DePaul Law Firm LLC Greg DePaul, Esq. Attorney at Law 505 Morris Ave,, Ste. 205, ‘Tek: (978) 376.8585 Springfield, NY 07081 Fax: (973) 757-1864 ‘wor. depaullawtitm.com depaul@depaullawfirm.com Peter Cecinini, Esq ofCoweed 2 December 22, 2015 Sent via certified & regstar mal Tor ‘Tort and Contract Unit Dept ofthe Treasury, Bureau of Risk Managment P.O. Box 620 ‘Trenton, NI 0862S Stato of Now Jersey Office ofthe Attorney General P.0, Box 080 ‘Teaton, NF 08625 [New Jersey Dept, f Children and Families PO, Rox 729 Trenton, NT 08625 ‘Cleck, County of Camden ‘520 Market St # 102 ‘Camden, NU 08102 Clerk, Winslow Township 125 South Route 7 Braddock, NJ 08037 CCletk, Gloucester Township 1261 Chews Landing Road Clementon, NJ 08021 1 tice represents David Vorembecg and Tana Vosembery, the parents of Caso known a _ wi is deceased In accordance with NJ.S.A, 59:8-4, we fle the fllowing Notice of Cain (tated) related co the wrongful deth of A VIM is did in an ac involving a motor vehicle on or about October 16th and 17h of 2015 in o nat Sietevil, or Winslow, "New Jerse. Pleas fee fo to coat thie aie with any conterns or que we Me ENC: Notie of Chim 65s)INITIAL NOTICE OF CLAIM FOR DAMAGES AGAINST THE STATE OF NEW JERSEY FOWARDTO: TORT AND CONTRACT UNTT DEPARTMENT OF THE TREASURY, OUREAY OF FISK GIT. POvOK E20 "TENTON, NEW JERSEY 8625 PHONE (0) 292-4347 ‘Font AUST BE FILED WITHIN 90 DRYS OF THE ACCIDENTOR YOU MAY FORFEIT VOURAIGHT 1. clam Vorenbe ont amt 1961 iastaawe FST DOLE - DATE ora 270Feret Die STREETADONESS TANG ADDRESS OTHER HAN STREET ADDRESE Snngiied omer — aware aeobe "Foci secuny wungen 2, IENOTICES AND CORRESPONDENCEIN CONNECTION WITH THIS CLAIM ARE TO BESENT TO A PERSON OTHER THAN reg DePaul Esa 505 Mes Avenue Sute 205 AME ALINGADORESS Seng u e7oet av STATE ZPCODE ——— RELATIONSHIPTO.CLAINANT: ATTORNEY ATLAW [3] OR — a "EXPLAIN RELATIONSHIP ‘THE OCCURRENCE OR ACCIDENT WHICH GAVE RISETOTHIS CLAIMS 3% octcbor1Gand/or 17,2018 _Betwoun 9PM 2AM ate THE by, DESCRIBETHELOCRTION ORPLACEOF THE ACCIDENT OR OCCURENCE. ‘Sell of Winslow ‘vornen 2038 Sin TmonicieaLery = EXACT LOCATION OFTHE OCCURRENCE. DESCRIBE HOW THE ACCIDENT OR OCCURENCE HAPPENED: IF & DIAGRAM WILL ASSIST YOUR EXPLANATION, PLEASE USE “THEREVERSE SIDE OFTHIS FORM. Lemans son NN wert of Youth Consutaon Sanco when he dad Octobe 161, 2015, He was “STATE THE NAME AND ADDRESS OF THESTATE AGENCY OR AGENCIES THAT YOU CLAIM CAUSED YOUR DAMAGE. 1 ef hlden and Eales, Division ofCHd Protection and Permanency Vormety DYES), Ofce of son of ‘STATE THE WANES OF STATEEMPLOYEES WHOM YOU CLAIM WEE AT FAULT, INCLUDING ANY INFORMATION THAT WILL [ASSISTININDENTIFYING AND LOCATING THEN, «STATE THE NEGLIGENCE OR WRONGFUL ACTS OF THE STATE AGENCY AND STATE EMPLOYEES WHICH CRUSED YOUR DAMAGES. of Child and Protacve Sere, 35 well as Camden Couny, Mons County, Wisow Ty owpshipand |. STATETHE NAME AND ADDRESS OF ALL WITHESSES TOTHE ACCIDENT OR OCCURRENCE. Dir other wlneses to 2 hvertgaton reves ‘9. STATETHE NAMES OF ALL POLICE OFFICERS AND POLICE DEPARTHENTS WHO INVESTIGATED THIS ACCIDENT, ew Poe are cme ves 4a, CLAIM FOR DAMAGES (CHECK APPROPRIATE BLOC LC) PeRSONALIWURY Cj PROPERTY OANAGE [kg OTHER-EXPLANINDETAL, Wrongful denth acon suvvorslp cal frost wages, companion enotoral damages.bs, IEYOUCLAM PERSONAL RURY (1) DESCRIBE YOUR URIS RESULTING FROM THIS ACCIDENT OR OCCURRENCE, led suring ciden sue emotional and xycheleleal (2) DOYOU CLAIM PERMANENT DISABILITY RESULTING FROM THIS NUURY: oO % gw | YES, OESCHIDE THE INJURIES BELIEVED TOBE PERMANENT. (2) FOREACH HoSPITAL, DOCTOR OR OTHER PRACTITIONER RENDERING TREATAENT, EXAHINATION OR DIAGNOSTIC. SERVICES, STATE: [NAME OF HOSTAL, DATES Jawr.PxIDORPAYABLESY ‘DocroROROTHER TREATRENT 8 ‘OTHERSOURCESUCH AS FACIUTY ‘EIVCE INSURANCE YouthConsaton Sve [2208 ScerileRs, Waslew TpNY [unl O=t 162015 (4) IF YOU CLAIM LOSS OF WAGE OR INCOME ASA RESULT OF THE INJURY STATE: ‘Aspat of wong death ca/suvivrhip ‘WANE OF ENPLOVER [ADDRESS OF EMPLOYER ‘Your occurarion DDATEVOU BECAME EMPLOYED RATEOFPAY DATE OF ABSENCE FROM WORK Unknown ‘TOTALLOSS WAGESTO DATE ‘STILL OUT, EXPECTED DATE OFRETURN NOTE: IF YOUR CLAIMED LOSS OF INCOME ARISES FROM SELF-EMPLOYMENT OR OTHER THAN WAGE, ATTACH A {CALCULATION SHOWING THE BASIS OF YOUR CALCULATION OF LOST INCOME,(5) SETFORTH AW AND ALL OTHER LOSSES OR DAMAGE CLAIMEDBY YOU. ‘pat of onal dat and suv dis funeral faye e hip emotional dios: candocholagal damaogs, | YOU CLAIM PROPERTY DAMAGE: (0) DeScRIBETHE PRoPEETY DAMAGED. (2) THE PRESENTLOCATION AND THE WHEN THE PROPERTY MAY BEINSPECTED. (2) paTEPRopeRTY ACQUIRED. (8) cosroFPRoPEnTY (5) VALUE OF PROPERTY ATTIME OF ACCIDENT: § (6) DESCRIPTION OF oAMAGE. (7) Has THEDANAGESEEN REPAIRED? 1 50,Y WHOM, WHEN AND COST OF REPAIRS. (8) ATTACHEACH ESTIMATE OF REPAIR COSTS TOTHIS FORM. (9) SETFORTHIN DETAIL THELOSS CLAIMED BY YOU FORPROPERTY DAMAGE. 44, SETFORTHIN DETAIL ALLOTHER ITEMS OF LOSS OR DARIAGES CLAIMED BY YOU AND THE METHOD BY WHICH YOU MADE THECALCULATION.‘5 THe AMOUNT OF THECLAI, Unspectiedatthis tie. ‘6, HAVE YOUBIADEA CLAIM AGAINST ANYONE ELSEFOR ANY OF THELOSSES OR EXPENSES CLAIMED IN THIS NOTICE? I es, SET FORTH THE NAME AND ADDRESS OF ALL PERSONS AND INSURANCE COMPANIES AGAINST WHOM YOU HAVE MADE SUCHCLAIMS: “7. ARE ANY OFTHELOSSES OR EXPENSES CLAIMED HEREIN COVERED BY ANY POLICY OF INSURANCE? Uno thie, FOR EACH SUCH POLICY, STATE THENAMIE AND ADDRESS OF THE INSURANCE COMPANY, POLICY NUMER AND BENEFITS 8, HAVE YOURECEIVED OR AGREED TO RECEIVE ANY MONEY FROM ANYONE FOR THE DAMAGES CLAIMED HEREIN? OS ww | Vs, SET FORTH THE DETAIL OFSUCH AGREEMENT. 9. THE FOLLOWING TENS MUST BE SUBTaTTED WITH THIS NOTICE: (0) COPIES OF rrentzeD BiLLS FOR EACH MEDICAL EXPENSE ANO OTHER LOSSES AND EXPENSES CLAIMED. [2) FULLCOPIES OF ALL APPRAISALS AND ESTIMATES OF PROPERTY OAMAGE CLAIMED BY YOU. (8) COPIES OF ALL WITTEN REPORTS OF ALL EXPERT WITNESSES AND TREATING PHYSICIANS. (@) ALETTER FROM YOUR EMPLOYER VERIFYING YOUR LOST WAGES. IF SELF-EMPLOYED, A STATEMENT SHOWING THE {CALCULATION OF YOUR CLAIMED LOSTINCOME. | eReaY CERTIFY THATTHE FOREGOING STATEMENTS MADE BY ME AE TRUE THAT THE ATTACHED STATEMENTS BLS, REPORTS AND [DOCUMENTS ANE THE ONLY ONES KNOW TO METO OE IN EXISTENCE AT THE TIME. LAM AWARE HAT FANY STATEMENT MADE ene Rein yo Pon (1-207 DATE Eamonn on PERSON FILING ON se man