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INVENTORY
REGISTER OF WILLS OF C U M B E R L A N D COUNTY, PENNS~'LVANIA
COMMONWEALTH OF PENNSYLVANIA ~ SS
COUNTY OF CUMBERLAND File Number 21 11 0 2 4 7
Personal Representative(s) of the Estate of CARL N • GATES , J R •
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal a;>sets 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. 1 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) L I N U S E• F E N I C L E (Supreme Court I. D. No.) 2 0 9 4 4
(Address) 2331 MARKET STREET CAMP HILL PA 17011
(Telephone) 717-763-1383
DATE OF DEATH LAST RESIDENCE DECEDENTS SOC. SEC. NO.
100 MOUNT ALLEN DRIVE
2/13/2011 MECHANICSBURG PA 17055 184:122913
FIGURES MUST BE TOTALED
Stocks >~ Bonds
Closely-Held Corporation, Partnership or Sole-Proprietorship
Mortgages & Notes Receivable
Cash, Bank Deposits, & Misc• Personal Property
1995 BUICK RIVIERA
PERSONAL PROPERTY
M & T BANK - CHECKING ACCOUNT - #9838438365
499 MITCHELL ROAD
MILLSBORO, DE 19966
(Attach additional sheets as needed)
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., _ ~ ~:=~
a
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L J
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Ri l
1,000.00
500.00
17,540.22
TOTAL: ~ 6 3, 5 0 3.6 4
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 RW-09 rev. 10.13.06
~.r~
~ Continuation of Inventory
CARL N• GATES, JR• 21 11 024?
Decedent Name
Pa e 1 File Number
Description of Inventory
M & T BANK - SAVINGS ACCOUNT - #15004211803611
499 MITCHELL ROAD
MILLSBORO, DE 19966
CUMBERLAND COUNTY VET• DEATH BENEFIT
MEDICARE PART D COVERAGE GAP REBATE/REFUND
CAPITAL BLUE CROSS REFUND
2011 TAX REFUND
Real Estate
42,999.62
100.00
250.00
153.80
960.00
Subtotal $ 4 4, 4 6 3. 4 2
Grand Total $ 63,503.64