HomeMy WebLinkAbout12-18-08IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, t-.~
PENNSYLVANIA n
ORPHANS' COURT DIVISION ~ ~ ~, ~.1_ . ~ _
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IN RE: ELI PETROVICH , an incapacitated person FILE NO. 21-07;.~R"~1`~ °~
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GUARDIAN OF THE ESTATE ANNUAL REPORT y-o, , -' ~ -~
[20 Pa.C.S.A.5521 (c)] ~'
FROM 12/20/07 TO 12/20/08
1) I am the Limited X Plenary Guardian of the Estate of my ward, named above.
I was appointed Guardian by Order of the Court dated ,which
was _X _ was not modified by Court Order (s) dated _
2) Is the incapacitated person still living?
YES
If no, answer the following:
(a) Date of Death
(b) Place of Death
(c) Name of Adminstrator/trix or Executor/trix
(d) Date Guardian of the Person filed the last Annual Report
PLEASE ANSWER THE FOLLOWING QUESTIONS WHETA:ER THE
INCAPACITATED PERSON IS LIVING OR DECEASED.
3) My initial Inventory was filed on 12/17/08 and listed a total estate value of.
$ 18,387.70
The Inventory listed a total monthly income of $ 3,266.40 comprised of the following:
SOCIAL SECURITY & VA PENSION
4) At the beginning date of this report period, my initial balance on hand was
$ 00.00
5) During this reporting period, the following reflects all sources of income (other than
Social security) received by me for my ward: (Add additional pages, of needed)
Date Received Source of Income Aimount
1. 12/10/08 SALE OF REAL ESTATE 27',072.53
2. 8/05/08 DEPOSIT FOR SALE 5,000.00
TOTAL 32;,072.53
6) During this reporting period, the following reflects all payments I have made for my
ward: (Add additional pages if needed)
Date To Whom Paid Reason for Payment Amount
1. SEE ATTACHED ALL TRANSACTION REPORT
(7) The present principal assets of my ward are:
Description of Asset
1. PAGA CUSTODIAL ACCT
TOTAL
8) The present amount and sources of income for my ward are:
Source of Income
1. SOCIAL SECURITY
2. VA PENSION
Present Value
18,387.70
18,387.70
Amount of Income
(Indicate whetheir (monthly),
Quarterly, annually)
9) The regular monthly expenses of my ward which I pay are:
'739.40
2x527.00
To Whom Paid Amount
1. PA GUARDIANSHIP 100.00
2. CLAREMONT NURSING 7,,500.00 APPROX
(10) I have/ have not (circle one) petitioned the Court for permission to invade principal
to meet the needs of my ward.
(If applicable) The following expenses of my ward have been paid from principal:
To Whom Paid Purpose Amount
1.
11) I (have) /have not (circle one) paid myself compensation for services I rendered as
guardian.
The amount I Paid myself totaled $1,000.00 and was
Calculated at the following rate: $ 100.00 per week/(month),(circle oae).
12) Check the correct response and complete, if appropriate.
_X There will be no need for extraordinary expenditures on behalf of my ward in
the next (12) months.
There will be a need for extraordinary expenditures on behalf of my ward in
the next (12) months because:
13) Check the correct response and complete, if appropriate.
A. My ward receives monthly social security benefits directly.
_X _B. I am the designated payee to receive my ward's social seecurity benefits.
C. The designated payee of my ward's social security benefits is
14) Please note any concerns about the incapacitated person's physical or mental well
being or the finances that the Court should know.
15) I_X_ am am not guardian of the incapacitated person's person. If yes,
report is attached.
I certify under the penalties of perjury that the information contained in this report is
true and correct to the best of my knowledge, information and belief.
_ ~
S GATURE
Name: BRIAN D. BROOKS
PENNSYLVANIA GUARDIANSHIP ASSOC. INC.
DATE-~I ~~
Telephone No. 717-299-4568
PO BOX 7295
LANCASTER, PA 17604
• ITEMIZED CATEGORY RBPORT
12/ 1' 7 Through 12/31' 8
PAGAC07-PAGATEMP
12/17' 8
Page 1
Date Num Description Memo C~itegory Clr Amount
INCOME /EXPENSE
INCOME
PBTROVICH, ELI
2/18'
3/ 5' 8
8 R9387
128115 DEPOSIT
BR GUARDIAN FBE PETROVICH, ELI/G X 200.00
3/ 7'
8
R2411 IAN D.BROOKS
DEPOSIT
GDN FEE PETROV'ICH,
' ELI/R X -3.50
3/14'
'
8
129355
PAGA GENERAL ACCT
3-4 2008 PBTROV
ICH,
PETROV'ICH ELI/G
ELI/G X
X 100.00
-200
00
4/10
5j 6' 8
8 R4$77
R5416 DEPOSIT
DEPOSIT GDN FEE ,
PETROV'ICH, ELI/G X .
100.00
5/15'
8
134055
WACHOVIA BANK GDN FEE
PERSONAL NEED PBTROV'ICH,
PETROVICH ELI/G
BLI/P X
X 100.00
47
5/23'
5/28'
8
8
134585
134
PAGA GENERAL ACCT
5-6/08 ,
PETROVICH,
BLI/G
X -
.92
-200.00
6/ 5'
8 99
R5547 CLAREMONT NURSING
DEPOSIT ELI PETROVICH PETROVICH, SLI/C X -50.23
6/24'
'
8
13701
PAMELA M. RBITENBA GDN FBB
APPRAISAL 3 PETROVICH,
PETROVICH ELI/G
BLI/F X
X 100.00
-350
00
7/ 9
8/ 4' 8
8 R8116
14002 DEPOSIT
FENTON AUCTION SER GDN FEE
ELI PETROVICH ,
PETROVICH,
PBTROVICH BLI/G
SLI/F X
X .
100.00
1
8/ 5'
8/ 5'
8
8
R2665
R26
DEPOSIT
BANK TRANSFER ,
PSTROVICH,
ELI/B
X -
,933.50
5,000.00
9/11'
8 66
R6028 DEPOSIT
DEPOSIT GDN FBE
GDN F PETROVICH, ELI/G X 100.00
9/12'
8
14288S
PAGA GENERAL ACCT E8
9/08 PETROVICH,
PBTROV:ICH ELI/G
ELI/G X
X 100.00
250
9/18'
9/19'
8
8
143095
143
LAMA HOOVER ,
PETROV:ICH,
ELI/C
X -
.00
-27
33
9/26'
8 79S
14413S WACHOVIA BANK
WACHOVIA BANK PERSONAL NEED PETROV:ICH, ELI/F X .
-137.23
9/26'
8
14413S
WACHOVIA BANK PERSONAL NEED
PERSONAL NEED PETROV:LCH,
PETROV:CCH BLI/P
ELI/P X
X -107.19
9/30'
10/ 2'
8
$
14421
1448
MARIE MEGILLIGAN
ELI PETR.OVICH ,
PETROV:CCH,
8LI/P
X -41.20
-4
80
10/ 6'
8 2S
R6151 PAGA GENERAL ACCT
DEPOSIT 10/08 PBTROV:CCH, ELT/G X .
-100.00
10/30'
8
R2045
DEPOSIT GDN FEB
SALE OF REAL PETROV:CCH,
PETROV:{CH 8LI/G
ELI/S X
X 100.00
27
11/ 4'
Il/ 5'
8
8
R2152
147
DEPOSIT
GDN FEE ,
PE'I'ROV7CCH,
ELI/G
X ,072.53
100
00
11/11'
8 185
14752 PAGA GENERAL ACCT
CLAREMONT NURSING 11/08
ELI PETROV7CCH, ELI/G X .
-250.00
11/12'
'
8
ET
RETURNED ITEM DEPO PETROVICH
RETURNED DEPO PBTROV7:CH,
PETROV7:CH ELI/C
ELI/B X
X -3,600.00
-27
0
11/24
11/24'
8
8
14801S
14
2
WACHOVIA VISA
PERSONAL NEED ,
PETROV]:CH,
BLI/P
X ,
72.53
-17
99
11/26'
8 8
7
14885 OMNICARE PHARMACY
CLAREMONT NURSING ELI PSTROVICH
E PBTROVI:CH, BLI/M .
-123.94
12/10'
'
8
R9920
DEPOSIT LI PBTROVICH
BANK TRANSFER PETROV]:CH,
PBTROVI:CH ELI/C
ELI/B -7,440.00
27
12/10
8
R9921
DEPOSIT
GDN FEB ,
PETROVI:CH,
ELI/G ,072.53
100.00
TOTAL PETROVICH, BLI
18,387.70
TOTAL INCOME
18,387.70
TOTAL INCOME/EXPENSE 18,387.70
/~~
ITEMIZED CATEGORY REPORT
12/ 1' 7 Through 12/31' 8
PAGAC07-PAGATEMP
12/17' 8
Page 1
Date Num Description Memo Category Clr Amount
INCOME /EXPENSE
INCOME
PE TROVICH, ELI
2/18' 8 R9387 DEPOSIT GUARDIAN FEE PETRO~'ICH, ELI/G X 200.00
3/ 7' 8 R2411 DEPOSIT GDN FEE PETROVICH, ELI/G X 100.00
4/10' 8 R4877 DEPOSIT GDN FEE PETROy'ICH, ELI/G X 100.00
5/ 6' 8 R5416 DEPOSIT GDN FEE PETRO~'ICH, ELI/G X 100.00
6/ 5' 8 R5547 DEPOSIT GDN FEE PETROVICH, ELI/G X 100.00
7/ 9' 8 R8116 DEPOSIT GDN FEE PETRO~'ICH, ELI/G X 100.00
8/ 5' 8 R2665 DEPOSIT BANK TRANSFER PETRO~~ICH, ELI/B X 5,000.00
8/ 5' 8 R2666 DEPOSIT GDN FEE PETROVICH, ELI/G X 100.00
9/11' 8 R6028 DEPOSIT GDN FEE PETRO~~ICH, ELI/G X 100.00
10/ 6' 8 R6151 DEPOSIT GDN FEE PETROti~ICH, ELI/G X 100.00
10/30' 8 R2045 DEPOSIT SALE OF REAL PETROVICH, ELI/S X 27,072.53
Il/ 4' 8 R2152 DEPOSIT GDN FEE PETRO~'ICH, ELI/G X 100.00
11/12' 8 ET RETURNED ITEM DEPO RETURNED DEPO PETRO`~ICH, ELI/B X -27,072.53
12/10' 8 R9920 DEPOSIT BANK TRANSFER PETROti~ICH, ELI/B 27,072.53
12/10' 8 R9921 DEPOSIT GDN FEE PETRO`TICH, ELI/G 100.00
TOTAL PETROVICH, ELI 33,272.53
TOTAL INCOME 33,272.53
TOTAL INCOME/EXPENSE 33,272.53
s
PAGAC07-PAGATSMP
12/17' 8
Date Num
ITEMIZED CATEGORY REPORT
12/ 1' 7 Through 12/31' 8
Description Memo Czitegory
INCOME/EXPENSE
INCOME
PETROVICH, ELI
3/14' 8 129355 PAGA GENERAL ACCT 3-4 2008
5/23' 8 134585 PAGA GENERAL ACCT 5-6/08
9/12' 8 142885 PAGA GENERAL ACCT 9/08
10/ 2' 8 144825 PAGA GENERAL ACCT 10/08
11/ 5' 8 147185 PAGA GENERAL ACCT 11/08
TOTAL PETROVICH, ELI
TOTAL INCOME
TOTAL INCOME/EXPENSE
~ ~~
Page 1
Clr Amount
PETROVICH, ELI/GD X -200.00
PETRO~~ICH, ELI/GD X -200.00
PETROi~'ICH, ELI/GD X -250.00
PETROVICH, ELI/GD X -100.00
PETROVICH, ELIJGD X -250.00
-1,000.00
-1,000.00
-1,000.00
IN THE COURT OF COMMON PLEAS OF CUMBERLAND CO.,
PENNSYLVANIA n ~
ORPHANS' COURT DIVISION cQ
'~' ~-
~T.Y ~r ` 1 __ _r
z, .,,,,_
IN RE: ELI PETROVICH , an incapacitated person FILE P1O.21-0~-f O0
l
GUARDIAN OF PERSON ANNUAL REPORT a -~ o ~ '
cn
[20 Pa. C.S.A. 5521 (c)] ~' °
FROM 12/20/07 TO 12/20/08
1.I am the Limited X Plenary Guardian of the Person of my ward, named above.
2. I was appointed Guardian by Order of the Court dated 12/20/07 ,which was
X was not modified by Court Order(s) dated
3. Is the incapacitated person still living? YES
If no, answer the following:
(a) Date of Death?
(b) Place of Death?
(c) Name of Administrator or Executor? _
(d) Date Guardian of the Person filed the last Annual Report?
4. If the incapacitated person is still living, answer the following y~uestions:
(a) Date Guardian of the Person fled the last Annual Rep<-rt?
THIS I5 FIRST
(b) Current address of the incapacitated person
CLAREMONT NURSING, 1000 CLAREMONT DR., CARLISLIE PA 17013
(c) Current age 85 Date of birth of incapacitated person 7/29/23
(d) The incapacitated person's residence is:
Ward's own residence Mw home/apartment
X Nursing Home Relative's Home
Hospital or Medical Facility Boarding Home
(e) The incapacitated person has been living there since 8/11/06
If moved within the past year, state from where and why.
('
_~
(f) I rated his/her living arrangement as:
_X Excellent Average Below Average
Explain•
(g) I believe he/she is:
content with the living situation
unhappy with the living situation
_X -unaware of the living situation
5. Physical health
(a) Current physical condition of the incapacitated person. is:
Excellent Good Fair X Poor
(b) His/her major physical health problems are as follows:
HE IS CURRENTLY STABLE
(c)During the past year, his/her physical condition has:
remained about the same.
improved. Explain
_X worsened. Explain DECLINE
(d) During the past year, he/she received the following medical treatment
(include check-ups and dental work):
Date Ailment Type of treatment Doctor's name
PERIODIC ONGOING CARE AT FACILITY DR. E. JOSEPH
PERIODIC PODIATRY SERVICES DPM PINKER
6. Mental Health
(a) The incapacitated person's condition is
Excellent Good X Poor
(b) His/her major mental health problems are as follows:
SDAT SENILE DEMENTIA ALZHEIMERS'S TYPE (SEVERE)
(c) During the past year, his/her mental condition has:
remained about the same.
Improved. Explain
X -Worsened. Explain DECLINE
(d) During the past year, treatment or evaluation by a psychiatrist, psychologist or
social worker was X was not provided. Such mental health services are
briefly described as:
ALL PSYCH AND SOCIAL SERVICES PROVIDED BY CLAREMONT
7. Social Activities / Services
(a) His/her current social condition is:
excellent good X fair poor
(b) During the past year, his/her social condition has:
_X -remained about the same.
improved. Explain.
worsened Explain
(c) During the past year he/she has participated in the following activities:
X -recreational
educational
X -social
occupational
no activities available
he/she refuses to participate in any activities
8. Visitation
(a) During the last year, I visited him/her as follows: QUARTERLY
(b) The average amount of time I spent on each visit was 1.0-15 MINUTES
(c) The last time I visited was on Date 12/11/08
9. During the last year I have performed the following activities a-n behalf the
incapacitated person:
ALL MEDICAL AND FINANCIAL DECISIONS
10. I believe he/she has the following unmet needs: NONE
11. The guardianship _X_ Should should not be continued without
modification because:
12. Please note any concerns about the Incapacitated person's ph3~sical or mental
well being or the finances that the Court should know.
13. I _X am am not guardian of the incapacitated person's estate. If yes,
my report is attached.
I certify under the penalties of perjury that the information contained in this report
is true and correct to the best of my knowledge, information and belief.
Date: '~ ~) , ,~~/~?
f' ~~/~~ ~
Signature of the Guardian o the Person
Name: BRIAN D. BROOKS TELE#: 717-299-4568
PENNSYLVANIA GUARDIANSHIP ASSOC. INC.
PO BOX 7295
LANCASTER, PA 17604