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HomeMy WebLinkAbout07-28-08GUARDIAN'S INVENTORY COURT OF COMMON PLEAS OF l~ ~,I'Y1, ~? rI Q h(~ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of C In Cyr I ~ S ~ , Tirzt_ S t~. 1 ~ an Incapacitated Person ' I 0 a Minor No.c~~~ ~- ~~~~ 1. Real Estate: (Location, by whom occupied and rental terms, if applicable) Sub-Total for Real Estate: 2. Personal Property: C~ . Q ~~ ua~., j Q. A- ~ y i }~ ~:v ~~1nT3 vim. (nn 1q~~ ~~~d E1~t:.'~. ~~yc,.,y 3. Jointly Held Property: (Set forth real and persona! properry owned by the Incnpacitated Person JOINTLY with any other person(s). State whether held as tenants by the entireties, ijnot, whether the right of survivorship exists.) Jointly Held Property L©- ~C~C~ 5~`/0 - 'i."-`~ Form G-04 rev. 10.13.06 ~~, C7 r~ ~' ,- _~ O ... c , Z c_.._. ~? r° c +-n N ' Estima~t~¢~`Valu~ - _ : ' ~ > --~ _~ ~.,~ y fz 0.00 Estimated Value: ~. t Cl ~ ~~,~ ~ .• o.: -T Estimated Value: ~O i t1G~C~ ~, TV ~ •v Page 1 of 2 a Estate of ,~ h Q rJ ~es ~) r ~'ra S t'~ l~ an Incapacitated Person ' ^ a Minor 4. Anticipated Assets: Estimated Value: (Set forth property ojany kind expected to be acquired hereafter, together with anticipated date ojacquisition.) Property Anticipated Dare ojAcquisition Sub-Total for Personal Estate: l~ (Attach additional sheets if necessary) TOTAL OF ITEMS 1, 2, 3, and 4 : .............................. Z2.1 ~ ley y.~u ~ Commonwealth of Pennsylvania ss. County of C ~! ~ ~ ~ ~ ~ `7 d (?`,t {'~ e b t q ~V~ ~ /~ • ~ ~ L ~ ~ ~r~ ? k ,says that the foregoing is a full, Guardian .~., true and complete Inventory of the Estate of C ~4~ ~e~ ~° i "' > ~ 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 18 Pa.C.S. § 4904 xelating to unsworn falsification to authorities. ~ n ~~ ,~ ~i Guardian Attorney for Guardian: `1 ~i~ ~1 ~. ~. -.~ ~. ~1 ~ ~~- ~ ~ Supreme Court I.D. No.: Address- ~ ~ S i;' e 1~~cs i~yv~~~ ~ ~~~ 11y~?~t Telephone: ~ "1 ~ ~~ ~ ~ 1 ~ ~ ~ ~ `~ Page 2 of 2 Form G-04 rev. /0.!3.06