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REV-1500 EX (~) OFFICIAL USE ONLY
PA DepeMient d Revenue Counh Code Year Fb Nurser
Bureau of indMrWuel Taxes INHERITANCE TAX RETURN
PA i712aasol RESIDENT DECEDENT ~' L 4~ ~~~
ENTT3! DECEDENT INFORMATION tMB.OW
Sodas Securky Number Dees of Dsatlr Wa of BMh
0 7 0 3 2 0 0 8 0 3 1 5 1 9 3 8
DerxdsrA's List Name Ballot Decedent's First Name MI
T U R K A B D U L S
15056041125
(M APPIk~) EnEeF Sufvl~Nlp 8pawe's Irrfonnatlon t?ielow
Spowe's Lrst Nams Sullbr Spouse's First Name MI
T U R K N Y A M U
5pouee's SociN Securky Number
2 1 3 7 8 3 2 5 9 71•1S ~~ ~~ ~ FN~D ~ DUPLICATE YYfI'H THE
REGISTER OF WILLS
FILL IN APPROPRIATE 01VM-8 BEI.OYY
^ 1.Oripinal Retum
^ 4. Limited Esaa
^ 8. Deoedsrd Died TeWa
(Mach copy a virlk)
^ 9. Litlpadon Prooesds Received
® 2.3uppbmsntal Retum ^
^ 4a. FrAuro Interost Compromise (daa of ^
deedh rlar 12-12-82)
^ 7. Dsoedsnt MairNairrsll a L.Nkq Tnrst _
(Attach Copy of Trust)
^ 10. spouse Poverty Crrdk (daa of death ^
lxelwsen 121-91 and 1-1-05)
3. Remainder Retum (date of death
prior to 12-13-82)
5. Federal Estaa Taz Retum Requirod
8. Total Number of Sate Depoak Boxes
11. Ebctbn b tax under Sec. 9113(A)
(Mach Bch. O)
-TINS SECTION tIwMT BE fX11pLETED. ALL fX~SPO110ENCE AND CONFOtelfi•IAL TAX StFORYATpl1 eeIDIR.D 6E ORECI®i0:
~~ Daytime Teleplwne Number
S U S A N J H A R T M A N 7 1 7 2 4 9 7 7 8 0
Finn Name (HApplicable)
D U N C A N & H A R T M A N, P C
First line of sddross
1 I R V I N E R O W
Seoond line of addroea
Cky or Pont OIBoe
C A R L I S L E
State ZIP Code
P A 1 7 0 1 3
REfibTER USE
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llyder pnleNes d perJlsy, I tlret I have eerNned tbY resnr, tncNdlnN aooaglerrytrp sdlelMrYs end elNerrrerrb, and b tlrs beet d my browbdpe and trelaf,
k p bw, coned end conplele. Dedentlon of pnparer clher lion tfis parsed repiseerrl~ee 4 bared an el hiarrneron o ersr Irea rry bioWled2e.
SIQ~NA OF PE REBPO BI LE F R FILNJO RETURN DATE
/~y~lo
1005 F~DWOOD DRIVE
CARLISLE
PA 17013
of
1 IRVINE RCf6i' / CARLISLE PA 17013
PLEASE tNIE ORKiINAL FORM ONLY
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Side 1
15056041125 15056041125 J
15056042126
REV-15oo oc
DsoedenPs Social Security Number
DeosasM'a Name: ABDUL S. TURK
RECAPRULATION
1. Real estate (Schsdub A) ..................................... ... 1. •
2. Stocks and Bonds (Schsdub B) ............................... ... 2.
3. Cloealy Hold Corpondlon, Partnership Or Sob-Proprietorship (Sdrsdub C) .. ... 3. -
4. Nbrlpapss 3 Notes Reosivabb (Schedub D) ..................... ... 4.
5. Cash, Bank Deposits 3 ~ Penonsi Property (Sdredub E) .... ... 5. 2 2 8 1 2 • 7 4
6. Jointly Owrrsd Property (ScMdub F) ^ Separate BBinp Requested .... ... 8. •
7. Inter-Vivoa Tranafere & MboeNaneoue N robete Property
(Sdredub G) ~S
t
Billi
R
apara
e
ng
equested .... ... 7.
e. Tow oroes AsaW ((oral Lkres 1-7) ........................... s. 2 2 8 1 2. 7 4
9. Funeral t_xperass ~ AdminbtratMe Costs (Schedub H) ............. ... 9.
1 D. Debts of Dsoedsnt, Mor~ags LiabiWtlss, 3 Liens (Schedub I) ......... ... 10.
11. Tow DWuetloM (total Lines 9 310) ........................ ... 11.
12. Net valve of Estate (Lirb 8 mkws Lies 11) ...................... ... 12. 2 2 8 1 2 • 7 4
13. Charitsbb and Go~rommsnw BequsstslSsc 9113 Trusts for vNNCh
an sbtdion to tax has not bserr made (Sohsdub J) ............... ... 13.
14. Nst Value Subject toy Tax (Line 12 minus Line 13) ............... ... 14. 2 2 8 1 2 • 7 4
TAXCOMPUTATION - SSE MISTRLICTIONS FOR APPLICABLE RATES
15. Amount of lkre 14 hntabb
at the spousal tax rake, or
transfers under Sea 911ti
(ax1.2)X.D _ 2 2 8 1 2. 7 4 15. 0. 0 0
1 B. Amount of Line 14 taxable
at Iirrsal race X .0 _ 0 . 0 0 16 0. 0 0
17. Amourd of Line 14 taorabb
n sibNng rab X .12 0. 0 0
17.
0.
0
0
1 S. Amount of Line 14 taxabb 0
0 0
.
at oolbteral rate X .15 18 0 . 0 0
19. Tax Due ................................................19.
20. FILL IN THE OVAL ~ YOU ARE RttQUESTiltf3 A REFUND OF AN OVERPAYMENT
81de 2
15056042126 15056042126
0. 0 0
REV-1500 EX Pleas 9
DecedenYa Ct~lnulaba ARidrnss:
Flb Number
00
oECEnENrs NAME
ABDUL S. TURK
sTREErADDRESS
1005 REDWOOD DRIVE
CRy -
CARLISLE STATE
PA ZIP
17013
Tax Payments and CndMs:
1. Tax Due (Page 2 Une 18)
2. CredtslPayrtrenis
A Credit
(1) 0.00
• Spousal PoverlY
B. Prior Payments
C. Dstbttnt
Tatal Credits (A + B + C) (2) 0.00
3. IrrteresUPenally if applic;sble
D. Interest
E. Penalty
Total IrtteresUPenally (D + E) (3) 0.00
4. ti Una 2 is greater than Line 1 + Una 3, enter the dilFererae. This is the OVERPAYMENT.
FM b oral on PaBir 2, Llae m do nqueet a nttMd. (4) 0.00
5. H Una 1 + Una 3 is greater than Una 2, enter the difiererae. This is the TAX dJE
A. Enter the interest on ti,e tmt due.
(5) 0.00
(~)
B. Enter the total d Lkre 5 +5A. This lathe BALANCE OUE (5B) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING tJtJESTION8 BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedern malts a transfer and: Yes No
a. retain the use 0r income d the property transferred : ...................................................................... ^
b. retain the right b designate who shah use the property transferred ar its ktcarrre : ...............................
c. retain a revers~ortary interest, a ................ ......................................................................... ^
d. receive the prWnise for life of either payments, benefits ar care7 ....................................................... ^
2. N death occurred after December 12,1982, did decedent transfer property witidn ane year of death
..
wfihout reoemrtg adequate txxrsrderaUort? .......................................................................................
3. Did decedent own an'in trust for' ar payable upon death bank account or security at his a Irer death? ......... ^
4. Did tlecedern own an Irxfividual Retirement Aooolxrt, anrwity, ar other ran-probate property which
contains a beneflbiary designation? .................................................................................................. ^
IF THE ANSMIER TO ANY i>F THE ABOVE QUESTIONS IS YE3, YOU MUST COMPLETE SCHEDULE (i AND FILE R AS PART OF THE RETIJRM.
For dales of rleatl- an or after July 1,199N and before January 1,1996, the tact tab irnpoaed an the net value of lrarrefers b ar far the use of the aurvivtrtg spouse
is tixee (3) pernent [72 P.S. §.9118 (a) (11) (t)].
Far dales of death m ar after January 1,'1995, the tax rate knpoeed on the rtet value d frerrefers b a for the use of the surviving spouse is zero (0) peroerrt
[72 P.S. §9118 (a) (1.1) (if)J. The statuM a trerrefer b a surviving spouse from tact, and the stahdwy requNenxatfs for dsdoeure of seeds and
ttiirtg a tax realm are stlfi applk~ble even if the survhdrg spouse is the ony b.
Far dales aF dealt an ar aNer July 1,2000:
The tax rate imposed on the net value of ~transfera from a deceased drYd twertty-0ne years d age or younger a< deatir b or for the use of a nature) parent, an
adoptive parent, or a stepparent of the child is mro (0) peroerd [72 P.S. ~116(aX1.2)].
The tax rate imposed on the net value of transfers b a for the use ofthe deoedertfs Ikreal berrelk;iaries re fcurand ane-half (4.5) peroent, e~toept ae ntAed in
72 P.S. §9118(1.2) (72 P.S. §9116(ax1)].
The tact tale imposed on the net value of transfers b or for the use of the decedenPs aibYrtgs is lwelre (12) percerrt ]72 P.S. §9116(ax1.3)]. A sibNng is defined, unduder
Section 9102, as an individual who tree at least one parent in common with the decedent, whether by blood a atlopdon.
REV-1508 EX + (&~)
SCNEDlJLE E
~,~~, ~ ~~,,,,,,,,~ CASH, BANK DEPOSRS, ~ MISC.
iN REStDE~NTE ECEOENT N PERSONAL PROPERTY
ESTATE OF
and the deb
feiMofsievF
lT~ VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t. ADDITIONAL SETTLEMENT PROCEEDS FROM MERCK LAWSUIT 22,812.74
TOTAL (Also enter an line 5, RecapitubUon) ~ t
REV-1513 EX + (&001
C.OMIAONNIEALTH of PENNSYWANw
INHERRANCE TAX RETURN
SCHEDULE J
BENEFICIARIES
ABDUL S . TURK 0 0
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Lid TnnMo(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (Yldde dierbutlolls, and translela under
Sec 9116 (a (1
1. NYAMU TURK Spousal 100.00
1005 REDWOOD DRIVE
CARLISLE PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRWTE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OFPART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REY-1500 COVER SHEET f
~ rc rrwvp erwna w rwwlArt mwat arlfliflnnal nMexlc M ihP, cartes viral
ABDUL TURK v. MERCK & CO., INC
ED I NAND BUTTON BCH~D~ ,
--
TOTAL QR088 AMOUNT AWARDED:
(100% Award Value at $1,866.01 per Point) 5161,998,32
Total Attorney fee pursuant to PTO 50
at 32%
less 8% common benefit fee = 24%
Attorney fee previously recovered $36,479.60
-$22, 830.48
TTORNEY FEE DUE FROM PTO 60 ----
-$13,649.12
Prior Interim Payment to Client 4/24/09:
Prior Final Payment to Client 12/10/09: -$48,037.90
Prior Attorney Fee: -$27,901.96
Prior Costs recovered: -$22,830.48
Medicare Reimbursement -$487.40
Medicaid Reimbursement '$2,b81.14
Government Liens '$0.00
Private Lien Resolution Program Holdback $0.00
Common Benefit Fee (8%) -$0.00
Common Benefit Cost (lor6) -$12,169.87
-$1, 519.98
TOTAL OF ALL DEDUCI'ION$: ------------------
-x128,167.86
PTO 60 REFUND DUE
~
. ------------------
(Total Grime Amount Awarded min~Total o
f~
This ie the amount disbursed by the Claims Adm ~ etorna. 522,830.47
to Handler, Henning, Qc Rosenberg, I.Lp., on your behalf.)
Less Out of Pocket Case Costs since last Payment:
Postage/FedEx
$8.73
COSTS TOTAL --------------'--
(To Handler, Henning & Rosenber $8•?3
B. LLP)
NET SUBTOTAL OF FINAL PAYMENT: •--•-------------
$22,821.74
NF,T AMnrnm~ nr rc.~r.n ,,..
--~L~~1 rnr~vtvU.~'LY RELIEVED:
NET AMOUNT DUE TO CLIENT $ 75, 939.86
= 22,821.74*
TOTAL FINAL NET: •----------------
598, 761.60
• Amount client will receive ae a reimbursement from the attorney fees withheld pursuant to PTO 50.
I have read the above Schedule of Distribution and I fully understand it. I authorize my attorney e,
Handler, Henning do Rosenberg, LLp to settle my case and disburse the monies obtained in
connection with my claim and the injuries I sustained, as set 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: /a ~ ~`~~~C.c.--
A.gMITA SABAIt, E~CECIITRIR OF THE
ESTATE OF ABDUL TURK
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