HomeMy WebLinkAbout05-01-13 (2) INVENTORY
REGISTER C1F WILLS QF ��BERLAhID COLTNTY,PENNSYLVANIA
CQMMONWEALTH OF PENNSYLVANIA
CO[JNTY OF �MBERLANT} SS Fite Number 2Q12-Q0911.
Persona!Representative{s)of the Estate of Niek Brussese Jr.
deceasecl,depose(s}and sap{s)that the items appearing in the£ollowing i�ventory include ali of ihe personal assets wherever situate
and all of the reai estate in the Commonwealth of Pennsylvania of said Decedent,that the valuation placed opposite each item of said
inventory represeats its fair value as of the date of t�e decedant's deatfi, and thai Decedent owned na reai estate outside of the
Commanwealth of Pennsylvania excapt that which appears in a memorandum e e s invenkory.
I verify that the statements made in this Inven-
toxy are true and carrect. I understand that false state-
ments herein are made subject ta the penalties of
18 PaC.S. § 4904 relating to unsworn faisificarion to
authorities.
Attorney-- (Name) K���1�� ��" (,Supreme Court I.D.N�.) ��� D
«a�ss� 1'0 13o�.B2 t , E-I,�iz.rL.isgu2ra. .�7toB - a Z r
�ere���e1 —t t7 — 2�2- .3�aS
DATEDFDEATH U+STRESIpENCE
FIGURES MUST BE TQTALED
Residence 8t0 Meadow Lane Carnp Hi11 PA 17011 id: 10-19-1596-021 appra'rsed$174,00(}fair candition 174,W0.00
2008 Fard Mustang odometer: I1,800 good eondition 13,060.Q0
1956 Eord Thunderbird odometer:8929 fair condition 15,000.00
US Savings Bonds t00ti EE 0$/2004 M$44&5485EE 627.60
�
US Savings Bonds 100Q EE 0812004 M804$5486EE � � � 627.6Q
US Savings Bqnds 1000 EE 07J2p04 M8Q485486EE � � � � 628.00
US Savings Bonds 1000 EE Ob12064 M80352820EE rn z � ;�! m 628.40
US Savings Sonds 1000 EE 03l2Q64 M80038757HE � .-�� .,�,.y "` � 634.R0
tJS Savings Bonds it)06 EE 0212004 M771�1774EE �� G? ',;� � c• �
c: .. 635.60
US Savings Bonds 1000 EE 02/2004 M77771773F.E �°� ��� '' � .= r 635.60
US Savings Bonds 11?00 EE 11l2003 M77559358EE • °;� � �.� � G36.80
US Savings Bonds ip00 ES 10l2403 M77467608EE � u� 643.20
US Savings Bonds 1000 EE t0/20t}3 M774G�604BE 64320
US S�vings Bonds t00Q0 EE 0211987 X1008719F.'E 17,012.00
tJ5 Savrngs Bands lOf)00 E�04/1942 X2173040EE i3,956.W
US Savings Bonds 10000 EE 64/1992 X2173041EE 13,956.00
(Attach additional sheets as needed)
TOTAL: 253,264.80
NOTE: The Memc�randum of real estate outside the Commomvearth oC Pe�msylvsnie may, at the ei�tion af the personal representalive inciude the veiue of esch
item,but smh Ciguees shauid twt be extended into the toPai of the Invanrory. {Seu dOPa.C.S§330t @)j
FormR6V-09 rev. l0.13.t16