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HomeMy WebLinkAbout07-06-12c~ ~ ~ ~~ ~ GUARDIAN'S INVENTORY 2~11,fUL -6 AM II ~ 25 COURT OF COMMON PLEAS OF CUY1f1h.Q (~.~ COiJ1VTY, PENNSYLVANIA `""`~ ` ' ~ ` T ORPHANS' COURT DIVISION CQ„ PIA Estate of ~~ ~ i ®an Incapacitated Person ' I ®a Minor No.2~-~2-UI~Cw 1. Real Estate: (Location, by wham occupied and rental terms, if applicable) Sub-Total for Real Estate: 3. Jointly Held Property: (Set forth real and personal property owned by the Incapactlated Person JOINTLY irifh any other person(s). State whether held as tenants by the enttrettes; if not, whether the right of survivorship extsts.J Jointly Held Properly Estimated Value: V 0.00 Estimated Value: ~u355.y4 C4~r3-1Z) ~;34~oo~i ~3L~ Estimated Value: Farni G-04 rev. 10.13.06 Page 1 of 2 Fstate of ~ i ©~ Incapacitated Person f ®a Minor 4. Anticipated Assets: Estimated Value: (Set forth property ofany I[tnd expeGed to be acquired herea,/ler, together wtth antlctpated dale ofaaqutsitton.J Property AnNctpated Date ofAcquisltton Sub-Total for Personal Estate: 0.00 (Attach additional sheets if necessary) TOTAL OF ITEMS 1, 2, 3, and 4 :.............................~ 3y r3~J~i ' ~ g Commonwealth of Pennsylvania ss. County of CtXn ~ ~ N, 2,iq h ~~(~ ~P.C-I.t~C1~ S ,says that the foregoing is a full, Guardian true and complete Inventory of the Estate of ~ ~ ,~ 1 ~ 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. j ~~A~~ cR ~~ ~c~s Guardian Attorney for Guardian: . Supreme Court I.D. No.: Address: 2Z2 S • ~ ~,~ i 71i ~ ~ 'f7~ll ~~ P ~ ~ 7022 Telephone: ~ ~~-31~7-~3-7d Form C-04 rev. 10.13.06 Page 2 of 2