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Home My WebLink About94-00393 .~~~m!'~mf'lf\\'l1'l\"'~11~\WI~I>''iI'\'j~I~ ;t,,:" "~'\- ,-' "i:; '~i' <~i,,:'J' '-^i'-:'-< 1 _,I-',',l>, ',- . I,-'<"i ';;;,':; ?/;.j.~,,:, i':-::':~;:\'>-:~-F'!: .. I' IN TIIF. MATTfoJR OF SP.AN M~'rTHEW nOSI ~K ~lleged Innapa~ltated. , , IN '{'HE COURT OF COMMON PL~lAS dUMBERLAND COUNTY, PRNNSYLVANIA ORPHANS' COURT DIVISION NO. 21-94-393 ("ITATION WP. COMMAND, you that laying aside all business and ex~uses ~Ihatsoever., you he and appear in your proper person before the Honorable Judges of the Common Pleas Court, orphans' Court Division at a session of the said Court there to be held, for the County of ("umberland and that a ~itation be issued direrted to the guardi~ns of Sean Matthew Doaiak, his natural parents, William R.Dosiak and Sharon Doslak. At least twenty (20) days written notlre of the hearing shall be glvMn to Soan Matthew Doslak, the alleged Inraparitated, by serVing Sean Matthow Doslak personally with the nltation and a (lOpy of the Petl tl on, and at least twenty (20) days of the Pet.Jtlon and Hearing shall also be gjven to any next of kin Usted In the Petitjon oither personally or by Certified Mall. Cj tatlon returnable anrlHeari ng thereon to be held on 6th' day of June, 1994 at ll:OOA.M., In Courtr.oom No.1, in the Cumberland County Courthouse. Witness my hand and offJrial seal of offlre at Carlisle, Pennsylvania this 29th day of Aprl1, 1994. \~(1~' ~ I ...,.' '/~..(f) () . ary (".LewJs , Cle. of orphans' Court Cumberlanrl ("ounty Carll Isle,Pa. " , .. E.xhibit, '.'A" ,,' PS Form 3800, Juno 1991 ~" if . f f f , " "~, f i , , jll~ 1 ! ., j f ~ " . i I 1 ..1 J ~ I J ., J r f 1 1_ 'C . . ., :. ~ I " IH ) , IJJ f f ',/ ) W~~ &'f .z: j ; j oJ ' ~I Q t { I '- 1 r~ ~~ ~.. . '. ' I'; , ^ ~ -6' I:" j o ... 01 .. R Q, In _0 ~ ~ :n1l:0 .c.., ,0 .. lI'" j ~ III .z: C " :II l)I .f) ~\i <:: Q 3:? . 0 . I a , ~a :J' .'.;..., .,._.....,...' ....'r~'.'...~.-"f".~Jl..-M'.., _"." '." ....,.,.....,"~ .~l~'f'f.-~.. I' ... .n . .' ',""'~_." I , t .I.':~' ' ,"I,"('i'/\.lty"'-'~4\\'II\II"'t,t4. ;':.l('{o.', . .', , " i I( ..I..... . 1.'-"-': ~.I'.J1:. :1">.: . ~_,,,-,,I"" . . ,. !. , . - ljOf.... .. --,,,,", . . ,. ~ _:1'........ .",,"""~I.I"jN,;jli\;'" . ,folloWln9,......IceI(fll!I~~;t: . 1'ltnl'fC'll_.............tlIe...oIll'o16fonn..INt...- .....1. . ; I'''! .." l', \ __....-, 'V';,''.,'; ':. ".,.." " ,... . .~. .' .' , :.:.,,=,:~~~~~~,~oir",:IM......It...... 1.0 Addl ',Addr... ' .. .. W....._........""'...__....IM........._IM..IolO....... 2 0 AI td D,II-Iert I ' ,..,.._""""...._._lhoorlldO....dollWftd.....IM_. f ~, Contult If '01 ... l 3, Artlcll Addlnttd 101 4t. Awoll Numbef 'bi\\i e.. -:SD ~ia,V> l' 0 i '''':L_ I "" ~ ~ 4b. Slrvlca Type, i . sa::. oIJ-Io( ("'\ '-l.......ku 0 Aegleltrtd 0 Inlured 0("'('\ '. _\.."~C~ -pA Ii Clrtlfled 0 CDD l' \' \e(..,.Y'A'() ~ ~ \j 0 EllPIH,MIIt 0 A'Mn 1 . nOSI) 7. DetlofD'Uverv . ~ 1 s 8. Addrt-" Addl Ind 1M I' plldl 8. S~~~~~Qtrr i I III illlU /11/ I ! P9 F~rm .. I D.lcomber 1891 .u.e.0I'0l1",-114 I \ j ", ..... .. ..... ...... I I 1\ 1 . 1 I' RecOlpt 'or J oil ~ ! y If roqUlltld j , j:.' I e. 'i"rrn) '1Im'1 II I II/I /I 1/111/1 I /III III", ::f,,,,,,: j .. PS~ . . December 1881 1lIlI.CII'Q'-'n., DOMESTIC RETuRN ~CEJJrr..!::, --'~".'''al''''",___,_",_""" ."" '.", -."----~..-------....~'"__"'w_~~~ "ONDER: " 'I . ComlllolO 110... tllldlor 2 'orlddhlontl MovIcoo. " Com;Ioto Ittmo 3, IIlCI .. . b, .. Prtnt vour-nlmtlnd Iddtt.. Oft the t....ttH of INt 'onn 10 thlt w. eM IttUm INt "III ,. V.... . Atltoh lNt'lorm '0 'ho'ront., 'ho m.N_, or OIl 'ho ....k /lIP". dote not PtmIIl. ., 'Wrlt."A......Rtctlt>tR_td"OIl'ho'""il>ltctbtloWthtlttlclt_ 2, 0 Rlltrlolld Dol/vl/y , Tho AllUm Iltct4pt WIN 1110.. t. whom 'ho ,_ WtO dtIvtrtd llId tho dill C , , 8!!!fivMd. "_ onlull oltmollor or II, , 3. AnloloAddrollld 10: ." 40. Anlolo Number DOl i~ ":D~ ic\\L., 15 (Aq ':?C"~y qL11 ,_, ~~~t Q"ctCl e. ~ N"Y' . II~ttd- , 1110 wllh to recllv. the '01l0wln8 1.lVlcol lIor an OXI" ,"): l. 0 Add'"III'. Add".. " B, . ~ FS Form 3800, .~n' ',991 ,^ lll~ " , , 1 ~ 01" i'V 5! 1 1 1 1:1 ..,0 .: { .. R "', I ~ . 'U J ~ i , I ii10Z ("):ll IJJ ~n ? ~~ 1 ~ 0 0 ell 111 .l: ~5""n C ',^ :;< :u!a ~ 3; ~I ~l i ~c" -'0 .... l.l '11 ~ (Qi ,. ~ " g 0- D> , \::' ~ - n ~ V1 " --gr~3:0 -0 .. II'" ~ < OJ , ~ :II .:: 3 . .Il - .'" :1," 0 V ' ." , " , ~ 0 ..Q () C'J -a ;:~ 0 lL", ., , , pate 7/07/94 7/08/94 7/18/94 . 8/03/94 8/03/94 8/03/94 8/03/94 8/08/94 8/09/94 8/15/94 8/24/94 8/29/94 8/29/94 8/29/94 0/31/94 9/08/94 9/20/94 10/18/94 10/21/94 10/30/94 11/02/94 11/12/94 11/12/94 11/12/94 11/22/94 11/26/94 12/10/94 12/13/94 pate 10/02/94 10/09/94 10/15/94 10/29/94 11/12/94 11/12/94 11/19/94 11/26/94 11/27/94 12/11/94 12/11/94 12/17/94 12/23/94 !!!K.PENliES, Payee.__------ pyrp(Jse_ -- Jan Wiley Legal tees tor Guardianship cash . TriP to Virl/inia & Pittsburgh Cash-Hills Dual fan for Sean's bedroom Wal-Mart school Clothes PayleRS Shoes K-Mart School clothes Lemoyne Sleeper Mattress and box spring for bedroom Hills Shirt and cord for radio Rx services Dilantin Medication R.T. Grim Ele. Deposit for TV repair (Sean's TV) cash Haircut Value city Clothes & shoes R.T. Grim TV Repair for Sean's TV Radio Shack TV Wire Mech. School School lunches Msch. School School lunches Mech. School School lunches Mech. School School lunches cash TriP to Virginia Mech. School School yearbook Mech. School School lunches Nation R~ svs Dilantin Medication Hills Clothes BosCOV's Shoes Mech School School lunches Hills Clothes Wal-Mart Christmas Gifts & Music tape Mech School School lun~hes ------- TOTAL PAYCHECKS ~~~ENSES FROM CIT P ayee ______..__.._P1!I~-~-,.---..,. Cash Haircut Cash-Giant Video cash-Wee Three Music Tape Cash-Wal-Mart Music Tape Cash Miniature Golf Cash-BoscoV's Music Tape Cash-Giant Christmas Tape Cash-MRM Music Music Video Cash-Hills Turtle neck shirt Cash-Hills Music tape cash-Mont,Ward Christmas Gifts Cash Haircut Cash-The Wall Music tapes --- 'TOTAL Amoynt 1625.00 50.00 37.07 36.48 14.99 18.00 366.76 20.15 5.00 30.00 7.50 38.68 154.76 11.11 7.25 7.25 7.25 7.25 50.00 28.00 7,25 12,00 27.94 44.99 7.25 52,88 27,20 7.25 2709.26 Amount 7.50 7,41 9.00 14.27 4,00 4.23 5.29 24.33 4.97 5.26 8,98 7.50 18.00 120.74 INCOME 67,028.04 EXPENSER . 2.830.00. 64,198.04 . . Checking Balance/December 31,1994 Cash on hand from CIT/Dec.31,1994 Mellon certificate/26 Mos. Mellon Certificate/6 Mos. Total- 4,402.36 2.76 55,000.00 _3~92 '.?A 64,198.04 We certify that the above is an accurate report of the income and expenses of the guardianship account. The needs of the incapacitated person as set forth above included expenses for Sean, including trips and vacations. Sean resides at home at 100 Second Street, Bowmansdale, PA 17008 with his Mother, Father, and Sister. Sean is still on Dilatin medication to control seizures. He has gone for another speech evaluation at Poly-Clinic. He has a severe speech delay and is getting language therapy in school and using a Cannon Communicator at CIT (if not understood) . Sean is a student with CAIU and is being trained at Central Industrial Training (CIT) three times a week. He has support with OVR. I feel the guardianship should be continued. The reaso~ 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. f- ;( IL? i liam R. Dosiak 100 Second Street Bowmansdale, PA 17008 S:-C'-- \)..<.-"'.,~ -I;)t~.~.L--RA:j Sharon Dosiak 100 Second Street Bowmansdale, PA 17008 Distribution: Clerk of Orphan's Court, COMMONWEALTH OF PENNSYLVANIA ,SS COURT OF CUMBERLAND J"'I..- tlC. On this, the' day of ....,.. 6-1.<""_~y , before me, a notary public in and for the County of Cumberland, Com~onwealth of Pennsylvania, the undersigned officer, personally appeared Willi~m R. Dosiak and Sharon Dosiak, known to me (of satisfactorily proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they execu~ed the same for purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand d officiayjeal. <.:-. M.~i,.tl>t., ~J~/I''''''''''~/ Nalnrlnl Soal Judllh N. Cornmall, Notnry Publlo Uppor Allvn Twp" Cllmborland County My Commission Explros July 4,1996 Morrbot, PuIYlSyNar/a AIlsociaIion 01 NoIar1ea Notary Public \, 02/11/95 02/18/95 03/07/95 03/28/95 03/07/95 03/28/95 04/30/95 05/02/95 05/08/95 05/08/95 05/12/95 05/13/95 05/13/95 05/14/95 OS/20/95 OS/23/95 OS/26/95 06/02/95 06/03/95 06/13/95 06/13/95 06/20/95 06/29/95 07/02/95 07/03/95 07/10/95 07/24/95 07/30/95 07/30/95 08/01/95 08/01/95 08/08/95 08/08/95 08/11/95 08/18/95 08/20/95 08/23/95 08/31/95 09101/95 09/03/95 09/08/95 09/12/95 09112/95 09/13/95 09/24/95 , \, .........,... KMart Underclothes/filing IOlelhalr cream/cd 46,07 National Rx Services DUantin 12,00 Cumb.Cty Orphans Ct. Filing Fee for Guardianship report 10.00 Mech School School Lunches 7,25 Bank Service Chg, Mellon 15,00 Mech School School Lunches 7,25 Value City Electric Razor 31. 79 Mech School School Lunches 7.25 Nation Rx Services Dilantin 12.00 Super Shoes Shoes & Polish 7,21 Cash(Wm&Sharon) PairShare Food/Sheller (Mar/Apr/May) 654,96 KMart Clothes/Fishing PolelRadio 101.98 Sears Shorts & Shirt 29.99 Harris TV Portable TV 137,79 Value City Clothes & Underwear 81.32 Mech School School Lunches 7.25 Cash Baseball/DinnerlVacationlSean 50,00 Cash (Wm&Sharon) Sean's Fair Share Food/Shelter (June) 29\,00 Harris TV VCR for Scan 308.44 Suncoast Video 15,85 Hills Clothes/Music Tape 22,63 KMart Comforter 21.19 New York Mets Mets Yearbook 9,00 Value City Bcd Ruffie 13.77 Cash(Wm&Sharon) Sean's Fair ShareIFoodlSheller (July) 29\'00 Rx Place Medication 10.64 NRM Music 2 Compact Discs 33.90 WalMart Clothes 31.68 Lowe's Bookcase & TV Stand 42.32 Cash(Wm&Sharon) Scan's FairShare/ShelterlFood (Aug) 291.00 Hill's School Shoes/Shirts 46,95 National Rx Services Dilantin 12,00 KMart School Clothes 54,29 Cash Trip & Recreation 80,00 The Rx Place Dilantin 8,64 Value City Clothes 9,99 KMart Shoe/Music Tape 20,28 Mech School School Lunches 7,25 Cash(Wm&Sharon) Sean's FairShare/FoodIShelter (Sept) 291.00 VFFO Met's Shirt 12,00 Mech School School Lunches 7.25 Life Touch School Pictures 6,50 Dr, Harhigh Tetnus Shot 10,00 Mech School School Gym Shirt 7,00 KMart T-shirts/Underwear 9.76 ........-. , .'..... . \ . ~ ,':f1Itr.~~~!V1~\l!~~\i,\n;r!i}!)'I~';':lit;.. .. .' ',," "Ii , ., ,;,.:~-;,,~'~~:~~f'~ ''4'I''~'~':'':.,t.:-~.....~.;,;~~,..__ ., . ~ , 09/26/95 Mech School School Lunches 7,25 09/29195 Cash(Wm&Sharon) Sean's PalrSharcIFoodIShelter 291.00 09/30/95 Hills Shirt & Pajama's 20.94 10/06/95 Cssh Hair Cut 7,50 10/09195 Suncoasl Movies ,33,90 , 10/11/95 Mech School Sohool Lunches 7,25 10/14/95 Value City Pants & Shirts 43.96 10/20/95 Mech School Yearbook 30,00 10/21/95 Hills Pajama's & CD Holder 19.42 10/31/95 Mcch School School Lunches 7,25 11/01/95 Cash(Wm&Sharon) Sean's FairShareIFood/Shelter 291.00 .' \ 1/04/95 Value ClIy Coat/Shirt/Sweaters 109,93 11/07/95 Dr. Harhigh Physical 34,00 11/10/95 Walmart MovielWallet 24,31 I tll 5/95 Nation Rx Service Dilantin 12.00 1 1/15/95 Mech School School Lunches 7,25 11/19/95 Value City Shirts/Chain for Wallet 17,97 11/25/95 KMart Christmas Gifts 18.21 11/26/95 Montgomery Ward Keyboard & Stand 166.38 12/01/95 Cash(Wm&Sharon) Sean's Fair ShareIFood/Shelter 291.00 12/05/95 Mech School School Lunch 7,25 12/17/95 Value ClIy Shirt 19.99 Total $4666.70 EXPENSES FROM crr PAYCHECKS Date Payee PUQ)Ose Am.wml. Otl18/95 Mech School Pizza Lunch 2,50 02/02/95 Cash Haircut 7.50 02/08/95 Mech School Made Lunch in School 1.50 02/11195 Camelot Music Music Tape 10.59 02/18/95 Hills Compact Discs 19.05 ' 03/01/95 Mech School Made Lunch in SQheol !.SO 03/15195 Mech School Made Lunch in School 1.50 03/15/95 Special Olympics Lunch for Special Olympics 1.20 03/29/95 Meoh School Made Lunch in School 1.20 04/01/95 Walmart Compact Disc 10.56 04/12/95 Movies With Class 4,00 04/16/95 Cash Bowling 6,00 05/03/95 Cash Bowling 2,50 05/07/95 Cash Bowling 5,00' 05/10195 Cash Card Shopping w/sohool 2,70 05/17/95 Cash Movies & Ice Cream 3,22 OS/24/95 Cash Golfw/School ,3.58 06/11/95 Cash Lunch '2,00 06/14/95 Giant Card 1.32 " , 1:-"::.7~1~,t1';"i"i'1 06/15/95 Phar.mor Music Tllpe . 8.47 06/20/95 CVS Baseball Cards & Bubbles 1,57 . 06/21/95 Phar.mor Music Tape 8.47 . 06/27/95 Cash Bowling 4,00 06/29/95 Phar-mor Music Tape 3.15 07/13/95 Cash Hair Cui 7.50 07/22/95 Cash Movies 5.00 07/24/95 Cash Ice Cream 1.69 07/30/95 Walmart Music Tape 5.26. 07/31/95 Cash Ice Cream U5 08/01/95 CVS Music tape 3.17 08/23/95 KMart Lunch 3,25 10/21/95 NRM Music Tapes 28,60 11/02/95 Cash Lun\1h 3.00 11104/95 Camelot Music Tape 16.95 11/04/95 Giant Music Tape 5,29 11/07/95 Hills Puzzle 3,15 11/13/95 CIT Turkey Dinner 2,85 11119/95 Walmart Music Tape 10,35 11/23/95 Cash Movie & popcorn 7,00 12/10/95 Burger King Lunch 3.70 12/12/95 Mech School Donation 1.00 12/17/95 Quick 6 Sub & Soda 4,65 12/17/95 Quick 6 Soda .95 12/23/95 Quick 6 Sub & S~da 4.92 Total $233.21 TOTAL INCOME: $ 5834,07 TOTAL EXPENSES: ~899.9L 934.16 .' " Checking Balance/December 31, 1995 908.56 Cash on hand from CITlDcc. 31, 1995 2till 934.16 Date. I nterest Type TR~~: INCOME Amount L ,th of CD 03/10/95 CD Interest 9 Month 27,09 03/10/95 CD Intercst 26 Month 254,75 04/10/95 CD Intercsl 9 Month 30.00 04/10/95 CD Intercst 26 Month 282,12 05/10/95 CD Intcrcst 26 Month 272.99 OS/26/95 CD Intcrcst 9 Month 36.03 06/09/95 CD Inlcrcst 26 Month 282,12 06/27/95 CD Intcrcst 9 Month 37,24 IN REI GUARDIANSHIP OF SEAN MATIHEW DOSIAK IN TilE COURT OF COMMON PLEAS OF , CUMBERLAND COUNTY, PENNSVINANIA ORPHAN'S COURT ,NO. 21.94-393 'TO: Clerk of Orphans' Court Courthouse, Carlisle, PA ANNUAL REPORT OF GUARDIANSHIP QE.SEAN MA 11'HEW DOSIAK , Estate: Sean Matthew Dosiak Guardian: William R. Dosiak and Sharon Dosiak Period: January \, \996. December 31, 1996 Date Filed: I " This is a report filed with the Court in compliancewith Section 552\ (0) of Act 24 of July, \992,20 PaCSA 5521. ' " " " no C' .- ~ ':O~ ' - III '1 ~" . l~, ' <:1"" 'J , ~ ':la. ,., ri .1'. " .' i' tj (10 ,. "k 31 I i ~ '. 4~ ~l U :Y ~.~ p , I,J ::::S" 'n'- i.11 ~l a :1' ; :~, N .. I" !'. , 'I' ;' .' "/. " , ,I ", ,. . " , " " , . I' , . :_1 INCOMe. . Date Sourc' - AmOunt 01/01/96 Chec\(boOk Balance as 0112/31/95 908,66 01101/96 CIT Calh on Hand as 01 12/31/95 25,60 01/02/96 551 Check 497.40 01/05/96 Paycheck 6,99 01/19/96 Paycheck 4,36 02/01/96 SS' Check . 497.40 02102196 Paychsck 14,71 02/16/96 PaycheCk 23,71 03/01/96 SSI Check 497.40 03/01/96 paycheck 14,74 03/16/96 poycheck . 4,06 03/29/96 payc.heck 16,23 04/02196 SSI Check 497.40 04/12/96 Paycheck 5,06 04/26/96 Paycheck 11,27 05/02/96 sst Check 497.40 05/10/96 Paycheck ," 16,67 OS/24/96 Paycheck 13,37 06/31/96 sst Check " j 497.40 06/07/96 Paycheck . 1.16 07/01/96 55' Check 497.40 08/01196 551 Chsck 497.40 08/30/96 551 Check 497.40 09127196 paycheck 26,13 10/01196 55' Check 497.40 10/11/96 paycheck '. 27,79 1 0/25/96 paycheck '" 19,07 11/01/96 551 Check 497.40 11/08/96 paycheck 24.02 . 11/22/96 Paychsck 17,20 11/29/96 551, Check 497.40 12/06/96 paycheck . 14,90 12/20/96 paycheck 22,50 . TOTAL 7165.91 exPENSES Dat. PUIPo.' _ Payee Amo'illL 01 (02/96 Sean's Fair Share/Food/Sheller/Jan Calh (William & Sharon) 291.00 01/15/96 School Lunchel Mech, School District 7,25 01120/96 Panls and Jacket Sesrs 52,73 02/01196 Saan's Fair SharalFoodlShaller/Feb Cash (WIlliam & Sharon 291.00 02/04/96 Clothes and Blanket Value City 60.41 02/04/96 Lunch Bo)l. Wal.Mart 10,57 02107/96 School Lunches Mech, School District 7,25 02106/96 Video Game/Sega c~sh 230,66 02/12/96 DIIElntln National RX Services 12,00 02118/96 Bedding for Camping Cash 03/01/96 Sean's Fall' Shal'a/FoodlShslterlMarCash (William & Sharon 03/12196 School Lunches Mech, School District 03/14/96 Oklahoma Tickets Mech, School District 03/16/96 Mualc Tape Wal-Mart 03/23196 Work Shoes Kinney Shoes 04/02/96 Sean's Fair Shsre/Food/Shelter/Apr Cash (William & Sharon 04/02196 School Lunches Mech, School District 04/03/96 Tharmometer CVS 04/04/96 Sinusltus Dr, Harhlgh 04/04/96 Madlcallon RX Place 04/13/96 Video and Tepe The Wall 04/13/96 Clothes Seara 04/14/96 Clothas Value City 04/17/96 School Lunches Mech, School District 04/26/96 Mets Year aook Now York Mets 04/27/96 Sneskers Value City 05/02/96 Sean's Fall' Share/FoodlShelterlMayCash (William & Sharon 05/07/96 Dllanlln Natlonsl RX Service 05/12/96 Fishing Equipment K-Mart 05/12/96 Tsckle Box Wal-Mart 05/15/96 School Lunches Mech, School District OS/24/96 Camping and Recreation Cash 05/31/96 Ssan's Fall' Share/FoodlShelter/JumCash (Wllllsm & Sharon 06/19/96 Bank Chargfo! Mellon 06/08/96 Recreational Toys Value City 06/11/96 ClothasNesURaft K-Mart 06/14/96 Fishing License & Camping Rec, Cash 07/01/96 Sesn's Fall' Shsre/Food/Shslter/JulyCash (Wllllsm & Sharon 07/06/96 Videos SunCoast 07/11/96 Haircut Cash 07/06/96 Bank Service Charge Mellon 07/27/96 School Clothes Value City 06/01/96 Sean's Fall' Share/Food/Shelter/AugCash (WIlliam & Sharon 08/02/96 School ClolheRlMuslc Tape Hills 08/05/96 Tennis RackeUShoes/Clothes K-Mart 08/07/96 Dllenlln National RX Service 08/09/96 Camping & Rec, Cash 08/27/'i16 School Lunches Mech. School District 08/30/96 Sean's Fall' Share/FoodlShelterlSep Cash (William & Sharon 09/05/96 School Lunches Mech, School District 09/06/96 Haircut Cash 09/07/96 Sweatshirt/cup Wal-Mart 09/08/96 Elook Ollles 09/13/96 Mets Fsn Club New York Mets 09/17/96 Pictures Life Touch 09/21/96 School Lunches Mech, School District 09/28/96 Shirts Valus City 10/01/96 Sean's Fall' Share/Food/Shelter/Oct Cash (William & Shsron 10/06/96 Tape & SneskfJrs Wal-Mart 10/06196 GamelMuslc Rack/Clothes Hills 10/10196 School Lunches Mech, School Diatrlct 10/13/95 Music Hilla 10/18/96 Pajamas Value City "I_ -.\ ,y..... I' "'i ".....',-.....-__._...H..._ 39,69 291.00 7,25 4.00 19.04 55.00 291.00 7.25 12.71 35.00 65,89 52.98 95.80 64.95 7.25 9.00 6,25 291,00 12,00 51,46 14,24 7,25 50,00 291.00 15,00 45,38 143,39 80,00 291,00 13.01 7,50 9.00 27,48 291,00 46.78 123,92 15,00 30,00 7,25 291,00 7,25 7,50 23,26 11,11 14,95 15,00 7,25 28,97 291.00 25,31 76,18 7,25 7,31 15,98 J '.... ~, "" '>'r', ., . 'I I ' '. 06I2a196 Puzzle Book ' Giant 4,76 06129/96 Muslo CD Camlllot 11.fJ6. 10108196 Video & Card Giant 21.09 10/19/96 Movies . Cash 8,00 10/25/96 Breakfast Shoney 6.~6 11/03196 Pretzel Cash 1,26 11/07/96 Bowling Cash 3,76 11108196 Haircut Cash 7.60 11108196 Music Tape Hills 10,67 11/10/96 Donation . Value City 3,14 11 /1 O/ll6 CD Camelot 11,66 11/18/96 Ice Show Hershey Par\( 13,60 11/16/96 Dinner Applebees 11,23 12101/96 Big Lots Safely GlasseslMuslo 6,17 12/02/96 Giant Gifts for T9achers 6,06 12/22/96 Isaao's Lunch 6.30 TOTAL 269,39 TRUST /NCOMe Dlt. Intlrelt Type Amount 01/01/96 Trust Checking Balance as of 12/31/95 3000,98 01/10/96 CD Inlerest 282,12 01/26/96 CD Interest 37,26 02109/96 CD Interest 282,12 .02/27/96 CD Interest 31,94 03/08/96 CD Inlerest 263.87 03/27/96 CD Interest 29,88 04/10/96 CD Interest ' , 282,12 04/16/96 CD Interest 31,94 06/10/96 CD Inleresl 272,98 OS/24196 CD Interest 30,91 . 06/10/96 CD Interest .236,41 06127/96 CD Interest , " 31.94 07/10/96 CD Inleresl 227,80 ' 07/26/96 CD Interest ,. 32,42 08/09/96 CD Interest ' ,,235,41 08/27/96 CD Interest " 33.60. 09/10/96 CD Interest . ;';" II 236.41 09/27/96 CD Interest 33.60 '10/10/96 CD Interest " 227.80 10/25/96 CD Interest 32,42 11/08/96 CD Interesl ,. 235.41 11/27/96 CD Interest 33,60 12/10/96 CD Interest 227.80 12/27/96 CD Interest ' 32.42 TOTAL ' 6400,85 . EXPENSES FROM TRUST FUND Dlt. 02102196 01/31/96 Purpo.. Guardianship filing fee Service Charge Amount 10,00 4,00 03/19/96 Allen Schenfelt preparation for 1995 taxes . 03120196 Internal Revenue Service 1995 taxes. 03120196 PA Department of Revenue Service 1995tsxes 02/29/96 Sef\l~ Charge 03129/96 Service Charge 04/08196 PA Depertment of Revenue Taxes Trust 04/08196 Intemal Revenua Taxes Trust 04/08/96 Randall L. Hartman Preparation of Truat Tax Retum 04/30/96 Service Charg9 05/31/96 Service Charge 06/28196 Service Charge 07/31/96 Service Charge 08/30/96 Service Charg9 09/30/96 Service Charga 10/31/96 Service Charge 11/29/96 Service Cl)arge 12/31/96 S~rvlce Charge TOTAL 20:00 .. 9,00 12,00 .4,O(l 4,00 49,00 258,00 200,00 4,00 4,00 4.00 4.00 4.00 ' 4.00 4.00 4.00 4,00 606,00 t", INCOME EXPENSES . BALANCE ,Checking Balance/December 31,1996 Cash on hand from CIT/December 31, 1996 . Trust Checking Balance/December 31, 1996 , . . 13586:76 6709.95 6876,81 Trust CDlMellon Trust CDlMellon 1042,80 39,16 ~ .~ 550:77.88 76!,!3,00 62170,88 , , '" " ' ,. , " . ,. " " , ; " ,I " " . , " '"~ ,., ',', ,I',j , \ ,., " , 1 ,I' \ " ., L' ' , : " " ,j"1 ,. . .' , ,. '" ;'j'",\, !'., i'-' ,. , \', /";,,' 'I 1\',", "1.1,1. I' (.1. ,. \", " , "\" '.1; , \ ,,' I I' "f. , ", ,'f', , I. I, '1'1; I' \ , I ,,' I', ',',' " ". !! .' 'j, I I' Ie;, .,' " ,.1 ' . I, j' ." , 'I ii','. 'f I Ii 1 ,. " '", I; , , . " II' ; " I, ., " " " , 'I' ~. ! ,.' I ._.,It., :; ,.'1, " If , ',' c IN Ul GUARDIANSHIP 0,.- I. IN TilE COURT 011 COMMON PLEAS OF . SEAN MATI'HEW OOSIAK I CUMBERLAND COUNTY; PENNSYLVANIA I I ORPIIAN'S COURT I I NO. 11-9+393 TO: Clerk of Orphans' Court Courthouse, Carlisle, PA , ,I, , ANNUAL REPORT OF OlJARDlANSHIP OF SEAN MAJIHEW DOSIAK " 'I- Bstate: Sean Matthew Dosiak Guardian: William R. Dosiak and Sharon Dosiak , Period: January I, 1997. December 31, 1997 Date Filed: This is a report filed with the Court in compliance with Section 552\ (c) of Act 24 of . July,1992,20 PaCSA 5521. . I, " " ". '1(' ,. . , ,,~I I;~:l "..' I" ., 1-" 1':1:1' 'i,'\,'_', ,. j,' I ~.' ',:~ " ~:;i . "i('1 ,,-.., _u '"0'.1 '.'li , ,. i"-/I' (l.," ,.,'J _ j, f-ll ,I l":j :, {.)(";' " , ,I' :11 ,. I ., . " .,. ~ Dat. Bourn Amount -- 01101/97 Checkbook Balance as of 12/31/96 1042,80 01101/97 C IT Cash on Hand as of 12/31/96 39,16 01101/97 SSI Check 511.40 01/03197 Psylt1eck 12,04 01/17/97 Paychacl\ 13.18 01/31/97 Paychacl\ ~7,20 01/31/97 SSI Chacl\ 511.40 02/14/97 Paycheck ?0,94 02128/97 PaychllCk 21.80 03103197 SSI Check 511.40 03114/97 Paychack 25,14 03128/97 Paycheck 19,27 04101/97 SSI Check 511.40 04111/97 Paycheck 5,92 04/25/97 Paycheck 19,91 05/01/97 SSI Check 511.40 05109/97 Paycheck 17,56 05123/97 Paycheck 24,40 05130197 SSI Chacl\ " 511,40 06106/97 Paycheck 17.75 07/01/97 SSI Check 511.40 08101/97 SSI Check , 511,40 08129/97 SSI Chacl\ 511.40 09/26/97 Paycheck 21.27 10101/97 SSI Check 611.40 10/10197 Paycheck 23,87 10/24/97 Paycheck 17,53 11/03/97 SSI Check 511.40 11107/97 Paycheck 26,35 11/21/97 Paycheck , , '17,08 12101/97 SSI Chacl\ 511.40 12/04/97 Paycheck .21.92 12/19/97 Paycheck 28.60 TOTAL 7600.29 EXPENSES Oat. Purpo.. PlY" Amount 01/01/97 Soan's Fair Share/FoodISheller/Jan Cash (Wllllam& Sharon) 302.00 01104/97 CD & Tape The Wall 43,44 01/05/97 Clothes Value City 50,96 01/10/97 School Lunches Mechanlcsburg School Dlsl. 7.50 01/18/97 CD The Wall 1907 02/03197 Sean's Fair SharelFoodlSheller/Feb, Cssh (William & Sharon) 302,00 02/01/97 Shoes & Clothes Hills 32.94 02/02197 Clothes Value City 65.90 02/02/97 CD Csmelol 28,61 02/08197 School Lunches Mach, School Dlsl 7.25 02/08197 DUantin Merck-Medea RX Service 15,00 02/14/97 Eye Exam KUmore 93,00 02/14/97 Glassas Cummings Optlcel 199,00 02128197 School Lunches Mach, School DI8t 7,25 03/03/97 Sean's Fair Share/FoodlShelterlMar. Cash (William /l, Sharon) 302,00 03/08/97 Tape Camelot 16.94 , I 03120/97 School Lunches Msch, School District 7.25 03/24/97 URI Dr. Hsrhlgh 35.00 04/01/97 Sean's Fair ShsrelFood/Shelter/Apr. Cash(Wllllam & Shsron) 302.00 04101/97 Yearbook New York Mets 9.00 04105/97 Ba!:ly Boom Box WalMart 8.45 04/05/97 Clothes Value City 37.22 04108197 Clothes Sears 79.00 04/11/97 School Lunches Mach. School District 7.25 04120197 Jacket & Shirt Vslue City 17.98 04/24/97 Dilantln Merk-Medco RX Ssrvlce 15.00 05101/97 Sesn's Fair Share/FoodlSheller/May Cesh (William & Sharon) 302,00 05102/97 School Lunches Mach School District 7.25 05103197 Clothes & CD Hills 58,02 05/10/97 Clothes Vslue Clly 15.97 05110/97 CD & Rack The WsII 46,61 05117/97 Video Sun Coast 15.85 05121/97 Medicine RX Place 39.08 05122/97 CAmping & Recreation Cash 50.00 05130/97 Sean's Fair SharelFoodISheller/June Cssh(Willlam & Shsron) 302,00 06/13/97 Waler Shoes K-Mart 6.99 06121/97 Clothes & GAme Value City 38.14 06127/97 CD The Wall 14.41 07/01/97 Seen's Fair Share/FoodlSheller/July Cssh(Wlllism & Sharon) 302.00 07/02/97 CD The Wall 13.77 07/03197 Hair CuVCamping Recreation C3sh 30.00 07/13/97 Shlrts/Nlte Light Vslue City 16.58 07/17197 Repair Glasses Cummings Optical 66,00 07/24/97 CD Box Set Media Play 63,59 07/29/97 Dilantin Msrck.Medco RX Service 18,00 07/30/97 C lothesfT ape Hills 55.42 08101/97 Sean's Fair Shere/Food/Sheller/Aug. Cash(William & Shsron) 302,00 08106197 Shoes Sears 69,98 08106197 Clothes Sesrs 150,46 08107/97 Membership to Mets Fsn Club Mets Fsn Club 24.95 08119/97 CD & Batteries The Wall 23,30 08120/97 Tis Hills 5.97 08120/97 Work Shoes Sesrs 40,00 08127/97 School Lunches Mer.h. School District 7.75 08129/97 Sean's Fair Shsre/FoodlShelter/Sept Cssh (Wllliem & Sharon) 302,00 09/04/97 School Lunches Mech. School District 7.75 09/10/97 Haircut Cash 7,50 09/15/97 School Lunches Mech. School District 7.75 09/16/97 School Pictures Lifelouch 11.75 09/17197 Shirt Sears 24,00 09/20/97 Clothes Value City 37,97 09/23/97 CD The Wail 4,23 09/28197 CD WalMar! 11.09 09/29/97 URI Dr. Harhlgh 10,00 09/29/97 Medication RX Place 3,89 10/01/97 Sean's Fair Share/FoodlSheller/Oct Cash (Willism & Sheron) 302,00 10/04/97 Clothes Value City 82,03 10/17/97 Yearbook Mech. School District 34.00 10/17197 Lunches Mech. School District 7,75 10/18/97 Flannel Sheets & Clothes Vslue City 74.15 10/28/97 Dllantln Merck-Medea RX Sorvlce 18.00 i, 10/29/97 CD Hills 16.93 l 11/03197 Sean's Fair Sharo/Food/Sheiler/Nov. Cssh (William & Sharon) 302,00 11/01/97 Coat & Tspes Value City 54.75 11/04/97 Lunches Mech. School District 775 11/08/97 Box Set Camelot 56.17 12101/97 Sun's Fair Share/FoodIShellerlOec. Cash (William & Sharon) 302.00 121061il7 CD Portable Player K-Mart 74.19 12/11/97 Lunches Mach. Sr.hool Olst 7,75 12/12/97 relmbursemenlof 1/3rd of gas fire place Cash 266,04 .12/13/97 Box Set Camelot 58,28 12/23/97 Frames Cummings Optical 53,00 TOTAL 6243,38 EXPENSES FROM err PA VCHECICS Date Purpose PlY" Amount 01/10/97 Haircut Cash 7,50 01/11/97 Hat Value City 1.99 01/11/97 Calendar CVS 5,29 01/11/97 Lunch McDonald's 3,81 01114/97 Card CVS 2,07 01/19/97 Gla88 & Paint Hachlnger's 12.54 02101/97 Lunch McDonald's 3.57 02/02/97 Video WalMart 7.38 02102/97 Ballerlas Hills 8.45 02102/97 Lunch McDonald's 2.12 02102/97 Dinner Hoss's 13,50 02109/97 Magazine Giant 6,68 02116/97 Magazine Giant 4.77 02/24/97 Book & CD NRM Music 23,30 03/12/97 Magazine GianI 5.73 03/12/97 Haircut Cash 7.50 03112/97 Lunch 3,00 03122/97 Deposit for CD Camelot 5,00 03123197 Greeting Cards Giant 2.68 04105/97 Radio Wal-Mart 5.27 04/05197 Lunch McDonald's 1.00 04105/97 CD WalMart 11.09 04105/97 Baseball Cards Hills 1.05 04106I97 Magazlna Glsnt 5,69 04/12/97 Greeting Card and Video Giant 12.15 04/15/97 CD Camelot 7,71 04/18197 Lunch McDonalds 2.12 05/19/97 Lunch McDonalds 3.11 05110/97 Puzzle Book Dollar Tree 1.06 05111/97 Beseball Cards CVS 1.59 05/15/97 Haircut Cash 7.50 05117/97 Ice Cream 2.00 05117/97 CD NRM 16,95 05118/97 Baseball Cards CVS 1,20 05/30/97 School Lunch Cash 1.50 00102197 School Lunch Cash 1,50 00/03/97 Basaball Cards and Book CVS 7.37 00/04/97 Baseball Cards CVS 1.59 00/00/97 School Pizza Party 5.00 00/07/97 lca Cream & Soda 2,50 06/18/97 Greellng Card Giant 1.67 06/12/97 CD NRM 14,63 06/20/97 Baseball Csrds CVS 1.37 06/20/97 Magazine Giant 2,15 06/28/97 Giani 1.68 07/02/97 Battery Giant 1,90 07/13/97 Lunch Long John Slivers 6,55 " '. ". ,e'. ". JllnuatY'16,1999 . Cunlberlanc\ County Courthouse Clerk of Orphans Court 1 Courthouse Square CarUsle J>A 17013 To Whom It May Cunccrn: Encloscd please find a copy of the Annual Report of Guardianship qf Scan Matthew Doslak. I,am abo ~nclosing $10,00 for the fiUng fees, I. am requesting that you selld me a copy of the report stamped received and mcd, . Thank YOll for your help In this matter, Sincerely, Mr, and Mrs. William It Doslak Guardian of Scan Matthew Doslak Bnclosure (1} sd/bls " .',. ,. ',I " 'Ii " ,. ", "I ,.1' ,. ,. " ,. ,. ,. ,.' , '. 'I, ,. L ,. ,',' " , , I , , :; .," ,. ':~~{",~_~,~~.,"J'rr:""f'~~""""'''~':'"'''' i'''~'''~'''~.'~'\I~~I/''''',''ln~Y'fI'''I~~'-''''li! "";"'-"--~"''''~ jl' , ,. /.' \. 'L I, i: " " ", ,,,1 " I' ,. '1\ ". ., ". , " ,. , Inn SI'.I;ONO 8'1'91111'1' IlllWMhNSIJHII I'^ 111108 " 'I, j.!' " ,. , 4k, 'Q R!!~, ::i .,1' I r" l ; I I': ' i. ,1.- ~.) '. I l'.- 1':Of: J",.\ " , ", '1', 1\ ....,. , ' (- !F1 ~ -0 , I'.) ~~ CO 'I, Ii I. ,. 'oW (.\)_~1 " '1,1 .', (j '/::' " II" , ~~ (,', ~Il ,. .1,," ~ " RXPBNBBS FROM CIT PAYCHBC.KS \)"'I1l PURI'OSJI. I'AYJl.1l AMOUNT 1/10/98 nalledes, N'I'o~paper GianI 3,33 1/16/98 1I0wllnll, Lnnch Cluh 4,28 2/6/98 IlIl1y Joel COlleer! Cash 50,00 2/18/98 MaRa.lne OIanl 5,n 3/13/98 Skadng School 2,00 " 3/1(,/98 Lonch McDonald'. 2.\0 3/19/98 I.uneh nurger KinK . 2.\0 3/21/98 Chair Sam. Cluh 10,0( 3/29/98 Orlole8 Game Cuh 15,70 3/29/98 I,unch Friendly'. 10,68 4/3/98 Ice Cream Dairy Queen 2,11 4/10/98 S.afond salad Cuh 5,72 4/10/98 Jllrewood Gellyshurg Camp 7,00 4/D/98 n"eh.1I Card. CVS 2,53 4/13/98 Greeting Card Giant 1.46 4/D/98 Lunch McDonald's 3.53 5/3/98 lIal& lIall GianI 3,17 5/6/98 lIaircut Cash 8,00 5/7/98 ~Use. GianI 3,86 5/10/98 Lunch lIurger King 3,67 5/17/98 lIagel & Juice Cash 2,49 ~/25/98 lIaseball Cards CVS 2,95 6/1/98 SehOQI Lunch School 2,10 6/2/98 Carnival qlU 1,50 6/6/98 Golf Cash 6,00 6/1/98 Hal Value Cily 2,99 6/7198 Lunch Subway 4,65 6/7198 Lunch Cash 1.06 6/7198 Snack Ca,h .1.50 6/7198 Snack Ruller'a 2,64 6/9/98 Greelinl! Card Giant 2,70 6/12/98 Lunch E.slde Rcsl 5,14 6/13/98 Greeting Card GianI 1.97 6/19/98 Tapc & Nowapaper Family Dollar 5,21 (,/26/98 Lunch Giant 3.02 7/2/98 Haircut Cuh 8,00 7/4/98 CD 11111, 14,81 7/4/98 Lunch . McDonald's 3.78 7/8/98 Ba.eball Card, K.Mart 2,58 7/11/98 Suntan Lodon, Kile IG/\ 9,18 . 7/16/98 Nail Sci"ora CVS 9.47 7/17/98 CD's Hills . 27,53 7/20/98 Greeting Card Giant ,74 7/26/98 Sega & CD Wal.Mart 17,94 7/31/98 Lunch Subway 2.10 7/31/98 CD Wal.Mart 13.66 8/8/98 Dinner Bob Evans 9.62 8/10/98 lIook GlUes 7,41 8/15/98 !.Imch Scallcs 2 Resl 6.05 8/18/98 Greedng Card GianI. ,74 8/21/98 Newspaper GianI ,52 8/28/98 Newspaper Giant .52 8/28/98 Haircut Cash 8,00 8/28/98 Lunch Dlamonoea 10,59 .. ,a 8/30/98 J,lIl1Ch Qlllk6 5,18 9/3/98 qolf CII.h (,,(X) 9/14/98 ClIrd & NeIV'(1a(1er Olant 2.73 9/19/1)8 l.onch (11l1111llho'. 4,5\ 9/26/98 "ccc.sorlcJ Vallie City 1 1.47 10/4/98 1.1Inch Marino'.I'lzzlI 10,23 10/4/98 Oolf IIl1l1\hle lIce ("CKI 10/4/98 (hunc 'Ihy. 'R' U. 31.78 I" , 10/7/911 'I'al'e K.MlIrt 12,(,0 i p \ , t 10/10/98 Ice Cream Cash 1.1,5 I' 10/11/98 Ie<' Cream &. Gal1\e CIII1\(1inA 1.29 i 10/13/98 \look & Cml Olllnl 4.92 I ' \0/16/98 lIook Ollie. 3,17 Ii 10/16/98 Card Olalll ,7\ 10/16/98 CD Wal.MlIrl 9.42 10/16/98 Lllnch MeDonllld'. 459 10/18/98 Dinner Fa.t.,ide \\esl 11.15 I' 10/23/118 Luuch IImger Kiug 3.47 I 10/27/98 lIailcllt Ca.1I 8,00. il/l/98 CD Camelol' 2(,,49 11 /2/98 \Illl,k Olllnt 4,23 11/7/98 Dinner lriRh Eye, 7,00 11/9/98 lIa,ehall clIllls, Tape KMllrt 20,98 11/14/98 Video 'I'1l(1es & 1111 Card. CV~ (,,76 11/15/98 Game &. 1I:11terlc. VlIllleCity 8.46 11/17/98 Tape WIII.Mart . 12,60 \1 /22/98 'n\pC WIII.Marl 4,nO 11/27/98 Movies Cash M6 TOTAL $ 579.18 l" No Lo~gel worked al crr a, of 10/14/98, D"TE 2/28/98 D"TIl 3/1/98 D/\'\1'. 1/1/98 1/9/98 . 1/27/98 2/10/98 2/27/98 3/10/98 3/27/98 4/10/98 4/27/98 5/8/98 5/27/98 6/10/98 MISCELLANEOUS INCOME SOURCE Refllnd fllr pallt' AMOUNT (,,00 M1SC~NSES PURPOSE Golf (w/nlOney from refllod) AMOUNT (,,00 I.RlJ.5.J' INCOME PURPOSE 'I'rllst \lalaoce liS of 12/31/97 CD Intelest CD Interest CD Intele", CD Intere,t CD Intere.t CD Interesl CD Intercs' CD lnterc", CD Interc,t CD Jntcrc't CD Inleresl I\MOUN'!' 3014.33 264,32 28,02 264,32 28,02 238,(,9 25,31 264,32 28,02 255,78. 27.12 264.32 , Seen'a'Reg, checking 1/6/00 SEAN'S CHECKING ACCOUNT 1/1/99 Through 12/31/99 Page 1 Dlte Otlcrlptlcn Cltegory Amount --- BAlANCE 12/31/98 1,082,02 1/1/99 Depoalt SSI Check 627,40 . 1/1/99 Ceah fYtIm, & Sharon Dcalak) Sean's Falrshare-Food & Shelter -306,00 1/3199 Sea(s Clothing .72,63 113/99 Bocov's Clothing -34,98 1f7/99 CVS pereonalltems -12,79 1/11/99 Merck-Medco Rx Medlcal:Medlclne -18,00 1/17/99 WalMart mus/c-CD's -17,77 1/17/99 Value Clly Clothing -29,46 1/21/09 Hille Clothlnglgame -53,07 1/21/99 The Rx Placa Medlcal:Medlclne .92,34 1/31/99 Value City Clothing -11,99 1/31/99 Borders muslc-CD'a -9,63 2/1/99 Deposll SSI Check 627,40 2/1/99 Cash (Wm. & Sharon Doslak) Sean'a Falrehare-Food & Shelter -305,00 2/9/99 CVS pelsonalllems -9,18 2/11/99 Caah Spending Money .60,00 2/2119\l KMart muslc-CD'a -14,83 2/26/99 Dr. George Harhlgh Medical -42,00 2/27/99 Media Play music-CO's -16,95 3/2/99 Deposit SSI Check 627,40 3/2199 Cash CNm, & Sharon Doslak) Sean's Falrahare.Food & Shalter -305,00 3f7/99 Value City Clothing .10,00 3/12/99 Cash Spending Money .50,00 3/15/99 Merck-Medea Rx Medlcal:Medlclne .3(1.00 3/15/99 Camalot muslc.CD's -11,64 3125/99 Merck.Medco Rx Medlcal:Medlclne .18.00 3/211/99 J. A. Gensblgler DDS Dentist -18.00 3/28/99 KMart Shoes -'12,49 3128/9!) Camelot music-CO's -32,88 4/1/99 Deposll SSI Check 527.40 4/1/99 Cash CNm, & Sharon Doslak) Sean's Falrahare-Food & Shelter -306.00 4/10/99 Sea(s Clothing -90.98 4/13/99 Morck.Medco Rx Medlcal:Medlclne -18.00 4/19/99 NY Mets Yearbook & Clothes -74,48 4124/99 Martin A Yohn Sr Treasurer personal Taxes .9,80 4129/99 Cash Haircut .8,00 4/30/99 Deposit 551 Check 527,40 4/30/99 Caah CNm, & Sharon Doslak) Sean's Falrahare-Food & Shelter -306,00 5f7 /99 Sear's Clothing -37.96 5/16199 Cash Baseball Game -30.00 5124/99 Cast, Camping Trip .50,00 6/1/~9 Deposit SSI Check 527.40 6/1/99 Caoh CNm, & Sharon Doslak) Sean's Falrshare-Food & Shelter .306.00 6f7 /99 Harrlo TV Air Condllloner -221.54 6/10/99 Sea(s Clothing -16,00 6/10/99 CVS personal Items -10.19 6/15/99 Camelot music-CO's -19,07 6/16/99 KMart Brlefa -6.49 6122/99 Refund From Harris TV Refund 10,60 6122/99 Calh Haircut .8,00 7/1199 SSI Check 551 Check 527,40 7/1/99 Cash fYtIm, & Sharon Doalak) Sean'a Falrahare.Food & Shelter -306,00 7/8/99 Calh Spending Money -50,00 7/12/99 CVS Baaeball Carda -8,93 7/19/99 Merck.Medea Rx Medlcal:Medlclne -18,00 7/19/99 Tha Wall mualc-CD'a .50,86 7/19/99 Sea(s Clothing -37,90 7/23199 Amea Video Tapea-muslc CD -24,24 7130/99 SSI Check SSI Check 627.40 . Shn'I'R811, checking 1/5/00 SEAN'S CHECKING ACCOUNT 111/99 Through 12131/99 Page 2 Dlte Dtlorlptlon Cltegory Amount 7/30/99 Cash (Wm, & Shlron Doslek) SIan's Falrshare-Food & Shelter .306,00 8/2/99 Mont9omery Ward Clothing .6,00 8/2/99 Bleacher Bum'a Clothing -23,76 8/2/99 Suncosst Video Tapes-muslo CD -16,96 813/99 Giant Pharmacy Medical-medicine .16.69 813199 Merck.Medea RK Medlcal:Medlclne .18,00 8/4/99 KMart Gamea/personal -23,49 8/10/99 The Wall muolc.CD's -47,68 8/17/99 Cash Haircut -9,00 8/20/99 The Wall music-CO's -22,24 8/23/99 Cash Spending Money :60.00 0/27/99 Marlin A Yohn Sr Treasurer parsonal TaKea . -9,80 911/99 Daposlt SSI Check 527.40 911/99 Cash r-Nm, & Sharon Doslak) Sean's Falrshare-Food & Sheller .305,00 9/11/99 . Value City Clothing .22,40 9112/99 WalMart Camping Chair .16.72 9113/99 CVS paraonalllama -8,69 9/24/99 Cash Haircut .9,00 1011/99 551 Check 551 Chock 527.40 10/1/99 Cash (Wm, & Sharon Doslak) Sean's Falrshare-Food & Sheltor -306.00 . 1013199 Value Clly ClothlngJpersonslllems -41.49 1017/99 Cash Spending Monsy -60,00 10111199 The Wall mus/c-CD's .20.48 10/23/99 The Bon. T on Clothlng1game , -00.99 10/24/99 Sear'a Clothlng1calendar -166,64 10/30/99 CVS porsonalllems -9,30 11/1/99 551 Check SSI Check 527,40 11/1/99 Cash (Wm, & Sharon Doslak) Sean'a Falrshare-Food & Shelter .306.00 11/6/99 The Bon.Ton Clothing -92.99 11/11/99 Sea~a Shoes -79.98 11111199 The Wall music-CO's -39,20 11/12/99 Montgomery Ward Golf-pulling Game -18,74 11/20/99 Sea~a . ClothlngJIJashllght -29.49 11/29/99 Merck-Medea RK Medlcal:Medlclne -36.00 12/1/99 551 Check 551 Check 527.40 12/1/99 Cash r-Nm, & Sharon Doslak) Sean's Falrshare-Food & Shelter -305,00 12/1/99 Cash Hslrcut -9,00 12/5/99 Toys R Us Play Station -143,08. 12/15/99 CVS personalllems -4.73 12/30/99 551 Check . 551 Check 539.40 12130/99 Cash r-Nm, & Shsron Doslak) Sean's Falrshsre-Food & Shelter .305.00 TOTAL 111/99 - 12/31/99 308.34 BALANCE 12131199 1,388.36 TOTAL INFLOWS 6,978.80 TOTAL OUTFLOWS -8,572.46 NETTOTAL 308.34 " ". " , , . ,. Sean's Certificate's of Deposit, 1/1/99 - U/31/99 i,: I" ",f ", ..' 12/31/99 12/31/99 Mellon Trust CD MeUon Trust CD " .,. \,1, ',', ," " (. .;. '.' , 'f' I. "'I, P,' '.";\' ,. " , , , , , I, "t' I'" ,I,ll' I. " I.. I,,' " " " 'j " " ' I..... .,'/ " " ,. " , ,. , ',.' I,t ,. " 1,/ .1 ", " I" " . ,. , " " " I," ;, " ": , , " ',. I " ','-; I' '1',.(1 ,. ',. " .,'. ., I. '" " ", ii, 0, " Balanoe " I'" It (. (I " ,. " '-,) I' " ",J"ilJ " I. . Ii '\\" " " " " " " {. ,'. <,. L " " ,. I' dr. "'Ii I' -'I ., 58,000.00 ' lQ.QQM4 6.8.0QP,7~ ,. ", , ,. ,. , ,. , ,I,' " " " I, 'I',' "',j' I, " - , ". ~., '...- " , " i " ., ,. ,I. , , , , " " " , , , ,.. ",I. ,.. ,. I ,. " ,. '" ." " " fl, ,. 'I " , , , , I' I, " "I" " , , " I' "" , , ' ',; " I, ,. I ", '0', , " ""', I,. l' I' ,I " ',. ;[. "~to , " Sean'e Reg, checking 1/19/01 SEAN'S CHECKING ACCOUNT 1/1100 Through 12/31/00 Pege 1 Date DelortpUon Callgory Amount -- BAlANCE 12/31/99 1,388,38 1/2/00 Sea~8 Pents .24,99 119/00 Value City Baseball Cards -8,47 1/16/00 CVS personalllema .12,24 1/17/00 Sea~s Clothes -88,73 1/23/00 WalMart Play Station Game -42,36 1/23/00 Valull City Clothes .18,97 1/27/00 Daposlt Deposited In Wrong Account 108,00 1/28/00 Marck.Medco Rx Medlcal:Medlclne -18,00 1/29/00 The Wall music-CO's -47.89 2/1/00 551 Chack 551 Check 639,40 2/1/00 Deposit 551 Check 539,40 2/1/00 Caeh (Wm, & Sharon Doslak) Sean'a Falrahare.Food & Shalter -306,00 2/6/00 The Wall muslc-vldao -1B,94 :JI6/00 Value City personalltema -13,82 2/10/00 Marek-Medea Rx Medlcal:Medlclne -36,00 2/13/00 Toys R Us Game For Playstatlon -21,19 2/14/00 Cash To Correct Error Of Wrong Dep", To Correct Error -108,00 2/2(1/00 Value City ClothesNub -16,21 2/23/00 Bank Chsrge For New Checke Bank Charge -18,60 3/1/00 Deposit 551 Check 639,40 3/1100 Caeh fY'Jm, & Sharon Doslak) Sean's Falrshare.Food & Shalter .306,00 319/00 Mets Yearbook -12,00 3/12/00 Sea~e Paint For Sean's Room -23,29 3/12/00 Walmart Slero Redia -63,67 3/12/00 Value City Curtalns&beddlng For Sean's Room -83.70 3/12/00 KMart Game For Playalatlon -16,96 3/19/00 Vslue City PillolV -6,00 3/19/00 WalMart Game For Playslallon -42,36 3/20/00 Cash Haircut -9,00 3/26/00 Walmart Clothes -8,69 3/29/00 US Postal Service Postaga For Mailing IRS TAXES -3,31 3/31/00 SSt Check 551 Check 639,40 3/31/00 Cash fY'Jm, & Sharon Doslak) Saan's Fslrehara-Food & Sheltar -306,00 4/1/00 Caah Spending Money -60,00 4/1/00 Sea~s Clothes -90,13 4/1/00 Bleachor Bum's HaVclothee -41.98 4/26/00 Merck-Medea Rx Medlcal:Medlclne -18,00 4/26/00 Martin A Yohn Sr Truasurar personal Taxss .9,80 4/30/00 Reebok Shoes/ahoes -86.97 4/30/00 Camp Colaman Inflater -21.16 4130/00 Remington Shaver .52,99 5/1/00 Deposit 551 Check 639,40 5/1/00 Ceah fY'Jm, & Sharon Doslak) Sean's Falrahare-Food & Shalter .305,00 6/2/00 The Walt muslc-CD'a -19.07 6/12/00 Caah Part Pymt Of 1/3 Of Furnace/ale TOlaI1764,lbaI927, .827,00 6/1100 Deposit SSI Check 639,40 6/1/00 Cash fY'Jm. & Shsron Doslak) Sean's Falrshare.Food & Shslter .305,00 6/2/00 Bank Service Chorge Bank Charge -10,00 6/13/00 Cash Haircut .9,00 6130/00 Daposlt 551 Check 539.40 6/30/00 Cash fY'Jm, & Sharon Doslak) Sean's Falrshare.Food & Sheller .306,00 7 moo Cssh Part Pymt Of 1/3 Of Furnace/ale -227,00 7/10/00 Bank Service Charge Bank Charge .10,00 7/18/00 Merck.Medco Rx Medlcal:Medlclne .18,00 7/25/00 Toys R Us Play Station Gama .21,19 7/25/00 The Wall muslc-CD'a -29,67 8/1/00 Deposit SSI Check 539,40 B/1/00 Cash fY'Jm, & Sharon Doslak) Saan's Falrahare-Food & Sheller -305,00 8/1/00 Circuit City CD -14,83 " Sean'l Reg, chlcklng 1/19/01 SEAN'S CHECKING ACCOUNT 1/1/00 Through 12131/00 Pege 2 OIW OlIlIcrlptlon Clwgcry Amount 8f7/OO Bank Service Charge Bank Charge -10.00 8/8/00 Cash Camping Trip/spending Money .35,00 8122/00 Marlin A Yohn Sr Treasurer p~rsonal Taxes .9,80 9/1/00 SSI Check SSI Check 539,40 9/1/00 Cash ryvm, & Sharon Doslak) Sean's Fa/rshare.Food & Sheller .305,00 9f7/00 Cash Pan Pymt Of 113 Of Furnacelalo Reimbursement -450,00 9/8/00 Bank Service Charge Bank Charge .10,00 I 9/14/00 Bleacher Bum'e Cuplwallet .14,84 9/19/00 Cash Basevball Gamelspendlng Money -30.00 9129/00 Dapaalt SSI Check 539,40 9129/00 Cash /yvm, & Sharon Doslak) Se~n's Falrshere.Food & Sheller -305.00 1016/00 Bank Service Charge Bank Charge -12,00 10/12100 Marek.Medea Rx Medlcel:Medlclne .18.00 10119/00 Cash Haircut -9,00 10125100 Dr, George Harhlgh Medlcel -44,00 11/1/00 SSI Chec. SSI Check 539,40 1111/00 Cash /yvm, & Sharon Doslak) Sean's Falrahare-Food & Sholter -305,00 11/1100 Cash Spandlng Monay -25,00 llf7100 Bank Service Charge Balik Charga .12,00 11110100 WalMan Movie Vldao .10.56 11125/00 WolMan Workbooka .21,82 1211/00 Cash ryvm, & Sharon Doslak) Soan's Falrshare.Food & Sheller, -305.00 1212100 Amaa Thermos .12.40 1212/00 Sea~s Clothes .36,40 12f7/00 Bank Service Chargo Bank Charga -12,00 1218100 Cash Final Pymt Nc & Furnace Relmburaement .100,00 1218100 The Glass Lounge Dinner -15,68 12124100 Value City Candles -7,94 12128100 The Wall muslc.CD's .90,77 12129100 551 Check 551 Check 657.40 12129100 Cash (Wm, & Shsron Doslak) Sean's Falrshere-Food & Sheller -305,00 TOTAL 111/00.12131100 -384,37 BALANCE 12/31/00 1,023,99 TOTAL INFLOWS TOTAL OUTFLOWS 6,598,80 -8,983,17 NET TOTAL -384,37 , , I I' Seln'a Truet 1/19/01 SEAN'S TRUST REPORT 1/1 /00 Through 12131/00 Page 1 Date Dttortptlon CltegClry Amount BALANCE 12/31/99 6,156,46 1/5/00 Billie Jo Snyder Preparatlon.court Report .200,00 1/10/00 CO Inlerllt CD Inlerllt 264,36 1/11/00 Pa Ollpt 01 Revenue Quarterly Taxea .20,00 1/11/00 Unlled Statea Treaaury Quarterly Taxea .130,00 1/14/00 Cumberland Cly Clerk 01 Orphan'a C." FIlling Fee For Court Report .10,00 1/28/00 CD Intereat CD Intereat 34,68 2/10/00 CD Inlereat CD Inlereat 264,36 2/24/00 SlIleler,Grler &Hartrnan CPA'a Preparatlon.tax Returna 1999 .160,00 2/28/00 CD Intoreat CD Inlereat 49,62 3/10/00 CD Intereat CD Inlarlll 247,26 3/28/00 CD Interllt CD Interllt 46,41 3/29/00 United Stat.. Treaaury Quarterly Taxes .70,00 3/29/00 Pa Oept 01 Revanue Quartllrly Taxea .26,00 4/10/00 CD Intereat CD Intereat 264,36 4/25/00 CD Intereat CD Inlerest 49,62 lJ/l0/OO COlntereat CD Interest 266,80 6/28/00 CD Intereat CD Interoat 48,01 618/00 United Statea Traasury Quarterly Taxes .70,00 618/00 Pa Dept 01 Ravenue Quarterly Taxes .26,00 619/00 COlntereat CD Intereat 264,36 6/28100 CD Intereat CD Inlerest 49,62 7110/00 COlnterest CD Intereat 265,80 7/28/00 CD Intereat CD Intereat 46,01 6110/00 COlnlerest CD Interest 264,36 6/24/00 Circuit City Ink For,Prlnlsr .74,18 6/26/00 CO Intereat CD Intereat 49,62 918/00 COlntereat CD Interest 264,35 9/12/00 United States Treaaury Quarterly Taxes .70,00 9/28/00 CD Interest CD Inlereal 49,62 10/10/00 COlnterest CD Intereat 266,80 10/27/00 CD Intereat CD Intereat 48,01 11/10/00 Inlareat CD Intereat 264,36 11/28/00 CD Intereat CD Intereat 49,62 1216/00 COlnlereat CD Intereat 266,80 . 12/28/00 CD tntereat CD Intereat 48,01 TOTAL 1/1/00 .12/31/00 2,838,47 BALANCE 12/31/00 6,995,93 TOTAL INFLOWS TOTAL OUTFLOWS 3,691,65 .852,18 ... ..... ~ _ ..-., ..~._.-_ ____0___. .___..._. ,_u ,... n.... .______.,.. ___.., ~.. _ __.'. .'_. ,.... NETTOTAL 2,838,47 . ,I '1' 12/31/00 12/31/00 ,Sean Matthew Doslak Trust Certificate's of Deposit 1/1/00-123/31/00 Mellon Tru~1 CD Mellon Trust CD I ~ . " , " ". II , I " I' , ,. ,I' " " " , ,. jl' ,. .1 .. ,. , 'i' I, " .0, ": " \il,' , .' ,I', " 'I" ". " ,. i" I' , , , " .,' ,. , ,. " " :' ,1 , ,. ,I Balance ,., '" I; "I, ,. 'j\ " ,1' , ." " , ," " " I ~, I d ,,1/'/.' , ,i 'lit I, .'_ It ,l "I, ,I I",! ,I' . ' .' I'"~ , I' ,11 I, " ,I .' 58,000.00 J QJlOO.1.4 ~ I, I, 0'. .. " ,. " .. ."\ " " " HI " " ,. " " , ,. ., " '1 l , i' " 1 I' " ,. ',,- d' ,I , .. I' " o \, "!', ,I j . " ".1., " " " " ,. I'. , " " " ,. I , , "II " ':, . ., ,j. ,,' . I' .' ',I ,I " " 0/ ,. " " ':'\;1", (.j ""j, ,. " " , , , , , I' i, " , ,. 'I'. ,. ., " ,,"'Jl' , ,. I' " ". " . ,. ,. "'1' , '1 !' ,. ,. J. i ,.1' '.'- " . i, " " " t', " ,. , " . " Sean's' Reg, chilcklng 1/21102 Transaction Report 111101 Through 12131/01 Page 1 Olte Num OtlorlpUon Memo Cltegory Clr Amount BALANCE 12/31/00 1,023.99 1/7/01 582 WalMan Play Stallon Oame -42.36 1/8101 Bank SaNlce Charge Bank Charga .12.00 1/17101 583 Marck.Medco Rx Medlcal:Madlclne .18,00 1/21/01 564 KMart Shoea/pereonal .14,99 2/1101 DEP Deposit SSI Check 557.40 2/1101 585 Caah rNm, & Shoron Doslak) Sean's Falrshare.Food & S", .305,00 2/0101 586 Tho Wall muslc-CD's .15,89 219101 587 Sea~a Socka1underwear .28,00 2112/01 588 Cash Haircut .9,00 3/1101 DEP SSI Chack SSI Check 557,40 3/1/01 589 Cash (WITl. & Sharon Doslak) Sean's Falraharo-Food & S", -305,00 3rl101 590 Cash Spending Money .50,00 316101 591 Value City Boots .9,75 319101 592 Now York Mala Mots Yearbook -12,00 319101 593 Tho Wall mualc-CD'a .19,07 3112/01 594 Kllmoro Eye Assoc Eyo Exam -112,00 3118/01 595 Kllmore Eye Assoc Eye Olas~~~ .235,00 3130/01 DEP Daposlt SSI Check 6bl.40 3/30101 596 Cash (Wm, & Sharon Dosl~k) Sean'a Falrahare.Food & S", .305,00 411/01 597 Circuit City Pial' Slallon .21,19 414101 598 Camelot Music-tapa .18,01 4117/01 599 Merck.Medco Rx Modlcal:Medlclno .18,00 4/24/01 600 Marlin A Yohn Sr Treasurer personal Taxes .9,80 4124/01 601 Cash Haircut .9,00 4/28/01 602 Sea~s Clothes/undorwear .93,99 4/28101 603 The Wall Movie Video .15,89 4/28101 604 Bleacher Bum's clothas Clothes .50,90 511/01 DEP Daposlt SSI Check 557,40 5/1/01 605 Cash (Wm, & Sharon Doslak) Sean's Falrshare.Food & S". .305,00 515101 606 Cash Spending Money .50.00 5118/01 60" CVS personal Items .11,09 5120/01 608 Camelot muslc.CD's .24,37 611/01 DEP SSI Check SSI Check 557,40 611101 609 Cash rNm, & Sharon Doslak) Sean'a Falrshare-Food & S", .305,00 613101 610 Harris TV VCR .105,99 613101 611 Void 0,00 6/5/01 612 Dr, Oeorge Harhlgh Medical .10,00 615101 613 Cash Spending Money .50,00 616/01 614 Home Dapot Light & Ceiling Fan .13,00 6112101 615 Void 0,00 6112/01 616 CVS peraonalllems .26,11 6112/01 617 CVS Baaeball Cards .12,68 6/23/01 618 Caah Recreallon/vacallon .150,00 6/29101 DEP Deposit SSI Check 557,40 6/29/01 619 Caah rNm, & Sharon Doalak) Sean'a Falrahare-Food & S", .305,00 712/01 620 Merck.Medco Rx Medlcal:Medlclne .18,00 719101 621 Bordars Book/cd -4~,76 7113101 622 Sear's Shoes1undarwear .94,97 7/25/01 623 Sea~s Clothes/undarwear .24,49 7/25/01 624 Bleacher Bum's clothes Socksltruck .22,90 7125/01 625 NRM mualc.CD's .58,29 8/2101 DEP SSI Chack SSI Check 558,40 812101 626 Caah rNm, & Sharon Doslak) Sean's Falrshare-Food & S", .319,00 8n/Ol 627 CirculI CItV CD Box Set .82,53 8117101 Received Caahle~a Check '" Opened Acct With PNC Benk .1,178,11 TOTAL 1/1/01 . 12131/01 .1,023,99 BALANCE 12/31/01 0,00 ...... , . Sean's 'estate checking 1/21/02 Register Report 1/1/01 Through 12/31/01 Page 1 ost. Num Dellortptlon Memo Category Clr Amount BALANCE 12/31/00 0,00 1/1/01 OEP SSI SS! Check 558,40 8/17101 Opening Balance [Sean's estate checking) R 1,178,11 8/28/01 141 Dr. G. H Harhlgh Modlr.nI:Ooctor .31.40 8/28101 142 Marlin A. Yohn, Sr, Treasurer Pereonal Taxaa -9,80 8/20/01 143 Sears Clothing -76,98 0/31/01 DEP SSI SSI Check 668.40 8/31/01 144 Cash (wm & Sharon) Sean's FS For Food & Shelter -319,00 9/8/01 145 Cash Spending Money .50,00 9/8/01 146 Value City Clothlng/geme -26.68 9/20/01 147 Bleacher Bum'a Shlrta,cup, Car .52,93 9/20/01 148 FYE CD's -47,30 9/20/01 149 Sears Clothing .36,00 10/1/01 OEP SSI SSI Check 55S,40 10/1/01 150 Cash (wm & Sharon) Sean's FS For Food & Shelter -319,00 10/8101 151 FYE CD's -54.03 1019101 152 Morck-Medea Rx Ser, Medlcal:Medlclne -18,00 10/18101 153 Cash ( Spending Money -50,00 10/22101 154 Merck-Medea Rx Ser, Medlcal:Medlclne -18,00 10/27/01 155 Sears Clothing .83,53 11/1/01 158 Cash (wm & Sharon) Sean's FS For Food & Shelter -319,00 11/1101 157 Giant CD's -19,66 11/5/01 158 CVS Personalltemslvldeo Tapea -13.23 11/6/01 159 Suncoasl Music Video -21,15 1119/01 160 Ames Movie Video -8,47 11110/01 161 Value City Clothing/game -52,96 11/12101 162 Borders Book/cd -49,76 11/13/01 163 FYE CD's -34,22 11/16101 164 Value City Clothing/game -32,94 11/23101 165 Cash ( Spandlng Money -50,00 11/30/01 DEP SGI SSI Check 658,40 11/30/01 166 Cash (wm & Sharon) Sean's FS For Food & Shelter -319.00 12/8/01 167 FYE CO'a -21.19 1219101 168 Soars Clothing -16,79 12/15/01 169 Valua City Csndles/game -27,54 12/15/01 170 BIllie Jo Snyder Reimbursement Concert Tic.., -90,29 12/16/01 171 KMart Sneakers -28,11 12/26/01 172 FYE CD's .52,99 12/31/01 OEP SSI SSI Check 572,40 12/31/01 173 Cash (wm & Sharon) Sean's FS For Food & Shelter .319,00 TOTAL 1/1/01 . 12/31/01 1,317.28 BALANCE 12/31/01 1,317,26 TOTAL INFLOWS TOTAL OUTFLOWS 3,984,11 .2,666.85 NET TOTAL 1,317,28 ,;<1"-''; '1" "',", "".-., " " , , " ,. , , ", ,. , ." " ,. , ,. ., ." , , ,., , '.", , , ., ,I" I' " " , . .!.~ ~ ~ ~!. g; ~'1Ji 1Ji 1Ji ~ ~ ~ l1:;' ~ fll (:j ~ 11 ~ ~ ~ ~ ~8;;j ~?l ~ l!l11l ~ ltl'~ ~~, .t i-l O! - \0 N.t.t '" \0 ~ \0 on~. ....~ '" '" 0 ~.. '" a a \O.t 0 0 0.... 00,........ 0- ~ on .t"''''M__ onon.t M---on on", ---on\OlOon"'''''''.t ~ ~~~~- ~~~ ~~ ~~ ~~~ ~~~~ ~', ' :J:: ~ U a ~ M........MOO'" ('>'r---r--\U~Q"" . I I . . . . . "''''~~liio-'''' 41')61) CA~ \OM~"'''''M''' QU)-l(l-f"'o"1 ..; on"; 0.. vi 0 ~~&l~~~~' 000 0'0\ 0'\ N 0 0' c;,;) 1(1"" "" - 99 ~~l2~~&lt:l OO\()M::jO gaOQ Q ~ ~ tii,~ ~ ~ , ~ i ] ~, ii 11 J i all , ...... e, !~ 1 j 1'i J 1 J ~ 1 ~ 1 f. 1113Bl111 1 ):11111 ~ ~J1Bl~ , 8 ~ t ~~ ~~, I'- ~ III = t~ ] ~1 Q ,'l1:J:: <~t ~ ~ 9 III ~ I "~l Il'_ ii ,el ~ ' " ~ ~ '" t= l>:CJ "!:J::~ t= .51 ~ "! ~ 0 ~ i ,51,51 ~ ~ ~~lIlu j ~ B B ] Ii III ~,~ "... ~~~~:=~~.c tl~ !~" i 1 ~ ~ "j &3~ b~b(j~~~~~ 8eb~f3~~ B Ntd el~1 ----------- -------- -------.... - -....--.... ~ nnnn~n('"Jt!"Innn nnnn("')t"')("')("") nnnnn('")("')("'"J nn~nsn -C!t1;a~--~-~- -;:0------ ~~$~~888 -Oi....;;o ~ tJ CM_t"-!Q ~'"'~~~(g~!(l ~t!~~~- Mtf1ffiM::::::"I:t:::~l() If'llf'l""~:::: \0\0 Q - (1')(1') ~ 'If lr.l() If'l \C '00\0\0 145 ;;; 'I " \ . Sean's Trust 1/21/02 Register Report 1/1/01 Through 12131101 Page 1 D.lt Num o.aoflptlon M.mo c.legofY Clr Amount BALANCE 12/31100 8,995,93 1/10/01 DEP CDlnlerast CD Inleresl 264,35 1111/01 1061 Unltod Statea Treasury Quarterly Taxes .70,00 1119/01 1073 Cash VacatlonlNsshvllleMamphls -250,00 1/23101 1062 Cumberland Cty Clerlt Of Or", Filing Fee For Court Reporl -1000 1/23/01 1063 Sharon Doslak Preperatlon-court Rspert -176,00 1/28/01 DEP CD Interest CD Interest 40,62 219101 DEP CDlnlsrest CD Interesl 264,35 2/26/01 1064 Stlteler,Orll!r &Hartman CP", Preparation Tex Relurns 2000 -75,00 2/28/01 1065 Internal Revenue Service 2000 Tax Relurn Trust -17,00 2/26101 1066 Pa Depl Of Revenue 2000 Tax Relum Trust .3,00 2/26/01 1067 Un~ed Slates Tressury Quarterly Taxes -161.00 2/26/01 1068 Pa Depl Of Revenue Quarterly Taxes -22,50 2/26/01 1060 U.S, Postal Service Postage Mall Tax Relurns -8,50 2/2RlOl DEP CD Intereat CD Inleresl 40,62 319/01 DEP CDlnterest CD Interest 238,71 3/28101 DEP CD Intereat CD Inleresl 44,80 4/10101 DEP Interest CD Inleresl 264,35 4127101 DEP CD Inlerost CD Inlaresl 49,62 5/10101 DEP 34,60 CD Inleresl 255,80 5/25/01 DEP CD Inter831 CD Inlerest 47,97 618/01 DEP 34,60 CD Interesl 264,26 6/11101 1070 United Stalea Traasury Quarterly Taxea -161,00 6/11101 1071 Pa Depl Of Revenue Quarterly Taxes -22,50 6111101 1072 U,S, Postal Service Postage Mall Tax Returns -4,08 6/28/01 DEP CD Interest CD Inlerest 35.42 7/10101 DEP 34,60 CD Intorast 255,80 7/27101 DEP CD Inlerest CD Interest 34,27 8/10101 DEF' CDlntereal CD Interest 264,35 8116101 1074 Void 0,00 8116101 1075 Amerlcen Funds Open Money Marltel -6,600,00 8/28/01 DEP CD Interesl CD Interesl 35.42 8/31101 Bank Service Charge -12,00 OnlO1 1070 Cash Relmbursemenl For CampI... -81.40 0110/01 Service Charge Refund Bank Service Charge Refund 12,00 0110101 1077 Pa Dept Of Revenue Quarterly Taxes .22,50 0110/01 1078 Unltad States Traasury Quartarly Taxes -161.00 9/10101 1070 U,S, Poslal Service Postage MslI Tax Returns -3,94 9/28101 DEP CD Inleresl CD Interesl 35.42 9/28101 Bank Service Charge Bank Charge .12,00 10/10101 Service Cherge Refund Bank Service Charge Refund 12,00 10/26101 DEP CD Inlerest CD Inleresl 34,27 10/31/01 Bank Service Charge Bank Charge -12,00 11/9101 Service Charge Refund Bank Service Charge Refund 12,00 11128/01 DEP CD Inler8el CD Interllt 35,42 11130101 Bank Service Chargo Bank Charge .12,00 1217101 Service Charga Refund Bank Service Charge Refund 12,00 12127/01 1080 Circuit Clly Ink For Printer/disks For Co"' -43,44 12/28/01 DEP CD Inlereet CD Interest 34.25 TOTAL 1/1/01 .12/31/01 -5,213,78 BALANCE 12131/01 3,782.14 TOTAL INFLOWS TOTAL OUTFLOWS 2,606,07 -'/,810,66 , . Sean'a'Truat Dale NETTOTAL " ," " " 'I: i' " i' .. , , " N~m o.lorlpUon " ,. ,'-' " ',I ., " " ~d !"i d .1 '\'., ,'", ,il " Register Report 1/1/1l1 Through 12/31/01 I' ',,' Memo " " ,. " " I, , 1 I'; i , , '.j< " I " " L' " " " ,. , \, " , , , " , , ,! , , . " ' II ,. " ,. .' 0,. Ii' " " , ., ';' ,,' '" l '/,' " II "I' 'I" ','f " '" Calegory .' " " .' , ; ,I' ". ,. ." " " " , " ,. " .'.i. " .. I." " " . ;','", " ". ", I" I , " ,. I'.' " , .,. , , Clr ',. 1121/02 P.ge 2 Amo~nt .e,213.78 " ,I' ." ,. I , , , ,. ',. ,; \' I. , " Janlll\l')' 22, 2003 ", " .,1 ., ,,, ,. " ,. " Cumberland County CQurthousQ Clerk of Orphans Court t Courthouse Square Carlisle PA 17013 Te Whom It May Concern: ." II', " " ,. ,,. , " ", '; Enclosed please find a copy of the Annual Report of Guardianship of Sean Matihew Doslak. I am also enclosing $ I 0.00 for the filing fees. I am requesting that you send me II copy of the report stamped received and filed, Thank you for your help In this matter. Sincerely, ) vv" :'+' }~, /'-i.L(..r_e..~ re ,I;;)~,J," Mr. and Mrs, William R. Doslak Guardian of Scan Matthew Ooslak ' EnoloslU'll (1) sd ,. I, " " " ,. , " " (l' " ji' .' . "-" , j'li "" f" q " , " ,\ " 100 SECOND STREET BOW MANS DALE PA 17008 " '" I' " ,.' '.1'. ,. ", .;,' , I'., ,. , ,. I. " t"'I' eJ,., ,1_,',':' , ~:-I ~ . iI",) .~ ~.. ';,,' '..... '. , .j... " " '-n' " \, " 'II ,. .\' :''0,' ,..1m 'n CI ,.;\ !;1' (:':<1' .. Ij \i:> ':\ ':1 ',l'" iii I~' 4"1 I' " ,. , '" " ',I' '1,1 'I" " ',) ',. " " ,'l' '0" " , , ., "" .8ean'a 8etate checking 1/18103 Transaction Report 1/1/02 Through 12/31102 pege 1 Dlta Hum o.lcrtptlon Memo Category elr Amount BALANCE 12/31/01 1,317,26 1/11102 174 Merck-Medea Rx Ser. Medlcal:Medlclne .18.00 1/11/02 176 Walmert Game/calculetor -65,33 1/24102 176 Cash ( Spending Money -50,00 1/24102 177 FYE CD's -51,71 1/24/02 178 Sears Clothing -41,50 2/1/02 OEP SSI 551 Check 572.40 2/1102 179 Cash (wm & Sharon) Saan's FS For Food & Shelter .319,00 2/3/02 180 Value City Game .21.19 2(1/02 181 Bleacher Bum's Msts Beorltoy .6,36 'm/02 182 FYE CD's .37,05 'm102 183 SealS Clothing -16,50 2/14102 184 Cash ( Spending Money .76,00 2/23/02 185 Cash ( Spending Money .60,00 3/1102 OEP 551 SSI Check 672,40 311/02 186 Cash (wm & Sharon) Sean'a FS For Food & Shelter .319,00 3/2/02 187 Harrle TV OVO Pleyer .168,99 3/2/02 188 Sun coset OVO CO -26,49 3f1/02 189 New York Mets New York Mets Yearbook -12,00 3/10/02 190 Walmart OVO CD/calculator -21,08 3/24/02 191 Value City Game -37,76 3/29/02 192 Cash ( Spending Money .50,00 3/29102 193 FYE OVD CD -31.79 4/1102 DEP 551 551 Check 672.40 4/1102 194 Cash (wm & Sharon) Sean's FS For Food & Shelter .319,00 416/02 195 Sears Clolhlng .97,97 4/8102 196 New York Mets Magazine -6.00 4/17/02 197 Bowmensdele Family Prectlce Medlcal:Doctor .12,00 4/18102 198 Merck-Medea Rx Ser, Medlcal:Medlclne -18,00 4/23/02 199 Mertln A. Yohn, Sr, Treasurer Personal Texes .9,80 4/25/02 200 Voided Check 0,00 4/29/02 201 New York Mets Magezlne .6,00 5/1102 OEP SSI 551 Check 572.40 6/1/02 202 Cesh (wm & Sharon) Sean's FS For Food & Shelter .319,00 516/02 203 CVS Personslltems .30,86 6/7/02 204 Seare Clothing -70,87 5/16/02 205 Cash ( MO For Mets Cat, Purchaes -145.68 5/18/02 206 Medls Play CO'a -44.49 6/20/02 207 Caah ( Spending Money .60,00 5/30102 208 CVS Personalltemslbb Cards -17,96 5/31/02 OEP SSI 581 Check 572,40 6/31/02 209 Cash (wm & Sharon) Sean's FS For Food & Shelter .319,00 8/6/02 210 Giant Medication .5,52 616/02 211 New York Mets Magazine -5,00 6/13/02 212 Seare Clothing .16,79 6/13/02 213 FYE OVO CD -47,68 6/20/02 214 Merck-Medco Rx Ser, Medlcal:Medlclne -18,00 6/22/02 215 Cash ( Vacation/spending Money .150,00 8/22102 216 Seara Clolhng/shoe .60,97 7/1102 OEP SSI SSI Check 572,40 7/1102 217 Caah (wm & Sharon) Sean'e FS For Food & Shelter .319,00 7/1102 216 Borders Book/cd .34,92 7/18/02 219 Sears Bedding .31.79 7/19/02 220 Kllmore Eye Assoclatea Repair Olassss -34,00 7/24/02 101 Universal Studios TAPE -19,90 7/30/02 102 KMart CD's .12,50 7/31/02 103 Pa. Dept, Of Transportation Photo 10 .10,00 8/1/02 DEP SSI SSI Check 672,40 8/1/02 104 Cash (wm & Sharon) Sean's FS For Food & Shelter -319,00 816/02 105 Circuit City OVO CD .25,42 .Sean's eatate checking 1/18/03 Transaction Report 1/1/02 Through 12/31/02 Page 2 Data Num Deaortptlon Memo Category Clr Amount 8~102 106 Bordelll Book/cd .5/i,06 8/16102 107 Seera Bedding -43,<< 8/17102 108 Cash ( Spending Money .50,00 8120102 109 Bowmanadale Family PraC1lce Medlcal:Doc1or '52,00 8/26102 110 Ma~ln A, Yohn, Sr, Trearurer Personal Taxes -0,80 8/30102 DEP SSI 551 Check 572,40 8/30102 111 Cash (wm & Sharon) Sean's FS For Food & Sheller .319,00 9/1102 112 CVS Personalltema/bb C~rds .10,55 9/2/02 113 FYE DVD CD .26,49 912102 114 Seera Clothes -48,79 9114102 115 CVS personalltema .25,79 9114102 116 Bleer.her Bum'a Shi~s,cup, Car .26,98 9120102 117 Caoh ( Spending Money -50.00 9126102 118 Merck.Medea Rx Ser, Medlcal:MedlcJne -18,00 1011102 DEP SSI 551 Check 572,40 '10/1102 119 Callh (wm & Sharon) Sean's FS For Food & Sheller .319,00 1018/02 120 Sears Clothas/ahoes .164,17 10112102 121 FYE CD's/plastlc Covers -36.01 10/12102 122 Cash ( Spending Money -50,00 11/1102 DEP SSI 551 Check 572,40 1111/02 123 Cesh (wm & Sheron) Sean's FS For Food & Shelter -319.00 1113102 124 Sears Clothes/sheeta -68,78 1113102 125 FYE CD's -21,19 11/ll/02 126 Value City Game -15,89 11129102 DEP SSI SSI Check 572,40 11129102 127 Cesh (wm & Sharon) Seen's FS For Food & Shelter -319,00 11129102 128 Seers Clothes/shaver -162,78 11129/02 129 Borders Book/cd .25,20 11130102 130 Cash ( Spending Money -50,00 1212102 131 CVS Personalltema .13.82 12115/02 132 Velue City Game -15,89 12117102 133 Merck.Medea Rx Ser. Medlcal:Mediclne -18,00 12/31/02 DEP SSI SSI Check 579.40 12131102 134 Cash (wm & Sheron) Sean's FS For Food & Sheller .319.00 12/31102 135 Cash ( Spending Money -50,00 12/31/02 136 KMnrt Cd ,socka,tapos ..52.31 12/31102 137 Seera Game -31,79 12/31/02 136 Se~ra Grooming Kit .13,25 TOTAL 1/1/02 -12/31/02 102.88 BALANCE 12/31/02 1,420,12 TOTAL INFLOWS TOTAL OUTFLOWS 6,675,00 -6,772,94 NeT TOTAL 102,88 , -'II', 'j' II" 4_" 'I.',,. Bean's lruet 1/18103 Transaction Report 1/1102 Through 12/31102 Pig. 1 Dale Num OeIorlptlon Memo CIlIgOfY Olr Amount BALANCE 12/31101 3,782,14 119102 1081 Un~8d States Treasury QUMerly Tax.. -160,00 tl9/(l2 1082 Pa Dept Of Revenue Qusrterty T.xlS -22,60 119102 1083 U,S, Post.1 Service Poslage M.II T.x Returns -3,94 1/24102 1084 Cumberland Cty Clerk Of Orp", Filling Fee For Court Report -10,00 1/24102 1085 Sharon Doslak Preparation-court Report -175,00 1/28102 DEP CD Interest CD Interest 20,89 2/t 5102 DEP Refund Circuit City Rofund From TDK Dleks 8,00 2/28102 DEP CD Intorest CD Intorost 20,89 3/7102 1088 Stholer & Associates, CPA'o Prepar.tlon Tax Return 200t -75,00 3/11102 1087 pa Dept Of Rovonuo Qusrtorly T.xos -20,00 3/11102 1008 Un~8d Stalos Treasury Qu.rtorly Toxos -75,00 3/28102 DEP CD Inlorost CD Inloresl 18,118 ' 4/28102 DEP CD Intorost CD Inlorost 20,89 5128102 DEP CD Intorost CD Inlorost 20,32 6110102 1089 Un~8d St.tos Tro88ury Qusrtorly Taxos -75,00 6/10102 1090 Pa Dept Of Rovonuo Qusrtllrly T.xos -20,00 6128102 DEP CD Intorest CD Interest 21,00 8130102 DEP Un~8d Statos Trosury Tax Refund 3,02 7/26102 DEP CD Intorest CD Interaet 20,31 8/26102 DEP CD Inlerost CD Interest 20,118 9/10102 1001 Unltod Statos Treasury Quartorly Taxos -75,00 9/10102 1002 Pa Depl Of Revonuo Quartorly Tax.. .20,00 9/10102 1003 U,S, Postal Sorvloe Postage Mall Tax Rltums ....79 9/27102 DEP CD Intorost CD Inlorosl 20,118 10/28102 DEP CD Intorest CD Inloraet 20,30 11/27102 DEP CD Intorost CD Intoresl 20,118 12/27/02 DEP CD Inlorest CD Inlerost 20,30 12/31102 1004 Clrcu~ City Ink For Computer .711,48 TOTAL 111102 - 12/31102 ..11,8' BALANCE 12/31102 3,222.G6 TOTAL INFLOWS TOTAL OUTFLOWS 2116,12 -815,71 . ....~. . .H.. , .! . NETTOTAL 088.... , , ,. " " " " ,,!, " '.'1 , ',' '" ~ ,'.. ,. , .' '." 'I , 'I 'I' I \ " " '" i. " ,. ,'I. ,. , .. ,if '! " , .~ ! j 1 " , , " " ,\1 " " ,. I , 'I ,,, " ,. , " , , " " " ,. , ., " ,. ,. , ,. ',. ,,' '" ,. " ,. " , , .," " ,. i ,. \i ,. 'i , " , , " , , I '. " Ii'. " : ,. ,. ., Ii " ,. ,. " 10, " I' I ~ ,,' , " " ,. .,. " '" " " \'. 'I,' ", , " '" ,. ,.'/ I I , " Ii, " ;), I., ,. ., lI:l' ,. , " , i " " ,. I " ,. , , I' , , " Sean'e ell8te checking DltI Hum Detorfptlon 11/8/03 266 KMert 1118103 2117 KMart 11/11103 266 FYE 11/11/03 269 FYE 11/11/03 270 Waldenbookl 11/18/03 271 Circuit City 11/21103 272 Calh ( 11/28103 OEP Cpare/elt 12/1103 OEP 551 12/1103 273 Calh (wm & Sharon) 12/1103 274 Seara 12/7103 275 Clrcuij City 12/t 1103 276 Kllmore Eya ASloclatel TOTAL 1/1/03.12/31/03 BALANCE 12/31103 TOTAL INFLOWS TOTAL OUTPLOWS NET TOTAL '.',' , . Transaction Report 1/1/03 Thruugh 12/31/03 Memo " , ,. " Celegory . Cd Jacket Panll CO'I CO'I Book . OVO CO Spending Money Retum From Social Security 551 Check Sean'l FS For Food & Shelter Clothel/lhoel Walkman/conlrollor Gla88el " " " " I',: 1/17104 Pege 2 Olr Amount -61.83 -15,00 -44,40 -21,19 .28,57 -13,77 -50,00 48.03 579,40 -375,00 -68,96 -64,78 .244,00 .325.01 1,095,11 . 6,449,79 .6,774,80 .328,01 , ' , . " " ", , ' '. ' '. " 1-' I' 'j" ;); " , , J,- "h':'-., ,...,.:,. ,,__,__ ". "" ". " , " " 'I' '" '" \'I' ~ - - - - 8 - ;t 8 tt !D to ~ ~ tt\ '" '''I N 8 tl C C ~ ~ ~ 01 ~18 ~l N tll:) ,[:) t- I{J '<t "l"r.'Il l"'l"'l"'l"'l ."'l. . . , , , ."r."l."l"l ,"1<'1<'1 . ,."l . "1"1 .~"l"ll'J ~ 000-0_ 0 ~~~-Q~~ O~NN~-~-oo 0 _ M- ~~~~A"I- ~~.~I~~~~~~~~~~~~~~~N~~~~~~ ~.~~ ~~~fi~~~~ C _.N '<t _ C C 01 --~CACA--Vl 11I11I . 11I11I' ~ ~ ,j ,'. '" 'u r I '~ I ~~I l]]~~]JJ~ J~ t-8I{JCOOl~IC- ~ .t'ttf")"1-:~~ t-<tl/:lCOC<tcco (AN-(;)-~-(A 11I11I III loll u ,.~, U ~ s:ii ~ ] J iJ ] ] J r~ S!8~~~0I!::; . . I , .l'J . ~ct-,,,<ttt\- (A-VifA(I)~~V; ~ ,~ i>'.' g g ?J e m !I ] ~'lll ~] ~ 8CCCtt\N- C~ICI/:l-C ~~~~~ci~ loll III I ],. , -, ~ lJ) 1 U 1 " '~ ,U ~ t ~ ! f ~f ~i~~ ~ ~ u .~ B.II \'J :! ' <t ~ j:.'" .'" 13 = 0.'" J~'ji~~1$B Vl"''''''''''~ '" ~. ::l b ~ ~ III VI ~ ~Vl .~ ~ , .c~~~'!lgB ~'" ::l",1iI ,B1 '5 "t ~ ] :: "B ,!,! B ~ ~ '. 01 u l>~>8c \:I ~>> 0::;: z ",ZCll>l.:l ow' W ::l ff'lff'lMtt)f'lff')ff')f!'lff') ("Itf'! tf') tf'lt"ltf') ,,,tf)tf') t"l t"l (" tf'l tf') tt) tt) t'l tt) t~ t')'f"ltf) (f')t"lt"lM S?~S?~~S?!?E'S? QQ !?S?~OQQOS:S? 00000000 t.!QC<::>QQQ '''C~OI t'~lr~'~ ~~ \Ci 1.0 Id f;) M (:);.;r rii ...:; r-lr:I~i;)OoO\o.;;::' -;:'l~t::N"~ "t.! I r:1 Oil 00 iii t t. ~CiO>i~~t~oo~ ~ !::::' ~ ;:.; ;:;, ;:;; ;.;,; t~ ,-t,l"' t'1~~::.i "::""c' oO~ .. 0\0\0\--0 000---__ ---C"r-t' - -- - - - -- , Sean Matthew DosiA" Trust CertificAte of Deposit 1/1101.12/31101 12i3.1l0t . Mellon Trust CD Is noW Citizen's Bank ---- " ',. ;1' " I,,'t ", ",'; , ,. , 'I' ..' 'j, "I;; " 1\,' " , --_._~_. " " ,i ,. " J1!!1l1nltlL .' , ., '" ,I). , I.. " '.; , . I' " L',' Ii', ,. " ,. I, '., 'I., Ii " " ,. , " .,. '.' '\ "\1 1\;' ". ",I, ,. .' 'I i L_" I,' , " 'II "'1 .'; <'I.' '1'\'.', . " ,. I"'; 10.000.11 '~ II Ii " ,. .. .' '" ",' ,.. ,I' ,. i, '1\' ,. .1', i, ,. ;, , , , \: ,,'. "I " , " .\' " ,. " I' ., .; ..'1,..._.,40......... _..... Sean's estate checking 1/18105 Transaction Report 111/04 Through 12131/04 Page 1 Dlle Num Delcrlptlon Memo Category Clr Amount --. BALANCe 12131103 1,095,11 111104 DEP SSI SSI Check 591.40 111104 277 Cash (wm & Sharon) Sean's FS For Food & Sheller .376,00 112/04 278 Cash ( Spending Money ,50,00 113/04 279 Toys R Us Game .31,79 113104 280 FYE CD's .33,33 116/04 281 Medea Heallh Dlllantln .18,00 1117104 282 Cash ( Spending Money -60.00 1/17104 283 Borders Cd ,socks,tapes .26.49 1130/04 DEP SSI SSI Check 591,40 1130104 284 Billie Jo SnydAr Cookies For Fund Raiser .12,00 1/30/04 285 Cash (wm & Sharon) Sean's FS For Food & Sheller .375,00 2/13104 288 Circuli Clly Cd1game .73,11 2113/04 287 KMart Shoes .14,99 2114/04 288 Value Clly Game .16,89 2125104 289 Cash ( Spending Money .50,00 3/1/04 DEP SSI SSI Check 591,40 311104 290 Cash (wm & Sharon) Sean's FS For Food & Sheller .375,00 3113/04 291 Cash ( Spending Money .50,00 3113104 292 FYE CD's -45,04 3113104 293 Velue Clly Clothes .30,97 3/18104 294 New York Mets Yearbook .12,00 3130104 295 Voided Check 0,00 3/30/04 296 Medco Heallh Dlllantln .18,00 4/1/04 DEP SSI SSI Check 691.40 411104 297 Cash (wm & Sharon) Sean's FS For Food & Shelter .375,00 413104 298 Cash ( Spending Money .50,00 413104 299 Value Clly Clothes .9,99 4122104 300 Star StrucklProteam Mets Merchandise .70,90 4/23104 301 CVS Personal Items .67,70 4129/04 PNC Bank Check Printing Fee .15,99 4130104 DEP SSI SSI Check 591,40 4130/04 302 Cash (wm & Sharon) Sean's FS For Food & Sheller .376,00 511104 303 Saars Clothes .83,43 5/1104 3CJ<1 FYE CD's -41.33 611104 305 Toys R Us Toy .15,89 513104 306 Billie Jo Snyder Reimbursement For Shorts .17,50 6/11104 307 Cash ( Spending Money .50,00 6/13104 308 KMart Clotheslvldeo Tapes .39,38 6116/04 309 Borders Book .28,46 5/28/04 310 Cash ( Spending Money .50,00 811104 DEP SSI SSI Check 691.40 6/1104 311 Cash (wm & Sharon) Sean's FS For Food & Sheller .376,00 8116/04 312 Medea Health Dlllantln .18,00 6117104 313 Seara Bedding .84,79 6/28/04 314 Giant Medication .5,62 6/28/04 315 CVS Personelltems .13,87 711/04 DEP SSI SSI Check 691,40 711104 316 Cesh (wm & Sharon) Sean's FS For Food'" Shalter .375.00 711104 317 FYE CD's .61,46 7/9/04 318 Cash ( Spending Money .50,00 719/04 319 Circuit City DVD CD1garne -62.97 7/9/04 320 KMert Shoes .26,98 7116/04 321 Cash ( Vocation .300,00 7130104 DEP SSI SSI Check 591.40 7130104 322 Cash (wm & Shsron) Sean's FS For Food & Shelter .376.00 6/7/04 323 Kllmore Eye Aasoclates Eye Exam -40,00 8/10/04 324 Walmart DVD CD .16,31 911/04 DEP SSI SSI Check 591,40 911104 325 Cash (wm & Sharon) Sean's FS For Food & Shelter .376.00 .' , " TMNSFER OF SEAN MA11'HEW DOSIAK TRUST FUNDS. " TRANSFER CD WITH MELLON !lANK FOR $58.000.00 264.34 INTEREST $58,26<1.34 TOTAL TRANSFER 9/2110 I TRANSFEREr) TO AN ANNUITY ACCOUNT WITH F&G LIFI!. , , TRANSFlJRED $6.500,00 FROM MELLON CHECKING TO A MONEY MARKllT ACCOUNT ,WITH AMERICAN FUNDS ON 8/16/01. . TOTAL OF ~ONEY MARKET $6759,22 .' I, " ,,, , , " ',' ., " ,_ 1I " ,. ,!,' ,', ,. ," , , .., 1,'1 ;" ';, I;" , " II I. "II; " ,I ,;, j'," " ", , , , 'J' " h; " " I' " ,. , " ,. , ,. " " ':1 ',. " ,.' Ii' ,\. 1 1 " ,. ,,, ,. ,. ',. "" " " ., , , I, " " " I, \, " 'I" " .,/ ,. , " " " " ,,' ,. " , , " ,II , \1,1 " .' ,. ",I ; "~~\l.":~'l-'/ ;4, 'j I~' ;i i., ,',f'" t' ,l~ n j 1:"1,,, '/" i'l'lll\.ltV I. ", ",." "'," , ,t K"~\.!-',"'Jl,' 'I ,,"'~l;: ~l: I' ,. 1~ /. P r. "'>' ,'. ,~. '\; \ t' ., I I .... . ,,' \' "'~J' ~. il} ,I , -II', I Il~ I I '\... ~, ,1 '{:t, !:;':I'!'i; I, :~\. j' 'I ; ,,' 1101" " ' I "I"!"ll':'l~"i/.1_ ~ '/1.,' . J, '.., II ! 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" , \ ~ '.' {'"'' ';':'''''''!\:'I:'''''''''~' "litf'a~ ' :. 11',11:' ;J.ii:if,\, ~ ~ ~W-~\f.:~~ ' p .', !;U~1ltl" '., '11'" " . 1',1 \ ,I' i l ; ~ ( I' , ' \ " "0: ',I'. .. ,,',' ., , , , , " "".' " , '1', II. " " I' , .. , ,0' "" "i',' i,'j,,',,' -',. I" ~' ii' ,. , L , 'APR ~\,,19Q4~, t:,;, . ,." 1 .1 I ! ' IAN M. WII.EV " A!1!lOl.~I...n~~ ATIOANUM AT U\\' 1 8ARUl (IRtU: UlI.ISllIMU, rA ltOI9 41' .. . ( . PETITION FOR APPOINTMENT OF GllARDIAN IN THE MATTER OF SIAN MATTHEW DOSX~1 Alleged Incapaoitated IN THE COURT OF coMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS COURT DIVISION NO. The petition of William R. Dosiak and Sharon Dosiak, natural parents of Sean Matthew Doaiak, respectfullY represents: 1. 'lour petitioner has custody of the alleged incapacitated at 100 Second street, Bowmansdale, cumberland county, pennsylvania. 2. The alleged incapacitated is domiciled at 100 Second street, Bowmansdale, cumberland county, pennsylvania. The alleged incapacitated is mentally deficient from birth due to the malpractice of a physician. 3. The alleged incapacitated is 17 years of age, having been born on August 31, 1976. 4 . The alleged incapacitated has never served in the United states Military. 5. The alleged incapacitated's marital status is single. 6. Those persons, if any, who are the alleged incapacitated's next of kin and their relationship to same, of whom your petitioner has knowledge are as follows: Billie Jo Dosiak (sister) 523 Barry court Mechanicsburg, PA 17055 JIINM, WII.t:V " IISSIK:III n~~ ..\l1C1MNt;\M AT UW 1 BAAW fHUU: 1IIU.liIUIRfl, p" 11019 . Please see Exhibit "e", attached hereto and made part herof in reference to the above number 9. 10. The alleged incapacitated is incapable of handling any and all financial affairs and making medical decisions set forth in the attached Affidavit and competency Report marked Exhibit "A" and made a part hereof. 11. William R. Dosiak and Sharon Dosiak, the petitioners and natural parents of the alleged incapacitated, having no interest adverse to the alleged incapaci t.ated, would like to make the court aware that they consent to serve as guardian to the alleged incapacitated, if this Honorable Court shall so appoint. The Consent of the proposed guardians to so act is attached hereto and made apart hereof as Exhibit "B". 12. If appointed as guardians, William R. Dosiak and Sharon Dosiak are required to act in compliance with regulations promulgated under Court Order in 5 pennsylvania Bulletin 931 et seq. (April 19, 1975), and Title 20 P.S. Section 5521. WHEREFORE, the Petitioners pray that, on recommendation of Dr. George H. Harhigh, physician for the alleged incapacitated, that Sean Matthew Dosiak, should be declared an incapacitated ,. ,( t, " , , ., Ii ,," (".., " , , , \11 " " , .. " I," I',', .. I. -'I' ',I. !' 'C,' ,. ., ,. " ,"\" " " " ,. , , ..Ii, ,. ,. '. , EXHIBIT "A" ',\ " " "1 ., ,I" '1', " ,., " '\ ''''It! , ., , " !. " ,,, " , " 'ii !' , "I, ,. , , " , II " " "i " " \l .' ",I',' ., I', \.. " 'I " , ','1 I' '-II- " .' I' (. ',- ,. I.' ,. 1,1' " ,. I'. ., ,. , , "" I. " " ',',; i',1 I, ,. " .'1' , , " ,." " "1_ " d'l ,. '-, , /,1 ';\ '" M /". 'j ,. If .._:)l'''~' 't~;il"'" ""'liI'1'!'l"",*'!'n-i-'"ffl~INfflll'!I~'~tit~r:ii;j,.~~I~_i~k"~.'i '!I'i,c: 't,;. i','," -,_" " ". ',': .. I_ -...- ''Wfl, (1"'-\/\, '_I/:':""'q-"~Ij'-n " <Ii' ',' , , l .'''''', "." , " " j: , ' " " . .1 . Chg, fa ~ I It Wi'" L C, - 4)~' de- ,,(,. fl." ?jJ'J! 'II lO, L/u.-L I (0 ~ t ,lUU ~"Jr-.' J1)~1 M'/f'.Gto/ ,', ~ (~~e&-) nr~ ) f) C I~ I, 'W1 ~ t:li 6- #. (7 e(1,: 00 .:l - ),\'\' " ee cs-- '-)'L~v-,..,~ ....... 3-,0-4 - po ~ hi. ,-I. .M.I ry---' . J4^--:- n- 1 r IJI ~ f"" .., ~~ IoN? .rf t> --; ~ Date ) f() Pd, Bal. \. I --- 30 -- 3'~lP - '"\..- 1)0 .~ r"i" I . f 3.0 3-D '" ' ~r;~ li"- )Jh"''};A' Au) J/ iLl. 16.l:~ -f MtI./ llll .-- v [/ -if (J If) I ~);;~ f"'/:. 1> -f,j.~ -: M ' '. ' I, 9r yJD- ~l:7~ \ '-I'I'i" ;yQ..".,1:c~~~' )",.,.,J-.>-:-- ~,,~ ' '8-((_&/ ' 'rw ().J.~. ,~V' ArK - -dvL--- T pt/VI ;r /1.) 'b-t T-q '2.... ([JY Date . ' .' , .,~ "1' ...w.... /1112.. ....'/'.11I-.,'- ...( . Chg. . Pu, . 80/, ]"10 t>2g' ....:J 'f ~. "1u ~.~ t,~ .JYb . , ,'" , . 'j;y/r,J .. -zS-'jO II rYL- lP~l( . ~P-)~-1-J;:../' (ilL ;lJf^' 'c L,p nt!k:t(.:J, , ~. :1r;0 - , , V~~ ! . '. ,j"b: . !f!~tJ- -"'~2' s~' . ~13 .- lJ~ '. . . ~h d- r ~t.- , ' iJ~ 01# . l~ & M. . ) I{ .. J/~I:( . .._) [q)~ r~,L-: . /71 J~JtJO~ -r ~ -rT ('1 #'" lID d6 :1--1/ - d. I' CENTRAL PENN 'CLINICAL LABS 395 ST, JOHN'S CHURCH ROAD CAMP HILL, PA 17011 (717) 737.8877 I PATIENT: DDSIAK I SEAN PATIENT NUMBEH: 020453 SEX: THERAPUT [C DRUGS PHENVTOIN , ' " DOSIAK, SEAN PATIF.NT 2959 .9.3 L '. , .' ." ,. , , Nav 29, 1993 19153' 1 p, W. Koontz, Ph, D. J OHOERlNG PHVSICIANHARHIGH, GEORt;)E H. MD l1 DATE OF SIRn!: . LOCATION: DATE DRAWN: Nov 29, 1993 10.0-20.0 , \. " , , , , ',. , Ii , , , , " " ., '.\ i " " , r,' , , , " , I;" I'" ,.) :, 'I' ' , II, 1 'I I ' " I; , ' ,.,,"j' J 020453 1.0. LOCATION . '" j' " ,,',"" " , ' TIME OflAWN. 11140 ug/mL , 'I ," ,I j I'P ",," , :'.1 , ,. ". '. ',I' " ,,'i', ,.,.,'.. \, , ," 'i. -j. " I.' :1, ".1' ,,' ,I' . , Nav 29, 1993 19153 REPORT O~TE /'.., I "1 \.,' '. .1 ',. , ',I '1\ ,. J ' loll Iroo In PA (BOOI 222.4403 FAX (2151 37B.1300 "Ihe . --TEST-- OMEGA MlIJlCAl lAllORA TORIES 2001 STATE HILL ROAD SlIlTE lOO WVOMISSING. PA l'JCJlO 121.i) 370:1900 bluud teNt eellters" ------------- PHENYTOIN IDILANTINI LAST DOSE ,'. '-., -----~ __'...__ptl,EN.! INFORMATION , :q 650-60 1(106 CENTRAL PENN CLINICAL LAB :195 ST JOHNS CHURCH RD CAMF' HILL PA 17~lll ili' 737 8877 UR'AWNiTmmr-T5NIT' --RESUL T-- 7, ~I LO --UNITS-- PATlENTi5A~ NAME I ODS I AI: I SEAN AGE,OOBI 17,l~83176 SEX, M' 101 REFI f1193f12 DOCTOR I HARHIGII DATEI J 1If16/9~ ACNI X309f10j --REFERENCE RANGE-- , NO I NFORMAIlON SlJPPL I ED MCG/ML' THERAPEUTICI 10.0-20,0 ,*** FINAL REPORT *** I' i , , , , " .. ,. .. , . , " " , "" ;1:/' ,I. ,. ,. '., " , , , " I " , ,-t' +' " 0,',"\ ,i.-" ,. .-. .,'-';, , ,. ,. , , .. . i '.' .1 " " ". "',.. ;.:,1, i"', ~ . , , :' ',' , , " ", , I "\' " " "\' ,. , " '. , ,! , . 'I, ~~'~"v\''^\~ -0 ~MOME I, MARCUS, M.O" 01""" . A....I:; :'(:~}~It",'l ','f.' ..ft' '(.'II.'!,.f~; .' ',I~i j',l>:;. 1,llr":i~i,:t~';I.:, D.H. HAI\HIGH, D.U. r''!.. .;~;,':!\"::,~;:. 2~~ ':,ClUHI 35TH STRl:.ET '~Il;t,(,'.,/< CAI"II.'H I L.L. p(., 170 II . r:'l, ,'t~'. \''..'1~ljY;I. t; ...1: ,',,{, ...~ . .', ,r1I""'~"'J ,'.' ; "1 ~'.' ", t"r "'., "\ ,VI., i ~ './, """1 ~ 'f,' 'I..II~', {,,: .~, ,., , .' , ...."" .Laborr,lory Report ,,: ;':~,\, ,,1,,', . , ,.;" ,t,' .,!:" .,,' It 1<.,Jl( t, > \ ".~' 1 ~ Y I' . ,." ! "~ '. " 't ,~I.,', 01 r !/ (~lIt ,..~,rO~~~~Ir~SSCo~~;'QiMl :.. :',:,:"': ;:~', 1 I' tlHorShant,~A'904fJ":::' .' . ',':?' . (2.16) 057 930P '.' ..,.... I '.'800'825;7330 (PAl ''''I ::: J : '. " .,' 800.8~6'7~~0 (C.IUtnl~rV~PI, ,.1 (",:;.\.;. d'-'IJ" ',\' ,! t' I "'V'I'I 003. 011 "'nociANINbCll/rjcplLa~"~Y'.';:}". ,,,;;!} :"~;li'.I: 11 .. \ H '~~"/ ~I .:} dJ,,' "" 'I '.., l{~, :'.'1 ,'~' \ ,'l~.t DUS I AI'. SEf:II'j IJlOI 111l.1S ,IllOn ilft tIC I' Qlr.,3 ""ll 1073 ,111l II::tJt'l\l() ,10 pclI'lK " 0&/lb/9~ 06/17/9~ ~INRL ._, I:. .. ." ~, . ' " , Tosl osu 5 WllhlnRm\ l1oforonco RmlQO O.lt nlll,lIlq(1 Unll. DILiliIIT HI OIL AN"llN DILAi~TIN 10.5 TI-IERA~'bUT I C RANGE: I a. 0-20. 0 M[;G/t~L TI IX I C VALUt.:. GflLZArER THAN ;;:0. QI MCC:1mL I'ICG I ~tL * ENO IJF FINAL REPORT * ", , P' 'I' ,I "'1 , ' , , 'i. ",-, , " ,,' ',' ; I' " j:,- ',' I", , "-, ,I' " ,., ',. .1 " " ' .' " ,I' .-- " I' ,. , " I"" " "j -" "I' " ' " ,. . (, H. ' ",",' '1 ,. .,' " ,1, "~,I I. 'I' " " " , ," II ',' , ' '1'1 L'. Mnrynm Bnkhlnr, M.o.. olroclor Josoph W. Flshor. M.o" olroclor ,Ioseph J. Murphy, olroclor ,;' ;,'1'" ,,' . I" '. " . , G. H. HARI-I I GH, D. O. 25 SOUTH 35TH STREET Cnl'lPHILL, PA 17011 r. .:, "i ,; ~ . .'; , . ' "'I'I.t ') '. ,I I ~.': '. ! ~ t, ~ I , ,,' '11 ,::(. p,blnl N.mt Dl1SHII<, SEAN HAf~HI GH D I LAI'IT I I~ DILANTIN DILANTIN " Marynm enklilnr,M.O.. 01100101 003.01 ..... rllllnllO tl1c,,%I~liZI7::; RoquUIiOQ Phyti~lln I Rtml,U ,., "'.. Laboratory Report ~, M.IP.lh Ino, III 900 BualnllS Cenler Drive ." Horsham, PA 19044 , (215)951.9300 '.,: '. . , ,600.112D.7330 (PAl,' '. '.., . ", BOO.82~.7320 (CllenIServlo.) . '1 CORNING Qllnlcll LlbOralcry , . ;',1'1: Ag. 17 St. Olt, ~Itclld TItTII Colllcltd M 02/27/93 11155 Dill Rtcltvld O,lt Rf90llld RlMtt Statut 02/27/9 03/01/')' HNAL. " ., AesuUs OUlnt 11,1Il1l" Wllhln AnngEl 7.9 L ....-' TH~.r<11~'E:.UTI" RHNGE I 8.0--20.0 MCG/ML. TOXIC VRLU~: GRSATER THAN 20.0 MCG/ML TO'I Anl."neo Anngn * li:NO OF' .F'IflIAL REPORT. * 1'/,' ". I, : " ,'; " I' ',', . .. ,," '., " <I; " " " ,. " ., ',. "1' , " '" , , ". 'I" 1-,,' ,. !-' "'I' , " ' .,. ,. ':1' " ,',1 1\ .1. ,. " 'I '. " ,. " , . , Josoph W. FI,hor, M.O.. Ol'oelor '.' " " " ,. 01' " " -.; , " j" " , ' ,. , " '. ,r' /: " " .'. " " " .. , " , , : , 'I,' ,. " , " ;\,.. , , " , " , ',.: , 1,,'..,_li,', ','.-, .' ',', ',I . "-"11 ',\'i I"',, ,\ ,"'1 . '"i!tl':;:", Acetllioft No, 1/,(,7%13 P'Ilf 1 Unlll JO!Oph J, Murphy, Dllooln, , " ':,/- , ,:. ~. , Laboratory Report , '.' ,it.'Y,. .." ;,' il" r,l, ,....' ~,,~ ' d' 111.~:(, IlIIZIJ. ill 1 1 MelPelh Ino. 900 Business Center Drive Horsham, PII19044 (215)957-9300 800.825.7330 lP1I1 800.825.7320 Cllant Sorvlce) a CORNINa Clinical Laboratory " 0.11. HI1I\IIIOII, D. O. 2~j ;)DUTII 3~)nl STf~LE1 G(.)JtIr.'llll..L. ron 17011 MQfPat6J III ,il" ',' '4""111 ~l';'{ 1. ,,\-.~ I\:"i',"':;':;" ,",: ""il""I. . 'IS ,.,1, ~ ;,1 ~ I , 1- ,',', :.; :::: . " ~: . ';I,:'~\''l'l;:' '. , ^oo SOl O,lle Colloctod limo Col1ocled },ce...lon No. 12c)7'JIZ111 PltlonINI,1I. Pa!lenllO Il,IC';:%'~I'~73 M 12/2c)/~2 12155 , I)I)l'JIAI\, :JU~N l-"I' ...." '.. '. I l"~ 0, ,. ',... 01110 nocol~od 0.11 Aeporldd A.por1 St.lu~ Requ..llno PhYllclan I R,m.'~. 12/29/92 12/30/92 FIN(1L ; HmlH WII I &.' ",'0 ',f I' '-,' "-.' , \",'\'" e5ults Wilhln Rango Rolorence Range Tell QuI 01 HnnlllJ DILAI~T HI DIU'ltH11,j DILAI'HII'l 'Lc) THERR~EUTIL RRNGEI 8.0-20.0 Mea/ML .TUXIC VRLUEI GR~ATCR THAN 20.0 MCG/ML ~ICG/I'IL. .,' .~ END I.1F FINAL REPORT .~, '.. , I,' , ' , , ~ ,. q " .. ,," . , , , It,-' ,. ,. , , " I'"~ ", ,I.' " " , ." '." , , .. "'1 .' I" .. ", , ' , "I I ,. ,\_1 ,,! 'I ., " " t'i I," " ",,' ,. '" " ,i' 'Ii. ;1.' i,.i. ". , " , ~': ,. " '.' " .. " '.-' ," " 'i , "I' , ' i' Unit. i MBlvam e.khlar,M.O.. Olroclor Josoph W. Flshor, M,O., Oll8clo' Josoph J. MurphV, OllOclor L..AbUIiAI UK V IiI:t'iUIi I U, H, HAF~H I HH' \.I. U , ~5 SOUTH J51H ~rR~~1 CM1PH\U..' f.'(., 1'/01.1 ..---------.- rAlI\.IH ,)mill~l\ ! ~\I.: MI ,t::s I. . ',J',):!,. 0:1. 1 ,) '11 ~!(.\ ......IUlell.latn Inc "."".,,,,,, , ,- , . 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ClIHF If~I1A 1'1 CIN Ilf I'i f'f\I'H.fI~1 :illl.,(i(.:::.;rHlI:, :;U' HY Mill 111M \'E::il II;i f\t:'.Cl.lflMENrH:I.I, Hf',M/'II't:II..UOY ~n::t.IIMOlli\nCIN flATE < 1.1/.0 ,l Mflltm O.'1.~i i1I\1'F: CCII"U:t.: l'El.i I 1)':;/ I 'I1'n .. 01'1 fE fin'(lfn'El.i I ()l~n :I.f,r;: .--------- liEf EllEN,,!: I1ANOES AilE fOil AmlLTf> --..--. -_._.~...-----_......----- ..-----.....----,---.-.-...-.---.-....-----.--'.---..--------. --- ---,----- , LABORATORY Rt:/-JOH I , . D.H. 'HM~HH;H.' I.I,fj, 00;\. OJ. I. ;:!~,i :,WI) rH .!:i) H :rrRf',f':) 0" j;:!6 C,{jMf"H I Lt.., fo',l) 'l10:1.'I. l. 'j) 1(11I U(J~1 r ,1)1\ J~IFi!\N 06;i60.1.0/'3 Rl::~ilJL r rES)' F'..H:I/;~LJ,I f~I\Tl n ) RON lIXNIIHW eM' ~;ATUfi'Arll:JN l.IHiC M.~(lN~:~1 x UM f.:HOI.lHIiI.. IfISK: h:/\I'i'l:1 .f ~;!II ~1. ~;Il} .~~, 0 .~. J 'UAn: !.:OI.U:C'I'f::U iiilMetfJatn, Inc. a CORNING Chmcall.bot.torv I~)().I\.' ~I' J ,I .111'111 IH) 11~!I.I.l;'OK~It'll i>l,rl\'J:l.1 rnl a..(fGU;[iTI~ll (:llllll:!1 h (H;:ltV!'1~! 111'1':,101.1/ UNITS W.1/f:l 1'11.: BI III.. F'f.iIWENT Ut.iltll.. Mlil/tll, 08/1~/~~ . DATE REPORTED ot:l/ ::! 119::! 'i , " " ". , I I" ',t, ,i ,I" ,. d' , . " , ,. I." ,. , : , , ,,, 'j, " .' , ':1 ." " . I' Ii i' " ,. , ,. I" ," Ii ,. .. " ',; , ~I\ In,l, 'j II, I~ 111111_'~41 ~i, I ,11111111 ~~~l '~)H:.)IMIIl\ lillll 1.'l~liI"/.lJl(\l l~lll (;Il ~li, MAII''''\lllAHlrAlt~rrl .~)~>I"~. W, 1'>lft'lt Uf, J()'>I;1I1.1 ~ll~~W,.1I '-imt;" " , lllU/'ft/l (U~llllU1 IfJ/:L 'I ~J/:~ 'l/V~ RF.F[:.f~~\NI,:F: , < t I '~~ ~:I:~ ()."~ I1II 1. ~~..llti H)6",~~J() 1.. fl"";!.1> ,,,, ,i' " " 1\ "J! ,. , " Ii ,. , , " " " , , ." 1:.i2~JII/\ H IWI/LV ; \ HUM. 1.0H I' ('1 i I , , , \ I I, , . ./ 1\, .. , IIUFERUNCr: R^NOeS ^nU FOR ^DUlTH; . , ...-.;. ... tJVeurologr . Center; Pc. . Marla Michalek, M,O, Todd L. samUels, M,o. April 7, 1992 George Harhigh, D.O. 25 South 35th Street Camp HUl, Pa, 17011 ReI Sean Dosiak Dear Dr. Harhighl Thank you very much for aSking me to evaluate Sean Dosiak. As you know, he iEl a 15-year old male who has had two generalized toniCl- olonic seizures. The first seizure occurred at 4130 A.I1. on l1arch 31st, 1990. He was hospitalized at that time and started on Dilantin. CT scan of th9 brain was reportedly normal. l1ild abnormalities were seen on the EEG according to patient's mother. He va. .tarted on Dilantin. He remained seizure free en the Dilarltin and it was discontinued in l1arch of 1992. Approximately three weeks after stopping the Dilantin he had a recurrent nocturnal generalized tonic-clonic seizure. This wall followed by a several hour's cf Postictal lethargy and confusion. Past m9dical history is signHicant for' birth hypoxia. His mother states that the umbilical cord was wrmpped around his neck. He had significant developmental delays. He is curr9ntly in a special edUcation program. He works in a sheltered workshop as well. He has marked speech and language abnormalities. He has poor gross motor skills. H9 is currently taking Dilantin 300 mg. per day. He had a toxic blood level of 27 UG/I1L on 400 mg. daily. l10st reoent Dilantin level vas 15 on l1arch 23rd. On examination, Sean is a tall thin gentleman. His speech is markedly dysllrthric. Pupils are 4 mm. and react to 2 mm. to light bilaterally. Extraocular mOVlL'ments are intact and there is no nystagmus. TherlL' are saccadic pursuit eye movements. There is prominent SPooning of digits of both upper extremities. Fine motor movements and rapid rhythmic alternating movements are slov and clumsy. H9 has increas9d deep t9ndon ref19xes in the lover extrspmities. Ther9 is increased tone throughout and h9 walks vith a spastic gait. Plantar reflexes are flwxor bilat9I'ally. Sean has spastic cerebral palsy dU9 to birth injury. He has a Medical Arts Building B90 Poplar Church Road · Suite 107 · camp Hili, PA 17011 . (717) 975.8585 . Fax (717) 975'0670 P~RUAPa VUE TO TH~ UHaRE~ OF " '. ,". i" ,'" " '.' "I , , ". j"; " \ ,. ,id! , I. ":1 ,.., .' , , " I" ,,1 " ',I (, ii"" ,. " " ,'i ,." '1\ " " I , 1'lft: O~l1A'I'lON. ,. ,. .". .'" I. " 'I ,. , , Albert H c~, M.D. ~L[lC'r RO ~NC ~1'IIA LOa IlAPtl Et~ ',. ,'"I.' .1 .., 'I, " " '1,' ,. ,. ." 'DOBIA/{ paga 1. I. " ;.1,\ DEAN ',-, ". .1' \ I. .1 " .. ,. I. 'II I, "1. ./. .. I " 'd , , " " i I. " ,,, 'i i "1' I' I'; I ., ,'. ,. " , ../1, I, I q" " j"j' 11 " ,- ,. ,. I' , , "I , Ii ,. .. .' " ,. I " ,. ,. .,. ,. " ','" 'fI' , , , , .. ,t' I' ." ,. I', ',. , ,. , " 'J, , , I, 'I" '. " / " , , 'I ,." , , , I' ,. I, " , " ,. " .. ,\ .. " , ,. " " , d' " ,', , I' ".---" . PreoparRtlve DlognoU1GI Acuteappandl~ltl0. . , Puntuperotlvu Dlognoslnl The some wlth micro leakage, Surgooo, Dr, Challg. Au!; 1 otaota 1 Operation. Laparotomy, appendectomy and perltuneal lavaga. Dotu, ~/6/91 ANC:::.lTllCSIA, a~NEUAL ENDOTRACll~AL. Thi~ j~u l~'l'oar'old wlllte lloy who haD II110wn maTI'Lal rotardatiull. Uo had mate tllan 2 Juya of abdominal pain and duveloped 0 high tever and IIDUuca. Preup 1.0101' wus 102.1. Tho whlto COUllt l~ 21.5 anll ohUt t(, thu la1:1., Uperative Plndlnys: Tbo pationt hud acutoly inflawmed dp~undl~ltin und a 1 I, 0 Ion 11 H1 d fJ u (' u Ion t a ~ C 1 to sin the fl LQ . r'I"OCudurui With tile patlont In tho supine pOsitloll, gonoral endotrachoal dlleutho~la was given. The lowor abdowon wa~ proppod ond drafJed ou ueual. 0.25r, Marca.lne was used Eor lucal Infiltration anel than an InCISlun woo made in the RLQ along the ukin crOasu which wuu carried down to the oxternal oblique Eascia. The external obllquu tascla wau then up~nod ~long It~ flberE and tho lnternal obllque and transvernullu Euucia was afJDuod ~long the flbera to ontor the perltonuu~ tranuveruely. Immurtlatuly, ~urou yoJlowluh aueituu wuu notlced which was tuken Eor culture and uencitlVit~ studi~u und finally tho cocum wan ldentiflod. Tho appendix woe delivered Into tho uporativo fleld. It was Dwollon with acut~ InflaIDmation. The appondoctomy was portarm~d by tying off the appondicali v " ~ ~ 0 I "I L II II ~ - 0 "IJr e 101 C . I t a I cow a .9 t 1 0 (j 0 f!' WI tll It 3. 0 chi' OIQl C , II 3 . 0 ';Iill wac ucc:l1 !'c,r tho pUl'uc.."trlng cuturo and ombcddud the ilP\J~nrlicuul ctuwp. Souondary clliurgem~nt of iymph nodo Of tho moaontory was no1.1cad. After lhat, tho peritoneal cavity ~aa lrrigatod alld cleaned up With tho cponqc. Tho Cocum was then rotulnud' and tho wound woo claoed with 130 clJrell\ic running auturo in the postorlor f.'a5cia anll' peritonoulII. Nuucular layot wuu upproxJmatod wlth #J-O Chromic. Extornol obliquo Eaociu was Cloooel wlth #3.0 Vlcrl'l rUnnlng nuture. aubcu tlssue wau clooed with #J.~ VicrYl. Tho skin wau approximated with 16-0 Vlcryl subcuticular rUnnlny D u t u t' t.; . llOllI AK, Il~AN ~3G Bucnrd or OpQratlon .. IlOl.Y 3l'IIUT HOQI'I1'''L COUl)' lIill, l'elllluylvanla Roterred BYI Or. G. Hurhigh Tentative Oiaynowisl History oC seizuros. Type oC Tl'aciny I Sieep. X Other. Routine. Length oC Traciny. 35 Minutes ~o I'J ~eport I ',' ';' ,,' .'. LlJ ~~~~J U~: : Type oC Eloctrodal 22 Disc, 2 EKG, T1 & T2 Activation. PG & UV 3' Sedation, 500 myCbloral Hydrate po Roportl Thlo iu a Courteen year with a remote hl~tory 01 soizurso. 6 to ~ cycieo per oscond medium amplltude activity wac bilatoraiiy prssent giving way to mlxod thota Hnd dolta actlvlty supsrlmpoced by well Cormed sluep splndieo. Thers woro K comploxes and vo~tsx sharp we~ec in context With tho spindle stago oC slow wavu sleep. PhotlC stimulation results in minimal drivlnq aCCoct. There was throughout a requlur sinus EKC rhythm. Hyperventllatlon did not markedly alter the tracing. IMPRESSION. TUIO IS AN ESSENTIALLY NORMAL EEG. THERE WAG NO OEFINITIVJ;; PAROXYSMAL ACTIVITY. ,f!:!:I.i~'O"kY' KD Eleatroencephalographsr CSYlJh D & T 07/30/91 " I I. NAME. ObSIAlC, SEAN ELECTROENCEPHALOCRAPH REPORT I I AGEl 14 1I0LY SPI RI T HOSPITAL I CAMP HILL, PENNSYLVANIA I MED.REC. NO. , 239625 I I ROOM NO.. Outpatient I I OA n: I 07/30/91" I Date/Vitals 1 }i~.1 ~<1 w.\.. \ alp \H. \Q~ p. ~(p 51p~ . , -- I - Name: Sean Doaiak Page 1 S: Pt haa moved to our practice having recently moved to this area from N.Y. He ia here for a Special Olympica physical for soccer this weekend; he apparently carries a diagnosis of brain injury since birth due to probably hypoxic cord damaRe and from what I can Rather from his mother, a lawsuit is still in the works. He basically has had no other medical problems or serious injuries or illnesses and has not had his activities restricted. He did heve a hearinR test done bac~ in August which showed decreased complience on the left, but has had no hearing problema and no complaint with regard to that ear. 0: Both TMs are clear, shiny and move well; the nose ia clear. Throat is negativ, PERRL; EOMs intact. Neck ia supple with a good ROM, thyroid is normal; there were no aignificantr nodea; heart is regular, 91 and S2 are nurmal with no signifi cant murmur. Abdomen soft, good bowel sounds; non-tender with no mass or organo- megaly; external genitalia: normal with bilaterally descended testes at Tanner. Sta~ll III. Extremities: pulses intact. joints mobile; normal gait and posture. There may be mild right thoracic scolioais although I was unable to get the pt to position himself properly for exam. A: III Healthy 02 Mild mental retardation PI . Form was ~igned for Special Olympics; recheck prn. ~anet Cincotta, M.D./cld .-.. "',' , . , , I. " " .,1 ,. '- ,J ~ "1 III ~ I J "'. ~ ' A',:, "e A'. .1.0l;Q()(lYLIlE . '..: r'AR/'i/"",VILLE ST Oil, Oe-31-?r, I" NY 11738 7 ~.. _ .... 0 'I I 0 S - 0 3 - 79 ImprlM~ clI<l ~.'l!'~I,tI" patlant's _ full nama and (ocard number ~:::~~h / n() Mather'IName J I-vo", 0)~f-l'cV/. Blnh e .J L.7.5- ~~ 0 'fX-.:>7 (;, Place 01 /1 . Weight 22(-Blrth (Holpllall ~''T)tdp..w l.. t(.(! v~ I'!:::!::h- Matlfnel Pregnancy ~~ Thll Pregnancy: _ /NU\I t....-- /. Pronatol Caro 0 No cYfcs N f M ~. 'i G !':8'illlrPragnenclea L o. 0 ontlll L - """ T I ongth of Gellati~n Rh So I ota Ab Stillborn Compllcalions (I" r,..;..R.IL~ I a.JM.u-(.V\' ro ogy -- Length of Llbor. . . Infant'l Condlllon at Birth: !'{fy;,t 0, ~ (-4, 'h~ - NeVI ~ri ,--=- J -}.I "J,:cP Condition 1 to 30 daYI 01 1110: (5.... '" (MIl~ ~"Ir-o/ 0dev-'"'^<... r f p~~ "'" i/Jr.-~ bN,-(i~1J< (S(.<-f-l- oL.v:...l. ~V\ R.,,,-::: . NO ~ ~cJ:.v..fv.o ~, (:!.<v'l>L;. ,,>i- ~ Developmeotal Hillary: tv<. W e>.fl~ _ 6' gv.........{ . Held hoad up Smllad I;,..."J. Sat - Talked (words) 1'0 '11~(lentonCOlI _ Up Stood up Welkod__ Teething Othor: t'~ iLt S~hOOI Grede Achievement: J {lv -:. : 6vC~ t>.l- Onset of menses - '~<vV C. PeltModlcaIHlltor'l:(yeerl 'J)\]'1Vl "ri-- cL c.':' l~.v;:'......u.... . "J Co.......:.-J, Meellos Chlckon POK "''/--' - (j v..... C2<' I-L.lr.t-< f'_ (N\ ;.n{/vv..i.,........... Mumps P Encophalllli Anomia ortuSlli C I I Rubella M . , onvu S ani Nephrltll cnlngltls Retardation Othcr Pall Halpilallzationa for Surgory and Medical T o t - - roatmont: a 0 HOlpital R oalon ~ W 14/1 "lN~...l 10 ~',;Ql}.t<. ~~I.t.~ (!e~'-...- ~'t J..d $v 11,~_..... W. ~.~ ~ ~rA 1..Q"'-t .-1+-'-4 f~~~ S''''1~ (~eM) C P ~ S'o"," ~U?-"1.~ .~~ I ff~ ~1~ _ Q..Lv-M~ (!tvPJ.~,lo,..' - ~J J..a-\.I- -(Ve.L~ Family HillarY: ~...;.,,_ Wt{ J,.... ~ pv< I'( eel' 15 Allerglel_Ji rl/r... V-"', fI_.Al"..h' ~ - Tubarculolls ~ ~JH (' e. omla_'1i Hypartenslon~ Hoart DII6~ I~'I e, r- c,.,,{ {l.'A /,.,~/j,~" c(/_,I Cancar H .H (/1.1' ,7 1/. Dlabetol -(). 'I ~ "l'- -.,.,0....., (1 1_ c,...... ^tM.Dh Olher , " "'-"",.. tU:fn,t-, Soolal Hillary: . rJ" V 'b ~:L {)) R. .~ 1tJ..t,{~ . W.. 'wdl ~ NS . (J J Se'J'1A~ o~ L p.r;f;J~ J..... t 0 "I lJo ,. -~ 'j;, . p~JJ> p;;;;][~n. ~'$-:(rv ntor Prolent IIlnoll on Pragroll Noto ~ )~:;;-. Date ~ 11 /7) Signature N, fl~4~. PEDIATRIC HISTORY ........ Feodlny Hillary: _ ~ptf-,,,.[ - I t-f.J ~ 0 ~~ ~V'P ,",-'.. PH M.D, .----,.., '-'- , ' l' I,'., . , II G . I :1 .) A I:. "l A II no WOOo"y CkEST DR r A. R II Ill', V ) L L E, NY 11738" OI:~31-7i) (., OS-03-79' n. -I; 09 _ PHYSICAL EXAMI~ATION H / Ii W J L L I A 11 WEIGHTJ/# / "I ~TEMP ImprlnclD clrd or PRINT PallenC" 'l; /' J cJ . RESP. full nlme and record number HEIGHT?~ %.; PULSE B/ EDIATRICS: HEAD P / CIRCUMFERENCE: GENERAL APPEARANCE: ~-t f{ ~ - ~. . rtJ. ~. n 9J.p. Jf/ CJvJ. ~ ~ :;f' ~'; ~~~ IQ~r-o SKIN _ N O~ HEAD IE,E.N.T.1 _ ~. cPA:<'V ~ ,.(fv.. I .~^. .J 0 n . VISION R:) q -J~ D ..,." ~ yV<';\1,Y'(..r HEARING L: R: INN l...-- L: CHEST NECK - r "'\ttt. CHEST _ J..ll._ BREAST - N e{- ~ LUNGS _ ~ HEART , ~ }w t- ABDOMEN ... N ~ ' )">D ~A TRUNK/EXTREMITIES - ~ ~- ~ '''' GENITALIA AND PELVIC .1--w,y, -1-1 f'Ju ~ I . rr'~ fvwV- ~ RECTAL (NpEcdUROI LOIGDICAL _ tL./(..,,~ M~~ ~....u.;). s, nc evelopmenlal Mllestone'~~rv'-'" . b , ~ I,~- fL'.-1c{ ,I (J" ASSESSMENT: Je.vJJ. _ Q, V f'-Il' 1..l - . . -. - ~ ~ - e~b::t..~ 'l'r v' c.tP-; w/..;r '1 f- P PLAN: __ HtNJ ~'"' ~ N'U-\"~J;f1- (1r f~ _ ~I_~ ~ W~4-<l v.p ~- r1~'4 .f~e~I.f1<.~~~~ d.. t1' H.e,) ~ So"',,) wl{/~ O\IA".( I3r.t:dtL..e~VIi-\, tvNlAj ",.U.h., C)-l4 ~_ lu.... 0.(.. L~ ~".~~...J c.2'V\o.{' ,. f1 HI<., Ti l-<. ~~ .' . --' . , . I "f"',' . .:), i. '.. S 0 06 ' ~~, ):.: :J ". , .1 'i I A K, 5 E A II " !,t' PROGRESS NOTES 137 W:)OD~ CREST D~;n8 Notllshould Include HI, Wt, BIP, Temp" Pulse. Notll mUll be f .\RI'\I ,,',VILLE, ~~-O~-7? deted, signed and Include discipline (MD or R N). All dictation (\ : _ 3 , - 71.l M_ mUll Includa full patient neme and record number. 73 6 ;?+H 7.1 '7..:1 11/:->01 n , 1111' ". DATE .' ORDERS. i .'S-- 1\ U\'l ~. ~/J'\J:. (), J , h ILJ!-~ , v J J? l'r. t1-JL-In.uvJ.......o.;.",. . r W J 1(' J . J I /f'V~'-'l ul . (j ( ()j- C{,7 '/1 ') F6 - 0 LJ:~:l~f1f~ff) .r, L1l0 v.r ~ t2 I~U (..(/'-' ,~vU-, J. FJ'j. ~v, (T I. ,; v.:, 1a+,/,~ 1M S'~ ~ haf' ,( ,~;id- ,C'el., N 'r?~ J.. w (,\.il . ?} klrrJ \--. h~ Jl.A> Vu\ooo- ~. - J r;L. Uv\.ctJ rJ ~7 ~-~- - 11 (,veJ.. !J ^ J.~_ ^ I 1/ - .. I , - i , . . . , -, , , - - .. . - I ... I " PROGRESS NOrES Notellhould Include HI, WI, B/P, Temp.. Pulse. Notes mUll be dated, Ilgned end Include dllclpllne (MD or RNI. All dlCtltlon munlnclude full patient name and record number. ( . 1/, ~ S' 0 I) : '~', lA I. , , . .: .\ 'j 1 37 :: 'j ') r y '. ~ € S T D h f '\' " , ~ ' , . .. ,v ILL ~, Ij Y 1 1 7 J 8 v~-Jl-/c ~ 05-03-79 13;-1;09 Imprint ID'~/'d or~~ ItJr P~I;\,t'l full n.me .nd rICord number ~_DAT"..11.1'1' ~. II iI. ;59}z. r+n:5/f<. , 1! - ~ (1L~!riJ ,/,,~-,~'ho^J Jb , ,.f\!O 'k'J..-':,;'lM]Jd, /;J,/J r. . J"jM/At.~;r.;:/v:'" (,!/ J.1l ...~ j{"J::]: ~~-1.;~~-2' /1... I v~.a..J ---r,/;h.l d~ U;;:;:;M .~ ~C}'/A1; ~ JmAAAAM~ /1'"",~ c.:J Ai,.=; Lr.,+-.~~~_. ,I~' ...-C"/ly\!!d Pff. {tJf?"" r q A>( .(, (') -- Ii -::: I{ (, ~ J=:' /,.p --- })~~.i ~~ ~^JA--;^l1y,)~" A]/Vl~.t, ..-1..-". 'I'-- - ... .;:;:1/1., /) m.lIL tlil./il- -/if A~JIt1/1- ::/J (/J~~", ':F . '..I,. h..~~../ rlll;'A~(/. 1~, ,/ '~V- r' ",M f I ../ jr.4/" r .cA,L]/L ( L.. ~Yi. ...1 ,'vcr- AV^ if, A (v flfnJ. 'J~' t\ j ),Ib ,1 n I . f ~ fY1 //;'AF.. f~. J~, (,.(1J.... d ; ~N)f'-l- /Y"iv __ -;;;:. /1. j1~_ I J 0-4 '" W\L / 7., J^., '- .' (\'"J- ---.:IJ77 A/l--~ . - " ,,/'../ rw ,.... /) ~ --" '-.. C . (j 'il- ; ^C: ^^'A. I. .. 7 C4'l17 AI '^ 'ij-/L ,-IIi / hJI./L"'~r.. '/1 .. -. j..l : ,~~ 7t7/. . - 1>\,. (f.-~.. - r Or;;-; 1/ ~ / 12i/r'~~--J J. ^ l'!'nr.J/..{L,,1. . A- ," ,L --I::!......,I-, ^' ~ . {....-. /\~L-t;;;/;i;" t.- I V/ IJ V I (I 1/ / (J ,'{II.. .JJJ,f /^ J!. (TlAA VI - IUR.)!''';) I.....J, d('} P4 /!l-~ lh^ //1j/ V il / I ~, J '-' f~lIi L?1 If.. ^ ./v{ /H ORDERS ~~~.A ,m .1 /1. T /I 7/ ,/' /i fl;r tl\v,~P'VtfJL /' dJvj 4{A' // /I v - , ~.; '---- r:; 1 l N liLi'<.. L-- ~ .-llicL: ( R...JNL. ...,... 0 p ~~o~ _wNL '^ liJ~/-'6.s. e... -rL oo...t'. pl!: '. clw 1"1 ~ Ico, /,( b.. ,... ~r-\/L-. , Ck'l-\d-...o fK.,:J - "', ", \ ~ U((1- '. I~ - .--- [ .~J If. ,If T"YVC ~ C\I\" __ eN-(' ..~ (! 1,,,J~!).-- . .1'" .~tI',' PROGRESS NOTES NOIII.hould Includl HI. W~ RIP, Tlmp" Pulse. Nolll mUlt be dltld, .Ignld Ind Includl dllclpllne (MO or RN). All dlctltlon mUltlncludl full pllllnt nlme Ind record number, 1 0 S IIIK S& A-"U I Imprint 10 card or PRINT pllllnt'l lull nlme Ind rlCord number DATE ORDERS -#-<J dtJ...<.>J. . Y' (., Co lll-~ eAJ"\~(' ' IV, L'Ji~) ,}" It) /0 L' JL - i>~. I ),e J'hrc{ h.oct ( ...\ 1./-' , ~ l~vt\' r-c;- L.)... '_No lv':-~ ~ 'l)-ll. (Jv..... .976" . . . , . ,I CONSENT OF PROPOSED GUARDIAN IN THE MATTER OF SEAN MATTHEW DOOIAK Alleged Incapacitaed IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS COURT DIVISION NO. We, William R. Dosiak and Sharon Dosiak, of 100 2nd street, Bowmansdale, Pennsylvania, do hereby certify that we are willing to act as Guardian for Sean Matthew Dosiak, and alleged incapacitated, if the court shall so appoint. Further, I do hereby certify that I am not a fiduciary of any estate in which the alleged incapacitated has an interest, nor have I any interest adverse to the alleged incapacitated. We agree to act in compliance with regulations promulgated under 5 Pennsylvania BUlletin 931 et seq. (April 19, 197B), and Title 20 P.S. section 5521. The facts and opinions containec;i herein are true and correct to the best of my knowledge, information and belief. William R. Dosiak t S-k~ ~ Sharon Dosiak---- IAN M. WILEY , ASSOCIA TF.~ I ' ATTORNEYS AT LAW ... "AWI "IRCU: . DIU....URlI,'A 11I1t '.'l' J....N M. WILE\' , ....SSOC.....TFJi AlTOlINIVI AT LAW I IAlU.O t11CL! I>l~URO, PA 11011 .1\ , , '.,\ " \", I, 1 " " " , ". " 11\' ,. ,. :,f i' j_ ,,1,\; ,I ,I; " J' ,. , ' , " I'. , ", '.'1; , ,. ,. I' ',', , ,. ,. I'" [, " ,,\' "~I' ,;\1 , , , " ,,' " EXIDBIT "CH ,. , \, .', \'. " " !I ;'1 , , " , , , , ;" ..\ " ,. ': ,. , , " , , " . ., , I.';' :" " .i' , 1 ,. 'i ,. , 1 , ,. ;1, " ii ,. '. " ,. fi I' " 'I, 1'1' "" I' ,-,I ,. I, I" 1.' ,. '1'; " [{ ,. !II' ,. I" d i, , " ,I' 'I'"., , "'I ,j;, , ., Ii. ,. 'I' ,. ''" ,." " .. ,. ',~ . '-Ii' d' " iI., I" " , i. ',!' ,. I' , ., ,. , ' ,I' '" ". " '. , " ,j ',.,1 " " ,I' .' ,. " " , ".'1." ,I' !,\ .' iI P' ,rl.. , " .Ii :. " " " ,. ;', 'j " " :1 " .0 '\., " I, , . PATCHOGUB OFFiCe . 62 SOUTH OCEAN AVENUE PACTHOGUe NY 11772 INTEREST INCOME FORM 7099-1NT Smement of Account Earning! For Th6 Year A ~w\tJIK I\lNl::wCaNml SEAN MATTHEW DOSIAK 100 2ND ST BOURMANSDALE PA 17008 1993 OMS NO. 1545.0112 EIN 11.08//9 I 85 Taxpayer Idenclfl081lon Number 063-60-10.73 2. Early 3. Int4l'8st on 4.FedM'lI .4ccount Number Account Type 7. Interest Wlthd"wal U.S. S,I/ingll Irrcoma T/lK S.contkry N,m. Incom. Psn,lty Bond. & Trull. WfthhtJd Obttglltlon& - Z368256 PASSBOOK SAVINGS 120.51 0.00 0,00 0.00/ 2402899 CERTIFICATES 2,007.74 0,00 0,00 0.00 j, ,..y.,"" "!! Tots/-Summaryi 2,128.25 0.00 0.00 1),00 This is Important taK information and is being furnished to the Intf!rnal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this Income is taKable and the IRS determines that it has not been (eported. nstruc:tlons for Recipient ox l..Shows Intorost paid 10 YOU dUring Iho calondar yoar y tho payor. ThiS doos nOllllcludo IIIl0rOst shown In Box 3. 'f vou roc~lvo a Form 1 099.INT for mlorosl paid on a x.oxompt obllgstlon. plea 10 soo tho InstruOllons for vour come ta~ raru,", ox 2..Shows IIIl'JrOSI or prlllclpal lorlo/lcd bocauso of oarly Ithdrawal 01 tlmo .avmgs. You may deduct this on your odoral Incom. lax roturn only on Iho spocllic IIno 01 Form 040 undor "Adjustments to Incomo," ox 3.Shows Intorost on U,S, Savings Bonds. Troasurv III.. T,oasury bonds. and Troasurv nOlO'. ThIS mayor may or be alllaxablo. ;;00 PUb,560. Invoslmoflllncomo and :<00n505, 7his tnl0re~t is 8xomot from state anC1looal come laXes. Thlslnter..t Is not Includ.d In 80x 1. x 4.Shows bac<up Withholding. ror o"mplo. porsons t furOlsnlng thalr taxpayor IdonllflOJIIOn numbor to tha yer bo"'~" ~UDloct to b~o'up Wllhholdlng at a 31~, "", Sae rm W. '~UOSI for Taxpayor Idonllllcatron Numbar aod COn/flc.tron. for Inform~tlon on hao<up Withholding. Inolude thl. amount on your Inoome tax ..lum e, tax withhold. Nomln", oolf your Fede"lldontllicatron numbor /s shown on this form and tho form Includes amounts bOlonging to anothor porson. you ar. conSldored a nomlnoo rOClplont, You must tllo Form 1099.INT for oaoh 01 tho othor owners showing tho amounts allowablo to eaoh. You mUSI also 'urnlSh a Form 1 099.INT 10 o.ch of tho olhor owners. Fllo Formlsll 099.INT Wllh Form 1 09B, Annua' Summary and Tran.m'ltal of U.S. Inlo,matron Roturns, w'th lho Intornal Revonuo SelVlca Conlee for your arCd. On each Form 100Y.INT.II.t '/oursOlt aSlho "pavor" and Ihe olher ownor as Iho ",eClplonl." On Fonn 1096. IlsI your"II as Ihe "fllor." A hUSba:1d or WIfe 1$ not reQUlrod to file J nominee roturn to show amounts owned by the 01hot. ,~ co'f'Y--' FORM 1040 - U.S. INDIVtbUAL'INCOME TAX RETURN . Use IRS label. *lIll*MMMMlIlI 5-DIGIT 17008 Other- WK 063-60-1073 S28 10 I wise,' SEAN H DOSIAK R print 100 2ND ST 005 S or type BOWMANSDALE PA PRESIDENTIAL ELECTION I Taxpayer CAMPAIGN I Spouse 11 DO Single FILINGI2 [J Married filing joint return (even if only one :3 [.1 Marl'ied filing separate. Enter spcuse name STATUSI4 [ .J Head of household. Enter child's name 15 [..J Qualifying widow(er) (year spouse died. .19 -----------.------------------------------------ . . 199:l OMS No. 1545-0074 17008 $17 [ ) Yes $1? [ ) Yes , , I , I Your SSN : 0~3::~&:,J9_74 :Spouse's SSN I I ". ............. ,_.,...,. , , [ J No r ] No had income) ) . ---------------~------------------------------_.._--_..------------------------ 6a.......[] Yourself 6c Name (Check if under 1) If 1 or : older; SSN: 6b [ ) Spouse Relation- :Mos : Ship :horne: 6a ,'l. 6b .... be ':hi ldren lived with.. 6e Children lived ou t . . . 6e Ot.her. . . . ,_.H,'._~ .....,..._.....'..__.~ .._. .............. 6d Child claimed under pre-85 agreement, eheel\ here...."... [ 6e. Total number of exemptions claimed....................... (6e) 7 Wages, salaries, tips, ete........... ...(7) 8a Taxable interest ine. Attac;h Seh B if over $400.. (8a)..4....;8<;1, INCOME: b Tax-exempt interest income..... .(8b) : 9 Dividend income. At.tach Schedule B If over $400....(9) 10 Taxable refunds, credits of state/local inc taxes.(10)........ 11 Alimony received.................................. ( 11 ) . __.. .. ......._ ._. 12 Business income Dr (loss). Attach Sch C or C-EZ... (12) ..._. __.... m..' 13 Capital gain or (loss). Attach Schedule D.,....... (13)..........__._ 14 Capital gain distributions not on line 13.....,... (14)..._................. 15 Ot.her gains 01' (losses). Attach Form 4797.........(15) ... 16a Total IRA b Taxable amount.....(16b). ........... O. 17a Total pens ...... b'Taxable amount.....(17b)..... O. 1B Rents, royalties, partnerShips, etc. Attach Seh E.(lB) 19 Farm income or (loss). Attach Schedule F.......... (19) 20 Unemployment compensation.:.........,...,......... (20) 21a Social security benefits. ." .(21a) I b Taxable amount...."............................. (21b) 22 Other income. List type and amount, . .......... ...... . (22). 23 TOTAL INCOME......................,.,............. (23) ..~.,_5B9. ______M________________________________~~_____________________________ ADJUST MENTS TO 24a Your IRA deduction f rom worksheet..... .. .. . . .. .. (24a) .. .. b Spouse's IRA deduction from worksheet...........(24b)_......._...._..... '25 One-hal'r of self-employment tax..,................ (25) ................. 26 Self-employed health insurance deduction..........(26)........_...____. 27 Keogh reti rement plan and SEP deduction........... (27) .,._... __.... 28 Penalty or1 early withdrawal of savings......".... (2B) ........... ..... 29 Alimony paid. Recip SSN: (29) C.__._ ...._........ ...... .. ..] 30 Add 1 i nes 24a thru 29. TOTAL ADJUSTMENTS........:... (30) .. 31 ADJUSTED GROSS INCOME .............,.............. (31) . ..2.~B9. INCOME AGI TurboTax For Paperwork Reduction Act Notice, see Separate Instructions SCHEDULE A (Form 1040) SEAN M. DOSIAK -------_._-----~--------------,-----~--~----------------------~---------------- 1992 * 07 OMS No. 1545-0074 063-60-1073 MEDICAL: CAUTION: 00 not include exp~ raimb or paid by others. AND : 1 Medical and den tal expenses.......... ( 1) _m .2 ,J146. DENTA'L : 2 Enter amount fl'om Form 1040, line 32. (2).._.__._2.L?~t't.. EXPENSES: 3 Multiply line 2 above by 7.5% (.075).(3) _..._____..J9_4.. : 4 Subtract ln 3 from 1. If zero or less, enter -0- (4). TAXES YOU PAID INTEREST YOU PAID ,10 : I 1 , , :12 2...652. ----------------------------------------..--------------------------- 5 S tll te and 1 oca 1 income taxes......... ( 5) 114. 6 Real estate taxes,............. .... ..(6) 7 Other taxes (incl personal prop taxes): . . . (7) ... . 8 Adci'i-iness"t.hrough 7. . . . ..... . .. . . . . . . . ... . . . . . . (8) 114. -------------------------------------------------------------~------ 9a Home mortgage interest and points reported to you on Form 1098.......(9a) b Home mortgage interest not reported to you on Form 1098. If paid to an individual. show name and addres~. . . (9b) Points not reported on Form 1098.... (10) Investment interest. If required. attach Form 4'152....... ....(11) Add lines 9a through 11..... .... ,....... ....~.. .(12) o. --______0.-____----------------.----------------------_________________________ :13 GIFTS TO: 14 CHARITY : :15 :16 Contribu tions by cash or check,..... (13) Other than cash or check. If over $500, you MUST ,~ttach Form 8283...,.(14) Carryover from prior year...........(15) Add lines 13 through 15........ ......... . ( 16) O. CASUALTY: 17 Casualty or theft loss(es). Attach Form 4684....(17)...._.......... O. MOVE EXP:18 Moving expenses. Attach rorm 3903 or Form 3903F.(18) MISC DEDUC- TIONS : 19 , , , I :20 , , , I , , :21 :22 '23 24 - ...._...... ..9. Unreimbursed employee expenses. If required, MUST attach Form 2106. .. _.. _ .. (19) Other expenses. List type and amount. . ... ~.-. . . , (20) Add lines 19 and 20........... '.... .(21) Enter amt from Form 1040, line 32.. .(22) 2,589. MUltiply line 22 above by 2% (.02)..(23).0- 0-....5.4.. Subtract line 23 from line 21. Zero if minus....(24) _.. _..... o. -------- ------------------------------------------------------------------~- OTHER MISC. DEDUC - TIONS 25 Other-from list on page A-5. List type & amount. . _..... ~ . ... .._, 4. (25) ..___..0. -------- --.------------------------------------------------------------------ TOTAL : 26 ITEMIZED: DEDUC- : TIONS : I , 0181 TurboTax Is the amt on Form 1040, ln 32, more than $105,250 ($52,625 if married filing separately)? o NO. Your deduction is not limited. Add lines 4, 8, 12, 16. 17, 18, 24 and 25. CJ YES. Your deduction may be limited. See instr(26). .2,766. For Paperwork Reduction Act Notice, see Separate Instructions , , .. .,1, SEAN H. DOSXAK . NOTE . for Sohedule A SSN: . ' ._____~_----M---------------M---fl-------------------------------------"---" 063-60-1073 SEAN H, DOSIAK 063-60-1073 12-31-92 MEDICAL EXPENSES TOTALING $2,846 WERE PAID ON.BEHALF OF THE TAXPAYER AS PER A COURT ORDER FROM HIS TRUST FUND, THIS TRUST FUND WAS ESTABLISHED AS PAR'r OF A MEDICAL MALPRACTICE LAWSUIT AND ITS SOLE PURPOSE IS TO PAY FOR COSTS DIRECTLY RELATED TO THE TAXPAYER INCLUDING MEDICAL EXPENSES, . ...ga.a.=a===a=~======================================~======~aa.aa~a==..a= ,. " ", " 'j, t, ,- " ,. , " ,I'; ,. \'" , , I." I, Ii ,".\ '1 !"" ", ',; .. , ,/, \ ~, ',1 . , II(. I,' c. I. >Ii' ,. \1' t/. , , (," 'i .01 1\ , ',.'1 "," I " , , ", ,. " ..:', ,. , , " ;1, ,\ 'q " " "., i' , , ,,:',,;' ,. ,j', ,. " ,.f":), ,. fI' .' i\ " ,')" ..' ;i " , I 'i ,,' ;" , ,. i" 'II " " " '" /1' " " 11' ", i' ' ,. " ,'\', " ., .1.". " , ,. " I.. " ,.10 " ,,". ,. i', " ,. " , !i , ,. , ,'I . 'i , , "" , , " " _,....n u. o~o" eOt.iKHlAtION IW~', w1ar'4t. tIP', ltC,1 ,," la, ". l~r\O" ,UIIHIIS 11'111111 m~ 1t"IOULI uloI ". Ie, uU8U CQt.i"HSAtl~H llll'lt \I tttlllf\4 IDI ",." Ir., I. IHmut tC6nl9MII'A $l;~tOIIlt A II MI ~OOl, .", I. 3. OWI0(1IOSIC(tl\tlII"'AScH6lI..aIIOYtr~OOI ,... 3, . "H"''flVANI,\ r.w.8Ll INGOl.lltAOd Ml'lIllC. 1'/'IIl n · a , 063 I ~o 1073 . U,u"'lIIlllllllllllllllllllCAR-RT-SORTUCROO B on-'0-1073 DO ~ &> SEAN H DOSIAI< . 100 2ND ST t 'eRii1 &QWMANSDALE i [ I II H H If ~i PA I"~~'W; ,1~,E.Je ~~~~~~nT,~pftl1\ . ... ......,.....',.... ..... .. II.......... pou.. I \11"1 II \1......... .......,.."., . -' o c.llIllI<<f . till n I IN'" " /fIdff/l'"'' 14" If/l" ,""" 1.......,._..~11,1"1I I L ML1 ~ I '>,0 "HlY\Dtll~~jf. M'i. lW:tC>autiU.T- mIil ~Ini~ JOU,f1Ie<l.Jolnl RIIUln uoulriiidTeiiiriiiToi;;;;;- IflO _ ....1 FOOlclUI,loflnll Rlluln DIll 01 011111 M$ICltJltC'f' StAtuS ~."'1OWl1 ,O'ln.yur Mlldtlll ijiii:vtAA 1lAII00Nt ,,..t.....1lrl1 111Wtl'l1ll1~.1lrl1 .....I...KM/I'I,tOlt\NllIMIIM11U.lWl.,.hl'..lllUIIl01MI. 1\.llJ~llllr\lOlll-O I.I.AUCOOtl 1I1ll111111.~lIl"M\IOIIlIlll"\C"llltlMtoMlellJll)ttl\l"1H I I ~';;'''' - ",I j"~'''''O.i'' WJII,~j""'IIIIll'lrtM1,IlJI"""If""'.IIYfIfttMd~1 poul'" CII04llOn ~p~t~V' ~o( M:t/JOllC:U~l..j) I 10TAL C~IOll$ IAdd 111'\" 6 ~o\d II I. I. TAX OUII""'U\ 1M 1111_ 1M Sl Y,,"CHIU'AYAlU TO,A DUA,U1UNT O'U'i'lltUI I, 2 Z. ..,~, 'Z.. 11't., l' ;1{: PA 17008 ,. 'A.XLlAAlllN'Ua,.otlIHt41I.l\lf\lQIy~IVf'02't'\ , 6. tolAL p~ IMCOI.II TAlUW\ttlHtlO l'IOtnln"MllS\.II.'IHII.. 1 P4UlII.1AlIOUl'4VltlfHtS 1II'1(II/iHIl1./HIl)C'IOI1rT'l1nlllnd 1991 cr'd,1I 10. 1l~(~PAYl,((Hl13YDUKI \.1\4 ~ r/~ 'I"" II. 10. IU, ~HUHO A./l'IOUnlol Ill'll 10 Id tAt tllunotd .IJ\O'lIl IlI_"_' lot I.hj/ld(ntl.- IU. lIb CRIOl1..I/Nll,iM dl \11'lt 1010 bI cr,(l11t<l10 1993111l1NltII1U . lID. lIe, ~H"1tON A/TIOl.lllldlhlltlOIOtlt6dNlldtO Hll11P.4~rtlCdnwmliO/\fl/l\d lie OIJE DATe rA oef"ART~ENt OF ReVENUE PA-40ES DECLARATION of ESTIMATED _ INDIVIDUAL 1993 PERSONAL INCOME TAX_ D'l(Onlls OlOCK 'F vOUAAE SUBMITttlO $ AN'MENOEO O€CU.llAllOH SEPT. ~S, 1993 OECLAAATlON Of ESTIMATED TAX FOR INDMOU.o.LS I 801<::>0 Ob3.bO.~073 l>Ob8 SEAN t1 ])OSIAK 100 2N]) S'I' BOWt1ANS])ALE PA AMOUNT OF YOUR PAYMENT 17008 dID m~\!m $ Pl<OTOCOPES ~P..9!~A 'n...S rc...."k \'B&PTUlLE .vi.iCC BUREAU USE DIll V 01:a31:a0laO?30b& Tff'VBR OR PRBFNlSR SICINATlJRS """NF. NUMaaR p~ ilo~ M!:~<:H~I..t:l SPOUSE'S SlONATU~e llF "' JCiNl oeCLJAATlONl DATE PA DEPAAl....eHT Of REVENue DUE DATE PA-40ES 1993 DECLARATION of ESTIMA.TED INDIVIDUAL PERSONAL INCOME TAX JAN. ~&, 1994 Ob3-bO.~073 ])Ob8 SEAN t1 DOSIAK J.OO 2ND ST aOWMANSDALE PA J.7008 O''('THIS OlOCK 'F voo mE $ SUOMlT1'~" ~c~iJl. ~C'OO :ltft.1,l: AMOUNT Of YOUR PAvMENT ellm $ ",0'00 ~T~' ,/CSlMUS fM,:.'l"e ~EPTAlllI DECLARATION OF ESTIMATED TAX FOR INDMOUAlS BUREAU use ONLY , , Ob3bOJ.0?30b8 [WYEIl OH 1'11EPAAEn SIONAIUI1E \'""NE NUMIlliII \'A.It\:. ,v"~ j: o It, M.'X1-JO~ <:: H:tLP \~se. SIONA'Ul1E II' , J"N' Otc!.",,!(IIIl \DA'E 1 .-..-.-..-...................11... _WI'f'~;' '.", , " Estlllc of SCIlIl MUllhcw ()osluk 111I21KIII Id3 I'M Keglsler: Estllle Ill' Selin Mllllhew Illlslllk From UI/ll1/2IKI~ throllgh 1213 1/2(K)~ SllIted hy: Illlle, Type, NlIlllher/Kel Ilate NUlnber "Iyee "ccounl Memo "Iyment C Ilepollt Halance IK1/01/21KI~ 374 Will, K, & SllIlnm II", Selin's FS 1'1Ir F&S m,IKI 1,~1>4,17 01lll1/2(KI~ m ellsh spelllllnlllllllney spending mllney ~II,(KI 1,~14,17 01ll11/21KI~ 376 K.llllln elllthes elnthes 12,79 I,~OI,JK 116/1~/2IKI~ 377 SUIlCUllSl IlVIl's IIVIl 7U,I}K 1,4.1U,40 01ll1~1200~ ,17K FYE CIl's CIl )(J.l12 1,J'}4JK UIIII~12UU~ 379 S~l1r's elnthes/plllllw c1l1thes/pillllw I~,l)(, 1,37K.42 IKI/17l2(KI~ .1KO Medell Ilclllih Olher Expenses Illedlelne IK,IK) IJ/oO.42 IKI/IKI20U~ 3KI CVS ellrds/I'er.mnlllliellls eurds/persllnllll", 21.JJ 1,331},O'J 07/0112lKl~ dep dlreel depllsli SSI income depnslt ~7'},(KI 1,91K,09 07/UII2IKI~ dep dlreel depnslt SSI' income depllslt 27.40 1,94M9 07/01121KI~ 3K2 Will. It. & Shllron II", Selin's FS lilr F&S m.IK) 1,~70.49 07/0212IK)~ 3K3 elL,h spending mnney spending mllney ~1I.00 1,~20A'} 07/1~}12(KI~ 3K4 clIsh 113 fllr wnter plllllp wnter pllmp KJ./oK 1,436,KI 07l0'll211O~ .1K~ elLsh vnelltinn vllcllllnn 250.00 1,IK6.KI OK1II1/200~ dcp direct depllslt SSI InC(lnlC depnslt ~79.0() 1,7/o5.KI OKIIII/2IKI~ dcp direct depllsi! SSP IlIelll11e depns!1 27.40 1,79,1,21 ()KIIII1200~ 3K/o Will, R. & Shllmn Il", Semi's FS lilr I'&S m.oo 1,4IK.21 OK/03121KI~ 3K7 WlIll11l1n ellllhes/hh ellrds c1ntheslhhellrds 42.20 1,37/0.01 OK/Oll211O~ 3KK StlnC()llS~ I>VD's DVD ,1/0.32 1,J2I}.Io'J OK/17/2IK)~ 3K9 IIlIIle }1I Snyder Orill1n's hinhdllY OrlOln's IIlnhdllY 30.1111 1,299.109 OKIIK/2IKI~ 390 Scarts c1l1thes cllllhes 125.44 1,174,2~ OK/2712IK)~ JlJI elLsh spending 11111ney spending ~O,()() 1,124,2~ 09111112IK)~ dep direct depllslt SSI Incllllle depnslt 579.00 1,703.25 0911I112005 dep direct dcpllslt SSP Inclll11e depllslt 27,40 1,730,/05 1~}IIIII2OtIS )1J2 WI11. K. & ShllmnD,,, Selin's FS I'm I'&S 375,00 I.m,/o~ 0911171200~ 393 Medelll/elllth Olher Espenses Illedlelne 18.lKI l,m.65 0'1110121105 394 ClrcIlItCIt)' DVD's DVIl 72.04 1.265,61 09/1012(KI~ 395 K'llllln shlles/slleks shoes 4K,96 1,216.65 09/11121KI5 3IJ/J Sunconsl DVD's DVIl ",72 1,15Km 11911412lK15 397 Clrclllt City CD's cd's 25,43 1,133.50 0911 7/21K)5 3'}K cllsh spending Illlllley spelllllng 50:lK) I,OK'uO 1011I1/2005 dep dlreel dep"slt SSI Inellllle depllslt 57'J,OtI 1,662.50 11111I I I21KI5 dcp dlreel depllslt SSI' Inellnw depllsll 27.40 \,6K'}.I)O 1111111/2IKI~ 3'}1) Will, K,&SllIlrIlIID". Sellll'S FS lilr I'&S 375,IK) 1,.114.\KI 1II/0K121KI~ 41KI FYE ('D's CD 65.1,K 1,24'J.22 IIII11KI2IKI~ 401 SlInclIllsl DVD's DVD 31.78 \,217.44 11II14/21K15 402 '" l11urt elllthes clllthes 51.47 1,11,5.'17 11II\~/2IKI~ 4l1J Cll'ih spending 1111111ey spcndlnl\ 50.110 1,1I~.'J7 11I01/21KI~ dcp dlrcct dcpllslt Incnme dcpllslt 571).00 1,(11)4.97 IIIOI/~(J(J~ dcp dlrccl dcrusll SSI' Incume Ilcrusll 27.40 1,722..17 I~llgc 2 ., Estntc of SCUll MUlthcw Doslnk 117i21KI/J(dJ 11M Ke~lstcr: Estnle urscnn Mnnhcw Iluslllk I'rtll11 OIIllI12IKI"hrtlll~h 121.l\I2IKI~ Suncd hy: Illllc, Type, NlIl1Ihcr/Kcl Ilatt Number "Iyet Account Memo Plymtnl C Oepotlt Oallnre 1I/01/21KI5 404 Will. K, & Shnmnll", Sellll's I'S I'ur I'&S m,IK) 1.347,)7 1110~12nn~ 40~ ensh . spending mlllley spending ~O,OO 1,297,)7 1111112IKI.\ 41111 Wlllnllln c1ulhes "'nlhcs 27,74 1,269,63 11111>12005 407 ClrclIlIClly CIl's cd's 41.32 1,22K..11 11/2112(KI~ 40K \'IL,h' spending muney spending ~O,(KI 1,11K,31 11122121KI~ 4(1) ClrellltClly CIl's cd's 41.49 1,13/1.K2 11122121KI~ 411I ClrcnllClly CIl's cd's 2.4'} 1,1J4.33 11/2612lKI~ 411 K'lIIl1n elulhcs elothc,.)gfll II},I)K 1,114..15 1112/o121KI~ 412 K'l11nn CIJ's cd W,~9 1,10),7/1 11/,10121K15 4IJ Mcdelll/eollh Olher I\xpenses medlelne IK.OO I,OK5,71, 121l11121KI~ dep dlrccl dcposll SSI Income IlI!l'OSIT 579,IKI 1,61>4,76 121l11/21K1~ IlEI' ssp Income IlIWOSIT 27,40 1,692.11, 1211l1121KJ~ 414 WI11, K. & Shnrtln Il", Scon', FS lilr F&S J75,OO l,m.16 \210J121K15 415 Scar's SlmHT SHT OWl' 21.19 1,295.97 1211012(KI~ 416 elL,h 'pending l110ney spending 511.00 1,245.97 1211 SilIKI5 417 Wnlmlln gill gin W.4K 1,2J5,41) 121271200~ 41K eo,h spending lI\oney spemllng 50,00 1,185,49 12IjOI200~ dep dlrccl depmlt SSI Income lfrJll,"1I 60J,OO 1.7KK.49 12IJO/2005 dep ssp Ineol11e dcp"'11 27.411 1,815,SI) 12IJO/2005 419 Wm, K, It Shllrtln I)". SClln's I'S fur I'&S J75,OO ' 1.440.89 , 12IJOI200~ 420 Scar's ellllhes clolhe, 34,9K 1,405,91 "1 'I ;,', " ,. Pnye J '~ CASH ON DATE PAYEE REASON Deposita Withdrawals HAND Balance as of 12/31/04 $ 1'155 1/7/05 cash spending money $ 30,00 $ 47.55 1/16/05 Midtown Pizza lunch $ 7.15 $ 40.40 1/16/05 Dollar Tree cards $ 1.06 $ 39.34 1/23/05 Underdog's lunch $ 9.10 $ 30,24 1/24/05 cash Sesame SI. Live $ 21.30 $ 8.94 1/30/05 cash church offering for month $ 2.00 $ 6.94 1/31/05 cash Ice cream $ 1.25 $ 5,69 2/11/05 cash spending money $ 50.00 $ 55.69 2/12/05 Giant magazine $ 6.67 $ 49.02 2/19/05 Giant batteries $ 3.16 $ 45.84 2/20/05 Memphis Olues lunch $ 13,68 $ 3216 2/20/05 cash haircut $ 10,00 $ .22.16 2/24/05 Wandy's lunch $ 5.30 $ 16.86 2/24/05 Holy Spirit Hoslpal snack $ 4,64 $ 12,22 2/25/05 Glngerbreadman dinner $ 7,61 $ 4,61 2/27/05 cash church offering for month $ 1.00 $ 3,61 3/5/05 cash spending money $ 50.00 $ 53.61 3/5/05 The Corner Stable dinner $ 7.99 $ 4562 3/6/05 GianI magazine $ 6.67 $ 3895 3/13/05 Underdog's lunch $ 10.00 $ 2895 3/14/05 Cracker Barrel dinner $ 10.58 $ 18,37 3/19/05 CVS cards/candy bar $ 2.75 $ 1562 3/20/05 Nick's 114 Cafe dinner $ 14.00 $ 1.62 3/26/05 cash spending money $ 50,00 $ 51,62 3/28/05 Toys R Us movie $ 6.35 $ 45.27 4/1/05 Underdog's dinner $ 10,00 $ 35.27 4/3/05 Westgate Rest lunch $ 10.00 $ 2527 4/8/05 cash Icecream/hoagle $ 6.85 $ 18,62 4/15/05 Dollar Tree card $ 0.53 $ 1609 4/15/05 Underdog's dinner $ 10.00 $ 8.09 4/15/05 cash spending money $ 50.00 $ 58,09 4/17106 Underdog's lunch $ 8.80 $ 49,29 4/18/05 cash baseball geme $ 20.00 $ 29.29 4/23/05 Giant magazine $ 4.72 S 24.57 4/23/05 Blue Room lunch $ 8,00 $ 16.57 4/25/05 Westgate Rest lunch $ 6.81 $ 9.76 4/27/05 Underdog's lunch $ 9.00 $ 0.76 5/14/05 cash spending money $ 50.00 $ 50.76 6/21/05 cash lunch $ 10.00 $ 40.76 6/21/05 cash haircut $ 10.00 $ 30.76 6/1/05 Underdog's dinner $ 8,76 $ 2201 6/3/05 PaPa John's pizza $ 7.06 $ 14.95 6/4/05 Underdog's lunch $ 8.60 S 615 6/6/05 cash chuch offering $ 1.00 $ 5.15 6/11/05 Midtown Pizza pizza $ 6.00 $ 0.15 6/11/05 cash spending money $ 60.00 $ 50.15 6/13/05 Giant CD pack/newspaper $ 11.08 $ 39,07 6/21/05 Underdog's lunch $ 8.07 S 31,00 6/26/06 Genova's lunch $ 9.15 $ 2185 7/1/05 Eastslde Lounge lunch $ 6,00 $ 15,85 7/2/06 cash spending money $ 50,00 $ 65,85 '7/2/05 Underdog's lunch $ 8.80 $ 57,05 7/6/06 .cash celebration 4th of July $ 15.00 $ 42.05 7/6/06 Giant lunch $ 4.19 $ 37.86 7/9/06 McDonald's lunch $ 3,18 $ 34.68 7/31/05 cash lunch $ 7.76 $ 2693 11\ 7/31/05 cash church offering for month $ 3.00 $ 2393 ," , 7/31/05 cash Ice cream $ 2.50 $ 2143 I i 8/4/05 cash Ice cream $ 3.76 $ 1768 8/7/05 cash hot dogs $ 3,00 $ 1468 8/20/05 Glngerbreadman dinner $ 12,00 $ 268 8/27/05 cash spending money $ 50.00 $ 5268 8/27/05 Midtown Pizza lunch $ 14.00 $ 38.68 8/31/05 cash church offering for month $ 4.00 $ 34,68 8/31/05 cash haircut $ 10.00 $ 2468 9/6/05 J&J Plzzella lunch $ 6,29 $ 1839 9/10/05 McDonald's lunch $ 5,38 $ 13,01 9/17/05 cash spending money $ 5000 $ 63,01 9/17/05 Bob Evans dinner $ 14.07 $ 48,94 9/23/05 Dollar Tree cards $ 1.59 $ 47,35 9/25/05 Underdog's lunch $ 8.00 $ 3935 9/30/05 cash church offellng for month $ 4,00 $ 35,35 9/1/05 Underdoa's lunch $ 10,00 $ 25,35 10/7/05 Pub on the trail dinner $ 7.46 $ 1789 10/16/05 cash foot long hot dog $ 6.00 $ 12,89 10/16/05 cash spending money $ 50.00 $ 62.89 10/20/05 Glngerbreadman dinner $ 11,00 $ 51.89 10/22/02 Giant dinner $ 4,19 $ 47.70 10/23/05 Glngerbreadman dinner $ 6,26 $ 41.44 10/30/05 Eastslde Lounge lunch $ 6.51 $ 3493 10/31105 cash Ice cream $ 3.50 $ 31.43 10/31/05 cash church offering for month $ 6,00 $ 25.43 10/5/05 cash haircut $ 10,00 $ 15.43 11/4105 Glngerbreadman dinner $ 14.14 $ 1.29 11/5/05 cash spending money $ 50,00 $ 51.29 11/9/05 cash Disney on Ice/snacks $ 22.00 $ 2929 11/10/05 Your Place lunch $ 6.50 $ 22.79 11/17/06 Underdog's lunch $ 9,00 $ 13.79 11/19/05 Glngerbreadman dinner $ 11.45 $ 2.34 11/19/05 Giant lunch $ 5.43 $ (3.09) 11/21/05 cash spending money $ 50,00 $ 4691 11/22/05 Giant cald/flowers $ 6,13 $ 40.78 11/26/05 Midtown Pizza lunch $ 9.47 $ 31.31 11/30/05 cash church offering for month $ 4.00 $ 2731 12/9106 Underdog's lunch $ 10.00 $ 17,31 12/10/05 cash spending money $ 50.00 $ 67,31 12/10/05 Blue Room lunch $ 9.13 $ 58.18 12/18/05 Bob Evans breakfast $ 9.04 $ 4914 12/18/06 Genova's lunch $ 9.66 $ :)9.48 12/20/05 Underdog's lunch $ 8.98 $ 30,50 " Selin Mllttl\Cw Dosillk Trust 1/11I1211111111:14 PM Keglslcr: SClllI Mlluhcw lloslll~ Trllsl !'rum 01101121KI~ thwllgh 121.1II2IKII. Soned hy: Illlle, Type, NlIl11hcrlKel Il.t. Number Payee "ccount Memo . Jlayment C Deposit nal.nee 1I1/201~(KI5 lillI, ClIl11hcrlllnd COllnl C", flllng I'ce . flllng fce 10,lK) 3,432,112 1I1/20121K15 11I17 Shllmllllllslllk prcpllrnlloll eoun rcplln 2IKI.IK) J,2J2.112 1I1/25/2(KIS dep Clllllterest Trnsl Interllst 27.IK 3,259,KII 1I1/2712IKI5 IIlllJ Keglslcr or Wills I1Ilng Ice 11IIIIg Ice llddill". 5,lK) 3,254.KO 112/2712IKIS dcp ClllntcrcM Trusl Illlerest 27.IK J,2K1.9K IIJI I 412005 1Il20 SlIleler & ASSlICIllles ". tll~ prcpllrullllll tllX prepllrullllll 30,IK) .1,251.9K 03/1612IKI~ 11I21 tiS PosIlll Service I'ostllge llnd 1l1Jllvcry poslllge lJ,07 .1,242.91 IIJ/24121105 1Il22 Illllle JlI Snydcr relmhusel11entlilr CIIIIl". cOlllpulersllull1 24,69 3,21K,22 0312~12IKI~ dcp Clllnlercsl Trust Interest 205 J,242.77 114/2512tKI5 dcp CIl Inlerest Trust Inleresl 27.IK J,26lJ.'J~ 1I~1261200~ 1112J Ilell ClIlIlputer clImpuler I'm trust expense 607.37 2,662.58 IIS12512l105 dep CIl IlIterest Trust IlItercsl 26.30 2,6KK,8K I16124/21K15 dep Cllllltcrest Trust Interest 27.18 2,716,06 07ml2ll0S dep CIl Interest Trust Interest 26.30 2,742.36 IIKI1912005 11I24 Klldlll Shllek Ink fur prlnler cXflCnsu 71,llO Z,67 1.36 OK/2~/2005 del' CIl Inlercsl Trllsl Inleresl 27,IK 2,6lJK.54 ll'J/2JI2IKI~ dep CIl Inleresl TnlSt Interest 27.18 2,725,72 I012~120()5 dep CD lnlerest Trusl Interest 26,31 2,752.0J 11/2~12IKIS dep CD Interest Trust Interest , 27,IK 2,779,21 1212312005 dcp CD Interest Trust Interest 26,.111 2,8115.51 I'" Pugc I " Sean Matthew Doslak .I' Cei'tlfl~ate of Deposit 111/01-12/31/01 12/31/01' Mellon Trust CD Is now Citizen's Bank transferred funds to g!Jzen's Bank on 6/20/02 10.000,74 Balllncc ' 10,000,74 " 'I I, ,. 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