HomeMy WebLinkAbout11-30-11__ __ _ _
1505610105
REV-1500 EX (oz-11) (FI)
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania Coun Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN -
PO BOX 280601
Harrtsburg, PA 1'7128-0601 RESIDENT DECEDENT +~ I I I 051
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
204-48-0752 ' 08/25/2009 ' 03/12/1967
Decedent's Last Name Suffix Decedent's First Name MI
_.. _ __
i Daly Joanne W
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix. Spouse's First Name MI
__ J
Daly Daniel
_ __ __ ..
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death
t3D 4. Limited Estate
O 6. Decedent Died Testate
(Attach Copy of Will)
~ 9. Litigation Proceeds Received
O 4a. Future Interest Compromise (date of
death after 12-12-82)
O 7. Decedent Maintained a Living Trust
(Attach Copy of Trust.)
O 10. Spousal Poverty Credit (Date of Death
Between 12-31-91 and 1-1-95)
Prior to 12-13-82)
O 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
O 11. Election to Tax under Sec. 9113(A)
(Attach Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
__
,Michael A. Scherer, Esq (717) 249-6873
First Line of Address
Baric Scherer LLC
Second Line of Address
19 West South Street
City or Post Office
Carlisle
State ZIP Code
PA ',17013
REGISTER OF 1~Hhl.S USE ONLY`, '
==.~~ -.
---,
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~~ -
DATE f,+¢EDI
Correspondent's a-mall address: mscherer@baricscherer.com
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 the personal representative is based on all information of which preparer has any knowledge.
SIGNATUR~ ~~,$ON RE~p BLE FOR FILING RETURN nw-rc:
ADDRESS ~
15 Sandy Bottom Road, Carlisle, PA 17015
SIGNATU PR£F~4FjIER OTNER THAN REPRESENTATIVE „~Tc
i / Y Y~ ~ I/! / /L_/ 1 I ~ 2-~ I I1
ADDRESS
19 West South Street, Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105 J
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1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: Joanne W. Daly 204-48-0752
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. 6,840.81 ',
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested...... .. 7. ',
8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 6,840.81
9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9.
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10.
11. Total Deductions (total Lines 9 and 10) ............................... .. 11.
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12.
13. Charitable and Governmental BequestslSec 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.
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
_ .._..
trans ers un er ec. 9116 _ .
36,840.81
(a)(1.2) X .0_
15.
16. _. _... ___,. ~-~_..._..__ _. ..___...-~ _,_ ........... . .
Amount of Line 14 taxable v ,~.,_, -
at lineal rate X .0 45 6,840.81: 16.
17. Amount of Line 14 taxable
at sibling rate X .12 ', 17,
18. T , . ~._._~_ ~._~..~,. ,.
Amount of Line 14 taxable ....a,......
at collateral rate X .15 ',
___ 1 g,
19. TAX OUE ....................................................... ..19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610205 1505610205
0.00
307.84
307.84
O
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
File Number
DECEDENT'S NAME
Joanne W. Daly
STREET ADDRESS
15 Sandy Bottom Road
CITY
Carlisle STATE 21P
PA 17015
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments _
B. Discount
(1)
307.84
Total Credits (A + B) (2)
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3)
Fill in oval on Page 2, Line 20 to request a refund. (q)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 307.84
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: Yes No
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 ........................................................................................................................ ...... ^
d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........................................................................................................ ...... ^
3. Did decedent own an "intrust 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 ~; - rs 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(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-i5o8 EX+ (u-io)
pennsylvania
DEPARTMENT pF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS & MISC.
PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Joanne W. Daly 21-11-0751
Include the proceeds of litigation and the date the proceeds were received by the estate.
Ail property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Decedent's survival action pursuant to 42 Pa.C.S.A. Section 8302 in the gross amount of 6,840.41
$43,681.62. The intectacy provision of the P.E.F. Code provides at 20 Pa.C.S.A. Section 2102 (3)
that the share of the surviving spouse is the first $30,000.00 plus one-half of the remainder.
$43,681.62 - $30,000.00 = $13,681.62
$13,681.62 ! 2 = $6,840.81
The share of the surviving spouse is $36,840.81.
The share of the surviving children is $6,840.81.
TOTAL (Also enter on Line 5, Recapitulation) $ 6,840.81
If more space is needed, use additional sheets of paper of the same size.
REV-1513 EX+ (01-10)
Pennsylvania SCHEDULE ]
}
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Joanne W. Daly 21-•11-0751
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).]
i • Daniel J. Daly, 15 Sandy Bottom Road, Carlisle, PA 17015 husband s t a t u t o r y
share
2. Colin Daly, 15 Sandy Bottom Road, Carlisle, PA 17015 son s s ha r 2 o r y
3. Olivia Daly, 15 Sandy Bottom Road, Carlisle, PA 17015 daughter s s h a r e o r y
4. Ava Daly, 15 Sandy Bottom Road, Carlisle, PA 17015 daughter s s ha r eor y
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. #
If more space is needed, use additional sheets of paper of the same size.
IN RE: IN THE COURT OF COMMON PLEAS OF
Estate of Joanne W. Daly CUMBERLAND COUNTY, PENNSYLVANIA.
Deceased ORPHANS' COURT DIVISION
__
N0. 21-11-0751 =-~ ~ - --
,, - _
-- ~:, -
ORDER OF COURT - __~
i -, ~_;
AND NOW, this ~ day of L~ ~~. , 2011, upon consuferation.of : r;
-.>~_
- -=;
the Petition For Court Approval Of Settlement Pursuant To Pa.R.C.P. 2206, Petitioner
is hereby authorized to settle the civil action as set forth in the Petition with Erie
Insurance Company for $330,000.00. Eighty-five percent of the settlement shall be
allocated to the Wrongful Death action and fifteen percent of the settlement shall be
allocated to the Survival Action. It is further Ordered that payment shall be made as
follows:
Gregory Hazlett, Esquire: attorney's fees: $ 33,000.0()
Gregory Hazlett, Esquire: cost reimbursement $ 2,450.0()
Baric Scherer: attorney's fees $ 3,100.0()
Baric Scherer: Register of Wills fees $ 239.18
PA Department of Revenue (inheritance tax) $ 308.04
Daniel J. Daly $175,605.31
Colin Daly $ 38,432.4'9
Olivia Daly $ 38,432.4!
Ava Daly $ 38,432.49
t;~ Ju_~U1IL;ji_'~_
A TRUE COPY FROiN RECORD
!n Testimony wherof, i hereunto
set my hand and the nea!
of said Court at Carlisle, P!1
'..:~~ayofi~!
talc or the Orphara ~u+t
C~ ~~e~ct Cce+t~r
The funds of the minors shall be deposited into an interest bearing savings
account in each respective minors' name at a Federally insured bank, building and loan
association, savings and loan association or credit union. The minors accounts shall
be marked that "No withdrawal can be made from the account until such minor attains
majority except as authorized by a prior Order of Court."
BY THE COURT,
/
'
; ~ ; i
, ,
J-'.,~Wesley Oler Jr., J
1
Michael A. Scherer, Esquire
Baric Scherer LLC
19 West South Street
Carlisle, Pennsylvania 17013
Gregory S. Hazlett, Esquire
Law Offices of Gregory S. Hazlett
7 West Main Street
Mechanicsburg, Pennsylvania 17055
IN RE: IN THE COURT OF COMMON PLEAS OF
Estate of Joanne W. Daly, : CUMBERLAND COUNTY, PENNSYLVANIA
Deceased ORPHANS' COURT DIVISION ~ =_ ~~-~
.-_ -
NO. 21-11-0751 ~,"~ c> ~--~
- ,
_ _~ ;-; .
<. -~,
PETITION FOR COURT APPROVAL ; ~:~=; - -
OF SETTLEMENT PURSUANT TO PA.R.C.P. 2206 ~'`~ __ ~ w
-~ --,
.r,,
AND NOW, comes Michael A. Scherer, Esquire, attorney for Daniel J. Daly,
Administrator of the Estate of Joanne W. Daly, deceased, and respectfully represents
as follows:
1. The Petitioner is Daniel J. Daly (hereinafter "Petitioner"), an adult
individual who resides at 15 Sandy Bottom Road, Carlisle, Cumberland County,
Pennsylvania 17015.
2. The decedent is Joanne W. Daly, who died on August 25, 2009.
3. Petitioner is the surviving spouse of decedent.
4. Petitioner was appointed administrator of decedent's estate by virtue of
letters issued by the Register of Wills of Cumberland County on July 8, 2011.
5. Decedent was born on March 12, 1967 and was 42 years of age at her
death.
6. Decedent had three minor children at the time of her death, all of whom
are children of the Petitioner, namely Colin Daly, born November 13, 1999, age 12,
Olivia Daly, born February 8, 2002, age 9 and Ava Daly, born March 8, 2005, age 6. All
three children live with the Petitioner at 15 Sandy Bottom Road, Carlisle, Cumberland
County, Pennsylvania 17015.
7. The decedent had no deceased children.
8. On August 25, 2009, decedent was driving on a property owned by
Theodore Shue and Donna Shue on Church Lane in Dickinson Township, Cumberland
County, Pennsylvania, when a tree owned by the Shue's fell onto the decedent's
vehicle, resulting in the instant death of the decedent.
9. At the time of her death, the decedent was employed as a chemist with
Ahlstrom Filtration in Mount Holly Springs, Pennsylvania.
10. Petitioner employed the services of Gregory Hazlett, Esquire (hereinafter
"Hazlett"), of 7 West Main Street, Mechanicsburg, Pennsylvania to pursue a civil action
against the Shues on behalf of himself and his minor children. A copy of the contingent
fee agreement whereby Petitioner employed Hazlett is attached hereto as "Exhibit A."
11. The Shues were insured by a liability policy issued by Erie Insurance, and
Erie has offered to settle the wrongful death claim for the sum of $330,000.00 as set
forth in a letter from Erie to Hazlett dated May 16, 2011 which is attached hereto as
"Exhibit B."
12. Petitioner has agreed to accept Erie's offer to settle the case as set forth
in paragraph 11 above.
13. Petitioner proposes to allocate 85% of the settlement to the wrongful
death claim and 15% of the settlement to the survival action.
14. Hazlett has incurred certain expenses in his representation of Petitioner
as follows:
a. Cumberland County Coroner's Office (photographs): $450.00
b. T. Davis Sydnor & David Hucker (arborists): $2,000.00
15. Petitioner has employed Michael A. Scherer, Esquire to open and settle
the estate at the hourly rate of $200.00.
16. The wrongful death statute, 42 Pa.C.S.A, section 8301(b) provides that
the beneficiaries in a wrongful death action shall be the spouse, children or parents of
the decedent, and the damages are distributed to the beneficiaries in the proportion
they would take the personal estate of the decedent in the case of intestacy.
17. The Intestacy provision of the Probate Estates and Fiduciary Code which
awards the share to the surviving spouse provides at 20 Pa.C.S. section 2102(3) that
the surviving spouse shall receive the first $30,000 of the estate plus one-half of he
remainder.
18. The Intestacy provision of the Probate Estates and Fiduciary Code which
awards the share to the children of the decedent provides at 20 Pa.C.S. section
2103(1) that the issue take the remaining one-half the decedent's estate; and section
2104 of the PEF Code provides that the children shall receive equal shares of the
estate.
19. A survival action is statutorily mandated at 42 Pa.C.S.A 8302 and the
proceeds therefrom would be part of decedent's estate; given the intestacy the
proceeds of the survival action would be distributed according to the formula set forth
paragraphs 16. and 17. above.
20. The Department of Revenue, Inheritance Tax Division, has agreed to this
settlement as set forth in their letter dated September 13, 2011 which has been
attached as "Exhibit C."
21. No judge has been assigned to this case.
WHEREFORE, Petitioner respectfully requests that this Honorable Court
convene a hearing and approve the proposed settlement and authorize allocation of the
settlement proceeds as follows:
Gregory Hazlett, Esquire: attorney's fees: $ 33,000.00
Gregory Hazlett, Esquire: cost reimbursement $ 2,450.00
Baric Scherer: attorney's fees $ 3,100.00
Baric Scherer: Register of Wills fees $ 239.18
PA Department of Revenue (inheritance tax) $ 308.04
Daniel J. Daly $175,605.31
Colin Daly $ 38,432.49
Olivia Daly $ 38,432.49
Ava Daly $ 38,432.49
Respectfully submitted,
BARK SCHERER LLC
l~ ^ ~i ~;
Michael A. Scherer, Esquire
I.D. # 61974
19 West South Street
Carlisle, Pennsylvania 1.7013
(717) 249-6873
VERIFICATION
The statements in the foregoing Petition For Court Approval Of Settlement
Pursuant To Pa.R.C.P. 2206 are based upon information which has been assembled by
my attorney in this litigation. The language of the statements is not my own. I have
read the statements; and to the extent that they are based upon information which I
have given to my counsel, they are true and correct to the best of my knowledge,
information and belief. I understand that false statements herein are made subject to
the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsifications to authorities.
DATE:
Daniel J~JDaIy
Gregory 5 f~aafett, Esquire
"' ~~'~~t Wain SCrear
{echaniespurg, P:~ !'0~5
rh,„~ ~~i?~ ~~o-ss~~o
Fax: (° !' i ?90-9? 79
Fte. RE"<'A.INER A~RE~I~TF'iti'T/W-.2®N~F~~ ~EA~'i$
Dear Dan:
Thank you. for sclccting me as solo attamey phis letter describes nc~ basi> on which my obi;e will
provide Legal services to you and the compenati~~n for those services, If you concur with the
provisions of this fetter, this will he the agreemen~ that you have rEta.i~led me to represent you.
A'fl'~~~~i~,~''~ ~~i,LI~aT'T~N~+
I agree to perform Ie,al services for you and to keep you advised of the services performed on your
behalf. T cannot guar~tee the success of any given ven~.ur°, bui i w-if! sirive to represent your
interests professionally a.nd efficiently, I will have primary responsibility for your rcprescn:ation
and wili utilize other attorneys and legal assistants in the offi~Wc in t~'~c oest exercise of tny~
professional judgtnenr. it' at any time, vo~a hav~a any q~.,estions, concerns or criticism;, please
contact nee at once.
411. 1~ 1../~' V IJ~9~ R 11+N.f~
As ~er• our general discussion our• fee fnr• v~osrr• Percaoanl graia,sv ~COain~ is ~nseci an st
eontin¢encv„ fee of ten percent, (10°~~) of onv out of court scttlcrncnt and 3()% of aa~v
settlement procured as a result of liti~atiou resultirc~ in :t recvvery. Client wi]l oat be
responsi'ote to pay any attorneys f°es prior to thz settl~,n~nt of her case a.rtd ;hill owe attorneys
nothing if no recovery is received on behalf of the client or the client retains another attarne ~of h.;
choosing. All attorney; fees shall be paid only after settlement of the case. Clint shalT'~e
responsibly co pay, in addition to thz forcgoin; cantingency~ i'ee, and to dle exte,~t deem°d
nc:ecssnry, all out of pocket expenses prior to the utilization of such sei^~ices which shall include but
not by way of limitation: The procurement of medical records, inrorR~aUOn, statements, eos!s of
°xperts both medical or otherwise. deposition costs, co~_a-t coats, ~r. Aie~,.se he advised that rnos`
cases are settled nut of court ~u~d to this ext°nt ~her~ i~ no ot,t of pac'.{et expenses incurred by ha
client with thy exception of t.hc pi~curement ~,f ~.~,ed:cal records ur dcpusi!un fees.
"EXHIBIT A"
-- _~u
'Y'er_mi~tation of Scrvi~es
This agreement may be tern~inatad by either party for ally reason upon notice, preferably written.
Termination does not :effect the ab{igations and rights related to ;cr`ric°s perfornied up to the dais of
termination "I`herefore, client will not be billed for lhc: time investad.n his or har case should he or
she terminate this a~7reement Qi1d later retain another attorney.
CLdENT'S ~Bl.I~ATf~'1~iS
Client understands that he~she is under an obligation to be candid with the attorney and with the
court; and adhere to all applicable laws, mules attid regulations of the United States and of the
Commonwealth of 1?ennsylv~uiia. Cliznt further understands that it i.~ hip or her ohligatior, to report
all information of conscquenec to your personal injury in a timely and accurate manner.
~,H~gC~ ~'F LAVV"
This agreement ,hall oe interpreted under thz 1a~us oi'the Common~,~~ealth of hennsylvtulia
~R;E,C;<~ItY 5. H..aZL,IETT
~~~®~ney' 6c C~ua~se6®r ~T Law
Dated; DarWd; ~ a' ~ f ~ p
JUN-~-~'71 ~_' ' ~~ =~'~P"::aP,Ea HA?L=TT =SG1 ~ ~ T7rJ92T9 -~' ~^~57j~
,~ f=rie
~a:~ Insuranceb
3r.3rcn ~ff!ce aJC _)I.ISd ~r~~ti ~ ?o,er^oyr~? 3r:eiroe~ ..^.ontnr ?:~ a~x ~q' ~ ~,~ -
'-' , a" 32(,(i roll '.^,0 ! yU0 ~~52 ' '.C`~ mix ~„ 7~ ,.93"-, ~ntiv',v 3r+einv.~~anC ;orn
Mav ! 5. ?0 ; I
Gregory 5. I-l~letr, esq.
Seven West Main Sweet
14iechanicsburg, PA 1?p55
Re F.RIEi C"aii:i
ERIC InSurcd
l?ate o i.~:~s~.
CLuirian!
o ~
~<;-i^r I gilrht-y ~?GG :~fG
.~.~aial7r. ~~CP f : ~.71C9i1( ~' (1~pjmn ,~i,u,,,ur
;IC 1 .~ t 710773
i l~codor~ Shue
UHi' ?-`Uy
I ;r;;c o.' Eoanne Daley
Dear Nlr. 1-iazlatt:
By means of this correspondence:, w~ confirm ar rhr~ !rmc ;ita~ nc~ ;c(:.i~rr.c~~i l~i~s l:a~cn reached or the injury
claim relative to the Estate of 7oanne Daley in the ai~~oun! ro;a;~,ny ~tiJ3';~ '.~C~l- ':;i;r W~ had previously provided
a copy of our Dec!<Frltions as you requeste~i_
~,y'e enclose a Ganeral Rel_<<se which will reyurr~ ?:<~~ur~.:.-,,, .i~d ro(_u rra~ ~ ;:~ ~ rc :\clminis[ra[or of [Ile C,rat~
Additiot~al(y, rha settlement will require court appr~~~~a!.
IP you hav;, any questions, feel free to contac~: me
5 urce rr~ l v
~~
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C:'1lrllj ~~C1~'JtilJl-
Harrisburo 13r.u~.ci-~ Oi~f::;
-~r'(7-bOQ-~ ~ r;
1-QUO-~4)-Oci~l~ ;~a?t'~
~17:.:la
~tl~lQ$r~lr.'
Ganeral Release
"EXHIBIT B"
~o6r_ ~ ~ roc
r~A E;I~ , ai;~,;~ _- ~ -
_ _~r
For the consideration of Three Hundred Thirty "l`hous~tnd Du!lars (:~33U,OC{~ iii;t_,-ec~ipr o.' which is hereby acknowledged
f;'wa release at~d discharge, and for myselF~ourselves and (-or my~,7ur heir:,, r--:presenratives, executors, administrators,
successors and assigns. do hereby rctnise, rc[~ase old forever dischar,e "I'hecxiors ~ Shue and gonna 1. Shue hereinatt~r
referred to as the releasee(s), his/her/tl7eir/its heirs, executors, administrators, insurers, successors and assigns, and any and all
other persons, firms, :orporations, associations, of and from any and all c~uues of act ion, suits, rights, judgments, claims and
demands of whatsoever kind in !aw or in equity, known and unknown, which f 'we now have or may hereafter leave, especially
the claimed legal Iirtbility of releasee(s), arising from or ay reasor, of any ancf all bodil;r or L~ersona! injuries andior property
damage known acid unknown, foreseen and unforeseen which hcrereforc has;"have hc~un ur which hereafter may be sustained by
me/us arising out of the accident on or about Augusi 25, ?UU9. ar or n~ar Canis!., ~~ the County ul' Cumbarlaa~d, in the Scats
of Pennsylvanra, which liability reEeasee(s) expressly deny(ies~ V
UWc lgree that dle consideration set forth above i; specilicauy ai~f)IiCal)!e !u ind p~ud to me/us with respoct to any and all
damage co any property, either real or personal, of mite;'ours :u~d wiU~ r_spcct ~u any and all personal ar bodily injury or"
none/ours, whether presently known or uN~rtown, foreseen or uni~c~rcc.n ~.r ,NPuei'i :nay subsequently develop and the
consequences thereof, al! as arising out of the aforementioned uCC,Clcni
UWe further agree that fhe consideration set forth above is ;peel; ically appf:ct+blo ~ <;nd laid io me/us with respect co any righi
of contribution that i,'we may have against the releasee(s), his/liar their'irs heirs, e:~cec~aors, adntinistrators, insurers. successors
ante assigns relative to clams of others that may he brought against i~~,~e, .,s by r~~tso~~ ~,i~ S;iid acei<lenf.
UW'e further a~rcc that fhe consideration set forth above is spucii'_al(y appftcabio ~:o myour a;reernent that (/we will nor join
nor attempt to~otn the ralaasee{s), his/her their;its executors, adnrinistrators~ insurers. >uccessors and assigns in any capaciLv
in dry action that tray be brought against me/us arising our or said accirlenr
five warratlt for myself;ourselves and my!our heirs, represer.t~~tives, dxocutur~; ttdn~nisrrarors, successors and assigns that
Uwe have received no money or other valuable consideration from dry other person or persons by reason of any causes of
action, suits, Covenants, agreements, judgments, claims a;~d demands or wl~atsoevar kind, which I!we now have or may
hereafter have, Por injuries to my'our person or proporry or f'or tti-:: other matt;:rs i'ur which :i?is release is given.
l%w~ further understand altd agree that [his Release is inclusiv;; of any a;,d all prese~l~.:ird future liars or claims for subrogation
against Ltie payments to be made in accordance with this R~leasc, h'wc tuldcrsta;td iiild are rliar Ciwc are responsible for the
payment of any liens or charges against the payments to he made hcreund~r ;~~oulc'. any such liens, subrogation, claims or
claims for expenses and cha~•ges be asserted. 'his ir,cl~.;des, but is not imit~~~1 to medical expense liens, workers
cornpensution bens, ERiSA liens, liens asserted by any r';,dcral, state or local yoscrnmcncal e;airy or agency or any medico!
expense claim, Should any person or entity make claim for pay;rera of ury Lcr:S ~: ~L^1ro~s ag:~inst The ERIE or dealt counsel.
Ii we agree to indeinnif,,, and hold harmless The ERIE ancf their tout;sl tron•: any ,t;2d n;'. such liens, charges, fees, claims.
attorney fees, casts, interests and any other sum,
Irwe understand that this settlement is the compromise of a disputed claim, and ;hu: th4 payment is net to be construed as an
admission of liability on the ptirt of the Persons, Frmc and co;vorarions h~r~h~~ rclcas~~C by whom liability is expressly denied.
Intending to be legally bound thereby, Wf'('NESS ~nyrnur h.and(ai arty. ;~a(~~~ ~:hi> ~~~ day or
vOT'lCEc '';*-ny persaii who knowingly and with intent to defraud wiy nuur~nce cociir,unr or ~,lhcr tn:rson 1"~~ as applleution I'or insurance
or statanent ut' claim enntaitNng an~~ materin!!y false ittfl,rntaliurr ur curn:ealy for the purpose of misiwding, infurmution
concerning any fact etwtrriul thereto conmilts o fcuudulcru in~or:encu act, ~~~hich :5 a crime and subJects the person to criminal and
civil r,ennlties.''
WIT?VIrSS
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C1aim~~OtQI?10~4'3l
ltEL2 1.2'04
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3,~,1'
Initials: _
Pa,~e 1 of 1
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~; -~,- permsylvania
D~PARTwIE~VT OF R~V_iVU~
September 13, 201 l
titichael :-~. Scherer, Esquire
Baric Scherer, LLC
19 West South Street
Carlisle, PA 17013-3432
Re
Estate of Joanne W. Daly
File Number 2111-0751
Court of Common Pleas Cumberland County
Dear i~Ir. Scherer:
The Department of Revenue has received the Petition for Approval of Settlement Claim 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 proceeds paid to
settle the actions.
Pursuant to the Petition, the 42 year old decedent died as a result of a tree falling on her
automobile. Decedent is survived by her husband and three minor children.
Please be advised that, based upon these facts and for inheritance iax purposes only, this
Department has no objection to the proposed allocation of the net proceeds of this action, $24',529.30 to
the wrongful death claim and $43,681.62 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. 39106, 9107. Costs and fees must be deducted in the same percentages as the
proceeds are allocated. In re Estate of Merryman, 669 AZd 1059 (Pa. Cmwlth. 1995).
I trust that ra'Zis 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 requires
anything additional from this Bureau.
S,in1 ~re1v, /1
I i Ps„,
~Shantibn .Baker
Trust Valuation Specialist
Inheritance Tax Division
Bureau or Indio!dual Taxes ~ PO Box 280601 ~ Harrisburg, PA 1?128 ', ?17 ?83 ~82~ snabaker'a~pa.gov
"EXHIBIT C"
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
DALY DANIEL J
15 SANDY BOTTOM ROAD
CARLISLE, PA 17015
fold
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: ssN: 2o4-4s-o752
FILE NUMBER: 211 1-0751
DECEDENT NAME: DALY JOANNE W
DATE OF PAYMENT: 1 1 /30/201 1
POSTMARK DATE: 1 1 /30/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 08/25/2009
REV-1162 EX(11-96)
NO. CD 015272
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ 5308.04
TOTAL AMOUNT PAID:
REMARKS: RECEIPT TO ATTY
SEAL
CHECK# 1289105
INITIALS: DMB
RECEIVED BY:
5308.04
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS