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Register of Wills Cumberland County I Pennsylvania
INVENTORY
Estate of John C. Serbieff No. 21-06-0086
also known as Date of Death 01/24/2006
,Deceased Social Security No. 207-07-6301
Carter B. Polm and Carol A. Polm,
Personal Representativa(s) of the above Estate, deceased, verify that the items appearing in the fallowing inventory include ail
of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania at said Oecedent, that
the valuation placed opposite each itam of said Inventory represents its fair value as of the date of the Dacedent's death, and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvanie except that which appears in a memorandum
at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that
false statements herein are made subject to the penalties of 18 Po. C.S. Section 4904 relating to unsworn falsification to
authorities.
Name of
Attorney:
Pels. on. al Representative:)
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Dated ~;-U)/ 06
Craig A. Hatch, Esquire
76361
Gates, Halbruner & Hatch, P.C.
1013 Mumma Rd., Ste. 100, Lemoyne, PA 17043
Telephone: 717-731-9600
1.0. No.:
Address:
Description
Value
$144,937.02
$5,995.00 (
$12.50
$93.60
$23.36
$15.00
$45.25
$828.93
$1,914.00
$160.00
$148,102.60
$64.50
Total:
$302,191.76
Real estate located at 113 June Drive, Camp Hill, PA
1999 Oldsmobile Cutlass GL
AARP - refund
Blue Cross/Blue Shield - refund
Boscov's - refund
Caremark Rx, Inc. - refund
Comcast Cable - refund
M&T Bank - Acct. No. 487953
Miscellaneous Petsonal Property
Peerless Insurance Company - refund
Sovereign Bank - Acct. No. 2331030898
Patriot-News Co. - refund = $28.50; Erie Insurance Co. - refund = $26.00
(Attach Additional Sheets if necessary}
NOTE: The Memorendum of real estate outside the Commonwealth of Pennsylvania may. at the election of the personal representative. include
the value of each item, bur:. such figures should not be extended into the totat of the Inventory.
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