HomeMy WebLinkAbout12-11-12 (2)INVENTORY
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland SS File Number 21-11-1224
Constance E. Roland. Executrix
Personal Representative(s) of the Estate of SAMUEL H. BLACK
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 appears in a memorandum at the end of this inventory.
I verify that the statements made in this Inven- /~ c~ ~ ~~~,~ ~u~~ ~~,,~~
tory are true and correct. 1 understand that false state- C. ~~
ments herein are made subject to the penalties of Constance E. Roland, Executrix
18 Pa.C.S. § 4904 relating to unsworn falsification to ~~ ~ ° F~-s~"''~~~
authorities. Mechanicsburg, PA 17055
Attorney -- (Name) Richard C. Snelbaker (Supreme Court I.D. No.) 6355
(Address) Snelbaker & Brenneman, P.C., 44 West Main Street, Mechanicsburg, PA 17055
(Telephone) 717-697-8528
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO.
11/11/2011 12 East Portland Street, Mechanicsburg, PA 17055
I FIGURES MUST BE TOTALED
1. General Electric Company, .1747 shares of common stock valued at $16.35 per share
2. 2010 Dodge Grand Caravan, sale value
3. Boats and Trailers, 1986 Smoker Craft Bass Boat $50.00, 1972 C-Spirit John Boat $25.00,
2002 Carry on trailer $150.00, 1987 Load EAZ trailer $25.00
4. Cumberland Valley Motors, wages due the decedent
5. Erie Insurance, premium refund due the decedent on auto insurance
6. Internal Revenue Service, refund due the decedent on 2011 Final Individual Taxes
7. Lincoln Financial Group, annuity #924426780
8. Member's 1st Federal Credit Union, savings account # 199599-OS
9. Member's 1st Federal Credit Union, checking account #199599-11
10. Member's 1st Federal Credit Union, savings account #199599-00
11. Proceeds from sale of chair lift
(Attach additional sheets as needed)
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2.86
15,200.00
250.00
33.86
348.00
74.00
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rn ~ 63,634.13
~ 363.70
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TOTAL: I 83,428.76
NOTE: The Memorandum of real estate outside [he 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(6))
Form RW-09 rev. 10.13.06