HomeMy WebLinkAbout01-09-15 (2) GUARDIAN'S INVENTORY
COURT OF COMMON PLEAS Ofl(�i f M,6 E.9 L AZ Z) —COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
n
®fir%ggpacit Persv>�'
Estate of tqt"y-llq A/ �/l/e /S�t n r
,fir
No.;2 Z2-05'33
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1. Real Estate: (Location, by who occupied and rental I✓stiate�,V" lt
terms, if applicable) 'Ur' P-
��� co o
Sub-Total for Real Estate: 0.00
2. Personal Property: Estimated Value:
-55 ?b o, o a
i .3�0,o 0
S
IV
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
X1/0 �Y E
Form G-04 rev.10.13.06 Page 1 of 2
Estate of ZX� A/V 1C �� /`1'5 Zan Incapacitated Person
4. Anticipated Assets: Estimated Value:
(Set forth property of any kind expected to be acquired hereafter,together with
anticipated date of acquisition)
Property Anticipated Date
of Acquisition
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 :
�t ss.
County ofJ��`"�
Ch says that the foregoing is a full,
Guardian `
true and complete Inventory of the Estate of r
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 ) Guardian
falsification to authorities.
Attorney for Guardian: Ch VjY 19 M, / A/
Supreme Court I.D.No.: -2 D 7 95�q
Address:f� N L &,2 /zSSDC.1 A S
Telephone:
Form G-04 rev.10.13.06 Page 2 of 2