Pennsylvania Insurance Department Complaint Form 2015a Re Geico Insurance Claim October 14, 2016

GEICO INSURANCE POLICY NO.
4430728685
COMMONWEALTH OF PENNSYLVANIA
INSURANCE COMPLAINT FORM
(PLEASE TYPE OR PRINT)
It is our goal to assist you in resolving your complaint as quickly as possible. Therefore, we ask that you
complete this form and return it to the office listed on the reverse side of this page. Please provide as much
information and documentation as you can. Within a few days following our receipt of your complaint, you will
receive a letter advising you of your file number, the name of the investigator assigned to assist you and
information on how to contact our office if you have questions. In general, you can expect the investigator to
contact you within thirty (30) days to advise you of our findings or the status of our review.
NAME:
DAYTIME TELEPHONE
Stanley J. Caterbone
1250 Fremont Street

ADDRESS: _____________________________________________
717
669-2163
HOME: (_____)_________________________
WORK: (_____)_________________________
Lancaster, PA 17603
stancaterbone@gmail.com
EMAIL: ________________________________
INSUREDS NAME: (IF OTHER THAN THE ABOVE) :

__________________________________________________________
INSURANCE CARD ID NUMBER:
4430728685
1. Does this complaint involve an individual that is Medicare eligible?

2. Type of
Insurance:
x Auto
Homeowners
Renters/Cond o
Commercial
Flood
Title
3. Type of
Problem:
Individual Life
Group Life
Annuity
Viatical
Cancellation/Nonrenewal
Sales Misrepresentation
(Y/N)
Individual Health
Medicare Supplement
Group Health
Long Term Care
HMO
Medicaid
Medicare
Medicare Advantage
x Claim Handling
Billing/Premium Dispute
Other (specify) _____________________________________
4. (A) If your problem involves an insurance company, give the full name of the company:
GEICO INSURANCE COMPANY

(B) If your problem involves an agent or broker, give his/her full name, address and phone number.
Denise Al-Mustafa, Claim Examiner

4430728685
5. Policy Number: ________________________
In what State was this policy sold? ________________
October 1, 2016 - Lancaster, PA
Claim No. 0557461720101022

6. Date & location of loss: __________________________ Claim #: ______________________________
7. Have you previously reported this problem to our office or any other agency?
Yes x No
PS-4 (REV. 12/15)

PA DEPT. OF INSURANCE COMPLAINT
Page 1 of 39
Friday October 14, 2016
GEICO INSURANCE POLICY NO. 4430728685
8. Are you represented by an attorney?
Yes x No If yes, please give name, address and telephone #:
Note: If you have proceeded with litigation against the company and/or agent we will not be able to assist you until the litigation
has been completed and the court has found misconduct on the part of these parties.
9. Briefly describe your problem and state how you feel it should be resolved. Copies of your policy, correspondence or
other supporting documentation will assist us in understanding or evaluating the issues, please include this
documentation with your complaint form. If more space is needed to describe your problem, please attach additional
sheets.
PLEASE READ, SIGN AND DATE THE STATEMENT BELOW:

I CERTIFY THAT THE INFORMATION THAT I HAVE GIVEN ABOVE IS TRUE AND ACCURATE TO THE
BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT A COPY OF THIS FORM AND
ATTACHMENTS MAY BE FORWARDED TO THE INSURANCE COMPANY, AGENT OR BROKER
INVOLVED.
October 14, 2016

(Signature)
(Date)
(IF YOUR COMPLAINT INVOLVES A MEDICAL ISSUE AND/OR CREDIT INFORMATION)

Please circle either Medical Issue, Credit Information or Both.
I AUTHORIZE__________________________________ (Name of Insurance Company) TO RELEASE TO THE
PENNSYLVANIA INSURANCE DEPARTMENT ANY MEDICAL OR CREDIT INFORMATION THAT MAY
BE PERTINENT TO THE RESOLUTION OF MY COMPLAINT.
October 14, 2016

(Signature)
(Date)
Mail or Fax Complaint Form to:

Pennsylvania Insurance Department
Bureau of Consumer Services
Room 1209, Strawberry Square
Harrisburg, PA 17120
Fax: (717) 787-8585
Toll Free Consumer Hotline: 1-877-881-6388
Please feel free to submit your question or complaint on-line at:
Website: www.insurance.pa.gov
PS-4 (REV. 12/15)
Page 2 of 39
Stan J. Caterbone
ADVANCED MEDIA GROUP
Freedom From Covert Harassment &
Surveillance,
Registered in Pennsylvania
1250 Fremont Street

Lancaster, PA 17603
www.amgglobalentetainmentgroup.com
scaterbone@live.com
717-669-2163
COMMONWEALTH OF PENNSYLVANIA
INSURANCE COMPLAINT FORM
9. Briefly describe your problem and state how you feel it should be resolved. Copies of your
policy, correspondence or other supporting documentation will assist us in understanding or
evaluating the issues, please include this documentation with your complaint form. If more
space is needed to describe your problem, please attach additional sheets.
I sincerely feel that my claim should be paid in an expedited fashion. As you will
see, and as you are already familiar with my previous complaints to you. As you will
see in the attached supporting documents, there is sufficient reason to believe that
there is FRAUD WITH INTENT TO INCUR THEFT BY DECEPTION IN THE STALLING OF
THIS CLAIM.
Page 3 of 39
CHAPTER
DIVIDER
Page 4 of 39
DocuSign Envelope ID: CF0A36B8-C141-482B-8201-256CEDDAD221

GOVERNMENT EMPLOYEES INSURANCE COMPANIES
Claim Number
0557461720101022
Policy Number 4430728685

Date of Loss 10/01/2016
Vehicle Theft Questionnaire

(Please complete even if vehicle is recovered)
Stanley J Caterbone
Name of Insured/Owner: _____________________________________________
Date of Birth: 07/15/1958
________________
1250 Fremont St , Lancaster, PA 17603-6812
Residence Address: ___________________________________________________________________________
Street
P
O
L
I
C
Y
H
O
L
D
E
R
City
State
Zip Code
(717) 826-5354
Telephone Number: Home: ___________________________
Business: _____________________________
10
How long have you been living at the above residence? _________________years
220 Stone Hill Road, Conestoga, PA 17538
Previous Residence Address: ____________________________________________________________________
Street
City
State
Zip Code
Disabled - SS Disability for Symptoms and Illnesses for U.S. Sponsored Mind Control since 2008
Employer Name: ______________________________________________________________________________
Address: __________________________________________________________________________________________________
Street
City
State
Zip Code
Occupation/Position: ________________________________________________ Length of Service: ___________

200-46-0959
PA
18195782
Social Security #: ________________
Driver's License #: ___________________________________
State:_____
Marital Status: Single
Married
Divorced
Separated
Widow
Spouse's Name: ____________________________________________ Date of Birth: ____________________
A
Address: (If different from residence address) __________________________________________________________
N
Street
City
State
Zip Code
Telephone Number: Home: ___________________________ Business: ___________________________

Employer: ________________________________________________________________________________
Address: _________________________________________________________________________________
O
W
N
E
R
Street
City
State
Zip Code
Occupation: _______________________________________________________________________________
Social Security #: _________________ Driver's License #: ______________________________ State:_____
I
N
F
O
R
M
A
T
I
O
N
Others Residing In Household:

NAME/RELATION
SEX
Male
Male
Male
Male
DATE OF BIRTH
DRIVERS LICENSE NUMBER
Female
Female
Female
Female
Other Vehicles Located At Residence Address:

YEAR
MAKE
MODEL
PLATE NO.
INSURANCE COMPANY
K M 8 S C 7 3 D 9 4 U 7 0 9 9 6 4
__________________________________
Vehicle Identification Number (VIN):
PA
KBC7596/KBC9575
94,000
State: ______________
License Plate Number: ______________________________
Mileage _______________
Maroon / Burgundy
TRAILER HITCH
2004 Make: ______________
HYUNDAI
SNTFE AWD
Year: _____
Model: ___________________
Color: __________
Special Packages: __________
V
E
H
I
C
L
E
I
N
F
O
Please check any vehicle options that apply:

Transmission
Power
Overdrive
4 Wheel Drive
Positraction
Power Steering
AM/FM Stereo Radio
Power Brakes
CD Player
Power Windows
Power Locks
Transmission Type
Radio
CD Changer/Stacker
Power Driver Seat
Automatic Transmission
Power Passenger Seat
6 Speed Transmission
Seating
Cloth Seats
Leather Seats
Reclining/Lounge Seats
Premium Radio
Bucket Seats
Satellite Radio
Heated Seats
Steering Wheel Touch Controls
Rear Heated Seats
Power Antenna
Auxiliary Audio Connection
3rd Row Seat
Power Mirrors
Equalizer
Power Third Seat
Power Trunk/Gate
Release
C-116 PA (03-14) NS
Power Adjustable Pedals
Page 5 of 39

Decor/Convenience
Roof
Safety/Brakes
Wheels
Air Conditioning
Electric Glass Roof
Drivers Side Air Bag
Climate Control
Electric Steel Roof
Passenger Air Bag
Rear Defogger
Skyview Roof
Tilt Wheel
Dual Power Sunroof
Auto Level
Aluminum/Alloy Wheels
Exterior/Paint/glass
Chrome Wheels
Luggage/Roof Rack
20" Or Larger Wheels
Exterior Woodgrain
Deluxe Wheel Covers
Rear Window Wiper
Full Wheel Covers
Alarm
Two Tone Paint
Spoke Aluminum Wheels
Front Side Impact Air

Bags
Rear Side Impact Air
Bags
Telescopic Wheel
Manual Steel Roof
Cruise Control
Manual Glass Roof
Keyless Entry
Flip Roof
Night Vision
Three Stage Paint
Styled Steel Wheels
Console/Storage
T-top/Panel
Intelligent Cruise
Clearcoat Paint
Wire Wheels
Metallic Paint
Wire Wheel Covers
Rear Spoiler
Rally Wheels
Locking Wheels
Overhead Console
Entertainment
Center
Navigation System
Communications
System
Glass T-tops/Panel
Power Convertible
Top
Detachable Roof
Head/Curtain Air Bags
Parking Sensors
Parking Sensors
W/Equip
Vinyl Covered Roof
Anti-lock Brakes (4)
Fog Lamps
Anti-lock Brakes (2)
Tinted Glass
Locking Wheel Covers
Privacy Glass
Additional Items not listed:
Heads Up Display
Cabriolet Roof
4-wheel Disc Brakes
Wood Interior Trim
Landau Roof
Electronic
Instrumentation
Roll Bar
Body Side Moldings
Padded Landau Roof
Traction Control
Dual Mirrors
Padded Vinyl Roof
Stability Control
On Board Computer
Heated Mirrors
Message Center
Headlamp Washers
Signal Integrated
Mirrors
Memory Package
Remote Starter
C
U
S
T
O
M
S
A
L
E
S
D
A
T
A
S
E
R
V
I
C
E
Please list any customizations or modifications to the vehicle. This should include any non-factory installed items:
Customization (Please include brand name and model information)
Date Installed
Value
TRAILER HITCH AND BIKE RACK
September 25, 2016
$300.00
$6,072.00
09/17/2016
Purchase/Lease Date: _______________
NEW
USED
Purchase Price: $____________
(717) 391-6757
Seller's Name: __________________________________
Telephone Number: ________________________
Barry Miller Quality Cars
1258 Manheim Pike, Lancaster, PA 17601
Address: ________________________________________________________________________________
NO
Trade In?
YES Value of Trade In: $_________________________
Lienholder/Leasing Co. Name: ___________________________________________________________________
Address: ________________________________________________________________________________
Street
City
State
Zip Code
Telephone Number: ___________________________

Account Number: _______________________________ Down Payment: __________________________
Last Payment: $_________________________________ Date: __________________________________
Has vehicle ever been repossessed?
NO
YES
Is the vehicle currently under a repossession order?
NO
YES
Are payments up to date?
YES
NO
Lienholder notified of THEFT?
YES
NO
Do you have any other outstanding loans on this vehicle or its equipment?
NO
YES
If yes, with whom? __________________________ Amount? $_______
Stanley J Caterbone
Owner(s) as shown on title: _________________________________________________________________
Name of Service Station: ____________________________ Telephone Number: ________________________
Address of Service Station: _____________________________________________________________________
Street
City
State
Zip Code
09/21/2016
Date of Last Service: _____________________
Work Performed: __________________________________
List any work performed since purchase other than tune-up, oil, grease:___________________________________
State Inspection/Oil Change
____________________________________________________________________________________________
September 21, 2016
When & Where Repaired: ______________________________________________________________________
C-116 PA (03-14) NS
Page 6 of 39
NO
Has vehicle been involved in any losses since its purchase?
YES
Date of Loss: _____________________ Location: ________________________________________________
Type of Loss: ________________________________________________________________________________
Damages/Area: _______________________________________________________________________________
Amount: $____________________________________ Repairs Completed?
NO
YES
Insurance Company: ___________________________________________________________________________
D
Telephone Number: _______________________
A Repair Shop Name: _______________________________
M
Address: ________________________________________________________________________________
P
R
I
O
R
A
G
E
T
H
E
F
T
I
N
F
O
Street
City
State
Zip Code
Was there any unrepaired body or mechanical damage on the vehicle prior to the theft?
NO
YES
If "YES" list damages: ____________________________________________________________________________
Stan J. Caterbone
Who had custody of vehicle at the time of the theft? __________________________________________________
Lot on North Mary Street 1st parking space closest to N. Mary Street, Lancaster City, PA
Exact location of theft: __________________________________________________________________________
When to get one drink at Hildeys Bar on the corner of N. Mary and East Federick
Reason car at location: _________________________________________________________________________
10/01/2016
01:40 AM
Date and time vehicle last seen before theft: _____________________
____________
A.M.
P.M.
02:10 AM
10/01/2016
Date and time vehicle discovered missing: _____________________
____________
A.M.
P.M.
2
How many keys were you provided at the time you purchased the vehicle? ______________
Did you have any additional keys made for this vehicle? NO
YES If yes, how many?_______
Are there any keys missing?
YES When did you notice these keys missing?____________________
NO
Were there any keys in or upon the vehicle at the time of the theft? NO
YES Where?_________________
Does the vehicle have either a factory or aftermarket remote starter? NO
YES
Was the vehicle locked?
NO YES Alarm in use?
NO YES
N/A
Was vehicle parked in a tow away zone?
NO
YES
YES If Yes, did police tow it? NO
Are there any outstanding parking tickets? NO
YES
Briefly describe any vehicle usage 24 hours prior to theft, up to and including a description of the loss:
L
O
S
S
I
N
F
O
I am a federal whistleblower and involved in litigation in the following cases: 1.J.C. No. 03-16-90005 Office of the Circuit Executive, United States Third Circuit Court of Appeals - COMPLAINT OF JUDICIALMISCONDUCT OR DISABILITY re 153400 and 16-1149; 03-16-900046 re ALL FEDERAL LITIGATION TO DATE
2.U.S.C.A. Third Circuit Court of Appeals Case No. 16-3284 Chapter 11 Bankruptcy Appeal; Case No. 16-1149 MOVANT for Lisa Michelle Lambert;15-3400 MOVANT for Lisa Michelle Lambert;; 16-1001; 07-4474
3.U.S. District Court Eastern District of PA Case No. 16-4641 Petition for Habeus Corpus; Case No. 16-cv-4014 2005 Conitued Case; Case No. 16-cv-49 Chapter 11 Appeal; 15-03984; 14-02559 MOVANT for Lisa Michelle Lambert; 05-2288; 064650, 08-02982;
4.U.S. District Court Middle District of PA Case No. 16-cv-1751 PETITION FOR HABEUS CORPUS
5.Commonwealth of Pennsylvania Judicial Conduct Board Case No. 2016-462 Complaint against Lancaster County Court of Common Pleas Judge Leonard Brown III
6.Pennsylvania Supreme Court Case No. 495 MAL 2016 Caterbone v. Lancaster County Residents; Case No. 496 MAL 2016 Caterbone v. Lancaster City Police Dept.; Case No. 353 MT 2016; 354 MT 2016; 108 MM 2016 Amicus for Kathleen
Kane
7.Superior Court of Pennsylvania Case No. 16-MD-1219 Preliminary Emergency Injunction; AMICUS for Kathleen Kane Case No. 1164 EDA 2016; Case No. 1561 MDA 2015; 1519 MDA 2015; 16-1219 Preliminary Injunction Case of 2016
8.Lancaster County Court of Common Pleas Case No. 08-13373; 15-10167; 06-03349, CI-06-03401
9. U.S. Bankruptcy Court for The Eastern District of Pennsylvania Case No. 16-10157
On Wednesday September 28, 2016 I had my computer and briefcase stolen. While I was at the bar on the night of the theft I was assaulted by Mr. John Keener, who refused to let me leave the bar. I had to take his picture in order to leave the
establishment and used my Yellow Cab App on my smartphone to summon a cab. He then followed me outside to again assault me, however, my cab arrived just in time.
I suspect that since I had a handicap placard that the parking spaces were filled prior to my arrival. This happens all the time and is called COMMUNITY STALKING.
NO - I CANNOT HAVE ANY CONTACT WITH POLICE DUE TO PRIOR ABUSE BY POLICE, SEE UPLOAD NO. 2
Who notified police? ____________________________________________________________________________
Precinct: ________________________________
G
E
N
E
R
A
L
Case Number: _________________
Agency/Department: _______________________________
Officer: __________________________
Date and time theft reported: _____________________
Time: _________
ARE YOU RENTING A CAR DUE TO THE THEFT?
NO
A.M.
YES
Badge Number: _____________

P.M.
By Phone
In Person
If "YES", please provide:
IF YOU PROVIDE
Rental Co.: ____________________________________
Telephone Number: __________________________
NO
WAS THE STOLEN VEHICLE LOANED OR BORROWED?
YES
I If "YES", complete this section:

N
Name: ____________________________________________ Telephone Number: ______________________
F
O Address: ____________________________________________________________________________________
Street
City
State
Zip Code
R
M
YES
NO
A Relationship: __________________ Purpose: ______________________ Does borrower own a vehicle?
T WAS VEHICLE PARKED IN PUBLIC GARAGE OR PARKING LOT? NO
YES If "YES", complete this section.
I
Name
of
parking
lot/garage:
_________________________________________________________________________
O
N Address: ________________________________________________________________________________________
Insurance Company of garage:_______________________________________________________________________

Who parked the car? __________________________________
Who was given possession of keys Attendant: __________________________________________________________
C-116 PA (03-14) NS
Page 7 of 39

P
O
L
I
C
E
NO
Have you or any member of your family ever had a vehicle stolen?
YES
If yes, Date: _____________________ Location: _________________ Insurance Company: __________________
If recovered, its condition: _______________________________________________________________________
Do you have any other Theft Insurance on stolen vehicle?

NO
YES ____________________________
I
Is
the
vehicle
that
is
reported
stolen
legally
registered
and
titled
at
the
Department
of Motor Vehicles that issued the
N
F title and plates?
YES
NO
O
Name and contact information of suspected thief:___________________________________________________
R
E
C
O
V
E
R
Y
D
A
T
A
P
E
R
S
O
N
A
L
E
F
F
E
C
T
S
RECOVERY
Date: ______________ Time:
A.M.
P.M. Place:____________________________________
Recovery Reported to GEICO?
NO
YES Date: _____________________
Is vehicle drivable?
YES
NO Who recovered the vehicle? ____________________________________
Arrests made?
NO
YES Name and Address: ____________________________________________
Damage due to theft?
NO
YES Describe: _______________________________________________
Was vehicle viewed by policyholder?
NO
YES Where: _____________________________________________
Vehicle located at the present time:________________________________________________________________
Telephone Number: _______________________________
IF THERE WERE ANY PERSONAL ITEMS IN YOUR VEHICLE THAT REMAIN UNRECOVERED AND YOUR
POLICY PROVIDES COVERAGE FOR PERSONAL EFFECTS, PLEASE COMPLETE THIS SECTION:
Please list items separately in the spaces provided below:
Value of each item:
See upload no. 2
TOTAL VALUE OF UNRECOVERED ITEMS (LIMIT OF $200):

NOTE: LOSS TO ANY TAPE, WIRE, RECORD DISC OR OTHER MEDIUM FOR USE WITH A DEVICE DESIGNED FOR THE RECORDING
AND/OR REPRODUCTION OF SOUND IS NOT COVERED. OTHER EXCLUSIONS MAY APPLY. PLEASE REFER TO YOUR CONTRACT.
If the identity of the person or persons responsible for the theft of this vehicle is established, are you willing to
NO
prosecute that person or persons?
YES
Any person who knowingly and with intent to defraud any insurance company or other person files an application for
insurance or statement of claim containing any materially false information or conceals for the purpose of misleading,
information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such
person to criminal and civil penalties.
Any person who knowingly and with intent to injure or defraud any insurer files an application or claim containing any
false, incomplete or misleading information shall, upon conviction, be subject to imprisonment for up to seven years and
payment of a fine of up to $15,000.
I swear that the information contained in the prior four
(4) pages are true and correct to the best of my knowledge.
Stanley J Caterbone
Name: _______________________________________
1250 Fremont St , Lancaster, PA 17603-6812
Address: _____________________________________
Signature: ____________________________________
10/03/2016
Date: ________________________________________
C-116 PA (03-14) NS
Page 8 of 39
CHAPTER
DIVIDER
Page 9 of 39
GEICO INSURANCE POLICY NO. 4430728685___________________________________________
GEICO Advantage Insurance Company

___________________________________________
Attn: Region 1 Claims, PO Box 9505
Fredericksburg, VA 22403-9505
Company:
GEICO Advantage
Date:
10/13/2016
From:
Denise Al-Mustafa
540-286-4638
To:
Mr. Stanley J Caterbone
RE:
Claim Documents 0557461720101022
Page 10 of 39

Government Employees Insurance Company
GEICO General Insurance Company
GEICO Indemnity Company
GEICO Casualty Company
One GEICO Boulevard Fredericksburg, VA 22412-0001
October 3, 2016
STANLEY CATERBONE
1250 FREMONT ST
LANCASTER, PA 17603-6812
CLAIM NUMBER: 0557461720101022

INSURED: STANLEY CATERBONE
DATE OF LOSS: 10/01/2016
Dear Mr. Caterbone:
Please complete the attached Vehicle Theft Questionnaire and disclosure forms and return them
immediately to allow us to promptly investigate your claim. The forms can be sent by mail, via fax to
703-738-2188, or the forms can be uploaded online at the GEICO Claim Center at
www.geico.com/claims/track/.
Along with the information requested above, please include:
1.
2.
3.
4.
5.
A copy of the title.

Service receipts for the general upkeep of the vehicle.
A photocopy of the key(s)
A copy of your drivers license.
A copy of the bill of sale
If your vehicle is recovered, we request you release the vehicle and contact us as soon as possible upon
notification of the recovery.
Please complete the entire questionnaire form before returning to us. If you have any questions, please
contact your adjuster at the number listed below. Thank you for your prompt attention to this matter.
Sincerely,
Denise Al-Mustafa
Total Theft Examiner
540-286-4638
PA DEPT. OF INSURANCEShareholder
COMPLAINT
Page
of 39 With The U.S. Government Friday October 14, 2016
Owned Companies
Not11
Affiliated

Government Employees Insurance Company
GEICO General Insurance Company
GEICO Indemnity Company
GEICO Casualty Company
One GEICO Boulevard Fredericksburg, VA 22412-0001
Date:
Policy Number:
Claim Number:
Consent to Disclose and Release Information Form

The undersigned party(ies) hereby consent to the release and transmittal to GEICO Insurance
Companies (collectively known as GEICO) any information pertaining to the undersigned or the
undersigneds insurance claim with GEICO including, but not limited to; any credit reports;
insurance claim reports; financial reports; bank statements and cancelled checks; medical
information; contracts; releases; agreements; all repair orders, estimates; electronic data storage
devices on said vehicle listed in the claim and the data it contains.
The undersigned further authorizes and directs any person who is presented a copy of this form
to promptly deliver to GEICO any of the information listed above upon GEICOs request.
___________________________________
Insured Signature
___________________________________
Insureds Printed Name
___________________________________
Date
___________________________________
Co-Insured
___________________________________
Date
___________________________________
Street Address
___________________________________
City
___________________________________
State, Zip Code
_____________________________
Social Security Number
_____________________________
Social Security Number
NOTARY SECTION
Subscribed before me this ____day of ________________, 2016
Notary Public______________________________
My Commission Expires_____________________(Date)
**Notary, Please apply seal**
PA DEPT. OF INSURANCEShareholder
COMPLAINT
Page
of 39 With The U.S. Government Friday October 14, 2016
Owned Companies
Not12
Affiliated
CHAPTER
DIVIDER
Page 13 of 39
To Claims Examiner Denise Al-Mustafa
Stan J. Caterbone
Surveillance,
1250 Fremont Street

Lancaster, PA 17603
scaterbone@live.com
717-669-2163
October 3, 2016
GEICO AUTO INSURANCE COMPANY
Denise Al-Mustafa, Claim Examiner
Phone (540) 286-4638
Fax (703) 738-2188
Re: Claim No. 0557461720101022 THEFT OF VEHICLE ON OCTOBER 1, 2016
Dear Ms. Al-Mustafa,
A follow-up to the recorded statement that I was submitted to on Saturday, October 1,
2016 at about 6:30pm, attached is my recollection of the contents of my vehicle. In addition I
have discovered another problem. When I purchased the vehicle I was provided a Pennsylvania
License Plate and Temporary Registration from Barry Miller Quality Cars. On October 3, 2016 I
discovered that the license plate and the PENNDOT Form MV-4st (10-14) do not match. The
license plate on my vehicle is KBC7596 and the license plate no. on the PENNDOT Form MV-4st
(10-14) is KBC7597. I did take photos of the vehicle immediately after arriving home from the
dealer on the day of purchase, September 17, 2016 and found the discrepancy. Please see
attached. As promised to the claim adjuster that took my interview on Saturday, attached are the
documents that I promised to send.
I am also eager to know when I can get my rental car. I am in desperate need of
transportation due to my continued pain that I am experiencing, walking and the bus is not a
viable option, and the fact that I have legal issues and cases that require my immediate attention.
I look forward to your cooperation and assistance today.
Respectfully,
___________/S/____________
Stan J. Caterbone, Pro Se Litigant
Freedom From Covert Harassment & Surveillance,
1250 Fremont Street

Lancaster, PA 17603
stancaterbone@gmail.com
717-669-2163
GEICO
PA
DEPT.
Claim
OF No.
INSURANCE
0557461720101022
COMPLAINT
Page
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39
Monday
Friday October
October14,
3, 2016
ACTIVE COURT CASES FOR STAN J. CATERBONE, PRO SE LITIGANT
J.C. No. 03-16-90005 Office of the Circuit Executive, United States Third Circuit
Court of Appeals - COMPLAINT OF JUDICIALMISCONDUCT OR DISABILITY re 153400 and 16-1149; 03-16-900046 re ALL FEDERAL LITIGATION TO DATE
U.S.C.A. Third Circuit Court of Appeals Case No. 16-3284 Chapter 11 Bankruptcy
Appeal; Case No. 16-1149 MOVANT for Lisa Michelle Lambert;15-3400 MOVANT for
Lisa Michelle Lambert;; 16-1001; 07-4474
U.S. District Court Eastern District of PA Case No. 16-4641 Petition for Habeus
Corpus; Case No. 16-cv-4014 2005 Conitued Case; Case No. 16-cv-49 Chapter 11
Appeal; 15-03984; 14-02559 MOVANT for Lisa Michelle Lambert; 05-2288; 06-4650,
08-02982;
U.S. District Court Middle District of PA Case No. 16-cv-1751 PETITION FOR
HABEUS CORPUS
Commonwealth of Pennsylvania Judicial Conduct Board Case No. 2016-462

Complaint against Lancaster County Court of Common Pleas Judge Leonard Brown III
Pennsylvania Supreme Court Case No. 495 MAL 2016 Caterbone v. Lancaster County
Residents; Case No. 496 MAL 2016 Caterbone v. Lancaster City Police Dept.; Case
No. 353 MT 2016; 354 MT 2016; 108 MM 2016 Amicus for Kathleen Kane
Superior Court of Pennsylvania Case No. 16-MD-1219 Preliminary Emergency

Injunction; AMICUS for Kathleen Kane Case No. 1164 EDA 2016; Case No. 1561
MDA 2015; 1519 MDA 2015; 16-1219 Preliminary Injunction Case of 2016
Lancaster County Court of Common Pleas Case No. 08-13373; 15-10167; 06-03349,
CI-06-03401
U.S. Bankruptcy Court for The Eastern District of Pennsylvania Case No. 16-10157
GEICO
PA
DEPT.
Claim
OF No.
INSURANCE
0557461720101022
COMPLAINT
Page
Page15
2 of
of24
39
Monday
Friday October
October14,
3, 2016
Stan J. Caterbone
Surveillance,
1250 Fremont Street

Lancaster, PA 17603
scaterbone@live.com
717-669-2163
CONTENTS OF 2004 SANTA FE

Monday, October 3, 2016 Valuation Approximately $1,400.00 Including
Improvements
1. Sirius Radio
2. 8 CD's
3. Permanent Handicap Placard
4. Vapor Pen
5. Complete Set of Dealer Documents
6. Electronic Component Accessories in blue pouch
7. Apple Headphones
8. Cane
9. Spider Flashing Light
10. Tupperware Container of Electronics
11. Green Recycle Bin Containing Tools
1. 2 Tow Chains
2. 2 Tow Straps
3. Misc Cleaning Supplies
4. Touchup Paint
5. Rope
6. Lubricants
7. Paper Towels
12. DashCam Camera
13. Inflatable Air Mattress and DC Pump
14. Accordion Box of Legal Documents
15. Ratchet Set
16. Vice Grips
17. Gym Bag with Toilet Kit, Cloths, etc.
18. Hitch
19. Bike Rack
20.
GEICO
PA
DEPT.
Claim
OF No.
INSURANCE
0557461720101022
COMPLAINT
Page
Page16
3 of
of24
39
Monday
Friday October
October14,
3, 2016
CHAPTER
DIVIDER
Page 17 of 39
Hyundai
GEICO
PA
DEPT.
Claim
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page
Page18
1 of
4
of24
21
39
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
GEICO
PA
DEPT.
Claim
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page
Page19
2 of
5
of24
21
39
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
GEICO
PA
DEPT.
Claim
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page
Page20
3 of
6
of24
21
39
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
CHAPTER
DIVIDER
Page 21 of 39
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page
Page22
1 of
4
7
of24
18
21
39
Purchased
Monday
Friday
September
October
October17,
14,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page
Page23
2 of
5
8
of24
18
21
39
Purchased
Monday
Friday
September
October
October17,
14,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page
Page24
3 of
6
9
of24
18
21
39
Purchased
Monday
Friday
September
October
October17,
14,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page
Page25
10
4 of
7
of21
18
24
39
Purchased
Monday
Friday
September
October
October17,
14,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page
Page26
11
5 of
8
of21
18
24
39
Purchased
Monday
Friday
September
October
October17,
14,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page
Page27
12
6 of
9
of21
18
24
39
Purchased
Monday
Friday
September
October
October17,
14,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page
Page28
10
13
7 of
of18
21
24
39
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page
Page29
11
14
8 of
of18
21
24
39
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page
Page30
12
15
9 of
of18
21
24
39
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page 31
10 of 39
13
16
18
21
24
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page 32
11 of 39
14
17
18
21
24
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page 33
12 of 39
15
18
18
21
24
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page 34
13 of 39
16
19
18
21
24
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page 35
14 of 39
17
20
18
21
24
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page 36
15 of 39
18
21
18
21
24
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page 37
16 of 39
19
22
18
21
24
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page 38
17 of 39
20
23
18
21
24
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016
Hyundai
Hyundai
GEICO
PA
DEPT.
Claim
Santa
Santa
OF No.
INSURANCE
Fe0557461720101022
$5,495 COMPLAINT
Page 39
18 of 39
21
24
18
21
24
Purchased
Monday
Friday
September
October
October14,
17,
3, 2016

Pennsylvania Insurance Department Complaint Form 2015a Re Geico Insurance Claim October 14, 2016

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Pennsylvania Insurance Department Complaint Form 2015a Re Geico Insurance Claim October 14, 2016

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GEICO INSURANCE POLICY NO.

1250 Fremont Street

INSUREDS NAME: (IF OTHER THAN THE ABOVE) :

1. Does this complaint involve an individual that is Medicare eligible?

Long Term Care

GEICO INSURANCE COMPANY

Denise Al-Mustafa, Claim Examiner

In what State was this policy sold? ________________

October 1, 2016 - Lancaster, PA

Claim No. 0557461720101022

PS-4 (REV. 12/15)

Friday October 14, 2016

GEICO INSURANCE POLICY NO. 4430728685

8. Are you represented by an attorney?

Yes x No If yes, please give name, address and telephone #:

PLEASE READ, SIGN AND DATE THE STATEMENT BELOW:

October 14, 2016

(IF YOUR COMPLAINT INVOLVES A MEDICAL ISSUE AND/OR CREDIT INFORMATION)

October 14, 2016

Mail or Fax Complaint Form to:

Friday October 14, 2016

GEICO INSURANCE POLICY NO. 4430728685

1250 Fremont Street

PA DEPT. OF INSURANCE COMPLAINT

Friday October 14, 2016

GEICO INSURANCE POLICY NO. 4430728685

PA DEPT. OF INSURANCE COMPLAINT

Friday October 14, 2016

DocuSign Envelope ID: CF0A36B8-C141-482B-8201-256CEDDAD221

GEICO INSURANCE POLICY NO. 4430728685

Policy Number 4430728685

Vehicle Theft Questionnaire

Occupation/Position: ________________________________________________ Length of Service: ___________

Telephone Number: Home: ___________________________ Business: ___________________________

Others Residing In Household:

DRIVERS LICENSE NUMBER

Other Vehicles Located At Residence Address:

Please check any vehicle options that apply:

AM/FM Stereo Radio

Power Driver Seat

Power Passenger Seat

Steering Wheel Touch Controls

Rear Heated Seats

Auxiliary Audio Connection

3rd Row Seat

Power Third Seat

Power Adjustable Pedals

PA DEPT. OF INSURANCE COMPLAINT

Friday October 14, 2016

DocuSign Envelope ID: CF0A36B8-C141-482B-8201-256CEDDAD221

GEICO INSURANCE POLICY NO. 4430728685

Electric Glass Roof

Drivers Side Air Bag

Electric Steel Roof

Passenger Air Bag

Dual Power Sunroof

20" Or Larger Wheels

Deluxe Wheel Covers

Rear Window Wiper

Full Wheel Covers

Two Tone Paint

Spoke Aluminum Wheels

Front Side Impact Air

Manual Steel Roof

Occupation/Position: ______________________________________ Length of Service: _

Telephone Number: Home: _ Business: _