HomeMy WebLinkAbout06-01-06 (2)
AFFIDAVIT OF EXECUTOR OR ADMINISTRATOR
Qrummunwra1tly uf l~lennll)11uania }
55:
Qruunt)1 uf .xm!tll~
Cumberland
Personally before me, the undersigned authority, a Notary Public
and State, appeared Peter and Margaret Califano
to law, deposes and says that he is the executor or administrator of the estate of
, deceased, that the foregoing schedules constitute a complete inventory
and appraisement of the real and personal estate of Daniel F. Califano
deceased, except real estate outside the Commonwealth of Pennsylvania, that the figures opposite each item of real and personal
estate in the foregoing schedules are determined and stated by the undersigned to be the fair value of said items as of the date of
the decedent's death.
in and for said County
who, being duly sworn according
Daniel F. Califano
this
Sworn and subscribed before me
day of
}
EXECUTOR-ADMINISTRA TOR
ADDITIONAL INSTRUCTIONS
1. The inventory shall be filed no later than the date the account is filed or the due date, including any extension, for the filing of
the Inheritance Tax Return (9 months from the date of death) whichever comes first.
2. A supplemental inventory must be filed within thirty days of discovery of additional assets.
3. An original and one copy must be filed.
4. Additional sheets may be attached as to personalty or realty.
5. See Section 3301 et seq. of the Probate Estates and Fiduciaries Code of 1972, as amended.
6. The inventory must be typed.
:r> :r> ." :J:l <
Q... ~ ro ro Q...
ro
Q... 0 Q... 0
..., ..., Z
ro ::l PI
IJ> ro ~ ~
IJ> '<: 1--4
f-'. Z
(1) N
f-' 0
< 0
'"Ij U1
tTl ['T1 I
(f) 0
() -...j Z 0
PI :r> .+::-
f-' -...j '"
f-'. tTl ~ U1
H'l 0 '\:l
PI ." 0 Dl
IC
~ ro
0 ::c
0 .-<
(\)
'"'
(\)
01
'"
(\)
a.
FORM 16 REG. WILLS
SUPPLEMENTAL
INVENTORY
of all real and personal estate of Daniel F.
d d I f 17 Kingswood Drive
ecease , ate 0
(number and ~1reet)
Califano
(city)
lCumberland
,~~~ County, Pennsylvania,
Mechanicsburq
(Borough or Township)
May 13, 2005
(date of death)
NO.
2005-00495
(Zip Code)
who died
PERSONAL ESTATE SCHEDULE
1 .
Nationwide Insurance
Settlement Proceeds
...,..
17055
$100,000.00
c)
'.--:c)
. -.',,)
;
.~
~ ') --1
(-
.~
J
\.---
-"(OJ
1 H)
r.-:)
, , ,
CJl