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IN THE COURT OF COMMON PLEAS OF CUMBERLAND CO~iTY,
PENNSYLVANIA ~.;. ~? '
ORPHANS' COURT DIVISION '` ;_ , ~ _.
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In re: y rr, rv ~~
No. 21-06-0177 ' `_ : ~- -~. ~_-. ~ -
PATRICIA A. EICHELBERGER, ~-~ ~ ,
an incapacitated person _ ~ =-+ • • - -
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ANNUAL REPORT OF GUARDIAN OF THE ESTATE UNDER
SECTION 5521(C) OF THE PROBATE, ESTATES AND FIDUCIARIES CODE
For the period: April 3, 2007 to Apri13, 2008.]
I . I am the plenary guardian of the estate of the above-named incapacitated person. I was
appointed guazdian by Order of the Court dated April 3, 2006, which has not been modified by
subsequent Court Orders.
2. The incapacitated person is living.
3. My initial inventory was filed on April 3, 2006 The inventory listed a total estate value
of $36430.63** The inventory listed a total monthly income of $ 0. comprising the following:
**This value was mistakenly listed as assets of Patricia when in fact they are assets of
her mother Evelyn G. Eichelberger. Patricia has no assets in her name.
4. This report constitutes the filing of my second annual report.
5. At the beginning date of this reporting period, my initial balance on hand was $0..
6. During this reporting period, Evelyn Eichelberger (Patricia's mother & designated
payee-see Section 14) received the following income for the incapacitated person (add
additional pages if needed):
Date Received Source of Income Amount
1. April 3, 2007 Social Security $938.00
2. May 3, 2007 Social Security $938.00
3. June 1, 2007 Social Security $938.00
4. Juiy 3, 2007 Social Security $938.00
S. August 3, 2007 Social Security $938.00
6. August 31, 2007 Social Security $938.00
7. October 3, 2007 Social Security $938.40
8. November 2, 2007 Social Security $938.00
9. December 3, 2007 Social Security $938.00
10. January 3, 2008 Social Security $959.00
11. February 1, 2008 Social Security $959.00
12. Mazch 3, 2008 Social Security $959.00
TOTAL $11319.00
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- ~ 7. During this reporting period, I made the following payments for the incapacitated
person (add additional pages if needed):
Date To Whom Paid Reason for Paymment Amount
1. 04/08/07 Church God Home SS $ Amount to Home $938.00
2. 05/09/07 Church God Home SS $ Amount to Home $938.00
3. 06/1 I/07 Church God Home SS $ Amount to Home $938.00
4. 07/03/07 Church God Home SS $ Amount to Home $938.00
5. 08/06/07 Church God Home SS $ Amount to Home $938.00
6. 09/07/07 Church God Home SS $ Amount to Home $938.00
7. 10/13/07 Church God Home SS $ Amount to Home $938.00
8. 11/15/07 Church God Home SS $ Amount to Home $938.00
9. 12/05/07 Church God Home SS $ Amount to Home $938.00
10. 01/03/08 Church God Home SS $ Amount to Home $959.00
11. 02!07/08 Church God Home SS $ Amount to Home $959.00
12. 03/03/08 Church God Home SS $ Amount to Home $959.00
TOTALS $ 11319.t?0
8. The present principal assets of the incapacitated person are:
Description of Asset Fresent Value
1. No Assets in Patricia's Name $0.00
are:
9. The sources and amounts of income that I expect to receive for the incapacitated person
Amount of Income
(Indicate whether rnonthiy,
quarterly or annually}
Sources of Income
1. SS Check (In Process of Being Transferred to Church of God $0.00
Home
10. The monthly expenses I expect to pay for the incapacitated person are:
To Whom Paid Amount
1. Patricia's Expenses Are Being Paid by Medicaid $0.00
11. I D have xO have not (check one) requested and received permission from the Court to
invade principal to meet the needs of the incapacitated person. If you have requested and
received permission to invade principal, list the expenses that you have paid from principal
during the reporting period:
To Whom Paid
Not Applicable
Amount
1_
12. i ^ have ®have not (check one) paid myself compensation for services I rendered as
guardian. The amount I paid myself totaled $ (amount] and was calculated at the following rate:
[rate] per O week ^ month (cheek one).
13. If the incapacitated person is living, please check the correct response and complete, if
applicable:
(a} Q There will not be a need for extraordinary expenditures on behalf of the
incapacitated person in the next 12 months.
(b) O There will be a need for extraordinary expenditures on behalf of the
incapacitated person in the next 12 months because
14. if the incapacitated person is living, please check the correct response and
complete, if appropriate:
(a) ^ The incapacitated person receives monthly social security benefits
directly.
(b) ^ I am the designated payee to receive the incapacitated person's social
security benefits.
(c) O The designated payee of the incapacitated person's social security benefits
is Evelyn G. Eichelberger whose address is 801 N. Hanower Street, Church of God
Home, Carlisle, PA 17013. The payee D is ^ is not (check one) related to the
incapacitated person as Mother ~ ~3 ~ s ~ . ~ ~ ~ ~ ~ ~ ~ ' ~` ~ ~ ~ ~°
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15. Please note any concerns about the incapacitated person's physical or mental well-
being or the finances that the Court should know.
16. I am the guardian of the person of Patricia A. Eichelberger. My annual report is
attached as well.
I certify that the information contained in this report is true and correct to the best of my
knowledge, information, and belief. This statement is made subject to the penalties of 18 Pa.C.S.
§ 4904 (relating to unsworn falsification to authorities}.
Date: April 14, 2008
Robert D. Eichelberger,
Guardian of Patricia A. Eichelberger
182 Chain Saw Road
Dillsburg, PA 17019
Telephone : 649-7074