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INVENTORY
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
Russell A. Koch
Personal Representative(s) of the Estate of
} SS
}
File Number 21-07-0423
June D. Koch
deceased, depose(s) and say(s) that the items al?pearing in the following inventory include all of the personal assets wherever situate
and all of the real estate in tlie 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, a cedent owned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a mem cum at e end 9j~nventory.
I verify that the statements made in this Inven- ~ / 3 ()
tory are true and correct. I understand that false state-
ments herein are made subject to the penalties of
18 Pa.C.S. S 4904 relating to unsworn falsification to
authorities.
Attorney.- (Name)
(Firm)
(Address)
(Telephone)
James D. Bogar
Bogar & Hipp Law Offices
One West Main Street, Shiremanstown, PA 17011
717-737-8761
(Supreme Court J.D. No.)
19475
DATE OF DEATH
04/15/2007
LAST RESIDENCE 4048 Seneca Avenue
Camp Hill, PA 17011
FIGURES MUST BE TOTALED
DECEDENT'S SOC. SEC. NO.
195-07-4895
Personal Property
Cash.. ...... ......... ....... .., ..... ....... ..... ...... .... '" ............... ................ .......
Personal Property................. .......... ........ ...... ............. ...................
Stocks/Listed......... .............. ...... ........ ......... .......... .......... ..... .., .......
Stocks/Closely Held......................................................................
Bonds.............................................................................................
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable...............................................
All Other Property.. ............. ............. ....... ............... ............. ..........
7,850.63
Total Personal Property.........................................
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f.;i50.63
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Total Real Property................................................
Total Personal and Real Property.........................
NOTE: The Memorandum 01 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. S 3301 (b))
Fonn RW-09 Rev. 10-13-2006
INVENTORY
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA } S5
COUNTY OF Cumberland }
File Number 21-07-0423
DATE OF DEATH
04/15/2007
LAST RESIDENCE 4048 Seneca Avenue
Camp Hill, PA 17011
DECEDENTS SOC. SEC. NO.
195-07 -4895
Cash
Gettysburg Operations, LLC - Refund of funds remaining in Resident's
Fund/Petty Cash Fund
28.83
M & T Bank - Checking Account No. 5281189 - date of death balance-
$6,261.33; accrued interest - $0.14 - Note: Joint Owner, Kenneth D. Koch, died
November 24, 2006.
6,261.47
Penn Treaty Network - Refund of unearned premium
56.20
Penn Treaty Network America - payment from nursing home disability
insurance
1.000.00
Penn Treaty Network America - payment from nursing home disability
insurance
133.32
Penn Treaty Network America - payment from nursing home disability
insurance
333.30
Prudential Financial - Dividend
37.51
Total Cash
7.850.63
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
7.850.63