HomeMy WebLinkAbout12-07-09 (5)INVENTORY
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REGISTER OF WILLS OF ~~ ^,ruxZC.~ COUNTY, PENNS~~ANIA ~ -, T
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COMMONWEALTH OF PENNSYLVANIA 1 SS ~ ^ (~ `-j~~ I l
COUNTY OF J File Number ~ .,. _ c ~ J ~ _ ' '}
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Personal Representative(s) of the Estate of ~ S ZS'c-I-, ~.~~ ~. ~i-l-I ~ ~ ~==? v~'
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the perso a assets wh~ver situatit'
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 appears in a memorandum the end of th' inventory.
I verify that the statements made in this Inven-
tort' are true and correct. I understand that false state-
ments herein are made subject to the penalties of S~/S ,,
18 Pa.C.S. § 4904 relating to unsworn falsification to ~~ ~ lid ~ ~-Pr,/ 1X
authorities.
Attorney -- (Name)
(Supreme Court LD. No.)
(Address)
(Telephone)
DATE OF DEATH LAST RESIDENCE
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FIGURES MUST BE TOTALED
l`'nME 3 I ~j 1C(• ~ `~~`'t Sr . Ci4yW~ l~tzc., ~- I Z ~ !t
1 ~ ~ ~ 771 Y~~A C~~
f'~!~- CN~cr~~titC~ ~c~vatr
DECEDENT'S SOC. SEC. NO.
lyu (G X07 1
'(Jot..' (~)
~~.To~ „~ -~ 3~
C~o,ur awtiee,~~ S~ovs~ ~ $~ 333 '~( -
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~To ~+~T vw~~> S(}pvsE~
C ~' "~' ~~~~ SPDVS~
M~x*(3Ia2S 7S2Si 5~~~45 ~-cvJrd i C~`v,r..ei Owe ~~ I~rhJGt7'C't~(Z-'
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M~I~a-s (S2s,- ~~n: Snv~~4s ~k,- ~~~~~~ a~u~~, ISttvc.t~~
(Attach additional sheets as needed)
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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 ltW-09 rev. 10.13.06
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