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INVENTORY
REGISTER OF WILLS OF CUMBERLAND
COUNTY,PENNSYLV~A
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
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File Number 2 0 0 8 00 357
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Personal Representative(s) of the Estate of . .:: ;'iE B ~ C.;
deceased, depose(s) and .say(s) that the items appearing in the.follow~g inventory include all of.the personal.~~~ wh~W'er situat:,~
~d all of the real es~te ~ the Commonwealth ofPennsylvama of saId Decedent, that the valuation placedo~e~e each Item ?fSaldJ
mventory represents Its farr value as of the date of the decedent's death, and that Decedent owned no real ~~6Utside:qpthe
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory:, ~ N "
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I verify that the statements made in this Inven-
tory are true and correct. I understand that false state-
ments herein are made subject to the penalties of
18 Pa. C.S. 9 4904 relating to unsworn falsification to
authorities.
Attorney - (Name) JAN L BROWN
(Address) 845 SIR THOMAS CT STE 12
(Telephone) 717 -5 41-5550
(Supreme Court J.D. No.) 67993
HARRISBURG PA 17109
DATE OF DEATH LAST RESIDENCE DECEDENrs SOC. SEC. NO.
6341 Stephens Crossing
3/10/2008 Mechanicsbura PA 17055
l FIGURES MUST BE TOTALED I
M&T Bank Checking 58433643 1 ,241 .72
Capital BlueCross; benefit reimb 2,610.00
Capital BlueCross; benefit reimb 810.00
Highmark; premium refund 424.98
Humana Inc 65.04
Myers-Harner Funeral Home Inc; funeral prepayment insurance refund 5,137.93
(Attach additional sheets as needed)
TOTAL: 10,289.67
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. S 3301 (b))
Form RW-09 rev. 10.13.06
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