HomeMy WebLinkAbout10-28-09 (2)INVENTORY
REGISTER OF WILLS OF
COMMONWEALTH OF PENNSYLVANIA 1 SS
COUNTY OF J
SZ~PI~T M. JAHN,
COUNTY, PENNSYLVANIA
File Number
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Personal Representative(s) of the Estate of WILLIAM F. JAHIV ~ _ ~ ~ r~ ~ ~'
deceased, depose(s) and say(s) that the items appearing in the following inventory include all ofthe per~b>~1 assets v~erevf~::$ttte
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation plaee~~pasite e~eh ite~r.of=5~id
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned.V~al estat@;butsi~ie ol~the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inven~dry. --- ~ - : t
0
/ _ ~
ments herein are made subject to the penalties of •
18 Pa.C.S. § 4904 relating to unsworn falsification to
authorities.
1 verify that the statements made in this Inven-
tory are true and correct. I understand that false state-
Attorney -- (Name) Ann E• ~~~ (Supreme Court 1. D. No.) 49631
(Address) C1eclcner-~iid Fearen, P. O. Box 11847, Harrisburg, PA 17108-1847
(Telephone) 717-238-1731
DATE OF DEATH
03/01/2009 LAST RESIDENCE
Hampden Township, C~unberland County pEC&DENT'S SOC. SEC. N0.
'3~0-32-9955
FIGURES MUST BE TOTALED
1. Real Property: 5 Ashley Drive, Dillsburg, York County, PA 191,439.60
2. 2001 Buick Centruy Automobile 4,200.00
3. Household Goods 5,000.00
4. Members First FCU Savings Account #37415-00 3,591.82
5. Members First FCU Savings Account #37415-04 4,000.00
6. Members First FCU C/D #37415-41 35,000.00
7. Members First FCU C/D #37415-43 27,000.00
8. Members First FCU C/D #37415-53 30,000.00
9. Members First FCU C/D #150139-41 15,592.03
10. State F~ Insurance/Verizon Refunds 150.09
11. Comcast Cable Refund 92.37
12. IRS income tax refund 592.00
13. Social Security 506.00
14. Balance unpaid c:anpensation 149.97
(Attach additional sheets as needed)
TOT
317,313.88
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal represient~tive 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(6))
Form RW-09 rev. 10.13.06