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INVENTORY
REGISTER OF WILLS OF CV~ bL//a..".d
COUNTY, PENNSYL VANIA
COMMONWEAL TH OF PENNSYLVANIA
COUNTY OF
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File Number
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Personal Representative(s) of the Estate of /11,. ~ -'" -1,- A P<4t~/
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the ersonal 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 verify that the statements made in this Inven- } Q~A.fD rJ ;S ~ / /
tory are tru: and correct. I ~derstand that false. state- ~~ ~ ~.."..~
ments herem are made subject to the penalties of" ~ .
18 Pa.C.S. ~ 4904 relating to unsworn falsification to
authorities.
Attorney -- (Name)
(Address)
(Telephone)
(Supreme Court J.D. No.)
LAST RESIDENCE
DECEDENT'S SOC. SEC. NO.
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(Attach additional sheets as needed)
TOTAL:
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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. f 3301 (b))
Form RW-09 rev. 10.13.06