HomeMy WebLinkAbout12-14-09 (2)INVENTORY
REGISTER OF WILLS OF
DAUPHIN COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA 1 SS (~-
COUNTY OF ) File Number 21 0398
Personal Representative(s) of the Estate of Barbaza Ann McCarthy a/k/a Barbaza A. McCarthy
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 appears in a memorandum at the end of this inventory.
I verify that the statements made in this Inven- 1 ~ ~, ~~-~~~ ~-- ~x ~ c:~;~~ ~~
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) Heather D. Royer, Esquire
(Address) 4431 N. Front Street, 3rd Floor, Harrisburg, PA 17110
(Telephone) (717) 234-2401
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO.
04/17/2009 11 Hartzdale Drive, Camp Hill, PA 17011 209-28-9279
I FIGURES MUST BE TOTALED I
1. Proceeds from sale of 11 Hartzdale Drive, Camp Hill, PA 17011 13 9,176.38
2. US Serie E and EE Savings Bonds 1 8,619.11
3. PNC Bank checking account #5005709724 25.00
4. Members 1st Federal Savings Union account #317556-00 7,483.97
5. Personal Property 7,642.00
6. Malzeppi Funeral Home Pre-Arrangement Plan 3,685.00
7. Holy Spirit Hospital refund 12.50
8. Ohio Casualty Homeowners Insurance refund ~ 38.00
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F,I,ECTRONIC MALFUNCTION WITH
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~fECLOCK -THE CLOCK DATE ON C : _ .
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THIS DOCUMENT IS 12 HOURS BEHIND ~ ~ _,_
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TIIE ACTUAL TIME. c,
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--RECUISTER OF a'ILIS/CLERK OF ORPEIANS' CRT
(Attach additional sheets as needed)
176,681.96
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(6))
(Supreme Court I.D. No.) 76327
Form RW-09 rev. 10.13.06