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· IN THE OFFICE OF THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of Burleson, Betty J.
No.21
06
0831
also known as
, Deceased
Date of Death 9/7/2006
Social Security No. 162220556
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Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following invento@~e all of tffi? ~~~J. :::c;
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent:t~e valuat~ ;~! i ~j
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and tha~ o;~~t owr€a no ( "; ,?:-3
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this. ~~ry. IfJie I}j t9
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein 1l'l~dB)~ subj~tlto the._) 0
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. ) Q 0 ):110 ': I :'"
~~ '3~~L1 ~ ~
~er onal Representative: .. =0 - \_., ron,
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Name of ., // /f? "1> 08 - -')'-"l12::_/_
Attorney: Gerald J. k etski Es . . ~.- ~ VI). ""r""""""--
Vdyg6
I.D. No.:
Address:
414 Bridqe S1.
New Cumberland
Dated
Patricia K. Given Darlene M. Noqqle
// /30 h
PA17070
Telephone: (717) 774-7435
Description
PERSONAL PROPERTY
Value
2004 Dodge Sedan, Title Number 60132365702BU,
VIN 1 B3ES56C54D583924
9,000.00
PNC Bank checking account #5140115187
6,989.49
PNC Investment Account Number 8196-1654
78,822.15
United Health Care premium refund
25.03
ServiceMaster lawn care refund
22.30
Total
(Attach Additional Sheets if necessary)
190,518.94
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.
RW-4
~
Continuation of Inventory
Blfleson, Betty J.
21
06
0831
PaQe 1
Description of Inventory
Description
HighMark Health Insurance premium refund
Value
378.62
Conseco Insurance (prescription coverage) premium refund
139.65
Nationwide auto insurance premium refund
134.10
REAL ESTATE
Undivided one-half interest in 3755 Sullivan St., Mechanicsburg, PA 17050
95,007.60
Subtotal $
95,659.97
190,518.94
Grand Total $