HomeMy WebLinkAbout05-06-11 (2)INVENTORY
REGISTER OF WILLS OF ~~ -~ ~~- ~~^ ~ COUNTY, PENNSYLV~-NIA
COMMONWEALT OF PENNSYLVANIA SS
COUNTY OF ~~' M 6~ ~~^ ~~
Q 7 5" ~
File Number
Personal Representative(s) of the Estate of ,~lr.~c ~~~ /~''~ Gzly ~
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-
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)
(Address)-
(Telephone)
DATE OF DEATH
LAST RESIDENCE
I FIGURES MUST BE TOTALED I
// i
C~~i, ~
,~
Q ~._,
1. ~._a
_ , z:
~; _ t _,' ~ _
( iT
-_~__ ._._: i
L.:. {_;;
L:.- f. .`
i
..
I
~r_ 1 "_
C. -. -
~~
_
. U
(Attach additional sheets as needed)
DECEDENT"'S SOC. SEC. NO.
.i~ s~, sUt~ , U
ya ~~ ~y ~%
07 a ~
/ ~l/ - CJ1 Jr
a~ ~~
y~U_
TOTAL: I .~ ~~ ~ ~°Z ~ 0.00
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representativf; 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 R W-09 rev. 10.13.06
(Supreme Court 1. D. 1Vo.)
~p ,~ , /yam .~!' ~ c ~%'!~ ~ ~(~ C.
7~
`,