HomeMy WebLinkAbout08-24-10 (2)48500D41D46
REV~85 EX (U5-04)
SAFE DEPOSIT
BOX fNVENTORY '
PA Deparbnent of Reverwe PLEABE YsE ORlfii~NAL PORM ONLY
Soda) Ssaxfly or Death CertlRcate Number Date of Death County Code Year File Num
210-26-6451 08/07/2010 ~ T
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Decedent's Last Name $u}lix First Name ~ ~~ ~ MI
SOLIDER :MERLE ' F
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ADDRE88 OF DECEDENT STREET: CITY 3TA ZIP CODE:
10 CREEKVIEW RD NEWVILLE P 17241
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE-SAFE DEPOSIT BOX
wuNE' CINDY L FINKENBINDER
STREETADORESS: CITY: 5174
~ ZIP CODE:
17241
10 CREEKVIEW RD NEWVILLE
NAME, ADDRl88 AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING
a, NAME; RELATIONSHIP: i
CINDY L FINKENBINDER DAUGHTER ~
STREET ADDRESS: CITY: STA ZIP CODE:
10 CREEKVIEW RD NEWVILLE p 17241
b. NAME: RELATIONSHIP:
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STREETADORESS: CITY: STA
i ZIP CODE:
a, NAME: RELATIONSHIP: i
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STREET ADDRESS: CITY: STA ZiP CODE:
NAME AND ADDRESS OF FR/ANCIAL INSTITU710N WHERE THE SAFE DEPOSIT BOX IS LOCATED
NAME:
ADAMS COUNTY NATIONAL BANK -
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STREET ADDRESS: CITY: 3TA ZIP CODE:
39 CARLISLE RD NEWVILLE P 17241
NAME OF PERSON MAKING LAST ENTRY DATE AND TAME OF LAST
CINDY L FINKENBINDER 11/18/09 0:00 am
DATE OF CONTRACT TO RENT BOX NUMBER OF BOX TITLE UNDER WHICH BOX IS RE c~
08/27/1985 80300365 MERLE F SOLIDER e~ ~.~
NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO 80X a'
a. NAME: b. NAME: ~ c~;A
MERLE F SOLIDER CINDY FINKENBINDER DEP iu ,`
STREET ADDRESS: STREET ADDRESS:
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10 CREKVIEW RD 10 CREEKVIEW RD ~ ~=,
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CITY: STATE: ZIP CODE: CITY: ODE::
NEWVILLE PA 17241 NEWVILLE 41 :..~
NAME AND TITLE OF EA~LOYEE TAKING THE INVENTORY Ca `'
DOUGLAS R LINDSAY, RETAIL OFFICE MANAGER t~T
wAa A WILL qr THE BOX4 ^ YES Q) No N ys, a. Dab of wlli:
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b. Name and addma of personal nPrasantatlw, N named In the will ~ ~
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(1) Cash: Report total ony.
(2) Stacks: Uat in detail every ctxnmon ar preferred ceriflcate, warrant or other rights found in box. Stodrs ars to be designated by
name of company, certificate number, date of certificate, name in which stock is registered. and number of shares and loss of stock.
(3) Obllgatlons of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership,
I.e., jointly held, payable on death, etc.
(4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
(5} Bank and. Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank
and branch, and balance.
(S} Jewelry, Coins, Stamps. Manuscripts, etc: List and describe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policlss or other evidences of indebtedness: List and describe as fuly as possible.
(S) All other conbnts.
(9) Return canpleted form to: DEPARTMENT OF REVENUE
INNERITANCE TAX WIASION
APT. 280601
HARRISBURG, PA 17128.0601
ITEM
NO. ITEM DfiSCRiPTION
1 PROSPECT HILL CEMETARY DEED
2 DEED FOR RD#3 NEWVILLE PA 17241
3 ERIE FAMILY LIFE INSURNCE POLICY 3105-466, X5,000.00 INSURED AMT.
4 WESTMINISTER MEMORIAL GARDENS LOT GB-23&D
I cEttTIFY UNDER PEIIAL.TY of PER.ItJRY Tw-T 7'HE Att+OVE tttiCORD re PERSON RItCEMNG COPY OF
CORRECT AND CO11~I.ETE TO TtiE BEST Of MY Kf101NE~0E AND t3tt11Et? t;AfL ~R SOX INVf~NTORY:
SIGNATURE SGNATURE
PRINT NAME PRINT NAME AND CHECK APPROPRIATE BOX BELOW:
PRINT TITLE ~ DATE CHECK APPROPRIATE BOX:
^ Executor(trlx) ^ Admi"hUetuif~bC)
Esta4 R~pns~nhtivs ^ Jdnt ownx of safra Gpwil bwc
NOTE: Attach addltlonal $'!:" x 11" sheet(s) if necessary or use duplicates of this page of form.
The DepMment u aulhorbxd bylaw, 42 U.S.C. f 105 (e)~(C)(i), to require disdoaure of Sadel Security numbefs in oonnecUon r~lh a6erNlg state tax laws. The DepeMorll uses the
Social Sscutktr number b iderNUy the deoedeld and persoral roprsserlfaUves of the estate. The Conurlonweilbh may also use tM hfor-natlon in exd~ange of tax infolrrlation agreements
wih Federal and bcal autllailba. The state law tlxi Carmalweeltl-'s from reMidendaf tax hfortnatlon for offk9al