HomeMy WebLinkAbout04-24-14 (2) INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA SS 2013-01008
COUNTY OF CUMBERLAND } File Number
Personal Representative(s)of the Estate of BETTY C.BARNES
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.
\ I verify that the statements made in this Inven- � �
� i
� 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 unsworn falsification to
authorities.
Attorne ame Ann E.Rhoads (Supreme Court I.D.No.) 49631
Y-- � �
(Address) 244 West Main Street,Hummelstown,PA 17036
(Telephone) �17-482-8392
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC.SEC.NO.
September 5,2013 3609 Kohler Pl.,#4,Camp Hill,PA 17011 182-22-5103
FIGURES MUST BE TOTALED
1. AAA membership refund 51.00
2. 2013 federal income tax refund 1,879.00
3. Penn National Insurance premium refund 20.00
4. Riversource Life Insurance Company premium refund 305.60
5. Riversource Life Insurance Company long term care benefits 2,380.79
6. Household goods n � � �Q0.00;
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(Attach additional sheets as needed)
TOTAL: 5,136.39
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.S.,¢3301(b))
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Form RW-09 rev.IOJ3.06
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