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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE:_ WILLIAM D. WlLSON_, an incapacitated person
FILE NO. 2000-00501
GUARDIAN OF PERSON ANNUAL REPORT
[20 Pa. C.S.A. 5521 (e)J
FROM_JULY, 25-,2006
TO _JULY, 25-,2007
1.1 am the_Limited _ X_Plenary Guardian of the Person of my ward, named
above.
2. I was appointed Guardian by Order of the Court dated _JULY, 25 2000,
which _ was -X.. was not modified by Court Order(s) dated
3. Is the incapacitated person still living? YES
If no, answer the following:
(a) Date of Death?
(b) Place of Death?
(c) Name of Administrator or Executor?
(d) Date Guardian of the Person filed the last Annual Report?
4. If the incapacitated person is still living, answer the following questions:
(a) Date Guardian of the Person filed the last Annual Report?_~6_ :-'~
,') (.::
" () (jj
(b) Current address of the incapacitated person n~: ~c~ N
. -'~j N
~~, .~.' ;~
(c) Current age _65_
r:Y
.r:-
Date of birth of incapacitated person_12121141 0
~
65 W. LOUTHER ST.
CARLISLE, P A 17013
(d) The incapacitated person's residence is:
_X Ward's own residence
Nursing Home
Hospital or Medical Facility
My home/apartment
_Relative's Home
_ Boarding Home
( e) The incapacitated person has been living there since MANY YEARS
If moved within the past year, state from where and the reason for the
change
~
(f) I rated hislher living arrangement as:
Excellent _X_Average
Explain:
Below Average
(g) I believe he/she is:
_X_content with the living situation
unhappy with the living situation
unaware of the living situation
5. Physical health
(a) Current physical condition of the incapacitated person is:
_Excellent _X_Good Fair Poor
(b) Hislher major physical health problems are as follows:
UROLOGICAL PROBLEMS, HYPERTENSION,
OBSTRUCTIVE NEPHROPATHY, REFLUX
(c) During the past year, hislher physical condition has:
_X_ remained about the same.
improved. Explain
worsened. Explain
(d) During the past year, he/she received the following medical treatment
(include check-ups and dental work):
Date
Ailment
Type of treatment Doctor's name
PERIODIC CHECK UPS STAFF PHYSICIANS @ STEVENS CLINIC
MONTHLY PSYCHlATRRlC MED MANAGEMENT @ STEVENS CLINIC
DR. PSYCH WYLEN
6. Mental Health
(a) The incapacitated person's condition is
Excellent Good _ X_ Poor
(b) Hislher major health problems are as follows:
SCmZOPHRENIA, DEPRESSION,
(c) During the past year, hislher mental condition bas:
_X_ remained about the same.
Improved. Explain
Worsened. Explain
(d) During the past year, treatment or evaluation by a psychiatrist,
psychologist or social worker _X_was was not provided. Such
mental health services are briefly described as:
ONGOING MED MANAGEMENT
7. Social Activities I Services
(a) Hislher current social condition is:
excellent _X~ood
fair
poor
(b) During the past year, hislher social condition has:
_X_ remained about the same.
improved. Explain.
worsened Explain
(c) During the past year he/she has participated in the following activities:
_X_recreational
educational
_X_ social
occupational
no activities available
he/she refuses to participate in any activities
8. Visitation
(a) During the last year, I visited himlher as follows: BI- YEARLY AND
MONTHLY PHONE CONTACT
(b) The average amount of time I spent on each visit was_l0 MINUTES_
(c) The last time I visited was on Date 7/02/07
9. During the last year I have performed the following activities on behalf the
incapacitated person:_ MEDICAL AND FINANCIAL DECISIONS
10. I believe helshe has the following unmet needs.
NONE
11. The guardianship _X_ should
modification because:
should not be continued without
12. Please note any concerns about the Incapacitated person's physical or mental
well being or the finances that the Court should know.
13. I _X_ am am not guardian of the incapacitated person's estate. If yes,
my report is attached.
I certify under the penalties of perjury that the information contained in this report
is true and correct to the best of my knowledge, information and belief.
Date:
~./;( /07
t~~-~
Signature of the 'Guar Ian f the Person
Name: BRIAN D. BROOKS
Telephone#(home) 1/1- 9~c?~75Y'5
Address:
(work) 717-299-4568
PENNSYLVANIA GUARDIANSmp ASSOC. INC.
PO BOX 7295
LANCASTER, P A 17604
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION
IN RE: WILLIAM D. WILSON ,an incapacitated person
FILE NO. 2000-00501
GUARDIAN OF THE ESTATE ANNUAL REPORT
[20 Pa.C.S.A.5521 (c)]
FROM JULY 25 ,2006
TO
JULY 25 ,2007
1) I am the _Limited _X_Plenary Guardian of the Estate of my ward, named above.
I was appointed Guardian by Order of the Court dated _7/2512000_, which
_was _X_ was not modified by Court Order (s) dated
2) Is the incapacitated person still living? YES
If no, answer the following:
(a) Date of Death
(b) Place of Death
(c) Name of Adminstrator/trix or Executor/trix
(d) Date Guardian of the Person filed the last Annual Report
PLEASE ANSWER THE FOLLOWING QUESTIONS WHETHER T~
INCAPACITATED PERSON IS LIVING OR DECEASED. ~o
~''2 C)
3) My initial Inventory was filed on _8/31/00_ and listed a total estate value-ti~
: ;:: =:J
$ 91.38_. '" ^
~
r-=:
G)
f';.)
N
The Inventory listed a total monthly income of $_240.00_ comprised ofthe
following: DISBURSE MENTS FROM A TRUST
".)
~?,
-n
r
o
4) At the beginning date of this report period, my initial balance on hand was
$ 71,199.77
5) During this reporting period, the following reflects all sources of income (other than
Social security) received by me for my ward: (Add additional pages of needed)
Source of Income
Amount
Date Received
SEE ALL DEPOSIT REPORT
TOTAL
22,000.00
~
6) During this reporting period, the following reflects all payments I have made for my
ward: (Add additional pages if needed)
Date
To Whom Paid
Reason for Payment Amount
SEE ALL TRANSACTION REPORT
TOTAL
7) The present principal assets of my ward are:
Description of Asset
Present Value
1. P AGA CUSTODIAL ACCOUNT
2. M&T TRUST
738.46
46,524.52
TOTAL
47,262.98
TRUST CAN BE USED FOR CARE & MAINTANENCE BUT IS NOT AN ASSET OF
THE ESTATE.
8) The present amount and sources of income for my ward are:
Source of Income
Amount of Income
(Indicate whether monthlv.
Quarterly, annually)
1. TRUST DISBURSEMENTS
$
2,000.00
9) The regular monthly expenses of my ward which I pay are:
To Whom Paid
Amount
1. LOUTHER PLACE LIMITED
$ 460.00
2. P A GUARDIANSHIP
250.00
3. SMART MED
APPROXIMATES
20.00
4. COMCAST
100.00
5. EMBARQ
90.00
10) I have/(have not) (circle one) petitioned the Court for permission to invade principal
to meet the needs of my ward.
(If applicable) The following expenses of my ward have been paid from principal:
To Whom Paid
Pumose
Amount
1.
11) I (have)/have not (circle one) paid myself compensation for services I rendered as
guardian.
The amount I Paid myself totaled $ 2,250.00 and was
Calculated at the following rate: $ 250.00per week! (month) (circle one).
12) Check the correct response and complete, if appropriate.
_X_There will be no need for extraordinary expenditures on behalf of my ward in
the next (12) months.
There will be a need for extraordinary expenditures on behalf of my ward in
the next (12) months because:
13) Check the correct response and complete, if appropriate.
A. My ward receives monthly social security benefits directly.
B. I am the designated payee to receive my ward's social security benefits.
C. The designated payee of my ward's social security benefits is
whose address is
and is/is not (circle one) related to my ward as
(insert relationship).
14) Please note any concerns about the incapacitated person's physical or mental well
being or the finances that the Court should know.
15) I_X_ am _am not guardian of the incapacitated person's person. If yes,
report is attached.
I certify under the penalties of perjury that the information contained in this report is
true and correct to the best of my knowledge, information and belief.
Name: 6u::.L>-~,~
TELEPHONE (Work) 717-299-4568
PENNSYLVANIA GUARDIANSHIP ASSOC.INC
PO BOX 7295
LANCASTE~ PA 17604
PAGA_CUS-PAGA Custodial
8/21' 7
CASH FLOW REPORT
1/ l' 0 Through 7/31' 6
Page 1
Category Description
1/ l' 0-
7/31' 6
INFLOWS
WILSON, WILLIAM
TOTAL INFLOWS
--
P fJ ~~!l
~
ITEMIZED CATEGORY REPORT
8/ l' 6 Through 7/31' 7
PAGA_CUS-PAGA Custodial
8/21' 7
Date
Num
Description
INCOME/EXPENSE
INCOME
WILSON, WILLIAM
9/ 8' 6 R9629
10/11' 6 R9741
11/ 7' 6 R9446
12/ 6' 6 R9538
1/11' 7 R1556
2/12' 7 R1663
3/13' 7 R1778
4/12' 7 R1908
5/14' 7 R2054
6/14' 7 R7254
7/16' 7 R6622
DEPOSIT
DEPOSIT
DEPOSIT
DEPOSIT
DEPOSIT
DEPOSIT
DEPOSIT
DEPOSIT
DEPOSIT
DEPOSIT
DEPOSIT
TOTAL WILSON, WILLIAM
TOTAL INCOME
TOTAL INCOME/EXPENSE
Memo
Category
BANK TRANSFER WILSON,WILLIAM/B X
BANK TRANSFER WILSON,WILLIAM/B X
BANK TRANSFER WILSON,WILLIAM/B X
BANK TRANSFER WILSON,WILLIAM/B X
BANK TRANSFER WILSON,WILLIAM/B X
BANK TRANSFER WILSON,WILLIAM/B X
BANK TRANSFER WILSON,WILLIAM/B X
BANK TRANSFER WILSON,WILLIAM/B X
BANK TRANSFER WILSON,WILLIAM/B X
BANK TRANSFER WILSON,WILLIAM/B X
BANK TRANSFER WILSON,WILLIAM/B X
~
~1
~
Page 1
Clr Amount
2,000.00
2,000.00
2,000.00
2,000.00
2,000.00
2,000.00
2,000.00
2,000.00
2,000.00
2,000.00
2,000.00
22,000.00
22,000.00
22,000.00
PA~CUS-PAGA CUstodial
8/21' 7
ITEMIZED CATEGORY REPORT
8/ l' 6 Through 7/31' 7
Date
1/31' 7
2/ 9' 7
2/12' 7
2/19' 7
2/20' 7
2/21' 7
2/28' 7
2/28' 7
3/ 6' 7
3/ 6' 7
3/12' 7
3/13' 7
3/19' 7
3/26' 7
3/26' 7
4/11' 7
4/11' 7
4/12' 7
4/22' 7
4/22' 7
4/22' 7
4/26' 7
5/ 2' 7
5/ 8' 7
5/10' 7
5/10' 7
5/14' 7
5/29' 7
5/29' 7
6/ 5' 7
6/ 8' 7
6/13' 7
6/14' 7
6/17' 7
6/20' 7
6/25' 7
6/25' 7
7/10' 7
7/10' 7
7/16' 7
7/16' 7
7/22' 7
7/29' 7
7/29' 7
Num
9867
9930
R1663
9951
9995
10005
10015
10022
10065
10076
10108
R1778
10165
10207
10208
10268
10326
R1908
10333
10334
10355
10389
10461
10496S
10509
10535
R2054
10597
10598
10622
10683
10738
R7254
10757
10763
10804
10805
10836
10855
R6622
10944
10981
10996
11014
Description
Memo
Category
EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X
SMARTMED INC W.WILLSON/ WI WILSON, WILLIAM/ME X
COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X
MOBILE CLEANNING S W.WILSON / 65 WILSON,WILLIAM/FI X
LOUTHER PLACE LIMI WILLIAM WILSO WILSON,WILLIAM/RE X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
SMARTMED INC W.WILLSON/ WI WILSON, WILLIAM/ME X
EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X
CAPITAL BLUE CROSS WILLIAM WILSO WILSON, WILLIAM/IN X
DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X
COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X
LOUTHER PLACE LIMI WILLIAM WILSO WILSON,WILLIAM/RE
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
SMARTMED INC W.WILLSON/ WI WILSON, WILLIAM/ME X
EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X
DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
LOUTHER PLACE LIMI WILLIAM WILSO WILSON,WILLIAM/RE X
COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X
MATT LOURDAU FOR W WILLIAM WILSO WILSON,WILLIAM/PE X
EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X
PAGA GENERAL ACCOU 3-5/07 WILSON,WILLIAM/GU X
COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X
SMARTMED INC W.WILLSON/ WI WILSON, WILLIAM/ME X
DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
LOUTHER PLACE LIMI WILLIAM WILSO WILSON,WILLIAM/RE X
EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X
SMARTMED INC W.WILLSON/ WI WILSON, WILLIAM/ME X
CAPITAL BLUE CROSS WILLIAM WILSO WILSON, WILLIAM/IN X
DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X
COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
LOUTHER PLACE LIMI WILLIAM WILSO WILSON,WILLIAM/RE X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
SMARTMED INC W . WILLSON/ WI WILSON, WILLIAM/ME X
EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X
DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X
COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
LOUTHER PLACE LIMI WILLIAM WILSO WILSON,WILLIAM/RE
MOBILE CLEANNING S W.WILSON / 65 WILSON,WILLIAM/FI
TOTAL WILSON, WILLIAM
TOTAL INCOME
TOTAL INCOME/EXPENSE
ad~
~h/O~
~
- 7/""?/J;Y7
Page 2
Clr Amount
-90.06
-200.00
2,000.00
-15.45
-101.05
-318.00
-460.00
-400.00
-2.14
-91.18
-1,066.89
2,000.00
-107.79
-460.00
-400.00
-23.77
-90.46
2,000.00
-400.00
-460.00
-113.38
-200.00
-90.31
-750.00
-94.33
-8.07
2,000.00
-400.00
-460.QO
-91.64
-15.45
-1,066.89
2,000.00
-114.50
-100.00
-460.00
-400.00
-10.08
-91.53
2,000.00
-103.29
-400.00
-460.00
-318.00
~ L
I?AGA_CUS-PAGA Custodial
B/21' 7
ITEMIZED CATEGORY REPORT
8/ l' 6 Through 7/31' 7
Date
8/ l'
8/ 7'
8/ 9'
8/17'
8/28'
8/28'
8/31'
9/ 6'
9/ 6'
9/ 7'
9/ 8'
9/12'
9/13'
9/14'
9/15'
9/25'
9/25'
10/ 3'
10/ 4'
10/ 4'
10/11'
10/17'
10/19'
10/23'
10/23'
10/23'
10/31'
11/ 3'
11/ 3'
11/ 6'
11/ 7'
11/14'
11/21'
11/21'
12/ 5'
12/ 6'
12/12'
12/15'
12/20'
12/20'
1/ 4'
1/11'
1/16'
1/22'
1/22'
1/22'
1/23'
Num
Description
Category
Memo
INCOME/EXPENSE
INCOME
WILSON, WILLIAM
6 8820
6 8839
6 8855
6 8892
6 8955
6 8956
6 8985
6 8996
6 9008
6 9009
6 R9629
6 9025 S
6 9036
6 9058
6 9063
6 9097
6 9098
6 9154
6 9161
6 9167
6 R9741
6 9255
6 9258
6 9290
6 9294
6 9300
6 9320
6 9335
6 9346
6 9352 S
6 R9446
6 9420
6 9477
6 9478
6 9557
6 R9538
6 9610
6 9639
6 9665
6 9666
7 9719
7 R1556
7 9790
7 9796
7 9797
7 9812
7 9524
EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X
SMARTMED INC W.WILLSON/ WI WILSON, WILLIAM/ME X
REGISTER OP WILLS WILLIAM WILSO WILgON,WILLIAM/CO X
COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X
LOUTHER PLACE LIMI WILLIAM WILSO WILSON,WILLIAM/RE X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X
VOID:SMARTMED INC W.WILLSON/ WI WILSON, WILLIAM/ME X
VOID:SMARTMBD INC W.WILLSON/ WI WILSON, WILLIAM/ME X
SMARTMED INC W.WILLSON/ WI WILSON, WILLIAM/ME X
DEPOSIT BANK TRANSPER WILSON,WILLIAM/BA X
BRIAN D. BROOKS POSTAGE WILSON,WILLIAM/RE X
CAPITAL BLUE CROSS WILLIAM WILSO WILSON, WILLIAM/IN X
S PAGA GENERAL ACCOU 7-9/06 WILSON,WILLIAM/GU X
COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X
LOUTHER PLACE LIMI WILLIAM WILSO WILSON,WILLIAM/RE X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X
SMARTMED INC W.WILLSON/ WI WILSON, WILLIAM/ME X
MOBILE CLEANNING S W.WILSON / 65 WILSON, WILLIAM/PI X
DEPOSIT BANK TRANSPER WILSON,WILLIAM/BA X
COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X
WILLIAM WILSON C/O W.WILSON / CL WILSON,WILLIAM/PE X
LOUTHBR PLACE LIMI WILLIAM WILSO WILSON,WILLIAM/RE X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
S PAGA GENERAL ACCOU 10-11/06 WILSON,WILLIAM/GU X
VOID:WILLIAM WILSO ACCT# 614689 WILSON,WILLIAM/PE X
EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X
SMARTMBD INC W.WILLSON/ WI WILSON, WILLIAM/ME X
BRIAN D. BROOKS POSTAGE WILSON, WILLIAM/PO X
DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X
COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X
LOUTHBR PLACE LIMI WILLIAM WILSO WILSON,WILLIAM/RE X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X
DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X
CAPITAL BLUE CROSS WILLIAM WILSO WILSON,WILLIAM/IN X
COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X
LOUTHBR PLACE LIMI WILLIAM WILSO WILSON,WILLIAM/RE X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X
DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
LOUTHBR PLACE LIMI WILLIAM WILSO WILSON,WILLIAM/RE X
WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X
S PAGA GENERAL ACCOU WILSON,WILLIAM/GU X
Page 1
Clr Amount
-90.72
-19.04
-15.00
-95.02
-460.00
-450.00
-90.19
0.00
0.00
-9.34
2,000.00
-1.11
-1,066.89
-750.00
-103.98
-460.00
-500.00
-90.33
-9.52
-318.00
2,000.00
-126.38
-200.00
-460.00
-500.00
-500.00
0.00
-89.95
-11.86
-0.87
2,000.00
-99.50
-460.00
-500.00
-89.81
2,000.00
-1,066.89
-99.50
-460.00
-500.00
-89.92
2,000.00
-200.00
-460.00
-400.00
-96.57
-250.00
ITEMIZED CATEGORY REPORT
8/ l' 6 Through 7/31' 7
~AGA_CUS-PAGA Custodial
B/21' 7
Date
Num
Description
Memo
INCOME/EXPENSE
INCOME
WILSON, WILLIAM
9/14' 6 9058 S PAGA GENERAL ACCOU 7-9/06
10/23' 6 9300 S PAGA GENERAL ACCOU 10-11/06
1/23' 7 9524 S PAGA GENERAL ACCOU 12/06
5/ 8' 7 10496S PAGA GENERAL ACCOU 1-3/07
TOTAL WILSON, WILLIAM
TOTAL INCOME
TOTAL INCOME/EXPENSE
WE
Category
WILSON,WILLIAM/GU X
WILSON,WILLIAM/GU X
WILSON,WILLIAM/GU X
WILSON,WILLIAM/GU X
~
Page 1
Clr Amount
-750.00
-500.00
-250.00
-750.00
-2,250.00
-2,250.00
-2,250.00
.
~
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(
.
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~\~ t; :i
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..- ! \:4
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0"- ,,,,,,,.~_.:<.il. b ~ $ b @
t- t- uI
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...~l
~
CASH FLOW REPORT
1/ l' 0 Through 7/31' 7
PAGA_CUS-PAGA Custodial
8/21' 7
Page 1
Category Description
1/ l' 0-
7/31' 7
INFLOWS
WILSON, WILLIAM
TOTAL INFLOWS
~~
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: WILLIAM D. WILSON-, an incapacitated person FILE NO. 2000-00501
- ~ -..
~~ `~'
c; O ~ -'
GUARDIAN OF PERSON ANNUAL REPORT `~` =~ ~~-
[20 Pa. C.S.A. 5521 (c)] ~-_ f-' 'J '
r-~ ; --
FROM 7/25/07 TO 07/25/08 - ~-,
~~
1.I am the Limited _ X Plenary Guardian of the Person of my ward, na~~ above
r ,.
2. I was appointed Guardian by Order of the Court dated -JULY, 25 2000,
which _ was X was not modified by Court Order(s) dated
3. Is the incapacitated person still living? YES
If no, answer the following:
(a) Date of Death?
(b) Place of Death?
(c) Name of Administrator or Executor?
(d) Date Guardian of the Person filed the last Annual Report?
4. If the incapacitated person is still living, answer the following questions:
(a) Date Guardian of the Person fled the last Annual Report? 7/25/07
(b) Current address of the incapacitated person
65 W. LOUTHER ST. CARLISLE, PA 17013
(c) Current age 66 Date of birth of incapacitated person 12/21/41
(d) The incapacitated person's residence is:
X Ward's own residence My home/apartment
Nursing Home Relative's Home
Hospital or Medical Facility Boarding Home
(e) The incapacitated person has been living there since MANY YEARS
If moved within the past year, state from where and the reason for the
change
(f) I rated his/her living arrangement as:
Excellent X Average Below Average
Explain•
~6~'
g) I believe he/she is:
_X content with the living situation
unhappy with the living situation
unaware of the living situation
5. Physical health
(a) Current physical condition of the incapacitated person is:
Excellent X Good Fair Poor
(b) His/her major physical health problems are as follows:
UROLOGICAL PROBLEMS ,HYPERTENSION,
OBSTRUCTIVE NEPHROPATHY, REFLUX
(c) During the past year, his/her physical condition has:
X remained about the same.
improved. Explain,
worsened. Explain.
(d) During the past year, he/she received the following medical treatment
(include check-ups and dental work):
Date Ailment Type of treatment Doctor's name
PERIODIC CHECK UPS STAFF PHYSICIANS @ STEVENS CLINIC
MONTHLY PSYCHIATRRIC MED MANAGEMENT @ STEVENS CLINIC
DR. PSYCH WYLEN
6. Mental Health
(a) The incapacitated person's condition is
Excellent Good X Poor
(b) His/her major health problems are as follows:
SCHIZOPHRENIA, DEPRESSION,
(c) During the past year, his/her mental condition has:
X remained about the same.
Improved. Explain
Worsened. Explain
(d) During the past year, treatment or evaluation by a psychiatrist,
psychologist or social worker _X_was was not provided. Such
mental health services are briefly described as:
ONGOING MED MANAGEMENT
7. Social Activities / Services
(a) His/her current social condition is:
excellent X good fair -poor
(b) During the past year, his/her social condition has:
X remained about the same.
improved. Explain.
worsened Explain
(c) During the past year he/she has participated in the following activities:
X recreational
educational
X social
occupational
no activities available
he/she refuses to participate in any activities
8. Visitation
(a) During the last year, I visited him/her as follows: BI-YEARLY AND
MONTHLY PHONE CONTACT
(b) The average amount of time I spent on each visit was 10 MINUTES
(c) The last time I visited was on Date 7/012/08
9. During the last year I have performed the following activities on behalf the
incapacitated person: MEDICAL AND FINANCIAL DECISIONS
10. I believe he/she has the following unmet needs. NONE
11. The guardianship _X_ should should not be continued without
modification because:
12. Please note any concerns about the Incapacitated person's physical or mental
well being or the finances that the Court should know.
13. I _X_ am am not guardian of the incapacitated person's estate. If yes,
my report is attached.
I certify under the penalties of perjury that the information contained in this report
is true and correct to the best of my knowledge, information and belief.
Date• ~ `~ ~
Name: BRIAN D. BROOKS
Signature of the Guardian of the Person
Telephone# (work) 717-299-4568
PENNSYLVANIA GUARDIANSHIP ASSOC. INC.
PO BOX 7295
LANCASTER, PA 17604
. ~
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: WILLIAM D. WILSON , an incapacitated person FILE NO. 2000-00501
GUARDIAN OF THE ESTATE ANNUAL REPORT rte?
--,
[20 Pa.C.S.A.5521 (c)] ~~ ~~~'
_, ~ ~~
FROM JULY 25 ,2007 TO JULY 25 ,2008 ' - -- ~ `_ ' _
_ ~ ; ._._
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1) I am the Limited X Plenary Guardian of the Estate of my ward, nari~d '~bove'~
- - - -~, --
I was appointed Guardian by Order of the Court dated _7/25/2000 , v~hich ~-''
was X_ was not modified by Court Order (s) dated r"
2) Is the incapacitated person still living? YES
If no, answer the following:
(a) Date of Death
(b) Place of Death
(c) Name of Adminstrator/trix or Executor/trix
(d) Date Guardian of the Person filed the last Annual Report
PLEASE ANSWER THE FOLLOWING QUESTIONS WHETHER THE
INCAPACITATED PERSON IS LIVING OR DECEASED.
3) My initial Inventory was filed on 8/31/00 and listed a total estate value of
$ 91.38
The Inventory listed a total monthly income of $ 240.00 comprised of the
following: DISBURSEMENTS FROM A TRUST
4) At the beginning date of this report period, my initial balance on hand was
$ 47,262.98
5) During this reporting period, the following reflects all sources of income (other than
Social security) received by me for my ward: (Add additional pages of needed)
Date Received Source of Income
SEE ALL DEPOSIT REPORT
TOTAL
Amount
24,000.00
r
6) During this reporting period, the following reflects all payments I have made for my
ward: (Add additional pages if needed)
Date To Whom Paid Reason for Payment Amount
SEE ALL TRANSACTION REPORT
7) The present principal assets of my ward are:
Description of Asset Present Value
1. PAGA CUSTODIAL ACCOUNT 939.73
2. M&T TRUST 21,681.03
TOTAL 22,620.76
TRUST CAN BE USED FOR CARE & MAINTANENCE BUT IS NOT AN ASSET OF
THE ESTATE.
8) The present amount and sources of income for my ward are:
Source of Income Amount of Income
1. TRUST DISBURSEMENTS
(Indicate whether monthly,
Quarterly, annually)
$ 2,000.00
9) The regular monthly ezpenses of my ward which I pay are:
To Whom Paid Amount
1. LOUTHER PLACE LIlVIITED $ 460.00
2. PA GUARDIANSHIP 250.00
3. SMART MED APPROXIMATES 20.00
4. COMCAST 100.00
5. EMBARQ 90.00
10) I have/(have not) (circle one) petitioned the Court for permission to invade principal
to meet the needs of my ward.
(If applicable) The following ezpenses of my ward have been paid from principal:
To Whom Paid Purpose Amount
1.
11) I (have)/have not (circle one) paid myself compensation for services I rendered as
guardian.
The amount I Paid myself totaled $ 4,500.00 and was
Calculated at the following rate: $ 250.00 per week/ (month) (circle one).
12) Check the correct response and complete, if appropriate.
_X There will be no need for extraordinary expenditures on behalf of my ward in
the next (12) months.
-There will be a need for extraordinary expenditures on behalf of my ward in
the nett (12) months because:
13) Check the correct response and complete, if appropriate.
A. My ward receives monthly social security benefits directly.
B. I am the designated payee to receive my ward's social security benefits.
C. The designated payee of my ward's social security benefits is
whose address is
and is/is not (circle one) related to my ward as
(insert relationship).
14) Please note any concerns about the incapacitated person's physical or mental well
being or the finances that the Court should know.
15) I_X_ am am not guardian of the incapacitated person's person. If yes,
report is attached.
I certify under the penalties of perjury that the information contained in this report is
true and correct to the best of my knowledge, information and belief.
Name: ~ ~~-~~ O~ TELEPHONE (Work) 717-299-4568
PENNSYLVANIA GUARDIANSHIP ASSOC. INC
PO BOX 7295
LANCASTER, PA 17604
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PAGAC07-PAGATEMP
8/13' 8
ITEMIZED CATEGORY REPORT
1/ 1' 0 Through 8/31' 8
Page 2
Date Num Description Memo Category Clr Amount
3/ 7' 8 R2445 DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X 2,000.00
3/12' 8 12894 SMARTMED INC WILLIAM WILSO WILSON,WILLIAM/ME X -17.79
3/12' 8 12895 CAPITAL BLUE CROSS WILLIAM WILSO WILSON,WILLIAM/IN X -1,172.55
3/14' 8 12917 COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X -99.30
3/14' 8 12936S PAGA GENERAL ACCT 3-4 2008 WILSON,WILLIAM/GD X -500.00
3/18' 8 12947 EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X -227.29
3/27' 8 129$8 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PE X -500.00
3/27' 8 12989 LOUTHER PLACE WILLIAM WILSO WILSON,WILLIAM/RE X -460.00
4/ 8' 8 13078 EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X -92.26
4/10' 8 R4911 DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X 2,000.00
4/15' 8 13182 COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X -106.52
4/30' 8 13223 LOUTHER PLACE WILLIAM WILSO WILSON,WILLIAM/RE X -460.00
5/ 6' 8 R5452 DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X 2,000.00
5/ 6' 8 13250 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PE X -500.00
5/ 7' 8 13286 SMARTMED INC WILLIAM WILSO WILSON,WILLIAM/ME X -20.93
5/ 7' 8 13291 MOBILE CLEANING SE WILLIAM WILSO WILSON,WILLIAM X -31$.00
5/ 7' 8 13315 EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X -91.42
5/21' 8 13452 COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X -130.85
5/23' 8 134605 PAGA GENERAL ACCT 5-6/08 WILSON,WILLIAM/GD X -500.00
5/27' 8 13461 LOUTHSR PLACE WILLIAM WILSO WILSON,WILLIAM/RE X -460.00
5/27' 8 13462 WILLIAM WILSON ACCT# 6146893 WTLSON,WILLIAM/PE X -500.00
6/ 3' 8 13567 EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X -93.40
6/ 5' 8 R5570 DEPOSIT BANK TRANSFER WTLSON,WILLIAM/BA X 2,000.00
6/11' 8 13597 CAPITAL BLUE CROSS WILLIAM WILSO WILSON,WILLIAM/IN X -1,172.52
6/16' 8 13686 COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X -125.27
6/25' 8 13707 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PE X -500.00
7/ 2' 8 13738 LOUTHER PLACE WILLIAM WILSO WILSON,WILLIAM/RE X -460.00
7/ 2' 8 13760 EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X -91.52
7/ 8' 8 13825 SMARTMED INC WILLIAM WILSO WILSON,WILLIAM/ME X -9.07
7/15' 8 138785 PAGA GENERAL ACCT 7-8 WILSON,WILLIAM/GD X -500.00
7/18' $ 13917 COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X -130.86
7/28' 8 13927 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PE X -500.00
7/28' 8 13933 MOBILE CLEANING SE WILLIAM WILSO WILSON,WILLIAM -318.00
8/ 4' 8 13981 LOUTHER PLACE WILLIAM WILSO WILSON,WILLIAM/RE -460.00
8/ 5' 8 R2702 DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA 2,000.00
TOTAL WILSON,WILLIAM 939.73
TOTAL INCOME 939.73
TOTAL INCOME/EXPENSE 939.73
~ ~~ ~~
ITEMIZED CATEGORY REPORT
1/ 1' 0 Through 8/31' 8
PAGAC07- PAGATEMP Page 1
8/13' 8
Date Num Description Memo Category Clr Amount
INCOME/ EXPENSE
INCOME
WILSON,WILLIAM
8/20' 7 11189 LOUTHER PLACE WILSON,WILLIAM/RE X -460.00
8/21' 7 11222 PAGA GENERAL ACCT GUARDIAN FEE WILSON,WILLIAM/GD X -750.00
9/ 6' 7 11292 EMBARQ WILSON,WILLIAM/UT X -90.84
9/10' 7 BEGINNING BALANCE WILSON,WILLIAM/BE X 4,300.56
9/13' 7 11313 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PE X -100.00
9i14' 7 11327 COMCA.ST WILLIAM WILSO WILSON,WILLIAM/UT X -98.81
9/14' 7 11358 CAPITAL BLUE CROSS WILLIAM WILSO WILSON,WILLIAM/IN X -1,066.89
9/14' 7 11381 SMARTMED INC WILLIAM WILSO WILSON,WILLIAM/ME X -10.12
9/21' 7 114085 PAGA GENERAL ACCT 9-10/07 WILSON,WILLIAM/GD X -500.00
9/27' 7 11495 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PB X -400.00
9/27' 7 11496 LOUTHER PLACE WILLIAM WILSO WILSON,WILLiAM/RE X -460.00
9/28' 7 11501 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PE X -100.00
10/11' ? 11619 SMARTMED INC WILLIAM WILSO WILSON,WILLIAM/ME X -18.68
10/11' 7 11622 EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X -91.05
10/17' 7 R8838 DEPOSIT ANNUITY WILSON,WILLIAM/AN X 2,000.00
10/17' 7 11658 COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X -94.32
10/23' 7 116?4 LOUTHER PLACE WILLIAM WILSO WILSON,WILLIAM/RE X -460.00
10/23' 7 11675 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PE X -400.00
11/ 6' 7 R8962 DEPOSIT ANNUITY WILSON,WILLIAM/AN X 2,000.00
11/ 8' 7 11849 SMARTMED INC WILLIAM WILSO WILSON,WILLIAM/ME X -10.23
11/ 8' 7 11851 BMBARQ WILLIAM WILSO WTLSON,WILLIAM/UT X -91.32
11/12' 7 11879 COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X -1.09.35
11/21' 7 11953 LOUTHER PLACE WILLIAM WILSO WILSON,WILLIAM/RE X -460.00
11/21' 7 11954 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PE X -400.00
12i 3' 7 120395 PAGA GENERAL ACCT 11-12/07 WILSON,WILLIAM/GD X -500.00
12/ 5' 7 12050 EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X -90.21
12/ 5' 7 R2188 DEPOSIT WILSON,WILLIAM/BA X 2,000.00
12/10' 7 12089 SMARTMED INC WILLIAM WILSO WILSON,WILLIAM/ME X -28.02
12/10' 7 12110 CAPITAL BLUE CROSS WILLIAM WILSO WILSON,WILLIAM/IN X -1,172.52
12/11' 7 12124 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PE X -600.00
12/17' 7 12172 MOBILE CLEANING SE WILLIAM WILSO WILSON,WILLIAM X -318.00
1/ 2' 8 12214 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PE X -400.00
1/ 2' 8 12215 LOUTHSR PLACE WILLIAM WILSO WILSON,WILLIAM/RE X -460.00
1/ 2' 8 12244 COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X -121.74
1/ 3' 8 12300 EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X -95.93
1/ 9' 8 R9243 DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X 2,000.00
1/21' 8 12409 COMCAST WILLIAM WILSO WILSON,WILLIAM/UT X -220.26
1/21' 8 R9279 DEPOSIT BANK TRANSFER WILSON,WILLIAM/BA X 2,000.00
1/31' 8 12491 LOUTFiER PLACE WILLIAM WILSO WILSON,WILLIAM/RE X -460.00
1/31' 8 12492 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PE X -400.00
1/31' 8 12515S PAGA GENERAL ACCT 1-2/08 WILSON,WILLIAM/GD X -500.00
2/ 5' 8 12539 EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X -91.47
2/ 6' 8 12566 SMARTMED INC WILLIAM WILSO WILSON,WILLIAM/ME X -12.21
2/23' 8 12740 WILLIAM WILSON ACCT# 6146893 WILSON,WILLIAM/PE X -500.00
3/ 4' 8 12741 LOUTHER PLACE WILLIAM WILSO WILSON,WILLIAM/RE X -460.00
3/ 4' 8 12762 WILLIAM WILSON CLOTHING WILSON,WILLiAM/PE X -150.00
3/ 4' 8 12765 EMBARQ WILLIAM WILSO WILSON,WILLIAM/UT X -91.31
.~- S ~'~
IL~~-c9-~°~
. ITEMIZED CATEGORY REPORT
8/ 1' 7 Through 7/31' 8
PAGA CUS-PAGA Custodial
8/13' 8
Date Num Description Memo
Category
INCOME/EXPENSE
INCOME
WILSON,WILLIAM
Page 1
Clr Amount
8/ 1' 7 11064 EMBARQ WILLIAM WILLO WILSON,WILLIAM/UT X
8/ 2' 7 110725 PAGA GENERAL ACCOU 4-6/07 WILSON,WILLIAM/GU X
8/ 7' 7 11122 SMARTMED INC W.WILLSON/ WI WILSON,WILLIAM/ME X
8/ 8' 7 R6745 DEPOSIT BANK TRANSFER WILSON,WILLIAM X
8/ 14' 7 11165 COMCAST W.WILSON WILSON,WILLIAM/UT X
8/ 20' 7 11179 WILLIAM WILSON ACCT# 614689 WILSON,WILLIAM/PE X
8/ 20' 7 11189 LOUTFIER PLACE LIMI WILLIAM WILLO WILSON,WILLIAM/RE
8/ 21' 7 11223 REGISTER OF WILLS WILLIAM WILLO WILSON,WILLIAM X
TOTAL WILSON,WILLIAM
TOTAL INCOME
TOTAL INCOME/EXPENSE
~-
-90.95
-750.00
-3.14
2,oao.oo
-98.81
-400.00
-460.00
-15..00
'~
' ITEMIZED CATEGORY REPORT
• 8/ 1' 7 Through 7/31' 8
PAGA_CUS-PAGA Custodial
8/13' $
Date Num
INCOME/EXPENSE
INCOME
WILSON,WILLIAM
8/ 8' 7 R6745 DEPOSIT
Description
Memo
Page 1
Clr Amount
Category
TOTAL WILSON,WILLIAM
TOTAL INCOME
TOTAL INCOME/EXPENSE
2,000.00
2,000.00
ITEMIZED CATEGORY REPORT
1/ it 0 Through 8/31' 8
PAGAC07-PAGATEMP
8/13' 8
Page 1
Date Num Description Memo Category Clr Amount
INCOME /EXPENSE
INCOME
WILSON,WILLIAM
$c~.oJ/~ 1 ~-ic1 s ~Ar s.
10/ 17' 7 R8838 DEPOSIT ~Y (~ WILSON,WILLIAM/A X 2,000.00
11/ 6' 7 R8962 DEPOSIT ~N1QVI '~Y ~~ WILSON,WILLIAM/A X 2,000.00
12/ 5' 7 R2188 DEPOSIT WILSON,WILLIAM/B X 2,000.00
1/ 9' 8 R9243 DEPOSIT BANK TRANSFER WILSON,WILLIAM/B X 2,000.00
1/ 21' 8 R9279 DEPOSIT BANK TRANSFER WILSON,WILLIAM/B X 2,000.00
3/ 7' $ R2445 DEPOSIT BANK TRANSFER WILSON,WILLIAM/B X 2,000.00
4/ 10' $ R4911 DEPOSIT BANK TRANSFER WILSON,WILLIAM/B X 2,000.00
5/ 6' 8 R5452 DEPOSIT BANK TRANSFER WILSON,WILLIAM/B X 2,000.00
6/ 5' 8 R5570 DEPOSIT BANK TRANSFER WILSON,WILLIAM/B X 2,000.00
8/ 5' 8 R2702 DEPOSIT BANK TRANSFER WILSON,WILLIAM/B 2,000..00
TOTAL WILSON,WILLIAM 20,000.00
TOTAL INCOME 20,000.00
TOTAL INCOME/EXPENSE
~~
BANK TRANSFER WILSON,WILLIAM X 2,000.00
2,000.00
~ ice. ~
20,000.00
PAGA_CUS-PAGA Custodial
8/13' 8
Date Num
ITEMIZED CATEGORY REPORT
8/ 1' 7 Through 7/31' 8
Category
Page 1
Clr Amount
Description
Memo
INCOME/EXPENSE
INCOME
WILSON,WILLIAM
8/ 2' 7 110725 PAGA GENERAL ACCOUN 4-6/07
TOTAL WILSON,WILLIAM
TOTAL INCOME
PAGAC07-PAGATEMP
8/13' 8
Date Num
WILSON,WILLIAM/G X -750.00
-750.00
-750.00
ITEMIZED CATEGORY REPORT
1/ 1' 0 Through 8/31' 8
Page 1
Description Memo Category
INCOME/EXPENSE
INCOME
WILSON,WILLIAM
Clr Amount
8/ 21' 7 11222 PAGA GENERAL ACCT GUARDIAN FEE WILSON,WILLIAM/GD X -750.00
9/ 21' 7 114085 PAGA GENERAL ACCT 9-10/07 WILSON,WILLIAM/GD X -500.00
12/ 3' 7 120395 PAGA GENERAL ACCT i1-12/07 WILSON,WILLIAM/GD X -500.00
1/ 31' 8 12515S PAGA GENERAL ACCT 1-2/08 WILSON,WILLIAM/GD X -500.00
3/ 14' 8 129365 PAGA GENERAL ACCT 3-4 2008 WILSON,WILLIAM/GD X -500.00
5/ 23' 8 13460S PAGA GENERAL ACCT 5-6/08 WILSON,WILLIAM/GD X -500.00
7/ 15' 8 138785 PAGA GENERAL ACCT 7-8 WILSON,WILLIAM/GD X -500.00
TOTAL WILSON,WILLIAM -3,750.00
TOTAL INCOME -3,750.00
TOTAL INCOME/EXPENSE
~~
O~~P
-3,750.00
ANNUAL REPORT OF GUARDIAN OF THE ESTATE
THE COURT OF COMMON PLEAS OF CUMBERLAND CO., PENNSYLVANIA
ORPHANS' COURT DIVISION ,~,
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Estate of: WILLIAM D. WILSON III , an incapacitated person ~ ~~
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FILE NO: 2000-00501
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'
I. INTRODUCTION
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,
PENNSYLVANIA GUARDIANSHIP ASSOC. / BRIAN D. BROOKS, way, -
appointed -Limited _X Plenary Guardian of the Person by Decree of
G.E. HOFFER ,Judge. Dated 7/25/00
X A. This is the Annual Report for the period from 7/25/08 to 7/25/09
_ B. This is the Final Report for the period from to 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 6y Decree of
,Judge, Dated
II. SUMMARY
A. State the value of the estate reported on the Inventory ~ 9138
B. State the value(s) of principle assets at the beginning of the Report Period.
(Same as inventory if this is first Report, otherwise, ending balance from last Report.)
$ 22,620.76
C. What is the total amount of income earned during the Report period?
$ 1,403.26
D. What is the total amount of income and principle spent for all purposes during
this Report period?
$ 23,54339
E. What are the balance remaining at the end of the Report period?
1. Principle $
2. Income $ 480.12
3. Total of Principle and Income $480.12
III. ADDITIONAL INFORMATION
(If more space is needed, please attach additional pages.)
A. Principle
L How is the principle balance listed above currently invested? (P'lease
specify, e.g. real estate, certificates of deposit, restricted bank accounts, etc.):
2. Have there been any expenditures from principle during this Report
period.? ves no
If yes:
a. Have all expenditures from principle been for the sole benefit of the
Incapacitated Person? yes _ no
b. List purpose and amount of expenditures:
C. Was Court of approval received prior to expending principal?
yes no
3. Were additional principle assets received during the Report period
which were not included in the Inventory or a prior Report filed for the Estate?
ves no
If yes:
a. Was Court approval requested prior to receiving additional principle?
ves no
b. State the sources and amounts of the additional principle received:
B. Income
1. State sources of income received during the Report period
(e.g., Social Security, pensions, rents etc.):
1. SUPPLEMENTAL SECURITY INCOME
2. (DISBURSEMENTS FROM SPECIAL NEEDS TRUST) NOT INCOME
3.
Total income received during Report period: $ 1,403.2b
2. How is the income currently invested? (Please specify, e.g. restricted
bank accounts, client care account, etc.):
PAGA CUSTODIAL ACCOUNT
C. Expenses for Care and Maintenance
Specify what expenditures were made from the principle and income for the care and
maintenance of the Incapacitated Person (e.g., clothing, nursing home, medicine, support,
etc.):
SEE ATTACHED ALL TRANSACTION REPORT
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.)
E. Guardian's Commissions
List amounts of compensation paid as Guardian's commission and state how amount was
determined:
Amoant Method of Determination Court Approval Obtained
$ 1,750.00 7(a, 250.00 (ves) no
F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
I verify that the foregoing information correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties if 18 Pa.
C.S.A. S/S 4904
Date: / ~/
ignature of the Guardian of the Person
Brian D. Brooks
Name of Guardian of the Person (type or print)
PENNSYLVANIA GUARDIANSHIP ASSOC.
PO BOX 7295
LANCASTER, PA 176041
Telephone 717-299-4568
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ANNUAL REPORT OF GUARDIAN OF THE PERSON
THE COURT OF COMMON PLEAS OF CUMBERLAND CO.,, PENNSYLVANIA
ORPHANS' COURT DIVISION n,,
n a
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Estate of: WILLIAM D. WILSON III ~~ ~ c 1
an incapacitated person ~ ~ ~'
FILE NO: 2000-00501 ~ ~ c.a `_ ~ -'
~;
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I. INTRODUCTION "~=' " ~ µ' '
~ ~ rv ,-
:~
PENNSYLVANIA GUARDIANSHIP ASSOC. / BRIAN D. BROOKS, wac~r~
appointed -Limited Plenary Guardian of the Person by Decree of
G. E. HOFFER , Judae. Dated 7/25/00
X A. This is the Annual Report for the period from 7/25/08 to 7/25/09
_ B. This is the Final Report for the period from to and is
fled 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
,Judge, Dated
For a Final Report, omit Sections II through IV
II. PERSONAL DATA
Age of the Incapacitated Person 64 Date of Birth 12/21/44
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
45 WEST LOUTHER ST, APT'3G, HANOVER, PA 17013
B. The Incapacitated Person's residence is:
X ward's 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)
C. The Incapacitated Person has been in the present residence since
20(11_ if the Incapacitated Person has moved within the past
year, state prior residence and reason for move:
f
Estate of: WILLIAM D. WILSON III , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
CARLISLE REGIONAL HOSPITAL
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as
follows: MILD DEMENTIA
B. Specify what if any ,social, medical, psychological and. support services
the Incapacitated Person is receiving:
PSYCH AND MED MANAGEMENT SERVICES PROVIDED BY THE STEVENS
CENTER OF CARLISLE
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship
should
X Continue be modified be terminated
The reasons for the foregoing opinion are:
B. During the past year, the Guardian of the Person has visited the
Incapacitated Person 4 times with average visit lasting
Hours, 15-20 minutes.
The report of a social service organizatwn 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 correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties if 18 Pa.
C.S.A. S/S 4904
Date: / D
ignature of the Guardian of the Person
Brian D. Brooks
Name of Guardian of the Person (type or print)
PENNSYLVANIA GUARDIANSHIP ASSOC.
PO BOX 7295
LANCASTER, PA 17604
Telephone 717-299-4568
ANNUAL REPORT OF GUARDIAN OF THE ESTATE
THE COURT OF COMMON PLEAS OF CUMBERLAND CO., PENNS °
ORPHANS' COURT DIVISION ~~ ~~
~~~ ""~
m ~
GrJ ~ ~.J
Estate of: WILLIAM D. WILSON III , an incapacitated person ~; o ° ,~
FILE NO: 2000-80501 ~ ~~ _
_~ -,
I. INTRODUCTION
PENNSYLVANIA GUARDIANSHIP ASSOC. / BRIAN D. BROOKS, was
appointed Limited ~_Plenary Guardian of the Person by Decree of
G.E. HOPPER .Judge. Dated 7/25/00
X A. This is the Annual Report for the period from 7/25/09 to 7/25/10
_ B. This is the Final Report for the period from to
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 h3' Decrce of
.Judge. Dated
II. SiJbIIVIARY
A, State the valae of the estate reported on the Inventory 9138
B. State the value(s) of principle assets at the beginning of the Report Period.
(Same as inventory if this is first Report, otherwise, eeding balance from hat Report.)
S 480.12
C. What ~ the total amount of income earned daring the Report period?
10,461.00
D. What m the total amoant of income aed principle spent for all purposes daring
this Report period?
10,133.22
E. What are the bahnce remaining at the end of the Report period?
1. Principle S
2. Ineome S 807.90
3. Total of Principle and Iernme S 807,90
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III. ADDITIONAL INFORMATION
(Ijnrore space is needed, please adocJk addWiortd Pages)
A. Principle
1. How is the principle balaace listed above currently invested? (Please
specify, e.g. real estate, certificates of deposit, restricted bank accounts, etc.):
2. Hive there been any ezpenditares tYom priaciple during this Report
period.? ves X no
If yes:
a. Have all ezpeuditares from principle been for the sole benefit of the
Incapacitated Person? ves no
b. List purpose and amount of ezpeaditnres:
C. Was Coart of approval received prior to ezpending principal?
ves no
3. Were additioaal principle assets received dsriag the Report period
which wen not included L the Inventory or a prior Report Sled for the Estate?
ves no
If yes:
a. Was Coart approval regaested prior to receiving additional principle?
ves ao
b. State the soar+ces and amoaets of the additional principle received:
B. Income
1. State soarcea of income received daring the Report period
(e.g., Social Security, Pensions, rents etc.):
1. SUPPLEMENTAL SECURITY INCOME
2. (DISBURSEMENTS FROM SPECIAL NEEDS TRUST) NOT INCOME
Total income received during Report period: 10,461.00
2. How is the income currently invested? (Please specify, e.g. restricted
bank aaxounts, client care aaxount, etc.):
PAGA CUSTODIAL ACCOUNT
C. Ezpenses for Care and Maintenance
Specify what e:penditnres were made from the principle and income for the care and
maintenance of the Incapacitated Person (eg., clothing, nnrsiag home, medicine, support,
etc.):
SEE ATTACHED ALL TRANSACTION REPORT
D. Other Ezpenditares
Specify what other ezpenditures were made daring the Report Period. (Do not inclnde any
items stated in response to question C. above.)
E. Guardian's Commissions
List amonnb of compensation paid as Guardian's commission and state how amount was
determined:
Amount
Mdkod ojlkterniination Court Apprnval Obtained
a 25Q00 l na, 2590 (ves) no
F. Coensel Fee
List amounts paw as counsel fce, and indicate whether Court approval was obtained.
I verify that the foregoing information correct to the beat of my knowledge,
information and belief; and that this Verificatioe is subject to the penalliea if 18 Pa.
C.S.A. S/S 4904
Date•
~aatare of the Guardian of the Person
Brian D. Brooks
Name of Guardian of the Person (type or print)
PENNSYLVANIA GUARDIANSHIP ASSOC.
PO BOX 7295
LANCASTER, PA 17604
Telephone 717-299-4568
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ANNUAL REPORT OF GUARDIAN OF THE PERSON
THE COURT OF COMMON PLEAS OF CUMBERLAND CO., FENNSYLVAN,1;~
ORPHANS' COURT DIVISION co d
~~~ ~
~ ~
Esbte of: WILLIAM D. WILSON III , an incapacibtcd person ~ ~;, ~ -r
FILE NO: 2400-OOSOl ~ p ~ a
QC =_
I. INTRODUCTION a ~
cn
L7
PENNSYLVANIA GUARDIANSHIP ASSOC. / BRIAN D. BROOKS, was
appointed Limited Plenary Guardian of the Person by Decree of
G. E. HOPPER . Judge. Dated 7/25/00
X A. This is the Annual Report for the period from 7/ZSN9 to 7/2S/10
B. Thin is the Final Report for the period from to and is
filed for the following reason:
1. The death of the Incapacibted Peyson. Date of death ~_
2. The Guardianship was terminated by the Court by Decree of
Jadae; Dated
For a Final Report, omit Sections II tlYrough l i
II. PERSONAL DATA
Age of the Incapacitated Person 6S Date of Birth 12/21/44
III. LIVING ARRANGEMENTS
A. Current address of the Incapacibted Person:
4S WEST LOUTHER ST, APT 3G, HANOVER, PA 17013
B. The Incapacitated Person's residence is:
X ward's 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)
C. The Incapacibted Person hAs been in the prevent residence since
20111_ if the Inexpacibted Person has moved within the past
year, abte prior residence and reason for move:
~~
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Estate of: WILLIAM D. WILSON III , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
CARLISLE REGIONAL HOSPITAL
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as
follows: MILD DEMENTIA
B. Specil~ what if any ,social, medical, psychological and support services
the Incapacitated Person is receiving:
PSYCH AND MED MANAGEMENT SERVICES PROVIDED BY THE STEVENS
CENTER OF CARLISLE
V. GUARDIAN'S OPII~IION
A. It is the opinion of the Guardian of the Person that the guardianship
should
X Continue be modified be terminated
The reasons for the foregoing opinion are:
B. Daring the past year, the Guardian of the Person has visited the
Incapaeibted Person ,_ 4 _ fumes with averse visit lasting __,`
Hours, 15-20 ^minutes.
Tlire report oja social service organization emyployed b3'tJlre Guardian to ovrrsee and
coordinate the cqn ojtlke Incapacitated Person jbr tJke period covered r6y tArts Report
nay be attached to srtpplentent tJkis Report
I verify that the forgoing information correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penautiea if 18 Pa.
C.S.A. S/S 4'904
Date: /
S' lure of the Guardian of the Person
Brian D. Brooks
Name of Guardian of the Person (type or print)
PENNSYLVANIA GUARDIANSHIP ASSOC.
PO BOX 7295
LANCASTER, PA 17604
Telephone 717-299-4568
COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: WILLIAM D. WILSON II
FILLE NO: 2000-00501
AN INCAPACITATED PERSON
ANNUAL REPORT OF THE GUARDIAN OF THE PERSON
1. INTRODUCTION
Pennsylvania Guardianship Association /Brian D. Brooks was appointed the
Limited, X Plenary Guardian of the person by Decree of
G HOFFER . Jude Dated: 7/25/00
X (A) This is the Annual Report for the period from 7/25/10 to 7/25/11
(B) This the Final Report for the period from to
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
Jude Dated
For Final Report, omit sections II through IV.
2. PERSONAL DATA
Age of the incapacitated person 66 Date of Birth 12/21 /44
3. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
GOLD-N-GRAY PCH 18801 MAIN ST. DRY RUN, PA 17220
B. The Incapacitated Person's residence is:
_ Ward's own home /apartment
- Nursing Home
X Boarding Home /Personal Care Home
_ Guardians Home /Apartment
_ Hospital or Medical Facility
Relative's Home (name, relationship and address)
C. The Incapacitated Person has lived here since: 9/10
~ -,-,
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-~~
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~,~ ~ ~ .
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If the Incapacitated Person has moved since the last report, state the prior address and reason for
move: PHYSICAL DECLINE
Estate of: WILLIAM D. WILSON III
D. Name and address of the Incapacitated Person's primary care giver:
GOLD-N-GRAY PERSONAL CARE HOME
4. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are:
MILD DEMENTIA
B. Specify what if any, social, medical, psychological and supportive services the
Incapacitated Person is receiving:
ALL SERVICES PROVIDED BY STAFF AND PHYSICIANS AT THE FACILITY
5. GUARDIAN'S OPINION
A. It is the opinion of the guardian that the guardianship should:
X Continue Be modified Be terminated
The reason for the foregoing opinion is: The need for the guardian continues
B. During the past year the Guardian of the Person has visited the Incapacitated Person
4 With an average visit time lasting 15-20 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 true and correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A.
S/S 4904.
Brian D. Brooks
Pennsylvania Guardianship Association
Date• ~~/
PO Boz 7295
Lancaster, PA 17604
717-299-4568
COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: WILLIAM D. WILSON III , AN INCAPACITATED PERSON
r- Q
FILLE NO: 2000-00501 ,~'~ ~'
_.,~~
~,
ANNUAL REPORT OF THE GUARDIAN OF THE ESTATE: ~~ T='
,.'(";ice
1. INTRODUCTION _~;
-- -+
i> ..
Pennsylvania Guardianship Association /Brian D. Brooks was appointed the
Limited, X Plenary Guardian of the Estate by Decree of
G. HOFFER , Jude Dated: 7/25/00
X (A) This is the Annual Report for the period from 7/25/10 to 7/25/11
_ (B) This the Final Report for the period from to
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
. Judge, Dated
2. SUMMARY
A. State the value of the estate reported on the inventory 91.38
B. State the value(s) of principle assets at the beginning of the Report Period.
(Same as the inventory if this is the first report, otherwise, balance from last report)
$ 807.90
C. What is the total amount of income earned during the report period?
$ 12,920.30
D. What is the total amount of income and principle spent for all purposes during the
report period.
$ 13,728.20
E. What are the balances remaining at the end of the report period?
1. Principle $
2. Income $
3. Total principle and income $ 00.00
~~ ;....
.~;
THE ESTATE OF: WILLIAM D. WILSON III
3. ADDITIONAL INFORMATION
(If more space is needed, please attach additional pages.)
A. Principle
1. How is the principle balance listed above currently invested? (Specify)
2. Have there been any expenditures from principle during this report period?
X Yes No
If yes:
a. Have al all expenditures from principle been for the sole benefit of the
Incapacitated Person? X Yes No
b. List the purpose and amount of expenditures:
THIS WARDS MONTHLY INCOME CONSISTS OF SSI PAYMENTS OF $1,113.30.
$1,028.30 IS HIS MONTHLY COSTS OF CARE AT THE FACILITY. HE SPENDS THE
REMAINING $85.00 EVERY MONTH ON CIGARETTES AND PERSONAL NEEDS. HE
DOES NOT CONSERVE ANY FUNDS.
c. Was approval received prior to expending principle?
Yes X No
3. Were additional principle assets received during this report period that were not
included in the inventory or any prior report filed for the estate?
Yes X No
If yes:
a. Was court approval requested prior to receiving additional principle?
Yes No
b. State the sources and amounts of additional principle received:
B. Income
1. State sources of income received during the report period:
1. SSI
Total income received during report period: $ 12,920.30
2. How is the income currently invested? (Specify)
ALL INCOME NOW MANAGED BY GOLD-N-GRAY PERSONAL CARE HOME
THE ESTATE OF: WILLIAM D. WILSON II
C. Expenses for Care and Maintenance:
(Specify what expenditures were made from the principle and income for the care and
maintenance of the incapacitated person)
ALL INCOME EXCEPT FOR $ 85.00 PER MONTH GOES TOWARDS HIS CARE.
D. Other expenditures (Specify any other expenditures not previously reported)
E. Guardians Commissions
(List the amounts of compensation paid as guardian's commission and state how amount
was determined:)
Amount Method of Determination Court Approval Obtained
650 00 4 ~a 100.001 (a~ 250.00 (Yes) No
F. Counsel Fee
(List amounts paid as counsel fee, and indicate whether Court approval was obtained.)
I verify that the foregoing information is true and correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A.
S/S 4904.
Tian D. Brooks
Date: ~0/y//
Pennsylvania Guardianship Association
PO Box 7295
Lancaster, PA 17604
717-299-4568
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COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: WILLIAM D. WILSON III
FILLE NO: 2000-00501
AN INCAPACITATED PERSON
ANNUAL REPORT OF THE GUARDIAN OF THE ESTATE
1. INTRODUCTION
Pennsylvania Guardianship Association /Brian D. Brooks was appointed the
Limited, X Plenary Guardian of the Estate by Decree of
G. HOFFER , Jude Dated: 7/25/00
X (A) This is the Annual Report for the period from 7/25/10 to 7/25/11
(B) This the Final Report for the period from to
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
Jude, Dated
2. SUMMARY
A. State the value of the estate reported on the inventory 91.3 8
B. State the value(s) of principle assets at the beginning of the Report Period.
(Same as the inventory if this is the first report, otherwise, balance from last report)
$ 00.00
C. What is the total amount of income earned during the report period?
$ 13,359.60
D. What is the total amount of income and principle spent for all purposes during the
report period.
$ 13,359.60
E. What are the balances remaining at the end of the report period?
1. Principle $
n ~w
~~'
2. Income $ z' ~_ c ~
~ ~ ~~ ~_
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3. Total principle and income ~i
$ 00.0~~ ~- _ ~
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,;:;=
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~ ~~
THE ESTATE OF: WILLIAM D. WILSON III
3. ADDITIONAL INFORMATION
(If more space is needed, please attach additional pages.)
A. Principle
1. How is the principle balance listed above currently invested? (Specify)
2. Have there been any expenditures from principle during this report period?
Yes X No
If yes:
a. Have al all expenditures from principle been for the sole benefit of the
Incapacitated Person? Yes No
b. List the purpose and amount of expenditures:
THIS WARDS MONTHLY INCOME CONSISTS OF SSI PAYMENTS OF $1,113.30.
$1,028.30 IS HIS MONTHLY COSTS OF CARE AT THE FACILITY. HE SPENDS THE
REMAINING $85.00 EVERY MONTH ON CIGARETTES AND PERSONAL NEEDS. HE
DOES NOT CONSERVE ANY FUNDS.
c. Was approval received prior to expending principle?
Yes No
3. Were additional principle assets received during this report period that were not
included in the inventory or any prior report filed for the estate?
Yes X No
If yes:
a. Was court approval requested prior to receiving additional principle?
Yes No
b. State the sources and amounts of additional principle received:
B. Income
1. State sources of income received during the report period:
1. SSI
Total income received during report period: $ 13,359.60
2. How is the income currently invested? (Specify)
ALL INCOME NOW MANAGED BY GOLD-N-GRAY PERSONAL CARE HOME
THE ESTATE OF: WILLIAM D. WILSON II
C. Expenses for Care and Maintenance:
(Specify what expenditures were made from the principle and income for the care and
maintenance of the incapacitated person)
ALL INCOME EXCEPT FOR $ 85.00 PER MONTH GOES TOWARDS HIS CARE.
D. Other expenditures (Specify any other expenditures not previously reported)
E. Guardians Commissions
(List the amounts of compensation paid as guardian's commission and state how amount
was determined:)
Amount Method of Determination Court Approval Obtained
$ 00.00 (Yes) No
F. Counsel Fee
(List amounts paid as counsel fee, and indicate whether Court approval was obtained.)
I verify that the foregoing information is true and correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A.
S/S 4904.
..
~~,~
< P ^_
r f,
Tian .Brooks
Pennsylvania Guardianship Association
Hate: ~ /~d `/.~'
PO Box 7295
Lancaster, PA 17604
717-299-4568
COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: WILLIAM D. WILSON II , AN INCAPACITATED PERSON
FILLS NO: 2000-00501
ANNUAL REPORT OF THE GUARDIAN OF THE PERSON
1. INTRODUCTION
Pennsylvania Guardianship Association /Brian D. Brooks was appointed the
Limited, X Plenary Guardian of the person by Decree of
G. Hoffer , Jude Dated: 7/25/00
X (A) This is the Annual Report for the period from 7/25/11 to 7/25/12
(B) This the Final Report for the period from to
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
Jude, Dated
For Final Report, omit sections II through IV.
2. PERSONAL DATA
Age of the incapacitated person 67 Date of Birth 12/21/44
3. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
GOLD-N-GRAY PCH 18801 MAIN ST. DRY RUN, PA 17220 .,
n
B. The Incapacitated Person's residence is: ~,
~ -x ~.~
~ ~
~-7--~ ; n
;.43! .1 J
Ward's own home i apartment ~' z ~ ' ~
~~.
~
" ~°
c
° .__~' ="
E ~ ' }
Nursing Home ~
'°
-, x ;.
X Boarding Home /Personal Care Home ~ ~.`' -v ° -~ '= T
Guardians Home /Apartment ~ `=_ ~ ~ = ~~'
Hospital or Medical Facility ~ ~ c,,3 ~~ ~;
Relative's Home (name, relationship and address) --~ r'
C. The Incapacitated Person has lived here since: 9/10
If the Incapacitated Person has moved since the last report, state the prior address and reason for
move:
h~
Estate of: WILLIAM D. WILSON III
D. Name and address of the Incapacitated Person's primary care giver:
GOLD-N-GRAY PERSONAL CARE HOME
4. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are:
MILD DEMENTIA
B. Specify what if any, social, medical, psychological and supportive services the
Incapacitated Person is receiving:
ALL SERVICES PROVIDED BY STAFF AND PHYSICIANS AT THE FACILITY
5. GUARDIAN' S OPINION
A. It is the opinion of the guardian that the guardianship should:
X Continue Be modified Be terminated
The reason for the foregoing opinion is: The need for the guardian continues
B. During the past year the Guardian of the Person has visited the Incapacitated Person
4 With an average visit time lasting.l5-20 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 true and correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A.
S/S 4904.
~rialt$: Brooks
Pennsylvania Guardianship Association
PO Box 7295
• ~s~l~/~
Date.
Lancaster, PA 17604
717-299-4568
,+ r
'f COURT OF COMMON PLEAS CUMBERLAND COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: WILLIAM D.WILSON 11 ,AN INCAPACITATED PERSON
FILLE NO: 2000-00501
ANNUAL REPORT OF THE GUARDIAN OF THE PERSON
1. INTRODUCTION
Pennsylvania Guardianship Association /Brian D. Brooks was appointed the
Limited, X Plenary Guardian of the person by Decree of
G. Hoffer , Judae Dated: 7/25/00
X (A) This is the Annual Report for the period from 7/25/12 to 7/25/13
(B) This the Final Report for the period from to
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
,JudQe, Dated
For Final Report,omit sections 11 through IV.
2. PERSONAL DATA
Age of the incapacitated person 68 Date of Birth 12/21/44
3. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person: �, = z m
STONEHEDGE RETIREMENT 7125 HORSE VALLEY RD. EAST WATER "D, PA3002,�i o
= z r, c� tn �
A r -f o
B. The Incapacitated Person's residence is: n r rn v r
Ward's own home/apartment o o Ci C
Nursing Home o C> �, Z-a
X Boarding Home/Personal Care Home i= m
v Guardians Home/Apartment p Cr-„ <,
Hospital or Medical Facility
_,, Relative's Home (name, relationship and address)
C. The Incapacitated Person has lived here since: 3/13
If the Incapacitated Person has moved since the last report, state the prior address and reason for
move:
GOLD-N-GRAY 18801 MAIN ST. DRY RUN, PA 17220
THE PERSONAL CARE HOME HE WAS LIVING IN CLOSED.
k ”
r +
Estate of: WILLIAM D.WILSON III
D. Name and address of the Incapacitated Person's primary care giver:
STONEHEDGE RETIREMENT HOME
4. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are:
MILD DEMENTIA,RENAL INSUFFICIENCE
B. Specify what if any, social, medical,psychological and supportive services the
Incapacitated Person is receiving:
ALL SERVICES PROVIDED BY STAFF AND PHYSICIANS AT THE FACILITY
5. GUARDIAN'S OPINION
A. It is the opinion of the guardian that the guardianship should:
X Continue Be modified Be terminated
The reason for the foregoing opinion is: The need for the guardian continues
B. During the past year the Guardian of the Person has visited the Incapacitated Person
4 With an average visit time lasting 15-20 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 true and correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A.
S/S 4904.
s
Date: FA
rian D.Brooks
Pennsylvania Guardianship Association
PO Boa 7295
Lancaster,PA 17604
717-299-4568
COURT OF COMMON PLEAS CUMBERLAND COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: WILLIAM D. WILSON III ,AN INCAPACITATED PERSON
FILLE NO: 2000-00501
ANNUAL REPORT OF THE GUARDIAN OF THE ESTATE
1. INTRODUCTION
Pennsylvania Guardianship Association / Brian D. Brooks was appointed the
Limited, X Plenary Guardian of the Estate by Decree of
G. Hoffer , Judae Dated: 7/25/00
X (A) This is the Annual Report for the period from 7/25/12 to 7/25/13
(B) This the Final Report for the period from to
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
Judge, Dated
2. SUMMARY
A. State the value of the estate reported on the inventory $ 91.38
B. State the value(s) of principle assets at the beginning of the Report Period.
(Same as the inventory if this is the first report, otherwise, balance from last report)
$ 00.00
C. What is the total amount of income earned during the report period?,, y
$ 14,031.60 x o m cl�
co c a
rn
v
D. What is the total amount of income and principle spent for all purposse,,EdyS ang the ."'-.i a
report period. n N rn'
$ 14,031.60 n c; o 0
o c 3 S
E. What are the balances remaining at the end of the report period? = :;a N r- m
1. Principle $ n w co o
2. Income $
3. Total principle and income $ 00.00
WILLIAM RECEIVES $85.00 PER MONTH IN SPENDING MONEY. HE SPENDS
ALL OF HIS MONEY MONTHLY ON SNACKS AND CIGARETTES.
THE ESTATE OF: WILLIAM D. WILSON III
3. ADDITIONAL INFORMATION
(If more space is needed, please attach additional pages.)
A. Principle
1. How is the principle balance listed above currently invested? (Specify)
2. Have there been any expenditures from principle during this report period?
Yes X No
If yes:
a. Have al all expenditures from principle been for the sole benefit of the
Incapacitated Person? Yes No
b. List the purpose and amount of expenditures:
THIS WARDS MONTHLY INCOME CONSISTS OF SSI PAYMENTS OF $1,169.30.
$1,084.30 IS HIS MONTHLY COSTS OF CARE AT THE FACILITY. HE SPENDS THE
REMAINING $85.00 EVERY MONTH ON CIGARETTES AND PERSONAL NEEDS. HE
DOES NOT CONSERVE ANY FUNDS.
c. Was approval received prior to expending principle?
Yes No
3. Were additional principle assets received during this report period that were not
included in the inventory or any prior report filed for the estate?
Yes X No
If yes:
a. Was court approval requested prior to receiving additional principle?
Yes No
b. State the sources and amounts of additional principle received:
B. Income
1. State sources of income received during the report period:
1. SSI
Total income received during report period: $ 1,4031.60
2. How is the income currently invested? (Specify)
ALL INCOME NOW MANAGED BY STONEHEDGE PERSONAL CARE HOME
r
THE ESTATE OF: WILLIAM D. WILSON 11
C. Expenses for Care and Maintenance:
(Specify what expenditures were made from the principle and income for the care and
maintenance of the incapacitated person)
ALL INCOME EXCEPT FOR $ 85.00 PER MONTH GOES TOWARDS HIS CARE.
D. Other expenditures (Specify any other expenditures not previously reported)
E. Guardians Commissions
(List the amounts of compensation paid as guardian's commission and state how amount
was determined:)
Amount Method of Determination Court Approval Obtained
$ 00.00 (Yes) No
F. Counsel Fee
(List amounts paid as counsel fee, and indicate whether Court approval was obtained.)
I verify that the foregoing information is true and correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A.
S/S 4904.
i
Date: .3 l3
. Brooks
Pennsylvania Guardianship Association
PO Box 7295
Lancaster,PA 17604
717-299-4568
COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: WILLIAM D. WILSON III , AN INCAPACITATED PERSON
FILLE NO: 2000-00501
ANNUAL REPORT OF THE GUARDIAN OF THE PERSON
1. INTRODUCTION
Pennsylvania Guardianship Association /Brian D. Brooks was appointed the
Limited, X Plenary Guardian of the person by Decree of
G. Hoffer , Jud�e Dated: 7/25/00
X (A) This is the Annual Report for the period from 7/25/13 to 7/25/13
_ (B) This the Final Report for the period from to
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
, Judge, Dated
For Final Report, omit sections II through IV.
2. PERSONAL DATA
Age of the incapacitated person 69 Date of Birth 12/21/44
3. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person: �, � � :
STONEHEDGE RETIREMENT 7125 HORSE VALLEY RD. EAST WATE�C�btD, P�70�ii n
ez� � c �? o
B. The Incapacitated Person's residence is: � � � rv � F°
_Ward's own home/apartment �': �; r� � "� °
Nursing Home � c- ��-, -z� -� °
X Boarding Home/Personal Care Home �' ��' �y 3 :� �
_ Guardians Home/Apartment - ��:� '—' � rTr
_ Hospital or Medical Facility .� � u' �
_ Relative's Home (name, relationship and address)
C. The Incapacitated Person has lived here since: 3/13
If the Incapacitated Person has moved since the last report, state the prior address and reason for
move:
Estate of: WILLIAM D. WILSON III
D. Name and address of the Incapacitated Person's primary care giver:
STONEHEDGE RETIREMENT HOME
4. MEDICAL INFORMATION
A. The major medical ar mental problems of the Incapacitated Person are:
MILD DEMENTIA, RENAL INSUFFICIENCE
B. Specify what if any, social, medical, psychological and supportive services the
Incapacitated Person is receiving:
ALL SERVICES PROVIDED BY STAFF AND PHYSICIANS AT THE FACILITY
5. GUARDIAN'S OPINION
A. It is the opinion of the guardian that the guardianship should:
X Continue Be modified Be terminated
The reason for the foregoing opinion is: The need for the guardian continues
B. During the past year the Guardian of the Person has visited the Incapacitated Person
4 With an average visit time lasting 15-20 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 true and correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties in 18 PA.
C.S.A. S/S 4904.
�`f Date: ��/�
Bria�:Brooks
Pennsylvania Guardianship Association
PO Box 7295
Lancaster, FA 17604
717-299-4568
COURT OF COMMON PLEAS CUMBERLAND COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: WILLIAM D. WILSON III ,AN INCAPACITATED PERSON
FILLE NO: 2000-00501
ANNUAL REPORT OF THE GUARDIAN OF THE ESTATE
1. INTRODUCTION
Pennsylvania Guardianship Association / Brian D. Brooks was appointed the
Limited, X Plenary Guardian of the Estate by Decree of
G. Hoffer , Jud�e Dated: 7/25/00
X (A) This is the Annual Report for the period from 7/25/13 to 7/25/14
_ (B) This the Final Report for the period from to
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
Judge Dated
2. SUMMARY
A. State the value of the estate reported on the inventory 91.38
B. State the value(s) of principle assets at the beginning of the Report Period.
(Same as the inventory if this is the first report, otherwise, balance from last report)
$ 00.00
C. What is the total amount of income earned during the report period?
$ 14,031.60
D. What is the total amount of income and principle spent for all purposes during the
report period.
$ 14,163.60
E. What are the balances remaining at the end of the report period?
1. Principle $
2. Income $
3. Total principle and income $ 00.00
WILLIAM RECEIVES $85.00 PER MONTH IN SPENDING MONEY. HE SPENDS
ALL OF HIS MONEY MONTHLY ON SNACKS AND CIGARETTES.
THE ESTATE OF: WILLIAM D. WILSON III
3. ADDiTIONAL INFORMATION
(If more space is needed, please attach additional pages.)
A. Principle
1. How is the principle balance listed above currently invested? (Specify)
2. Have there been any expenditures from principle during this report period?
Yes X No
If yes:
a. Have al all expenditures from principle been for the sole benefit of the
Incapacitated Person? Yes No
b. List the purpose and amount of expenditures:
THIS WARDS MONTHLY INCOME CONSISTS OF SSI PAYMENTS OF $1,180.30.
$1,095.30 IS HIS MONTHLY COSTS OF CARE AT THE FACILITY. HE SPENDS THE
REMAINING $85.00 EVERY MONTH ON CIGARETTES AND PERSONAL NEEDS. HE
DOES NOT CONSERVE ANY FUNDS.
c. Was approval received prior to expending principle?
Yes No
3. Were additional principle assets received during this report period that were not
included in the inventory or any prior report filed for the estate?
Yes X No
If yes:
a. Was court approval requested prior to r�ceiving additional principle?
Yes No
b. State the sources and amounts of additional principle received:
B. Income
1. State sources of income received during the report period:
l. SSI
Total income received during report period: $ 1,163.60
2. How is the income currently invested? (Specify)
ALL INCOME NOW MANAGED BY STONEHEDGE PERSONAL CARE HOME
THE ESTATE OF: WILLIAM D. WILSON II
C. Expenses for Care and Maintenance:
(Specify what expenditures were made from the principle and income for the care and
maintenance of the incapacitated person)
ALL INCOME EXCEPT FOR$ 85.00 PER MONTH GOES TOWARDS HIS CARE.
D. Other expenditures (Specify any other expenditures not previously reported)
E. Guardians Commissions
(List the amounts of compensation paid as guardian's commission and state how amount
was determined:)
Amount Method of Determination Court Approval Obtained
$ 00 00 (Yes) No
F. Counsel Fee
(List amounts paid as counsel fee, and indicate whether Court approval was obtained.)
I verify that the foregoing information is true and correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties in 18 PA.
C.S.A. S/S 4904.
- Date: �
rian D. Brooks
Pennsylvania Guardianship Association
PO Box 7295
Lancaster,PA 17604
717-299-4568