HomeMy WebLinkAbout05-28-13 (2) - _
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INVENTORY
REGISTER OF WILLS OF �,G(.f'YtC1.P�1C(.��(A COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANI�1 } SS ,� a�r .�-ov���
courr�oF C�„�,,-��,�,�{ � -a o-�3 3 8' File Number
Personal Representative(s)af the Estate of
deceased,depose(s)and say(s)tliat the items appe�ing in the fallowing inv�rtory inc e all of the persaial assets wherever situ�t�
and all af the real estate in d�e Camrnoaiwealth of Petmsy bar►ia of said Decedent,that the valuation placed opposite each it�n of sapd
inventory represerrts its fair value as of the date of the decedenYs death, and that Decedent owned no real estate outside a�f tlh�
Cammonwealth of Pennsybania except that which appears in a memorartdum at the end of this inventory.
I verify that the statements made in ihis Iriven-
tay are true and correct I unda-stand that false state-
ments herein are made subject to the penalties of `��/�„���� ��,�°
18 Pa.C.S. §4904 relating to unswa�n falsification to K15Y�
authorities.
Attorney-- (Ncane)
(S�preme Cot�t 1.D. No.) .
(Address)
(Telephone)
DATE OF DEATH LAST RESIDENCE
�
FIGURES MUST BE TOTALED
l�'101'YL� / �'/$ We►'�"ZVf JIC°. IZCI, �i?OL0.. P0. � 7UoZ5 I LI�� (�C7C�� � �
�8 Dod�e., C�,ra�ct.,-, 5oa�o
��Chevy Sco�-}S dale �ruc,;� Svo,v �
�
,�, �, F�rd �rac+c,r 15�o , o �
c a� r`' � �--
�� ,.� �,� : �Tr-GL i I�Y� ] v U . O C�
`= -� � � � G 1 �od� '�r0.�'C�r'1 5 o v, o c�
�w �::. �
�: ..� cL_ �,
,
`v��� � � � Q �lari s �TV /,�vv. r� v
�-a a �:� � � CIv-I-hhes i5v . v o
.:; ��:
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�� G^ � �.' � � �-c.�r n i f u I'�.`N�c�i�GtC�S 5 0 �::�
c.a � � � g (�O.
� � `J' � � �C�� IS ,3b�; " <�',
(�addEfFowot s��dr as�re�ded)
TOTAL• I �S C�, ��;�'
NdTE: The Memorandum of real estate outside t6e Commonweatth of Pennrylvania may, az t6e election of the personal representanee include the value of eac1G'
item,but such figures should not be eatmded into the total of the Inventorq. (See 10 Pa.C.S,¢3301(h))
Form R W-04 rev.I Q.I 3.06
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