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GUARDIAN'S INVENTORY
COURT OF COMMON PLEAS OF COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of G Yf����� or, Pi Ean Incapacitated Person
f �/ � I�a Minor
Ivo.�1a 7rr��— / a '7 '7
1. Real Estate: (Location,by whom occupied and rental Estimated Value:
terms,if applicable)
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Sub-Total for Real Estate. = , 00 4IT,
2. Persona Property: Estiniate'd V,aluc:
q,py
c�
M
N Cn O
'r7
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 Held Property
Form c-04 rev.10.13.06 Page I of 2
Estate of
an Incapacitated Person
')E]a Minor
4. Anticipated Assets: Estimated Value:
(Set forth property of any kind expected to be acquired hereafter,together with
anticipated date of acquisition)
.Proper(y Arddeipated Date
ofAcquLd ion
Sub-Total for Personal Estate: 0.00
(Attach additional sheets if necessary)
TOTAL OF ITEMS 1,2,3, and 4: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.00
Commonwealth of Pennsylvania
ss.
County of C tlA�( l iR!• -(f b
says that the foregoing is a full,
Guardian f ,
true and complete Inventory of the Estate of kay�. Y J
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 ) Guardian
falsification to authorities. )
Attorney for Guardian:-l 5 6 �•
Supreme Court I.D.No.: G `�
Address: LZ;� 0&�
Telephone y I F —�� V
Form C-04 rev.Ja13.06 Page 2 of 2