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GUARDIAN'S INVENTORY
COURT OF COMMON PLEAS OF ~/6.~ COUNTY,PE~YLVAN~
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ORPHANS' COURT DIVISION . ~;g U1
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Estate of
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No. OL( -
1. Real Estate: (Location, by whom occupied and rental
terms, if applicable)
Estimated Value:
~
.
'&
Sub-Totalfor Real Estate:
0.00
2. Personal Property:
Estimated Value:
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G Lfoo. r.IQ
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'It LfOo. ~
3. Jointly Held Property:
(SetjOrth real and personal property owned by the Incapacitoted Person JOINTLY with any
other person(s). State whether held as tenants by the entireties; ifnot, whether the right of
lfUTVivonhip exists.)
J!./::.~ a.u;/- :t'r~......t ~
~u... ~J ~
Estimated Value:
$' .3 S-o . 0 ~
'I c2 S"(D J to
'fty7:-r
..~cto.?<o
Form G-04 rev. 10.13.06
Page 1 of2
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Fsaleof /~ ). ~
~on Inl:apaci1lIl1: Person
. IDa Minor
4. Anticipated Assets:
Estimated Value:
(Set forth property of any kind expected to be acquired hereqfier, together with
anticipated date of acquisition.)
Property
Anticipated Date
of Acqllisitlon
~
~
Sub-Total/or Personal Estate:
(Attach additional sheets if necessary) "
TOTAL OF ITEMS 1, 2,3, and 4: .............................. (Dolo .3~ ....
0.00
Commonwealth of Pennsylvania :
~ :ss.
County of .Of ~,....-cJ.., :
says that the foregoing is a full,
Guardian A
true and complete Inventory of the Estate of --ue:":' ~. J./!./,,!
the aforesaid Incapacitated Person or Minor; and that all of the information set forth herein is
true and correct to the best of the 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 ) \.. i;). ~.. ~ .
18 Pa.C.S. ~ 4904 relating to unsworn) Guardi () - ., . -
falsification to authorities. )
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Attorney for Guardian:\....:~ ~
Supreme Court I.D. No.:
Addn:ss: c29J!3 f 'F~ Sf:
/1110
Telephone: '7 I 7 - 0< .3 .3 - L./ I 0 I
Form 0-04 rev. 10.13.06
Page 2 of2