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INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
couNn oF Cumberland } ss File Number 21-13-0792
C. Diane Hain
Personal Representative(s)of the Estate of Clarence E. Hain
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 decedenYs death, and that Decedent owned no real estate
outside of the Commonwealth of Pennsylvania except that which appears in a orandum at the end of this inventory.
I verify that the statements made in this Inven- ( c��� ���
tory are true and correct. I understand that false state- � C. Diane Hain
ments herein are made subject to the penalties of �
18 Pa.C.S.§4904 relating to unsworn falsification to
aufhorities.
Attorney-- �Name) Marielle F. Hazen Esq. (Supreme Court I.D. No.) 68003
�F'r"'� Hazen Elder Law
(Address) 2000 Linglestown Road, , Harrisburg, PA 17110
(Telephone) 717-540-4332
DATE OF DEATH LAST RESIDENCE 120 N. 36th St DECEDENTS SOC.SEC.N0.
06/28/2013 Cam Hill PA 17011
FIGURES MUST BE TOTALED � � ;„� rn
-,.. o r��
Personal Proper�y � �' � '_? u
�-� �' z � „�
Cash............................................................................................... ,� �:: c-�
-. �_ r- 21,872�03=:r
Personal Property........................................................................ ' ri> �� �8,8Z3?0�=�
Stocks/Listed. .............................................................................. �=� �"� ;; �i
c� � --c�' � ,_ -,��
Stocks/Closely Held..................................................................... �, � � _..
. � F—� • � C7
Bonds............................................................................................ ` --i ►--� �' rn
� �'
Mutual Funds................................................................................ � cn cn Q
0
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable...............................................
AllOther Property........................................................................
Total Personal Property........................................ 30,695.03
Total Real Property................................................ 150,000.00
Total Personal and Real Property........................ �' � �p,6����,!
�.,
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))
Fo.m RW-09 Re�.ia�s-2oos
INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
couNnroF Cumberland } ss FileNumber 21-13-0792
DATE OF DEATH LAST RESIDENCE 120 N. 36th St DECEDENTS SOC.SEC.NO.
06/28/2013 Camp Hill, PA 17011
Cash
Adjustment on sale of residence-Co./Town taxes HUD-1 Line 406 263.43
Adjustment on sale of residence-School taxes HUD-1 Line 407 296.36
Adjustment on sale of residence-Sewer/Water HUD-1 Line 409 15.00
Members 1st FCU Checking 213307-11 999.08
Members 1st FCU MM 213307-05 18,998.16
Members 1st FCU Savings 213307-00 5.00
Refund-Alistate Ins. Premiums(auto&house) 386.40
Refund -Monumental Life Ins. Overpayment of premium 381.80
Refund of Comcast-final cable bill 69.35
Refund-Tru Green overpayment 62.78
Woods at Cedar Run-resident refund 394.67
Total Cash 21,872.03
Personal Pro�er�tv
Auto-2001 Buick LeSabre 1,730.00
Westminster Cemetery, Inc. (vault 8�casket) 7,093.00
Total Personal Property 8,823.00
(Attach additional sheets if necessary) Total Personal PropePty and Real Estate 180,695.03
INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTYOF Cumberland } SS FileNumber 21-13-0792
DATE OF DEATH LAST RESIDENCE 120 N. 36th St DECEDENTS SOC.SEC.NO.
06/28/2013 Camp Hill, PA 17011
R al a _
Real Est.-120 N. 36th St. ,Camp Hill, PA-selling price--see attached HUD-1 150,000.00
Total Real Estate 150,000.00
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