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REGISTER OF WILLS OF CUMBERLAND CO�JNTY, PEI��I��'L�F�4NIA `, r'�+
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COMMONWEALTH O�PENNSYLVANIn SS �1-14-056fj � �� -� ��
COUN"l Y OF CUMBERLAND File Numher -- x ,
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Mark R Mengle and David C. Mengle, Co—Executors �
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Ph liss C. Men=le ' � ��j
Personal Representative(s)of the Estate of y �
deceased,depose(s)and say(s)that the items appearing in the following inventory include all ofthe 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
Conu»onwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory.
1 verify that the statements made in this Inven- �
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tory are true and correct. 1 understand that false state- Mark R. Mengle � David C. Mengl
ments herein are made subject to the penalties of 76 Skyline Drive 84 Skyline Drive
18 Pa.C.S. § 4904 relating to unsworn falsification to Mechanicsburg, PA 17050 Mechanicsburg, PA
authorities. ll050
Attorney-- (Name) Keith O. Brenneman _ (Supreme Coa�rt LD. No.) 47077
(Address) Snelbaker& Brenncman,P.C.,44 West Main Street,Mechanicsburg, PA 17055
(Telephone) �17-697-8528
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC.SEC.NO.
OS/30/2014 92 Skyline Drive,Silver Spring Twp.,Mechanicsburg,PA 17050 200-24-0718
FIGURES MUST BE TOTALED
1. Property known and numbcred as 92 Skyline Drive,Silver S}�ring Twp.,Mechanicsburg,PA(sale value) 330,000.00
2. Lot located at 100 Skyline Drive,Silver Spring Twp,Mechanicsburg,PA(38-18-1336-003) 45,590.00
3. Lot located on Skyline Drive,Silver Spring Twp., Mechanicsburg,PA(38-07-0459-023) 69,161.00
4. Aetna, fnc.,pension payment due the decedent 4,319.73
5. Ameriprise Financial,dividend chcck due the decedent 850.53
6. Cash withdraw on the decedent's date of death from Orrstown Bank 10,000.00
7. Erie Insurance,premiuin refund due the decedcnt 233.00
8. Highmark,premium rcfund d�ie the decedent 251.t 7
9. Household goods,retained by bene(iciaries 400.00
10. John Hancock Insurance Company,premium refund due the decedent 189.95
1 1. The Qank of Landisburg,certificate of deposit#700029243 10,002.55
I 2. Orrstown Bank,checking account#1 1 1000088 4���'��
I 3. United Stales Treasury,refund due the decedent on 2014 Individual Inco�ne Tax Rcturn >>79�•��
14. Com�i�onwealth of Pennsylvania,refund due the decedent on 2014 Individual Income Tax Ret�irn 268.00
(Attuc/r ndditiurin!slreets ns needed)
TOTAL: 473,506.00
NOTG� "fhe Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the rlection of the personal rcpresentadve indude the value of eac�
item,but such tigures should not be extended into the total of the Inventory. (See?0 Pa C.S�3=0l�b)) �
F�orm!ZW-09 rer. 10.13.06 �