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Home My WebLink About09-12-08_ try ~~ ANNUAL REPO T OF ~o GUARDIAN OF TH ESTATE ~ ~~ =o COURT F COMMON CU b _ COUN' ORPHANS' COURT l Estate of l1(.~K 1 ~ I 1 - No. Z(~ LD - ~ I. INTRODUCTION _ ~~ .`f J ~EAS OF f" ' -: ' ~? ~? PENNSYLVANIA ,~, ,, ;;>> JISION v--' r-a 0 "C3 N -~ an Incapacitated Person -w, --.- ~-~, r>> ~: s~ ~> _.~~ i~:7 c ~;i v =° r` ~,~.~ ,-: ~-:~ was appointed , J., denary ®Limited Guardian of the Estate by Decree of dated ~=~ - ~~ D A. This is the Annual Report for the perio from _ ~2 _~ to S`lP ~' (the "Report Period"); or ® B. This is the Final Report for the period om , to for the following reason: 1. The death of the Incapacitated Name of Personal Representat 2. The Guardianship was Form G-O2 rev. /0.13.06 Page 1 of 5 `~ (the "Report Period"), and is filed Date of death: e~ by the Court by Decree of J~. dated Estate of ~ ~. '~ , An Incapacitated Person I~ II. SUMMARY A. State the value of the estate reported on the B. State the value(s) of principal assets at the b ginning of the Report Period. (Same as Inventory if fir t Report, otherwise, ending balance from last Report.) C. What is the total amount of income earned dg the Report Period? D. What is the total amount of income and spent for all purposes during the Report E d~ $~. 5. $~_.~- $_~~~u~U.35 E. What are the balances remaining at the end f the Report Period? q 1. Principal $ ~ ~' , 1 2. Income $ 3. Total of Principal and Income $ I o7 ~I .5 ~ - III. ADDITIONAL INFORMATION (If more space is needed, please attach A. Principal 1. How is the principal balance listed al invested? (Please specify, e.g., real E certificates of deposit, restricted banl ~I~,;ghr~~a~d ~ O,cco~x~t pages.) currently accounts, etc.): > e~ t~CQ S C~S~~~ 2. Have there been any expenditures fr~m the principal during the Report Period? ....... ................... ~'es ®No If yes: a. Have all expenditures from a principal been for the sole benefit of the Incapa itated Person? ........ Yes ^ No Foy„~ c-oz rev. 10.13.06 Page 2 of 5 Estate of b. ist purpose and amount of An Incapacitated Person .~~~~~. r~e $ 30 .oo $,~ OOD • °p $ c. Was Court approval received rior to expending the principal? ... .................. ^ Yes ~No 3. Were additional principal assets recei ed during the Report Period which were not includ din the Inventory or a prior Report filed fort a Estate? ........... ~ Yes ~To If yes: a. Was Court approval req receiving the additional b. State the sources and amounts of the additional principal received: prior to gal? ................ ^ Yes ^ No B. Income 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): Total income received during $~~-L.,~15G , 35 $ $ Period: $~~- ,~L~ d •~' Form G-02 rev. 10.13.06 Page 3 Of 5 ~I Estate of ~ 2. How is income currently invested? (lease specify, e.g., restricted bank accounts client care account, etc.): ~ e~ hl~hoc~ c~ ~ C. Expenses for Care and Maintenance Specify what expenditures were made from t] income for the care and maintenance of the b Person (e.g., clothing, nursing home, medicin l ,q I O ~~~5 ~ '(Y1ar~U 5~ o . od -I-o Ida r~~ ~ 2oob ~ N ~;~hbcxho~ -For cars a~ ba D. Other Expenditures Specify what other expenditures were made c Period. (Do not include any items stated in r question C above.) X30 .GO -b ~~ ~~.~ ~- O~ w ~ ~o , oc, -to ~ J ~"1~ r ~ u' ~ IC;bG a' ~ ~1fio U.)0. Cho v i'c~ E. Guardian's Commissions List amounts of compensation paid as Guard and state how amount was determined: Amount Method of Determination ~IbCZ- ~Y~on~hl~ - -~ An Incapacitated Person iCkS ~~iCe~ C~CCC~~YL`r ie principal and capacitated e, support, etc.): ~a~-e Nurse 'fir of ~~tiCQ S trot c~~lians c~-c~-~ d -F..ee.S the Report oe to I I S ~a~ 'Cl~ -'0 7 c o~rc t- ~-epcrl~ S i I I S '~~ C'~v~fi oro~x S ~-,~ c~ ~ 's commission Court Approval Obtained ®Yes ~No ® Yes ®No Form C-02 rev. 10.13.06 Page 4 of 5 Estate of __l. \ 1A,1 F. Counsel Fee List amounts paid as counsel fee, and Amount An Incapacitated Person icat~ whether Court approval was obtained. Cou1•t 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 subj ct to the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. Date Sign tare of Grrardi of the Estate ~ n /` Nanr of Guarr~ian of the Estate (ry pe or print) rr~aG>~olsHOOn si~xv~css Add ss p O. BOX 1593 LANCASTER, PA 17608-1593 Cih~ State, Zip ~~7 - 3~_ a21 ~ 5_ Xt- 2 Form G-Ol rev. 10.13.06 Page 5 Of 5 ANNUAL REPOT OF GUARDIAN OF COURT OF OMMON coUN~ ORPHANS' COURT I Estate of ~-1ZQ,~6 ~-~ ~ I. INTRODUCTION :PERSON ~Q ~ _ .. -; _- ~O Cn : , . i-=i ~ 7 -~ i ~ ~ F'~1 '.C? ;--. ;:~7 ~ = ,ti,J ~ c r'h ' ~:~ <.t~7 ' .- ~j ~ ~ , ._~ LEAS OF ~~ ~-~ n - r~ f~, PENNSYLVANIA < ~ ri - ~ ` ~ [VISION --o -'' .. . ` - ~ D ~ .. r_) ,..... r~. an Incapacitated Person was appointed Lena Limited Guardian of the Person by Decree ted ~Q - I'~, - C~ J., This is the Annual R~e.port for the to ~'~ I' L , (the "Report Period"); or ® B. This is the Final Report for the period f~om , to , ~_ (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Pe son. Date of death: 2. The Guardianship was terminated by the Court by Decree of II J., dated For a Final Report, omit Sections II through IV. Form G-03 rev. 10.13.06 Page 1 of 4 ~O ill Estate of ~ ~~` ~- ~ ~ ~~ , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person: ~ I Date of Birth: ~ ` 2 ~ ~ ~ y 7 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: '~1an ~ r Ca ~'.e CcAr Us ~. q~1U ~gltl~~- ~o~0~'Y~ CC~.r(«t~, PA «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 Q relative's home (name, relationship . address) ®other: C. The Incapacitated Person has been in the . If the past year, state prior residence and reason(s) residence since ~~ ~ ~ ~~~ Person has moved within the move: Fornr G-03 rev. 10.13.06 Page 2 of 4 Iil Estate of (~ j , an Incapacitated Person '~' D. Name and address of the Incapacitated Pers~n s primary caregiver: I`(~a~~r C~a rsz IV. MEDICAL INFORMATION A. The major medical or mental problems of '~-Iz~ ~ 5 ~~cl,;,c~ - ~ c~6~-~ Incapacitated Person are as follows: B. Specify what, if any, social, medical, Incapacitated Person is receiving: ~ n,~ `~~, ~- (Ylanc,- Car.-e.. and support services the ~c~.,Q cex~l~e~r V. GUARDIAN' S OPINION A. It is the opinion of the Guardian of the continue that the guardianship should: ®be modified ®be terminated Form G-03 rev. 10.13.06 Page 3 o f Q~ I Estate of ~ ~ I' , an Incapacitated Person ~' The reasons for the foregoing opinion arE B. During the past year, the Guardian of the ~2- times with the average visit las The report of a social service organization e; coordinate the care of the Incapacitated Person for attached to supplement this Report. I verify that the foregoing information is con information and belief; and that this Verification is s relative to unsworn falsification to authorities. ~`~~"~~ Dale Fornr G-03 rev. 10.13.06 Pe son has visited the Incapacitated Person tin hours, _~ minutes. mpl yed by the Guardian to oversee and the eriod covered by this Report Inay be sect to the best of my knowledge, ~ubj ct to the p en al ti 8 Pa. C.S.A. § 490 ' / 1 W I Y t~dl Sign hrreof Ge r than of the Person p ~ p ~ ~ ~-t ~1 C S~ V Nam of Guardian f the Person (type or prfnQ I ~~ Addr ss Ciq; tale, Zip 7- 2~2(7`~ f. 2 Tele rove I I Page 4 0 S ~~S O~ f4