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INVENTORY
REGISTER OF WILLS OF CuNtsE�u.nrrn COLJNTY, PENNSl'�3�ANIA
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COMMONN'EALTH OF PENNSYLVANIA SS � � � � �o
COIJNTYOF CUMBERLAND � FileNumber 2013 m ��
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Personal Representative(s)of the Estate of SHIRLEY E. HANSEN o r, _ � -n -n
deceased,depose(s)and say(s)that the items appearing in the following inventory include all of t��tsonal asse�s whera_v�er situate
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent,that the valuation pdaced opppsrte each�tem of said
inventory represenu its fair value as of the date of the decedenYs death,and that Decedent owned-no real estate�pytsic�e,�,o�the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this in`v`entory. p '�
I verify that[he statements made in this Inven- SM,�� � �����
tory are true and wrrect. I understand that false state- SUSAN J.KARAKANTAS,EXECUTRIX
menu herein are made subject to the penalties of
18 Pa.C.S. §4904 relating to unsworn falsification to
authorities.
Attorney — (Name) �AMES D.CULLEN (Supreme Court LD. No.) 16797
(Address) 100 STATE STREET. SUiTE 700 ERIE PA 16507-1459'
(Te(ephone) 814-870-7705
DATE OF DEATH LAST RESIDENCE DECEDENi'S SOC.SEC.N0.
5225 WILSON LANE,SUITE 311 �
Ol/23/13 MECHANICSBURG PA 17055
FIGURES MUST BE TOTALED
Cash,Bank Deposits.& Misc. Personal Prooertv:
PNC Bank checking account#60-3266-5370 14,070.25
Accrued interest on previous item 0.06
Household goods and furnishings I,000.00
Jewelry 3,000.00
Banker's Life-claim paymenu 9932
Pennsylvania Treasury-unclaimed property proceeds 10.59
(Anach addl[iona/sheets as needed)
TOTAL: 29,I 87.59
NOTE: The Memorendum ofreal estate outside the Cammonwealth of Pennsylvenia may,at Ne election of the personai reprcsentative include the veluc ofcach
item,but such figurcs should not be extended ina the totel of thc Invrnmry.(See 10 Pa.C.S¢3301(6J)
Form RW-09 m. 10.13.06 r l
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+� . �� Continuation of Inventory
SHIRLEY E.HANSEN 2013 00318
Decedent Name PaQe� File Number
Description of Inventory
Banker's Life-premium refund 682.05
Genworth-claim payments 5,657.58
Pennsyivania Deparhnent of Revenue-2012 PA-40 refund 14.00
Asbury Communities, Inc.-refund of phartnacy overage 43.87
Harrisburg Patriot News-subscription refund 80.24
Nationwide Insurance-renter's insurance premium refund 147.00
Genworth-premium refund 827.53
Yankee Magazine-subscription refund 20.00
V. Eugene Kilmore,Jr., MD. PC.-refund �6 �2
Bethany Village-rentrefund 722.50
United Healthcare-reimbursements 252.57
Lower Allen Ambulance-2013 membership refund 60.00
United States Treasury-2012 1040 refund 2,255.00
American Home Patient-claim payment refund Zzg 3�
SubtoWl S 11,00737
GrendTota� S 2g,�87.59