FMS~-e

Judgment FundPayment Request

. (Litigative Award)

AUTHORIZED FOR LOCAL REPRODUCTIONFMS FORM 194

Departmcnt of the Treasury

Date: . July 29, 2002

Judgment Fund SectionFinancial Management ServiceDepartmentofthe Treasury .

Room 6D373700 East-West HighwayHyattsville, Maryland 20782

Matter of: Terry Richards v. United States of Americ~Case No. 8:02':'cv-1203-T-17TGW

Dear Sir or Madam:

I am the authorized representative of the United States in the captioned matter. As described in.the encloseddocumentation, I certify all of the pertinent criteria required by law for the approval of the claim(s) has been satisfied.I believe the award made in the enclosedjudgment or settlement is payable by the United States. The United Stateswill seek no further judicial review of this award, ~nd I have obtained all approvals necessary for its referral forpayment.

I believe that this award qualifies for payment pursuant to 31 U.S.C. § 1304. Accordingly, I request that you certifythis award for payment from the Judgment Fund established by that law. Enclosed are completed copies ofFMS.Form196: Judgment Fund Award Data Sheet and FMS Form 197A: Voucher for Payment; the judgment or settlementagreement; and any other enclosures required by FMS regulations. Unless payment by electronic funds transfer isindicated on FMS Form 196, please have the check sent to the agency contact shown in item 5(c) ofFMS Form 196.

Signature

MICHAEL L. RUBINSTEIN

Name (printed or typed)Assistant United States AttorneyOffice of the United States AttorneyTitle and Agency

Enclosures: FMS Form 196 and FMS form 197A

Incomplete submissions will be returned to the submitter without action.

FMS Form 194

7-97 (pREVIOUS EDITIONS ARE OBSOLETE)

DEPARTMENT OF THE TREASURYFINANCIAL MANAGEMENT SERVICE

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FMS Form 196

Department of the Treasury

Vii FJ Lt- # Lt {;;o J7J'AUTHORIZED FOR LOCAL REPRODUCTION

Financial Manae:ement Service

FMS Judgment Fund Award Data Sheet"

1. Claim/Case"a. Name of claim/case:

4. OaimantJPlaintifi's Counsel, If Anya. Name and Address:

N/ATerry Richards v. United States of America

e. Brief Description of Facts Giving Rise to Claim/Case:- "

5. Agency Informationa. Submitting Agency:

Department of Veterans Affairsb. Submitting Agency's File No.:

None

c. Submitting Agency's Contact:i. Name and Address:

Michael L. RubinsteinAssistant United States Attorney400 North Tampa Street, Suite 3200Tampa, Florida 33602" -

b. ClaimantJPlaintifi's File No., If Known:

c. If Litigative Award:i. Court Name: United States District Courtii. Docket No. 8:02 cv-1203-T-17TGW

iii. D.O.J. Compromise Settlement? Yes

d. Date Award Made (mo/day/year): July 1, 2002

Plaintiff alleges wrongful eviction ftom VAdomiciliary program.

ii. Phone Number: 813/274-6346iii. Fax No.: 813/274-6200

2. ClaimantJPlaintiffa. Name and Address:

Terry RichardsPlaintiff, Pro SeP.O. Box66202St. Petersburg, Florida 33736-6202

d. If Agency Subject to Oaim/Suit is Not SubmittingAgency:

i. Subject Agency:ii. Subject Agency's File No.:

e. Statutory Function Claim/Case Arose Under:FTCA 28 U.S.C. § 2671, ~~.

f If Claim is Within Contract Disputes Act, 41 USC §§ 601,612:

i. Name and Address of Agency ReimbursementContact:

ii. Phone Number:iii. Contract Number:iv. B.C.A. Number:

b. If Claim is For Back Pay, Give Claimant's:i. Social Security Number:

ii. Birth Date (mo/day/year):

3. Payee Name (If Different From ClaimantJPlaintiffNamedAbove):

6. If Payment Will Be Made in a Foreign Currencya. Country and Currency: N/A

,::::::::::::::::::::::::::IIW.BIiH.¥i¥miv:e.ilim1i::ftm$:fi6.mIwll:_1!:iNl¥.$:ll~:¥8¥JI;::$~~I::I::::III:::t::::::::::::::::::::::::::.. ."

FMS Form 196 DEPARTMENT OF THE TREASURY7-97 (pREVIOUS EDITIONS ARE OBSOLETE) FINANCIAL MANAGEMENT SERVICE

. u__ __ 4.__

FMS Fonn 196Dcpartmcnt of the Trea.sury

E.V}'I "- f'J (~ V f> ~ I L~ 11- J l , '0 \) \j S AUTHORIZED FOR LOCAL REPRODUCTION

Judgment Fund Award Data Sheet: Instructions for Lines 7-15

9.Costs.n _.. n. _..,-. -'. .'. .'.-.',.'. .~..~,.:.-. . . . .'.' ..., '..' .'-. -. ,', .'. .'. ,. ,'. .

.;.m::::~~H$!~~~i.i:X~:~~~j~:I,~#~;.:;:. .

10. Interest:;'::'::i .:~,". ;';:'::" . . . . ":.:::.': . ,,:::.' . .

.::;<;j9~.gt!!,tigp;i?k~~!kY:~194§~)",;.:,;:.,;;.;.,:.;.

11. Total Amow\ls PayableFrom The Jud:mel1t Fund

13. Deductions From Other Pages(Nwnber of Addllionnl Pages =

14. Total Amowd to be Deducted

15. Net Amount Pa)l1ble to QaimanUPlaintifi'From the Judgment Fund

ALL If payment will be in a foreign currency, specify all monetarydata in that currency.

7-10 If amounts for fees, costs, or interest were included in theprincipal amount (stated on line 7) as part ofa "lump sum"

award, enter "INCLUDED ABOVE" in the white area ofcolumn A for each such item. Enter "NONE" for any of

these items (principal, fees, costs, or interest) for which noamount was awarded/included.

7. Enter the principal amount payable (excluding attorney fees,costs, and interest) in the column A white area. Cite tl).e legal

authority for that a\\'ard (for instance, "FICA, 28 EUSC 2672-or "5th Amend. Reg. Taking") in the gray area below the

amount.

8. Enter attorney fee (if any) payable in colunm A white area.Cite legal authority for that award (for instance, "EAJA, 28

USC 2412(b)") in the gray area below the amount.9. Enter costs payable (if any) in colunm A white area. Cite

legal authority for that award (for instance, "EAJA, 28 use2412(a)") in the gray area below the amount.

10. If interest was payable and is calculable by the submittingagency, enter total amount in colunm A white area. Cite legalauthority for that award (for instance, "Back Pay Act, 5 USC5596(b)(2)") in the gray area below the amount and, if known,the rate, compounding period (if any), and the dates interestaccrual begins and ends.

11. Add and enter the total amounts shown in white areas of lines7 through 10.

12. Starting in colunm A white area, enter any deductionsspecified in the judgment or settlement agreement, or tobe set off under 31 USC 3728. Place each deduction in

its own column and indicate in the gray areas below itthe reason (for instance, "debt setoff, 31 USC 3728" or"FlCA withholding") for it and the recipient's name,

address, and appropriation account. Ifmare than threedeductions, attach additional sheets. If there are nodeductions, enter "NONE" in column A white area.

13. Enter the number of extra pages (if any) attached for line12.deductions in the space provided. Enter total amount. .

from all additional pages used.14. Enter the total amounts sho\\t1 in all columns of line 12

(A, B, & C) and line 13(A).15. Subtract the amount in line 14 from that in line 11. If

greater than 0, enter the difference on line 15. If thedifference is 0 or less, enter "NONE" on line 15.

DEPARTMENT OF TIlE TREASURYFINANCIAL MANAGEMENT SERVICE

ProvACYACTSTATE~mNT

.'.:-. :,.,

This information is required in accordance with 31 U.S.C. § 1304 and5 U.S.C. § 552. The doto )'ou furnish will be used to effect certificationof your claim. The Information may be shnred with lither brancheswithin FMS for the purpose of certifying your claim. Failure to pro\idethis information may resuU in your claim being returned to you.

FMS Form 1967-97 (pREVIOUS EDITIONS ARE OBSOLETE)

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FMS Form 197ADepartment of the Treasury

AUTHOIDZEDFORLOCALREPRODUCTION

VOUCHER FOR PAYMENT Voucher No.

WHERE A SETTLEMENT AGREEMENT HAS BEEN EXECUTED Schedule No._'''-.6<_,"

AND ATTACHED OR WHERE A FINAL JUDGMENT IS ATTACHED ClalIn No.

A. PAYMENT DATA: (PLEASE TYPE OR PRlNTCLEA"~LY)

(1) Submitting Agency/Office: United States Attorney's OLlice

(6) Total Amount - ~ II, _~, _ __t t"~.. . ' _$

(2) AgencylOfficeMailingAddress:400NorthTampaStred.Suite 3200Tampa, Florida 33602

(3) Agency/Office Contact Person and Telephune No.: Michael L. Rubinstein(81~) 274-6346

(4) Payee(s): (a) Terry Richards, PlaintitTPro Se

(5) Taxpayerldentification No., SSN, or BIN of each Pa)'ce: (a) 261-88-7225

(7) Electronic Funds Transfer (EFT) Information:

(a) Payee Account Name: (d) Bank Name and Address:

(b) ABA Bank # (9 digits):

(c) Payee Account #:

(d) Checking: Savings:

(8) Briefly Identify Claim:

Automobile accident invo!\'ing SBA employee dri'/ing a rental car from National Car Rental System, Inc.

FMS Form 197A7-97 (pREVIOUS EDITIONS ARE OBSOLETE)

DEPARTMENT OF THE TREASURYFINANCIAL MANAGEMENT SERVICE

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:I

~- --- -. . .... - - -"'. _.. . ~ -

/i!

\WIIWI Nil" ~ \!II~~'" e 000

~..~''I IT1 ~l\' iJ

~.~

Check No.

PHILADELPHIA, PA 2049 65328904

M1 MC02116915 J02428291

. w--..-...

08 13 02

20180002

92

TERRY RICHARDSATTN M L RUBINSTEINC/O DOJ400 NORTH TAMPA ST #3200TAMPA, FL 33602

.

6797715-0-89214

-:000000 5 ~B-: b 5 ~ 2BqO" :ln8 0 ~OBO 2

Dated:

This is to acknowledge receipt of the above check by Terry Richards. Pro Se.

By:TERRY RIcaMtnsPlaintiff, Pro Se

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UNITED STATES DISTRICT COURTMIDDLE DISTRICT OF FLORIDA

TAMPA DIVISION

TERRY RICHARDS,

Plaintiff,

v. CASE NO. 8:02-cv-1203-T-30TGW

UNITED STATES OF AMERICA,

Defendant./

JOINT MOTION FOR DISMISSAL

COMES NOW the plaintiff, Terry Richards, Pro Se, and the defendant, the United

States of America, by and through the undersigned Assistant United States Attorney, and

hereby jointly move that the above-entitled action be dismissed with prejudice, each party to

bear its own costs and attorney's fees.

Respectfully submitted,

PAUL I. PEREZUnited States Attorney

...,- /'-

/' _ " T" _,_TERRY RICHARDSPlaintiff, Pro SeP.O. Box 66202St. Petersburg, Florida 33736-6202

Dated:

By:MICHAEL L~RUBINSTEINAssistant United States AttorneyUSAO No. 036400 North Tampa Street, Suite 3200Tampa, Florida 33602Telephone: (813) 274-6346Facsimile: (813) 274-6200

I

{ cf 2iJd!..Dated: --

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UNITED STATES DISTRICT COURTMIDDLE DISTRICT OF FLORIDA

TAMPA DIVISION

TERRY RICHARDS,

Plaintiff,

v. CASE NO. 8:02-cv-1203-T-30TGW

UNITED STATES OF AMERICA,

Defendant.I

RELEASE AND SATISFACTION OF COMPROMISE SETTLEMENTAS TO THE UNITED STATES OF AMERICA

The undersigned person does hereby acknowledge receipt from the United

States of America of Treasury Check No. 2049 65328904 and dated August 13, 2002,

respectively; in full payment and satisfaction of the Compromise Settlement previously

entered into in the above entitled cause on July 22, 2002 and any and all attorney's

fees; and I, Terry Richards, Pro Se, by affixing my signature hereto, do hereby release

and forever discharge, and for my heirs, executors, administrators and assigns do

hereby release and forever discharge the United States of America of and from any and

all claims, demands, rights, and causes of action of whatsoever kind and nature, arising

from, and by reason of, any and all known, foreseen or unforeseen, damages and the

consequences thereof, resulting and to result from the alleged injuries suffered from or

arising thereafter from the allegations enumerated in the complaint filed in this action.

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This release shall be filed in the Office of the Clerk of the United States District,

Middle District of Florida, Tampa Division.

This the~ day of ~ ,2002.

STATE OF FLORIDA

COUNTY OF HILLSBOROUGH

The foregoinginstrumentwas acknowledgedbeforemethis~ day of~+ .2002, by Terry Richards,ProSe, who is personallyknownto me or who has producedas

identificationand who (did) (didnot) take an oath.FL br"\lU~ l.i~€.ns(....-

WITNESS my hand and official seal this ~day of ~2002, at Tampa, Florida.

2

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