HomeMy WebLinkAbout03-22-13 (4) REGOR DE 0 7-'- 4E- OF INVENTORY
REG"'T} GT R OF WILLS OF 6u1013i4�-L- "
COUNTY, PENNSYLVANIA
'113 MR 22 "i l 1 `'1
COMMONWEALTH OF PENNSYLVANIA q p
COUNTY OF M"IA 4N-,> A SS File Number A01.3 - 0 O 0 Q l
_-�H t�,t GOURT
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PerscG11 IA#ft&&N A(�j° ?AAstate 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 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 ,jA-- 114
1S Pa.C.S. § 4904 relating to unsworn falsification to
authorities.
Attorney-- (Name) (Supreme Court LD. No.)
(Address)
(Telephone)
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC SEC,NO
30 �kfe`fi�f><.riL ��- (,i�F Al-(?d-At--01 eIK`tst.Ls
FIGURES MUST BE TOTALED
o�QS �r I�U/Lnlislfir/✓fj-C �UUU, �t
Spa. a o
LL
i � sFfin� �
(Attach additional sheets as needed) p
TOTAL: `y0 .vl 'e'm-
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 10 Pa.CS§3301(6))
Form RW-09 rev. 10.13.06