HomeMy WebLinkAbout07-14-14 GUARDIAN'S INVENTORY
COURT OF COMMON PLEAS OF C u�j P t I u n � COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
M ���e� 1_1d'an Incapacitated Person
Estate of /� r�n c� -'��a Minor
No. �t- � y- D3 �S
1. Real Estate: (Location, by whom occupied and rental Estimated Value:
terms, if applicable) J�,
Sub-Total for Real Estate: 0.00
2. Personal Property: Estimated Value:
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3. Jointly Held Property: Estimated Value:
(Set forth real and personal properry owned by the Incapacrtated Person JOINTLY with any
orher person(s). State whether held as tenants by the entireties;if not,whether the right of
survivorship exists.)
Joinlly Held Property
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Form G-04 rev. 10.13.06 Page 1 of 2
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Estate of .�} n n q /V( , ,�j,�� � � �1 -- an Incapacitated Person
1�a Minor
4. Anticipated Assets: Estimated Value:
(Set forth property of any kind expected to be acguired hereafter,together with
anticipated date of acquisition.)
Property Ankcipated Dnte
ofAcquisition
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Sub-Total for Personal Estate: 0.00
�Attach ada%itional sheets if necessary)
TOTAL OF ITEMS 1,2,3,and 4: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.00
Commonwealth of Pennsylvania :
p : ss.
County of L��r, G n�Jl :
'.�� I � � ("�� t l'c� , d a u A h�-u�says that the foregoing is a full,
Guardian
true and complete Inventory of the Estate of �-.�.rt a �`'��v� ,vP 2� ,
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 tha±false statements herein are ) , �
made subject to the penalties of ) n.C.e.� .�t� a��i
18 Pa.C.S. § 4904 relating to unsworn ) Guar n
falsification to authorities. )
Attorney for Guardian: �=2��� S � r �4� �j
Supreme Court I.D.No.:
Address: ?(��,� �1c� �� ,�i �� .S�"/' �Q.-�-
�}�r��� chur �, �/� 1 �JIQ
Telephone: ( '�/ �) `1`� 4 ' I � �'�
Form G-04 rev. 10.13.06 Page 2 of 2