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GUARDIAN'S IWENTORY
COURT OF COMMON PLEAS OF CO A4 t0o elld COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
` ( an Incapaieated�srsoiE rn
Estate of 0 a Miq@r� _� 6
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1. Real Estate: (Location, by whom occupied and rental Estinigta,Valuern
terms,if applicable) / y� C3' U'
Sub-Total for Real Estate. 0.00
2. Personal Property: Estimated Value:
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;ijnot,whether the right of
survivorship exists.)
Jointly Held Property
1 04
Form G-04 rev.10.13.06 Page l of 2
Page 19
CSP
Estate of 4enoiw an Incapacitated Person
'10 a Minor
4. Anticipated Assets: Estimated Value:
(Set forth property of any kind expected to be acquired hereafter,together with
anticipated date ofacquisition)
Proper'), Anticipated Date
ofAcquisition
Sub-Total for Personal Estate: 0.00
(Attach additional sheets if necessary) "4000.00
TOTAL OF ITEMS 1,2,3,and 4: . . . . . . . . . ... . . . . . . . . . . . . . . . . . . .
Commonwealth of Pennsylvania
: ss.
County of &A&4-10114 :
aAA R. , says that the foregoing is a full,
Guardian
true and complete Inventory of the Estate of
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 V 81
18 Pa.C.S. § 4904 relating to unsworn Guardian
falsification to authorities.
Attorney for Guardian:
Supreme Court I.D.No.:
Address:
Telephoner
Form G-04 rev.10.13.06 Page 2 of 2
Page 20