HomeMy WebLinkAbout08-26-15 (3) INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA �
COUNTY OF CUMBERLAND SS
File Number 2015 00063
Personal Representative(s)of the Estate of Robert A. Kayer
deceased,depose(s)and say(s)that the items appear�ng�n the following�nventory�nclude 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- � '�
tory are true and correct. I understand that false state- i � � <^'1'
ments herein are made subject to the penalties of Kristjn �VI. /j,r�q ner, Co-Admin; J ' es, . Ka r, Co-Admin;
18 Pa. C.S. §4904 relating to unsworn falsification to ��� /'
authorities. )('l�A. Kay r, Co-Admin '.%`
Attorney -- (Name) Jacqueline A. Kelly
(Supreme Court I.D. No.) 91973
(Address) 845 Sir Thomas Court Suite 12 Harrisbur PA 17109
(Telephone) 717-541-5550
DATE OF DEATH LAST RESIDENCE
4837 EAST TRINDLE ROAD DECEDENTS SOC.SEC N0.
1/9/2015 MECHANICSBURG PA 17050
FIGURES MUST BE TOTALED
M&T Bank savings account; Account#15004229590771 64,178.01
NY City Employees' Retirement System; finai pension payment � � 633.25
�' u, ;:� �
� o s� c�
� � � �? c_>
Country Meadows; refund 3,701.19
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s C7
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NY City Employees' Retirement System; death benefit paid to estate -� ;, ��, 32,100.12
—� . -_,,
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PA Treasury; unclaimed property � '�� C�"
��� G-, 0 9.30
c�
U.S. Treasury; 2014 income tax refund 1,729.05
Carlisle Regional Medical Center; refund 313.82
(Attach additional sheets as needed)
TOTAL: 102,664.74
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 �
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