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Jan M. Wiley
David J. Lenox
THE WILEY GROUP
Attorneys at Law
March 12, 2010
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
In Re: Estate of James P. Burgess, Jr., deceased
File Number 21-09-00629
Dear Register:
Enclosed for filing please find an Inventory and the inheritance tax return in duplicate with
regard to the above captioned estate. Also enclosed is a check in the amount of $102.38
representing the tax due, and a check in the amount of $30.00 representing the filing fee.
Please return the recording receipts to my attention in the enclosed envelope.
Thank you for your cooperation.
Sincerely,
Dawn Gladfelter/Legal Assistant
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130 W. Church Street, Suite 101 Dillsburg, PA 17019 Phone: (717) 432-9666 ~ (800) 682-4250 • Fax: (717) 432-0426
INVENTORY
REGISTER OF WILLS OF
COMMONWEALTH OF PENNSYLVANIA } SS
couNTY OF Cumberland }
James P. Burgess III
CUMBERLAND COUNTY, PENNSYLVANIA
File Number 21-09-00629
Personal Representative(s) of the Estate of James P. Burgess Jr.
deceased, depose(s) and say(s).that the items appearing in the following inventory include all of the personal assets wherever
situate and all of the real estate In the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each
item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate
outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. ~,,,,
I veri that the statements made in this Inven- /~~j_~ ~ ~,~ ~~ ~
tory are true and correct. I understand that false state- -~~ - -- - ~ ~ _ ~ s ` I
,,
James P. Bur ess III , ,
ments herein are made subject to the penalties of 9 ~ C? ~ t. ' ~'
18 Pa.C.S. 4904 relatin to unsworn falsification to _ _ _ _ _ ____ ~l `c=;~_rn______--- ~ ` :.i
authontles. :.. ~:..~-~ ~ ~ ~ ~ :~_
ti""' C.... ~ ___ :'._"3
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Attorney -- (Name) David J. Lenox (Supreme Courf~l.D. No.) 078
(Firm)
(Address)
(Telephone)
The Wiley Group, PC
130 W. Church Street, Dillsburg, PA 17019
717-432-9666
DATE OF DEATH LAST RESIDENCE $24 Lisburn Rd., Apt. 513 DECEDENT'S SOC. SEC. NO.
06/25/2009 Camp Hill, PA 17011 048-09-2780
FIGURES MUST BE TOTALED
Personal Property
Cash ...............................................................................................
Personal Property .........................................................................
Stocks/Listed .................................................................................
Stocks/Closely Held ......................................................................
Bonds .............................................................................................
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable ...............................................
All Other Property .........................................................................
Total Personal Property .........................................
Total Real Property ................................................
Total Personal and Real Property .........................
782,714.97
782,714.97
782,714.97
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each
item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b))
Form RW-09 Rey. ~o-~s-loos
INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland } File Number 21-09-00629
DATE OF DEATH LAST RESIDENCE $24 Lisburn Rd., Apt. 513 DECEDENTS SOC. SEC. NO.
06/25/2009 Camp Hill, PA 17011 048-09-2780
Verizon (refund):
Woods at Cedar Run (refund):
Total Cash
1
2,095.70
782,714.97
-2-
INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland } SS File Number 21-09-00629
__
DATE OF DEATH LAST RESIDENCE g24 Lisburn Rd., Apt. 513 DECEDENT'S SOC. SEC. NO.
06/25/2009 Camp Hill, PA 17011 048-09-2780
Cash
1st National Bank of Marysville CD#3066597: 40,068.73
Cash found: 652.00
Department of Commerce Account #5678300: 100,281.03
Household Goods: 250.00
Juniata Valley Bank Account #43-259680-7: 92,484.31
M&T Bank CD#31003913916060: 101,759.43
M&T Bank Checking Account #9843064859: 21,869.66
Members 1st FCU CD#253911-41: 100,274.19
Members 1st FCU Savings Account #253911-00: 25.00
MidPenn CD#3090002259: 100,227.84
Patriot News (refund): 113.10
Sovereign Bank Checking Account #2331046921: 32,283.75
Susquehanna Bank CD#335162941: 40,058.95
Susquehanna Valley FCU Share savings account aand share certificate: 50,139.59
Tower Bank Time Deposit #3000034924: 100,116.44
(Attach additional sheets if necessary) Total Personal Property and Real Estate 782,714.97