HomeMy WebLinkAbout01-13-15 (3) GUARDIAN'S INVENTORY
„a
� �,
COURT OF COMMON PLEAS OF �v�� r3 c� ��rr0 COUNTY,P�'N�ISYLV�NI�� cr'''.,
:.» � `'—' G? Ca
ORPHANS' COURT DIVISION ��' -p 7 �� �
,.,� „� c—a ._.� �a
--,, »,, r_... f,_, ._ea ;-t�
��...._ r„�.� ;� ...,� i:�
TM ,�� > ��..3
1�an Ir�capa�itate�ersbh�'�
Estate of L M /L y .l i�E �� 14 c�R , , z, . ---
1❑a Muaor� _w� ra
►—, �__ t�t
No. 2 I - I 2 -q ,5 lo :.:; r--
� r,,-1 � C�
. C17
1. Real Estate: (Location,by whom occupied and rental Estimated Value:
terms,if applicable)
2�s nl, �ar�t.r�z siY ��iz�s�'rrt7z�wN, f��9. /7o�y � o, ot,r�
E L� Z�3�rr-�cvN 13vif'���t, ��rvc�s�'r-�z; C'��
/'�G r_U Pi��7 ��/ ,". 17J�lJ 6—H TL��� �[�/ �. /��1/L.L�2
;
Sub-Total for Real Estate: '7�.c�v0.00
2. Personal Property: • Estimated Value:
e H�KiNG' n��n�l3�'-�z s ,�c�Y' Evz.A�3�rt�tv�v�+ A� �63.
S A-+%iaG-s: ti�ic--��3r�z s Is r. �� l9
GN�/c..HG-r ���s�2ur��,vA 8K , EG�z�n3�?NP��vN, l��- lI , �3�
ll. l��7
3. Jointly Held Property: Estimated Value:
(Set forth real and personal property owned by the Incapacitated Person JOINTLYwith any
other person(s). State whether held as tenants by the entireties;if not,whether the right of
survivorship exists.)
Jaintly Held Property
Form G-04 rev./0./3.06 PagB 1 Of 2 \
^ f '�
Estate of �rM i�y J'/�-iv�- ��)/ ���/L- 1�an Incapacitated Person
'1❑a Minor
4. Anticipated Assets: Estimated Value:
(Set forth property of any kind expected to be acquired hereafter,together with
anticipated date of acquisition.)
Property AnHcipated Date
ojAcquisition
N a nr�'
Sub-Total for Personal Estate: 0.00
(Attach additional sheets if necessary)
TOTAL OF ITEMS 1,2,3, and 4: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �l/ !o ti'�•00
Commonwealth of Pennsylvania : "
. ss.
County of (;U M t3EQ�-�9�v D .
�N-e4lt�e� M EL v�N �o/�A-vc�H , says that the foregoing is a full,
Guardian -
true and complete Inventory of the Estate of ��n�t,y ��c !�����✓Z ,
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:
Supreme Court I.D.No.:
Address:
Telephone:
Fo,m c-oa rev.10.13.06 Page 2 of 2