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HomeMy WebLinkAbout04-14-09JAN L. BROWN 8z ASSOCIATES ATTORNEYS AND COUNSELORS AT LAW JAN L. BROWN, ESQUIRE` JACQUELINE A. KELLY, ESQUIRE 'ADMIT'TED IN PA AND DISTRICT OF COLUMBIA OLDE ENGLISH GAP S45 .SIR THOMAS COURT SUITE 12 HARRISBURG, PA 17109 EMAIL: jlbassoc@verizon.net www.janbrownlaw.com TELEPHONE (717) 541-5550 FACSIMILE (717) 541-9223 April 13, 2009 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Edna S. Chase, deceased No. 21-06-1003 To Whom It May Concern: BRENDA F KEPHART, LEGAL ASSISTANT PAULA K. WHITE, LEGAL ASSISTANT JUDITH A. EBERSOLE, ADMINISTRATIVE ASSISTANT Enclosed for filing are an original and one copy of the Annual Report of Guardian of the Person and Annual Report of Guardian of the Estate for the Estate of Edna S. Chase, an Incapacitated Person. Edna S. Chase passed away on February 15, 2009. Also enclosed is a check in the amount of $15.00 for the filing fee. Please return a time stamped copy of these documents for my file in the envelope provided. If you have any questions, please feel free to contact my office. Thank you for your time and attention to this matter. Sincerely, J cqueline A. Kelly JAK/cma Enclosures r ~, ANNUAL REPORT OF GUARDIAN OF THE ESTATE 1COUR~ OF gOMMON PLEAS OF t~y`-l~ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of S. ~s~- No. o~ ~ -O(o "" l~~ >~s, r~u~ denary ~ Limited Guardian of the Estate by Decree of dated l -- ~ ~ -~ . appointed J., ® A. This is the Annual Report for the period from to (the "Report Period")~ or ~B. This is the Final Report for the period from Q,..,.,~Q„- O ~g to ~ v- c..c. l S ~ (the "Report Penod"), and is filed for the following reason: The death of the Incapacitated Perso .Date of death: ~ , a.~~ Name of Personal Representative: ,~,~~ 2. The Guardianship was terminated by the Court by Decree of J., dated I. INTRODUCTI Form G-OZ rev. !0.13.06 N n o _:~~ ~ ~ f ~ ~, L- ' . ~ - 7-F !" -- -- r ; j ~;~~ .~-- ,' } t~ - -fl ; , , l J '~ ~ ~ ~ { _Y~: ^~ -r _.. N w an Incapacitated Person Page 1 of 5 V~-j ~' Estate of (~t~~ ~ , 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, otherwise, ending balance from last Report.) C. What is the total amount of income earned during the Report Period? D. What is the total amount of income and principal spent for all purposes during the Report Period? An Incapacitated Person $ ~-L 5 ~ p~D, Gb $ ~? ~, gr~, c~ $ S ~ ,D $ ~a, R7.~ E. What are the balances remaining at the end of the Report Period? 1. Principal $ S~~ ~(o , GD 2. Income $ ~~ Sa~.~ 3. Total of Principal and Income $ ~, 0.00 III. ADDITIONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principal 1. How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accou` nts, etc.): v ti~w~~ ~ ~~ ~~ ~w~~ ~~. ~ 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? ........ Yes ^ No Form G-02 rev. 10.13.06 Page 2 of 5 C' Estate of b. List purpose and amount of expenditures: An Incapacitated Person ~ $ ~.o~ ~ $ G, ~ ~ .~.~( iJ ~r..1Y1.5 C~~r $ 1 [G.ar~ ~.~ iG;~ c~.~ ,r-.~, ,,,,~~ ~~1 ~ ~~t,~, ~ ~b~ svr~ . as c. Was Court approval received prior to expending the principal? ....................... :Yes ^ 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 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): ~~~ $ i ~.4~ ae --s: a ~ $ l ~ moo _ ab Total income received during Report Period Form G-02 rev. 10.13.06 $ ~ 5 c7 . o®. Page 3 of 5 Estate of L~ S. 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person (e g clothin nursin home med' rt An Incapacitated Person •, g, g acme, suppo ,etc.). ~~~~ ~ `1~~~V~~O ~~,~~ 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.) E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: ~-nount Method of Determination Court Approval Obtained Yes ~ No Yes ©No Form G-OZ rev. 10. /3.06 Page 4 of 5 Estate of C.~ F. Counsel Fee An Incapacitated Person List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amozznt Court Approval Obtained Yes ~ No ~ Yes Q 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 a penalties of 18 Pa.C.S. § 4904 relative to uns orn f lsification to authorities. ~ a lJnte Signn re of Gun diwi of the Estnte Nnnee of Gtrarclirrn of the Estnte (type or print) ~r t t~' Address City, Stnle. Zip ~ ~~-~~a- ~~~ Telephone Fonn G-03 rev. 10.13.06 Page 5 of 5 E ANNUAL REPORT OF GUARDIAN OF THE PERSON COURT OF COMMON PLEAS OF Cumberland COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of Edna S. Chase an Incapacitated Person No. 21-06-1003 n o c ~ -, - ' - -U C i - L ~ ~ ~ ~ i=- ~ " ~j C , -- ~ . ~ l ~ ~. ~ r .'+~1 ~' _..... ... I. INTRODUCTION _~ r ~ ~-r~-,' ~ `.: ` ,t Deborah McHugh Y~was appoj~ed -~ w Plenary Limited Guardian of the Person by Decree of Judge Guido J ' dated 1-17-2007 0 A. This is the Annual Report for the period from to (the "Report Period"); or B. This is the Final Report for the period from January 1 2009 to February 15 ~ 2009 (the "Report Period"), and is filed for the following reason: ] . The death of the Incapacitated Person. Date of death: February 15, 2009 2. The Guardianship was terminated by the Court by Decree of For a Final Report, omit Sections II through IV. Form e-03 rev. 10.!3.06 J., dated Page l of 4 CT Estate of Edna S. Chase II. PERSONAL DATA an Incapacitated Person Age of the Incapacitated Person: Date of Birth: III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: B. The Incapacitated Person's residence is: own home /apartment nursing home boarding home /personal care home Q Guardian's home /apartment hospital or medical facility 0 relative's home (name, relationship and address) other: C. The Incapacitated Person has been in the present residence since If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev. 10.13.06 Page 2 of 4 Estate of Edna S. Chase an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: Q continue be modified be terminated Form G-03 rev. /0.!3.06 Page 3 of 4 Estate of Edna S. Chase The reasons for the foregoing opinion are: death of the incapacitated person an Incapacitated Person B. During the past ar~uardian of the Person has visited the Incapac' ated Person ~~ 1 j ~'j1~ ~} times ith the average visit lasting ~~ hours, v 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 correct to the best of my knowledge, information and belief; and that this Verification is subject t e pe yes o a C.S . § 4 4 relative to uns orn f lsification to authorities. Date Signature of Guardian of the Person Deborah McHugh Name of Guardian of the Person (type or print) 3609 Weymouth Drive Address Mechanicsburg, PA 17055 Ctty. State, Zip 717-732-7253 Telephone Form G-O3 rev. !0.lJ.06 Page 4 of 4