HomeMy WebLinkAbout02-13-12 (3)f x "7
INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA ~ SS
COUNTY OF
File Number 21 10 0242
Personal Representative(s) of the Estate of GERTRUDE MITTELSDORF
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the pers al assets w>~rever situate
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation plac~~posite eft item of~uid
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no rea~s~te outsic~bf that
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory ~ rte-- va , : -~~
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I verify that the statements made in this lnven- ~ ~"~ ^ ~ ~_~ ~ ~'
tory are true and correct. I understand that false state- _ _ -~
ments herein are made subject to the penalties of ~~~ `~= C s
18 Pa. C.S. § 4904 relating to unsworn falsification to ^' ~ `^~ m
authorities. ~
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Attorney -- (Name) Stanley J. A. Laskowski, Esquire (Supreme Court /. D. No.) 37422
(Address) 3631 North Front Street Harrisburg PA 17110
(Telephone) 717-232-7661
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. N0.
Bethany Village at 5225 Wilson Lane
2/13/2010 Mechanicsbur PA 17055 139-09-7984
FIGURES MUST BE TOTALED
1. AIG Sun America Financial -Annuity 56,259.44
Acct. No. A009744581 (See attached)
2. T. Rowe Price Acct. No. 7004310980-4 22,966.36
4,719.672 shares @$4.86/share, plus accrued dividend of $28.75 (See attached)
3. United Healthcare System, Inc. -Refund 37.40
4. Asbury Communities, Inc. -Refund Skilled Nursing 4,016.66
5. The Philadelphia Contributorship -Homeowner Ins. Refund 70.00
6. Asbury Communities, Inc. -Bethany Village Refund of Deposit 208,350.00
7. Pinnacle Health Emergency Dept. -Refund 45.43
(Attach additional sheets as needed)
TOTAL: I 380, 012.99
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)J
Form RW-09 rev. 10.!3.06
1 Continuation of Inventory
r
GERTRUDE MITTELSDORF 21 10 0242
Decedent Name Page 1 File Number
Description of Inventory
8. Pinnacle Health System -Refund
9. Pinnacle Health System -Refund
10. Continuing Care RX -Refund
11. Jewelry (See attached appraisal) -Total
12. Misc. Personal Effects, Clothing
13. Nationwide -Annuity -Acct. No. 19-9100002174 (See attached)
14. Natiownide Annuity -Acct. No. 01-5698974 (See attached)
25.35
6.37
568.20
9,589.00
100.00
10,389.56
67,589.22
subtotal S 88,267.70
Grand Total $ 380,012.99