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INVENTORY
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA 1 SS
COUNTY OF CUMBERLAND J Fite Number 2007-01159
Personal Representative(s) of the Estate of Nancy S. Roth
deceased, depose(s) and say(s) that the items appearing 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 appe
1 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. § 4904 relating to unsworn falsification to
authorities.
Attorney -- (Name) Patricia Carey Zucker (Supreme Cour,~LD. No.) ,3.x334
(Address) Daley Zucker Meilton Miner & Gingrich, LLC, 1035 Mumma Rd., Ste. 101, Wo~leysbuPA - "
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(Telephone) (717) 724-9821 ~ ~~~ ~
DATE OF DEATH LAST RESIDENCE OEC~N~f~ SOC. SFII. N0. - . -
12/19/2007 120 Prowell Drive, Camp Hill, PA 17011 T8~ ~79483~ `__
FIGURES MUST BE TOTALED ~ ~~ ~"~ s'
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1. Real estate located at 120 Prowell Drive, Camp Hill, Cumberland County, Pennsylvania 153,000.00
2. Personal property of decedent 700.00
3. 1987 Lincoln Continental 500.00
4. 2000 Ford Explorer 5,000.00
5. SERS pension benefit 642.83
6. Members 1st Federal Credit Union Savings and Checking Accounts 1,190.46
7. Refund from Transamerica for Long Term Care Insurance payment 307.99
8. Refund of car insurance 67.00
9. Refund of homeowner's insurance 251.00
10. Refund of State tax 12.00
11. Refund from Wells Fargo 39.00
12. Pennsylvania Stimulus Tax 525.60
13. Ameriprise proceeds 2,119.14
14. Oppenheimer Funds (IRA) 12,749.28
15. Ameriprise Financial (Annuity) 133,196.30
(Attach additional sheets as needed)
TOTAL: 310,300.60
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. ,¢ 3301(b))
Form RW-09 rev. 10.13.06
`'tom
INVENTORY
(continued)
Estate of Nancy S. Roth
File No. 2007-01159
Balance forward $ 310,300.60
16. Union Central (Annuity)
17. Lincoln Benefit Life Company (Annuity)
113,798.55
100,578.90
TOTAL: $ 524,678.05