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Home My WebLink About03-15-10 (3)-~ 15D56D7120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO 60X.280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 - RESIDENT DECEDENT 2 1 0 9 0 0 6 2 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 048 09 2780 06 25 2009 03 15 1920 Decedent's Last Name Suffix Decedent's First Name MI BURGESS JR. JAMES p (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS --, ~X ~ 1. Original Retum _ ! _ Ji 2. Supplemental Return _ ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate C--~ qa_ Future Interest Compromise (date of death after 12-12-82) ~ ~ ~_ ; 5. Federal Estate Tax Retum Required X~I g. Decedent Died Testate (Attach Copy of Will) ~ ~~ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 8. TOtal Number of Safe De pOSlt BOX@S ~~ 9. Litigation Proceeds Received ~ L-J 1 p. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ~ 11 _ Election to tax under Sec. 9113 A ~ i ( ) _ (Attach Sch. O} CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number DAVID J. LENOX 717 432 9666 Firm Name (If Applicable) THE WILEY GROUP, PC First line of address 130 W. CHURCH STREET Second line of address City or Post Office DILLSBURG State ZIP Code PA 17019 Correspondent's a-mail address: d a v e l e n o x a~ c o m c a s t. n e t REGISTER WILLS US~NLY c~~ . '"~.. ,__,,: Q + 1 r r--.. r r rV .l .-.... W ~ t .. I T <~--.4j DAT~.irILED --~- ^ _ w ~.y r. , s... . . ~... C.* t "' 3 .7 _~ .f _? :7 ,..~ _... j -i ~~ ~naer penalties or pequry, 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. SIG TURE OF PERSON RESPONSIBLE FOR FILING RETURN DAT /a ~ `tTi James P. Burgess III 3~z~~ 0 ~ a 11700 Dinwiddie Drive_ Rnr_I~viflflcs Mn ~nst~~ v ~.~ ~ ~ r r rttK U I tK 1 F1AN KtF'K ~ NTATIVE David J. Lenox ADDRESS 130 W. Church Street, Dillsburg, PA 17019 DATE I !~ Side 1 15056D7120 15056D7120 J J 1505607220 REV-1500 EX Decedent's Social Sec urity Number oe~~e~t'S Name James P. Burgess J r. 0 4 8 0 9 2 7 8 0 TULATION ____ _--- 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 & Notes Receivable (Schedule D) ......................................................... 4. 5~ Cash, Bank De osits 8 Miscellaneous Personal Pro a P p rty (Schedule E) ................ 5. 7 8 2 7 1 4 9 7 6. - -- Jointly Owned Property (Schedule F) ~ _r Separate Billing Requested ............. 6. nter-Vivos Transfers 8 Miscellaneous N on-Probate Property (Schedule G} Separate Billing Requested ............. 7, 8. Total Gross Assets (total Lines 1-7) ....................................................................... g, 7 8 2 7 1 4 9 7 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 2 9 5 6 6 7 8 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................................ 10. 2 3 3 5 1 8 11. Total Deductions (total Lines 9& 10) ...................................................................... 11. 3 1 9 0 1 9 6 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 7 5 0 8 1 3 0 1 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. 7 5 O 8 1 3 0 1 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 0 0 0 15• 0 0 0 16. Amount of Line 14 taxable at -ineal rate x .045 7 5 0, 8 1 3. 0 1 16. 3 3, 7 8 6 5 9 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17• 0 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18• 0 0 0 19. Tax Due ...................... ......................... ...................................................................... 19. 3 3 7 8 6 5 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 150560?220 1505607220 Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERfTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Burgess, James P. Jr. 21-09-00629 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 1st National Bank of Marysville CD#3066597: 40,068.73 2 Cash found: 652.00 3 Department of Commerce Account #5678300: 100,281.03 4 Household Goods: 250.00 5 Juniata Valley Bank Account #43-259680-7: 92,484.31 6 M&T Bank CD#31003913916060: 101,759.43 7 M&T Bank Checking Account #9843064859: 21,869.66 8 Members 1st FCU CD#253911-41: 100,274.19 9 Members 1st FCU Savings Account #253911-00: 25.00 10 MidPenn CD#3090002259: 100,227.84 11 Patriot News (refund): 113.10 12 Sovereign Bank Ghecking Account #2331046921: 32,283.75 13 Susquehanna Bank CD#335162941: 40,058.95 14 Susquehanna Valley FCU Share savings account aand share certificate: 50,139.59 15 Tower Bank Time Deposit #3000034924: 100.116.44 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 5, Recapitulation) 782,714.97 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev1508 EX+ (6-981 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Burgess, James P. Jr. 21-09-00629 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+ (12-99) ,- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Burgess, James P. Jr. 21-09-00629 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions James P. Burgess 111 Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 11700 Dinwiddie Drive City Rockvi'Ile State MD Zip 20852 Year(s) Commission paid 2. Attorney's Fees The Wiley Group, PC 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. ~ Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 8,644.25 10,175.00 9,753.75 660.00 7. Other Administrative Costs 333.78 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 29,566.78 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Burgess, James P. Jr. 21-09-00629 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Boyer Funeral Home: 4,709.98 2 D'Agata Granite & Bronze: 413.00 3 James P. Burgess, 111 (reimbursement for down payment on funeral, cemetery, 3,242.00 service): 4 Susan E. Whittier (reimbursement for Patriot News Obituary): 279.27 H-A Subtotal $,644.25 Other Administrative Costs 5 Cumberland Law Journal (advertise estate): 75.00 6 Register of Wills (filing fee): 30.00 7 Sovereign Bank (fee for receipt of date of death letter): 20.00 8 The Sentinel (advertise estate): 208.78 H-e7 subtotal 333.78 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COWMAONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESfDENT DECEDENT ESTATE OF FILE NUMBER Burgess, James P. Jr. 21-09-00629 Include unreimbursed medical expenses. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Forrrt PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Burgess, James P. Jr. 21-09-00629 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSONS} RECEIVING PROPERTY (Words} ($$$} Do Not List Trustee(s) I ' TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a}(1.2)] 1 James P Burgess, III Son 195,211.38 11700 Dinwiddie Drive Rockville, MD 20852 2 Ruth E. Burgess Granddaughter 120,130.08 2797 Timberline Court Oakton, VA 22124 3 Lena R. Kemble Granddaughter 120,130.08 2101 Hominy Ridge Rd. Newport, PA 17074 4 Scott J. Whittier Grandson 120,130.08 597 Woodhouse Ave. Wallingford, CT 06492 5 Susan E. Whittier Daughter 195,211.38 3122 Middle Ridge Rd. Newport, PA 17074 Total 750,813.00 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cove r sheet III NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TnT AI f)F PART II _ FNTFR TnTAI N(1N_TAXARI F r11CTF?IRI ITI(lf~IC nt\t I tAtC ~~ nc ~w unn rn~~co CLJCCT AAA Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) ~MM~RMA ~[~D;FLt7ta s _ _K~ O~~ ~~( ou.: .yl f JAMES ~'. I3tlR(_J~55-,_JR. i, J.AI1~~>~S ~'. BL1R~E~~, JR., currcr~tly qfi Cumhc:rland County, Pennsylvania-~. declare CI1is to he t~~~, I.._ast t~~'ill and Te:st~~ment, hereby rel•okin~ piny ~~nd tell prior VViIIs and Ct?dicils made by t~1e. I. I direct that all tn~ ,~u~t debts and tur~~r~~ ~\E1~Il~~ti Eye ~~ald trc~ITl tl~~' attiti<'i~ ~}t IZ1~ estate as soon as pz•acticable after my detl~ise. II. I direct that all estate and irlheritsnce taxes that rrlay L~~ assessed i>«. consequence of rt~y dcath_ Shall lie' paid ouE t~f the principal vfmy general ~~tatc to the same effect as if sa~iil taxes ~vete expenses df administration and aI1 property i.nclt~dahle in my taxable estate tivhether or not passing under this V~ill shall be frt~:c and clc.~ar thereof. III. t11I the rest, residue and remainder of my estate. of~ whatever nature and tivherevcr 5ituatt, including property o~~er which I bold a pc»fer vl' arppointment I devise and bequeath as follows; li. Twenty-six pcrcc~nt (2C~%) Ltrtlc7 rrty 5c~n. Jar~les P. L'ttrgess. III. If he predeceases me_ this bequest st-tall p~3s5 tc~ I,i_; surviving spouso, or his issue per stirpes, if his spouse does not survive hiti~. B. Twenty-six percent (2F~%}unto my clau~l~ler, Susan l~~_ ~`hittier. It she predeceases me, this beclt.~est shall pass tit }ter sttrviving s~ovse, or her tSSUE qtr sttrpes_ ~t~ her spouse does trot ~;t-,r-vi~~e h~~r. C. Ft~zty~eight percent (48`°} to he divided among my following grandchi.Idren ~vhc~ SUrvtve me: SCOtt .~. ~~hTtt.~e[-, I.e:t1~i R. Kcmblc and IZl~th E. Burgess. IV. I appoint my scan, James P. I~urgcss, III, I/xecutc~t" c>1.~t.his my Will. In the event that he fails to qualify or ceases to ~~c~ a5 E tect~lc?r, I appoint ~~i}~ daug}lter_ Susan E. Whittier, 1~ xccutrix ip hiS place_ ,.-, ' ' f 1 S~-~ .~ i- a ~;..: II'i ~=.•: -; ~A~ Cam: :~_ .~ _. E ~:: -:,_ .~ Y-- _ ~f:. ..,~. :~-- „. ~_ ~. ~... L- - EF ... l f - -- -. _. _. ~..w.~ .A' s HlE,r ~,~~:~ •~~t~ y thy: Et8 3~1 ~~ :;E=t5~+t, ~.at.;~F~~ F,: ~_;F _- PHGE 03;' tit ~,F,. 3E_~: ?E_jF=t~~+ E~~~: E=t,= `~~1 ; 1~~EtS~~F P1~~iF~ F. ~~F F'H~:~E ~t4r't~; V. I direct that no bond he required of mv_ fiduciary for the faithful perforrnaltce of his or her duties its any jurisdiction. III WI~'NESS ~'VH~~t~C1F, I, T~~!1~5 P. B~~RG~SS, JR., heretivith set my hand to this my l:.ast V~ill, t~rpeti~~ritten on t«~o t2} sheets of paper including the attestation clause and signatures of ~.vitnesses, this `l 7-' ~ day of Septernber_ 203 . / ~ 1 '"~ ~ ~--~--~_.~~~E. _ ~ ~-;1,t ~.,t,~J~.~::,'~{SEAL) J11Iv~ES P. BURGESS, JR. Signed by JA,~ES P. BU~GES~S,1R., by him declared to be his till in our presence, «~ha have he.reuntt~ subscriE~ed tour nar~nes as witnesses in his presence and at his z'equest, this ~~ ~~~ day of Septerrxber, ZC103. - i' )~ ~` ~ f ; ,~ . ~~ z~ ~, residi~tg at ~ ~f L ~-~r_.zr_~-.~`J, _ ~~ ~~= ~~ Tr " - ~ J ~~ ~ ~ `~ ~/ ~ _ ,`, ,>._ residing at_ "1 C',r- t ~ -~~,~~r~~''i/~- - ,. i f:_ ; 1" -2- ;_~l COM.MONW~A-LTH +f~F PENNS1rL~'~NIA ~. CC~UNT~' ~F ~~~ ~1 r~ar~~~F~_, F: ~~ r F~[~E E_t~,/E_t ~'E, JAMES P. BURGESS, .~R., GERAL.D J. BRtNSER and ~'~'~fr.t/ ,~ u~i~ of t ,the testator and the ~~itnesscs, res,~?ectlvely, wl~vse names are signed to the attached or- foregoing instrument, bezng f rst duly affirmed. ~o l~erel~y declare to the undersigned authority that the testator signed and erecL~ted the instrument as his Last ~1iU and that he signed willingly {or ti~~illin~iy directed another to sign for him}, and That he executed it as his free and voluntary act for the purposes therein e?~pressed, acid that each ofithe ~~ itnesscs. in the presence and hearing of the testator. s~~ned tllu ~l'ill ;~ ti~ itneu~'s ajici that tv the test ~f our knowledge the testator was $t that time eighteen years ofage or older, of sound mind end under no constraint or undue influcnce_ '~ -~ P J MES P_ .t3URGESS, JR.°- C FITNESS ~4/1TN ~ SS Subsczibed, sworn or aflizmed and acl{nowlcdged before me by 3.A.1WtES P_ $U'RtJESS, JIZ., the testator, GERALD J. BRIMS ~ R ~~nd .~ 4~~~ ~ 3 . ~ ~, , ; ; , ~ ~ witnesses, ti~is `7~t4• aay of September, 2Ut~3. ,. SEAL} N4YAR~AL SEAL Notary Publi ~NEAtDYL CRAINfORD, ~Jotary Pvb~fQ Patinyy,~ Baro., ~e6anar~ Cvun ~amtrtls~ion Expires Sept '~0, 2~3 _~~ ~`. ,_ p~. ,.,. =~: ~,~ ~F ~' ~° -~,. ;_ R ~' ~_ x ~'~ i_: i- e..~~~ C f`llll,BtC i~,~G~i,~ YOUR BANK OF CHOICE 4 N Market St PO Box G Mi 11 erstown, PA 17062 July 20, 2009 "I'he Wiley Group 130 W Church St, Suite 101 Dillsburg, PA 17019 µ~ ~ ~.7x?.4.>r~.~~e~ ~r lynx . i ~""'~ ~:~ F w - .- ,. -. - .. ,r~ _ _ RE: James P Burgess, Jr., Estate SS#: 048-09-2780 D/O/D: June 25, 2009 To Whom It May Concern: Enclosed is the standard decedent form for the information regarding the above decedent. ce Representative If I can be of further assistance, please let me know. THE JUN/ATA VALLEY BANK MIFFLINT0INN PA 17059 Phone: (717) 436-8211 Fax: (717) 436-8889 Decedent: Buries s , James P Date of Death: June 25 , 2009 SSN: (?48-f~9-2780 i ACCOUNT #: _ _ ACCOUNT #: BALANCE DOD: $q~ 3R8 13 BALANCE DOD: ACCRUED INTEREST: __ 7 96.18 _ ACCRUED INTEREST: DOD VALUE: 92, 484.31 DOD VALUE: INTEREST PAID YTD: 1, 750.55 INTEREST PAID YTD: _ OPENING DATE: T)PrPmhPr 1 F, _ ~f~nR OPENING DATE: MATURITY DATE: __ December 16 ~ 2011__ MATURITY DATE: OWNERSHIP: Individual OWNERSHIP: ACCOUNT #: ACCOUNT #: BALANCE DOD: _ BALANCE DOD: ACCRUED INTEREST: _ ACCRUED fNTEREST: DOD VALUE: DOD VALUE: INTEREST PAID YTD: INTEREST PAID YTD: OPENING DATE: OPENING DATE: MATURITY DATE: MATURITY DATE: OWNERS~---P : OWHERSNtP: ACCOUNT #: ACCOUNT #: BALANCE DOD: BALANCE DOD: ACCRUED INTEREST: ACCRUED INTEREST: DOD VALUE: DOD VALUE: INTEREST PAID YTD: INTEREST PAID YTD: OPENING DATE: OPENING DATE: MATURITY DATE: MATURITY DATE: OWNERSHIP: OWNERSHIP: ACCOUNT #: ACCOUNT #: BALANCE DOD: BALANCE DOD: ACCRUED INTEREST: ACCRUED INTEREST: DOD VALUE: DOD VALUE: INTEREST PAID YTD: INTEREST PAID YTD: OPENING DATE: OPENING DATE: MATURITY DATE: MATURITY DATE: OWNERSHIP: OWNERSHIP: bats: July 15, 2009 Prepared by: Tanwa S Al Px~ndPr . Customer Service Rep Phone: 717-589-3141 Fax: 717-589-3142 SUSQUEHANNA ALLEY FEDERAL CREDIT U N I O N July 22, 2009 David J. Lenox, Esquire The Wiley Group 130 W. Church St., Ste 101 Dillsburg, PA 17019 Re: Estate of James P. Burgess,lr. Dear Mr. Lenox: The following is the information in which you requested regarding the account of James P. Burgess, Jr. at Susquehanna Valley FCU. This account was opened on April 23, 2009 in the name of James P. Burgess, Jr. There are no joint owners on this account. Mr_ Burgess had a share savings account and a share certificate. The share savings had a date of death balance of $5.00 and the share certificate had a date of death balance of $50,000. Accrued interest on the certificate would have been $134.59. Please let me know if you need any additional information. Kind regards, Kathy Jo Shoaff Member Services Supervisor i y-~~ . ~ ~, ~ --,~ -~ 3850 HARTZDALE DRIVE • CAMP HILL, PA 1701 l -7809 ' ~- ~~~-~ LOCAL: (7I7) 737-41 S2 TOLL FREE: (800) 948-1454 FAX: (717) 737-0589 `~~ ti WER -BANK- .a nivr~io~ c~F c~:~,~o~E ro~wEa ~.A~K NAME OF DECEASED. JAMES P BURGESS JR SOCIAL SECURITY NUMBER: 048-09-2780 DATE OF DEATH: 6/25!2009 NAME OF FINANCIAL INSTITUTION: TOWER BANK DATE PREPARED: 7/27/2009 PREPARED BY: TAMMY JOHNSTON ACCOUNT NUMBER: 3000034924 ACCOUNT TYPE: TIME DEPOSIT JAMES P BURGESS JR NAMES ON ACCOUNT: DATE OF JOINT N/A OWNERSHIP: DATE FIRST OPENED OR ISSUED: 2/9/2007 DATE OF LAST ROLLOVER IF ANY: 3/9/2009 DATE CLOSED OR MATURED: N/A DATE OF DEATH PRINCIPAL: $100,000.00 DATE OF DEATH ACCRUED INTEREST (DOD INT ON CHECKING ACCOUNTS 116.44 WILL NOT BE POSTED TO ACCT IF ACCT IS CLOSED BEFORE STMT CYCLE DATE: ) DATE OF DEATH TOTAL PRINCIPAL & $100,116.44 ACCRUED INTEREST: TOTAL INTEREST PAID BEFORE DEATH FOR $2,100.06 CURRENT YEAR: J i~ i ~/ r- ational : . of Marysville MAIN OFFICE One Centre Square • PO. Box B • Marysville, PA 17053 • Phone: 717-957-2196 • Fax: 717-957-4578 July 15, 2009 The Wiley Group 130 W Church Street Ste 101 Dillsburg PA 17019 RE: Estate of lames P Burgess Jr Here is the information you requested per your letter dated 7-13-09: Certificate of Deposit 3066597 James P Burgess Jr Int Rate: 3.92% Opened: 1-09-09 DOD Bal: $40,000.00 DOD int: 68.73 If you require any further information, please feel free to contact us. Sincerely, ,. rA. ~--~`--- ''`-1--- Barbara Recher, Manager First National Bank of Marysville st MEMBERS 1St FEDERAL CREDIT UNION SAVINGS ACCOUNT: Account Number/Suffix 253911-00 Date Account Established 11/06/2004 Principal Balance at Date of Death $25.00 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $25.00 Name of Joint Owner None CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner {Opened by transfer of funs 253911-41 11 /06/2008`` $100,000.00 $274.19 $100,274.19 None is from 253911-00. ~ MBERS 1ST FEDERAL C EDIT UNION _ e ~~ Danielle A. Kline Insurance Services Specialist July 22, 2009 ~f ~- Estate of: JAMES P. BURGESS Date of Death: 06/25/2009 Social Security Number: 048-09-2780 5000 Louise Drive PO. Box 40 Mechanicsburg, Pennsylvania 17035 (800) 283-2328 ~~nv~v_memberslst.org July 20, 2009 DAVID J. LENOX, ESQUIRE 130 W CHURCH ST SUITE 101 DILLSBURG, PA 17019 RE: James P. Burgess Jr. Estate SS#: 048-09-2780 DOD: June 25, 2009 To Whom It May Concern: Sus uehanna 9 Susquehanna Bank 26 North Cedar Street P.O_ Box 1000 Lititz, PA 17543-7000 Toll free 800.311.3182 In response to your letter of Jufy 13, 2009, here is the above customer account information as of June 25, 2009. Account #1 • Account Title: James P. Burgess Jr. • Account Type/# CD/335162941 • Date Opened /Maturity 1 1 / 14/05 / 1 /14/ 10 • Interest Rate: 5.00% • Account Balance*: 40,000.00 • Accrued Interest: 58.95 • YTD Interest: 975.05 *Account balance does not include accrued interest. There is no safe deposit box in the name of this decedent. If I can be of further assistance, please feet free to call. ~ incerely, -~- s Y1 . f-~-C~~,~ ~anet M_ Peters Support Services Supervisor 1-717-625-6295 JMP/Ijr ~~\` DEPARTMENT of~ COMMERCE FEDERAL CREDIT UNION July 30, 2009 The Wiley Group 130 W. Church Street Suite 101 Dillsburg, PA 17019 RE: James P Burgess Jr 824 Lisburn Rd Apt 513 Camp Hill PA 17011 Dear Mr. Lenox: P.O Box 14720 Washington, D.C_ 20044-4720 (202) 4$2.4134 www.docfcu_org Herbert C. Hoover Building Room 8-818 Washington, D.C. Per your request this letter is to verify the account relationship as well as the accrued interest up to June 25th 2009 for James Burgess Jr. a member of the Dept. of Commerce FCU. Account number: 5678300 Share lD Description Open Date Current Balance 60-Day Avg. Balance 00 Savings 03/20/2009 $5.00 $5.00 40 60 Month CD 03/20/2009 $100,000.00 $100,000.00 As of June 25, 2009 Mr. Burgess received an accrued interest for $276.03. Please contact me if you desire additional assistance. Sincerely, ,~ ibal is Branch Manager Dept. of Commerce FCU 301-588-4722 phone 301-589-2321 fax Agarcia@docfcu.org CC James P. Burgess, III 1 1700 Dinwiddie Dr. Rockville, MD. 20852 MBTBarik 499 Mitchell Street, Millsboro, DE 19966 July 20, 2009 The Wiley Group Attorneys at Law 130 W. Church Street, Suite I01 Dillsburg, PA 17019 RE: Estate of James Burgess Jr. Date of Death: June 25, 2009 Social Security Number: 048-09-2780 Dear Mr. Lenox: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type .... . .... . . ... . ............ Checlflng Account Account Number . .. . . . . ... . .. . . ... _ .. _. 9843064859 Ownershzp (Names of) . ... . . . . .... .. James Burgess Jr. Opening Date .... . . . . . . ... . . ... . ........08 / 11 / 06 {account closed 07 / 08/ 09) Balance on Date of Death_ .. _ ...... $21, 869.2 7 Accrued Interest $ 0 39 Total .......................................$21,869.66 2. Account Type .... . ... . . . . .............. . Certificate of Deposit Account Number . . . . . . . . . . . . . . ......... 3 1 0039 1 39 1 6060 Ownership (Names off .. .. . .... . .... James Burgess Jr_ OpenirtgDate ...........................02/11/00 Balance on Date of Death... _ .. _ _ .. $101,676.36 Accrued Interest $ 83 07 TotaL--------------------------------------$101,759.43 The above named decedent did not have a safe deposit box. • Page 2 July 20, 2009 * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or the name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please contact our West Shore Plaza branch at 1200 Market Street, Lemoyne, PA 17043, or # 717-255- 2271. Sincerely, ~ ~~Y~~ ~~~~ Charlene Warrington, Adjustment Services 1-888-502-4349 Making things happen for you. July 20, 2009 The Wiley Group Attorneys At Law 130 W Church Street Suite 101 IJ illshurg, PA 17019 Re: Estate of James P Burgess Jr. Date of Death: June 25,2009 SSN: 048-09-2780 Dear Mr. Lenox In response to your letter requesting information on the accounts of James P Burgess Jr, I have accumulated the necessary data below: Account #: 309002259 -Certificate of Deposit Account Name: James P Burgess Jr Date Opened: 8/5/08 Maturity Date: 10/5/09 Balance DOD: $1.00,000.00 Balance Accrued Interest DOD: $227.84 Total DOD Balance: $100,227.84 Joint Ownership Name: NA ,. , -~ if you have any fta~ Sher :luest;vi~s, please ca~~ rr~e at ; 17-~yc-53a~ Sincerely, 1 ~ ~' I ~ 1 ~ ~~ Jennifer aSalle Deposit Services Member FDIC Corporate Headquarters_ 349 Union Street, Millersburg, PA 17061 • (717) 692-2133 • wvvw.midpennbank.com Soverei n g Court Ordered Processing 1 Decedents - MA1-MB3-02-10 - P_ O. Box 84I005 -Boston, MA 02284 July 28, 2009 David J. Lenox The Wiley Group 120 W. Church St, Suite 101 Dillsburg, PA 17019 RE: Estate of James P. Burgess, Jr_ Date of Death: June 25, 2009 Dear Mr. Lenox: Per your request, enclosed please find the account information as of the date of death for the above-named decedent. For your information, accrued interest is not included in the date of death balance. Please feel free to contact me if I can be of any further assistance. Very truly yours, ' -~ ~-.~t.'~'~ -`----- Linda Spavento Team Leader 617-533-1789 Sovereign Bank ESTATE OF James P. Burgess, Jr. SOCIAL SECURITY #: 048-09-2780 DATE OF DEATH: June 25, 2009 Account #: 233 1 04692 1 Type: In the name of: .Tames P. Burgess Jr. Date of Death Balance: Int.(YTD) from I/1 /2009 to _ Accrued interest to date of death: Other Info: Account #: 2335253668 Type: In the name of: James P. Burgess Jr. Date of Death Balance: Closed prior I n t.(YTD) from 1 / 1 /2009 to _ Accrued interest to date of death: Other Info: Closed 1/9/09 $40,004.54 Account #: 2335253742 Type: In the name of: James P. Burgess Jr. Date of Death Balance: Closed prior I nt.(YTD) from 1 / 1 /2009 to _ Accrued interest to date of death: Other Info: Closed 3/20/09 ~ 12R_444 ~ 4 Checking Open date: 8/4/1999 $32,282.10 6/7/2009 $1.65 $65.28 CD Open date: 2/7/2000 1 /9/2009 $0.00 . $32.08 CD Open date: 4/I 7/2000 $0.00 . $1,024.31 3/20/2009 Page 1 of 1 ~~~ ~ ~~.vv nv~i ~ -~ ~-~;1