HomeMy WebLinkAbout03-25-11 (3)INVENTORY
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND SS 21-09-0774
File Number
(trar~a F_ ~rhTlPldPr and K n h F Smi h Fxe ~t'nrS
Personal Representative(s) of the Estate of HOWARD E. SMITH
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 elcept 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- 1~ ,, , , ~ %"~ ~_. ,,-~ °~ ' t
tory are true and correct. I understand that false state- ~ `~' c '`" 1'°";~~ ~~ ~
Grace E. Schneider Kennet~~. Smith
ments herein are made subject to the penalties of 64 Ashburg Drive 1624 Williams Grove Road
18 Pa.C.S. § 4904 relating to unsworn falsification to Mechanicsburg, PA 17050 Dillsburg, PA 17 19
authorities.
Attorney -- (Name) Richard C. Snelbaker (,Supreme Cour•tLD. _~~o.) 6355
(Address) 44 West Main Street, Mechanicsburg, PA 17055
(Telephone) 717-697-8528
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO.
August 7, 2009 1700 Market Street, Borough of Camp Hill, Camp Hill; PA 17011 183-12-3001
FIGURES MUST BE TOTALED
1. HCR Manor Care, personal account held at nursing home 2,317.59
2. Highmark, refund unused insurance premium 428 54
3. Heartland Healthcare Services, refund on prescription plan 954.6b
4. Citizens Bank, checking account #6213378034 10,389.02
5. Citizens Bank, checking account #6213378069 1,474.71
6. United States Treastuy, refund on 2008 (Form 1040) income tai return 300.00
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(Attach additional sheets as needed)
TOTAL: ~ 15,864.52
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))
Form Ru'-09 rev. 10.13.06 p
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