HomeMy WebLinkAbout11-20-0915056041125
REV-1500 EX (~)
PBuNau of YgMid~aid Tws Cooky Cods Y~r Fie Number
ppg~~gt MHERRANCE TAX RETURN 2 1 0 8 0 8 5 6
tierdebeo. PA 171260AD7 RESDENT DECEDENT
ENTl7t DECEDENT INFORMATION BELOW
Social Securty Number Data of Death Data of Birth
0 7 0 3 2 0 0 8 0 3 1 5 1 9 3 8
DeoadenPs last Name Ballot DeoadaM's Fret Name MI
T U R K A B D U L S
(M Applicable) Erlbx Survivirlp spouse's Irdormatlon Below
Spouse's Last Name Ballot Spouse's Fret Name MI
T U R K N Y A M U
Spouse's Social Security Number
2 1 3 7 8 3 2 5 9 ~~ RETURN MUST ~ FlLED IN DUPLICATE WITH THE
REGISTER OF WILLS
FHl IN APPROPRUITE OVALS BELOW
® t. Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death
poor to 12-13-02)
4. Limited Estate ~ 4a. Future Imerest Compromise (date of ~ 5. Federal Estate Tax Retum Required
death after 12-122)
6. Decedent Died Testate ~ 7. Decedent Maintained a LMng Tmst 8. Total Number of Safe Deposk Boxes
(Attach Copy of Wilp (Attach Copy of Trust)
9. Lkigatan Proceeds Received ~ 10. Spousal Poverty Credft (date of death ~ 11. Ebctbn to tax under Sec. 9173(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
COR RESPONDENT - TNB SECTION WST BE CO~LEi®. ALL ~ AIDf~NFDB1iNL TAX KORMIITIOM 811011LD BE D~CTEDTO:
Nam e Daytime Tekpllare Number
S U S A N J H A R T M A N 7 1 7 2 4 9 7 7 8 0
Frm Name (M Appbcable)
D U N C A N & H A R T M A N P C
Frst Nne ~ address ~,
1 I R V I N E R O W
Seoorrd ine or adarees
cky a Post Once
C A R L I S L E
Correspondent's e-mail
REfIISTER~OF WILLS US~ILY
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smm zIP code
~rc~ruRE OF PERSON Ri~S LE FOR FILING RETURN DATE
005 REDWOOD
013
SIGr~'jORE OF PREPARER O THAN REPRESENTATNE pq~
FORM ONLY
Side 1
15056041125
15056041125
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15056042126
REV-1500 EX
Decedem's Soda) Security Number
oecederrrstV«ns: ABDUL S. TURK
RECAPrruuTaN
1. Real estate (Sdredule A) ........................................ 1.
2. SMdcs and Bootle (Sdredub B) .................................. 2.
3. Cbsey Held Coryoration, Partnership or Sole-Proprietorship (Sdbduk C) ..... 3.
4. Morfgapes 8 Notes Receivabb (Sdredule D) ........................ 4.
5. Cash, Bank Deposits 8 ktiaoeNaneoua Personal Property (Schedub E) ....... 5.
6. Joirdy Owned Property (Schedule F) ^ Separate Biting Requested ....... 6.
7. Inter-Kivos Transfers & MiacNlaneous N~Pro~b Properly
(Sdrodule G) U Separate Billing Requested ....... 7.
8. Total Gross Assets (total Linea 1-7) ........................... 8.
7 5 9 3 9, 8 6
7 5 9 3 9, 8 6
9. Funeral Experrees & Administratise Costa (Schedule H) .......... ...... 9. 2 7 2 0 , 6 6
70. Debts of Decedent. Mortgage LiabliUes, s Liana (Sdxedub q ...... ...... 10. 1 0 2 1 5 , 5 3
t t. Toe Dsarrenorrs total Linea 9 310 t t. 1 2 9 3 6, 1 9
12. Nat VNrs: of EsfaES (Clete 8 minus lire 11) ................... ...... 12. 6 3 0 0 3 , 6 7
13. Charitable and Gowmrrrrerd~ Bequesta/Sec 9113 Treats for which
an ebclion ro tax has not been made (Schedule J) ............ ...... 13.
14. Net Value Suejset fa Tax (Line 12 maws Lino 13) ........... ..... .. 14. 6 3 0 0 3 , 6 7
TAX COMPUTATION -SEE INSTRUCT1ON3 FOR APPLICABLE RATES
15. Amount of Line 14 taxabb
at the spousal tax rate, or
transfers under Sec. 9116
(a>(1.z) x.ooo 6 3 0 0 3, 6 7 t5. 0, 0 0
16. Amount of Line 14 taxable
at lineal rate X .0 _ 0, 0 0 16 0, 0 0
17. Amourrt of Line 14 taxabb
ataDlirrgratex.t2 0.0 0 t7. 0, 0 0
18. Artqurd of L'me 14 taxable
at oolbteral rate X .15 0, 0 0 18. 0, 0 0
19. Tax Due ................................................ 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
15056042126 15056042126
0, 0 0
J
REV-7500 EX Pape 3
Decedent's Complete Address:
Foe NumEer
21 os Doss
DECEOERrst~
ABDUL S. TURK _
STREET ADDRESS
1005 REDWOOD DRIVE
CffY
CARLISLE STATE
PA ZIP
17013
Tax Payments and Credits:
t. Tax Due (Page 2 Line 19)
2. CreditslPaymeds
A. Spmsal Povady Credit
B. Pd« Payments
C. Discount
3. InteresUPenalty'rf applicants
D. Interest
E. Penalty
4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT.
Flp M oval on Peps 2, Line 201o request a refund.
5. H Litre t +Line 3 is greater than Une 2, enter the difierenco. This is the TAX DUE.
A. Eller the interest on the tax due.
(4) 0.00
(5) 0.00
(5A)
B. Enter the teal d Line 5 +5A. This is the BALANCE DUE. (5B) 0.00
Make Check Payable to: REGISTER OF WIUS, AGENT
PLEASE ANSWER THE FOLLOIMNG QUEST11ON3 BY PLACING AN "X' IN THE APPROPRIATE BLOCKS
1. Did decedent make a irarwfer and:
a reNaintheuae«imm~edtheprapertytrarrskned : .........................................................
b. ratan the dgM b designate who shaft u~ the pmpeAy trar~ened «~ krmne : ..................
c. retain a reversionary « ...................................................................................
d. receivelhepaNeebrMedeitll«pa~1~,6enalNs«cae7 ...........................................
2. if death aoaned aRer Dec«riber 12,1982, did dacedeM transfer properly witlrin one year d death
wiMrad receivkg adequate oorwidewfim4 ...........................................................................
3. Oki decedent awn an'h trust br"' «payaAle rpon dash tlarrdc aooolad «seaaily at his «her death?
4. Did decedent awn an Individual Retirement Amount, annuity, «othernDn-probate property which
contains a benefiaary designation?
Yes No
IF THE ANSYYER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FN.E R AS PART OF THE RETURN.
F« dales d death on «after July 1,1994 and before January 1,1995, the tax rate imposed co the net value d transfers to «for the use d the surviving spouse
s Beee (3) peroeM fy2 P.S. l~116 (a) (1.1) (11•
F« dabs d death on «afler January 1,1995, the tart rate inKxrsad on the net value d transtws ro «kx the use d the survivkg spouse Ls zero (0) parted
[72 P.S. §9116 (a) (1.1) flip. The statute does rrd exend a transfer b a s«vivin9 spouse brn tao4 and Yle stahAdY regriremerMS (« d~adosrre d asap and
fifing a tax redprr are sdfi appYrxble even'd the survivirg spouse is Ble only lrerreRdary.
Fordebs ddealh on «allei Juy t, 201Xb
The tax tale imposed an the net value d 6arwters from a deceased child M~eMy-«le years d age «y«eger d d~ b «f« the use d a ndural gazed, an
adoptive parent, «a stepparent d the did is zero (O) percent (72 P.S. ~118(a)(12p.
TAe twr rate bpoeed on the rrel vakre dtrarwfflrs b «fa the use d the deoeded's ~I benefitiades is bur and one~Aalf (4.5) percent, ezoept as noted in
72 P.S. x'116(12) (72 P.S. (~118(aX+)~
The tax rob unposed an the net value d trarekrs b«brihe ups d the decedent's srTirgs is trehw (12) perowrl [/2 P.S. §91t6(aJ[1.3p. A sibirg s defined. under
Secdm 9102, as an individual who Ilan at least one parent in odmm w~ 1he decederM, wheMer by flood «adopim.
(+) o.oo
Total Credits (A * B +C) (2) 0.00
Tots InterestlPenahy (D+E) (3) 0.00
REV-1508 EX i (&98)
3CHEO1/LE E
DEALT„ ~ ~,,~,~, CASH, BANK DEPOSRS, & MISC.
"' PERSONAL PROPERTY
n~~
~~ VALUE AT DATE
NUMBER nccrR~arviu ..~ ~.r..
TOTAL (Abo enter m Nne 5, RecaipNulabon) I S
REV-1511 EX+(12-89)
~.n+oF PEwNSnvum~
NF1ERIfANCE rAX RETURN
SCNEDI/LE N
FUNERAL EXPENSES 8
AO~IISTRATIVE COSTS
ABDUL S. TURK 21 08 0858
Dtbfs of d~wdrk Mint a nOeAtd on SNue~Ae L
REM
NUMBER DESCRIPiI~I AMOUNT
A. FIA~tAL E%PENSES:
1. RONAN FUNERAL HOME 1,200.00
B. ADMINISTRATIVE COSTS:
1. F'Meanei Repnssentasra's Consniasbns
Nero of PMamd RepnssNe~ive (s)
Soael Sewey NumeM(ajlEM Numberaf PMaaid RepMeenteWe(a)
SYeM Adtlnms
state
Testal Canmbslsn Pdd:
p, AtbseyFees DUNCAN & HARTMAN, PC
3. FMNyExengbn:(Ndecede~Reeedies6rottUeaMroffideYroi[a,~e~enaYon)
CleYront
SeeM AdOnm
~Y Slele _
ReletenNdp aClenaMto DecedMrt
4. RenMeFees REGISTER OF WILLS
5. I Aaaseaers Fees
s. ~ r~ Retun PiePsrels Fees
7. DEATH CERTIFICATES
8. THE SENTINEL -LEGAL
9. CUMBERLAND LAW JOURNAL -LEGAL NOTICE
10. REGISTER OF WILLS -FILING FEE
1,200.00
52.00
38.00
142.66
75.00
15.00
TOTAL (Also enter on Pne 9, RecapihdaUOn) ~ i
zp
Zip
REV-1512 EX + (12~
C.OMIONYVEALTFI OF PENNSYI.vANM
NHERIMNCE TAX RETINtM
scirEOVr>~ i
DEBTS OF DECEDENT,
MORTGAGE LUIBILRIES, 8~ LIENS
ABDULS.TURK _ 21 08 0858
Resort da8b YKwrod by tlN dacadaN p110r b dsdh Nillich ramNwd ixipNd K of tlM dNe a(ds>tlh, NICIudYq umaNnbwsed medipl azpsnaas.
C~EM VALUE AT DATE
~~ ~SCRIPiION OF DEATH
1. NATIONAL RECOVERY AGENCY 51.73
2. IMASLAND ASSOCIATES
3. ALEXANDER SPRINGS EMERGENCY PHYSICIANS
4. IHEAIING ARTS SURG. ASSOCIATES
5. BLUE MOUNTIN ANESTHESIA ASSOCIATES
6. INCO -CARLISLE REGIONAL HOSPITAL
18.26
21.41
95.85
20.28
10,008.00
TOTAL (Abo elder on Bne 10, RecapRulabon) I S
(If nnia space fs needed, Mroed addWonel ahaeb of tlw3 same she)
REV-1513 EX • (400)
caewanwEALn~ oi= PErx~snv~v.
SCHEDULE)
BENEFICWRIES
ABDUL S.TURK 21 08 0858
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RC-CEIVING PROPERTY Do Not LM TnsYe(p ~ ESTATE
I, TAXABLE ~pp~y
°uYigMi )2 ] dhYhdbro, end eanstas under
~~~~~I(( .2]
1. NYAMU TURK Spousal
1005 REDWOOD DRNE 100%
CARLISLE, PA 17013
BITER OOLLAR AMOUNTS fOR DISTRIBUf10NS SHOVMN ABOVE ON UNES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE aSTRIBUTpNS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR NMK~1 AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUiIDrLS
i.
TOTAL OFPART II - EMERTOTALNON-TAXABLE DISTRIBUTIONS ON UL~ 13 OF REV-1500 COVER SHEET =
in rtwnR Rn~rp iR npp11R(1 Ineurt arlAifimte ChIMdC of thR Car11R ai~Rl
ABDUL TURK v. MERCK & CO., INC
RECAPITULATION AND DISTRIBUTION SCHEDULE
TOTAL GROSS AMOUNT AWARDED
(100% Award Value at $1,865.01 per Point)
$161,998.32
Prior Interim Payment to Client
Prior Attorney Fee on Interim Payment
Prior Coats on Interim Payment
Medicare Reimbursement
Medicaid Reimbursement
Government Liana
Private Lien Resolution Program Holdback
Common Benefit Fee (8%)
Common Benefit Coat (1%)
Withholding Pursuant to PTO 49
TOTAL OF ALL DEDUCTIONS
SUBTOTAL
(Total Grose Amount Awarded minus Total of All Deductions.
This ie the amount disbursed by the Claims Administrator
to Handler, Henning, & Rosenberg, LLP., on your behalf)
Leas Out of Pocket Case Coata~
COSTS TOTAL
(To Handler, Henning & Rosenberg, LLP)
NET SUBTOTAL OF FINAL PAYMENT
•$48,037.90
-$22,830.48
•$476.86
-$2, 581.14
•$0.00
-$0.00
-$0.00
-$12,159.87
-$1, 519.98
•$36,479.60
-$124,08b.83
$ 27,912.60
$ 10.54
$ 10.54
$27,901.96*
NET TO CLIENT OF INTERIM PAYMENT ~ $ 48,037.90
NET TO CLIENT OF FINAL PAYMENT $ 27,901.96
TOTAL NET TO CLIENT $ 76,939.86
* Please note that this subtotal reflects the total amount disbursed to Handler, Henning & Rosenberg, LLP., on your case ae a
Finai Payment with only Handler, Herring & Ftoaenberg, LLP's out of pocket cane costa since the Interim Payment deducted.
At this point, Handler, Henning & Rosenberg, LLP ie not deducting any attorney fee on the final payment, but rather, ie
awaiting the resolution of the appeal of the Judge's Order limiting attorney fees to 32%. Upon resolution of that ieeue, you
may be issued an additional payment which would reflect any balance owed to you.
** In addition, this subtotal reflects 16% of the total settlement award that was withheld under Judge Faflon'e order until the
negotiations are cemplete on the Private Lien Resolution Progxam. Upon resolution of this issue, you may be issued
additional payment which would reflect any balance owed to you on the amount withheld to satisfy any private liana.
I have read the above Schedule of Distribution and I fully understand it. I authorize my attorney's,
Handler, Henning & Rosenberg, LLP, to settle my case and disburse the monies obtained in
connection with my claim and the injuries I sustained, ae eat forth in the Schedule of Distribution.
Furthermore, I acknowledge that Handler, Henning & Rosenberg, LLP, is paying only those
expenses from my settlement as set forth in this Schedule of Distribution and any medical bills that
may be outstanding will be my responsibility.
DATE: 1,1 I '"( I C ~1 ~,~ ' ~~~~.
-r-T Name E
ASMITA SABAR, EXECUTRIX OF THE
ESTATE OF ABDUL TURK