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HomeMy WebLinkAbout02-1138 Orphans CourtIN THE COURT OF COMMON P AS OF CUMBERLAND COUNTY NO. ZI- 02- ~ « ORPHANS' COURT ESTATE OF MARIAN E. DEIBERT PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE MARIAN E. DEIBERT TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE TO THE HONORABLE, THE JUDGES OF SAID COURT: The Petition of Holy Spirit Hospital respectfully represents that: 1. Your Petitioner, Holy Spirit Hospital of the Sisters of Christian Charity ("Holy Spirit Hospital") is an acute care hospital located at 503 North 21St Street, Camp Hill, Cumberland County, Pennsylvania 17011-2288. 2. The alleged incapacitated person is Marian E. Delbert, a married woman, age 69, who resides at 703 Allison Avenue, Mechanicsburg, Cumberland County, Pennsylvania. 3. The alleged incapacitated person is married to Carl M. Delbert, age 79, who by Order of this' Court docketed to No. 21-02-645 was declared an incapacitated person in August, 2002 and guardians were appointed for his person and his property. 4. The only known relatives of the alleged incapacitated person are: A. Carl M. Delbert -husband B. Jean Trout -sister C. George Trout -nephew 5. On or about November 15, 2002, Marian E. Deibert was admitted to Holy Spirit Hospita Community Mental Health Center involuntarily based upon a Petition filed by her husband's court appointer guardians. She has continued to reside at Holy Spirit Hospital from the date of her admission to the preserr time pursuant to an involuntary commitment under the Mental Health Procedures Act. 6. Marian E. Deibert suffers from the following medical conditions: hypertension, abnormal heart echo, history of motor vehicle accident with closed head injury, and history of breast disease. 7. While a patient at Holy Spirit Hospital, Marian E. Deibert has been examined by David Petkash, M.D. who has provided the opinion that she does not have the capacity to make medical or personal decisions on her behalf or to handle her financial affairs. 8. Dr. Petkash has diagnosed her mental health condition as delusion disorder, paranoid subtype. 9. Marian E. Deibert is an incapacitated adult person who needs a court appointed guardian for her person and her estate. 10. It is believed and therefore averred that Marian E. Deibert does not have a Power of Attorney nor a Will. 11. A guardian is necessary to facilitate Marian E. Deibert's continuing medical care and treatment, and to handle her personal and financial affairs in a responsible fashion. 12. Petitioner believes and therefore avers that Marian E. Deibert does not have the capacity to care for affairs of daily living and needs a guardian appointed to handle her person and her property. 13. Petitioner believes and therefore avers that Marian E. Deibert needs to be placed in a facility that will provide her with 24 hours of care. 14. Less restrictive alternatives are not available because there is no one able to care for her. 15. Pennsylvania Guardianship Association is willing to accept the appointment of guardian of her property. Pennsylvania Guardianship Association is presently guardian of the property of Carl M. Deibert. 16. Pennsylvania Guardianship Association is willing to accept the appointment of guardian of the person of Marian E. Deibert. 17. No other court has ever assumed jurisdiction in any proceedings to determine the capacity of Marian E. Deibert. WHEREFORE, your Petitioner prays that a Citation be issued to Marian E. Deibert to show cause why she should not be adjudged to be incapacitated and a plenary guardian for her estate and person be appointed, and that the Court schedule a hearing on this Petition. Date: ~---~-a ~ 2 ~ ~ ~-- JOHN N, UFFIE, A & DNER By: avid W. eLu Attorney I.D. #41687 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Petitioner, Holy Spirit Hospita 165624 VERIFICATION I, Steven Bucciferro, Director of Behavioral Health Services, Holy Spirit Hospital of the Sisters of Christian Charity, verify that the statements made in the foregoing Petition are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. teven Bucciferro, Director Behavioral Health Services Holy Spirit Hospital Dated: ~~ '~ d iz~osi2oo2 J,a;s7 Faa ~>.~ ~u sofa s~sthw 0 oioioia tN ~~ COt~RT ~ COlYIfrIION PLRAS of cUMBI_RLAND COUNTY NO. ORPFRANB' COURT E8'fATE Of MARtAHt ~. Oa!`~RT PETRION PURSEJANT TD SECTION Ss11 CF TM& PROBA3E, EJS'tAT ES ~ AND t=1DUCIARY GODlt TO ADJUDIC/1TE MAWgN E, ppgERr ro BE INCA~'ACIl'ATED A111D TO APPQINT oUARD1Af~;3 f0#t HER P~RSpN AND HER ESTAT>c i ACCEPTANC BYPROPOS~D ~UARD/AIV Dated: ~~~~U ~~ z.~ Penn,ylvanfa Ouandlanship Assoaieffan, 1253 Wat~ank l4vad, Lancaster, Pilrtnsytvanla 17GQ3, hereby sprees to BCOapt the aPpointrnnnt of plenary gusniia~ of the person and ecteft3 cat Manan E. Deitaeri if shg is txlJt~cfged to be sn inGapeciteted parson by the C.~imbarland County Orphans' CruM. , F3tian Bro ~ resi t --...~-...-`- ~ ~ d 8SLS6SLOLS L II'~H aual~eQ V~Jd ZE~Z ZOOZ ~b0 ~egweoad ',(epsAUpati~ ' ~~~ ~ ~ goo IN THE COURT OF COMMON PL;~ OF CUMBERLAND COUNTY t~_ NO. %ZI-O~- I I ORPHANS' COURT ESTATE OF MARIAN E. DEIBERT PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE MARIAN E. DEIBERT TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE PRELIMINARY DECREE AND NOW, this ---1~- day of ~~% y~yj-t,~,~~ 2002, upon consideration of the annexed Petition, it is ORDERED AND DECREED that a hearing on this matter is set for the / ~ ~a of ~ - Y ~~-~~ ~ , 20(,1, in Courtroom No. _ "~ , at f~~'.~ ~~ l~r.M at th Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania, and that a Citation be issued to Marian E. Deibert commanding her to show cause why she cannot ai~pe~.~r al the aforementioned hearing pursuant to the Petition of Holy Spirit Hospital to have Marian E. Deibert adjudicated an incapacitated person and to have plenary guardians appointed for her person and her estate. Notice of the hearing shall be given to Marian E. Deibert in accordance with 20 P.S. § 5511(a) not less than twenty (20) days prior to the hearing. f t~~ v ~ IN RE: MARIAN E. DEIBERT IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-2002-x-138 t ~ IMPORTANT NOTICE CITATION WITH NOTICE A petition has been filed with the Court to have you declared an Incapacitated Person. If the Court finds you to be an Incapacitated Person, your rights will be affected, including our right to manage money and property and to make decisions. A copy of the petition which has been filed by HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY is attached. You are he;reby ordered to appear at a hearing to be held in Court Room No. 3, Cumberland County Courthouse, Carlisle, Pennsylvania, on JANUARY 13TH , 2002, at 10:30 AM. to tell the Court why is should not find you to be an incapacitated Person and appoint a Guardian to act on your behalf. To be an incapacitated Person means that you are not able to receive and effectively evaluate information and communicate decisions and that you are unable to manage your money and/or other property, or to make necessary decisions about where you will live, what medical care you will get, or how your money will be spent. At the hearing, you have the right to appear, to be represented by an attorney, and to request a jury trial. If you do not have an attorney, you have the right to request the Court to appoint an attorney to represent you and to have the attorney's fees paid for you if you cannot afford to pay them yourself. You also have the right to request that the Court order that an independent evaluation as to your alleged incapacity. If the Court decides that you are an Incapacitated person, the Court may appoint a Guardian for you, based on the nature of any condition or disability and your capacity to f ~ ~. • ,, make and communicate decisions. The Guardian will be of your person and/or your money and. other property and will have either limited of full powers to act for you. If the court finds you are totally incapacitated, your legal rights will be affected and you will not be able to make a contract or gift of your money to other property. If the court finds that you are partially incapacitated, your legal rights will also be limited as directed by the Court. If you do not appear at the hearing (either in person or by an attorney representing you) the court will still ]hold the hearing in your absence and may appoint the Guardian requested. Clerk, Orphans' Court Division ~ ,(~,~ Cumberland County, Carlisle, PA ~~ ~)v - ~~~~ My Commission Expires 1St Monday, ~~~~!~ January, 2006 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. 21-02-1138 ORPHANS' COURT ESTATE OF MARIAN E. DEIBERT PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE MARIAN E. DEIBERT TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE AFFIDAVIT OF DAVID W. DeLUCE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss: DAVID W. DeLUCE, being duly sworn according to law, upon his oath, deposes and says: 1. I am counsel for Petitioner Holy Spirit Hospital in the above matter. 2. On the ~ day of December, 2002, I personally served upon Marian E. Delbert at Holy Spirit Hospital, Camp Hill, Pennsylvania, and offered to read to her the Petition to adjudicate her to be incompetent and to appoint a guardian for her person and her estate, the Citation issued pursuant thereto by the Clerk of the Orphans' Court, and the Preliminary De a schedul~ g ring. David . DeL ce Sworn to and subscribed 4~~ V S,.il. befpre me this ~` v day r of i ~~ ~_"~ i~iti~~t~ j't , 2002. t i ,' ` Notary Public Notarial Seal :165624-9 Kristee K. Myers, Notary Public Lemoyne Boro, Cumberland Countyy My Commission Expires Dec. 2, 2006 Member, Perx~sylvania Association Of Notaries PETITIONER'S EXHIBIT ~_ i 3 C3 LAW OFFICES JOHNSON, DUFFIE, STEWART ~ WEIDNER JERRY R. DUFFIE RICHARD W. STEWART C. ROY WEIDNER, JR EDMUND G. MYERS DAVID W. DELUGE RALPH H. WRiGHT, JR. DAVID J. LANZA MARK C. DUFFIE MELISSA PEEL GREEVY MICHAEL J. CASSIDY ROBERT M. WALKER A Professional Corporation 301 MARKET STREET P. O. BOX 109 LEMOYNE, PENNSYLVANIA 17043-0109 WEBSITE: www.jdsw.com TELEPHONE 717-?61-4540 FACSIMILE 717-761-3015 E-MAIL mail®jdsw.com December 24, 2002 CERTIFIED MAIL, RESTRICTED DELIVERY Jean G. Trout 1412 Carlisle Road Camp Hill, PA 17011 Re: Marian E. Deibert Dear Ms. Trout and Mr. Trout: CERTIFIED MAIL, RESTRICTED DELIVERY George Trout 1910 Valley Road Etters, PA 17319 HORACE A. JOHNSON COUNSEL TO THE FIRM KEIRSTEN WALSH DAVIDSON OF COUNSEL WRITER'S EXT. NO. 116 E-MAIL dwdQjdsw.com PETITIONER'S EXHIBIT Please be advised that we represent Holy Spirit Hospital. On behalf of my client, a Petition was filed with the Cumberland County Orphans' Court to declare Marian E. Deibert an incapacitated person and to appoint Pennsylvania Guardianship Association guardian of her person and her property. Enclosed is a copy of the Petition that has been filed as well as a Preliminary Decree scheduling a hearing for January 13, 2002 at 10:30 a.m. at the Cumberland County Courthouse in Courtroom No. 3; a proposed Final Decree; and a copy of the Citation that has been served on Marion Fulton. I am required by law to provide you with notice of this hearing and the opportunity to come to the Court and present your position, if any. This is not a subpoena and you are not required to attend the hearing. If you have any questions, please call me. Very truly yours, JOHNSON, DUFFIE, STEWART & WEIDNER David W. DeLuce DWD:lar:kkm:166518 Enclosure S O a ...0 ~ m Postage $ a ~ Certified Fee _ ~ Return Receipt Fee ~ (Endorsement Required) O Restricted Delivery Fee O (Endorsement Required) ~ Total Postage & Fees .Q~, rl U7 ru rl 0 «_ Post r~ar~--- ~_ /~~rP I / ' \'.. f~ ~/ - ~ ~`~~ F ~~ /~ ~ , Sent To ~ ~~ ~~ _ ~.J ~l~ ~ ~f . ~~ LI \,, Street, Apt. No.; ^ "-- t ~_~ --= ---- or PO Box No. ~ " /~ - ----------------~-- -~~ -- ~-- ~~_ L ~_ c(~ c{ - City, State. Z/P+ - - - - - --------------------------- ---- ~~,< rub l~ 111 ~~ l "741 / t ^ Com lete items 1, 2, and 3. Also complete item if Restricted Delivery is desired. ^ Prin your name and address on the reverse sot at we can return the card to you. ^ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: /~//~ ~rdkli~lc ~~~~ Cra~bt~ f ~~ l~~ ~~ 1~~4~~ A. Receiv A by (Please Pr~iint Clearly) `B Date of,~Iel~ery C. Signature ~~ + ,~ir ~~ ^ Agent ~.ry1 ~. r,,,~ ^ Addressee D. I~ slivery address diff~ent from item 1? ^ Yes S, enter delivery address below: ^ No 3. ~S,ervice Type ~j Certified Mail ^ Express Mail ^ Registered ^ Return Receipt for Merchandise ^ Insured Mail ^ C.O.D. 4. Restricted Delivery? (Extra Fee) Yes 2. Article Number (Cc 7001 2510 000], 4],38 61,04 PS Form 3811, July 1999 Domestic Return Receipt 102595-99-M-1789 a a a ~ -_ _ ` ~ m Postage $ ~ ~' ~' \ ~~- '~ ~ ~ Certified Fee J f Postmark ~ ~ -~` Return Receipt Fee + G? Vie. _. ~' , ~ ~ (Endorsement Required) ; -; ~ ~ ~ ' O O Restricted Delivery Fee / ~ ~ p (Endorsement Required) ~,-__ _ _.. , Total Postage 8 Fees 1` ~ / r~ - N Sent To ~, ~. ~ ~ C /R C(~~- ----' . ----F----------- ------- ------° --- ----------------------------- ----- ~ ~ ~ Street, Apt. No.; ~ ~~ ~ ~ q ~ (~ or PO Box No. H~ L ------------- - 4 ) ~ ZIP L~ ~ -- / ~ t~ + ~ / ~ ~~ City, State, t t N ~ I / ~~ / / / complete items 1, 2, ana 3. rlisv uvr r rNrc~° tem 4 if Restricted Delivery is desired. rlntyour name and address on the reverse o that we can return the card to you. ttach this card to the back of the mailpiece, ,._ ,.., a° s,-.,.,t if mace permits. 1. Article Addressed to: ~js= ~~z y~ ~~ T c' ~t I `1 I G V~ l (~--~- k~~r . r ~ ~~ kyS t ~,~ , ~3/ ^ Express Mail ^ Return Receipt for Merchandise rl C-O.D. ti_, 2. Article Number (Copy from °°^"^^ ~DD1 2510 DDO1 4138 b1 $11 J I 1999 Domestic Return Receipt Is deliv2~y addr~ss different from item i', u ,cam If YES, enter delivery address below: ^ No 102595-99-M-1789 PS Form 3 u Y ~~~~~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. 21-02-1138 ORPHANS' COURT ESTATE OF MARIAN E. DEIBERT PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE MARIAN E. DEIBERT TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE 'LENARY GUARDIANS yY AND NOW, this day of January, 2003, a hearing in this case having been held on January 13, 2003, and it appearing to the Court that Marian E. Deibert was properly served with a Citation and Notice of this hearing and she was present at the hearing, and based upon the testimony presented at the hearing, the Court further finds from the testimony: 1. That Marian E. Deibert suffers from delusion disorder, paranoid subtype, the condition or disability which totally impairs her capacity to receive and evaluate information effectively and to make and communicate decisions concerning her management of financial affairs or to meet essential requirements for her physical health and safety. 2. That there exists no other less restrictive alternative mechanism for decision making. 3. That based on the total incapacity of Marian E. Deibert to receive and evaluate information and to make or communicate decisions, a plenary guardian of the person and a plenary guardian of the estate are required on a permanent basis. NOW, THEREFORE, based on the clear-and convincing evidence supporting the foregoing findings it is ORDERED, ADJUDGED and DECREED that Marian E. Deibert be and is hereby adjudged an incapacitated person and Pennsylvania Guardianship Association is appointed Plenary Guardian of the Person and the Estate of Marian E. Deibert. .~ A Report by the Plenary Guardian shall be filed on an annual basis with the Court. No bond shall be required of the Plenary Guardian named herein. The Plenary Guardian is hereby authorized to make decisions on Marian E. Deibert's behalf concerning her medical care and treatment including her admission to nursing homes, personal care facilities, hospitals and other healthcare providers, as well as to consent to and authorize medical treatment; and the Plenary Guardian herein appointed is further authorized to handle all of the assets of her Estate including the principal and interest, and to conduct her business affairs on her behalf, including the sale or transfer of any of her assets, including her interests in real property, payment of bills ar~d expenses, investment of assets and all matters rel ted thereto. ~,~ ~, Q~k~ ~`~ r__ ~~-~ ~-( A ~~~ ~ ~~~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. 21-02-1138 ORPHANS' COURT ESTATE OF MARION E. DEIBERT PETITION TO APPROVE SALE OF REAL ESTATE TO THE HONORABLE, THE JUDGES OF SAID COURT: And now, comes the Petitioner, Pennsylvania Guardianship Association, Inc. by and through its attorneys, Johnson, Duffie, Stewart & Weidner and petitions this Court and in support of this petition avers as follows: 1. Petitioner, Pennsylvania Guardianship Association, Inc. located at P.O. Box 7295, Lancaster, Pennsylvania 17604 is the court appointed guardian of the person and the estate Marion E. Deibert by Order of Judge Hoffer entered on January 13, 2003. Attached hereto as Exhibit "A" is a true and correct copy of said Order. 2. At the time of the hearing on January 13, 2003, the incapacitated person was a patient at Holy Spirit Hospital. She is now residing at an assisted care, secured facility, Harrisfield, located at 3251 Butler Street, Harrisburg, Pennsylvania 17103. 3. The incapacitated person is 69 years of age, suffers from hypertension, abnormal heart echo, history of motor vehicle accident with closed head injury, and history of breast disease and is never expected to return to her home or to be released from a secured facility. She also has a psychiatric diagnosis of delusion disorder, paranoid subtype. 4. The incapacitated person and her husband, Carl M. Deibert, are the title owners to real property located at 703 Alison Avenue, Mechanicsburg, Mechanicsburg Borough, Cumberland County, Pennsylvania having acquired the property by deed dated October 22, 1969 and recorded in the Cumberland County Recorder of Deed office in Deed Book K-23, Page 938. Attached hereto as Exhibit "B" is a true and correct copy of said deed. 5. Carl M. Delbert, the incapacitated person's spouse, died on May 2, 2003 thus vesting sole ownership of the aforesaid real property in the name of the incapacitated person. 6. The total value of the incapacitated person's assets, not including the real estate, is approximately $320,000.00. In addition, she has monthly income of $500.00 which is expected to increase to $1,800.00 after she begins receiving her husband's social security benefits and pension. 7. The approximate annual costs for the incapacitated person to be maintained in Harrisfield, an assisted care facility, is approximately $30,000.00. 8. Since the incapacitated person will not be able to return to the real estate to reside, and no one else resides in the home, Petitioner authorized a public auction of the real estate which occurred on May 31, 2003. Attached hereto as Exhibit "C" is a report of the auctioneer, Cindy Fenton, who conducted a sale of the real estate ion that date. 9. The aforesaid real estate (tax parcel 17-24-0789-134) has a current assessed value of $123,110.00, and after applying the Cumberland County common level ratio of 1.05, has an approximate market value of $129,265.50. 10. Since the auction generated a sale of $147,000.00, Petitioner believes that a fair and equitable price has been obtained for the real estate and respectfully requests this Court to approve the sale. 11. Subsequent to the public auction, and consistent with the bid awarded by the auctioneer, your petitioner and the successful bidder, W. Wayde Kelly entered into a written agreement of sale for real estate in the amount of $147,000.00 with settlement to occur on or within forty-five (45) days of the date of auction. WHEREFORE, Petitioner requests this Court to enter an Order authorizing the sale of the real estate at 703 Alison Avenue, Mechanicsburg, Mechanicsburg Borough, Cumberland County, Pennsylvania to W. Wayde Kelly for $147,000.00. Date: / ~ ~~ Respectfully submitted, JOH N, DUFFI , S ART EIDNER By: ~. avid DeL Attorney I.D. #41687 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Petitioner :214493 _ _ _ _ ___ rJti (r!;+ 2r;'~:3 ? 5:54 F:Y:`{ 71 i '7ii1 3015 1~S&'•i' ^ r t ~J ~ ~ c Il ~ I VERIFIGA~,~,N I, f3riarti I~. brooks, President, ~'enr+sylvania Guardianship Association, Irc., v~;riry tf,at tl~e statements made in the far~gaing Petitio+~ are true and carrect to thF tyest of my k.nawl~;dg~;, ir+fc;rmatian and beli~t. i ~~nder:s#and that false staterne:rts herein are made subject to the penalties of ~$ Pa,f,;.S. §4.~(?~ relating to ur~s,worn falsification to authorities. B ari . 13rooMt~n~r~sident Pennsyivenia ~Ue~ianship ,Assaci.atian, Inc, Dated: _,._--~~! ~'~©_ a __ IN THE COURT OF COMMON PLEAS Of CUMBERLAND COUNTY NO. 21-02-1138 ORPHANS' COURT ESTATE OF MARIAN E. DEIBERT PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE MARIAN E. DEIBERT TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE AND NOW, this,, day of January, 2003, a hearing in this case having been held on January 13, 2003, and it appearing to the Court that Marian E. Deibert was properly served with a Citation and Notice of this hearing and she was present at the hearing, and based upon the testimony presented at the hearing, I the Court further finds from the testimony: !, 1. That Marian E. Deibert suffers from delusion disorder, paranoid subtype, the condition or disability which totally impairs her capacity to receive and evaluate information effectively and to make and communicate decisions concerning her management of financial affairs or to meet essential requirements for her physical health and safety. 2. That there exists no other less restrictive alternative mechanism for decision making. 3. That based on the total incapacity of Marian E. Deibert to receive and evaluate information and to make or communicate decisions, a plenary guardian of the person and a plenary guardian of the estate are required on a permanent basis. ~ `~ .; NOW, THEREFORE, based on the cl~a, ~iancl~ ccgn~vi~cing evidence supporting the foregoing findings it is ORDERED, ADJUDGED and DECREED that Marian E. Deibert be and is hereby adjudged an incapacitated person and Pennsylvania Guardianship Association is appointed Plenary Guardian of the Person and the E=state of Marian E. Deibert. ~IIBIT "A'• A Report by the Plenary Guardian shall be filed on an annual basis with the Court. No bond shall be required of the Plenary Guardian named herein. The Plenary Guardian is hereby authorized to make decisions on Marian E. Deibert's behalf concerning `her medical care and treatment including her admission to nursing homes, personal care facilities, hospitals and other healthcare providers, as well as to consent to and authorize medical treatment; and the Plenary Guardian herein appointed is further authorized to handle all of the assets of her Estate including the principal and interest, and to conduct her business affairs on her behalf, including the sale or transfer of any of her assets, including her interests in real property, payment of bills and expenses, investment of assets and all matters rel ted thereto. ~l ~'O~ ~~-~ ~--C G,, ~ ~,,,,,,,~.~ C~ ~ ,~ ,~ ~ ~ ~~~ ~e ,, ,,~, ~; 1 . r. t;. ~ ~ j ;nlf~ ~ ~~ # L ~~ ~ HlheA HY4 I~SeiL~. nt 1M~, 4t a[ itN. I r~~g.r~-3FFiEE OF THE ~~ ~~ ' f :C CcR CF rr sp5 ~,~ \~~l/ Cyr OGT~3 ~ is F'r1G~ ->,~! - oefrELord one thowaxd xtne htexdred and slxty1nine (-a-~~'~:-~~:1n ths;xCar F•e:.n;r~•:au;a ' ,: .. .. _ - ; ; Grdxtee a .~~ ... ~ ' ., WITNES3ETH, that ix conaidemtio+e oj: Four. Thousand Six Hundred ----------__ - - ($4,600.00) Doi~ara, ix hand paid, the receipt whersoj• {e •hereby acknowkdped, the, said praetors do hereby yraxt arui eonroey to the said prnxtee s; ~- ALL that certain piece or parcel of 3an8 situate in the Borough of Mechanicsburg, County"of Cumberland and State of Pennsylvania, bounded and described as follows, to wits BETiYEEN WILLIAM A. KNAUB and BETTY L. IQVAUB, his wife, _ ~• of the City of Harrisburg, County of Dauphin'"'"'~ • and State of Pennsylvania, Grantors , owed CARj, M. DEIBERT and .MARION E. DEIBERT, his wife, of the Borough of Camp Hill, County of Cumberland and..State of Pennsylvania, ;~ BEGINNING at a point on the northern••line of Alison Avenue, .said point being at the dividing line between Lots Nos. 61 and 62 on the hereinafter >aentioned Plan of Lota~ thence continuing along the northern Iine of Alison Avenu® South 64 degrees 51 minutes West, eighty (80) feet to a point at the dividing line between Lots Nos. 62 and 63 on said plant thence; along said_diyiding line North 25 degrees 09 minutes West, one hundred twenty-nine and eighty hundredths (129.80) feet to a pointF thence North 67 degrees 47 minutes East, eighty and ten hundredths (80.10) feet to a point at the dividing line between Lota Nos. 61 and 62 on said p1anF thence along said .•-dividing line South 25 degrees 09 minutes East, one hundred twenty- " five and seventy hundredths (125.70) feet to a point on the northern line of Alison Avenue, the place of BEGINNING. BEING Lot No. 62 on Plan No. 1, Plot "B" of Heritage Acres, said plan being recorded in the Cumberland County Recorder's Office in Plan Book 20, Page 74. ~ , ~~ ..:~ t ~:wa4~tE1~, BEING part of the same premises which Elizabeth G. Shelley, et al., by deed dated December 9, 1967 and recorded in the Cumberland County Recorder's Office in Deed Book "P", Volume 22, Page 574, granted and conveyed unto William A. Knaub, one of the grantors herein. Sohool DisF.aCrerib, Co., Pe ~~ t'=i ~~ Vii:: e; s ~ `+.-i': lwl EyfN. rn.af~r T.r ~ R.dSS ftl.f. Tr.mlrr T.. ,~k,~ rv~' ~~y} ~ r'-'~'~' ~y~ ~' • ~~.~ f~J ~ •~. ~Wn Mit. .~`~ E ~~Tl'~. ~ L ~: '. ~:... Cu~..b. G. Did. Cnl.•Aer LS ~wwb, Co. Did. GI, Aaf C ' •~~.. {r ~j,~ u .i. dpi • 'I V~Arj' I~'~~r~•ilt'ira~{ BJCiK~f".C;jPA6E 53d E'~~1_~1~'i'~~: _.. _,__ T____.._.~_.._......_..~_ _. --- ~. David Deluce, The a~xction ott May 31,20031ocated at 703 ,A,llison ,A,ve.Mechanicsburg, had a wonderful turn out of 75 registered bidders, approQCimately six of these bidders wcaro there for the real estate. ,Adverting started one moth Frzvr to the audion,to give potential buyers opportunity to inspect the property. I advrattized throe tiooo~es v~itlt Fry Ca~mmunications, wluickt ks the local newspaper in the ~ and I advertized one tune in the Y3arrisib~ug Fatziot N~ on Sunday May 4th. I laavc had two open houses previous to the auction with axt overr~ebming response. Prior t4 the auction, I have locdced into comparable properties which have sold iux the same neighboz~ood, and in my opinion, tb.e real estate located at 703 Allisa~u ,A,ve. Mechaoacsburg, sold above or e[lual to the market value in this neigbtborb,oocl. Chady Fenton- Audianeer alb' F~IIBPI' "C^ JUN 1 2 2003 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. 21-02-1138 ORPHANS' COURT ESTATE OF MARION E. DEIBERT PETITION TO APPROVE SALE OF REAL ESTATE DECREE AND NOW, this day of June, 2003, upon consideration of the Petition of Pennsylvania Guardianship Association, Inc., the court appointed plenary guardian of the estate of Marion E. Delbert, the proposed sale to W. Wayde Kelly for $147,000.00 is hereby authorized and upon receipt of the full purchase price, the court appointed guardian is authorized to make, execute and deliver a deed to W. Wayde Kelly for the premises at 703 Alison Avenue, Borough of Mechanicsburg, Cumberland County, Pennsylvania. Court. The purchase money shall be accounted for by the guardian in the annual accounting filed with this BY THE COURT: ~c~ ~- `:~t -~ ... t'rl C1 ., .~ ~ ~,~; C!'~ lc~~. COURT OF COMMON PLEAS OF~COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION I'~nRe: an Incapacitated Person File No. a 1- ~ a - ~ ~ 3 $ PERIODIC REPORT OF THE GUARDIAN OF THE PERSON FROM ~ ~ 3,199_ TO ~ ~~,199_. PA GUARDIANSHIP ASSOC. 1) I am the lei 't a (circle one) guardian of the person of the ward named a~~~}~ ~5 address, including zip code, is: Lancaster, PA 176047295 My telephone number is: work (7r~ , g'- Y.s?~$ home (.~'~/17~~`9 - y S~ d' 2) I was appointed guardian by Order of Court dated ~ ~/ ~ ~~ -~ which (circle one) modified by Court Order(s) dated 3) Wazd's present age is ~ ~ and date of birth is l~ /33 4) I iving Arrangements a. Current address of my ward is ~ G~. ~((~ ,~ ~ 1-E'-- ~ ~. b. My ward's residence is: [ ] Ward's own home/apartment [-j~ursing home [ ]Foster or boazding home c. My ward has been residing there since [ ] My home/apartment [ ]Hospital or medical facility [ ]Relative's home (relationship) (insert date) If moved within the past yeaz, state from where and the reason for the change: d. Irate my wazd's living arrangeme [ ]Excellent [ Average Explain: [ ]Below Average e. I ieve my ward is: [ Content with the living situation. [ ]Unhappy with the living situation. ] Unawaze of the living situation. 5) physical Health a. My wazd's current ph ical condition is: [ ]Excellent [ ood [ ]Fair [ ]Poor b. My ward's major physical health problems aze as follows: c. During the past year, my wazd's physical condition has: [ wined about the same. [ ]improved. Explain [ ]worsened. Explain d. During the past year, my ward received the following medical treatment include check-ups and dental work Date Ailment ^ Ty~p'e of Treatment Doctor's Name l~"~ 6) Mental Health a. My ward's current mental health is: [ ]Excellent [ ]Good [ ]Fair oor b. My ward's major mental health problems are as follows: ~!Sl_-l.(~~~ Q~ r~--C~.~ ~-~'lJ o-,,ra-- r~ ,~. ~ Wis.-- c. D ng the past yeaz, my ward's mental condition has: remained about the same. [ ]improved. Explain [ J worsened. Explain d. During the past year, treatment or evaluation by a psychiatrist, psychologist or social (circle one) provided. Such mental health se ces %are 1brLiefly,des, /cri~bed/a~s.~_~ C "~~~ C~('~ cr1A~,(i~ :l cs.r~ GL.f~~ Y'~ A Y.~r~ (~l_A-~ 1. /V./1-C.tJ. 7) Social Activities/Servces a. My ward's current social condition is: [ ]Excellent [ ]Good - [~ [ ]Poor b. D ng the past year, my ward's social condition has: ~,ained about the same. [ ]improved. Explain [ J worsened. Explain c. D~'ing the past year, my ward has participated in the following activities: f- recreational [ ] e tonal [ social f 1 occupational [ ] no activities available. [ ] my ward refused to participate in any activities. [ ] my ward was unable to participate in any activities. 8) During the past year, l visited (nape) 9) Activ~g,~ During the past year, I perfo~ed t)~e ~ ~ ,,,J. ina activities on of my ward: 10) I believe my ward has the following unmet needs:_ 11) The guardianshi (circle one) be continued without modification because: a. The average amount of time I spent on each visit was b. The last time I visited with my ward was on 12 (circle one) guardian of my ward's estate. If yes, my Report for the Estate 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. I further certify that I have sent a copy of the Notice below to all persons entitled to notice thereof .D. ~`~~~ Print Name: ~~ , ~-Y\ ~~~-~s _ ~/ ~ Signature of Guar ian of the Person Date:. ~ J In the matter of the Estate of f cG ~, ~n Incapacitated Person. To the care providers, next-of--kin, and all parties in interest in said affairs: Notice is hereby given that ~~ (guardian of the person) has filed in the office of the Clerk of the said Court his annual report concerning the affairs of said incapacitated person. A copy of the report is available for inspection in the office of the Clerk of the Orphans' Caurt, Berks County, Pennsylvania. _ _ _ ~. Guardian of the Person t ~.J COURT OF COMMON PLEAS OF BERKS COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In e. ~ :File No. ~ - doh ' ~ J ~ ~' an Incapacitated Person : PERIODIC REPORT OF THE UARDIAN OF THE ESTAT FROM ~ 3 .3 ,199 TO 3 C~ ,199_. 1) I am the lilnil~!d~~l (circle one) guardian of the estate of the ward named above, and my address, incIudmg zip code, is: My telephone number is: work j r7) `~ S~home - SZ9~ A GUARDIANSHIP ASSOC. P.O.BOX 7295 2) I was appoin uardian by Order of Court dated ~3~ Lancaster, PA 17604.7295 which (circle one) modified by Court Order(s) dated 3) My initial inventory was filed on ~ ~ ~3 and listed a total estate value of $31 ~~ t(~O, a-? The inventory listed a total monthly income of $ , ml comprised of the following: S , S 4) At the beginning date of this reporting period, my initial balance on hand was $ ~ 5) During this reporting period, the following reflects all sources of income (other than social security) received by me fnr my ward- fa~a A~.~~r;,.,.9~ „9su ;fnn.,de,eil Date Received Source of Income Amount ~ n ~ /b ~ ~ ,~ I1 TAT . i acs (;~a~~ ` 6) During this reporting period, the following reflects all payments I have made for my ward: (Add additional es if needed Date To Whom Paid Reason for Payment Amount TOTAL 7 1~he resent nnci at assets of m wara are: Description of Asset Present Valuc TOTAL 8 The resent amount and sources ot-income form ward are: Sources of Income Amount of Income (indicate whether monthly, quarterly, annually) r 9 There iar months ex enses of m ward which I a are: To Whom Paid Amount 10) I have/have not (circle one) petitioned the Court for permission to invade principal to meet the needs of my ward. 1f a licable The followin ex nses of m ward have been aid from rinci al: To Whom Paid Purpose Amount 11 v v t (circle one) paid myself compensation for services I rendered as guardian. The am un1t I paid myself totaled ~ 5 ~, ~ and was calculated at the following rate $ cam( J ~ ~ lJD per P circle one). ~~rb~ Ltiti~,4"~ 12) Circle the correct response and complete, if appropriate. ~fhere will be no need for extraordinary expenditures on behalf of my ward in the next twelve (12) months. or B. There will be a need for extraordinary expenditures on behalf of my ward in the next twelve (12) months because: t 13) Circle the correct response and complete, if appropriate. A. My ward receives monthly social security benefits directly. B. I am the designated payee to receive my ward's social security benefits. nn '' C''~ .~The designated payee of my ward's social security benefits is ~~T~~n-~^~ COL whose address is and circle one) related to my ward as ~ 1~4,, c c~ \o.~_ (insert relationship). 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. I further certify that I have sent a copy of this report to all those parties in interest listed in the original Petition to declare my ward incapacitated and that I have added a notice to those parties in th form below. Print name:` 1U ~~ Signature of uardian Date: In the matter of the Estate of ~~r ~a ri ~l ~ ~e/; ~n Incapacitated Person. To the care providers, next-of--kin, and all parties in interest in said affairs: Notice is hereby given that 'C~'C~ ~ (guardian ofthe estate) has filed in the office of the Clerk of the said Court his annual report concerning the affairs of the said incapacitated person. A copy of the report is available for inspection in the office of the Clerk of the Orphans' Court, Berks County, Reading, Pennsylvania. - .~. Guardian of the Estate ITEMIZED CATEGORY REPORT 1/ 1' 0 Through 1/31' 4 PAGA_CUS-PAGA Custodial 1/ .2' 4~ Date Num Description 12/12' 3 4041 HARRISFIELD 12/16' 3 4075 S HALL SERVICES 12/16' 3 4075 S HALL SERVICES 12/16' 3 4075 S HALL SERVICES 12/16' 3 4075 S HALL SERVICES TOTAL DEIBERT,MARION TOTAL INCOME Page 2 Memo Category Clr MARIAN DIEBER DEIBERT,MARION/ 181 HRS @ $25 DEIBERT,MARION/ 639 MILES @ DEIBERT,MARION/ TELEPHONE DEIBERT,MARION/ DEIBERT,MARTON/ Amount -2,605.00 -4,525.00 -223.65 -54.25 -381.03 417,380.84 417,380.84 TOTAL INCOME/EXPENSE 417,380.84 ITEMIZED CATEGORY REPORT 1/ 1' 0 Through 1/31' 4 PAGA_CUS-PAGA Custodial 1/ , 2 , '4' Page 1 Date Num Description Memo Category Clr Amount INCOME/EXPENSE INCOME DEIBERT,MARION 2/11' 3 3007 HALL SERVICES DEIBERT,MARION/ X -2,313.45 2/11' 3 ET MARION DIEBERT DEIBERT,MARION/ X 10,000.00 2/12' 3 3039 PLATINUM PLUS FOR 403647000030- DEIBERT,MARION/ X -639.57 2/25' 3 3071 PLATINUM PLUS FOR 403647000030- DEIBERT,MARION/ X -111.50 3/31' 3 3157 S PAGA GENERAL ACCOU DEIBERT,MARION/ X -1,500.00 4/ 3' 3 R8223 DEPOSIT 1/2 BANK / IR DEIBERT,MARION/ X 24,966.20 4/ 3' 3 R8224 DEPOSIT BANK TRANSFER DEIBERT,MARION/ X 2,408.67 4/ 3' 3 R8225 DEPOSIT BANK TRANSFER DEIBERT,MARION/ X 28,462,48 4/ 3' 3 R8226 DEPOSIT BANK TRANSFER DEIBERT,MARION/ X 52,663.83 5/ 5' 3 R8235 DEPOSIT REAL ESTATE S DEIBERT,MARION/ X 300.00 6/ 4' 3 ET DEPOSIT BANK TRANSFER DEIBERT,MARION/ X 203,183.61 6/ 4' 3 3347 S CLERK OF THE ORPHA INVENTORY DEIBERT,MARION/ X -10.00 6/12' 3 3363 MANORCARE CAMP HIL DEIBERT, CARL DEIBERT,MARION/ X -255.00 6/13' 3 3415 HARRISFIELD MARIAN DIEBER DEIBERT,MARTON/ X -3,047.77 6/23' 3 3422 HARRISFIELD MARIAN DIEBER DEIBERT,MARION/ X -3,426.47 6/30' 3 3442 WITHLACOOCHIE RIVE CM DIEBERT 1 DEIBERT,MARION/ X -46.50 6/30' 3 3456 S HALL SERVICES 186HRS @ $25 DEIBERT,MARION/ X -4,650.00 6/30' 3 3456 S HALL SERVICES 817 @ .34 DEIBERT,MARION/ X -277.78 6/30' 3 3456 S HALL SERVICES FLORIDA DEIBERT,MARION/ X -1,167.99 6/30' 3 3459 MYERS FUNERAL HOME MARIAN E. DIE DEIBERT,MARION/ X -8,719.00 6/30' 3 3461 S PETTY CASH C/0 DAR POSTAGE DEIBERT,MARION/ X -6.25 7/ 2' 3 3465 PLATINUM PLUS FOR 403647000030- DEIBERT,MARION/ X -9.89 7/ 3' 3 3468 S BRIAN D. BROOKS POSTAGE DEIBERT,MARION/ X -1.29 7/ 3' 3 R8346 DEPOSIT DEIBERT,MARION/ X 2,238.81 7/ 3' 3 R8347 DEPOSIT INSURANCE DEIBERT,MARION/ X 2,100.97 7/ 3' 3 R8348 DEPOSIT SSDI DEIBERT,MARION/ X 528.00 7/ 9' 3 3506 MANORCARE CAMP HIL DEIBERT, CARL DEIBERT,MARION/ X -3.00 7/30' 3 3206 S PAGA GENERAL ACCOU 7-8 DEIBERT,MARION/ X -500.00 7/30' 3 3571 HARRISFIELD MARIAN DIEBER DEIBERT,MARION/ X -3,086.10 8/ 1' 3 3574 S PLATINUM PLUS FOR DEIBERT,MARION/ X -163.72 8/ 5' 3 R6007 DEPOSIT BANK TRANSFER DEIBERT,MARION/ X 1,027.27 8/ 5' 3 R6008 DEPOSIT REAL ESTATE S DEIBERT,MARION/ X 134,280.16 8/ 5' 3 R6009 DEPOSIT SSDI DEIBERT,MARION/ X 528.00 8/26' 3 3642 HARRISFIELD MARIAN DIEBER DEIBERT,MARION/ X -2,969.42 9/ 3' 3 ET CARL DIEBERT FUNDS TRANSFE DEIBERT,MARION/ -927.77 9/ 4' 3 R6061 DEPOSIT BANK TRANSFER DEIBERT,MARION/ X 336.57 9/ 4' 3 R6062 DEPOSIT SSDI DEIBERT,MARION/ X 528.00 10/ 2' 3 3759 WITHLACOOCHIE RIVE CM DIEBERT 1 DEIBERT,MARION/ X -30.00 10/ 2' 3 3760 HARRISFIELD MARIAN DIEBER DEIBERT,MARION/ X -2,605.00 10/ 7' 3 R6130 DEPOSIT PENSION DEIBERT,MARION/ X 336.57 10/ 7' 3 R6161 DEPOSIT SSDI DEIBERT,MARION/ X 528.00 10/27' 3 ET CARL DEIBERT TRANSFER DEIBERT,MARION/ X -500.00 10/27' 3 3843 HARRISFIELD MARIAN DIEBER DEIBERT,MARION/ X -2,605.00 11/ 4' 3 R6206 DEPOSIT BANK TRANSFER DEIBERT,MARION/ X 336.57 11/ 4' 3 R6207 DEPOSIT SSDI DEIBERT,MARION/ X 528.00 11/21' 3 3966 S PAGA GENERAL ACCOU 11-12 DEIBERT,MARION/ X -500.00 11/23' 3 3984 S PLATINUM PLUS FOR DEIBERT,MARION/ -39.47 C~'r~berlo. nc~ IN THE COURT OF COMMON PLEAS OF 11~II COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: M n r t 0 t'1 }. ~~ ~`~,~} an incapacitated person FILE NO.~_~ ~3~ GUARDIAN OF THE ESTATE ANNUAL REPORT [20 Pa.C.S.A. 5521 (c)] FROM 1 I ~ 3 , 200 y TO 1 ~ ; ~, , 200 S 2) 1) I am the Limited ~ Plenary Guardian of the Estate of my ward, named above. I was appointed Guardian by Order of the Court dated I J 131 y~ ,which was was not modified by Court Order(s) dated Is the incapacitated person still living? ~e ,~ If no, answer the following: (a) Date of Death (b) Place of Death (c) Name of Administrator/trix or Executor/trix (d) Date Guardian of the Person filed the last Annual Report_ PLEASE ANSWER THE FOLLOWING QUESTIONS WHETHER THE INCAPACITATED PERSON IS LIVING OR DECEASED. 3) My initial Inventory was filed on ~ ~ W (p3 and listed a total estate value of The Inventory listed a total monthly income of $ t,; ~ ~ , L ~ comprised of the following: C c ~~ ~ «\ Q cj c ~.} t~ ~ ~~i 4) At the beginning date of this reporting period, my initial balance on hand was ~ y~~,C1~1,9~. C.A. - 28 _. a~ 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 if needed) Date Received Source of Income 1. crnt;~\Y~~~4~ P~~iS ~(`,t'~ 2. SCE-1-~ C~4 C(j~`+~~ ~ ~~C-C~C~-v 4- _~C~C 1 C).l ~ p C ~~r ~ ~-~-~ 5. 6. Amount 1. 2. 3. 4. 5. 6. S ~ ~- ~~~k c~~ ~ c~i ~P ~l TOTAL 'l (.1, ~ ~ ~ ~~ • 9 S 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 ~ ~ F c~ -tt r~~ C'f~c~ C~ TOTAL 7) The present principal assets of my ward are: Description of Asset Present Value i 2. ~~ C~ l~ C ~.1.~~ lS~l tl~(~ C~ ~. ~~~ f- Ill ~.l~S ~~ ~ ~ co L> . ~ ~ 3. 4. 5. 6. 1. 2. 3. 4. 5. 6. TOTAL s~5 4 ,~~f 3 _ --~ ~3 8) The present amount and sources of income for my ward are: Source of Income Amount of Income (Indicate whether onthly, quarterly, annually) 1. \iC'~C'3~('1 \ ,SPC llt'1~~( `~ ~~ . 0~ 3. 4. 5. 6. 9) The regular monthly expenses of my ward which I pay are: To Whom Paid Amount ,S Q ~ ~ -~~~..f~~G~ 10) I hav ave no 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 Se ~ c~-tta+c~e c~ 1. 2. 3. 4. 5. 6. 11) hav ' ave not (circle one) paid myself compensation for services I rendered as guardian. The amount I Paid myself totaled $ 3 , ~C;~ and was calculated at the following rate: $_.~~ per wee onth~(circle one). 12) Check the correct response and complete, if appropriate. There will be no need for extraordinary expenditures on behalf of my ward in the next (12) months. There well be a need for extraordinary expenditures on behalf of my ward in the next (12) months because: 13) Check the correct response and complete, if appropriate. A. My ward receives monthly social security benefits directly. ~B. I am the designated payee to receive my ward's social security benefits. C. The designated payee of my ward's social security benefits is whose address is and is/is not (circle one) related to my ward as (insert relationship). 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 ~ am am not guardian of the incapacitated person's person. If yes, report is attached. I certify under the penalties of perjury that the information contained in this report is true and correct to the best of my knowledge, information and belief. Name: Telephone No. (Home) 717 -vl- 9~ yt5'~ ~" Address: (Work) ~~~ --~ t{Q -7~~~ PA GUARDIANSHIP ASSOC. P.O.DOX 7195 I~~ncaster, PA 116C~4.7~95 - - .. , ~, l/o y ITEN(IZED CATEGORY REPORT 1/ 1' 4 Through 1/31' 5 PAGA_CUS-PAGA Custodial Page 1 6/13' 5 Date Num Descr_~ptior. Memo Category Clr Amount ~ INCOME . /EXPENSE INCOME DE IBERT,MARION 1/ 5' 4 4102 PLATINUM F~LUS FOR 403647000030- DEIBERT,MARION/ X -92.10 1/ 6' 4 R6310 DEPOSIT PENSION DEIBERT,MARION/ X 336.57 1/ 6' 4 R6311 DEPOSIT PENSION DEIBERT,MARION/ X 336.57 1/ 6' 4 R6312 DEPOSIT SSDI DEIBERT,MARION/ X 528.00 1/ 6' 4 R6313 DEPOSIT SSDI DEIBERT,MARION/ X 532.00 1/ 7' 4 4114 COMCAST MARION DEIBER DEIBERT,MARION/ X -124.15 1/ 7' 4 4125 HARRISFIEI,D MARIAN DIEBER DEIBERT,MARION/ X -2,605.00 1/ 7' 4 4129 WITHLACOOC".HIE RIVE CM DIEBERT 1 DEIBERT,MARION/ X -30.00 1/20' 4 4170 S PLATINUM PLUS FAR CLOTHING DEIBERT,MARION/ X -43.75 1/29' 4 4201 CLERK OF THE ORPHA MARIAN E.DIEB DEIBERT,MARION/ X -20.00 1/29' 4 4203 S PAGA GENEF?AL AC^OU 5-6/03 9-10/0 DEIBERT,MARION/ X -1,500.00 1/30' 4 4204 S BRIAN D. BROOKS POSTAGE DEIBERT,MARION/ X -1 06 1/30' 4 4205 HARRISFIEI~D MARIAN DIEBER DEIBERT,MARION/ X . -2,605.00 2/ 3' 4 4215 S PLATINUM PLUS FOR DEIBERT,MARION/ X -97 13 2/ 3' 4 R6358 DEPOSIT REFUND DEIBERT,MARION/ X . 5 00 2/ 3' 4 R6395 DEPOSIT SSDI DEIBERT,MARION/ X . 532.00 2/ 3' 4 R6396 DEPOSIT PENSION DEIBERT,MARION/ X 282 81 2/ 6' 4 4239 COMCAST MARION DEIBER DEIBERT,MARION/ X . -39 64 2/25' 4 4279 HARRISFIELD MARIAN DIEBER DEIBERT,MARION/ X . ~-2,605.00 2/26' 4 4288 COMCAST MARION DEIBER DEIBERT,MARION/ X -79 28 2/27' 4 4303 WEST SHORE EMS MARION DIEBER DEIBERT,MARION/ X . -59 22 2/28' 4 4307 S PAGA GENERAL AC~~OU DEIBERT,MARION/ X . -250 00 3/ 3' 4 R5204 DEPOSIT PENSION DEIBERT,MARION/ X . 282 81 3/ 9' 4 R5241 DEPOSIT SSDI DEIBERT,MARION/ X . 532 00 3/17' 4 4388 COMCAST MARION DEIBER DEIBERT,MARION/ X . -2 66 3/23' 4 4401 HARRISFIELD MARIAN DIEBER DEIBERT,MARION/ X . -2 740.00 3/31' 4 4426 S PLATINUM PLUS FIR DEIBERT,MARION/ X , 221 80 4/ 8' 4 4443 S PAGA GENERAL AC~~OU DEIBERT,MARION/ X . -250 00 4/ 8' 4 R5263 DEPOSIT SALE OF PERSO DEIBERT,MARION/ X . 2 450.00 4/ 8' 4 R5264 DEPOSIT SSDI DEIBERT,MARION/ X , 532 00 4/ 8' 4 R5265 DEPOSIT PENSION DEIBERT,MARION/ X . 282 81 4/12' 4 4447 LOYALTON OF CREI~~KV MARION DIEBER DEIBERT,MARION/ X . -8 195.00 4/12' 4 4463 JEAN TROUT MARION DEIBER DEIBERT,MARION/ X , -330 00 4/12' 4 4465 DARLENE HALL FO}t M NEW CLOTHES DEIBERT,MARION/ X . -1 000.00 4/20' 4 4489 MARION DIEBERT WACHOVIA MONE DEIBERT,MARION/ X , -300 000.00 4/21' 4 4517 COMCAST MARION DEIBER DEIBERT,MARION/ X , -42 31 4/23' 4 4524 HARRISFIEL:D MARIAN DIEBER DEIBERT,MARION/ X . -~2 Ct66.32 5/ 4' 4 4546 S VOID:PLATI:NUM P1~US DEIBERT,MARION/ X ~ 0 00 5/ 4' 4 4548 S PLATINUM PLUS FC)R DEIBERT,MARION/ X . -194 77 5/ 4' 4 R5313 DEPOSIT DEIBERT,MARION/ X . 5 49 5/ 4' 4 R5314 DEPOSIT PESION DEIBERT,MARION/ X . 282 81 5/ 4' 4 R5315 DEPOSIT SSDI DEIBERT,MARION/ X . 532 00 5/10' 4 4579 PLATINUM PLUS FC>R 403647000030- DEIBERT,MARION/ X . -342 97 5/13' 4 4587 S PAGA GENERAL ACC:OU DEIBERT,MARION/ X . -250 00 5/13' 4 4590 S HALL SERVICES DEIBERT,MARION/ X . -4 903 11 5/21' 4 4600 S PLATINUM PLUS FC~R DFsIBERT,MARION/ X , . -684 20 5/21' 4 4606 LOYALTON OF CREF:KV MARION DIEBER DEIBERT,MARION/ X . -2,695.00 ITEMIZED CATEGORY REPORT 1/ 1' 4 Through 1/31' 5 PAGA_CUS-PAGA Custodial 6/13' 5 Page 2 Date ------ -- Num ------ Description ------------- Memo Category Clr Amount 5/21' 4 4607 ----- BRONSTEIN JEFFERIE ------------- MARION DIEBER --------------- DEIBERT,MARION/ - - X ---------- -100.00 5/26' 4 4650 OMNICARE PHARMICIE MARION DEIBER DEIBERT,MARION/ X -86.44 6/ 1' 4 R5367 DEPOSIT PENSION DEIBERT,MARION/ X 210.00 6/ 1' 4 R5368 DEPOSIT DEIBERT,MARION/ X 49.41 6/ 1' 4 R5369 DEPOSIT PENSION DEIBERT,MARION/ X 282.81 6/ 8' 4 4705 OMNICARE PHARMICIE MARION DEIBER DEIBERT,MARION/ X -86.44 6/ 8' 4 R6406 DEPOSIT SSDI DEIBERT,MARION/ X 532.00 6/30' 4 4784 S PAGA GENERAL ACCOU DEIBERT,MARION/ X -500.00 7/ 2' 4 R6451 DEPOSIT SALE OF PERSO DEIBERT,MARION/ X 2,483.00 7/ 2' 4 R6452 DEPOSIT PENSION DEIBERT,MARION/ X 282.81 8/ 2' 4 4934 CREDIT PLUS COLLEC MARION DEIBER OEIBERT,MARION/ X -106.94 8/ 3' 4 4939 OMNICARE PHARMICIE MARION DEIBER DEIBERT,MARION/ X -35.00 8/ 5' 4 4979 SOUTH CENTRAL EMS M.DEIBERT 186 DEIBERT,MARION/ X -40.00 8/ 5' 4 4980 VOID:HOLLY SPIRIT MARIAN DEIBER DEIBERT,MARION/ X 0.00 8/ 5' 4 4984 WEST SHORE EMS MILDRED MYERS DEIBERT,MARION/ X -186.77 8/ 5' 4 R6511 DEPOSIT PENSION DEIBERT,MARION/ X 282.81 8/ 5' 4 R6512 DEPOSIT SSDI DEIBERT,MARION/ X 532.00 8/ 5' 4 R6513 DEPOSIT SSDI DEIBERT,MARION/ X 532.00 8/27' 4 5029 S PAGA GENERAL ACCOU 8-9 DEIBERT,MARION/ X -500.00 8/28' 4 5030 HALL SERVICES MARION DIEBER DEIBERT,MARION/ X -4,282.80 9/ 3' 4 R6593 DEPOSIT PENSION DEIBERT,MARION/ X 282.81 9/ 7' 4 5048 AUTUNIl~I HOUSE WEST POLLY BRENNEM DEIBERT,MARION/ X -3,416.00 9/ 7' 4 5050 LANA L. HOOVER. LP M.DIEBERT/ PR DEIBERT,MARION/ X -292.50 9/ 8' 4 5115 OMNICARE PHARMICIE MARION DEIBER DEIBERT,MARION/ X -35.00 9/13' 4 ET S POSTMASTER DEIBERT,MARION/ X 0.37 9/13' 4 ET POSTMASTER DEIBERT,MARION/ X -10.27 9/17' 4 5209 DARLENE HALL FOR M CLOTHING DEIBERT,MARION/ X -500.00 9/23' 4 R5443 DEPOSIT SSDI DEIBERT,MARION/ X 532.00 10/ 1' 4 5232 LOYALTON OF CREEKV MARION DIEBER DEIBERT,MARION/ X -11,081.20 10/ 5' 4 R5476 DEPOSIT PENSION DEIBERT,MARION/ X 282.81 10/14' 4 5266 S PLATINUM PLUS FOR EXERCISE EQUI DEIBERT,MARION/ X -924.41 10/14' 4 5272 DARLENE HALL FOR M PERSONAL NEED DEIBERT,MARION/ X -1,500.00 10/14' 4 5273 LAMA L. HOOVER, LP MARION DIEBER DEIBERT,MARION/ X -360.00 10/18' 4 5318 OMNICARE PHARMICIE MARION DEIBER DEIBERT,MARION/ X -70.00 10/27' 4 5343 S PAGA GENERAL ACCOU 10-11 DEIBERT,MARION/ X -500.00 11/ 3' 4 5367 LOYALTON OF CREEKV MARION DIEBER DEIBERT,MARION/ X -5,390.00 11/ 3' 4 5378 OMNICARE PHARMICIE MARION DEIBER DEIBERT,MARION/ X -70.00 11/ 3' 4 R5520 DEPOSIT SSDI DEIBERT,MARION/ X 532.00 11/ 3' 4 R5521 DEPOSIT SSDI DEIBERT,MARION/ X 532.00 11/15' 4 5454 OMNICARE PHARMICIE MARION DEIBER DEIBERT,MARION/ X -70.00 11/16' 4 5485 LANA L. HOOVER, LP MARION DIEBER DEIBERT,MARION/ X -360.00 11/29' 4 5497 LANA L. HOOVER, LP MARION DIEBER DEIBERT,MARION/ X -1,395.00 11/30' 4 5548 LANA L. HOOVER, LP MARION DIEBER DEIBERT,MARION/ X -180.00 12/ 2' 4 5553 LOYALTON OF CREEKV MARION DIEBER DEIBERT,MARION/ X -2,695.00 12/ 3' 4 R0006 DEPOSIT PENSION DEIBERT,MARION/ X 282.81 12/ 3' 4 R0007 DEPOSIT SSDI DEIBERT,MARION/ X 532.00 12/ 6' 4 5554 S PLATINUM PLUS FOR DEIBERT,MARION/ X -139.14 12/ 14'' 4 'ET BANK SERVICE FEE DEIBERT,MARION/ X -10.00 l~/ 20' 4 5643 LANA L. HOOVER, LP MARION DIEBER DEIBERT,MARION/ X -360.00 12/ 21' 4 5666 HALL SERVICES MARION DIEBER DEIBERT,MARION/ X -1,926.40 1/ 4' 5 RO101 DEPOSIT PENSION DEIBERT,MARION/ X 282.81 1/ 4' 5 R0102 DEPOSIT SSDI DEIBERT,MARION/ X 537.00 ITEMIZED CATEGORY REPORT 1/ 1' 4 Through 1/31' 5 PAGA_CUS-PAGA Custodial 6/13' 5 Page 3 Date ------- - Num ------ Description ---------- Memo Category Clr Amount 1/10' 5 5735 -------- LANA L. HOOVER, LP ------ MARION ------- DIEBER --------------- DEIBERT,MARION/ - - X ---------- -360.00 1/10' S 5737 LOYALTON OF CREEKV MARION DIEBER DEIBERT,MARION/ X -2,695.00 1/10' 5 5743 HERSHEY LTC PHARMA MARIAN DEEBER DEIBERT,MARION/ X -6,656.20 1/13' 5 5774 LANA L. HOOVER, LP MARION DIEBER DEIBERT,MARION/ X -360.00 1/24' 5 5799 S PAGA GENERAL ACCOU DEIBERT,MARION/ X -750.00 TOTAL DEIBERT,MARION TOTAL INCOME TOTAL INCOME/EXPENSE -~~~ -+-,~ ,.~ /~ ~ ~ c~ Ppc~ ~~-S ITEMIZED CATEGORY REPORT 1/ 1' 4 Through 1/31' 5 PAGA_CUS-PAGA Custodial Page 1 6/13' 5 Date ------ -- Num ------ Description ----------------- Memo - ------------- Category ---------------- Clr - - Amount --------- INCOME/EXPENSE INCON IF___-_-_ ~DEIBERT,MARI N 1/ 6' 4 R6310 DEPOSIT PENSION DEIBERT,MARION/P X 336.57 1/ 6' 4 R6311 DEPOSIT PENSION DEIBERT,MARION/P X 336.57 1/ 6' 4 R6312 DEPOSIT SSDI DEIBERT,MARION/S X 528.00 1/ 6' 4 R6313 DEPOSIT SSDI DEIBERT,MARION/S X 532.00 2/ 3' 4 R6358 DEPOSIT REFUND DEIBERT,MARION/R X 5.00 2/ 3' 4 R6395 DEPOSIT SSDI DEIBERT,MARION/S X 532.00 2/ 3' 4 R6396 DEPOSIT PENSION DEIBERT,MARION/P X 282.81 3/ 3' 4 R5204 DEPOSIT PENSION DEIBERT,MARION/P X 282.81 3/ 9' 4 R5241 DEPOSIT SSDI DEIBERT,MARION/S X 532.00 4/ 8' 4 R5263 DEPOSIT SALE OF PERSO DEIBERT,MARION/S X 2,450.00 4/ 8' 4 R5264 DEPOSIT SSDI DEIBERT,MARION/S X 532.00 4/ 8' 4 R5265 DEPOSIT PENSION DEIBERT,MARION/P X 282.81 5/ 4' 4 R5313 DEPOSIT DEIBERT,MARION/R X 5.49 5/ 4' 4 R5314 DEPOSIT PESION DEIBERT,MARION/P X 282.81 5/ 4' 4 R5315 DEPOSIT SSDI DEIBERT,MARION/S X 532.00 6/ 1' 4 R5367 DEPOSIT PENSION DEIBERT,MARION/P X 210.00 6/ 1' 4 R5368 DEPOSIT DEIBERT,MARION/R X 49.41 6/ 1' 4 R5369 DEPOSIT PENSION DEIBERT,MARION/P X 282.81 6/ 8' 4 R6406 DEPOSIT SSDI DEIBERT,MARION/S X 532.00 7/ 2' 4 R6451 DEPOSIT SALE OF PERSO DEIBERT,MARION/S X 2,483.00 7/ 2' 4 R6452 DEPOSIT PENSION DEIBERT,MARION/P X 282.81 8/ 5' 4 R6511 DEPOSIT PENSION DEIBERT,MARION/P X 282.81 8/ 5' 4 R6512 DEPOSIT SSDI DEIBERT,MARION/S X 532.00 8/ 5' 4 R6513 DEPOSIT SSDI DEIBERT,MARION/S X 532.00 9/ 3' 4 R6593 DEPOSIT PENSION DEIBERT,MARION/P X 282.81 9/23' 4 R5443 DEPOSIT SSDI DEIBERT,MARION/S X 532.00 10/ 5' 4 R5476 DEPOSIT PENSION DEIBERT,MARION/P X 282.81 11/ 3' 4 R5520 DEPOSIT SSDI DEIBERT,MARION/S X 532.00 11/ 3' 4 R5521 DEPOSIT SSDI DEIBERT,MARION/S X 532.00 12/ 3' 4 R0006 DEPOSIT PENSION DEIBERT,MARION/P X 282.81 12/ 3' 4 R0007 DEPOSIT SSDI DEIBERT,MARION/S X 532.00 1/ 4' 5 RO101 DEPOSIT PENSION DEIBERT,MARION/P X 282.81 1/ 4' 5 R0102 DEPOSIT SSDI DEIBERT,MARION/S X 537.00 TOTAL DEIBERT,MARION 16,435.95 TOTAL INCOME 16,435.95 TOTAL INCOME/EXPENSE 16,435.95 CASH FLOW REPORT 1/ 1' 0 Through 1/31' 5 PAGA_CUS-PAGA Custodial -~~" 6/13' 5 1/ 1' 0- Category Description 1/31' 5 ---- ---------- ----------- NFLOWS DEIBERT,MARION 52,160.78 TOTAL INFLOWS 52,160.78 i ~ cc~ ~ ~~~ ~~ C--~ ,~ c ~S~ C~ ~ ~~. i c~ ~ c ~ ~,~ ~-~-- a ~~ ~ -f ~ / 3 ~ l o,~ Page 1 ,. ~: i_ " IN THE COURT OF COMMON PLEAS OF C~Y}'~Y cxY COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: I~(~f ~C~rl ~ ~ t~pC--~ , an incapacitated person FILE NO. o~ - ~~ _ 3~ GUARDIAN OF PERSON ANNUAL REPORT [20 Pa. C.S.A. 5521 (c)] FROM } ~_, 200 TO , 200' 1. I am the Limited /. Plenary Guardian of the Person of my ward, named above. 2. I was appointed Guardian by Order of the Court dated ; ~ t3 (U ~ ,which was was not modified by Court Order(s) dated 3. Is the incapacitated person still living?T,~? 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 questions: (a) Date Guardian of the Person filed the last Annual Report? ~ ~ t 3 I C? ~-} (b) Current address of the incapacitated person ~-_ oT t ~~n cry- C r~ Y ~~ ~ ~ ~z (c) Current age 1 ~ Date of birth of incapacitated person 1 ~~ -~ , t c{ 3'', (d) The incapacitated person's residence is: Ward's own residence My home/apartment Nursing Home elative's Home Hospital or Medical Facility ~oarding Home (e) The incapacitated person has been living there since If moved within the past year, state from where and t e reason for the change ~~ C~~' ti c-~~~p~-1- C.A. - 27 a i (f) I rate his/her living arrangement as: Excellent Average Below Average Explain: (g) I believe he/she is: content with the living situation unhappy with the living situation unaware of the living situation 5. Physical health (a) Current physical condit~ n of the incapacitated person is: Excellent ~ Good Fair Poor (b) His/her major physical health problems are as follows: ~~t~~~ ~~ . ~,c>~ (c) During the past year, his/her physical condition has: ~/ remained about the same. improved. Explain worsened. Explain (d) During the past year, he/she received the following medical treatment (include check-ups and dental work): Date Ailment Type of treatment Doctor's name ~ ~ ,~~ ~ ^. 6. Mental Health (a) The incapacitated person's condition is excellent good ~ poor (b) His/her major mental health problems are as follows: ~-~r.,,~~~~~-~~Q ..~., J~V ~~(Q [~IlY1~r, nC~ n ~~ ~~- (c) During the past year, his/her mental condition has: remained about the same. Improved. Explain Worsened. Explain _ , ~ . (d) During the past year, treatment or evaluation by a psychiatrist, psychologist or social worker _~ was was not provided. Such mental health services are briefly described as: 7. Social Activities /Services (a) His/her current social condition is: excellent good fair ~ poor (b) During the past year, his/her social condition has: remained about the same. improved. Explain. worsened. Explain. t~Q,~ ~ j r~~u~ ~ ~~-~Z1~ ~Y1 +n,~o.~~ t~ l_~~4~1.~ (c) During the ast year he/she has participated in the following activities: recreational educational social occupational no activities available. he/she refuses to participate in any activities. he/she is unable to participate in any activities. 8. Visitation (al During the east year. I visited him/her as follows: ~-Y~ni-,~E~~1`, (b) The average amount of time I spent on each visit was _ ~~ i~ ~ (c) The last time I visited was on / 5 ~d date 9. During the last year I have performed the following activities on behalf the incapacitated person: ~M~c,;\ ~ C C~ \ . ct~Cl C i ~~ -7~c-~ Y ~ ~~n F i l'~ qtr tC~y"ter ~Qk~~~iln~'lt~-~Ft 10. I believe he/she has the following unmet needs: Y-~~,r-~~. 11. The guardianship ~ should should not be continued without modification because: 12. Please note any concerns about the Incapacitated person's physical or mental well being or the finances that the Court should know. t,-~ c> ~-~c~c~ ~-r~ S 13. I . f 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: _ ~~3 Q' j/ ignature of the uardian of e Person Name: ~ !' i ~-~ D- ~lozo% Address: Telephone # (Home) ~ ~~,~~ (Work) ~,,~; _ ~~C. P.~~, Lanca~~w~, PA GUARDIANSHIP ASSOC. P.O.BOX 7295 Lancaster, PA 17604.7295 ~.: ;.~,, IN THE COURT OF COMMON PLEAS OF~Cum~er~an COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: I `~ ar i Q~ ~ Deid er f, an incapacitated person FILE NO. ~ 1- n a - /~ 3 GUARDIAN OF THE ESTATE ANNUAL REPORT j20 Pa.C.S.A. 5521 (c}] FROM _ 3 U 200 TO _ / / 3~D C~ , 200 1) I am the Limited ~/ Pienazy Guardian of the Estate of my ward, named above_ I was appointed~'than by Order of the Court dated ~ ,which was _,~/was not modified by Court Order{s} dated 2) Is the incapacitated person siz~ll living? (,~-.d If no, answer the following: (a) Date of Death (b) Place of Death (c} Name of A+dministrator/trnc or Executor/trix {d) Date Guardian of the Person flied the last Annual Report PLEASE ANSWER THE FOLLOWING QUESTIONS WHETHER THE INCAPACITATED PERSON IS LIVING OR DECEASED. 3) My initial Inventory was filed on ~ Q ?j and listed a total estate value of $ 3 ~>> y~~. ~ ~ The Inventory listed ~ total monthly income of $ -~ ~ $ . ~ comprised of the following: ~~-c,co~ ~ A ,~,, .~ ~` 4) At the bed date of this reporting period, my initial balance om' Band was C.A. - ZS ' _ 1~ S) During this reporting period, the following reflects all sources of income (other than social security) received by me for my ward: (Add additional pages if needed) Date Received Source of Income I. 2. 3. 4. 5. 6. ~ ~- ~ TOTAL Amount 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 2. 3. 4. 5. 6. TOTAL 7) The present principal assets of my ward are: Description of Asset Present Value 2 ,,C~93.~ ~ s q i ~ r~ - l 3. 4. 5. 6. ` ~ TOTAL ~ ~ 5~~-- 8) The present amount and sources of income for my ward are: Source of Income Amount of Income (Indicate whethe onthl quarterly, annually) ~ r ~~~ I ~~~ .~ ~~ 3. ~; 4. ~ 5. 6. 9) The regular monthly expenses of my ward which I pay are: To Whom Paid 4. s. 6. Amount ~~D : ~~ 1~ - ~ ~~ ~-54.d~ 10) I hav ave not ' cle one) petitioned the Court for permission to invade principal to meet the s of my ward. (If applicable) The following expenses of my wazd have been paid from principal: To Whom Paid 1. 2. 3. 4. 5. 6. P ose Amount 11) av ave not (circle one) paid myself compensation for services I rendered as guardian. The amount I Paid myself totaled $ ~ SCE OZ) and was calculated at the following rate: $ n2 S7} •- per w el on circle one). // 12) Check the correct response and complete, if appropriate. ~~There will be no need for extraordinary expenditures on behalf of my ward in the next (12) months. There well be a need for extraordinary expenditures on behalf of my wazd in the next (12) months because: 13) Check the correct response and complete, if appropriate. A. My wazd receives monthly social security benefits directly. I am the designated payee to receive my wazd's social security benefits. C. The designated payee of my ward's social security benefits is whose address is and is/is not (circle one) related to my ward as (insert relationship). 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 ~am am not guardian of the incapacitated person's person. If yes, report is attached. I certify under the penalties of perjury that the information contained in this report is true and correct to the best of my knowledge, information and belief. Name: ~ ~ '~ ~ f ~~/ Address: l Telephone No. (Home} (Work) _7/ 7,-~~} ~_y'y'~ ~ PA GUARDIANSHIP ASSOC. P.O.BOX 7295 Lancaster, PA 17604.7295 ~ ~ ITEMIZED CATEGORY REPORT 1/ 1' 5 Through 12/31' 5 PAGA_CUS-PAGA Custodial Page 1 2/ 9' 6 Date Num Description Memo Category Clr Amount INCOME /EXPENSE ~ INCOME DE IBERT,MARION 1/ 4 RO101 DEPOSIT PENSION DEIBERT,MARION/PE X 282 81 1/ 4 R0102 DEPOSIT SSDI DEIBERT,MARION/SS X . 537 00 1/10 5735 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X . -360 00 1/10 5737 LOYALTON OF CREEKVI MARION DIEBERT DEIBERT,MARION/CO X . -2 695.00 1/10 5743 HERSHEY LTC PHARMAC MARIAN DEIBERT DEIBERT,MARION/ME X , -6 656.20 1/13 5774 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X , -360 00 1/24 5799 S PAGA GENERAL ACCOUN DEIBERT,MARION/GU X . -750 00 2/ 3 5830 LOYALTON OF CREEKVI MARION DIEBERT DEIBERT,MARION/CO X . -2 695.00 2/ 7 5871 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X , -450 00 2/ 7 5893 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X . -360 00 2/ 7 5895 OMNICARE PHARMICIES MARION DEIBERT DEIBERT,MARION/ME X . -3 25 2/ 7 5910 S BRIAN D. BROOKS POSTAGE DEIBERT,MARION/RE X . -2 63 2/10 R0181 DEPOSIT BANK TRANSFER DEIBERT,MARION/BA X . 274 92 2/10 R0182 DEPOSIT SSDI DEIBERT,MARION/SS X . 537 00 2/24 5981 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X . -405 00 2/24 5985 LOYALTON OF CREEKVI MARION DIEBERT DEIBERT,MARION/CO X . -2 695 00 2/24 5999 S PLATINUM PLUS FOR B DEIBERT,MARION/PE X , . -900 43 3/14 6046 OMNICARE PHARMICIES MARION DEIBERT DEIBERT,MARION/ME X . -38 25 3/14 R5894 DEPOSIT PENSION DEIBERT,MARION/PE X . 274 92 3/14 R5895 DEPOSIT SSDI DEIBERT,MARION/SS X . 537 00 3/16 6085 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X . -360 00 3/22 6112 LOYALTON OF CREEKVI MARION DIEBERT DEIBERT,MARION/CO X . -2 695 00 3/22 6118 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X , . -360 00 3/30 6130 S BRIAN D. BROOKS POSTAGE DEIBERT,MARION/RE X . -1 66 3/30 6140 OMNICARE PHARMICIES MARION DEIBERT DEIBERT,MARION/ME X . -73 61 4/ 1 6158 S PAGA GENERAL ACCOUN 3-4/05 DEIBERT,MARION/GU X . -500 00 4/ 4 R5962 DEPOSIT PENSION DEIBERT,MARION/PE X . 274 92 4/ 8 6188 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X . -360 00 4/11 R0612 DEPOSIT SSDI DEIBERT,MARION/SS X . 537 00 4/11 R0613 DEPOSIT BANK TRANSFER DEIBERT,MARION/BA X . 5 27 4/18 6260 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X , -360 00 5/ 2 6277 S HALL SERVICES 140 HRS / 720 DEIBERT,MARION/FI X . -3 730 40 5/ 2 6286 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X , . -765 00 5/ 5 6306 S PLATINUM PLUS FOR B DEIBERT,MARION/FI X . -998 39 5/ 9 R0646 DEPOSIT BANK TRANSFER DEIBERT,MARION/BA X . 274 92 5/ 9 R0647 DEPOSIT SSDI DEIBERT,MARION/SS X . 537 00 5/16 6333 NEIL BISER DPM MARION DEIBERT DEIBERT,MARION/ME X . -40 58 5/16 6356 FINANCIAL RECOVERIE FINREC# 742956 DEIBERT,MARION/ME X . -57 10 5/17 6366 LOYALTON OF CREEKVI MARION DIEBERT DEIBERT,MARION/CO X . -2 695 00 5/17 6378 OMNICARE PHARMICIES MARION DEIBERT DEIBERT,MARION/ME X , . -3 75 5/17 6385 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X . -360 00 5/18 6396 S HALL SERVICES PETTY CASH REF DEIBERT,MARION/FI X . -431 39 5/25 6423 LOYALTON OF CREEKVI MARION DIEBERT DEIBERT,MARION/CO X . -5 390 00 5/31 5/31 6440 6441 DARLENE HALL FOR MA REMODELING DOW DEIBERT,MARION/PE X , . -5,000.00 5/31 6442 S JEAN TROUT MARION DEIBERT DEIBERT,MARION/RE X -250.00 6/ 1 R0704 PLATINUM PLUS FOR B DEIBERT,MARION/FI X -571.52 DEPOSIT BANK TRANSFER DEIBERT,MARION/BA X 274.92 1 PAGA_CUS-PAGA Custodial 2/ 9' 6 ITEMIZED CATEGORY REPORT 1/ 1' 5 Through 12/31' 5 Page 2 Date Num Description Memo Category Clr Amount 6/ 3 R0748 DEPOSIT SSDI DEIBERT,MARION/SS X 537.00 6/13 6464 REGISTER OF WILLS ANNUAL REPORT DEIBERT,MARION/CO X -30.00 6/14 6476 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X -360.00 6/14 6536 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X -450.00 6/14 6542 OMNICARE PHARMICIES MARION DEIBERT DEIBERT,MARION/ME X -45.75 6/28 6622 LAMA L. HOOVER, LPN MARION DIEBERT DEIBERT, MARION/PE X -360.00 7/ 6 R0412 DEPOSIT BANK TRANSFER DEIBERT,MARION/BA X 274.92 7/ 6 R0413 DEPOSIT SSDI DEIBERT,MARION/SS X 537.00 7/ 6 6649 S PLATINUM PLUS FOR B DEIBERT,MARION/FI X -300.84 7/13 6714 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X -360.00 7/13 6733 HALL SERVICES MARION DIEBERT DEIBERT,MARION/FI X -5,197.96 7/13 ET GREAT OAKS MED DEIBERT,MARION/ME X -70.00 7/18 6750 NEIL BISER DPM MARION DEIBERT DEIBERT,MARION/ME X -40.58 7/21 6772 S PAGA GENERAL ACCOUN 5-8 DEIBERT,MARION/GU X -1,000.00 7/27 6811 LOYALTON OF CREEKVI MARION DIEBERT DEIBERT,MARION/CO X -2,695.00 7/27 6817 S LANA L. HOOVER, LPN DEIBERT,MARION/PE X -360.00 7/27 6829 S PLATINUM PLUS FOR B DEIBERT,MARION/FI X -469.58 7/29 6836 S PLATINUM PLUS FOR B DEIBERT,MARION/FI X -214.36 8/ 8 R0514 DEPOSIT SSDI DEIBERT,MARION/SS X 537.00 8/ 9 6910 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X -495 00 8/22 6984 S BRIAN D. BROOKS POSTAGE DEIBERT, MARION/RE X . -1.06 8/22 R0566 DEPOSIT PENSION DEIBERT,MARION/PE X 274.92 8/23 6993 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X -495.00 8/25 7010 OMNICARE PHA.RMICIES MARION DEIBERT DEIBERT,MARION/ME X -17.52 8/26 7015 LOYALTON OF CREEKVI MARION DIEBERT DEIBERT,MARION/CO X -2,695.00 8/29 7021 S PLATINUM PLUS FOR B DEIBERT,MARION/FI X -386.41 9/ 8 7077 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X -360.00 9/13 R7001 DEPOSIT PENSION DEIBERT, MARION/PE X 274 92 9/13 R7002 DEPOSIT SSDI DEIBERT,MARION/SS X . 537.00 9/14 7110 S PAGA GENERAL ACCOUN 9-10 DEIBERT,MARION/GU X -500 00 9/22 7129 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X . -405 00 9/27 7159 HALL SERVICES MARION DEIBERT DEIBERT,MARION/FI X . -5 621.01 10/ 4 7176 SUSQUEHANNA TOWNSHI MARION DEIBERT DEIBERT,MARION/ME X , -35 00 10/ 4 7198 OMNICARE PHARMICIES MARION DEIBERT DEIBERT, MARION/ME X . -38 88 10/ 5 7204 LOYALTON OF CREEKVI MARION DIEBERT DEIBERT,MARION/CO X . -2 695.00 10/ 6 R7071 DEPOSIT SSDI DEIBERT,MARION/SS X , 537 00 10/ 6 R7072 DEPOSIT PENSION DEIBERT,MARION/PE X . 274 92 10/11 7246 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X . -540 00 10/11 7248 S PLATINUM PLUS FOR B DEIBERT,MARION/FI X . -637 30 10/21 7308 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X . -360 00 11/ 1 7344 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X . -427 50 11/ 2 7354 OMNICARE PHARMICIES MARION DEIBERT DEIBERT,MARION/ME X . -87 88 11/ 8 7384 SUSQUEHANNA TOWNSHI MARION DEIBERT DEIBERT,MARION/ME X . -92 00 11/14 7416 S PLATINUM PLUS FOR B DEIBERT,MARION/FI X . -1 262 19 11/15 7422 LOYALTON OF CREEKVI MARION DIEBERT DEIBERT,MARION/CO X , . -2 820 00 11/15 7432 NEIGHBORCARE - YORK MARION DEIBERT DEIBERT,MARION/ME X , . -63 00 11/21 R9219 DEPOSIT PENSION DEIBERT,MARION/PE X . 274 92 11/21 R9220 DEPOSIT SSDI DEIBERT,MARION/SS X . 537 00 11/28 7449 LOYALTON OF CREEKVI MARION DIEBERT DEIBERT,MARION/CO X . -2 820 00 11/29 7461 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X , . -360 00 12/ 8 R9265 DEPOSIT PENSION DEIBERT,MARION/PE X . 274 92 12/ 8 R9266 DEPOSIT SSDI DEIBERT,MARION/SS X . 537.00 ~-. a~.F"~-~vvc.c. ' ITEMIZED CATEGORY REPORT 1/ 1' 5 Through 12/3 1' 5 PAGA_C US-PAGA Custodial Page 3 2/ 9' 6 Date Num Description Memo Category Clr Amount 12/13 7518 S PLATINUM PLUS FOR B POSTAGE DEIBERT,MARION/FI X -1.52 12/14 7550 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X -360.00 12/14 7586 LANA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X -360.00 12/14 7592 NEIGHBORCARE - YORK MARION DEEBERT DEIBERT,MARION/ME X -113.80 12/16 7612 S PLATINUM PLUS FOR B DEIBERT,MARION/FI X -1,633.56 TOTAL DEIBERT,MARION TOTAL INCOME TOTAL INCOME/EXPENSE ~„~,~„~~,~~, Q,l~ 7.~.,~~~ ~i~-~ li ITEMIZED CATEGORY REPORT 1/ 1' 5 Through 12/31' 5 PAGA_CUS-PAGA Custodial 2/ 9' 6 Page 1 Date Num Description Memo Category Clr Amount INCOME /EXPENSE INCOME DE IBERT,MARION 1/ 4 RO101 DEPOSIT PENSION DEIBERT,MARION/PEN X 282.81 1/ 4 R0102 DEPOSIT SSDI DEIBERT,MARION/SSD X 537.00 2/10 R0181 DEPOSIT BANK TRANSFER DEIBERT,MARION/BAN X 274.92 2/10 R0182 DEPOSIT SSDI DEIBERT,MARION/SSD X 537.00 3/14 R5894 DEPOSIT PENSION DEIBERT,MARION/PEN X 274.92 3/14 R5895 DEPOSIT SSDI DEIBERT,MARION/SSD X 537.00 4/ 4 R5962 DEPOSIT PENSION DEIBERT,MARION/PEN X 274.92 4/11 R0612 DEPOSIT SSDI DEIBERT,MARION/SSD X 537.00 4/11 R0613 DEPOSIT BANK TRANSFER DEIBERT,MARION/BAN X 5.27 5/ 9 R0646 DEPOSIT BANK TRANSFER DEIBERT,MARION/BAN X 274.92 5/ 9 R0647 DEPOSIT SSDI DEIBERT,MARION/SSD X 537.00 6/ 1 R0704 DEPOSIT BANK TRANSFER DEIBERT,MARION/BAN X 274.92 6/ 3 R0748 DEPOSIT SSDI DEIBERT,MARION/SSD X 537.00 7/ 6 R0412 DEPOSIT BANK TRANSFER DEIBERT,MARION/BAN X 274.92 7/ 6 R0413 DEPOSIT SSDI DEIBERT,MARION/SSD X 537.00 8/ 8 R0514 DEPOSIT SSDI DEIBERT,MARION/SSD X 537.00 8/22 R0566 DEPOSIT PENSION DEIBERT,MARION/PEN X 274.92 9/13 R7001 DEPOSIT PENSION DEIBERT,MARION/PEN X 274.92 9/13 R7002 DEPOSIT SSDI DEIBERT,MARION/SSD X 537 00 10/ 6 R7071 DEPOSIT SSDI DEIBERT,MARION/SSD X . 537.00 10/ 6 R7072 DEPOSIT PENSION DEIBERT,MARION/PEN X 274 92 11/21 R9219 DEPOSIT PENSION DEIBERT,MARION/PEN X . 274 92 11/21 R9220 DEPOSIT SSDI DEIBERT,MARION/SSD X . 537 00 12/ 8 R9265 DEPOSIT PENSION DEIBERT,MARION/PEN X . 274 92 12/ 8 R9266 DEPOSIT SSDI DEIBERT,MARION/SSD X . 537.00 TOTAL DEIBERT,MARION 9,756.20 TOTAL INCOME TOTAL INCOME/EXPENSE 9,756.20 9,756.20 ~r ~~ ITEMIZED CATEGORY REPORT • 1/ 1' 5 Through 12/31' 5 PAGA_CUS-PAGA Custodial 2/ 9' 6 Date Num Description Memo Page 1 INCOME/EXPENSE INCOME DEIBERT,MARION 1/24 5799 S PAGA GENERAL ACCOUN ~~ ~/~'~j ¢ %~-~ON DEIBERT,MARION/GUA X -750.00 4/ 1 6158 S PAGA GENERAL ACCOUN 3-4/05 DEIBERT,MARION/GUA X -500.00 7/21 6772 S PAGA GENERAL ACCOUN 5-81Gs; DEIBERT,MARION/GUA X -1,000.00 9/14 7110 S PAGA GENERAL ACCOUN 9-10/C 5 DEIBERT,MARION/GUA X -500.00 TOTAL DEIBERT,MARION -2,750.00 TOTAL INCOME -2,750.00 TOTAL INCOME/EXPENSE // ~ Aso. ~ • ~ „ .., ., CASH FLOW REPORT . 1/ 1' 0 Through 12/31' 5 PAGA_CUS-PAGA Custodial 2/ 9' 6 1/ 1' 0- Category Description 12/31' 5 INFLOWS DEIBERT,MARION -9,093.49 TOTAL INFLOWS -9,093.49 Page 1 High Performs ce Money Market 01 1010083980356"' 752 30 0 2 261,474 -~ WACHOVIA 00071866 01 MB 0.309 01 MAAD 260 MARION E DIEBERT C/0 P.A.6.A p6 P.O. BOX 7295 ~~ LANCASTER PA 17604 High Performance Money Market Account number: 1010083980356 Account owner(s): MARION E DIEBERT C/O P.A.G.A Account Summary Opening balance 12/06 $307,626.05 Interest paid 623.86 + Closing balance 1/OS 5308,249.91 Deposits and Other Credits Date Amount Description 1/05 623.86 INTEREST FROM 12/06/2005 THROUGH 01/05/2006 ota 23.86 Interest Number of days this statement period Annual percentage yield eamed Interest earned this statement period Interest paid this statement period Interest paid this year 31 2.41% $623.86 $623.86 $623.86 12/06/2005 thru 1/05/2006 INTRODUCING PERSONAL CHECKING AND SAVINGS STATEMENTS IN SPANISH! Banking at Wachovia just got easier! Trust Wachovia to offer you and your family an _ easy way to manage your money. To receive your next statement in Spanish, stop by your local Financial Center or call us at 800-WACHOVIA (922-4684) and select option 7 for assistance in Spanish. IPRESENTAMOS LOS ESTADOS DE CUENTA EN ESPANOL PARA CUENTAS CORRIENTES Y DE AHORROS PERSONALESf IAhora realizar sus transacciones bancarias con Wachovia es macho mas facil! Conffe en que Wachovia le ofrecera a usted y a su familia aria manes facil de administrar su dinero. Para recibir su proximo estado de cuenta en espanol, visits su Centro financiero local o Ilamenos al 800-WACHOVIA (922-4684) y oprima 7 para recibir asistencia en espanol. WACHOVIA BANK, N.A. , MANOR STREET page 1 of 2 CASH FLOW REPORT 1/ 1' 0 Through 12/31' 4 PAGA_CUS-PAGA Custodial Page 1 2/ 9' 6 1/ 1' 0- Category Des~c~zption 12/31' 4 INFLOWS DEIBERT,MARION 62,162.17 TOTAL INFLOWS 62,162.17 CY,n ~-( 13~3~~~~ 1TACHOVIA High Perform ice Money Market 01 1010083980356 752 30 0 2 00070155 1 MS 0.309 02 MAAD 306 MARION E DIEBERT C/0 P.A.6.A PB P.O. BOX 7295 LANCASTER PA 17604 237,790 ~ ~~ High Performance Money Market Account number: 1010083980356 Account owner(s): MARION E DIEBERT C/O P.A.G.A Account Summary " Opening balance 12/04 $301,826.40 Interest aid 55 + _...._ (;Losing balance U05 5311,18295 ..-- Deposits and Other Credits ~--~"" pate Amount pescripaon 1/05 356.55 INTEREST FROM 12/04/2004 THROUGH 01/05/2005 ota 56.55 Interest Nurr~er o1 days this statement period Annual percentage yield eamed 33 1.31 ~o Interest earned this statement period Interest paid this statement period Interest paid this year $356.55 5356.55 x356.55 12/04/2004 thtu 1 ENJOY THE CONVENIENCE AND SECURITY OF PAYING YOUR BILLS ONLINE WITH FREE ONLINE BILLPAY -ANYTIME. ANYWHERE YOU HAVE INTERNET ACCESS. TO LEARN MORE, CALL 800-654-1276, VISIT A FINANCIAL CENTER, OR GO TO WACHOV/A.COM. __ __ -__ ~__ WACHOVIA BANK, N.A. , MANOR STREET page 1 of 2 ~~ .• IN THE C01;7RT OF COMNYON PLEAS OF ~lCl~'I~~rIGrO COI3N`I'~, PENNSYLVAI~TIA ORPHANS' COURT DIVISION IN RE: ~~ ~~ r ~ ~ ~ ~ . De; b e. ~ ~ , an incapacitated person FILE NO. a ! - o a - // 3~ GUARDIAN OF PERSON 1?-NNUAL REPORT [20 Pa. C.S.A. 5521 (c)] FROM ~ 3/~ 200 TO ~ / 3 O ,- 200 l . I am the _ Limited denary Guardian of the Person of my ward, named above. 2. I was appointed Guardian by Order of the Court dated ~ ! ` which was was notyhodified by Court Order(s) dated 3. Is the incapacitated person still living? 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 questions: (a) D;ate Guardian of the Person filed the last Annual Report? /~ ~~~ ~ (b) ~Ciurent ddress of the incapac~.tated person 70 (c) Ctcrrent age `~ Date of birth of incapacitated person /`~- 7/~ (d) The incapacitated person's residence is: Ward's own residence My home/apartment Nursing Home Relative`s Home Hospital or Medical Facility _~_ Boardin Home i~Li cEt-=-e_ (e) The incapacitated person has been living there since ~ ~ fd _ ! if moved within the past year, state from where and the reaiscui for the change G.A. - 27 _ _'. J~ V' Y (f) I rate his/her. living arrangement as: _~cellent Average Below Average Explain: (g) I believe he/she is: content with the living situation unhappy with the living situation unaware of the living situation 5. Physical health (a) Current physical condition of the incapaci .person is: Excellent Good Fair Poor (b) Hisfhe r major physical health problems are as follows: Date Ailment (c) During the past year, his/her physical condition has: remained about the same. . improved. Explain _ c/worsened. Explain o A ~- ~a~ ,~ ~ n (d) During the past year, he/she received the following medical treatment (include check ups and dental work): Type of treatment Doctor's name ~r G ti-..2 .r9-~.-~ b~~l~tz-e I r I 6. Mental Health (a) The; incapacitated person's condition is excellent good `. i ~or ! ~ (b) His/her major mental health problems are as follows: n !1 ~+ /l ~-/- n A /1 / i i (c) During t~.e past year, his/her mental condition has: i ~/ remained about the same. ' _ Improved. Explain _ Worsened Explain , , {d) Durvag th .past ear treatment or evaluation by a psychiatrist, psychologist or social work t id t lth i iefl ~~ d S h l h b er .was ~ was-no prov uc ea serv ces are r y e . men a ~ described as: ff) I~ i . Social Activities /Services { ~I E I (a) His/her current social condition is: ~ E excellent ~ood fair poor ~ ~ I, I (b) During the ast year, his/her social condition has: ~ ~ ~emained about the same. ~ improved. Explain. _ ~ ~ worsened Explain. ~ (c) During the year he/she has participated in the following activities: ~ ~~ recreational ' rational social ~ occupational no activities available. he/she refuses to participate in any activities. he/she is unable to participate in any activities. ,; 8. Visitation i j ~ (al Dori the east year. I visited er as fo ows: ~~j ` ~~ ji , ,. (b) The average amount of time I spent on each visit was 3D - ~%O _ ,~ ~ ~ i _ %/~ ~~' ~ ' c The last time I visited was on {) S date 9. During the last year I have performed the following activities on behalf the incapacitated I person: ~, ~ ~ ~ i . r J-~ ~ I 10. I believe h+:/she has the following unmet needs: 11. The guardianship /should should not be continued without modification ~ because: j l2. Please note any concerns about the Incapacitated person`s physical or mental well being or the finances that the Court should know. 13. I / am _ am not guardian of the incapacitated person's estate. If yes, my report is attached. I certify under the penalties of perjury that the information contained in this report is true and correct to the best of my knowledge, information and belief. ~. Date: ~~ Q ~ , ignature of the Guardian o the Person Name: ~ ~ r r ~ ~ lj. f~ ~~ ~~5. Address: Telephone # (Home) (Work) ~ ~ ~ •-- ~ 9 ~ •- ~~ 5 G - ~ PA GUARDIANSHIP ASSOC. P.~O.BOX 7295 Lancaster, PA 17604.7295 j i ' j IN THE COURT OF COMMON PLEAS OF CUMBERLAND CO. PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: MARION DEIBERT , an incapacitated person FILE N0.21-02-1138 GUARDIAN OF THE ESTATE ANNUAL REPORT [20 Pa.C.5.A.5521 (c)] FROM 1/13106 TO 1/13/07 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 _1/13/03 ,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 WHETHER THE INCAPACITATED PERSON IS LIVING OR DECEASED. 3) My initial Inventory was filed on _6/4/03_ and listed a total estate value of. $ 317,420.27 The Inventory listed a total monthly income of $_528.00_comprised of the following: SOCIAL SECURITY 4) At the beginning date of this report period, my initial balance on hand was $ 299,156.42 _ . , _,. __-_ - - -, .: r- -. _. ~. i~_, c.:> 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 Amount 1. MONTHLY PSERS PENSION 237.47 TOTAL 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 2. (7) The present principal assets of my ward are: Descriation of Asset 1. PAGA CUSTODIAL ACCOUNT 2. WACHOVIA CD 3. WACHOVIA MONEY MARKET ACCOUNT 4. 5. 6. TOTAL TOTAL Present Value 40,210.85 150,935.07 20,837.18 $ 211,983.10 8) The present amount and sources of income for my ward are: Source of Income Amount of Income (Indicate whether (monthly), Quarterly, annually) 1. PSERS PENSION 237.47 2. SOCIAL SECURITY 551.00 3. 9) The regular monthly expenses of my ward which I pay are: To Whom Paid Amount 1. MANORCARE APPROX. 6,000.00 2. LANA HOOVER (PRIVATE NURSE) 450.00 3. HAMPDEN CLEANERS 80.00 4. PAGA 250.00 (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 urincinal: To Whom Paid Pur ose Amount 1. 2. 3. A 5. 6. 11) I (have) /have not (circle one) paid myself compensation for services I rendered as guardian. The amount I Paid myself totaled $ 3,500.00 and was Calculated at the following rate: $ 250.00 X 14 MONTHS per week/(month) 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 security 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. SIGATURE Name: BRIAN D. BROOKS DATE ,~~ Telephone No. 717-299-4568 PENNSYLVANIA GUARDIANSHIP ASSOC. INC. PO BOX 7295 LANCASTER, PA 17604 RPTDAI A914476 TF91'1817 Aacaunt Pro~ile Tama Doposit Inq AAADC075 02/05/0? 5 STAR 09:35 Org: 075 Serv: CDA Acct: 247402302527618 Stage: PA Bank: 24 Short Name DESHLRT MARIAN Cust Zd Code RG Prod best RECsLiLAR CD Doc Type RECEIPT OwnQr eranc~: 8380 PVBK Br 00000 Int Rate/APY 4.29 d.37 Status ACTIVE Merger Cd: NRxt Rate/APY: .00 .00 Issue Amount: 200,000.00 Int Method IMPOUND Issue Datc 03/10/2006 Divest Cd: Year 3ase 365 Matr Date 03/10/200$ Prod 'Type: 230 Daily Accrual: 17.69869 Last Renewal: Promo Cd Accrued Int 935.07 Term 0024 M Bonus Cd CurreZt Bal 150,000.00 Holds NO Rene~ral Opt: RENEOQABLE Available Bal: 150, 935.07'' DL Maint 09/C8/2006 Published Rate 9.03 Payout Amt 147 769.04 DL Cust Cont: 09/06/2006 Call Floor Rate: 0.00 Fed if8/Hd Due t .OG Int Pymt Cycle Code: IQ Call Floor APY 0.00 Next Payment 03!10/2007 3ayment Disp: CAPITALIZE Call Flag Last Payment 12/10/2006 Int Lead Day: 3 Last Pymt Amt: 2,192.29 DCS ~ Outstq Pymt 0/ .00 Internal Acct to Credits>Orq: Acct: Command: APTDA22 FX=Help F3=Exit F4~TDADPT P'6=IRAWC F9=TDAHTI FI1=IRAWP F12=TDANMHI F13=TDAHI (jl,~ ore-~e9-o~ ~~C. G /~jsC X35.07 Z99-d l00/100~d 126-1 -~~~ ~6l~Ol 100- LL • ITEMIZED CATEGORY REPORT 1/ 1' 6 Through 12/31' 6 PAGA CUS-PAGA Custodial 2/ 5' 7 Date Num Description Memo Category Page 3 Clr Amount 10/11 10/11 R9660 R9661 DEPOSIT DEPOSIT SSDI DEIBERT,MARION/SS X 551.00 10/11 R9662 DEPOSIT BANK TRANSFER PENSION DEIBERT, MARION/BA X 50,000.00 10/13 9242 S PLATINUM PLUS FOR B PERSONAL NEEDS DEIBERT, MARION/PE DBIBERT MARION/FI X X 237.47 10/17 10/20 9246 9265 HAMPDSN CLEANERS LAM MARION DIEBERT , DEIBERT, MARION/FI X -360.01 -87 52 10/20 9273 S A L. HOOVER, LPN HALL SERVICBS MARION DIEBERT SOCIAL S DEIBERT,MARION/PE X . -450.00 10/23 9300 S PAGA GBNERAL ACCOUN ERVICE 10-11/06 DEIBERT,MARION/FI DEIBERT MARION/GU X X -1,520.40 11/ 1 11/ 3 9323 S 9334 PLATINUM PLUS FOR B PERSONAL NEEDS , DEIBERT,MARION/FI X -500.00 -351 72 11/ 7 R9756 LAMA L. HOOVER, LPN DEPOSIT MARION DIEBERT DEIBERT,MARION/PE X . -450.00 IZ/ 7 R9757 DEPOSIT SSDI PENSION DEIBERT,MARION/SS X 551.00 lI/ 8 11/ 9 9365 NEIGHBORCARE - YORK MARION DEIBERT DEIBERT,MARION/PE DEIBBRT MARION/ME X X 237.47 -5 573 11/10 9385 9393 MANORCARE CARLISLE DARLENE HALL FOR M MARION DIEBERT , DEIBERT,MARION/CO X , .58 -5,848.00 11/14 9416 A HAMPDEN CLEANERS CHAIRS / BEDDI MARION DIEBERT DEIBFFRT,MARION/PE DEIBERT MARION/FI X X -750.00 11/21 11/27 9470 9499 LAMA L. HOOVER, LPN MANORCARE C MARION DIEBERT , DEIBERT,MARION/P8 X -71.35 -450.00 11/29 9509 ARLISLE LAMA L. HOOVER LPN MARION DEIBERT MARION DIEBERT D}3IBERT,MARION/CO D X -5,848.00 12/ 1 9525 S , PAGA GENERAL ACCOUN EIBBRT,MARION/PE X -405.00 12/ 6 R9468 DEPOSIT SSDI DEIBERT,MARION/GU X -250.00 12/ 6 12/11 9567 S 9571 PLATINUM PLUS FOR B PERSONAL NEEDS DEIB}3RT,MARION/SS D}.sIBERT,MARION/FI X X 551.00 -2 080 83 12/11 9573 MANORCARE CARLISLE HEALTHDRIVE DENTAL MARION DEIBERT DEIBERT,MARION/CO X , . -135.00 12/12 9603 LAMA L. HOOVER, LPN MARION DIEBERT MARION DIEBERT DEIBERT,MARION/ME DEIBERT MARION/PE X X -146.00 12/12 12/20 9624 R9546 HAMPDEN CLEANERS DEPOSIT MARION DIEBERT , DEIBERT,MARION/FI X -225.00 -62.04 12/20 ET POSTMASTER PENSION DEIBERT,MARION/PE X 237.47 12/31 R9572 DEPOSIT BANK TRANSFER DEIBERT,MARION/PO DEIBERT MARION/BA -2.85 , 56,393.52 TOTAL DEIBERT,MARION ~R TOTAL INCOME ~~ TOTAL INCOME/EXPENSE i~ RQ~ ~~ %~,~<<zo PAGA CUS-PAGA Custodial 2/ 5' 7 ITEMIZBD CATEGORY REPORT 1/ 1' 6 Through 12/31' 6 Page 2 Date Num Description Memo Category Clr Amount 4/26 4/26 8251 8260 LOYALTON OF CREEKVI MARION DIEBERT DEIBERT,MARION/CO X -2,849.50 4/26 826 LAMA L. HOOVER, LPN MARION DIEBERT DEIBBRT,MARION/PE X -360.00 4/28 8 8278 LINKS 2 CARE MARION DIEBERT DBIBERT,MARION/MB X HEALTHDRIVB EYE GRO MARION DEIBERT -140.40 5/ 3 8303 DBIBERT,MARION/MB X LAMA L. HOOVER, LPN MARION DIEBERT DBIBERT,MARION/PE X -38.00 -485 00 5/ 4 5/10 8321 R810 HBALTHDRIVE DENTAL MARION DIEBERT DEIBSRT,MARION/ME X . -193.00 5/10 4 R8105 DEPOSIT DEPOSIT SSDI DEIBERT,MARION/SS X 551.00 5/16 8400 PENSION DBIBERT,MARION/PB X LAMA L. HOOVER, LPN MARION DIBBERT DSIBERT MARION/PB X 237.47 45 5/16 5/16 8404 8406 HAMPDEN CLEANERS , MARION DIEBERT DEIBERT,MARION/FI X - 0.00 -25.29 5/17 S PLATINUM PLUS FOR B 8413 PERSONAL ITEMS DEIBERT,MARION/FI X -156.33 6/ 2 84 HALL SERVICES MARION DEIBERT DBIBERT,MARION/FI X -481.28 6/ 5 55 S 8469 PAGA GENERAL ACCOUN 5-6 DEIBBRT,MARION/GU X -500.00 6/ 8 R8197 LAMA L. HOOVER, LPN MARION DIEBERT DBIBERT,MARION/PE X -360.00 6/ 8 R819 DEPOSIT PBNSiON DBIBERT,MARION/PB X 237.47 6/ 9 8 8534 S DEPOSIT PLA SSDI DEIBBRT,MARION/SS X 551.00 6/14 8556 TINUM PLUS FOR B MA PERSONAL NEBDS DBIBBRT,MARION/FI X -1,129.98 6/14 8569 NORCARB CARLISLE HA MARION DEIBERT DEIBERT,MARION/CO X -30.00 6/16 8580 MPDSN CLEANERS LAN MARION DIEBERT DBIBERT,MARION/FI X -290.27 6/20 8588 A L. HOOVER, LPN ME MARION DIEBERT DBIBSRT,MARION/PE X -360.00 6/26 8619 S TRO MED SERVICES HA MARION DEIBERT DEIBERT,MARION/TR X -195.60 6/27 8630 LL SERVICES LAMA L H 5/06 DBIBERT,MARION/FI X -2,322.20 7/ 6 R7509 . OOVER, LPN DEPOSIT MARION DIEBERT DEIBERT,MARION/PE X -360.00 7/ 6 R7510 DEPOSIT SSDI PENSION Dts'IBBRT,MARION/SS X 552.00 7/ 6 8671 NEIGHBORCARE - YORK MARION DEIBERT DEIBERT,MARION/PE X DEIBERT MARION/MB X 237.47 -257 35 7/11 7/19 8704 8755 LAMA L. HOOVER, LPN MARION DIEBERT , DBIBERT,MARION/PB X . -405.00. 7/31 S 8786 PLATINUM PLUS FOR B MAN PERSONAL NEEDS DEIBERT,MARION/FI X -438.90 8/ 1 8799 ORCARE CARLISLE LA MARION DEIBERT DEIBERT,MARION/CO X -8,762.10 8/ 1 8804 MA L. HOOVER, LPN HAMPDEN CLBANERS MARION DIEBERT MARION DIEBERT DSIBBRT,MARION/PE X DEIBERT MARION/FI X -450.00 8/ 7 8/ 9 8840 R757 MANORCARE CARLISLE MARION DEIBERT , DEIBERT,MARION/CO X -59.03 -5,838.00 8/ 9 1 R7572 DEPOSIT DEPOSIT SSDI D}3IBERT,MARION/SS X 551.00 8/14 8882 LANA L. HOOVER, LPN PENSION MARION DIEBERT DEIBERT,MARION/PE X DEIBERT MARION/PE X 237.47 -40 8/17 8/21 8902 8913 HAMPDEN CLEANERS MARION DIEBERT , DEIBERT,MARION/FI X 5.00 -27.45 8/23 S 8936 PLATINUM PLUS FOR B H PERSONAL NEEDS DEIBERT,MARION/FI X ,. -472.81 8/28 8947 ALL SERVICES PATHOLOGY ASSO OF MARION DIEBERT MARION DEIBERT,MARION/FI X -785.76 8/29 8974 . LANA L. HOOVER, LPN DEIBERT MARION DIEBERT DEIBFRT,MARION/MB X DEIBERT MARION/PE X -124.00 4 9/ 6 9/ 8 9002 R7 LAMA L_ HOOVER, LPN MARION DIEBERT , DEIBBRT,MARION/PE X - 05.00 -450 00 9/ 8 45? R7458 DEPOSIT DEPOSIT SSDI DEIBERT,MARION/SS X . 551.00 9/13 9029 MANORCARB CARLISLE PENSION MARION DEIBERT DEIBERT,MARION/PE X DEIBERT MARION/CO X 237.47 -5 8 9/13 9/14 9048 9058 HAMPDEN CLEANERS MARION DIEBBRT , DEIBERT,MARION/FT X , 48.00 -47 83 9/19 S 9074 PAGA GENERAL ACCOUN L 7-9/06 DEIBERT,MARION/GU X . -750.00 9/26 9109 S AMA L. HOOVER, LPN HALL SERVICES MARION DIBBERT 8/06 DEIBERT,MARION/PE X -450.00 9/26 9109 S HALL SERVICES 7/06 DEIBBRT,MARION/FI X -959.28 10/ 3 10/ 4 9157 916 LAMA L. HOOVER, LPN MARION DIBBERT DBIBBRT,MARION/FI X DEIBERT,MARION/PE X -1,701.60 -450 00 6 S 10/10 9199 PLATINUM PLUS FOR B M STORAGE UNIT DEIBERT,MARION/FI X . -27.00 ANORCARE CARLISLE MARION DEIBERT DBIBBRT,MARION/CO X -5,868.00 ~~~~ ' ITEMIZED CATEGORY REPORT 1/ 1' 6 Through 12/31' 6 PAGA CUS-PAGA Custodial 2/ 5' 7 Page 1 Date Num Description Memo Category Clr Amount INCOME/EXPENSE INCOME DEIBBRT,MARION 1/ 3 1/ 6 7639 R933 HALL SERVICES MARION DIEBERT DEIBERT,MARION/FI X -6,292.00 1/ 6 8 R933 DEPOSIT SSI DEIBSRT,MARION/SS X 551.00 1/ 6 9 R9340 DBPOSIT PENSION DEIBSRT,MARION/PE X 274.92 1/ 9 7702 DEPOSIT PENSION D}3IBERT,MARION/PE X 4.22 1/ 9 7723 LAMA L. HOOVER, LPN MARION DIEBERT DEIBBRT,MARION/PE X -360.00 1/ 9 '7728 LOYALTON OF CREEKVI MARION DIEBBRT DEIBBRT,MARION/CO X -2,820.00 1/10 7741 NEIGHBORCARE - YORK MARION DEIBERT DEIBERT,MARION/MB X -42.34 1/11 7753 S LAMA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X -360.00 1/24 7787 PAGA GENERAL ACCOUN L 11-1/06 DEIBBRT,MARION/GU X -750.00 2/ 7 R772 AMA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X -360.00 2/ 7 3 R7724 DEPOSIT SSI DEIBERT,MARION/SS X 551.00 2/ 9 7852 S DEPOSIT P PENSION DBIBBRT,MARION/PE X 225.73 2/ 9 7863 LATINUM PLUS FOR B LA CLOTHING DEIBERT,MARION/FI X -1,119.52 2/ 9 7877 NA L. HOOVER, LPN MARION DIEBBRT D}3IBERT,MARION/PE X -270.00 2/ 9 7879 BRONSTEIN JEFFERIES MARION DIEBERT DBIBERT,MARION/ME X -28.84 2/10 7882 WEST SHORB EMS R MARIAN DIEBERT DEIBERT,MARION/TR X -144.05 2/10 7893 EGISTER OF WILLS NE MARIAN DEIBERT DEIBERT,MARION/CO X -15.00 2/10 7895 IGHBORCARE - YORK L MARION DEIBERT DEIBERT,MARION/ME X -4,5,'t: 2/13 7912 OYALTON OF CREEKVI W MARION DIEBERT DEIBERT,MARION/CO X -2,849.50 2/22 7936 EST SHORE EMS WEST SHORE EMS MARIAN DIEBERT MARIAN DIEBERT DEIBERT,MARION/TR X -251.22 2/22 7937 VOID:BRONSTEIN JEFF MARION DIEBERT DBIBERT,MARION/TR DEIBBRT MARION/ME X X -271.89 0 00 2/22 2/24 7940 7958 LAMA L. HOOVER, LPN MARION DIEBERT , DEIBERT,MARION/PE X . -360.00 2/28 79?3 S LOYALTON OF CREEKVI P MARION DIEBERT DEIBERT,MARION/CO X -2,872.50 3/ 8 R7613 LATINUM PLUS FOR B PERSONAL NEEDS DBIBBRT,MARION/FI X -278.42 3/ 8 R7614 DEPOSIT DEPOSIT SSDI DEIBERT,MARION/SS X 551.00 3/ 8 R7615 DEPOSIT BANK TRANSFER DEIBERT,MARION/BA X 40,000.00 3/ 8 7986 S BRIAN D. BROOKS PENSION POSTAGE DEIBERT,MARION/PE X 225.73 3/ 9 8010 WEST SHORE EMS MARIAN DIEBERT DEIBERT,MARION/RE DBIBERT MARION/TR X X -1.11 -252 39 3/10 3/10 8031 8042 NEIGHBORCARE - YORK MARION DEIBERT , DEIBBRT,MARION/ME X . -24.41 3/21 8106 LAMA L. HOOVER, LPN MARION DIEBERT DEIBERT,MARION/PE X -360.00 3/22 8087 S LAMA L. HOOVER, LPN B MARION DIEBERT DEIBERT,MARION/PE X -495.00 3/28 8120 RIAN D. BROOKS LINKS 2 CARE POSTAGE DEIBERT,MARION/RE X -p,87 3/30 8135 HALL SERVICES MARION DIEBERT MARIAN DIEBERT DEIBER.T,MARION/ME DBIBERT MARION/FI X X -711.75 7 4/ 3 4/ 5 8138 S 8 PLATINUM PLUS FOR B CLOTHING , DEIBERT,MARION/FI X - ,317.36 -1 962 81 4/ 5 145 8165 WEST SHORE EMS MARIAN DIEBERT DBIBERT,MARION/TR X , . -90.50 4/ 5 8166 LINKS 2 CARE LANA L. HOOVER, LPN MARION DIEBERT MARION DIEBERT DBIBERT,MARION/ME DEIBERT MARION/PE X X -48.26 4/ 5 4/ 5 8171 8173 NEIGHBORCARS - YORK MARION DEIBERT , DEIBERT,MARION/ME X -765.00 -56.64 4/10 R80p8 LOYALTON OF CREEKVI D MARION DIEBERT DBIBERT,MARION/CO X -2,849.50 4/10 R8080 EPOSIT DEPOSIT SSI DBIBERT,MARION/SS X 551.00 4/11 8197 S PAGA GENERAL ACCOUN PENSION 2-4/06 DEIBERT,MARION/PE X DEIBERT MARION/GU X 237.47 -7 0 4/16 4/26 8206 823 HEALTHDRIVE DENTAL MARION DIEBERT , DEIBERT,MARION/ME X 5 .00 -157.00 6 VOID:LOYALTON OF CR MARION DIEBERT DEIBERT,MARION/CO X 0,00 ~V ,~~~ PAGA CUS-PAGA Custodial 2/ 5' 7 CASH FLOW REPORT 1/ 1' 0 Through 12/31' 6 Category Description INFLOWS DEIBERT,MARION TOTAL INFLOWS ~~~~a 1/ 1' 0- 12/31' 6 40,210.85 40,210.85 Page 1 • ITEMIZED CATEGORY REPORT ' 1/ 1' 6 Through 12/31' 6 PAGA_CUS-PAGA Custodial 2/ 5' 7 Date Num Description Memo Category Page 1 Clr Amount INCOME/EXPENSE INCOME DEIBERT,MARION 1/11 7753 S PAGA GENERAL ACCOUN 11-1/06 4/11 8197 S PAGA GENERAL ACCOUN 2-4/06 6/ 2 8455 S PAGA GENERAL ACCOUN 5-6 9/14 9058 S PAGA GENERAL ACCOUN 7-9/06 10/23 9300 S PAGA GENERAL ACCOUN 10-11/06 12/ 1 9525 S PAGA GENERAL ACCOUN ~~/U6 TOTAL DEIBERT,MARION TOTAL INCOME DEIBERT,MARION/GUA X -750.00 DEIBERT,MARION/GUA X -750.00 DEIBERT,MARION/GUA X -500.00 DEIBERT,MARION/GUA X -750.00 DEIBERT,MARION/GIIA X -500.00 DEIBERT,MARION/f X -250.00 TOTAL INCOME/EXPENSE ~~~~~r,:e~l/~ ~ o`L5~_dZJ -~_~nn_nn -.s,5uu.uu -3,500.00 ITBMIZED CATEGORY REPORT 1/ 1' 6 Through 12/31' 6 PAGA CUS-PAGA Custodial 2/ 5' 7 Page 1 Date Num Description Memo Category Clr Amount INCOME/EXPENSE INCOME DEIBERT,MARION 1/ 6 1/ 6 R9338 R9339 DBPOSIT SSI DEIBERT,MARION/S X 551.00 DEPOSIT PENSION DEIBERT,MARION/P X 274 92 1/ 6 R9340 DEPOSIT PENSION DEIBBRT,MARION/P X . 4 22 2/ 7 2/ 7 R7723 R7724 DEPOSIT D SSI DEIBBRT,MARION/S X . 551.00 3/ 8 R76 EPOSIT PENSION DEIBBRT,MARION/P X 225.73 3/ 8 13 R76 DEPOSIT SSDI DEIBERT,MARION/S X 551.00 3/ 8 14 R76 DEPOSIT BANK TRANSFER DEIBBRT,MARIONJB X 40,000.00 4/10 15 R800 DEPOSIT PBNSION DBIBBRT,MARION/P X 225.73 4/10 8 R8080 DEPOSIT SSI DEIBERT,MARION/S X 551.00 5/10 R8104 DEPOSIT PENSION DEIBBRT,MARION/P X 237.47 5/10 R8105 DBPOSIT SSDI DEIBBRT,MARION/S X 551.00 6/ 8 R8197 DEPOSIT PENSION DEIBERT,MARION/P X 237.47 6/ 8 R819 DBPOSIT PBNSION DBIBERT,MARION/P X 237.47 7/ 6 8 R7509 DEPOSIT SSDI DEIBBRT,MARION/S X 551.00 7/ 6 R7510 DEPOSIT SSDI DEIBERT,MARION/S X 551.00 8/ 9 R757 DEPOSIT PENSION DEIBBRT,MARION/P X 237.47 8/ 9 1 R7572 DEPOSIT SSDI DBIBFsRT,MARION/S X 551.00 9/ 8 R74 7 DBPOSIT PENSION DEIBBRT,MARION/P X 237.47 9/ 8 5 R7458 DEPOSIT SSDI DEIBERT,MARION/S X 551.00 10/11 R9660 DEPOSIT DEPOSIT PBNSION DEIBERT,MARION/P X 237.47 10/11 R9661 DEPOSIT SSDI BANK TRANSFER DEIBBRT,MARION/S DEIBERT,MARION/B X X 551_00 50 000 00 10/11 11/ 7 R9662 R975 DEPOSIT PENSION DEIBERT,MARION/P X , . 237.47 11/ 7 6 R97 DEPOSIT SSDI DSIBERT,MARION/S X 551.00 12/ 6 57 R94 DEPOSIT PBNSION DEIBERT,MARION/P X 237.47 12/20 68 R9546 DEPOSIT DEPOSIT SSDI DEIBERT,MARION/S X 551.00 12/31 R9572 DEPOSIT PENSION BANK TRANSFER DEIBERT,MARION/P DEIBERT,MARION/B X 237.47 56,393.52 TOTAL DEIBERT,MARION 155,873.35 TOTAL INCOME 155,873.35 TOTAL INCOME/EXPENSE 155,873.35 ~~ OH~~ c~~~ s,,~~ , High Perform Wince Money Market - 01 1010083980s~_- 752 30 0. 2 210,7,-V WA~CxOVIA OOO6i654 01 MS " 0:326'Oi MAADa87 ~~ MARION E DIEBERT _ _ C/O P.A.6.A pg "~~~ P . O . .BOX 7295. ~~ LANCASTER PA 17604 _ ~ High Performance ~Vioney Market- ~tiosf2oos tnru ~io5i2oo~ Acxoutrt number: ~010083s8035s ~~~ d't c( 7~/D; a3d~-asa7f'L Account owner(s): MARION f ©IEBERT : __ Account Summ } f ni balance i 2/06 520.805.36 Interest aid 31.82 G7osing balance 1/05 S2A,$37.I8 = s - .~ Deposits and-Other Credits - = Date Amount Description ~l05 31.82 INTEREST FROM i?J062006 TJ-IROUGH 01105/2007 otal 1.82 . -- 9 Interest Number of days this statement period 31 Annuaf percentage yield earned 1:829'0 interest earned this statement period 531.82 Interest paid this statement period: 531.82 Interest paid this year $31:82 . -- _. _ . _ Enjoy the stability of a fixed interest rate and the flex~~ity ~ up b four payment options each_-- month. W~h World _ Savmgs'.new Fixed Rate Pick-a-Payment_(sm)1Mortgage`. otfened through yf/achovia Morbga9e Corporation.~s~uc cl>Qioe -Visit . aymenttodaY ----- ---- ----- --- -- to learn. more: _ _ __ _ *Onginated by Wo~MaLSavings Bank, FSB, a Wachcwiia campeny, st~bjiecf to approval. Certain rest-ictinns apply. - Equal lYousing i:.ender: WACHOVIA BANK, N.A. , MANOR STREET page 1 of 2 IN THE COURT OF COMMON PLEAS OF CUMBERLAND CO., PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: MARION E. DEIBERT , an incapacitated person FILE NO 21-02-1138 GUARDIAN OF PERSON ANNUAL REPORT [20 Pa. C.S.A. 5521 (c)) FROM 1!13/06 TO 1/13/07 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 _1/13/03,, which was X was not modified by Court Order(s) dated 3. Is the incapacitated person still living? If no, answer the following: YES (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 questions: (a) Date Guardian of the Person filed the last Annual Report? 1/13/06 (b) Current address of the incapacitated person MANORCARE CARLISLE, 940 WALNUT BOTTOM RD. CARLISLE, PA 17015 (c) Current age _83_Date of birth of incapacitated person 1/27/33 (d) The incapacitated person's residence is: Ward's own residence My homelapartment _X -Nursing Home Relative's Home Hospital or Medical Facili ` ~' t3' Boarding ,Dome ~_..., (e) The incapacitated person has been living there since_6/16/06 If moved within the past year, state from where and the reasan_for-tfie `, change , . NEED FOR NURSING HOME CARE -- ~ , -~~ `~; .. .-~ ~~ (f) I rated his/her living arrangement as: _X Excellent Average Explain• Below Average (g) I believe he/she is: X -content with the living situation unhappy with the living situation unaware of the living situation 5. Physical health (a) Current physical condition of the incapacitated person is: Excellent _X -Good Fair Poor (b) His/her major physical health problems are as follows: HISTORY OF BREAST CANCER, HYPERTENSION (c)During the past year, his/her physical condition has: X -remained about the same. improved. Explain worsened. Explain (d) During the past year, he/she received the following medical treatment (include check-ups and dental work): Date Ailment Type of treatment Doctor's name 11/15/06 OPTOMETRY EXAM MD D. HARTZELL 2/06 BREAST CANCER MASTECTOMY MD. SOTO-HAMLIN 5/9/06 BREAST CANCER FOLLOW UP MD. SOTO-HAMLIN 8/10/06 BREAST CANCER FOLLOW UP MD. SOTO-HAMLIN MONTHLY ONGOING CARE AT FACILITY DO. D. GUISTWITE 6. Mental Health (a) The incapacitated person's condition is Excellent Good X Poor (b) Hisllier major mental health problems are as follows: DELUSION DISORDER WITH PARANOID SUBTYPE, POSSIBLE MULTIPLE PERSONALITY DISORDER (c) During the past year, his/her mental condition has: _X -remained about the same. Improved. Explain Worsened. Explain (d) During the past year, treatment or evaluation by a psychiatrist, psychologist or social worker _X_was was not provided. Such mental health services are briefly described as: KEYSTONE PSYCHIATRIC SERVICES 7. Social Activities / Services (a) His/her current social condition is: excellent X_good fair poor (b) During the past year, his/her social condition has: remained about the same. X _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:_MONTHLY_ (b) The average amount of time I spent on each visit was 1-3 HOURS (c) The last time I visited was on 12/18/06 Date 9. During the last year I have performed the following activities on behalf the incapacitated person: ALL MEDICAL AND FINANCIAL DECISIONS 10. I believe he/she has the following unmet needs: NONE f' 11. The guardianship _X_ Should should not be continued without modification because: 12. Please note any concerns about the Incapacitated person's physical or mental well being or the finances that the Court should know. 13. I _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: 5 Name: BRIAN D. BROOKS ~- ~ ~ gnature of the Guardian of the erson TELE#: 717-299-456$ PENNSYLVANIA GUARDIANSHIP ASSOC. INC. PO BOX 7295 LANCASTER, PA 17604 COURT OF COMMON PLEAS CUMBERLAND CQUNTY, PENNSYLVANIA 4I~HiS' COURT DIVISION IN RE: MARIAN E. DEIBERT , AN INCAPACITATED PERSON FILLS NU: ZI-4Z-I138 ANNUAL REPORT OF THE GUARDIAN OF THE PERSON l , INTRQAUCTIQN Pennsylvania Guardianship Association /Brian D. Brooks was appo~d the Limited, ~_ Plenary Guardian of the person by Decree of ', J~ Dated: X (A) This is the Annual Report for the period from 1/13/10 to I,1/13/11 _ (B) This the Final Report for the period from to 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 . Jude. D Ti For Find Report, omit secHona II through IV. 2. PERSONAL DATA Age of the incapacitated person 77 Date of Birth 1/27/33 I '~ 3. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: MANORCARE, 940 WALNUT BOTTOM RD. CARLISLE, PA 17015 ', c~ ~ ' ~.._._, ~' B. The Incapacitated Person s residence is: ~ ~ ~} ~r ~ _,-~ Ward's own home /apartment ~ n ~ r'' X Nursing Home '~ ~ ~ k~ ~' _ Boarding Home /Personal Care Home ~~ ` ~ , _ ~~ _ Guardians Home /Apartment ~ -" ~ ' _ Hospital or Medical Facility ' ..~i-, ~`'' ' ~:? f.=~ r'` `n ~ Relative s Home (name relationship and address) ~ ~ _ , C. The Incapacitated Person has lived here since: 6/ 16/06 ffthe Incapacitated Person has moved since the last report, state the prior address reason for move: COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSY$.VANIA ORPHANS' COURT DIVISION '' IN RE: MARIAN E. DEIBERT , AN INCAPACITATED PERSQN FTLLE NO: 21-02--1138 ANNUAL REPORT OF THE GUARDIAN OF THE ESTA~'E L INTRODUCTION Pennsylvania Guardianship Association /Brian D. Brooks was appd Limited, X Plenary Guardian of the Estate by Decree of Q~han's Court . Jude Dated: 1/13/03 X (A) This is the Annual Report for the period from 1/13/10 jto _ (B) This the Final Report for the period from to ', and is filed for the following reason: ~~ 1. The death ofthe-incapacitated person, Date of Death ~~ 2. The gu~ardianslup was tE:rminated by the Court by Decree of . Ju e. Dated '~ 1 2. SifMMARY A. State the value of the estate reported on the inventory $ 317.420.2' B. State the value(s) of principle assets at the beginning of the Report Pori (Same as the inventory if this is the first report, otherwise, balance from Il $ 2,186.24 C. What is the total amount of income earned during the report period? ' I'~ $ 10,559.87 D. What is the total amount of income and principle spent for all purposes report period. $ 10,163.04 - E. What are the balances remaining at the aad of the report period? 1. Principle $ 2. Income $ E 3. Total principle and income $ 2,~8 the 1'/13/11 t art) wring the... ,. M:.> © _.' ~,: ~..~ ~ ,- ' ~, . : , c~ ~ -- _z~ ;- .t e~ ~ ~ -T-, ~ ...~, _.. ~-.- - =: c _ . -~ ~ _ ~~ ~; a e,:. THE ESTATE OF: MARIAN E. DEIBERT 3. ADDITIONAL II~iFQRMATION '' (If more space is needed, please attac>- additional pages.) ~ A. Principle 1. How is the principle balance listed above currently invested? (Specifyj) PAGA CUSTODIAL ACCOUNT 2. Have there been any expenditures from principle during this report p$~ X If yes: a. Have al all expenditures from principle been for the sole benefit Incapacitated Person? Yes No b. List the purpose and amount of expenditures: '~ SEE ATTACHED ALL 'TRANSACTION REPORT, c. Was approval received prior to expending principle? Yes ,_._ io _ 3. Were additional principle assets received during this report period that ~ included in the inventory or any prior report filed for the estate? ff yes: d? the not Yes X No !, a. Was court approval requested prior to receiving additional pri~c pie? _~~ ~°- b. State the sources and amounts of additional principle received: B. Income 1. State sources of income received during the report period: 1. SOCIAL SECURITY 2, PENSION Total income received during report period: $ 10.559.87 2. How is the income cun*ently invested? (Specify) PAGA CUSTODIAL ACCOUNT THE ESTATE OF: 1~I.~RIAN E. DEIBERT C. Expenses for Care and Maintenance: (Specify what expenditures were made from the principle and income fob t11~ care and maintenance of the incapacitated person) SEE. ATTACHED ALL TRANSACTION REPORT D. Other expenditures (Specify any other expenditures not previously ~e~drted) E. Guardians Commissions II (List the amounts of compensation paid as guardian's commission and s~at~ how amount was determined:) ', ', Amount Method of Determination COnrt App#o~tall Obtained F. Counsel Fee ~~ (List amounts paid as counsel fee, and indicate whether Court approval pbtained.) 'I III I I verify that the foregoing information is trae and correct to the best of my I ledge, information and belief; and that this VeriScation is subject to the penalties~in 8 PA. C.S.A. S/S 4904. rian D. Brooks Pennsylvania Guardianship Association PO Boa 7295 Date: ~7/~~ Lancaster, PA 17604 717-29~-568 <- ~ ~ ~' a T .C ~" a~ ~~ t 3~ 0 ~~ U~ a n 4 ~. p O ti r ` t A N N z a w m ~ ~ ~ z a C ~ a s.~ or~~ ~~~ ~ ' ~ V ~ d~OGpG wI r ~C~ r ~7 (~ O ~~ ... ~- a m O O~aC Q N Dir~`~W ~~~4~~~a ~. ~ ~ 4 ~~ ~ ~WW ~~~~~ ~~~~~~o w~~~~~~ NNN °°°r~df=may arr~ ~~1~~®®~ o ~ r dui Q a 5 `~. r r r G. -~ O V m a z W a a a r a r r r 0 ~- r U 1 0 =i a V O O N S S N W N S O N S O O !Y S~ O~ S N H~ W O S O W S p p S W~ S S OCD fir' 'r'O ~O!l;pQ~pr I~W~C~ oA ~ ~ (~e~Q ~QQ R~ r Q r r~ r~ O r m Q r r 8 r ~ r ~ g r 0 Nro~c~mc`Pia~c~ia~t~~iaanNC~aa~~i~a~c~ic~~~~~m ~ ro~~~~c'Cim~~4 ~oc~~~~cr~oc~~~~oc~~~~~~~~~~~ac~ac~j~a~~~~~~~ac~z I e W N m ~ m _m m m m Illml ~ D ~ ~ ~ O ~ I~ O O z z ~Q z z z z z O O SOD _Oo QoQ ~ ~~ OQ OQ ~O O tzii ~? w ~~~ ~•~ W W~r ~~~ ~~~~~a~~~ a~~rV1~~~VJ ~{i~ .F~~i~~ pia pia 3~~n ~ ~ z o z'c°~• W W W W W W W 'W JV ~ ~ ~V NU~ ~VV N ~a ~ o~ ~a ~a~ craa la ~ c`~ c'3 ~ W ~ W~W ~~ IIW !-FH~~~--~ ~-~CC~WC~~UUU~JJJ(~t ~~ ~W~F-~ m v~ v! t7~ v'3 (~ 0. ~ U' ~C ~~ o o d .[ ~ Ow~ ~~a_ a ~~ ~~a ~ ~''44 ~~~~ aa~t a~~ c~ ~~ ao~ a~ ~iS aa~~ t'7 t+> aQ c1D ~~~~~~~~~~~~~~~a~~~s~~~~~~~~~ W~~rr~d"r~~r rr ~- 0000 000 O 00 OOOI~O ~r1Lr`Orr 000000'r00~'-r000pO00r'~-~-r ~~N~raa 3 r`~~ ass as=~~ ~ sa~~~ ~~aaa~a~a~a~~~~~~~~~a~~~~~a~~aa~a~a W W t? W Z w w ~a~ a~ ~a4'w qat~ W ~~~~~~~~ za~c~~ ~ ~~~~a~ :~$$.~ _.. N N ~ ~ N N O O Q O 0 0~ 0 0 ~~~rr~ar~ a a~~~=~~ r~ r r r r r r r T T r m r t,' O c~S ~~ ~- O LL. W Q Q a j ~' 0 ~Y~j !V N ti r O 0 rt U ~ W W ~ ~.,~ ~ ~ Z `~ V r r N~ i r T ifiV~ .~ o~ ~~ Uo ~~ .NJ E d a r W a 7 _~ V ~i a i I I ~ p p o N N p N S~ S S~ S~ o S S W S G S S 0 ~Ctai~.p-~pC1~~p~~~p-~~~ep-W ~ W ~~ O/ N Dm NNIDNmNm~GNm~m~m~~mm~m . r r ~~~oc~ac~~ococ~oc~oca~cc~~~cc~ $ $~ ~ o o d $ o~ Q ~ ~~~W~~~~a~~~~~~~~~~~~~~~ 0000 ooooO°oo~~- n ~~oaoooo==oo~~~~~$•- ~~~ aa~a~~~~~~~~~~a~~~~~ ~~~~W ~ a a S r a A r P ~- 3 ~_ .C ~- O m ~~ Uo ~~ s$ss8~ss .. s ~ ~~~~gsss Nrrrr r r r ~~~~~~~~ O_ O c+~~~~~~~a: .~ ~ ~ ~-- f- F- F- i-- F- t- F- ~- UVtVJVU~VUV m ddddddddd ~~~ ~~~ a ~z zzz `c'~ot`~~~c~~c`~~ aaaaaaaada _ = z ~ ~°~go" °~~"~ O ra-NN NNNN ~ Z Ooomooooo= ~ ~_~ ~ r ~ r ~ ~ O Z ,~ ~ ~ W V z ~ O F- O !- O 1- a a \~ T COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVA1~iIA ORPHANS' COURT DIVISION IN RE: MARIAN E. DEIBERT AN INCAPACITATED PERSON FILLE NO: 21-02-1138 ANNUAL REPORT OF THE GUARDIAN OF THE ESTATE 1. INTRODUCTION Pennsylvania Guardianship Association /Brian D. Brooks was appointed the Limited, ~_ Plenary Guardian of the Estate by Decree of Qrphan"s Court , Jud~e_ Dated: 1/13/03 X (A) This is the Annual Report for the period from 1/13/11 to 1/13/12 - (B) This the Final Report for the period from to 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 . Judge. Dated ___ 2. SifiVEViARY A. State the value of the estate reported on the inventory $ 317.420.27 B. State the value(s) of principle assets at the beginning of the Report Period. (Same as the inventory if this is the first report, otherwise, balance from last report) $ 2,583.07 C. What is the total amount of income earned during the report period? $ 10,965.27 D. What is the total amount of income and principle spent for all report period. $ 12,455.24 E. What are the balances remaining at the end of the report period? 1. Principle $ 2. Income $ 3. Total principle and income .~ ~ ,, ~. ~ ~ the ~^ 3 ~~ ~ cxa ~y~R~ $ 1,093.10 THE ESTATE OF: MARIAN E. DEIBERT 3. ADDITIONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principle 1. How is the principle balance listed above currently invested? (Specify) PAGA CUSTODIAL ACCOUNT 2. Have there been any expenditures from principle during this report period? X es No If yes: a. Have al all expenditures from principle been for the sole benefit of the Incapacitated Person? Yes No b. List the purpose and amount of expenditures: SEE ATTACHED ALL TRANSACTION REPORT. c. Was approval received prior to expending principle? Yes X No 3. Were additional principle assets received during this report period that were not included in the inventory or any prior report filed for the estate? Yes X No If yes: a. Was court approval requested prior to receiving additional principle? Yes No b. State the sources and amounts of additional principle received: B. Income 1. State sources of income received during the report period: 1. SOCIAL SECURITY 2. PENSION Total income received during report period: $ 10.965.27 2. How is the income currently invested? (Specify) PAGA CUSTODIAL ACCOUNT THE ESTATE OF: MARIAN E. DEIBERT C. Expenses for Care and Maintenance: (Specify what expenditures were made from the principle and income for the care and maintenance of the incapacitated person) SEE ATTACHED ALL TRANSACTION REPORT D. Other expenditures (Specify any other expenditures not previously reported) E. Guardians Commissions (List the amounts of compensation paid as guardian's commission and state how amount was determined:) Amount Method of Determination Court Approval Obtained 5 2.250.00 5 ~ 100 00 7 C~ 250 00 (Yes) No F. Counsel Fee (List amounts paid as counsel fee, and indicate whether Court approval was obtained.) I verify that the foregoing information is true and correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A. S/S 4904. 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W F= O ~ J W O p F- O V Z Q O H W W W 2 a O f- N ~ M ~ W a 'C O a ~~ N w ~ ~ r ~L Ur -a ~~ N .~ .- ..~-. a w Q c~ a c 0 V I O c C z Z t $$$$$$ggggg$c4s, `~, ~ ~~~~~s~~$s~s~ ~ ~ N N N N N ~ ~ N ~ ~ N ~ N N ~ i i i i~ i ~~ i~ ~ N N N ~ ~ ~ ~~~ ~-r~-erg-~ e-~-a-~-~N ~-;;~;;;;a~a; aC7~~fDf~0001r~~e- F- F- F- H I- t- I- !- F- 1- t- F- UUUUUUUUUUUU QQQQQQQQQQQQ QJ J J J J4 Q J J J J J J J W W W W W W W W W W W W zzz~zzzzzazz ~~~c~~~~~~~~~ c~~~~~~c~c~~~~~ aaaaaaaaaaaa aaaaaaaaaaaa N N N N N N N N N~ N N~ Z ~~~ ~e-.-~.-.-.-~~~e-a-Nf' W F,,; o z J W m W ~. G O O W N z W X W W O z Q O t- \~ ~` . COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: MARIAN E. DEIBERT AN INCAPACITATED PERSON FILLE NO: 21-02-1138 ANNUAL REPORT OF THE GUARDIAN OF THE PERSON 1. INTRODUCTION Pennsylvania Guardianship Association /Brian D. Brooks was appointed the Limited, .~~ Plenary Guardian of the person by Decree of . Jude Dated: ~ (A) This is the Annual Report for the period from 1/13/11 to 1/13/12 _,,,_ (B) This the Final Report for the period from to 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 . Jude, Dated For Final Report, omit sections II through IV. 2. PERSONAL DATA Age of the incapacitated person 7$_ Date of Birth 1/27/33 3. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: MANORCARE, 940 WALNUT BOTTOM RD. CARLISLE, PA 17015 B. The Incapacitated Person's residence is: ~ ~ ,~' Ward's own home /apartment c'~` ~-- ~ ~~~ X Nursing Home ~~ ~,, ~~-, _ Boarding Home /Personal Care Home Guardians Home /Apartment ~~ ~ _ x ' _~ _, Hospital or Medical Facility ~ `" _ Relative's Home (name, relationship and address) ~' ~'~ C. The Incapacitated Person has lived here since: 6/16/06 If the Incapacitated Person has moved since the last report, state the prior address and reason for move: Estate of: MARIAN E. DEIBERT D. Name and address of the Incapacitated Person's primary care giver: MANORCARE HEALTH SERVICES 4. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are: SEVERE DEMENTIA, HISTORY OF BREAST CANCER, HYPERTENSION B. Specify what if any, social, medical, psychological and supportive services the Incapacitated Person is receiving: ALL SERVICES PROVIDED BY STAFF AND PHYSICIANS AT THE FACILITY 5. GUARDIAN'S OPINION A. It is the opinion of the guardian that the guardianship should: ~_, Continue Be modified Be terminated The reason for the foregoing opinion is: The need for the guardian continues B. During the past year the Guardian of the Person has visited the Incapacitated Person 4 With an average visit time Y S - 20 u s . 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 true and correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A. S/S 4904. . Brooks Pennsylvania Guardianship Association PO Boa 7295 Date: ___~._` ~ ~~- Lancaster, PA 17604 717-299-4568 rn�� COURT OF COMMON PLEAS CUMBERLAND COUNTY,PENNSYLVAlvIA ORPHANS' COURT DIVISION c� - C �_; �, :� IN RE: MARIAN E.DEIBERT , AN INCAPACITAT��ERSO�#? n � � c, --�- �,� :-� � :=. r- ��, . • i:�.� �:-� rr:-, `.'; f.,� FILLE NO: 21-02-1138 =� �,; : ; � `�;-; � �.� .'' �y � ANNUAL REPORT OF THE GUARDIAN OF THE ESTA''�'E. � �:_! �'' �V,' , . ,.. . .._. . r_., . __ 1. INTRODUCTION - • E-, � • �� .:., �.. �-� _;� Pennsylvania Guardianship Association/Brian D. Brooks was appointed the Limited, X Plenary Guardian of the Estate by Decree of Or�han"s Court , Judge Dated: 1/13/03 X (A) This is the Annual Report for the period from 1/13/11 to 1/13/12 _ (B) This the Final Report for the period from to and is filed for the following reason: 1. The death of the incapacita.ted person, Date of Death 2. T'he guardianship was terminated by the Court by Decree of ,Judge, Dated 2. SUMMARY A. State the value of the estate reported on the inventory $ 317,420.27 B. State the value(s) of principle assets at the beginning of the Report Period. (Same as the inventory if this is the first report, otherwise, balance from last report) $ 1,093.10 C. What is the total amount of income earned during the report period? $ 9,375.52 D. What is the total amount of income and principle spent for all purposes during the report period. $ 10,083.87 E. What are the balances remaining at the end of the report period? 1. Principle $ 2. Income $ 3. Total principle and income $ 384.75 � _ _ _ _ _ m,� , THE ESTATE OF: 1�ZARIAN E.DEIBERT 3. ADDITIONAL INFORMATION (If more space is needed,please attach additional pages.) A. Principle l. How is the principle balance listed above currently invested? (Specify) PAGA CUSTODIAL ACCOUNT 2. Have there been any expenditures from principle during this report period? X Yes No If yes: a. Have al a11 expenditures from principle been for the sole benefit of the Incapacitated Person? X Yes No b. List the purpose and amount of expenditures: SEE ATTACHED ALL TRANSACTION REPORT. c. Was approval received prior to expending principle? Yes X No 3. Were additional principle assets received during this report period that were not included in the inventory or any prior report filed for the estate? Yes X No If yes: a. Was court approval requested prior to receiving additional principle? Yes No b. State the sources and amounts of additional principle received: B. Income 1. State sources of income received during the report period: 1. SOCIAL SECURITY 2. PENSION Total income received during report period: $ 9.375.52 2. How is the income currently invested? (Specify) PAGA CUSTODIAL ACCOUNT — — —�nqmr i THE ESTATE OF: MARIAN E. DEIBERT C. Ezpenses for Care and Maintenance: (Specify what expenditures were made from the principle and income for the care and maintenance of the incapacitated person) SEE ATTACHED ALL TRANSACTION REPORT D. Other ezpenditures (Specify any other expenditures not previously reported) E. Guardians Commissions (List the amounts of compensation paid as guardian's commission and state how amount was determined:) Amount Method of Determination Court Approval Obtained $ 1,100.00 11 (a� 100.00 (Yesl No F. Counsel Fee (List amounts paid as counsel fee, and indicate whether Court approval was obtained.) I verify that the foregoing information is true and correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A. S/S 4904. � � , r Date: �/�/ � � an . Brooks Pennsylvania Guardianship Association PO Boz 7295 Lancaster,PA 1'1604 717-299-4568 .. . _ _ .. ._ .. . _ . . . _ _ _ _ �q^w _ fh �<-� �\ M OI �� N (C � a � � � � _. �O N N N O N N N O O N N O O N O N O N N p N N O b � � �. �OMC'�MOC'�MMOOMM<]OC�OMOC'�MOMMOI� 1� C a-e- lL)�e-�Mc- �O� tnrO�r- �e-�Me- �1p0 {r 3 OD � 1�� �}i-CO� 0�1� �Or f0�}��Od'�hO� O Ch�N1�f� t�Nt� N�NNf� CONN�t� t�Nf�(ONf�NM M � Q f � U I LL LL LL. LL LL LL 1..1�LL.LL LL Y�LL I.L.LL Y� LL 1.L. 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Brooks was appointed the _ Limited, X Plenary Guardian of the person by Decree of O h<�n's Court Jud�e Dated: 1/13/03 X (A) This is the Annual Report for the period from 1/13/12 to 1/13/13 _ (B) This the Final Report for the period from to 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 Jud�e Dated For Fi�al Report,omit sections II through IV. 2. PERSONAL DATA Age of the incapacitated person 79 Date of Birth 1/27/33 3. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: MANORCARE, 940 WALNUT BOTTOM RD. CARLISLE, PA 17015 B. The Incapacitated Person's residence is: _Wazd's own home/apartment X Nursing Home -:' �7 _ Boarding Home/Personal Care Home � o `�' � c� _ Gua.rdians Home/Apartment a =`y � ;�; � _ Hospital or Medical Facility � � C' �, � ;� ;',�s _ Relative's Home(name, relationship and address) n �;, �' a' '�T .�" �. , �, � _: --� --, �:�3 �C. T'he Incapacitated Person has lived here since: 6/16/06 7 `' �` , �_ r, -. �� . ="•' r�� rii If the Incapacitated Person has moved since the last report, state the prior�iddress an�eas n 3�'ir move: _ _ _ _. _ _ - - 'IU _ _ ..�� � Estati,of: MARIAN E. DEIBERT D. Name and address of the Incapacitated Person's primary care giver: MANORCARE HEALTH SERVICES 4. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are: SEVERE DEMENTIA, HISTORY OF BREAST CANCER, HYPERTENSION B. Specify what if any, social, medical,psychological and supportive services the Incapacitated Person is receiving: ALL SERVICES PROVIDED BY STAFF AND PHYSICIANS AT THE FACILITY 5. GUARDIAN'S OPINION A. It is the opinion of the guardian that the guardianship should: X Continue Be modified Be terminated The reason for the foregoing opinion is: The need for the guardian continues B. During the past year the Guardian of the Person has visited the Incapacitated Person 4 With an average visit time lastin�15 -20 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 true and correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A. S/S 4904. � Date• 3�� rian D. Brooks Pennsylvania Guardianship Association PO Boz 7295 Lancaster,PA 17604 717-299-4568