HomeMy WebLinkAbout11-06-08 (2)A
INVENTORY
Estate of Esther L. Johnson
also known as
Deceased
No. 21 08 00766
Date of Death July 07, 2008
Social Security No. 190-16-7471
Personal Representative(s) of the above Estate, deceased, verify 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 the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We
verify that the statements made in this inventory are true and correct. I/VHe understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of l'~~ (~~ `~ ,
Attorney: Shaun B. Adrian, Esquire
I.D. No.:
57309
Address: 100 State Street Suite 700
Erie PA 16507
Telephone: (814) 870-7758
Dated ~~~~~~~
Stocks Sti Bonds
Description
1.859.314 shares of Franklin Equity Income Fund CL A, NAV of
$16.74 per share (OTC) CUSIP No. 353612 401
Cash Bank Deposits, 8~ Misc. Personal Property
1. Decedent was a resident of a nursing home and except as
reflected on Schedule G owned limited personal belongings
2. Commerce Bank -checking account no. 537564692
3. West End Lions Club -check for Lottery proceeds
Total
(Attach Additional Sheets if necessary)
Value
N
C
"T3
1~384~Z~'
c~ v ~, a c..~
~ c ~_`'
_ t ~_~
s
~-~
.. ~-- rn
04,Ofl:-~.~
rn -~:~
20,834.43
25.00
38, 638.17
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
~ 21 08 00766
Esther L. Johnson
ti Pa e 1
Description of Inventory
Description Value
4. Goodville Mutual Casualty Company -refund of unearned 68.00
premium
5. HARP -check for refund of unused member benefit 6.44
6. Reiman Publications - 3 checks for refunds of prepaid magazine 63.22
subscriptions
7. MetLife -insurance proceeds under policy no. 5-352-627M 3,256.16
payable to the decedent's estate
sut,tota~ a 3,393.82
Grand Total S 38,638.17
a
0
N
°I
a
0
z .~
-°' o°
ii Oq
z
0
~
o ~
A ~
o ~ o
~
o W w
w
a Q
~
z
a ~
W
H
w
°I ~I
~ ~ H
a W
> a
o
a
f-~
~
x z ~~
~ •~ ~
~ ~ o
~ ~
w `' ~
W a,
W
a ~
~
~°
~ ~ ~
o
v
~o
a R
a
~
~ `"
ar
~ w a o
O
= Q ~
~°
~ c~ 3 a N w` ¢ ~~ wQ