as parents
and natural guardians of
ASHLEY VANKIRK, a Minor
Page 3 of 3
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