HomeMy WebLinkAbout08-27-10 (2)INVENTORY
REGISTER OF WILLS OF CUMBERLAND
COMMONWEALTH OF PENNSYLVANIA ~ SS
COUNTY OF CUMBERLAND
Personal Representative(s) of the Estate of GENEVIEVE M. POLM
deceased, deposes} 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- ~~~ I~~~ ~ ~ triL/ti.~ %•---
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) JOHN R. ZONARICH, ESQUIRE (Supreme Court L D. No.) 19632
(Address) 17 S. 2ND STREET, 6TH FLOOR, HARRISBURG, PA 17101
(Telephone) 717-233-1000
DATE OF DEATH LAST RESIDENCE DECEDEIVT'S SOC. SEC. NO.
MAY 24, 2010 5026 AMELIA PATH WEST, MECHANICSBURG, PA 17050 188-14-7875
FIGURES MUST BE TOTALED
SEE ATTACHED
COUNTY, PENNSYL`IANIA
File Number 21 - 10 - 0612
5,515.23
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(Attach additional sheets as needed)
TOTAL: ~ 5,515.23
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representatives 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
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Page 1
Estate of Genevieve M. Polm
Estate Inventory
Valued as of Date of Death
Cash and Cash Equivalents
Citizens Bank Checking Account
No. 6220185602
Citizens Bank Checking Account
No. 6220185599
Citizens Bank Savings Account No.
6251716984
Highmark -premium refund
Loyalton of Creekview -Refund
Revenue Rebate
Total Cash and Cash Equivalents
No. of
Shares Stocks
30 Met Life Common Stock
Total Stocks
Total Inventory
$ 2,511.55
808.34
101.56
41.78
226.00
650.00
$ 1,176.00
$ 4,339.23
1,176.00
$ 5,515.23
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