HomeMy WebLinkAbout08-10-11 (3)INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMON\~EALTH OF PENNSYLVANIA ~ SS
COUNTY OF CUMBERLAND
File Number 21
Personal Representative(s) of the Estate of DOROTHY EVINA
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 caned' o real estate outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end o~is inve~tto~y.
I verify that the statements made in this Inven- r '~ ~'~-! . ~~
~ ,,
tory are true and correct. I understand that false state-
ments herein are made subject to the penalties of t; PA NE E. STEV ~ E C TOR
18 Pa. C.S. § 4904 relating to unsworn falsification to
authorities.
Attorney -- (Name) DAVID R. GETZ, ESQ. (Supreme Cou.r~t LD. No.) 34838
(Acldr-ess) WIX WENGER & WEIDNER, P.O. BOX 845 HARRISBURG PA 17108
(Telephofze) (717) 234-4182
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO.
CHAPEL POINTE HEALTH CARE CENTER
1/28/2011 CARLISLE PA 17013 177261262
FIGURES MUST BE TOTALED
CHAPEL POINTE HEALTH CARE CENTER 2,328.74
"PERSONAL CARE ACCOUNT" REFUND
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(Attach additional sheets as zzeeded)
2.328.74
NOT[:: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at [he eleLtion of the personal representative include the value of each
item, but such figures should not he extended into the [oral of the Inventory. (See 20 Pa. C.S. § 3301(6))
11 563
Fonn RW-OJ rev. 10.13.06