HomeMy WebLinkAbout10-23-07
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. Clerk of Orphans' Court of Cumberland County
IN RE: J 0 it n N ~e I /11
An Incapacitated erson
7QO~ -00 440
Docket No.
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ANNUAL REPORT OF GUARDIAN OF THE ESTATE
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. Dated J\.,tne.... This is my annual
, ("The Report Period").
appointed plenary guardian(s) of the estate of
by Decree of the Honorable Judge 6 lev-
report for the period from
to
I. SUMMARY
A. Value of principal assets at the beginning of the Report Period? $
B. Total amount of income earned during the report period? $
T otaI amount of all expenditures made for care and maintenance of the
C. incapacitated person during the Report Period?
1. From principal $
2. From income $
D. Total amount spent for all other purposes during the Report Period? $
E. Total amounts remaining at the end of the Report Period?
1. Principal $
2. Income $
Total Income and Principal $
II. ADDITIONAL INFORMATION
A. Principal:
1. Total amount remaining at the end of the Report Period?
$
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2. How is principal currently invested?
~
3. Have there been any expenditures from principal during the Report
Period? 0 Yes 0 No
If you answered YES, was there Court approval for all expenditures
from principal? 0 Yes 0 No
4. Did you receive any principal assets during the report period which
were not included on the inventory or a prior report filed for the estate? 0 Yes 0 No
If you answered YES, did you receive Court approval prior to receiving
additional principal? 0 Yes 0 No
5. State the sources and amounts of the additional principal you received:
$
$
B. Income:
1. State sources and amounts of income received during the Report Period (i.e., social
security, pension, rents, etc.):
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$ ;237~--
$ 73:{,---
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$
Total Income received during Report Period $ 8'/ 031-
2. How is income currently invested? (Please specify, restricted bank accounts, client care
account, etc.)
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3. Specify what payments were made for the care and maintenance of the incapacitated
person (i.e., clothing, nursing home, medicine, support, etc.).
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4. Specify what other payments were made during the Report Period.
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 J 8 Pa. C.S.A. 94904 relative to
unsworn falsification to authorities. -,---
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Date
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Signature 0 uar'
· FILING FEE $15 MUST ACCOMPANY THIS FILING.