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INVENTORY
REGISTER OF WILLS OF Cumberland
COMMONWEALTH OF PENNSYLVANIA l SS
COUNTY OF Cumberland )
COUNTY, PENNSYLVANIA
File Number
Personal Representative(s) of the Estate of Goldie Barnes
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- 0.~
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) David H. Radcliff/Radcliff Law Office, P.C. (Supreme Court I. D. No.) 25483
(Address) 1011 Mumma Road, Suite 201, Lemoyne, PA 17043
(Telephone) (717) 236-9318
DATE OF DEATH LAST RESIDENCE DECEDENTS SOC. SEC. NO.
November 6, 2010 135 Messiah Circle, Mechanicsburg, PA 17055 188-12-3729
See Attached Inventory Sheet
21-10-1204
40,265.00
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(Attach additional sheets as needed)
TOTAL: ~ 40,265.00
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(6))
FIGURES MUST BE TOTALED
Form RW-09 rev. 10.13.06
4
FILE NUMBER:
INVENTORY FOR THE ESTATE OF
Goldie Barnes
Who Died on November 6, 2010
Bonds
25 Series E Saving Bond Issue Date 3/1980 111.00
25 Series E Saving Bond Issue Date 10/1978 107.00
25 Series E Saving Bond Issue Date 5/1977 139.00
25 Series E Saving Bond Issue Date 11/1975 134.00
25 Series E Saving Bond Issue Date 6/1974 130.00
25 Series E Saving Bond Issue Date 1/1973 130.00
Cash
Wachovia Checking Acct No. ####53380
Interest Accrued to 11 /6/2010
United Steelworkers Reimbursement of Medicare Part B Premium Paic
Reimbursement of Medicial Payment
Reimbursement of Medicial Payment
Penn Treaty Long Term Care Reimbursement
US Treasury 2010 Individual Income Tax Refund
PA Department of Revenue 2010 Individual Income Tax Refund
Verizon Pension Payment
Verizon Final Pension Payment
Client Account Held with David Radcliffe
Personal Property
Gross Proceeds Sale of Tangible Personal Property
Sewing Box Contents & Cigar Box
Miscellaneous
Harry Barnes Litigation Estimated Proceeds
Total
28,595.00
1.00
850.00
26.00
117.00
2,640.00
3,470.00
801.00
879.00
120.00
357.00
578.00
80.00
1,000.00
40,265.00