HomeMy WebLinkAbout09-13-12GUARDIAN'S INVENTORY
COURT OF COMMON PLEAS OF ~ a ,~ COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVIS[ON
Estate of ~~ ~ ~ ~ - w ~-~ ~- i ~n Incapacitated Person
_ ' J ^ a Minor
1. Real Estate: (Location, by wham occ-aped and rental
terms, if applicable)
Sub-Total for Real Estate:
3. Jointly Held Property:
(Set forth real and personal property owned by the /ncapacitated Person JO/NTLY with any
other person(s). State whether held as tenants by the entireties: if not, whether the right of
survivorship exists.)
Joittt/y Held Properly
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Form G-04 rev. /0.13.06
12ECORDED OFFICE OF
R};GISTI?R Ol+ WII,I.S
2012 SEP 13
CLERK OF
ORPHANS COURT.
CUIVtEiI ;RLANll COURT, PA
Estimated Value:
0.00
Estimated Value:
IUO. °°
.~. UCs
1~0. Od
Estimated Value:
~~
Page 1 of 2
2. Personal Property:
Estate of ~U ~~.. ~ • ~ ~~ ~Z- ~an Incapacitated Person
' ~a Minor
4. Anticipated Assets:
(Set forth property of any kind expected to be acquired hereafter. together with
anticipated date of acquisition.)
Property
Anticipated Date
ojAcquisitioa
Sub-Total for Personal Estate:
Estimated Value:
0.00
(Attach additional sheets if necessary)
TOTAL OF ITEMS 1, 2, 3, and 4 :............................. 0.00
Commonwealth of Pennsylvania
n 1 ss.
County of l" 1axr~aQY1(Ilncl
~Ou~~r~ ~ . ~l~~s ,says that the foregoing is a full,
Guardian
true and complete Inventory of the Estate of ~ l q g . ~~EX-k~ ~. ,
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: ~-~tRx~x~L~ ~E? r rr~0.h ~Sn
Supreme Court I.D. No.:
Address: 0200 N . `~Oa'1~1.-QJ2.. ~"'•
`~ Telephone:
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Form a-04 rei~. ro.i3.o6 Page 2 of 2