HomeMy WebLinkAbout12-06-12 (3)INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA 1 SS
colnvTY of CUMBERLAND f
File Number
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Personal Representative(s) of the Estate of rn ~?' ,.,
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of tht~edsvt~
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuatiot>~h~d~
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned n®r~ ens
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventc3n~. -
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I verify that the statements made in this Inven- d ~ / ~ ~ ~k
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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assets whe~~v~ situate
Ipo~t eao~ iti:~h of said
to ett{side~f
,.:3 ' =T
F.. , c`a
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Attorney -- (Name) Theresa L. Shade WiX, Esq. (,Supreme Court ID. No.) 43089
(Address) 4705 Duke Street Harrisburg PA 17109
(Telephone) 717-652-8455
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO.
1067 Nanroc Drive
FIGURES MUST BE TOTALED
Pennsylvania State Employees Credit Union
Savings Account, Money Market and Certificate
PNC -Checking Account, Savings Account
United Healthcare -Refund
AARP -Member Refund
Erie Insurance -Auto Insurance Refund
Commonwealth of Pennsylvania State Employees Retirement System
Household Goods and Personal Belongings
(Att¢ch additional sheets ¢s
75, 684.88
4,702.54
2.28
16.00
45.00
48.45
300.00
TOTAL: I 90,814.92
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. ,>S 3301(bJJ
Form RW-09 rev. !0.13.06
l-f-~
**Duplicate Page for Co-Executor's
Signature**
INVENTORY
REGISTER OP WII,LS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA ~ SS
COUNTY OF CUMBERLAND
File Number 20 12 00384
Personal Representative(s) of the Estate of
deceased, depose(s) and says} that the items appearing in the following inventory include alI 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
Commonweahh of Pennsylvania except that which appears in a memorandum at the end of this inventory.
I verify dial the statements made in this Inven-
tory aze true and correct. I understand that false state-
ments herein are made subject to the penalties of
t 8 Pa. C.S. § 4904 relating to unsworn falsification to
authorities.
Attorney -- (Name) Theresa L. Shade Wix. Esq.
(Supreme Court I.b. No.) 43089
(Address) 4705 Duke Street_ Harrisburg PA 17109
(Telephone) 717-652-8455
once of otaant twsr ~sroerrcts -
1087 Nanroc Drive ttecsoatrs roc. sec. no.
3/9/2012 Mechanicsbu PA 17055 209-12-8833
FIGURES MUST BE TOTALED
Pennsylvania State Employees Credit Union 75,684 88
Savings Account, Money Market and Certificate
PNC -Checking Account, Savings Account 4,702.54
United Healthcare -Refund 2 28
AARP -Member Refund 16.00
Erie Insurance -Auto Insurance Refund 45.00
Commonwealth of Pennsylvania State Empbyees Retirement System 48.45
Household Goods and Personal Belongings 300.00
trddillorsal skeefs as
NOTE: The Memotanduttt of teal eatatc outside the Commonvnxlth of Pautsylvania may, at the election of the personal representative include the value of each
item, but such figures should not be extended into the rural of the Inventory. (Saa 20 P¢ C.S. § 3301(bll
Farm RW-09 rev. 10.13.06
Continuation of Inventory
20 12 00384
Decedent Name
Paae 1 File Number
Description of Inventory
Allstate Life Insurance Co. -Annuity 5,015.77
2005 Honda Accord 5,000.00
subtotal 3 10,015.77
Grand Total S 90,814.92