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HomeMy WebLinkAbout93-0346 ?G~B~~t^ I9 ~~It~ 45 ANNUAL REPORT OF (~ .: GUARDIAN OF THE ESTATE ~~"^' l ^_~'nT ~` ' ii t l~q t/~~ .~ ~'_. ("T1 COURT OF COMMON PLEAS OF ~t.~~~~~~ COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION Estate of C~~+-t ,~ ~~ ~Q.~n-Q~~. an Incapacitated Person I. INTRODUCTION ~~ ""~ 'r' ~ ~' ' ~~ I P ~~r N ,was appointed ~ Plenary ~ Limited Guardian of the Estate by Decree of ~ a(~x,~Y ~ ~~~~ J., dated Sa / i ~ `~ ~ ~ A. This is the Annual Report for the period from-~ 1 ..1,~~' to ~, ~ j L~ (the "Report Period"); or B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: I . The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J., dated Form G-02 rev. 10.13.06 Page 1 of 5 ~,~ Estate of ~~ ~ ie ~ ~ (J r ~, c~~ Y-1f ~~~ , An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ ;L~j''~"p ~ O~ B. State the value(s) of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, otherwise, ending balance from last Report.) $~Q C. What is the total amount of income earned during the Report Period? $~ ~ r D. What is the total amount of income and principal spent for all purposes during the Report Period? $ ~ ~ ,,,~'+p j, 7p ,.- E. What are the balances remaining at the end of the Report Period? 1. Principal $ ~ 2. Income $_ ~ CJ „_. 3. Total of Principal and Income $ 0.00 III. ADDITIONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principal 1. How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): ~~'~ ~j ~~ Uh,;©~ cheer icf~~ ~- s~Ye~~s ~cct 2. Have there been any expenditures from the principal during the Report Period? ............................ ~ Yes ~ No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? ........ ~ Yes 0 No Form G-02 rev. 10.!3.06 Page 2 of 5 Estate of ~ai~;,o ~__,=____~~~~p~y~ , An Incapacitated Person b. List purpos and amount of expenditures: `' e_ $~.$ ~d_ c~a L2~e~'; ra 1 C;~re $---~?~ ~. Was Court approval received prior to expending the principal? ....................... ^ Yes 'l~No Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? ........... Q Yes ~ No If yes: a. Was Court approval requested prior to receiving the additional principal? ................ ^ Yes ~No b. State the sources and amounts of the additional principal received: >NI ~ B. Income State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): r • _ ~~ r. . c . .~ ~ ~ ~, Total income received during Report Period: Farm G-02 rev, 10.13.06 $-~_ ~P "7 - ~l~ $ 1 f , c~~2- z3~ Page 3 of 5 Estate of _ ~'~~jP ~ y (` ~ ~ -~ , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): ~ Sc-e(~~--~' !~h/G'i'J c ~1 PC}ti ~ 9 ~`"S'~YtY1~ S ~' c~ l ~~'- C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person (e. g., clothing, nursing home, medicine, support, etc.): GI v~~~n , Pu~'~Dha ~ Gv r~ 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.} ~ht2Y'~~iY~y'J~er~1 j ~-Ivb-6r~s C,:~rn S E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Court Amount Method of Determination Approval Oi5tained - (Yes [~No [~ Yes ~ No Form G-Ol rev. 10.13.06 Page 4 of 5 Estate of ~~ ~~ j ~~ ~ f,~,~;~p i!`, , An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Court Amount Approval O15tained ~lc~i"yt~ Yes 0 No Yes ~ ]~Io 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 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. y l ~..~~ I ~~,~~' Date ,~~U~t~_ ~ ~ p SignGuardian of th~ Est~x~_ ~J ~~l Q_! ~ ~~~Lt~ .i ('.fin Name ofGuardlan of the Estate (type or print) Address Ctry, State, Ztp Telephone Form G-02 rev. 10.13.06 Page 5 of 5 ANNUAL REPORT OF GUARDIAN OF THE PERSON COURT OF COMMON PLEAS OF C c,'~nn ~~~~r!~ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ^ri^a ~~i' i 9 i';~ I I ~ ~5 t~.ru ~a ...;,,, ,,,r u:_-. ~~ ,,., ^iJ`. ra. Estate of ~~^ i~ 1 F~ 1 ~_ C ~P_I~~ 5O i~ , an Incapacitated Person I. INTRODUCTION ~~~ i~. I 1'~=~ l~~ 5'c~ ~ ,was appointed Plenary Limited Guardian of the Person by Decree of I"=7~i ;~ ~ , ~~ ~~~, J., dated S/ ~ 1 ~ } g.3 T A. This is the Annual Report for the period from _,~;n .. I ~P~ to (~P/', ~ ~ 2~n~ (the "Report Period"); or Q B. This is the Final Report for the period from , to (the "Report Period"), 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 J., dated For a Final Report, omit Sections II through IV. Form G-03 rev. 10.13.06 Page 1 of 4 ~~ Estate of ~/' a ~~ ~ p ~ ~•, ~~P y+~,ii ~, l~ , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person:_ III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: Date of Birth:~~ ~ h 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 relative's home (name, relationship and address) '~ other: ~~''O;,t,. ~ ~ ~m ~ C. The Incapacitated Person has been in the present residence since T7~C~ ~ If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: d .~ ~~%~~~ n7. r~~itK~7-_ 5~_ D"'1c~~_h~i'71~='~~~'~~ ~~i l 1~~ Form G-03 rev, 10.13.06 Page 2 of 4 Estate of ~ x1 Y1T~_ ~ ~'; r (,o l~ ~~~ 1~~. , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: ~Lnr ~' n~ ~ ~ l •y ~~ta 1' ~-~ ~ ~-~.- Try.; 4'1 ry ~ ~~ '~j~~~~rc he~,r~ `f 6 ~ ~Qh~r~~r~'~Y B. Specify what, if any, social, medical, psychological and support services the; Incapacitated Person is receiving: ~syc~ ~;~.~"'rt - C~r~ ~./C~~K ~ 1 ~C~,e - Fr ~`-'P._r.`~PY rr~r' ..~-v!~i%,3~~"rt~ 1 Tr~lrta~~ V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: continue be modified be terminated Form G-03 rev. 10.!3.06 Page 3 of 4 Estate of G'~ i ~ ~ ~• r f j? js} ~ ~'~ l~ , an Incapacitated Person The reasons for the foregoing opinion are: B. During the past year, the Guardian of the Person has visited the Incapacitated Person ~~ ~ ~ ~_ times with the average visit lasting ~ hours, ,~ s7_ minutes. Z~ 1 ~ © a The report of a social service organization employed by the Guardian to oversE>e 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 correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. 9 / ~, ~ i ~ ~ _ _ _---- Dare Signature of Guardian of the Person Name of Guardian of the Person (type or print) Address P ~'. !;~ ill ~ e L1. ~i" C1 Ciry, Srare, Zip ^4 ~ ~ ~ .-~..~ ~ i '~ ~ r Telephone Form G-03 rev. /o. t3.o6 Page 4 of 4 COYNE & C��NE, P.C. � Lisa Marie �oyne, Esquire c� � x► � Pa. Supreme Ct. Na. 53788 � � � � � 3901 Market Street � � � � `�' �� _-� .:_ � �.. r- �---� r�-, �`_� Camp Hill, PA 17011-4227 � :z � --..� .�_. �-� (717} 737-0464 Atto��Pe,�,itio�e�F r„� 4� ,.� � .— ':s IN RE: : IN THE COURT OF COMMON P3�AS 4� � - '` DANIEL F. CLEMSC}N, : CUMBERLAND COI:JNTY,PEN�YSYLVr�1�FIA�'�� � incapacitated persan: : CfRPHANS COURT D►IVISION : NO. 21-93-346 PETITI(JN FtJR APPOINTMENT C1F CO-GUARDIAN PURSUANT T{J 20 Pa,C.S.A. � 5514 TO THE HONORABLE, THE JUI7GES OF THE SAID COURT: AND NOW COMES, Daniel R. Clernson and Jennifer K. McKee, Petitioners, by and through his attorney, Henry F. Coyne, Esquire, and aver the failowing in support af the within Petition For Appaintment of Co-Guardians Pursuant to 20 Pa.C.S.A. § 5514: 1. Petitioner, Daniel R. Clemson, an adult individual, resides at 5213 Royal Drive, Mechanicsburg, Cumberland County, Pennsylvania. 2. On May 19, 1993, Danie1 F. Clemson was adjudicated an incapacitated person by the Honorable J. Wesley Oler, Jr. and Petitioner, Daniel R. Clemsan, and Genevieve K. Clemson, parents of Daniel F. Clernson, were appointed co-guardians of the person and estate af their san, Daniel F. Clernson.. (See Exhibit"A"—Qrder dated May 19, 1993). 3. Genevieve K. Clemson died on December 29, 1999. 1 �" 4. On March 17, 2000, Jennifer K. McKee, formerly Jennifer K. Stouffer, sister of the incapacitated person, was appointed as co-guardian of Daniel F. Clemson, the incapacitated person, to fill the vacancy left by the death of Genevieve K. Clemson. (See Exhibit "B" —Order dated March 17, 2000). 5. Daniel F. Clemson, the incapacitated person, currently resides at the United Cerebral Palsy Group Home located at 829 Lisburn Road, Camp Hill, Pennsylvania. 6. Petitioner, due to his advanced age, desires to resign as co-guardian of his son, the incapacitated person herein. 7. Kathleen T. Stouffer is an adult individual, sui juris, who resides at 5213 Royal Drive, Mechanicsburg, Pennsylvania and is the sister of Daniel F. Clemson, the incapacitated person and is also the daughter of the Petitioner herein. 8. Petitioner desires to have his daughter, Kathleen T. Stouffer replace him as co- guardian of her brother, the incapacitated person. 9. Jennifer K. McKee, co-guardian, consents to Kathleen T. Stouffer replacing Daniel R. Clemson as co-guardian. 10. The proposed replacement co-guardian has no interests adverse to Daniel F. Clemson,the incapacitated person. 11. The consent of the proposed replacement co-guardian is attached hereto. (See Exhibit"C"—Consent of replacement Co-Guardian). 2 12. Petitioner has advanced his personal resources to secure legal representation regarding this Petition and has advanced filing fees associated with this Petition and seeks reimbursement of the same from the incapacitated person's funds. 13. No bond was required of the current guardians. WHEREFORE, Petitioner requests that this Honorable Court enter an order directing the following: (1) the Petitioner, Daniel R. Clemson, is permitted to resign as co-guardian; (2) Kathleen T. Stouffer is appointed to replace Daniel R. Clemson as co-guardian; (3) reimbursement of costs and fees advanced by Petitioner in this matter, and (4) any such relief this Honorable Court determines appropriate. Respectfully submitted: COYNE & COYNE, P.C. . � ,. Dated: �' — � 3 r i � B� --'�,isa Marie Coyne, squire Pa. Supreme Ct. No. 53788 3901 Market Street Camp Hill, PA 17011-4227 (717) 737-0464 Attorney for Petitioner 3 VERIFICATION The facts set forth in the foregoing are true and correct to the best of the undersigned's knowledge, information and belief and are verified subject to the penalties for unsworn falsification to authorities under 18 Pa. C.S.A. § 4904. Dated:�,��_���� '�� � � Daniel R. lemson 4 _ __ , . � ���a/�7�� . ' IN RE: ESTATE OF . IN THE COURT OF COI�i�N PLEAS OF `' D,At�TIEL F. CLEMSON, . CUMBERLAND CG►UNTY, PENNSYLVANTA INCC3MPETENT . . ORPF�ANB` COIIRT DIVISIQN ,,�,,- � . N0. 21-93-346 TN RE: PETIT�ON FOR APPOxNTI�+tENT OF A GUARDIAN • BEFQRE OLER, J. ORDER OF COURT AND NOW, this 19th day of May, 1993, upon consideration of the Petition far Appointmeat of a Guaardian, and £ollawing a heari.ng hel.d pursuan� ta due not3.ce at whieh the al3.egedly inaapaca,tated person was presez�t, the eaid persan, Danie2 F Clemsan, ia ad�udicated an incapacitated persan, and his parents, �anieZ R. Clemsoa and Genev3.eve R. CZemsan, are { �PPoizzted plenary guardians of his persori and hi� estate. The guardians are directed to �'ile regor�s in accordance wi�.h the `� provisione af 2Q Pa. C.S. Section 5521(c) . Na bond shall be required oE the guardians. Notice is hereby prc�vided to. T�aniel. F. Clemson of his right ta appeal arid ta petition Go modify or terminate the ; guardianship. By the Court. . . � ,�� �� . J� Wesley t}le � Jr« . J. --y,f John R. Zonarich, Eaquire • Counsel for Petitior�ers DanieZ F. Clemsan s `-'' :s1r � 1� 1} rt ���► � '�� ,��-1 � =� '�`' `�� � � °�� a� "' z''� �"�'c �. � � �. � � � � � . .`.�Y Y 's`t�, ,,� . i +r .� r.`7 �. . •�+' � dx'. p�,. �C �`eiM1 b � �E"s' hz+s �•x ,, x .r"7 s:. �, �� s , r , .,��s^y: ,� �Y� p� ��.��� a�r� as�:p.x`�s,�}y r , ,�c ;�`-"�r ¢d t +�"'��,`� °��^�c�� �`'`r '�--� . '�i'��a,y.wY#§4.�.�' �� .:,y. 45��"� �II x.y,�; y.w` ~�"� �* 3 .: t �-�. 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' `{i f} #- !I ,i� - t' � i ,t i " f i ! # ' �• [ . • •.i ! i" i i i i i � s • • i E i i �. t" `f 'f • . i .t t i - 'i • i !"• t �.; ' '!1 !# i t .'�,•M3 ! .i�'• .i! �' 1 i! f p�� s - i� t- • . • . t z • ' Er� � ,� ur � . �•��. � � 4�._.._� J r � .. ., k ' . . � . COYNE & COYNE, P.C. Lisa Marie Coyne, Esquire Pa. Supreme Ct. No. 53788 3901 Market Street Camp Hill, PA 17011-4227 (717) 737-0464 IN RE: : IN THE COURT OF COMMON PLEAS OF DANIEL F. CLEMSON : CUMBERLAND COUNTY, PENNSYLVANIA incapacitated person: : ORPHANS COURT DIVISION : NO. 21-93-346 CONSENT OF CO-GUARDIAN OF THE ESTATE AND THE PERSON I, KATHLEEN T. STOUFFER, hereby consent to act as a Co-Guardian of the Estate and the Person of DANIEL F. CLEMSON. I reside at 5213 Royal Drive, Mechanicsburg, Pennsylvania and am employed at the Pennsylvania Department of Public Welfare. I am a citizen of the United States of America and can speak, read and write the English language. I have no interest adverse to Daniel F. Clemson, the incapacitated person. Dated: ������ � THLEEN T. STOUFFER roposed Co-Guardian �C t ���� ��� � � , � • CERTIFICATE OF SERVICE I, Lisa Marie Coyne, Esquire, of Coyne & Coyne, P.C., hereby certify that true copy of the foregoing Petition for Appointment of Co-Guardian was served this date upon the below- referenced individuals at the below listed address by way of first class mail, postage pre-paid: Jennifer K. McKee 2 Cedar Road Mechanicsburg, PA 17055 Dated: G — t 3— �3 , �� vv`-- Lis rie Coyne, Esquir 3901 Market Street Camp Hill,PA 17011-4227 (717) 737-0464 Pa. S. Ct. No. 53788 Attorney for Petitioner 5 IN RE: : IN THE COURT OF COMMON PLEAS OF DANIEL F. CLEMSON, : CUMBERLAND COUNTY, PENNSYLVANIA An incapacitated person : : ORPHANS' COURT DIVISION : N0. 21-93-346 ORDER AND NOW, this Z a' day of June, 2013, the above-captioned case is assigned to the Honorable J. Wesley Oler, Jr., Senior Judge. BY THE COURT, Kevi . Hess, P. J. The Honorable J. Wesley Oler, Jr. Court Administrator :rlm ca t-'' � � c' " r�' ?' � � � :�� � rn � �-, � �., :1 � � � N ..., �--� � � �'V; d .... _ r .__ ,� ,� � • �: _ ��. _ y �'j ..� i ^.�i _ � �' � ? � �i f_' {�t� � �7 v7 � C1l � � : ORPHANS' COURT DIVISION . COURT OF COMMON PLEAS OF In Re: DANIEL F CLEMSON,An Incapacitated Person . CL7MBERLAND COUNTY . PENNSYLVANIA , N0.21-93-034b CERTIFICATE C1F SERVICE O�41tDER QRDER DATE: 6120113 NDGE'S INITIALS: kah TIME STAMP DATE: 6l20/13 IN RE: Order .................................................................................................*....,.,.....,,..........., SERVICE TO: J Wesley Oler Jr Court Administratar METHOD OF MAIT.,ING: ENVELOPES PROVIDED BY: ❑USPS ❑PBTITIONER �RRR ❑JUDGE �HAND DELIVERED ❑CLERK{�F QRPHANS COURT ❑OTHER MAILED: 6/20/13 .�................................�......�.........................,........,...,,.....,......,...�.....�..�.�....�..,...,.. SERVICE TO: METHOD OF MAILING: ENVBLOPES PROVIDED BY: ❑USPS ❑PETITIC}NER ❑RRR ❑ JUDGE ❑HAND DELIVERED ❑CLERK OF ORPHANS CC}URT ❑OTHER MAILED: �� �. . -r1 `� ��Z��l d�l� ���uty Clerk of Orphans' Court IN RE: : IN THE COURT OF COMMON PLEAS OF DANIEL F. CLEMSON, : CUMBERLAND COUNTY, PENNSYLVANIA Incapacitated person : ORPHANS' COURT DIVISION : NO. 21-93-346 IN RE: PETITION FOR APPOINTMENT OF CO-GUARDIAN PURSUANT TO 20 Pa.C.S.A. § 5514 AND NOW, this 24th day of June, 2013, upon consideration of the Petition for Appointment of Co-Guardian Pursuant to 20 Pa.C.S.A. § 5514, the petition is granted, Petitioner Daniel R Clemson is withdrawn as a co-guardian of his son, Daniel F. Clemson, and his daughter (the incapacitated person's sister), Kathleen T. Stouffer, is appointed co-guardian in his place. NO BOND shall be required of the new co-guardian. NOTICE IS HEREBY provided to Daniel F. Clemson of his right to appeal and petition to modify or terminate the guardianship. BY THE COURT, Wesley Ole r., S.J. Lisa Marie Coyne, Esq. 3910 Market St. Camp Hill, PA 17011-4227 Attorney for Petitioner Daniel R. Clemson 5213 Royal Drive Mechanicsburg, PA 17055 Petitioner a n rn Jennifer K. McKee rn _ � z 2 Cedar Road ' n c Mechanicsburg, PA 17055 c. o CO-guardian � C FJ •,ch r cn o A L � r � 10 ?M MI I ➢'tfll+ll°l,' .%'.? AlX,AV,JY2'V'M-,9 �YTI IUO 4 � i!t3'::`i�<s 03sit:a,S�r:�fLS F . W{N KO 103 rloiti 119 witia (f5Lts_96i2roD ffogm ,-;s+; .�r;i? sc y rfttS affli ,I)VOO; GXA zi froiii 2q aril J4 Z� .A E?.J_f:'S i1L C,f tawaz'ttill' fFrit�fi r:��-t 3 30 afrrt! Gc{I': S 19itrfCa antra nit[ u v€.ibr u -aa :, aii !r«ri7bdliv1 2i tfoam51:) Jq hiasC lufjorti+sl .T p91(i?ii.2 .;(d�5tid z'f,! pa' (.I 2ff5 bi''m jlo1 l!}r. s�;iCt zid s,i Lyrtib�!b��-cis �9ic!ioc,cy� rwlbas ;-era w5"1 sf`.!I o 1,�rFif= ,.3L A, lade Qv,Ofi Gl/ brsr, S4-.?C;(,=s of tdgst, p6d 10 :ro , .15K) . i. b'g%Q U4 bt)bi fmq ?€iIR 314 ?t 3 lTrZ'rt S`s 3arff,€a aL=irk :�t6t °3t ift*nirr.Y �o �krh«xn c�1 tin tt 2sq pa3 .wvoD s tr;if.f 2i� IS11t-1IUI Ail ,[liti tSmfZ) trcxa,^rt9l a . i torras� 9ui!f! le'Cor� �twc Mi 1 Ali ;�7u%I25SS71f1J9�`! s`- a91Ia1 l ..ti 19t Kathleen T. Stouffer 5213 Royal Drive Mechanicsburg, PA 17055 Co-guardian Daniel F. Clemson United Cerebral Palsy Group Home 829 Lisburn Road Camp Hill, PA 17011 Incapacitated Person I l;t1K37ff�a }1?'tYV !Y: b;IOA -3,wdaf,t QS( F z c AA .11th ff�l�,���sT i�se�ii�rs�satt( ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF In Re: DANIEL F CLEMSON CUMBERLAND COUNTY PENNSYLVANIA NO. 21-93-0346 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 06/24/2013 JUDGE'S INITIALS: JWO TIME STAMP DATE: 06/24/2013 IN RE: ORDER ................................................ SERVICE TO: COYNE&COYNE 3901 MARKET ST,CAMP HILL PA 17011 JENNIER MCKEE 2 CEDAR ROAD.MECHANICSBURG PA 17055 METHOD OF MAILING: ENVELOPES PROVIDED BY: ® USPS ®PETITIONER ❑ RRR ❑JUDGE ❑ HAND DELIVERED ❑ CLERK OF ORPHANS COURT ❑ OTHER_ MAILED: 06/241/2013 SERVICE TO: KATAHLEEN STOUTER 5213 ROYAL DRIVE,MECANICSBURG PA 17055 DANIEL F CLEMSON 829 LISBURG RD,CAMP HILL PA 17011 DANIEL R CLEMSON 5213 ROYAL DR,MECHANICSBURG PA 17055 METHOD OF MAILING: ENVELOPES PROVIDED BY: ®USPS ❑PETITIONER ❑ RRR ®JUDGE ❑ HAND DELIVERED ❑CLERK OF ORPHANS COURT ❑ OTHER MAILED: 06/24/2013 40rCler ' Court c � ;. .. � � C..�:� � � �-�-J � f'� �w� � �#r \✓ y�j G� � r -� � � �� —_. � :Z7 R'} � � _�.� �3 a f"" }_�,. � t'r'i A►NNUAL REPORT OF � �:_ �: �, � . , � �:� GUARDIAN OF TI3E ESTATE � "' =�� � �� �:..7 �.tiY, 4.� ...�..� ,�,� _4�.� G`y <,':� � .-�3 � .;,� ::'r .,..�: c;7 V � � ,..,. �,r,.� COURT OF COMMON PLEAS OF �� �y �, � � CUMBERLAND COUNTY,PENNSYLVA.►1�IA `� � ORPHANS' COURT DIVISION Estate of DANIEL F. CLEMSON , an Incapacitated Person No.21-93-346 I. INTRODUCTION DA1vIEL R. CLEMSON / JENNIFER K.MCKEE ,was appointed C3 Plenary �Lunited Guardian of the Estate by Decree of E.B. Bailey / G.E.Hoffer �J.� �t�5/3/1993 - 3/17I2000 , � A. This is the Annual Report for the period from January 1 ,�(�� to December 31 . (the"Report Period");or 0 B. This is the F�nal Report for the period from , to , (the"Report Period"),and is filed for the following reason: 1. The death pf the Incapacitated Person. Date of death: Name of�'ersonal Representative: 2. The Guardianship was termi.nated by the Court by Decree of 1.,c�ated Form G-01 rev.1013.06 Page 1 of 5 �_7 . Estate of D�L F. CLEMSON ,An Incapacitated Person II. 5UMMARY A. State the value of the estate reported on the Inventory $ B. State the value(s)of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, othervvise,ending balance from last Report.) � C. What is the total amount of income earned during the l� R.eport reriod? S _ . —_— D. What is the total amount of income and principal ,� spent for all purposcs during thc Rcport rcriod? � � • � E. What are the balances remaining at the end of the Report Period? 1. Principal $ 2. Income $ Q( 3. Total of Principal and Incomc $ �" � III. ADDITIONAL INFORMATION (If more space is needed,please attach additional pages.) A. Principal 1. How is the principal balance listed above currently invested? {Please specify,e.g.,real estate, certYficates of deposit,rest;ricted b�nk accounts,etc.): PSECU SAVINGS ACCOUNT 2. Have there been any expenditures from the principal during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes ❑No If yes: a. Have a11 expenditures fxom the principal been for the sole benefit of the Incapacitated Person? . . . . . . . . �Yes ❑No Fa�c-o2 rev.10.13.06 Page 2 of 5 � Estate of DANIEL F. CLEMSON ,An Incapacitated Person b. List purpose and amount of expenditures: $ SEE ATTACHED REPORT � $ � c. Was Court approval received prior to expending the pri.ncipal? . . . . . . . . . . . . . . . . . . . . . . . �Yes �No 3. Were additional principal assets received during the . Report Period which were not included in the Inventory or a prior Report filed for the Estate? . . . . . . . . . . . �Yes �No If yes: a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . . . �Yes �No b. 5tate the sources and amounts of the additional principal received: $ SEE ATTACHED REPORT $ $ $ $ B. Income 1. State sources and amounts of income received during the Report Period(e.g., Social 5ecurity, pension,rents,etc.): � SEE ATTACHED REPORT $ $ _ � - $ $ Total income received during Report Period: $ �•� Form G-U2 rev 10.13.06 Page 3 of 5 Estate of DArtIEL F. CLEMSON .An Incapacitated Person 2. How is income currently invested? (Please specify,e.g.,restricted bank accounts, client care account, etc.): PSECU CHECKING ACCOUNT C. Ezpenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person(e.g.,clothing,nursing home,medicine,support,etc.): SEE ATTACHED REPORT D. Other Ezpenditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) SEE ATTACHED REPORT E. Guardian's�pmmissions List amounts pf compensation paid as Guardian's commission and state how amount was determined: Court Amount Method o,f'Determination Approval Obtained 0.00 [�Yes [[�No 0.00 (�Yes �No Form G-02 rev. 10.13.06 , Page 4 of 5 . Estate of DANIEL F. CLEMSON ,An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee,and indicate whether Court approval was obtaincd. Court Amount Approval Obtained �Yes Q No ❑Yes ❑No I verify that the foregoing information is correct to the best of my lcnowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. §4904 relative to unsworn falsification to authorities. 9/20/2013 ' e�� Date SYgnature of Guardian of the Es e Daniel R. Clemson / Jennifer K.McKee Name of Guardian of ti�e Estate(type or print) 5213 Royal Dr. 1 2 Cedar Rd. Address Mechanicsburg,PA 17055 City,State,Zip 717-571-9367 Telephone Fo�„c-oa �.�o.��.06 Page 5 of 5 ., , r.,; � r�,=� n �� � � � � m �-�=f � � ANNUAL REPORT UF � =;� � ��� � � � ��. r~ r-� 3:.<,, � GUARDIAN OF THE PERSON � �'; ��� `�' �, ° � ..:, �� � �':,� �-, � �� �,...., �� t'"� r, : Y.:� �.�� .�.., . ; �;°:.i ��, �,.,_ �„�� w� �.,.. COURT OF COMMON PLEAS OF +-t�, ��� r-,, �3 ,` (!t�t M(��GA��>> cotnv�,PENNSYLVANIA�`:* `� , 4RPHANS' COURT DIVISION : Estate of DANIEL F. CLEMSON .an Incapacitated Person � � No.21-93-346 I. INTRODUCTION Dan�e1 R Clemson / Jennifer K.Mckee ,was appointed �Plenary OLimited Guardian of the Person by Decree of E.B. Bailey / G.E.Hoffer �J.� dated 5!3/1993 / 3/17/2000 � A. This is the Annual Report for the period from ��uary 1 ��� to December 31 � (the"Report Period");or � B. This is the Final Report for the period from , to , (the"Report Period"),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 J.,dated For a Fina1 Repor� omit Sectlons II through IV. Fo�c-o� ►��o.�3.06 Page 1 of 4 Estate of DAl�TIEL F. CLEMSON an Incapacita.ted Person II. PERSONAL DATA Age of the Incapacitated Person:38 Date of Birth:July 29, 1970 III. LIVING ARRANGEMENT5 A. Current address of the Incapacitated Person: UCP Lisburn Group Home 829 Lisburn Rd. Camp Hill,PA 17011 B. The Incapacitated Person's residence is: ❑own home/apartment �nursing home �boarding home/personal care home 0 Guardian's home/apartment Q hospital or medical facility 0 relative's home(name,relationship and address) �other: G�.D�u.P �}6/�� C. The Incapacitated Person has been in the present residence since February l,2U08. . If the Incapacitated Person has moved within the past year,state prior residence and reason(s)for move: 604 N.Market St.,Mechanicsburg,PA 17055 � From aging father's home,to group home care Form G-03 rey 1013.06 PSge 2 Of 4 Estate of DAI�TIEL F. CLEMSON an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: United Cerebral Palsy of Central PA , IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: Mentally Retarded-trainable Hyperchenetic Behavior B. Specify what,if any, social,medical,psychological and support services the Incapacita.ted Person is receiving: Psychiaxric care � Psychological care Workplace�P. Center for Industrial Training Social,t�ran,sportation-CumberlandlPerry MH/MR Program V. GUARDIAN'S OPINION A. It is the opi.nion of the Guardian of the Person that the guardianship should: �continue ❑be modified ❑be terminated Form G-03 �.�0.13.06 Page 3 of 4 Estate of D�EL F. CLEMSON an Incapacitated Person The reasons for the foregoing opinion are: He is permantley retarded. B• During the past year,the Guardian of the Person has visited the Inca acitated Per P son _ �'` times with the average visit lasting hours �_�____minutes. The report of a social service organization employed by the Guurdian 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 correct to the best of my knowledge, information and belief; and that this Verifcation is subject to the penalties of 18 Pa. C.S.A. 4904 relative to unsworn falsification to authorities. § 9/20/Z013 . � Date Signature oJGuardia�t nf the Per,snn Daniel R. Clemson/Jennifer K. McKee Name of Guardian of the P¢rson(type or print) 5213 Royal Dr./2 Cedar Rd. Address Mechanicsburg,PA 17055 City,State,Zip 717-571-2556 / 717-571-9367 Telephone r Fornr G-03 ►,��0.�3.06 Page 4 of 4 � _ .,. _.:.:� IN E: GUARDIANSHIP OF :tN THE COURT OF COMMON PLEAS OF DANIEL F. CLEMSON :CUMBERLAND C�UNTY, PENNSYLVANIA :ORPHANS DIVISION :NO. 21-93-346 TQ Clerk of Orphans' Court Courthouse: Carlisie, PA ANNUAL REPORT OF CUARDIAN OF ESTATE ESTATE: DANIEL F. CLEMSON GUARDIAN: DANIEL R. CLEMSON&JENNIFER K. STOUFFER McKee PERIOD: January 1 -December 31, 2008 DATE FILED: INCOME 20Q8 Source Amount 1/1/2008 BEGINNING BALANCE $972.44 1/3/2008 Social Security/SSI $803.00 1/4/2008 CPARC Pay $35.94 1/18/2008 CPARC Pay $31.39 1/31/2008 Bank lnterest $0.30 2/�/2008 CPARC Pay $49.68 2/1/2008 Social Security/SSI $803.00 2/13/2008 From Trust $1,000.00 2/15/2008 CPARC Pay $�48.44 2/29/2008 CPARC Pay $32.85 ?J29/2008 Bank Interest $0.31 3/3/2008 Social Security/SSt $803.00 3112/2�8 From Dad: Group home fumishings $522.64 3/14/2008 CPARC Pay $44.86 3/28/2008 CPARC Pay $28.78 3/31l2008 Bank Interest $0.22 4/3/2008 Social Security/SSI $803.00 4/11/2�8 CPARC Pay $41.54 4125/2008 CPARC Pay $58.34 4/30/2008 Bank Interest $0.22 5/2/2t�8 Social Security/SSI $803.00 5/9f2008 CPARC Pay $53.28 5/23/2008 CPARC Pay $56.87 5/31/2008 Deposit: Xfer[Personal Expenses $118.00 5/31l2008 Bank Interest $0.22 6/3/2008 Social Security/SSI $803.00 6/6/2008 , CPARC Pay $33.21 6/20/2008 CPARC Pay $78.44 6/29/2008 Deposit: CPARC[too much tRS taxj $280.96 6/30/2008 Bank Interest $0.13 7/3/2008 CPARC Pay $83.49 7���8 Sociai Security/SSI $803.00 ����8 Deposit: PA PSL[tax refund] $57,00 7/18/2008 CPARC Pay $50.03 7���008 Deposit: Birthday Gifts $119.25 7/31/2008 Bank Interest $0.21 �1�4� CPARC Pay $58.82 8/1/2008 Social Security/SSI $803.00 8/15/2008 CPARC Pay $49.63 �9�� CPARC Pay $28.13 ���4� Bank Interest $0.15 9J�� Transfer: From Savings $49.32 913/2�8 Social Security/SSI $803.00 9/12/2�8 CPARC Pay $40.47 9/15/2008 From Dad: Money Market[replenish] $500.00 9/15/2008 From Dad: Reimbursement[wrong card] $148.53 9/17/2008 From Dad: Loan[repayj $�pp,� 9/23/2008 From Dad: Reimbursement[wrong card] $G4.77 9/26/2008 C PARC Pay $40.82 9��� Bank Interest $0.13 10/3/2008 Social Security/SSI $gp3.p0 10/10/2008 CPARC Pay $37.62 10/24/2008 CPARC Pay $103.17 10/31/2008 Bank Interest $0.14 11l3/2008 Social SecuritylSSl $803.00 11R/2008 CPARC Pay $45.37 11/8/2008 From Dad: Reimbursement[wrong cardJ $202.00 11/21/�008 C PARC Pay �51.69 11/30/2008 Bank Interest $0.14 ���� Social Security/SSl $803.00 1���8 CPARC Pay $44.75 12/19/2008 CPARC Pay �29.32 1 Z/31/2008 Bank Interest $0.15 TOTAL INCOME: $15,030.16 EXPENSES ���� KAC Christmas Party $25.pp 1/7/2008 Donation: St Jude Memorial $15.� 1/7/2008 UCP of Central PA $15.00 1/8/2�8 AT&T $59.06 1!9/2008 Donation: ARC of PA $15.00 1111/2Q08 Donation: Women's Memorial $15.00 1/14/2008 Verizon: Phone $37.40 1/15I2008 Kacy for VCR purchase $50.00 ��%��QB To Dad: Share of family visit to Huntingdon $247.00 ����8 To Dad: Share of family visit to Huntingdon $164.00 1/24/2008 MAC: Petty Cash $102.25 ����8 Aurora Club-January Events $23,00 1��� MAC: Circuit City $37.09 2i4/2008 MAC: Petty Cash $101.00 2/4/2008 UCP: Rent-February $478.31 2/412p08 MAC: FYE[CD's] $38.08 2/6/2008 Alert Pharnnacy $32.58 2/412008 M. Lebo: Dec/Jan Stipends $50.00 2/11/2008 AT&T �•� 2/11/2008 Donation: Aurora Rehab $25-00 2/15/2008 CPARC -dues $25•00 2/20/2008 CPARC-dinner $15.00 2/22/2008 To Dad: Group Home Money $7�•� 2/23/2008 MAC: Petty Cash $101.95 2/29/2008 Birthday: Mike �5•� 3/1/2008 MAC:Wages $102.25 3/3/2008 MAC: Petty Cash $202.00 3/3/2008 MAC: Giant $75.56 3i4/2008 UCP: Rent-March $478.31 3/4/2008 MAC:Wages $102.25 3/4/2008 Theo's Dinner ��•� 3/4/2008 FYE: CD's $63.87 3/10/2008 Verizon: lnstall $77.03 3/10/2008 MAC: Petty Cash $101.00 3i10/2008 Philhaven Medical Services $16.29 3/10/2008 Alert Pharmacy $18.00 311?J2008 AT&T: Final Service $12•79 3/13t2�8 Donation: UCP of Centrai PA $10.00 3I15/20p8 MAC: Petty Cash $101.95 3/17/2008 Verizon: Phone $15.37 3/17/2008 Donation: Foundation Comm. Playground $10.00 3I18/2008 Verizon: New Service&2 Months $142.46 3/1 Sl2008 Easter Seals CP: Athletic Events $150.Q0 3/24/2�8 Birthday: Michele $45.00 3I26/2008 Donation: Speciat Olympics PA $10.00 4/1/2008 Philhaven Medical Services $16.29 4/2/2008 UCP Rent-April $478.31 4/5/2pp8 MAC: Petty Cash $102.25 4l16/2008 Alert Pharmacy ��.0� 4/23/2�8 MAC: Petty Cash $101.95 5/1/2008 MAC: Best Buy[DVD Player] $127.18 5/612�8 UCP: Rent-May $478.31 5/7/2008 CVS: Misc. $28.00 5/7/2008 Alert Pharmacy �.� 5R/2008 Medical Service: Dentist $100.00 5/8/2008 Donation: St. Jude Shrine $10.� 5/12/2008 PCIT: Lunch �.� 5/13/2008 Barry Heckard Tax Collector $10.00 g/18/2pp8 MAC: Petty Cash $102.25 5/24/2008 MAC: Petty Cash $202.00 5127/2�8 Easter Seals of Central PA �•� 5t28t2008 Verizon: Phone $53.46 6/312008 To Dad: 1/2 Vacation �37•� 6i3/2008 UCP: Rent-June $478.31 6/11/2008 Comcast: N Sharing Bill $�•� 6/13/2�8 MAC: Petty Cash $102.25 6/16/2008 Easter Seals-Swim Program $80.00 g/18/2008 Birthday: Jesse �0•� 7/2/2�8 Phiihaven Medical Services �5•� 7/3/2�8 Verizon: Phone $65.83 713/2p08 Alert Pharmacy $57•� 7/s/2p08 MAC: Petty Cash $102.25 7/7/2008 Sears: Birthday Gift $31.79 7/8/2008 CPARC:Annual Appeal $�•� 7/8/2008 UCP: Rent-July $478.31 7/9/2008 Birthday: Jen �5•� 7/10/2008 Donation: Special Olympics PA $10.00 � 7/11/2008 Donation: Toys 4 Tots $10.00 7/14/2008 Easter Seals of Central PA $60.00 7/2512�8 Philhaven Medical Services $19.13 7/28/2008 Verizon: Phone $70.73 . 7/30/2008 Diocese of Harrisburg: Summer Camp $25.00 7/31/2008 UCP: Rent-August $478.31 8/3/2008 MAC: Petty Cash $102.00 8/6/2008 To Jen: Camcorder ��•� 8/6/2008 Donation: Women's Memorial $1�.4� S/7/2008 UCP: Rent-August $478.31 g/1 g/�pp8 MAC: Petty Cash $102.00 g/Zp/2008 Alert Pharmacy $21.15 S/27/2008 MAC:Athletic Dept. [Clemson] $148.53 9/2/2008 UCP: Rent-September $478.31 g/3/20p8 MAC: Petty Cash $102.25 9R/2008 MAC: Circuit City[Boom Box] $152.60 9/13/2008 MAC: CVS[Razor] $71.53 9/15/2008 To Dad: Bellefonte Trip $145.00 9/15/2008 Easter Seals: Bowling �5�� 9116/2008 Birthday: Kacy �5.� 9/17/2008 MAC: Dad Loan $102.25 g/;�008 Diocese of Harrisburg: Summer Camp $350.� 9/23/2008 MAC: Giant(Dad Wrong Card] $64•77 9/23/2008 Clerk of Orphans Court: GR $15.00 g/3p/2�8 Verizon: Phone �9•� 9/26/2008 Alert Pharmacy $33.15 �p/3/2008 MAC: Petty Cash $101.95 10/3/2008 UCP: Rent-October $478.31 10/4/2008 MAC: Walmart $45.30 10R/2008 Donation: St. Jude Shrine $10.00 10/9/2008 Donation: Easter Seals �•� 14/26/2008 MAC: Petty Cash $102.00 11/3f2�8 E.S. Therapeutic: Nov/Dec �•� 11/4/2008 Verizon: Phone �9•� 11/4/2008 MAC: Dad Lost Card $202.00 11/4/2008 Alert Pharmacy $14.15 . , . 11/5/2008 Donation: Women's Memorial $10.00 11/6l2008 Alert Pharmacy $23.45 11/6/2008 UCP: Rent-November $478.31 11/7/2008 Donation: Toys 4 Tots $10.00 11/7/2008 Birthday: Jim Stouffer $45.00 11/10/2008 Donation: Special Olympics PA $10.00 11/12/2�8 Kreidner&Cherenka: Dentist $110.00 1 1/1 412008 Comcast:TV Sharing Bill $102.76 11/17120tJ8 PCIT: Holiday Dinner $5.50 11/19/2�8 MAC: Petty Cash $102.00 12�6/2a08 MAC: Petty Cash $102.00 12/9/2008 Verizon: Phone �9•� 12/1112008 Donation: UCP $10.00 12/11/2008 Alert Pharmacy $�•� 12/11/2008 Capital City Mall: Gift $27.00 12/12/2008 UCP: Rent-December $478.31 12/15/2008 Donation: Special Olympics PA $8.00 12/16�22008 MAC: Petty Cash-Christmas $162.25 12/17/2008 MAC: Petty Cash $102.00 12J30/2008 MAC $102.50 TOTAL EXPENSES: $14,728.75 ENDING BALANCE: s301.41 ♦ . # r�`_' � �,�_; C� �a � � �"�'1 � � 0 c"�.: f:"'� � � � C:% ^""" �} � ""w."d "'� �!'� � � � i�.�.' F--� ;�1� �� 1�„' (�.1 �'� � C�� � ;-�• � ;� _...�.� ..R-� ""�'i C::3 �" ��� �� �^( ANNUAL REPORT OF �� �-.. :,; =� �� �� �.,�. r....., p`�`� GUARDIAN OF THE ESTATE :� �.�� r'' ��;� �, _;� �,, .� � � COURT OF COMMON PLEAS OF � CUMBERLAND COUNTY,PENNSYLVANIA ORPHANS' COURT DIVISION Estate of D�L F. CLEMS�N ,an Incapacitated Person No.21-93-346 I. INTRODUCTION DANIEL R. CL,EMSON / JENNIFER K.MCKEE ,was appointed �Plenary 0 Limited Guardian of the Estate by Decree of E.B. Bailey / G.E.Hoffer ,J.i �t�5/3/1993 - 3/17/2000 . � A. This is the Annual Report for the period from January 1 , v�Ol�9 to December 31 , (the"Report Period"); or 0 B. This is the Final Repott for the period from . to , (the"Report Period"),and is filed for the following reason: l. The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Guardianship was tertninated by tlie Court by Decree of J.,dated Form G-01 rev.10.13.06 Page 1 of 5 Esta.te of DANIEL F. CLEMSON ,An Incapacitated Person II. SIfMMARY A. State the value of the estate reported on the Inventory $ B. State the value(s)of principal assets at�he beginning of the Report Period. (Sanne as Inventory if first Report, otherwise, ending balance from last Report.) $ C. What is the total amount of income earned during the !/ Report Period? $ � �J�D`��, �� D. What is the total amount of income and principal �] s ent for all purposes during the Report Period? � ��.���� J P E. What are the balances remaining at the end of the Report Period? l. Principal $ 2. Income $ , O r, ,7 � 3. T�tal of Princi�al and Inc�me S 7 � III. ADDITIONAL INFORMATION (If more space is needed,please attach additional pages.) A. Principal 1. How is the principal balance listed above curtently invested? (Please specify,e.g.,real estate, cer�ificates of deposit,restricted bank accounts,etc.): PSECU SAVINGS ACCOUNT 2. Have there been any expenditures from t�ie principal during th��eport Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes a No If yes: . a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? . . . . . . . . �Yes 0 No F�G-o2 rev 10.13.06 Page 2 of 5 � , Estate of DANIEL F. CLEMSON .An Incapacitated Person b. List purpose and amount of expenditures: $ SEE ATTACHED REPORT � $ � c. Was Court approval received prior to expending the principal? . . . . . . . . . . . . . . . . . . . . . . . �Yes �No 3. Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? . . . . . . . . . . . �Yes 0 No If yes: a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . . . �Yes �No b. State the sources and amounts of the additional principal received: $ SEE ATTACHED REPORT $ $ � � B. Income 1. Sta.te sources and amounts of income received during the Report Period(e.g., Social Security, pension,rents, etc.): $ SEE ATTACHED REPORT � $ $ $ $ Total income received during Report Period: $ o•� Form G-02 rev.lo.l�.06 Page 3 of 5 � , Estate of DANIEL F. CLEMSON _ ,An Incapacitated Person 2. How is income currently invested? (Please specify,e.g.,restricted bank accounts, client care account, etc.): PSECU CHECKING ACCOUNT C. Ezpenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person(e.g., clothing,nursing home,medicine,support, etc.): SEE ATTACHED REPORT D. Other Ezpend�tures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) SEE ATTACHED REPORT E. Guardian's Commissions List amounts of compe�nsation pa�d as Guardian's commission and state how amount was determined: Court .Amount Method of Determination Approval Obtained 0.00 Q Yes a No 0.00 �Yes 0 No Fo�c-o2 �.�o.�3.06 Page 4 of 5 � , . Estate of DANIEL F. CLEMSON ,An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee,and indicate whether Court approval was obtained. Court Amount Approval Obtained ❑Yes Q No �Yes 0 No I verify that the foregoing infonnation is correct to the best of my knowledge, information and belie� and that this Verification is subject to the penalties of 18 Pa.C.S. §4904 relative to unsworn falsification to authorities. 9120/2013 � ��(,� ."''l. Date Signature of Guardian of t Estate Daniel R. Clemson / Jennifer K.McKee Name of Guardian of tbe Estate(type or print) 5213 Royal Dr. / 2 Cedar Rd. Address Mechanicsburg,PA 17055 City,State,Zip 717-571-9367 Telephone For�n G-OZ rev. 10.13.06 P8g@ 5 Of 5 • r A►NNUAL REPORT OF GUARDIAN OF THE PERSON �, w �, m � � p r� t�! � � .3 �+� _.._ � � ::? � -----� �9 %.L7 „��+ �'-- f..�, �x� f� 1 COURT OF COMMON PLEAS OF �"" �: � cr ;� � .ys �M�12 �f��,� covrr�,PENNSYLV �� �?' �. �►��a �F;� � � � , ORPHANS' COURT DIVISION �� � � �-�� � • � -"�' ,::� � _ � _ � , . _... „ ...:� r�.; ,�.. ��� v�� z�-- ""�J r,, �� � � 4� � Estate of DANIEL F. CLEMSON an Incapacitated Person No. 21-93-346 I. INTR�DUCTION Daniel R Clemson / Jennifer K.Mckee ,w�appointed �Plenary�Limited Guardian of the Person by Decree of E.B. Bailey / G.E.hoffer J.� dated. 5/3/1993 / 3/17/2000 � � A. This is�he Annual Report for the p�riod fr m January 1 '=�-��('�-� t o D e c e m b e r 3 1 (t he"Report Perio d"); or � B. This is the Final Report for the period from , to , (the"Report Period"),and is filed for the following reason: l. The death of the Incapacitated Person. Date of death: 2. The Guardianshi�was term.inated by the Court by Decree of J.,dated For a F�nal Repor� om�t Sections II through IV. Form G-03 rev.10.13.06 Page 1 of 4 . Estate of DAN�L F. CLEMSON an Incapacitated Person �T. �'��tJNAL I)A�'=A Age of the Incapacitated Person:�,;� Date of Birth:J�Y 29, 1970 III• LIVING ARRANGEMENTS A. Current address of t�he Incapacitated Person: tT�P Lisbur��`rro���ia�� 829 Lisburn.Rd. Camp Hill,PA 17011 B• The Incapacitated Person's residence is: � ❑own home/apartment �r�urs���� ❑boarding home/personal care home �Guardian's home/apartment ❑hos�itaa,i ar�edical faei��ty Q relative's home(name,relationship and address) �J other: �2.,(�(,P f f D/�� C. The Incapacitated Person has been in the present residence since February 1,2008. . If the Incapacitated Person has moved within the past yeaz,state prior residence and reason(s)for move: 6 •M et St., 'csbur 1 rom aging s home,to group home care �'- Form G03 r�10.13.06 Page 2 of 4 . — -:�� • r Estate of DANIEL F. CLEMSON a.n Inca aci p tate�rcrson D. Name and address of the Incapacitated Person's primary caregiver: United Cerebral Palsy of Central PA IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: Ment�al�y Retarded-trainable Hyperchenetic Behavior B. Specify what,if any, social,medical,psychological and support services the Incapacitated Person is receiving: Psychiatric care Psy�chulogical ca�e Workplace-P. Center for Industrial Traini.ng Social,transporta.tion-Cumberland/Perry MhUMR program V. GUARDIAN'S OPINION A. It is the opinion of the Guardian.of the Person that the guardianship should: �continue ❑be modified ❑be terminated Form G-03 rev 10.13.06 Page 3 of 4 � Estate of D�EL F. CLEMSON an Incapacita.ted Person The reasons for the foregoing opinion are: He is permantley retarded. B. During the past year,the Guardian of the Person has visited the Incapacitated Person =times with the average visit lasting 3 hours, 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`correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa. C.5.A. §4904 relative to unsworn falsification to authoriries. 9/2b/2013 e�/,� Date �� Signature nf Guardim�nf the Per.snn Daniel R. Clemson/Jennifer K. McKee Name of Guardian o�'the Person(type ur print) 5213 Royal Dr./2 Cedar Rd. Address Mechanicsburg,PA 17055 c�r�,sr�ne,z� 717-571-2556 / 717-57i-9367 Telephone Form G-03 ��a�3.06 Page 4 of 4 f IN RE: GUARDIANSHIP OF :IN THE C�URT OF C�MMON PLEAS OF DANIEL F. CLEMSON :CUMBERLAND COUNTY, PENNSYLVANIA :ORPHANS DIVISION :NO. 21-93-34fi T�Cierk of Orphans' Court Courthouse: Carlisle, PA ANNUAL REPORT OF GUARDIAN OF ESTATE ESTATE: DANIEL F. CLEMSON GUARDIAN: DANIEL R. CLEMSON&JENNIFER K. STOUFFER-McKee PERIOD: January 1 -December 31, 2009 DATE FILED: INCOME 2� urce Amount BEGINNING BALANCE $301.41 1i212009 CPARC: Wages $38.58 1/2/2�9 Social Security Income $850.00 1/16/2�9 CPARC: Wages $35.93 1/30/2009 CPARC: Wages $31.29 1/31/2009 Bank: Interest Eamed $0.07 2/3i2009 Sociai Security Income $850.00 2/13/2009 CPARC: Wages $53.85 2/27/2009 CPARC: Wages $30.93 2/28/2009 Bank: Interest Eamed $0.03 3/3/2009 Sociat Security Income $850.00 3/13/2009 CPARC: Wages $50.26 3/27/2009 CPARC: Wages $45.59 3/31 J2009 Bank: interest Eamed $0.03 4/1/2009 Deposit $44,44 4/3/2009 Social Security Income $850.0� 4/10/2009 CPARC: Wages $38.53 4/20l2009 From Dad: Extra Funds $25.pp 4/24/2009 CPARC: Wages $69.34 4/2�2009 From Dad: Reimbursment $102.00 4/30/2�9 Bank: Interest Eamed $0.03 5/1l2009 Socia!Security Income $850.00 5/7f2�9 US Treasury Refund $250.00 5/8/2009 CPARC: Wages $75.35 5/22/2009 CPARC: Wages $51,44 5/31/2009 Bank: Interest Eamed $0.07 6/3/2009 Social Security Income $850.00 6/5/2009 CPARC: Wages $73.10 6/19/2009 CPARC: Wages $82.g6 6/30/2�9 Bank: Interest Eamed $0.06 7l2/ZOQ9 Social Security Income �850.p0 7/3/2009 CPARC: Wages $72.92 . , 7/17/2009 CPARC: Wages $97.62 7/31/2009 CPARC: Wages $58.91 7/31/2009 Bank: Interest Eamed $0.06 8/3l2009 Deposit: Reimbursement $25.00 8/3/2009 Social Security Income $850.00 8/9/2009 Transfer. From Savings $300.00 8/14/2009 CPARC: W�ges $79.01 8/2812009 CPARC: Wages $32.32 8i31/2009 Bank: Interest Earned $0.06 9/3/2009 Social Security income $850.00 9/512009 From Dad: Loan Repayment $100.00 ' 9/11/2009 CPARC: Wages $92.23 9/25/2009 CPARC: Wages $38.90 9/30f2009 Bank: interest Eamed $0.04 10/2/2009 Social Security Income $850.00 10/9/2�9 CPARC: Wages $70.47 10/23/2009 CPARC: Wages $43.65 10/31/2009 Bank: Interest Earned $0.05 11/3/2008 Social Security Income $850.00 11/6/2�8 CPARC: Wages $30.43 11l20/2009 CPARC: Wages $41.46 11l30/2009 Bank: interest Eamed $0.05 12/312009 Social Security income $850.00 12/4/2�9 CPARC: Wages $28.56 12/1 Sl2�9 CPARC: Wages $39.92 12/31/2009 CPARC: Wages $39.00 12/31i2009 Social Security Income $850.00 12/31/2009 Bank: Interest Eamed $0.03 TOTAL INCOME: $13,640.88 EXPENSES 1/8/2009 Verizon: Phone Service $69.44 1/8/2009 Alert Pharmacy $10.00 � 1111/2�9 MAC: CVS[electronics] $103.86 1/13/2009 MAC: Petty Cash $102.50 1/15/2009 Easter Seais of Centrai PA $100.� 1/23/2009 Birthday: Nicole Stouffer $40.00 1/23/2009 UCP: Rent-January $505.01 2/1/2009 MAC: Petty Cash $102.00 2/2l2�9 Verizon: Phone Service $69.96 2/5/2009 Alert Pharmacy $35.75 2/5/2009 UCP: Rent-February $505.01 2/9/2009 CPARC Dues $25.00 2/19/2009 Easter Seals Dues $7.00 2/19/2009 Aurora Rehab. Event $10.50 2119i2�9 Aurora Rehab. Event $25.00 2i21/2009 MAC: Petty Cash $102.00 2/21/2009 MAC: CVS[perscriptions] $71.00 2/2512009 Birthday: Mike $40.00 3I2/2009 Verizon: Phone Service $69.04 3/2/2009 Intemists of PA[Medical] $59.37 3/5/2009 To Jen: Gift $16.20 3/5/2�9 Unica�e Ins. $7.40 3/5/2009 CPARC Awards Dinner $30.00 3/5/2009 UCP: Rent-March $505.01 3/9/2009 MAC: Petty Cash $102.25 3/12/20�9 Easter Seals Therapeutic $65.00 3/13/2009 West Shore Tax Bureau $3.24 3/19l2009 Birthday: Michele $40.00 3/31/2009 Verizon: Phone Service $69.04 3/31/2�9 Alert Pharmacy $34.15 4/1/2009 MAC: Emergency Card $102.00 4/1/2009 MAC: Petty Cash $102.25 4/?J2�9 B.L. Heckard: Psi. Tax $9.80 4/2/2009 Dues: UCP $10.00 4/3/2�9 UCP: Rent-April $505.01 4/13l2009 Donation: St. Jude Shrine $10.00 4/13/2009 Donation: Special Olympics PA $10.00 4/20/2009 Jen-DVD Player $70.40 4/27/2009 Verizon: Phone Service $69.47 4/27/2009 MAC: Petty Cash $102.00 4/29/2009 Unicare Ins. $7.40 4/29/2009 Diocese of Harrisburg: Camp $25.00 5/1/2009 UCP: Rent-May $505.01 5/3/2009 MAC: Petty Cash $102.00 5/21/2009 Kraner&Cherenka[Dentist] $110.00 5/23/2009 MAC: JC Penny[Bedding] $25.98 5/25/2009 MAC: Petty Cash $102.50 5/25/2009 FYE: CDs � $45.55 6/3/2009 Alert Pharmacy $60.45 6!4/2�9 Verizon: Phone Service $70.53 6/4/2009 UCP: Rent-June $505.01 6/S/2�9 Unicare Ins. $7.40 6/8/2009 ES Therapeutic Rec. $65.00 6/11/2009 MAC: Petty Cash $62.00 6/12/2009 Easter Seals: "Walk with me"Drive $25.00 6/14/2009 MAC: CVS[toiletries] $39.39 6/15J2009 Intemists of PA[Medical] $15.00 6/16/2009 MAC: Petty Cash $102.50 6/18/2009 To Dad: Loan $25.00 6/19/2009 Aurora Social Event $10.50 6/26/2009 Birthday: Jesse $35.00 6/29/2009 Kmart: Supplies $51.92 6130/2�9 Verizon: Phone Service �70.53 6/30/2009 Alert Pharmacy $23.15 7/1/2009 Unicare Ins. $3.70 7/2/2009 Donation: Women's Memorial Foundation $15.00 7/2/2009 Donation: UCP $20.00 • � 7/2/2009 UCP: Rent-July $505.01 7/4/2009 MAC: Petty Cash $103.00 7/8/2009 Nicole's Graduation $25.00 7/14/2009 MAC: Petty Cash $102.50 7/30/2009 Aurora Rehab. Event $15.00 8i1/2009 MAC: Petty Cash $103.00 S/2l2009 To Dad: Misc. Bilis $97.70 8/6/2009 UCP: Rent-August $505.01 8R/2009 Donation: Toys 4 Tots $10.0� 8/9/2009 To Dad: Bills[church camp/comcast] $565.00 8i10/2009 Donation: Special Olympics PA $10.00 8/10/2009 MAC: Petty Cash $102.25 8/12/2009 Jesse: Birthday $40.00 8/27/2009 Verizon: Phone Service $70.85 8/29/2009 MAC: Petty Cash $202.25 8/31/2009 Unicare ins. $3.70 8/31/2009 Snappers: Dinner $56.33 9/3/2009 MAC: Petty Cash $202.25 9/3/2009 UCP: Rent-September $505.01 9J8/2009 MAC: Walmart[CDs] $12.60 9/13/2009 MAC: Kmart[Stereo] $114.46 9/17/2009 Donation: Easter Seals $1�.00 9/23/2009 MAC: Petty Cash $102.25 9/28/2009 FYE: CD $19.06 9/30/2009 Unicare Ins. $3.70 9/30/2009 Alert Pharmacy $23.15 10/1/2009 MAC: Petty Cash $102.25 10/2/2009 Birthday: Kacy $40.00 10/2/2009 UCP: Rent-October $505.�1 10/9/2009 Donation: St. Jude Shrine $10.00 10/15/2009 Alert Pharmacy $14.15 10/23/2009 Aurora Rehab. Event $12.00 10/23/2009 ES Therapeutic Rec. $65.00 10l24/2009 MAC: Petty Cash $103.00 10/29/2009 Verizon: Phone Service $142.51 11/2/2009 MAC: Petty Cash $102.25 11/2/2009 Unicare Ins. $3.70 11/3/2�9 Alert Pharmacy $33.15 11/4/2009 UCP: Rent-November $505.01 11/18/2009 Birthday: Jake $40.00 11/29/2�9 CVS: Toiletries $78.49 11/30t2009 MAC: Petty Cash $102.50 12/312009 Verizon: Phone Service $70.72 12/3/2009 To Dad: Gift Money $30.00 12/3/2009 Alert Pharmacy $23.15 12l3/2�9 UCP: Rent-December $505.01 12/4/2009 Kraner&Cherenka[Dentist] $110.00 12/7/2(�9 Unicare Ins. $3.70 12/7/2009 Donation: UCP Foundation $10.00 12lS/2009 Donation:Women's Memorial Foundation $8.00 + . 12/8/2009 Donation: CRS $10.00 12/9/2009 Donation: E Toys for Tots $10.00 12/9/2009 Donation: Special Olympics PA $8.00 12i9/2009 Donation: PVA $8.�0 12/10/2009 Donation: Easter Seals $10.00 12/11/2009 Donation: VFW $6.00 12/14/2009 MAC: Petty Cash/Gift Money $202.25 12/16/2009 Birthday: Nicole $35.00 1?J20/2009 To Dad: IOU $10.00 1?J30/2009 MAC: Petty Cash $103.00 TOTAL EXPENSES: $12,576.71 ENDING BALANCE: $1,064.17 . , ;--�...; C7 � � � C 0 � � � �.,;°� �� � � A►NNUAL REPORT 4F �' ��� ---; �:� =� m � �, :U �. i-- E..� �=',-:� L� GUARDIAN OF THE ESTATE � ;�. �-�� � ��.� �;� (�3 .:� d ;;:�:;, � C�7 �`� �, "�.� ".�.,, '�•� � � w� � .. �F"1 COURT OF COMMON PLEAS OF :�� � � �' CUMBERLAND . .�f W� rv � �. ,��, COUNTY,PENNSYLVA�!�tI� � �, �, ORPHANS' COURT DTVISION �'' � � c Y � ; � Estate of DANIEL F. CLEMSON ,an Incapacitated Person No.21-93-346 I. INTRODUCTION DA►NIEL R. CLEMSON / JENNIFER K.MCKEE ,was appointed 0 Plenary ❑Limited Guardian of the Estate by Decree of E.B. Bailey / G.E.Hoffer �J.� �t�5/3/1993 - 3/17/2000 . � A. This is the Annual Report for the period from ��u�'Y 1 , 0/ to December 31 , (the"Report Period"); vr � B. This is the Final Report for the period from , to , (�the"Report Period"),and is filed for the following reason: l. The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Cuardianship was terminated by the Court by Decree of J.,dated Fo,m c-o� rev 1013.06 Page 1 of 5 Estate of DA►NIEL F. CLEMSON ,An Incapacita.ted Person II. 5IT11�ViARY A. State the value of the estate reported on the Inventory $ B. State the value(s}of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, otherwise,ending balance from last Report.) $ C. What is the total amount of in.come earned during the ��L��` n Report Penod. $ �� D. What is the total amount of income and principal � spcnt fir all purp�scs�uring thc R.cport rcri�l? S E. What are the balances remaining at the end of the Report Period? 1. Principal $ � 2. Income $ � 3, Total of Principal and Incomc $ � �" III. ADDITiONAL INFORMATION (If more space is needed,please attach additional pages.) A. Pr�ncipal 1. How is the principal balance listed above currently invested? (Please specify,e.g.,real estate, certificates of deposit,restricted bank accounts, etc.): PSECU SAVINGS ACCDUNT 2, Have there been any expenditures from the principal during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes �No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? . . . . . . . . �Yes �No Form G-02 rev 1013.06 Page 2 of 5 . , Estate of DANIEL F. CLEMSON ___,An Incapacitated Person b. List purpose and amount of expenditures: S SEE ATTACHED REPORT � � � c. Was Court approval received prior to expending the principal? . . . . . . . . . . . . . . . . . . . . . . . �Yes �No 3. Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? . . . . . . . . . . . �Yes 0 No If yes: a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . . . ❑Yes �No b. State the sources and amounts of the additional principal received: $ SEE ATTACHED REPORT � � $ � B. Income 1. State sources and amounts of income received during the Report Period(e.g., Social Security, pension,rents, etc.): � SEE ATTACHED REPORT $ $ , � $ � Total income received during Report Period: $ o•� Form�02 rev 10.13.06 Page 3 of 5 . --�. . � Estate of DANIEL F. CLEMSON .An Incapacitated Person 2. How is in.come currently invested? (Please specify,e.g.,restricted bank accounts, client care account, etc.): PSECU CHECKING ACCOUNT C. Ezpenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person(e.g., clothing,nursing home,medicine,support,etc.): SEE ATTACHED REPORT D. Qther Ezpenditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) SE�ATTACHED REPORT E. Gnardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Court Amount Method of Determination Approval Obtained 0.40 �Yes ❑No 0.00 QYes QNo Fo�c-oa rev.I0.13.06 Page 4 of 5 • . � Estate of DArTIEL F. CLEMSON ,An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Court Amount Approval Obtained �Yes a No �Yes 0 No I verify that�the foregoing information is correct to the best of my knowledge, infonnation and belief; and that this Verification is subject to the pena.lties of 18 Pa.C.S. §4904 relative to unsworn falsification to authorities. 9/20/2013 ' ��, Date Signature of Guardian of the Estote Daniel R. Clemson / Jennifer K.McKee Name of Guardian oJthe Estate(t}pe or print) 5213 Royal Dr. / 2 Cedar Rd. Address Mechanicsburg,PA 17055 Ci ,State,Zlp �t7� S7� ��5� 717-571-9367 Telephone Fo�G-oa �.�o.�3.06 Page 5 of 5 . + ANNUAL REPORT OF GUARDIAN OF THE PERSON ^; � �.., � � � t�+ e> G'� c�� �'7 G p �-�.� �. -�S COURT OF COlViMON PLEAS OF � ��'' =� �� � � `;€� � �� ��"� �� �„L��IC�►�IZC��[T11 ,_COLJNTY,PFNNSYLVANIA, ,��. .y�: `;�" U�, � .�, , �.. ORPHANS' COURT DIVISION � ��� }�;� � � ';�;� t;r, ° -^�� _� .�,�„ .. ;_�, ..� Y „�.:.. .��..-. ---- � �._., �� ',�3 _... ,�� � f..-�� �, ' v 4 t� �� ,...} �"�"� `� . +""';.) ��� � Estate of DANIEL F. CLEMSON an Incapac tated Person , - No. 21-93-346 I. INTRODUCTION Daniel R. Clemson / Jennifer K.Mckee was appointed �Plenary�Limited Guardian of the Person by Decree of E.B. Bailey / G.E.lfoffer �.� dated 5/3/1993 / 3/l�/2000 � � A. This is the Annual Report for the period fror� January 1 �Q/� to De_,cember 31 (the"Report Period");or � B. This is the Final Report for the period from , � to , (the"Report Period"),and is f led for the following reason: l. The death of the Incapacitated Person. Date of death: � 2. The Guardianship was ternunated by the Court by Decree of J.,dated For a Final Repor� omit Sections II through IY. Form G-03 rev.10.13.Ob Page 1 of 4 . s Estate of DAI�TIEL F. CLEMSON a,n Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person:��_ Date of Birth:J�Y 29� 1970 III. LIVING ARIRANGEMENTS A. Current address of the Incapacitated Person: UCP Lisburn Group Home 829 Lisburn Rd. Camp Hill,PA 17011 B. The Incapacitated Person's residence is: [�own home/apartment ❑nursing home �boardi.ng home/personal care home (�Guardian's home/apartment (�hospital or medical facility (,�relative's home(name,relationship and address) �other: ��C�(,�,P {�(�/1�(� C. The Incapacitated Person ha.s been in the present residence since February 1,2008. . If the Incapacitated Person has moved within the past year,state prior residence and reason(s)for move: . AY'ket St., , rom a ' g fa r's home,to group home care Furm G-U3 rev.]0.13.06 Page 2 of 4 . s Estate of DANIEL F. CLEMSON , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: United Cerebral Palsy of Central PA N. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: Mentally Retarded-txainable Hyperchenetic Behavior B. Specify what, if any, social,medical,psychological and support services the Incapacitated Person is receiving: Psychiatric care Psychological care Workplace-P. Center for Industrial Training Social,transportation-Cumberland/Perry MH/MR Program V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: 0 connnue 0 be modified ❑be terminated Form G03 rev.10.13.06 Page 3 of 4 � Estate of D�EL F. CLEMSON an I$capacitated Person The reasons for the foregoing opinion are: He is permantiey retarded. B. During the past year,the Guardian of the Person has visited the Incapacitated Person �times with the average visit lasting_� hours, 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 cortect to the best of my knowledge, informahon and belief;and that this Verification is subject to the penalties of 18 Pa. C.S.A. §4904 relative to unsworn falsification to authorities. 9/20/2013 ' �t�� 1� Date Signat nJGuardian nf the Per,son Daniel R. Clemson/Jennifer K.McKee Na»�e of Guardian uf the Person(type or prir�t) 5213 Royal Dr./2 Cedar Rd. Address Mechanicsburg,PA 17055 c�ey,s:o�,2� 717-571-2556 / 717-571-9367 Telephone F�c-o3 rev.1 D.13.06 Page 4 of 4 . y IN RE: GUARDIANSHIP OF :IN THE COURT OF COMMON PLEAS OF DANIEL F. CLEMSON :CUMBERLAND COUNTY, PENNSYLVANIA :ORPHANS DIVISION :NO. 21-93-346 TtZ Clerk of Orphans' Court Courthouse: Carlisie, PA ANNUAL REPORT OF GUARDIAN OF ESTATE ESTATE: DANIEL F. CLEMSON GUARDIAN: DANIEL R. CLEMSON&JENNIFER K. STOUFFER McKee PERIOD: January 1 -December 31, 2010 DATE FILED: INCQME 20� o r e Amount BEGINNiNG BALANCE 1 4.17 1/15/20'I 0 CPARC: Wages $33.69 1129/2010 CPARC: Wages $37.32 1/31/2010 Bank: interest $0.04 2/3/2010 Social Security: Income $850.� 2/1?J2010 CPARC: Wages $36.31 � ?J26/2010 CPARC: Wages $38.32 2/28/2010 Bank: Interest $0.04 3/3/2010 Sociai Security: Income $850.� 3/12/2010 CPARC: Wages $41.47 3/26/2010 CPARC: Wages $37.32 3/31/2010 Bank: Interest $0.04 4/2/2010 Social Security: Income $850.00 4/9/2010 CPARC: Wages $39.41 4/11/2010 Radio Shadc: Electronics $31.78 4/23/2010 CPARC: Wages $43.32 4/30/2010 Bank: Interest $0.05 5/3/2010 Social Security: Income $850.� 5/7/2010 CPARC: Wages $31.58 , 5/15/201� ATM: IRS $50.� 5I21/2010 CPARC: Wages $32.62 5/31/2010 Bank: Interest $0.03 6/3/2010 Social Security: lncome $850.00 6/4/2010 CPARC: Wages $45.13 C�1812010 CPARC: Wages $61.99 6/30t2010 From Dad: Transfer[Dentist] $220.OU 6/30/2�10 Bank: Interest $0.03 7/212010 CPARC: Wages $41.48 7/2/2010 Social Security: Income $85�.Op 7/15/2010 MAC: Deposit $15.00 7/16/2010 CPARC: Wages $44.44 7/30/2010 CPARC: Wages $77.55 r 7/31I2010 Bank: interest $0.04 8i3/2010 Social Security: income $850.00 8/13/2010 CPARC: Wages �105.52 8/27/2010 CPARC: Wages $70.97 8/31/2010 Bank: Interest $0.07 9/3/2010 Social Security: Income $850.00 9/9/2010 Transfer: From Savings $100.00 9/10%2010 CPARC: Wages $47.37 9/16/2010 From Dad $50.00 9/21/2010 From Savings: Overdraft $1.71 9/23/2010 Savings to Checking: Overdraft $70.50 9/24/2010 CPARC: Wages $41.26 9/29/2010 From Dad: Repayment $15.00 9/30/2010 Bank: Interest $0.02 10/1/2010 Sociai Security: Income $850.00 10/8/2010 CPARC: Wages $81.92 10/21/2010 CPARC: Wages $46.94 10/31/2010 Bank: Interest $0.03 11/3/2010 Social Security: Income $850.00 11/5/2010 CPARC: Wages $31.80 11/19l2010 CPARC:Wages $70.04 11/30/2010 Bank: lnterest $0.03 12/2/2010 Transfer: From Money Market $300.00 12/3/2010 CPARC: Wages $66.75 12/3/2010 Social Security: lncome $850.00 12/17/2010 CPARC: Wages $78.51 12/21/201� Transfer: From Money Market $1�0.00 1?J2112010 From Dad: Radio Shack Refund $25.00 12/23/2010 From Dad: Dad's lost card $200.00 12/29/2010 From Dad:Transfer[Funds] $160.00 12/30/209 0 From Dad: Lost Card $300.00 12131/2010 CPARC: Wages $24.33 12/31/2010 Bank: (nterest $0.03 TOTAL INCOME: $13,360.97 EXPENSES 1/6/2010 Alert Pharmacy $23.15 1/6/2010 Verizon: Phone Service $70.72 1/6/2010 UCP: Rent-January $505.01 1R/2010 Unicare Ins. $0.70 1/18/2010 MAC: Petty Cash $103.00 1/2?J2010 Verizon: Phone Bill $71.10 1/25l2010 MAC: Petty Cash $103.00 1l27/2010 Easter Seals Dues $10.00 1/29/2010 E.S. Rec: Dues/Bowling $85.00 2/3/2010 Alert Pharmacy: Meds $13.15 2/5/2010 UCP: Rent-February $505.01 2/19/2010 MAC: Petty Cash $103.00 2/24/2010 Mac $102.50 , . 2/24/2010 Donation: Easter Seais $10.00 2/25/2010 Birthday: Mike $40.00 2/28i201� MAC: Kmart[CDs] $21.19 3/1/2010 Aurora Rehab.: Event $11.50 3I3/2010 Alert Pharmacy: Meds $43.15 3/3l2010 UCP: Rent-March $505.01 3/1?J2010 To Dad: Chedcbooks $25.00 3/12/2010 Easter Seals Bowling $65.00 3/15/2010 Donation: St. Jude Shrine $15.00 3/23/2010 MAC: Petty Cash $102.50 3i24/2010 Verizon: Phone Bill $142.20 3/24/2010 MAC: 011ies[Dad Birthday] $31.78 3/24/2010 Birthday: Mich $35.00 3/26/2010 BL Heckand: Tax $9.80 3/29/2010 Snappers: Dinner $32.52 4/1 J2010 S. Heart League: Crucifix $6.00 4/3/2010 MAC: Petty Cesh $103.00 4/11/2010 Radio Shack: Electronics $49.80 4/13/2010 UCP: Rent-April $505.01 4/16/2010 Alert Pharmacy: Meds $69.15 4/21/2010 MAC: Petty Cash $102.25 4/21/2010 Donation: Special Olympics $10.00 4/23/2Q10 Aurora Rehab.: Event $7.50 4/27/2010 Verizon: Phone Bill $71.41 4/29/2010 Donation: UCP $10.00 5/3/2010 MAC: Petty Cash $102.25 5/3/2010 UCP: Rent-May $505.01 5/6/2010 Tax Bur.: Balance Due $4.16 5/15/2010 MAC: Petty Cash $102.25 5/15l2010 MAC: Walmart(Recorder] $47.57 5/19l2010 ES Therap. Rec. $65.00 5/20/2010 Verizon: Phone Bill $71.41 5/20/2010 Alert Pharmacy: Meds $51.15 5l28/2010 Intemists $10.00 611/2010 Alert Pharmacy: Meds $51.15 6/1/2010 UCP: Rent-June $505.01 6/4/2010 MAC: Petty Cash $102.25 6/12/2010 To Dad: Chedcbooks $15.00 6/18/2010 Aurora Rehab.: Event $5.50 6/19/2010 MAC: Petty Cash $102.25 6/14/2010 Verizon: Phone Bill $71.41 6/23/2010 Birthday: Jen $40.00 6/25/2010 Birthday: Jesse $35.00 6/28/2010 Donation: Special Olympics $10.00 6/29/2010 MAC: Giant $32.44 6/30/2010 Intemists: Medical $50.56 7/2/2010 MAC: Petty Cash $102.25 7/2/2�10 Smiles Dental $220.00 7/2/2010 UCP: Rent-July $505.01 719J2010 Diocese of Harrisburg: Camp Deposit $25.00 �t ' 7/14/2010 MAC: Petty Cash $102.25 7l28/2010 Alert Pharmacy: Meds $87.15 7/28/2010 To Dad: Reimbursment $10.00 7/28/2010 To Jen: Reimbursment $5.00 7/30/2010 Donation:Toys 4 Tots $10.00 7/30/2010 Aurora Rehab.: Event $7.50 7/31l2010 MAC: Petty Cash $102.25 8/2/2010 E. Seais of Central PA $65.0� 8/17I2010 MAC: Petty Cash $102.50 8/23/2010 To Dad $10.00 8/16/2010 UCP: Rent-August $505.00 8/27i2010 Verizon: Phone Bili $141.92 8/30/2010 MAC: Petty Cash $102.25 9/1/2010 Alert Pharmacy: Meds $146.91 9/4/2010 To Savings $225.00 9/5/2010 ATM: Fee' $0.25 9/5/2010 MAC: Church camp/Dad $202.5fJ 9/8/2010 MAC: Petty Cash $102.25 9/10/2010 UCP: Rent-September $505.01 9/14/2010 Birthday: Kacy $40.00 9l18/2010 MAC: Petty Cash $102.25 9/21/2010 Verizon: Phone Biil $73.08 9/23/2010 Aurora Rehab.: Event $5.50 9/23/2010 Easter Seals CPA: Bowling $65.00 9/28/2010 AAAC: Davis Country[Dad] $15.07 10/7/2010 MAC: Petty Cash $102.25 10/8J2010 UCP: Rent-October $505.01 10/10/2010 To Dad: Checkbooks $15.00 10/11/2010 MAC: Petty Cash $62.25 10l17/2010 MAC: Kmart[Equip.] $35.57 10/18/2010 Donation: PA Special Olympics $8.�0 10/20/2010 Alert Pharmacy: Meds $69.15 1 Q/21l2010 Verizon: Phone Bill $71.83 90/21/2010 Aurora Rehab.: Event $12.00 10/23/2010 MAC: Petty Cash �` $83.00 11I8/2010 MAC: Petty Cash $102.25 11/9/2010 Birthday: Jake $40.00 11/6/2010 UCP: Rent-November $505.01 11/19/2010 Easter Seals CPA: Bowling $65.00 11/21/2010 MAC: Petty Cash $102.25 11/23/2010 Verizon: Phone Bill $71.83 11/29/2010 Donation:Women's Mem. Fnd. �8.00 11/29/2010 MAC: Petty Cash $102.25 12/1/2010 Donation:Toys 4 Tots $8.00 12/2/2010 To Dad: Share of Clemson Trip $200.00 1212/2010 Donation: Easter Seals $8.00 1216/2010 Birthday: Nicole $40.00 12/S/2010 UCP: Rent-December $505.01 12/9/2010 Alert Pharmacy: Meds $84•62 1 211 1/201 0 MAC: Petty Cash $202.25 � . 12/12/2010 To Dad: Checkbooks $15.00 12/13/2010 Spirit Phys. Ser.: Cyst Removal $15.00 12/15/201 tJ To Dad: Reimbursment $16.00 12/19/2010 To Dad: Gifts $24.23 12/21I2010 Verizon: Phone Bill $71.83 12/21/2010 To Dad: Christmas Gifts $50.00 12/23/2010 MAC: Petty Cash $102.25 12/23/2010 JeNFrank Wedding $40.00 1?126/2010 MAC: Lost Card $202.25 12/29/2010 MAC $9 62.50 12/29/2010 Christmas: Jesse $15.� Total Expenses: $13,006.97 ENDING BALANCE $354.00 • r �-..�, C `�`' � t�"i � Q �=;� � �, f.., �- ; � "'� --s �;y+'? � �'�'] �,; �'7 „_..� �:.s ANNUAL REPORT OF � �; � `��' �� ~"� c.�-� � �..� GUARDIAN OF THE ESTATE � `�' =�'� --� ° `�; : c) a.�-,� __, .;-� C'^,� a� --� r_ �� �� �' ' � • __n,, �� ,...`.:� � �... . COURT OF COMMON PLEAS OF �� �� r-�� �� � CUMBERLAND COI:fNTY,PENNSYLVArTIA `� ORPHANS' COURT DIVISION Estate of DANIEL F. CLEMSON an Incapacitated Person No.21-93-346 I. INTRODUCTION DANIEL R. CLEMSON / JEI�TNIFER K.MCKEE was appointed ❑Plenary ❑Limited Guardian of the Estate by Decree of E.B. Bailey / G.E.Hoffer �J� dated 5/3/1993 - 3/17/2000 � A. This is the Annual Report for the period from J�u�'Y 1 _���l to December 31 ' ., (the"Report Period'�; or � B. This is the F�nal Report for the period from s to , (the"Report Period"),and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J.,dated Fo��02 rev 10.13.06 Page 1 of 5 � � Estate of DANIEL F. CLEMSON .An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ B. State the value(s)of principal assets at t11e beginning of the Report Period. (Same as Inventory if first Report, otherwise, ending balance from last Report.) $ C. What is the total amount of income earned.during the /�y� Report Period? $ ��tJ`7S• �� D. What is the total amount of income and principal spent for a11 purposes during the Report Period? $ � E. What are the balances remaining at t1�e end of the Report Period? l. Principal $ 2. Income $ 1 • r `�$� 3. Total of Princi al and Income $ � `1 P III. ADDITIONAL INFORMATION (If more space is needed,please attach additional pages.) A. Principal 1. How is the principal balance listed above currently invested? (Please specify,e.g.,real estate, certificates of deposit,restricted bank accounts,etc.): PSECU SAVINGS ACCOUNT 2. Have there been any expenditures from the principal during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes �No If yes: a. Have a11 expenditures from the principal been for the sole benefit of the Incapacitated Person? . . . . . . . . �Yes ❑No Form G-o� rev 10.13.06 Page 2 of 5 . � Estate of DAI�TIEL F. CLEMSON ,An Incapacitated Peirson b. List purpose and amount of expenditures: $ SEE ATTACHED REPORT � $ � c. Was Court approval received prior to expending the principal? . . . . . . . . . . . . . . . . . . . . . . . 0 Yes �No 3. Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? . . . . . . . . . . . �Yes 0 No If yes: a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . . . �Yes �No b. State the sources and amounts of the additional principal received: $ SEE ATTACHED REPORT � $ $ $ B. Income 1. State sources and amounts of income received during the Report Period(e.g., Social Security, pension,rents, etc.): $ SEE ATTACHED REPORT � � $ $ $ Total income received during Report Period: $ o•� Form G-0� rev 10.1�.06 Page 3 of 5 Esta.te of DANIEL F. CLEMSON ..An Incapacitated Person 2. How is income currently invested? (Please specify,e.g.,restricted bank accounts, client care account, etc.): PSECU CHECKING ACCOUNT C. Ezpenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person(e.g.,clothing,nursing home,medicine, support,etc.): SEE ATTACHED REPORT D. Other Egpenditvres Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) SEE ATTACHED REPORT E. Guard,�an's,Commissions List amounts of compensation paid as Guardian's cornmission and state how amount was determined: Court Amount Method of Determination Approval Obtained 0.00 DYes 0 No 0.00 �Yes 0 No For►n G-02 rev.IO.��.o6 Page 4 of 5 . � Estate of DAlvIEL F. CLEMSON ,An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee,and indicate whether Court approval was obtained. Court �lmount Approval Obtained 0 Yes 0 No ❑Yes �No I verify that the foregoing information is correct to the best of my knowled�e, informarion and belief; and that this Verifica.tion is subject to the penalties of 18 Pa.C.S. §4904 relative to unsworn falsification to authorities. 9/20/2013 � yr�C���� Date Signature of Guardian of the Estate Daniel R. Clemson / Jennifer K.McKee Name o,�'Guardian of the Estate(type nr print) 5213 Royal Dr. / 2 Cedar Rd. 1lddress Mechanicsburg,PA 17055 City,SYate,Zip �!�-5?�-a�� 717-571-9367 Telephone Forin G-02 �.�o.�3.oa Page 5 of 5 _ __ _ _ __ �__ _ _� � I ANNUAL REPQRT OF � ��== c � �a � GUARDIAN OF THE PERSON � ° �:� �� � c�a .,.�� �� � G,, � 't:: C"� _'...� £.� � :�1 f`M" �� ......� �.;,� �,"' "�° ._... o.�,�„ `..,�t �"1 . �, .�::::' � � �.,,�. (;,r� ..� .�� � COURT OF COMMON PLEAS OF �� �:, �,�; --�, .� �"� j �1A�g�1ZLA��� cou�v�,P�tvivs�,v�� `��> .`3 � �`� '�^y r c, �w� ORPHANS' COURT DIVISION -�-�; � r" � w r jw# ; � f`�J i''� � '� �? '�"1 � Estate of DA1vIEL F. CLEMSON an Incapacitated Person No. 21-93-346 I. INTRODUCTION Daniel R. Clemson / Jennifer K.Mckee was appointed �Plenary OLinnited Guardian of the Person by Decree of E.B. Bailey / G.E.Hoffer J.� dated 5/3/1993 / 3/17/2000 � � A. This is the Annual Report for the period from January 1 .���� to December 31 (the"Report Period"); or ❑ B. This is the Final Report for the period from , to , (the"Report Period"),and is filed for the followin�reason: 1. The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of J.,dated For a F�nal Reporti om�t 5ections II through IV. Form G-0� r��o�3.06 Page 1 of 4 , , Estate of D�L F. CLEMSON an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person:� � Date of Birth:July 29, 1970 III. LIVING A�RRANGEMENTS A. Current address of the Incapacitated Person: UCP Lisburn Group Home 829 Lisburn Rd. Camp Hi11,PA 17011 B. The Incapacitated Person's residence is: ❑own home/apartment Q nursing home [�boarding home/personal care home Q Guardian's home/apartment ❑hospital or medical facility 0 relative's home(name,relationship and address) �other: l'�2c�(.�(' ��'l� C. The Incapacitated Person has been in the present residence since February 1,2008. , If the Incapacitated Person has moved within the past year,state prior residence and reason(s)for move: N, ark t.,Me c , 1705 From a father s ome,to group h are Fornr G-03 rev 10.13.06 Page 2 of 4 Esta.te of D�IEL F. CLEMSON an.Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: United Cerebral Palsy of Central PA IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: Mentally Retarded-�rainable Hyperchenetic Behavior B. Specify what, if any, social,medical,psychological and support services t�.e Incapacita.ted Person is receiving; Psychiatric care Psychological care Workplace-P. Center for Industrial Training Social,transportation-CumberlandlPerry MFUMR pragram V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: �J continue �be modified 0 be terminated Form G-03 rev 1013.06 Page 3 of 4 . , Estate of D�EL F. CLEMSON an Incapacitated Person The reasons for the foregoing opinion are: He is permantley retarded. B• During the past year,the Guardian of the Person has visited the Incapacitated Person ...i- �'/ times with the average visit lasting_��hours, minutes. The report of a social service orgunization 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 correct to the best of my knowledge, information and belief;and that this Verification is subject to the penalties of 18 Pa. C.S.A. §4904 relative to unsworn falsification to authorities. 9/20/2013 ' ��Cy/��-� na:e C. ignat�e n uardian nf the Per,con . Daniel R. Clemsop/Jenn�ife�r K.McKee Nanee of Guardian uf the Person(type or priiu) 5213 Roya1 Dr./2 Cedar Rd. �ddress Mechanicsburg,PA 17055 c�r�,srare,z�p 717-�71-2556 / 717-571-9�67 Telepbone Form G-03 ��o.�3.06 Page 4 of 4 IN RE: GUARDIANSHIP OF :IN THE COURT OF COMMON PLEAS OF DANIEL F. CLEMSON :CUMBERLAND COUNTY, PENNSYLVANIA :ORPHANS DIVtS14N :NO. 21-93-346 �Clerk of Orphans' Court Courthouse: Carlisle, PA ANNUAL REPORT OF GUARDlAN OF ESTATE ESTATE: DANIEL F. CLEMSON GUARDIAN: DANIEL R. CLEMSON&JENNIFER K. STOUFFER McKee PERIOD: January 1 -December 31, 2011 DATE FILED: � INCOME Da e ource Amount BEGINNING BALANCE $ 354.00 1/312011 Social Security income 850.00 1/3/2011 Transfer from Dad 180.00 1/5/2011 Transfer from Dad: Repayment 10.00 1/13/2011 Savings transfer: overdraft 36.55 1/14/2011 CPARC Wages 16.15 1/17/2011 From MoneyMarket 100.00 1/21/2�11 Savings transfer: overdraft 39.26 1/28/2011 CPARC Wages 32.51 1/28/2011 From MoneyMarket 100.00 1/31/2011 Interest Eamed 0.02 2/3/2011 Sociai Security Income 850.00 2/11/2011 CPARC Wages 30.04 2/24/2011 CPARC Wages 25.18 2/28/2011 Interest Eamed 0.01 3/3/2011 Sociai Security Income 850.00 3/9/2011 From MoneyMarket 150.00 3/11/2011 CPARC Wages 38.32 3/25/2011 CPARC Wages 27.17 3/27/2011 From MoneyMarket 100.00 3/31/2011 Interest Eamed 0.02 4/1/2011 Social Security Income 850.00 4/5/2011 From Dad 200.00 4/8/2�11 CPARC Wages 96.63 4J2?12011 CPARC Wages 52.85 4/30/2011 Interest Eamed 0.04 5/33/2011 Social Security Income 850.00 5/f/2011 CPARC Wages 76.43 5/20/2011 CPARC Wages 65.06 5/31/2011 Interest Eamed 0.04 6/3/2011 CPARC Wages 66.50 6/3/2011 Sociai Security Income 850.00 . , 6/17/2011 CPARC Wages 60.97 6126f2011 Deposit 46.00 6/30/2011 Interest Eamed 0.04 7/1/2011 CPARC Wages $87.36 7/1 i2011 Sociai Security Income $850.00 7/15/2011 CPARC Wages $41.39 7/29/2011 CPARC Wages $72.29 7/31/2011 Interest Eamed $0.04 8/3/2011 Social Security Income $850.00 8I11/2011 CPARC Wages $29.62 8/26/2011 CPARC Wages $34.25 8/31/2011 interest Eamed $0.06 9/2/2011 Social Security Income $850.00 9/9/2011 CPARC Wages $97.92 9/18/2011 From Dad: Repay Check#1700 $55.00 9I23/2011 CPARC Wages $30.96 9/30/2011 Interest Eamed $0.08 10/3/2011 Social Security income $850.00 10/7/2011 CPARC Wages $54.01 10/21/2011 CPARC Wages $117.41 10/31l2011 interest Eamed $0.07 11/3/2011 Social Security income $850.00 11i4/2011 CPARC Wages $58.37 11i1812011 CPARC Wages $57.50 11/30/2011 Interest Eamed $0.06 12/2/2011 CPARC Wages $79.87 1 Z/2/2011 Social Security Income $850.00 12/16/2011 CPARC Weges $59.15 12/30/2�11 CPARC Wages $65.90 12/31/2011 Interest Eamed $0.05 TOTAl.INCOME: $13,045.15 EXPENSES 1/1/2011 To Dad: Lost Card $ 300.00 1/2/2011 Owed Dad $ 43.00 1/3t2011 MAC: Petty Cash $ 122.25 1!3/2011 MAC $ 182.50 1/5/2011 Woodrings: Cemetary Flowers $ 67.79 1/11/2011 UCP: Rent-January $ 505.01 1/13/'1011 ES Therapeutic:ABC Bowling $ 85.00 1/13/2011 Smiles Dental Care $ 125.00 1/14/2011 Donation: UCP $ 10.00 1/1 S/2011 Donation: St. Jude Shrine $ 10.00 1/19/2011 Mac withdrawal $ 63.00 1121/2011 Verizon Phone Bill $ 72.41 1/30/2011 MAC: Petty Cash $ 63.00 2/1/2011 Christmas: Nicoie $15.00 2/3/2011 UCP: Rent-February $ 505.01 2/7/2011 Aurora Jan. Event $ 5.50 2/7/2011 Alert Phannacy: Meds $ 158.99 2/13I2011 MAC: Petty Cash $ 102.50 2/18/2011 Aurora Feb. Event $ 11.50 ?J23/2011 Verizon Phone Biil $ 72.41 2/28/2011 Birthday: Mike $ 40.00 3/3/2011 ATM inq. $ 0.25 3/3/2011 MAC: Petty Cash $ 102.50 314i2011 UCP: Rent-March $ 505.01 3/7/2011 Intemists of CP $ 57.13 3/9/2011 Spirit Physic. Serv. $ 42.74 3/9/2011 ES Therapeutic:ABC Bowling $ 65.00 3/15/2011 Alert Pharmacy: Meds $ 174.90 3/18/2011 Birthdey: Michele $ 40.00 3/21/2011 Verizon Phone Bill $ 72.41 3/27/2011 MAC: Petty Cash $ 102.50 4/5i2011 MAC: Petty Cash $ 202.25 4/9/2011 MAC: Petty Cash $ 102.50 4/11/2011 UCP: Rent-April $ 485.28 4/1?J2011 To Dad: Mills CD $ 25.90 4/16/2011 MAC: Petty Cash $ 103.00 4/21/2011 Verizon Phone Bill $ 72.26 4/26/2011 Intemists of CP $ 64.48 5/4/2011 Alert Phamtacy: Meds $ 55.47 5/1l2011 UCP: Rent-May $ 485.28 5/6/2011 Donations: PA Special Olympics $ 8.00 5/9/2011 ES Therapeutic:ABC Bowling $ 65.00 5/11/2011 Donation: Easter Seals $ 8.00 5/12/2011 MAC: Petty Cash $ 103.00 5/23/2011 Verizon Phone Bill $ 72.26 5l26/2011 MAC: Petty Cssh $ 103.00 5/28/2011 MAC: Finish Line $ 101.05 5/30/2011 MAC: Kmart $ 31.79 5/30/2011 To Dad $ 23•00 6/2p1011 Alert Pharmacy: Meds $ 63.47 6/6/2011 Donation: Toys 4 Tots $ 8.00 6/6l2010 Donation: UCP $ 10.00 6/S/2011 UCP: Rent-June $ 485.28 6/16/2011 MAC: Petty Cash $ 100.00 6/21/2011 Verizon Phone Bill $ 72.26 6I25I2011 MAC: Kmart $ 9.53 6/29/2011 Smiles Dental Care $ 125.00 6/30/2011 Birthday: Jesse $ 35.00 7/1/2011 Diocese of MBG: Gamp $ 25.00 7/1/2011 ES Therapeutic:ABC Bowling $ 65.00 7/3/2011 MAC: Petty Cash $ 100.00 7/5/2011 Donation: St. Jude $ 8•00 716/2011 UCP: Rent-July $ 485.28 7/9/2011 MAC: Petty Cash $ 100.0� 7/10/2011 To Dad: Checkbooks $ 15.00 7/11/2011 PA Special Olympics: Dues $ 10.00 7/11/2011 Alert Pharmacy: Meds $ 66.00 7/21/2011 Verizon Phone Bi I I $ 72.�g 7/25/2011 Donation: MDA $ 5.00 7/26/2011 Birthday: Jen $ 40.00 7/27/2011 To Dad: Trans. Petty Cash $ 19�.00 8/4/2011 Lady of Guadalupe Donation-Pate $ 30.00 8/5/2011 Alert Pharmacy: Meds $ 63.47 8/7J2011 MAC: K-Mart Clothing $ 67.43 8/11/2011 Donation: Women's Memoriai Foundation $ 8.00 S/15/2011 To Dad: Kacy, Computer things $ 19.00 8/19/2011 Aurora Rehab Events $ 17.00 8/20/2011 MAC: Petty Cash $ 100.00 8/22/2011 Verizon Phone Bill $ 74.09 8/29/2011 Tracey Molen-Services $ 35.00 8/30/2011 FYE: CD's $ 17.15 9/5/2011 Bleacher Bum's Clothing $ 26,00 9/6/2011 MAC: Petty Cash $ 100.00 9/7/2011 UCP: Rent $ 2gp.gg 9/8/2011 MAC: Kmart $ 42.39 9/14/2011 ES Therapeutic: ABC Bowling $ 65.00 9/15/2011 Kacy-Birthday $ 40.00 9/17/2011 MAC: Petty Cash $ 100.00 9/19/2011 Alert Pharmacy: Meds $ 176.24 9/20/2011 To Dad: Kacy, Pillow $ 20.00 9/21/2011 Verizon Phone Bill $ 74.09 9/21/2011 D. Witmer Cleaning $ 55.00 9/23/2011 To Savings $ 51.00 9/23/2011 Aurora Rehab Events $ 5.50 9/25/2011 MAC: CVS Toiletries $ 27,5g 9/27/2011 Frank-Birthday $ 40.00 9/27/2011 FYE: CD's $ 59.13 10/6/2011 UCP: Donation $ 10.00 10/7/2011 UCP: Rent $ 485.28 10/11/2011 To Dad: Checkbooks $ 15.00 10/15l2011 MAC: Petty Cash $ 100.00 10/17/2011 Alert Pharmacy: Meds $ g5,22 10/20/2011 Donation: Toys 4 Tots $ �p,pp 10/21/2011 Verizon Phone Bill $ 100.29 10/24/2011 Aurora Rehab Events $ 12.00 10/26/2011 MAC: Petty Cash $ 100.00 10/27/2011 Donation: St. Jude $ 7.00 11/1/2011 FYE: CD's $ 19.06 11/2/2011 PennDot-Photo ID Card $ 13.50 11/2/2011 Jake-Birthday $ 40.00 11/4/2011 ES Therapeutic:ABC Bowling $ 65.00 11/4/2011 UCP: Rent $ 485.28 11/8/2011 MAC: Petty Cash $ 140.00 11/14/2011 Donation: Women's Memorial Foundation $ 10.00 11/17/2011 Donation: Easter Seals $ g.pp , . 1 111 8/201 1 MAC: CVS $ 28.08 11/21/2011 Verizon Phone Biil $ 74.29 11/21/2011 CIT: Holiday Dinner $ 6.00 11/26/2011 MAC: CVS $ 58.82 11/28/2011 MAC: Petty Cash $ 100.00 11/28/2011 FYE: CD's $ 7.62 12/1/2011 MAC: Petty Cash $ 9 20.00 12/3/2011 MAC: Dollar General $ 29.15 12/8/2011 UCP: Rent $ 485.28 12/10/2011 MAC: Petty Cash $ 120.00 12/12/2011 MAC: CVS $ 55.25 12/12/2011 Alert Pharmacy: Meds $ 49.22 12/6/2011 Donation: UCP $ 8.00 12/12/2011 Nicole-Birthday $ 40.00 12/17/2011 MAC: Christmas Gifts $ 120.00 12/20/2011 Donation: Special Olympics $ 8.00 12/21/2011 Verizon Phone BiN � 75.85 12/6/2011 Donation: St. Jude $ 8.00 12/23/2011 Aurora Rehab Events $ 13.50 12/24/2011 MAC: Petty Cash $ 100.00 12/29/2013 CPARC Sweat Shirt $ 15.00 12/29/2011 FYE: CD's $ 40.26 12/31/2011 MAC: Petty Cash $ 100.00 12/31/2011 Smiles Dental Care $ 165.00 Total Expenses: $ 13,030.73 ENDING BALANCE: $14.42 � r �r--� �' � ('r1 � fi � t7 c'� c� �"�.? ,.,... � � Q �-,_'� C1"� °�~"� ..� �.� � �= � �'`' '��; � cs� f � � �M; �..� '`�`� ,:_ ,�?,. �,.-� �,,: _,� "�,_ _.„,� "-r�; - �..; .... A►NNUAL REPORT OF �'� �� `:.°` �', ': ;r� : GUARDIAN OF THE ESTATE �' �-.y�� �.\ � ��M� � . , �.� .. �.-�� ..� COURT OF COMMON PLEAS OF CUMBERLAND COLJrJTy,PENNSYLVAI�tIA ORPHANS' COUR.T DIVISION Estate of D�EL F. CLEMSON an Incapacitated Person No.21-93-346 ' I. INTRODUCTION DANIEL R. CLEMSON / JEIVNIFER K.MCKEE was appointed 0 Plenary ❑Limited Guardian of the Estate by Decree of E.B. Bailey / G.E.Hoffer J � dated 5/3/1993 - 3/17/2000 � A. This is the Annnal Report for the period from J��'Y 1 to December 31 ' (the"Report Period");or ❑ B. This is the Final Report for the period from ,_ to , (the"Report Period"),and is filed for the following reason: � 1. The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J.,dated Form G-02 r�lo.l�.06 Page 1 of 5 ` � Estate of D�L F. CLEMSON An Incapacitated Person II. S y A. State the value of the estate reported on the Inventory $ B. State the value(s)of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, otherwise,ending balance from last Report.) $ C. What is the total amount of income earned during the Report Period? � � ` �/''� D. What is the total amownt of income and principal spent for al1 purposes during the Report Period? $ 3 E. What are the balances remai.ning at the end of the Report Period? 1. Principal $ 2. Income $ 3. Total of Principal and Income $ 8;�- III. ADDI'TIONAL INFORMATION (If more space is needed,pleuse attach additional pages.) A. Principai 1. How is the principal balance listed above currently in.vested? (Please specify,e.g.,real estate, certificates of deposit,restricted bank accounts,etc.): PSECU SAVINGS ACCOUNT 2. Have there been any expenditures from the principal during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes ❑No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacita.ted Person? . . . . . . . . �Yes ❑No Fo�c-o� �lo.r3.o6 Page 2 of 5 Estate of DAI�EL F. CLEMSON ,An Incapacitated Person b. List purpose and amount of expenditures: $ SEE ATTACHED REPORT � $ $ c. Was Court approval received prior to expending the principal? . . . . . . . . . . . . . . . . . . . . . . . �Yes �No 3. Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? . . . . . . . . . . . �Yes �No If yes: , a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . . . [,�Yes �No b. State the sources and amounts of the additional pri.ncipal received: $ SEE ATTACHED REPORT � � � $ B. Income 1. State sources and a.mounts of income received � durin�the Report Period(e.g., Social Security, pension,rents, etc.): $ SEE ATTACHED REPORT � $ $ $ $ Total income received during Report Period: $ o.00 Form G-02 rev 10.13.06 Page 3 of 5 . • Estate of DANIEL F. CLEMSON ,An Incapacitated Person 2. How is income currently invested? (Please specify,e.g.,restricted bank accounts,client care account,etc.): PSECU CHECKING ACCOUNT C. Ezpenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and mai.ntenance of the Incapacitated Person(e.g.,clothi.ng,nursing home,med.icine, support, etc.): SEE ATTACHED REPORT D. Other Ezpend�tures Specify what other expenditures were made during the Report Period. (Do not include any itelns sta.ted in response to question C above.) SEE ATTACHED REPORT E. Guardian's Commissions List amounts of compensation paid as Guardian's conunission and state how amount was determined: Court Amount Method of Determination Approval Obtained 0.00 �Yes �No 0.00 ❑Yes (�No Fo�c-oa ,�.�o.�3.06 Page 4 of 5 I � Estate of DANIEL F. CLEMSON ,An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Court Amount Approval Obtained � �Yes 0 No �Yes 0 No I verify that the foregoing information is correct to the best of my knowledge, information and belief; and tha.t this Verification is subject to the penalties of 1 S Pa.C.S. §4904 relative to unswom falsification to authorities. . 9/20/2013 e y Date Signature of Guardian of the Estate Daniel R. Clemson / Jennifer K.McKee Name of Guardia»oJt)te Estate(type or print) 5213 Roya1 Dr. / 2 Cedar Rd. 1lddress Mechanicsburg,PA 17055 City.State,Zip 717-571-9367 Telephone Form G-02 �.�0.�3.06 Page 5 of 5 � C w � rn � , ANNUAL REP�RT QF :,� � �, ��» �t '==r rMa � GUARDIAN OF THE PERSON ��� µ;�' � `=� �%� � -:��' ;r�. r--- }.._, �,,,„� �' f""_ _. � a�� � '� �C•., C �� ..,::.� � ' '' �::v .� '� -�t � COURT OF COMMON PLEAS OF � `� "� k `� �° �-�-� 4..,..� f�..,i w . . ...� (`�� ♦ ___� � C�UN'TY�PE'NNSYI.vA�TIA.. �, �'..� �'" �_. �� ORPHANS' COURT DIVISION �"�" � `'� `� .� . . r � Estate of DANIEL F. CLEMSON an Incapacitated Person No. 21-93-346 I. INTRODUCTION Daniel R. Clemson / J+ennifer K.Mckee ,�,�,�appointed �Plenary❑Limited Guardian of the Person by Decree of E.B. Bailey / G.E.Aoffer J.� dated 5/3/1993 / 3/17/2000 ' � A. This is the Annual Report for t11e erio from J�u�'Y 1 to December 31 ' (the"Report Period");or ❑ B. This is the Final Report for the period from ,_ to , (t�ie"Report Period"),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 J.,dated For a Final Repor� omit Sections II through IV. F°m`c°3 r�.�0.�3.°� Page 1 of 4 � . Estate of D��L F. CLEMSON an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person�2� Date of$irth:J�Y 29, 1970 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: UCP Lisburn Group Home 829 Lisburn Rd. Camp Hill,PA 17011 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 ❑relative's home(name,relationship and address) �other: �f�P tf�/�'�� C. The Incapacitated Person has been in the present residence since February 1,2008. . If the Incapacitated Person has moved within the past year,state prior residence and reason(s)for move: ec c ,P F � g ather hom ,to gr up home c e Form G-03 rev.10.13.06 Page 2 of 4 � Estate of DANIEL F. CLEMSON , an Incapacitated Person D. Name and address of the Incapacitated Person's pri.mary caregiver: United Cerebral Palsy of Central PA IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: Mentally Retarded-trainable Hyperchenetic Behavior � B. Specify what,if any, social,medical,psychological and support services the Incapacitated Person is receiving: Psychiatric care Psychological care Workplace-P. Center for Indus�rial Training Social,transportation-Cumberland/Perry MI�UMR Program v. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: �continue �be modified ❑be terminated Form G03 rev.10.13.06 Page 3 of 4 Estate of D�EL F. CLEMSON an Incapacita.ted Person The reasons for the foregoing opinion are: He is permantley retarded. B• During the past year,the Guardian of the Person has visited the Incapacitated Person �_times with the average visit lasting_�_____ho�, � minutes. The re�ort of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapaci�ated Person for the period covered by this Report may be attached to supplement this Report. I verify that the foregoing information is correct to the best of my kaowledge, � mformahon and beli�f; and that this Verification is sub�ect to the penalties of 18 Pa. C.S.A. §4904 relative to unsworn falsification to authorities. 9/20/2013 • e Date Signature n Guardian of the P�rsnn • Daniel R. Clemson/Jennifer K. McKee Name o,f'Guardian of the Person(type ar pri►it) 5213 Royal Dr./2 Cedar Rd. Address Mechanicsburg,PA 17055 c�r�,s:d:e,z� 717-571-2556 / 717-571-9367 Telephone Fo�c-o� �.10.13.06 Page 4 of 4 R � IN RE: GUARDIANSHIP OF :IN THE COURT OF COMMQN PLEAS OF DANIEL F. CLEMSON :CUMBERLAND COUNTY, PENNSYLVANIA :ORPHANS DIVISION :NO. 21-93-346 TQ Cierk of Orphans' Court Courthouse: Carlisle, PA ANNUAL REPORT OF GUARDIAN OF ESTATE ESTATE: DANIEL F. CLEMSON GUARDU4N: DANIEL R. CLEMSON&JENNIFER K. STOUFFER McKee PERIOD: January 1 -December 31, 2012 DATE FILED: INCOME Date ource Amount BEGINNING BALANCE $ 14.42 1i3/2012 Social Security Income $ 880.00 1/12/2012 From Money Market $ 150.00 1/13/2012 CPARC Wages $ 22.93 1/23/2012 Overdraft $ 36.05 1/27/2012 CPARC Wages $ 66.38 1/31 i2012 Bank Interest $ 0.02 2/3/2012 Social Security Income $ 880.00 2/10/2012 CPARC Wages $ 120.49 2/24/2012 CPARC Wages $ 130.72 ?J29/2012 Bank Inferest $ 0.03 3i2/2012 Sociai Security Income $ 880.00 3/9/2012 CPARC Wages $ 96.70 3/23/2012 CPARC Wages $ 146.13 3/31/2012 Bank Interest $ 0.05 4/3/2012 Social Security Income $ 880.00 4/6/2012 CPARC Weges $ 94.20 4/20/2012 CPARC Wages $ 91.38 4/30/2012 Bank lnterest $ 0.06 5/3/2012 Social Security Income $ 880.00 5/4/2012 CPARC Wages $ 35.29 5/18/2012 CPARC Wages $ 86.22 5/31/2012 Bank Interest $ 0.07 6/1/2012 CPARC Wages $ 38.10 6/1/2012 Social Security Income $ 880.00 6/15/2012 CPARC Wages $ 70.69 6/29/2012 CPARC Wages $ 61.82 6/30/2012 Bank Interest $ 0.07 7/1/2�12 Social Security Income $ 880.00 7/13/2012 CPARC Wages $ 80.87 7/27/2012 CPARC Wages $ 83.93 7/31/2012 Bank Interest $ 0.07 . ' 8i312012 Social Security Income $ 880.00 8/10/2012 CPARC Wages $ 61.33 8/24/2012 CPARC Wages $ 74.66 8/31/2012 Social Security Income $ 880.00 8i31/2012 Bank Interest $ 0.06 9/7l2012 CPARC Wages $ 58.11 9/20/2012 MAC Deposit $ 398.81 9/21/2012 CPARC Wages $ 75.74 9/30/2012 Bank interest $ 0.06 10/3/2012 Social Security Income $ 880.00 10/4/2012 From Dad: Repayment $ 55.44 10/5/2012 C PARC Wages $ 31.16 10/19/2012 CPARC Wages $ 83.94 10/31/2012 Bank Interest $ 0.08 11/212012 CPARC Wages $ 66.93 11/2/2012 Social Security Income $ 880.� 11/16/2012 CPARC Wages $ 47.74 11/18/2012 From Dad $ 15.00 11/23/2012 From Savings $ 23.00 11/30/2012 CPARC Wages $ 28.93 11/30/2012 Bank Interest $ 0.08 12/3/2012 Social Security Income $ 880.00 12/14/2012 CPARC Wages $ 43.61 12/28/2012 CPARC Wagesr $ 39.35 1?J31/2012 Bank Interest $ 0.05 TOTAL tNCOME: $ 13,090.77 EXPENSES 1/5/2012 To Dad: Checkbooks $ 15.00 1/S/2012 MAC: Petty Cash $ 100.00 1/9/2012 UCP: Rent-January $ 485.28 1/10/2012 To Jen: Purchase $ 49.00 1/11/2012 Alert Pharmacy $ 145.44 1/12/2012 UCP $ 85.00 1/20/2012 Alert Pharmace $ 19.44 1/22/2012 MAC: CVS $ 55.07 1/22/2012 MAC: Petty Cash $ 80.00 1/23/2012 Verizon $ 69.17 1/27/2012 Easter Seals $ 10.00 2/4/2012 To Dad: Repayment $ 10�.00 2/7/2012 UCP: Rent-February $ 485.28 2/9/2012 Donation: St. Judes $ 8.00 2/10/2012 Donation:Womens Memorial $ 5.00 2/12/2012 Withdrawal $ 100.00 2/13/2012 Aurora Rehab: January Event $ 5.50 2/17/2012 UCP: Rent-supplemental Jan/Feb $ 66.38 2/22/2012 Verizon $ 69.17 2/22/2012 MAC: Petty Cash $ 100.00 3/4/2012 MAC: Dollar General $ 10.50 3/5/2012 FYE: CD's $ 34.7fi 3/9/2012 Aurora Rehab: February Event $ 12.50 3/11/2012 MAC: Petty Cash $ 100.00 3/14/2012 Alert Pharmacy $ 137.42 3/14/2012 UCP: Rent-March $ 518.47 3/15/2012 ES Therapeutic:ABC Bowiing $ 65.00 3/16/2012 Barry Heckard Tax Collector $ 9.80 3/14/2012 Michele-birthday gift $ 40.00 3/21/2012 Verizon $ 69.17 3/24/2012 MAC: CVS $ 44.09 3/24/2012 To Dad: Checkbooks $ 25.00 3/2fi/2012 FYE: CD's $ 35.72 3/27/2012 Donation: Easter Seals $ 8.00 4/5/2012 MAC: Petty Cash $ 100.00 4/17/2012 Alert Pharmacy $ 64.42 4/13/2012 UCP: Rent-April $ 518.47 4/19/2012 Aurora Rehab: Event-Aprii $ 12.00 4/23/2012 Verizon $ 69.12 4/24/2012 Donation:Toys for Tots $ 8.00 4/24/2012 MAC: Petty Cash $ 100.00 4/25/2012 UCP: Membership $ 10.00 4/30/2012 Donation: PA Special Olympics $ 8.00 4/30/2012 FYE: CD's $ 42.85 5/10/2012 CVS Pharmacy $ 28.08 5/14/2012 MAC: Petty Cash $ 120.00 5/15/2012 ES Therapeutic:ABC Bowling $ 65.00 5/15/2012 UCP: Rent-May $ 518.47 5/19/2012 MAC: CVS $ 42.24 5/21/2012 Verizon $ 69.12 6/2/2012 MAC: Petty Cash $ 100.00 6/5/2012 UCP: Rent-June $ 518.47 6/11/2012 Alert Pharmacy $ 57.22 6/15/2012 Donation: St. Judes $ 5.00 6/20/2012 MAC: Petty Cash $ 100.00 6/21/2012 Verizon $ 69.74 6/24/2012 CVS Pharmacy $ 64.07 7/5/2012 MAC: Petty Cash $ '100.00 7/10/2012 UCP: Rent-July $ 518.47 7/11/2012 ES Therapeutic: ABC Bowling $ 65.00 7/11/2012 Smiles Dental $ 155.00 7/21/2012 MAC: Petty Cash $ 100.00 7/23/2012 Verizon $ 96.39 7l25/2012 Donation: Easter Seals $ 8.00 7/27/2012 Alert Pharmacy $ 146.66 7/29/2012 MAC: Radio Shack $ 85.16 7/31/2012 PA Special Olympics Membership $ 10.00 8/2/2012 Hbg. Diocese Camp Deposit $ 2g.pp 8/4/2012 MAC: K Mart $ 36.35 8/5/2012 MAC: Petty Cash $ 120.00 8/6/2012 FYE: CD's $ 20.01 8/10/2012 UCP: Rent-August $ 518.47 8/17/2012 MAC: Vacation spending money $ 120.00 8/19/2012 MAC: Vacation room&board $ 140.00 8l21/2012 Verizon $ 69.78 8/23/2012 Donation: Toys for Tots $ 8.00 8/23/2012 Donation: UCP $ 8.00 S/24/2012 Donation: St. Judes $ 8.00 9/3/2012 MAC: Petty Cash $ 100.00 9/6/2012 UCP: Rent-September $ 518.47 9/8/2012 MAC $ 100.00 9/10/2012 ES Therapeutic:ABC Bowling $ 65.00 9/11/2012 To Jen: Camcorder $ �pg.pp 9/15/2012 MAC: Petty Cash $ 100.00 9/21/2012 Verizon $ 69.70 9/25/2012 MAC: Giant $ 55.44 9/25/2012 FYE: CD's $ 12.39 9/26/2012 Donation: Toys for Tots $ 8.00 9/26/2012 Donation: UCP $ 10.00 10/1/2012 Donation: PA Special Olympics $ 8.00 10/5/2012 MAC: Petty Cash $ �pp.pp 10/9/2�12 UCP:Rent-October $ 518.47 10/12/2012 Aurora Rehab: Events $ 5,5p 10/14/2Q12 MAC: Petty Cash $ 103.00 10/15/2012 CVS Pharmacy $ 60.77 10/18/2012 Donation: Womens Memorial $ 10.00 1012?12012 Verizon $ �p.� 10/23/2012 MAC: Petty Cash $ 100.00 10/23/2012 Donation: St. Judes $ 5.00 10/27/2012 Super Shoes $ 44.99 10/29/2012 Alert Pharmacy $ 99.60 11/1/2012 ES Therapeutic:ABC Bowling $ 65.00 11/3/2012 MAC: Radio Shack $ 42,36 11/4/2012 CVS Pharmacy $ 45.15 11/5/2012 FYE: CD's $ 46.40 11/15/2012 MAC: Petty Cash $ 100.00 11/16/2012 UCP: Rent $ 518.47 11/17/2012 To Dad:for Christmas $ 28.00 11/18/2012 CVS Pharmacy $ 30.99 11/19/120 Flinchy's-Dinner $ 37.33 11/21/2012 Verizon $ ?p.� 11/23/2012 To Dad:for Christmas $ 23.00 11/24/2012 MAC: Petty Cash $ �pp,pp 11/25/2012 CVS Pharmacy $ 47.22 11/29/2012 Alert Pharmacy $ 68,� 11/30/2012 Donation: St. Judes $ 5.00 11/30/2012 Donation: Toys for Tots $ 8.00 12/S/2012 MAC: CVS $ 22.60 12/7/2012 Donation: PA Special Olympics $ 8.00 12/11/2012 MAC: Christmas shopping $ 200.00 12/11/2012 Diocese of HaRisburg Camp $ 200.00 12/11/2012 UCP: Rent-December $ 518.47 12/15/2012 CVS Pharmacy $ q4.5p 12/20/2012 Donation: Easter Seals $ 8.00 12/21/2012 Verizon $ 71.61 12/27/2012 Alert Pharmacy $ 65.74 12/27/2012 MAC: Petty Cash $ gp.pp 12/27/2012 MAC: CVS $ 37.38 12/28/2012 JeNFrank-Christmas $ 30.00 Total Expenses: $ 13,004.59 ENDING BALANCE: $ 86.18