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~~ Clerk of Orphans' Court of Cumberland County
IN RE: ~ ~ ~ 1'1 ~ ~~e ~ l ~ ~ Docket No. ~~ ~ ~ ~G' ~ ~ ~ ~ ~ (~ i
An Incapacitate~n __ ~-
C~ r-~
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ANNUAL REPORT OF GUARDIAN OF THE ESTATE-' ~..~ ~ ` ~~
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6~`1 Y1~_,',~ E_ hh ~e- , wa~-.bwere ~
~1 ~'1 N Y ~ ~ ~ ~ "a
appointed plenary gu dian of the estate of 0 y~
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by Decree of the Honorable Judge 6 ~ ~lr .Dated Jltne, ~~. This is my annual
report for the period from / ~ D0~ to v ~ 02®!~ , ("Z~e Report Period").
I. SUMMARY
A. Value of principal assets at the beginning of the Report Period?
B. Total amount of income earned during the report period?
Total amount of all expenditures made for care and maintenance of th:e
C. incapacitated person during the Report Period?
1. From principal
2. From income
D. Total amount spent for all other purposes during the Report Period?
E. Total amounts remaining at the end of the Report Period?
1. Principal
2. Income
Total Income and Principal
$ _~
S~
$ __._
$ ~~~5'~. /,3
$ ~%
t 54
#- ~
$ -~
$ ~'
$ lJ
~~
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II. ADDITIONAL INFORMATION
A. Principal:
1. Total amount remaining at the end of the Report Period? $
2. How is principal currently invested?
~~
3. Have there been any expenditures from principal during the Report
Period? ^ Yes ^ No
If you answered YES, was there Court approval for all expenditures
from principal? ^ Yes ^ No
4. Did you receive any principal assets during the report period which
were not included on the inventory or a prior report filed for the estate? ^ Yes ^ No
If you answered YES, did you receive Court approval prior to receiving
additional principal? ^ Yes ^ No
5. State the sources and amounts of the additional principal you received:
B. Income:
1. State sources and amounts of income received during the Report Period (i.e., social
security, pension, rents, etc.): _ ,~~"~
•o C , ~~ c: Ur, ~ $ ~~ ~ ~~ . ~ v
' / / ' ~ 1~
~I~~
_~
Total Income received during Report Period $ g~~~
2. How is income currently invested? (Please specify, restricted banl: accounts, client care
account, etc.)
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3. Specify what payments were made for the care and maintenance of the incapacitated
person (i.e., clothing, nursing home, medicine, suppo/rt, etc.). "~~
ui {- !"en, ~~vo~ ihG~v~. ~,unt,~ 6%~ ,~~/-eyt/~iHahe~u! ~T)~~~DD, ~'-
~ ~ ~ ~-, 1 y 5~-
i° I ~ ` a d''
~x~rT~ ,~~U~ C`haSS (TvI~ ~.~60-7 ~r~ d?J4r. ~°7,F r~r, 102~0~-~,-.v,~~~,o?D
~ ~, /3
4. Specify what other payments were made during the Report Period.
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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. X4904 relative to
unsworn falsification to authorities.
- ~-.
~~' ~ y~"~ - ~ - -
Date Signature o uar '
* FILING FEE $15 MUST ACCOMPANY THIS FILING.