HomeMy WebLinkAbout12-03-12GUARDIAN'S INVENTORY
COURT OF COMMON PLEAS OIL. ~c ~ /~ i ~ ~/~ _ ~/,~~ COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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} ~ , 7 -, ' f ~ a~Incapated~~'son
Estate of _ ~C:' /t. ~/ /-~ /~ ~ ~ _ 1 f~ / ~~~` } ~` ~~-, ~°
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v f,~ `~`, ~.:.Y ~.:o..y
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1. Real Estate: (Location, by whom occupied and rental ystimated~alu~2? ~'
terms, if ap~-~~~e)
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Sub-Total for Real Estate: 0.00
2. Personal Property: Estimated Value:
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~ s
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3. Jointly Held Property: Estimated Value:
(Set forth real and personal property owned by the Incapacitated Person JOINTLY with any
other person(s). State whether held as tenants by the entireties: if not, whether the right of
survivorship exists.)
Jointly Neld Property
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Form G-04 rev. 10.13.06 Page I of 2
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'? ~ 1 ', } ~ ~~an Incapacitated Person
Estate of ~~'~ ~~ ~ ! ~
' ^ 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
of Acquisition
(Attach additional sheets if necessary)
Sub-Total for Personal Estate:
Estimated Value:
0.00
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TOTAL OF ITEMS 1, 2, 3, and 4 : ............................. ~~; ~ ~~ ~7, '~'~ ''
Commonwealth of Pennsylvania
ss.
County o f~ ~ ~~
~ ~ (~`' , / /-~ _J . L_..~'1,/~ (~5 -~~ ,says that the foregoing is a full,
Guardian ~
true and complete Inventory of the Estate of ~ - i` ~ l ,
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.
_ y ~
Guardian
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Attorney for Guardian: ~ l ~~ t J~Z"~ tr'y~ , ~`~L) ~ ~ n
Supreme Court I.D. No.: =~'G ~ ~f' ~ ~.~
Address: ~JC1.v1 ~ ~~'j,'L~,,;;~-, ~. ~ ~~c;~~~~;,~-~'-s.
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Telephone: ~ ~~~ r~~~ ~ ._`75 ~ ~
Form G-04 rev. 10.13.06 Page 2 of 2