HomeMy WebLinkAbout09-02-09ANNUAL REPORT OF
GUARDIAN OF THE ESTATE
COURT OF COMMON PLEAS OF
Cumberland COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of Nicole Hlavac
No. 06-0608
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an Incapacitated Person
I. INTRODUCTION
Rose and Dana Hlavac ,was appointed
Q Plenary ^ Limited Guardian of the Estate by Decree of J. Oler J
dated 8/31/06
^ A. This is the Annual Report for the period from September 1 2008
to August 31 2009 (the "Report 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:
Name of Personal Representative:
2. The Guardianship was terminated by the Court by Decree of
J., dated
Form G-OZ rev. !0.13.06
Page l of 5
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Estate of Nicole Hlavac
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
$ 0.00
$ 2,238.02
$ 5,625.31
$ 7,199.55
E. What are the balances remaining at the end of the Report
Period?
1. Principal $
2. Income $ 663.78
3. Total of Principal and Income $
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.):
Pennsylvania State Employee Credit Union
663.78
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
Estate of Nicole Hlavac , An Incapacitated Person
b. List purpose and amount of expenditures:
See attached cash flow statement for details $
The principle from the end of last year was used to ;~
to help pay for add new grab baz, seat, hand held $
shower and heat fan to the bathroom Niki uses ~
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.):
SSI
PA SSP
Interest /Dividends
Total income received during Report Period:
$ 328.80
$ 5,293.40
$ 3.11
$ 5,625.31
Form C-02 rev. 10.!3.06 Page 3 of 5
Estate of Nicole Hlavac , An Incapacitated Person
2. How is income currently invested? (Please
specify, e.g., restricted bank accounts, client
care account, etc.):
Pennsylvania State Employee Credit Union
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., clothing, nursing home, medicine, support, etc.):
See attached cash flow statement -Total $7,199.55
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.)
None
E. Guardian's Commissions
List amounts of compensation paid as Guardian's commission
and state how amount was determined:
Amount Method of Determination
None
Court
Approval Obtained
Yes ~ No
Yes ~No
Form G-02 rev. IQ.13.06 Page 4 of 5
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