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IN REI ESTATE OF RICHARD
GREENE, DECEASED
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-94-475
d(ff
AND NOW, this ~, day of
ORDBR
I\(p,,--~
,
, 1997,
upon consideration of Petition for Approval of compromised
Settle~ent and Distribution of Proceeds, IT IS HEREBY ORDERED I
1. That settlement by Colleen Greene, Individually and as
Administratrix of the Entate of Richard Greene, Deceased, is hereby
ratified and approved. Colleen Greene is authorized to mark the
above-captioned action settled, discontinued and ended as to
Defendants and to execute any release required to consummate the
settlement.
2. That the proceeds shall be allocated between the Wrongful
Death and Survival Aotions brought by plaintiff, in the following
fashionl
$405,000 to be divided by the Wrongful Death
Beneficiaries, Colleen, Racquel and Richard Greene, Jr., and
$45,000 to the Estate of Richard Greene, to desoend to his
intestate heirs, Colleen, Raoquel and RiChard Greene, Jr., in the
manner set out in the provisions of the Pennsylvania Fiduciary Code
governing Intestate Succession, 20 Pa.C.S.A.SS 2102 and 2203.
3. That the total settlement shall be distributed as in the
fashion set out at length in paragraph 17 of Plaintiff's Petition
ORIGINAL
Wrongful Death Act for the benefit of those relativee of the
decedent entitled by law to recover damages for his wrongful death,
and one under the Survival Act for the benefit of those rel.atives
of the decedent anti tled by law to recover damages fOl" his wrongful
death.
4. The case arose from the Defendant chiropractors' failure
to identify an abnormality in decedent's lung causing a delay
in diagnosis of Plaintiff's decedent's lung cancer of about three
months. Mr. Greene died only three month later, leaving only a
six-month period from the date the cancer first appeared and Mr.
Greene's death.
5. Defendants disputed liability and vigorously defended the
case on causation, claiming a three-month delay in diagnosis had
virtually no demonstrable effect on Plaintiff's disease as lung
cancer of this type and aggression would certainly have been fatal
no matter even if treatment had started three months earlier.
6. Although Plaintiff's experts were prepared to offer
testimony that immediate treatment would have prolonged Plaintiff's
life, all experts would have had to agree that Mr. Greene had less
than a lOt chanoe of surviving 10 years no matter when his oancer
was treated. Mr. Greene was also totally disabled from a baok
injury and on Worker's compensation for 2~ years prior to his
death.
2
,"
"
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7. Despite serious disputes on causation and damages,
Defendants have nevertheless agreed to pay and to compromise the
disputed clai~ arising from the suit in the amount of Four Hundred
Fifty 'l'housand ($450,000) Dollars. .2.U, Release attached as
Exhibit "A".
a. In view of the disputed claim and the uncertainty of
oecuring a verdict, Your Petitioner considers the offer to be a
fair, just and equitable settlement and to be in the best interest
of the Estate, the persons entitled to take under the Wrongful
Death action including Richard E. Greene, Jr., who is a minor by
three months, and the persons entitled by law to recover damages
for the debts of the deoedent.
9. Prior to coming to Angino & Rovner, Petitioner Colleen
Greene had had the medical malpractice case evaluated by another
law firm specializing in medical malpractice claims. That firm
rejected the case giving Angino & Rovner little time to evaluate
tho case prior to expiration of the statue of limitations.
10. The Petitioner retained the firm of Angino & Rovner,
P.C., to proseoute this aotion, and entered into a contingent fee
agreement with soid attorneys for their professional services of
any amount reoovered plus expenses. A copy of the Power of
Attorney and Fee Agreement is attached hereto as Exhibit "B".
11. In this case, liability was developed primarily in
depositiono. It was not until Angino , Rovner comprehensively
3
deposed the Defendants that the facts giving Defendants the
incentive to settle the case were developed. Had Angino & Rovner
not asked the "right questions" at depcsition this case would have
been defended on causation or settled for a considerably lower
amount.
12. Pursuant to the Power of Attorney and contingent Fee
Agreement, Angino & Rovner, P.C. / is entitled to 35% of any amounts
recovered plus expenses.
13. Angino & Rovner, P.C./ ~s attorneys for Petitioner, has
incurred expenses for investigation, depositions and miscellaneous
items, which expenses total $7/547.53.
14. Prior to decedent's death, the following debts were
outstanding:
CIGNA Healthcare $59,906.50
(Subrogation lien for medical expenses paid for Richard Greene
Sr.'s cancer treatment. ~, SUbrogation t'rintout attached as
Exhibit "C".)
15. Petitioner's counsel has discussed the case with the
Pennsylvania Department of Revenue who has agreed to an allocation
of 90' of the proceeds to the Wrongful Death Action and 10% to the
Survival Action. Acknowledgment letter from the Department of
Revenue to be provided.
16. Consistent with paragraph 15, the total settlement shall
be allocated, as follows between Wrongful Death and Survival:
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FULL AND FINAL REI.EASE
FOR AND IN CONSIDERATION of the sum of Four Hundred and Fifty
Thousand Dollars ($450,000,00) paid to the undersigned, receipt of which is hereby
acknowledged, by the Princeton Insurance Company, the undersigned do fully release
and discharge Thomas J, Smorsh, D,C. P.C" the Princeton Insurance Company, and
all other persons, associations and corporations whether or not named herein, their
heirs, executors, administrators, successors, assigns and insurers, and their
respfJctive agents, 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 undersigned and, specifically, from any
daims, or joinders, for sole liability, contribution, indemnity or otherwise as a result
of, arising from, or in any way connected with all medical professional health care
services rendered by the above named Health Care Provider, Rnd on account of which
Legal Action was instituted by the undersigned in the Court of Common Pleas,
Cumberland County Pennsylvania, docket number 95.1844, The undersigned does
understand, and agrees, that the acceptance of said sum is in full accord and
satisfaction of a disputed claim and that the payment of said sum is not an admission
of liability by any party named herein,
I t is expressly understood and agreed that this release and settlement is
intend!ld to cover and does cover not only all now known injuries, losses, damag!ls, but
any further injuries, losses and damages which arise from, or are related to, the
occurrence set forth in the Legal Action noted above,
'rhe undersigned hereby agrees, on her behalf and on behalf of my heirs,
executors, successors andlor assigns, to indemnify and save forever harmless the
1
Releasees named in this document from and against any and all claims, demands or
actions known or unknown made against the Releasees by any person or entity on
account of, or in any manner related to or arising from the Legal Action noted above.
In the event court approval is required for the settlement, compromise or
resolution of this claim, this settlement is conditioned upon plaintiff undertaking any
and all necessary action to obtain same, If this settlement is ever determined by any
court to be without effect becauee some necessary court. approval was not obtained, or
if the released parties are subjected to further legal action or claim which could not
have been instituted or presented had proper court approval been obtained by
plaintiff, then plaintiff will indemnify the released parties for any future loss, cost, or
expense including but not limited to reasonable attorney's fees for defending,
litigating and settling any such claims or action, and for any judgment resulting from
any such action or claim.
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 representative parties
hereto.
It is further understood and agreed and made part hereof, that neither the
undersigned nor our attorneys nor other representatives, will in any way publicize, in
any news or communications media, including but not limited to newspapers,
magazines, radio or television, the facts or terms and r.onditions of this sett.lement,
All parties to this agreement expressly agree to decline commcnt of any aspcct of this
2
"
,
settlement to any member of the news media, This paragraph i8 intended to become
part of the consideration for settlement of this claim.
THE UNDERSIGNED HEREBY DECLARES that the terms of this settlement
have been completely read; and that they have discussed the terms of this settlement
with legal counsel of their choice; and said terms are fully understood and voluntarily
accepted for the 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
suits arising out of the aforesaid claims,
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
day of
1997.
(Seal)
Colleen Greene, Individually and as
Administrlltrix of the Estate of
Richard Greene
"
Social Security Number
SWO~N to and subecribad
before me this day
of 1997.
Notary Public
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, POWER OF ATTORNEV AND FEE AGREEMENT
8y alJnlng thll Agreement, I (we) acknowledge that I (we) have engaged the law firm 01 Anglr",' & Rovner,
P.C., to reprllent me IUI) under the following terms end conditions: '
1. Anglno & Rovner, P.C. may on my (our) behalf secure medical, work end other similar records, conduct an
Inveatlgatlon, negotlat , and I neceasery atart suit against anyone responsible for my (our) injuries and losses
with respect to , with full powar and suthorlty to appear on behalf
of the undersigned In any Court of record or In any' administrative or other proceeding, to do and perform all
Ind every act and thing whatsoever that msy be requisite and necessary to be done In connection with the
Ibove claim al fully II the undersigned might or could do If personally present; hereby rstlfylng and
confirming III thst aald attorneya ahall lawfully do or cause to be done therein by virtue of this power of
Ittorney.
2. I (we) agree to pay Anglno & Rovner,P.C., any out.of-pocket expenses they Incur to secure records, experts,
etc., plus. contingent fee that Is totally dependent upon their obtaining monies for me (us) as followa:
Analno & Rovner. P,C.
MLl.l.lil
70%
b.
Settlement prior to starting suit
Settlement fC\lIowlng suit but
prior to trial or arbitration
30%
a.
35%
65%
c.
Settlament or verdict at trial
or arbitration, after trial,
arbitration, or appeals or shortly
before trial and after the case
has been totally prepared
40%
60%
d.
e.
Settlement or verdict If for any
reason I (we) negotiate directly or
engege other counsel to represent
me (us)
20%
80%
f. Other cases
3. In the event that any settlement Is made on a structured or deferred payment basis, attorneys shall ba
entitled to receive their percentage besed on the present value of the structured settlement, If paid ss a lump
sum at the time of settlement.
Ilwe) agree not to settle or discuss settlement of my (our) case without the written consent of Anglno &
Rovner, P.C.
By signing thll Agreement, this II day of Yv1 Av.. , 191f.., I (we) acknowledge that I (we) have
read, understood, and received a copy of seme and agre~erms and conditions.
\Cu~ )~
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f'1rrW!f~I~'f~mm.t.\~0:\>.'!',' H JI.'-II' .j,"r"f:~' \~:'~"f'f<"'~"\I"~1 '.''''....'In(!'''',...!,..!...~'f....,,' "-' .......~,\ f
03/03/1995 CIGIA Healtll care Page 2
Payout Report
rile ID: LJB003813
Soc Sec I: 183-44-5520
Patient's Nale: IICBAiD GIEENB
Begin Date End Date AIount AloWlt Paid
Provider of Service of Service Billed by CIONA lemlts
......._.-........~._........ ............ -........ ....-......... -........... ---.....................--....
A Z RITZMAN ASSOCIATES 09/24/1992 09/24/1992 $22,00 $22.00
A Z RITZMAN ASSOCIATES 09/24/1992 09/24/1992 $31.00 $31.00
AJDREWS , PATEL ASSOCIATES 06/01/1992 06/01/1992 $135.00 $122.25
AJDIEWS , PATEL ASSOCIATES 07/16/1992 07/16/1992 $80,00 $80.00
AJDREWS , PATEL ASSOCIATES 08/06/1992 08/06/1992 $85.00 $85.00
AJDREWS , PATEL ASSOCIATES 08/20/1992 08/20/1992 $3,391.00 $3,391.00
AJDREWS , PATEL ASSOCIATES 09/10/1992 09/10/1992 $60,00 $60.00
AJDREWS , PATEL ASSOCIATES 09/14/1992 09/22/1992 $639.00 $639.00
CEIlTRAL PA JlRI CEIl'I'ER 09/15/1992 09/15/1992 $175.00 $175.00
rolOOJlllTY PBYSICIAIlS IIIC OS/28/1992 OS/28/1992 $135.00 $135.00
El<G ASSOCIATES INC OS/28/1992 OS/28/1992 $35,00 $31. 50
El<G ASSOCIATF,s INC 09/14/1992 09/14/1992 $35,00 $35.00
HOLY SPIRIT HOSPITAL OS/28/1992 06/04/1992 $8$627.84 $7 $ 751. 40
HOLY SPIRIT HOSPITAL 07/13/1992 07/13/1992 925.00 925.00
HOLY SPIRIT HOSPITAL 07/20/1992 07/20/1992 $893.00 $893.00
HOLY SPIRIT HOSPITAL 09/14/1992 09/21/1992 $10,480.00 $10,454.56
HOLY SPIRIT HOSPITAL 09/14/1992 09/21/1992 ~3,800.00 ~3,800.00
HOLY SPIRIT HOSPITAL 09/24/1992 09/24/1992 4,277,00 4,277.00
HOLY SPIRIT XRAY OS/28/1992 OS/28/1992 $609,00 $609.00
HOLY SPIRIT XRAY 06/12/1992 06/12/1992 $117 .00 $117.00
HOLY SPIRIT XRAY 08/13/1992 08/13/1992 ~175,OO ~175.00
HOLY SPIRIT XRAY 09/12/1992 09/18/1992 748.00 748.00
IIllIEIS DAVIS ASSOCIATES OS/29/1992 06/03/1992 $400.00 $320.00
I1lTEillISTS or CENTRAL PA OS/28/1992 06/05/1992 $570,00 $570.00
INTERHISTS or CEIl'l'RAL PA 06/17/1992 06/23/1992 $147.00 $135.60
INTERIIISTS or CEIl'I'iAL PA 07/04/1992 07/04/1992 $20.00 $20.00
INTElIIISTS OF CEIl'I'RAL PA 07/24/1992 07/24/1992 $32.00 $32.00
1MR ALLEN FIlE ro 09/23/1992 09/23/1992 $209.00 $209.00
OAlOOOD CENTEl 06/08/1992 06/12/1992 t899.00 12,899.00
OAlOOOD CENTER 06/08/1992 07/02/1992 4,669,00 4,669.00
OAOOOD CENTER 06/08/1992 07/10/1992 1,416.00 1,416.00
OAlOOOD CENTER 06/17/1992 07/10/1992 ~2,699.00 ~2,699.00
OAOOOD CENTER 07/10/1992 08/05/1992 8,386.00 8,386.00
PA IfEUROl.OOlCAL ASSOCIATION 09/15/1992 09/17/1992 $265.00 $265.00
PRESCRIPl'IONS 09/23/1992 09/23/1992 $16.79 $16.79
SfOCK'l'OlIlID 09/17/1992 09/18/1992 ~182.00 $182.00
llEST SHORE PATBOl.OOISTS 05/30/1992 06/02{1992 $795.00 $795.00
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03/03/1995
CIGIA IIea1th Care
Payout Report
rile lDI LJBOO3813
Boo see II 113-44-5520
Patient'. lue: UCB1ID GIBIlII
paqe
3
lle9in Date BndDate AIount AIount Paid
Provider of servi~ of service Billed by CIGIIA Ruerks
.............~.._..--....~~ --...... -....... --.. -....-.... ,--...------.-...
-..-.. ----.
fotalsl 151,110.63 $57,171.10
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OBRTIrIOAT! or SBRVIO!
AND NOW, this 27th day of Maroh, 1997, I, Pamela J. MOClellan,
an employee of Angino & Rovner, P.C., do hereby oertify that I have
.erved a true and oorreot oopy of the PETITION rOR APPROVAL or
OOMPROXISID 81TTLBHBNT AND DISTRIBUTION or PROOBBDS in the united
states mail, postage prepaid at Harrisburg, Pennsylvania, addressed
as follows:
Joseph A. Riooi, Esquire
2000 Linglestown Road, suite 108
Harrisburg, PA 17110
Attorneys for Defendants
Linda J. Holloway, Assistant Direotor
CIGNA HealthCare
P.O. Box 460
Hartford, CT 06141-0460
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Pamela J. 0 lellan
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
L
'OR OATIS 0' DIATHAmR 12/31191 CHICK HIRI
If A SPOUSAL
POVIRTY CRIDI! IS CLAtMID 0
fill NUMBlR
21
COUNTY WOE
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COMMONWEAltH Of PENNSYlVANIA
OEPARTMENT or REVENUE
DEPT. 280601
HAA.iHSBUA..O. fA 17128.0601
ClEceDENT'$ NAME IlAST, fiRST. AND MIDDle INITIAl)
Greene, Richard E.
SOCIAl SECURITy NUMBfR
1304 Stratford Road
Camp Hi 11, PA 17011
c':cot Cumberl and
AMOUNT RECflveo (SEE INSTRUCTIONSI
----.
o :J. Remalr.der Return
Ifor dot.. of d.olh prior 10 12.13,821
o .5. Federal Eltate Talt Relurn Required
94
YEAR
0475
NUMB!R
OICEOEN1'S COMPLfIf ADDRESS
DAft Of DEAT"
175-48-4425
9/28/92
I" ...,'II(...UI) IU.V1VING VouH'1 ""'M( lU\!, IllS! "'NO MIOOIIINlll,1,'1
[] 1. Original Relurn
D A. llmiled eUalo 0 do. Fulure Inlerell Compromile
Ifor dole' of d.olh after 12.12.821
o 6. Decedenl Died Tellale 0 7. Decedenl Mainl":..,,,d u living Trull
IAllo,h copy of Will) IAlloch copy of Tro,ll
ALL CORRESPONDENCE AND CONFIDENflAL TAX INFORMATION SHOULD BE DIRECTED TO.
NAME . COMPUTE MAILltlG AOORESS
Colleen M. Greene, Administratrix 1304 Stratford Road
""PHON' NUM'" Camp Hi 11, P A 17011
llLl161-3420
o 2, Supplemenlol R.lu,"
_ e. Total Number of Sale Depalil Boltel
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S
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1. Real Ellol. ISchedul. AI
2, Slockl and BondI (Schedul. 81
3, Clo,ely Hold SlocklPo~ne"hip Inl"ell ISch.dule C)
A. Mortgages and Nolel Receivable lSchedule DI
5. Cosh, Bank Depolill & MhcellaneouI POflonol Properly
ISchedul. E1
6. Jointly Owned Properly ISch.dule FI
7, Tro"fe" ISch.dulo G) ISch.dul. LI
8, Totnl Grall Aile" (Iolollin.. 1.7)
9. Funeral E1tpenles, Adminhlrolive COlh, Milcellaneoul
Expe"" ISch.dule H)
10, Oebll, Morlgoge liobililie" lio" ISchedul. II
,1. Tolol O.du~io" Ilolollln.. 9 & 101
12, Net Value 01 Ellole lline 8 minUl Line III
13, Chorilobl. and Go,,,nmentol 8.qu.." {Sch.dul. JI
1~, Net Volu. Subject 10 Tax ILine 12 mlnu, Line 131
15, Spoulol Tro"fou Ifor dol.. of d.olh oher 6,30.9AI
See Inslruc1lonl for Appllcabll Percentage on Reverse
Side, Ilndud. ,olu.. Irom Sch.dul. K or Sch.dule M,I
16. Amount or line 1 A taltable 01 6% role
Ilndude ,oluus from Schedul. K or Sch.dul. M.I
17. Amounl 01 LIne 1 A taltable at 15% role
(Indud. ,olu.. from Schedul. K or Schedul. M.I
18, Principal lox duelAdd tax from Un.. IS. 16 and 17,1
19. Credill Spoulal Poverty Credit Prior Poymenll DiICount Inllrell
+--+ --
20, If line 19 I, greoler than line 18, enl" Ih. difference on line 20. Thl, II the OVERPAYMENT,
gO
(19)
120)
111
12 )
131
I ~ I -.
151 24,710.00
161
171
181 24Jl0.00
191
11 ,002,64
858.29
(101
(II) 11,860,91
(121 12,849. 09
(131
(I ~I 12 , 849.09
(151 x,_=
(161_12,849.09 ____x ,0'; =
770.95
(17)
x .15 =
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(18)
Check here II you arc requosting n refund 0' your overpovmtHII.
21. II line \8 is 9,ealer than Lint 19, enler the difference on line 21. This II the TAX DUE.
A. Enter tlul lnleresl on Ihe bolanr. due on line 21 A,
8, Enter the lotol of line 21 and 21A on line 218. Thi,I'lh. BALANCE DUE,
Mok. Check Payable tal R.gl.t.. al Will., Agent
,;.. BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH <( <(
LInder penahifll of perjury. I declare thai I hay, uamined this r4lurn, includll\g accompanying schedvle, and stotemenh, and to Ihe be" of my knowledge and belief
il Illtue, (orreel and eomplele I declare thai all real ellale hal been reporlod al Irue market valvo Declarolion of pre~are other Ihon tho pOrlonal repr"enlotive i;
baled on alllnlormollon of which pre parer hOI any knowledge
/ $ION"ATURE 0' 'USONrSPOt~~1lf 'OR '1IINQ REtURN ,~~DR!!I!1 I' _5:: - -:0;-,.1.." --4 \" ~1- _ --I OAlf _ ~ .-,
\. '." ~ '.,. ',- )h:~ '<. \,: ._t'} ;:, ~t......:.I' \ ,(., ~"...I, _ Ji:~~~_:'o,-,t,^'\' 1.\ (~~:'-.:I I
!I10N~~~~~f.JiU""R!1l O1"fII1t~AN REPRfSEN''''ll'1l "'ODIlB!I lJ F~ ) f t I -~-~ l/} O"'T! ""'I -- -.-----
-- /::.. '~ , ,L <,' , 'r .'b'1 lV, !~ ,~\ - ( J&0<- _ lP- J / IZ'j/f; -)
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1211
121AI____,_
12181
Act 141 of 1994 provldll for the reduction of th. tall ratll Impolld on the net value of trande,. to or for
the u.e of the .pou... Th. rate. a. prelerlbed bV thll .tatute will bel
. 3~ (.031 will b. applicable for IItatll of d.cedent. dvlnll on or after 7/1/94 and before 1/1/96
I
e 2~ (.021 will be applicable for IItat.. of decedenll dvlnll on or after 1/1196 and before 1/1/97
e 1 ~ (.011 will be applicable for IItat.. of decedenll dvlnll on or after 1/1/97 and before 1/1/98
e Spou.al'ran.fe,. occurrlnll an or nfter 1/1/98 will be exempt from Inheritance tall,
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (1") IN THE APPROPRIATE BLOCKS.
5 NO
1, Old dlcedent make a transfer andl
a. r.taln the USI or Income of the property transferred, .......".."....".".....".."......."".....~.....
x
b, retain the right to de.lgnate who .hall use the property trans/erred or III Income, """."."."
x
c, retain a reversionary Interelt; or ...",."......"..,.,..,....,............".................,..;..................
d, receive the proml.e for life of either paymenll, benefit. or care' ."""."""""."""""."""".
2, If death occurred on or before December 12, 1982, did decedent whhln two years preceding
death transfer property without receiving adequate con.lderatlon' If death occurred ahar
D.cember 12, 1982, did decedent transfer property within one year of death without receiving
ad.quate conslderallon'..,.....,.,..,...."".............,.,........,........,.......,.,.....",.,........."..,.........
x
x
3. Old decedent own on 'In tru.t for' bank account 01 hi. or her deClthL,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.
x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
O()
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COi/.lIONWIAlnO 01 NNNI,jWjIA
INHlllTA!ICl wcmulH
I IllltNI DICIDfIiT
SCHEDUU H
FUNERAL IXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Richard E. Greene
21-94-0475
!TIM
NUMtU
A. h_' bp.ftMtI
DUCRIPTION
AMOUNT
I.
Gilbert W. Parthemore Funeral Home, 1303 Bridge Street,
New Cumberland, PA, 17070
Kerr Brothers Funeral Home,' 463 East Main Street,
Lexington, Kentucky
Blue Grass Memorial Gardens, 4915 Harrodsburg Road,
Nicholasville, Kentucky
6,152.29
1,332.00
1,480.35
2.
3.
.. Adm\tllltratlvt Cnltl
1. hraonGI RtprtltntGtlY't CommlllloM
Sodal s.curlty Number 011Wto1lO1 RepNHIlIali\'lI
'l'tar Commlulont pGld
2. A/1wney I'M,
3.
Pomlly Eump~on
Clalmclnl Coll een Greene R.\crtto",~lp wi fe
Add..1I 01 Claimant at c1~nt'1 c1eatft
$tMt Addl'lll 1304 Stratford Road
CIty Camp Hi 11 StGte PA Zip CocIt 17Qll
2,000.00
4. Probate I'M,
C. M1utllo_ bpt_1
1. Administration expenses 23.00
2. Fil i ng fee 15.00
3.
.
4.
$.
6.
7.
8.
TOTAL (Alia ,",If on hot 9, RtcopltIIIGllonl S 11,002.64
Ilf mON 'pclA It IItHteI, mltrt .lIdItlon.llhooll .f tom. l'It.)
UV,I;UI'tp.l7J
ESTATE OF
ITEM
NUMBER
2.
3.
ITEM
NUMBER
'*'
COM,MouwlAl'" Of .IHNIYlVANIA
~HUI1ANct ,,u, ..IUIN
.UIOfHl 0lClOIN1
SCHEDULE J 1
BENEFICIARIES
Richard E. Greene
FILE NUMBER
21-94-0475
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
.
A. To"obl. B.qullh:
1.
Co 11 een Greene wife
1304 Stratford Road, Camp fli 1 1, PA 17011
Raquel Greene daughter
1304 Stratford Road, Camp Hll 1 , PA 17011
Richard Greene, Jr. son
1304 Stratford Road, Camp Hill, PA 17011
NAME AND. ADDRESS OF BENEFICIARY
B, Cho,lIobl. ond Go.ernm.n'ol B.qUII'Ii
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS IAho .nlor on IIn. 13, R"opllulollonl S
III "'art .paco II n"d.d, In..r! addUlonal.h".. 0'.0"" .Iltl
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AMOUNT OR
SHARE OF EST ATE
AMOUNT OR
SHARE OF ESTATE
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IN RE: ESTATE OF RICHARD
GREENE, DECEASED
I IN 'l'HE COURT OF COMMON PLEAS OF
I CUMBERLAND COUN'l'Y, PENNSYLVANIA
I
: ORPHANS' COURT DIVISION
I
I NO. 21-94-475
ORDER
AND NOW, thb .;:>..,j day of
~
, 1997,
upon consideration of Petition for Approval of compromised
Settlement and Distribution of Proceeds, 1'1' IS HEREBY ORDERED:
1. That 8ettlement by Colleen Greene, Individually and as
Administratrix of the Estate of Richard Greene, Deceased, is hereby
ratified and approved. Collean Greene is authorized to mark the
above-captioned action settled, discontinued and ended alY to
Defendants and to execute any release required to consummate the
settlement.
2. That the proceedS shall be allocated between the Wrongful
Death and Survival Actions brought by Plaintiff, in the following
fashion:
$405,000 to be divided by the Wrongful Death
Beneficiaries: Colleen, Racquel and Richard Greene, Jr., and,
$45,000 to the Estate of Richard Greene, to descend to his
intestate heirs, Colleen, Racquel and Richard Greene, Jr., in the
manner Bet out in the provisions of the Pennsylvania Fiduciary Code
governing Intestate Succession, 20 Pa.C.S.A.SS 2102 and 2203.
3. That the total settlement shall be distJ!ibuted as in the
fashion set out at length in Paragraph 17 of Plaintiff'S Petition
."
. .
, ~.:.:'" . ',\" .
. ~ ,. . ~ .. .J~;J , . Ill. I'
6
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent I Ji chard E. Gr.eene
Date of Deathl
Seotember 28. 1992
Admin. No,
1994 -004Z.5...
Will No.
To the Registerl
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to
the following beneficiaries of the above-captioned estate on
May 2~94 I
Raque 1 Greene
Address
1304 St.rntford ROnrl, Camp Hill, PA 17011
130LSt.rntford Road, Camp Hil 1, PA 17011
1304 Stratford Road.- Camp Hi 1 1 I PA 17011
Name
Colleen M. Greene
Richard Greene, Jr.
Notice has now been given to all persons entitled thereto under
Rule 5,6(a) except
Date 109 " So -'l~
.C',..'",)".>>-.,.. (' '1\.~-""
Signature
Name Co 11 een M. Greene
Address 1304 Stratford Road
Camp Hill, PA 17011
Telephoneill7l 761-3420
j{;
Capacity I X
Personal Representative
Counsel for personal
representative
"
, .
If,;?/} ~- !fJ
BUREAU OF INOIVIDUAL TAKES
INHERITANCE TAX DIYIS!O.
DEPT. ZI0601
HARRISlUAO, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
(/
NOTICE OF INH~HITANCE TAK
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESS"ENT DF TAK
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
COLLEEN M. GREENE
1304 STRATFORD ROAD
CAMP HILL PA
17011
04-20-98
GREENE
09-28"92
21 94"0475
CUMBERLAND
101
r-
AMount R..IUod
*'
IINI4IumCU.III
RICHARD
E
l
MAKE CHECK PAYABLE AND REMIT PAYMENT TOl
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ....
REV: is''? "EX" "AF p"" i 0"9":97T" Nii'ffcE" "OF" YN'ii iiiif ANCE" i,'Ax" 'A"p pilA"i SiH ENr;" ALrliwAN"cE. iili"... -""""".""....
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GREENE RICHARD E FILE NO. 21 94-0475 ACN 101 DATE 04"20-98
TAX RETURN WAS, I ) ACCEPTED AS FILED I Xl CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. Rool E.toto (Schodulo A)
2. Stack. and Band. (Schodulo B)
3. Clo.oly Hold Stock/Portnor.hlp Intoro.t lSchodulo C)
4. "ortgogo./Noto. Rocolvoblo (Schodulo D)
S. Co.h/B.nk Dopo.lt./HI.c. P.r.onol Prcp.rty (Schodulo EI
6. Jointly awnod Proporty ISohodulo F)
7. Tron.f.r. (Sch.dulo G)
8. Totol A..ot.
APPROVED DEDUCTIONS AND EXEMPTIONSl
9. Funorol Expon.o./Ad.. COlt./HI.c. Expon.o. (Schodulo H)
10. Dobt./Hortglgo Llabllltio./Lion. (Schodul. II
11. Tot.l Doduotlen.
12. Not Voluo of To. Roturn
13. Ch.rltoblo/Gcv'l'nllOnhl BOq\luhl Non-olootod 9113 Tru.h ISchodulo J)
14. Not Voluo of E.toto Subj.ot to T..
If an a.....ment was i..ued praviou.1y, line. 14, IS and/or 16, 17 and 18 will
ref1.ct figur.. th.t include the total of 6hh return. .....sed to date.
ASSESSMENT OF TAXI
IS. A.ount of Llno 14 ot Spou.1l roto US)
16. Aoaunt of Line 14 to.oblo ot Lino.l/Cl... A roto (16)
17. Aoount of Llno 14 to.oblo ot Collotorol/Clo.. B r.to 117)
18, Prlnolpul T.. Duo
TAX CREDITS I
PAYHENT
DATE
01"18"96
05"31-97
NOTEl
RECEIPT
NUHBER
AMNP PEN
AA211405
DISCOUNT (+)
INTEREST/PEN PAID (-)
138,82
.00
BALANCE OF UNPAID INTEREST/PENALTY AS OF 06-01-97
. IF PAID AETER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
III
(2)
(3)
141
(51
(6)
171
.00
.00
.00
,00
24,710,00
,00
.00
NOTE. To Insur. propor
credit to your lecount,
sub.lt tho upp.r portion
of thl. farM with your
h)( PIYlllnt.
24.710.00
II .860 91
12,849.09
.00
12.849,09
,00
770.95
.00
770.95
NOTE, AMNESTY NP
PENALTY ASSESSED
77 0.95
,00
388.33
388.33
IF TDTAL DUE IS LESS TNAN II, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR1, YOU HAY BE DUE
A R~EUND. SEE REVERSE SIDE DF THIS FORN FDR INSTRUCTIONS. I
(81
19l
UOI
11,002.64
858,29
1111
U21
(13)
U41
,OOX,OO.
12,849.09 K .06.
.00 X .15.
U81
AHOUHT PAID
.00
770.95
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND ~EN.
TOTAL DUE
RESERVATION I E.t,t.. of dlcDdlnt. dvl". on or before o.c...r 12, 1982 -- If InV future Int.rllt In thl ut.tl I. trtn,'.rred
In po.....lon or enjoy.."t to ell.. . (collltlrtU benefJohrl.. of the cSlctdlnt .ft.r thl 'lfplr.tlon of tnV ..tit. for
lIf. or for Vllr., the C~n....Jth herebv .lfpr...h r...rvII thl rlDht to ",pr.lt. and ...... trentl.r Inhtrltenc. Tllfll
It the lewful el... . (coll.t.r.l) r.t. on tny .uch future Int.r..t.
PIJIIl'OIl!IIF
HOTleE1 To fulfUI thl r.qulrlMnt. of SlOtlon 2UO of the Jnn.rltlnCl end Elt.t. Tllf Act, Aat 21 0' 1995. (72 P.I.
hell... 91~0).
PAYM!NTl Dliheh the top portion of thlt Hatlc. tncJ .utMllt with your PIVllnt to thl Atglthr of Will. printed on the rlv.rll tla.
--Male. chock or ..... ordor ...IIbI. 10. REGISTER OF MILLS, AGENT
REFUND (U)I Ii r.fund of . ttlC crtdlt, which WII not r.qullt.d on the Talf Alturn, .IV be "que.ted bv cOIIPIIUnt In "Appllc.tlon
for R.fl.nd of PennlYhenll Inhlr1tanc. end ftt.tt lelC" (REV4lSlS). Application. Ir' IvaUtbl. at the Offlc'
of the Reght.r 0' .Ull., InY of the 25 AlvtnW Dlttrlct Offlc.., or bv ClUing the lpeol.l 2~-hour
"'....rIOl 'arvle. hUlbtr. for for.. ordlrlntl In Ptnn.ylvtnl. 1-100-56242050, out. Ide Pennlylvenl. Ind
..Ithln local H.rrl~rg ar.. (717) 787-8094, TOnt (717) 772-2252 (He.rlnt lap.lred Only).
OIJlCTIOHSI Any p.rtv In Int~r..t not ..tl.fled ..Ith thl 'Pprll..-.nt, Illowono. or dl.allowtnO. of dtductlon., ar ",.....ot
0' t.1C (Including dltoount or Int.r..t) .. Ihowl on thlt Notle. lUat objlOt ..lthln .hety (60) dlV' 0' nc.lpt 0'
thl. Notle. bYI
"-..rlttln prot..t to thl P^ D'PlrtHnt 0' A.vtnUl, laird a' Appt.ll, Dept, 211021, Herrltburg, PA 17121-1021, nR
....el.otlon to hay. thl ..ttlr dtt"llned .t 1Ud1t of the ICCOl.l1t 0' thl p.rlonal rep"..nt.tI~., OR
....IIppIl.l to thl Orphtn.' eMlrt.
ADIUM
IS1RATlYE
CORRECTIONS I F-.otuII erroft dltcav".d on thlt ......ant lhould be tdd"uld In ..rUlno tOI PA DIPltttent 0' R.Vlnut,
lure"" 0' Iodl~ldual T.lfll, ATTHI po.t A......."t R.v.... Unit, t'ltpt. 210601, Htrrhburg, PA 17121-0601
Phone (717) 717-6S0S. S.. plgl 5 0' thl bookl.t "In.tructlon. 'or InhtrltlnCl TIIC Alturn 'or I A.lldwnt
o.cedtnt" (AEY"150l) for Il"I Ilfplanatlon of tdIIlnhtrltlvltv cerrRttblt erroft.
DIICIlUIl.
If tny \l1C du4t 11 paid ..Ithln thr.. (5) c.lntr IMH1th. Ifter thl decldlnt'. delth, . f1~. pere,"t (s;() dlteount 0'
thl tlM p.ld I. Illowed.
ThI UX 111C .-M.tv non-p"tlelpltlon peNHY 11 co.puted on thl totll of thl tlX end Int"..t 'U'"ed, II'ld not
p.ld blfor. JenutrV 11, 1996, thl flftt d.V .ft" thl end 0' thl t.1C ~Ity period, Thlt non"partlolpatlon
penalty It eppnlebll In thl '''' '8Mer end In tM thl 'Me till per I oct .. you NOuld 'Ppt.1 thl tlM end Intlr..t
thet h.. been ......ed ,. Indlc.tld on thll notlc..
,
,
I
, I
Pt:HALlY.
INTEIlUl.
Jnt.r..t It cMrlld btglmlng with flret dev 0' dellnqutnCy, 01' nlM (9) IOnth. Met ant (1) d.v Irow thl det. 0'
dt.th, to thl dati 0' Plvaent. T.IC.. Mhlch bto... dtllnqutnt bI,orl JlnUlrv 1, 1911 belt Int.r..t .t thl r.t. 0'
a1M C6:() percent Plr IiI'W'IUa c.leulated It I dlllv ret. 0' .0001". All t.... which bto... delinquent on end liter
JtnUlrY 1, 1911 ..111 b..r Interllt It I r.tl tfh1ch ..III Vlrv 'rOll e.I8nd" Vllr to Clltndlr vur ..lth thlt retl
II'II"lOUnCICI by thl PA o.plttllnt 0' R.vlnUl. ThI epplleebl. Intar..t rltll for 1911 through 1'" "II
't!!J: Int"..t AI" Dilly Int.r..t Fletar ~ Intar..t A,t. DIllv Int".., I'lOtor
1911 lOX .0005~1 1911 9X .ooom
19U 16X .00001 1911-1991 IU .000101
19M IlX .000101 1991 U .ooom
1911 IlX .000156 1"~-I9M IX .000192
1916 lOX ,00021~ 1991-1"1 9X .ooom
....Inter..t .. c.leul,tld .. 'allow. I
INTEREST . IALANCE OF TAX UNPAID X NUHIER OF DAYS DELINQUENT X DAILY INTEREST FACTO.
....Any Notlc. IIIUId a"." thl tlM bteoeel delinquent ..Ill reUlHlt an Int".., ollculltlon to flit"" UI) diU
bevond thl dlt. 0' thl .........nt. If PIVMI'lt it IIdt Iftlf the Intlrut COllP'ltltlon at. shown on thl
NotlOI, Iddltlontl Inter..t IUlt be o.lcullttd.
.
.
. ,
PAVItENT,
D,taoh tho top portion of this Hotte. and Iubllt with your Ply.."t ..d. payablt to tho na.e and addre'l
prJntld on the river.. .ida.
If RESIDENT DECEDf.HT Ink, chick or loney orDer payable tOI REGISTER OF WILLS, AGENT.
If NOll-RESIDENT DECEDENT ..k. .hock or '011<1, Ol'd., .".bl. to! CDHHotflfEAL TN OF PENNSYLVANIA.
REFUND (CR>I A rofund of . ta~ crldlt, which WI' hot r.que.ted on tho Tax Return, .ay be reque.ted by coaplotJng an
"AppUcat1on for Refund of PtnnlylvanJa InheritancQ and E'tate TIlle" fREY'1313L Appl1catlon. are avaUabl. .t
the Office of the R,ghter of NUll, any of the Zl RClvlnul Dhtrlot OffiCII or frol the nlpart..nt', 24-hour
an,wlring servicI ou.btr. for fori. orderlngl In Pennsylvania 1-800-362-2050, out, Ide Plnnsvlvanl,
and w!thln local Harrisburg ar/ilft (717) 787-&094, TODI (717) 77t-Z2SZ U1ellrlng hpalred onh).
REPlV TOI Questions rlgorlllng errorl contained 011 \hh notice should be addrotnd tOI PA Depart.ent 0' Rlvlnue, 8ur..u
of Individual lex.., A11NI Post AIIUlIIlent Review Unit, Dept. 280601, lI:srrisburo, PA 17128~0601, phone
(717) 767-6505.
DISCOl.llT,
If any ta~ due I~ paid within threo (3) calendar .onths a,ter the dec.dent's death, a five perc.nt (5%) discount
of the tax paid Is allowed.
,PENAL TV,
The 15% tax a.nlsty non-participation penalty I, co.put.d on the total of the tax and Interest as.o..ed, and not
paid be'ore January 18, 1996, the flr.t day a,ter the end of the tax a.ne.ty periOd.
INTEREST I
Intero.t I. charged beginning with flr.t day 0' dellnquenoy, or nln. (9) .onth. and one (1) day fro. the date 0'
death, to the date 0' paY.lnt. TaXI' which beoa.e uelJnquen\ before January 1, 1982 bear Intere.t at the rate of
elx (6%) plrolnt per annue caloulatld at a dailY rate of .000164. All taxI' which beoaee delJnqutnt on and a'tlr
January 1, IfJS? will bur Intlrut at .. rato which will var'y froa calendar year to cblendar yeer with that rate
announcld by the PA Depart.ent of Rlvenue. The applloabll :ntero.t rate. for 1982 through 1998 arel
V..r Inhro.t Rat. Dally Int.r.st Faotor Vear Intlr..t Rate Dally Int.rolt Faotor
--
196? 20i: .000S46 1967 9% .000247
1965 16% .000438 1988~1991 11% ,000501
1964 11% .000501 1992 fJ% .000247
1965 15% .000556 1993-1994 n .000192
1966 10% ,000274 1995-1998 9% .000247
--lntll'lIt Is calculated .. 'allow&!
INTEREST . BALANCE OF TAX UNPAID X NU"BER OF DAVS DELINQUENT X DAILV INTEREST FACTDM
-~Any HotlCQ h.uld "ft.r the tex bl'lo.e. deUnqulnt will refl.ct tin hhrut oaloulatlon to ,lft..n US) dlY'
beyond the dati 0' the a.......nt. If paY.lnt is nd. n'ter the Inter..t 'lo.putation dati .hown on the
Hot1el., additional 'nt.rut .u.t be oalculated.
k
6--
STATUS REPORT UNDER RULE 6.12
,
, ';
Name of Decedent I Richard E. Greene
of Doathl 9/28/92 ( .
Date ( '.
Will No, Admin, No. 21-94-475
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estatel
1, State whether administration of the estate is completel
Yes No X
2, If the anSWBr is No, state when the personal
representative reasonably believes that the adrninistration will be
complete I pend; ng 1 it i gat ion
3, If the answer to No, 1 is Yes, state the followingl
a, Did the personal representative file a final
account with the Court 7 Yes No
b. The separate Orphans' Cuurt No, (if any) for
the personal representative's account iSI
. c, Did the personal representative state an
account informally to the parties in interest.? Yes No___
d, Copies of receipts, releases, joinders and
approvals of formal or informal accounls may be filed with the
Cork of the Orphans' Court and may be attached to this report.
. )" ..
~~;, ;:7
~ tur/-,
Ter S (",," .
Name (Please type or print)
Angina & Rovner, P,C,
4503. Nortll Fr.Qnt Street, HOG.. PA 17110
Address
10/31/94
Datel
UJlJ..l.38 - G 7 91
1'e I, No.
Capael t Y I
Personal Representative
X
Counsel for personal
representa ti ve
(MAH I rmf/ AM3)