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INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY,PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF SS File Number 21-2014-0683
Personal Representative(s)of the Estate of SOPHIE L.SHAFFER
deceased,depose(s)and say(s)that the items appearing in the following inventory include al l of the personal assets wherever situate
and all ofthe 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-
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.
Attorney-- (Name) NONE (Supreme Court ZD.No.)
(Address)
(Telephone) 'v
C-)
DATE OF DEATH LAST RESIDENCE � ' DECEDENTS SOCA, O.
April 19,2014 Emeritus at Creekview,55 Grandon Way,Mechanicsburg.PA 17050
FIGURES MUST BE TOTALED � M rrl Fri
w'e
Personal:Contents of room(not provided by assisted-living facility)in which she resided since 08/01/2Q_1'2�-' 270.00
f- r- rn
consisting of flat screen TV-$100.00;wooden book case-$40.00;mini-fridge-$40.00;four boxes 6f ry r-
C-3 0
assorted books-$20.00;table lamp-$20.00;quilt-$20.00; and chair-$30.00. Personal clothi`n'g �
donated. Family phots and albums retained by family.
Real Estate: Brick ranch-style house at 6007 Robert Drive,Mechanicsburg,PA. Hoene has been vacant 147,000.00
since 08/01/2012. Decedent disposed of house contents diring 2013 in anticipation of selling home to
pay for assisted-living expenses. Assessed value of house on DOD was$148,200.00. An offer of
$147,000.00 has been accepted with a settlement date of 01/16/2015.
An M&T joint checking account opened on 06/28/1977 valued at$19,626.25 on DOD. One-half value. 9,813.12
Deposits after DOD of$1,102.00 pro-rated refund from assisted-living facility and$238.98 refund from 1,340.98
funeral home.
See Page Two
(Attach additional sheets as needed)
TOTAL:
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))
Form RW-09 rev, 10.13.06 ���
Estate of Sophie L Shaffer
Inventory— Page Two
An estate checking account opened on 08/27/2014 $ 4,275.14
containing the following:
$3,145.44 - life insurance payout that reverted
to the estate exempt from PA Inheritance Taxes; (3,145.44)
$127.07 —a health provider refund; and
$1,002.63 — monies held by the PA Department of Treasury
Unclaimed Property Division
Both checking accounts together have earned 59 cents in .59
Interest to date (12/15/2014 Nov/Dec 15th Bank Statements)
Value of Estate before Debts $ 159,554.39