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GUARDIAN'S INVENTORY
COURT OF COMMON PLEAS O~~<.~ COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of
;J~ (7-. s:j.7
No. cZl - c> ~ -'19;2..
~} an Incapacitated Person
,}5 a Minor
1. Real Estate: (Location, by whom occupied and rental
terms, if applicable)
Estimated Value:
~
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Sub-Totalfor Real Estate:
---9-
o. ()()
2. Personal Property:
Estimated Value:
~ J_~V\~,
'R 40() cu.
-r erC-P
... '-/00. S!.
3. Jointly Held Property:
(Set forth real and personal property owned by the Incapacitated Person JOINTLY with any
other person(s). State whether held as tenants by the entireties; ifnot. whether the right of
survivorship exists.)
Z ('" Jt.. ~ ]".om:!' Hdd Property
~EU-L ~ ~
~ 0-G0f &::f I'"~~~ y\.IJA~
Estimated Value:
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Q
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1'1 7
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Form G-04 rev. /0./3.06
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~E! "Page 1 <&2
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l~ Incapacitated Person
. JOa Minor
4. Anticipated Assets:
Estimated Value:
(Set forth property of any kind expected to be acquired hereqfter. together with
anticipated dote of acquisition.)
Property
Anticipated Date
of Acquisition
/77~
.
-G-
Sub-Totalfor Personal Estate: ;9-
(Attach additional sheets if necessary) ~ c$
TOTAL OF ITEMS 1, 2, 3, and 4: .............................. 5 t.f 7.
0.00
-
Commonwealth of Pennsylvania :
(\ / .4 .: ss.
Countyof~ :
-r ~ 1). Sfirr
Guardian
true and complete Inventory ofthe Estate 0
~ ~ . says that the foregoing is a full,
~~?J-' S/z(f ,
the aforesaid Incapacitated Person or Minor; and that all of the information set forth herein is
true and correct to the best ofthe Guardian's knowledge and belief.
I verify that the statements made in this )
Inventory are true and correct. I under- )
stand that false statements herein are )
made subject to the penalties of )
18 Pa.C.S. ~ 4904 relating to unsworn )
falsification to authorities. )
~~[).~~
~~
Attorney for Guardian: ~;d~
Supreme Court I.D. No.:
Address: c1Cf3~ N. F~
H~~ ~
Telephone: c/7 .~ - :; I D I
Sf:
17flO
Form G-04 rev. /0.13.06
Page 2 of2