Free Form G-04 - rev. 10-13-06 - Inventory for Incapacitated or Minor's Estate - Pennsylvania

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GUARDIAN'S INVENTORY
COURT OF COMMON PLEAS OF ORPHANS' COURT DIVISION COUNTY, PENNSYLVANIA

Estate of No.

,}

an Incapacitated Person a Minor

1.

Real Estate: (Location, by whom occupied and rental terms, if applicable)

Estimated Value:

Sub-Total for Real Estate: 2. Personal Property:

0.00

Estimated Value:

3.

Jointly Held Property:
(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

Estimated Value:

Form G-04 rev. 10.13.06

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Estate of

,}

an Incapacitated Person a Minor

4.

Anticipated Assets:
(Set forth property of any kind expected to be acquired hereafter, together with anticipated date of acquisition.) Property Anticipated Date of Acquisition

Estimated Value:

Sub-Total for Personal Estate: (Attach additional sheets if necessary) TOTAL OF ITEMS 1, 2, 3, and 4: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.00

0.00

Commonwealth of Pennsylvania : : ss. County of : , 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 understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.

) ) ) ) ) )

Guardian

Attorney for Guardian: Supreme Court I.D. No.: Address:

Telephone:

Form G-04 rev. 10.13.06

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