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INVENTORY
REGISTER OF WII,LS OF cuMBERLAND COUNTY, PENNSYLVANIA
CO1vIIvIONV/EALTH OF PENNSYLVANIA ~ SS
COUNTY OF CUMBERLAND
File Number 21 11 0960
Personal Representative(s) of the Estate of GEORGE S • D A V I S
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 planed 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-
ments herein are made subject to the penalties of
18 Pa. C.S. § 4904 relating to unsworn falsification to
authorities.
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JAN A• DAVIS
Attorney -(Name) DAVID W • REAGER
(Supreme Court I.D. No.) 208 6 8
(Address) 2331 MARKET STREET CAMP HILL PA 17011
(Telephone) 717-763-1383
DATE OF DEATH LAST RESIDENCE DECEDENTS SOC. SEC. NO.
511 PARK AVENUE
8/2/2011 NEW CUMBERLAND _ PA 17070 226590 ~-` __
FIGURES MUST BE TOTALED
Stocks 8 Bonds
Closely-Held Corporation, Partnership or Sole-Proprietorship
FALLOW FIELD, a Pennsylvania general partnership
Real Estate 4550 Valley Road, Hampden Township
Assessed Value - #10,OOD•00 x 1.00 CLR =~10,OOD Fair Market Value
(FALLOW FIELD partnership is no longer in existence, the real
estate is the only item in the partnership name)
(GEORGE DAVIS INTEREST IS HALF OF X10,000.00)
A & G INVESTMENTS, LLC, a Pennsylvania limited liability company
(20 UNITS= 2i MEMBER IN COMPANY
Mortgages 8 Notes Receivable
Cash, Bank Deposits, 8 Misc• Personal Property
(Attach add}tional sheets as needed}
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5,000.00
202,026•D^
459,801.67
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(bj)
Forne RW-09 rev. 10.13.06
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,_ ~ Continuation of Inventory
GEORGE S• DAVIS 21 11 O96D
Decedent Name
Pa e t File Number
Description of Inventory
INHERITANCE FROM SISTER - ESTATE OF VIOLA BLACK 180,000.00
LONGTERM INSURANCE PREMIUM REFUND I 1,159.03
HIGHMARK PREMIUM REFUND I 316.64
Real Estate
LOT 2 VALLEY ROAD, HAMPDEN TOWNSHIP, TAX PARCEL 10-13-0995-011 I 71,300.00
ASSESSED VALUE- #71,300 X 1.00 CLR = X71,300.00 FAIR MARKET VALUE
Subtotal I S 252,775.67
Grand Total I i 459.801.67