HomeMy WebLinkAbout06-14-11GUARDIAN'S INVENTORY
COURT OF COMMON PLEAS OF ~iJ~/l~U' (~~ COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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an Inc ~ated P~son ! ' c
Estate of ~ ~ (G ~~~ i yl U m v+~~ , } , n ~ ,-,-. _-'?
a Mino~~ ~ _ ~_.~
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~ ~ `n
'~ ~~ ~' i
1. Real Estate: (Location, by whom occupied and rental Estimated Value:
terms, if applicable)
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Sub-Total for Real Estate:
2.1 . P spnal Property: Estimate Via ue:
~1 ~ -~-~
3. Jointly Held Property: Estimated Value:
(Set forth real and personal property owned by the Incapacitated Person JOINTLYwith any
other person(s). State whether held as tenants by the entireties; if not, whether the right of
survivorship exists.)
Jointly Held Property
Form G-04 rev. 10.13.06 Page 1 of 2
j n Incapacitated Person
Estate of Q (~Pl ~ ~ y ~~G~ ~ a Minor
4. Anticipated Assets: Estimated Value:
(Set forth property of any kind expected to be acquired hereafter, together with
anticipated date of acquisition.)
Property Anticipated Date
n } of Acquisition
1 v ~~
Sub-Total for Personal Estate:
3c'~ov
(Attach additional sheets if necessary)
TOTAL OF ITEMS 1, 2, 3, and 4 : ............................. 3 d ®.1~0
Commonwealth of Pennsylvania
County of
ss.
says that the foregoing is a full,
Guardian
true and complete Inventory of the Estate of
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. )
Attorney for Guardian:
Supreme Court LD. No.:
Address:
Telephone:
Form G-04 rer. 10.13.06 Page 2, Of 2