HomeMy WebLinkAbout08-18-08IN THE COURT OF COMMON PLEAS OF DAUPHIN COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE:~' y~~~j CYIC- a; , an incapacitated person FILE NO. ~Ut~ "" OpS,~Q
~1N/~L ~ ~i~C~~ j
GUARDIAN OF THE ESTATE ANNUAL REPORT
[20 Pa.C.S.A. 5521 (c)]
FROM ;~ - J ~ , 200 ~ TO 1 I - I _, 200 7
1) I am the Limited / Plenary Guardian of the Estate of my ward, named above.
I was appointe Guardian by Order of the Court dated ~ ~~~ - y - ,~(,(~,;~,z ,which
was was not modified by Court Order(s) dated
2) Is the incapacitated person still living? ~ f ,^
If no, answer the following:
(a) Date of Death ~ j - j - ~~L~7
(b) Place of Death Ht~ rr~; ~L~ rt ~~ ` ~i
(c) Name of Administrator/trix or ~xecutor/trix ~
(d) Date Guardian of the Person filed - , ,
Jr~~ na.l i~a ~c~~r~ry
PLEASE ANSWER THE FOLLOWING QUESTIONS WHETHER THE
INCAPACITATED PERSON IS LIVING OR DECEASED.
3) My initial Inventory was filed on ;~ - j ,~ - ~~7 and listed a total estate value of
$ ~~~°r~, ~L~C!~~t' (~wr7rc_~h Inc°~rrec~>y rnC'j~:!(=~PC~ dC~~% v~t~~ n~ j~'~~~ rr
~~ P P ~
~_.>
The Inventory listed a total monthly income, of $~~~ . ! ~ comprised of the
following: <<' • ~ ~'' ~ r ~ ~ c~~ -_ . r,
--
4) At the beginning date of this reporting period, my initial balance on 'lid wad.' ,
G~
~,i1 h i C h ~ `~ ~`~ U v ~ 5 b L> i`~? ~ ~? t," 5 5 c~ %~ G F~ ,~i ~ r r7 t Pr C ~t`- r
C.A. - 28
s) During this reporting period, the following reflects all sources of income (other than
social security) received by me for my ward: (Add additional pages if needed)
Date Received Source of Income Amount
3. ~~~~~ ~ ~ ft'1 f ~ f" ~ T' i 1"~ ~ 1 ~~'' ~ j~~ ~~' ~ ~ ~~' ~~ . L~`~
TC)TAL ~ ~ ~(' ( C~ LI? ~ U
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
1. ~~ l ;;;C~ ~~ ~~ ~~~r of ~~
s. ,~ °~ ~-~ ~ ,`~ TrPcx ~ ~.e~l~
Reason for Payment Amount
~; t-7 i7'~ Q~~{'C'~ 'SCI X ~"S ~' ~ ~, L~f1 ti , Q~1
TOTAL ~ Wit' t' L4~Gi (' y? L'C'~
7) The present principal assets of my ward are:
Description of Asset
I . I ~ i lam' f' G' i~C~` ~i ~Z~i1 U? C' f
Present Value
~~
~t~ ~, ~ ~~ `~ ~
5. > ~j1 c ~ ~~ ~ ~ ~%
TOTAL ~ ~~' ~ udC` ~
8) The present amount and sources of income for my ward are:
Source of Income Amount of Income
(Indicate whether monthly,
quarterly, annually)
2.
3.
4.
5.
6.
9) The regular monthly expenses of my ward which I pay are:
To Whom Paid
2.
3.
4.
5.
6,
1. ~f; f r1 /r C'Cl~~/F " ~~%~~('('Q-~~~c~ - -
Amount
~~
10) I not circle one) petitioned the Court for permission to invade principal to
meet the ne of my ward.
(If applicable) The following expenses of my ward have been paid from principal:
To Whom Paid Purpose Amount
1.
2.
3.
4.
5.
6.
iCr
11) I not circle one) paid myself compensation for services I rendered as
guardian.
The amount I Paid myself totaled $ and was
calculated at the following rate: $ per week/month (circle one).
12) Check the correct response and complete, if appropriate.
There will be no need for extraordinary expenditures on behalf of my ward in
the next (12) months.
There well 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).
l4) Please note any concerns about the incapacitated person's physical or mental well
being or the finances that the Court should know.
15) I / 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: ' f'1 ~~
Address: - ~ ~, (' i-~ ~. K r?, ~ ~
fti'~'w~ V- iP~ ~~ I~:~~ ~
Telephone No. (Home) _~ I Z ~ ~ .7 {~ ° ~ ~ 53
(Work) ..7 - . i ._ ?.~; 5 - t1 ~ l ~}
5.) Continued
Date Received Source of Income ount
7. 3/27/2007 Interest (Oppenheimer) $ 21.23
8. 4/24/2007 Interest (Oppenheimer) $ 22.36
9. 5/22/2007 Interest (Oppenheimer) $ 22.37
10. 6/26/2007 Interest (Oppenheimer) $ 21.37
11. 7/24/2007 Interest (Oppenheimer) $ 22.61
12. 8/28/2007 Interest (Oppenheimer) $ 21.66
13. 9/25/2007 Interest (Oppenheimer) $ 23.24
14. 10/23/2007 Interest (Oppenheimer) $ 23.39
15. 3/27/2007 Bond Interest (Oppenheimer) $ 8.91
16. 4/24/2007 Bond Interest (Oppenheimer) $ 9.38
17. 5/22/2007 Bond Interest (Oppenheimer) $ 9.39
18. 6/26/2007 Bond Interest (Oppenheimer) $ 8.97
19. 7/24/2007 Bond Interest (Oppenheimer) $ 9.49
20. 8/28/2007 Bond Interest (Oppenheimer) $ 9.09
21. 9/25/2007 Bond Interest (Oppenheimer) $ 9.75
22. 10/23/2007 Bond Interest (Oppenheimer) $ 9.82
23. 9/27/2007 Interest (M&T Bank) $194.70
24. 3/2007-11/1/2007 Interest (M&T Bank) $ 46.50
25. 10/5/2007 Interest (M&T Bank) $249.45
Income Total: $1,028.86
6.) Continued
Date Paid Payee Reason Amount
7. 5/29/2007 U.S. Treasury Estimated taxes $ 570.00
8. 7/20/2007 U. S. Treasury Estimated taxes $ 500.00
9. Dr. Tuchinda medical $ 131.62
10. medical $ 23.44
11. Manor Care room hold $ 240.00
12. Manor Care medicine $ 64.87
13. Manor Care medicine $1,418.89
14. 3/2007 local tax Estimated taxes $ 125.00
15. 6/2007 local tax Estimated taxes $ 125.00
16. 5/29/2007 local tax Estimated taxes $ 125.00
17. Register of Wills filing fee $ 15.00
18. Register of Wills copy of court order $ 5.00
19. Jan L. Brown & Associates attorney fees $8,500.00
20. tax preparation $ 525.00
21. Recorder of Deeds filing of deed $ 38.50
Payments Total: $22,817.32
7.1 Continued
Description of Asset
7. Commerce Bank Checking (joint with spouse)
8. Citizens Bank Checking (joint with spouse)
9. Bank of America CD
10. M&T Checking (joint with spouse)
11. Citizens Investment Services
Present Value
$1,010.64
$ 160.00
$8,222.57
$2,937.23
$7,413.09
Total Assets: $57,022.87
IN THE COURT OF COMMON PLEAS OF DAUPHIN COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: L~; ,~j j_, Y?"3~t,~1S , an incapacitated person FILE NO. ;-~ ~ - pig - ~, ~ ~
~~IN~L ~~~ ~'C~~ ~
GUARDIAN OF PERSON ANNUAL REPORT
[20 Pa. C.S.A. 5521 (c)]
FROM ;~ -1~ , 200 TO ~ I ~- j , 200 ~
1. I am the Limited J Plenary Guardian of the Person of my ward, named above.
2. I/was appointed Guardian by Order of the Court dated )~-~ -,~bb(r., which was
/ was not modified by Court Order(s) dated
3. Is the incapacitated person still living? n/~ _
If no, answer the following:
(a) Date of Death? ~ ~ -) - ,~~~~
(b) Place of Death? r~ r ' ~ r ::~ ~ t~.4~
(c) Name of Administrator or Exec tor? ~1~~,~?cje'~ 1-L?~.I ~'nClti, `,~
(d) Date Guardian of the Person filed the ~'~ `~,~ - ~, -- :~(; ~ -~
/ n, ~ ~-i a~-,r l n v-e ~ r~,~.
4. If the incapacitated person is still living, answer the following questions:
(a) Date Guardian of the Person filed the last Annual Report?
(b) Current address of the incapacitated person
(c) Current age Date of birth of incapacitated person
(d) The incapacitated person's residence is:
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
If moved within the past year, state from where and the reason for the change
C.A. - 27
(f) I rate his/her living arrangement as:
Excellent Average
Explain:
(g) I believe heJshe is:
5. Physical health
Below Average
content with the living situation
unhappy with the living situation
unaware of the living situation
(a) Current physical condition of the incapacitated person is:
Excellent Good Fair Poor
(b) His/her major physical health problems are as follows:
(c) During the past year, his/her physical condition has:
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
6. Mental Health
Type of treatment Doctor's name
(a) The incapacitated person's condition is
excellent good poor
(b) His/her major mental health problems are as follows:
(c) During the past year, his/her mental condition has:
remained about the same.
Improved. Explain _
Worsened. Explain
(d) During the past year, treatment or evaluation by a psychiatrist, psychologist or social
worker was was not provided. Such mental health services are briefly
described as:
7. Social Activities /Services
(a) His/her current social condition is:
excellent good fair poor
(b) During the past year, his/her social condition has:
remained about the same.
improved. Explain.
worsened. Explain. _
(c) During the past year he/she has participated in the following activities:
recreational
educational
social
occupational
no activities available.
helshe refuses to participate in any activities.
he/she is unable to participate in any activities.
8. Visitation
(al During the east year. 1 visited him/her as follows:
(b) The average amount of time I spent on each visit was
(c) The last time I visited was on
date
9. During the last year I have performed the following activities on behalf the incapacitated
person:
10. I believe he/she has the following unmet needs:
1 1. The guardianship 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 ~ 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:
Signature of the Guardian of the Person
Name: ' ,. ~ ~ ~ Telephone # (Home) ~ ~ 7 - -77 v - ~ 7 53
Address: i~.~ ~'r .e, ~' ~r~t~nl (Work) ~ 17- `'S~s - G~1~~
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