HomeMy WebLinkAbout02-06-13 (4).~ . ~ ~- ~y 1~ J l z~9
GUARDIAN'S INVENTORY
COURT OF COMMON PLEAS OF 11M ~G~' ~ COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
`1 ,n Incapa~ted~e~ , on
Estate of '(~ ~ ~ ~ 11~ , } m n
~, minor ran ,~ ~
No. ,, o ~ rn,,, ~' rn v
rn
r~rn c~ ~~
to ~ ~ c~
-~ ~ ~
c ~
1. Real Estate: (Location, by whom occupied and rentalsated V~lue~~- ~
terms, if applicable) ~
~ ~
~~
Sub-Total for Real Estate:
2. Personal Property:
3. Jointly Held Property:
(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 Held Property
Form G-04 rev. 10.13.06
d• ~
o.oo
Estimated Value:
Estimated Value:
o -~ao. 5
~IV.Z
d 1
Page 1 of 2
ti~
+' ~•~
Estate of ~'~('~ `1. ~(~ V`e' ~ an Incapacitated Person
®a Minor
4. Anticipated Assets:
(Set forth property of any kind expected to be acquired hereaTter, together with
anticipated date of acquisition.)
Property
Anticipated Date
ojAcquisition
Sub-Total for Personal Estate:
Estimated Value:
0.00
(Attach additional sheets if necessary)
TOTAL OF ITEMS 1, 2, 3, and 4: ............................. 4 ~~ , ~~Z •
Commonwealth of Pennsylvania
ss.
County of ~~fi~~
,says that the foregoing is a full,
Guardian ~` ~ ~ i ~ ~,~~
true and:complete Inventory of the Estate of C ~1(~ ~ ,
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 ,- Guardians
Attorney for Guardian:
Supreme Court I.D. No.:
Address:
Telephone:
Form G-04 rev. 10.13.06 Page 2 of 2