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INVENTORY
REGISTER OF WILLS OF
CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA } SS
couNTY of Cumberland }
Samuel Richard Martin
File Number 21 -11 - 0153
Personal Representative(s) of the Estate of Martin, Samuel I.
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. _
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I verify that the statements made in this Inven- t/ ~~~-t' V 1 v `-`-~ ~ ~_ <~ `n-~ -, , ~~
tory are true and correct. I understand that false state- } n ~ ` ` '
) p Samuel Richard Martin ~ T- ~ __~,
ments herern are made sub'ect to the enalties of i.; U ~ 'r ~ !
18 Pa.C.S. § 4904 relating to unsworn falsification to } "'~'~ ~
authorities. '' -'~
Attorney - (Name)
(Firm)
(Address)
William C Cramer
14 North Main Street, Ste. 414
Chambersburg, PA 17201
y --r.
(Supreme Cowrt~~. No.) ~~2495 =- ~ ''~
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(Telephone) 717/264-3711
DATE OF DEATH LAST RESIDENCE 129 Walnut Bottom Road DECEDENTS SOC. SEC. NO.
1/7/2011 Shippensburg, PA 17257 205-09-9182
FIGURES MUST BE TOTALED
Personal Property
Checking account #15418030 maintained with Orrstown Bank held in decedent's 9,301.60
name alone, including interest accrued through date of death.
Money market account #828173 maintained with Orrstown Bank held in 54,100.65
decedent's name alone, incuding interest accrued through date of death.
Certificate of Deposit #4000013955 maintained with Orrstown Bank held in 5,002.79
decedent's name alone, includuing interest accrued through date of death.
(Attach additional sheets if necessary) Total Personal Property and Real Estate $259,360.58
INVENTORY
(continued)
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
couNTY of Cumberland } ss File Number 21 -11 - 0153
DATE OF DEATH LAST RESIDENCE 129 Walnut Bottom Road DECEDENT"S SOC. SEC. N0.
11712011 Shippensbur , PA 17257 205-09-9182
Certificate of Deposit #4000020905 maintained with Orrstown Bank held in
decedent's name alone, including interest accrued through date of death.
Certificate of Deposit #4000021368 maintained with Orrstown Bank held in
decedent's name alone, including interest accrued through date of death.
Mutual fund #690015999 maintained with Invesco held in decedent's name
alone, including interest accrued through date of death.
Mutual fund #6900160873 maintained with Invesco held in decedent's name
alone, including interest accrued through date of death.
Mutual fund #6900161427 maintained with Invesco held in decedent's name
alone, including interest accrued through date of death.
Retained Assets Insurance Account #9860059174 maintained with Northern
Trust held in decedent's name alone, including interest accrued through date of
death.
Refund from Elmcroft, for unused nursing home fee
Refund from Internal Revenue Service, for decedent's 2010 income tax
Total Personal Property
33,202.38
67,285.07
2,138.42
5,762.85
13,868.73
60,441.49
2,092.60
6,164.00
259,360.58