HomeMy WebLinkAbout07-31-15 (3) � 1505610148
REV-1500 EX(01-10)
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes �NHERITANCE TAX RETURN 2 L ]�0 0 617
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Sociai Security Number Date of Death MMDDYYYY D8t2 Of Bifth MMDDYYYY
198- , 06092010 ],7,291,929
DecedenYs Last Name Suffix DecedenYs f=irst Name M I
MEREDITH CARL A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M I
MEREDITH LOURENE D
Spouse's Social Security Number THIS RETURN MUST BE F�LED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
� 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 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)
0 9. Litigation Proceeds Received ❑ 10. Spousai 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 TO:
Name Daytime Telephone Number
RICHARD C • SNELBAKER, ESQ 717-697-8528
REGISTER O�IIILLS USE ON�
�--•a �.
� O CJ^� �.,.
� C� �
First line of address � '� � Q
� �.,, f7 � Zl
44 WEST MAIN STREET ,; � � � �� � rn
. c-� _ .� -,-, �
Second line of address -
7 .� :;`) C�
e:, -� � � r�
� � :� � �
_., .._.
City or Post Office State ZIP Code [7AT�.F.I�ED `" �
f
_,� --i � f'i'!
MECHANICSBURG PA 17055 �=r !'-1'� � �
tn -*�
CorrespondenYs e-mail address: ___._.
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 w ich pr parer has any knowledge.
SIGNATl1RE OF PERSON R SPONS L F FILI RETURN .�,,,..�-�- ATE
' ,. . � -J'1•F�
ADDRESS Jody eler, Co—Executor te en . ere i , o— xecutor
108 East Earl�Street, Boiling Springs, PA 17007 1535 Ridge Road, Wellsville, PA 17365
SIG T RE OF PREPARER OTHER THAN REPRESENTATIVE DATE
�'�� �-�?-� �
ADDRESS
Keith 0. Brenneman, Esquire 44 WEST f1AIN STREET, MECHANICSBURG
rLEASE USE ORIGINAL FORM ONLY PA
Side 1
� 1505610148 gM46474000 1505610],48 � �
��
J 1505610248
REV-1500 EX
DecedenYs Social Security Number
198-22-8471
�eoede�t'S rvarne M E R E D I T H C A R L _ A
RECAPITULATION
1. Real Estate(Scheduie A) . . . • • • • • • � • • • • • • • • • • • • • � • • • • 1. � • ��
2. Stocks and Bonds(Scheduie B) . . . . . . . . . . . . . . . . . . . . . . . . . 2 � • 0�
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , . 3. � • �Q
4. Mortgages and Notes Receivabie(Scheduie D) , , , , , , , , , , , , , , , , , 4. � - ��
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , . 5. ],9 6,8 8 4 • 81
6. Jointly Owned Property(Schedule F) � Separate Billing Requested , . , , g. � • �0
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested . . . . 7. � • ��
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . g, ],9 6,8 8 4 - 81
9. Funeral Expenses and Administrative Costs(Schedule H), , , , , , , , , , , , , ,g. 1,8 3 0 • �0
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) , _ , . , , , , , �p. � • ��
11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 11. 1�8�� • ��
12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , 12. ],9 5�0 5 4 • 8],
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. 19 5,L15 4 • 81
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers un�{er Sec.9116
(a)(1.2)X.Ou � • �� 15. � � ��
16. Amount of Line 14 t xabie
at�inea�ratex.o4� 195,054 - 81, �s. 8�77? ' 47
17. Amount of Line 14 taxable
at sibling rate X.12 Q . 0 0 �7. � ' ��
18. Amount of Line 14 taxable
at collateral rate X.15 � - �0 18. � • ��
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 8���7 • 4 7
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT a
Side 2
� 150561�248 1505610248 �
9M4648 4.000
REV-1500 EX Page 3 File Number
DecedenYs Complete Address: 2], 10 0 61,7
DECEDENTS NAME
hIEREDITH �ARL __.—A_
STREET ADDRESS
��9 E OLD YORK ROAD, SOUTH MIDDLETON TOWNSHIP
CUf1BERLAND COUNTY —
CITY STATE ZIP
CARLISLE PA 1,7015-
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (�) 8�7 7 7 • 4 7
2. Credits/Payments
A. Prior Payments � • 0�
B. Discount 0 • ��
Total Credits(A+�3� (2) � - ��
3. Interest
(3) � - ��
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) 0 • ��
5. If Line 1 + Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. 15) 8���� • 4 7
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;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 within 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 decedenYs 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)J.A sibiing is defined,under
Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
9 M4671 2.000
REV-1508 EX+(6-98)
SCHEDULE E
COMMONWEAITH OF PENNSYLVANIA CASH, BANK DEPOSITS� 8c MISC.
INHERITANCE TAX RETURN pERSONAL PROPERTY I
RESIDEt�fT DECEDENT —_�1__
ESTATE OF FILE NUMBER
Carl A. Meredith _ 21 10 0617
InGude the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Proceeds from wrongful death action for professional
medical negligence (Docket #12-191-CIVIL) 196,880.04
(see attached copy of Petition for Court Approval and
Court approved order)
Interest accrued to 6/9/2010 4•��
TOTAL(Also enter on line 5,Reca��ituiation $ 196,884.81
3w4sn�i o00 (If more space is needed,insert additional sheets of the same size)
REV-1511 EXi�,0-09, SCHEDULE H
pennsylvania
DEPARTMEMOF REVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Carl A. Meredith _ _21 10 0617
DecedenYs debts must be reported on Schedule I.
ITEM
NUMEiER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) ____._
Street Address _.. _
City State ZIP________
Year(s)Commission Paid: ________
2. AttorneyFees: Snelbaker & Brenneman, P.C. (Estimated) 800.00
3. Family Exemption: (If decedent's address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP_ _
Relationship of Claimant to Decedent _____
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
1 Register of Wills
filing fee for supplemental Inheritance Tax Return
and Amended Inventory 30.00
Total from continuation schedules . . . . . . . . . 1,000.00
TOTAL(Also enter on Line 9,Recapitulation) $ 1,830.00
swasac z o0o If more space is needed, use additional sheets of paper of the same size.
Estate of: Carl A. Meredith 21 10 0617
Schedule H Pazt 7 (Page 2)
2 Reserve
for filing fees, accountant fees and other
miscellaneous costs associated with the
administration of the decedent's estate 1,000.00
Total (Carry forward to main schedule) 1,000.00
REV-1513EX+�o,-,o> SCHEDULE J
pennsylvania
DEPAF2TMENTOF REVENUE BENEFICIARIES
WHERITANCE TAX RETURN
RESIDENT UECEDENT
ESTATE OF: FILE NUMBER:
Carl A. Meredith ___.._ 21 10 0617 __
RELATIONSFiIP TO DECEDFNT AMOUNT OR SNARE
NUMBER NAME AND ADDRESS OF PERSON(S)RFCEIVING PROPL=RTY _ Do Not�ist Trustee(s) OF ESTATF_
� TAXA6LE DISTRIBUTIONS[Indude outright spousal distributions and transfers under
Sec.9116(a)(1.2).J
i Tonya L. Meredith Motter
408 Kerrsville Road
Carlisle, PA 17015
� , Daughter 48,763.70
2 Michael A. Meredith
521 Park Drive
Boiling Springs, PA 17007 Son 48,763.71
ENTER DOLIAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 1511-IROUGH 18 OF REV-1500 COVcR SHEET,AS APPROPRIATE.
�� NON-TAXABLEDISTRIBUTIONS
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 RFV-1500 CJVER SHEET. $ 0.00
If more space is needed,use additional sheets of paper of the same slze.
9W46AI 2.000
Estate of: Carl A. Meredith 21 10 0617
Schedule J Part 1 (Page 2)
Item
No. Description Relation Amount
3 Jody A. Wheeler
106 East Earl Street
Boiling Springs, PA 17007
Daughter 48,763.70
4 Steven M. Meredith
1535 Ridge Road
Wellsville, PA 17365
Son 48,763.70
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�•J.MARZELLA&ASSOCIATES,P.C.
BY: CHARL�S W.MARSAR,ESQUIRE ATTOR��Y FOR PLAINTIFFS
PA SUPRFME COURT I.D.NO. 56072 STEVEn:��SEKEDITH&,�UDY
3513 NORTH FRONT STREET WHEEL]GR,EA'ECUTORS OF THE
HnxitlsBURG,PA 17110-1438 ESTATE Or CARL A.MEREDITH
TELEPHori'E: (737)234-7828
FAC5I1�1ILE: (717)234-688�
FMATi ('MARSAR@RJMAR��'T 1 A C011T
IN THE COURT OF COMMON PLEAS
CUMF3ERLAND COUNTY,PEI�TNSYLV.ANIA.
STEVEN MEREDITH AND,TODY WHEELER, : DOCK.ET NUMBI;R: 12-191 CNII.
EXECUTORS OF THE ESTA'I"E OF CARL A. . �- �- �
��;
MEREDITH,DECEASED � ,-.;t-c' -�,- :
PLATNTIFFS . �=� '
VS. PROFESSIONAL MEDICAL NEGLIGED3.�B �
WII.[.[AM R.CUR[tIE,D.D.S.,CURR�&HECxT : r=.:-: �:
ORAL AND MAXILLOFACIAL SURGEONS,P.C., . -" - �
BEVERI,Y UI�IIACKE,M.D.,PINNACLE HEALTH : -- _ . ��
MEDICAL SERVICES D/B(A PINNACLE HEAL'I'H : � --= ��
FAMILYCARF_,ROBERT SKOT!�1ICKI,M.D., . � :-
ASSOCIATED CARDTOLIGiSTS,P.C., •
OP"FUMRX,INC.,AND WAL-MART STORES . JU12Y TR.i.AI_DEM.4hDED
EAST,LP •
DEFENDAI�TTS .
OItDER
�t�
AND NOW, this � � day of , 2015, the Petition to Approve the
Settlement of the Survival and Wrongful Death claims is GRANTED.
---- --____ --�
!,��--—
____=�---_------- --==-__---�_
� �����F
1`��mas A.Plac��r
J, ��mmUn Pleas Judg�
TRl.1� CQPY Ff2QM R�C�RQ
in T2stimony whereof, I here unlo set my hand
and the sea of said Court a1 Ca lisle,Pa.
This��Y°E��20�
Prothon�tary i
��.�..��.�� ►
Distribution Leaend
Patrick J.McDonnell, Esquire
Metropolitan Business Center
860 First Avenue, Unit SB
King of Prussia, PA, 19406
Gary V. Gittleman, Esquire
Naulty, Scaricamazza&McDevitt, LLC
One Penn Center, Suite 7S0
1617 JFK Boulevard �
Philadelphia, PA 19103
Michael M.Badowski,Esquire
Margolis Edelstein
3510 Trindle Rd.
Camp Hi11,PA 17011
Joseph J. McHale,Esquire
Stradley Ranon Stevens & Young, LLP
2600 One Commerce Square
Philadelphia,PA 19103
Charles W.Marsar,3r.,�squire
RJ Marzella &Associates
3513 North Front Street
Ha�risburg, PA 17110
I' II.II. II •I• i
- - . ., , � �.. r . . _
I �
I
R.J.MARZELLA&ASSOCIATES,P.C. ;',;,.;;. ,' :,._: i;..',;' ;
BY: CHARLES W.MARSAR�ESQUIRE ATTORNEY FOA`PCAINTIFFS�;;�,
. , � �_�:,:.., .
PA SUPRENlE COURT I.D.NO. 86Q�2 STEVEN M£REDITH&JODY
jS1j NORTM FRONT STREET WHEELER}EXECUTORS OF THE
HARRISBURG�PA 1]110-]438 ESTATE OF CARL A.MEREDITH
TELEPHONE: (7�7)Z34-78a8
Facsinni�e: (7�7)z34-6ss3
EM$1L' CMARSARnQ RJIV�ARZELLA COM —_-
1N THE COURT OF COMMON PLEAS
CUMBERLAND COUNlY,PENNSYLVAI�IA
STEVEN MEREDITH AND.IODY WHEELER, . DOCKET I�UMBER: 12-191 CIVIL
EXECUTORS OF THE ESTATE aF CARL A. •
MEREDITH,DECEASED -
PLAINTIFFS .
VS. PROFESSIONAL MEDICAL NEGLIGENCE
WILLIAM R.CURRIE,D.D.S.,CURR(E&HECHT .
ORAIANDMAXILLOFACIALSURGEONS,P.C., •
BEVERLY UNIACKE,M.D., PINNAtLE hiEALTH •
MEDIGSLSERVICES D�BIA PINNACLE HEALTH .
FAMILYCARE,ROSERT SKOTNICKI,M.D., •
ASSOCIATED CARDI0LIG1ST5,P.C., •
OPTUMRX�INC.,AND WAL-MARTSTORES . )URYTRIAI DEMANDED
Ea,sr,LP •
DEFENDANTS .
PETiT(ON FOR COURT APPROVAL OF WROMGFUL DEATH AND SURVIVAL ACTION SETTLEMENT
The Petition of Steven Meredith and lody Wheeler, Executors of the Estate of Cari A.
Meredith, Deceased, by their attorney, Charles W. Marsar, Esquire, respectfully requests:
�. Petitioners are Steven Meredith and Jody Wheeler, Executors of the Estate of Carl A.
Meredith, Deceased, as indicated by the Certificate of Grant of Letters issued by the Register
of Wills of Cumberland County, Pennsylvania on June �7, zo�o. (See,Certificate attached
hereto as Exhibit"A").
1
z. The Decedent died on lune�o, zo�o as a result of a drug-on-drug induced hemorrhagic
stroke.(See, copy of Death Certificate attached as Exhibit"B"}.
3. Cari A. iVleredith died testate.
q. At the time of his death, Cari A. Meredith was married and was survived by his spouse,
Lourene Meredith, and his four adu(t children,Tonya L. Meredifih-Motter, Michaef A. Meredith,
Steven M. Meredith, and Jody A.Wheeler, who are the beneficiaries entitled to bring an .
Action for Wrongful Death and Surviva(Action under 4z Pa. C.S.A. §83o�(b)and 4a Pa.C.S.A.§
83oz,respectivefy.
5. AI[egations of negligence were resolved by way of a mediation conducted by the
Nonorabie Judge Eugene F. Scanlon,.Jr.on February z, zo�5.
6. An agreement was reached whereby the Defendants will callectively pay$6z.5,000.00
to the Estate of Carl A. Meredith.
7. Pursuant to the Decedents fast wili and testament his four children wilf inherit his
estate.
8. The wrongfu( death sefitlement wi[I be distributed to Mr. Meredith's widow and four
children equally pursuant to 4z Pa.C.S.A. § 83o�{b), respectively.
�. The funeral bills of decedent have been paid in full,and no otner unpaid claims have
been raised or are outstandirg in ttie Decedents estate.
2
�o. Petitioners have executed a Power of Attorney and Fee Abreement with R.J. Marzella
&Associates, P.C. on October�6, zoiq., in which they agreed to pay this firm 40% in attorney's
fees and the associated expenses with litigation.(See• Power of Attorney and Fee Agreement
attached hereto as Exhibit "C"}.
��. Counsel is requesting approval of 40%attorney's fees in this settfement,total fees
being�z5o,000.0o for the claims of the estate.
�2. A copy of our law firm's expense sheet is attached hereto as Ehhibit"D".
�3. A copy of the previous law firm's expense sheet is attached hereto as Exhibit"E".
�4. Total cosfs re[ated to this litigation total $�o,365•95•
�5. Petitioners have agreed to reimburse attorneys for those expenses from the proceeds
of the settlement in accordance with the approved allocations by the Department of Revenue.
ib. There is a 5�46,�3z.66 claim against the Estates of Carl A. Meredith by Medicare and a
United HealthCare-AARP claim of$�z,377.57, which are currently being reduced to reflect
attorney's fees and costs,
�7. The final liens for Medicare and United HealthCare-AARP wili be paid by Petitioners
from the money received which wi11 be held in escrow.
�8. Petitioner requests allocation of the net proceeds as twenty(?o%)to the Wrongful
Death Action and eighty(80%)to the Survival Action.
3
I'..III!. II �I■ �
�9. The Pennsyivania Department of Revenue has approved the following allocations by
fetter dated March 5, zo15. {5. ee,copy of the [etter attached hereto as Exhibit"F").
zo. In accordance with the above allocation, $�z5,000 wili be allocated to the Wrongful
Death Action and$500,00o wili be allocated to the Survival Action.
Wron ful Death Claim zo% Survival Claim 80% _
Gross-$iz5,000 Gross-$500,000
Atty fees-$ 5a,000 Atty fees-$ zoo,000
Expenses-�Z,o73.�g Expenses-$ 8,Zgz.76
Medicare Lien-$�46,�3z.66
United HealthCare Lien-$1a,377•57
Net= $70,9z6.8o 1Vet= $ �33>>97.a�
z�. Pursuant to 4a Pa.C.S.§830� (b),the beneficiaries of fihe Wrongful Death Action and
their respective interests, are as follows:
�1 AM E B��_AILO N 5 H I P =_�-Z�R�
Lourene Meredith Wife of Mr. Meredith z0�
Tonya L. Meredith Motter Daughter of Mr. Meredith Zo�
Michael A. Meredith Son of Mr. Meredith Zo�
Jody A.Wheeler Daughter of Mr. Meredith zo%
Steven M. Meredith Son of Mr. Meredith 20�
4
I III:, II •I• �
zz. Therefore,these beneficiaries will each receive the fol(owing from the Wrongful Death
Attion:
NAME RELATIONSHIP ==_,INTEREST
Lourene Meredith Wife of Mr. Meredith $ T4,�85•36
Tonya L. Meredith Motter Daughter of Mr. Meredith $ �4��85•36
Michael A. Meredith Son of Mr. Meredith � �4,�85•36
Jody A.Wheeler Daughter of Mr. Meredith $ �4,�g5•36
Steven M. Meredith Son of Mr. Meredifih $ �4,�85•36
z3. Petitioners have served a copy of this Petition on the potential testate heirs of the
Decedent as provided in zo Pa.C.S. § z1o1 et seq., who are as foflaws:
�r„nnr REL T�NIP ADDR���.
IVI"11VIL
Lourene Meredith Wife 339 East Old York Road.
Carlisle, PA�70�5
Tonya L. Meredith-Motter Daughter 408 KerrsviUe Road
Carlisie, PA��0�5
Michael A. Meredith Son 5Z� Park C7rive
Boiiing Springs, PA�7007
Jody A.Wheeler Daughfier �08 Earl Street
Soiling Springs, PA�7007
5
Steven M. Meredith Son �535 Ridge Road
Wellsville, pA�7365
z4. The funeraf bills of the decedent have been paid in fufl,and no cther unpaid claims
have been raised or are outstanding for the decedent's estate.
z5. The Survival Action proceeds will be held in escrow until the Meclicare and UHC liens
have been finaIized and paid.
z6. The remaining balance will be distributed to the beneficiaries according to the
provisions outlined in the Decedenfi's Will. Specifically,each child of the Decedent will receive
Z59�•
z7. Petitioner has been advised by counsel and understands that should this settlement be
approved,there will be no future or further payments from the defendants or their insurance
carriers for any claims against the Defendants or their insurance carriers arising out of the
Decedent's death.
z8. Petitioners have b�en advised by counsef that they will be required to execute a
release totaliy and fully discharging the Defendants and their insurance carriers from any
abligatian to pay additional sums with respect to the wrongful death and surviva!claims of
the Estate against the Defendants or their insurance carriers.
WHEREFORE, Petitioners requests that they be permitted to enter into the settlement
recited above.
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Respectfu(ly Submitted,
R.J.MARZE &AS OUATES, P.C.
.��
By� -- - -
� }�s-�y-�larsar,�J�, Esqu' e
Attorney for St v�ee�n N1e e,d.i,h and
Jody Wheeler, Executors of the Estate of
Cari A. Nlereaith, t�eceased
Dated:
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CERTIFICATE (�F SERVICE
T, Enjoli Neely, hereby certify tlaat a true and correct copy of the foregoulg
document was served upon counsel of record this 13th day of March, 2015,by depositing
said copy in the United States Mail at Harrisbu.rg, Pennsylvania,pastage prepaid, first class _
delivery, and addressed as follows:
Patrick 7. McDonnell,Esquire
Metropolitan Business Center
860 First Avenue, Unit 5B
King of Prussia,PA, 19406
Counsel for Wnl-Mart Stores Ec�st, L.P.
Gary V. Gittleman,Esquire
Naulty,Scaricamazza& McDevitt,LLC
One Penn Center, Suite 750
1617 JFK Boulevard
Philadelphia,PA 19103
Counsel for Defendants, Willr.'am R. Currie, D.D.S c�nd
Currie and Hecht Orc�l Maxiltofacial Surgeons, P.C.
Michael M. Badowski,Esquire
Margolis Edelstei.i�
3510 Trindle Rd.
Camp Hill,PA 17011
Cotsnsel for Deferadcznts, Beverly Uniacke,L17.1). and Pir2raacle I-Iealtli Medical Services
d/b/a/Pinnacle Health Family Care
Joseph J. McHale, Esquire
Michelle 4rloski,Esquire
Stradley Ronon Stevens &Young, LLP
2600 One Commerce Square
Philadelphia, PA 19103
Counsel for OptumR:e, Inc.
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R.3•iVIARZELLA&ASSOCTAT�S,P.C.
BY: � �
Enjoli Neely, 'aralegal
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C�RTIFICA7� C�F
CtJMBERLAND COUNTY GRANT OF LETTERS
P�NNSYLVANIA
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No. �o�o- �oos�� PA I�7o. z�- �o- os��
Es ta te Of: CARL A ME'RED1Ty
rrirr,Mlpolc,dnSU
I'�ate Of: SOUTN M/ODLET'QN TQWNSHIA
CUMBER/AND COUNTY
Deceased
Speza.Z Security Np;
wHE,R�A.S, on the 17t,12 day of June 20.�0 �..rt ins�1-ume,��: datQd
February �st 2006 u,��6 adm.i lted, to probate as the Ias.t wi�t of
CARL A MEREDITH
tri,.ct,hJklvm.,eoau
1 a.�e of SoU7'H MIDDLETCN rOWNSHrP, eUMBERLANO Counry,
whn di�d on L'he 9th day o� Jur2e 2010 �nd,
WH!?REAS, a trve copy o,� the wiJ.l as probated is annexed ne.reto.
3'HEREFOR£, I, GLENDA FARN�R STRASBAUGH , .�egie�er of. Wi1,1s i.zt ard
for. CUMPERI.,AND County, in �he CoRunonwedlth p�` ,P�nn.sylvan.i.a, her�by
certify that .Z hav� �hie day gran�cd Letter.s TFSTlaMENTARYto:
JODY/� WHEELER and STEV�NM MER�t�lTN '
who have duly quali.fied as �XECUTOR(R!k!
and have agreed to admZniSL'er �he estat� accozding �o Zaw, a13 of whicl��
.f.ully a�peaxs of recoz�d in my o,f�'ice at CUMBERLAN4 COtJNTY COURT HOUSE,
CARUSLF, PENNSYL VANIA. '
.TN �ESTIM.�NY WHE.�EUF, I have .h�r�;zr.r to se L my .Fiand a.nd a,i fixed the sPa.�
of my off.ice on th� 97th day of June 20�0.
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PO�NER Or ATTORN�YANd
CONTINGCN7 FEE A�R��fViEN7
We, Steve�l Me�•edith and Jody Wheeler, as the Co-Executo!�s of the Est�ite �f C�z�l
ivleredith the undersigned, hereinar�er called "CLI�,NT" hereby :etai�i, appoint, and nomina�e
R.J. MARZELLA a,t�D AS50CJATES� p.C., its nieti�bers and assoc;iates, hereinafter ca3led
"A'r�roI�rr�,x" to repi�esent Ciient as Iega1 couz�sel for the xeco��et�y of dan�ages in connection
wit?�t.he death o�Caz-11VZez-etIitl�
CLIEiJT AND ATTORNEI'HEREBY AGREE AS FOLLO�VS:
�, ��zxrAx, ��v��,��xron — Attorney will under�ake an �inilial investigatio�� at�d
eva.luate tl�e merits of tLis case. No attorney fec w�ill be::htu�ged for�.ttorney work
in connection with the evaluation. Client shal] provide in advance a retainer of�
0 ZET20 to be used for the pttzposes of paying tne costs associated with t.he
initial znvestigatioii.
Attoiney will review t�le pertinent records a�ld will advise the Client eoiiccining
the pro�ba.ble rnerits of the case. Tf the initial evaluation of the merits of the ela:itn
is favorable, A�torney will advatice th.e costs of prosecuting tlie case, These costs
s.1�al.l be z�e�;aid by Client as speci�ied in pa��agi�aph�belo�v.
Attainey 1•eserves the right to terrninate the agi•eeme��t t�{�.er the initia] evaluat.ion
if the case is determinecl not to have merit, at wh:�h timc any balance remaining
in th�trust account afte��payment of expenses shall b�.returned to Client. :
2, A.TTOI(tN�YS TLLS — In payment for f.l�e services perfoi•med by tl�e Aitoz-ne�, �
Client hereby agrees tha.t (40%) attorneys' fees sha.lp be paid to R.J. Mt�rzella & I
Associates, P.C. from the total amount paid in either settlement of the c�,se or in a.
jui�y verdict, iticluding any araounts due and owing as clelay dama.ges.
In t.he eve�lf. of a settlemeiit i�z the form of a strucbared s��t:klemen�,it is agt�eed that
attorney fees shall be pa.id according to the above term� based on the cost of the I
struc#ured settlement to the se,ttling parcys. It is fu��her understood and agreed
that the am.oui�i to be paid as the attori�eys' �ees on tt�e structured settlement shall �
be paid on � Ii�mp sum basis t�t the ti�ne tlle sf.iactured settlement is eizCered into
by tl�e Client.
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3. S�rTT��b[�NT —No settlement cf tl�,s case shall l�e made without the Client prior ,
approval.
� 'PlAIN71FF'S `'
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Sep. 11. 20i4 12; 16PPi1 RJ P�4a.�zFlla & Asscciaies No. 648) �'. 3
�. Drsr�iguTzoN o:� P�toc��ns — Ctient furlher agrees i1���it from r11e piocee�s of
an� rec�ve�y, tivhether by settlement, jud�ment or otheitivise, the attorney mny
deduct t1�e stto��neys' fees to �vnich it is entitled, toge�:her w':th a1I costs and
expenses w��ich have beeii advariced or ramain unpail, ���d Ciient further agree
that the Attorney inay deduct the amount of a!1 unpa�,�i bills for prc�essional
S�Z'YIC�S hcld f71d}Ce(�1SvU1-S�1Tle11tS Of SUCjl fU11CIS G1L�ctly to�he creditors i�lvolved.
5. CoST A�vAt�CE — Attorney shall have the aut�lority to make advances and to
incur such cosfs as the Attorney dete�nlines necessar� i;,i the processing of the
client case, Such adva�lces and costs include bllt are��ot Iimited to:
(�) Fees i'or physicians, psychologists, accountants and other experts which
attorney d�ems necessary to assist in handling pT C(ients' ease; and __
(b) Cop��ing eharges, tra.vel expenses, eourt cosis, deposition e�cpei�ses, long
distance telephone ca]Is, postage.
Tn the event of a rnonetar� zeco�ery, C�i:ent ag�ees to �eia�burse Attorney fox�the
abor1e-zeferenced expenses iiicurred. After the atto���eys' �ees are deducted fiom
fl�e settlement and/or verdict, the ex,penses shall be repaid to R.1. M�uzella &
Associa.tes,P.C. out of the remaining balance of the sef�ler:lent and/or verdict, �
Tf Ciient sejecfs a settleanezlt offez� ihat Attorne}r belie.ves is reasonabJe and �
equitable under the circumstances, Client agrees to l�e responsibie for an�and all
out-of pocket expenses incurred during the pursuit of their claim,irrespective of a
monetary reeovery. See paxagraph thirteen(13) below.
(, WTxH.DC1AV✓.A.'�—If, cluring tiae pttrsu'tt of 1l�is case, tl�e A:lor�zey deternlines tl�ai,
under the eYisting�.ireumSt9hCe5,it i��}ot feasible or pr�c;t.icahle to prosecute this
c�se, upon notifzc�tion to the Clievt of such facts,, ;he Attor�zey may withdraw
fiorn representation under this agreement. Client agrees to execute all documents
and ta.ke all st�ps requestect by Aitorney that are nec�ssary to facilitate the
withdraw o�z�epa:eset�tat.ioz�,
7, App�n�,—If the Client a.u;��orizes aii a.ppeal of this case, .�le attarneys' fees shail
be increased by 5%more than fhe fee set forth above to cover the additional work
involved in ha.ndlir�g of the appeal.
$, FEE D, t�tstotv — Tn the event that Client was/were ref�erred to R.J. Marzella and
Associates, �'.C, by a refei7;ing attorney, Client rloes not object ta the division of I
tl�e atlo�7le�s' fees chaiged to the Clieni bet�,veei� t11P At`orney and the zeferring ;
attorney, Client understand(s) that they wi11 not pay aily��dditional fee as a result
of the division of the fe�bet�veen Attorney and refer.ring attorney.
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� 9. TER�tiIth�.�TT01� oF AGI�EENIENT sY CLIE�T— In ii�2 eJe.�t that the Cliei�t seeks
IegAl represeniation elsewl�ere regarding the inci�lei�t de;cz�ibed herei�l a�lcJ af.er
tl�e instant �ee Agreernent is executed, Client a�rees io iir'nediately re�_rnbLuse
Attorney for all exper.ses incun�ect to date. Moreover,for the work periorrnec� by
rfle Attorney up to the d�te of separation of��tol-ne4' and Client, Client agrees
tl�at, �n the e�vent oF a.�� 111timate monetary l�eco°�e����, Attorne� zs entitled �to
reasvnable co�npensation(quantum merit}fi�o�n any verdict or settlement.
10. ARs�T_ TItAT1oN -- Az�y d�spute between the Attorney and the Client shall be
resolved by arbi,t�•ation. �]?e a�b�,t�afors shall be�rtenbers of tfie pennsylva��ia Bar
Association. The At�orney shall select one nrbitratcr. Tl�e CIient shall select one
�rbitrator. The two arbiti'ators sha.l] select a third arbitcator. The arbitrators shall,
by majority vote, establish all rules pertain�ng to the arbitration, inc(uding
deternlining how tl�e cost of arbiiration shall be paid. 7f the dispute is riot
r,eso3�red, the rules of the American Arbitrat:ioz� Associat':on in ef.�ect at the time
sha11 apply aaid
control.
11, T�RMt�ATtoN — Tlais Agreement applies oa��� to the Attomey's pll�su�t of tl�e
claim specified �.bove, This Agreeme��t terrninates upoit�he final distribufion of
proceeds recovered on behalf of the Client tiuough verdict, settlement or
otherwise, if not terminatecf before such tinle.
Jn t�ae evenC Client desire(s) additional services ?�erl'o�la.�.�d b�..Atto.x��e�, wlleihez
reiated to the avove-described�ncident or not, tlie fee� and cosks t.o be cha��ged by
the Attorney in the event representaiion is Lndei�lakPn, is subject to other
Ageeement.
12, M�tzNx�HAI�C�or�r1�1�—After this matter is coG�cluded and the Attorne�-Cliez�t
relatioi�sl�ip is fenninated foz• aaiy reason, the Ciient file �vill be 3�ai�itained for a
period. of four (4) years. Du_i•ing tf�e time that the file is beil�g maintaii�ed, the
Client inay obtain a copy of the file upon ��vritten requ�st, and agz•ees to pay a
reasonable c�pying charge. A$er mai�ltaining tl�xe �'ile for four {4) years, the #i1e
�nay be�iestz�oyed withiil fl�e Atfori�ey's disc��eti.oi�.
13. nToN-r.T�HTT,TTY o�'�XEcu'roRs- �xeept ss provi�3ed in the]�st subpara.�raph of
paragrapll five {5) above, tlie Co-Executors (Stevcn aild Jody), shall haue no
personal liability�oa�costs, ex.penses, etc.
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�� STEV�N�1'I�REbITH AND .��D�'WYi.E��,CR,.gS T�T$CO-E'��CI1T��'.S OF THE�STATE OF CAFtL
MEREDITH, HAV�FtEAU TT-�E A80VE AGREEiYTENT AN� TJND�ItSTAi^��.4i?J ACYREE TC3 IT5 TERMS.
THERE ARE 1�0 OT'�5��AuREEi�IE.R'TS BETV,'EEiv'T'H��'r�12TIFS�SES�'1�T0.
TT�ITS AGREENIENT TS E�tT�l'��p TNTO"fT�I,S (;, DAY OF�> C��L�{;t;" ,2dX4,
�STATE OF CATiL I4'��R�DI'I'T��I?EC ASED
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BY' ��.2.�i'v-� � j),� rr �. G �:" I
STL'V�LN 1VIEREDITH,C -��FCUTOR' DATE 4
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�ObY�WHEELEI2 CO-�?��CYITOI4 T�ATE
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, �L�,A Ass rAT�s,P.C. AA.TE
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PO`�h'�I� �Fftl`TC)Fl�1�YANC�
CONTWGLNr FEE{1{�I�EE��IFI�T
We, Steven Nleredith and 7udy �Vheeler, as tl�e Co�F-�ecutors of the E�tnte of Ct�i•1
��fe�edith the l�ndersigned, hereinsfter calle�� "C�.1F;11T" het�eby retai�l, appoint, ;ind. nominate
'�„7, Ntpa7EL,Ln ,LN1� :Assoc:l,1'rFs, �'.(:., �.ts rri��rrib�:rs and ��ssoci�tes, ilereinafter calle:d
"AxTOR��FY" to cepresent: Client as 1c�;a1 cou.nsel �or i:he tzcovery of d�nap;es in connection
wi.tli the deaih of Car)^�lerecIit�l
�L1Ei�T A�lD t'�`1'fORNEY]�Er.E13X AGi2EL As�F�OLLO`�'S; ,
1, �wt�r1A�.,�'v����Ttor� — At.torney yvill uudezt;il:c ��n inilial investigatio.n ar�d.
evaiva.te tl�ie ir�erifs of tl�is r,�ise. i1c> attorney fe.c tivii�be c't�arged for afiorney tivork
in conn�ction �vit}�� tht ev,iLua.tic�r.�.. Clicnt shall pio�'ide,in advance a.retainer of�
O�Z;�;T'�.C1�to he used fo:� t:ie p?v�o;es of paying t}�P cc��,ts a.ssociatc.d with tl�e
initi,al iszvesCigation.
Attorney will review tlie p�itinent recoz�ds and �Yiii advise i:he Client concei�irt�
the�robahle merits of ihe case. 7f thf:inilial evaluatian a�the merits of the clai.rn.
is fa��or��ble, Attor�iey wil�, a.dvatice ihe costs of pi�o:�ecuting t}ie case. These cost�
sE.�.all be��e}�aitl b�Cliealt as specii:ied in��ara�rr���l�5 beio��r.
Attorney rese:ves thc:rigt.tt to terminate tlie agrcernent afier tl�e initial evaluatior.�
if fhe cas� is dctermined �.tiot to Y�ave n�er�t, at ���hicll ti.mc any ba!ance reinaininR;
�ri ihe t���.ist account afier paymer�i o.f e;�pei�ses shall�be return�d to Client.
z, ,A�TroRiv�:YS .C`E�s — I�z payrr�.ent f��r flie servic:es perz�}rined by tlae Attoznep., '
Client he��eby agrees ihat (�109'0) attorneys' fees shtiill be pa.id to 1ZJ. A1�rzellZ &:
A.;;soci��.es, P.C. fc•om the teta} ar�iount paid in ��ifher seitle:nent of the case oi'in .�
jur;�ve:rd3et; incluc�i�ig an}' ��.mouiits c�t.te and o�r�ii�zJ as delay dania.ges. -
In 1:i�e event�f.a settlE:ment.in the form of;�.struc4ured seiile�nent., it is agreed f.hn:
�t�ori�e,� fees s1�a11 be pa.id accerding to t1�e aboie te��ms based on the cost of t1.�c:
strueturecl settlement to the: sc;ttliag partys. IT i� :furthc:r unc]crscood and agreed
that ihe az�ouni to be Paid�:a lh.e a11o�'ne�s' fees on ihe, stri�ctured settlement sh:tl]
ve }���id on � Ium�i suan U;asis a1: lhe t:une the sfi'uc�urecl settlernenf.is entei�ed iuf;�
b}'ti].e (�ller:t.
3. Sr�rTL,�:�-f�,NT �- \o sfittlement o:�tl�,is�. :;ase �hal1 be made without tlie Client prin::� �
a�a�)rov��l. � �
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4. l�isTu;�,ta'r�on� o� �'t�oC�rUS -- �:lier�t fu;,(.er a;:'ecs t���i f;om fhe pioceeds r.�:
' a;ly� re..UV(:TV, wheihcr �,y setclemertt, j��dgme?1t'e: otheitivise, the attoi�ney �rl�}r
deduct ;l�e atto�nf;ys' fees �to ��vhie�ll it i:; entitl.e�, lo�etlicr with all costs and
zxpenses wh�ch hav� �;eeri aclvancecl <;r r<:rnain ur•�paid; and Clierit rizrtner an�ec;
t�,r�t tt�e �`.Tto��ne� .�Y�a;r �3er.l�ict tiie a�now�i o� ali unpa.ici bills f�r profes�ior,jl
serS�ices ��nd rnake disLu.rselnezit:� ofsuch func�s dircr,tly t� tlie creditors in��ol�ed.
5. CosT ADVA�vCt; — Attornr,�� �ha1.1 ha'.�<: thc; auihoiity to makc; advanccs and [o
incur such r,psts as the 1�ttol�.e.y detenuines necessar}� in the pr�cessing of tbe
CIie�i��i�e. SZ1CI1 adva��ces and costs int;lude bllr arc not liinitec�fo:
(�) Fe�.s Co� physicians, psyc'�olo�rists, accountants and other experts which
attorney deenis necessary� to assist in haridl'ir.g of Clients'cas�; and
(b) Co���ing cliarces, travel expf;rises, court cosls, deposition e�peiZses, lon�
distance te,le,ph��ie calls, posta�e. �
Tn the event of a rnc�netary z�eco�rezy, (;.tierd agrees to reimburse Attorney for t};e
abo�re-referenced espenses incurre�i. �'�fte:r 111e �tiorrleys' .fees Zre deducted fi•o�n
fhe seft).;,merit and/or verdict, tlif; ex�ens�s sh�ll be repsicl. to R.I. Ma�•zella &
Associates,P.C. ottt:of the rernail=_n� balanee of tlie �;ettle_nent andlor verdict. ;
if i;lieni �ejects a seltlemenC offe�� t11at Afioiile;- beiieves is zeasor�abLe and '
equitable under ihe cirr.,umsfa.ncr-•s, Cli��iit �igree� tp be responsible fcr any and all �
out-of-pocket expenses incucred c3urin€;th��ursuit c�r"their claim, irrespective of a.
mor..etary recovery. Sec pa�'a�rapri t.hirte;,n(l:l) bclo��v, ;
�
(, Wr7��tU�.a�,�pY, --.�f, cll�z�ing tl�e pl�.rsuit of 11:is case, il�e �!.ttori�e}t ilete,rnzines thal, �
undf�r the eYist.ing c.i�cuinst�tl�es, it is riot ieasiE,l�or preci.ical�le t.o prosecute this �
. case, upon notification to the C'liei�t ��f sueh iac.ts, t]ie �ttc�t�ney m�y uithdra�.v
fron�re�n�esentation�m:ier thSs agreem�_:nt. Client agrees to exec�ate all documen�s ,
and takc all stc;ps r�quested b.� Attorney that ari: necessary to facilitatc the
vvithdrav✓ of rep�-ese�-�ta[ion.
i
; -
7, AppG,��,—If tlie Client aut���rize:s aii n.��peal of t�iis �.�se, the ztforne��s' fees sh��l ;
Ue inci•eased by S% morc thali the fee�.e:r furth above: t� c�ver the additioval work
involved in handlirig of'the apper:�l
8. F��.Utv[stoy — In tIs� event tliat C[ie;nt tivas/were refeired to R.J. Marzella an�,] ;
Associates, P.C. by a refen:ing �.ttori�e;�, Clieiit dues not object to th� division of �
the atia�zle.ys' fees cliarged t.o tl;e CliEv�f: l�et��veen t;�e A(I.orne�� and tlie �eferring �
� attorne.y. ClienC Under:stanti(s) t'�E.at tl��e�� will not pa�,� �ny .��dditional fee �s a resu?t �
of t}�e division o f the�e� bF.t�veer:�Atlorney an�l re:crrir:��it.torncy. ;
i
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i=�, " CO '4 �Z: i�,'r'lu� '�,ri�.r:e ' 'u K �i;;r�,: i�i?; !i�. u��`� ;' ,�
�. Telz,tirr�.�.l�roy o��A_c��E.Nr���•i� r��r C:r.r���v_T — i,� ti�e ���ent ti��at �he Clie,�t see�:s
� 1eg�.i1 represe�tation elsewhf;�c ��egar�ing the �l�cidr:lt describe�J l�ereii� and af'ter
t11e inst,n� Fee Agree,rricr.t is execute:ci, Clici;T �.>_rees to iir�mediatel_�� i'eimbu.r:,e,
Attc>in�-y for all expenses ineurred to date. �loreov�;r, to�t;.e wo,3c per�ormed by
th.e Atiorney up to The date of separatior_ of At1or��.ey and Client, Client agreE;s
that, in [he. even! oi' a.�i 11��liT;aie r�onetr�ry reco�-er��, Attorne�� i; er,tirled io
res�sonable corzipe��sation(qual7tu.m merit) from any vc:rdict or seltlems�lt.
10. ARI3ITR..ATIUN -- Atl� C�ispute betweei.i t�ie r1�Tor:�ey a:�d the t�li�nt shall bc
� resolverl L�y arbrtration. Tl�e arbi.trators sh�31.1 be men�.uers oi tFie Pennsylv��ia l3�u�
AssociaTion. The A(terney shall select one arbitrexor. The Client shall select onE:
arbitratoz�. 1'he two a��bitra.tors s'�,311 sele,ct a thirci arlait�atcr. The a.rl�itrators shall,
by majority vote, es:abIis}i a1l rules pr.rtainin� to the ai•bitration, including __
clete:rmiiiing .how ttic cost of �u�bit�ati�n. st�all 'ue paid. 7f the dispute is ric�t
rescl��ed, fhe Iules c>f rhe Ainei�-cai1 Fa�bitraf:ion�.s�ociation in effect at the time
sh,�ll �xpply 7�Zd
co».:rol.
11, T�F.rir�,�xr.o�t — Tlais Ag:�eeme.iii ap��lie.5 onl�r io i:1ze Artoi7ley's }�ursuit o� tl�.e
clainl specified 5bove. This Ag,reelne:nt tierrninates upoit rize final distribution af
proc:eec�.s reeovercx� on beha.lf of the Clie,nt t�u�ou�h verdi�t, settlemei�t c�r
otherv�ise, if not 1:er�niiiatecl before such tir.��e. ;
I:n the event Client de;;ire(s) adclition�l ser��ices pe��:�o�X�aea by .A.itorney, wtlet}ica�
rela�ed tu il�e a.bove-described ir..eidraz�t or not,tlie,fecs anc' cosfs to ba cha��ged by
the Attorney in tlie eve.nt rf;�:>resentatian is upc.iert.a.ke��,, is subject to othc:r
Agr;,em�;nt.
12, i1�,�rt�1'�i�,�yC�o�T'fY.•�—Ai7er illi� rnalte�-is cc�ncluded and the Attorney-Clie��t
� rel�_ionship is term�nated for a.ny reason> the Client file�vill be inaintained for a
period. of four {4} ye.a.rs. D�arir�g the tirne that tl�e ��I� i� being in;�intained, the:
Clie.nt ma.y obt�i.in a eopy of tl�e file upon «ritten f ec�uest, and a.grees to pay a
reasonat;lr. copyin� charge. Afie.r niaintaining the file for four. (�) years; the fi].�;
may be ciestro�ed wifhin ih�;�.tco��ney's disc�etioz..
13 No�d-7,I_��ILrrY oF r„�Ecv'roFt�;- rxr.ePt .�s provide d in tl�e l;ist subpara.graph ot
� �ara.grapli �ve (5) ab��ve, tlze Co-��xccutors (St�ven and Jody), s)lall lia.ve no
��ersona.l Iiability for cc>sls, exper�:e�, etc.
� �i■ �
Sep. 11. 2014 i2: 16PPJ� RJ Ufar?ella & Associates fVo. 64�� P. 5
Y, S I'EV�N�'I�R�bTTH AND.�OD Y��H�E�,�lZ,AS TFI�CO-�'�ECYJ70RS GF THE ESTATE OF CAI2L
MEREDITH, H�'V� '�AD TT3E ABOVE AGREEiY1EN'Z'A�D TJND�nST.A`�D ANU ACr�2$�TO ITS 7'ERNIS�
THERE ARE NO OT}S��t AGF(�Ei�IENT5 BETWEEN TAE PARTI�:S IX�1��x0.
T�rrs Ac���,n�iF�T Is�Nx��t�n 1t�ro�rT�ts f�9 DAY OF �� `�'�' ,zQX 4�
�STATE OF CARL 11'��Tt�DI"T�T�T�DECEASED
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Department Name Meredith,Carl ( d , `N � .� `-�
Department Code 13015
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_ De�artment Information Page J of 1
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Department Number 149
Depariment tJame Meredith,Carl
Department Code 13015
Priat Counter
Copy Fax Printer ,ust Total
Small 2338 0 755 �0 3093 _
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file:///C:/Users/jprice/AppData/Loca1/Temp/Low/HMPEGB2S.htm 2/6/2015
I tll.11'. II �'1■. �
11:21 AM R.J.MARZELLA,ESQUIRE AND ASSOCIATES, P.G.
oz�osi�� Account Qu9ckReport
Accrual Basis All Transactions
Type Date Num Name _ Memo ` Sp�it _ Amount_ Balance
Client Prepaids
CWM'S
Meredith, Est Carl
Check 11l05/2013 21087 Charles W Mars... Hearing Bank(M&T) ... 36.40 36.40
Check 1'{11812013 Verisma VOID:Prep... Bank(M&T)... 0.00 36.40
Check 11/20/2013 Verite� Bank(M&l� ... 1,000.00 1,036.40
Check 03/01/2014 21399 Verite�rt PA1929674 Bank{M&�... 148.15 1,184.55
Check 04/D7/2014 21466 Cumbertand Cou... Bank(M&l�... 10.50 1,195.05
Check 04/25/2D14 21488 Cumberiand Cou... VOtD: Bank(M&� ... �.00 1,195.05
Check 04/3012�14 21495 The Browning Gr... Process Se... Bank(Ni&�... 58.50 i,253.55
Check 07/25/2094 22'118 Verite� Bank�(M&T}... 487.25 1,740.80
Check 11/14/2014 22364 Jeffrey J Price Bank(M&� ... _ 11.51 1,752.31
Total Meredith,Est.Carl 1,752.31 1,752.31
Totai CWM'S 1,752.31 1,752.31 "-
7otal Client Prepaids 1,752.31 1,752.31
TOTAL 1,752.31 1,752.31
Page 1
.ir.i� �e.■ir. �
Meredith Costs
Feb/ 7/2015 serger '_aw Firm, P.C.
Page 1
Client costs �ournal
To Feb/ 7/2015
----------------------------------------------------
------------------
---------------------------
Date Paid To Source Matter Client Name
Ref# G/L Acct Amount
Entry# Explanation
---------------------------------------------------
---------
Dec/27/2010 Berger Law Firm ` + CER 370-0�1 Meredith,
�ourene 00570 5531 - Postage R 2.b1
24155 Postage
Total for �ec/27/2010 : Z•61
�eb/17/2011 Berger �aw Firm CER 370-001 Meredith,
�ourene 00584 5521 - Photocopy 0.40
24750 Photocopies
Feb/17/2011 Berger �aw �irm, P.c, cER 37Q--00� Meredith,
Lourene 00585 5531 - Postage R 1.76
24761 Postage
Total for Feb/17/2Q11 : 2.16
Feb/25/2011 Berger Law Firm, P.C. CER 370-001 Mered�th,
�ourene 00585 5531 - Postage R 1.39
24773 Postage
Total for Feb/25/Z011 : 1.39
Mar/24/2011 Church of God Home GB 370-001 �teredith,
�ourene 4729 5010 - Client �i 206•98
24954 Medicai Records
Total for Mar/24/2011 : 206.98
Apr/11/2011 Berger �aw Firm, P.C. CER 370-001 Meredith,
�ourene 00596 5531 - Postage R 1.83
Z5212 Postage
Total for Apr/11/2011 : �-•83
May/ 2/2011 Star Med GB 370-001 Meredith,
�ourene 4759 5010 - Client Di 62.23
25235 Medical Records ---Invoice # PA-552Z2
Total for May/ 2/2011 : 62.23
7un/ 6/2011 Berger Law Firm, P.0 CER 370-001 meredith,
�ourene 00602 5531 - Postage R 1. 52
25991 Postage
Total for 7un/ 6/2011 : 1.52
7u1/11/2011 Berger t_.aw Firm, P.�. CER 370-001 Meredith,
�ourene 00607 512 - Freight & 1.08
26352 Postage Expense
Page 1
� � r�I,f�1Ir�lV�- ��'.
_ - ExNIB�j' "�
�r L r ,:
h� . :,���, <,
m�' r
�
Meredith costs
Total for �ul/11/2011 : �•08
7u1/18/2011 Star Med GB 370-�01 Meredith,
�ourene 4802 SQIO - client �i 763.15
26252 Medical Records ---znvoice # PA-51-01�16526
�ul/18/2011 Berger �aw Firm, P.C. CER 370-001 Meredith,
�ourene 00607 512 - Freight & 0.44
26363 Postage Expense
Total for �ul/18/2011 : 763.59
Aug/ 4/2011 serger �aw Firm, P.C. CER 370-001 Meredith,
�ourene OQ626 512 - Freight & 0.44
26843 Postage Expense
Total for Aug/ 4/2011 : 0.44 -
Aug/ 5/2011 Associated Cardiologists GB 370-001 Meredith,
Lourene 4820 5010 - Client Di 101.50
26585 Medical Records
Total for aug/ 5/2011 : 101.50
Aug/ 9/2011 gerger �aw Firm, P.C. CER 370-001 Meredith,
�ourene 0062b 512 - Freight & 0-88
26844 Postage Expense
�otal for Aug/ 9/2011 : �•$$
Aug/10/2011 Berger Law Firm; P.C. CER 370-001 Meredith,
�ourene 00626 512 - Freight & 0.88
26845 Postage Expense
Totai for Aug/10/2011 : �•88
Aug/25/2011 gerger �aw Firm, P.C. CER 370-001 Meredith,
�ourene 00626 512 - Freight & 1.08
26846 Postage Expense
Aug/25/2011 Berger �aw Firm, P.C. CER 370-001 Meredith,
�ourene 006Z6 5�2 - Freight & 0.44
26847 Postage Expense
�otai for Aug/25/2011 : 1.52
�Feb/ 7/2015 Berger taw Firm, F.C.
Page 2
Clzent Costs 7ournal
To Feb/ 7/2015
----------------------------------------------------�-------
------------------------------------------------
Date Paid To Source �atter Client Name
Re�# G/L ACCt AmOUnt
Entry# Explanation
----------------------------------------------------------
----
Sep/�l/2011Y Berger Law Firm, P.C. ^ CER 370-001 Meredith,
�ourene 00630 5521 - Photocopy 82.45
Page 2
Meredith costs
27123 Photocopies
To�ai for Sep/ 112011 : 82.45
Sep/ 2/2011 USPS GB 370-QOl Meredith,
�ourene card 5531 - Postage R 36.59
26927 Postage
sep/ 2/2011 serger �aw �irm, P.C. CER 370-001 Meredith,
�ourene 00629 5531 - Pastage R 0.44
27099 Postage
7ota1 for Sep/ 2/2011 : 37.03
Sep/15/2011 HealthPort GB 370-001 Meredith,
�ourene 4841 5010 - client Di 41.41
27011 Medical Records —
Sep/15/ZO11 HealthPort GB 370-001 Mered�th,
�ourene 4841 5010 - Client Di 9�•l�
27012 Medical Records '
Total for Sep/15/2011 : 137.58
Sep/28/2011 Berger �aw Firm, P.C. CER 370-�001 Meredith,
�ourene 00629 5531 - Postage R 0.44
27117 Postage
Total for sep/28/2011 : Q•4�
Oct/ 7/2011 USPS GB 370-001 Meredith,
�ourene card 5531 - Postage R 10.50
27223 Postage
Oct/ 7/2011 Berger Law Firm, P.C. CER 370-OQ1 Meredith,
�ourene Q0632 5521 - Photo�opy 35.40
Z7320 Photocopies
Total for oct/ 7/2011 : 45.90
Oct/21/2011 Berger �aw Firm, P.C. CER 370-001 Meredith,
�ourene 00634 5531 - Postage R 1.08
27410 Postage
Total for Oct/<1/2011 : 1.08
oct/27/2011 se1ect specia3ty Hospita1--Camp Hill GB 370-001 Meredith,
�ourene 485Q 5Q10 - Client Di Z�7•1�
2737� Medical Records
Total for oct/27/2011 : Z8�•l�
�an/ 6/2012 aerger �aw Firm, P.C. CER 370-QO1 Meredith,
Lourene 00643 5531 - Postage R 0.64
28081 Postage
Total for �an/ 6/2012 : 0.64
�an/17/201z Cumberland County Prothonotary GB 370-001 Meredith,
�ourene 4886 5560 - Client Ad 103.75
28006 Filing Fee --writ of summons
�an/17/2012 �umberland County sheriff GB 370-001 Meredith,
Page 3
Meredith costs
�ourene 4887 5500 - �elivery 200.00
28008 sheriff costs
7an/17/2012 Berger �aw Firm, P.C. CER 370-001 Meredith,
Lourene 00644 5521 - Photocopy 1.20
28101 Photocapies
Jan/17/2012 Dauphin County sheriff's �epartment GB 370-G01 Meredith,
��urene 4888 5500 - Delivery 135.25
Z9718 Sheriff Costs - Service of Complaint
Total for �an/17/2012 : 44Q.20
7an/18/2012 8erger Law Firm, P.C. CER 370-001 Meredith,
�ourene 00643 5531 - Postage R 0.88
28084 Postage
Total for Jan/18/2012 : �•$s :
7an/Z4/2012 USPS GB 370-001 Meredith,
�ourene card 5531 - Postage � 5.04
z8051 Postage
�an/24/2012 Berger �aw Firm, Q.�. CER 370-001 Meredith,
�aurene OQ644 5521 - Photocopy 2.90
28102 Photocopies
7an/24/Z01Z USPS GB 370-001 Meredith,
�ourene CARD 512 - Freight & 5.04
29720 Postage Expense - Meredith service
�Feb/ 7/2015 gerger Law Firm, P.C.
page 3
Client costs �ournal
To Feb/ 7/2015
--------------------------------------------------------------------------
------------------------------------------------
Date Paid To Source Matter Client Name
Ref# G/L ACCt AmOUnt
Entry# Explanation
------------------------------------------------------------------------
------------------------------------------------ ;
Total for Jan/24/2Q12 : �2•98
Feb/ 7/2012 Arthur Adamo, DDS GB 370-001 Meredith,
Lourene 4892 5210 - Client Di 1500.00
28192 Expert Reports
Feb/ 7/2012 Robert stark, M.D. GB 370-001 Meredith,
�ourene 4893 5210 - [lient �i 1050.00
28194 Expert Reports
Feb/ 7/2012 USPS GB 370-001 Meredith,
�ourene card 5531 - Postage R 11.09
28196 Postage
Total for Feb/ 7/2012 : 2561.09
Feb/17/2012 Berger �aw Firm, P.C. CER 370-001 Meredith,
�ourene 00648 55Z1 - Photocopy 9•g5
Page 4
t
Meredith costs
28323 Photocopies
Feb/17/2012 6erger �a4v Firm, PC cER 370-�O1 Meredith,
�ourene 00649 5531 - Postage R 11.80
28335 Postage
7ota1 for Feb/17/2012 : Z1•�5
Feb/22/2012 Berger �aw Firm, PC CER 370-001 Meredith,
�ourene 00649 5531 - Postage R 1.35
28336 Postage
�otal for Feb/2Z/2012 : 1.35
Feb/24/2012 $erger Law Firm, PC CER 370-001 Meredith,
�ourene 00649 5531 - Postage R 11.50
2833$ Postage
Total for Feb/24/2412 : 1.1. 50
Mar/ 7/2012 U5P5 GB 370-001 Meredith,
�ourene card 5531 - Postage rt 5.10
28415 Postage
Total for Mar/ 7/2012 : 5.10
Mar/23/2012 USPS Gs 370-001 Meredith,
�ourene card 5531 - Postage R 5.Z4
28505 Postage
Mar/23/2012 Berger �aw �irm. P.C. CER 370-001 Meredith,
�ourene 00651 5521 - Photocopy 23.10
28544 Photocopies
Mar/23/2012 Berger �aw Firm, P.C. CER 370-001 Meredith,
�ourene 00652 5531 - Postage R 17.80
28556 Postage
Tota1 for Mar/23/2012 : 46.14
Apr/18/2012 Berger �aw Firm CER 370-001 Meredith,
t�ourene 00654 5521 - photocopy 6.55
28719 Phatocopies
Apr/18/2012 Berger �aw Firm cER 370-001 Meredith,
�ourene 00655 5531 - Postage R 5.70
Z8735 Postage
Totai �For Apr/18/2012 : lZ•25
]un/13/2012 Robert M. Stark, M.D. , P.C. GB 37G-001 Meredith,
�ourene 4938 5210 - Client Di 2345.OQ
28997 Expert Reports
Total �or Jun/13/2012 : 2345.00
Oct/17/2012 Robert L. Irvin GB 370-�O1 Meredith,
�ourene 4999 5210 - Client oi z92.50
29659 Video deposition
Total for Oct/17/201Z : 292.5d
------------------------------------------------
Page 5
Meredith Costs
------------------------------------------------
��t� Client Costs Journal - G/L Account
summary �rti`
�/� account Debit Credit
1210 - Client �isb Recov 7491.64
5010 - Client Disb Expense 1558.61
512 - Freight & Postage 1'0'28
�Feb/ 7/2015 gerger Law Firm, P.C.
Page 4
Client Costs .7ournal --
To Feb/ 7/2015
----------------------------------------------------
------------------------------------------------
Da�e Paid To
source Matter Client Name
Ref# G/L ACCt AmOUnt
Entry# Explanation
-------------------------------------------------------
------------------
5210 - Client �isb Clearin 5187.50
5S00 - Delivery Expense 335.25
5521 - Photocopy Recovery 1b1,95
5531 - Postage Recovery 134.34
5560 - client Advances 103.75
Total : 749I.64 7491..64
--------------------------___---------------------
------------------------------------------------ ,
REPORT SELECTIONS - Cli2tlt COStS 7ournal
Layout Template: Al1
Requested by: ADMIN
Finished: Saturday, February 07, 2015 at 04:03:40 PM
Date Range: To Feb/ 7/2015
Matters: 370-001
Clients: All
Major Clients: All Matter zntro
�awye r: a11
Page 6
.ee.i:i..n'rin _ �
Meredith Costs
Responsible Lawyer: All Client zntro
Lawyer: All T e of Lata:
Assigned Lawyer: All Y�
Aii New Page for
Sort by Resp �awyer: �o
Each �awyer: No znclude Ex
G/L Account: All G/L ACcounts p•
Recoveries: Yes Include Accounts
Ref#: All Checl<s
Payable Entries: Yes znclude �enera1
G/L Summary Only: No
Check Allocations: Yes 5how user Name:
Display in Order Entered: No
�vo
corrected Entries: Not zncluded summary by �zesp
Lawyer: No
Select From: Ac�tive, Inactive, Archived Matters
Explanat�on Codes: All
ver: 11.0 SP2 HF1 (7.1.0.20120315)
�
Page 7
.t[i..s.■�u, i
I�oi�
�-� .'
��� �e �' per�nsyt�rania
j� �' DEPARTMENT OF REVENUE
'__.__..�
March S,2015
Charfes Marsar,Esquire
R7 MarzeIla&Associates
3513 North Front Street
Harrisburg,PA 17110
Re: Bstate of Carl Mereditt�
File Number 2110-0617
Court of Common Pleas Cumberland County
Dear Mr.1Vlarsar:
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 Comrnonwealth's approval of the allocation of the proceeds paid to
settle the actions.
Pursuant to the Petition,the 80 year old decedent died as a result of rnedical negligence.
Decedent is survived by his wife and four adult children.
Please be advised that,based upon these facts and for inheritance tax purposes only,this
Department has no objection to the proposed aliocation of the nel proceeds o£this action,$75,926.81 to
the wrongful death claim and$145,197.01 to the survival claun. Proceeds of a survival action are an
asset included in the decedent's•estate and are subject to the unposition of Pem�sylvania inheritance tax.
42 Pa.C.S.A. §8302; 72 P.S. §91Cifi, 9107. Costs and fees must be deducted in the same percentages as
the proceeds are alloeated. Tn re Estate of Merr�an, 669 A.2d 1059{Pa. Cmwlth. 2995).
I trust Chat this letter is a sufficient representation of the Department's position on this matt.er. 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 ary questions or requires
anything additional from this Bureau.
Sin ely,
�'���..1��
annon F.Baker
Trust Valuation Specialist
Inherita�zce Tax Division
' PLAINTIFF'S ;
= EXHIBIT -
� - t� �:r
� �
,� �
.m
���VyBureau of Individual Taxes � PO Box1280601 { Narrisburg, PA 17128'� 717J83.5824 � shabaker@pa.gov