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HomeMy WebLinkAbout02-02-091505607121 .~ REV-1500 EX (os-05, PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po sox 2aosol 2 1 0 6 0 5 4 7 Harrisbur PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 7 9 6 6 4 8 4 2 0 5 1 9 2 0 0 6 0 2 0 2 1 9 8 5 Decedent's Last Name Suffix Decedent's First Name MI B E N T Z L E S L I E K (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) h O S between 12-31-91 and 1-1-95) . ) c (Attach CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number H U B E R T X G I L R O Y E S Q 7 1 7 2 4 3 3 3 4 1 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY M A R T S O N L A W O F F I C E S First line of address N _ ~_,, 1 0 E A S T H I G H S T R E E T ~© `~' -*~ Second line of address :i:1 ~`r-~- ~ ~' ? ~' ~'rn t ~ ~ ,._ ' ED - ~ City or Post Office State ZIP Code - ~ ~ ~"' ~~..j ~ --~ ' P A 1 7 0 1 3 ~_' c-~ C A R L I S L E ~ -+ _. -_ ._~~ Correspondent's a-mail address: H G I L R O Y a M A R T S O N L A W• C O M ~ _~ ` Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT OF PER~QN RESPO IBLE FOR FILING RETURN ~'• U I t ( C' ADDRESS 228 N I A NEWVILLE PA 17241 SIGN R AN REPRESENTATIVE DATE Z ~- D ~~ ADDRESS 10 E HIGH ST CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 1505607221 REV-1500 EX Decedent's Social Security Number Decedent's Name: LESLIE K• B E N T Z 1 7 9 6 6 4 8 4 2 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) .................. ...... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . ...... 5. 1 0 0 4 0 6 0 . 4 2 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . ...... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested . ...... 7. , 8. Total Gross Assets (total Lines 1-7) ..................... ...... 8. 1 0 0 4 0 6 0. 4 2 9. Funeral Expenses & Administrative Costs (Schedule H) .......... ...... 9. 1 3 6 8 3 , 2 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...... ...... 10. 9 3 . 5 4 11. Total Deductions (total Lines 9 & 10) ...................... ..... 11. 1 3 7 7 6 , 7 4 12. Net Value of Estate (Line 8 minus Line 11) .................... ..... 12. 9 9 0 2 8 3. 6 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................. 13. • , 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. 14. 9 9 0 2 8 3 . 6 8 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .000 9 9 0 2 8 3. 6 8 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17_ 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18 19. Tax Due ................................................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505607221 1505607221, 0. 0 0 0. 0 0 O.o 0 0. 0 0 0. 0 0 F FILES`Clirnts.123'_8 Bentz, 1_325. Lintx.taxrate. l ESTATE OF BENTZ, LESLIE K. TAX COMPUTATION LINE 16, EXPLANATION OF TAX RATE OF 0.00%: Transfer is from a child, aged 21, to and for the use of her natural parents. 21-06-0547 72 P.S. §9116(a)(1.2) REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME LESLIE K. BENTZ STREET ADDRESS 228 GREEN HILL ROAD CITY NEWMLLE Tax Payments and Credits: 1 • Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty File Number 21 06 0547 STATE ~ ZIP PA ! 17241 0.00 Total Credits (A + B + C) (2) Total InteresUPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 0.00 (3) 0 00 (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Make Check Payable to: REGISTER OF WILLS, AGENT 0 00 0 00 0 00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ................................. ......................... ^ ^X ........... b. retain the right to designate who shall use the property transferred or its income; ............................... ^ c. retain a reversionary interest; or .............................................................................................. d. receive the promise for life of either payments, benefits or care? ................. . .. .................. ^ 0 ................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................... ^ 0 ................... 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER LESLIE K. BENTZ 21 06 0547 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right o} survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. Wendy's, final wages OF DEATH 221.55 2 (Cornerstone Federal Credit Union, No. 2162-01, regular share account I 28.66 3 Cornerstone Federal Credit Union, No. 72162-01, regular share account 2,138.27 4 Cornerstone Federal Credit Union, No. 72162-07, share drab account 1,671.94 5 Erie Insurance Company and Erie Exchange, proceeds of settlement of underinsured motorist 600,000.00 benefits action filed to No. 2008-6986 in the Court of Common Pleas of Cumberland County, PA [Gross settlement $900,000 less attorney fees of $300,000] (see various exhibits attached) 6 Sentry Select Insurance, insurer for Barber Trucking, Inc., et al., proceeds of settlement of 400,000.00 Wrongful Death and Survival Action filed to No. 2007-3895 in the Court of Common Pleas of Cumberland County, PA [Gross settlement of $600,000 less attorney fees of $200,000] (see various exhibits attached) TOTAL (Also enter on line 5, Recapitulation) I $ 1 004 060 4~ (if more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ca i w r ~ yr FILt NUMBER LESLIE K. BENTZ 21 06 0547 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home, Carlisle, PA 8,688.20 2. Carlisle Memorial Service, Inc., Carlisle, PA 730.00 B. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City State Year(s) Commission Paid: Zip 2, Attorney Fees , 3, Family Exemption: (If decedent's address is not the same as claimants, attach explanation) 3,500.00 Claimant Thomas & Dorothy Bentz Street Address 228 Green Hill Road City Newville State PA Zip 17241 Relationship of Claimant to Decedent Parents 4. Probate Fees Register of Wills, Cumberland County 70.00 5 Accountants Fees 6. Tax Return Preparer's Fees 7. Register of Wills, filing fee, Inheritance Tax Return 15.00 8. Register of Wills, additional probate fee 680.00 TOTAL (Also enter on line 9, Recapitulation) I $ 13,683.20 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LESLIE K. BENTZ SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 06 0547 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Cornerstone Federal Credit Union Credit Card Acct 4457 4900 0003 0562, account payable 93.54 TOTAL (Also enter on line 10, Recapitulation) I $ 93.54_ (If mare space is needed, insert additional sheets of the same size) REV-1513 EX + (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER LESLIE K. BENTZ 21 06 0547 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J 1. Thomas E. Bentz (Father) Lineal 495,141.84 228 Green Hill Road Newville, PA 17241 2. Dorothy L. Bentz (Mother) Lineal 495,141.84 228 Green Hill Road Newville, PA 17241 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ (If more space is needed, insert additional sheets of the same size) r MART SON LAW OFFICES IU I:_1lT I~1GFi $TRF.F:"C ~..1RF.ijt.F~:, Pe~~,tT~.".~~~F.-~ 1'(113 T; i_i:F~t~c~.~;i~. ~~t , ?43-3341 F_~csutu.F i~l -; 243-1350 I\TI~.R\I~.T ~t'~L'\t'.m:trtSU[?IagCCOm ~ t ~ ~,~ ~ ~ . ~ ~ ~r'ul_F.~~F I? \L~RT~~_~x D.~_~ii?~1. FiTZ~ur~~ )~,FF~ B. I~~F~rF.FR III CF~RIC7Y;i~~F R [;. RirF~ D,~~it~F. K. Dr.,~.Rnr~RF~r Tu~,,,F,~~ JF_a~u i R L. ~i~F-.ERs (. AF~ir~_F_~ u,- SF,"rii T. ~I~ ;,F~_iaF.~~ I~.u ~: O~rr<> III TRF ~w I?. Ilt+.r.i~cF.R I3f.Nf-R"r .l"". Gu_R~rr h rnf J. ~L~.a:~ti i i.i. GFURCF B. F.1;.1.I.R)R.` \t . rB .~I. ~I'i I} t~ 'Bowan C:ranrien Crnt. Taus Jrea.~ur SETTLEMENT STATEMENT RE: ESTATE OF LESLIE K. BENTZ vs. BARBER TRUCKING et al TOTAL SETTLEMENT: $1,500,000.00 $600,000.00 paid by Insurer for Barber Trucking $900,000.00 paid from Underinsured Motorist Benefits Attorney's Fee-Martson Law Offices as per Contingent Fee Agreement 500 000.0_ ~_ Net Proceeds payable to Estate of Leslie K. Bentz $1,000,000.00 Settlement proceeds payable as follows: A. " $300,000.00 in cash . B. Periodic payments guaranteed by Prudential Insurance Company ofAmerica payable to Thomas E. and Dorothy L. Bentz in the amount of $1,089.00 per month, for forty years, guaranteed, payable jointly with 100% to the survivor, beginning February 1, 2009, with the last guaranteed payment on January 1, 2049. This periodic payment has a current value of $200,000.00 with guaranteed payment over forty years of $522,720.00. C• Periodic payments guaranteed byPrudential Insurance CompanyofAmericapayable to Thomas E. and Dorothy L. Bentz in the amount of $2,850.26 per month, for twenty years, guaranteed, and continuing for life, payable jointly with 100°% to the survivor, beginning on February 1, 2009. This periodic payment has a current value of 5500,000.00 with guaranteed payments over twenty years of $684,062.40 subject, however, to the payments continuing beyond twenty years for the life of the survivor of Thomas E. Bentz and Dorothy L. Bentz. Exhibit to Schedule `B", Items Ic&2 and Sdredade "H", Item B, ? (1/2) December 17, 2008 Page 2 We, Thomas E. Bentz and Dorothy L. Bentz, agree to the distribution ofproceeds asset forth above. WITNESS: ~ ~ ,. _tL ~'~ ~ r ~ THOMAS E. BENT7~ ' ~~ ~ Q DOROT L. BENTZ Date: December 18, 2008 Er/ribit to Sclrednle `B ", Items 1 &2 and Schedule "H", Item B, Z (2/?) j.ti FOR ~fATION • ,~DY"ICE + :~DVOC.ICY ~ -~ov z b Zoos G F. FlLES'Ctirn[s 1_328 Bentr ;2328.1.Pattionl.Prtaionl Crer[ed: 9.0,04 d:06P.N Ra isctt: I I '26 G8 1138AM Hubert X. Gilroy, Esquire MARTSON DEARDORFF WILLIAI~IS OTTO GILROY & FALLER :~IARTSON LAW OFFICES I.D. 29943 10 East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Plaintiffs ESTATE OF LESLIE K. BENTZ by THOMAS E. BENTZ, Administrator of THE ESTATE OF LESLIE K. BENTZ and THOMAS E. BENTZ individually and DOROTHY L. BENTZ individually, • Plaintiffs : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. ERIE INSURANCE COMPANY and ERIE EXCHANGE , Defendants NO. 2008-6986 CIVIL ACTION -LAW JURY TRIAL DEMANDED ORDER AND NOW this ~ day of , 2008, upon the consideration o Petition for Court Approval of Settlement, and it appearing that all parties have the attached agreement in connection with settlement in this case and all parties have requested the Ched an approve the settlement without a hearing, it is ordered and directed as follows: ourt to The settlement between the parties as set forth in the Petition for Court Approval of Settlement tiled by the Plaintiffs is approved. -'• Eire Insurance Company-and Erie Insurance Exchan e shall ut~~90U,000.00 to the Plaintit~ts payable as follu~~s:g pay the dross settlement ~-~• 5200,000.00 payable in up front cash payable to Thomas E. Bentz, E.~-hibit to Schedule "E'; Item 1 (1/18) Administrator of the Estate of Leslie K. Bentz, deceased, and Hubert X. Gilroy, his attorney. B• The remaining sum of $700,000.00 to be structured through the purchase of an annuity by Erie Insurance Company and/or Erie Insurance Exchange from the Prudential Insurance Company of America. The periodic payments will be assigned to Prudential Assigned Settlement Services Corporation (PASSCorp) bythe wayofa Uniform Qualified Assignment and Release, and the periodic payments will be guaranteeed by the Prudential Insurance Company of America by way of a Guarantee Letter which guarantees the payment obligation of PASSCorp. In accordance with the structured Underinsur'ed/LTnderinsured Motorist Release, the Prudential Insurance Company of America shall make periodic payments to Thomas and Dorothy Bentz as follows: 1• $1,089.00 monthly, for onl fort Y y years, guaranteed, payable jointly with 100% to the survivor, beginning on February 1, 2009; with the last guaranteed payment on January 1, 2049. ii. $2,850.26 monthly, guaranteed for 20 years and continuing for life, payable jointly with 100% to the survivor, beginning on February 1, 2009. C• All sums set forth herein constitute damages on account ofpersons physical -njuries or physical sickness, ~~~ithin the meaning of Section 10-1(a)(2) ofthe Internal Re~~enue Code of 1986, as amended. I'he Plainti fts are aut}~orired to execute the Release; attached to the Petition as Exhibit 'B' and deli~~er that release to the Defendants. Exhibit to Schedcrle "E", Item 1 (?/18) 4. This Action is hereby settled and dismissed with the Court only retaining jurisdiction to enforce the terms of the Order as set forth above. BY THE COURT, .~ Judge cc: Hubert X. Gilroy, Esquire ,~, ~~ .4 ra m i ~,~ a ~~- ~ ~~ ~' ~~ i .~..-- E.~ltibit to Schedcrle "E", Item: 1 ~.»+an_•,~,;~~z'(11 F. FILES' Clirnts' 12378 Brntr 17378.1. Pttnion I .Petition I Crratrd: 9-:0 0.1 ~iG6P.~1 Rn~aed: 1176. G8 I I _'6AM Hubert X. Gilroy, Esquire MARTSON DEARDORFF WILLIA~'~1S OTTO GILROY & FALLER :~IARTSON LAW OFFICES LD. 29943 10 East High Street Carlisle, PA 17013 . , (717) 243-3341 ` ' Attorneys for Plaintiffs - t ESTATE OF LESLIE K. BENTZ by THOMAS E. BENTZ, Administrator of ~ ~ THE COURT OF COM;/1ON PLEAS OF J THE ESTATE OF LESLIE K. BENTZ and CUMBERLAND COUNTY, pENNSYLVANIA THOMAS E. BENTZ individually and DOROTHY L. BENTZ individually, ; Plaintiffs . v. NO. 2008-6986 ERIE INSURANCE COMPANY and CIVIL ACTION -LAW ERIE EXCHANGE , Defendants JURY TRIAL DEMANDEp PETITinN Ti'nn r~r,r<,.,, . ~__ Petitioners, the Estate of Leslie K. Bentz by Thomas E. Bentz, Administrator and E. Bentz individually, and Dorothy L. Bentz individually, set forth the followin ; ~ ~Omas g 1 • Petitioners, Thomas E. Bentz and Dorothy L. Bentz, are husband and wife individuals residing at 228 Green Hill Road, Newville, Pennsylvania 1741 d adult ~'• Petitioner. Thomas E. Bentz, is also :administrator of the Estate of Leslie hay ~n j K. Bentz ~ been appointed .-administrator by appropriate action of the Register of ~~'ills of Cumberland County on June ~0, ?006 at Estate Docket ~"umber ?1-06-~j~}~ - copy of a Certificate of Grant of Lcttcrs being attached hereto and marked Exhibit .~'. ;; ~~ EYhibit to Schedule E ", Item I (4/18) 3• Leslie K. Bentz (Decedent} died on May 19, 2006, as a result of an automobile accident which took place on Pennsylvania Route 581 in Cumberland County, Pennsylvania. 4• Leslie K. Bentz was born on February 2, 1985, and was twenty one years of a eat the time of her death. g 5• At the time of her death, Leslie K. Bentz was not married, had no children, was a college student and resided at home with her parents, Thomas E. Bentz and Dorothy L. Bentz, petitioners herein, and her twin sister, Elaine Bentz. 6• The above captioned action is a Contract Action filed in order to receive Underinsured Motorist Benefits. ~• At the time the Decedent's death, Defendant Erie Insurance Company was an insurer of Leslie K. Bentz for Underinsured Motorist Benefits pursuant to a policy issued at Policy Number Q08 5805608. 8• At the time of the Decedent's death, Defendant Erie Insurance Exchange was an insurer of Thomas E. Bentz and Dorothy L. Bentz, which correspondingly provided Underinsured Motorist Benefits to Leslie K. Bentz at Policy Number Q 11 1002282. 9• In connection with the tw.o above referenced insurance policies, the Petitioners have submitted a claim to Ene Insurance Company and Erie Insurance Exchange for Underinsured Lotorist Benefits and the parties have reached a gross settlement for a value of X900,000.00 to be paid by Erie [nsurance Company and Erie Insurance Exchange to be paid as follows: .1. S?00,000.00 up front cash payable to Thomas E. Bentz, .-administrator of the Estate of Leslie K. Bentz, deceased, and Hubert Y. Gilroy, his attorney. Erltibit to Schedule "E'; Item 1 (S/18) B• Periodic payments payable to Thomas E. Bentz and Dorothy L. Bentz in th amount of $1,089.00, for onl fort e Y y years, guaranteed, payable jointly with 100% to the survivor, beginning on February 1, 2009, with the last guaranteed payment on Janua 1 2049. This eriodic a ry p p yment has a current value of $200,000.00. C• Periodic payments to be made to Thomas E. Bentz and Dorothy L. Bentz in the amount of $2, 850.26 monthly, guaranteed for twenty years and continuin for life, payable jointly with 100% to the survivor, beginning on February Ig 2009. These guaranteed payments have a current value of $500,000.00. 10. The settlement between the parties and the terms of the cash payment and e p nodic payments are confirmed and as set forth in the Release Agreement between the parties, a copy of which is attached hereto and marked Exhibit `B'. 11. Since Leslie K. Bentz died unmarried, without a will, without issue and surviv her two parents, Petitioners Thomas E. Bentz ahd. Dorothy L. Bentz, in their ca' aciby' as parents of Leslie K. Bentz, are the sole beneficiaries of the Estate of Lesle K. Bentz pursuant to 20 Pa. C. S. A. Section 2103(2). 12. Because Leslie K. Bentz was twenty one years of age at the time of her death an parents are the sole beneficiaries of her Estate, the Pennsylvania Inheritance Ta d her on her Estate will be 0% pursuant o 72 P.S. Section 911 A 1 2 rate Pennsylvania Inheritance Tax will be owin on the ~ ( ) `accordingly, no g assets acquired pursuant to this settlement or any other assets of the Leslie K. Bentz Estate. However, the Petitioners and the undersigned counsel will file the appropriate Pennsylvania Inheritance Tar Return as required to conclude the: Estate administration. 13. This settlement represents a compromise ofa contractual claim the Petitioners against the Det~ndants and that there is no requirement for any court hearin ~nhave g this E.rhibit to Schedule "E'; Item 1 (6/18) matter. Petitioners request the court to approve the settlement without a hearing, and attached hereto and marked Exhibit `C' is a letter from the Defendants confinnin the terms ofthe settlement and also indicating that Defendants do not believe that ang hearing is necessary. y 14. Because of the rate sensitive nature of the periodic payment agreements reache part of this compromised settlement, it is important that the court quickly resolve has matter and approve the settlement so that the existing interest rates as required to achieve the periodic payments set forth in the settlement agreement ma be maintained. Y 15. No prior Judge has been involved in the case between these parties to date. Howev the Honorable Wesley J. Oler, Jr., has involvement in a claim filed by the Estate of Leslie K. Bentz against Barber Trucking Company, Inc., et al at Docket No. 2007- 3 895 in Cumbrland County. The matters involved in the separate action by the Bentz Estate against Barber Trucking Company, Inc., et al, have no bearing with res ect to ` the. settlement of this contractual claim as set forth above. p 17. It is the Petitioners position that, technically, court approval of this settlement d not need to be obtained pursuant to Pennsylvania Rule of Civil Procedure 2206 because there is no minor or incapacitated person involved in this action. ~-ldditionally, in light of the fact that there is no inheritance tax owing, Petitioners do not need the court to apportion or allocate the settlement proceeds between an Survivor Action or Wrongful Death Action. However, Petitioners seek this court approval at the request of Defendants based upon the custom of the Defendants to request a court approval in any death action, and courts of this county and other Pei~ns~ fvania counties have participated in approving a settlement ~~~here the parties a~~ree. E_ihlhit to Schedule "E", Item I (7/18) Wherefore, the Petitioners request this Honorable Court to issue an Order a r ' settlement as set forth above. Pp oving the :~fARTSON LAW OFFICES ~--~ ; Y ~ !~ Hubert X. Gilroy, Esquire I.D. Number 29943 i 10 East High Street Carlisle, PA 17013 (717) 243-3341 Date: November ~', 2008 Attorneys for Plaintiff E.rhibit to Schedule "E", Item 1 (8/18) `'ERIFICATION The foregoing Petition is based upon information which has been gathered by my counsel in the preparation of the la«•suit. The language of the document is that of counsel and not my own. I have read the document and to the extent that it is based upon information ~ti•hich I have given to my counsel, it is true and correct to the best of my knowledge, information and belief: To the extent that the content of the document is that of counsel, I have relied upon counsel in making this verification. This statement and verification are made subject to the penalties of 18 Pa. C.S. Section =I90~ relating to unsworn falsification to authorities, which provides that if I make knowingly false averments, I may be subject to criminal penalties. ;~,~~ -- THOMAS E. BENTZ. Ad"" ' istrator of the Estate of Leslie K. Bentz THOIViAS E. BENTZ, individu~y .~ DOROTH L. BENT ,individually Exhibit to Schedule "E", Item 1 (9/18) REGISTER OF WILLS CUMBERLAND County, Pennsylvania CERTIFICATE OF GRANT OF LETTERS No . 2006- 00547 PA No . 21- 06- 0547 Estate Of: LESL/EKBENTZ Fiat, MlddA~ Gup Late Of : WES T PENNSBORO TO WNSH/P CUMBERLAND COUNTY Deceased Soci a1 Security No : 179-66-4842 ` WHEREAS, LESL/EKBENTZ rFr~c Mkldll, ~.ni late of WEST PENNSBORO TOWNSHIP CUMBERLAND COUNTY died on the 19th day of May 2006 and, WHEREAS, the grant of Letters of Administration is required for the administration of the estate. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi11s in and for CUMBERLAND. County.,, in the Commpnwealth of Pennsylvania, have this day granted Letters of Administration to: " THOMAS E BENTZ who has duly qualified as ADMINISTRATOR (RIX) of the estate of the above named decedent and has agreed to administer the estate according to law, all of which fu11y appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARL/SLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 20th day of June 2006. ,~Z(t ~ u ~ i S f fL i y~`~+ ePuty EXHIBIT ~ ~1 Exhibit to Schedule "E", tem (10/18) * *.~~TE* * _~LL ;I,~~IES :~Ev~E r1FPEr~R (FIRST, ~~IIDDLE, LAST UNDERINSURED/UNINSURED MOTORIST RELEASE This Settlement Agreement/Underinsured/Uninsured Motorist Release (the "Settl Agreement") is made and entered into this ement between and among: --- day °f 2008, by "Claimants" Thomas E. Bentz, father and Administrator of the Estate of L Bentz, deceased and Dorothy L. Bentz, mother eslie K. "Insureds" Leslie K. Bentz, Thomas E. Bentz and Dorothy L. Bentz "Insurers" Erie Insurance Company and Erie Insurance Exchange REC----ITALS A. On or about May 19, 2006, Leslie K. Bentz was fatally injured in an accident occurri at or near Route 581, Westbound, in Cumberland County, in the Commonwealth of Pennsylvania. Claimant alleges that physical, personal injuries and death arose out this accident, and has made a claim seeking monetary damages. of B. Erie Insurance Company as the insurer of Leslie K. Bentz would be obligated to any claim made or judgment obtained ° which is covered under the Uninsured/Underinsured Motorist sections of its policies (policy number Q08 580560 with Erie Insurance Company. 8) C. Erie Insurance Exchange as the insurer of Thomas E. and Dorothy L. Bentz would b obligated to pay any claim made or judgment obtained which is covered under the Uninsured/Underinsured Motorist sections of its policies e with Erie Insurance Exchange. (policy number Q11 1002282) D. The parties desire to enter into this Settlement Agreement in order to provide f certain payments in full settlement and discharge of all claims which have, or mi ht be made, by reason of the incident described in Recital A above, upon the terms and conditions set forth below. AGREEMENT The parties agree as follows: EXHIBIT D 9 --- -- nitiai here E,rhibit to Schedule "E'; Item 1 (11/18) RELEASE AND DISCHARGE A. In consideration of the payments set forth in "Payments, Sections A. an Claimants hereby completely release and forever discharge the Insurers from an B all past, present, or future claims, demands, obligations, actions, causes of ay and wrongful death claims, rights, damages, costs, losses of services, expensesc en compensation of any nature whatsoever, whether based on a tort, contract or other theory of recovery, which the Claimants now have, or which may hereafter accr otherwise be acquired, on account of, or may in any wa ue or described in Recital A above, including, without limitation 9 any and allhknowdent unknown claims for bodily and personal injuries to Claimants, or any future wron or death claim of Claimants' representatives or heirs, which have resulted or ma r gful from said accident. y esult B. This release and discharge shall also apply to Insurers' past, present and officers, directors, stockholders, attorneys, agents, servants, representatuture employees, subsidiaries, affiliates ves, and assigns and all other persons, firmseor~ orpoeationsrwith dVSUCCessors in interest, have been, are now, or may hereafter be affiliated. hom any of the former C. This release, on the part of the Claimants, shall• be a fully binding and corn I settlement between the Claimants and the Insurers, and their heirs a p ete• successors. ssigns and D. The Claimants acknowledge and agree that the release and discharge set forth a is a general release of all parties listed in Paragraphs A & B Above. Clair hove expressly waive and assume the risk of any and all claims for damages which exist as of this date, but of which the Claimants do not know or suspect to exist, whe through ignorance, oversight, error, negligence, or otherwise, and which, if kn ther would materially affect Claimants' decision to enter into this Settlement Agreement wn outstanding medical bills or liens, to the extent required to be paid in accordance wAll law, will be satisfied out of the proceeds of the within settlement. The Claim h further agree that they have accepted payment of the sums specified herein ants complete compromise of matters involving disputed issues of law and fact. Claimants assume the risk that the facts or law may be other than Claimants believe. It is understood and agreed to by the parties that this settlement is a compromise of disputed claim, and the payments are not to be construed as an admission of liabili s on the part of the Insurers, by tivhom liability is expressly denied. ty ~ Initial here _ E,rhibit to Schedule "E", Item 1 (IZ/18) The Claimants further agree, represent, and fully certify that they will a agreed upon amount of any lien asserted b an p Y the fully of the proceeds of this settlement. The Claimantsrfurther agree'to d adeove directly out harmless the Insurers from any future lien b an mnify and hold not been previously made known to the part es herein ider as outlined above which has E. For himself/herself and his/her heirs, personal representatives and assi Claimants do hereby fully release and forever discharge Insurers from an gns' the claims and causes of actions arising out of bodily injuries sustained by Leslie Kand all in the accident described in Recital A, which he/she may now have or ma Bentz against said company under the Uninsured/Underinsured Motorist sectionsY fave policies of insurance, and from any and all liability and an its obligations whatsoever (except those contained herein) under Polica No,all contractual and Q11 1002282 issued by the Insurers. y Q08 5805608 PAYMENTS In consideration of the release set forth above, the Insurers agree to pay to the ind' named the sums outlined in Sections A. and B. below: ividuals A. Payments due at the time of settlement as follows: •$ 200,000 up front cash, inclusive.of attorney•fees and expenses., payable to Thomas E. Bentz, Administrator of the Estate of Leslie K. Bentz, deceased and Hub Gilroy, his attorney ert X. B. Periodic Payments, to be made to Thomas E. and Dorothy L. Bentz ("Payee" ac to the schedule as follows (the Periodic Payments"): ) cording $ 1,089.00 monthly, for only 40 years, guaranteed, payable jointly with 100% to the survivor, beginning on February 1, 2009 with the last guaranteed January 1, 2049 payment on $ 2,850.26 monthly, guaranteed for 20 years and continuin for life jointly ~,vith 100°% to the survivor, beginning on February 1, 7008 g ~ payable •all sums set forth herein constitute damages on account of personal physical in~uri physical sickness, within the meaning of Section 104 a 1 es or of 1986, as amended. l) (2) of the Internal Revenue Code 3 Initial here _ Ea-hibit to Schedule "E ", Item 1 (13/18) ----- CLAIMANTS' RIGHTS TO PAYMENTS Claimants acknowledge and agree that neither the Periodic Payments n thereto or interest therein can be sold, assigned led ed h or any rights transferred or encumbered, either directly or indirectly, by such Plai t'ff oa an or otherwise unless such sale, assignment, pledge, hypothecation or other transfer or ~ other Payee (any such transaction being hereinafter referred to as a "Transfer") has bee ncumbrance advance in a "qualified order" as defined in Section 5891(b)(2) of the Inter approved in Code of 1986, as amended (a "Qualified Order"), and otherwise com lies ,nal Revenue state law, including without limitation any and all applicable state stuctufeth applicable protection statutes. d settlement CLAIMANT'S BENEFICIARY Any payments to be made after the death of any Payee pursuant to the Settlement Agreement shall be made to the survivor or to such person or entiterms of this designated in writing to the Insurers or the Assignee. If no person orb as shall be designated by the Payee, or if the person designated is not living at the entity is so Payee's death, such payments shall be made to the estate of the Pa a time of the designation, nor any revocation thereof, shall be effective unless it is yne No such delivered to the Assignee. The designation must be in a form acceptable to thwriting and before such payments are made. a Assignee CONSENT TO A QUALIFIED ASSIGNMENT A. Claimants acknowledge and agree that .the Insurers will make a "qualified a ' within the meaning of Section 130 (c) of the Internal Revenue Code of srgnment" amended, of the Insurers' liability to make the Periodic Payments set 1 086, as "Payments, Section B." to Prudential Assigned Settlement Services Cor P rth in ("the Assignee"). The Assignee's obligation for payment of the Periodic PSSCorp) shall be no greater than that of the Insurers (whether b ayments immediately preceding the assignment of the Periodic Payments obligation. agreement) B. Such assignment shall be accepted by the Claimants without ri shall completely release and discharge the Insurers from the Perrod cJ Pafon and obligation assigned to the Assignee. The Claimants recognize that the Assi ne ments be the sole obligor with respect to the Periodic Payments obligation, and that e shall releases ~~~ith respect to the Periodic Payments obligation that pertain to the liabi other the Insurers shall thereupon become final, irrevocable and absolute. Cf . lity of acknowledge and agree that Insurers shall not be the owner of an armants asset" and Insurers do not guarantee an Y "qualified funding annuity. Y payments to be made pursuant to said 4 Initial here _ Exhibit to Schedule "E ", Item 1 (14/18) --- C RIGHT TO PURCHASE AN ANNUITY The Insurers, itself or through the Assignee, reserves the right to fund the li the Periodic Payments through the purchase of an annuit ability to make Insurance Company of America. The Assignee shall be thepsole ow erThe Prudential policy and shall have all rights of ownershi of the annuity Insurance Company of America mail payments directly tofthe Pa ee have The Prudential responsible for maintaining a current mailing address for Payee w theThe F shall be Insurance Company of America. rudential DISCHARGE OF OBLIGATION The obligation of the Assignee to make each Periodic Payment shall be disc the mailing of a valid check in the amount of such payment to the desi nateharged upon the Payee named in "Payments, Section B." of this Settlement Agreement o~ address of by electronic funds transfer in the amount of such payment to an account de the deposit the Payee identified in "Payments, Section B." signated by ATTORNEY'S FEES Each party hereto shall bear all attorney's fees and costs arising from the own counsel in connection with this Settlement Agreement, the matters and do um f its referred to herein, and all related matters. ents R In entering into this Settlement Agreement the Claimants represent that the upon the advice of their attorney, who is the attorney of their own choice, cooce nenrelied legal and income tax consequences of this Settlement Agreement; that the ter g the Settlement Agreement have been completely read .and explained to Claiman ms of this attorney; and that the terms of this Settlement Agreement are fully underst by their voluntarily accepted by Claimants. ood and The Prudential Insurance Company of America will issue a letter pertormance of the obligations assigned to PASSCor b guaranteeing the Assignment Agreement and for which PASSCor p y way °f a Qualified Prudential Insurance Company of America to coverphese same obli ations y from The 9 5 Initial here _ E.~hibit to Sclredarle "E", Itcrn 1 (15/18) ~- WARRANTY OF CAPACITY TO EXECUTE AGREEMENT Claimants represent and warrant that no other person or entity has, or has had, any interest in the claims, demands, obligation, or causes of action referred to in this Settlement Agreement, except as otherwise set forth herein: that Claimants have the sole right and exclusive authority to execute this Settlement Agreement and receive the sums speci>'ied in it; and that Claimants have not sold, assigned, transferred, conveyed or otherwise disposed of any of the claims, demands, obligations or causes of action referred to in this Settlement Agreement. GOVERNING LAW This Settlement Agreement shall be construed and interpreted in accordance with the laws of the Commonwealth of Pennsylvania. ADDITIONAL DOCUMENTS All parties agree to cooperate fully and execute any and all supplementary documents and to take all additional actions which may be necessary or appropriate to give full force and effect to the basic terms and intent of this Settlement Agreement. ENTIRE AGREEMENT AND SUCCESSORS IN INTEREST This Settlement Agreement contains the entire agreement between the Claimants and the Insurers with regard to the matters set forth in it and shall be binding upon and inure to the benefit of the executors, administrators, personal representatives, heirs, successors and assigns of each. No promise, inducement or agreement not herein expressed has been made to Claimants, and this Settlement Agreement contains the entire agreement between the parties hereto. 6 Initial here E,rhibit to Schedule "E", Item 1 (16/18) EFFECTIVENESS This Settlement Agreement shall become effective immediately following executio of the parties. n by all Claimant: Thomas E. Bentz By: Individually, and as Administrator of the Estate Of Leslie K. Bentz, deceased Date: Claimant: Dorothy L. Bentz By: Date: Insurers: Erie Insurance Company By: _ Title: Date: Insurers: Erie Insurance Exchange By: Title: Date: NOTICE: An --~"- y person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containin a materially false information or conceals for the g nY concerning any fact material thereto commits a fraudulent assurance actdwhichnso crime and subjects the person to criminal and civil penalties. 7 Exhibit to Schedule "E", Item 1 (!7/18) '' Erie ~~. Insurance' Branch -Rice 1901 _~-~ise Cr 71 Z '95 d200 ?,., Free 1 d00 Ur~oher 1 U, ?l)U,y Hubert Gilroy. Esquire ~Iartson Law Offices 10 East High Street Carlisle, PA 17013 ~(~mj ~. F icrey, CpCU..al ' ,,., .;tart 'l.ca Fri:; ~i-r• ,; , ...;i~!"g ~d3r.: G: ~e R•,sarcy~e 8us;ress Cer.(ar ? - ., ,,. , O. Eox 2013 A"echar:csb~rg. FA t'C55-~'.'10 ,:d~ .a,4 ax ; 17 ~ :5.,_31S uvww.Friem;;urance.ccm Re: Your Client: Estate of Leslie Bentz Erie Claim :~'o.: 01017086643 & 010170887183 Erie Insured: Leslie Bentz and Thomas & Dorothy Bentz Date of Loss: iV1ay 19, 2006 Dear Mr. Gilroy: As you are aware, Erie is offering the underinsured motorist limits of $900,000.00 as settle Estate of Leslie Bentz. Specifically $300,000.00 under Leslie Bentz's policy and $600 0 ment to The Thomas and Dorothy Bentz's policy. In addition, this will confirm that Erie does not ne 00.00 under present or require a hearing as it pertains to the Petitign for Court Approval. d to be If you have any questions please contact me. Since ly, Douglas G. Kocher Claims Rzpresentati~e (717) 761-775 EXHIBIT ~ _~ ExJrihit to Schedule "E", Item 1 (18/18) GENERAL RELEASE AND SETTLEMENT AGREE'~fENT FOR AND IN CONSIDERATION OF THE SL':~i OF SIY HtiNDRED THOUSAND ($600,000.00) DOLLARS, the receipt of which is hereby acknowledged, the undersi ed t~ , ESTATE OF LESLIE K. BENTZ, BY THOMAS E, BENTZ, ADMINISTRATOR OF THE ESTATE OF LESLIE K. BENTZ, THOMAS E. BENTZ, INDIVIDUALLY AND DOROTHY BENTZ on behalf of the undersigned and each of their heirs, executors a ministrators, successors and assigns (hereinafter referred to as "Releasors"), hereby releases and forever discharges BARBER TRUCKING, INC., BARBER TRUCKING COMPANY INC., DANE B. CLARK AND SENTRY SELECT INSURANCE (hereinafter referred to as "Releasees"), of and from any and all claims, demands, damages, actions and causes of action, suits, debts, dues, accounts, bonds, covenants, contracts, agreements, judgments, claims and demands of every kind, whatsoever, known or unknown, in law or a uit q y, wrthout limitation, and specifically including, but not limited to, any and all claims, whether for wrongful death, personal injury, payment and/or reimbursement ofinedical or hospital char es g , or otherwise, ar7sing out of or in any way connected with an incident which occurred on :~Ia Y 19, 2006 as a result of which Leslie K. Bentz, deceased, allegedly sustained injuries which is the subject of a civil action in the Court of Common Pleas, Cumberland County, Docket No. 07-3895, as ~~~ell as any claim that Releasors hereafter can, shall or may- ha~-e for or by reason of any cause, matter or thing whatsoe~~er from the beginning of the world to the date of this Genc;ral Release and Settlement .1b'r'~'c'ment. I~' FLRTIIER CONSIDER.~TION of the abo~ e mentioned sum, the Releasors agre:c as E.~hibit in Sdtedtde `E", Item ? ~1/S) follows: 1 • There is a risk that subsequent to the execution of this release the Releasors will incur or suffer personal bodily discomfort, monetary or other loss, death, dama ge or any of these which are in some way caused by or related to the occurrence referred to above ut which are unknown and unanticipated at the time this release is signed; and further there is a nsk that the damages presently known may be or may become more extensive than the Releasors now expect or anticipate. 2• The Releasors shall assume the above mentioned risks, and this release shall apply to all unknown or unanticipated results of the occurrence described above as we 11 as those known and anticipated. 3• The above mentioned sum is the entire and only consideration for this release and the Releasors shall be responsible for the payment of their attorneys' fees and le al g expenses incurred on their behalf as well as any and all claims for medical and hospital - expenses, or workmen's compensation or Medicare liens, both past and future. 4• It is intended by Releasors and Releasees, and each of them, that this release shall be complete and shall not be subject to any claim of mistake of fact or law b the Y undersigned and, regardless of the adequacy or inadequacy of the amount paid, this release is intended to avoid litigation and to be final and complete. 5• This release is the result of a compromise of a disputed claim and shall ne~-er at any time for any purpose be considered as an admission of liability or responsibility of the parties hereby released, and in particular Barber Trucking Co., Inc. who continues to den • y such liability and to disclaim such responsibility- in that it was only the I-eSSOr of the tractor trailer and not the operator, or cmplovcr of Dane Clark, and thereby has no exposure to these Eelribit to Schedule ` E ", Item 2 (?/S) claims pursuant to the F~ICSR or other applicable DOT Regulations. 6• A division, if any, of the above mentioned sum between the Releasors and anyone else shall in no way affect the validity of this release. ~• This settlement is intended to, and Releasors warrant that they will dispose of all liability of Releasees, and each of them, to Releasors, Releasors' heirs a ' signs, subrogees and to any other person or entity that might now or in the future have a clai masa result of the injury to Releasors, including but not limited to the workmen's com ens ' insurer and healthcare providers. Should any such further claim be made p anon by any person or entity for which Releasees, or any of them, might be liable, directly or indirectly, Releasors o n behalf of Releasors, Releasors' heirs and assigns agree to and will hold harmless and ind emm fy Releasees, and each of them, of and from any and all liability for such claim, includin al g 1 costs, expenses and attorneys' fees in defending such claim. However, this indemnification does not • apply to any claim that may be filed against the Releasors by Ronald E. Clark and/ Attorney. or his g• It is agreed and stipulated by the undersigned that the amount paid in consideration for this release is a fair and reasonable settlement. 9• In entering into this General Release and Settlement Agreement, Releasors have relied upon the legal advice of:~Iartson Law Offices; Hubert X. Gilro • y, Esquire, ~ti ho are the attorneys chosen by the undersigned. This General Release and Set tl~,ment \greemcnt has been read by the undersigned, w•ho understands and voluntarily acce is its t p c.rms. 10. This General Release and Settlement Agreement shall operate as a final s~ttlcmcnt and disposition of the disputes between the Releasors and Releasees. This C c.n~.ral E,1-hibit to Schedule `E", Item Z (3/S) Release and Settlement Agreement supersedes all prior a eeme understandings, whether oral or written, between the Re ~ nts, negotiations, leasors and the Releasees. No promise, agreement, statement or representation not expressed herein has been made to or relie either the Releasors or the Releasees. This General Rclea d upon by se and Settlement Agreement constitutes the entire agreement between the Releasors and the Releasees and determined that no Court approval of this settlement and Releasors have this agreement is necessary. 11. Ifanypart orprovision ofthis General Release and Settlement A ee should be held to be void or invalid, the remaining provisions shall re ~ ment mam m full force and effect. 12. Releasors and Releasees understand and agree, that the entire amou the consideration bein nt of g paid hereunder shall be pursuant to and in satisfaction of all of Releasors' claims under the applicable law. 13. Releasors shall famish to Releasees the appropriate documents to c the dismissal with prejudice of the pending litigation hereinabove describ ause ed including a filed copy of an Order to Settle, Discontinue and End. '` r THOMAS E. BENTZ, ADMINISTRATOR OF THE ESTATE OF LESLIE K. BENTZ TIiOLi:aS E. BENTZ DOROTHY BED"TZ•~ -- S~~orn to and subscribed: Exhibit to Schedule B", Item 2 (4/S) Before me this ~ i G' day: Of '' ~ ~ `_ , 2008: _ "~~ -_ _ a P ~~ 1 ~~ ,. SOT.-~RX PUBLIC' a .. ` ~' ~ ... '~'3 ~, ~, E_rhibit to Schedule "E", Item ? (S/SJ