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HomeMy WebLinkAbout96-0917 Clerk of Orphans' Court of Cumberland County IN RE:t1f<IS1/JJA flAP--IS hAIGJJ6AUG-H An Incapacitated Person Docket No. eJ/- 96- 9/7 ANNUAL REPORT OF GUARDIAN OF THE PERSON I, SU5A/J T kAIGJJ8'AVG-H ' was /were appointed plenary guardian(s) of the person of CtJ?/S7/NI+ 111tR-le.. hE/tR.1J8A\J6 i-I by Decree of the Honorable JudgeJ. LJeSi..f.:.tOI.E.~,~f. , dated RB. 5".. /997 . This is my annual report for the period from /P/;R.CII /, ;;006 to HL3RV;;,e.; ;;;2..)007 , ("The Report Period"). 1. Present age of the incapacitated person: d 9 Yrs. 2. Current address of the incapacitated person J1()7 SHULfUG. S:r/2&Er /%CHfi)"}/C5AU~~ ~ /.If /71J55--YtJ1I'9 3. The incapacitated person's residence is: 0 own home/apartment 0 nursing home 0 boarding home/personal care home ~ guardian's home/~partment 0 hospital or medical facility 0 relative's home 0 other: (j f~S,J ~'l" --c :::~j -..J :~3 \..0 --j 0) (Name and relationship) (describe) 4. The incapacitated person has been in the present residence since .13/-1'7.# . If the incapacitated person has moved within the past year, state change and reason(s) for ~ "\~ change: 5. Name and address of the incapacitated person's primary care giver: 5USAtJ T fErl/2JJ/3AlJG i-I ?](}7 5;;Ultf!.12.. :;//2&&7"' /Jgtll~N/C5/.3lJk!6, //1- /705.5"-.lf{)1/9 . 6. The major medical or mental problems of the incapacitated person are as follows: /lJPJJT/iL A7/l~f)/17)tf/1 7. Specify what, if any, social, medical, psychological and support services the incapacitated person IS recelvmg: 8. It is our opinion as guardian of the person that the guardianship should: (check one) g{ontinue, 0 be modified, 0 be terminated. (Briefly explain your response) 5#& /5 t//I//i,8t~ /'0 ///l,uDt'Z.)/&/C, /l.&e50If}A~~.P .//AJfifllC/.RL- //"/.47TPL\ 9. During the past year, I have visited the incapacitated person .3"~ times with the average visit lasting /~ JloV/tS (LlVtS wiTH hie; ) (Staie number ofhourslminutes, etc.) , The report of a social service organization employed by the guardian to oversee and coordinate the care of the incapacitated person for the period covered by this report may be attached to supplement this report. I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this verification is subject to the penalties of 18 Pa. C.S.A. 94904 relative to unsworn falsification to authorities. IIfl!../L /11 J/)o1 Date .~/~i7 !/ ~4~~/~ Signature @ Guardian * FILING FEE $15 MUST ACCOMPANY THIS FILING. IN RE: ~/S1'iNA a~/f!., /V;/CAlNvtrll An Incapacitated Person Docket No. ,2/... Pb" 9/7 ANNUAL REPORT OF GUARDIAN OF THE ESTATE I, c;'uSIUJ J. hA--€AlL3AU6H ' was Iwere appointed plenary guardian(s) ofthe estate of tJ;R.JS7//II1t ~,elf., h,Rft!AJI3A VG 1-1 by D~cree of the Honorable Judge) lVy;,L~1(JL€'~1 ~.Dated RA ~I /99.7 . This is my annual report for the period from ;%/UJI /,..J/JlJb to hL3k'I).4IZ'I.)~ ;)007 ' ("The Report Period"). I. SUMMARY B. Total amount of incon).e earned during the report period? $ 17.Lfo.5,/ $ &'9&>3. ~S A. Value of principal assC1ts at the beginning of the Report Period? , Total amount of all expenditures made for care and maintenance of the C. incapacitated person dluring the Report Period? 1. From principal $ "39/ .f9 $ Y93E.3~ 2. From income D. Total amount spent f1r all other purposes during the Report Period? Total amounts remai+ng at the end of the Report Period? I $ 0 E. 1. Principal $ /.9J/.t. ~:j $ o 2. Income Total Income and Pr ncipa1 $ /3i/~..~:5' t..:::'::~_:l --' -.J \~J c...) --l \ ~ II. ADDITIONAL INFO ATION A. Principal: 1. Total amount remaini g at the end of the Report Period? $ /~'Ig.t5 ~ - 3. Have there been any e penditures from principal during the Report Period? ~Y es 0 No If you answered YES was there Court approval for all expenditures from principal? r;;;:rY es 0 No 4. Did you receive any p incipal assets during the report period which were not included on he inventory or a prior report filed for the estate? 0 Y es ~o If you answered YES did you receive Court approval prior to receiving additional principal? 0 Yes 0 No 5. State the sources and ounts of the additional principal you received: $ $ B. Income: 1. State sources and ounts of income received during the Report Period (i.e., social security, pension, r nts, etc.): It :JO()5 7/1)l Af- VPDS: 1'..4 $/3& -r&l>&/!./u- ~3'13 . 53/. 00 S ~Jfs: - 551 ~ $ ~ 1'17. ita 5fJ $ /'13/./9 $ ;) 7L/. 00 Total Income recei ed during Report Period $ 39 F3.3,!;' 2. How is income cur ently invested? (Please specify, restricted bank accounts, client care account, etc.) 3. Specify what paym nts were made for the care and maintenance of the incapacitated person (i.e., clothin , nursing home, medicine, support, etc.). I ' ft 4. Specify what other ayments were made during the Report Period. 1 verify that the foregoing nformation is correct to the best of my knowledge, information and belief; and that this veri fie tion is subject to the penalties of 18 Pa. C.S.A. 94904 relative to unsworn falsification to a thorities. iJ/~/1.. /7" do01 Date .4--//JA~ d ~L?/?/YJk</f1-A Signature eft Guardian * ILlNG FEE $15 MUST ACCOMPANY THIS FILING. ANNUAL REPORT OF GUARDIAN OF THE PERSON COURT OF COMMON PLEAS OF dw,Sp.R. LH>> lJ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of ~r/2I5;7"/AJ If /i.1.eJf"~ /E.4/!AJ/SA UG i-I ;""-.J (~.. ". , an Inca:~tated I!tson --) No. 2/- 96 -7/7 (...1 ;'~) I.~':) I. INTRODUCTION ~SANT ~ARN~~U&# , was appointed mlenaryDLimited Guardian of the Person by Decree of T !.L1e.SL'i.'1 OJfl!., Je. , J., dated HAk'l/,qR."J' ~,/9'77 . , ~. This is the Annual Report for the period from /7A/CC.H / , ;)()tJ7 to HAKV,q/!.'1 /) 9 , ;JtJ/JR (the "Report Period"); or D B. This is the Final Report for the period from (the "Report Period"), and is filed to for the following reason: 1. The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of J., dated For a Final Report, omit Sections II through IV. Form G-03 rev" /0"/3"06 Page 1 of 4 Estate of ----,--Z/2} <;///(//1- a~J~- hA.eA/AAI/h H , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person: 3() Date of Birth: /2t4A:.'CH'd,) 1977 , III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: S:>07 SHUI-SIl- S'7/zeSr /JJ&,(J)-//TItJ/CSI3i.JI2G; /fi 17055,1/0'19 B. The Incapacitated Person's residence is: D own home / apartment D nursing home D boarding home / personal care home ~uardian' s home / apartment D hospital or medical facility D relative's home (name, relationship and address) D other: C. The Incapacitated Person has been in the present residence since "tJl/:! 7// . If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev. 10..13.06 Page 2 of 4 /J Estate of -LiI/2/S7/A/A fiHJ::/t:.. h/l~AhBA/J6 // , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: SV5~>> ]~ rEA/2#.rB,q/J6f/ f1 () 1 SJI V L f..,e S r"e~~ r jo/&C1I1A))/c $,&;12(;, //1 / 7()S5 -//ty/7 IV. MED][CAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: /1&/I/;r /l L. /& T A,R lJ/17/tJ71 B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: ~ntinue D be modified D be terminated Form G-03 rev. /0./3.06 Page 3 of 4 /-1 __ Estate of ~.i-I~/<;7//l.Jfi J%LJf:.. /:.:f'/9/!JJE,A})r,H , an Incapacitated Person The reasons for the foregoing opinion are: {3.;I2/S-rINIi 1.5 U/IIIU3Le. TCJ h'rJND~~ H&,12. 1'f:,€50JUf+L AND j='/AJ/VJCiA '- />11t7"rg~5. B. During the past year, the Guardian of the Person has visited the Incapacitated Person ~~~< times with the average visit lasting hours, SJI&. j..1V~S /,(/17)1 ;ne. {~IJ $&&. ;#&.e ,4li/l.f/"l/ne. minutes. The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. 94904 relative to unsworn falsification to authorities. ~/M!f!/I _?I; ,;)lJlJg Dillc 6:,-;",", ~:;;:k/:J'./ .~SAjJ or IiA..eAJ.dA UG 1-/ Name o/Guardian o/thc Person (type or print) ,f1J? S'HVL&-A2. ST/2E.&r Address /%(}///1JJ/csl.~JeG fA /7055-'IIJl/9 City. State. Zip . 17/7) ~c;7-/dSO Telephon: Form G-03 rev. 10.13.06 Page 4 of 4 , ANNUAL REPORT OF GUARDIAN OF THE ESTATE .-....) 'I COURT OF COMMON PLEAS OF ~fiJ.I3ELLt7A/ D COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION :., } c) Estate of ~~J2jC,7"/AjA ~~J'P~ h~/G.IJ~U6H , an Incapacitate<!.-Ferson No. c:JJ- 9t6.. 7"/7 I. INTRODUCTION ~S;1/J T hA.eAJ/.3.,t1V61-1 , was appointed !!f1>lenary CILimited Guardian of the Estate by Decree of 'r b.kC;d.~II)a.R.. J:e , J., dated ~ A. This is the Annual Report for the period from /%;/.!C/I J , ~/)(Y7 to hAPI/A/.!.i( d9 , .?I)()~ (the "Report Period"); or ' o B. This is the Final Report for the period from (the "Report Period"), and is filed to for the following reason: 1. The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J., dated Form G-02 rev. 10.13.06 Page 1 of5 Estate of ---L);/?J57IAl/J ~.I!Jf!... hAfi?/tJ/3AUGII , An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ /5'/9. S7 B. State the value(s) of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, otherwise, ending balance from last Report.) $ J311~. ~5" C. What is the total amount of income earned during the Report Period? $ gc; g 7'. 3 9 D. What is the total amount of income and principal spent for all purposes during the Report Period? $ J?L//gJ!1 E. What are the balances remaining at the end of the Report Period? 1. Principal $ 2. Income $ 3. Total of Principal and Income 1.'3.J/:l ~ 5' /7{). 7;;1 $ /:5:J 0.00 III. ADDITIONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principal 1. How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): CJI&CK./JJ6 ACCOU;J7 .- $/7'dJ7. 5), ?/iSI-I 5:). oS' 2. Have there been any expenditures from the principal during the Report Period? ............................ ~es D No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? . . . . . . .. ~es 0 No Form G-02 rev. /0./3.06 Page 2 of 5 /1 ~ Estate of ~I/RJS///rJfi ~R..J"i _ /'.?,,4LAI/3AUGJ.! , An Incapacitated Person )06/) - .$ gg;;. ()h , I/OV5&;'/OLD -- 3387. ;)3 /It/SUl2.I+)JC'f.., - ~~ 7. (}.O /, c 'gO fr.l!5ONfI'- 7AY-if5 - I. ot:'~""7 -/5.00 Cu fi/2D)lIiJSH I P M.vr-- oiP,S - ,;).30.97' b. List purpose and amount of expenditures: t''L/J7'' J.I r.. <:; ;:>t:f,eSONA~ CI1/!.'L ~el>/CA'- fJF";CJ.)C,II7/on / &}JT6L7A/NIYI~;A) i , V,tKA71 tn'\ c. Was Court approval received prior to expending the principal? ....................... $ ~33 ,"J9 $ .~9;;;. 50 $ L/~L/. J~ $ /~37 ,;)r; ~ /35'6. r;g' DYes ~o 3. Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? ........... 0 Y es ~o If yes: a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . .. D Yes D No b. State the sources and amounts of the additional principal received: $ $ $ $ $ B. In<:ome 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): ~/AL, 5&.:l/.R./rf/ 5's/ ;:>/1 SSP /1/9 //IIConJt. 7A.x .tk-c/h1h~ - ,)06f." F&b. /NC,.)m~. -z:;.J( hFI/JJ6 - dMt., $ ij'~th d. () () $ 334' 3 () () $ 356. ;;0 $ t?s O{) $ /~ 3. i 9 $ Total income received during Report Period: $ 51 S 89 ~.oo Form G-02 rev. /0./3.06 Page 3 of5 Estate of --..t~/!/57//$ /Zu!J'E., ~L:!A~UGH 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): C ).jal'/AJ0 (lASH $)-1/7. <', /tCCOU NT - 7fP -' oC. 5d.OS C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person (e.g., clothing, nursing home, medicine, support, etc.): C Lo 7Ht..S - ;A d 3-3. d 9 ~/!5()/JIU.- C:AE,~ - 39;;.50 /lJtD/GfU.- - ~~'-/. /~ ,n.?O 1:) - g 2;;) . ()t:, HOVsUJOLD - 3387.;)3 D. Other Expenditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) ~ . Afc,eE~r/tJh )CA/7;f.e;r/l//II/llWT - "/;;37. d2" /;r)SUI2.,!/AJCf.- - ~:J7. ~ 0 j%.e50ltlfli.- MXf$ -- 9. gO OO,A12.DIANSHlfJ ~t:m,er - /5-00 E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Amount Method of Determination .-L.lJ IJ /II e- , An Incapacitated Person G'jFrS - ';)30.9Y VI1CA71071 - /3:;g.9ff' Court Approval Obtained DYes DNo DYes DNo Form G-02 rev. 10.13.06 Page 4 of 5 . Estate of ~~L/5,7/AJ/1 /ZrrLJt-. .~/lRAl.6/1LJh# , An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount Court Approval Obtained DYes DNo DYes DNo ~/()AJ& I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. S 4904 relative to unsworn falsification to authorities. /%..eCh' 3~ dt)tJ~ Date ~~//2 tI ~/?~~ Signature of C'fifardian of the Estate S;;~.I:Vj T h~~AJA.,tJ{jr,-!/ Name of Guardian of the Estate (type or print) )'.07 . ~/Ji.-9J2.. .('7A?~er Address /%t:/I.t}iJJC5l3iJ..er: /A 17t155-/T'{F/9 City, State, Zip , (7/7,) d 97- /-;)-~O Telephone Form G-02 rev. 10.13.06 Page 50[5 ANNUAL REPORT OF GUARDIAN OF THE PERSON COURT OF COMMON PLEAS OF l G~iy//.3F/~.i~~iJ ,tom COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION r_~ ~y ~;'' Estate of ,.H/~iS>ic/H //~~'~~ ./ ~~,a/'.tJ/~~!/G-f-t , an Incapa~iid Pers~ ~~ N - No..~?/- 9~ ~%~ ~ ~ w _ .~. Cj='~ `_ .J7 ~ - _~ ~ .. I. INTRODUCTION ~(~SF}~J J . f ~i9~~.t/,C3iIUG/-~ ,was appointed L~ Plenary Limited Guardian of the Person by Decree of ~~.~1~'~~;~ r'~i'~~~{ .T' . , J., dated % fi~~2t~ttF ~' _`i , ~ 99,7 ~. This is the Annual Report for the period from /y/r~~'L.~ / .~0/IS~' to ,~3i~1~A,~y ~5t „J~~O9 (the "Report Period"); or B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of J., dated For a Final Report, omit Sections II through Iii Form G-03 rev. 10.13.06 L Page 1 of 4 Estate of .~'~~ ~ ST,~.~-7 / lr~i' i~ /';~A~,U.gA UG /f , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person:~_ Date of Birth: ~~2G't/ :-7~~ l ~75~ III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: ~'C~`7 ~HU~~;1'. S~r~~:~:z' ~~cGh'f~.V/CS/3c.!.ErC~ ~/g ~~U ~-~'~i1~J~~ B. The Incapacitated Person's residence is: own home /apartment nursing home boarding home /personal care home [~Liuardian's home /apartment hospital or medical facility relative's home (name, relationship and address) other: C. The Incapacitated Person has been in the present residence since ~/,C T,S~ . If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form c-n3 rev. 10.13.06 Page 2 of 4 Estate of l ~/~'/S?i.r1.H //s~i''i~ ~.;.~.E'~i/~.~-lU~r=~ , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: ~C~1 SNV~~~~ ST,ei:~f~T' IV. MEDICAL INFORMATION A. The major medical or mental problems ofthe Incapacitated Person are as follows: B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: continue be modified be terminated Farm c-o3 rev. 10.3.06 Page 3 of 4 ANNUAL REPORT OF GUARDIAN OF THE ESTATE COURT OF COMMON PLEAS OF _ /i/yl/.~r;/?.Ct3~J t7 COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION I ~ Estate of ~ry/'iSTiyA y/'i~: /,"_<H~i/.~3q 11Gf~ , an Incapacitated Person ~~ --~ _ ~_~ No. ~~ ~ 1~0 ' y~~ ~7 L:a ~ ~ G~ °,~. _[-c ::~ Ca ~ ~ .~ iJ -:_. ~T PV :. '~ ~~ ~~ - > s ' s3„ I. INTRODUCTION '°~ '~ ~~ -'~ c~ --~ ~U.Sf1.U .T ~~~ti~~ r/l N , w~ appointed-- ~enary ~ Limited Guardian of the Estate by Decree of _!_ ~~~'Si.~ 1 ~~.<i' ,. !,E . , J., dated /&'!3k'UA.~ ~/ S". / r y7 . ~A. This is the Annual Report for the period from /?J,y~c:~ / , ~:~~ to ~i~7 ~ ~' ~~~~ ~ (the "Report Period"); or B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of Form G-02 rev. 10.13.06 J., dated Page 1 of 5 ' ' ' /`"~/~/2~t//'A U~ i~ , an Incapacitated Person Estate of %~/~~S T/.~~ ~/~/ ice. The reasons for the foregoing opinion are: ~/ ~ ?"T~.~ 5. B. During the past year, the Guardian of the Person has visited the Incapacitated Person ~,~'z times with the average visit lasting hours, minutes. j%-i~ ~.iv~ S tctlTN /j7~ - C:9~+/ S~~ .~l~~ f~i/y Tr/i~. The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. ~/~2i ~ ~ 3 ,~C~ C5 ~ Dare ,~~Q~/f7 ~ ~a~~~~~~~ Signature of G~of the Person / Name of Guardian of the Person ~(ty'pe or print) Address ~cG~//~.ViGS/~Lt.~G, ~i~ /705.~~ -~/D~f9 City, State, Zip Telephone Form G-03 rev. IOJ3.06 Page 4 Of 4 Estate of ~/?iS T ,olA f}/_?i ~ /';~".9i?af,3~ UG H , An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ /,.~ jI 3 . ;7.3 B. State the value(s) of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, otherwise, ending balance from last Report.) $ /S / ~i'. ~ C. What is the total amount of income earned during the Report Period? $„~. _ 3~) ~. ~~ D. What is the total amount of income and principal spent for all purposes during the Report Period? $ %(~:~% D~ E. What are the balances remaining at the end of the Report Period? 1. Principal $ /,~ ~ ~..~13 2. Income $ 3. Total of Principal and Income $ j~~„3 x.00 III. ADDITIONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principal 1. How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): L'i-f ~'ClC /N C f~CCC> urU T ~-- /~ .~ ~ ~ ~ c~sN - h`8~ s~ 2. Have there been any expenditures from the principal during the Report Period? ............................ ~ 'es ~ No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? ........ C~es ^ No Form G-02 rev. 10.13.06 Page 2 of 5 Estate of ~,P/ST/.ys3 /~~3.C'/~ ~i~2,1J.~3AUGfr' , An Incapacitated Person `U~l~ -- / 3U /: ~~ ~i'OUS`ifU~D - X73"7. D;~ /.v$v2f1~C_f~ ~ 777. 3~ /~~/c'.SONf~~- TAX ~~ - 9~'O b. List purpose and amount of expenditures: CLU?HCS P~25o~-Ht~ C~2~. /n~~tc~L ~ ~C~2~ i~Ti ar / ~nrl~>2>~i~um ~:~>' $ , ~~R. ~9 $ ~i~_~~ ~~oTD ~~ ~ ~ ~G~- D L~ VAC t~ 7io-n Was Court approval received prior to / 7v r. 77 expending the principal? ....................... ^ Yes ~lo 3. Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? ........... Yes 0110 If yes: a. Was Court approval requested prior to receiving the additional principal? ................ ^ Yes ^ No b. State the sources and amounts of the additional principal received: B. Income 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): SC.~r'.;Y~r_ 5=c.;.;~IT~ Ssi f-A - SSP ST/i~U~ c.~ ,~fG~~G ~ Total income received during Report Period: $ 3/ 7 ~ ao $ ~~ ~_9/ $ ~yD .00 $ /~s 3 v 5/ ;e'oo Form G-02 rev. 10.13.06 Page 3 of 5 r Estate of .!~'/~iST/,d,A / ~.~ij~ ~ ~A/?.r/,[3~IU61~ , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): ~. C~~f~i~vG ~cc~~vti-~ --- /~3~f ~~~~ C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person (e.g., clothing, nursing home, medicine, support, etc.): Cu,Tr~~s -~~a~.s~ ~f/7 ~ f /jjf d /G fi ~. ---~- /=vn D ___----- /3~~ 7~ D. Other Expenditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) ~ 2~[:/'~o4Ti~~Jt~<i,Ji'~~1~/•U/17~'.L' i ~' ~13:'I ~• i ~ C~ bf~I2Dif~~~;i-! I P ~? c.1~D~,T ~~ »~ ~o G~iF°rs - /i(JJ 4 /G f}~i/ L' `L~ ~,s,~SuNAL 7.f} ~ £, : - ''j. 1?O ~'/qC.!}T/llYl P~oTo / v /o • c5 E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Amount Method of Determination NO/J~i Court Approval Obtained Yes ®No Yes ®No l' ~i' S, CEO .~ 7~. X ~f / 741 77 Form G-O2 rev. !0.13.06 Page 4 of 5 ~? ~ Estate of ~'.%i57/,c/A- ~f~P ~ ~ f~ft,~eJBHV ~ l-J , An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount Court Approval Obtained ',old//~~ ^ Yes ^ No ^ Yes ^ No I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. Date Signature of Gu dian of the Estate Name of Guardian of the Estate (type or print) /JI~J Si~l>L[~ STG~ Address City, Sdate, Zap Telephone Form c-oz rev. 10.13.06 Page 5 of 5 x r` . ~ r rf ~~C+Ck ~~ 1.. ~1',J L ~ ', i1L~.-i 2010 APR 23 AM 10= 27 ANNUAL REPORT OF GUARDIAN OF THE PERSON CLERK CF ORPHAN'S COURt ClltiRRER.:~AI~ C~., PA /~ COURT OF COMMON PLEAS OF (- /~~~3 .e~f7 D COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of GH.L~/_sT/ A /%fr/'~~' /sq ~/Bt~iii' ~ an Incapacitated Person No. ,-~/-96- 9/~ I. INTRODUCTION _~US.rIIJ ~ ~i7/~~lE3.g/li' !-f was appointed ~'lenary®Limited Guardian of the Person by Decree of ~1. ~ .SLtN dG£2~ 1~ , J., dated ~,cs.P A y s / 9 9~~_. [,~A. This is the Annual Report for the period from //A,Q y / a~0~ to ~~.vu~r.eti.,7x' ~o/~ (the "Report Period"); or ® B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: I . The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of For a Final Repot omit Sections II through II! Form G-03 rev. 10.13.06 J., dated Page 1 of 4 Estate of /_,S/ i sT/,~ .g B~ ~ C~'~.oei~4v~i~ ~ an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person:_ ~~ Date of Birth:~~2i'N ~~, /9717 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: X07 ,Sk UGf 2 STS&ET ~~Cfi~i9.U/GS~U.2G, ~fi' /7055-4/O~ B. The Incapacitated Person's residence is: ©own home /apartment ®nursing home boarding home /personal care home ['Guardian's home /apartment ^ hospital or medical facility © relative's home (name, relationship and address) ®other: C. The Incapacitated Person has been in the present residence since alp T,s/ If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev. 10.13.06 Page 2 of 4 • r Estate of G/~iP/ T/irlH //~,['is' ~jq/~ l/3,A~JG /./ an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: o/~/4N T. F.9.2~tJf.~9UG I-t /f~~y~,r//CSBU2G, Pte' X7055-5/059 IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: ~G~iv7AG ~T•9~?D/9T/O~`I B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: continue ®be modified ^ be terminated Form G-03 rev. 10.!3.06 Page 3 of 4 ~ Y • '. Estate of !~f/,e/ST//JA ~,~~~, ~~ ~~p~l~, y an Incapacitated Person /I The reasons for the foregoing opinion are: (~fi~/?/ST/.~/~1 /5 UiUR6C.~ TO HA.U DL ~ ~jg~ ~~ p~/~q L '~'~o F/.vA rJG/R L. /~ATT~25. B. During the past year, the Guardian of the Person has visited the Incapacitated Person times with the average visit Iasting hours, minutes. ~~€ L/v~,S Gd/TiSt /~7 c . ~~+N SSS /!&2 f!d/ t! T//~t ~ , The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. ~.oi2/~ ~~ a7a~n Dlate Form G-03 rev. 10.13.06 J~gnature of an of the Person S,JS,gA1 T ~AOIJRo1~r u Name ojGnardian of the Person (type or print) SID 7 1-1 1/ s',~, ST,2 ~ r Address City, State, Zap _17f~~ ~q7-/LSD Telephone Page 4 of 4 I'A ~~~~~. ~~~i~I1 ~ l y~' j~~. ~~.+iV ~...i~ vl ~il..~'J 2010 APR 23 AM 10~ 27 ANNUAL REPORT OF CLERK C~ GUARDIAN OF THE ESTATE COMB ~~~,iC~O PA COURT OF COMMON PLEAS OF ~~B~,e,~,g,~ ~ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of / ~'° 1 S >/~~ ~ /A~/~ ~A~'~~~1~~'`'~ . ar- Incapacitated Person No.~7~-9/ - 9/~ I. INTRODUCTION >'iSBN T ~R2/JfSAUG `~ ,was appointed [~'lenary ^Limited Guardian of the Estate by Decree of T ,J!^c( sy nl rQ T2- • J•' dated ~i3 uA,~y S; /~ 99~ ~A. This is the Annual Report for the period from /JAS ~ • ~-- to /-~':~,~~•:..~.'~ .~'. ° - ~o/o (the "Report Period"); or ^ B. This is the Final Report for the period from -• to _, (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. T'he Guardianship was terminated by the Court by Decree of J., dated Form G-02 rev. 10. (3.06 Page 1 of 5 ~t ~i[is7inir? ///I.2/ /f~5i°"~~~'l~r ~ . An Incapacitated Person Estate of II. SUMMARY A. State the value of the estate reported on the Inventory B. State the value(s) of principal assets at the beginning of the Report Period. (Same as Inventory if fast Report, otherwise, ending balance from last Report.) C. What is the total amount of income earned during the Report Period? D. What is the total amount of income and principal spent for all purposes during the Report Period? $ /~D 7. 90 $ /?~3 ~ 3 $ 9~~a . ~ ~ $ ~5~~~3 E. What are the balances remaining at the end of the Report Period? 1. Principal $ ,~~~ ~ ~~ 2. Income $ $ / .~ ~j ~ 9D ~' 3. Total of Principal and Income III. ADDITIONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principal How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): C/-l~cK//~G i9000UAIT - '~//iD.BS ~'AS/~ - /y7.OS 2. Have there been any expenditures from the principal _!_ ~ No ............................ during the Report Period? es If yes: a. Have all expenditures from the principal been for -! the sole benefit of the Incapacitated Person? ........ Ud"Y es ^ No Page 2 of 5 Form G-02 rev. 10.13.06 /~ ~A~,J~s.9u/ ,y , An Incapacitated Person Estate of ~ -5~2/~T/.t/A ~A / -' ao ~33/s iyou~/o~n . G/FTS -" -~ S~ p `f D / 3S8 ~~~' yi4c'~rTien yiP ( ~R ~ jS.OO ~~b2 , b. List purpose and amount of expenditures: LD TN1;S ~} 2S/~~t/~ ~ SAP u ~~tD/G.rl L ,r~c,~HT. e~/s . scoTA~iIl~n EA1 f ,cDO D c. Was Court approval received prior to $ ~S'7 R 7 /i78. ~s expending the principal? ...................... . ^ Yes O~o 3. Were additional principal assets received during the Report Period which were not included in the ,~! Inventory or a prior Report filed for the Estate? ........... ®Yes o B. Income If yes: a. Was Court approval requested prior to receiving the additional principal? ................ ^Yes ^ No b. State the sources and amounts of the additional principal received: $ State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): SS/ $ 3oaS.00 SS $ ,SO~R.00 Ps s~_ $ a9~4. io $T//IiULAS y!/eelG// $ ~SO.Q_D Total income received during Report Period: $1.Y ~~ Page 3 of 5 Form G-02 rev. 10.13.06 Estate of ~z°'.ST/.vti' i ih%~~' ~"~O°~~~'"UG'~'~ , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): G'.95N - /%7 OS C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person (e.g., clothing, nursing home, medicine, support, etc.): CwT~ES - asg.~3 PEQSouH+- GA~~ - ~/!6. ~3 /~J~'D/GAL --~' .356.00 fao~ - ii7S.~~ ,_ ~a~s ao ,~jDUS£NOLD D. Other Expenditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) _. /358. ~Z ~,~yT~~~~i~T~2T,gi.Uiy/S.v9' ~- 857.87 VAGATiarr /,t/SU2AuL' ~ 058• `~D ~SoNA~ 7ftx~R.£.Pokr -~ S. DD GUR 2D/ANSN ~ P 6ii"rS --'-- S.ao. ~D E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Court Amount Method of Determination Approval Obtained ~D~- ®Yes ®No ©Yes ®No Page 4 of 5 Form G-01 rev. 10.13.06 ,• ' , Estate of / fig /5Tit~ft ~~~/~ ~ SBA U G /-/ , An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount Court Approval Obtained ~ ®Yes ®No ^Yes ®No I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. ~io~ ,~,~ 0~0/ D ,~ ~ ®ail / iii Signature of Gu tan of the Estate Date ~~~,J T ~A,e,~/,gA u C N Name of Guardian of the Estate (type or pant) ~D `/ ~N u r e it ST.ZS's T _ Address Form G-01 rev. 10.13.06 ~: ~A:~: ii c rr„or ~i~ /7DS5_-~0~/~ City, State, Zip ~7/~ 6~7-/LSD Telephone Page 5 of 5 ANI~TUAL REPORT OF GUARDIAN OF THE PERSON COURT OF COMMON PLEAS OF n ~~ :^~ -~ CUMBERLAND COUNTY, PENNSYLVANIA ?~ ~. x.. ~ ~? ORPHANS' COURT DIVISION ~, ~ ~ ~ m ~ ~'~ ~} ~ ==° ~ tv v ; ,; - -~ ~a ~ ': ; A MARIE FEARNBAUGH an Incapacitated Pei ~ f CHRISTIN a c? ~-~ 9 Estate o ~, ~, c No.21-96-917 I. INTRODUCTION SUSAN J FEARNBAUGH, was appointed Plenary Guardian of the Person by Decree of J WESLEY OLER- JR. J., dated February 5, 1997. This is the Annual Report for the period from March 1, 2010 to February 28, 2011. II. PERSONAL DATA Date of Birth: Marc_978 Age of the Incapacitated Person: 33 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: 807 Shuler Street Mechanicsburg, PA 17055-4049 B. The Incapacitated Person's residence is: Guardian's home C. The Incapacitated Person has been in the present residence since birth. D. Name and address of the Incapacitated Person's primary caregiver: Susan J. Fearnbaugh 807 Shuler Street Mechanicsburg, PA 17055-4049 Estate of CHRI5TINA MARIE FEARNBAUGH an Incapacitated Person Page 2 IV. MEDICAL INFORMATION The major medical or mental problems of the Incapacitated Person are as follows: Mental retardation V . GUARDIAN' S OPINION A. It is the opinion of the Guardian of the tPhear~ Chn tit a i ~b,~so handle her continue. The reason for the foregoing opimon is personal and financial matters. B. During the past year, the Guardian of the Person has visited the Incapacitated Person 365 times as she lives with me and I can see her anytime of the day. I verify that the foregoing information is correbt~t o th penalt1ie of 18 Pae~ information and belief; and that the Verification ~ C.S.A. 4904 relative to unsworn falsification to authorities. r~/'02 / L a ~', ~ ©t 1 Guardian's Signature Date Name of Guardian of the Person: Susan J. Fearnbaugh Address: 807 Shuler StreePA 17055-4049 Mechanicsburg, Telephone: (717) 697-1250 ANNUAL REPORT OF GUARDIAN OF THE ESTATE ~ o _ ~ ~ ~-; t-r~Z~ ~ ~~ ~- ~J ~ '~ COURT OF COMMON PLEAS OF m ` ~ rv v~~ -- CUMBERLAND COUNTY, PENNSYLVANIA l C_,rj X = ~ ~-~; - ORPHANS' COURT DNISION ~ ~ ~ ~ -" m --+ ~ Estate of CHRISTINA MARIE FEARNBAUGH, AN Incapacitated Pe~'son ~.. _. c ~ ~ No. 21-96-917 I. INTRODUCTION Susan J. Fearnbaugh, was appointed Plenary Guardian of the Estate by Decree of J. Wesley Oler, Jr., J., dated February 5, 1997. This is the Annual Report for the period March 1, 2010 to Feb 28, 2011. II. SUMMARY A. State the value of the estate reported on the Inventory B. State the value(s) of principal assets at the beginning of The Report Period. (Same as Inventory if first Report, Otherwise, ending balance from last Report.) C. What is the total amount of income earned during the Report Period? D. What is the total amount of income and principal Spent for all purposes during the Report Period? $ /a7~D.39 $ /.3c» 90 $ y9oi iy $ ~~ ~o~ 7/ E. What are the balances remaining at the end of the Report Period? 1. Principal $ ~ D• .~ 2. Income $ 3. Total of Principal and Income $ /~ ~ D..~ 9 Estate of CHRISTINA MARIE FEARNBAUGH, an Incapacitated Person Page 2 III. ADDITIONAL INFORMATION A. Principal 1. How is the principal balance listed above currently invested? (Please Specify, e.g., real estate, certificates of deposit, restricted bank Accounts, etc.): Checking account // ,3 7 d / Cash /,~ ~ _ ~~' 2. Have there been any expenditures from the principal during the Report Period? Yes If yes: A. Have all expenditures from the principal been for the Sole benefit of the Incapacitated Person? Yes B. List purpose and amount of expenditures: Clothes '~ /83. ~7 Personal care 3 ~ y, p p Medical ~ ~ O. •y~ $ Recreation/entertainment ~,~ ~ ,~, ~~ ~ Food / 3 7~..a~ Household 3' ~ ~>. ~ ~' Insurance ~ ~ 7_ ,~ p Personal taxes ~ S O Gifts t3/ 6. d 9 Vacation // ~y 3 Guardianship report /.5'. U O C. Was Court approval received prior to expending the Principal? No 3. Were additional principal assets received during the Report Period Were not included in the Inventory or a prior Report filed for the Estate? NO Estate of CHRISTINA MARIE FEARNBAUGH, an Incapacitated Person Page 3 B. Income 1. State sources and amounts of income received During the Report Period (e.g., Social Security, Pensions, rents, etc.): Checking account balance Cash on hand SSI Social Security PA SSP $ /~7 D~ $ 33vo. 00 $ Sb a S. o0 $ dbS.~D Total income received during Report Period: $ qpp ~ / D 2. How is income currently invested? (Please specify, e.g., restricted Bank accounts, client care account, etc.): Checking account $ /l.~ ~ D / Cash $ la ~. 3 S~ C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the Care and maintenance of the incapacitated Person (e.g., clothing, nursing Home, medicine, support, etc.): Clothes $ % ~ ~, &' ~ Personal care $ S.~ ~ © O Medical $ 3 ~ b. ~8 Food $ /3 7~ ..~~ Household $ 3~ ~ !. ~ S~ Estate of CHRISTINA MARIE FEARNBAUGH, an Incapacitated Person Page 4 D. Other Expenditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) Recreation/Entertainment Insurance Personal taxes Guardianship report Gifts Vacation $ ~~ 7. ,~ b ~ s ~~ $ ice. 00 $ 3fb_d9 $ i~y~ 3 E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and Sate how amount was determined: Amount: None F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was Obtained. Amount: None Estate of CHRISTINA MARIE FEARNBAUGH an Incapacitated Person Page 5 I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of Pa.C.S. 4904 relative to unsworn falsification to authorities. Date Signature o Guardian of the Es to Susan J. Fearnbau Name of Guardian of the Estate 807 Shiner Street Address Mechanicsburg PA 17055-4049 717 697-1250 Telephone e .? ~~ ~ ~'J ~ ANNUAL REPORT OF ~~ ~, ~ ~ ~;~ GUARDIAN OF THE ESTATE I ~ ~ oo ~~;' ;~~ ~ COURT OF COMMON PLEAS OF _~ ~" '" ~= / If M6~~2LA1! D COUNTY, PENNSYLVANIA ~' Qs `~ ~ 'rf - ORPHANS' COURT DIVISION Estate of / /~/~I5>i.yA ~A.ei~ ~A.P./.BAu~,-s~ , an Incapacitated Person No. ~/- 96- 9/7 I. INTRODUCTION S" ~~ ~ T ~,ged~vGS/ ,was appointed [denary ~ Limited Guardian of the Estate by Decree of . Usy~~ T,e. , J., dated ~'tst.PUS- y .s /99,7' [l~A. This is the Annual Report for the period from /'7A,er.~ / a°„ to /~f./32u.9~2y x,19 ~d/,~ (the "Report Period"); or ~ B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: I . The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J., dated Form G-02 rev. 10.!3.06 Page 1 of 5 Estate of / y.P~sTic/A //~IR~~ J'~.4.~,f/,C3.quGh/ . An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory B. State the value(s) of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, otherwise, ending balance from last Report.) C. What is the total amount of income earned during the Report Period? D. What is the total amount of income and principal spent for all purposes during the Report Period? $ /D ~3.3~ $ /„70.39 $ 944/. ~ 1 E. What are the balances remaining at the end of the Report Period? 1. Principal $ /D ?3..~jo 2. Income $ 3. Total of Principal and Income $ /D ~3.3b ~'~" III. ADDITIONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principal 1. How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): C'N&CKiNG Accou.vr - /003. ~3 C'fISN ~-" 76.6 2. Have there been any expenditures from the principal --!! during the Report Period? ............................ l,~Yes ^ No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? ........ fia'Yes ^ No Form G-O2 rev. 10.13.06 Page 2 of 5 Estate of L.Y/~i59/~[/A //A.e/° /~A.E'.r/,~3puG,~,~ _. An Incapacitated Person Ctv7~~ .~ ~aa. 79 ~.v7~'~~.vi~~r -. 995. %`D fdo~ ---` ~dya..3~ ~ J dD ~X~~~D 3. b. List purpose and amount of expenditures: HDUS /1/_1LV /,usu .a.d~L YA AriDe/ Gigs GvA~a~A~s,~~ a ks~Rr c. Was Court approval received prior to $ .335~3.55~ $ a~ ~ ~o $ ~sa.b~i /S UO expending the principal? ....................... ^Yes f~'l~io Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? ........... ®Yes Ld'No If yes: a. Was Court approval requested prior to receiving the additional principal? ................ ^Yes 0 No b. State the sources and amounts of the additional principal received: B. Income 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): ~~~k~~~ A~~r,~..vo .esL~.uc~ $ i/37d/ ~'s/ $ 33/S.oo P~ .Ss~ $ ass :~o $ Total income received during Report Period: $ 99d/. 59 ~' Form G-01 rev. 10.13.06 Page 3 of 5 Estate of H.P/5>/,dA ~A/'i _ ~~A.P,t/,(3.4 //G f~ , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): G'~I~CN/.vG h'CCOUNT' ~ ~~d03..~3 C'r9s/a ----- 9a.6~ C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person (e.g., clothing, nursi~ home, medicine, support, etc.): Cto ~Hirs -- ~aa. ~9 ~~RSO~~~ C~p~ - ~7/. 8 7 /~l~Ditp G ---' .317. 70 FOOD -' /Dh~~.,~~ D. Other Eapeuditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) ~ GUARDll4.J$N1 P R~PoR.'r '~ ~/S DO ~,vi~rgidr~l~.~/T -' 995. ~D ~XP~S i°~+D - ! • 8 3 ~~¢soyAo 7Ax6s ~' 9.8D .N~ul Gk~~us ---~ ~ 3.39 E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Court Amount Method of Determination Approval Obtained ~(/~,~ ~., ®Yes 0 No ©Yes ®No Form G-02 rev. 10.13.06 Page 4 of 5 Estate of is?i 6t //.9.P/~ f~~.~/L3.9iirsJ , An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount .(~B~I C~ ^ Yes ®No Court Approval Obtained ©Yes ~ No I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. 0 77at Sigtmlure of dian ojthe Estate ~SA F.A.PA/~1111 ~! Name ojGuardian of the Estate (type or print) ~L7 .yu s~ STP sf i Ad/d~rJess p City, //State, Zip /71~) /9'/.. /~~/7 Telephone Farm G-02 rev. 10.13.06 Page 5 of 5 ANNUAL REPORT OF GUARDIAN OF THE PERSON // COURT OF COMMON PLEAS OF LU/~78~-.PG~w/D COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ~ ~,,, ~= ~~ v C ~ ~ " ~ } ~~ ~ G 7 7J ~'~., i.7 TJ~r rr-i _ 1- c} r ~~~ ~ - m rv Estate of G/~.~/ST/,r/A ~fI/'/~ ffil.6'.U/.~t7i1G N , an Incapacitated Person No. ,~/- 9G - 9/ ~ I. INTRODUCTION _~SA.y J. rCAiPA/i4A/J1.5/ ,was appointed Plenary ®Limited Guardian of the Person by Decree of T 1 e y DLS,e . T,e _ , J., dated F~~Q,~y s~947 ~A. This is the Annual Report for the period from ~sr2es.~ / D// to F&i~,c~ug,2~ a9 . ~i.~ (the "Report Period"); or ^ B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of For a Final Report, omit Sections II through Ii! Form G-03 rev. 10.13.06 J., dated Page 1 of 4 Estate of~.P/ST/.tli! ~,ei~ ~2,c%~4.a~iry . an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person:~_ Date of Birth:~A2_ ~~. /9>SI III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: 8U7 S//uGS.e ST.e~~T ~f~yy.~JiCS~3ukG, Pfi' /7oSS- ~U~g' B. The Incapacitated Person's residence is: ^ own home /apartment ^ nursing home ® boarding home /personal care home ~'(~iuardian's home /apartment ® hospital or medical facility ^ relative's home (name, relationship and address) ^ other: C. The Incapacitated Person has been in the present residence since ~i~T•s! . If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-o3 rev.10.13.06 Page 2 of 4 Estate of,/,.~f%~iSTi~/~y //A.v/~ ~i9~/B.9yGS./ , an Incapacitated Person D. Name and add~~r^-ess of the Incapacitated Person's primary caregiver: ~US~N T /~,q,2,J,B.9UGl~ 8D~ S.~v~,~ ST.e~r- /i~CHA.r//GSi3ueG, ~r9 /7o55-/af9 IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: ~~,UT,gL ~TA~DATi~sYl B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: continue ®be modified ~ be terminated Form G-03 rev. 10.13.06 Page 3 of 4 Estate of //1.e/59/.~ii4 ///'2i~ ~sdt?,yE3.9~rGs.~ , an Incapacitated Person The reasons for the foregoing opinion are: GH.G~/ST/.t/fl /S U.t/ABiGL. ?d HfI.UDL~. ,h~f.,~ ~'•~SOiUAG. A"'D F/NSJ.VC/A[~ /fA~~S. B. During the past year, the Guardian of the Person has visited the Incapacitated Person ,.3 P times with the average visit lasting hours, minutes. S~/e miss cdir~ tn~. ~' CAN saa ,crs,e ANy Tiin~, The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. ~.a.~ /7 ,~D/9 ~r Form G-03 rev. !0.13.06 Sigrutture ojCn ian ajthe Person Jv.SR.~ J. r~'A.e~/~aU~N Name ojGuardian ojthe Person (type or print) ~o~ s~~L~~. ~~~~T Address Ciry, State, Zip 'I/7~ ~g7 ~o7s~ ~~ Telephone Page 4 of 4 ~~'~' rn rn C"> M ANNUAL REPORT OF :;0 T- rn 61 7;D GUARDIAN OF THE PERSON -:7, ::3 COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ✓111) --1 Estate of //*-v!�:, , an Incapacitated Person No. I. INTRODUCTION �salo T was appointed [9-Klenary MLimited Guardian of the Person by Decree of &6P-, J•, dated EJ'A. This is the Annual Report for the period from Z/�` Z to �3, i,,,y,2 Z 22, -, ,2jqv,,j (the"Report Period"); or 17 B. This is the Final Report for the period from to (the"Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of J., dated For a Final Report, omit Sections H through IV. Form G-03 rev, 10.13.06 Page I of 4 Estate of L ,57-1A1d an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person:_96 Date of Birth: A,—e 1 e-, /f z, III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: B. The Incapacitated Person's residence is: r7 own home/apartment nursing home ®boarding home/personal care home 'Guardian's home/apartment rj hospital or medical facility rj relative's home (name, relationship and address) n other: C. The Incapacitated Person has been in the present residence since ";rej . If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev. 10.13.06 Page 2 of 4 Estate of �7/N!q I/r4Pfe, /� an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: JUS,gA) T J'�PrP,A)6pt 064 /7.066' IV. MEDICAL INFORMATION A. The major medical mental problems of the Incapacitated Person are as follows: /%AA1 ,,JZ- ti -7'W,ieAg7fa7t B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: continue rl be modified El be terminated Form G-03 rev.10.13.06 Page 3 of 4 Estate of an Incapacitated Person The reasons for the foregoing opinion are: To iNAN aL S 14 P— NASOAA Z.. '�"� F��1/�r i A L B. During the past year, the Guardian of the Person has visited the Incapacitated Person times with the average visit lasting hours, minutes. The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. I verify that the foregoing information is correct to the best of my knowledge, information and belief, and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. AIZZ4 J61-3 Date rSignature ofGua than of the Person Name of Guardian of the Person(type or print) 4-J� 'S IJixp— �Tie�uT Addrreesssss Al/// �7d 'lrlQ�j� City,State,Zip / L-7 2 X;20 Telephone Form G-03 rev. 10.13.06 Page 4 of 4 M C> M C> C13 M G7 rt7 cl) ;L3 .-A )> :zj ANNUAL REPORT OF C�. GUARDIAN OF THE ESTATE CL71 coo> C) COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION l Estate of an Incapacitated Person No. ZZ I. INTRODUCTION S'U' S,q,V j— was appointed ePlenary El Limited Guardian of the Estate by Decree of 72- J., dated I,- IfFZ a"A. This is the Annual Report for the period from A,x eAl to , � . �y 5,=:201,5 (the "Report Period"); or El B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J., dated Form G-02 rev.10.13.06 Page 1 of 5 Estate of `.4�Alo",-L/6 An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ B. State the value(s) of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, otherwise, ending balance from last Report.) $ /D ;P C. What is the total amount of income earned during the Report Period? $ /D� �6 �7. OR D. What is the total amount of income and principal spent for all purposes during the Report Period? $ .�3 E. What are the balances remaining at the end of the Report Period? 1. Principal $ / 2. Income $ 3. Total of Principal and Income III. ADDITIONAL INFORMATION (If more space is needed,please attach additional pages.) A. Principal 1. How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): ell 6C 6 14 CCUVNT -- "lOdf/ .5-U eRS -- 13916 2. Have there been any expenditures from the principal , during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Y es El No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? . . . . . . . . a Yes ❑No Form G-02 rev.10.13.06 Page 2 of 5 %.t/,B�U6sf An Incapacitated Person Estate of Z X157%411y f,�ouSuNOLA s�•�fD b. List purpose and amount of expenditures: v,�RN�� 557. G/Y>S 1 16 70.10 I/ftC�7�vn �QrcVOk'l -� /•s od �✓v,���G�.�i.✓��✓;' $ /mod�.S'9 �opr3aa.�Sr��P �8'U Th>< - ����DD c. Was Court approval received prior to expending the principal? . . . . . . . . . . . . . . . . . . . . . . . 0 Yes �To 3. Were additional principal assets received during the Report Period which were not included in the , Inventory or a prior Report filed for the Estate? . . . . . . . . . . . Yes 9 If yes: a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . . . ❑ Yes ❑No b. State the sources and amounts of the additional principal received: B. Income 1. State sources and amounts of income received during the Report Period(e.g., Social Security, pension,rents, etc.): 19CGa viv> $ /dd 3. 3 ac.a� S<cULIt rV $ S�aa.vc3 $ 3 �8 . Od $ 8,7. 53 Total income received during Report Period: $/d X,67 OR Form G-02 rev. 10.13.06 Page 3 of 5 &,erszz-Estate of c% 11,19 XI An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): C hl�Ckln�6 h'CC0UNT — /dQ` SD 6711514 /39 /(o C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person (e.g., clothing, nursing home,medicine, support, etc.): e Z o 7//CS 0795.16 ldc450NAL fdov /,/o I's Eti0c.D 3asp• 0 D. Other Expenditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) a7. Z)a GUf? =DlRl�S�/P P Po47' fvsv2ANC= 5 --- 18-S O T�XEs — .�1� Piro>o /.� j1,4CA7-10N /l 70•/D �E�PR/D SS 801 ,00 E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Court Amount Method of Determination Approval Obtained /UUN Yes FINo Yes F7 No Form G-02 rev. 10.13.06 Page 4 of 5 Estate of ,yid/STi rJ,4 //d elEl ZY AOit4629 061-1 , An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Court Amount Approval Obtained &A) E]Yes M No Yes El No I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. 0 13 Date Signature of GZrdian of the Estate SsgA.J T 1ZgA0AWgV61-1 Name of Guardian of the Estate(type or print) &7 S'uuL.ce ST,e5!�r Address City,State,Zip Telephone Form G-02 rev. 10.13.06 Page 5 of 5 0 s rn o rn C> ANNUAL REPORT OF rn n (n o GUARDIAN OF THE PERSON 2 � °' � o C; c-� o -mo ° M N � rn COURT OF COMMON PLEAS OF n Cn GU1;7,&FeZA.UQ COUNTY, PENNSYLVANIA w ORPHANS' COURT DIVISION Estate of Z�ZIA119 //AP1i= 1�1,9.e:V.BH616171 an Incapacitated Person I. INTRODUCTION �US/9N /`iA.G'A/.�iAUG!•/ , /was appointed ®Plenary©'Limited Guardian of the Person by Decree of TksLgy QL£k, Jig_ J., dated Fly uAe y s i 9 p�7 . This is the Annual Report for the period from e, ., ,w to VAAv .28 , -20/!-1 (the "Report Period"); or El B. This is the Final Report for the period from to (the"Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of J., dated For a Final Report, omit Sections II through IV. Form G-03 rev./0.13.06 Page 1 of 4 _ z , . . . .. _ _ t , _ �. _ .. _.: r . . ,,. . , h / ,. . v�k . j... � 3 1 a �. ` � � � •L i f' � .).. b �' '(: � .� L .� r) a _�! . . a �+t � _ _ _t .. .... _ v. __.. �, MW.Y_a+�" wYUr.:+.t.Y�+-��t.t!*9^3uM awKa�+�x,..,.s.,..'.+„+,.:w?rsF'•ra.ekrw.iu... .rriM- �'^-n'�. ^•'^lW.r �.�4wnenrb'WMw+vR' — x�.n�+++W�^"`Jd Estate of an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: SUSp,) T. AS,4eA0AUGF/ gD 7 SN UL S,e-- �ECHf7 c//CS l3U�G� Oe�9 IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: V. GUARDIAN'S OPINION A. It is,, the opinion of the Guardian of the Person that the guardianship should: @continue Elbe modified ®be terminated Form G-03 rev. 10.13.06 Page 3 of 4 Estate of ///�/ST/,{/iJ //f/j�/y /�.9/'.r/�AUGf/ an Incapacitated Person The reasons for the foregoing opinion are: �///'/S7/,t/ !S U/✓/tBG£ TD ¢�DL/yfJr/c/flG� /113TT�oS. B. During the past year, the Guardian of the Person has visited the Incapacitated Person _3 times with the average visit lasting hours, minutes. 5"NF, 4iV65 Wt1-N mr_. Z CAr/ SEA 11-1 ,4 4vyT/irl6, The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. I verify that the foregoing information is correct to the best of my knowledge, information and belief, and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. Date Signature ofGtWd�an of the Person Name e,of,Guardian of the Person(type or print) Address City,State,zip Telephone ' Form G-03 rev. 10.13.06 Page 4 of 4 ; s M ANNUAL REPORT OF GUARDIAN OF THE ESTATE = D rn M o /� COURT OF COMMON PLEAS OF o �°— n /. ii/l/3ti?LA.utD COUNTY, PENNSYLVANIA Eu r\3 r- M ORPHANS' COURT DIVISION w °i C> Estate of /Z/'/g_ an Incapacitated Person I. INTRODUCTION _ .,U.SAn1 _T- f6A2n//.3AU(,-N was appointed denary El Limited Guardian of the Estate by Decree of dated X-Zae"A2y .S/ff/ . 53"A. This is the Annual Report for the period from �.ee to /'�. 91j q 2Y ay , ,�D!�/ (the "Report Period"); or El B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J., dated Form G-02 rev.10.13.06 Page I of 5 V Estate of zL 7,, //A"" An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ B. State the value(s) of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, otherwise, ending balance from last Report.) $ C. What is the total amount of income earned during the Report Period? $//, D. What is the total amount of income and principal spent for all purposes during the Report Period? $ E. What are the balances remaining at the end of the Report Period? 1. Principal $ .9/57 2. Income $ 3. Total of Principal and Income 4-eft- 111. ADDITIONAL INFORMATION (If more space is needed,please attach additional pages) A. Principal 1. How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit,restricted bank accounts, etc.): C</�C�'/V6 Cl9s� � i�s�s 2. Have there been any expenditures from the principal during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . El Yes Q No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? . . . . . . . . ❑ Yes ❑No Form G-02 rev. 10.13.06 Page 2 of 5 Estate of A l5ZIM9 ZZ is ';iA.,OgAq UG N An Incapacitated Person /[ X b. List purpose and amount of expenditures: � /A15U.2t?A�Grr'" z9d7d17 �F.2Snn/aL ,5-97 641 Texts f 9 8� inn. 90 GVRRDIR�IaMJP /z�PO�? ,-.• ,r�':DO c. Was Court approval received prior to N&uJ CAI t -48 7/3' expending the principal? . . . . . . . . . . . . . . . . . . . . . . . ❑Yes Ca<o 3. Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? . . . . . . . . . . . Yes 12r�o If yes: a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . . . Q Yes Q No b. State the sources and amounts of the additional principal received: $ B. Income L State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): Jf/ GCC��A/G f1C[ouJ✓T em/w/var. $ SOGlfiL Sseugyey $ 5 66.00 S / $ 3964. 00 $ 02 7 30 Total income received during Report Period: $�f Form c-oz rev.10.13.06 Page 3 of 5 Estate of /e 4fJ g,2 (,1! An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): Cy�c�ivG h'ccouNr — /11�/5� Cf/a// dny �/9•t/D — /�s 93 C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person (e.g., clothing,nursing home, medicine, support, etc.): el-0 — X.?-P'/' Ss, ��RSd t/HG (:AC6 — 6­89,&13,1 hlevsgy,Xv — 336&.7,9 D. Other Expenditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) p (�11'F/- ,VA1P1SNT -'¢tea/0.9D GU/}k.D�R x15,IP X£G., —��S,Od /,rrsveauc� — aa7.aO .Vg&i Cs/£ces 35. 9 G/t7S 41,90.69 1119C6710-n iSSa.9a A e,SONAL AW 5 9.8 a E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Court Amoun�t��/�� Method of Determination Approval Obtained --f Yes ONo DYes F."INo For„�c-02 rev. 10.13.06 Page 4 of 5 Estate of LH�✓S7/Ui9 //q �y yeAIBAU6/� An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Court Amount Approval Obtained . Yes D No DYes DNo I verify that the foregoing information is correct to the best of my knowledge, information and belief, and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. Q �/ Date Signature 01 UuKrdlan of the Estate loe Name of Guardian a,the Estate(type ,pit) �D7 �yUG&,e Si �T Address Cety,State,Zip L9/7) X97-�aso Telephone Form G-02 rev 10,13.06 Page 5 of 5 IIIII , ! IIIIIIIIII I r-v C"'� ANNUAL REPORT OF � � � � Q GUARDIAN OF THE ESTATF� �, -� �, �, �, � � � �, �:,f� � ,,,.,�. �- �:�-3 � ��, c:, r. :t� COURT OF COMMON PLEAS OF �.� v `� � C7 ,.i � ft `r7 �U rf!'�i?�.�.✓2� COUNTY, PENNSYL VANIA. ; [' ""� � � -`-' ORPHANS' COURT DNISION � T �;� n � rn `�''F» C�J C1'3 C� Cp 'z7 . ,� ,/ Estate of ,�,PiS'l/�f/A /'ff!/�l� ��.9.eN'�`3.91/�!� , an Incapacitated Person No.�?/- 9� -9�7 I. INTRODUCTION .�I1SAn1 .J. �.�,4��t/,�AtlGN , was appointed �Plenary �Limited Guardian of the Estate by Decree of ,,� �r.,�}, :„;!E y� �,�. , J., dated to �".�.PU,�• �A'p -�oi_� ,/ I ���� A. This is the Annual Re ort for the� eriod fromth i���,�,°�;� / �J�.� � y '" ( e "Re�port Period"); or � B. This is the Final Report for the period from , to , (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Datc of�death: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J., dated Form G-02 rev.10./3.06 Page 1 Of 5 � � iii � iin i � / Estate of d'��t.'!57"/.�lA //i9f'/� ��A.E'N/�.fi U G/� , An Incapacitated Person IL SUMMARY A. State the value of the estate reported on the Inventory $ /.-�.�� �� B. State the value(s) of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, otherwise, ending balance from last Report.) $ /5"� 7-5�-`'j C. What is the total amount of income earned during the Report Period? $ /d _�Df. 7� D. What is the total amount of income and principal spent for all purposes during the Report Period? $ ��,, ,� �v� ��o E. What are the balances remaining at the end of the Repurt Period? 1. Principal $ /,-�_39 D� 2. Income $ 3. Total of Principal and Income $ %.-�3 � C�3 �- III. ADDITIONAL INFORMATION (If more space is needed,please attach additional pages.) A. Principal 1. How is the principal balance listed above curretitly invested? (Please specify, e.g.,real estate, certificates of deposit, restricted bank accounts, etc.): `"�h'�G"KiN6 f1CCdv�vT — `��°`iD; _5,�2 �'R`"a N ,i;� . .:�% 2. Have there been any expenditures from the principal during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . �es �No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? . . . . . . . . C�I'�Yes ❑No Form G-02 rev. 10.13.06 Page 2 of 5 IIII'' ! I IIIIIIIIII I � / Estate of ,/�,�/STi.�✓A� //f//'>� ��f��/'�/��7U�/�/ , An Incapacitated Person �,,v7��',4iN/�7P✓✓T -' �3�-�� b. List purpose and amount of expenditures: �lU�rs�sto�� --- �Y�y,�-d�' �Le l"�!�S $ o?�7/,3 /.�sv�er�Ne� -- ��7�c� ���s��raL G4,e�. $ -Y��99 ._.._- 636 3�r' VHC�►>�dn� ,��'vich+� $ �5�'«. �35�' Gi�A��rPrN p�P j�.t�l� `vOCU $ /a��`_ i� �� SDI,�I •e�i�/D SOCil�L S�'('L��.'1T`/ G/'y4 �� G/F>s ��— c. Was Court approval received prior to expending the principal? . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes �10 3. Were additional principal assets received durin� tl�e Report Period which were not included in the Inventory or a prior Report filed for the Estate? . . . . . . . . . . . �Yes �'�To If yes: a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . . . ❑Yes ❑No b. State the sources and amounts of the additional principal received: $ $ $ $ $ B. Income 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension,rents, etc.): /.��si�-o�r/;.s��i,�u7� $ /.-�S.93 �h��C,'i�/.N 6 .f�CC U UN ?� $ �y�/. �lo �DG/f1 G �E'C U�./7 i/ $ /5�.��.c�O ��/ $ d�C�y�O /��'-I` �S/� $ /r 8. 9� $ Total income received during Report Period: $��c��.%f -e�' Fonn G-0? rev. 10.13.06 Page 3 Of 5 � in i /� /� r-- Estate of �y/'i ST/.fld� i'/f7�'/� ��f�.�'A/,�'�9 U�i� , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g.,restricted bank accounts, client care account, etc.): �l,l�'CkiN G f��CD�rvT ��',,���-�". :�� �,`J'�f/ CS�/ �AN� ,,%,_3 i. :�i/ C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person(e.g., clothing, nursing home, medicine, suppoit, etc.): �''iv7N�s -- ,,��7.i3 �'��snnJ�L CA�'..� — h����9 /r/cD/G r7 L ...— •yll�.,�8 `OdD - ���i ia ,�G�US ci,l�U�D — h�/��,D� D. Other Expenditures Specify what other expenditures were made during the Re1�ort Period. (Do not include any items stated in response to question C above.) ���.;�/ G`��tf7 r���.�'.��a ,�o,e�" — i�c�o �.�T��'-��l•J/�1�iJ% J U' . � ��7�p (�''�r,,��:-��,g'�� - �O/.// /.,r�5�,�f/e9,v c� _ 6,�6. 3 n �f�CHTDit1 " �`'f31�%;� ,S�c.�t;/f3L �Sc`'�'U,('.ITy �I'•f. �� E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Court Amount Method of Determination Approval Obtained �/Q,tJ� DYes �No �Yes �No Form G-02 rev. 10.13.06 Page 4 of 5 IIII'' ' i'I IIIIIIIIII I � Estate of �/c'/S�/�/fl �i9.E'/� /��i9.P.t//�A�IG�/ , An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Court Amount Approval Obtained ,��,{/� �Yes �No �Yes �No I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. ii>i� /.�, aa�s� ��.� � �;;;���u:�-�2.�,`�� Date Signature of GEr2k�dinn of the Estate i LSf�iV ....� ,A���il�.�i9/�Cj� Name of Guardian of Ghe Gstnte(rype or print) /J�/ c�17r r'",l G.�i��f<'� ���f'i�i� Address s/���A.r!/�`S,�'�;;-�'G �� ,��e��'"S-�D�,� City,State,Zip �7>7� ,�,��°�I;��-,,,./��,� ,� Telephone Form C-02 rev. 10.13.06 Page 5 of 5 i i n � i • r\1 ANNUAL REPORT OF c �, � m rn GUARDIAN OF THE PERSON � � � � �n � � �„ r-- �, --.-� r� � �, � � ;.;� r� l;) ,.:T :� L."7 � ,,. _ .: , � �:S � COURT OF COMMON PLEAS Of' , �� � � '�' Jr' _ � U�'1,8�P '_s3,✓r� COUNTY, PENNSYLVANIA ' ``;-i F—�' `` � . _i p t� I`�l ORPHANS' COURT DIVISION �;';' � �; o ct7 -� Estate of G,,S�iPiti�,�/p i'1.�/'f�` ��'.9r�.'.�/.��1/Gf1 , an Incapacitated Person No. �-�7/-��y� I. INTRODUCTION � USA,c/ � y,%'�AP,f/d-�AfJI f,� , was appointed � � E�Ylenary OLimited Guardian of the Person by Decree of �.����,'�'7i��:d���2 � _�,� , J., dated �.�•a y .�/�� �. This is the Annual Report for the period from^�''',%�i�"�;',�,� / ,� to �,�2�y �S� , ��" (the "Repo►�t Period"); or � B. This is the Final Report for the period from , to , (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of J., dated For a Final Report, omit Sections II through IT! Form G-03 rev. l0.13.06 Page 1 of 4 `� .� i in � � Estate of /�2/Si/,�1,� //s��i 1�A2,U',�AUG,�! , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person: .�% Date of Birth:�s,2�.s1 �a, l9'7g III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: �D7 S�NU�.£�e 5�.��'�'T ,��Cf�f�•tllGS.8L3�'G, �f/ %�d55—�D'�9 B. The Incapacitated Person's residence is: �own home/apartment �nursing home �boarding home/personal care home �uardian's home/apartment ❑hospital or medical facility �relative's home (name, relationship and address) �other: C. The Incapacitated Person has been in the present residence since ,6/�'T.S/ . If the Incapacitated P�rsoil has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev. l0.13.06 Page 2 Of 4 i u i n i � ./�A/�.�/,�'At�G f1 , an Inca acitated Person Estate of �f,�iS,Tf A h'.�i� p D. Name and address of the Incapacitated Person's primary caregiver: �U�HnJ T .��AP_,t/,�A�/Gh� ��J �F11/L�,�?. �72c''G^.i ��C•�/r.vlCS�8U2G, /� /•'OSa-�D��`;i� IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: //�it/>fi'4 /��7A,'edA?/r1Y� B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: �ntinue �be modified �be terminated Form c-o3 rev. 10.l3.06 Page 3 of 4 i i n � � ' 1 Estate of �iP✓'S7/NfJ //r�2/� /G��i'.��.9t�G.� _, an Incapacitated Person The reasons far the foregoing opinion are: ��'/S9i'.il� �S U�JA�L�. 7G ,L/fI,U�L� f1�2 f'�,2,.�'c7/Jf�L A�'D�"iNfINC/A�L �fl?`1��5, B. During the past year, the Guardian of the Person has visited the Incapacitated Person �� times with the average visit lasting hours, minutes. �� ����s w�r�l /�"l�. �'v 1 GA�✓ 5��: .���1;,�. fl,vyTim�, The report of a social service organization employed by the Guczrdian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. •;>� / �PiP�L. /3�LD/� �g � � ,�%'�� .���'�"��1��-�Cc � Date Si nature o G rdia��ofthe Person ��,s�� -T-_ ��.�C},��a,���u Name of Guardian of the Person(rype or print) �11a7 if °L° /:' �Ti.�' €T Address ���A,v�,��,,�,i,L,6;:�, .�i� I�OJS'�d�Q City,Stale,Zip l_ ��� (1J<',�/ _."✓c�J O Telephone Form G-03 rev. !0.13.06 Page 4 of 4 � GUARDIAN'S INVENTORY COURT OF COMMON PLEAS OF Cumberland COL)NTY, PENNSYLVANIA ORPHANS' COURT DIVISION �an Incapacitated Person Estate of David B. Weaver °��a Minor No.21-12-0357 t.�.., N � � 1.�Real F�state: (Location, by whom occupied and rental Estimated Value: � -� �terms;'�f�pplicable) �� �:: i�. � �:.:;: � i.�._ [1.. c�:; � �-, ,;� Ga E.' � - ka.J t:.,, �.,.� � �:; �.'. Cr� F_..,. CC _ � p,_ � O W L�J C? , � � � Sub-Total for Real Estc�te: 0.00 �_, 2. Personal Property: Estimated Value: Television 50.00 Clothes 50.00 Furniture 50.00 3. Jointly Held Property: Estimated Value: (Set forth real and persona!properry owned by the/ncapacitated Person JOINTLY tia ith ar�c other person(s). State whether held as tenants by the entireties:rfnot,whether the ri�;ht of survivorship ezists.) Joindy Held Property Trust for David B.Weaver is held by Helen Shoemaker&Ellen Rahn as Trustees of the Trust upon the death of David's mother in York County. 1 have no access to monies or accounts held in this trust. You may contact them at. 166 Barrens Church Rd.;Dillsburg or the attorney handling the trust;Suzan�7e Griest with Griest,Himes Herrold,Schaumann,Rynosa at 129 East Market St.; York,PA (717)846-8856 � Fo.m c-oa rev.10.13.06 Page 1 of 2 � � � �an Incapacitated Person Estate of David B. Weaver '��a Minor 4. Anticipated Assets: Estimated Value: (Set forth property of any kind expected to be acquired hereafter,together with attticipated date of acguisdtion.) � Property Anticipated Dnte of AcRuisition Sub-Tota!for Personal Estate: 150.00 (Attach additional sheets if necessary) TOTAL OF ITEMS 1,2,3, and 4: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150.00 Commonwealth of Pennsylvania : . ss. County of Cumberland , Pauline E. Myers , says that the foregoing is a full, Guardian true and complete Inventory of the Estate of David B. Weaver , the aforesaid Incapacitated Person or Minor; and that all of the information set forth herein is true and correct to the best of the Guardian's knowledge and belief. I verify that the statements made in this ) Inventory are true and correct. I under- ) stand that false statements herein are ) � .• Q, � made subject to the penalties of ) Q�-a'��� ,'��� � 18 Pa.C.S. § 4904 relating to unsworn ) Guardian falsification to authorities. ) Attorney for Guardian: n/a Supreme Court LD.No.: Address: 365 E. Baltimore Street Carlisle,PA 17013 Telephone: ��17)448-9115 Form G-04 rev. 10.13.06 Page 2 of 2