HomeMy WebLinkAbout09-19-12 (3)INVENTORY
REGISTER OF WILLS OF l' f\IYIC' ~ (3 t ~t COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF ~'.~~~ 1'~ ~'~ Z Vlar~ )
File Number ~~/ /r~ -~V '
Personal Representative(s) of the Estate of
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 appeazs in a memorandum at the end of this inventory.
I verify that the statements made in this Inven- ~~~)(~/IC ~ . ~( ~i7V'd~~.~A°
tory aze 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.
~~ ~'~~ ~~ (S reme Court LD. No.)~
Attorney -- (Name) /7~~ j
(Address) ~/~ /~/~ S~ ~)3l`I ~
(Telephone) ~~7 ~~'~~5~
n DECEDENT'S SOC. SEC. NO.
DATE OF DEA~ ~ ~ ~ES~EN(:E ~/~ `~
FIGURES MUST BE TOTALED ~ / 1 ~ J
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(Attach additional sheets as needed) /, 0
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NOTE: The Memornndum of real estate outside the Commonwealth o£ Pennsylvania may, at the election of the personal representative include the value of each
item, but such figures should no[ be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b))
Form RW-09 rev. 10.13.06