HomeMy WebLinkAbout01-07-86
v
/O-ISS- g
~
~~
A.EV.15(jQ.EX+ (B-831 ~
.7' INHERITANCE TAX RETURN
,. COMMONWEALTH OF PENNSYlVANIA RESIDENT DECEDENT
DEPARTMENT OF REVENUE (TO BE FilED IN DUPLICATE
BUREAU Of EXAMINATION FILE NUMBER 21-78-0209
P.O. BOX 8327 WITH REGISTER OF WillS)
HARRISBURG, PA 17105
.. DECEDENT'S NAME (LA:~T, FIRST, AND MIDDLE INITIA4 DECEDENT'S ADDRESS
Z
... Roland, Robert W. 607 Magaro Road
0
... SOCIAL SECURITY NUMSER DATE qF DEATH Enola, Pa. 17025
v
... 186-30-5556 April 6, 1978 Cumberland
0 CoUlltv
~ 01. Original Return j(] 2. Supplemental Return 03. Remainder Return
..'" '"
A. .. 04. D AD. Future Interest Compromise ll5.
~O~u life Estate Federal Estate Tax
%",<(0 Return Required
vA. ...
A. III 06. Decedent died testate D 7. Decedent maintained a living trust _8. Total N umber of safe deposit boxes
<( (Attach coPY of Will] (Attach copy 01 trust)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
.. NAME ADDRESS .
J.Z
...... The Commonwealth National Bank, Administr tor P. O. Box 1010
",0
"'z TELEPHONE NUMBER
00
VA. 717 -5641:,9500 Harrisburg Pa. 17108
CITY STATE ZIP
1. Real Estate (Schedule A) (1) ,
2. Stacks and Bands (Schedule B) ( 2)
3. Closely Held Stack/Partnership Interest (Schedule q ( 3)
4. Mortgages and Nates Receivable (Schedule DI ( 41
5. Cashi, Bank Deposits & Miscellaneous Personal Praperty( 5) 179,592.11
z (Sc edule E) .
0 .
;:: 6. Jointly Owned Property (Schedule F] ( 6)
:S
::l 7. Translers (Schedule G] (Schedule l) (7)
..
;: 8. Total Grass Assets (total lines 1-7) ( 8) 179,592.11
<(
v 9. Funeral Expenses,. Administrative Cosls, Miscellaneous ( 9) ip7.~~~.4R
...
'" Expenses (Schedule H) . . .
10. .Debts, Mortgage Uabilitie.. liens (Schedule I) (10]
11. Total Deductions (total lines 9& 10] Ill] 187 , 53~.48
12. Net Value 01 Estate (line 8 minus line 111 112] 0.00
13. Charitable and Governmental Bequests (Schedule J] (13] U.UU
1 A. Net Value subject to lox (line 12 minus line 13) (14]
15. Amounl of line 14 laxable at 6% rate (15] X .06=
(include values .from Schedule K or Schedule M)
16. Amount of line 14 taxable at 15% rate (16) x .15 =
(include values from Schedule K or Schedule M) 0.00
Z 17. Principal lax due (add .tax from Iirie 15 plus tax from line 16) (17)
0
;:: 18. Total Prior poyme~ts: Amount Paid Discount Interest
c(
.. - (18)
::l +
A.
::e 19. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT. (19) 0.00
0 A. DCheck here if you ore requesting a refund of your overpayment.
V
>< 20. If line 17 is greater than line 18, enter Ihe difference on line 20. This is the BALANCE DUE. (20) 0.00
~
A. Enter the interest on the balance due on line 20A. (20A)
8. Enter the total of line 20 and 20A on line 208. (208)
Make Check Payable to: Regllter of Willi, Agent
.~
.....BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH....
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, correp. and complete. I declare that all real estate has been reported at tru, market yolue'fe~ara~ion of preparer other than the personal representative is
based on olVi for") li"nof...ww~ ichpreparerhasanyknowledge. Commonwealtn Natlona tsanK .
B: 'r77...A4i Vice President & Tax Mana er I. 7. f>G
SIGNATU [, EROON RESP!5NS18L FILING RETURN ADDRESS DATE
~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
DATE
.
Jl[V.15OI fX+ ,".811
~'
CO"lMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
~ Robert W. Roland
SCHEDULE "E"
CASH AND MISCELLANEOUS
PERSONAL PROPERTY
FILE NUMBER
21-78-0209
(All property jointlv-owned with the Riqht of Survivorshio must be disclosed on Schedule "F")
ITEM.
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
1.
Present value of amount received by virtue of survival
by order. of the Court of Common Pleas, Dauphin County,
Pennsylvania in April. 1984
action
. .
.-.~;,-~~~:'':":-.::...:~<?,'..-~--:-:
"~F~"~:-;.,:.: ....:\"-;.,::.
-"(1...-...........
Total amount received
Prime rate first quarter 1978 8.25%
....fr-eSei'll> va 1 ue factor at 8.25%
. $294,~24.00
.61060
179,592.11
-'"
"
.;,t
~",
d
TOTAL {Also enter on line 5, Rec<lpitulationl
s
179,592.11
~
(If mot. space is needed insert additional sheets of same size)
"
~
<\
:;i
i
"
.'
:~
CONMONWEALTH NATIONAL BANK,
ADMINISTRATOR OF THE ESTATE
OF ROBERT W. ROLAND, SR.,
Plaintiff
:
IN THE COURT OF Cm'H-toN PLEAS
DAUPHIN COUNTY, PENNSYLVANIA
:
:
:
NO. 2968 - S - 1978
:
v.
:
IN TRESPASS
:
.,
HERSHEY FOODS CORPORATION,
Defendant
:
:
ORDER
,
AND NOI'I, this
C-..'S'
day of
~
, 1984, upon
consideration of the foregoing Petition,
~:
IT IS HEREBY ORDERED AND DECREED:
.."-,
,I. The settlement and compromis~ of the action of
Commonl-lealth National Bank, Administrator of' the Estate of Robert
:/r
w. Roland, Sr., deceased, instituted under and by virtue of the
"Survival Act" of the Commbnwealth of pennsylvania for the sum of
Two Hundred Ninety~Four Thousand One Hundred Twenty-Four
($294,124.00) Dollars, is hereby approved as fair and reasonable.
2. The settlement and compromise of the action of
Commomwalth National Bank, Administrator of the 'Estate of Robert
W. Roland, Sr., deceased, instituted under and by virtue of the
"\'Irong[ul 'Death Act" of the Commonwealth of pennsylvani.:J. on behalf
of Hob0rt vI. Roland, Jr., Christina I\nn Roland and David Roland for
the sum of One Hundre:d Eighty Thousand '1'1-10 Hundred Seventy
($180,270.00) Dollars, is hereby approved as fair and equitable.
3. The attorneys' fees of Cleckner and ~earen and Knupp
c- CLtC",'"" ''''!W!d Andt-el-Is, in thc sum of THO lIundccd ~'orty-Six Thousanrl
"HOAIIE,.:: AT u..v
H..<illl:i3UnG. J'[1<t"~'-(I.VASI'"
-..
',.
, "'
""
'"
.
($246,000.00) Doll~rs are approved as fair and equitable.
.
4. Distribution in accordance with the "Structured
Settlement" attached hereto and marked Exhibit "A" is hereby
directed as follows:
(",,-
\..:
(al Commonwealth National Bank
repayment of loan
$ 22,000.00
(b) Cleckner and Fear~n costs
advanced and'interest
3,560;20
~ c)
~,:.or.\
.'.--
Knupp and Andrews - costs
advanced and' interest
,2,824.61
(d)
Charles Roland - repayment of loan
2,500.00
-::'"',
(e) 'Commomlealth National Bank -
Administrator and Guardian fees
28,250.00'
(f) Cleckner and Fearen, Knupp and
Andrews - attorneys' fees
'246,000.00
(9) Reserve for costs
5,259.19
(h) Commonwealth National Bank -
Guardian of the, Estate of
Christine Ann Roland, a minor
12,000.00
{il Commonwealth National Bank -
Guardian of the Estate of David
George Roland, a minor.
12,000.00
(j) Robert W. Roland, Jr.
12,000.00
Total Cash Disbursement
$346,39'1.00
5. I~ addition to the distribution set forth in Paragraph
4 hereof the other pr.ovisions of the "Structure0 Settlem2nt",
'\.:
marked Exhibit "A" are approved and payment thereof shall be made
as follows:
CL~CKtl'S:R a FEAf'lEIl
.lIlOil!l5:l!O loT LAW
':;.",.ll~:l\J;tC. PErlJi~n\'~:a"
~
.. ".--~ -.; ~'-':':;""-'-''''''~~\'::'.'.~:.~
.
"
"
i
:~r
"
CLEClCtlC:R 6- FEAREr:
AnOp.~tTS AT Ll'.Y
",,";USIIU;:tG, P\:t.KSYl'...u;l"
:~
A. Monthly Payments
(II Commencing 45 days from the date of the
"Structured Settlem'ent" to Robert W. Roland, Jr. or his
estate Seventy-Two (72) monthly payments in the amount of
$375.50.
(2) Commencing 45 days from the date of the
"Structured Settlement" to Commonwealth National Bank,
Guardian of Christine Ann Roland during her minority and
;..
then to Christine Ann Roland or her estate Eighty-Four
(84) monthly payments in the amount of $339.20.
(3) Commencing at age 19 to David George Roland
or his estate Eighty-Four (84) monthly payments in the
amount of $426.67.
B. Lump Sum Payments
(1) Each child or their respective estate shall
receive the sum of, $20,000.00 during their respective
26th year of life on the anniversary date of the annuities
to be purchased in accordance with the terms of the
"Structured settlement" attached heretoj marked Exhibit
"A" and made a part hereof.
(2) Each child or their respective estate shall
receive the sum of ($100,000.00) during their respective
35th year of life on the anniversary date of the
annunities to he purchased in accordance with the terms of
the "Structured Settlement" attached hereto, marked
Exhibit l'Al1 and made a part l)ercof~
'-,-' ,",
," '. u
,
-~-""'';'~ ~-,-:""'-'.<.- - ;-,....
;",
'"
.
)
6. Upon payment of the sums set forth herein and the
payments to be made in accordance with the .Structured Settlement"
marked Exhibit "A", attached hereto and made a part hereof, the
Commonwealth National Bank, Administrator of the Estate of Robert
".
,-
\~. Roland, Sr., deceased, is hereby directed to discontinue the
action brought on behalf of said Estate and on behalf of the next
"""~
"."'
of kin of Robert W. Roland, Sr., deceased, and the release of all
claims of whatsoever kind or nature of the Estate of Robert W.
Roland, Sr., deceased, and his next of kin, against Hershey Foods
Corporation, and all other persons, firms or corporations, arising
by reason of or as a result of theinjuries to and the death of
Robert \~. Roland, Sr., deceased as set forth in the "s tructured
~~
Settlement" is approved.
7. Payment of the aforesaid sums and compliance with the
terms and conditions of the "Structured Settlement" marked Exhibit
"A", attached hereto and made apart hereof, will constitute
conclusive evidence of complete satisfaction of all claims and
demands of whatsoever kind or nature of the Estate of Robert W.
Roland, Sr., deceased, and his next of" kin against Hershey Foods
Corporatidn, and all other persons, firms or corporations arising
from or as the result of injuries and the death of Robert W.
Roland, Sr., deceased, from the accident described in the foregoing
Petition.
BY THE COURT,
Ct:T~::I~~~~&~:(~:~~r:4 t\w ~~ d-.5"- 19~.
. . ..~.;x:. ~,,~t the fo-ep'ol.nO'
H"III1IS~t.;II~."[U';Sy'l"':!1Greoy eel. l.~I.v 1..~.J..":' l..:: 'f~f\ _ .
is ~ true ~nd correct copy of the ~~~~"~~
origin,"-l filed.
~;t 0A. .jG-.,~^'
g Prothonotary
(
\\\ ~J\..J\..\.;LQY]
J.
.~
.
COi':"'IOI'I~.:EAL TfI NATIONAL IlMlK,
Administrator of the Estate
of ROBERT W. ROLAND, SR.,
. Plaintiff
HI THE COURT OF COi.jf,!ON PLEAS
DAUPHIN COUNTY, PENNSYLVAlIIA
.,
:
NO. 2968 S 1978
. IN TRESPASS
v.
HERSHEY FOODS CORPORATION,
Defendant
JURY TRIAL DEMANDED
GENERA( RELEASE AND STRUCTURED SETTLEMENT AGREEMENT
KNml ALL HEN BY TIIESE PRESENTS , THAT:
WHEREAS, Commonwealth National Bank is the Administrator of the Estate of
Robert H. Roland, Sr.,' by virtue. of Letters of Administration iSslledby the
Register of Wills of Cumberland County, Penrsylvania, on April 20, 197B~ and
~/HEREAS, Robert \~. Roland, Sr., ~Iho resided at 607 r.lagaro Road, Enola,
Cumberland County, Pennsylvania 17025, died on April 6, 1978; and
WHEREAS, o~ April 6, 1978, Robert W. Roland, Sr., was employed by General
'Electric Services Company, Inc., to perform certain electrical installation work
at Hershey Foods COl"poration, Hershey, Dauphin County, Pennsylvania; and
HHEREAS, on April 6,'1978, Robert H. Roland, Sr., (hereinafter refer'red to
as I1Rolun~r') \'-/as performing \':ork in prcAimity to a fully automated pallet~e
elevator knovlIl as Alvey Elevator No. 37 \.,hich, after he sat on the outer
, carriage of said elevator, a photoelectric :ell actjv~ted said elevator carriage
and transported Roland into the elevator shaft, and thereafter said elevator
rose in the shaft and Roland was caused to be struck in the bac~ of the head by
a beam at the top of the shaft, resulting in his death; and
WIERU,S, a COi,'plaint \'/a5 filed to the above Tel"m and rlo. on behalf of
Robert H. Roland, 51"., by Commol1\-fcalth National Bank, Adr;linistrator of the
~~:::.~~;.}::~::~~~:.:..-:";:':~:-'T7.1',~fl?'?~..~..)-..~,~~~::~;~:::-=:.....~ ~ ;~~~~7":2~~~~~"I~-::!':"~;1m:"".~~~-.;:.;~-:~.::;:~~:S':r?~~:"!.-:.":."'1':::""'.~~~~:;~V'-;~:~-;::::ir~:~0.;'~~~-::"
;~~
",.- ,"
,
~
>
.
Estute of Robert W.
Roland, Sr. on behulf. of the Estate of Robert W.
Roland, Sr., and those persons entitled to recovery by virtue of the Hrongful
Deu th Act of the Commom,ea lth of Pennsyl vani a, in wh ieh it HuS alleged that
Defendant, Hershey Foods Corporation, ~Ias legally liable for. the injuries
suffered by Robert !-I. Roland, Sr., and the death of Robert H. Roland, Sr.,
which liability was denied by said Defendant; .and
WHEREAS, the persons entitled to recover damages under the Wrongful Death
Act of the Corr.'11om'/ealth of Pennsylvania lvere and are Robert W. Roland, Jr., son,
of 607 Magaro Road, Enola, Cumberland County, Penn~ylvania, born on June 5,
1954, Christine Ann Roland, daughter, of 607 f1agaroRoad, Enola, Cumberland
County, Pennsylvania, born on May 20, 1955, and David George Roland, son, of
.607 r-tagaro Road, Enola, Cumberland County, Pennsylvaniu, born on October 1,
1957; and
WHEREAS, Plaintiff alleged in its Complaint that the Defendant was
"
.,
negligent as specified in the Complaint filed to the. above Ter'm and No., and
after a trial before the Court and jury in the Court of Common Pleus of Dauphin
County, Pennsylvania, resulting in a verdict against Defendant and in favor of
Plaintiffs, and afte)" denial of all post-trial Notions filed on behalf of
Defendant, a judgment \'/as entered against Defendant in the amount of
$502,954.05; and
WIIEREAS,. an appeal from the judgment entel"ed by the Court of COElmon Pleas
of Dau~hin C.ounty on Hal'ch 10, 1983, ~/as filed to the Superior Court of
Pennsylvania; and
WHEREAS, the partiiCs have agreed to compromise all claims made by the
Estate of Robert W. Roland, Sr., and on behalf of those legally iCntitled to
-2-
.?f:-:::~:':': ;;:.:..::.~T~.-::.l~~:::",:,,_,,~::= .:-.S~;~:~7:~:'r:'~~7'~~~:z.:.>~.:~.:S?'",~"T::~:::::!:~~~...~':.z?~.~~~::?;:.:.~- ~',~--;~::~~'.-:;~~_::::~~-r.~,t,-rr:'-:~"~"":.":~:~'~~>"'!;:~~~
"":';
L
.~
.
recover damages for I'Irongful death,' and all other persons entitled by laH to
recover damages as a result of the injuries to and death of Robert W.
:I, Roland, Sr., in \'Ihich event, Commom,ealth National Bank, Administrator of the
Estate of Robert ~1. Roland, Sr., will discontinue, upon proper approval of the
Court of Common Pleas of Dauphin County, the aforesaid action in consideration
,'of the present and futul"e payr.:ents. set forth herein to be made by Defendant or
designees on' behalf of Defendant, and mark satisfied the judgment entered
therein, and Defendant \~ill ~Iithdraw its' appeal to the Superior Court of
Pennsylvania.
;~
Nm[ THEREFORE, in consideration of the mutual promises, considerations and
guarantees ~ade by Defendant and in consideration of the future guarantees made
by Americ2n Home Assurance Company Commom'/ealth. National Bank, Administrato)"
of the Estate of Rob2rt H. Roland, Sr., realizing that. thel"e is doubt 'and
uncertainty as to the liability of Hershey Foods Corporation as to th~ liability
~
of Def-cndant for the injuries to and death of Robert H. Roland, Sr., does
release ~.nd by these presents does for itself, its heirs, executors,
.
administrators,
successors
and
assigns,. for
the
heirs,
executors,
administrators, successors and assigns of Robert ~1.
Rol and,. Sr., deceased,
release, acquit
and forever di scharge
. .
Hershey Foods Corporation, its heirs,
offi cers, representat i ves, employees, insurers, executors, successo:-s and
assigns, and all other persons, firms or corporations from any and all actions,
causc.s of action, claims, damages, dcr.:ands of ~'/hutsoever kind or nature arising
out of or ever to arise out. of the injuries to and death of Robert W.
Roland, Sr., and in consideration of the above, the Defendant, by and through
its insurer, American Home Assurance Company agrees to pay the following sums
as a full and complete settlement of all claims against Hershey Foods
-3-
.~
, ;._:""~,::~""~..;oo.~~'""_!""",:_"-",,.,,-,,,-___,, OL'_O_.;._ .'.
~
Cor~oration, including specifically all claims under the Hron~ful Death and
Survival Acts of the Commomlealth of Pennsylvania to pay the following sums:
.)5
1. lump sum payments \1ithin forty-five (45) days .of the, date of the
execution of this Agreement as follo\1s:
a. To Robert W. Roland, Jr.
$
12,000.00,
b. To Commonwealth National Bank, gUilrdiiln
of the Estilte of Christine Ann Roland
12,000.00,
c. T~ Cbmmonwealth National Bank, guardian
of the Estate of David George Roland
12,000.00
",
'.
.2. lump sum payments as follows:
a. To Robert W. Roland, Jr., during his
26th y~ar of life on the anniversary
date of the annuity to be purchased
, in accordance \;ith the terms of this
agreement
and
during hi's 35th year of life on the
anniversary date of the annuity to be
,purchased in accordance with the terms
of this agreement
y.
$
20,000.00
100,000.00
b. To Christine Ann Roland, during her
26th yeilr of life on the anniversary
date of the annuity to be purchased
in accordance with the terms of this
agreerr;ent
and
during her'35th year of life Dn the
anniversary date of the annuity to be
purch?~ed -in accordance with the terms ."
of this agreement
c. To Oavid George Roland, during his
26th year of life on the anniversary
date of the annuity to be pUl'chased
in accordance with the terms of this
agreement
and
during his 35th year of life on the
anniversary date of the annuity to be
purchased in <lccol'dance Ilith the tel'ms
of this agreement
20,000.00
100,000.00
20,000.00
loa,OOO.Oo
-4-
" ,.,."" "->?,:::-,,-~,,:;;-:;,,,,~:.",-.,>,. ,~"s'';'''T--''<''''H'''''''''~'7''?f-~",c::,,,,=-,-,''''''~':''.:'-'';''''"_,,,~~f~'',.':;:;.;~~~7;:'~;:~I""'~~:~)zr:r'~~
f
.
3. Monthly payments in accordance with the following schedule:
a. Seventy-two (72) monthly payments in the amount of $375.50 to
Robert l( Roland, Jr., commencing \~itflin forty-five (45) days from the date
of the execution of this Release.
b.
Ei ghty-four (84) monthly payments in the amount of $339.20
commencing \'Iithin forty-five (45) days of the date of this Release to the
Commonwealth,National Bank, guardian of the, Estate of Christine Ann Roland,
during her minority and then to Christine Ann Roland thereafter.
c.Eighty-four (84) monthly payments in the amount of $426.67 each to
David George Roland commencing at age 19.
,';
4.
The _ follOl'ling additional sums are "to' be paid within ,forty-five (45) _-
- '. . - .,-- . --.. . .
days of the execution of this Release on account of fees and costs incurred by 'I
Plaintiff and in settlement of all claims as aforesaid:
.1;) a. Commomlea lth Nati ana 1 Bank, Administrator
of the Estate of Robert W. Roland, Sr. --
loan repayment $ 22,000.00
b. Richard Cleckner, Esquire - costs
advanced and interest 3,560.20
c. Robert Knupp, Esqui re - costs
advanced and interest 2,824.61
d. Charles Roland - repayment of loan 2,SOQOO
e. Commonwealth National Bank, Administra-
tion 'and guardianship fees 28,250.00
f. Cleckner and Fearen, Knupp and Andt'e~ls;
and Jc I'orne T. Foster - attorneys fees 246,000.00
g. Reserve for costs 5,259.19
-5-
5"
,,-.. .-:. .' - ''', ~...,.-=.~.. --.......---~...~""~_. _ .. :....~....;:;-~ ",;,,".::. ~,,?,-:,,:,: :r<.".:"h', ~.;~"
'-.~.~:;:-..,,:,,:~-:~..:~.-.,..:-~= .. .-._'-~~....,."
.'~
f:
IT IS UNDERSTOOD AND AGREED that al1 future payments are gual"anteed and
will be paid monthly or as they become othen:Jise due, pursuant to the terms of
~
"
this Agreement" to the Estates of Robert ~L Roland, Jr.,' Christine Ann Roland'
and/or David George Roland, in the event of any of their deaths, until the full
payments set forth in this agreement have been completed.
IT IS SPECIFICALLY UNDERSTOOD AND AGREED that this Agreement constitutes a
full and 'complete release of any and al1 claims of Commom1ealth National Bank"
Administrator of the Estate of Robert W. Roland, Sr., and of the heirs and
assigns of Robert H. Roland, Sr., against Defendants and al1 other persons,
.'
firms, insurers and corporations for all claims arising out of the injuries to
and death of Robert W.
Roland, Sr.,. this agreement constituting, the ful1
agreement between the parties hereto.
IT IS FURTHER AGREED that as the method for securi ng payment of all per'j od
payments' set forth above, Defendant, by the American Home Assurance Company
'co \1i 11 purchase an annuity contract or contracts with Robert W. Roland, J:r.,
Commomieal th National Bank, guardian of the Estate of Christine Ann Roland,
Christine Ann Roland, Commoni'iealth National Bank" guardian of the Estate of
Davi~ George Roland and David George Roland, as the beneficiaries, and with the
. ~~er~:an Home Assurance Com~any
as the owner of sa i d annui ty contract or
contracts. In no event, hOl'/ever, shall the o\.mer of said annuity contract or
contl"acts have the power or authority to change the beneficial"ies mentioned
above, nm' shal1 any such o',mer have the author,ity to alter the other terms of
. thi s agreement. Payments made pursuant to sa i d annui ty contract shall oper'a te
as a pro tanto discharge of the periodic payment obligations' set forth herein.
-6-
i~.'~':~~:~~~:~'?'~'=~:~".~'f1~::~~T7~':.~.:":.:.~.:3.r=.~:..~~:~~:;:m-::::~.:-::f~:;;?~_"~--:'..~~.? .~},r:;~~~~-:~':::::~~.~:'..::.:~t:?~::::l'~:~:-':r:;",~~\:~:7~~:.f::~
.., .
" ,
.
.
IT IS FURTHER AGr~ED that the Defendant is not legally liable for any
:}
obligation assumed herein, all liability being assu~ed by the American Home
Assurance Company" and it is further agreed that no other person, firm or
corporation, other than the A~erican Home Assurance Company is so liable, b~t
that Defendant, Hershey Foods Corporation, its heirs, executors, administr:ators"
successors and assigns, is fully and completely released from any action, causes
of action, damages and demand of "hatsoever kind or nature arising 'out of the
,
injuries to and death of Robert I,. Roland, 'Sr. In the event of 'any default by
the A~erican Ho!ae Assurance Company under the terms of this agreement, all
'rights are reserved herein to proceed under the terms of this agreemant against
. ~.
the American Home Assurance Company and no one else.
This General Release and Structured Settlement Agreement is dratYU, prepared
"
and executed ill accordance "ith the Order ,of the Court of Comraon Pleas of
Dauphin County, Pennsylvania" d2ted~, 1984. It is agreed that upon
execution of thi!; Release, that Plaintiff "ill mark satisfied the judgment
recorded against Defendant herein in the Court of Common Pleas ,of Dauphin County,
and Defcncl'lllt will l<itndraw its appeal filed to the Superior Court of Pennsylvania.
HlTNESS nlE DUE EXECUTION TrlEREOF:
/ .... ATTEST:, ,
't~~~'~,' '_<-jo~~'
v J' -77 -r;! 1_ /It:&.u..,...
,~L (/" 1.-UI LcH
I 'I \ \
ATTEST/'- ~
';%
"',:~~;:;-!.{.;y.... ~~;>-~~
'Sccretnry r r ~\GC ~ . ~~(.......)';":':.l:.ar.x.
cmlHONHEiV.TH NATIONtf BA.",:;,! ,
~~~f:l!.1J ,~
By _ 'f ' ,,,,,.)i.rprr-'25IJi'd'J /ri"sTJI
A~~ listrator of' the' ~s tate:' of .
RQ.boert H. RoLmd 51'.
..
AHERI;:C;u.; 1,181"1' A,5S\;1:.,<\Il"C, E CO;lPM1Y
, ,-, /'0'"
h L' //"/1
' ."".?/h P
By :~ ".. r::,~~,,'<~:_/2i7::-"::=:; ~, . :~.r:. ~;7'~::r'~t--.--
p.:te:s~(G2n t o'r /':ri'c.Q (lh:_~sidcn t
--::'li '-..; , I//~
.'. "
,
~<
,
-7-
" '.
';.:
,\
,
~
."::':!;::"::=:--..'~l:::-~'.~'!.'.r::-"""",''-'''__''''-__''~ ...".,--~,.,........__~--=:J...=-.:t.::C'~;..:~~.~-
....._-.--._.&.C'"<-.._...~-...~~~:>o.-_
.
'~~j
,~ -
.
.
CONS EN, A~D JOINDER
;~
Robert N. Roland, Jr., one of the "intestate heirs of
Robert W. Roland, Sr., deceased, being nineteen (19) years of age,
does hereby consent to and join in the prayer set forth in the
'C":;.
attached petition for Approval of Compromise Settlement.
\HTNESS:
"'''',
)
1 () A~ J
AJ 3- ~V~
,
- -
//};' ", f-d' ~ /) (1 vAYh
;j( i 'i, f;r/,/ 'j_
!/( ,,-€,,-, t" 1\0- <1 111 ..
ROBERT \-1. ROLAND, JR. {!
I _
,
Tt
"
:'ti.!
<'
Cll;:CKtIER ~ J[.\!l.<:tI
ATT':I;t:1(f5#..TlJ,',,;
l':"'l~Lau~c.. ,t"P,!';H.\:'~IA
Ex~.-n:B:,}.' IIn"
11
. .;-...;:':.~;.: ~" .
. - . -.-<"" ," .~". - ..;'...... .""'-" "''-~~ ";'€:'i"?! .-r..._~~j;:...,:,7:.~.;;-. ;.~-''::':';':;
-----.-
.'
'f
.
CONSENT AND JOINDER
)
Commonwealth National Bank, as Court appointed Guardian of
Christine Ann Roland and David George Roland, intestate heirs of
Robert W. Roland, Sr., deceased, does hereby consent to and join
in the prayer set forth in the attached petition for Approval of
Compromise Se.ttlement.
COMMONWEALTH NATIONAL BANK
By
/C)J
I//Cl:" Res i /1'11.51- fl!t;r
)
/
J
CLECKUER Q n::ARErI
AUOIlf:US AT UW
HIt.'1~IS8t1Rc.. rUH,;S1LV,l~.I'"
EXHIBIT "c"
~9
.
,y;
.
CON~ENT AND JOINDER
-:3
Christine Ann Roland, one of the intestate heirs of Robert
W. Roland, Sr., deceased, being seventeen (17) years of age, does
hereby consent to and join in the prayer set forth iri the attached
;~;
petition for Approval of Compro~ise Settlement.
\VITNESS:
.1a~ ;[);fjA ~~"--
C .Po >-1 I' "'+, ~ Q n m rYlRoQn111LL
CHRISTINE ANN ROLAND
~~;1
u
,
CI.EC~tl!::R &; HARErt
AnOlOtIOS.1It LA~
Ill~;>I:iBURC. PE"HSn.Vol.tllA
(!-o
EXF~3IT "DII
.",
~;i"
......_ ,"..0"
.- ,._<......,.-........--~~~~.......""-:.,-".-
~.
.r
.
CONSENT AND JOINDER
-:~
David George Roland, one of the intestate heirs of Robert
W. Roland, Sr., deceased, being sixteen (16) years of age, does
hereby consent to and join in the prayer set forth in the attached
petition for, Approval of Compromise Settlement.
\-lITNESS:
1'1A/ J- fD,a/l~'-t"5'---
'Di\:''''-~'~ <?:~\
DAVID GEORGE ROLAND
;;.-
T~
CLECI(:lER a rEAPEtl
""O~~EY:O AY l~W
,.-.ft"~llS.BUR", rUil'ls.r,-v~:.:"
EXHIRIT "E"
~~
.REV-l!5"11 EX+ (7-83)
:::
'.
"
<40MMONWEAL TH OF PENNSYlVANIA
. INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert W. Roland
.,:~
SCHEDULE "H"
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Page 1 of 2
FILE NUMBER
21-78-0209
ITEM
NUMBER
A.
"''':' 1.
.,
B.
,,-
~~
. 4.
-
C.
1.
2.
3.
~'..
~ ...
,,~-
DESCRIPTION
AMOU~IT
Funeral Expenses:
,~
Administrative Costs:
1.
Personal Representative Commissions Commonwea 1 th Na t i ona 1 Bank
Social Security Number of Persopal Representative:
Year Commissions paid 198/1
16,080,32 *
2.
Attorney Fees Knupp & Andrews
Cleckner & Fearen
Family Exemption
Claimant
Address of Claimant at decedent's death
75,103.00*
. 75,103.00*.
3.
Relationship
Pro bate Fees
Miscellaneous Expenses:
George Geiger Reporting Service - record deposition
598.49 *
10.60
12.00
6.00
37.82
6,593.70 *
6,062.96 *
22.00
3,491.84 *
- 804.47
*
,
$ Conti need
Ray's Sporting Goods - appraisal
Register of Wills
filing costs
short certificates
4. Oavid Carr Agency - liability insurance
5.
Sil C. Bozzacco - expense of litigation
6. Investigative Consultant Services, Inc. - services
7. Commonwealth National Bank - reimburse filing fees
8.
Commonwealth National Bank - interest on loan for litigation
9. Charles Roland ~ interest on Estate loan
a>
TOTAL (Also enter on line 9. Recapitulation)
(If more space i. needed insert IIddltlonalaheets of same size)
i'
REV-151l EX+ (7-83)
;f
CQMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert W. Roland
SCHEDULE "H"
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Page 2 of 2
ITEM
NUMBER
A.
1.
B.
1.
FILE NUMBER
21-78-0209
DESCRIPTION
Funeral Expenses:
Administrative Costs:
Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions peid
.':i
2. Attorney Fees
3.
4.
C.
10.
II.
12.
13.
14.
15.
16.
17.
18.
19.
rt)
Family Exemption
Claimant
Address of Claimant at decedent's death
Relationship
Probate Fees
Miscellaneous Expenses:
Knupp & Andrews - reimbursement for interest on funds advanced
Cleckner and Fearen - reimbursement for interest on funds advance
Conrad S1egel -. statement
Prothonotary
Harrisburg Blue Print
John Marchi, M. A., Inc.
Copying and postage
James Stanley - consultation
Various witness fees
Closing costs
AMOUNT
309.99 *
310.00 *
861.BO *
50.~;3 *
65.72*
607.90 *
166.~i2*
237.00 *
749.82 *
250.00
-
TOTAL (Also enter on line 9. Recapitulation)
$ 187,535. ~,8
(If more Ipace i. needed inlert additional Iheets of same lize)
*SeeAttached Schedule
.I'
.
'.'
Supplement to Inheritance Tax Return
Robert W. Roland Estate
21-78-0209
Schedule H
All amounts marked with an asterisk (*) are 62% of the total amount paid.
They are expenses incurred with regard to litigation within the estate. Since
only 62% of the award is includible in the gross estate as Survival Attion,
'only 62% of the ,expenses have been deducted.
The entire amount of the Attorneys' Fees is as a result of the litigation.
The attorneys have chosen to waive the fee due to them on Probate Assets.
.~) REII.1513 EX'+- (9-81)
. C~MONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
,,,
., Robert W. Roland
SCHEDULE "J"
BENEFICIARIES
FILE NUMBER
21-7il-O?OQ
c'
ITEM
NUMBER NAME AND AD[)RESS OF BENEFICIARY RELATIONSHIp. AMOUNT
A. T axabl e Bequests:
1. Robert W. Roland, Jr. Son 1/3 of Residue
607 Magaro Road
Enola, PA 17025
2. Christina A. Roland Daughter 1/3 of Residue
607 Magaro Road
Enola, PA 17025
3. David G. Roland Son 1/3 of Residue
I 607 Magaro Road
Enola, PA 17025 .
,~,~
r~
,,>
~!~
I..
q.;
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUI\IT
(:.
B. Charitable Bequests:
1.
c
('."f:.
',,-;.
f;.~
TOTAL CHARITABLE BEQUESTS (Also enter on line 13, Recapitulation)
$
(If more spece 't needed Insert additional th88t1 of same size)