INVENTORY REGISTER OF WILLS OF COMMONWEALTH OF PENNSYLVANIA County of }SS File Number The undersigned, _______________________________________________________________________________, Personal Representative(s) of the Estate of ___________________________________________________________________________ deceased, depose(s) and say(s) that the items appearing in the following Inventory include all of the personal assets wherever situated 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 Decedent's death, and that Decedent owned no real estate outside of the Commowealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I verify that the statements made in this Inventory are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Attorney -- (Name) Corporate Fiduciary (if applicable) } ________________________________ Name of Corporate Fiduciary ________________________________ Name of Representative and Title ________________________________ Signature of Officer/Representative __________________________________ Signature of Personal Representative __________________________________ Signature of Personal Representative __________________________________ Date (Supreme Court I.D. No.) (Name of Law Firm) _____________________________________________________________________________ (Address) (Telephone) ___________________________________________________________________________________ (Email) ____________________________________________________________________________ DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO. FIGURES MUST BE TOTALED (Attach additional sheets as needed) TOTAL: 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 eff. 09.01.16 American LegalNet, Inc. www.FormsWorkFlow.com