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HomeMy WebLinkAbout06-17-09INVENTORY REGISTER OF WILLS OF CUMBERLAND COMMONWEALTH OF PENNSYLVANIA } SS couNTY of Cumberland } KAREN L. ROZMAN Personal Representative(s) of the Estate of THOMAS J. ROZMAN COUNTY, PENNSYLVANIA File Number 21-09-00288 deceased, depose(s) and say(s).that the items appearin in theyfollowing inventory include all of the ersonal assets wherever situate and all of the real esta n{sntshfaCvalueoas of the date of the decede t s death and that Decedent owne no ~eal a fate ch item of said inventory represe outside of the Commonwealth of Pennsylvania except that which appears in a memor~anDdum at the end of this inven~ ~~ I verify that the statements made in this Inven- ~ ,,/~~j.~,¢..-.. ol- v %""r"r-'-•~ ~ tory are true and correct. I understand that false state- KAREN L. ROZMAN ments herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Attorney -- (Name) EDMUND G. MYERS (Firm) JOHNSON DUFFIE (Address) 301 MARKET STREET, LEMOYNE, PA 17043 (Telephone) (717) 761-4540 DATE OF DEATH 0212712009 LAST RESIDENCE 1424 TIMBER CHASE DRIVE MECHANICSBURG, PA 17050 FIGURES MUST BE TOTALED Personal Property Cash ............................................................................................... Personal Property ......................................................................... StockslListed ................................................................................. Stocks/Closely Held ...................................................................... .... Bonds .................. ................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable ............................................... All Other Property ......................................................................... Total Personal Property......••••••••••••••••••••••••••••••••••• Total Real Property ................................................ Total Personal and Real Property ......................... 13,251.57 15,300.00 ~~ C? ° , ;~ ~ C ~ ~ ~? ~ "-i ``~ v~ ~ C =i _~~ ~_;} v ~-t -~ `i ~j ~ 28,55'f~.'57 -- r Y ~ bQQ• ..~._ . __ 136,700~i10 165,251.57 NOTE: liem butlsuchdfguresrshould ntot be elxtended ~ to~the totaltof t eenventory! (See 20 PaeC IS~§ 3301(b))personal representative include the value of each (Supreme Court I.D. No.) 20558 DECEDENTS SOC. SEC. N0. 181-58-8220 Form RW-09 Rey. ~o-~3-zoos INVENTORY COUNTY, PENNSYLVANIA REGISTER OF WILLS OF CUMBERLAND COMMONWEALTH OF PENNSYLVANIA } SS File Number 21-09-00288 COUNTY OF Cumberland DECEDENTS SOC. SEC. NO. DATE OF DEATH LAST RESIDENCE 1424 TIMBER CHASE DRIVE 181-58.8220 02/2712009 MECHANICSBURG, PA 17050 Cash 3.68 Cash 8,496.35 Commonwealth of Pennsylvania -final salary check and unused -vacation. 3,861.54 PSECU Checking Account. -Date of death balance. 890.00 United States Treasury -refund - 2008 Form 1040. 13,251.57 Total Cash Personal Properi~' ( 14.200.00 Automobile - 2008 G35 Sedan Journey -Sale Price 1,100.00 Household Goods -appraised value 15,300.00 Total Personal Property Real Estate 136,700.00 Condominium - No. 1424 Timber Chase Drive, Hampden Township, - Cumberland County, PA. (Book 157, Page 112) Sale Price -Copy of Settlement Statement attached. 136,700.00 Total Real Estate 165,251.57 (Attach additional sheets if necessary) Total Personal Property and Real Estate