COUNTY OF MONTGOMERY, SS. ………………………………………………………………………………... PERSONAL REPRESENTATIVE(s) of the ESTATE of: .................................................................................................., verify that the items appearing in the following inventory include 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/We understand that false statements herein are made subject to the penalties of 18 Pa C.S. Section 4904 relating to Unsworn Falsification to Authorities. ………………………………………… SIGNATURE DATE ………………………………………… ADDRESS ................................................................ CITY/TOWN STATE ZIP ……………………………… Attorney Information ………………………………….. ………………………………….. American LegalNet, Inc. www.FormsWorkflow.com FILE IN DUPLICATE REGISTER OF WILL OF MONTGOMERY COUNTY INVENTORY AND APPRAISEMENT Estate of: ___________________________File Number_________ DATE ACQUIRED PERSONAL PROPERTY TOTAL AMOUNTS: AMOUNTS $ NOTE: If additional space is required attach extra sheet(s) American LegalNet, Inc. www.FormsWorkflow.com