HomeMy WebLinkAbout07-05-11 (2)1,50561,01,40
REV-1500 EX (01-10)
OFFICIAL USE ONLY
PA Department of Revenue -
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisbur , PA 17128-0601 RESIDENT DECEDENT 2 1, 0 9 0 ], 6 9
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2 0 2 2 0 1, 2 9 6 1, 1, 3 0 2 0 0 7 0 8 1, 9 1, 9 2 9
Decedent's Last Name Suffix Decedent's First Name MI
T A Y L O R J O A N V
(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 W11fH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
a 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 Ta:x Return Required
death after 12-12-82)
OX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 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 antler Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O;I
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SIiOULD BE DIRECTED TO:
Name Daytime Telephone Number
B E N J A ~1 I N J B U T L E R 7 1, 7 Z 3 6 1, 4 8 5
First line of address
5 0 0 N T H I R D S T R E E T
Second line of address
P O B O X ], 0 0 4
City or Post Office State
H A R R I S B U R G P A
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REGISTER O~IVILLS USE OILY ~
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ZIP Code ___ D~ I-ICED ~,,,,._~
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1, 7 1, 0 8
Correspondent's a-mail address: LAWYERS~BUTLERLAWFIRM.COM
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of rr~y Knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on afl information of which preparer has ;any knowledge.
SIGNATURE OF PERSON RESPO SIBLE FOR ICING RETURN D TE- iy
ADDRESS -
64 EAST LANE S~1ITHFIELD f1E 04978
SIGNATUR F P P ER ER H N ATIVE DA - ~ ~
,, ,'Z ~_
ADDRESS -
500 N THIRD STREET, PO BOX 1,0.04 HARRISBURG PA 1,'718
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1,50561,01,4CI
1505610240
REV-1500 EX
decedent's Name: J O A N V T A Y L O R
Decedent's Social ~~ecurity Number
2 0 2 2 a ].. 2 9 6
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 and Notes Receivable (Schedule D) .......................... 4. •
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 4 0 '~ 0 0 . 0 0
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 through 7) ........................... 8. 4 0 IJ 0 0 0 0
9. Funeral Expenses and Administrative Costs (Schedule H) ........... ....... 9. 2 4 ~~ 6 5 . 9 4
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ...... ....... 10. 7 2 c~ 9 4 2 2
11. Total Deductions (total Lines 9 and 10) ........................ ....... 11. 9 ~ ~~ 6 0 . ~, 6
12. Net Value of Estate (Line 8 minus Line 11) ..................... ....... 12. - 5 7 ~) 6 0 . I, 6
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. - 5 7 ~~ 6 0 . I, 6
TAX CALCULATION -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 0 0 ~ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 ~ 0 0 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
1,505610240 150561,0240
o. 0 0
0. 0 0
0. 0 0
0. 0 0
0. 0 0
J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 09 0169
DECEDENT'S NAME -
.IOAN V. TAYLOR
--- --
STREET ADDRESS
442 Walnut Bottom Road
_ --
_ _ ---
-- --
CITY ,STATE ' ?IP
Carlisle PA 17013
Tax Payments and Credits:
~~ 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 oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Total Credits (A + B) (2)
(3)
(4)
(5)
Make check payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : ...................................................................... ^ Q
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X^
c. retain a reversionary interest; or ................................................................................................ ^
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ ^X
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? ......... ^ ^X
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 FART 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)J.
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.
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC.
IN RES DENTEDECEDENTRN PERSONAL PROPERTY _
ESTATE OF FILE NUMBER
JOAN V. TAYLOR 21 09 0169 _
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. Michelle Coxen Glover, Administratrix of the Estate of Joan Taylor, Deceased, Plaintiff v. United 40,000.00
Church of Cluist Homes, Inc., d/b/a Thornwald Home, Defendant (50% allocated to survival
action) -See attached
TOTAL (Also enter on line 5, Recapitulation) I $ 40,000.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
.LOAN V. TAYLOR 21 09 0169
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ronan Funeral Home 4,325.98
B
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s) Michelle Cohen Glover
Street Address 64 Eastwood Lane
2
3
City Smithfield State ME ZIP 04978
Year(sl Commission Paid: 2011
Attorney Fees: Butler Law Firm
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
4
5
6
7.
8.
9.
10
12
City State ZIP
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
Kelly, Parker & Cohen, LLP -Litigation Expenses (50% allocated to survival action)
Kelly, Parker & Cohen, LLP -Legal Fees (50% allocated to survival action)
Kelly, Parker & Cohen, LLP -Medicare Lien
Cumberland Law Journal -Estate Advertising
The Sentinel -Estate Advertising
Cumberland County Register of Wills -Filing Fees
2,000.00
2,650.00
70.()0
1,463.38
13,333.33
598.85
75.00
219.40
30.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 24,765.94
If more space is needed, use additional sheets of paper of the same size.
RSV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
JOAN V. TAYLOR 21 09 0169
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM \/ALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Commonwealtl~~ of Pennsylvania/Department of Public Welfare -Class 3 Claim (20 Pa. C.S.A. 3392(3)) 23,03397
2. Commonwealth of Pennsylvania/Department of Public Welfare -Class 5.1 Claim (20 F'a. C.S.A. 3392(5.1))
TOTAL (Also enter on Line 10, Recapitulation) I $
If more space is needed, insert additional sheets of the same size.
49,260.25
72,294.22
REV-1513 EX+ (01-10)
pennsylvania ~ SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
.T(~AN V TAYT.(~R ~~ nn ni~n
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. Insolvent Estate Lineal
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
I.I. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $~
~~ iiiuiC sNace is neeueu, use aaaiuonai sneers or paper or the same size.
..~,
OF
JOAN V. TAYLOR
BE IT REMEMBERED, that I, JOAN V. TAYLOR, of 1112
Columbus Avenue, Apt. #1, Lemoyne, Cumberland County,
Pennsylvania, being of sound mind, memory and understanding,
do make, publish and declare this as and for my Last Will and
Testament, hereby revoking and making null and void any and
all Wills and Testaments and writings in the nature thereof
by me at any time heretofore made.
ITEM 1; I direct that all my just debts and funeral
expenses be paid as soon after my demise as may be
convenient.
ITEM 2: I give the sum of Two Thousand Dollars
($2,000.00) to RUTZ'S UNITED METHODIST CHURCH, Claremont
Road, Drytown, PA 17613.
ITEM 3L All the rest, residue and remainder of my
estate, of whatsoever nature and wheresoever situate, whether
it be real, personal or mixed, including property over which
I have a power of appointment, I give, devise and bequeath
unto my two children, MICHELLE D. COXEN-GLOVER and JOHN C.
BROWN, in equal shares, per stirpes.
ITEM 4: I direct my hereinafter named Personal
Representative to sell at either public or private sale, all ~
of my personal property and add it to the residue of my
estate,
ITEM 5: I direct my hereinafter named Personal
Representative to pay all inheritance, estate, succession and
legacy taxes of whatsoever nature and kind, to which my
WITN.ES S : /,
~~~-Giy. Yl•1. ~ .~~ .~~ l' •~' ~~~ ( SEAL)
~ JOAN V. TAYLOR
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estate or the transfer of any property passing hereunder or
otherwise passing by reason of my demise, may be subject and
to charge such taxes against my residuary estate, it being my
intention that none of the aforesaid taxes., either federal or
state, on any property required to be included in my gross
estate, under the provisions of any state or federal law now
in force or hereafter enacted, shall be prorated among the
persons interested in my estate to whom such property is or
may be transferred or to whom any benefit accrues.
ITEM 6: I appoint my daughter, MICHELLE D. COXEN-
GLOVER, as Executrix of this my Last Will and Testament.
Should my daughter predecease me, fail to qualify, cease to
act or renounce probate, I then appoint my son, JOHN C.
BROWN, as alternate Executor of this my Last Will -and
Testament.
ITEM 7: I direct that my Executrix or her successor
shall not be required to give bond for the faithful
performance of their duties in any jurisdiction.
I,Nr WITNESS WHEREO\`F, I have hereunto set my hand and seal
this /~~ th day of ~1~" ^~l •rz~ ,d •~( 1.? ~ , 1998 .
WITNESS:
c.., ,~ . , L__ ? _..t' ~,~ ~i.~~ ~% / ,~Gi.-(~~~G-•'/ ( SEAL )
JOAN V . TAYL012~
,%~
-2-
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF YORK
We, JOAN V. TAYLOR, JAN M. ALLEY, ESQUIRE and JANICE
E. YOCUM, the Testatrix and the witnesses respectively,
whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to
the undersigned authority that the Testatrix signed and
executed the instrument as her Last Will and Testament
and that she had signed willingly (or willingly directed
another to sign for her), and that she executed it as her
free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the
presence and hearing of the Testatrix, signed this Last
Wii1 and Testament as witness anti that to the best of
their knowledge the Testatrix was at the time eighteen
(18) years of age or older, of sound mind and under no
constraint or undue influence. ~
~TOAN\V . TAYLOR
.1
WITNFy~SS 1
,~+~ /~^'
/W TNESS
Sworn to and s~.ibscribed
before me this /(,t ~~f day of
~e .`-
~..~ ~ .,n ~ 1 It ~:~ fr`~. f :C:'S ~
NOTARY PUBLIC
MY COMMISSION EXPIRES:
Notarial Seal
g, pawn Gtadtelter, Notary Public
Dillsburgg Boro, York County
Nyy t;pmmisslon Expires May 17, 2001
Memher, Pennsyivanta Association o1 Notaries
i
I~~~IICHELLE CUX_EI~ GLOVER; TN THE C~JURT OF COMI~~I ~)I~? PLEAS
AdITllnlStratrl3> of the Estate of CU1vIBERL,~~I~TD COUNTY,
Joan Taylor, Deceased, PEI~TI~'SYLV ANIA
Plaintiff
CIVIL ACTION - L~,W
v.
UNITED CHURCH OF CHRIST IIOI~~IES 110. U9-6741 Civil Term
LTC.. d~ b/a THORN~~ALD HOI~LE
Defendant NRY TRI.~:.L DEh~,d~DED
ORDER
~L~D NO~~,~, this (3~" day of ,1 .2011., upon :.•onsideratior. of the
attached Petition for Approval of Settlement of wrongful death and s~arvi~~al action.:
It is URDERED that settlement of the above-captioned action for the gross sum of
$80,C~OU is approved, to be allocated fifty percent to the wrongful death action and fifty percent
to the survival action.
It is also ORDERED that the settlezrient proceeds sriall be distributed as follows:
~._,.. .
TOTAL RECEIPTS: ~ $80,000
SURVIVAL ACTIN Sn40.400
to Kelly, P arl:er ,T Cohen LLP ;~ 14,7 96.71
fifty percent of co~,insel fees ($13,333.33)
fifty percent of costs expended ($1,463.38)
to Estate of Joan Taylor, $24,604.44
to Kelly; Parker & Cohen LLP escrow account $598.85
(to pay Medicare lien)
l T I
~ RO1~ GFL L DEATH ~40,OC 0
to Kelly, Parlter ~ Cohen LLP X14,796.71
' fifty percent of course] fees ($13,333.33)
-,
l
~~ .
fifty pexcent of costs e~~pended (5;1,463.38)
to l~~~chelle Cohen-Glover ~1;7 2,01.65
to John C. Brown ;3~12,601.b4
IT IS FUI'..THER ORDERED upon receipt of the Survival Action proceeds, the persona]
representative of the Estate of Joan Taylor steal] promptly file a supplemental irlventor~~ and
inheritance ta>: ret~arrl v,Titl1 the Register of Wills of Cumberland County.
I BY THE COURT.
i
' s _
J.
TRUE COPY FRgidl R~CDRD
in Testimony whereof, I :here uni~ se4 my hand
and the seal of said Court gat ~:arlislp., Pa
~' . , Prcrt:~9notary
~~
DISTRIBUTIOT~T: ~ ~ , ~~- ; -
Craig A. Stone, Esquire, and IVlichael C, IVlongiello, Esquire; Marshall, DPr~.nehe~~, ~~Tarner,
Coleman & Goggle, X200 Cn~ms Tvlill Road, Suite B, Harrisburg, PA 171.12 ~ ~.
~. ,
Lee S. Cohen; Esquire, Kelly, Parlcer & Cohen LLP, 542 Jonestov~Tn Road, Suite: 103,
Harrisburg, PA 17112
2
Lee S. Cohen
PA ID No. 89278
Anthony W. Parker
PA ID No. 81251
KELLY, PARKER ~. CO1~EN LLP
5425 Jonestown Road, Suite 103
Harrisburg, PA 171 l2
717-920-2220
FAX 717-920-2370
lscohennkpc-]aw.com
aparkernkpc-]aw.com
MICHELLE COXEN GLOVER,
Administratrix of the Estate of
Joan Taylor, Deceased,
Plaintiff
v.
UNITED CHURCH OF CHRIST HOMES
INC., d/b/a THORNWALD HOME
Defendant
r
~'u ~ ~ ~~~~~ ~ ~ lo~ ~~~
~:~#~~~~~R~~i~~D C~ ~ ~ ,~,
IN THE COURT OF COMMO'~1 PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
CIVIL ACTION -LAW
No. 09-6741 Civil Term
JURY TRIAL DEMANDED
PETITION FOR APPROVAL OF SETTLEMENT AND DISTRIBUTION OF FUNDS
Plaintiff Michelle Coxen Glover, Administratrix of the Estate of Joan Taylor, deceased,
by and through her counsel, Kelly, Parker & Cohen LLP, hereby petitions this Court for approval
of the settlement for wrongful death and survival action, pursuant to Pa. R.C.P. 2206, and avers
in support thereof as follows:
1. Plaintiff Michelle Coxen Glover is an adult individual who resides at 64
Eastwood Lane, Smithfield, Maine 04978.
2. Plaintiff was appointed Administratrix of the Estate of Joan Taylor, deceased, on
March 16, 2009, by the Register of Wills of Cumberland County. See Appendix A.
3. The names and addresses of all persons entitled by law to recover damages for
Joan Taylor's wrongful death and the relationship to the decedent are as follows:
a. Michelle Coxen Glover, Plaintiff herein, who resides at 64 .Eastwood
Lane, Smithfield, Maine 04978, and was the natural born daughter of the decedent.
b. John C. Brown, 1475 Baechtel Road, Apt. M4, Willits, California 95490,
and was the natural born son of the decedent.
4. Joan Taylor was born on August 19, 1929 and died on November 30, 2007, at the
age of 78.
5. The decedent had multiple medical problems, including Type II diabetes,
mellitus, anemia, right leg below knee amputation, edema, urinary tract infections, unstable
blood sugars and pressure, gastrointestinal bleed, renal failure, decreased continencf; a.nd
function, sepsis, osteoporosis, defibrination syndrome, atrialfibulation, hypertension, peripheral
vascular disease, renal insufficiency, amputation of the left third toe, and had resided at United
Church of Cluist Holnes, Inc., t/d/b/a Thornwald Home, in Carlisle, Pennsylvania, from
August 14, 2002, through the date of her death.
6. On November 6, 2007, Joan Taylor fell, resulting in a left tibia and fibula fracture.
After the tibia and fibula fractures, the records show progressive decline in decedent, until she
ultimately died on November 30, 2007, survived by her daughter and son.
7. This is a nursing home malpractice and wrongful death lawsuit initiated by
Michelle Coxen Glover, Adininistratrix of the Estate of Joan Taylor, Deceased, against United
Church of Christ Homes, Inc., t/d/b/a Thornwald Home, alleging negligent nursing home
treatment which allegedly resulted in the wrongful death of Joan Taylor on Noveml'ber 30, 2007.
8. After an initial investigation and consultations with necessary and appropriate
medical experts, the undersigned counsel commenced this action by way of a Writ of Summons
filed on October 8, 2009, in the Cumberland County Court of Common Pleas, Pennsylvania,
Docket No. 09-6741, against the aforementioned Defendant.
2
9. Thereafter, on March 22, 2010, Plaintiff filed her Complaint alleging, inte~• alia,
that Joan Taylor's death was premature and preventable, directly and proximately resulting from
the left tibia and fibula fractures caused by the negligence of Defendant.
10. Plaintiff's Complaint includes separate counts for survival and wrongful death,
including claims for lost services, counsel, affection, guidance, etc.
11. On April 8, 2010, Defendant filed Preliminary Objections to Plaintiff :~
Complaint. As a result, on April 27, 2010, Plaintiff filed an Amended Complaint. Thereafter, on
May 25, 2010; Defendant filed Preliminary Objections to Plaintiff's Amended Complaint. The
Preliminary Objections were briefed and argued by both parties. Thereafter, by Order dated
November 4, 2010, the Honorable Albert H. Masland overruled Defendant's Preliminary
Objections.
12. In the meantime, the parties exchanged discovery requests. Plaintif~c had
completely and fully responded to all discovery requests propounded upon her by Defendant.
13. On August 25, 2010, Defendant served upon Plaintiff's counsel a 30-clay notice of
intention to enter judgment of non p~~os on professional liability claims pursuant to Pa.R.C.P.
1042.6. As a result, on September 20, 2010, Plaintiff filed a Motion for Determination by the
Court as to the Necessity of Filing an Additional Certificate of Merit. After discussion of
applicable law between counsel, the matter was resolved.
14. After the pleadings were closed, and during the discovery process, t:he: parties
reached an agreement whereby the Plaintiff would settle all claims in exchange for a total
payment of $80,000. The parties agreed on a settlement agreement, attached as Appendix B.
15. Plaintiff and undersigned counsel agree that the settlement is fair and reasonable
under the circumstances and seek formal approval of the negotiated settlement. Plaintiff
3
understands the terms of the settlement, agrees it is in the best interests of the Plaintiff and the
Estate, and freely and voluntarily accepts the same.
16. Litigation expenses were incurred in the amount of $2,926.75. Itemization of
these expenses is attached to the Court's copy to protect attorney work product and confidential
information as Appendix C. The law firm of Kelly, Parker & Cohen LLP has paid these costs in
their entirety and Plaintiff approved these expenses in their entirety.
17. Pursuant to the contract for legal services with undersigned counsel, Plaintiff
requests that attorney's fees in the amount of $26,666, representing 33'/3% of the gross
settlement, be paid to undersigned counsel. A copy of the contract for legal services i.s attached
to the Court's copy only to protect attorney work product and confidential information as
Appendix D.
18. After attorney's fees and expenses, the net sum of proceeds remaining is
$50,407.25. The federal government has a lien in the amount of $598.85. See Appendix E. It is,
therefore, requested that the law firm of Kelly, Parker & Cohen LLP hold $598.85 in escrow and
provide Medicare, within 10 business days, with a copy of the Court's Order and the Settlement
Agreement. Kelly, Parker & Cohen LLP shall pay Medicare the $598.85 lien amount upon
authorization from Medicare to do the same.
19. The Department of Public Welfare has no medical/cash assistance li.eri against the
settlement proceeds. See Appendix F.
20. The Department of Revenue has approved a 50/50 allocation with fifty (50%)
percent of the net sum in proceeds allocated to the wrongful death action and fifty (S~0%) percent
of the net settlement proceeds allocation to the survival action. A letter from the Department of
Revenue approving said allocations is attached as Appendix G.
4
21. While the Department of Public Welfare has no medical/cash assistance lien
against the settlement proceeds, it does have a lien in the amount of $72,294.22 against the
Estate. See Appendix H. The Estate will be administered, the lien paid and inheritance tax
return filed by the Estate attorney after the Estate's receipt of the net settlement proceeds.
22. In accordance with Pennsylvania Rule of Civil Procedure 2205, Mr. Brown was
notified of the settlement by registered mail and first class mail on January 18, 2011. and by first
class mail on March 17, 2010. Mr. Brown contacted undersigned counsel in response to the
correspondence and requested that his share of the settlement proceeds be sent to the address set
forth in Paragraph. 3 above.
23. Based upon the foregoing, Plaintiff respectfully requests of this Honorable Court
that the settlement monies of $80,000 be distributed as follows:
SURVIVAL ACTION
to Kelly, Parker & Cohen LLP
x,40,000
$14,796.71
fifty percent of counsel fees ($13;333.33)
fifty percent of costs expended ($1,463.38)
to Estate of Joan Taylor, ~>24,604.44
to Kelly, Parker & Cohen LLP escrow account ~>598.85
(to pay Medicare lien)
WRONGFUL DEATH
to Kelly, Parker & Cohen LLP
~~40,000
$14,796.71
fifty percent of counsel fees ($13,333.33)
fifty percent of costs expended ($1,463.3 8 )
to Michelle Coxen-Glover $ ].2,601.65
5
to John C. Brown
$12,601.64
24. Plaintiff Michelle Coxen Glover approves and consents to this Petition in all
aspects, and the distributions contained herein in all respects, including attorney's fees and costs,
as evidenced by the attached Verification and Consent of Michelle Coxen Glover, attached as
Appendix I.
WHEREFORE, Plaintiff Michelle Coxen Glover, Administratrix of the Estate of Joan
Taylor, deceased, respectfully requests that this Honorable Court issued an Order approving the
settlement and distribution in accordance with the terms of the foregoing Petition and attached
Order.
Respectfully submitted,
Lee S. Cohen
PA ID No. 89278
Anthony W. Parker
PA ID No. 81251
KELLY, PARKER & COHEN LLP
5425 Jonestown Road, Suite 103
Harrisburg, PA 17112
717-920-2220
FAX 717-920-2370
lcohenna,kpc-law. coin
auarkernkpc-law. corn
Dated: April 8, 2011
Counsel for Plaintiff
6
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DEPARTMENT OF REVENUE --
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March 9, 2011 ,
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Lee S. Cohen, Esquire ; "~-~ ~ ~ ~._..,, ;
Kelly, Parker, & Cohen, LLP ' . ~ ~~~~~°~-~-----a
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5425 Jonestown Road, Suite 103 ; :_ ~;~ '
Harrisburg, PA 17112
Re: Estate of Joan V. Taylor
File Number 2109-0169
Court of Common Pleas Cumberland County
Dear Mr. Cohen:
The Department of Revenue has received the Petition for Approval of Settlement Cl;airn to be
filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action.. It has
been forwarded to this Bureau for the Commonwealth's approval of the allocation of the proce~°ds paid to
settle the actions.
Pursuant to the Petition, the 78 year old decedent died as a result of negligence. Dec;ed:ent is
survived by her two adult children.
Please be advised that, based upon these facts and for inheritance tax purposes only, this
Department has no objection to the proposed allocation of the gross proceeds of this action, $40,000.00 to
'~ the wrongful death claim and $ 40,000.00 to the survival claim. Proceeds of a survival action are an asset
included in the decedent's estate and are subject to the imposition of Pennsylvania inheritance tax. 42
Pa.C.S.A. §8302; 72 P.S. §9106, 9107. Costs~and fees must be deducted in the same percenl:ages as the
~ proceeds are allocated. In re Estate of Merriman, 669 A.2d 1059 (Pa. Cmwlth. 1995).
I trust that this letter is a sufficient representation of the Department's position on this :matter. As
the Department has no objections to the Petition, an attorney from the Department of Revenue will not be
attending any hearing regarding it. Please contact me if you or the Court has any questions or r. equines
anything additional from this Bureau.
Sin rely,
~~J
neon E. Baker
Trust Valuation Specialist
Inheritance Tax Division
Bureau of Individual Taxes ~ PO Box 280601 ~ Harrisburg, PA 17128' ~ 717.783.5824 ~ sFiabaker(~si_a~te.pa..usw~ _.~.,
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