Free Notice (Other) - District Court of Delaware - Delaware

Case 1 :06-cv-00539-SLR Document 4 Filed O9/O1/2006 Page 1 of 3
United States District Court
844 King Street
Wilmington, Delaware 19701
Jourdean Lorah - Plaintiff
114 Walls Ave. O[<:··‘ S 5 G]
Wilmington, Delaware 19805
V
Department of Natural Resources
and Environmental Control- Defendant
89 King’s Highway
Dover, Delaware 19901
The PMA Group- Defendant
P.O. Box 25249 Q cn
Lehigh Valley, Pennsylvania 18002-5249 W ga]
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MOTION REGARDING THE IDENTIFICATION OF THE 4-. *79
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ENCLOSED REPORT FROM DNREC
Plaintiff, Jourdean Lorah has verified that the identification of Jordan Lorah is
not the Plaintiff, Jourdean Lorah. Officer Kubrick of The Delaware State Police
researched the identification, and name of Jordan Lorah through their computer
system, No one by the name of Jordan Lorah with the gender of a male and the
social security number that is on the DNREC report came up in their system.
Officer Kubrick of the Delaware state police verified that a female named Jordan
Lorah is residing in Sussex County. Neither female or male Jordan Lorah matched
the identification of the Plaintiff, Jourdean Lorah. The fraud concerning the report

Case 1:06-cv-00539-SLR Document 4 Filed O9/O1/2006 Page 2 of 3
has economically extorted the Plaintiff, Jourdean Lorah. Plaintiff, Jourdean Lorah
respectively prays that the United States District Court considers compensation for
her loss. The dispute/conflict with employment has engendered the Plaintiff,
Jourdean Lorah.

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P0 Box 8902 Case 1 :06-cv—00539-SLR Do<§I,IReEt 4: IFA`?/d QE/01 /2006 Page 3 of 3
Wilm, DE 19899-8902 Fmgr DE A
302-761 -8200 REPORT
y OF
OCCUPATIONAL INJURY OR DISEASE
I- 40-0600-210 299400-76-21-40-2
LOCATION/DEPT INSURANCE POLICY NUMBER
1. EMPLOYEE: FIRST MIDDLE LAST 2. EMPLOYEE SOCIAL SECURITY NO.
Jordan Lorah . - 6601
3. ADDRESS - INCLUDE COUNTY AND ZIP CODE 4. MALE E 5. EMPLOYEE TELEPHONE NUMBER
Route 5 Box 150, 318 Frankford, DE 19945, Sussex Co. FEMALE I] (302) - 539 - 4773
6. " ""` ` ’ BIRTH 7. AGE 8. WAGE I- 9. WEEKLY HOURS WORKED
384 18 S 9.50 per hour 40
10. OCCUPATION (REGULAR) 11. DIVISION REGULARLY EMPLOYED 12. HOW LONG EMPLOYED
Lifeguard DNREC/Parks & Recreation 2 years ( seasonai)
13. EMPLOYER 14. PERSON MAKING OUT THIS REPORT
DEPT. OF NAURAL RESOURCES & ENVIRONMENTAL CONRTOL 80*****6 K°'$I¤¤Q°
15. ADDRESS — INCLUDE COUNTY AND ZIP CODE 16. EMPLOYER TELEPHONE NUMBER
89 Kings Highway, Kent County, DE 19901 (302)- 739-5823
17. MAILING ADDRESS - IF DIFFERENT FROM ABOVE 18. NATURE OF BUSINESS
A N/A STATE GOVERNMENT
19. DATE OF REPORT 19. DATE OF INJURY AND TIME 21. NORMAL STARTING TIME 22. IF EMPLOYEE BACK TO 23. AT SAME WAGE
06/30/2003 06/29/2003 9:00 E AM DPM WORK GIVE DATE E YES E] NO
4:30 I] AM E PM 06/30/2003
24. IF FATAL INJURY, GNE DATE OF 24. DATE EMPLOYER KNEW OF INJURY 26. DATE DISABILITY BEGAN 27. LAST FULL DAY PAID - DATI
DEATH 06/30/2003 / I / /
/ /
28. DESCRIBE THE INJURY/ILLNESS AND PART OF BODY AFFECTED.
Injured right hand
29. SPECIFY THE DEPARTMENT WHERE INCIDENT OCCURRED AND THE WORK PROCESS INVOLVED.
Cape Henlopen State Park
30. LIST THE EQUIPMENT, MATERIALS, AND CHEMICALS EMPLOYEE WAS USING WHEN THE INCIDENT OCCURRED. E.G. ACETYLENE.
None
31. DESCRIBE THE EMPLOYEE‘S ACTIVITY AT THE TIME OF INJURY OR ILLNESS. I.E.
Working out - diving into water
32. DESCRIBE HOW THE INJURY/ILLNESS OCCURRED.
While diving into water, employee jammed right hand into sand.
33. NAME OF PHYSICIAN 34. PHYSICIAN‘S ADDRESS
None 'Z:§ed at this tim
35. HOSPITAL (IF APPLICABLE) 36. HOSPITAL ADDRESS
WORKER'S COMPENSATION INSURANCE COMPAYN AND COMPLETE ADDRESS (PREPRINT OR STAMP INCLUDE IAB CODE)
37. (THIS SECTION MUST BE COMPLETED IN ORDER TO PROCESS)
...._...—
P.O. BOX 25248 I.A.B. CODE 40 POLICY NO. 7621402
LEHIGH VALLEY, PA 18002
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SIGNATURE OF PERSON IN BOVE OFFICIAL POSITION