HomeMy WebLinkAbout05-14-13 (3) INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY,PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA I SS 2007-00756 PA#21-07-0756)
COUNTY OF CUMBERLAND File Number I
Personal Representative(s)of the Estate of SUSAN L.SEMUTA
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.
W
I verify that the statements made in this Inven- At�
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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 unworn falsification to
authorities.
Attorney-- (Narne) (Supreme Court LD.No)
(Address)
(T'elephone)
DATE OF DEATH LAST RESIDENCE
FIGURES MUST BE TOTALED
CASH AT DATE OF DEATH 0.00
CASH PROCEEDS RECEIVED IN LITIGATION SETTLEMENT OF MARCH 2013 190,000.00
EXPENSES PAID BY ESTATE FROM LITIGATION PROCEEDS RECEIVED IN MARCH 2013 -107,307.84
REAL ESTATE 0.00
n 0
OTHER PERSONAL ASSETS C: ` m n 0.00
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(Attach additional sheets as needed)
TOTAL: 82,692.16
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.B.§3301(b))
Form RW-09 rev. 10.13.06
i
REV-17374 EX+(6-08)
pennsylvania SCHEDULE E, PART 1
DEPARTMENT OF REVENUE MISCELLANEOUS
INHERITANCE TAX RETURN PERSONAL PROPERTY
NONRESIDENT DECEDENT
ESTATE OF FILE NUMBER
SUSAN L.SEMUTA 2007-00756 (PA#21-07-0756)
Part 1 must include all tangible personal property having its situs in Pennsylvania. Examples of tangible personal property are
jewelry,furniture,paintings,etc.All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
Complete Part 2 on reverse side ONLY when the proportionate method of tax computation is elected.
ITEM
NUMBER DESCRIPTION VALUE AT DATE OF DEATH
1. CASH AT DATE OF DEATH 0
2 CASH PROCEEDS FROM LITIGATION SETTLEMENT-FUNDS NOT RECEIVED UNTIL MARCH 190,000
OF 2013 AND DEPOSITED IN INTEGRITY BANK
PART 1 TOTAL
$ 190,000
PART 2TOTAL
From reverse side. $ 0
TOTAL Also enter on Line 5 Recapitulation.) $ 190,000
(If more space is needed, use additional sheets of paper of the same size)