HomeMy WebLinkAbout12-21-09GUARDIAN'S INVENTORY
COURT OF COMMON PLEAS OF ~urtid cr' I a/1d~ COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
1 ~an Incapacitated P~ on
Estate of ~- e- ~ e I
' ~ a Mine d ?..,
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No. o?/- 07 ' 6 937 ~'~~ n ~-
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1. Real Estate: (Location, by whom occupied and rental Estim~~ Valuelw ~ . m
terms, if applicable) ~' ~ `''
Sub-Total for Real Estate: 0.00
2. Personal Property: Estimated Value:
3. Jointly Held Property: Estimated Value:
(Set jorih real a-~d personal property owned by the Incapacitated Person JOINTLY with any
other person(s). State whether held as tenants by the entireties; ijnot whether the right of
survivorship esisu.)
louuly Held Property
Form G04 rev. 10.13.06 Page 1 of 2
Estate of ~ O f'1 r e ~ a c i~an Incapacitated Person
a Minor
4. Anticipated Assets:
Estimated Value:
(Set jorth property ojany kind expected to 6e acquired hereafter, together with
anticipated date ojacquisitioa)
ProPerh'
Sub-Total for Personal Estate:
(Attach additional sheets if necessary)
TOTAL OF ITEMS 1, 2, 3, and 4 :............................. .
Anticipated Date
ojAcqutsition
Commonwealth of Pennsylvania
. ss.
County of
0.00
0.00
c ~ U ~, ~ itrit Pr ,says that the foregoing is a full,
Guardian
true and complete Inventory of the Estate of L o n ~ e ~ a y ly i fi".-r, r r ,
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 relating to unsworn )
falsification to authorities. )
-e
G~ar~i an
Guardian
Attorney for Guardian:
Supreme Court I.D. No.:
Address:
Telephone:
Form a-04 rev. /0.13.06 Page 2 of 2