HomeMy WebLinkAbout07-14-10 (2)INVENTORY
REGISTER OF WILLS OF CUMBERLAND
COMMONWEALTH OF PENNSYLVANIA 1
COUNTY OF Cumberland f SS
Ann M. Myers, Executrix
Personal Representative(s) of the Estate of ERMA I. MILLARD
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- ~,' ~~
tort' are true and correct. I understand that false state- ~ , _
ments herein are made subject to the penalties of 302 N.E. 49th Street
18 Pa.GS. § 4904 relating to unsworn falsification to ,
authorities.
Attorney -- (Name) Richard C. Snelbaker (Supreme Court LD. No.) 6355
(Address) Snelbaker & Brenneman, P.C., 44 West Main Street, Mechanicsburg, PA 17055
(Telephone) 717-697-8528
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO.
03/04/2009 801 North Hanover Street, North Middleton Twp.,Carlisle, PA 17013 170-30--3733
FIGURES MUST BE TOTALED
1. Church of God Home, refund due the decedent from nursing home account which included 6,929.08
a refund from Highmark Insurance in the amount of $389.88
r~..7
:: ~-] ~ -~
-
- `~:
`c~ ~ ,
{ •~ ^~-
i
-._ .,T
.,l /
,.~...~,..
~
f-,. .. .
.
", ~. .. ..1
-~
1,
~~I ~ -- F _i„_~
(Attach additional sheets as needed) ~.ri '' '' <'-~
c-~ ~ ~
TOTAL: 6,929.08
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))
COUNTY, PENNSYLVANIA
File Number 21-09-0698
Form RW-09 rer. 10.13.06