HomeMy WebLinkAbout03-14-12 (2)INVENTORY
REGISTER OF WILLS OF cuneERLAND
COMMONWEALTH OF PENNSYLVANIA ~ SS
COUNTY OF CUMBERLAND
COUNTY, PENNSYLVANIA
File Number 21 12 008?
Personal Representative(s) of the Estate of RONALD J • S M I T H
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-
tory are true and correct. I understand that false state- ~ LI," ~~ ~tw
ments herein are made subject to the penalties of VV I R G I N I A S M I T H
18 Pa. C.S. § 4904 relating to unsworn falsification to
authorities.
Attorney -- (Name) SUSAN H • CONFAIR (S'upreme Courtl.D. No.) 70241
(Address) 2331 MARKET STREET CAMP HILL PA 17011
(Telephone) 7177631383
DATE OF DEATH LAST RESIDENCE DECEDENTS SOC. SEC. NO.
512 POPLAR CHURCH ROAD
5/13/2011 CAMP HILL PA 1'7011 201 380935
FIGURES MUST BE TOTALED
Stocks l~ Bonds `~ t ,
c~
~ ~,
'
~
' ~s
..~ r~
Closely-Held Corporation, Partnership or Sole-Proprietorship ~,,,~ - t?
z,~ ` =
Mortgages & Notes Receivable _~ ~--
~ ~
-,ss '~ --'i
_ ,.;
r-. l."'3 ~-.~
Cash, Bank Deposits, 8 Misc• Personal Property ~'' ~'-'
HERITAGE MEDICAL GROUP - REFUND HCA 40.00
GGNSC CAMP HILL WEST SHORE LP - REFUND 4,596.27
GGNSC ADMINISTRATIVE SERVICES LLC - REFUND 4,885.04
(Attach additional sheets as needed)
16,192.79
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))
Form RW-09 rev. 10.13.06
Continuation of Inventory
RONALD J• SMITH 21 12 0087
File Number
Decedent Name Page 1
Description of Inventory
GGNSC ADMINISTRATIVE SERVICES LLC - REFUND
Real Estate
6,671.48
Subtotal 5 6 , 6 71.4 8
Grand Total 5 16,192.79