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HomeMy WebLinkAbout01-15-09 ~~ irt~;n `n~~ JF..i~ I S Pt~i l! ~ 06 ANNUAL REPORT OF GUARDIAN OF THE ESTATE Estate of an Incapacitated Person CRrN:APd S CnURT COURT O COMMON PLEAS OP ~~r-t.a,.,.~ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION No. oZ l - OCo - /Gb~ I. INTRODUCTION ~~ 1,~ ~ ~~ , wa11s appointed Plenary ^ Limited Guardian of the Estate by Decree of ~c Gµ fdo , J., dated ~ - ~~- ~~~ [~, A. Thi is the Ann al Report for the period from o , ~~_$ to ~eei~ ~ ~ l o~ (the "Repo eriod"); or ^ B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J., dated Form G-0? rev. 10.71.06 Page 1 of 5 Estate of ~~iw!.~ ~ ~ ~..G~ , An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ ~~~ B. State the value(s) of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, (~ 5~~ otherwise, ending balance from last Report.) $ C. What is the total amount of income earned during the -y Report Period? $ °C~>- ~d D. What is the total amount of income and principal ~~ d`,~ spent for all purposes during the Report Period? $ , OJy E. What are the balances remaining at the end of the Report Period? ~ ]. Principal~t~dcw+~et+-'~`~ 7~ 2. Income ~~`~~ ~ $ I,~R6 .00 3. Total of Principal and Income ~77 ~~ $ ~] ], ~6 0.00 III. ADDITIONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principal How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificat~e-s oI f 1de_posit, restricted bank anccounts, etc.): ~ ~~y.~,. `~ C ,~ ~~ r~'~c~-..nn~o~11~~-~-ar.a.+av,~.:eo{ G~Os~i~~""y"r"'" V:r~oi.ti~'~Y i~`L \ ~ ~ V 2. Have there been any expenditures from the principal during the Report Period? ............................ Yes ~ No If yes: a. Have all expenditures from the principal been. for the sole benefit of the Incapacitated Person? ........ 1~Yes ^ No Fonn G-03 rev. /0./3.06 Page 2. Ot 5 Estate of b. List purpose and amount An Incapacitated Person S7o, m ya..~ °1Sd. cb 1 ~ 3.9~.ao c. Was Comet approval received prior to -~'\ 6 ~ ',~ a= expending the principal? ....................... 'i~l'Yes U No 3. Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? ........... ~ Yes ~No If yes: a. Was Court approval requested prior to receiving the additional principal? ................ ^ Yes ^ No b. State the sources and amounts of the additional principal received: B. Income State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): Total income received during Report Period: Fonn G-02 rev. 10./3.06 $ a~, o9o_~e? Page 3 of 5 Estate of 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): ~-~1y, An Incapacitated Person C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Pers\\o``n--(e.g., clothing, nursing hom~Fe, rgedicine, suppo{t, etc~~ ~~. 1 F+~~:w..r~Fl~~"'"b' L°""e. .~c~l.~ (6.-1-.~s(~8.~-{x4 ~l Uidiw~ D. Other Expenditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) tn~ ~.,.....~.~+w ~.ew..~w:.~ (.:~'4c LvbwvaK'2-Q°w~.~-y .-d ~-'t6 `~ ~ ..- ~..~ ,.,........,.,..y~b,,.-;oJ.~ o, ~s E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: 1 mount Method ofDetermination Court Approval Obtained DYes ^No ^Yes ^No Dorm G-0? rev. /0./3.06 Page 4 of 5 Estate of F. Counsel Fee An Incapacitated Person List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount Court Approvaf Obtained ^ Yes ^ No ^ Yes ©No I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to penalties of 18 Pa.C relative to u wom lsification to authorities. / r ra t (lam On(e Signmare ofGunrdimr oflGe Esmle Nmne ofGum'diun of Use Esm(c (type or print) Address ~~ ~s Ciry. S!nle, Zip ' \ Form G-03 rev. 10.13.06 Page 5 of 5