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Home My WebLink About03-09-111505610148 REV-1500 Ex ~°'-'°' OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes Po Box zsosot INHERITANCE TAX RETURN 21 O S 10 7 8 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 215-08-2513 10182005 04301969 Decedent's Last Name Suffix Decedent's First Name M I RESUTA CABOT L (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 BOXES BELOW ^ 1. Original Return ^ 4 Li i . m ted Estate ^ 6. Decedent Died Testate (Attach Copy of Will) ® 9. Litigation Proceeds Received ® 2. Supplemental Return ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ 7. Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 3. Remainder Retum (date of death prior to 12-13-82) ^ 5. Federal Estate Tax Retum Required ~ 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ELIZABETH P• MULLAUGH 717-237-5243 First line of address 100 PINE STREET Second line of address PO BOX 1166 City or Post Office HARRISBURG State ZIP Code PA 17108 REGISTER OF WILLS USE ONLY C'7 __ •-~ n _ .. .: ~.,_. -1~~~, I - ~ , ; ? ~.~ -~ -, -~ --~ ,,=; ~.• ~ O ~.?"t "Tl Correspondents e-mail address: E M U L L A U G H~ M W N• C O M Under penalties of perjury, I declare that I have examined this return, inGuding 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. 4208 MID~ILEBURG ROAD UNION BRIDGE, MD 21791 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE AT MCNEES WALLACE & NURICK LLC, Y • ~• ~• /~ ADDRESS 1D0 PINE STREET, P•0• BOX 11 H RRISBURG, PA 17108 15D561D148 Side 1 9M4647 4.000 1505610148 J 1505610248 REV-1500 EX Decedent's Social Security Number 215-08-2513 Decedents Name: R E S U T A CABOT L RECAPITULATION 1. Real Estate (Schedule A) 1 0 • 0 0 2. Stocks and Bonds (Schedule B) . 2 0 , 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. 0 , 0 0 4. Mortgages and Notes Receivable (Schedule D) 4 0 • 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5, 10 9 , 3 3 3.3 3 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6. D • 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. Q . Q Q 8. Total Gross Assets (total Lines 1 through 7) 8 10 9 , 3 3 3.3 3 9. Funeral Expenses and AdminisVative Costs (Schedule H), , 9 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10 11. Total Deductbns (total Lines 9 and 10), 11 12. Net Value of Estate (Line 8 minus Line 11) . 12 13. Charitable and Governmental Bequests/Sec 9113 Trusts for vahich an election to tax has not been made (Schedule J) , , 1 g. 14. Net Value Subject to Tax (Line 12 minus Line 13) . 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 16. Amount of Line 14 xable 0 4~ at lineal rate X . Q • Q Q 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 BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610248 Side 2 1505610248 9,880.00 0.00 9,880.00 99,453.33 o•oo 99,453.33 0.00 0.00 0.00 0.00 0.00 X^ 9M4648 4.000 REV-1500 EX Page 3 File Number ai. n s l.n7A DECEDEM'S NAME RE TA CA OT L STREET ADDRESS CITY MECHANCISBURG STATE PA ZIP 17050- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments ~ • ~ ~ B. Discount 3. interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) 250.94 0.00 (5> 250.94 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; ^ 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 Dec. 12, 1982, did decedent transfer property wfthin one year of death without receiving adequate consideration? . 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? . 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S.§9116 (a) (1.1} (i}]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 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 21 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 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 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 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. (1) 0.00 Total Credits (A + B) (2) ~ ' 0 9M4671 2.000 REV-1508 EX + (6-96) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8c MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Cabot L Resuta 21 05 1078 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntlyowned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Civil Action File No. 06-3975 - Order dated 4/24/2008 - Survival Action Settlement $ 145,000.00 Legal Fees (48,333.33) 96,666.67 We ask the abatement of the interest from July 18, 2006 to the date check was issued 04/30/2008 2 Civil Action File No. 06-3975 - Order dated 11/02/2007 - Survival Action Settlement $ 19,000.00 Legal Fees (6,333.34) 12,666.66 We ask the abatement of the interest from July 18, 2006 to the date check was issued 04/17/2008 109,333.33 3W46AD x.000 (Ii more space is needed, insert additional sheets of the same size) REV-1511 EX+(10-09) SCHEDULE H Pennsylvania DEPARnuENrOF REVENUE FUNERAL EXPENSES AND IN-ERITANCE TAX RETURN ADMINISTRATIVE COSTS RES~ENroECEOENr ESTATE OF FILE NUMBER Cabot L Resuta 21 05 1078 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. None B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 5 , 380.00 Name(s) of Personal Representative(s) Robert Resuta Street Address 4208 Middleburg Road Gity Union Bridge State MD ZIP 21791 Year(s) Commission Paid: 2011 2. Attorney Fees: 1, 000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3 500.00 Claimant Cameron and Noah Resuta ' Street Address 500 Rittenhouse Square City Mechancisburg State PA ZIP 17050 Relationship of Claimant to Decedent CHILDRED 4. Probate Fees: 5. Accountant Fees: 6. Tax Retum Preparer Fees: 7. None TOTAL (Also enter on Line 9, Recapitulation) ~ $ 9 , 880.00 9W46AG 2.000 If more space is needed, use additional sheets of paper of the same size. 00 ~ ~O l~ O O ~O ~O O 00 N p~ N N ~ d' pp [~ o0 0o vl ~ 01 ~ i i i ~ i ~` ~ ~ ~ 000 h ~ D\ ~ ~ O~ ~ C 00 ~O ~O 00 V ~ ~ ~ N ~ ~ N ~ ~ ^. M O rl ~ ~" 0 1 N `~ `~ 6y ~ O is v ~ . ~ M z ~ . . ~~~° o ~ o 0 0 0 0 0 0 o00 0 Q Ooop w 0 ~ o 0 0 °~ v v v o 0 0 0 0 0 0 F M M N N ~ Q Q L ~_ 7 ~ d ~ ~ ~" y M 0 M M M 0 0 0 0 0 0 0 A ~~~°~$ N a ~ ~ y .a ~° o°O°ooooo00 „ ° a z ~~ ~ ~ ~ N ~ _ _ N 0 4-. y Q Q . S M 0 M M M 0 0 0 0 0 0 0 C Y O C ~ 'd v t9 ~ io .O O e't7o r. 7 , ;~ :b L V ~ Q ¢ ~ p O O O O O O O O O O O LL N ~ 7 M O M M M O O O O O O O Q X H T ,_, M .. O M M M O O O O O O O ~ ti U C ~~„ = 0 0 0 0 0 0 0 0 0 0 0 0 ~ ~ ti t C ~ ,-. c~ M r. 0 M M M O O O O O O O Q L a Q O O O O O O O O O O O O s U M ,'~ ~~ 0 0 0 0 0 0 0 0 O~ ~ 0~0 N N N 0 0 0 0 0 0 0 0 N y w C M M M M O O O O O O O O ct dd ~ .. ~ ~ / W +~+ N I~ f~ N ~ N ~ O~ l~ 'C P~ 00 M M O~ ~ M O M~ <!' Y o aoooooooooog ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 . ~ oooopooooop U A w o OOOa°ooo ~OOO L M V1 V1 [~ d0 N h ~ V1 ~ D\ ~ y W ~ ~ O O O O O O O O O O d O O O O O O O O O O O }~ N N N N N N N N N N N N ~yy CQ 0 N Cd U C~ U G7 ..~ G7 ~+ F~ ~~ - . - yarn ~ fi 2008 IN RE: PETITION FOR APPROVAL OF DISTRIBUTION OF SETTLEMENT PROCEEDS BROUGHT BY ROBERT JOHN RESUTA, ADMINISTRATOR OF THE ESTATE OF CABOT RESUTA, DECEASED on behalf of minor children NOAH RESUTA and CAMERON RESUTA IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW NO. 06-3975 ORDER AND NOW, this 2 y~ day of 14 r~~ , 200, upon consideration of the ~~ - - attached Petition for Approval of Compromise Settlement and Distribution of Proceeds, IT IS HEREBY ORDERED THAT: 1 } Settlement of this matter in accordance with the terms of the Petition is hereby approved. 2) All proceeds shall be allocated as set forth in the Petition for Approval of Compromise Settlement and Distribution of Proceeds, as follows: (a) The sum of $48,333.33 to Metzger, Wickersham, Knauss & Erb, P.C. as 20% fees, including expenses, allocated to the Survival Action recovery; (b) The sum of $193,333.34 to Metzger, Wickersham, Knauss & Erb, P.C. as 80% of fees, including expenses, allocated to the Wrongful Death recovery; (c) The net sum of $96,666.b7 to the Estate of Cabot Resuta; (d) The net sum of $193,333.33 to Cameron Resuta in a Structured Settlement with The Conte~Brown Group, LLC, on behalf'of Old Mutual Financial Network, for lump sum payments at age 18, 21, 23 and 25; and (e) The net sum of $193,333.33 to Noah Resuta in a Structured Settlement with The Conte--Brown Group, LLC, on behalf of 0Id Mutual Financial Network, for lump sum payments at age 18, 21, 23 and 25. 392252-] 3) Petitioner is authorized to execute all necessary re]eases. ~w ~~ ~,,,,~ 1 g'" ?.ao~ ~ v~.ceJ~r1 ~ BY THE COURT: 392252-1 IN RE: PETITION FOR APPROVAL OF DISTRIBUTION OF SETTLEMENT PROCEEDS BROUGHT BY ROBERT JOHN RESUTA, ADMINISTRATOR OF THE ESTATE OF CABOT RESUTA, DECEASED on behalf of minor children NOAH RESUTA and CAMERON RESUTA . IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW NO. 06-3975 PETITION FOR APPROVAL OF SETTLEMENT AND DISTRIBUTION OF SETTLEMENT PROCEEDS PURSUANT TO 20 Pa. C.S.A. & 3323(a) and Pa. R.C.P. 2206(b)(1) 1. Petitioner is Robert John Resuta, personal representative of the Estate of Cabot Resuta, as evidenced by the Short Certificate attached hereto as Exhibit "A." 2. Cabot Resuta was born on April 30, 1969, and died in a motor vehicle accident on October 18, 2005, while operating his motorcycle. The police report of the accident is attached hereto as-Exhibit "B." The certificate of death is attached hereto as Exhibit: "C." 3. At the time of his death, Cabot Resuta was survived by his two children, Noah Resuta and Cameron Resuta who are .the sole beneficiaries entitled to bring an action for wrongful death under the Wrongful Death Act, 42 Pa. C.S.A. § 8301(b}. Robert John Resuta was the father of Cabot Resuta and is bringing this action on behalf of Cameron Resuta and Noah Resuta. 4. Cameron Resuta was born on March 27, 1995 and Noah Resuta was born on May 2, 1999. Both children legally reside with their birth mother, Michelle Resuta. 5. Cabot Resuta died intestate, and under the laws of intestate succession, Cameron Resuta and Noah Resuta are also the sole lawful heirs of the Estate of Cabot Resuta under 20 Pa. C.S.A. § 2103(2). 6. As indicated in the .attached police report, the motor vehicle accident occurred when a vehicle being driven by Laura Kelly collided with the motorcycle that was driven by Cabot Resuta. A claim has been brought by Robert John Resuta against Laura Kelly and her liability insurance carrier, which claim is still pending and has not been settled. A Complaint has been filed against Laura Kelly in Cumberland County at Civil Action No. 06-3975. 7. .Cincinnati Insurance Company, the liability insurance carrier for the Defendant, has offered $725,000.00 to settle the claim of Cabot Resuta against Laura Kelly. Attached hereto as Exhibit "D" is a letter of March ] 0, 2008, from defense counsel, Donald Desseyn advising settlement in the amount of $725,000.00. 9. Cameron Resuta and Noah Resuta, are entitled to recover wrongful death damages individually due to the death of their father, Cabot Resuta, which damages include the pecuniary value of the services, society, support and comfort which they would have received from the decedent over their lifetime. Slasernan v. Myers, 309 Pa. Super. 537, 455 A.2d 1213 (1983). 10. Petitioner and Michelle Resuta each have entered into a Contingent Fee Agreement with their attorney, Francis J. Lafferty, 1V, Esquire, of the law firm of Metzger, Wickersham, Knauss & Erb, P.C. in the amount of thirty three and a third (33 1/3%) percent, which Fee Agreement is attached hereto as Exhibit " E". The agreements tl!-erefore provide for an attorney's fee in this matter of $241,666.b7. 392252-1 11. The Fee Agreements provide that all litigation expenses be deducted from the attorney's fee. See expense breakdown attached hereto as Exhibit "F". 12. At the time of his death, Cabot Resuta was survived by his father, and his two minor children, Cameron Resuta and Noah Resuta. 13. Petitioner has asserted both a wrongful death and a survival. claim in this matter. Petitioner requests allocation of the net proceeds of the settlement, after payment of the attorney's fees, pursuant to the written approval from the Pennsylvania Department of Revenue, a true and correct copy o.f which is attached hereto as Exhibit "G", as follows: (a.) For the survival action, twenty percent of the net settlement proceeds to the Estate of Cabot Resuta, Deceased. (b.) For the wrongful death action, eighty percent of the net settlement proceeds to the Petitioner on behalf of minor children Cameron Resuta and Noah Resuta to be placed in a structured settlement account with The Conte~Browne Group, LLC, on behalf of Old Mutual Financial Network, as follows: (1) Cameron Resuta - See Exhibit "H." (2) Noah Resuta -See Exhibit "H." 14. At the time of the accident and his death, Cabot Resuta was employed in the food safety industry. A copy of the economic report is attached hereto as Exhibit "I." 15. Petitioner requests that the attorney's fees be deducted and. allocated on a pro rata basis with twenty percent, or $96,666.67, allocated to the survival action claim and settlement, and eighty percent, or $386,666.66, allocated to the wrongful death claim and settlement. 392252-1 16. The minor children have lost the society, contribution, care, comfort, and companionship of their father. Therefore, entitling them to recover damages under the wrongful death claim. 17. Petitioner wishes to accept the settlement offers totaling $725,000.00 in a structured settlement, as set forth in the proposals attached hereto as Exhibit "J." Also attached are the proposed structured settlement agreement and release. WHEREFORE, Petitioner respectfully requests this Honorable Court to enter an Order approving the compromise and settlement in accordance with the preceding paragraphs; approving the proposed allocation; and authorizing the Petitioner to execute any necessary releases. Respectfully submitted: METZGER, WICKS AM, KNAUSS & ERB, P.C. By: _ Fri cis J. icf rty, IV, Esquire Attorney I.D. No.84099 3211 North Front Street P.O. Box 5300 Harrisburg, PA 1 7 1 1 0-03 00 (717)238-8187 Date: ~ ~,0~ ~, Attorney for Petitioner ~' D 392252-1 VERIFICATION The undersigned hereby certifies that he is the attorney for Petitioner and that the facts in the foregoing Petition are true and correct to the best of his knowledge; information and belief, and that said matters relating to the Petition are as known to the undersigned as to the clients, said knowledge being based upon information contained in the attorney's file in this matter, and further states that false statemerits herein are made subject to the penalties of 18 Pa. C.S.A. §4904 relating to unsworn falsification to authorities. v Francis J. L ferty, N, Esquire Dated: ~ l ~6 u0 1 IN RE: . PETITION FOR APPROVAL OF . DISTRIBUTION OF SETTLEMENT PROCEEDS BROUGHT BY ROBERT JOHN RESUTA, ADMINISTRATOR OF THE ESTATE OF CABOT RESUTA, DECEASED : on behalf of minor children NOAH RESUTA and CAMERON RESUTA IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION CIVIL ACTION -LAW NO. 2005-01078 CERTIFICATE OF SERVICE I, Melanie L. Kirk, of the law firm of Metzger, Wickersham, Knauss & Erb, P.C., hereby certify that I served a true and correct copy of the PETITION to counsel for Defendant by first class mail, postage prepaid, this ~~~ day of 1~ ~ , 2008, on the following: Laura Kelly c/o Donald M. Desseyn, Esquire 4999 Louise Drive, Suite 103 Mechanicsburg, Pa 17055 METZGER, WICKERSHAM, KNAUSS & ERB, P.C. ~: / ~ , Mel ie L. Kir 392252-1 McNees Wallace & Nurick Ltc David E. Gruver, Pa. C.P. Paralegal Direct Dial: 717.237.5362 Direct Fax: 717.260.1658 dgruver@mwn.com March 8, 2011 Cumberland County Register of Wills 1 Courthouse Square Carlisle, PA 17013 VIA CERTIFIED MAIL RE: Estate of Cabot L. Resuta File No.: 21-05-1078 Supplemental Inheritance Tax Return Dear Sir or Madam: Enclosed for filing are the following items for the above-mentioned Estate: Supplemental Inheritance Tax Returns (two originals); Tax check in the amount of $1,941.83; and Check for filing fee in the amount of $15.00. Please date-stamp our file copy and return it to me in the envelope provided. If you have any questions or need additional information, please contact me. Thank you. Ve tru our David E. r, Pa. .P, Paralegal ~ _o ~~'~c~ ~, Enclosures -- ~r c: Robert John Resuta -'t ~ c ~ ;c~~~ -, -- zi -~ www.mwn.com _~. _ r, ' =~ .... ,; ~ , ~.> _ ,=` `r ~'~ O HARRISBURG, PA • LANCASTER, PA • STATE COLLEGE, PA • I'IAZLETON, PA • UOLUMBU$, ~H • WASHINGTON, DC