THIS FORM MUST BE FILED IN DUPLICATE 117-No. 25 Commonwealth of Pennsylvania Delaware County If the decedent owned U.S. Savings Bonds ss: issued, jointly or otherwise, submit list giving full information. Execut of the Estate of _______________________________________________________ Administra Deceased, verify (ies) that the statements contained in the following Inventory are true and correct to the best of my (our) knowledge, information, and belief. I (we) understand that false statements herein are made subject to the penalties of 18 PaC.S. Section 4904, relating to unsworn falsification to authorities. This inventory includes 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 the decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. _________________________________________ _________________________________________ INVENTORY Of all the real and personal property of _________________________________________________ Late of _________________________ of _____________________________ Delaware County, PA, deceased ___________________________________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ___________________________________________________________________ American LegalNet, Inc. www.USCourtForms.com