HomeMy WebLinkAbout12-02-11 (3)INVENTORY
REGISTER OF WILLS OF CUMBERLAND
COMMONWEALTH OF PENNSYLVANIA 1 SS
COUNTY OF CUMBERLAND J
COUNTY, PENNSYLVANIA
File Number 2011-0688
Personal Representative(s) of the Estate of Viola J. Black
deceased, depose(s) and say(s) that the items appearing in the following inventory include all .Df 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 de a ecedent owned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a or at the nd of this inventory.
I verify that the staterrtents made in this Inven-
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) Elyse E. Rogers
('
J (Supreme Courtl.D. No.) 41274
(Address) Saidis, Sullivan & Rogers 635 North 12th S t Sui 400 Lemoyne PA 17043
DATE OF DEATH
June 3, 2011
(Telephone) 717-612-5801
LAST RESIDENCE DECEDENT'S SOC. SEC. NO.
1488 Brandt Avenue, New Cumberland, PA 17070 195-16-3398
FIGURES MUST BE TOTALED
PA Department of Revenue - 2010 income tax refund
Transamerica Select Value Annuity Contract 27343144 (Beneficiary: Decedent's husband -Kenneth G.
Black who pre-deceased Decedent -- now payable to Estate of Viola J. Black)
PA Unclaimed Property - PA Employees Benefit Trust Fund claims payment check
PA State Employees' Retirement System Final Payment
Cumberland County Death Benefit
Ameritas Life Insurance Policy 0000237066
(Attach additional sheets as needed)
BCD
i
j~L~
.~~
~~ ~
'T'7
53.00
40,636.32
13.24
84.43
a~~== 100.00
~~. y-~
~ 2,9,8~(~:
n7 _ -
C7 [~j
~J t'~~
C.I'I ~"'~
O^. "~,"t
TOTAL• ~ 43 873 07
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. /0.13.06