Page 1 of 2 GUARDIAN222S INVENTORY COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA ORPHANS222 COURT DIVISION Estate of , } No. 1.Real Estate: (Location, by whom occupied and rentalEstimated Value:terms, if applicable) Sub-Total for Real Estate: 2.Personal Property:Estimated Value: 3.Jointly Held Property:Estimated Value: (Set forth real and personal property owned by the JOINTLY with anyotherperson(s). State whether held as tenants by the entireties; if not, whether the right ofsurvivorship exists.) Jointly Held Property American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Estate of , } 4.Anticipated Assets:Estimated Value:(Set forth property of any kind expected to be acquired hereafter, together withanticipated date of acquisition.)PropertyAnticipated Date of Acquisition b-Total for Personal Estate: TOTAL OF ITEMS 1, 2, 3, and 4:.............................. Commonwealth of Pennsylvania:: ss.County of : , says that the foregoing is a full, true and complete GuardianInventory of the Estate of information set forth herein is true and correct to the best of theGuardian222s 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. 247 4904 relating to unsworn) Guardian falsification to authorities.) Attorney for Guardian: Supreme Court I.D. No.: Address: Telephone: American LegalNet, Inc. www.FormsWorkFlow.com