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HomeMy WebLinkAbout09-17-10 (2)na f1") t INVENTORY `--_=~:° - m r`-~i fem... ~ ..~ ; ~ - .. i REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNS~~11IA.=.~ ` . ~ ` '_=, r,., __ . `_~ ,-.© _ c. COMMONWEALTH OF PENNSYLVANIA ~ ~} ^ ~~ ~ -~ COUNTY OF CUMBERLAND } SS File Number 21 - 10 - 0446 - ' ~~ ~ _ ~ f• ~,'. .,... . 'a z` ~ Personal Representative(s) of the Estate of ANN G. LARSEN 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- ~,~~~~'"~-,-~_~.f:~`~Z.--~'` tort' 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) GREGORY S. CHELAP, ESQUIRE (Supreme Court I. D. No.) 78443 (Address) 17 S. 2ND STREET, 6TH FLOOR, HARRISBURG, PA 17101 (Telephone) 717-233-1000 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)) Form RW-09 rev. l0. l3.Ob - Estate of ANN G. LARSEN Estate Inventory Valued as of Date of Death Face Value Cash and Cash Equivalents Belco Certificate of Deposit Interest at Date of Death Belco Money Market Account Interest at Date of Death Belco Savings Account No. S 1 Citizens Bank C/D No. 6255-533191 Citizens Bank C/D No. 6245-023241 Citizens bank C1D No. 6255-533213 Citizens Bank Checking Account No. 620938-705-9 Country Meadows Associates - Refund Metro Bank -Cash found in Safe Deposit Box (see Inventory attached hereto) Metro Bank Checking Account No. 833086358 Metro Bank Checking Account No. 513180000 Metro Bank Savings Account No 616307600 Metro Bank Savings Account No. 616092657 National States Insurance -Refund of health insurance PA Department of Revenue - '09 Tax Refund PA Life Insurance -Refund of policy premium The Patriot News -Refund Total Cash and Cash Equivalents Page 1 1,005.03 2.58 44,03 8.5 $ 73.63 5.00 25,925.14 56,475.22 51,789.51 2,659.09 5,510.46 23,950.75 75,515.04 3,136.93 17,666.62 30,307.84 355.23 275.00 39.50 191.00 ~ 338,922.15 (1) Estate Inventory (Continued) Tangible Personal Property Household goods and personal property $ 500.00 Total Tangible Personal Property $ 500.00 Miscellaneous Ameriprise Account No. 60321155 $ 16,941.04 Jewelry -see appraisal attached hereto 1,940.40 Total Miscellaneous 18,881.44 Totallnventory $ 358,303.59 Page 2 (2)