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INVENTORY
REGISTER OF WILLS OF C'[1MBERL~ND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA ~ SS
COUNTY OF ~'U~E~-~D
File Number 21-10-0998 _
Personal Representative(s) of the Estate of Ray A. Coy
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 rE;al 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- ~~ ~ ~C~K-~~' ._._
tory are true and correct. I understand that false state- +
ments herein are made subject to the penalties of Lola L. Cohick, ~dministratrix:
1$ Pa.C.S. § 4904 relating to unsworn falsification to
authorities.
Attorne ame Joseph A. Macaluso (Supreme Court I.~~. No.) 38262
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(Address) 9614 Rowe Run Loop, Shippensbura, PA 17257 .
(Telephone) ~7~,7) 532-4832 .~
DATE OF DEATH LAST RESIDENCE 3O1 West Creek Road DECEDENT'S SOC. SEC. N0.
September 10, 2010 Newburg, PA 17240 200 22 6533
FIGURES MUST BE TOTALED
See attached
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(Attach additional sheets as needed)
TOTAL:
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative i~~clude the value of each
item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. ,¢ 33D1(b))
Form RW-09 rev. 10.13. D6
~~~~Y
INVENTORY
Re: Estate of Ray A. Coy
File No. 2010-00998; PA File No. 21-10-0998
NUMBER ITEM AMOUNT
Real estate
1. 301 West Creek Road $40,000.00
Newburg, PA 17240
Bank Account
2. Checking Account No. 549010 $504.98
Orrstown Bank
77 East King St.
Shippensburg, PA 17257
Vehicle
3. 1990 Olds Regency $600.00
Miscellaneous
4. 1975 trailer 200.1)0
TOTAL $41, 31)4.98