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Home My WebLink About94-0393 January 19,2008 Cumberland County Courthouse Clerk of Orphans Court 1 Courthouse Square Carlisle P A 17013 To Whom It May Concern: Enclosed please find a copy of the Annual Report of Guardianship of Sean Matthew Dosiak. I am also enclosing $15.00 for the filing fees. I am requesting that you send me a copy of the report stamped received and filed. Thank you for your help in this matter. Sincerely, t./4'd- ~ ~ ~~ Mr. And Mrs. Williams R. Dosiak Guardian of Sean Matthew Dosiak Enclosure (1) sd 100 N. SECOND STREET MECHMTICSBURG P A 17055 . . I iN RE: GUARDIANSHIP OF SEAN MATTHEW DOSlAK IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT NO.21-94-393 TO: Clerk of Orphan's Court Courthouse, Carlisle P A ANNUAL REPORT OF GUARDIANSHIP OF SEAN MATTHEW DOSIAK C) Estate: Sean Matthew Dosiak Guardian: William R. Dosiak and Sharon Dosiak Period: Date Filed: January I, 2006- December 31, 2006 This is a report filed with the Court in compliance with Section 5521 (c) of Act 24 of July, 1992, 20 PaCSA~D 5521. (; :, '1 I t.....-' '-o::J (;::.:) --' ,,) C. -a (,) . I, Estate of Sean Matthew Dosiak 1/18/20074:33 PM Register: Estate of Sean Matthew Dosiak From 0110112006 through 12131/2006 Sorted by: Date, Type, Number/Ref Date Number Payee Account Memo Payment C Deposit Balance 01/1212006 check printing fee bank charge/check prin... expense 19.99 1,385.92 01/15/2006 421 Oflice Max Chair/tile totes VOID: X 1,385.92 01115/2006 422 Office Max Chair/file totes expense 127.88 1,258.04 01/16/2006 423 Sear's clothes clothes 75.81 1,182.23 01/16/2006 424 Suncoast DVD's DVD 47.99 1,134.24 01/16/2006 425 FYE CD's CD 69.95 1,064.29 01/20/2006 426 cash spending money spending 50.00 1,014.29 02/01/2006 dep direct deposit ssr income deposit 603.00 1,617.29 02/01/2006 dep ssp income deposit 27.40 1,644.69 02/01/2006 427 Wm. R. & Sharon D... Sean's FS for F&S 375.00 1,269.69 02/1 0/2006 428 cash spending money spending 50.00 1,219.69 02/21/2006 429 Dr. Paul H. Williams dentist expense 68.00 1,151.69 02/24/2006 430 cash spending money spending 50.00 1,101.69 02/28/2006 431 Suncoast DVD's DVD 15.89 1,085.80 03/01/2006 dep direct deposit SSI income deposit 603.00 1,688.80 03/01/2006 dep ssp income deposit 27.40 1,716.20 03/0112006 432 Wm. R. & Sharon D... Sean's FS for F&S 375.00 1.341.20 03/05/2006 433 Walmart Dvd's/clothes expense 93.54 1,247.66 03/07/2006 3/16/06 Walmart CD's expense 15.78 1,231.88 03/07/2006 434 New York Mets yearbook expense 12.00 1,219.88 03/14/2006 462 best Buy CD's expense 45.57 1,174.31 03/18/2006 436 cash spending money spending 50.00 1,124.31 03/19/2006 437 Bosco's clothes expense 79.95 1,044.36 03/21/2006 438 Medco Health Other Expenses medicine 18.00 1,026.36 04/01/2006 dep direct deposit SSI income deposit 603.00 1,629.36 04/01/2006 dep ssp income deposit 27.40 1,656.76 04/01/2006 439 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,281.76 04/08/2006 440 ca~h spending money spending 50.00 1,231.76 04/14/2006 441 Toys R Us DVD's expense 10.59 1,221.17 04/14/2006 442 FYE CD's CD 68.88 1,152.29 04/24/2006 443 cash spending money spending 50.00 1,102.29 04/25/2006 444 FYE CD's CD 19.07 1,083.22 05/0112006 dep direct deposit SSI income deposit 603.00 1,686.22 05/01/2006 dep ssp income deposit 27.40 1,713.62 05/01/2006 445 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,338.62 05/01/2006 446 cash concert (train) expense 40.75 1,297.87 05/06/2006 447 K-mart clothes expense 9.09 1,288.78 05/13/2006 448 Sear's clothes clothes 50.88 1,237.90 05/13/2006 449 Suncoast DVD's DVD 95.36 1.142.54 05/14/2006 450 ca~h spending money spending 50.00 1,092.54 Page 1 , Estate of Sean Matthew Dosiak 1/18/20074:33 PM Register: Estate of Sean Matthew Dosiak From 01/01/2006 through 12/3 1/2006 Sorted by: Date, Type, NumberIRet Date Number Payee Ac~ount Memo Payment C Deposit Balanc~ 06/01/2006 dep direct deposit SSI income deposit 603.00 1,695.54 06/01/2006 dep direct deposit SSP income deposit 27.40 1,722.94 06/01/2006 451 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,347.94 06/12/2006 452 cash spending money spending 50.00 1,297.94 06/13/2006 453 Circuit City CD's/BATTERIES EXPENSE 52.96 1244.98 06/13/2006 454 K-mart clothes/SHOES expense 38.56 1,206.42 06/14/2006 455 Sear's clothes clothes 89.47 1,116.95 06/29/2006 456 Giant medication medication 17.68 1.099.27 06/29/2006 457 cash spending money spending 50.00 1,049.27 06/30/2006 Dep direct deposit SSP income DEPOSIT 27.40 1,076.67 06/30/2006 DEP directdepositSSI income DEPOSIT 603.00 1,679.67 06/30/2006 458 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,304.67 07/03/2006 459 Medco Health Other Expenses medicine 18.00 1,286.67 07/11/2006 460 cash spending money spending 50.00 1,236.67 07/21/2006 461 cash spending money spending 100.00 1,136.67 07/29/2006 463 Penndot ID photo expense 10.00 1,126.67 08/0 1 /2006 dep direct deposit SSJ mcome deposit 6m.00 1,729.67 08/01/2006 dep direct deposit SSP Income deposit 27.40 1,757.07 08/0 I /2006 464 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,382.07 08/04/2006 465 Suncoa<;t DVD's DVD 10.89 1,371.18 08/04/2006 466 Bleacher Bum's shirt expense 18.00 1,353.18 08104/2006 467 FYE DVD's DVD 40.26 1,312.92 08/07/2006 468 Circuit City DVD's EXPENSE 37.08 1,275.84 08/07/2006 469 K-mart gift expense 14.29 1,261.55 08/11/2006 470 cash vacation expense 200.00 1,061.55 08/17/2006 471 cash 1/3 for sewer expense 788.33 273.22 09/01/2006 dep direct deposit SSI income Deposit 603.00 876.22 09/0 I /2006 dep direct deposit SSP income deposit 27.40 903.62 09/01/2006 472 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 528.62 09/21/2006 fee bank fee for photo co... bank fee photocopy of ... expense 20.00 508.62 09/23/2006 473 Circuit City DVD's EXPENSE 25.42 483.20 09/30/2006 475 Bleacher Bum's shirt/calendar expense 33.78 449.42 09/30/2006 476 Suncoast DVD's expense 19.07 430.35 I % 1/2006 dep direct deposit SSI income deposit 603.00 1,033.35 10/01 /2006 dep direct deposit SSP income deposit 27.40 1,060.75 10/01/2006 474 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 685.75 1 0/07/2006 477 cash spending money expense 50.00 635.75 10/20/2006 478 cash spending money expense 50.00 585.75 11/01/2006 dep direct deposit SSI income deposit 603.00 1,188.75 11/01/2006 dep direct deposit SSP income deposit 27.40 1,216.15 Page 2 Estate of Sean Matthew Dosiak 1118/2007 4:33 PM Register: Estate of Sean Matthew Dosiak From 01/01/2006 through 12/31/2006 Sorted by: Date, Type, Number/Ref Date Number Payee Account Memo Payment C Deposit Balanc-e 11/01/2006 479 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 841.\ 5 11/09/2006 480 ca~h spending money expense 50.00 791.15 11111/2006 481 Walmart DVD's expense 21.\6 769.99 11/20/2006 482 Circuit City DVD's EXPENSE 21.\9 748.80 11/27/2006 483 cash spending money expense 50.00 698.80 11/27/2006 484 K-mart clothes expense 27.20 671.60 12/01/2006 dep direct deposit SSI income deposit 603.00 1,274.60 12/01/2006 dep direct deposit SSP income Deposit 27. 40 1,302.00 ] 2/01/2006 485 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 927.00 12/03/2006 486 Value City clothes expense 21.98 905.02 12/09/2006 487 JC Penny gifts expense 5L10 853.92 12112/2006 488 Medco Health medication medicine expen... 51.91 802.01 12/26/2006 489 Circuit City DVD's EXPENSE 26.49 775.52 Page 3 ~ ("A~U tl.... -.. ..-.... -..- DATE PAYEE REASON Deposits Withdrawals UAMn . ~.. .._- Balance as of 12/31/05 <;; 'ill <1 'i 1/5/06 Sesame Street live show and food $ 21.00 - oJ} 4:~."'t.J 1/8/06 Burger King lunch $ 5.97 <:" r)') 110 - 1/19/06 Underdog's lunch $ 9.00 :b '144tl 1/20/06 Midtown Pizza lunch $ 10.00 '" . '" '" .,..-,.v 1/20/06 cash spending money $ 50.00 <;; 'iLl A,q 2/3/06 Bob Evans lunch $ 11.00 " '-tJ.'-to 2/4/06 Giant dinner $ 4.19 <1' "'f'\ ')() ~ 2/5/06 Duke's dinner $ 10.98 j, Iii ,) 1 2/7/06 My Place lunch $ 6.61 ... "- I.: '..... 2/7/06 Giant magazine $ 6.67 <1: '1'" () ~ 2/9/06 cash haircut $ 10.00 .:!> ::i. v.:> 2/10/06 cash spending money $ 50.00 '" rc fl"'l - 2/10/06 Giant magazine $ 7.63 <;; 4/4il 2/10/06 CASH Church offering 2 wks $ 4.00 - .,; "1'v...'lV 2/18/06 cash lunch $ 7.13 <t .,(< ',-j 2/18/06 Hoss's dinner $ 11.99 .:!> Ll.t.Lu 2/19/06 Underdog's dinner $ 10,00 '" AI -' '""ll""l 'v 2/20/06 Dollar General video's $ 5.30 ;:; i-i Yi-i 2/24/05 cash spending money $ 50,00 - "' ,-.n..;..:;;\.) 2/24/06 Underdog's lunch $ 9.26 <:" 1l07r) 2/27/06 Moe's lunch $ 9.20 :b ....u ;),,~ 3/5/06 McDonald's lunch $ 3.18 '" " 3/6/06 Weis lotion $ 5.35 :;:: ''Ii qq 3/11/06 cash lunch $ 9.00 - ..;; L..c........V' 3/11/06 Mountain View Dine dinner $ 13.34 <r n cc:: - 3/18/06 cash spending money $ 50.00 ;, ;y~ b~) 3/19/06 Midtown Pizza lunch $ 8.00 ,- - 3/19/06 Dollar General card $ 1.06 G: ;:;n ;:;0 3/20/06 cash ice cream $ 2.50 " "to.vc;; 3/25/06 cash Church offering 2 wks $ 3.00 c A,r:: An - 3/17/06 cash haircut $ 10.00 ;,) ,Il I i<.; 3/23/06 Giant batteries $ 4,22 '" y .~.' ~..J ' ',...: 4/1/06 Underdog's lunch $ 8.05 " -J) Q'/ 4/8/06 Kokomo's lunch $ 10.00 '" i ~:.....u'-::" 4/8/06 cash spending money $ 50.00 .- ~ 4/9/06 Underdog's lunch $ 8.55 ~. ~_.~:1, ''- 4/11/06 Giant cards $ 6.35 .- '" '-t! ~.~ 4/14/06 Underdog's lunch $ 9.06 t'!: r~n 0(" 4/15/06 cash sausage sandwich $ 2,00 ;:, ~}o. C~ 4/15/06 Weis magazine $ 3.70 ,+- 4/23/06 Underdog's lunch $ 9.05 ., ~1 -1 1 4/24/06 cash spending money $ 50.00 .. ,~ ,q. ~ I 4/27/06 Snapper's sandwich $ 6.31 '. c.; ';' Ot~, . 4/29/06 Underdog's lunch $ 10.00 ~ ~..: ~u 4/30/06 Giant magazine $ 3.33 5/1/06 Camp Hill Diner lunch $ 9.22 'l. .tI\:; ")F 5/6/06 Underdog's dinner $ 12.00 '" """.. [.:,) 5/12/06 Underdog's lunch $ 11.00 C' "';""'j -::::: - 5/14/06 cash spending money $ 50.00 '<; 7'7 'Je; 5/22106 cash haircut $ 10.00 J') OL '<:0 5/19/06 cash hotdog $ 3.00 " ::'.""') ~r:: ... 5/31/06 cash church offering $ 5.00 S ~4 ')~ 6/4/06 Subway lunch $ 6.55 ~ '" -rl IV 6/6/06 Big Lots plastic tub $ 7.37 tt': ;~ (1 '1'1 6/6/06 Giant magazine $ 2.86 ::!> .:' ( '+ i 6/8/06 Underdog's lunch $ 10.11 ... '''',''''i' ')'''":' 6/10/06 cash hotdogs $ 6.00 ~ ') 1 ',,-, 6/10/06 cash ice cream $ 3.18 -- .;J lUll) 6/11106 cash lunch $ 5.56 'l: 1 '1 ~'1 6/11/06 Ruby Tuesday dinner $ 12.38 1) IU.,,4! 6/12/06 cash spending money $ 50.00 .. '" 6/12/06 Subway lunch $ 7.73 '!; !I? ,,1 6/12/06 Dollar Plus card $ 0.53 " ,J) 44' Jl...J 6/16/06 Giant movies $ 18.00 ~ '"1') r:n . 6/17106 Weis puzzle book $ 1.06 :; /144 6/24/06 Underdog's lunch $ 8.50 o. w I 'oJ, '-'**1 6/25/06 Camp Hill Diner lunch $ 11.00 ct. ? 0.1. 6/29106 cash spending money $ 50.00 Jl ~)L ::1'f 6/29/06 Gingerbreadman lunch $ 6.80 <!' ,'.- '^. - 6/30/06 Underdog's lunch $ 9.31 s ~h rL~ 7/7106 Jumbo Buffet lunch $ 6.30 ., '" ....;v.-..I....' 7/8/06 Genova's dinner $ 8.42 <!: .f)') 01 1 7/10/06 Giant candy/batteries $ 6.05 ~ '0 uo 7/11/06 cash spending money $ 50.00 ~ ,.~.~ ."\f.' 7/11/06 cash ice cream $ 3.00 s f-i:~ !!h 7/13/06 cash haircut $ 10.00 - '" ...J.,J.uu 7/14/06 Underdog's lunch $ 7.41 ~~ 1t: ~r:. 7/15/06 Charlestown dinner $ 5.49 ;>) L.Pj. I 'J 7/16/06 Ruby Tuesday dinner $ 11.03 ... "'~ J'i .1 "'l 7/13/06 Weis magazine $ 11.65 '" 1 ? 4H 7/21/06 cash spending money $ 100.00 - ,,0 : i, ( ~u 7/22/06 Ollie's puzzle books/candy $ 3.12 <!' "! '''',,1 "')~ 7/22106 Duke's dinner $ 11.48 ~ ., UL /51:1 7/25/06 Giant magazine $ 7.67 ,~ 7/26/06 Weis magazine $ 3.70 <!' 04 &;.1 7/27/06 Maggie's ice cream $ 2.75 .r- oo fU 7/27/06 Giant candy/CD $ 7.85 " Co,,", n~ - 7/29/06 Midtown Pizza lunch $ 6.30 :~, l4 hl 7/30/06 Weis magazine $ 3.70 .-. '" 8/1/06 Underdog's lunch $ 8.19 <!: r:O n') 8/6/06 City Bar & Grill lunch $ 11.00 .J.I 'fO. UL 8/6/06 Kmart towel &shirt $ 10.64 ~ ...~~ "")0 8/5/06 Ruby Tuesday dinner $ 19.40 "" 1 ( YrI 8/11/06 cash money for vacation $ 200.00 -- '" "-:. f .~u 8/13/06 cash spent on vacation $ 145.61 ~ 70 '17 8/15/06 Weis magazine $ 3.70 J:> oe.or 8/17/06 Giant wrapping paper $ 3.14 ,..,.. o . . 8/18/06 Giant candy & cup $ 6.10 '" hq 4'" 8/21/06 cash haircut $ 10.00 " .;J .....tv."-t.J 8/27/06 Underdog's lunch $ 6.30 t!' "''') ...? . 9/3/06 cash church offering $ 2.00 .t ;j 1 1 "- 9/4/06 Jumbo Buffet lunch $ 7.31 .'j) ,).) 01- 9/9/06 Circuit City DVD $ 14.83 ~ ~ ~ (''lti, y 9/24/06 Eastend dinner $ 11.02 ~ .I Y.l 9/30/06 cash church offering $ 2.00 - '" "';..;;JI 1 0/7/06 cash spending money $ 50.00 <t hk 07 1 0/7/06 cash haircut $ 10.00 .:1> Lf'J 'j r 10/8/06 Bob Evans breakfast $ 7.35 t!' .... 10/11/06 Bob Evans dinner $ 7.35 " ".1 ') ( 10/14/06 Underdog's lunch $ 10.00 - "' -. .;; L f ,,_f 10/20/06 Ollie's book $ 10.59 <!' -1 n (":':) . 1 0/20/06 cash spending money $ 50.00 ~ t")u .1Jt5 10/20/06 cash concert/food $ 23.00 .- .... 10/20/06 cash birthday gift $ 20.00 q: "7 t::.R 10/28/06 cash hot dog/chips $ 3.49 ,p I Lf. 1:::1 10/29/06 Giant card $ 1.90 ~ f"" -;n ~ 10/29/06 cash church offering $ 4.00 ~ M ..JY 11/5/06 Your Place dinner $ 9.95 " , :.vv, 11/9/06 cash spending money $ 50.00 <l: M{ ~.~ 11/11/06 Underdog's lunch $ 10.00 ,J) .)0 .)<f 11/19/06 TGI Friday's lunch $ 16.47 '" ro "I n-,. - 11/24/06 cash haircut $ 10.00 ~ 11 HI 11/25/06 Snapper's dinner $ 13.45 .- '" \ 1....JUI 11/27/06 cash spending money $ 50.00 <!: ..~ Q l',,) 12/2/06 Harbor Freight tool aiplane $ 7.41 ;:)) 41.UI 12/2/06 Underdog's lunch $ 9.04 ,.. "",..1 1"'\""':- 12/3/06 Genova's lunch $ 9.99 " '11 lJK 12/9/06 fye dvd $ 6.35 - '" Iv.V"; 12/22/06 Hoss's dinner $ 11.75 <t '1 QQ 12/24/06 cash church offering $ 2.00 :!' ! .~i5 Sean Matthew Dosiak Trust 1/20/2007 10:26 AM Register: Sean Matthew Dosiak Trust From 0 I /0 1/2006 through 12/31/2006 Sorted by: Date, Type, NumberIRef Date Number Payee Arcount Memo Payment C Deposit Balance -_._------------~ _._-."------ ~- --"..---._-- _____.M.___.__ 01/19/2006 1025 Register of Wills filing fee YOID X 2,805.51 01/19/2006 1026 Sharon Dosiak preparation court report YOID: X 2,805.51 01/19/2006 1027 Register of Wills filing fee expense 15.00 2,790.51 01/19/2006 1028 Sharon Dosiak preparation court report expense 225.00 2,565.51 01/25/2006 dep CD Interest Trust interest 27.18 2,592.69 02/24/2006 deo CD Interest Trust interest 27.18 2,619.87 02/28/2006 1029 Stiteler & Associates ... tax preparation tax preparation 30.00 2,589.87 03/0112006 1030 US Postal Service Postage and Delivery postage 9.28 ~,580.59 03/24/2006 dep CD Interest Trust interest 24.55 2,605.14 04/25/2006 dep CD Interest Trust interest 27.18 2,632.32 OS/25/2006 dep CD Interest Trust interest 26.30 2,658.62 06/23/2006 dep CD Interest Trust interest 35.42 2,694.04 07/25/2006 dep CD Interest Trust interest 34.28 2,728.32 08/25/2006 dep CD Interest Trust interest 35.42 2,763.74 09/25/2006 dep CD Interest Trust interest 35.42 2,799.16 I % I /2006 1031 void check sent to Ruth wolffor a... void 2,799.16 1 0/25/2006 dep CD Interest Trust interest 3427 2,833.43 11/24/2006 dep CD Interest Trust interest 35.42 2,868.85 11/27/2006 dep Equitrust Life I Prem... Trust interest 335.02 3,203.87 12/19/2006 dep Equitrust Life I Prem... Trust interest 271.52 3,475.39 12/22/2006 dep CD Interest Trust interest 34.28 3,509.67 Page 1 Sean Matthew Dosiak Certificate of Deposit 1/1/01-12/31/01 12/31/01 Mellon Trust CD 10.000.74 is now Citizen'~Bank transferred funds to Citizen's Bank on 6/20/02 Balance 10,000.74 TRANSFER OF SEAN MATTHEW DOSIAK TRUST FUNDS TRANSFERRED ANNUITY WITH F&GLIFE $58,264.34 19,087.55 INTEREST $77,351.89 TOTAL TRANSFER 10/05/06 TRANSFERED TO AN ANNUITY ACCOUNT WITH .EQUlTRUST. TRANSFERED $6,500.00 FROM MELLON CHECKING TO A MONEY MARKEY ACCOUNT WITH AMERICAN FUNDS ON 8/16/01. TOTAL OF MONEY MARKET $7,262.85 . . . We certifY that the above is an accurate report of the income and expenses of the guardian account. The needs of the incapacitated person as set forth above, included expenses for Sean, including trips, vacations, and recreations. Sean resides at 100 N. Second Street, Mechanicsburg P A 17055 with his mother and father. He continues to take Dilantin medication to control his seizures. Sean still goes to Dr. James. He has a Dilantin level test and liver test every-six months. His dentist is Dr. Paul Williams. He sees him every six months. We take him to dinner or lunch on the weekends and shopping. Sean wenttothe-shorethis-summerwithus. He-spendstimewithhis-sisterand family. He goes to church with his sister. He saw an Elvis impersonator again this year. He went to a concert with his sister. He enjoys TV, word fine puzzles, listening to music, and watching his movies. Sean is with his parent-s during the day. 1 feel the guardianship should be continued. The reason being, Sean is mentally deficient from birth due to malpracticeofaphysician and cannot manage his affair-s,makemedicaldecisions,'Of take care of himself. We feel as Sean's parents that we have an understanding for Sean and his needs. {/~~ ~ William R. Dosiak 100 N. Second Street MechanicsburgPA 17055 ~~ Sharon Dosiak 100 N. Second Street MechanicsburgPA 17055 Distribution: Clerk of Orphan's Court COMMONWEALTH OF PENNSYLVANIA S8 COURT OF COMMON PLEAS On this, the day of , before me, a notary public in and for the County of Cumberland, Commonwealth of Pennsylvania, the undersigned officer, personaUy appeared William R. Dosiak and Sharon Dosiak, known to me (of satisfactory proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same forpurpeses therein contained. IN WITNESS WHEREOF, I HEREUNTO SET MY HAND AND OFFICIAL SEAL. .JQ1Af.l.Qry ~~ :2.~7 Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Jay M. Zimmerman. Notary Public Upper Allen Twp., Cumberland County My Commission Expires Mar. 16, 2010 Member. Pennsylvania Association of Notaries fr$, IN RE: GUARDIANSHIP OF SEAN MATTHEW DOSIAK IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHAN'S COURT NO.2 1-94-393 TO: Clerk of Orphan's Court Courthouse, Carlisle P A ANNUAL REPORT OF GUARDIANSHIP OF SEAN MATTHEW OOSIAK Estate: Sean Matthew Dosiak Guardian: William R Dosiak and Sharon Dosiak Period: Date Filed: January 1,2007- December 31, 2007 This is a report filed with the Court in compliance with Section 5521 (c) of Act 24 of July, 1992,20 PaCSA 5521. o c- ,......, = c:::::) LO c._ :r::.." ~) UI -n -0 w ~> Estate of Sean Matthew Dosiak 1/19/2008 6:33 PM Register: Estate of Sean Matthew Dosiak From 01/01/2007 through 12/31/2007 Sorted by: Date, Type, Number/Ref Date Number Payee Account Memo Payment C Deposit Balance 01/01/2007 dep direct deposit SSI income deposit 623.00 1,398.52 01/01/2007 dep direct deposit SSP income Deposit 27.40 1,425.92 01/01/2007 490 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,050.92 01/06/2007 491 cash spending money expense 50.00 1,000.92 01/16/2007 492 Sear's clothes expense 100.70 900.22 01/16/2007 493 FYE DVD's expense 26.49 873.73 01/20/2007 494 cash spending money expense 50.00 823.73 01/25/2007 dep reimbursement from i... Ins. reimbursement deposit 40.00 863.73 02/01/2007 dep direct deposit SSI income deposit 623.00 1,486.73 02/01/2007 dep direct deposit SSP income deposit 27.40 1,514.13 02/01/2007 495 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,139.13 02/04/2007 4% best Buy CD's expense 45.57 1,093.56 02/04/2007 497 Sear's clothes expense 23.78 1,069.78 02/1 0/2007 498 cash spending money expense 50.00 1,019.78 02/25/2007 499 Walmart DVD's expense 29.64 990.14 02/25/2007 500 Value City clothes expense 6.23 983.91 03/01/2007 dep direct deposit SSI income deposit 623.00 1,606.91 03/01/2007 dep direct deposit SSP income deposit 27.40 1,634.31 03/01/2007 501 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,259.31 03/04/2007 502 Sear's clothes expense 87.95 1,171.36 03/04/2007 503 FYE DVD's expense 52.99 1,118.37 03/09/2007 504 cash spending money expense 50.00 1,068.37 03/20/2007 505 Medco Health medication medicine expen... 40.00 1,028.37 03/23/2007 506 New York Mets yearbook expense 12.00 1,016.37 03/25/2007 507 K-mart clothes/cd/easter basket expense 43.27 973.10 03/31/2007 508 FYE DVD's expense 47.68 925.42 03/31/2007 509 Sun coast DVD's expense 39.21 886.21 04/01/2007 dep direct deposit SSI income deposit 623.00 1,509.21 04/01/2007 dep direct deposit SSP income deposit 27.40 1,536.61 04/01/2007 510 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,161.61 04/20/2007 511 FYE DVD's expense 89.32 1,072.29 04/21/2007 512 cash spending money expense 50.00 1,022.29 04/24/2007 dep reimbursement from i... Ins. reimbursement deposit 40.00 1,062.29 05/01/2007 dep direct deposit SSI income deposit 623.00 1,685.29 05/01/2007 dep direct deposit SSP income deposit 27.40 1,712.69 05/01/2007 513 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,337.69 05/05/2007 514 K -mart books expense 7.72 1,329.97 05/12/2007 515 cash spending money expense 50.00 1,279.97 05/16/2007 516 Comeast cable sports channel expense 44.87 1,235.10 OS/27/2007 517 K-mart clothes expense 84.56 1,150.54 Page 1 Estate of Sean Matthew Dosiak 1/19/2008 6:33 PM Register: Estate of Sean Matthew Dosiak From 01/01/2007 through 12/31/2007 Sorted by: Date, Type, NumberlRef Date Number Payee Account Memo Payment C Deposit Balance -- 06/01/2007 dep direct deposit SSI income depsit 623.00 1,773.54 06/01/2007 dep direct deposit SSP income deposit 27.40 1,800.94 06/01/2007 518 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,425.94 06/02/2007 519 K-mart beach towel expense 11.92 1,414.02 06/04/2007 520 Border's books expense 27.51 1,386.51 06/08/2007 521 cash spending money expense 50.00 1,336.51 06/08/2007 522 Circuit City DVD's EXPENSE 22.24 1,314.27 06/11/2007 523 Medco Health medication medicine expen... 40.00 1,274.27 06/12/2007 524 K-mart clothes/magazine expense 15.61 1,258.66 06/12/2007 525 Circuit City CD's EXPENSE 14.83 1,243.83 06/15/2007 526 Walmart clothes/SHOES expense 57.35 1,186.48 06/22/2007 527 Comcast cable sports channel expense 44.87 1,141.61 06/26/2007 528 Value City pillow expense 8.34 1,133.27 06/29/2007 529 BJ's throw blanket expense 26.49 1,106.78 06/30/2007 530 cash spending money expense 50.00 1,056.78 07/01/2007 dep direct deposit SSI income deposit 623.00 1,679.78 07/01/2007 dep direct deposit SSP income deposit 27.40 1,707.18 07/01/2007 531 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,332.18 07/06/2007 532 Bleacher Bum's clothe/mug expense 72.38 1,259.80 07/06/2007 533 FYE CD's expense 10.59 1,249.21 07/06/2007 534 Sear's clothes expense 76.87 1,172.34 07/07/2007 535 Suncoast box set expense 52.99 1,119.35 07/07/2007 536 Sear's bedding expense 42.39 1,076.96 07/09/2007 537 cash vacation expense 500.00 576.96 07/16/2007 dep reimbursement from i... Ins. reimbursement Deposit 40.00 616.96 07/23/2007 538 Comcast cable sports channel expense 44.87 572.09 08/0112007 dep direct deposit SST income deposit 623.00 1,195.09 08/01/2007 811/07 direct deposit SSP income deposit 27.40 1,222.49 08/01/2007 539 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 847.49 08/01/2007 540 Kilmore Eye AssocI pymt for glasses expense 30.00 817.49 08/03/2007 dep direct deposit Social... income deposit 335.00 1,152.49 08/07/2007 541 Sear's clothes expense 31.47 1,121.02 08/07/2007 542 FYE DVD's expense 72.04 1,048.98 08/15/2007 543 cash spending money expense 50.00 998.98 08/16/2007 544 Ollie's gift expense 10.59 988.39 08/1712007 dep direct deposit Social ... income deposit 20.00 1,008.39 08/22/2007 545 Comcast cable sports channel expense 44.87 963.52 08/22/2007 546 Medco Health medication medicine expen... 40.00 923.52 08/28/2007 547 FYE DVD's expense 40.25 883.27 08/28/2007 548 Sear's clothes expense 28.88 854.39 Page 2 Estate of Sean Matthew Dosiak 1/19/2008 6:33 PM Register: Estate of Sean Matthew Dosiak From 01/01/2007 through 12131/2007 Sorted by: Date, Type, NumberlRef Date Number Payee Account Memo Payment C Deposit Balance 08/28/2007 549 cash spending money expense 60.00 794.39 08/31/2007 dep direct deposit SSP income deposit 27.40 821. 79 08/31/2007 dep direct deposit Social... income Deposit 335.00 1,156.79 08/31/2007 dep direct deposit SSI income deposit 623.00 1,779.79 08/31/2007 550 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,404.79 08/31/2007 551 Circuit City box set EXPENSE 26.49 1,378.30 09/07/2007 552 cash spending money expense 50.00 1,328.30 09/14/2007 553 cash spending money expense 50.00 1,278.30 09/27/2007 dep reimbursement from i... Ins. reimbursement deposit 40.00 1,318.30 10/0 1/2007 dep direct deposit SSI income deposit 308.00 1,626.30 10/01/2007 dep direct deposit SSP income deposit 27.40 1,653.70 10/01/2007 554 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,278.70 10/02/2007 555 Circuit City CD's EXPENSE 32.83 1,245.87 10/03/2007 dep direct deposit Social... income deposit 335.00 1,580.87 10/06/2007 556 cash spending money expense 50.00 1,530.87 10/07/2007 557 Walmart luggage/radio/clothes expense 180.29 1,350.58 10/07/2007 558 Kohl's shaver/clothes expense 121.26 1,229.32 10/07/2007 559 Toys R Us stereo system expense 114.98 1,1l4.34 10/08/2007 560 Radio Shack stereo system expense 105.97 1,008.37 10/12/2007 561 cash spending money expense 50.00 958.37 10/16/2007 DEP REfund from Toys R ... refund refund income 114.98 1,073.35 10/28/2007 562 K -mart shoes expense 9.00 1,064.35 10/29/2007 563 cash spending money expense 100.00 964.35 11/0 lI2007 dep direct deposit SSP income deposit 27.40 991.75 IlIO lI2007 DEP direct deposit SSI income DEPOSIT 308.00 1,299.75 Il105/2007 564 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 924.75 11105/2007 565 Medco Health medication medicine expen... 40.00 884.75 12/0ll2007 dep direct deposit SSI income deposit 308.00 1,192.75 12/01/2007 dep direct deposit SSP income deposit 27.40 1,220.15 12/0 lI2oo7 566 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 845.15 12/15/2007 567 Walmart gloves expense 4.64 840.51 12/15/2007 568 Walmart Dvd'slclothes expense 25.93 814.58 12/24/2007 569 cash spending money expense 50.00 764.58 ] 2/28/2007 570 Border's books expense 29.68 734.90 Page 3 CASH ON DATE PAYEE REASON Deposits Withdrawals HAND Balance as of 12/31/06 $1.88 1/6/07 cash spending money $ 50.00 $51.88 1/6/07 Midtown Pizza lunch $ 8.76 $ 43.12 1/8/07 Camp Hill Diner lunch $ 9.78 $ 33.34 1/13/07 cash hotdogs $ 6.00 $ 27.34 1/14/07 Jumbo's dinner $ 12.86 $ 14.48 1/16/07 cash haircut $ 10.00 $ 4.48 1/20/07 cash spending money $ 50.00 $ 54.48 1/20/07 Doc Holidays dinner $ 15.13 $ 39.35 1/26/07 Hoss's dinner $ 11.76 $ 27.59 1/28/07 cash church offering $ 2.00 $ 25.59 2/4/07 Underdog's lunch $ 10.56 $ 15.03 2/10/07 cash spending money $ 50.00 $ 65.03 2/11/07 Gingerbreadman dinner $ 14.94 $ 50.09 2/11/07 Karn's magazine $ 8.47 $ 41.62 2/18/07 Underdog's lunch $ 10.00 $ 31.62 2/17/07 Weis magazine $ 7.41 $ 24.21 2/25/07 Westgate lunch $ 7.27 $ 16.94 3/3/07 Jumbo's dinner $ 11.61 $ 5.33 3/9/07 cash spending money $ 50.00 $ 55.33 3/10/07 Hoss's lunch $ 11.87 $ 43.46 3/16/07 cash haircut $ 10.00 $ 33.46 3/18/07 Circuit City CD $ 2.11 $ 41.35 3/25/07 Underdog's lunch $ 10.00 $ 31.35 3/25/07 Dollar Store cards $ 1.59 $ 29.76 3/25/07 Dollar Store puzzle books $ 4.24 $ 25.52 3/31/06 FYE deposit for box set $ 6.00 $ 19.52 4/6/07 Giant cards/candy $ 2.11 $ 17.41 4/14/07 cash sausage $ 2.92 $ 14.49 4/15/07 cash church offering $ 5.00 $ 9.49 4/21/07 cash spending money $ 50.00 $ 59.49 4/21/07 Champions dinner $ 13.60 $ 45.89 4/28/07 cash haircut $ 10.00 $ 35.89 5/5/07 Your Place lunch $ 10.00 $ 25.89 5/7/07 Giant cards $ 1.90 $ 23.99 5/12/07 Ye Olde House lunch $ 11.20 $ 12.79 5/12/07 cash spending money $ 50.00 $ 62.79 5/14/07 cash ice cream $ 3.00 $ 59.79 5/27/07 Dollar Store pens/book $ 2.65 $ 57.14 6/2/07 Dockside Willie's lunch $ 16.01 $ 41.13 6/7/07 Bob Evans lunch $ 11.00 $ 30.13 6/8/07 cash spending money $ 50.00 $ 80.13 6/10/07 Kokoma's lunch $ 12.00 $ 68.13 6/14/07 Hoss's dinner $ 12.42 $ 55.71 6/14/07 cash haircut $ 10.00 $ 45.71 6/15/07 Burger King lunch $ 4.24 $ 41.47 6/16/07 cash snack $ 2.92 $ 38.55 6/21/07 Giant magazine $ 1.86 $ 36.69 6/22/07 McDonald's lunch $ 1.90 $ 34.79 6/26/07 Big Lots ice cream $ 2.00 $ 32.79 6/26/07 Genovas lunch $ 10.52 $ 22.27 6/29/07 Burger King lunch $ 3.18 $ 19.09 6/29/07 Ollie's puzzle books $ 1.59 $ 17.50 6/30/07 cash spending money $ 50.00 $ 67.50 7/6/07 Bruster's ice cream $ 1.87 $ 65.63 717/07 McDonald's dinner $ 3.70 $ 61.93 7/8/07 McDonald's milk shake $ 2.83 $ 59.10 7/8/07 Subway lunch $ 5.44 $ 53.66 7/7/07 Bleacher Bums difference on exchange $ 4.00 $ 49.66 7/9/07 cash vacation $ 500.00 $ 549.66 7/10/07 Delaware Park ice cream $ 3.00 $ 546.66 7/14/07 cash total vacation $ 347.06 $ 199.60 7/17/07 Giant magazine/DVD $ 11.80 $ 187.80 7/19/07 Wal-Mart curtain valances/DVD $ 58.47 $ 129.33 7/22/07 McDonald's shake $ 2.53 $ 126.80 7/23/07 McDonald's shake $ 2.53 $ 124.27 7/23/07 Underdog's lunch $ 8.32 $ 115.95 7/23/07 Wal-Mart curtain tiers $ 23.66 $ 92.29 7/24/07 cash haircut $ 10.00 $ 82.29 7/25/07 McDonald's shake $ 2.85 $ 79.44 7/28/07 McDonald's shake $ 2.85 $ 76.59 7/28/07 The Boro lunch $ 12.00 $ 64.59 7/29/07 Burger King lunch $ 4.76 $ 59.83 7/30/07 McDonald's shake $ 2.85 $ 56.98 8/1/07 McDonald's shake $ 2.85 $ 54.13 8/1/07 Weis magazine $ 3.17 $ 50.96 8/3/07 Circuit City cd $ 21.19 $ 29.77 8/3/07 McDonald's lunch $ 2.12 $ 27.65 817/07 McDonald's lunch $ 2.75 $ 24.90 8/9/07 Maggie's shake $ 3.50 $ 21.40 8/11/07 Subway lunch $ 7.29 $ 14.11 8/11/07 Ollie's book $ 10.59 $ 3.52 8/15/07 cash spending money $ 50.00 $ 53.52 8/15/07 Giant magazine $ 2.86 $ 50.66 8/17/07 Wendy's frosty $ 2.00 $ 48.66 8/20/07 McDonald's breakfast $ 3.67 $ 44.99 8/20/07 Wendy's frosty $ 2.00 $ 42.99 8/24/07 Giant dinner $ 4.19 $ 38.80 8/26/07 McDonald's lunch $ 5.29 $ 33.51 8/26/07 Underdog's dinner $ 9.00 $ 24.51 8/28/07 cash spending money $ 60.00 $ 84.51 8/30/07 Mets/phillie game game/food/beverages $ 45.00 $ 39.51 8/30/07 Underdog's dinner $ 13.25 $ 26.26 9/1/07 Brother's Pizza dinner $ 7.53 $ 18.73 9/2/07 Kapona food/beverages $ 16.00 $ 2.73 9/7/07 cash spending money $ 50.00 $ 52.73 9/9/07 McDonald's shake $ 3.14 $ 49.59 9/9/07 Eastend cheeseburger $ 5.75 $ 43.84 9/9/07 Mountain View Dine dinner $ 18.85 $ 24.99 9/14/07 cash haircut $ 10.00 $ 14.99 9/14/07 cash spending money $ 50.00 $ 64.99 9/15/07 cash gift $ 20.00 $ 44.99 9/16/07 cash church offering $ 2.00 $ 42.99 9/21/07 Wendy's frosty $ 2.00 $ 40.99 9/22/07 Burger King lunch $ 2.12 $ 38.87 9/29/07 cash hotdogs $ 3.00 $ 35.87 10/4/07 McDonald's shake $ 2.85 $ 33.02 10/6/07 Midtown Pizza lunch $ 6.02 $ 27.00 10/6/07 cash spending money $ 50.00 $ 77.00 10/7/07 Pete's lunch $ 11.88 $ 65.12 10/8/07 Value City candy $ 2.51 $ 62.61 10/8/07 Thirsty's lunch $ 6.37 $ 56.24 10/12/07 McDonald's milk shake $ 2.85 $ 53.39 10/12/07 cash spending money $ 50.00 $ 103.39 10/13/07 Brookhaven Hosp snack $ 2.00 $ 101.39 10/13/07 Brookhaven Hosp lunch $ 5.15 $ 96.24 10/13/07 Charlie Brown's dinner $ 25.00 $ 71.24 10/19/07 Wendy's frosty $ 2.00 $ 69.24 10/21/07 Wal-Mart CD/mag $ 23.11 $ 46.13 10/27/07 Underdog's lunch $ 10.00 $ 36.13 1027/07 Giant salad $ 4.71 $ 31.42 10/29/07 Subway lunch $ 5.29 $ 26.13 10/29/07 cash spending money $ 100.00 $ 126.13 11/3/07 Wendy's frosty $ 2.00 $ 124.13 11/17/07 cash haircut $ 10.00 $ 114.13 11/17/07 Circuit City DVD $ 20.13 $ 94.00 11/17/07 Duke's lunch $ 15.00 $ 79.00 11/25/07 cash movies $ 13.25 $ 65.75 12/1/07 Dollar Store books/cards $ 5.30 $ 60.45 12/1/07 Ted Bar & Grill lunch $ 10.00 $ 50.45 12/1/07 Ollie's books $ 2.95 $ 47.50 12/15/07 paxtang Grill lunch $ 13.00 $ 34.50 12/16/07 Hoss's dinner $ 15.55 $ 18.95 12/21/07 Wal-Mart breakfast $ 4.23 $ 14.72 12/24/07 cash spending money $ 50.00 $ 64.72 12/24/07 cash gifts $ 40.00 $ 24.72 12/24/07 cash church offering $ 5.00 $ 19.72 12/26/07 Subway lunch $ 4.32 $ 15.40 12/29/07 Genovas lunch $ 7.00 $ 8.40 Sean Matthew Dosiak Trust 1/19/20086:54 PM Register: Sean Matthew Dosiak Trust From 01/01/2007 through 12/31/2007 Sorted by: Date, Type, Number/Ref Date Number Payee Account Memo Payment C Deposit Balance -- 01/20/2007 1032 Register of Wills filing fee expense 15.00 3,494.67 01/25/2007 dep CD Interest Trust interest 35.42 3,530.09 01/26/2007 1033 Sharon Dosiak preparation court report expense 250.00 3,280.09 02/23/2007 dep CD Interest Trust interest 35.42 3,315.51 03/19/2007 1034 Stiteler & Associates... tax preparation tax preparation 30.00 3,285.51 03/23/2007 dep CD Interest Trust interest 31.99 3,317.50 03/23/2007 1035 Pa Dept.Revenue taxes taxes 15.00 3,302.50 03/24/2007 1036 US Postal Service Postage and Delivery postage 9.52 3,292.98 04/25/2007 dep CD Interest Trust interest 35.42 3,328.40 OS/25/2007 dep CD Interest Trust interest 34.27 3,362.67 06/22/2007 dep CD Interest Trust Interest 33.14 3,395.81 07/23/2007 dep CD Interest Trust Interest 34.27 3,430.08 08/31/2007 dep CD Interest Trust Interest 35.42 3,465.50 08/31/2007 1037 Circuit City ink for printer expense 79.45 3,386.05 09/21/2007 dep CD Interest Trust Interest 35.42 3,421.47 10/09/2007 1038 cash262 death in fa... 262death in family/338... expense 600.00 2,821.47 10/11/2007 dep Equitrust Life I Prem... Trust ~ interest 1,845.00 4,666.47 10/23/2007 dep CD Interest Trust interest 34.28 4,700.75 11/23/2007 dep CD Interest Trust interest 35.42 4,736.17 12/21/2007 dep CD Interest Trust interest 34.27 4,770.44 Page I Sean Matthew Dosiak Certificate of Deposit 1/1/01-12/31/07 12/31/01 Mellon Trust CD 10.000.74 is now Citizen's Bank transferred funds to Citizen's Bank on 6/20/02 Balance 10,000.74 TRANSFER OF SEAN MA TIHEW DOSIAK TRUST FUNDS TRANSFERRED ANNUITY WITH F & G LIFE $58,264.34 19,087.55 INTEREST $77,351.89 TOTAL TRANSFER 10/05/06 TRANSFERED TO AN ANNUITY ACCOUNT WITH EQUlTRUST. Accumulated value Interest earned 10/09-06-10/9/07 withdrawals Balance 78556.44 77,351.89 3,723.49 2518.94 transferred to Citizen's trust checking TRANSFERRED $6,500.00 FROM MELLON CHECKING TO A MONEY MARKEY ACCOUNT WITH AMERICAN FUNDS ON 8/16/01. TOTAL OF MONEY MARKET $7612.62 We certifY that the above is an accurate report of the income and expenses of the guardian account. The needs of the incapacitated person as set forth above, included expenses for Sean, including trips, vacations, and recreations. Sean resides at 100 N. Second Street, Mechanicsburg PA 17055 with his mother and father. He continues to take Dilantin medication to control his seizures. Sean still goes to Dr. James. He has a Dilantin level test and liver test every six months. His dentist is Dr. Paul Williams. He sees him every six months. His eye doctor is Dr. Kilmore, he got new glasses this year. We take him to dinner or lunch on the weekends and shopping. Sean went to the shore this summer with us. He spends time with his sister and family. He goes to church with his sister. He does different activities with his sister and nephew. He went to his nephew's soccer games. He enjoys TV, word fine puzzles, listening to music, and watching his movies. Sean's grandfather passed away the end of October, we had to go to Long Island for a week to make arrangements and the funeral. Sean is with his parents during the day. I feel the guardianship should be continued. The reason being, Sean is mentally deficient from birth due to malpractice of a physician and cannot manage his affairs, make medical decisions, or take care of himself. We feel as Sean's parents that we have an understanding for Sean and his needs. '"'. j/~ /L ~ William R. Dosiak 100 N. Second Street Mechanicsburg P A 17055 ~~ Sharon Dosiak 100 N. Second Street Mechanicsburg P A 17055 Distribution: Clerk of Orphan's Court COMMONWEALTH OF PENNSYLVANIA SS COURT OF COMMON PLEAS On this, the day of , before me, a notary public in and for the County of Cumberland, Commonwealth of Pennsylvania, the undersigned officer, personally appeared William R. Dosiak and Sharon Dosiak, known to me (of satisfactory proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for purposes therein contained. IN WITNESS WHEREOF, I HEREUNTO SET MY HAND AND OFFICIAL SEAL. Notary Public ~(A1tf COMMONWEALTH OF PENNSYL V/V'~IA Notarial Seal Benjamin DeBell, Notary Public East Hempfield TVvp., :"'ancaster County My Commission Expires March 22, 2011 Member. Pennsylvania Association of ~,:~_~;;~ IN RE: GUARDIANSHIP OF SEAN MATTHEW DOSIAK TO: Clerk of Orphan's Court Courthouse. Carlisle PA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT N0.21-94-393 ANNUAL REPORT OF GUARDIANSHIP OF SEAN MATTHEW DOSIAK Estate: Sean Matthew Dosiak Guardian: William R. Dosiak and Sharon Dosiak Period: January 1, 2008- December 31, 2008 Date Filed: This is a report filed with the Court in compliance with Section 5521 (c) of Act 24 of July, 1992, 20 PaCSA 5521. h,> s.J _-~ '1 ~f -, rW~ ~Z ` V • _t~ . ~./ 4 ~ _.. ~~ J t '.~ 1 -. .= - ~~ _~ ~: __ ~ it O ll , yp V I Estate of Sean Matthew Dosiak vt4/2o~9 7:t7 PM Register: Fstate of Sean Matthew Dosiak From O 1 /01 /2008 through 12/31 /2008 Sorted by: Date, Type, Number/Ref Date Number Payee Account Memo Payment C Deposit Balance __ _ -- 0110112008 dep direct deposit SSI income deposit 637.00 1,29690 01/01/2008 dep direct deposit SSP income deposit 27.40 1,324.30 01/01/2008 571 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 949.30 01/03/2008 dep direct deposit Social ... income Deposit 7.00 956.30 01/12/2008 dep reimbursement from i... Ins. reimbursement deposit 40.00 996.30 01/12/2008 572 cash spending money expense 50.00 946.30 01/22/2008 dep direct deposit Social ... income deposit 155.00 1,101.30 02/01/2008 dep direct deposit SSP income deposit 27.40 1,128.70 02/01/2008 dep direct deposit SSI income deposit 637.00 1,765.70 02!01/2008 573 Wm. R. & Shazon D... Sean's FS for F&S expense 375.00 1,390.70 02/02/2008 574 cash spending money expense 50.00 1,340.70 02/09/2008 575 Medco Health medication medicine expen... 40.00 1,300.70 02/09/2008 576 cash spending money expense 50.00 1,250.70 02/14/2008 fee check printing fee bank charge/check prin... expense 20.00 1,230.70 02/18/2008 577 Circuit City DVD's EXPENSE 39.20 1,191.50 02/18/2008 578 K-mart personal items expense 16.48 1,175.02 02/23/2008 579 cash spending money expense 50.00 1,125.02 02/28/2008 580 New York Mets yearbook expense 14.00 ],1 11.02 02/29!2008 dep direct deposit SSP income deposit 27.40 1, ] 38.42 02(29/2008 dep direct deposit SSI income deposit 637.00 1,775.42 02/29/2008 581 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,400.42 03/10/2008 582 Billie Jo Snyder reimbursement for Elvi... expense 15.00 1,385.42 03!15/2008 583 cash spending money expense 50.00 1,335.42 03/15/2008 584 FYF, DVD's expense 39.21 1,296.21 03/15/2008 585 Seaz's clothes expense 112.93 1,183.28 03/26/2008 dep reimbursement from i... Ins. reimbursement Deposit 40.00 1,223.28 04/01/2008 dep direct deposit SSP income deposit 27.40 1,250.68 04/01/2008 dep direct deposit SSI income deposit 573.30 1,823.98 04/01/2008 586 best Buy box set expense 31.79 1,792.19 04/01/2008 587 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,417.19 04/19/2008 588 cash spending money expense 75.00 1,342.19 04/21/2008 589 Medco Health medication medicine expen... 40.00 1,302.19 04/24(2008 590 Comcast cable sports channel expense 40.00 1,262. i9 04/24/2008 591 Sear's clothes expense 108.95 1,153.24 04!26/2008 592 VOID clothes VOID: expense X 1.153.24 04/26/2008 593 cash spending money expense 75.00 1.078.24 04/27/2008 594 K-mart clothes/SHOES expense 100.04 978.20 04/29/2008 595 Billie Jo Snyder reimbursement forBeatl... expense 40.00 938.20 OS/O1 /2008 dep direct deposit SSP income Deposit 27.40 965.60 05/01/2008 dep direct deposit SSI income deposit 573.30 1,538.90 Page 1 Estate of Sean Matthew Dosiak 1/14(2009 7:17 PM Register: Estate of Sean Matthew Dosiak From O l /01 /2008 through 12/31 /2008 Sorted by: Date, "type, NumberlRef Date Number Payee Account Memo Payment C Deposit Balance 05/01/2008 596 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,163.90 05/03/2008 direct deposit Social ... income deposit 342.00 1,505.90 05/06/2008 597 FYE DVD's expense 84.77 1,421.13 05/06/2008 598 Toys R Us guitar expense 67.82 1,353.31 05/18/2008 599 K-mart clothes/SHOES expense 68.06 1,285.25 05/27/2008 600 Comcast cable sports channel expense 40.00 1,245.25 05/28/2008 dep reimbursement from i... Ins. reimbursement deposit 40.00 1,285.25 05/28/2008 601. cash spending money expense 75.00 1,210.25 06/01(2008 dep direct deposit SSI income deposit 573.30 1,783.55 06/01/2008 dep direct deposit SSP income deposit 27.40 1,810.95 06/01/2008 602 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,435.95 06/03/2008 dep direct deposit Social ... income income 342.00 1,777.95 06/13/2008 603 K-mart personal items expense 68.26 1,709.69 06/13/2008 604 best Buy DVD's expense 74.18 1,635.51 06/21/2008 605 Walmart bedding/misc expense 213.49 1,422.02 06!24/2008 606 Denise Getgen reimbursement Springs... expense 114.78 1,307.24 06/25/2008 607 Comcast cable sports channel expense 40.00 1,267.24 07/01/2008 dep direct deposit SSf income deposit 251.30 1,518.54 07/01/2008 dep direct deposit SSP income deposit 27.40 1,545.94 07/01/2008 608 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,170.94 07/03/2008 dep direct deposit Social ... income deposit 342.00 1,512.94 07!08/2008 610 best Buy DVD's expense 47.68 1,465.26 07/15/2008 611 Comcast cable sports channel expense 40.00 1,425.26 07!21/2008 612 Medco Health medication medicine expen... 40.00 1,385.26 07/24/2008 613 Billie Jo Snyder shirt expense 135.86 1,249.40 07!26/2008 614 cash vacation expense 200.00 1,049.40 08(01/2008 dep direct deposit SSI income deposit 251.30 1,300.70 08/01/2008 dep direct deposit SSP income deposit 27.40 1,328.10 08/01/2008 dep direct deposit Social ... income deposit 342.00 1,670.10 08/01/2008 615 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,295.10 08/04/2008 616 Kilmore Eye Assoc! pymt for glasses expense 55.00 1,240.10 08;12/2008 617 Toys R Us DVD's expense 21.19 1,218.91 08!22/2008 618 Walmart CD's expense 31.38 1,187.53 08/29!2008 dep direct deposit SSI income deposit 251.30 1,438.83 08/29/2008 dep direct deposit SSP income deposit 27.40 1,466.23 08/29/2008 619 cash spending money expense 75.00 1,391.23 08/29/2008 620 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,016.23 09/03/2008 dep direct deposit Social ... income deposit 342.00 1,358.23 09/05/2008 621 Border's DVD's expense 26.49 1,331.74 09/20/2008 622 cash spending money expense 75.00 1,256.74 Page 2 Estate of Sean Matthew Dosiak 1(14/2009 7:17 PM Register: Estate of Sean Matthew Dosiak From O l /0l /2008 through 12/31/2008 Sorted by: Date, Type, Number/Ref Date Number Payee Account Memo Payment C Deposit Balance 09(20(2008 623 K-mart DVD player/cd expense 69.94 1,186.80 10/01/2008 dep direct deposit SSI income deposit 251.30 1,438.10 10!01/2008 dep direct deposit SSP income deposit 27.40 1,465.50 10/01/2008 624 Wm_ R. & Sharon D... Sun's FS for F&S expense 375.00 1,090.50 10/03/2008 dep direct deposit Social ... income deposit 342.00 1,432.50 10/I 1/2008 dep reimbursement Ins. Co. Ins. reimbursement Deposit 40.00 1,472.50 10!11/2008 625 cash spending money expense 75.00 1,397.50 ]0/18/2008 626 cash spending money expense 75.00 1,322.50 10/20/2008 627 Medco Health medication medicine expen... 40.00 1,282.50 10/25/2008 628 K-mart clothes expense 76.97 1,205.53 10/28/2008 629 best Buy remote/DVD expense 42.38 1,163.15 11/01/2008 dep direct deposit SSP income deposit 27.40 1,190.55 11/01/2008 dep direct deposit SSI income deposit 251.30 1,441.85 I U01 /2008 630 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,066.85 11/03/2008 dep direct deposit Social ... income deposit 342.00 1,408.85 11/14/2008 631 Border's DVD's expense 50.03 1,358.82 11/18(2008 632 XM Statellite radio expense 142.45 1,216.37 11/22/2008 633 cash spending money expense 75.00 1,141.37 11/29!2008 dep reimbursement Ins. Co. Ins. reimbursement deposit 40.00 1,181.37 12/Ol/200~8 dep direct deposit SSI income deposit 251.30 1,432.67 12/01/2008 dep direct deposit SSP income deposit 27.40 1,460.07 12/01/2008 634 Wm. R. & Sharon D... Sean's FS for F&S expense 375.00 1,085.07 12/03/2008 dep direct deposit Social ... income deposit 349.00 1,434.07 12/13/2008 635 cash spending money expense 100.00 1,334.07 12/13/2008 636 K-mart clothes expense 38.23 1,295.84 12!27(2008 637 FYE DVD's expense 29.53 1,266.31 Page 3 CASH ON DATE PAYEE REASON Balance as of 12/3107 1/5/08 McDonald's shake 1 /8/08 Weis gold bond-medicated cream 1/12/08 cash spending money 1/16/08 cash haircut 1!20/08 Duke's lunch 1 /26/08 Panera Bread breakfast 1 /26/08 Ted's lunch 2/2/08 cash hot dog 2/2/08 cash spending money 2/3/08 East Side Lounge lunch 2/5/08 Giant magazine 2/7/08 Giant DVD 2/9/08 Paxtang Grill lunch 2/9/08 cash spending money 2/9/08 Cremo's Dart board 2/9/08 Walmart magazine 2/10/08 McDonald's shake 2/12/08 cash ice cream 2/16/08 Weis magazine 2/17/08 Ollie's book 2/17/08 Duke's lunch 2/17/08 cash ordered G. Hawk candy 2/20/08 McDonald's shake Z/23/08 cash spending money 2/23/07 McDonald's lunch 2/24/08 Jumbo Buffet lunch 3/1/08 McDonald's shake 3/14/08 McDonald's shake 3/14/08 Giant Newspaper 3/15/08 cash spending money 3/15!08 cash haircut 3/21/08 Cremo's gift 3/21/08 Dollar Tree cards/puzzle book 3/23/08 cash church offering 3!25/08 McDonald's shake 3/29/08 Genovas dinner 3/29/08 Panera Bread breakfast 4/4/08 McDonald's shake 4/5/08 Underdog's lunch 4/7/08 Giant book/candy 4/8/08 McDonald's shake 4/15/08 Duke's dinner 4/19!08 cash spending money 4/21/08 Wendy's breakfast 4/24/08 McDonald's lunch 4/25/08 Siddoto's dinner 4/25/08 cash haircut 4/26/08 Bleacher Bums clothes Deposits Withdrawals $ 2.75 $ 3.45 $50.00 $ 10.00 $ 14.60 $ 3.27 $ 9.90 $ 3.00 $50.00 $ 15.00 $ 6.67 $ 21.19 $ 14.15 $ 50.00 $ 50.00 $ 50.00 $ 75.00 4.23 6.67 2.85 3.13 2.95 10.59 11.48 7.00 2.85 2.12 12.70 2.95 2.95 1.00 10.00 4.23 2.12 4.00 2.95 20.00 4.75 2.95 10.00 5.62 2.95 10.00 3.14 4.01 6.24 10.00 44.80 HAND $ 8.40 $ 5.65 $ 2.20 $ 52.20 $ 42.20 $ 27.60 $ 24.33 $ 14.43 $ 11.43 $ 61.43 $ 46.43 $ 39.76 $ 18.57 $ 4.42 $ 54.42 $ 50.19 $ 43.52 $ 40.67 $ 37.54 $ 34.59 $ 24.00 $ 12.52 $ 5.52 $ 2.67 $52.67 $ 50.55 $ 37.85 $ 34.90 $ 31.95 $ 30.95 $ 80.95 $ 70.95 $ 66.72 $ 64.60 $ 60.60 $ 57.65 $ 37.65 $ 32.90 $ 29.95 $ 19.95 $ 14.33 $ 11.38 $ 1.38 $ 76.38 $ 73.24 $ 69,23 $ 62.99 $ 52.99 $ 8.19 4126/08 cash spending money $ 75.00 $ 83.19 4/27/08 McDonald's lunch $ 4.55 $ 78.64 4/30/08 McDonald's shake $ 2.95 $ 75.69 5/2/08 Giant card $ 1.89 $ 73.80 5/4/08 Gingerbreadman lunch $ 10.75 $ 63.05 5/14/08 Giant magazine/sm salad $ 7.83 $ 55.22 5/16/08 Hoss's lunch $ 10.00 $ 45.22 5117/081saac's dinner $ 9.52 $ 35.70 5118/08 Duke's lunch $ 13.94 $ 21.96 5/28/08 McDonald's shake $ 2.95 $ 18.81 5/28/08 cash spending money $ 75.00 $ 93.81 5/29/08 Holy Spirit Hosp.Caf~ lunch $ 7.87 $ 85.94 6/10/08 McDonald's shake $ 3.06 $ 82.88 6/11108 cash Italian Ice $ 2.00 3 80.88 6/13/08 cash haircut $ 10.00 $ 70.88 6/13/08 Wendy's frosty $ 2.11 $ 68.77 6/14/08 McDonald's lunch $ 6.43 $ 62.34 6/15/08 Walmart soda $ 1.47 $ 60.87 6/21/08 Duke's lunch $ 11.00 $ 49.87 6/23/08 Funcks Exxon sandwich/drink $ 6.97 $ 42.90 6/26/08 Weis magazine $ 12.71 $ 30.19 6/27/08 McDonald's shake $ 3.06 $ 27.13 7/3/08 McDonald's shake $ 3.06 $ 24.07 7/4/08 Subway lunch $ 5.30 $ 18.77 7/5/08 McDonald's lunch $ 3.69 ~ 15.08 7/5/08 Ollie's Puzzle books $ 628 $ 8.80 7/7/08 cash hot dogs $ 5.40 $ 3.40 7/7/08 cash spending money $ 75.00 $ 78.40 7/12/08 Ye Olde Ale House lunch $ 16.00 $ 62.40 7/16/08 Giant magazine $ 3.81 $ 58.59 7/16/08 Maggies Italian Ice $ 1.90 $ 56.69 7/17/08 McDonald's shake $ 3.06 $ 53.63 7/21 /08 McDonald's shake $ 3.06 $ 50.57 7/23/08 cash haircut $ 10.00 $ 40.57 7/25/08 McDonald's shake $ 3.06 $ 37.51 7/26/08 cash vacation $ 200.00 $ 237.51 7/28/08 cash total used for vacation $ 125.85 $ 111.66 7130/08 Giant salad bar (mushrooms) $ 6.36 $ 105.30 8/2/08 Ye Olde Ale House lunch $ 13.00 $ 92.30 8/3/08 Giant lunch $ 4.19 $ 88.11 8/10/08 Hollywood dinner $ 8.59 $ 79.52 8//8/08 Weis magazine/golf set $ 6.87 $ 72.65 8/13!08 Bob Evans lunch $ 13.00 $ 59.65 8/19/08 cash money for concert $ 20.00 $ 39.65 8122/08 McDonald's shake $ 3.06 $ 36.59 8/23/08 Hoss's lunch $ 17.34 $ 19.25 8/24/08 Colonial Diner dinner $ 11.06 $ 8.19 8/26/08 McDonald's shake $ 3.06 $ 5.13 8/29/08 cash spending money $ 75.00 $ 80.13 8/29/08 cash haircut $ 10.00 $ 70.13 8!30/08 Burger King whopper,coke,fries $ 4.00 $ 66.13 9/2108 Ye Olde Ale House lunch $ 16.00 $ 50.13 9/7/08 Hoss's dinner 9/13/08 Duke's lunch 9/20/08 Dollar Tree misc 9/20108 cash spending money 9/15/08 cash gift (Rod Birthday) 10/3/08 Genovas dinner 10/4/08 Value City snacks 10/5/08 Gilligan's dinner 10!6/06 Giant card 10111/08 Glitterati's dinner 10/11/08 cash spending money 10112/08 cash gift (Billie Jo birthday 10/13/08 cash haircut 10/17/08 Target CD 10/17/08 Hoss's lunch 10/18/08 cash spending money 10/18/08 Ted's dinner 10!19108 McDonald's lunch 10/24/08 McDonald's shake 10/25/08 Mechanicsburg Di ner dinner 10/28/08 Pizzatown dinner 11/8/08 Ted's dinner 11/9/08 Applebee's dinner 11/10/08 Giant magazine's 11/16/08 Jumbo Buffet dinner 11/21/08 McDonald's shake 11/22/08 cash spending money 11/22/08 Burger King lunch 11 /25/08 cash 12/6/08 McDonald's lunch 12/9/08 Hoss's dinner 12/11/08 McDonald's shake 12/13/08 Toys R Us game 12/13/08 Bleacher Bums cup/ornament 12/13/08 cash spending money 12/13/08 Arooga's dinner 12/19/08 Giant lunch 12/20/08 Eagle Hotel ice tea 12/20/08 Friendly's dinner 12/23!08 Giant magazine 12/24/08 cash church offering 12/25/08 cash Christmas gifts 12/26/08 Subway dinner $ 10.00 $ 40.13 $ 15.00 $ 25.13 $ 2.59 $ 22.54 $ 75.00 $ 97.54 $ 20.00 $ 77.54 $ 21.43 $ 56.11 $ 3.73 $ 52.38 $ 15.20 $ 37.18 $ 2.57 $ 34.61 $ 15.26 $ 19.35 $ 75.00 $ 94.35 $ 25.00 $ 69.35 $ 10.00 $ 59.35 $ 21.19 $ 38.16 $ 19.00 $ 19.16 $ 75.00 $ 94.16 $ 11.40 $ 82.76 $ 5.17 $ 77.59 $ 3.06 $ 74.53 $ 11.45 $ 63.08 $ 5.30 $ 57.78 $ 14.14 $ 43.64 $ 17.34 $ 26.30 $ 5.66 $ 20.64 $ 13.92 $ 6.72 $ 3.06 $ 3.66 $ 75.00 $ 78.66 $ 5.06 $ 73.60 $ 10.00 $ 63.60 $ 3.89 $ 59.71 $ 15.22 $ 44.49 $ 3.06 $ 41.43 $ 16.95 $ 24.48 $ 14.84 $ 9.64 $ 100.00 $ 109.64 $ 14.00 $ 95.64 $ 4.19 $ 91.45 $ 2.11 $ 89.34 $ 13.96 $ 75.38 $ 11.44 $ 63.94 $ 5.00 $ 58.94 $ 40.00 $ 18.94 $ 6.76 $ 12.18 $ 12.18 $ 12.18 $ 12.18 $ 12.18 $ 12.18 $ 12.18 $ 12.18 $ 12.18 $ 12.18 Sean Matthew Dosiak Trust 1 / (4!2009 7:21 PM Register: Sean Matthew Dosiak Trust From O1/O1/2008 through 12/31/2008 Sorted by: Date, Type, Number/Ref Date Number Payee Account Memo Payment C Deposit Balance 01/21/2008 1039 Register of Wi(is filing fee expense 15.00 4,755.44 OU23/2008 dep CD Interest Trust interest 35.35 4,790.79 01!26/2008 1040 Sharon Dosiak preparation court report expense 300.00 4,490.79 02/22(2008 dep CD Interest Trust interest 35.33 4,526.1.2 03/20/2008 1041 Stiteler & Associates ... tax preparation tax preparation 30.00 4,496.12 03(20/2008 1042 United States Treasury taxes taxes 91.00 4,405.12 03/20/2008 1043 Pa. Dept.Revenue taxes taxes 23A0 4,382.12 03/21/2008 dep CD Interest Trust interest 33.04 4,415.16 03/21/2008 1044 US Postal Service Postage and Delivery postage 10.59 4,404.57 03/31/2008 1045 United States Treasury taxes taxes 40.00 4,364.57 04/01/2008 1046 US Postal Service Postage and Delivery postage 5.21 4,359.36 04!23(2008 dep CD Interest Trust interest 35.32 4,394.68 05!18/2008 1047 Ashley Furniture Armoire,dresser,nightst... expense 715.30 3,679.38 OS/21f2008 dep CD Interest Trust interest 17.11 3,696.49 06/13/2008 1048 United States Treasury taxes taxes 40.00 3,656.49 06/13/2008 1049 US Postal Service Postage and Delivery postage 5.32 3,65].17 06/20/2008 dep CD Interest Trust interest 18.94 3,670.11 07/21/2008 dep CD Interest Trust interest 18.33 3,688.44 08/21/2008 dep CD Interest Trust interest ]8.94 3,707.38 09/12/2008 1050 United States Treasury taxes taxes 40.00 3,667.38 09/12/2008 1051 US Postal Service Postage and Delivery postage 5.32 3,662.06 09/19/2008 dep CD Interest Trust interest 18.94 3,681.00 10/14/2008 dep Equitrust Life I Prem... Trust interest 1,845.00 5,526.00 10/21/2008 dep CD Interest Trust interest 18.33 5,544.33 11/21/2008 dep CD [merest Trust interest 18.95 5,563.28 11/27/200,8 1052 Billie Jo Snyder reimbusement for com... expense 25.00 5,538.28 11/30/200$ 1053 Billie Jo Snyder reimbusement for com... expense 95.38 5,442.90 12/19/2008 dep CD Interest Trust interest 18.33 5,461.23 Page 1 Sean Matthew Dosiak Certificate of Deposit 1/1101-12/31/08 12/31/01 Mellon Trust CD 10,000.74 is now Citizen's Bank transferred funds to Citizen's Bank on 6/20/02 Balance 10,000.74 TRANSFER OF SEAN MATTHEW DOSIAK TRUST FUNDS TRANSFER' ED ANNUITY WITH F & G LIFE $58,264.34 19,087.55 INTEREST $?7,351.89 TOTAL TRANSFER. 1Of05/06 TRANSFERED TO AN ANNUITY ACCOUNT WITH EQUITRUST. Balance $82,162.15 TRANSFERRED $6,500.00 FROM MELLON CHECKING TO A MONEY MARKEY ACCOUNT WITH AMERICAN FUNDS ON 8f16/O1. TOTAL OF MONEY MARKET $7,761.33 PETTY CASH Cash left from funeral $338.00 ~ _, o - ~~, Billy Joel Concert - 222.90 ~~ Money spent at concert - 33.85 ~ _ ~ ~~ ~ $Money at Bruce Springteen concert - 81.00 Total - 337.75 Balance of petty cash .25 We certify that the above is an accurate report of the income and expenses of the guardian account. The needs of the incapacitated person as set forth above, included expenses for Sean, including trips, vacations, and recreations. Sean resides at 100 N. Second Street, Mechanicsburg PA 17055 with his mother and father. He continues to take Dilantin medication to control his seizures. Sean still goes to Dr. James. He had his physical this year. He has a Dilantin level test and liver test every six months. His dentist is Dr. Paut Williams. He sees him every six months. His eye doctor is Dr. Kilmore, he got new glasses this year. We take him to dinner or lunch on the weekends and shopping. Sean went to the shore this summer with us. He spends time with his sister and family. He goes to church with his sister. He does different activities with his sister and nephew. He enjoys TV, word fine puzzles, listening to music, and watching his movies. Sean went to several concerts with his sister and family this year. Sean is with his parents during the day. I feel the guardianship should be continued. The reason being, Sean is mentally deficient from birth due to malpractice of a physician and cannot manage his affairs, make medical decisions, or take care of himself. We feel as Sean's parents that we have an understanding for Sean and his needs. William R. Dosiak 100 N. Second Street Mechanicsburg PA 17055 Sharon Dosiak i 00 N. Second Street Mechanicsburg PA 17055 Distribution: Clerk of Orphan's Court COMMONWEALTH OF PENNSYLVANIA SS COURT OF COMMON PLEAS On this, the ~ S day of J~~+w h`y ~~ ~ ,before me, a notary public in and for the County of Cumberland, Commonwealth of Pennsylvania, the undersigned officer, personally appeared William R. Dosiak and Sharon Dosiak, known to me (of satisfactory proven) to be the persons whose names are subscn'bed to the within instrument, and acknowledged that they executed the same for purposes therein contained. IN WITNESS WHEREOF, I HEREUNTO SET MY HAND AND OFFICIAL SEAL. ~~y~ Notary Public /t~~ y, Ufi IN RE: GUARDIANSHIP OF SEAN MATTHEW DOSIAK IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT TO: Clerk of Orphan's Court Courthouse, Carlisle PA N0.21-94-393 ANNUAL REPORT OF GUARDIANSHIP OF SEAN MATTHEW DOSIAK Estate: Sean Matthew Dosiak Guardian: William R. Dosiak and Sharon Dosiak Period: January 1, 2009- December 31, 2009 Date Filed: This is a report filed with the Court incompliance with Section 5521 (c) of Act 24 of July, 1992, 20 PaCSA 5521. ~~ o . ~ ~ ~ _ ~ ? - - ~ ~ .. ~- - ~ , ~_:~ :~ O ~ ~ C ,7 i_7 h" - _i ", i. J ~ .1 ~ _~ ~ ~~~ "~ 1 J Register: Estate of Sean Matthew Dosiak From 01/01/2009 through 12/31/2009 Sorted by: Date, Type, Number/Ref Date _ Number Payee 01/01/2009 dep 01!01/2009 dep 01/01/2009 638 01/02/2009 dep 01/02/2009 639 O l /04/2009 640 01/20/2009 641 O 1 /23/2009 642 01/26/2009 dep 01/30/2009 dep 01/30/2009 dep 01/31/2009 643 02/02/2009 dep 02/07/2009 644 02/12/2009 645 02/23/2009 dep 02/27/2009 dep 02/27/2009 dep 02/28/2009 646 02/28/2009 647 03/05/2009 648 03/07/2009 649 03/13/2009 650 03/28/2009 651 03/28/2009 652 03/28/2009 653 03/29/2009 654 03/31/2009 655 04/01/2009 dep 04/01/2009 dep 04/01 /2009 656 04/20/2009 657 04/25/2009 658 05/01!2009 dep 05/01/2009 dep 05/01/2009 dep 05/01/2009 659 05/O 1 /2009 660 05/03/2009 661 05/14/2009 dep direct deposit SSI direct deposit SSP Wm. R. & Sharon D... direct deposit Social ... cash Bon-Ton Medco Health cash direct deposit Social ... Estate of Sean Matthew Dosiak Account income income Sean's FS for F&.S income spending money mattress-box spring medication spending money income direct deposit SSP income direct deposit SSI income Wm. R. & Sharon D... Sean's FS for F&S direct deposit SSI income cash spending money Walmart CD's reimbursement fns. Co. Ins. reimbursement direct deposit SSP income direct deposit SSI income Wm. R. & Shazon D... Sean's FS for F&S cash spending money New York Mets year~ok K- GAMES Walmart SHEETS/GAMES cash spending money ~'E DVD's Seaz's clothes Sear's clothes Medco Health medication direct deposit SSI income direct deposit SSP income Wm. R. &. Sharon D... Sean's FS for F&,S Comcast cable sports channel cash spending money direct deposit SSP income direct deposit SSI income direct deposit Social ... income Wm. R. & Shazon D... Sean's FS for F&S Walmart games/dvd Ashley Furniture furniture reimbursement Ins. Co. Ins. reimbursement Page 1 Memo Deposit deposit expense deposit expense expense medicine expen.. expense deposit deposit deposit expense deposit expense expense deposit Deposit deposit expense expense expense expense expense expense expense expense expense medicine expen... deposit deposit expense expense expense deposit deposit deposit expense expense expense deposit 1/18/2010 3:26 PM Payment C Deposit 310.30 27.40 375.00 369.00 75.00 643.48 40.00 50.00 540.00 27.40 296.00 375.00 378.00 75.00 114.10 40.00 27.40 674.00 375.00 100.00 14.00 52.99 116.28 100.00 37.09 194.46 27.98 40.00 606.60 27.40 375.00 42.25 150.00 27.40 606.60 376.00 375.00 197.95 275.60 40.00 Balance 1,576.61 1,604.01 1,229.01 1,598.01 1,523.01 879.53 839.53 789.53 1,329.53 1,356.93 1,652.93 1,277.93 1,655.93 1,580.93 1,466.83 1,506.83 1,534.23 2,208.23 1,833.23 1,733.23 1,719.23 1,666.24 1,549.96 1,449.96 1,412.87 1,218.41 2,190.43 1,150.43 1,757.03 1,784.43 1,409.43 1,367.18 1,217.18 1,244.58 1,851.18 2,227.18 1,852.18 1,654.23 I ,378.63 1,418.63 Estate of Sean Matthew Dosiak Register: Estate of Sean Matthew Dosiak From 01/01/2009 through 12/31/2009 Sorted by: Date, Type, Number/Ref Date Number Payee Account 05/18/2009 dep direct deposit Social ... stimulus check Memo income Payment C 1/18/2010 3:26 PM Deposit Balance 250.00 1,668.63 Page 2 1/18/2010 Date ccount um Register Report 5/18!2009 through 12/31/2009 Description Memo ategory Clr Page 1 Amount BAUINCE S/t'7/2008 0.00 5l182009 Estate of Sea.. . Opening Bala .. [Estate of Sea... R ---- - -- - 1,668.63 5/25/2009 Estate of Sea.. . 662 Harris N Household -157.94 5/26/2009 Estate of Sea.. . 663 - Comcast Cable __ Utilities:Cable ... -42.28 6/1/2009 Estate of Sea.. . DEP SSP Other Mc _ 27.40 8/1/2009 Estate of Sea., . DEP Social Security Other Inc 96.40 6/1/2009 Estate of Sea.. . DEP SSI Other Inc x.60 6/1/2009 Estate of Sea.. . 664 Cash Fair Share -375.00 6/3/2009 Estate of Sea... DEP Social Security Other Inc 279.00 6/6/2009 Estate of Sea... 665 Cash Cash _50,00 6/112009 Estate of Sea... 666 FYE Entertainment -21.19 6/122009 Estate of Sea... 667 KMart Clothing -107.68 6/18/2009 Estate of Sea... 668 Cash Cash _100.00 6222009 Estate of Sea... 669 Comcast Cable Utilities:Cable ... -42.25 6/23/2009 Estate of Sea... 670 Borders Entertainment _55.10 7/1!2009 Estate of Sea... DEP SSP Other Inc 27.40 7/1/2009 Estate of Sea... DEP SSI Other Inc 250.60 7/12009 Estate of Sea... 671 Cash Fair Share -375.00 7/32009 - Estate of Sea... DEP Social Security _ Other Inc 376.00 782009 Estate of Sea... 672 _ Cash Cash -150.00 7/21/2009 Estate of Sea... 673 Comcast Cable Utilities:Cable ... -42.25 7/22/2009 Estate of Sea... 674. Cash Cash _150.00 7292009 Estate of Sea... 675 Kilmore Eye ... Medical -20.00 7/312009 Estate of Sea... 676 Star Mist, „61.88 7/312009 Estate of Sea... DEP SSP Other Inc 27.40 7/312009 Estate of Sea... DEP SSI Other Inc 263.20 7/31/2009 Estate of Sea... 677 Cash Fair Share -375.00 8/32009 Estate of Sea... DEP Social Security Other Inc 376.00 8!52009 Estate of Sea... B78 Cash Cash _ -500.00 8/172009 Estate of Sea... 679 Kilmore Eye A... Medical _109 00 9/12009 Estate of Sea... DEP SSI Other Inc 318.00 9/12009 Estate of Sea... DEP SSP Other lnc 27.40 9/12009 Estate of Sea... 680 Cash Fair Share -375.00 9/32009 Estate of Sea... DEP Social Security Other Inc 376.00 9/202009 Estate of Sea... 681 Wa1Mart Clothing -55.88 9242009 Estate of Sea... 682 Kilmore Eye A... Medical $8,00 9272009 ---- Estate of Sea... 683 KMart Entertainment -63.59 10l12009 Estate of Sea... DEP SSf Other Inc 318.00 10/12009 Estate of Sea... DEP SSP Other Inc 27,40 10/12009 Estate of Sea... 684 Cash Fair Share -375.00 10/3/2009 Estate of Sea... DEP Social Security Other Inc 376.00 10/132009 Estate of Sea... DEP Social Security Other Inc 37$,00 10/172009 Estate of Sea... 685 ___ Sears ___ Clothing -173.63 10/172009 Estate of Sea... 686 Void _ 0.00 10/17/2009 Estate of Sea... 687 Best Buy Entertainment -529,gg 10/302009 - Estate of Sea... DEP _ SSI Other Inc 318.00 10/30/2009 Estate of Sea... DEP SSP Other Inc 27.40 1122009 Estate of Sea... 688 Cash Fair Share -375.00 11/32009 - Estate of Sea... __ DEP Social Security Other Inc 376,00 11/142009 Estate of Sea... 689 Cash Cash _100.00 11222009 Estate of Sea... 690 WalMart Entertainment _84.13 Register Report 5/18/2009 through 12/31/2009 1/18/2010 Page 2 Date Account Num Description Memo Category Cir Amount 11/25/2009 Estate of Sea... 691 Comcast Cable Utilities:Cabie ... -29.30 11272009 Estate of Sea... 692 WalMart Entertainment -61.96 12/1/2009 Estate of Sea... DEP SSP Other Inc 27.40 12/12009 Estate of Sea... DEP SSI Other Inc 318.00 12!1/2009 Estate of Sea... 693 Cash Fair Share -375.00 12/32009 Estate of Sea... DEP Socal Security Other Inc 376.00 12/5/2009 Estate of Sea... 694 __ _ Cash __ Cash -100.00 12/172009 Estate of Sea... 695 XM Satellite R... _- Entertainment -164.24 12212009 Estate of Sea... 696 Comcast Cable lJtilities:Cable ... -29.30 12232009 Estate of Sea... __ __ 697 __ Cash Cash -100.00 12/312009 Estate of Sea... DEP _ SSI -. __ Other tnc 250.60 12/312009 Estate of Sea... DEP Social Security Other Inc 376.00 12/312009 Estate of Sea... DEP SSP Other Inc 27.40 12/312009 Estate of Sea... 698 Cash Fair Share -375.00 5H8/2009 -12131/2009 1,744.67 BAI;AN+OE ~~t3!l2009 _-- __-- TOTAL OUTFLOWS TOTAL INFLOWS 7,914.23 7,744.13T x,169.56 NET TOTAL 1,744.67 CASH ON DATE PAYEE REASON Balance as 12/31/2008 1/1/09 Lyndon City Line dinner 1/2/09 cash spending Money 1/2/09 Ruby Tuesday dinner 1/4/09 Texas Roadhouse dinner 1/11/09 Hampden Grille lunch 1/18/09 Applebee's dinner 1/23/09 cash spending Money 1/23/09 Cracker Barrel dinner 1/28/09 cash haircut 1!30/09 Giant Chinese food 1/31/09 McDonald's lunch 1131/09 Bob Evans dinner 2/5/09 Giant magazine 2/7/09 cash spending Money 2/12/09 Outback dinner 2/14109 Hershey Bears ticket/food 2/15/09 Gilligan's lunch 2/21/09 Weis medicine 2/23/09 Giant magazinelcard 2/28/09 cash spending Money 2/28/09 Subway lunch 2/28/09 Peachtree dinner 3/7/09 ICmart magazines 3/12/09 Subway lunch 3/14/09 Gilligan's dinner 3/18/09 Weis magazine 3/20/09 Giant Chinese food 3/21/09 Sheetz sub 3/23/09 cash haircut 3/26/09 McDonald's shake 3/28/09 cash spending Money 3/28/09 Bleacher Bums shirts/glass/misc 3129/09 Dollar Tree cards 4/2/09 McDonald's shake 4/5/09 cash bageUice cream 4/10109 McDonaki's fish filet/fry 4/11/09 Cracker Barrel dinner 4/11109 CVS cough medicine 4/18/09 McDonald's shake 4118/09 cash mets hat 4/25/09 cash spending Money 4/25/09 McDonald's shake 4/25/09 Subway dinner 4/29/09 McDonald's shake 5/1/09 McDonald's lunch 5/2/09 Sheetz dinner 5/6/09 Madelynas dinner 5/6/09 CVS cards Deposits Withdrawals HAND $ 12.18 $ 12.00 $ 0.18 $ 75.00 $ 75.18 $ 16.83 $ 58.35 $ 13.85 $ 44.50 $ 15.30 $ 2920 $ 11.56 $ 17.64 $ 50.00 $ 67.64 $ 11.98 $ 55.66 $ 10.00 $ 45.66 $ 4.19 $ 41.47 $ 4.54 $ 36.54 $ 12.03 $ 24.90 $ 7.63 $ 17.27 $ 75.00 $ 92.27 $ 12.82 $ 79.45 $ 20.00 $ 59.45 $ 12.00 $ 47.45 $ 2.79 $ 44.66 $ 8.56 $ 36.10 $ 100.00 $ 136.10 $ 7.10 $ 129.00 $ 18.35 $ 110.65 $ 5.20 $ 105.45 $ 5.30 $100.15 $ 20.00 $ 80.15 $ 3.70 $ 76.45 $ 4.18 $ 72.27 $ 3.17 $ 69.10 $ 10.00 $ 59.10 $ 3.06 $ 56.04 $ 100.00 $ 156.04 $ 51.84 $ 104.20 $ 1.59 $ 102.61 $ 3.06 $ 99.55 $ 8.00 $ 91.55 $ 5.49 $ 86.06 $ 13.74 $ 72.32 $ 4.49 $ 67.83 $ 3.06 $ 64.77 $ 25.99 $ 38.78 $ 150.00 $ 188.78 $ 3.06 $ 185.72 $ 5.30 $ 180.42 $ 3.06 $ 177.36 $ 3.58 $ 173.78 $ 4.98 $ 168.80 $ 5.57 $ 163.23 $ 7.09 $ 156.14 5/9/09 Wegmans magazine 5/9/09 Villa Roma lunch 5/16/09 cash hot dogs 5/20/09 cash haircut 5/21/09 McDonald's shake 5/23/09 cash hot dog 5130/09 Subway lunch 5/31109 Crossroads Cafe lunch 6/4/09 Pizzatown dinner 6/6/09 cash ticket for Orioles game 6/6/09 cash ticket/food 6/6/09 cash spending Money 6/7/09 McDonald's shake 6/11/09 McDonald's shake 6/12/09 Hoss's dinner 6/13/09 Gilligan's dinner 6/15/09 Gettysburg Museum book 6/15/09 Dollar General books 6/15/09 Tommy's Pizza lunch 6/16/09 McDonald's shake 6!18/09 cash newspaper 6/18/09 cash spending Money 6/18/09 cash food/train/Bbgame 6/20/09 cash hot dog 6/24/09 McDonald's shake 6/26/09 McDonald's lunch 6/30/09 Giant magazine 7/7/09 CVS book/candy 7/7/09 cash spending Money 7/8/09 cash haircut 718/09 Target DVD 7/8!09 Target CD's/clothes 7/9/09 Kmart snack 7/18/09 Giant magazine 7/20/09 Dukes lunch 7/22/09 cash spending Money 7/23/09 Fye dud's 7/23/09 Borders book 7/24/09 Giant magazine's 7/26109 Giant sub 7/27/09 Weis magazine 7/28/09 Weis car 8/4/09 Giant magazine/candy 8/5/09 cash vacation/spending money 8/5/09 cash total vac8/5-8/7 8/17/09 Giant cards 8/18/09 cash gift 8/18/09 Giant candy 8/20/09 cash haircut 8/21/09 JC Penney clothes 8/24/09 Target game 8/27/09 McDonald's lunch $ 50.00 $ 100.00 $ 150.00 $ 150.00 $ 500.00 $ 4.23 $ 151.91 $ 4.00 $ 147.91 $ 5.30 $ 142.61 $ 10.00 $ 132.51 $ 3.06 $ 129.55 $ 2.65 $ 126,90 $ 7.10 $ 119.80 $ 13.23 $ 106.57 $ 6.36 $ 100.21 $ 20.00 $ 80.01 $30.00 $ 50.21 $ 100.21 $ 3.17 $ 97.04 $ 3.06 $ 93.98 $ 14.16 $ 79.82 $ 20.00 $ 59.82 $ 4.23 $ 55.59 $ 2.12 $ 53.47 $ 7.62 $ 45.85 $ 3.06 $ 42.79 $ 1.00 $ 41.79 $ 141.79 $ 29.05 $ 112.74 $ 2.65 $ 110.09 $ 3.06 $ 107.03 $ 5.38 $ 101.65 $ 3.81 $ 97.84 $ 4.63 $ 93.21 $ 243.21 $ 10.00 $ 233.21 $ 10.59 $ 222.62 $ 138.85 $ 83.77 $ 4.22 $ 79.55 $ 3.81 $ 75.74 $ 11.00 $ 64.74 $ 214.74 $ 54.02 $ 160.72 $ 18.55 $ 142.17 $ 28.54 $ 113.63 $ 10.59 $ 103.04 $ 6.35 $ 96.69 $ 1.06 $ 95,63 $ 3.86 $ 91.77 $ 591.77 $ 134.70 $ 457.07 $ 1.90 $ 455.17 $ 25.00 $ 430.17 $ 1.00 $ 429.17 $ 10.00 $ 419.17 $ 45.90 $ 373.27 $ 52.99 $ 320.28 $ 5.18 $ 315.10 8/27/09 Toys R Us game 8/28/09 Kmart candy 8/31/09 Weis magazine/CD 9/12/09 McDonald's lunch 9/12/09 Giant prescription 9/13/09 Maggies ice cream 9/13/09 Subway dinner 9/15/09 cash birthday gift 9/15/09 Giant cards/magazines 9/19/09 Kmart magazines 9/26/09 Big Lots food 9/26/09 Ollie's BB figure/soda 10/3/09 Nick's 114 dinner 10.8/09 cash haircut 10/10/09 cash birthday gift 10/10/09 McDonald's dinner 10/17/09 Giant dinner 10/24/09 McDonald's dinner 10/31/09 Friendly's dinner 11/1/09 cash movies/snacks 11/3/09 Hoss's dinner 11/8/09 Walmart CD/magazine 11/8/09 McDonald's shake 11/13/09 Giant dinner 11/14/09 Giuseppes dinner 11/14/09 cash spending Money 11/17/09 Walmart CD's 11/20/09 Kohl's game 11/21/09 Friendly's dinner 11/25/09 McDonald's lunch 11/27/09 Walmart 6 comp cable 12/1109 cash haircut 12/5/09 cash spending Money 12/6/09 Walmart clothes 12/12/09 Kmart DVD 12/13/09 GameStop WII games 12/13/09 Bob Evans lunch 12/21/09 Giant prescription 12/23/09 cash spending Money 12/24/09 cash Christmas gifts 12/24/09 cash church offering $ 47.68 $ 267.42 $ 2.67 $ 264.75 $ 11.60 $ 253.15 $ 6.24 $ 246.91 $ 3.20 $ 243.71 $ 3.97 $ 239.74 $ 6.77 $ 232.97 $ 20.00 $ 212.97 $ 9.30 $ 203.67 $ 5.78 $ 197.59 $ 8.42 $ 189.47 $ 19.34 $ 170.13 $ 20.00 $ 150.13 $ 10.00 $ 140.13 $ 20.00 $ 120.13 $ 6.87 $ 113.26 $ 4.77 $ 108.49 $ 4.24 $ 104.25 $ 12.59 $ 91.66 $ 15.00 $ 76.66 $ 14.00 $ 62.66 $ 21.20 $ 41.46 $ 3.06 $ 38.40 $ 4.77 $ 33.63 $ 6.10 $ 27.53 $ 100.00 $ 127.53 $ 31.55 $ 95.98 $ 22.51 $ 73.47 $ 12.59 $ 60.88 $ 4.12 $ 56.76 $ 10.00 $ 46.75 $ 10.00 $ 36.76 $ 100.00 $ 136.76 $ 24.00 $ 112.76 $ 17.19 $ 95.57 $ 52.98 $ 42.59 $ 14.49 $ 28.10 $ 3.20 $ 24.90 $ 100.00 $ 124.90 $ 25.00 $ 99.90 $ 4.00 $ 95.90 Register: Sean Matthew Dosiak Trust From 01/01/2009 through 12/31/2009 Sorted by: Date, Type, Number/Ref Date Number Payee Sean Matthew Dosiak Trust 1 / 18/2010 3:29 PM Account Memo Payment C Deposit Balance 01/12/2009 1054 United States Treasury taxes taxes 39.00 5,422.23 01/12/2009 1055 US Postal Service Postage and Delivery postage 5.32 5,416.91 01/14/2009 1056 Office Max ink for printer expense 92.20 5,324.71 01/14/2009 1057 Register of Wills filing fee expense 15.00 5,309.71 01/14/2009 1058 Shama Dosiak preparation court report expense 300.00 5,009.71 01/19/2009 1059 Biltie Jo Snyder reimbursement for WII expense 409.13 4,600.58 01/21/2009 DEP CD Interest Trust INTEREST 8.49 4,609.07 02/20/2009 DEP CD Interest Trust interest 8.49 4,617.56 03/16/2009 1060 Pa. Dept.Revenue taxes taxes 13.00 4,604.56 03/16/2009 1061 Stiteler & Associates ... tax preparation tax preparation 35.00 4,569.56 03/16/2009 1062 US Postal Service Postage and Delivery postage 10.81 4,558.75 03/20/2009 dep CD Interest Trust interest 7.67 4,566.42 04/21/2009 dep CD Interest Trust interest 8.50 4,574.92 05/10/2009 dep IRS refund tax refund deposit 84.00 4,658.92 OS/2I/2009 dep CD Interest Trust interest 8.22 4,667.14 06/19!2009 dep CD Interest Trust interest 8.49 4,675.63 07!05/2009 1063 Staples Quicken starter edition/... 39.83 4,635.80 07/21/2009 dep CD Interest Trust interest 8.22 4,644.02 08/20/2009 dep CD Interest Trust interest 8.22 4,652.24 09/18/2009 dep CD Interest Trust interest 10.19 4,662.43 10/13/2009 dep Equitrust Life I Prem... Trust INTEREST 1,845.00 6,507.43 10/19/2009 DEP CD Interest Trust interest 10.20 6,517.63 11/19/2009 dep CD Interest Trust interest 10.53 6,528.16 12/18/2009 dep CD Interest Trust interest 10.19 6,538.35 Page 1 Sean Matthew Dosiak TRUST Certificate of Deposit 1/1/01-12/31/09 12/31 /01 Mellon Trust CD 10.000.74 is now Citizen's Bank transferred funds to Citizen's Bank on 6/20/02 Balance 10,000.74 TRANSFER OF SEAN MATTHEW DO5IAK TRUST FUNDS TRANSFERRED ANNUITY WITH F & G LIFE $58,264.34 19,087.55 INTEREST $77,351.89 TOTAL TRANSFER 10/OS/06 TRANSFERED TO AN ANNUITY ACCOUNT WITH EQUITRUST. Balance $83,997.59 TRANSFERRED $6,500.00 FROM MELLON CHECKING TO A MONEY MARKEY ACCOUNT WITH AMERICAN FUNDS ON 8/16/01. TOTAL OF MONEY MARKET $7,770.59 We certify that the above is an accurate report of the income and expenses of the guardian account. The needs of the incapacitated person as set forth above, included expenses for Sean, including Mps, vacations, and recreations. Sean resides at 100 N. Second Street, Mechanicsburg PA 17055 with his mother and father. He continues to take Dilantin medication to control his seizures. Sean still goes to Dr. James. He has a Dilantin level test and liver test every six months. His eye doctor is Dr. Kilmore, he got new glasses this year. He goes to the eye doctor every six months. He has a new dentist, Dr. Brown (his other one moved out of state.) He sees him every six months. We take him to dinner or lunch on the weekends and shopping. Sean went to the shore this summer with us for a couple of days. He spends time with his sister and family. He goes to church with his sister. He does different activities with his sister and nephew. We take him to his nephew's sporting games (baseball, basketball, soccer, etc.) He enjoys TV, word fine puzzles, listening to music, and watching his movies. Sean went to the movies with his sister and family. We took him to Long Island to see his grandmother, who was very ill. We took him to Baltimore for a Mets game. Sean is with his parents during the day. I feel the guardianship should be continued. The reason being, Sean is mentally deficient from birth due to malpractice of a physician and cannot manage his affairs, make medical decisions, or take care of himself. We feel as Sean's parents that we have an understanding for Sean and his needs. William R Dosiak 100 N. Second Street Mechanicsburg PA 17055 Sharon Dosiak 100 N. Second Street Mechanicsburg PA 17055 Distribution: Clerk of Orphan's Court COMMONWEALTH OF PENNSYLVANIA S5 COURT OF COMMON PLEAS On this, the day of ,before me, a notary public in and for the County of Cumberland, Commonwealth of Pennsylvania, the undersigned officer, personally appeared William R Dosiak and Sharon Dosiak, known to me (of satisfactory proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for purposes therein contained IN WITNESS WHEREOF, I HEREUNTO SET MY HAND AND OFFICIAL SEAL. Notary Public IN RE: GUARDIANSHIP OF SEAN MATTHEW DOSIAK TO: Clerk of Orphan's Court Courthouse, Cazlisle PA IN THE COURT OF COMMON PLEAS.OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT . N0.21-94-393 ANNUM, REPORT OF GUARDIANS OF SEAN MATTHEW DOSIAK Estate: Sean Matthew Dosiak Guardian: William R. Dosiak and Sharon Dosiak Period: January 1, 2010-December 31, 2010 Date Filed: This is a report filed with the Court in compliance with Section 5521 (c) of Act 24 of July, 192, 20 PaCSA 5521. ~,.:~ ,~, ~ c~ x~ ~ -- ~ ~~ ~ ~ ~~~ a7 N O ,~,. ~~ s. ~ ~...7 ~Q ~ - 1~ ..~ `` S~ ~ ~ w" ~ ~- ~~ .w. (~"} s~ Register Report - 2010 1/1/2010 through 12/31/2010 1/18/2011 Date Acxount Num Description Memo Category Clr Amount Page 1 ~;~ ~ 1.T+iiii~:~T 1/2/2010 Estate of Sea... 699 Sears Clothing -77.95 1/172010 Estate of Sea... 700 Sears Clothing -154.96. 1/172010 Estate of Sea... 701 Comcast Cable Utiiities:Cable ... ' -29.30 1262010 Estate of Sea... 702 Wa1Mart Entertainment -33.84 1/302010 Estate of Sea... 703 Cash Cash -100.00 2/12010 Estate of Sea... DEP SSP Other Inc 22.10 2/12010 Estate of Sea... 704 Cash Fair Share -375.00 2/12010 Estate of Sea... DEP SSI Other Inc 250.60 2/3/2010 Estate of Sea... DEP Social Security Other Inc 376.00 2!82010 Estate of Sea... DEP Social Security Other Inc 14.20 2/142010 Estate of Sea... 705 Sears Clothing -26.34 2/172010 Estate of Sea... 706 KMart Entertainment ' -53.24 2242010 Estate of Sea... 707 Comcast Cable Utilities:Cable ... ' -29.30 3/12010 Estate of Sea... DEP SSI Other Inc ', 250.60 3/12010 Estate of Sea... 708 Cash Fair Share ' -375.00 3/12010 Estate of Sea... DEP SSP Other Inc ~' 22.10 . 3/42010 Estate of Sea... 709 KMart Entertainment -52.99 3/62010 Estate of Sea... 710 Cash Cash ' -100.00 3/82010 Estate of Sea... 711 New York Mets Entertainment ' -14.00 3/122010 Estate of Sea... 712 Sears Clothing ', -23.16 3222010 Estate of Sea... 713 Comcast Cable Utilities:Cable ... ': -29.30 3/312010 Estate of Sea... 714 Cash Cash ' -100.00 4/12010 Estate of Sea... DEP SSP Other Inc 22.10 4/12010 Estate of Sea... DEP SSI Other Inc 188.00 4/12010 Estate of Sea... 715 Cash Fair Share -375.00 422010 Estate of Sea... 716 Void 0.00 422010 Estate of Sea... 717 WalMart Entertainment -105.93 4/92010 Estate of Sea... 718 Star Misc. -61.88 4222010 Estate of Sea... 719 Comcast Cable Utilities:Cable ... ' -74.05 4/302010 Estate of Sea... DEP SSI Other Inc 674.00 4/302010 Estate of Sea... DEP SSP Other Inc 22.10 5/12010 Estate of Sea... DEP Social Security Other Inc 376.00 5/12010 Estate of Sea... 720 Cash Fair Share -375.00 5152010 Estate of Sea... fee Bank Charge ... Bank Charge -19.99 5/72010 Estate of Sea... 721 Cash Cash -150.00 5222010 Estate of Sea... 722 Comcast Cable Utilities:Cable ... ' -74.05 6/12010 Estate of Sea... DEP SSI Other Inc 674.00 6/12010 Estate of Sea... DEP SSP Other Inc 22.10 6/32010 Estate of Sea... DEP Social Security Other Inc ', 376.00 6/102010 Estate of Sea... 723 Cash Fair Share -375.00 6/102010 Estate of Sea... 724 Cash Cash -100.00 6/102010 Estate of Sea... 725 Kohl's Clothing -56.03 6212010 Estate of Sea... 726 Cash Cash -200.00 6222010 Estate of Sea... 727 Comcast Cable Ualities:Cable ... -74.05 7/12010 Estate of Sea... DEP SSP Other Inc 22.10 7N2010 Estate of Sea... DEP SSI Other Inc 318.00 7/12010 Estate of Sea... 728 Cash Fair Share -375.00 722010 Estate of Sea... DEP Social Security Other Inc 376.00 7/172010 Estate of Sea... 729 Comcast Cable Utilities:Cable ... -74.05 7/172010 Estate of Sea... 730 Cash Cash ', -500.00 1 /182011 Date ccount Num Register Report - 2010 1/1/2010 through 12/312010 Description Memo ategory Clr Page 2 Amount 7292010 Estate of Sea... 731 Penndot Photo ID -12.00 7/302010 Estate of Sea... DEP SSI Other Inc 318.00 7/302010 Estate of Sea... OEP SSP Other Inc 22.10 8/22010 Estate of Sea... 732 Cash Fair Share -375.00 8/3/2010 Estate of Sea... DEP Social Security Other Inc 376.00 8/152010 Estate of Sea... 733 ToysRus Entertainment -275.56 8212010 Estate of Sea... 734 Comcast Cable Utilities:Cable ... -23.15. 9/12010 Estate of Sea... DEP SSI Other Inc 318.00 9/12010 Estate of Sea... DEP SSP Other tnc 22.10 9/1/2010 Estate of Sea... 735 Cash Fair Share -375.00 9/3/2010 Estate of Sea... DEP Social Security Other Inc 376.00 9/112010 Estate of Sea... 738 Cash Cash -150.00 9232010 Estate of Sea... 737 Comcast Cable Utilities:Cable ... ' -23.15 10/12010 Estate of Sea... 738 Cash Fair Share -375.00 10/12010 Estate of Sea... 739 Cash Cash -100.00 10/12010 Estate of Sea... DEP. SSI Other Inc 318.00 10/12010 Estate of Sea... DEP SSP Other Inc 22.10 10/12010 Estate of Sea... DEP Social Security Other Inc 376.00 10/16/2010 Estate of Sea... 740 Cash Cash , -150.00 10232010 Estate of Sea... 741 Sears Clothing -179.69 10/25/2010 Estate of Sea... 742 Comcast Cable Utilities:Cable ... -23.15 11/1/2010 Estate of Sea... DEP SSI Other Inc 318.00 11/12010 Estate of Sea... DEP 5SP Other Inc 22.10 11 /112010 Estate of Sea... 743 Cash Fair Share -375.00 11/1/2010 Estate of Sea... 744 Medco Medical ' -20.00 11/32010 Estate of Sea... DEP Social Security Other Inc 376.00 11/102010 Estate of Sea... 745 Medco Medical -91.56 11/14/2010 Estate of Sea... 746 HH Gregg Entertainment -158.99 11/202010 Estate of Sea... 747 KMart Clothing -76.95 11/212010 Estate of Sea... 748 Comcast Cable Utilities:Cable ... , -23.15 11/212010 Estate of Sea... 749 Cash Cash -150.00 12/12010 Estate of Sea... 750 Cash Fair Share -375.00 12/12010 Estate of Sea... DEP SSI Other Inc 318.00 12/1/2010 Estate of Sea... DEP SSP Other Inc 22.10 12/3/2010 Estate of Sea... DEP Social Security Other Inc 439.00 12/13/2010 Estate of Sea... 751 Sirius Entertainment -159.83 12/182010 Estate of Sea... 752 Cash Cash -150.00 12272010 Estate of Sea... 753 Comcast Cable Utilities:Cable ... -23.15 121302010 Estate of Sea... DEP SSI Other Inc 318.00 12/302010 Estate of Sea... DEP SSP Other Inc 22.10 1h/2010 -12/31/2010 -240.14 1L504.88 TOTAL INFLOWS 7,989.60 TOTAL OUTFLOWS -8,229.74 NET TOTAL -240.14 DATE PAYEE Balance as of 12/31/09 1/1/10 Wal-mart 112/10 Summit Rest 1/10/10 Gilligan's 1!17!10 Subway 1/18/10 Seat's 1/25/10 cash 1/27/10 Weis 1/30/10 McDonald's 1/30/10 cash 1/31/10 Burger king 2/4/10 Giant 2/11/10 Giant 2/13!10 Gilligan's 2/17/10 Friendly's 2/20/10 Weis 2/20/10 Villa oma 2/21h0 Burger king 2/27/10 Wal-mart 2127110 cash 3/4110 Giant 3/6/10 cash 3/6/10 cash 3/12/10 FYE 3/13/10 Subway 3/14/10 Friendly's 3/18/10 CVS 3/19/10 cash 3/20/10 Giant 3126110 cash 3/27/10 Wendy's 3/28/10 Waffle House 3/31110 Giant 3/31 /10 cash 4/1/10 cash 4/3/10 McDonald's 4/4/10 cash 4/11/10 Jumbo Buffet 4111110 Wendy's 4117/10 Duke's 4/18/10 Peachtree 4/25/10 Midtown 4/25/10 Dollar Tree 4/26/10 Giant 5/1/10 cash 5/7/10 cash 5/7/10 Wal-mart 517/10 cash 5/7/10 Kmart REASON Depasils Withdrtawals tote box lunch dinner dinner exchanged pants haircut magazine shake spending money dinner lunch magazine lunch lunch puzzle books dinner dinner baseball cards hot dog/soda medication It. Sausage sandwich spending money DVD dinner dinner bookJcandy/etc haircut medication donation(AmerHeattAssoc dinner dinner misc. items spending money soda hamburger's church offering dinner float lunch dinner lunch misc. items bbrards haircut ice tea cd spending money clothes/candy $100.00 $ 100.00 $ 100.00 $ 150.00 $ 3.61 12.02 $ 21.02 $8.58 $ 1.79 $ 10.00 $ 8.47 $ 3.06 $ 7.20 $ 4.77 $ .8.47 $ 18.38 $ 12.09 $ 2.12 $ 7.89 $ 7.63 $ 4.16 $ 3.25 $ 6.88 $ 6.31 $ 52.99 $ 5.30 $ 11.53 $ 7.87 $ 10.00 $ 3.30 $ 5.00 $ 4.76 $ 6.30 $ 7.67 $ 0.60 $ 2.12 $ 3.00 $ 15.93 $ 2.64 $ 15.00 $ 10.75 $ 10.75 $ 4.24 $ 6.34 $ 10.00 $ 1.25 $ 10.60 $ 68.22 CASH ON HAND 6 95.90 6 92.29 ~ 80.27 6 59.25 6 50.67 6 48.88 6 38.88 6 30.41 $ 27.35 $ 127.35 $ 120.15 $ 115.38 $ 106.91 ~ 88.53 ~ 76.44 $ 74.32 $ 66.43 $ 58.80 !~ 54.64 51.39 i - ~F~I~,SI ~ 38.20 ~ 138.20 85.21 $79.91 ~ 68.38 ~ 60.51 50.51 $ 47.21 $ 42.21 $ 37.45 31.15 $ 23.48 $ 123.48 $ 122.88 $ 120.76 117.76 $ 101.83 $ 99.19 $ 84.19 $ 73.44 $ 62.69 $ 58.45 $ 52.11 42.11 $ 40.8s $ 30.26 $ 180.26 112.04 5112/10 Giant lunch 5/13/10 Giant bbcards 5118/10 cash donation(leukemia) 5/23/10 Midtown Pisa lunch 5/31/10 Friendly's dinner 6/10/10 cash haircut 6/10/10 cash spending money 6/11 /10 cash soda 6/11110 cash Bbgame 6111/10 The Nest dinner 6/12/10 Wa{-mart candy/bbcards 6/12/10 Dunkin Donuts breakfast 6/11/10 Wendy"s lunch 6/15/10 Giant card 6/19/10 Giant prescription 6/20/10 Subway lunch 6/19/10 Gilligan's lunch 6/21/10 cash spending money 6/22/10 FYE dvd 6/25/10 Lotus Diner lunch 6/26/10 Subway lunch 6!29!10 Wal-mart wii fit plus 7/1/10 Maggie's float 7/2/10 Palumbo's lunch 7/5/10 Sheeiz sandwich 7/17/10 Giant prescription 7/17/10 cash vacation/spending money 7118-7/23/1 cash vacation 7124/10 cash haircut 7/31/10 Amici Rest lunch 8/2/10 Dollar Tree cards 8/2/10 Kmart wii game 8/2/10 Wal-mart game/bb cards 8/6/10 Skyline Rest dinner 8/7/10 Bob Evans lunch 8/16/10 cash fund raiser 8118/10 Giant prescription 8/21/10 SkiRoundtop soda 8/27/10 Giuseppes dinner 8/27/10 Weis batteries 8/28/10 Skyline Rest dinner 9/4/10 cash haircut 9!4/10 Skyline Rest dinner 9/5/10 cash hamburger/ice cream 9/5/10 Philly steak hoagie sub 9/6/10 Bob Evans dinner 9!11110 cash soda 9/11/10 cash spending money 9/11/10 Gamestop games 9/11/10 Branding Iron lunch 9/11/10 cash ice cream 9/12/10 Bob Evans breakfast $ 6.25 $ 105.79 $ 3.17 $ 102.62 $ 10.00 $ 92,62 $ 10.31 $ 82.31 $ 12.00 $ 70.31 $ 10.00 '$ 60.31 $ 100.00 $ 160.31 $ 1.00 $ 159.31 $ 48.68 '$ 110.63 $ 18.00 ',$ 92.63 $29.73 ',$ 62.90 $ 3.58 $ 59.32 $ 5.26 I$ 54.06 $ 2.67 '$ 51.39 $ 3.30 '~$ 48.09 $ 5.68 '$ 42.41 $ 20.00 $ 22.41 $ 200.00 '$ 222.41 $ 15.89 '$ 206.52 $ 10.32 $ 196.20 $ 5.30 $ 190.90 $ 104.94 ~ 85.96 $ 3.18 $ 82.78 $ 5.51 ~ 77.27 $ 3.70 ~ 73.57 $ 3.30 ~$ 70.27 $ 500.00 ~ 570.27 $ 308.64 ~ 261.63 $ 10.00 $ 251.63 $ 7.47 ~ 244.16 $ 3.71 $ 240.45 $ 21.19 ~ 219.26 $ 37.08 ~ 182.18 $ 20.49 ~ 161.69 $ 11.34 __ ~~~=~~ $ 31.00 $6 119.35 $ 3.30 $ 116.05 $ 2.00 $ 114.05 $ 6.31 $ 107.74 $ 6.35 $ 101.39 $ 14.98 $ 86.41 $ 10.00 $ 76.41 $ 15.73 $ 60.68 $ 3.50 $ 57.18 $ 7.19 $ 49.99 $ 12.90 ~ 37.09 $ 0.75 $ 36.34 $ 150.00 $ 186.34 $ .42.37 $ 143.97 $ 11.22 $ 132.75 $ 3.00 $ 129.75 $ 8.28 $ 121.47 9/18/10 Doiiar Tree cards $ 1.06 $ 120.41 9/18/10 cash gift $ 10.00 $ 110.41 9/21!10 Giant prescription $ 3.30 $ 107.11 9/24/10 Skyline Rest dinner $ 11.48 $ 95.63 9/15/10 Capitol Diner dinner $ 9.04 $ 86.59 9/26/10 Ollie's games/batteries $ 21.80 '$ 64.79 9/26/10 Genova's lunch $ 8.57 $ 56.22 10/1/10 cash spending money $ 100.00 '$ 156.22 10J2/10 Subway lunch $ 5.30 $ 150.92 10!3110 Skyline Rest dinner $ 10.70 $ 140.22 10/9!10 Two Cousins lunch $ 8.96 $ 131.26 10/10/10 Hoss's dinner $ 15.88 '$ 115..38 10/10/10 Burger king lunch $ 2.43 $ 112.95 10/11/10 Subway lunch $ 5.30 $ 107.65 10/12/10 McDonald's dinner $ 5.28 $ 102.37 10/12/10 cash gift $ 15.00 $ 87.37 10/15/10 cash haircut $ 10.00 $ 77.37 10/16/10 cash spending money $ 150.00 $ 227.37 10/16/10 Tommy's Pizza Lunch $ 8.35 $ 219.02 10!17!10 cash Spirit Cups $ 15.00 $ 204.02 10/23/10 fye CD $ 15.89 $ 188.13 10/23/10 Hi Life Diner dinner $ 25.16 $ 162.97 10/24/10 Bob Evans dinner $ 12.98 $ 149.99 10/25/10 Giant prescription $ 21.89 $ 128.10 10/30/10 Gilligan's lunch $ 10.55 $ 117.55 10/31/10 Skyline Rest dinner $ 18.40 $ 99.15 11/6/10 Hoss's dinner $ 22.11 $ 77.04 11/6110 Burger king lunch $ 3.48 ffi 73.56 11/10/10 McDonald's dinner $ 5.07 $ 68.49 11 /12110 Jazzmans Cafe breakfast $ 4.64 $ 63.85 11/12/10 Seven Bridges lunch $ 7.91 $ 55.94 11/13/10 Hogie House lunch $ 8.02 $ 47.92 11/14/10 Denny's Lenny's Rest lunch $ 10.85 $ 37.07 11/14/10 Bob Evans dinner $ 10.37 $ 26.70 11/20/10 McDonald's lunch $ 8.03 $ 18.67 11/21/10 cash spending money $ 150.00 $ 168.67 11/21/10 Bob Evans dinner $ 12.40 $ 156.27 11!21/10 Sheetz snack $ 3.81 $ 152.46 11/24/10 Duke's lunch $ 14.99 $ 137.47 11/25/10 Lotus Diner dinner $ 15.00 $ 122.47 11/27/10 McDonald's dinner $ 6.87 $ 115.60 11/29/10 Wal-mart magazine $ 9.00 $ 106.60 12/4/10 Bob's Bagels breakfast $ 2.07 $ 104.53 12/8/10 Wegmans dinner $ 6.00 $ 98.53 12/12/10 Skyline Rest dinner $ 13.07 $ 85.46 12/17/10 McDonald's dinner $ 7.82 $ 77.64 12/18110 Amid Rest lunch $ 4.03 $ 73.61 12/18!10 cash spending money $ 150.00 $ 223.61 12/18/10 Kmart game/towel set $ 55.63 $ 167.98 12/18/10 Sidoti's dinner $ 6.88 $ 161.10 12/18/10 Target CD $ 14.83 $ 146.27 12/23/10 cash haircut $ 10.00 $ 136.27 12/24/10 cash gift $ 25.00 $ 111.27 12/24/10 cash church offering $ 3.00 $ 108.27 12/25/10 Colonial Park Rest dinner $ 16.87 $ 91.40 Sean MatthCW DOSIak Ttvst 1/18/2011 1:36PM Register: Sean Matthew Dosiak Trust From 01/01/2010 through 12/31!2010 Sorted by: Date, Type, Number/Ref Date Number Payee Account Memo Payment t^ Deposit Balance 01/18/2010 1064 CVS ink for printer expense 41.33 6,497.02 01/19/2010 dep CD Interest Trust interest 10.53 6,507.55 01/19/2010 1065 Register of Wilts filing fee expense 15.00 6,492.55 01/19/2010 1066 Sharon Dosiak preparation court report expense 300.00 6,142.55 02/19/2010 dep CD Interest Trust interest 10.54 6,203.09 03/11/2010 1067 Pa. Dept.Revenue taxes taxes 4.00 6,199.09 03!11/2010 1068 US Postal Service Postage and Delivery postage I L25 6,187.84 03/19/2010 dep CD Interest Trust in terest 9.51 6,197.35 04/14/2010 1069 Stiteler & Associates ... tax preparation tax preparation 35.00 6,162.35 04/19/2010 dep CD Interest Trust interest 10.53 6,172.58 04/21/2010 dep IRS refund tax refund deposit ' 32.00 6,204.88 05/02/2010 1070 Billie Jo Snyder fixed computer from vi... expense 100.00 6,104.8$ 05/19/2010 dep CD Interest Trust interest 1.23 6,106.11 06/18/2010 dep CD Interest Trust interest 1.28 6,107.39 06/21/2010 1071 cash virus scanner expense 39.95 6,067.44 07/19/2010 dep CD Interest Trust interest 1.23 6,068.67 08/15/2010 1072 HH Gregg printer expense 211.97 5,856.70 08!15/2010 1073 Staples printer paper/supplies expense 51.43 5,805.27 08/19/2010 dep CD Interest Trust interest 1.27 5,806.54 09/17/2010 dep CD Interest Trust interest 1.28 5,807.82 10/13/2010 dep Equitrust Life I Prem... Trust interest 1,845.00 7,652.82 10/13/2010 dep CD Interest Trust interest 1.19 7,654.01 11/01/2010 dep American Funds closed money market transfer of mon... 7,770.59 15,424.60 11/18/2010 dep CD Interest Trust interest 0.85 15,425.45 12/08/2010 1074 Staples ink for printer expense 5.29 15,420.16 12/17/2010 dep CD Interest Trust interest 0.82 15,420.98 Page 1 i s Sean Matthew Dosiak TRUST Certificate of Deposit 1/1/O1-12/31/10 12/31 /01 Mellon Trust CD 10.000.74 is now Citizen's Bank transferred funds to Citizen's Bank on 6/20/02 Balance 10,000.74 TRANSFER OF SEAN MATTHEW DOSIAK TRUST FUNDS TRANSFERRED ANNUITY WITH F 8c G LIFE $58,264.34 19,087.55 INTEREST $77,351.89 TOTAL TRANSFER 10/f15/06 TRANSFERED TO AN ANNUITY ACCOUNT WITH EQUITRUST. Balance $85,512.31. TRANSFERED $6,500.00 FROM MELLON CHECKING TO A MONEY MARKET ACCOUNT WITH AMERICAN FUNDS ON 8/16/01. TOTAL OF MONEY MARKET $7,770.59 11/1/10 We certify that the above is an accurate report of the income and expenses of the guardian account.. The needs of the incapacitated person as set forth above, included expenses for Sean, including trips, vacations, and recreations. Sean resides at 100 N. Second Street, Mechanicsburg PA 17055 with his mother and father. He continues to take Dilantin medication to control his seizures. Sean still goes to Dr. James. He has a Dilantin level test and liver test every six months. His tye doctor is Dr. Kilmore. He goes to the eye doctor every six months. He has a new dentist, Dr. Brown (his other one moved out of state.) He sees him every six mouths. We take him to dinner or lunch on the v~aekends and shopping. Sean went to the shore this summer with us and our grandson for a week. We also took Sean to Baltimore for a baseball game with the Mets and the Orioles. He spends time with his sister end family. He goes to church with his sister. He does different activities with his sister and nephew. We take him to his nephew's sporting games (baseball, basketball, soccer, etc.) He enjoys TV, word fine puzzle, listening to music, and watching his movies. Sean went to the movies with his sister and family. Sean is (with his parents during the day. I feel the guardianship should be continued. The reason being, Seam, is mentally deficient from birth due to malpractice of a physician and cannot manage his affairs, make medical decisions, or take care of himself. We feel as Sean's parents that we have an understanding $or Sean and his needs. William R. Dosiak 100 N. Second Street Mechanicsburg PA 17055 ~,~'j.~-t,e~,~., Sharon Dosiak 100 N. Second Streett Mechanicsburg PA 17055 Distribution: Clerk of Orphan's Court COMMONWEALTH OF PENNSYLVANIA SS COURT OF COMMON PLEAS On this, the day of ,before me, a notary public in and for the Coun~3' of Cumberland, Commonwealth of Pennsylvania, the undersigned officer, personally appeared WiAiam R Dosiak and Sharon Dosiak, known to me (of satisfactory proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for purposes therein contained. IN WITNESS WHEREOF, I HEREUNTO SET MY HAND AND OFFICIAL SEAL. Notary Public aoMMOww~u.Ttl of r~tsnvMtvt Nnn+d.r ~r PubNc ~ ,~ t~orrer Nen Twv., anibertnb counlr OOIIIIaMM011 71N1e 2014 Mertes. PennsMvarNa Ibe0detbn d Notark5 ~,~ -- q~1 - a 3G~ January 10, 2011 Cumberland County Courthouse Clerk of Orphans Court 1 Courthouse Square Carlisle PA 17013 To Whom It May Concern: Enclosed please find a copy of the Annual Report of Guardianship of Sean Matthew Dosiak. I am also enclosing $15.00 for the filing fees. I am requesting that you send me a copy of the report stamped received and filed. Thank you for your help in this matter. Sincerely, Mr. And Mrs. Williams R. Dosiak Guardian of Sean Matthew Dosiak Enclosure (1) sd 100 N. SECOND STREET MECHANICSBURG PA 17055 IN RE: GUARDIANSHIP OF IN THE COURT OF COMMON PLEAS OF SEAN MATTHEW DOSIAK CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT N0.21-94-393 TO: Clerk of Orphan's Court Courthouse, Carlisle PA ANNUAL REPORT OF GUARDIANSHIP OF SEAN MATTHEW DOSIAK Estate: Sean Matthew Dosiak Guardian: William R. Dosiak and Sharon Dosiak Period: January 1, 2011-December 31, 2011 Date Filed: This is a report filed with the Court in compliance with Section 5521 (c) of Act 24 of July, 1992, 20 PaCSA 5521. ~~ ~ a~ =x~ -- ~, ~~ --, _ ~_ ~.~ ,~._ ..~ - ~; a~ :-. c _, _. ,_, _.. } ,_ .. -y A ~_ ~`: ~~~~ ~~ "' - - - ! 1`J Register Report - 2011 1/1/2011 through 12/31/2011 1/9/2012 Date Account Num Description Memo Category Clr Amount Page 1 _BALANCE 12/31!201.0 _ _ __ 1,504.53 1/3/2011 Estate of Sea... DEP Social Security Other Inc 383.00 1/3/2011 Estate of Sea... 754 Cash Fair Share -375.00 1/6/2011 Estate of Sea... 755 Cash Cash -150.00 1/6/2011 Estate of Sea... 756 Sears Glothing -80.27 1/12/2011 Estate of Sea... 757 WalMart Entertainment -52.96 1!15/2011 Estate of Sea... 758 Cash Cash -150.00 1/19/2011 Estate of Sea... 759 Comcast Cable Utilities:Cable ... -23.15 2/1!2011 Estate of Sea... DEP SSI Other Inc 255.00 2/1/2011 Estate of Sea... DEP SSP Other Inc 22.10 2/3/2011 Estate of Sea... DEP Social Security Other Inc 383.00 2!3/2011 Estate of Sea... 760 Cash Fair Share -375.00 2/16/2011 Estate of Sea... 761 Comcast Cable Util'dies:Cable ... -23.15 2/17/2011 Estate of Sea... 762 Cash Cash -150.00 3/1/2011 Estate of Sea... DEP SSI Other Inc 311.00 3/1/2011 Estate of Sea... DEP SSP Other Inc 22.10 3/1/2011 Estate of Sea... 763 Cash Fair Share -375.00 3/3/2011 Estate of Sea... DEP Social Security Other Inc 383.00 3/5/2011 Estate of Sea... 764 New York Mets Entertainment -14.00 3/17/2011 Estate of Sea... 765 Comcast Cable Utilities:Cable ... -28.14 3/25/2011 Estate of Sea... 766 Cash Cash -150.00 4/1/2011 Estate of Sea... DEP SSP Other Inc 22.10 4/1!2011 Estate of Sea... DEP SSI Other Inc 311.00 411!2011 Estate of Sea... DEP Social Security Other Inc 383.00 4!1/2011 Estate of Sea... 767 Cash Fair Share -375.00 4/1/2011 Estate of Sea... 768 Star Misc. -77.48 4/18/2011 Estate of Sea... 769 Comcast Cable Utilities:Cable ... -67.90 4/20!2011 Estate of Sea... 770 Cash Cash -150.00 4/27/2011 Estate of Sea... 771 Dr. Brown DDS Medical -129.00 4/29/2011 Estate of Sea... 772 Cash Cash -200.00 4/29/2011 Estate of Sea... DEP SSI Other Inc 311.00 4/29/2011 Estate of Sea... DEP SSP Other Inc 22.10 5/2/2011 Estate of Sea... 773 Cash Fair Share -375.00 5/3/2011 Estate of Sea... DEP Social Security Other Inc 383.00 5116!2011 Estate of Sea... 774 Gomcast Cable Utilities:Cable ... -71.77 5!2112011 Estate of Sea... 775 Cash Cash -150.00 6/1/2011 Estate of Sea... DEP SSP Other Inc 22.10 6/1/2011 Estate of Sea... DEP SSI Other fnc 311.00 6/1/2011 Estate of Sea... 776 Cash Fair Share -375.00 6/3/2011 Estate of Sea... DEP Social Security Other Inc 383.00 6/6/2011 Estate of Sea... DEP Social Security Other lnc 271.00 6/9/2011 Estate of Sea... 777 Sears Clothing -26.97 6/9/2011 Estate of Sea... 778 JC Penney Clothing -48.96 6/9/2011 Estate of Sea... 779 BonTon Clothing -59.97 6/14/2011 Estate of Sea... 780 KMart Entertainment -64.98 6/20/2011 Estate of Sea... 781 Comcast Gable Utilities:Cable ... -71.97 6/25/2011 Estate of Sea... 782 Cash Cash -150.00 7/1/2011 Estate of Sea... DEP SSI Other Inc 311.00 7/1/2011 Estate of Sea... DEP Social Security Other {nc 383.00 7/1/2011 Estate of Sea... DEP SSP Other Inc 22.10 7/1/2011 Estate of Sea... 783 Cash Fair Share -375.00 Register Report - 2011 1 /1 /2011 through 12/31/2011 1/9/2012 Page 2 Date Account Num Description Memo Category Clr Amount 7119/2011 Estate of Sea... 784 Comcast Cable Utilities:Cable ... -71.97 7!20/2011 Estate of Sea... 785 Cash Cash -150.00 8/1!2011 Estate of Sea... DEP SSI Other Inc 40.00 8/1/2011 Estate of Sea... DEP SSP Other Inc 22.10 8/1/2011 Estate of Sea... 786 Cash Fair Share -375.00 8/3/2011 Estate of Sea... DEP Social Security Other Inc 383.00 8/5/2011 Estate of Sea.., 787 Cash Cash -150.00 8/16/2011 Estate of Sea... 788 Kilmore Eye ... Medical -130.00 8/18/2011 Estate of Sea... 789 Comcast Cable Utilities:Cable ... -23.15 8/25/2011 Estate of Sea.., 790 Kilmore Eye ... Medical -276.00 8/29!2011 Estate of Sea... 791 Dr. Brown DDS Medical -83.00 9/1/2011 Estate of Sea... DEP SSI Other Inc 311.00 9!112011 Estate of Sea... DEP SSP Other Inc 22.10 9/1!2011 Estate of Sea... 792 Cash Fair Share -375.00 9/2/2011 Estate of Sea... DEP Social Security Other Inc 383.00 9/6/2011 Estate of Sea... 793 Cash Cash -150.00 9/19/2011 Estate of Sea... 794 Comcast Gable Utilities:Cable ... -23.15 9/30/2011 Estate of Sea... DEP SSI Other Inc 311.00 9!30/2011 Estate of Sea... 795 Cash Cash -150.00 9/30/2011 Estate of Sea... DEP SSP Other Inc 22.10 10/3/2011 Estate of Sea... DEP Social Security Other Inc 383.00 10/3/2011 Estate of Sea... 796 Cash Fair Share -375.00 1018/2011 Estate of Sea... 797 Cash Cash -150.00 1 011 9/201 1 Estate of Sea... 798 Comcast Cable Utilities:Cable ... -23.15 11!1/2011 Estate of Sea... DEP SSI Other Inc 311.00 11/1!2011 Estate of Sea... DEP SSP Other Inc 22.10 11/1/2011 Estate of Sea... 799 Cash Fair Share -375.00 11/3/2011 Estate of Sea... DEP Social Security Other Inc 383.00 11/11 /2011 Estate of Sea... 800 Cash Cash -150.00 11/19/2011 Estate of Sea... 801 Comcast Cable Utilities:Cable ... -23.15 11/29/2011 Estate of Sea... 802 Cash Cash -150.00 12/1/2011 Estate of Sea... DEP SSI Other Inc 311.00 12/1/2011 Estate of Sea... DEP SSP Other Inc 22.10 12/112011 Estate of Sea... 803 Cash Fair Share -375.00 12/2/2011 Estate of Sea... DEP Social Security Other Inc 460.00 12/15/2011 Estate of Sea... 804 Sirius Entertainment -159.83 12!15/2011 Estate of Sea... 805 Comcast Cable Utilities:Cable ... -23.15 12/21/2011 Estate of Sea... 806 Reebok Clothing -19.99 12/23/2011 Estate of Sea... 807 Cash Cash -150.00 12/28/2011 Estate of Sea... 808 Best Buy Entertainment -125.46 12/30/2011 Estate of Sea... DEP SSI Other Inc 314.00 12/30/2011 Estate of Sea... DEP SSP Other Inc 22.10 _ 111 /2011 -12131 /2011 -- -- - ~- - -_ ~ ~ - -_~ - -155.47 BALANCE 12i311Z011 1,349.06 TOTAL INFLOWS 8,617.20 i TOTAL OUTFLOWS -8,772.67 TOTAL -155.47 DATE PAYEE REASON Balance as c 12/31/2010 1/1/11 Red Lobsters/b12/30/10) dinner 1/1/11 Applebee's dinner 1!2/11 cash pd for ticket Globetrotters 1/4/11 McDonald's shake 116/11 cash Spending money 1 /6/11 Fye DVD 1/7/11 Bob Evans dinner 1/9/11 Friendly's dinner 1/12/11 Sandwichman dinner 1/15111 cash Spending money 1115111 McDonatd's Punch 1/15/11 Genova's dinner 1/16/11 Burger King lunch 1/16/11 Gilligan's dinner 1/22!11 M&J's Pizza dinner 1/30/11 cash soda 1!31/11 Turkey Hill baseball magazine 2/3/11 cash haircut 2/6/11 Capitol Diner dinner 2/7111 cash newspaper 2/7/11 Giant word find puzzle bks 2/8/11 Sears coat 2110/11 Gilligan's lunch 2/10/11 Bob Evans dinner 2/11/11 Pizzatown USA lunch 2/11111 Giant prescription medicine 2/12/11 Skyline Diner dinner 2/17/11 McDonald's lunch 2/17/11 cash Spending money 2/19/11 Subway 2/19/11 Friendly's ice cream sundae 313/11 Weis CD/magazine 3/5/11 Giltigan's dinner 3/8/11 Best Buy CD/DVD 319/11 Weis card 3/11111 Skyline Diner dinner 3/12/11 Buffets, Inc dinner 3/15/11 cash haircut 3/16/11 Weis magazine 3/17/11 Burger King lunch 3/19111 Yankee Doodle Diner dinner 3/25/11 cash Spending money 3/26111 McDonald's milkshake 3/27/11 Subway dinner 3/23!11 Giant magazine 4/2/11 Midtown Pizza dinner 4/2/11 Friendly's ice cream sundae 4/3/11 Gilligan's dinner Deposits Withdrawals $ 19.60 20.14 $ 22.16 $3.07 $ 150.00 $ 150.00 $ $ $ 61.46 14.49 17.67 7.31 8.03 20.00 3.79 18.38 8.20 2.00 8.47 10.00 26.80 2.00 8.33 23.99 13.08 12.60 6.35 1.10 16.04 5.38 $ 150.00 $ 150.00 $ $ $ 7.10 5.93 12.18 13.88 37.07 2.64 13.07 11.31 10.00 3.13 3.06 15.42 2.96 5.30 5.78 21.01 a.6s 10.50 CASH ON HAND $91.40 $ 71.80 $ 51.66 $ 29.50 $ 26.43 $ 176.43 $ 114.97 $ 100.48 $ 82.81 $ 75.50 $ 225.50 $ 217.47 $ 197.47 $ 193.68 $ 175.30 $ 167.10 $ 165.10 $ 156.63 146.63 $ 119.83 $117.83 $ 109.50 $ 85.51 $ 72.43 $59.83 $ 53.48 $ 52.38 $ 36.34 $ 30.96 $ 180.96 $ 173.86 $ 167.93 $ 155.75 $ 141.87 $ 104.80 $ 102.16 $ 89.09 $ 77.78 $ 67.78 $ 64.65 $ 61.59 $ 46.17 $ 196.17 $ 193.21 $ 187.91 $ 182.13 $ 161.12 $ 156.46 $ 145.96 4/9/11 Capitol Diner dinner $ 11.53 $ 134.43 4!10/11 Champions dinner $ 14.30 $ 120.13 4/12/11 Giant magazine $ 6.94 $ 113.19 4/15/11 Skyline Diner dinner $ 17.60 $ 95.59 4/16/11 Ollie's pens/book $ 12.70 $ 82.89 4/21/11 cash haircut $ 10.00 $ 72.89 4121/11 Bleacher Bums shirt $ 25.00 $ 47.89 4!21/11 Fye CD $ 14.83 $ 33.06 4120111 cash Spending money $ 150.00 $ 183.06 4/21 /11 Sears clothes/shoes $ 77.47 $ 105.59 4123/11 Bob Evans dinner $12.90 $ 92.69 4/26111 Giant magazine $ 6.30 $ 86.39 4127/11 cash soda $ 0.65 $ 85.74 4/27/11 Kmart WII game $ 15.89 $ 69.85 4/27/11 Kmart shoes $ 22.49 $ 47.36 4/28/11 Skyline Diner dinner $ 11.87 $ 35.49 4!29111 cash Spending money $ 200.00 $ 235.49 4/30/11 cash RipkenStadium(food/rm $ 105.34 $ 130.15 5/1/11 Genova's dinner $ 11.03 $ 119.12 5!2/11 Giant prescription(medicine $ 3.30 $ 115.82 5/2/11 Giant card $ 2.85 $ 112.97 5/5/11 cash fund raiser $ 5.00 $ 107.97 5/6/11 Kmart shorts/ointment/card $ 29.60 $ 78.37 5/7/11 McDonald's lunch $ 4.02 $ 74.35 5/19/11 Friendly's dinner $ 23.15 $ 51.20 5121/11 cash Spending money $ 150.00 $ 201.20 5!21111 Hoss's dinner $ 11.53 $ 189.67 5/27/11 Subway dinner $ 7.04 $ 182.63 5/28/11 Bob Evans dinner $ 14.70 $ 167.93 5/30/11 Cross Keys Diner dinner $ 11.66 $ 156.27 5130/11 Dollar General books/snack $ 6.59 $ 149.68 612111 McDonald's lunch $ 2.32 $ 147.36 6/3/11 cash haircut $ 10.00 $ 137.36 6/3/11 Camp Hill Diner dinner $ 13.82 $ 123.54 6/4111 cash hot dog/soda $ 3.00 $ 120.54 6/5/11 AAA Convenience soda $ 1.79 $ 118.75 6!9/11 McDonald's lunch $ 2.52 $ 116.23 6/11/11 Giant wiffle bait/card $ 4.02 $ 112.21 6/12/11 Skyline Diner dinner $ 12.00 $ 100.21 6118/11 cash 66 tournament $ 52.48 $ 47.73 6/21/11 Weis CD/magazine $ 12.18 $ 35.55 6/25/11 cash Spending money $ 150.00 $ 185.55 6/25/11 Subway dinner $ 7.10 $ 178.45 6/26/11 McDonald's dinner $ 4.64 $ 173.81 6/30/11 McDonald's lunch $ 3.58 $ 170.23 7/2/11 Big Lots games/lighthouse $ 16.96 $ 153.27 7/2/11 Ollie's scrabble game $ 13.77 $ 139.50 7/3/11 McDonald's lunch $ 3.38 $ 136.12 7/3/11 Subway dinner $ 5.30 $ 130.82 7/4/11 Giant magazine $ 6.30 $ 124.52 7/7111 McDonald's lunch $ 7.19 $ 117.33 7/9111 Gi{iigan's lunch $ 12.00 $ 105.33 7/9/11 Subway 7110/11 Bob Evans 7116/11 Epic Buffet 7/17/11 cash 7/17/11 Villa Roma 7/18/11 Weis 7119/11 Giant 7!20!11 cash 7120111 cash 7/20!11 ToysRus 7/22/11 Friendly's 7/30111 Giant 7!30/11 Capitol Diner 7/31/11 cash 7/31/11 Tommy's Pizza 8/5/11 cash 8/6111 Toninos 8/8111 Sears 8/8!11 Bleacher Sums 8/12!11 Weis 8/14/11 McDonald's 8/17/11 Giant 8/21/11 Champions 8/21/11 Dollar General 8/21/11 McDonald's 8128111 Denny's 8/29111 Jake's Seafood 8/30/11 McDonald's 8/31/11 Jennies Diner 9/4/11 Subway 9/6/11 cash 9!10/11 cash 9/14/11 Giant 9/8111 cash 9112/11 Weis 9115/11 cash 9122/11 McDonald's 9124/11 Jumbo Buffet 9/25/11 Camp Hilt Diner 9/28/11 Kmart 9/28/11 Subway 9/30/11 cash 9!30111 ToysRus 10/1/11 Capitol Diner 10!2/11 Red Lobster 10/5/11 Barnes & Noble 10/8/11 Angie's Family Rest 10/8!11 cash 10/9/11 Tonino's Pizza 1019111 cash 10/11/11 Bob Evans 10/14/11 GiNigan's dinner dinner dinner hot dog dinner magazine pens haircut Spending money WII game Dinner prescription medicine Dinner baseball game8~food Dinner Spending money $ pizza Clothes notebook magazine dinner mag/itunes/b'daycard/batteries lunch puzzle book. fish fillet dinner dinner dinner dinner lunch Spending money $ mets game-food-etc magazine haircut card gift shake dinner dinner baseball cards lunch Spending money $ DSI/WII game dinner dinner book $150.00 5.30 16.29 23.31 1.00 6.75 3.71 2.95 10.00 $ 74.17 $ 13.75 $ 3.30 $ 14.14 $ 25.00 $ 8.05 150.00 150.00 150.00 6.63 16.66 3.18 3.71 6.02 34.42 13.24 1.06 3.70 13.64 26.00 6.98 11.28 7, 53 94.11 3.17 10.00 2.96 25.00 3.06 15.50 10.18 5.29 5.30 $ 52.98 $ 11.00 $ 23.00 $ 42.40 $ 13.87 Spending money $ 150.00 lunch $ 8.22 gift $ 25.00 dinner $ 13.00 lunch $ 10.00 100.03 83.74 60.43 59.43 52.68 48.97 46.02 36.02 186.02 111.85 98.10 94.80 80.66 55.66 47.61 197.61 190.98 174.32 171.14 167.43 161.41 126.99 113.75 112.69 108.99 95.35 69.35 62.37 51.09 43.56 193.56 99.45 96.28 86.28 83.32 58.32 55.26 $39.76 29.58 24.29 18.99 168.99 116.01 105.01 82.01 39.61 25.74 175.74 167.52 142.52 129.52 119.52 10/15/11 John's Diner dinner $ 15.13 $ 104.39 10!22/11 Giant prescription(medicine $ 1.10 $ 103.29 10/22!11 Friendly's dinner $ 11.59 $ 91.70 10/23/11 Hoss's dinner $ 12.64 $ 79.06 10/31/11 McDonaid's dinner $ 6.12 $ 72.94 10/9/11 Ollie's puzzle book $ 11.60 $ 61.34 11/2/11 cash haircut $ 10.00 $ 51.34 11!5/11 Subway dinner $ 5.30 $ 46.04 1116111 Capitol Diner dinner $ 21.56 $ 24.48 11/11/11 Old Country Buffet dinner $ 9.62 $ 14.86 11/11!11 cash Spending money $ 150.00 $ 164.86 11/19/11 Subway lunch $ 5.18 $ 159.68 11/25/11 Pizzatown USA lunch $ 7.53 $ 152.15 11/26/11 John's Diner ice cream sundae $ 4.73 $ 147.42 11/27/11 Walmart CD $ 15.78 $ 131.64 11/27/11 Kmart WII game $ 31.79 $ 99.85 11/29/11 cash Spending money $ 150.00 $ 249.85 12/1/11 Walmart clothes/various items $ 57.43 $ 192.42 12/2/11 Friendly's dinner $ 14.71 $ 177.71 12/3/11 Denny's dinner $ 9.73 $ 167.98 12/8/11 Bleacher Bums omaments(baseball) $ 12.72 $ 155.26 12/8/11 ToysRus WII game $ 39.75 $ 115.51 12/8111 McDonald's shake $ 3.06 $ 112.45 12/8/11 Ollie's puzzle book $ 2.72 $ 109.73 12!9111 Midtown Pizza dinner $ 10.48 $ 99.25 12/10/11 Capitol Diner dinner $ 13.64 $ 85.65 12/17/11 Boro Bar & Grill dinner $ 11.22 $ 74.39 12/18/11 Kmart gift $ 10.59 $ 63.80 12/20!11 cash haircut $ 10.00 $ 53.80 12/21/11 Tommy's Pizza lunch $8.04 $ 45.76 12/22/11 Hoss's lunch $ 13.64 $ 32.12 12/23/11 cash Spending money $ 150.00 $ 182.12 12/24/11 cash gifts $ 30.00 $ 152.12 12/26/11 Perkins Rest dinner $ 16.18 $ 135.94 12/28/11 Rockin Brew lunch $ 10.50 $ 125.44 12!31!11 McDonald's lunch $ 4.12 $ 121.32 Sean Matthew Dosiak Trust 1/912012 6:54 PM Register: Sean Matthew Dosiak Trust From 01 /01 /2011 through 12/31 /2011 Sorted by: Date, Type, N umber/Ref Date Number Payee Account Memo Payment C Deposit Balance 01/14/2011 DEP CD Interest Trust interest 0.82 15,421.80 01/19/201 I 1075 Register of Wills filing fee expense 15.00 15,406.80 01/19/2011 1076 Sharon Dosiak preparation court report expense 300.00 15,106.80 02/17/2011 DEP CD Interest Trust interest 0.85 15,107.65 02/21/2011 1077 Staples ink for printer/mouse expense 64.20 15,043.45 02/23/2011 1078 Integrity Bank to open money market transfer from ... 10,000.00 5,043.45 03/17/2011 dep CD Interest Trust interest 0.77 5,044.22 03/18/2011 1074 Pa. Dept.Revenue taxes taxes 2.00 5,042.22 03!18!2011 1080 US Postal Service Postage and Delivery postage 11.25 5,030.97 03/25/2011 1081 Stiteler & Associates ... tax preparation tax preparation 35.00 4,995.97 04/15/2011 dep CD Interest Trust interest 0.85 4,996.82 04!18!201 l dep CD Interest Trust interest 0.03 4,996.85 05/17/2011 1082 US Postal Service Postage and Delivery postage 5.59 4,991.26 06/07/201 I 1083 United States Treasury taxes taxes 180.80 4,810,46 06/07/2011 1084 US Postal Service Postage and Delivery postage 5.54 4,804.87 06/09/2011 dep IRS refund tax refund income 181.12 4,985.99 07/24/2011 1085 Office Max ink for printer expense 32.85 4,953.14 10/12/2011 dep Equitrust Life I Prem... Trust interest 1,845.00 6,798.14 12/17/2011 1086 Billie Jo Snyder reimbursement for IPad... expense 854.33 5,943.81 Page 1 SEAN MATTHEW DOSIAK TRUST FUNDS ANNUITY ACCOUNT WITH EQUITRUST. Balance $87,092.92. CLOSED MONEY MARKET ACCOUNT WITH AMERICAN FUNDS IN THE AMOUNT OF X7,770.59 ON 11/1/10 PUT IN CITIZEN'S BANK CHECKING IN THE AMOUNT $7 770 59 ON 11/I/10. TRANSFERRED $10,000 FROM CITIZEN'S TO A MONEY MARKET ACCOUNT AT_INTEGRITY BANK ON 2/23/2011 CLOSED CERTICATE OF DEPOSIT WITH CITIZEN'S BANK IN THE AMOUNT OF $10 000 75 TRANSFERRED TO A MONEY MARKET ACCOUNT AT INTEGRITY BANK ON 4/19/11 INTEGRITY BANK MONEY MARKET AMOUNT $20.000.75 INTEREST 75.29 TOTAL $20 076.04 We certify that the above is an accurate report of the income and expenses of the guardian account. The needs of the incapacitated person as set forth above, included expenses for Sean, including trips, vacations, and recreations. Sean resides at 100 N. Second Street, Mechanicsburg PA 17055 with his mother and father. He continues to take Dilantin medication to control his seizures. Sean still goes to Dr. James. He has a Dilantin level test and liver test every six months. His eye doctor is Dr. Kihnore. He goes to the eye doctor every six months. His dentist is Dr. Brown, he goes every six months.. We take him to dinner or lunch on the weekends and shopping. He spends time with his sister and family. He goes to church with his sister. He does different activities with his sister and nephew. We take him to his nephew's sporting games (baseball, basketball, soccer, etc.) We took him to Allentown Pa. and Maryland to watch our grandson play baseball on the GoWags traveling team. We went to Washington DC for a baseball game with the Mets. His sister and family took him to New York to see a Mets game for his birthday. He enjoys TV, word fine puzzles, listening to music, and watching his movies. Sean went to the movies with his sister and family. Sean is with his parents during the day. I feel the guardianship should be continued. The reason being, Sean is mentally deficient from birth due to malpractice of a physician and cannot manage his affairs, make medical decisions, or take care of himself. We feel as Sean's parents that we have an understanding for Sean and his needs. William R. Dosiak 100 N. Second Street Mechanicsburg PA 17055 .-~-,~~ i Sharon Dosiak 100 N. Second Street Mechanicsburg PA 17055 Distribution: Clerk of Orphan's Court COMMONWEALTH OF PENNSYLVANIA SS COURT OF COMMON PLEAS On this, the IQ~ day of JaA gCtfy ~ao~a, before me, a notary public in and for the County of Cumberland, Commonwealth of Penhsylvania, the undersigned officer, personally appeared William R. Dosiak and Sharon Dosiak, known to me (of satisfactory proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for purposes therein contained. IN WITNESS WHEREOF, I HEREUNTO SET MY HAND AND OFFICIAL SEAL. ~~ Notary Public - CAMMONWEALTH OF PENNSYLVANIA NotaAa15ea1 Robert Mesarick, Notary Public Mechanicsburg Boro, Cumberland County My Commissbn Expires ]an. 5, 2015 MEMBER, PENNSYWANU ASSOQATION OF NOTARIES IN RE: GUARDIANSHIP OF SEAN MATTHEW DOSIAK TO: Clerk of Orphan's Court Courthouse, Carlisle PA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT N0.21-94-393 ANNUAL REPORT OF GUARDIANSHIP OF SEAN MATTHEW DOSIAK Fstate: Sean Matthew Dosiak Guardian.: William R. Dosiak and Sharon Dosiak Period: January 1, 2012- December 31, 2012 Date Filed: This is a report filed with the Court in compliance with Section 5521 (c) of Act 24 of July, 1992, 20 PaCSA 5521. ~ ; ~ ~' rn C ~ . f'~1 G'1 ~ ~7 ~ °~ Q ~z,.r- r*tir~7 ~ ~ m ~ ..,a ;,,s e.:~ x ? ~ c-> a~ ~. C7 C? -..,.o ~ t .~~ F--' ~~~~ ~,~ v~ ~ t._,_ ~ rv co . ~ ~~ ~} Check Register Estate of Sean Matthew Dosiak Page 1 1 /2/2013 Date Num Payee Category Memo Amount C Balance 1!3!2012 DEP Social Security Other Inc 404.00 _.__ 1,753.06 1/3/2012 808 Cash Fair Share -375.00 1,378.06 1/12/2012 DEP Refund RX Ins Refund 4.40 1,382.46 1/12/2012 810 Cash Cash -150.00 1,232.46 1/18/2012 811 Comcast Cable Utilities:Cable ... -23.15 1,209.31 1/3112012 812 Cash Cash -150.00 1,059.31 2/1/2012 DEP SSI Oilier tnc 258.00 1,317.31 2/1/2012 DEP SSP Other Inc 22.10 1,339.41 2/3!2012 DEP Social Security Other Inc 404.00 1,743.41 2/3/2012 813 Cash Fair Share -375.00 1,368.41 2/17/2012 814 Comcast Cable Utilities:Cable ... -23.15 1,345.26 2/29/2012 815 Void 0.00 1,345.26 2/29/2012 816 Dr. Brown DDS Medical -193.00 1,152.26 3/1!2012 DEP SSI Other Inc 314.00 1,466.26 3/1/2012 DEP SSP Other Inc 22.10 1,488.36 3/2/2012 DEP Social Security Other Inc 404.00 1,892.36 3/2/2012 817 Cash Fair Share -375.00 1,517.36 3!4/2012 818 Sears Clothing -55.98 1,461.38 3/7/2012 819 Cash Cash -150.00 1,311.38 3/8/2012 820 New York Mets Entertainment -14.00 1,297.38 3/21/2012 821 Comcast Cable Utilities:Cable ... -23.15 1,274.23 3!23/2012 822 Cash Cash -150.00 1,124.23 3/30/2012 DEP SSI Other Inc 314.00 1,438.23 3/30/2012 DEP SSP Other Inc 22.10 1,460.33 4/2/2012 823 Cash Fair Share -375.00 1,085.33 4/3/2012 DEP Social Security Other Inc 404.00 1,489.33 4/19/2012 824 Comcast Cable Utilities:Cable ... -71.97 1,417.36 4/21/2012 825 Ebbe Xpress Graphics Clothing -13.00 1,404.36 4/27/2012 826 Cash Cash -150.00 1,254.36 5!1!2012 DEP SSI Other Inc 314.00 1,568.36 5/1/2012 DEP SSP Other Inc 22.10 1,590.46 5/1/2012 827 Cash Fair Share -375.00 1,215.46 5/3/2012 DEP Social Security Other Inc 404.00 1,619.46 5/14/2012 828 Comcast Cable Utilities:Cable ... -71.97 1,547.49 5/16/2012 829 WalMart Misc. -72.50 1,474.99 5/17/2012 830 Cash Cash -300.00 1,174.99 5/30/2012 831 Wa1Mart Misc. -168.50 1,006.49 6/1/2012 DEP SSI Other Inc 314.00 1,320.49 6/1/2012 DEP Social Security Other Inc 404.00 1,724.49 6/1/2012 DEP SSP Other tnc 22.10 1,746.59 6/1/2012 832 Cash Fair Share -375.00 1,371.59 6/15/2012 833 Cash Cash -150.00 1,221.59 6/15/2012 834 Comcast Cable Utilities:Cable ... -71.97 1,149.62 6/17/2012 835 WalMart Misc. -108.39 1,041.23 6/29/2012 DEP SSI Other Inc 314.00 1,355.23 6/29/2012 DEP SSP Other Inc 22.10 1,377.33 7/1/2012 836 Cash Fair Share -375.00 1,002.33 7/3/2012 DEP Social Security Other Inc 563.00 1,565.33 7/17/2012 837 Comcast Cable Utilities:Cable ... -71.97 1,493.36 7/17/2012 838 Cash Cash -150.00 1,343.36 7!22/2012 839 WalMart Entertainment -252.20 1,091.16 8/1!2012 DEP SSI Other Inc 314.00 1,405.16 8/1/2012 DEP SSP Other Inc 22.10 1,427.26 8/1/2012 840 Cash Fair Share -375.00 1,052.26 8/3/2012 DEP Social Security Other Inc 563.00 1,615.26 8!13/2012 841 Cash Cash -150.00 1,465.26 8/17/2012 842 Comcast Cable Utilities:Cable ... -22.15 1,443.11 8!17/2012 843 Kilmore Eye Assoc Medical -130.00 1,313.11 8!20/2012 844 Cash Cash -150.00 1,163.11 8/22/2012 845 Dr. Brown DDS Medical -132.00 1,031.11 8/31/2012 DEP Social Security Other Inc 563.00 1,594.11 8/31/2012 DEP SSI Other Inc 155.00 1,749.11 8/31/2012 DEP SSP Other Inc 22.10 1,771.21 8/31/2012 846 Cash Fair Share -375.00 1,396.21 Check Register Estate of Sean Matthew Dosiak Page 2 1/2/2013 Date Num Payee Category Memo Amount C Balance 9/6/2012 847 Cash Vacation -300.00 1,096.21 9/20/2012 848 Comcast Cable Utiiities:Cabie ... -22.15 1,074.06 10/1/2012 DEP SSI Other Inc 155.00 1,229.06 10!1/2012 DEP SSP Other Inc 22.10 1,251.16 10/1/2012 DEP Social Security Other Inc 563.00 1,814.16 10!1/2012 849 Cash Fair Share -375.00 1,439.16 10!9!2012 850 Cash Cash -150.00 1,289.16 10/25/2012 851 Comcast Cable Utilities:Cable ... -22.15 1,267.01 11/1/2012 DEP SSI Other Inc 155.00 1,422.01 11/1/2012 DEP SSP Other Inc 22.10 1,444.11 1 1 /212 0 1 2 DEP Social Security Other Inc 563.00 2,007.11 11!2!2012 852 Cash Fair Share -375.00 1,632.11 11/2/2012 853 Cash Cash -150.00 1,482.11 11/19/2012 854 Cash Cash -150.00 1,332.11 11/20/2012 855 Comcast Cable Utilities:Cable ... -22.15 1,309.96 11!20/2012 856 Sears Clothing -113.91 1,196.05 11!2912012 857 Sears Misc. -28.61 1,167.44 11/30/2012 DEP SSI Other Inc 155.00 1,322.44 11/30/2012 DEP SSP Other Inc 22.10 1,344.54 12!3/2012 DEP Social Security Other Inc 575.00 1,919.54 12/3/2012 858 Cash Fair Share -375.00 1,544.54 12/11/2012 859 Best Buy Entertainment -164.27 1,380.27 12/12!2012 860 XM Satellite Radiio Entertainment -177.01 1,203.26 12/15/2012 861 Best Buy Entertainment -15.89 1,187.37 12/17/2012 862 Comcast Cable Utilities:Cable... -22.15 1,165.22 12/18/2012 863 Cash Cash -150.00 1,015.22 12/31/2012 DEP SSI Other Inc 165.00 1,180.22 12/31/2012 DEP SSP Other Inc 22.10 1,202.32 DATE PAYEE REASON Balance as c 12/31/2011 1/1/2012 Walmart tote bag/wii game 1!1/2012 Chili's lunch 1/7/2012 TGI Friday's lunch 1/8/2012 cash church offering 1/10/2012 Tommy's Pizza lunch 1!12!2012 cash spending money 1/14/2012 cash raffle ticket 1/15/2012 Friendly's dinner 1/19/2012 Walmart carrying case/cleaner 1!22!2012 Giant prescription 1/22/2012 Mc Donald's dinner 1/26/2012 Mc Donald's dinner 112 812 0 1 2 Subway lunch 1!29!2012 Soda Jerk dinner 1/30/2012 cash haircut 1/31/2012 Giant magazine 1131/2012 cash spending money 2/2!2012 Soda Jerk dinner 2/4/2012 cash Globetrotters ticket 2/4/2012 cash pizza @sister's 214/2012 cash Itunes card Toysrus 2!10!2012 Walmart socks/tote box 2/10/2012 Mc Donald's lunch 2/12/2012 Giant dinner 2/12/2012 Burger King lunch 2!1812012 Mc Donald's lunch 2/23/2012 Mc Donald's lunch 2/25/2012 cash hot dog 2126/12 Heath Cafe lunch 2!27!12 Cafe in Atrium lunch 2/28/12 Summit family rest. dinner 2/28/12 Mc Donald's lunch 3!2112 Bob Evans dinner 3/3(12 Perkins Rest dinner 3/7/12 cash spending money 3/7/12 Fye Itunes card/CD 317112 Gamestop game for wii 3/7!12 Giant card 3/10/12 Zeiderelli's lunch 3/11/12 Red Robin lunch 3116112 Capitol Diner dinner 3/16/12 Fire Mountain lunch 3/17/12 Mc Donald's shake 3!18/12 Perkins Rest dinner 3119112 cash haircut 3/22/12 Gilligan's lunch 3/23/12 Boulevard Cafe snack 3/23/12 cash spending money Deposits Withdrawals $ 37.03 $ 8.97 $ 17.00 $ 2.00 $ 6.10 $ 150.00 $ 150.00 $ 150.00 $ 150.00 4.00 12.59 38.08 1.10 5.08 3.70 7.10 20.41 10.00 8.47 14.62 28.00 10.00 30.00 17.01 4.71 4.77 3.71 4.97 4.23 3.00 7.40 3.16 13.11 4.23 12.60 14.17 40.89 42.39 1.05 8.48 15.23 9.53 8.14 3.06 13.65 10.00 12.00 6.50 CASH ON HAND $121.32 $ 8429 $ 75.32 $ 58.32 $ 56.32 $ 50.22 $ 200.22 $ 196.22 $ 183.63 $ 145.55 $ 144.45 $ 139.37 $ 135.57 $ 128.57 $ 108.16 $ 98.16 $ 89.69 $ 239.69 $ 225.07 $ 197.07 $ 187.07 $ 157.07 $ 140.06 $ 135.35 $ 130.58 $ 126.87 $ 121.90 $ 117.67 $ 114.67 $ 107.27 $ 104.11 $ 91.00 $ 86.77 $ 74.17 $ 60.00 $ 210.00 $ 169.11 $ 126.72 $ 125.67 $ 117.19 $ 101.96 $ 92.43 $ 84.29 $ 81.23 $ 67.58 $ 57.58 $ 45.58 $ 39.08 $ 189.08 3/25/12 Sheetz sub sandwich $ 4.01 $ 185.07 3/27/12 Mc Donald's shake $ 3.06 $ 182.01 3/31112 cash tournament shirt $ 10.00 $ 172.01 3/31/12 cash hot dog $ 1.50 $ 170.51 3131/12 Applebee's dinner $ 16.47 $ 154.04 3/31/12 Rutter's orange juice $ 1.90 $ 152.14 3131112 cash (LaQuinta) lodging $ 24.38 $ 127.76 4!1/12 Marino's Pizza dinner $ 15.01 $ 112.75 4/3/12 Gamestop WII GAME $ 42.39 $ 70.36 4/5/12 Mc Donald's lunch $ 4.85 $ 65.51 419/12 Range End Golf driving range $5.00 $ 60.51 4!15(12 Subway Vunch $ 6.10 $ 54.41 4/18/12 Friendly's dinner $ 12.59 $ 41.82 4/21!12 Giant prescription $ 1.10 $ 40.72 4!21/12 Rita's Italian ice $ 2.75 $ 37.97 4125/12 Two cousins pizza Sub & soda $ 8.22 $ 29.75 4/27/12 Mc Donald's dinner $ 3.79 $ 25.96 4/27/12 cas spending money $ 150.00 $ 175.96 4/28/12 Subway Sub & soda $ 5.94 $ 170.02 4/28/12 Burger King whopper $ 3.81 $ 166.21 5/1/12 Big Lots soda $ 1.54 $ 164.67 5/1/12 Kmart clothes $ 16.79 $ 147.88 5/1/12 Dollar Tree cards $ 1.06 $ 146.82 5/1112 Duke's lunch $ 15.20 $ 131.62 5/3/12 cash haircut $ 10.00 $ 121.62 515/12 Subway lunch $ 5.30 $ 116.32 516112 Jumbo Buffet dinner $ 15.75 $ 100.57 5/7(12 Giant BB cards $ 5.29 $ 95.28 5/16/12 Gamestop WII GAME $ 31.79 $ 63.49 5/16/12 Mc Donald's shake $ 3.06 $ 60.43 5117112 cash spending money $ 300.00 $ 360.43 5/18/5/21 BB tournament food & lodging $ 197.55 $ 162.88 5/25/12 Giant batteries/bb bat/ball $ 13.01 $ 149.87 5/26/12 cash shirt $ 13.00 $ 136.87 5!26/12 Bob Evans dinner $ 14.91 $ 121.96 5/27/12 Sandwich Man dinner $ 6.10 $ 115.86 6/1/12 Giant Chinese food $ 8.75 $ 107.11 6/1/12 Giant magazine/bug spray $ 12.14 $ 94.97 613112 Vif1a Roma dinne' $ 10.55 $ 84.42 6!7/12 Subway lunch $ 7.21 $ 77.21 6/8/12 cash haircut $ 10.00 $ 67.21 6/9/12 cash hot dog $ 1.00 $ 66.21 6/9!12 Duke's dinner $ 21.77 $ 44.44 6/10/12 John's Diner dinner $ 14.37 $ 30.07 6/15112 cash golf $ 10.00 $ 20.07 6/15/12 cash spending money $ 150.00 $ 170.07 6116/12 Weis misc $ 4.76 $ 165.31 6!17/12 Ollie's BB cards/game $ 6.87 5 158.44 6/17/12 Wendy's lunch $ 4.85 $ 153.59 6120/12 Mc Donald's lunch $ 8.25 $ 145.34 6/21!12 Mc Donald's lunch $ 7.19 $ 138.15 6/23/12 Subway lunch $ 5.30 $ 132.85 6/24/12 Burger King lunch $ 5.17 $ 127.68 6/24!12 Wendy's cheeseburger $ 5.07 $ 122.61 6/26112 Giant bat and ball $ 3.97 $ 118.64 6!30/12 Mc Donald's lunch $ 2.64 $ 116.00 7/1/12 Jumbo Buffet dinner $ 16.25 $ 99.75 7/4/12 Soda Jerk lunch $ 11.44 $ 88.31 7/5/12 Mc Donald's lunch $ 4.45 $ 83.86 7!6(12 Subway lunch $ 7.10 $ 76.76 7/7/12 Duke's lunch $ 14.19 $ 62.57 7/10/12 cash hot dog $ 1.00 $ 61,57 7/14!12 Giant sub $ 6.35 $ 55.22 7/15/12 Burger King lunch $ 4.32 $ 50.90 7/15/12 Red Lobster dinner $ 17.89 $ 33.01 7/17/12 Giant BB cards $ 5.29 $ 27.72 7117112 cash spending money $ 150.00 $ 177.72 7!21!12 Giant prescription $ 1.10 $ 176.62 7/22/12 Dollar Tree pens/cardslmisc $ 5.83 $ 170.79 7/22/12 Mc Donald's lunch $ 2.43 $ 168.36 7/22112 Waimart sub $ 5.81 ~ 162.55 7/26/12 cash haircut $ 10.00 $ 152.55 7/27/12 Wegman's sub $ 4.50 $ 148.05 7/29/12 Friendly's dinner $ 15.56 $ i 32.49 8/3/12 Gettysburg Museum Store name sign $ 4.23 $ 128.26 8/3/12 Gettysburg Foundation ticket $ 8.00 $ 120.26 8/4/12 Hoss's dinner $ 18.51 $ 101.75 8/5/12 Lower Allen Diner dinner $ 5.95 $ 95.80 8110/12 Bob Evans dinner $ 15.23 $ 80.57 8/11/12 Walmart game for wii and dsi $ 37.06 $ 43.51 8/11/12 Subway lunch $ 5.51 $ 38.00 8/13/12 cash spending money $ 150.00 $ 188.00 8/13/12 Giant magazine $ 3.71 $ 184.29 8114/12 Dollar Tree puzzle books $ 2.12 $ 182.17 8/15/12 Ross lamp $ 13.77 $ 168.40 8/15/12 Best Buy Alf dud's $ 63.57 $ 104.83 8/15/12 Best Buy micromax bal from card $ 0.59 $ 104.24 8/16!12 cash fund raiser $ 12.00 $ 92.24 8!18/12 cash gift $ 20.00 $ 7224 8/18/12 Red Lobster dinner $ 17.89 $54.35 8/20/12 cash spending money $ 150.00 $ 204.35 8/21/12 Mc Donald's dinner $ 6.24 $ 198.11 8/23/12 Burger King lunch $ 6.14 $ 191.97 8/26/12 Wendy's sandwich $ 1.37 $ 190.60 8/26/12 Giant Chinese food $ 5.29 $ 185.31 8/29/12 Mc Donald's shake $ 3.17 $ 182.14 8/31/12 cash Sub & soda $ 7.69 $ 174.45 8/13/12 Rita's Italian ice $ 2.55 $ 171.90 9/1/12 Lower Allen Diner dinner $ 12.80 $ 159.10 9/2/12 Wendy's lunch $ 2.73 ~ 156.37 9/6!12 cash vacation $ 300.00 S 456.37 9/8112 Subway IunCh $ 6.89 $ 449.48 9/12!12 cash spent on vacation $ 285.33 $ 164.15 9/15/12 Tonino's Pizza lunch $ 9.07 $ 155.08 9!15/12 cash gift $ 20.00 $ 135.08 9/15/12 cash football game $ 4.00 $ 131.08 9/15112 Dollar Tree books/card $ 3.71 $ 127.37 9/16/12 Red Lobster dinner $ 22.00 $ 105,37 9!25/12 Weis magazine $ 6.88 $ 98.49 9/26/12 Mc Donald's dinner $ 4.54 $ 93.95 9!28/12 Subway lunch $ 7.10 $ 86.85 9130/12 Wendy's Punch $ 3.49 $ 8336 9/30/12 cash football game $ 2.00 $ 81.36 10/4/12 Mc Donald's lunch $ 6.14 $ 75.22 10/6/12 Ruby Tuesday dinner $ 25.77 $ 49.45 10/7!12 cash football button $ 1.57 $ 47.88 10/7/12 Bob Evans dinner $ 15.12 $ 32.76 10/8/12 Mc Donald's lunch $ 3.80 $ 28.96 1019112 CASH spending money $ 150.00 $ 178.96 10/9/12 Friendly's dinner $ 13.00 $ 165.96 10/10/12 cash haircut $ 10.00 $ 155.96 10/12/12 Subway lunch $ 6.04 $ 149.92 10/12/12 cash gift $ 20.00 $ 129.92 10/12/12 Mc Donald's shake $ 3.17 $ 126.75 10/13/12 Bob Evans dinner $ 13.53 $ 113.22 10/14/12 Mc Donald's shake $ 3.17 $ 110.05 10!14112 Resslers Bagel Shop bagel/juice $ 3.34 $ 106.71 10/14/12 Walmart storage boxes $ 10.54 $ 96.17 10/15/12 Wendy's lunch $ 3.49 $ 92.68 10/15/12 John's Diner dinner $ 11.42 $ 81.26 10/16/12 Weis magazine $ 3.17 $ 78.09 10/17/12 cash sub $ 4.00 $ 74.09 10/19/12 Wendy's lunch $ 5.38 $ 68.71 10/20/12 Burger King lunch $3.81 $ 64.90 10120!12 Mc Donald's dinner $ 3.80 $ 61.10 10/21/12 Subway lunch $ 4.45 $ 56.65 10/24/12 Giant prescription ~ $ 1.10 $ 55.55 10!25!12 Subway lunch $ 7.10 $ 48.45 10/30/12 TGI Friday's lunch $ 13.74 $ 34.71 11/1/12 Giant magazine $ 3.71 $ 31.00 11/2/12 pizza shop lunch $ 7.69 $ 23.31 11/2/12 Friendly's dinner $ 12.59 $ 10.72 11/2112 cash spending money $ 150.00 $ 160.72 11/4112 Skyline Family rest. dinner $ 16.09 $ 144.63 11/4/12 Target tee shirts $ 13.99 $ 130.64 11/7/12 CVS skin lotion $ 7.20 $ 123.44 11!8/12 Friendly's dinner $ 11.05 $ 112.39 11/10/12 Walmart Briefs $ 7.47 $ 104.92 11/10/12 4B's Res dinner $ 13.88 $ 91.04 11/11/12 Subway lunch $ 6.04 $ 85.00 11!11!12 TGI Friday's dinner $ 16.18 $ 68.82 11/17/12 Pan Tree dinner $ 14.49 $ 54.33 11/18/12 Tonino's Pizza dinner $ 9.06 $ 45.27 11/19/12 cash spending money $ 150.00 $ 195.27 11!20/12 ABC East lanes bowling $ 17.05 $ 178.22 11/20/12 Mc Donald's lunch $ 6.88 $ 171.34 11/24/12 Subway lunch $ 7.21 $ 164.13 11/25/12 Mc Donald's shake $ 3.17 $ 160.96 11129/12 Walmart haUcandle $ 16.21 $ 144.75 11!30/12 Gilligan's dinner $ 11.19 $ 133.56 12/2/12 cash basketball game $ 2.00 $ 131.56 12/2/12 Burger King lunch $ 4.23 $ 127.33 12/4112 cash haircut $ 10.00 $ 117.33 12/5!12 Mc Donald's lunch $ 5.50 $ 111.83 12/7/12 Gilligan's lunch $ 12.44 $ 99.39 12/8/12 Burger King lunch $ 4.24 $ 95.15 12/9/12 Perkins Rest dinner $ 16.29 $ 78.86 12!11(12 Chick-fil-A lunch $ 6.94 $ 71.92 12/12/12 Pan Tree dinner $ 13.43 $ 58.49 12/15/12 cash basketball game $ 2.00 $ 56.49 12115/12 Jumbo Buffet dinner $ 10.01 $ 46.48 12/16!12 Mc Donald's shake $ 3.17 $ 43.31 12/16/12 Giant /tunes card $ 15.00 $ 28.31 12/18/12 Rite Aid card $ 3.70 ~ 24.61 12/18!12 cash spending money $ 150.00 $ 174.61 12!19!12 Kmart clothes $ 15.99 $ 158.62 12/19/12 Mc Donald's lunch $ 4.23 $ 154.39 12/20/12 John's Diner shake $ 4.41 $ 149.98 12/23/12 cash gifts $ 40.00 $ 109.98 12/30/12 Chili's dinner $ 14.38 $ 95.60 12/31/12 Gilligan's dinner $ 20.98 $ 74.62 Sean Matthew Dosiak Trust Register: Sean Matthew Dosiak Trust From 01/01/2012 through 12/31/2012 Sorted by: Date, Type, Number/Ref Date Number Payee Account Memo Ol /10!2012 1 D87 Register of Wills filing fee expense OTfI 1!2012 1088 Sharon Dosiak preparation court report expense 03(23(2012 closed acct with Citiz... tranfer to Integrity bank transfer 03/28/2012 1001 Pa. Dept.Revenue taxes taxes 03/29/2012 1002 US Postal Service Postage and Delivery postage 03/29/2012 1003 Sliteler & Associates ... tax prepazation tax preparation 03/31 /2012 VOID Equitrust Life I Prem... void check VOID: VOID 04!15/2012 dep Interest 'c'rust interest 05/02/2012 1005 United States Treasury taxes taxes 05/03/2012 1006 US Postal Service Postage and Delivery postage 05/15/2012 DEP Interest Trust INTEREST 06/11/2012 1007 CVS ink for printer expense 06!15/2012 dep Interest Trust INTEREST 07/1512012 dep Interest Trust iNTEREST 08!15!2012 dep lnterest Trust INTEREST 09(15/2012 dep lnterest Trust INTEREST 1 D/11 /2012 dep Equitrust Life I Prem... Trust INTEREST 10/15/2012 DEP Interest Trust IN'['EREST 10/24/2012 1008 Office Max ink for printer expense 11/15/2012 dep lnterest Trust IN'T'EREST 12/15/2012 dep Interest Trust INTEREST Payment C 15.00 300.00 2.00 11.50 35.00 X 143.05 5.75 35.82 42,91 1!2/2013 5:33 PM Deposit Balance 5,928.81 5,628.81 5,628.81 5,626.81 5,615.31 5,580.31 5,580.31 0.65 5,580.96 5,437.9] 5,432.16 0.91 5,433.07 5,397.25 0.92 5,398.17 0.88 5,399.05 0.91 5,399.96 0.91 5,400.87 1,845.00 7,20.5.87 0.94 7,246.8] 7,203.90 1.22 7,205.12 1.18 7,206.30 Page 1 SEAN MATTHEW DOSTAK TRUST FUNDS ANNUITY ACCOUNT WITH EQUITRUST. WAS CLOSED ON 10/18/20121N THE AMOUNT OF $83,849.49 AND OPENED A CERTIFICATE OF DEPOSIT WITH INTEGRITY BANK IN THE AMOUNT OF $83,849.49 TRANSFERRED $10.000 FROM CITIZEN'S TO A MONEY MARKET ACCOUNT AT INTEGRITY BANK ON 2/23/2011 IN THE AMOUNT OF $ ] 0 000 TRANSFERRED $10 000 75 FROM CITIZEN'S BANK CD TO INTEGRITY BANK ON 4/19/2011 TOTAL 20 000 75 TRANSFERRED TOTAL MONEY MARKET- INTEGRITY $20 135 20 TRANSFERRED TRUST CHECKING FROM CITIZEN'S BANK TO A CHECKING ACCOUNT WITH INTEGRITY BANK ON 3123/12 IN THE AMOUNT OF $5 628.81 We certify that the above is an accurate report of the income and expenses of the guardian account. The needs of the incapacitated person as set forth above, included expenses for Sean, including trips, vacations, and recreations. Sean resides at 140 N. Second Street, Mechanicsburg PA 17055 with his mother and father. He continues to take Dilantin medication to control his seizures. Sean still goes to Dr. James. He has a Dilantin level test and liver test every six months. His eye doctor is Dr. Kilmore. He goes to the eye doctor every six months. His dentist is Dr. Brown, he goes every six months.. We take him to dinner or lunch on the weekends and shopping. He spends time with his sister and family. He goes to church with his sister. He does different activities with his sister and nephew. We take him to his nephew's sporting games (baseball, basketball, soccer, etc.) We took him to Ocean City MD for baseball that his nephew was in, also several places he played baseball in Pa. He also had a tournament in MD. He enjoys his WII games and I Pad. We took him to Ocean City, MD for a vacation., Sean is with his parents during the day. I feel the guardianship should be continued. The reason being, Sean is mentally deficient from birth due to malpractice of a physician and cannot manage his affairs, make medical decisions, or take care of himself. We feel as Sean's parents that we have an understanding for Sean and his needs. 111iam R. Dos>ak i 00 N. Second Street Mechanicsburg PA 17055 Shazo~`~L. ~ rv~ 100 N. Second Street Mechanicsburg PA 17055 Distribution: Clerk of Orphan's Court COMMONWEALTH OF PENNSYLVANIA SS COURT OF COMMON PLEAS On this, the 3r`~ day of .~(~l'1 Ult J ~ ~~ before me, a notary public in and for the County of Cumberland, Commonwealth of Pennsylvania, the undersigned officer, personally appeared William R. Dosiak and Sharon Dosiak, known to me (of satisfactory proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for purposes therein contained. IN WITNESS WHEREOF, I HEREUNTO SET MY HAND AND OFFICIAL SEAL. Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Barbara L. Tome, Notary Public Camp HIII Boro, Cumberland County My Commission Expires Nov. 12, 2013 Member, Pennsvlvanla Association of Notaries IN RE: GUARDIANSHIP OF . IN THE COURT OF COMMON PLEAS OF SEAN MATTHEW DOSIAK . CUMBERLAND COUNTY,PENNSYLVANIA . ORPHAN'S COURT . N0.21-94-393 TO: Clerk of Orphan's Court Courthouse,Carlisle PA ANNUAL REPORT OF GUARDIANSHIP OF SEAN MATTHEW DOSIAK Estate: Sean Matthew Dosiak Guardian: William R.Dosiak and Sharon Dosiak Period: January 1,2013—December 31,2013 Date Filed: This is a report filed with the Court in compliance with Section 5521 (c)of Act 24 of July, 1992,20 PaCSA 5521. � C'� s �CS � � � C�. 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Oo OD O; � OD O O -� N O CT O O O CJ� O O O Oo CT O O O O O O : �0 v co m w _ _ � CASH ON DATE PAYEE REASON Deposits Withdrawals HAND Balance as of 12/31/2012 $ 74.62 1/4/2013 post office stamps $ 3.20 $ 71.42 1/5/2013 McDonald's lunch $ 6.35 $ 65.07 1/10/2013 Fire Mountain lunch $ 9.09 $ 55.98 1/12/2013 cash basketball game $ 2.00 $ 53.98 1/12/2013 Wendy's lunch $ 5.37 $ 48.61 1/12/2013 DaVinci dinner $ 10.00 $ 38.61 1/13/2013 McDonald's lunch $ 3.76 $ 34.85 1/13/2013 Bob Evans dinner $ 14.06 $ 20.79 1/18/2013 LowerAllen Diner dinner $ 13.51 $ 7.28 1/18/2013 cash spending money $ 200.00 $207.28 1/20/2013 John's Diner dinner ' $ 14.59 $192.69 1/25/2013 Subway lunch $ 6.31 $186.38 1/26/2013 cash lunch $ 12.27 $174.11 1/26/2013 cash basketball game $ 2.00 $172.11 1/26/2013 Giant prescription $ 1.15 $170.96 1/26/2013 Walmart med/Ipad charger $ 34.52 $136.44 1/29/2013 cash haircut $ 10.00 $126.44 1/29/2013 McDonald's lunch $ 4.76 $121.68 1/29/2013 McDonald's shake $ 3.17 $118.51 1/30/2013 Burger King dinner $ 4.22 $114.29 1/31/2013 �Bob Evans dinner $ 14.09 $100.20 2/3/2013 Kmart lamp shade $ 15.89 $ 84.31 2/3/20'3 Dollar Tree puzzle books $ 2.12 $ 82.19 2/3/2013 McDonald's lunch $ 4.63 $ 77.56 2/6/2013 DaVinci dinner $ 10.48 $ 67.08 2/6/2013 Giant magazine $ 8.47 $ 58.61 2/7/2013 McDonald's shake $ 2.95 $ 55.66 2/9/2013 cash basketball game $ 2.00 $ 53.66 2/14/2013 cash spending money $ 150.00 $203.66 2/15/2013 Outback dinner $ 27.00 $176.66 2/16/2013 cash basketball game $ 1.00 $175.66 2/16/2013 McDonald's lunch $ 2.12 $173.54 2/24/2013 Hi Life Diner dinner $ 12.32 $161.22 3/1/2013 Friendly's breakfast $ 9.78 $151.44 3/1/2013 Peachtree Rest dinner $ 12.86 $138.58 3/2/2013 Walmart pillow $ 3.80 $134.78 3/3/2013 McDonald's shake $ 3.48 $131.30 3/7/2013 Pivatown lunch $ 7.78 $123.52 3/9/2013 cash basketball game $ 3.00 $120.52 3/9/2013 Hoss's lunch $ 11.52 $109.00 3/9/2013 Wendy's dinner $ 4.10 $104.90 3/11/2013 Giant magazine $ 8.47 $ 96.43 3/13/2013 Five Below puzzle books $ 12.19 $ 84.24 3/14/2013 Subway lunch $ 6.36 $ 77.88 3/14/2013 cash spending money $ 150.00 $227.88 3/15/2013 Burger King dinner $ 5.50 $222.38 3/15/2013 Dollar Tree card/pens $ 2.12 $220.26 3/15/2013 cash donation heart assoc $ 10.00 $210.26 3/15/2013 cash GlobeTrotters8�food $ 43.00 $167.26 3/16/2013 Wendy's dinner $ 7.41 $159.85 � CASH ON DATE PAYEE REASON Deposits Withdrawals HAND 3/22/2013 Burger King lunch $ 5.50 $154.35 3/24/2013 John's Diner dinner $ 8.41 $145.94 3/25/2013 cash haircut $ 10.00 $135.94 3/27/2013 Game Stop I tunes $ 15.00 $120.94 3/29/2013 Subway dinner $ 8.96 $111.98 4/5/2013 DaVinci lunch $ 7.42 $104.56 4/5/2013 Walmart briefs $ 8.96 $ 95.60 4/5/2013 cash spending money $ 150.00 $245.60 4/6/2013 Subway lunch $5.51 $240.09 4/7/2013 Round the Clock lunch $ 14.27 $225.82 4/11/2013 Walmart clothes $ 21.73 $204.09 4/11/2013 Best Buy movie $ 10.59 $193.50 4/13/2013 cash BB tournament fd&rm $ 55.16 $138.34 4/13/2013 Sweet Frog yogurt $ 5.21 $133.13 4/13/2013 Texas Roadhouse dinner $ 10.97 $122.16 4/14/2013 McDonald's shake $ 2.95 $119.21 4/14/2013 Subway lunch $ 6.41 $112.80 4/17/2013 McDonald's lunch $ 5.71 $107.09 4/21/2013 John's Diner dinner $ 10.63 $ 96.46 4/24/2013 Giant prescription $ 1.15 $ 95.31 4/24/2013 cash spending money $ 150.00 $245.31 4/25/2013 Dollar Tree cards $ 1.06 $244.25 4/27/2013 Burger King lunch $ 7.41 $236.84 4/28/2013 Bob Evans dinner $ 15.33 $221.51 5/1/2013 cash pretzelat BB game $ 1.25 $220.26 5/1/2013 Rita's Italian ice $ 4.12 $216.14 5/2/2013 McDonald's lunch $ 6.35 $209.79 5/6/2013 Subway lunch $ 8.16 $201.63 5/11/2013 Wegmans lunch $ 4.50 $197.13 5/15/2013 cash haircut $ 10.00 $187.13 5/16/2013 Fire Mountain dinner $ 9.62 $177.51 5/18/2013 Caf�in Atrium lunch $ 6.55 $170.96 5/18/2013 Two Cousins dinner $ 8.74 $162.22 5/19/2013 Wendy's dinner $ 4.62 $157.60 5/19/2013 McDonald's lunch $ 2.12 $155.48 5/24/2013 Sheetz sandwich $ 3.61 $151.87 6/1/2013 John's Diner dinner $ 19.90 $131.97 6/4/2013 Dollar Tree misc $ 4.53 $127.44 6/6/2013 Hoss's dinner $ 18.70 $108.74 6/9/2013 Pizzaworks lunch $ 6.10 $102.64 6/11/2013 cash soda26B game $ 1.00 $101.64 6/11/2013 Pizzaworks dinner $ 6.10 $ 95.54 6/15/2013 cash hot doq bbqame $ 2.00 $ 93.54 6/15/2013 Union Jack lunch $ 14.00 $ 79.54 6/19/2013 Game Stop game $ 5.29 $ 74.25 6/19/2013 Five Below Batteries/books $ 29.12 $ 45.13 6/20/2013 cash spending money $ 200.00 $245.13 6/20/2013 McDonald's lunch $ 4.66 $240.47 6/20/2013 Kmart candy $ 6.00 $234.47 6/21/2013 McDonald's shake $ 3.17 $231.30 6/22/2013 Midtown Piva lunch $ 16.77 $214.53 � CASH ON DATE PAYEE REASON Deposits Withdrawals HAND 6/2 312 0 1 3 Friendly's dinner $ 15.24 $199.29 6/29/2013 McDonald's shake $ 3.17 $196.12 6/29/2013 Giant misc $ 4.23 $191.89 6/30/2013 John's Diner dinner $ 14.60 $177.29 7/1/2013 cash haircut $ 10.00 $167.29 7/6/2013 Red Lobster dinner $ 23.00 $144.29 7/7/2013 Burge�King lunch $ 4.53 $139.76 7/10/2013 Burger King lunch $ 3.81 $135.95 7/10/2013 McDonald's dinner $ 3.16 $132.79 7/14/2013 Thrift Store baseball cards $ 3.00 $129.79 7/14/2013 Subway lunch $ 8.16 $121.63 7/19/2013 7-Eleven drinks $ 2.74 $118.89 7/19/2013 Pizzaworks dinner $ 7.16 $111.73 7/24/2013 Big Lots candy $ 6.75 $104.98 7/26/2013 cash spending money $ 200.00 $304.98 baseball 7/26/2013 cash game/food/lodging $ 123.36 $181.62 7/29/2013 7-Eleven drinks $ 2•74 $��8.88 7/31/2013 cash candy $ 3.37 $175.51 7/31/2013 Giant prescription $ 1.15 $174.36 8/3/2013 John's Diner dinner $ 12.48 $161.88 8/10/2013 Jason's Deli dinner $ 15.13 $146.75 8/13/2013 Dollar Tree Snacks/card $ 6.71 $140.04 8/13/2013 7-Eleven slurpee $ 1.47 $138.57 8/11/2013 Perkins Rest dinner $ 14.27 $124.30 8/17/2013 Red Lobster dinner $ 22.59 $101.71 8/18/2013 cash gift $ 15.00 $ 86.71 8/18/2013 McDonald's dinner $ 4.02 $ 82.69 8/20/2013 Subway lunch $ 7.10 $ 75.59 8/24/2013 cash spending money $ 200.00 $275.59 8/24/2013 McDonald's dinner $ 4.63 $270.96 8/28/2013 Burger King lunch $ 4.44 $266.52 8/21/2013 cash haircut $ 10.00 $256.52 8/25/2013 Walmart games/personal $ 49.26 $207.26 8/25/2013 Jumbo Buffet dinner $ 16.25 $191.01 8/30/2013 Hoss's dinner $ 18.73 $172.28 8/30/2013 Walmart candy $ 1.06 $17122 9/1/2013 Walmart game&floss $ 24.80 $146.42 9/1/2013 John's Diner dinner $ 11.74 $134.68 9/7/2013 Friendly's dinner $ 13.00 $121.68 9/8/2013 Midtown Pizza dinner $ 11.54 $110.14 9/10/2013 Burger King lunch $ 8.99 $101.15 9/14/2013 Midtown Pizza lunch $ 10.75 $ 90.40 9/14/2013 cash gift $ 15.00 $ 75.40 9/15/2013 Denny's lunch $ 12.26 $ 63.14 9/20/2013 cash spending money $ 150.00 $213.14 9/20/2013 cash footballgame/food $ 11.75 $201.39 9/21/2013 Special Place breakfast $ 12.00 $189.39 9/21/2013 Houlihan's dinner $ 16.04 $173.35 9/24/2013 McDonald's dinner $ 7.52 $165.83 9/26/2013 cash sub $ 5.51 $160.32 � CASH ON DATE PAYEE REASON Deposits Withdrawals HAND 9/27/2013 McDonald's dinner $ 8.46 $151.86 9/29/2013 Dollar Tree card/books $ 2.65 $149.21 10/1/2013 John's Diner lunch $ 11.42 $137.79 10/2/2013 cash haircut $ 10.00 $127.79 10/4/2013 McDonald's lunch $ 4.63 $123.16 10/8/2013 Sheetz lunch $ 5.51 $117.65 10/12/2013 Friendly's dinner $ 14.71 $102.94 10/12/2013 cash gift $ 15.00 $ 87.94 10/19/2013 Denny's breakfast $ 11.27 $ 76.67 10/25/2013 Dairy Queen Ice cream $ 4.87 $ 71.80 10/25/2013 John's Diner diner $ 11.42 $ 60.38 10/26/2013 Giant prescription $ 1.15 $ 59.23 10/26/2013 Wendy's lunch $ 2.00 $ 57.23 10/27/2013 Subway lunch $ 5.30 $ 51.93 10/28/2013 cash spending money $ 150.00 $201.93 10/29/2013 Burger King lunch $ 3.16 $198.77 11/1/2013 Wendy's lunch $ 6.22 $192.55 11/2/2013 JoJo's Piva dinner $ 12.00 $180.55 11/5/2013 Amazon USB cable $ 5.82 $174.73 11/8/2013 McDonald's lunch $ 0.94 $173.79 11/8/2013 McDonald's dinner $ 3.37 $170.42 11/9/2013 Kmart clothes/DVD $ 37.94 $132.48 11/9/2013 DQ Grill lunch $ 5.30 $127.18 11/11/2013 Hoss's lunch $ 11.88 $115.30 11/13/2013 cash haircut $ 10.00 $105.30 11/16/2013 Pizzaworks dinner $ 9.48 $ 95.82 11/17/2013 Burger King dinner $ 7.20 $ 88.62 11/20/2013 Walmart batteries $ 6.37 $ 82.25 11/22/2013 JoJo's Pizza dinner $ 17.36 $ 64.89 11/24/2013 Burger King lunch $ 7.18 $ 57.71 11/24/2013 Giant chinese food/dinner $9.00 $ 48.71 11/26/2013 cash lunch $ 5.31 $ 43.40 11/26/2013 cash spending money $ 150.00 $193.40 12/5/2013 Subway lunch $ 6.31 $187.09 12/6/2013 Sears game $ 21.19 $165.90 12/6/2013 Burger King lunch $ 4.74 $161.16 12/6/2013 Walmart jersey $ 7.00 $154.16 12/7/2013 Friendly's lunch $ 14.71 $139.45 12/8/2013 Skyline Rest. dinner $ 17.14 $122.31 12/15/2013 Giant floss $ 1.94 $120.37 12/15/2013 Friendly's dinner $ 15.00 $105.37 12/19/2013 Jumbo Buffet dinner $ 6.82 $ 98.55 12/20/2013 cash spending money $ 150.00 $248.55 12/20/2013 M8J pizza dinner $ 9.01 $239.54 12/21/2013 cash basketball game $ 2.00 $237.54 12/21/2013 cash gifts $ 40.00 $197.54 12/22/2013 Five Below basket/book/pens $ 7.69 $189.85 12/22/2013 Round the clock din dinner $ 18.94 $170.91 12/24/2013 cash haircut $ 10.00 $160.90 12/24/2013 cash church offering $ 5.00 $155.91 12/27/2013 DaVinci dinner $ 11.54 $144.37 � CASH ON DATE PAYEE REASON Deposits Withdrawals HAND 12/28/2013 rue 21 shirt $ 6.00 $138.37 12/29/2013 TA#012 dinner $ 16.50 $121.87 12/30/2013 Subway lunch $ 4.03 $117.84 12/30/2013 Cocoa Diner dinner $ 23.29 $ 94.55 12/17/2013 Bleacher Bums tee shirt $ 25.00 $ 69.55 . � d � �v • a O OOOf�MOMOMOt� I r N N a0 a0 aD O Of�chOC'70c�Or I� O O O O O O O M MMtntDI��ON('7tnf0 (D f0 f0 f0 CO f0 O Nl'7�tOh�ONM M O O O O O O O (� (O NM��f�00O�0 N N M M M O �NM��t0a0O�O O O tp � O O O O O 0��Q1��00 O �t V (O (O (O ' O O N N �GO CO OD OD OD CO OD CO�� f� 1� 1� ' ' M M C f� f0 f0 t0 t�t0(O(O t0 f0(fl t0 (O M c`� M c'� c'� � �p I I N I m i I � I O O O�(O!��1� M O h(O I�M h M I�� f� O I O O O O O O N�O e- (O N e-O� M O O O O O O�� O LL� LL� O O O O� � i� � i� i � i O O C M � M � I ' M M � I O � Q i � 3 3 3 3 3 3 3 � 3 3 3 ma� a� a� a� da� dm m a� ,�,�� C L L L L L L L L.0 L L • O ��.�. � � mmmmmmmmco m m � � a�i 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F- w .y N m � � a � � � o � ' r- � Q � • 00 O 00 00 a- , � ln� � �M N N v�aMMv • � U NNMMCh a � �� I m I U � OONNOM � tn(O �M y.. aONMNN � N � � N � 0 � � Q i W H Z � O n' � z N Q � w F- � ^ a � O � U � � � � i � � � Y ~ (� Y Z'I •m .p o � � Q � 0 � � a s � V � cw c c ,. �+ � N V tA tn �C � N_ N N C � N� N N � I fn C Q C C � � � � Q� � � � N �C U G N � �w �ww � � �m �� a� �� pzmzz ca o E � � a 3 Z � w a� ° � �.'' �.,� M�,.� M c'� (� d, .- •- c- � o � � oMOo � M 0 �o��cv � � �� . � � j SEAN MATTHEW DOSIAK TRUST FUNDS CERTIFICATE OF DEPOSIT WITH INTEGRITY BANK IN THE AMOUNT OF$84,080.18 TOTAL MONEY MARKET-INTEGRITY $11,34231 CHECKING ACCOUNT WITH INTEGRITY - $6,905.10 • We certify that the above is an accurate report of the income and expenses of the guardian account. The needs of the incapacitated person as set forth above,included expenses for Sean,including trips,vacations, and recreations. Sean resides at 453 Pawnee Drive,Mechanicsburg PA 17050 with his mother and father. He continues to take Dilantin medication to control his seizures. Sean still goes to Dr.James.He has a Dilantin level test and liver test every six months.His eye doctor is Dr.Kilmore. He goes to the eye doctor every six months.His dentist is Dr.Brown,he goes every six months..We take him to dinner or lunch on the weekends and shopping.He spends time with his sister and family.He goes to church with his sister.He does different activities with his sister and nephew.We take him to his nephew's sporting games(baseball,basketball,soccer,etc.) We took him to Maryland for baseball that his nephew was in,also several places he played baseball in Pa He enjoys his WII games and I Pad.Sean also likes doing word search puzzles.He plays games with his nephew.Sean is with his parents during the day. I feel the guardianship should be continued. The reason being,Sean is mentally deficient from birth due to malpractice of a physician and cannot manage his affairs,make medical decisions,or take care of himself. We feel as Sean's parents that we have an understanding for Sean and his needs. `�/y��" ' /� � /��Gu-�2� ��L�..:�1--i ��--�.� William R.Dosiak Sharon Dosiak 453 Pawnee Drive 453 Pawnee Drive Mechanicsburg,Pa. 17050 Mechanicsburg,Pa. 17050 Distribution: Clerk of Orphan's Court COMMONWEALTH OF PENNSYLVANIA . : SS COURT OF COMMON PLEAS . On this,the '/� day of.�G n vu.,v�a' �1 L3,before me,a notary public in and for the County of Cumberland,Commonwealth of Pennsylvania,the undersigned officer,personally appeared William R. Dosiak and Sharon Dosiak,known to me(of satisfactory proven)to be the persons whose names are subscribed to the within instrument,and acknowledged that they executed the same for purposes therein contained. IN WITNESS WHEREOF,I HEREUNTO SET MY HAND AND OFFICIAL SEAL. Notary Public ��L,/�'(,!�`�/(,�-�- oC'��`J�_ COMMONWFALTH OF PENMSYLVANiA Notarlal5eal Barbara L.Tome,Notary Public Camp H!il Boro,Cumbertand County My Comrnissian Expires Nov 12,2013 Nsem�r,Penr,svlva;rla As:�cfation of Notaries IN RE: GUARDIANSHIP OF IN THE COURT OF COMMON PLEAS OF SEAN MATTHEW DOSL4X CUMBERLAND COUNTY,PENNSYLVANIA ORPHAN'S COURT NO.21-94-393 TO: Clerk of Orphan's Court Courthouse,Carlisle PA ANNUAL REPORT OF GUARDIANSHIP OF SEAN MATTHEW DOSIAK Estate: Sean Matthew Dosiak Guardian: William R.Dosiak and Sharon Dosiak Period: January 1,2014—December 31,2014 Date Filed: This is a report filed with the Court in compliance with Section 5521 (c)of Act 24 of July, 1992,20 PaCSA 5521. rq C> r>. r1 63 -3 „ ' ►-� t �..,_ M w l =rt r 0 We certify that the above is an accurate report of the income and expenses of the guardian account. The needs of the incapacitated person as set forth above,included expenses for Sean,including trips,vacations, and recreations. Sean resides at 453 Pawnee Drive,Mechanicsburg PA 17055 with his mother and father. He continues to take Dilantin medication to control his seizures. Sean still goes to Dr.James.He has a Dilantin level test and liver test every six months.His eye doctor is Dr.Kilmore. He goes to the eye doctor every six months.His dentist is Dr.Brown,he goes every six months.We take him to dinner or lunch on the weekends and shopping.He spends time with his sister and family.He goes to church with his sister.He does different activities with his sister and her family.This year his sister took him to a Billy Joel concert in State College PA. We take him to his nephew's sporting games(baseball,basketball and football) We took him to Maryland for baseball that his nephew was in, also several places he played baseball in Pa He enjoys his WII games and iPad. Sean also likes doing word search puzzles.He plays games with his nephew. Sean is with his parents during the day. I feel the guardianship should be continued. The reason being,Sean is mentally deficient from birth due to malpractice of a physician and cannot manage his affairs,make medical decisions,or take care of himself. We feel as Sean's parents that we have an understanding for Sean and his needs. iiliam R.Dosiak Sharon Dosiak `J 453 Pawnee Drive 453 Pawnee Drive Mechanicsburg,Pa. 17050 Mechanicsburg,Pa. 17050 Distribution: Clerk of Orphan's Court COMMONWEALTH OF PENNSYLVANIA SS COURT OF COMMON PLEAS On this,the I I day of FP—brLA&r ,before me,a notary public in and for the County of Cumberland,Commonwealth of PennsylYania,the undersigned officer,personally appeared William R. Dosiak and Sharon Dosiak,known to me(of satisfactory proven)to be the persons whose names are subscribed to the within instrument,and acknowledged that they executed the same for purposes therein contained. IN WITNESS WHEREOF,I HEREUNTO SET MY HAND AND OFFICIAL SEAL. Notaryublic NOTARIAL SEAL KRYSTINA LAUDERMILCH Notary Public LOWER PAXTON TWP.U•AUPHIN COUNTY My ComMissjonaExpires May 4,20.1 �..;Ia+A�=?T,rX.R14.�'A"�eY.4Yd^:SiG4W�e'+�'.,v�;M'S.3xK� �:�'^rsai:�3c4?'ss34 Nir�ra;iitws2�if).i XXL°"t�r2 ih� 5(}i? f?144�5.{294°kal).'3!�4�c+ �ti�b:'1t$?1�Ci(1�.L� '� y40��i�,{��?PEC ►;�t�.�li�7Rt f§ft?t3�tik'�if Gid 14f3!t1�!!�'f c 3�N�' I i �, i �.�. . �, SEAN MATTHEW DOSIAK TRUST FUNDS • CERTIFICATE OF DEPOSIT WITH INTEGRITY BANK IN THE AMOUNT OF$84,290.63 • TOTAL MONEY MARKET-INTEGRITY $11367.83 • CHECKING ACCOUNT WITH INTEGRITY-$6547.79 I I I I' Il - I 2014 Cash On Hand CASH DATE ' PAYEE REASON Deposits : Withdrawals ON HAND Balance as of 12131/2013 $ 69.55 1/6/2014 Panera Bread breakfast $ 5.18 $ 64.37 1/8/2014 Davinci, lunch $ 8.48 $ 55.89 1/10/2014 Burger King lunch $ 3.90 $ 51.99 1/10/2014 McDonalds dinner $ 3.17 $ 48.82 1/10/2014 cash spending money $ 150.00 $ 198.82 1/11/2014 Isaac's dinner $ 15.00 $ 183.82 1/12/2014 Subway lunch $ 5.30 $ 178.52 1/12/2014 Walmart music $ 32.61 '$ 145.91 1/14/2014 Burger King lunch $ 5.18 $ 140.73 1/19/2014 McDonalds lunch $ 4.66 $ 136.07 1/21/2014 McDonalds lunch $ 3.16 $ 132.91 1/21/2014 Courthouse Common ice tea $ 1.68 $ 131.23 1/25/2014 Giant prescription $ 1.20 $ 130.03 1/25/2014 cash basketball game $ 2.00 $ 128.03 1/25/2014 Subway lunch $ 7.21 $ 120.82 1/29/2014 Giant magazine/medicine $ 13.46 $ 107.36 2/1/2014 cash fund raiser $ 15.00 $ 92.36 2/11/2014 Two Cousins lunch $ 8.22 $ 84.14 2/13/2014 Hearth Cafe drink $ 1.69 $ 82.45 2/14/2014 Wendy"s lunch $ 3.57 $ 78.88 2/17/2014 cash haircut $ 10.00 $ 68.88 2/17/2014 John's Diner lunch $ 17.09 $ 51.79 2/18/2014 Evergreen lunch $ 9.31 $ 42.48 2/19/2014- cash spending money $150.00 $ 192.48 2/20/2014 Big Lots candy $ 2.00 $ 190.48 2/20/2014 Subway lunch $ 5.62 $ 184.86 2/22/2014 Bob Evans lunch $ 12.59 $ 172.27 3/1/2014 Walmart CD/floss/card $ 17.27 $ 155.00 3/1/2014 Burger King lunch $ 4'.06 $ 150.94 3/2/2014 Subway lunch $ 2.65 $ 148.29 3/7/2014 Fire Mountain dinner $ 11.15 $ 137.14 3/8/2014 Tomato Pie Caf& lunch $ 13.98 $ 123.16 3/8/2014 Denny's dinner $ 13.64 $ 109.52 3/12/2014 Great Wall dinner $ 5.59 $ 103.93 3/15/2014 Wendy"s lunch $ 7.20 $ 96.73 3/16/2014 Perkins dinner $ 14.27 $ 82.46 3/22/2014 Two Cousins lunch $ 7.15 $ 75.31 3/23/2014 Subway lunch $ 5.20 $ 70.11 3/24/2014 Wendy"s lunch $ 4.84 $ 65.27 3/24/2014 Simply Turkey&more lunch $ 8.30 $ 56.97 3/25/2014 Wendy"s lunch $ 3.18 $ 53.79 3/25/2014 Hearth Cafe juice $ 1.79 $ 52.00 3/26/2014 Giant juice $ 1.52 $ 50.48 3/27/2014 Subway lunch $ 7.21 $ 43.27 3/28/2014 Wendy"s lunch $ 3.15 $ 40.12 3/29/2014 Great Wall dinner $ 5.90 $ 34.22 3/31/2014 cash spending money $ 150.00 $ 184.22 4/1/2014 Rita's Itialian ice $ 2.66 $ 181.57 4/1/2014 John's Diner dinner $ 16.03 $ 165.54 4/5/2014 cash haircut $ 10.00 $ 155.54 4/6/2014 Friendly's lunch $ 11.43 $ 144.11 4/7/2014 cash raffle ticket $ 10.00 $ 134.11 4/13/2014 Perkins dinner $ 15.76 $ 118.35 4/19/2014 Giant prescription $ 1.20 $ 117.15 4/23/2014 Amici lunch $ 8.63 $ 108.52 4/25/2014 McDonalds lunch $ 7.41 $ 101.11 Page 1 of 5 T L 2014 Cash On Hand CASH DATE PAYEE REASON Deposits Withdrawals ON HAND 4/26/2014 McDonalds lunch $ 6.99 $ 94.12 4/27/2014 Bob Evans dinner $ 15.12 $ 79.00 5/1/2014 Wendy",s lunch $5.58 $ 73.42 5/2/2014 Wendy"s lunch $ 6.56 $ 66.86 5/4/2014 Friendly's lunch $ 17.77 $ 49.09 5/4/2014 China Wok dinner $ 8.48 $ 40.61 5/5/2014 Giant top flightintict $ 4.87 $ 35.74 5/7/2014 Hearth Cafe drink $ 1.69 $ 34.05 5/8/2014 Perkins dinner $ 12.80 $ 21.25 5/9/2014 Wendy"s lunch $ 5.58 $ 15.67 5/9/2014 Healthsouth dinner $ 3.71 $ 11.96 5/10/2014 Subway lunch $ 7.21 $ 4.75 5/12/2014 McDonalds lunch $ 3.78 $ 0.97 5/13/2014 Healthsouth lunch $ 4.06 $ (3.09) 5/16/2014 Healthsouth lunch $ 3.90 $ (6.99) 5/17/2014 cash spending money $ 150.00 $ 143.01 5/17/2014 Healthsouth lunch $ 3.71 $ 139.30 5/17/2014 Weis dinner $ 5.30 $ 134.00 5/18/2014 Sheetz dinner $ 7.42 $ 126.58 5/18/2014 Sheetz lunch $ 7.42 $ 119.16 5/19/2014 Burger King lunch $ 2.01 $ 117.15 5/20/2014 McDonalds dinner $ 3.78 $ 113.37 5/20/2014 Best Buy CD[matterof trust] $ 15.89 $ 97.48 5/21/2014 Karn's dinner $ 3.93 $ 93.55 5/21/2014 cash haircut $ 10.00 $ 83.55 5/21/2014 Healthsouth lunch $ 5.09 $ 78.46 5/22/2014 Denny's dinner $ 13.32 $ 65.14 5/23/2014 Summit Rest. lunch $ 11.17 $ 53.97 5/24/2014 cash spending money $ 150.00 $ 203.97 5/24/2014 JoJo's Pizza dinner $ 17.88 $ 186.09 5/29/2014 Subway dinner $ 7.15 $ 178.94 5/30/2014 Giant dinner $ 7.10 $ 171.84 5/31/2014 CASH Basball shirt $ 20.00 $ 151.84 6/4/2014 McDonalds lunch $ 5.08 $ 146.76 6/5/2014 Friendly's lunch $ 17.87 $ 128.89 6/8/2014 McDonalds lunch $ 1.58 $ 127.31 6/8/2014 Kohl's clothes $ 52.78 $ 74.53 6/9/2014 Davinci dinner $ 6.36 $ 68.17 6/11/2014 Cocoa Rest dinner $ 14.87 $ 53.30 6/12/2014 cash spending money $ 150.00 $ 203.30 6/17/2014 Red Lobster dinner $ 24.00 $ 179.30 6/19/2014 Subway lunch $ 4.56 $ 174.74 6/20/2014 JoeyPeeps dinner $ 9.06 $ 165.68 6/20/2014 cash hamburger&drink $ 4.50 $ 161.18 6/21/2014 Bob Evans dinner $ 14.38 $ 146.80 6/26/2014 cash drink $ 1.00 $ 145.80 6/26/2014 McDonalds lunch $ 5.48 $ 140.32 6/28/2014 Rita's icecream $ 2.39 $ 137.93 6/28/2014 red robin lunch $ 15.00 $ 122.93 6/29/2014 Alfredo's Pizza soda $ 2.01 $ 120.92 7/2/2014 McDonalds shake $ 3.17 $ 117.75 7/3/2014 Burger King lunch $ 3.70 $ 114.05 7/4/2014 Friendly's breakfast $ 6.43 $ 107.62 7/4/2014 Five Beow puzzle book/candy $ 8.28 $ 99.34 7/4/2014 Rockvale Outlets underwear $ 3.00 $ 96.34 7/4/2014 Your Place dinner $ 13.65 $ 82.69 7/9/2014 Subway lunch $ 4.35 $ 78.34 Page 2 of 5 2014 Cash On Hann CASH DATE PAYEE. REASON Deposits Withdrawals ON HAND 7/10/2014 Subway lunch $ 2.65 $ 75.69 7/10/2014 fye bal for charger $ 10.60 $ 65.09 7/12/2014 cash spending money $ 150.00 $ 215.09 7/12/2014 MountainGate Rest lunch $ 13.67 $ 201.42 7/13/2014 Soda Jerk lunch $ 12.12 $ 189.30 7/14/2014 Pizza Grille lunch $ 14.82 $ 174.48 7/17/2014 Rite Aid prescription $ 1.20 $ 173.28 7/17/2014 cash haircut $ 10,00 $ 163.28 7/17/2014 Wendy"s lunch $ 1.30 $ 155.98 7/19/2014 Jumbo Buffet dinner $ 15.83 $ 140.15 7/20/2014 McDonalds dinner $ 5.29, $ 134,86 7/23/2014 011ie,s snacks $ 4.49..$ 130.37 7/25/2014 Subway lunch $ 4.98 $ 125.39 7/25/2014 Pan Tree dinner $ 16.83 $ 108.56 7/26/2014 Village Thrift Shop bb cards $ 6.30 $ 102.26 7/26/2014 Burger King lunch $ 3.91 $ 98.35 7/27/2014 011ie'S I pad case $ 10.59 $ 87.76 7/27/2014 McDonalds soda $ 1.06 $ 86.70 7/27/2014 Burger King lunch $ 6.99 $ 79.71 7/27/2014 Walmart music $ 11.28 '$ 68.43 7/30/2014 McDonalds lunch $ 2.51 $ 65.92 7/31/2014 cash tournament shirt $ 17.00 $ 48.92 8/2/2014 Chili's lunch $ 15.33 $ 33.59 8/412014 cash spending money $ 150.00 $ 183.59 8/6/2014 Burger King lunch $ 6.55 -$ 177.04 8/6/2014 Walmart music/marshmeilows $ 13.98 $ 163.06 816/2014 Big Lots screen protector/candy $ 8.30 $ 154.76 8/14/2014 cash snacks $ 3.00 $ 151.76 8/15/2014 Subway lunch $ 5.30' $ 146.46 8/15/2014 Liberty Forge golf $ 3.00 $ 143.46 8/15/2014 Liberty Forge golf $ 5.00 -$ 138.46 8/1612014 011ies basketball/music $ 21.17 $ 11729 8116/2014 Pantree Rest DINNER $ 13.38 $ 103.91 8/18/2014 cash gift $ 20.00 $ 83.91 8/18/2014 Liberty Forge golf $ 5.00 $ 78.91 8/19/2014 ABC Lanes bowling $ 11.00 $ 67.91 8/1912014 McDonalds lunch $ 3.16 $ 64.75 8/20/2014 cash haircut $ 10.00 $ 54.75 8/20/2014 cash spending money $ 150.00 $ 204.75 8/23/2014 Soda Jerk lunch $ 15.72 $ 189.03' 8/24/2014 Ocean Pride lunch $ 26.00 $ 163.03 8/24/2014 Kmart pens $ 4.55 $. 158.48 8/24/2014 John's Diner dinner $ 12.58 $ 145.90 8/27/2014 Denny's dinner $ 12.64 $ 133.26 8/29/2014 Subway lunch $ 5.41 $ 127.85 8/30/2014 cash trip metsbb game&football $ 115.14 $ 12.71. 8/31/2014 cash spending money $ 150.00 $ 162:71 9/1/2014 Burger King lunch $ 10.69 $ 152.02 9/1/2014 Perkins dinner $ 11.00 $ 141:02 9/6/2014 Pan Tree lunch $ 13.61 $ 127.41 9/7/2014 Cash Football game and drink $ 3.00 $ 124.41 9/12/2014 Red Lobster lunch $ 23.75 $ 100.66 9/13/2014 Pan Tree dinner $ 13.17 $ 87.49 9/14/2014 Cash Birthday gift $ 20.00 $ 67.49 9/20/2014 Bob Evans lunch $ 13.85 $ 53.64 9/23/2014 Villa Roma lunch $ 9.01 $ 44.63 9/23/2014 cash spending money $ 150.00 $ 194.63 Page 3 of 5 2014 Cash On Hand CASH DATE PAYEE REASON Deposits Withdrawals ON HAND 9/27/2014 Subway dinner $ 7.00 $ 187.63 9/28/2014 McDonalds breakfast $ 2.54 $ 185.09 9/29/2014 Pizza Hut lunch $ 4.77 $ 180.32 9/29/2014 pizza but drink $ 1.59 $ 178.73 9/30/2014 Subway lunch $ 8.00 $ 170.73 10/1/2014 Cafe in Atrium lunch $ 6.34 $ 164.39 10/2/2014 McDonalds lunch $ 4.95 $ 159.44 10/3/2014 Subway lunch $ 5.15 $ 154.29 10/5/2014 Hearth Cafe lunch $ 4.55 $ 149.74 10/6/2014 Simply Turkey&more lunch $ 8.27 $ 141.47 10/6/2014 Hearth Cafe drink $ 1.69 $ 139.78 10/7/2014 Hearth Cafe drink $1.78 $ 138.00 10/7/2014 Cafb in Atrium drink $ 1.69 $ 136.31 10/7/2014 Barber haircut $ 10.00 $ 126.31 10/9/2014 M&J Pizza lunch $ 5.30 $ 121.01 10/11/2014 McDonalds lunch $ 4.33 $ 116.68 10/13/2014 Cafe in Atrium drink $ 1.59 $ 115.09 10/13/2014 Subway lunch $ 5.30 $ 109.79 10/14/2014 McDonalds lunch $ 3.28 $ 106.51 10/16/2014 McDonalds lunch $ 3.59 $ 102.92 10/17/2014 Rite Aid pharmacy $ 1.20 $ 101.72 10/19/2014 Burger King lunch $ 4.24 $ 97.48 10/22/2014 Pizza lunch $ 4.75 $ 92.73 10/22/2014 Life Care lunch $ 6.89 $ 85.84 10/23/2014 McDonalds lunch $ 4.55 $ 81.29 10/24/2014 Pizza lunch $ 7.81 $ 73.48 10/25/2014 ABC Lanes bowling $ 10.20 $ 63.28 10/25/2014 ABC Brewery lunch $ 19.06 $ 44.22 10/26/2014 Papa Johns dinner $ 6.36 $ 37.86 10/26/2014 Cash spending money $ 150.00 $ 187.86 10/27/2014 Life Care lunch $ 2.62 $ 185.24 10/28/2014 Pizza lunch $ 9.22 $ 176.02 10/29/2014 Life Care lunch $ 4.77 $ 171.25 10/30/2014 Pizzatown lunch $ 4.42 $ 166.83 10/31/2014 Life Care lunch $ 3.18 $ 163.65 11/2/2014 McDonalds lunch $ 4.95 $. 158.70 11/3/2014 Life Care lunch $ 3.18 $ 155.52 11/6/2014 Life Care lunch $ 2.65 $ 152.87 11/6/2014 Papa Johns lunch $ 4.91 $ 147.96 11/6/2014 Sheetz breakfast $ 1.70 $ 146.26 11/8/2014 Cafe in Atrium juice $ 1.79 $ 144.47 11/8/2014 Subway lunch $ 4.40 $ 140.07 11/8/2014 Lower Allen Diner dinner $ 18.86 $ 121.21 11/10/2014 Subway lunch $ 4.40 $ 116.81 11/11/2014 Healthsouth lunch $ 4.61 $ 112.20 11/12/2014 Subway lunch $ 8.80 $ 103.40 11/12/2014 Barber haircut $ 10.00 $ 93.40 11/13/2014 5 Brothers lunch $ 7.16 $ 86.24 11/14/2014 Amici dinner $ 6.30 $ 79.94 11/14/2014 McDonalds lunch $ 5.59 $ 74.35 11/15/2014 Giant lunch $ 5.75 $ 68.60 11/17/2014 Sheetz lunch $ 6.29 $ 62.31 11/18/2014 pizzatown usa lunch $ 4.90 . $ 57.41 11/19/2014 Ressler's Bagel breakfast $ 1.35 $ 56.06 11/20/2014 Pizzatown lunch $ 8.73 $ 47.33 11/21/2014 Burger King lunch $ 2.65 $ 44.68 11/21/2014 Cash spending money $ 150.00 $ 194.68 Page 4 of 5 2014 Cash On Hand CASH DATE PAYEE REASON Deposits Withdrawals ON HAND 11/22/2014 Denny's breakfast $ 12.51 $ 182.17 11/23/2014 Vincenzo's Pizza lunch $ 13.48 $ 168.69 11/24/2014 Amici dinner $ 8.63 $ 160.06 11/27/2014 Walmart music $ 26.38 $ 133.68 11/29/2014 McDonalds breakfast $ 2.00 $ 131.68 11/29/2014 John's Diner lunch $ 13.07 $ 118.61 11/30/2014 McDonalds lunch $ 2.74 $ 115.87 12/6/2014 fundraiser sub $ 6.00 $ 109.87 12/6/2014 Sheetz lunch $ 6.69 $ 103.18 12/7/2014 Pantree Rest dinner $ 8.69 $ 94.49 12/7/2014 cash spending money $ 150.00 $ 244.49 12/7/2014 011ie's pants $ 10.28 $ 234.21 12/7/2014 Radioshack I tunes $ 25.00 $ 209.21 12/8/2014 Kmart gloves $ 6.99 $ 202.22 12/9/2014 Burger King lunch $ 4.23 $ 197.99 12/10/2014 Amici SODA $ 2.00 $ 195.99 12/11/2014 Ross pillow $ 8.47 $ 187.52 12/11/2014 Subway lunch $ 6.36 $ 181.16 12/13/2014 Pantree Rest DINNER $ 10.43 $ 170.73 12/14/2014 Grand Buffet DINNER $ 10.00 $ 160.73 12/14/2014 Walmart shirt $ 14.25 $ 146.48 12/14/2014 McDonalds lunch $ 5.61 $ 140.87 12/17/2014 Bob Evens lunch $ 13.38 $ 127.49 12/17/2014 cash haircut $ 10.00 $ 117.49 12/19/2014 JoJo's Pizza dinner $ 22.10 $ 95.39 12/20/2014 cash spending money $ 150.00 $ 245.39 12/20/2014 Subway lunch $ 4.03 $ 241.36 12/20/2014 Longhorn dinner $ 24.18 $ 217.18 12/24/2014 cash gifts $ 40.00 $ 177.18 12/27/2014 McDonalds lunch $ 2.95 $ 174.23 12/30/2014 Capitol lunch $ 13.64 $ 160.59 12/31/2014 McDonalds lunch $ 2.64 $ 157.95 Page 5 of 5 i Estate of Sean Matthew Dosiak Check Register- Last year 1/1/2014 through 12/31/2014 2/10/2015 Page 1 Date Account Num Description Memo Category Amount BALANCE 12/31/2013 1,165.34 1/2/2014 Estate of Sean Matthew Dosiak 923 Cash Fair Share -375.00 1/2/2014 Estate of Sean Matthew Dosiak 922 Comcast Cable Utilities:Cable TV -10.55 1/3/2014 Estate of Sean Matthew Dosiak DEP Social Security Other Inc 583.00 1/10/2014 Estate of Sean Matthew Dosiak 924 Cash spending money Cash -150.00 1/30/2014 .Estate of Sean Matthew Dosiak 925 Comcast Cable Utilities:Cable TV -10.55 1/31/2014 Estate of Sean Matthew Dosiak DEP SSP Other Inc 22.10 1/31/2014 Estate of Sean Matthew Dosiak DEP SS-1 Other Inc 158.00 2/1/2014 Estate of Sean Matthew Dosiak 926 Cash Fair Share -375.00 2/3/2014 Estate of Sean Matthew Dosiak DEP Social Security Other Inc 583.00 2/17/2014 Estate of Sean Matthew Dosiak 927 Sears new bed and frame Bed And Frame -752.58 2/19/2014 Estate of Sean Matthew Dosiak 928 Cash spending money Cash -150.00 2/28/2014 Estate of Sean Matthew Dosiak DEP SSP Other Inc 22.10 2/28/2014 Estate of Sean Matthew Dosiak DEP SSI Other Inc 158.00 3/3/2014 Estate of Sean Matthew Dosiak DEP Social Security Other Inc 583.00 3/3/2014 Estate of Sean Matthew Dosiak 929 Cash Fair Share -375.00 3/4/2014 Estate of Sean Matthew Dosiak 930 Comcast Cable Utilities:Cable TV -10.55 3/4/2014 Estate of Sean Matthew Dosiak 931 Dr. Brown DDS Medical -141.00 3/12/2014 Estate of Sean Matthew Dosiak 932 New York Mets Entertainment -14.00 3/20/2014 Estate of Sean Matthew Dosiak 933 Pa. Dept Of R... Tax -8.00 3/29/2014 Estate of Sean Matthew Dosiak 934 Comcast Cable Utilities:Cable TV -10.55 3/31/2014 Estate of Sean Matthew Dosiak 935 Cash spending money Cash -150.00 4/1/2014 Estate of Sean Matthew Dosiak DEP SSP Other Inc 22.10 4/1/2014 Estate of Sean Matthew Dosiak DEP SSI Other Inc 158.00 4/3/2014 Estate of Sean Matthew Dosiak DEP Social Security Other Inc 583.00 4/3/2014 Estate of Sean Matthew Dosiak 936 Cash Fair Share -375.00 5/1/2014 Estate of Sean Matthew Dosiak DEP SSI Other Inc 158.00 5/1/2014 Estate of Sean Matthew Dosiak DEP SSP Other Inc 22.10 5/2/2014 Estate of Sean Matthew Dosiak DEP Social Security Other Inc 583.00 5/3/2014 Estate of Sean Matthew Dosiak 937 Cash Fair Share -375.00 5/8/2014 Estate of Sean Matthew Dosiak 938 Comcast Cable cable sports package Utilities:Cable TV -59.67 5/17/2014 Estate of Sean Matthew Dosiak 939 Cash spending money Cash -150.00 5/24/2014 Estate of Sean Matthew Dosiak 940 Cash spending money Cash -150.00 5/25/2014 Estate of Sean Matthew Dosiak 941 Sears. Clothing -45.87 5/26/2014 Estate of Sean Matthew Dosiak 942 WalMart personal items Personal -49.66 5/31/2014 Estate of Sean Matthew Dosiak DEP SSP Other Inc 22.10 5/31/2014 Estate of Sean Matthew Dosiak DEP SSI Other Inc 158.00 Estate of Sean Matthew Dosiak Check Register- Last year 1/1/2014 through 12/31/2014 2/10/2015 Page 2 Date Account Num Description Memo Category Amount 6/2/2014 Estate of Sean Matthew Dosiak 943 Cash Fair Share -375.00 6/2/2014 Estate of Sean Matthew Dosiak 944 Comcast Cable cable sports package Utilities:Cable TV -59.67 6/3/2014 Estate of Sean Matthew Dosiak DEP Social Security Other Inc 583.00 6/12/2014 Estate of Sean Matthew Dosiak 945 Cash spending money Cash -150.00 7/1/2014 Estate of Sean Matthew Dosiak DEP SSP Other Inc 22.10 7/1/2014 Estate of Sean Matthew Dosiak DEP SSI Other Inc 158.00 7/2/2014 Estate of Sean Matthew Dosiak 946 Cash Fair Share -375.00 7/3/2014 Estate of Sean Matthew Dosiak DEP Social Security Other Inc 583.00 7/3/2014 Estate of Sean Matthew Dosiak 947 Comcast Cable cable sports package Utilities:Cable TV -61.27 7/9/2014 Estate of Sean Matthew Dosiak 948 Kohl's Clothing -172.96 7/9/2014 Estate of Sean Matthew Dosiak 949 FYE Entertainment -44.50 7/12/2014 Estate of Sean Matthew Dosiak 950 BonTon Clothing -16.44 7/12/2014 Estate aof Sean Matthew Dosiak 951 Cash spending money Cash -150.00 7/31/2014 Estate of Sean Matthew Dosiak 952 Comcast Cable cable sports package Utilities:Cable TV -60.64 8/1/2014 Estate of Sean Matthew Dosiak DEP SSI Other Inc 158.00 8/1/2014 Estate of Sean Matthew Dosiak DEP SSP Other Inc 22.10 8/1/2014 Estate of Sean Matthew Dosiak DEP Social Security Other Inc 583.00 8/4/2014 Estate of Sean Matthew Dosiak 953 Penndot Photo ID -27.50 8/4/2014 Estate of Sean Matthew Dosiak 954 Cash Fair Share -375.00 8/4/2014 Estate of Sean Matthew Dosiak 955 Cash spending money Cash -150.00 8/10/2014 Estate of Sean Matthew Dosiak 956 Ross Clothing -31.78 8/20/2014 Estate of Sean Matthew Dosiak 957 Cash spending money Cash -150.00 8/20/2014 Estate of Sean Matthew Dosiak DEP SSI Other Inc 158.00 8/24/2014 Estate of Sean Matthew Dosiak 958 WalMart personal items Personal -57.20 8/26/2014 Estate of Sean Matthew Dosiak 959 Kilmore Eye... Medical -156.00 8/29/2014 Estate of Sean Matthew Dosiak DEP SSP Other Inc 22.10 8/31/2014 Estate of Sean Matthew Dosiak 960 Cash spending money Cash -150.00 9/2/2014 Estate of Sean Matthew Dosiak 961 Comcast Cable cable sports package Utilities:Cable TV -10.55 9/3/2014 Estate of Sean Matthew Dosiak DEP Social Security Other Inc 583.00 9/4/2014 Estate of Sean Matthew Dosiak 962 Cash Fair Share -375.00 9/11/2014 Estate of Sean Matthew Dosiak 963 Dr. Brown DDS Medical -141.00 9/23/2014 Estate of Sean Matthew Dosiak 964 Cash Cash -150.00 10/1/2014 Estate of Sean Matthew Dosiak DEP SSI Other Inc 158.00 10/1/2014 Estate of Sean Matthew Dosiak DEP SSP Other Inc 22.10 10/1/2014 Estate of Sean Matthew Dosiak DEP Social Security Other Inc 583.00 10/4/2014 Estate of Sean Matthew Dosiak 965 Cash Fair Share -375.00 10/5/2014 Estate of Sean Matthew Dosiak 966 Comcast Cable cable sports package Utilities:Cable TV -10.55 10/26/2014 Estate of Sean Matthew Dosiak 967 Cash Cash -150.00 Estate of Sean Matthew Dosiak Check Register- Last year 1/1/2014 through 12/31/2014 2/10/2015 Page 3 Date Account Num Description Memo Category Amount 11/1/2014 Estate of Sean Matthew Dosiak 968 Comcast Cable cable sports package Utilities:Cable TV -10.55 11/1/2014 Estate of Sean Matthew Dosiak 970 Billie Jo Snyder Reimbursement for C...Entertainment -500.00 11/2/2014 Estate of Sean Matthew Dosiak DEP SSI Other Inc 158.00 11/2/2014 Estate of Sean Matthew Dosiak DEP SSP Other Inc 22.10 11/2/2014 Estate of Sean Matthew Dosiak 969 Cash Fair Share 375.00 11/3/2014 Estate of Sean Matthew Dosiak DEP Social Security Other Inc 583.00 11/21/2014 Estate of Sean Matthew Dosiak 971 Cash Cash -150.00 11/29/2014 Estate of Sean Matthew Dosiak 972 Comcast Cable cable sports package Utilities:Cable TV -10.55 12/2/2014 Estate of Sean Matthew Dosiak DEP SSI Other Inc 158.00 12/2/2014 Estate of Sean Matthew Dosiak DEP SSP Other Inc 22.10 12/2/2014 Estate of Sean Matthew Dosiak 973 Cash Fair Share 375.00 12/3/2014 Estate of Sean Matthew Dosiak DEP Social Security Other Inc 583.00 12/7/2014 Estate of Sean Matthew Dosiak 974 Cash Cash -150.00 12/7/2014 Estate of Sean Matthew Dosiak 975 Sears Clothing 125.97 12/20/2014 Estate of Sean Matthew Dosiak 976 Cash Cash -150.00 12/30/2014 Estate of.Sean Matthew Dosiak 977 Comcast Cable cable sports package Utilities:Cable TV -10.55 1/1/2014-12/31/2014 -393.56 BALANCE 12/31/2014 771.78 TOTAL INFLOWS 8,977.10 TOTAL OUTFLOWS -9,370.66 NET TOTAL -393.56 r .: �_ � � `r. � . fi� r Sean Matthew Dosiak Trust (Checking) - Last year 1/1/2014 through 12/31/2014 2/10/2015 Page 1 Date Account Num Description Memo Amount BALANCE 12/31/2013 6,905.10 1/6/2014 Sean Matthew Dosiak Trust(Checking) 1011 Register Of Wills Filing Fee -15.00 1/6/2014 Sean Matthew Dosiak Trust(Checking) 1012 Sharon Dosiak Preparation Court... -300.00 1/6/2014 Sean Matthew Dosiak Trust(Checking) 1013 CPU Stamps -3.84 1/15/2014 Sean Matthew Dosiak Trust(Checking) DEP INTEREST Interest 1.16 2/15/2014 Sean Matthew Dosiak Trust(Checking) DEP INTEREST Interest 1.12 3/15/2014 Sean Matthew Dosiak Trust(Checking) DEP INTEREST Interest 1.01 3/20/2014 Sean Matthew Dosiak Trust(Checking) 1014 Mark Wetzel Accountant Fee -50.00 4/15/2014 Sean Matthew Dosiak Trust(Checking) DEP INTEREST Interest 1.11 5/15/2014 Sean Matthew Dosiak Trust(Checking) DEP INTEREST Interest 1.08 6/15/2014 Sean Matthew Dosiak Trust(Checking) DEP INTEREST Interest 1.11 7/15/2014 Sean Matthew Dosiak Trust(Checking) DEP INTEREST Interest 0.83 8/15/2014 Sean Matthew Dosiak Trust(Checking) DEP INTEREST Interest 0.83 9/15/2014 Sean Matthew Dosiak Trust(Checking) DEP INTEREST Interest 0.83 10/15/2014 Sean Matthew Dosiak Trust(Checking) DEP INTEREST Interest 0.81 11/15/2014 Sean Matthew Dosiak Trust(Checking) DEP INTEREST Interest 0.83 12/15/2014 Sean Matthew Dosiak Trust(Checking) DEP INTEREST Interest 0.81 1/112014-12/31/2014 -357.31 BALANCE 12/31/2014 6,547.79 TOTAL INFLOWS 11.53 TOTAL OUTFLOWS -368.84 NET TOTAL -357.31 t _ � � � � J F f. Sean Matthew Dosiak Trust (MM) Check Register- Last year 1/1/2014 through 12/31/2014 2/10/2015 Page 1 Date Account Num Description Memo Amount BALANCE 12/31/2013 11,342.31 1/20/2014 Sean Matthew Dosiak Trust(MM) DEP INTEREST Interest 2.41 2/20/2014 Sean Matthew Dosiak Trust(MM) DEP INTEREST Interest 2.41 3/20/2014 Sean Matthew Dosiak Trust(MM) DEP INTEREST Interest 2.18 4/20/2014 Sean Matthew Dosiak Trust(MM) DEP INTEREST Interest 2.41 5/20/2014 Sean Matthew Dosiak Trust(MM) DEP INTEREST Interest 2.33 6/20/2014 Sean Matthew Dosiak Trust(MM) DEP INTEREST Interest 2.38 7/20/2014 Sean Matthew Dosiak trust(MM) DEP INTEREST Interest 1.87 8/20/2014 Sean Matthew Dosiak Trust(MM) DEP INTEREST Interest 1.93 9/20/2014 Sean Matthew Dosiak Trust(MM) DEP INTEREST Interest 1.93 10/20/2014 Sean Matthew Dosiak Trust(MM) DEP INTEREST Interest 1.87 11/20/2014 Sean Matthew Dosiak Trust(MM) DEP INTEREST Interest 1.93 12/20/2014 Sean Matthew Dosiak Trust(MM) DEP INTEREST Interest 1.87 1/1/2014.12/31/2014 25.52 BALANCE 12/31/2014 11,367.83 TOTAL INFLOWS 25.52 TOTAL OUTFLOWS 0.00 NET TOTAL 26.52 2} .+ � .-