HomeMy WebLinkAbout11-22-10 1505607121
06
05
REV-1500 EX
(
-
) OFFICIAL USE ONLY
PA Department of Revenue .
Bureau of Individual Taxes County Code Year File Number
Po Box 2sosol INHERITANCE TAX RETURN
Harrisburg, PA 1712s-0601 RESIDENT DECEDENT 2 1 0 8 0 1 0 8 0
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
0 9 2 0 2 0 0 8 0 9 0 8 1 9 3 8
Decedent's Last Name Suffix Decedent's Firs t Name MI
R U S S E L L S R ~1 A R L I N E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ^X 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)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
M A R C U S A M c K N I G H T I I I 7 1 7 2 4 9 ~,,,3 5 3
c~ `"°'
Firm Name (If Applicable) ---
I R W I N & M c K N I G H T P C-
First line of address
6 0 W E S T P O M F R E T S T R E E T
Second line of address
City or Post Office State ZIP Code
C A R L I S L E
Correspondent's a-mail address:
=,
-- _.~
_.
_~
"T 1
~-'
P A 1 7 D 1 3
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 representative is based on all information of which preparer has any knowledge.
SIG~'UF~`E OF PERSON RF~6PONSIS.LE-fsOR FILING RETURN DATE
322' OLTON AV UE CARLISLE
RE OF PR; ER HE HAN REPRESENTATIVE
,.
DD `
O~WEST POMFRET S BEET CARLISLE
PLEASE USE ORIGINAL FORM ONLY
Side 1
Lsos6a~121
i/-~'~ - sd
PA 17013
PA 17013
1505607121 J
1 1505607221
~J
REV-1500 EX
oeceaent'sName: P'IARLIN E • RUSSELL ~ SR •
Decedent's Social Security Number
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 8 9 8 4 2 . 5 1
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 8 9 8 4 2. 5 1
9. Funeral Expenses 8~ Administrative Costs (Schedule H) .......... 9. 3 ®• 0 0
10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ........ .... 10. •
11. Total Deductions (total Lines 9 & 10) ....................... .... 11. 3 0 • 0 0
12. Net Value of Estate (Line 8 minus Line 11) ................. . ... .... 12. 1 8 9 8 1 2 . 5 1
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. 1 8 9 8 1 2 • 5 1
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) x .0 1 8 9 8 1 2 5 1 15.
16. Amount of Line 14 taxable
~
0
~
at lineal rate X •0 16.
17. Amount of Line 14 taxable
~
~
~
at sibling rate X .12 17.
18. Amount of Line 14 taxable
~
~
0
at collateral rate X .15 18.
19. Tax Due ............ ........................... .. ..... ..19.
20. FILL iN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
],505607221 1505607221
a
U
0. 0 0
0. 0 0
0. 0 0
0 e 0 0
D. 0 0
J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 08 01080
DECEDENT'S NAME
MARLIN E. RUSSELL, SR._ __ _______________________
STREET ADDRESS
322 BOLTON AVENUE
CITY STATE ~ ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2) 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.00
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. (4) 0.00
5 enter the difference. This is the TAX DUE.
If Line 1 + Line 3 is greater than Line 2 (5) 0.00
. ,
Enter the interest on the tax due
A (5A)
.
.
Enter the total of Line 5 + 5A. This is the BALANCE DUE.
B (5B) 0.00
.
Make Check Payable fo: REGISTER OF WILLS, AGENT
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 : ................................................................. ..... ^
^ 0
0
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? ................................................. ......
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
^
0
without receiving adequate consideration? .................................................................................
"
" ......
^
or payable upon death bank account or security at his or her death? ...
in trust for
3. Did decedent own an ......
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................................................ ...... ^
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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are sti11 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)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARLIN E. RUSSELL, SR. 21 08 01080
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. SURVIVAL ACTION DAMAGE -SETTLEMENT STATEMENT ATTACHED 189,842.51
PAYABLE TO THE ESTATE OF MARLIN RUSSELL
IT IS THE INTENTION THAT THIS INHERITANCE TAX RETURN REPLACE THE
INHERITANCE TAX RETURN FILED APRIL 21, 2010
TOTAL (Also enter on line 5, Recapitulation) I $ 189, 842.51
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARLIN E. RUSSELL, SR. 21 08 01080__ __
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B.
2
3
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City
Year(s) Commission Paid:
State Zip
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. I Probate Fees
5 Accountant's Fees
6. Tax Return Preparer's Fees
7. REGISTER OF WILLS -FILING FEE 30.00
TOTAL (Also enter on line 9, Recapitulation) I $ 30.00
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-001
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARLIN E. RUSSELL SR. 21 08 01080
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)]
1. VIRGINIA RUSSELL Spousal 189,812.51
322 BOLTON AVENUE REMAINDER
CARLISLE, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
jj, NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
(If more space is needed, insert additional sheets of the same size)
~: ~C~ ~ L ~ 'c ~ ~ Iii ~ ~ ~ ~. ~ F ~-
A I_ I M I l' ~ l7 I_ I A F3 1 i.. i '1' Y f' A R 'f N~ R S 1-1 1 ra
SETTLEMENT DISTRIBUTION REPORT
Client: Marlin Russell Date: 6/1/10
Payee: Various per family Settlement Agreement of 12/10/2008
DEFENDANT
Ingersoll Rand
GROSS SETTLEMENT
LEGAL FEES:
COSTS ADVANCED:
MEDICARE REIMBURSEMENT ESCROW:
NET SETTLEMENT TO CLIENT:
Distribution per family settlement agreement of 12/10/2008:
Estate of Marlin Russell
Virginia Lee Russel{
Brenda Russell Kelley
Kelly Russell Whitten
Marlin Eugene Russell Jr.
25.00%
37.50%
12.50°!0
12.50%
12.50%
AMOUNT
$150,000.00
$150,000.00
$60,000.00
$0.00
$15,000.00
$75,000.00
$18,750.00
$28,125.00
$9,375.00
$9,375.00
$9,375.00
FEE DISTRIBUTION REPORT:
COUNSEL
DeLuca & Nemeroff, LLP
Robert Peirce & Associates, PC
Skein Law Center, Ltd.
AMOUNT
45.00% $27,000.00
45.00% $27,000.00
10.00% $6,000.00
TOTAL LEGAL FEES $60,000.00
The terms and amount of this settlement are confidential and are not fo be shared, disclosed
and/or discussed with anyone other than your attorney(s). Failure to maintain the conildentlally
of this settlement could result Jnlegal act/on being taken by the settQng defendant against you
to recover the amount paid to you plus any legal fees incurred by them to do so.
If you are asked to disclose the terms and/or amount of this settlement by anyone,
p/ease notify us at once.
If medical or hospital expenses relating to your claim have been paid by Medicare or Medicaid or
time loss, pemmanent partial or permanent total disability, or widow's benefits have been paid
by any agency of the state or tederel government, the US Govemment may in the future seek
to recover such amou-rts, less a credit for proportionate attorney's fees.
Our records do not show that you have received any form of public assistance, Medicare or
Medicaid payments for which a subrogation claim is being made by an agency or intrumentality
of the Federal Govemment. However, if you have received such benefits, a subrogation
claim may be made against you by such agency or instrumentality.
No notice has been received by this office to date of any such claim for reimbursement
by any governmental or private agency (such as a Group Health plan) which may have paid or provided
you with medical or other benefits, and no funds have been withheld on this account. Therefore,
you wfll be responsible for all subrogation claims and any unpaid and/or future asbestos.relatedbllls.
$372,500.00
$149,000.00
$2,943.27
$40,000.00
A I_IMIl'kl'~ 1_IAF311.,IT'Y i'~AP2'rNFf:SHIf~
SETTLEMENT DISTRIBUTION REPORT
Client: Marlin Russell Date: 5/12/10
Payee: Various per family Settlement Agreement of 12/10/2008
DEFENDANT AMOUNT
Riley Stoker $200,000.00
JH France $172,500.00
GROSS SETTLEMENT
LEGAL FEES:
COSTS ADVANCED:
MEDICARE REIMBURSEMENT ESCROW:
NET SETTLEMENT TO CLIENT:
Distribution per family settlement agreement of 72/70/2008:
Estate of Marlin Russell
Virginia Lee Russell
Brenda Russell Kel{ey
Kelly Russell Whitten
Marlin Eugene Russell, Jr.
FEE DISTRIBUTION REPORT:
COUNSEL
DeLuca & Nemeroff, LLP
Robert Peirce & Associates, PC
Shein Law Center, Ltd.
TOTAL LEGAL FEES
25.00%
37.50%
12.50%
12.50°l0
12.50°Jo
$180,556.73
$45,139.18
$67,708.78
$22,569.59
$22,569.59
$22,569.59
AMOUNT
45.00% $67,050.00
45.00°!0 $67,050.00
10.00°l0 $14,900.00
$149,000.00
The terms and amount of this settlement are confidential and are not to be shared, disclosed
and/or discussed with anyone other than your attorney(s). Failure to maintain the confrdentially
of this settlement could result In legal action being taken by the settling defendant against you
to recover the amount paid to you plus any legal fees incurred by them to do so.
If you are asked to disclose the terms and/or amount of this settlement by anyone,
please notify us at once.
If medical or hospital expenses relating to your claim have been paid by Medicare orMedlcaid or
time loss, permanent partial or permanent total disability, or widow's benefits have been paid
by any agency of the state or federal government, the US Govemment may in the future seek
to recover such amounts, less a cred/t for proportionate attorney's fees.
Our records do not show that you have received any form of public assistance, Medicare or
Medicaid payments for which a subrogation claim Js being made by an agency or intrumentaliry
of the Federal Govemment However, if you have received such benefits, a subrogation
claim maybe made against you by such agency or instrumentality.
No notice has been received by this office to date of any such claim for reimbursement
by any governmental or private agency (such as a Group Health plan) which may have paid or provided
you with medical or other benefits, and no funds have been withheld on this account Therefore,
you will be responsible for all subrogation claims and any unpaid and/or future asbestos•re/ated bills.
A I._IMI"i'E17 l..IABILi'i'Y 17A~RTNFI7SFilf~
SETTLEMENT DISTRIBUTION REPORT
Client: Marlin Russell Date: 4/17/10
Payee: Various per family Settlement Agreement of 12/10/2008
DEFENDANT AMOUNT
Edwards Valve $100,000.00
Crane Co. $225,000.00
Zurn Industries $275,000.04
GROSS SETTLEMENT $600,000.00
LEGAL FEES: $240,000.00
COSTS ADVANCED: $21,344.85
ESCROWED COSTS: $0.00
NET SETTLEMENT TO CL{ENT: $338,655.15
Distribution per family settlement agree ment of 12/10/2008:
Estate of Martin Russell 25.00% $84,663.79
Virginia Lee RusseN 37.50% $126,995.69 ~ll
Brenda Russetl Kelley 12.50% $42,331.89 ~,~('[-
Kelly Russell Whitten 12.50% $42,331.89
Martin Eugene Russell, Jr. 12.50% $42,331.89 IG
FEE DISTRIBUTION REPORT:
COUNSEL % AMOUNT
DeLuca & Nemeroff, LLP 45.00% $108,000.00
Robert Peirce &Associates, PC 45.00% $108,000.00
Shein Law Center, Ltd. 10.00% $24,000.00
70TAL LEGAL FEES $240,000.00
The terms and amount of this settlement are confidential and are not to be shared, disclosed
and/or discussed with anyone other than your attorney(s). Failure to maintain the confrdentially
of thfs settlement could result in legal action being taken by the settling defendant against you
to recover the amount paid to you plus any legal fees incurred by them to do so.
If you are asked to disclose the teens and/or amount of this settlement by anyone,
please notify us at once.
If medical or hospital expenses relating to your claim have been pa)d by Medicare or Medicaid or
time loss, permanent partial or permanent tots! disability, or widow's benefits have been paid
by any agency of the state or federal government, the US Government may in the future seek
to recover such amounts, less a credit for proportionate attorney's tees.
Our records do not show that you have received any form of public assistance, Medicare or
Medicaid payments for which a subrogation claim is being made by an agency or intrumentality
of the Federal Government However, if you have received such benefits, a subrogation
claim maybe made against you by such agency or Instrumentality.
No notice has been received by this office to date of any such claim for reimbursement
by any governmental or private agency {such as a Group Health plan) which may have paid or provided
you with medical or other benefits, and no funds have been withheld on this account Therefore,
you will be responsible for all subrogation claims and any unpaid and/or future asbestos-related bills.
A I_ I M I 'i' ~ L:U I_ I A f3 I L I 'i' Y f~ ;4 I'2 'r N F r: 5 H 1 f~
SETTLEMENT DISTRIBUTION REPORT
C{ient: Marlin Russell Date: 2/20/10
Payee: Various per family Settlement Agreement of 12/10/2008
DEFENDANT
AW Chesterton
GROSS SETTLEMENT
LEGAL FEES:
COSTS ADVANCED:
ESCROWED COSTS:
NET SETTLEMENT TO CLIENT:
Distribution per family settlement agreement of 12/90/2008:
Estate of Marlin Russell 25.00%
Virginia Lee Russell 37.50%
Brenda Russell Kelley 12.50%
Kelly Russell Whitten 12.50°l0
Marlin Eugene Russell, Jr. 12.50°!0
FEE DISTRIBUTION REPORT:
COUNSEL
DeLuca & Nemeroff, LLP 45.00%
Robert Peirce 8~ Associates, PC 45.00%
Skein Law Center, Ltd. 10.00%
TOTAL LEGAL FEES
$30,000.00
The terms and amount of this settlement are confidential and are not to be shared, disclosed
and/or discussed with anyone other than your attorney(s). Failure to maintain the confidentially
of this settlement could result fn legal action being taken by the settling defendant against you
to recover the amount paid to you plus any legal fees incurred by them to do so.
!f you are asked to dfsclose the terms and/or amount of this settlement by anyone,
please noSfy us at once.
Jf medical or hospital expenses relating to your claim have been paid by Medicare or Medicaid or
time loss, permanent partial or permanent total dfsability, or w/dow's benefits have been paid
by any agency of the state or federal government, the US Government may fn the future seek
to recover such amounts, less a credit for pmportlonate attorney's fees.
Our records do not show that you have received any form of public assistance, Medicare or
Medicaid payments for which a subrogation claim is being made by an agency or Intrumentality
of the Federal Government However, ff you have received such benefits, a subrogation
claim may be made against you by such agency or lnshumentality.
No notice has been received by this office to date of any such claim for reimbursement
by any governmental or private agency (such as a Group Health plan) which may have paid or provided
you with medical or other benefits, and no funds have been withheld on this account. Therefore,
you will be responsible for all subrogation claims and any unpaid and/or future asbestos-related bills.
AMOUNT
$75,000.00
$75,000.00
$30,000.00
$16,100.44
$0.00
$28,899.56
$7,224.87
$10,837.34
$3,612.45
$3,612.45
$3,612.45
AMOUNT
$13,500.00 blj
$13,500.00 ~~
$3,000.00
A I_ I M 11' ~ [~ L I A. k3 I l_ I 'r Y I~ A:IZ T' N E f7 S .H I la
SETTLEMENT DISTRIBUTION REPORT
Client: Marlin Russell Date: 1/31/10
Payee: Various per family Settlement Agreement of 12/10/2008
DEFENDANT AMOUNT
Yarway $150,000.00
GROSS SETTLEMENT: $150,000.00
LEGAL FEES: $60,000.00
COSTS ADVANCED: $5,256.07
ESCROWED COSTS: $0.00
NET SETTLEMENT TO CLIENT: $84,743.93
Distribution per family settlement agreement of 12/90/2008:
Estate of Marlin Russell 25.00% $21,185.99
Virginia Lee Russell 37.50% $31,778.97 l
S
Brenda Russell Kelley 12.50% $10,592.99 QQ'b
Kelly Russell Whitten 12.50% $10,592.99 ~~1
Marlin Eugene Russell, Jr. 12.50% $10,592.99
FEE DISTRIBUTION REPORT:
COUNSEL °1o AMOUNT
DeLuca & Nemeroff, LLP 45.00% $27,000.00
Robert Peirce & Associates, PC 45.00% $27,000.00
Shein Law Center, Ltd. 10.00% $6,000.00
TOTAL LEGAL FEES $60,000.00
The terms and amount of this settlement are confidential and are not to be shared, disclosed
and/or discussed with anyone other than your attorney(s). Failure to maintain the confrdenflally
of this settlement could result In legal action being taken by the settlfng defendant against you
to recover the amount pa/d to you plus any legal fees Incurred by them to do so.
If you are asked to disclose the terms and/or amount of this settlement by anyone,
please notify us at once.
If medical or hospital expenses relating to your claim have been paid by Medicare or Medicaid or
time loss, permanent parfia/ or permanent iota/ disability, or widow's 6enefifs have been paid
by any agency of the state or federal government, the US Government may In the future seek
to recover such amounts, less a credit for proportionate attorney's fees.
Our records do not show that you have received any form of public assistance, Medicare or
Medicaid payments for which a subrogation claim is being made by an agency or Intrumentality
of the Federal Government. However, !f you have received such benefits, a subrogation
claim may be made against you by such agency or insirumenfal!!y.
No notice has been received by this office to date of any such claim for reimbursement
by any governmental or private agency (such as a Group Health plan) which may have paid or provided
you with medical or otherbenefits, and no funds have been withheld on this account. Therefore,
you will be responsible for aU subrogation claims and any unpaid and/or future asbestos-related bills.
~~,. .. D E L'u• CA .Sc • N:°E~~M.:E.R~C] F'`F'
A LIMITED L.iABiLITY PAR`TNE•RSHIP
SETTLEMENT DISTRIBUTION REPORT
Client: Marlin Russell Date: 812512009
Payee: Various per family Settlement Agreement of 12/10/2008
DEFENDANT AMOUNT
Garlock $100,000.00
GROSS SETTLEMENT: $100,000.00
LEGAL FEES: $40,000.00
COSTS ADVANCED: $8,365.23
ESCROWED COSTS: $0.00
NET SETTLEMENT TO CLIENT: $51,634.77
Distribution per family seftlement agreement of 92/10/2008:
Estate of Marlin Russell 25.00% $12,908.68
Virginia Lee Russell 37.50°!0 $19,363.04
Brenda Russell Kelley 12.50°10 $6,454.35
Kelly Russell Whitten 12.50% $6,454.35
Marlin Eugene Russell, Jr. 12.50% $6,454.35
FEE DISTRIBUTION REPORT:
COUNSEL % AMOUNT
DeLuca 8~ Nemeroff, LLP 45.00% $18,000.00
Robert Peirce & Associates, PC 45.00% $18,000.00
Shein Law Center, Ltd. 10.00% $4,000.00
TOTAL LEGAL FEES $40,000.00
The teens and amount of th/s settlement are confidenUa/ and are not to be shared, disclosed
and/or discussed w/th anyone other than your attomay(s). Failure to maintain the confidentially
of this settlement could result !n legal act/on being taken by the settling defendant against you
to recover the amount paid to you plus any legal fees /ncumed by them to do so.
If you are asked to disclose the teens and/or amount of this settlement by anyone,
please nofify us at once.
If medical or hospital expenses relating to your claim have been paid by Medicare or Medicaid or
time loss, permanent partial or permanent total d/sabllity, or widow's benefits have been paid
by any agency of the state or federal government, the US Govemmenf may !n the future seek
to recover such amounts, less a credit for proportionate attorney's fees.
Our records do not show that you have received any form of public ass-stance, Medicare or
Medicaid payments for which a subrogation claim !s being made by an agency or intrumentallty
of the Federal Government However, !f you have received such benefits, a subrogation
claim may be made agalost you by such agency or Instrumentality.
No notice has been received by this office to date of any such c/a/m for reimbursement
by any governmental or private agency (such as a Group Health plan) which may have paid or provider
you w/th medical or other benefits, and no funds have been withheld on this account. Therefore,
you w/l/ be responsible for all subrogation claims and any unpaid and/or future asbestos•re/aced bills.
5P~ S