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Home My WebLink About03-25-09~1~, 21y .~~, In the Court of Common Pleas of Cumberland County, Pennsylvania Orphans' Court Division File No. 21-07-0606 Court Appointed Guardian Claire R Weldon First and Final Account Keystone Guardianship Services Date of Death: 12/05/2008 Date of Incapacity, if any: 08/06/2007 Date of First Receipt of Funds: 08/06/2007 Accounting for the period: 08/06/2007 to 03/20/2009 Purpose of Account: Keystone Guardianship Services, offers this Account to acquaint interested parties with the transactions that have occurred during the Administration. It is important that the Account be carefully examined. Requests for additional information or questions or objections can be discussed with: Steven M. Montresor Latsha Davis Yohe & McKenna, P.C. ~ ~~ _ 1700 Bent Creek Blvd, Ste 140 `- o `-J __. Mechanicsburg, PA 17050 ' ~ ~~ '~. 717-620-2424 -' ~ ~ -~ :: Supreme Court LD. No. 74244 ~ =, ~ ?~ - _- - _~„ _ ' _~ o --~ .. ~~ SUMMARY OF ACCOUNT Court Appointed Guardian Claire R Weldon For the aeriod of August 6 2007 through March 20 2009 Proposed Distributions PAGES to Beneficiaries PD PRINCIPAL Receipts: This Account A Net Gain (or Loss) on Sates or Other Dispositions C 147,035.62 Less Disbursements: General Disbursements Fees Balance Before Distributions Transfer to (from) Principal Distributions to Beneficiaries Principal Balance on Hand For Information: Investments Made Changes in Holdings INCOME Receipts This Account Net Gain (or Loss) on Sales or Other Dispositions Less Disbursements Balance Before Distributions Transfer to (from) Income Proposed Distribution of Income Income Balance on Hand For Information: Investments Made Changes in Holdings COMBINED BALANCE ON HAND Signature Verification PBOH 17,778.27 147,035.62 0.00 129,257.35 17,778.27 0.00 0.00 17,778.27 G 11,688.53 0.00 11,688.53 I 10,252.74 1,435.79 0.00 J 1,435.79 IBOH 1,435.79 L CBOH 129,257.35 0.00 19,214.06 Court'Appointed Guardian Claire R Weldon RECEIPTS OF PRINCIPAL Assets Listed in Inventory (Valued as of Date of Death) Fiduciary Acquisition Value Cash ING -Life Insurance Policy Surrendered 3.730.60 M 8< T Bank -Weldon Cafe Business Checking 2.676.58 Acct 9834771116 Total Cash 6,407.18 i~bP~~~~t,~C .~12~oPF,gc-c~ Liquor License 100,000.00 Total Personal Property 100,000.00 Real Estate 523 S. 19th Street, City of Harrisburg, Dauphin 40,000.00 County, Pennsylvania Total Real Estate 40.000.00 Total Receipts 146,407.18 Subsequent Princiual Receipts 05/28!2008 Prorated City Taxes 522.26 05/28/2008 Prorated School Taxes 106.18 Total Subsequent Principal Receipts 628 44 Total Adjustments and Subsequent Receipts 628.44 Total Receipts of Principal 147,o35.s2 A-1 Court Appointed Guardian Claire R Weldon DISBURSEMENTS OF PRINCIPAL General Disbursements 1% Transfer Tax 05/28/2008 transfer tax on sale of real estate 400.00 Advanced Podiatry 07/23/2008 service prior to qualifying for medical 14.89 assistance Belvedere Medical 07/23/2008 service prior to qualifying for medical 129.45 assistance Brown Optical 07/23/2008 service prior to qualifying for medical 100.00 assistance Central Medical Equip 07/23/2008 service prior to qualifying for medical 29.89 assistance Century 21 at the Helm 05/28/2008 Real Estate Commission 05/28/2008 Transaction Fee 2,800.00 05/28/2008 Liquor License Commission 125.00 7,000.00 400.00 14.89 129.45 100.00 29.89 C-1 ' Court Appointed Guardian Claire R Weldon DISBURSEMENTS OF PRINCIPAL Continued 9,925.00 Citv of Harrisburg 05/28/2008 Water Termination Fee 25 00 05/28/2008 2008 City Taxes . 509 92 05/28/2008 Utilities . 307.79 842.71 Cumberland Countv 01/09/2009 $15 for file inventory $15 to file to continue guardianship 30.00 30.00 Custer Faust 8 Associates 10/17/2008 preparation of 2007 corporate tax return 1 050 00 03/19/2009 preparation of 2008 individual tax return (Paid , . 330.00 to prevent late fee costs) 1,380.00 Dauphin Countv 05/28/2008 2009 County Tax 368.53 368.53 Ed Maxwell 08/15/2008 Final payment for accounting services rendered 2 676 58 08/15/2008 Final payment for accounting services rendered , . 123.42 2,800.00 Halifax National Bank 07/23/2008 Checks 812 8.12 C-2 ' Court Appointed Guardian Claire R Weldon DISBURSEMENTS OF PRINCIPAL Continued Holv Spirit Hospital 07/23/2008 service prior to qualifying for medical 953.76 assistance 953.76 Janice Youna 8 Eauene M Gingrich 05/28/2008 Court Approved Reimbursement for funds 11,206.63 deposited to keep business running inorder to keep license 11,206.63 Keystone Guardianship Services 05/28/2008 Guardianship fees as approved by the Court 2,730.21 05/28/2008 Guardianship fees as approved by the Court 3,111.67 5,841.88 Liquor Control Board 05/28/2008 License renewal fee 03/1/08 - 5123/08 126.58 126.58 Millennium Pharmacy 07/23/2008 Medicines 2,062.07 2,062.07 Myers Funeral Home 05/28/2008 Court Approved Purchase Forethought Life 4,995.00 Insurance Policy for prearranged burial expenses of Claire Weldon 4,995.00 C-3 ' Court Appointed Guardian Claire R Weldon DISBURSEMENTS OF PRINCIPAL Continued PA Dept. of Revenue 10/17/2008 2007 corporate PA tax return 7 608 00 03/19/2009 Final Tax due on 2008 Individual PA Income Tax , . 2,302.00 Return (Paid to prevent interest and penalties) 9,910.00 Penn Credit Corg 07/23/2008 service prior to qualifying for medical 119.00 assistance 119.00 Roof Repair Allowance 05/28/2008 3,000.00 3,000.00 Sarah Todd Memorial Home 05/28/2008 Amount paid from sale of real estate 11 090 44 05/28/2008 Amount paid from sale of liquor license and , . 39,929.30 equipment 08/26/2008 Proceeds from ING and balance in Corporate 6,407.18 Checking allocated to Sarah Todd on Recap 57,426.92 Tax Claim Bureau 05/28/2008 Delinquent Taxes 2,269.92 2,269.92 United States Treasury 11/12/2008 2007 Corporate Federal Tax Payment 14,517.00 14,517.00 C-4 Court Appointed Guardian Claire R Weldon DISBURSEMENTS OF PRINCIPAL Continued Yoffie 8~ Yoffie 05/28/2008 05/28/2008 05/28/2008 Deed Prep 150.00 Notary Fees 15.00 Attorney's Fee 635.00 800.00 Total General Disbursements TOTAL DISBURSEMENTS OF PRINCIPAL 129.257.35 129.257.35 C-5 Court Appointed Guardian Claire R Weldon PRINCIPAL BALANCE ON HAND Fiduciary # Units Description Acquisition Value Cash Final Tax/dissolution Reserve 17,778.27 Total Cash 17,778.27 17,778.27 PBOH-1 ' Court Appointed Guardian Claire R Weldon RECEIPTS OF INCOME Interest/Bank Sarah Todd Personal Care Account 10131 /2007 11/30/2007 2.69 12/31/2007 3.14 01 /31 /2008 4.50 02/29/2008 5.04 03/29/2008 4.30 04/30/2008 4.64 05/31/2008 5.05 06/30/2008 5.55 07/31 /2008 6.00 08/31/2008 6.43 09/30/2008 6.40 10/31 /2008 3.97 11 /30/2008 0.41 12/31/2008 2.23 1.24 61.59 TOTAL BANK INTEREST Other Income Sarah Todd Personal Care Account 10/01 /2007 10/31/2007 Social Security Benefit 11!03/2007 Social Security Benefit 12/28/2007 Social Security Benefit 01/01/2008 Social Security Benefit 02/29/2008 Social Security Benefit 03/31/2008 Social Security Benefit 04/30/2008 Social Security Benefit 05/30/2008 Social Security Benefit 2,730.34 545.00 545.00 545.00 557.00 557.00 557.00 557.00 557.00 61.59 G-1 Court Appointed Guardian Claire R Weldon RECEIPTS OF INCOME Continued 06/30/2008 Social Security Benefit 557.00 07/31/2008 Social Security Benefit 557.00 08/27/2008 Social Security Benefit 557.00 09/30/2008 Social Security Benefit 557.00 10/31/2008 Social Security Benefit 557.00 10/31/2008 Refund from SS for Personal Care 385.60 11/20/2008 Social Security Benefit 653.00 12/29/2008 Social Security Benefit 653.00 TOTAL RECEIPTS OF INCOME 11,626.94 11,626.94 11,688.53 G-2 Court Appointed Guardian Claire R Weldon DISBURSEMENTS -INCOME Exaense /INCOME Keystone Guardianshia Services 09/30/2008 Monthly Fees 1.000.00 1,000.00 Mobile Xray 12/29/2008 22.32 22.32 Sarah Todd Personal Care Account 11/30/2007 Paid to Sarah Todd toward care prior to 12/31/07 07/01/2008 SS paid toward Care for 1 @ 545.00 6@ 557.00 09/30/2008 Paid to Sarah Todd toward care 10/31/2008 Paid to Sarah Todd toward care 11/24/2008 Paid to Sarah Todd toward care 12/29/2008 Paid to Sarah Todd toward care TOTAL DISBURSEMENTS OF INCOME 3.826.17 3.887.00 267.42 416.61 416.61 416.61 9.230.42 10.252.74 I-1 Court Appointed Guardian Claire R Weldon INCOME BALANCE ON HAND # Units Description Cash Final Tax/dissolution Reserve Fiduciary Acquisition Value 1,435.79 Total Cash 1,435.79 1.435.79 IBOH-1 Court Appointed Guardian Claire R Weldon PROPOSED DISTRIBUTION -INCOME Fiduciary Acquisition Value T0: Pennsylvania Department of Welfare Estate Recovery 1,435.79 1,435.79 TOTAL 1,435.79 J-1 Court Appointed Guardian Claire R Weldon PROPOSED DISTRIBUTIONS TO BENEFICIARIES TO Belvedere Medical -Final Expenses for medical services Eugene M. 8 Janice Gingrich -Reimbursement for Funeral Service Expenses paid Keystone Guardianship Services -Final Expenses and costs Latsha Davis Yohe 8 McKenna, P.C. -Legal Fees Myers Funeral Home -Balance Due on Funeral Service Expenses Pennsylvania Department of Welfare Estate Recovery -All remain principal cash after payment of expenses Sarah A. Todd Memorial Home -Nursing Home cost Fiduciary Acquisition Value 162.73 477.25 1,514.46 1,000.00 477.25 1,532.62 12,613.96 17,778.27 Total 17,778.27 PD-1 GUARDIANSHIP OF INCAPACITATED PERSON COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF Claire R. Weldon AN INCAPACITATED PERSON ACCOUNT OF Keystone Guardianship Services ,GUARDIAN No. 21-07-0606 ~ N d ~a _.. - , I --•r - 7 ~J ~n _ _ PETITION FOR ADJUDICATION / STATEMENT OF PROPOSED DISTRIBUTION . ' rr' can r PURSUANT TO Pa. O.C. Rule 6 9 - -. -~ - . -; =: ~ :~ -- ' .~~ -: ~ ---+ . c~ r~ ~ This form may be used in all cases involving the Audit of the Account of a Guardian of the Estate ~ of an incapacitated person. If space is insufficient, riders may be attached. INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM. Name of Counsel: Steven M. Montresor Supreme Court I.D. No.: Name of Law Firm: Latsha Davis Yohe & McKenna P.C. Address: 1700 Bent Creek Blvd Suite 140 Mechanicsburg PA 17050 Telephone: 717-620-2424 Fax: 717-620-2444 Form oc-o3 rev. /0.13.06 Page 1 of 6 Estate Claire R. Weldon An Incapacitated Person 1. Name(s) and address(es) of Petitioner(s): Petitioner r~~ume: Keystone Guardianship Services Addresr 512 Market St, Suite 2 Millersburg, PA 17061 Petitioner: 2. Date of Adjudication of Incapacity: August 6 2007 Date of Appointment as Guardian: August 6.2007 Attach copy(ies) of Decree(s). * Attachment "A" 3. A. Explain the reason for filing this Account (if incapacitated person has died, state date of death, name and address of personal representative and of his or her counsel and attach a Short Certificate if available. If incapacitated person has been adjudged to have regained capacity, state date of Decree. If Account is filed for any other reason, state address of incapacitated person): Date of Death - December 5, 2008 A Last Will & Testament for Claire R. Weldon was not located A list of closest living relatives as known by the Guardian Janice Young Gingrich Daughter 6 East Beale Avenue Enola PA 17025 Roy Willoughby Son 430 Jennifer Drive New Cumberland, PA 17070 B. Have prior accountings been filed? .................................................................. ^Yes ~No If yes, state accounting periods and dates of adjudication. 4. Describe in detail any questions requiring adjudication and state the position of the Petitioner(s) as to each question: Form OC-03 rec. 10.13.06 Page 2 Of 6 Estate Claire R. Weldon An Incapacitated Person 5. Written Notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has been or will be given to all parties in interest listed in item 6 below. In addition, notice of any questions requiring adjudication as discussed in item 4 above has been or will be given to all persons affected thereby. A. If Notice has been given, attach a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice. B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice shall be submitted at the Audit together with a statement executed by a Petitioner or counsel certifying that such Notice has been given. C. If any such party in interest is not sui juris (e. g., minors or incapacitated persons), Notice of the Audit has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 5.2. List all parties of whom Petitioner has notice or knowledge, having or claiming any interest in the estate, including the incapacitated person's heirs at law. This list shall: A. State each party's relationship to the incapacitated person and the nature of each party's interest(s): Name and Addre.c.c of Fnrh Pnrh, t~ Inm.o~~ D,.i..,:.._..i - - - - - -..._. _... . ~.~..,,,..,,« Sarah A. Todd Memorial Home u„u ~~n,me.eta r u.e enterest Nursing Home Caring for Claire R. Weldon $12 613.96 100 West South Street , Carlisle PA 17013 Belvedere Medical Corporation Medical provider $ 144.13 850 Walnut Bottom Road Carlisle, PA 17013-3698 Myers Funeral Home Funeral Expenses $ 477.25 37 E. main Street Mechanicsbur , Pa 17055 Keystone Guardianship Services Fees & Costs advanced to file reports and $ 1,514.46 512 Market Street meet tax dead lines Millersbur , Pa 17061 Latsha Davis Yohe & McKenna, P.C. Fees regarding final Guardianship $ 1,000.00 Steven Montresor Filings 1700 Bent Creek Blvd, Suite 140 Mechanicsbur PA 17050 Eugene M. & Janice Gingrich Reimbursement for Funeral Expenses paid $ 477.25 6 East Beale Avenue Enola PA 17052 Department of Public Welfare, T.P.L. Casualty Unit - Medical assistance Remaining Cash Estate Recovery Program (Principal) P O Box 8486 $ 1,532.62 Harrisbur , PA 17105-8486 Form OC-03 rev. 10. 13.06 Page 3 of 6 Estate Claire R. Weldon An Incapacitated Person B. Identify each party who is not sui juris (e.g., minors or incapacitated persons). For each such party, give date of birth, the name of each Guardian and how each Guardian was appointed. If no Guardian has been appointed, identify the next of kin of such party, giving the name, address and relationship of each. 7. Is the Court being asked to direct the filing of a Schedule of Distribution? ............................................................................... ®Yes C No Form OC-03 rev. 10.13.06 Page 4 of 6 Estate Claire R. Weldon An Incapacitated Person Wherefore, your Petitioner asks that distribution be awarded to the parties entitled and suggests that the distributive shares of income and principal (residuary shares being stated in proportions, not amounts) areas follows: A. Income: Proj~a'cr! Dir7ribu/rr(~) Amount/Psopa7ion Dcnartment of Public Welfare I^state Recovery $1.435.79 B. Principal: Pnpard DLXnbutre(cJ Sarah A. 'Todd Memorial Home Belvedere Medical Corporation Mvcrs Funeral Home Keystone Guardianship Service, l,atsha Davis Yohe & McKenna Eugene M. Janice Gingrich Department of Public Welfare Amami/Proportiar Nursing Home Caring for C R $ 12.613.96 Weldon Medical provider $ 162.73 Funeral Expenses ,~ 477.25 Pees & Costs advanced to file reports $ 1.514.46 and meet tax dead lines Fees re final Guardianship filing_e $ 1.000.00 Reimbursement for Funeral $ 477.25 Expenses Medical Assistance $ 1.532.62 Submitted By: Keystone Guardianship Services ~~~~i1~~ ~~i~~~C~.! ~~ Name of Petitioner: Constance E. Stoneroad C~O~Sr-~N~IG" ,~ ~fO~V~~U~4 !~ Name of Petitioner: rLnn oc-~~j>z,~. ,o.lj.o~ Page 5 of 6 Estate Claire R. Weldon An Incapacitated Person Verification of Petitioner (Verification must be by at least one petitioner) The undersigned hereby verifies that she, Constance E. Stoneroad, is the President of the above- named Keystone Guardianship Services, NPC. and that the facts set forth in the foregoing Petition for Adjudication /Statement of Proposed Distribution which are within the personal knowledge of the Petitioner are true, and as to facts based on the information of others, the Petitioner, after diligent inquiry, believes them to be true; and that any false statements herein are made subject to the penalties of 18 Pa. C.S. ~ 4904 (relating to unsworn falsification to authorities). Keystone Guardianship Services ~~~~ ~i<.~~~ Constance E. Stoneroad, President Certification of Counsel The undersigned counsel hereby certifies that the foregoing Petition for Adjudication / Statement of Proposed Distribution is a true and accurate reproduction of the form Petition authorized by the Supreme Court, and that no changes to the form have been made beyond the responses herein. Signature of Counsel for Petitioner F~oc~j,~t.. ~o.r3.o( Page 6 of 6 IN RE: : IN THE COURT OF COMMON PLEAS OF :CUMBERLAND COUNTY, PENNSYLVANIA CLAIRE R. WELDON,AN ALLEGED :ORPHANS' COURT DIVISION An Alleged Incapacitated . Person : 21-07-0606 CERTIFICATE OF SERVICE I, Constance E. Stoneroad of Keystone Guardianship Services, Court Appointed Guardian of the estate of Claire R. Weldon, do hereby certify that on March 2~ 2009, I caused notice of the filing of the Guardian's Account of the Court Appointed Guardianship of the Estate for Claire R. Weldon to be served on the parties in interest, as follows: U.S. FIRST CERTIFIED MAIL RETURN RECEIPT REQUESTED Date: March 2~, 2009 Constance E. Stoneroad Keystone Guardianship Services 512 Market Street Suite " 2" Millersburg, Pa 17061 717-692-5173 Estate of Claire R. Weldon ,An Incapacitated Person CERTIFICATE OF SERVICE I, Constance E. Stoneroad, President of Keystone Guardianship Services, Court Appointed Guardian of the estate of Claire R. Weldon, do hereby certify that on March 24, 2009, I caused notice of the filing of the Guardian's Account of the Court Appointed Guardianship of the Estate for Claire R. Weldon to be served on the parties in interest, as follows: U.S. FIRST CERTIFIED MAIL RETURN RECEIPT REOUESTED Janice Young Gingrich 6 East Beale avenue Enola Ply 17025 Roy Willoughby 430 Jennifer Drive New Cumberland, P~1 17070 Sarah ~1. Todd Memorial Home 100 West South Street Carlisle Pr1 17013 Belvedere Medical Corporation 850 Walnut Bottom Road Carlisle, P ~ 17013-3698 Myers Funeral Home 37 E. main Street Mechanicsburg, Pa 17055 Keystone Guardianship Services 5121~1arket Street 1~lillersburg, Pa 17061 Latsha Davis Yohe & McKenna, P.C. Steven Montresor 1700 Bent Creek Blvd, Suite 140 Mechanicsburg P ~ 17050 Department of Public Welfare, T.P.L. Casualty Unit -Estate Recovery Program P O Box 8486 Harrisburg, P~1 17105-8486 Date: March 24, 2009 ~~ ~~~~ Constance E. Stoneroad Keystone Guardianship Services 512 Market Street Suite "11" 1~Iillersburg, Pa 17061 717-692-5173