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INVENTORY
REGISTER OF WII.,LS OF CUMBERLAND COUNTY, PENNSXLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND SS File Number 21 10 0915
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Personal Representative(s) of the Estate of Pauline R. Raker
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personalsets wherever situate
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed op osite each item of said
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estat~ outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. ',
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I verify that the statements made in this Inven- ~~~
tory are true and correct. I understand that false state-
ments herein are made subject to the penalties of Paula S. Williams
18 Pa. C.S. § 4904 relating to tu~sworn falsification to
authorities.
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Attorney -(Name) Benjamin J. Butler (Supreme Court I~D. No.) 81948
(Address) 500 N. Third Street, P.O. Box 1004 _ Harrisburg. PA 17108-1004
(Telephone) 717.236.1485
DATE OF DEATH LAST RESIDENCE OEC DENTS SOC. SEC. NO.
100 Mt. Allen Drive
8/21/10 Mechanicsburg PA 17055 I186~46-4081
FIGURES MUST BE TOTALED
Stocks & Bonds
363.00 shares Principal Financial Group, Inc. (PFG)
Cash, Bank Deposits, & Misc. Personal Property
Fields Family Dentistry -Refund
Medicare -Refund
2010 PA-40 -Refund (estimate)
Miscellaneous
(Attach additional sheets as needea
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:::~ ,``-'~ 900.00
250.00
483.00
16,747.91
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative in lude 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))
Form RW-09 rev. 10.!3.06
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Continuation of Inventory
Pauline R. Raker 21 10 0915
Decedent Name Page ~ File Number
Description of Inventory
The Prudential Life Insurance Company of America -Policy No. 10575494 6,997.32
Beneficiary: Esffite
Subtotal S 6,997.32
Grand Total 3 16,747.91