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GUARDIAN' S INVENTORY cn `=
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COURT OF COMMON PLEAS OF C~MGLI~-~+a9 COUNTY, PEr~~,~1NI~
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ORPHANS' COURT DIVISION `~ c.a C~
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Estate of L ~ ~ i ~ ~ , ~ u ~ 2f`-S~t~ ~an Incapacitated Parson ~ ~ c'
' f ~ a Minor
No. ~1'f~"~~11
1. Real Estate: (Location, by whom occupied and rental
terms, if applicable)
~ Z f OJT fi ~c,FJ i ~ti~~ ~
Sub-Total for Real Estate:
2. Personal Property:
~~fl~.rn6~~-.~ ISi ~~
3. Jointly Held Property:
(Set forth real and personal property owned by the Incapacitated Person JOINTLY with a,ry
other person(s). State whether held as tenants by the entireties; if not, whether the right of
survivorship exists.)
Jointly Held Properly
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Form G-04 rev. 10.13.06
Estimated Value:
C~ a .I~~.~ '7 - o -l
o.oo
Estimated Value:
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S2. ~c
Estimated Value:
Page 1 of 2
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Estate of ~~W~~- ~• ~~9~~Jc~ ~~~an Incapacitated Person
^ a Minor
4. Anticipated Assets:
(Set forth property of any kind expected to be acquired hereafter, together with
anticipated date ofacquisition.J
Property
Antlclpated Date
Estimated `value:
'JI (,~3. (5
ofAcqutsition I
~.t1/~L- /~Ahi fIQCK ul+~~~Jffi~N
l'E-Nbi a~ ~ .IAc~ v ~ 1 lo~l~ )
Sub-Total for Personal Estate: 0.00
(Attach additional sheets if necessary) d
TOTAL OF ITEMS 1, 2, 3, and 4 :............................. R 7~~ uty --~~`
Commonwealth of Pennsylvania
ss.
County of ~~o mb ~t~(,n~t~
~A~z~l ~ /~-IPf/vJ~~/ ,says that the foregoing is a full,
Guardian JJ
true and complete Inventory of the Estate of LfG.7 ~ ~, l~• /~ ~~fn~1 cN
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. )
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Guardian
Attorney for Guardian:
Supreme Court I.D. No.:
Address:
Telephone:
Fo,,,, c-oa rev. 10./3.06 Page 2 of 2
RECEIPT FOR PAYMENT
GLENDA EARNER STRASBAUGH
Cumberland County - Orphans Court
One Courthouse Square
Carlisle, PA 17613-3387
ANDERSON LEWIE B
File Number: 2011-00011
Paid By Remarks: LEWIE B ANDERSON
HMW
------------------------ Receipt Distribution
Receipt Date: 7/27/2011
Receipt Time: 09:26:34
Receipt No.: 1046171
Fee/Tax Description Payment Amount Payee Name
INVENTORY 15.00 CUMBERLAND COUNTY GENERAL FUN
GUARDIAN'S BOND 15.00 CUMBERLAND COUNTY GENERAL FUN
----------------
Check# 559 $30.00
Total Received......... $30.00