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INVENTORY
REGISTER OF WILLS OF
CUMBERLAND
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland } SS File Number 21-11-0825
Carolyn R Romig
Personal Representative(s) of the Estate of Catherine S Romig
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the per;
situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuat
item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent
outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end
I verify that the statements made in this Inven- ,.~
tory are true and correct. I understand that false state- ~ Caroly R Romig
ments herein are made subject to the penalties of
18 Pa.C.S. § 4904 relating to unsworn falsification to
authorities.
Attorney -- (Name)
(Firm)
(Address)
(Telephone)
EDMUND G. MYERS
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COUNTY, PENNSYLVANIA
.,:,
5_Yal assets wherever ~;~
~~ced oppte e~ --"`-j
r no rea tate , ; C'~
,, ~ f, r -s'_ _-_
`7 v art ~_ -~-i
_. ,
n,a `~
(Supreme Court I.D. No.) 20558
JOHNSON DUFFIE _
301 MARKET STREET, Lemoyne, PA 17043 _
(717) 761-4540 _
DATE OF DEATH I LAST RESIDENCE Golden Living Nursing Home I DECEDENT'S SOC. SEC. N0
07/05/2011 Camp Hill, PA 17011 186-10-2900
FIGURES MUST BE TOTALED
Personal Property
Cash ...............................................................................................
Personal Property ........................................................................
Stoc ks/Listed ................................................................................
Stocks/Closely Held .....................................................................
Bonds ............................................................................................
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable ...............................................
All Other Property ........................................................................
Total Personal Property ........................................
Total Real Property ................................................
Total Personal and Real Property ........................
107,097.73.
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))
107, 097.73
107,097.73
Form RW-09 Rey. io-~s-zoos
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INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
r
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland } SS File Number 21-11-0825 _
DATE OF DEATH LAST RESIDENCE Golden Living Nursing Home DECEDENT'S SOC. SEC. N0.
07/05/2011 Camp Hill, PA 17011 186-10-2900
Cash
Highmark -Refund on prescription drug plan
M&T Bank Power Checking Account 000000072574321
M&T Bank Regular Time Deposit Certificate of Deposit Account No. 031003914381072
M&T Bank Regular Time Deposit Certificate of Deposit Account No. 031003914471740
MB~T Bank Regular Time Deposit Certificate of Deposit Account No. 031003914487870
Total Cash
44.60
28,532.93
7,003.76
50,002.40
21,514.04
107,097.73
(Attach additional sheets if necessary) Total Personal Property and Real Estate 107,097.73