HomeMy WebLinkAbout12-10-09t
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GUARDIAN'S INVENTORY
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLV~-I~TIA
ORPHANS' COURT DIVISION
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~ ~ Inc~acitated son
Estate of MIRIAM EVELYN ZUERNER
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No. 2009-701 -~ ~ r? ~'' ~'- A ' , ~,
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1. Real Estate: (Location, by whom occupied and rental
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Estimaf~ Value: o 4
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terms, if applicable) ""'~
NONE KNOWN
Sub-Total for Real Estate: o.oo
2. Personal Property: Estimated Value:
Resident Trust Fund Balance held at Green Ridge Village
Balance as of statement date 10/14/09: 733.37
The fcaility is Rep Payee for her sole source of income-Social Security
3. Jointly Held Property: Estimated Value:
(Set forth real and personal property owned by the Incapacitated Person JOINTLY with arty
other person(s). State whether held as tenants by the entireties; if not, whether the right of
survivorship exists.)
Jointly Held Property
Form G-04 rev. 10.13.06 Page 1 of 2
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Estate of MIRIAM EVELYN ZUERNER
i~ an Incapacitated Person
f ~ a Minor
4. Anticipated Assets: Estimated Value:
(Set forth property of any kind expected to be acquired hereafter, together with
anticipated date of acquisition.)
P'"O~~' Antictpated Date
ofAcquisition
Sub-Total for Personal Estate: 733.37
(Attach additional sheets if necessary)
TOTAL OF ITEMS 1, 2, 3, and 4: ............................. 733.37
Commonwealth of Pennsylvania
ss.
County of CUMBERLAND
GOOD NEWS CONSULTING, Inc.
says that the foregoing is a full,
Guardian
true and complete Inventory of the Estate of MIRIAM EVELYN ZUERNER
the aforesaid Incapacitated Person or Minor; and that all of the information set forth herein is
true and correct to the best of the Guardian's knowledge and belief.
I verify that the statements made in this) ~
Inventory are true and correct. I under- )
stand that false statements herein are )
made subject to the penalties of )
18 Pa.C.S. § 4904 relating to unsworn )
falsification to authorities. )
Attorney for Guardian: Douglas H. Gent
Supreme Court I.D. No.: 29964
Address: 1157 Eichelberger Street, Suite 4
Hanover, PA 17331
Telephone: 1717) 632-4040
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GOOD NEWS C NSULTING, Inc.
Guardian
Farm G-04 rev. 10.13.06
Page 2 of 2
SWAIM HEALTH CENTER
210 BIG SPRING ROAD
NEWVILLE PA 17241-948fi
M~I~IA~ ~~~'~~r
c/o ZUERNER, MIRIAM E
210 BIG SPRING ROAD
NEWVILLE PA 17241
STATEMENT OF TRUST ACCOUNTS
Statement Date: 10/14/2009
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Account Number: fi150fiGRV
Trust Accoun t: GREEN RIDGE VILLAGE
Balance Forward:
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07/
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08/2009 DEP Deposit SSA 07/09 W~~
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45
00
07/31/2009 INT INTEREST DISTRIBUTION .
0
05
08/11/2009 DEP Dep SSA 8.09 .
45
00
08/31!2009 INT INTEREST DISTRIBUTION .
0
06
09/10/2009 DEP Dep SSA 9.09 .
45
00
09/30/2009 INT INTEREST DISTRIBUTION .
0
07
10/12/2009 ADJ REV 10.12.09 deposit .
10/12/2009 DEP SSA 10/09 45.00
10/13/2009
DEP
Dep SSA 10.09 45.00
4
5.00
Account Totals: 225.18 45.00
t ____. __ .__.._
__._ _ __
ance onward Deposits Interest Withdrawals Adjustments Ending Balance
~ 553.19 ~ 225.00 0.18
______... 0 00 (45.00) 733.37 i
553.19
598.19
598.24
643.24
643.30
688.30
688.37
643.37
688.37
733.37
SWAIM HEALTH CENTER: MIRIAM ZUERNER fi150fiGRV