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Register of Wills of c�sExLnrm County, Pennsylvania
INVENTORY
Estateof Gwyn M. Wertz No. 21-2012-1325
also known as Gwyn Marie Wertz Date of Death 09/18/2012
,Deceased Social Securiry No.
David W. Potts,
Personal Representative(s)of the above Estate,deceased,verify that the iterr�s appearing in the following Inventory include all of the
personal asseGS wherever situate and all of the real estate in the Commonweakh of Pennsylvania of said Decedent,that the valuation
placed opposke each item of said Inventory represents its fair value as of the date of the DecedenYs death,and that Decedent owned
no real estate outside of the Commonweakh of Pennrylvania except that which appears in a memorandum at the end of this
Inventory. I NJe verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein
are made subject to the penakies of 18 Pa. C.S. Section 4904 relating to unsworn fals'rfication to authorities.
Personal Representative
Name of /�� �
Attorney: Marlin R. McCaleb Esq. Signature: � �,� ,
David . Potts
I.D.No.: 06353 Signature:
Address: 219 East Main Street Address: 21 Maple Avenue
Mechanicsburq, PA 17055 Camp Aill, PA 17011
Telephone: 717/691-7770 Telaphone: 717 - � �7 - ��� 6
� Dated: G�/�� /�3
Description y� ^ �
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(See continuation page(s) attached) o Q �� � `` c�
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(Attach add"rtional sheets'rf necessary) Total: 25�367.12
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. � ��, �I )
Preparetl by the Pennsylvania Bar Assoclatlon V`
CopyrigM(c)1996 torm sottware only CPSystems,Ina Form MR W-7(1992)
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INVENTORY
Estate of: Gwyn M. Wertz
Date of Death: 09/18/2012
County: Cumberland
CASH:
Belco FCU Savings Account No. 832.82
844326-0001, - principal
balance as of D.O.D. :
$832.82; no accrued
interest.
Belco FCU Checking Account No. 1,137.80
844326-0040, - principal
balance as of D.O.D. :
$1,137.80; no accrued
interest.
Belco FCU Money Market Account 6,073.50
No. 844326-0060, - principal
balance as of D.O.D. :
$6,073.50; no accrued
interest.
--------------
8,044.12
PERSONAL PROPERTY:
2008 Pontiac G6-V6 17,323.00
convertible, - 30,941 miles,
good condition.
--------------
17,323.00
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TOTAL RECEIPTS OF PRINCIPAL. . . . . . . . . . . . . . . 25,367.12
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