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James D.
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland }
INVENTORY
File Number 21 -12-0298
David N, Kurth
Personal Representative(s) of the Estate of Dorothy A. Adomaitis
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 w pears in a memorandum at the end of this inventory.
I verify that the statements made in this Inven- ~ ~~~~ ,~/ S'r7> /Z
tory are true and correct. I understand that false state- ~-~-David N. Kurth
menu herein are made subject to the penalties of
18 Pa.C.S. § 4904 relating to unsworn falsification to
authorities.
Attorney -• (Name)
(Firm)
(Address)
(Telephone)
(Supreme Courtl.D. No.) 19475
Bogar & Hipp Law Offices
One West Main Street, Shiremanstown, PA 17011
(717)737-8761
DATE OF DEATH f LAST RESIDENCE 909 Williams Grove Road I DECEDENTS SOC. SEC. NQ
0 210 912 01 2 L Mechanicsburg, PA 17055 I+ 180-16-7377
LFIGURES MUST BE TOTALED
Personal Property
Cash ............................................................................................... n 105~~0.32
Personal Property ........................................................................ ~~ -~ T
Stocks/Listed ................................................................................ ~~~ ~ ~; c5
StockslClosely Held ..................................................................... L. > ~ ~-
`'n~J <~ ,
Partnerships and Sole Proprietorships ..................................... _w -' ~ _,_-_ -..
_ -,:-. ,-
Mortgages and Notes Receivable ............................................... ~~,' - '- m
•• f.
All Other Property ........................................................................ ~ ~ c~
Total Personal Property ........................................ 105,080.32
Total Real Property ................................................
Total Personal and Real Property ........................ """'
~ ,,'1~D5r08~{32'i
NOTE; The Memorandum of real estate outside the Commonwealth of Pennsylvania may, ai the election of the personal representative include the value of each
item, but such figures should not be eMended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b))
Form fiW D9 Rev. 10.73-2006
.,
INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland } SS File Number 21-12-8298
DATE OF DEATH lASTRESiDENCE 909 Wi11iamsGrove Road DECEDENTS SOC. SEC. NO.
S.t~
Janney Montgomery Scott -investment Account No. 3369-7569
Keystone Elder Law -Refund
Quantum Imaging -Refund
Sovereign Bank -Checking Account No. 1161092854. Date of death balance
$80,492.57; accrued interest $0.09.
U.S. Treasury - 2071 Personal Income Tax Refund
Total Cash
20.803.12
3,000.00
46.92
80,492.66
737.62
105.080.32
(Attach additional sheets if necessary) Total Personal Property and Real Estate 105,080.32