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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
55:
and says that he "U.c --42,-
of ~ C. 11.....-> -
, Cumberland County, Pa., deceased and that ~
within is an inventory made by ., the said ",1'~.(~S4.. (' . ,
of the entire estate of said decedent, onsisting f all the personal propdrty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
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Date of Death
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Char1es Hilmer. Jr., Notary Public
Hampden Twp., ~ COUnty
MyComf1lil;s' DeQ.10,2007
Memoer. Penn" seciation or HuMMa
aFay
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INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. S'~e Article IV, Fiduciaries Act of 1949.
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