HomeMy WebLinkAbout01-16-07 (3)
Register of Wills of~UMBE~LAND County, Pennsylvania
INVENTORY
Estate of
Catharine E. Bousum
No. ZC[2]lJ~~-P~9 f)1i 2: 5 I
also known as
. March 14 2006
Date of Deattfi E:T< ,",-: '
'~i"9J.;-1 8- 3 92 0
, Deceased
Social $:E!,9urifV N'o.
'."
Personal Representative(s) of the above Estate, deceased, verify that the items ilPpearing 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/We verify that the statements made in this Inventory are true and correct. I/We understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsificatIon to
authorities.
Telephone:
(717) 697-8528
Personal RelJresentative: Marie E.
Richard M. Bousum Bousum-Forbes
894 Flagler ~ve . 740 Allen Road
~~ .~ Car1i'~ PA 17013
- . ~<-
Dated /.,?... E -I)~
'-m~~W7n~~;{Odf
Name of
Attorney:
Richard C. Snelbaker
I.D. No.:
06355
Address:
44 West Main Street
Mechanlcsburg, fA l/U~~ ~
Description
Value
$ 424.00
94.92
351.25
3,440.00
74.00
$ 4,384.17
$ 0.00
$ 4,384.17
PERSONAL TY:
1. Commonwealth of Pennsylvania, rent rebate
2, Highmark Blue RX, refund on prescription insurance program
3, Highmark Medigap Insurance Program, refund unused premium
4. PNC Bank, NA, checking account #50-7007-7102
5. U.S. Treasury, refund on 2005 Individual Income Tax
TOTAL PERSONALTY:
REAL ESTATE:
1. At the time of her death the Decedent did not own any real estate
TOTAL PERSONALTY AND REAL ESTATE:
Total:
(Attach Additional Sheets if necessary)
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
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