HomeMy WebLinkAbout05-09-11 (3)INVENTORY
REGISTER OF WILLS OF CUMBERLAND
COMMONWEALTH OF PENNSYLVANIA ~ SS
COUNTY OF CUMBERLAND
COUNTY, PENNSYLVANIA
File Number 21 10 00888
Personal Representative(s) of the Estate of Ann M. Dykstra a/k/a Ann Marie Dykstra
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 eacl~,item of said
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real emote outside ~,Ihe
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- ~/ r ~ ;~~ ~` -
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tory are true and correct. I understand that false state- ~~
ments herein are made subject to the penalties of Paul S. Cribbms -- ~--~,t-~ ~ _
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18 Pa. C.S. § 4904 relating to unsworn falsification to _
authorities. ~..' ~ f-"`~. - ;
Attorney -- (Name) Benjamin J. Butler (Supreme Court LD. No.)
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81948
(Address) 500 N. Third Street, P.O. Box 1004 Harrisbur PA 17108-1004
(Telephone) 717.236.1485
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. N0.
4110 Carrington Court West
8/14/10 Mechanicsbur PA 17050 528-64-7592
FIGURES MUST BE TOTALED
Cash, Bank Deposits, & Misc. Personal Property
Citizens Bank -Checking Account ~ 4,974.15
Dickinson College -Accrued Vacation Pay ~ 1,324.81
Long Term Care Insurance -Refund ~ 2,851.41
2006 Acura RSX ~ 15,000.00
1999 Mazda Miata 5,000.00
(Attach additional sheets as needed)
TOTAL: 29,150.37
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 ZO Pa. C.S. ~ 3301(b))
For~rn RW-09 rev. 10.!3.06 _