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IN THE COURT OF COMMON PLEAS s n
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CUMBERLAND COUNTY, PENNSYLVANIA
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1N RE: ESTATE OF STEVEN G. DOLLINS ' `-= y"
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No.: 2008-00350 ~ `=-'
PETITION FOR APPROVAL OF SETTLEMENT
1. Your Petitioner, Carolyn Dollins, is the personal representative for the
Estate of Steven G. Dollins, who is the deceased father of the minors,
Gage Dollins, Owen Dollins, and Taryn Dollins.
2. The minor children, Gage Dollins, was born on March 17, 2003, Owen
Dollins, was born on December 12, 2006, and Taryn Dollins was born on
February 8, 2008.
3. On March 3, 2008, Steven G. Dollins was killed in a motor vehicle
accident. At the time of his death he was single and had three minor
children, Gage Dollins, Owen Dollins, and Taryn Dollins.
4. Carolyn Dollins was appointed administratrix of the estate of Steven G.
Dollins on April 2, 2008, by Glenda Farner Strasbaugh, the Register of
Wills of Cumberland County.
8. All sums set forth above constitute damages on account of personal
injury/wrongful death, arising from the occurrence, within the meaning of
§ 104 (a) (2) of the Internal Revenue Code of 1986, as amended.
9. The $50,000.00 dollars to be divided pursuant to the fee agreement as
follows:
A. 25% to Rominger & Associates as an attorney fee, in the
amount of $12,500.00 (see attached fee agreement)
B. 50% of the remaining $37,500.00 to the Estate, as the proceeds
of the survival action in the amount of $18,750.00.
C. 50% of the remaining $37,500.00 to the Estate, as the proceeds
of the wrongful death action in the amount of $18,750.00, which will be
placed in a federally insured bank or saving institution as permitted by the
Rules of Civil Procedure for benefit of each of the minor children, in equal
shares.
10. It is the specific intent of Petitioner in seeking Court approval as required
by the Rules of Civil Procedure, since a minor is involved, that Court
approval not in any way limit the rights of Petitioner to seek any other
relief from any other party
11. Any and all remaining monies will be placed in a federally insured bank or
saving institution as permitted by the Rules of Civil Procedure, and it is
requested that the Court specifically authorize said federally insured bank
or savings institution to invest the same in any federally insured vehicle
and to pay income tax on behalf of the minors in said account or accounts.
13. The Department of Revenue has agreed to an allocation of 50% of the
award to the wrongful death action. (See attached letter)
WHEREFORE, your petitioner prays that the settlement afore referenced be
approved.
Respectfully submitted,
ROMINGER & ASSOCIATES
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Date: July 21, 2008
Karl E. Rominger, Esquire
155 South Hanover Street
Carlisle, PA 17013
(717) 241-6070
Supreme Court ID # 81924
Attorney for Petitioner
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
Po Box 280601
HARRISBURG, PA 17128-0601
Karl E. Rominger, Esq.
Rominger & Assoc.
155 S. Hanover St.
Carlisle, PA 17013
Dear Mr. Rominger:
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
WEB ADDRESS WWW.State.pa.us
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July 18, 2008
Re: Estate of Steven G. Dollins
File Number: 2108-0350
Court Number: CCP Cumberland Co. No. 2008-00350
The Department of Revenue has received the Petition for Approval of Settlement Claim to
be filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action.
It has been forwarded to this Bureau for the Commonwealth's approval of the allocation of the
proceeds paid to settle the actions.
Pursuant to the Petition, the decedent died as a result of a motor vehicle accident.
Decedent is survived by three minor children.
Please be advised that, based upon these facts and for inheritance tax purposes only, this
Department has no objection to the proposed allocation of the net proceeds of this action, $ 18,750
to the wrongful death claim and $ 18,750 to the survival claim. Proceeds of a survival action are
an asset included in the decedent's estate and are subject to the imposition of Pennsylvania
inheritance tax. 42 Pa. C.S.A. §8302; 72 P.S. §§9106, 9107. Costs and fees must be deducted in
the same percentages as the proceeds are allocated. In re Estate of Merryman, 669 A.2d 1059
(Pa. Cmwlth. 1995).
I trust that this letter is a sufficient representation of the Department's position on this
matter. As the Department I.as no objections to the Petition, an attorney from the Department of
Revenue will not be attending any hearing regarding it. Please contact me if you or the Court has
any questions or requires anything additional from this Bureau. Finally, the approval of this
allocation is limited to this estate and does not reflect the position that the Department may take in
any other proposed distribution of proceeds of a wrongful death/survival action.
Sincerely,
Holly A. McClintock
Trust Valuation Specialist
Inheritance Tax Division
Bureau of Individual Taxes
PHONE: 717-787-1794 FAX: 717-783-3467 EMAIL: hmcclintocC~state.pa.us
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: ESTATE OF STEVEN G. DOLLINS
No.: 2008-003 50
CERTIFICATE OF SERVICE
The same has been provided sent, addressed to responding counsel, by first class
mail, as follows.
Erica Conway, Claim Representative
State Farm Insurance Companies
Complex Claims unit
P.O. Box 142
Concordville, Pennsylvania 19331
Respectfully submitted,
ROMINGER & ASSOCIATES
,~
Date: July 21, 2008
Karl E. Rominger, Esquire
155 South Hanover Street
Carlisle, PA 17013
(717) 241-6070
Supreme Court ID # 81924
Attorney for Petitioner
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: ESTATE OF STEVEN G. DOLLINS
No.: 2008-003 50
AFFIDAVIT
I hereby swear or affirm that the Foregoing is true and correct to the best of my
knowledge and/or information and belief. This is made subject to the penalties of 18
Pa.C.S §4904 relating to unsworn falsification to authorities.
Date: July 21, 2008
Respectfully submitted,
ROMINGER & ASSOCIATES
Karl E. Rominger, Esquire
155 South Hanover Street
Carlisle, PA 17013
(717) 241-6070
Supreme Court ID # 81924
Attorney for Petitioner