HomeMy WebLinkAbout02-10-14 (2) iNVENTORY
I:EG[S�CEROH VV[LLSOE ���(�"1 �J�� L�-/�� ('OUN'I�Y, PE:NNSYLV��NIA
t'O;�I�ION�VEAL'CII OF PENNSYLVrW(A l
COUN'CY t)F 1 �S t�il�Number
['�rsonal Representativc(s)of the Estate of �(2t�I /�l �- � - ��F�M� �—
�l�ceased,depose(s)and say(s)that the items appear�ng in the following inventory include all of the personal assets wherever situate
:uid all ufthe real estate in the Commonwealth ot Pennsylvania of sai�i Decedent,that the valuation placed opposite each item of said
inventory represents its fair value as of the date of the ciccedent's �ieath, and that Decedent o�vned no real estate outside of the
Cu�nmonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory.
[ verify that the statements made in this Inven- ���u� �,��
�ury are true and correct. I understand that false state-
m�nts herein are made subject to the penalties of
l S Pa.C.S. y �904 relating to uns�vorn falsitication to
authorities.
:�ttorney-- (Nc:me) (Sa�preme Court I.D. No.)
(.�l ddress)
(Telephone)
DATE OF DEATH LAST RESIDnENCE /) /� �( / O DECEDENT'S SOC.SEC.N0.
LJ��o� `o�`�/� ��°E�/1��C/Gt' �/T��YIN :�/7�t�Sr' ��d� /CG� /v`a�U l �F. /�f- c`�(�j l—/10 `_7�l G'/
FIGURES MUST BE TOTALED
���� S�� • ��
,�J"/Y �f��lK C'�PC,C�/�C �CC�i S
(Attach additional slleets as needed)
TOTAL: �� S�� - 0.00
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the vafue of each
item,but such figures should not be exrended into the total of the Inventory. (See 20 Pn.C.S.§3301(6))
Form RW-09 rev. l0.13.06