Loading...
HomeMy WebLinkAbout04-30-09 ANNUAL REPORT OF r.~ GUARDIAN OF THE ESTATE n ~ ° ,:~ -, ~ ~r, . m h ST ~ COURT OF COMMON PLEAS OF S C!~ c ~ ;-; ~; - s~ PENNSYLVANIA C u.~m berla nol COUNTY `~' ~ ~` ~;` ~ r , ORPHANS' COURT DIVISION = ~~ 9 ~ ~_• ~ ! ,_. rr Estate of ___~~~ ~ e S I V , ~1~Q.S I~ , an Incapacitated Person lvo.o2UU~ ' b30~ I. INTRODUCTION f P_nrl P iv ~{ ~ 1 /~f . 1 rQ S k ,was appointed v , Plenary ^ Limited Guardian of the Estate by Decree of ___ 1~eV L ~Q ~ . 1 ~sS , J., dated ~ d A. This is the Annual Report for the period from ~~A i~ 1 ~~~ to rna.l 1 , `Z~9 (the "Report Period"); or' ^ B. This is the Final Report for the period from to for the following reason: (the "Report Period"), and is filed 1. 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-02 rev. 10.13.06 Page 1 of 5 ~' ',. Estate of C h Q,r l e s N • i 1~ S ~ , 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, 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? $ 221 ~, l C~4 ,°o $ Z2~ ~ ~4 .vo $ 3~'~ i.~ E. What are the balances remaining at the end of the Report Period? 1. Principal $ 2. Income $ 4~ 3. Total of Principal and Income ~' $ ~ , r 13~ • 'tom 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 accounts, etc.): See ~.~~c~Q~ 2. Have there been any expenditure 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? ........ 0 Yes O No Foy c-oz rev. fo.l3.06 Page 2 of 5 L ~l', ~iE,+3 ~'~1uN~ ~ ti _ ~ ~~~ _ ~- .. ~~ ~ ~ ~ y ` ~ ~ Y ~h V 1,`` y ~~ ~ ~r ~ ~ i ~~ Y -~ r ~, ~ _ -~~,~~~ ~ 3~ 1G5~, ~~,'y~~ ry ~ i ~~ 7 (- C~lr ~- ~ (~ - ~ V ~ ~{:l UJ J V ~ ~ f ~ ~ ~ ~ ~ ~ J i7:v y ~~~ Sep -~ 2 ~~~.., ~tv ~: '~t ~ ~ , ~t ~ L ~~~ ~ ~~ {-l ~ I . ~,4, Ue~, .~ '~6~`~L ~` ~ ~ v~ 1 s ~n,~ 'v~ Z~~2~ ~~ y.~~ 4U~ rrC' ~ V ~~~ ~ ~~ J ~~ -~ ~J ~;~ ''1~S'lI ~~ ~t~L ~v ~ G ~ '9~`~ ~ ~ ~ '^' ~ ~ ~,J `~ ~ ~ ~ ~ ~~ ((~~ L~ ~U' ~'~uy~j 1 ~• .~ ~ 'L Cif S ~' ~ o ~"f ~` ~~ ~ ~~ L i ~~ ~ r..~ ~ J r!a,~CE. ~~ ~ ~ ~ 9 ~~ ~ ~:~-~ C,~ ~~ ~ 2~r%~ V' i;J l~ ee ~~ ~. ~, j c~G. ~~'1 ~~.~ ANNUAL REPORT OF GUARDIAN OF THE PERSON {7 N r~ _ - ~ ~ ~ ' [ -gym w ` w<~ tr o - - ~:~ ~~ ~ ,, ~ - ~~ _ - . ., = --~ .. -~ --- rn COURT OF COMMON PLEAS OF rn b-er I COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of ~~ ~ ~ ~ 'e.S ~ ~ J IrCj, S K , an Incapacitated Person Noo~O~Fs-03~°I I. INTRODUCTION ~~ G .r ~ p J r'Gl Sk ~ ~~a YU~~ ~} ~ ~ (7,1 S ~~ ,was appointed ®Plen ^Limited Guardian of the Person by Decree of K~ V ! h A ~ I~e~ . J •, dated ~ ® A. This is the nnual Report for the period om ~~ ~ ~~~ to ~AY ~ 2~ (the "Rep Period"); or ^ B. This is the Final Report for the period from to (the "Report Period"), 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 For a Final Report, omit Sections II through IV. Form G-03 rev. !0.!3.06 J., dated Page 1 of 4 Estate of ___~~,~~ ~ . T-rl~ ~ , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person:~_ Date of Birth: SC,~~ Z Z ~ l9 Z~} III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: ~o~deN L~v~N~ Ce,~~er ~~ C;r ~as~ Ra. C,~a~p 1~'~li ~ ('a. 11n11 B. The Incapacitated Person's residence is: ^ own home /apartment nursing home ^ boarding home /personal care home ^ Guardian's home /apartment ^ hospital or medical facility ^ relative's home (name, relationship and address) ^ other: C. The Incapacitated Person has been in the present residence since ~ ~ . ~ 2 ~ Q''~ 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 C ~ G r l ~ S ~1. 1 ~Q S l~ , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: Go i~eN ~,.ivi,~c~ CQ~ ~Qr ~tk ~,r~u~~ R~. IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: Q.ar~~~~- s o,~s `J `i~~e ~t~Ve~eS i~u~~ ~Trau-.„-~ ~ ~e ~,~ Ga1- o,.~ fJov., 200 `7 B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: ~4 h~. ~v~ L~,,,9 Gyre ~ 17~~~~r cage l~l os p ~ ~~ (;~ re V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: continue ©be modified ^ be terminated Form G-03 rev. /0. /3.06 Page 3 of 4 Estate of C h~ r Lis N- ~Ti~Q S~~ , an Incapacitated Person The reasons for the foregoing opinion are: B. During the past year, the Guardian of the Person has visited the Incapacitated Person times with the average visit lasting hours, minutes. ~b 2 -~iw.e~ wee41y - ~ h.c'~ 11ver,~gL gee ~1~>>~ ~(?1~aw~ C~11 The report of a social service organisation employed by the Guardian to oversee and ~.4 ~ ~Y . 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 convect to the best of my lrnowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. iMgy ~ 200 Date Signature of Guardian of the Person ~ Pea~~ P. Trask ~~ ~ gel ~, Try-s1~ Name ojGuardian ojthe Person (type or print) I D70 ~~e~e~s (~c~, Address Ala- ~C ~I,~uedu ; i?A. _1 ~ ~~ ~ City. State. Zip C7r~) °I 3 ~- ~~S~ ~yyrge ~~ Telephone Form G-03 rev. 10.13.06 Page 4 of 4