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Home My WebLink About04-0066REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP HILL, PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717-730-7366 WEBSlTE: ReagerAdlerPC.com THEODORE A. ADLER + DAVID W. REAGER CHARLES E. ZALESKI LINUS E. FENICLE DEBRA DENISON CANTOR Wdter's E-Mail Address: jclough@epix.net THOMAS O. WILLIAMS SUSAN H. CONFAIR JOANNE HARRISON CLOUGH SUSAN J. SMITH + Certified Civil Trial Specialist February 9, 2004 VIA FACSIMILE (717) 240-6460 and First Class Mail The Honorable Edward G. Guido Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Brooke Lynn Sariano Orphan's Court Division Docket No.: 2004-066 · Request to Reschedule Hearing on Petition for Appointment of Plenary Guardian of the Person and Estate of Brooke Lynn Sariano Our File No.: 03-1012 Dear Judge Guido: Please be advised that we have filed a Petition on behalf of the proposed guardian, Deborah Cornter, the natural mother of Brooke Lynn Sariano, requesting the Court to appoint her as plenary guardian of the person and estate of Brooke Lynn Sariano. Ms. Sariano is 33 years old and severely disabled. She lives at a group home run by United Cerebral Palsy. Your secretary had contacted our office last week to ask if Brooke Sariano had independent legal counsel. Please be advised that Ms. Sariano does not have independent legal counsel. Ms. Sariano suffers from severe cerebral palsy, with marked mental and physical handicaps. She is unable to verbalize her needs or care for herself, and needs total assistance currently available in the group home. Ms. Sariano's assets are limited to Social Security benefits she receives in the amount of $591.40 per month. 70% of this monthly money is paid to United Cerebral Palsy, and 30% of the balance of the monies are used for clothing and miscellaneous expenses. The current balance of Ms. Sariano's miscellaneous expense account is approximately $350. Pursuant to 20 Pa.C.S.A § 5511 (a), Ms. Sariano has "the right to request the appointment of counsel, and have counsel appointed if the Court deems it appropriate, and the right to have such counsel paid for if it cannot be afforded." Subparagraph (c) further provides "If the alleged incapacitated person is unable to pay for counsel or for the evaluation, the Court shall order the County to pay these costs. These costs shall be reimbursed by the Commonwealth in the following fiscal year." It was Petitioner's sincere hope that Orphan's Court would not need to exhaust the balance of Ms. Sariano's monies in her minimal savings account (which are used to meet her daily needs) to pay for Judge Edward E. Guido Page 2 February 9, 2004 Court appointed counsel in this matter. I am enclosing a copy of a proposed Order rescheduling the hearing on the Petition for Guardianship from February 9, 2004 at 3:00 p.m. to a future date. I am also enclosing a proposed Order directing the appointment of legal counsel for Brooke Lynn Sariano and request that, pursuant to the statute, the County/Commonwealth bear the independent counsel expense. JHC/drb Enclosures Thank you for your attention to this important matter. ~inI~el~' k~ Joanne Harrison''~d''-'x~x'~ ~Ct cc: Deborah Cornter Conner, Rich Associates Internal Medicine 207 House Avenue, Suite 101. Camp ~'11, PA 17011 phone 717-761-8331o fax 717-761-5032 November 13, 2003 Debra Denison Cantor Reager & Adler, PC Attorneys and Counselors at Law 2331 Market Street Camp Hill, PA 17011-4626 RE: Brooke Sariano D.O.B.: 1/11/70 S.S.#: 206-56-2988 Dear Ms. Cantor: I've been asked to express an opinion regarding Brooke Sariano. There are several issues that I was asked to address including the patients's primary diagnosis, the patient's physical and mental limitations, and to confirm whether or not she is able to handle financial or personal decisions on her own behalf. Brooke is a pleasant but very unfortunate woman with severe cerebral palsy with marked mental and physical handicaps. She is unable to verbalize her needs. She is unable to care for herself and in fact she needs total assistance currently living in a group home. She is totally unable to manage any of her financial or personal, concerns. Therefore from a medical viewpoint it is imperative that she has a guardian to look out for Brooke's financial and medical affairs. Brooke also has a history of a seizure disorder for which she is on an anti-seizure medication. She also has a history of peptic ulcer disease with a GI bleed for which she's on a medication to decrease the acid production in her stomach. I hope this provides you with all the necessary information that you may need. If not, please feel free to contact me. Sincerely, J h A. Torchia, JAT/tls #400517 Kenneth ~ Conner, MD James F Rich, MD Joseph A. Torchia, MD Robed Kusztos, ~D Claudette G. JaHo, MD Jasna ~ Bait/b, MD DebraA. Fo~e~ CRNP M.D. Member, Heritage Medical Group IN RE: BROOKE LYNN SARIANO : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO.: 2004-066 : : ORPHANS COURT DIVISION ORDER FOR APPOINTMENT FOR INDEPENDENT COUNSEL FOR BROOKE LYNN SARIANQ AND NOW this ~jl~ day of February, 2004 this Court hereby appoint__ ~/~[~t~~, Esquire, as Independent Counsel for Brooke Lynn Sariano, to represent her interests in the legal action commenced by her mother, Deborah Cornter, petitioning the Court for appointment of a Plenary Guardian for the Person and Estate of Brooke Lynn Sariano. Pursuant to 20 Pa.C.S.A. §5511, the County and Commonwealth of Pennsylvania shah bear the cost for appointment of independent counsel. Edward E. Guido, Judge IN RE: BROOKE LYNN SARIANO : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO.: 2004-066 : : ORPHANS COURT DIVISION AND NOW, this ~'~ ORDE~R day o£February, 2004, the hearing on the Petition for Appointment of Plenary Guardian for the Person and Estate otBrooke Lynn Sariano previously scheduled for February 9, 2004 at 3:00 p.m. shall be rescheduled to -~__~lay of Edward E. Guido, Judge IN RE: BROOKE LYNN SARIANO IN THE COURT OF COMMON PLEA~.~F 2 CUMBERLAND COUNTY, PENNSYLVANIA NO.: ~!-' ~4-~ ORPHANS COURT DIVISION TO: Brooke Lynn Sariano 340 Fulton Street Enola, Pennsylvania 17025 IMPORTANT NOTICE CITATION WITH NOTICE A petition has been filed with the Court to have you declared an Incapacitated Person. If the Court finds you to be an Incapacitated Person, your rights will be effected, including your right to manage money and to make decisions. A copy of the petition which has been filed by Deborah Comter is attached. You are hereby ordered to appear at a hearing to be held in Court Room No..~ Cumberl~tnd. ~ou.nt~ J2o_urthou,s~,~One Courthouse. Squa~re, Carlisle, Pennsylvania, 17013, on ff/Qt~/~/~ )¢, p~ ~:l~t, lM~7 7 , 2004, at.J~, OO~n. to tell the Court why it should not find you to be an fncapacitated Person and appoint a Guardian to act on your behalfi To be an incapacitated Person means that you are not able to receive and effectively evaluate information and communicate decisions and that you are unable to manage your money and/or property, or to make necessary decisions about where you will live, what medical care you will get, or how your money will be spent. At the hearing, you will have the right to appear, to be represented by an attorney, and to request a jury trial. If you do not have an attorney, you have the right to request the Court to appoint an attorney to represent you and to have the attorney's fees paid for you if you cannot afford to pay them yourself. You also have the right to request that the Court order an independent evaluation as to your alleged incapacity. If the Court decides that you are in Incapacitated Person, the Court may appoint a Guardian for you, based on the nature of any condition or disability and your capacity to communicate and make decisions. The Guardian will be of your person and/or your money and other property and will have either limited or full powers to act for you. If the Court finds you are totally incapacitated, your legal rights will be effected and you will not be able to make a contract or gift of your money to other property. If the Court finds that you are partially incapacitated, your legal rights will also be limited as directed by the Court. If you do not appear at the hearing (either in person or by an attorney representing you) the Court will still hold the hearing in your absence and may appoint the Guardian requested. BY: Clerk, Orphans' Court Division Cumberland County, Carlisle, Pa My Commission Expires REAGER & ADLER, P.C. BY: DEBRA DENISON CANTOR, ESQUIRE Attorney I.D. No. 66378 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 Attorney for Petitioner IN RE: BROOKE LYNN SARIANO : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO.: : : ORPHANS COURT DIVISION PETITION FOR THE APPOINTMENT OF A PLENARY GUARDIAN OF THE PERSON AND ESTATE OF BROOKE LYNN SARIANO AND NOW, this '~x~4~aY_ . of3q.atx,_)(,axak ,_ _ _ 200~comes_ the Petitioner and proposed guardian, Deborah Comter, by and through her coun(so), Reager & Adler, P.C. and respectfully represents the following: 1. The name and address of the Petitioner is Deborah Cornter, an adult individual residing at 299 Woodsedge Place, Langhome, Pennsylvania 19047. The Petitioner, Deborah Cornter, is the natural mother of Brooke Lynn Sariano. 2. Brooke Lynn Sariano (herinafter "Sariano"), is a 33 year old individual currently residing in a group home run by United Cerebral Palsy, located at 340 Fulton Street, Enola, Pennsylvania 17025. 3. Sariano's father is Michael Patrick Sariano, an adult individual, age 52, with a last known address of 213 Echo Glen Road, Harrisburg, Pennsylvania. Michael Sariano has had no contact with Brooke for the past ten years and has never had any meaningful relationship with Brooke Lynn Sariano and has deferred all parental responsibilities and obligations concerning Brooke to her mother, Deborah Cornter. 4. Sariano has resided in the group home since approximately 1995, and is enrolled in a day program. At the time of her enrollment in the UCP group home, Cumberland County had Deborah Cornter appointed as the temporary guardian of Brooke Lynn Sariano. 5. Sariano was born with multiple birth defects and suffers from severe cerebral palsy, mental retardation, and other physical handicaps. 6. Sariano's primary care physician is Dr. Joseph A. Torchia, M.D., of Conner, Rich Associates Internal Medicine, located at 207 House Avenue, Suite 101, Camp Hill, Pennsylvania, 17011. A true and correct copy of the letter, dated November 13, 2003, setting forth the physical condition of Sariano, is attached hereto as Petitioner's Exhibit "A." 7. Sariano suffers from severe cerebral palsy, mental retardation, and numerous physical handicaps. As a result of her physical condition, she is unable to verbalize her needs of care for herself and needs total assistance. She is currently living in a group home. She is completely unable to manage any of her financial or personal concerns. Sariano also has a history of seizure disorders and numerous other medical ailments. 8. No one presently has been appointed Guardian of the Person and Estate of Brooke Lynn Sariano, and she is in need of the appointment of a Guardian, so that someone is authorized to make decisions regarding her person and estate on her behalf. 9. Petitioner Deborah Cornter is the mother of Sariano and is 52 years old. She has complete knowledge of Sariano's estate and physical needs. 10. Petitioner is the most qualified person to serve as guardian for Sariano since she is her mother, and has complete knowledge of her estate and physical needs. 11. Petitioner is seeking appointment as a plenary guardian of the person and the estate of Sariano because Sariano is completely unable to take care of any of her personal estate matters, due to her severe cerebral palsy and marked mental and physical handicaps. 12. If appointed guardian, Petitioner Deborah Comter can safeguard Sariano's property for Sariano's well-being and continue to oversee her physical care. Petitioner's appointment as guardian should be for an indefinite period of time. 13. Petitioner's interest is not adverse to Sariano's interest. 14. The estimated value of Sariano's estate is minimal. She receives Social Security Benefits in the amount of FIVE HUNDRED NINETY ONE and 40/100 DOLLARS ($591.40) per month. Petitioner Deborah Cornter is the Representative Payee designated by the Social Security Administration to receive the payments on behalf of Sariano. Seventy percent (70%) of each Social Security check goes to United Cerebral Palsy, and the thirty percent (30%) balance of the monies are used for clothing and miscellaneous expenses, including monies for a cash box at the group home. The current bank balance of the account of Sariano is approximately $ 350.00. 15. In approximately 1995/1996, when Sariano went into the group home, temporary guardianship was issued by Cumberland County to Deborah Cornter. However, this guardianship has since expired and no other individual or entity has been appointed as guardian of the person and estate of Sariano. 3 16. The appointment of Petitioner as plenary guardian is the least restrictive manner by which Sariano's interests can be protected. 17. No other court has ever assumed jurisdiction in any proceeding to determine the capacity of Sariano, except as set forth in this Petition. 18. Petitioner fully understands the duties and responsibilities that would be required of her as plenary guardian of the person and estate of Sariano, and she is willing to fulfill said duties and responsibilities. WHEREFORE, Petitioner, Deborah Cornter, requests this Court to appoint Petitioner as plenary guardian of the person and estate of Brooke Lynn Sariano. Dated: I 1'~0 ID~ By: By: Respectfully submitted, REAGER & ADLER, P.C. ["'/'~' ~t Deni~qui~7 ~r~neyI.D. No. 66378 // Joar Harrison Clo"~g~h,/~ ;quire Attorney ID No.: 36461 f 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 Attorneys for Petitioner Deborah Cornter 4 VERIFICATION I, Deborah Cornter, verify that the statements made in the foregoing pleading are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. Date: /- i/- ~ l~eb~rah Cornter EXHIBIT A Conner, Rich Associates Internal Medicine 207 House Avenue, Sui/e 101. Camp H/ll, PA 17011 phone 717-761-B331o fax 717-761-5032 November 13, 2003 Debra Denison Cantor Reager & Adler, PC Attorneys and Counselors at Law 2331 Market Street Camp Hill, PA 17011-4626 RE: Brooke Sariano D.O.B.: 1/~1/70 S.S.#: 206-56-2988 Dear Ms. Cantor: I've been asked to express an opinion regarding Brooke Sariano. There are several issues that I was asked to address including the patients,s primary diagnosis, the patient's physical and mental limitations, and to confirm whether or not she is able to handle financial or personal decisions on her own behalf. Brooke is a pleasant but very unfortunate woman with severe cerebral palsy with marked mental and physical handicaps. She is unable to verbalize her needs. She is unable to care for herself and in..fact she needs total assistance currently living in a group home. She is totally unable to manage any of her financial or personal, concerns. Therefore from a medical viewpoint it is imperative that she has a guardian to look out for Brooke's financial and medical affairs. Brooke also has a history of a seizure disorder for which she is on an anti-seizure medication. She also has a history of peptic ulcer disease with a GI bleed for which she's on a medication to decrease the acid production in her stomach. I hope this provides you with all the necessary information that you may need. If not, please feel free to contact me. Sincerely, J h A. Torchia, JAT/tls #400517 Kenneth ~ Conner, MD Jsrne$ F. t~ich, MO Joseph A. Torchis, MD t~Dbert t~USZ/O$, MD Claudette G. Jstto, MD Jasns P. Bs#/h, MD Debre A. Forker, CRNP M.D. 2003 Member, Hedtag. e Medical Group oa/o~/~ou4 1~2:54 FAX 763 i~U? REAGER&ADLER REAGER & ADLER, PC A]-I-ORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP HILL, PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717-730-7366 WEBSITE: ReagerAdlerPC.corn THEODORE A, ADLER + DAVID W. REAGER CHARLES E. ZALESKI LINUS E. FENICLE DEBRA DENISON CANTOR Wdter's E-Mail Add~ess: jcloul~h(~,eplx.net THOMAS O. WILLIAMS SUSAN H. CONFAIR JOANNE HARRISON CLOUGH SUSAN J. SMITH Certified Civil Trial Specialis[ February9,2004 ¥1A FACSIMILE (717) 240-6460 and First Class Mail The Honorable Edward G. Guido Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Brooke Lynn Sariano Orphan's Court Division Docket No.: 2004-066 Request to Reschedule Hearing on Petition for Appointment of Plenary Guardian of the Person and Estate of Brooke Lynn Sariano Our File No.: 03-1012 Dear Judge Guido: Please be advised that we have filed a Petition on behalf of the proposed guardian, Deborah Cornter, the natural mother of Brooke Lynn Sariano, requesting the Court to appoint her as plenary guardian of the person and estate of Brooke Lynn Sar/ano. Ms. Sariano is 33 years old and severely disabled. She lives at a group home run by United Cerebral Palsy. Your secretary had contacted our office last week to ask if Brooke Sariano had independent legal counsel. Please be advised tlmt Ms. Sanano does not have independent legal counsel. Ms. Safiano suffers from severe cerebral palsy, with marked mental and physical handicaps. She is unable to verbalize her needs or care Ibr herself, and needs total assistance currently available in the group home. Ms. Sariano's assets are limited to Social Security benefits she receives in the amount of $591.40 per month. 70% of this monthly money is paid to United Cerebral Palsy, and 30% of the balance of the monies are used for clothing and miscellaneous expenses. The current balance of Ms. Sariano's miscellaneous expense account is approximately $350. Pursuant to 20 Pa.C.S.A § 551 l(a), Ms. Sariano has "the right to request the appointment of counsel, and have counsel appointed if the Court deems it appropriate, and the right to have such counsel paid for if it c n an ot be afforded. Subparagraph (c) further provides "If the alleged incapacitated person is tmable to pay for counsel or for the evaluation, the Court shall order the County to pay these costs. These costs shall be reimbursed by the Commonwealth in the following fiscal year." It ~vas Petitioner's sincere hope that Orphan's Court would not need to exhaust the balance o£Ms. Sariano's monies in her minimal savings accmmt (which are used to meet her daily needs) to pay for 02/09/2004 12:55 FAX 763 1907 REAGER&ADLER Judge Edward E. Guido Page ~ Febmaryg, 2004 003 Court appointed counsel in this matter. I am enclosing a copy of a proposed Order rescheduling the hearing on the Petition for Guardianship from February 9, 2004 at 3:00 p.m. to a future date. I am also enclosing a proposed Order directing the appointment of legal counsel for Brooke Lynn Sariano and request that, pursuant to the statute, the County/Commonwealth bear the independent counsel expense. Thank you for your attention to this important matter, IHC/drb EncLosures Joa-nne Hart/son C~h cc: Deborah Comter o2/09/2004 12:54 FAX 763 1907 REAGER&ADLER ~ o01 THEODORE A, ADLER+ DAVID W, REAGER CHARLES E. ZAL~SKI LINUS E, FENICLE DE~A DEN[SON CANTOR REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP HILL, PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717-730-7366 WEBSITE: RaagerAdlerPC.com THOMAS O, WILLIAMS SUSAN FI. CONFAIR JOANNE HARRISON 'CLOUGH SUSAN J, SMITH FA CSlMILE CO VER SHEET To: Sandy Fax IVo. : (717) 240-6460 Same to Follow by Mail: yes ];rom: Joanne Harrison Clough Date: February 9, 2004 Page(s) to Fo/lo w: Message: I~E: Brooke Lynn Sariano Please call Daria at (717) 763-1383 if there is any problem in transmission. The information contained in this telet'acsimile is transmitted by an attorney. It is privileged and coalldential, intended only fur the use of the Individual or entil.y named above. If the reader o£ this message is not the intended recipient, you are hereby notified that any di.~sernlnation, distribntiop or copying of this communication is strictly prohibited. Ir this communication has been received in error, please immedialely notify us by telephone, collect if I~ecessary, and return the original message to uS at the above address via the U.S. Postal Service (we will reimburse postage). Thank you. IN RE: BROOKE LYNN SARIANO : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION : NO. 21-04-0066 IN RE: APPOINTMENT OF GUARDIAN ORDER OF COURT AND NOW, this 22nd day of March, 2004, after hearing, Deborah Cornter is appointed the permanent plenary guardian of the person and estate of Brooke Lynn Sariano. By the Cou~ Edward E. Guido, J. Debra Denison Cantor, Esquire For the Petitioner Michael Whare, Esquire Guardian ad litem :mae IN RE: BROOKE LYNN SARIANO IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-2004-0066 IMPORTANT NOTICE CITATION WITH NOTICE A petition has been filed with the Court to have you declared an Incapacitated Person. If the Court finds you to be an Incapacitated Person, your rights will be affected, including our right to manage money and property and to make decisions. A copy of the petition which has been filed by Deborah Cornter is attached. You are hereby ordered to appear at a heating to be held in Court Room No. 5, Cumberland County Courthouse, Carlisle, Pennsylvania, on March 22 ,2004, at 1:00 PM. to tell the Court why is should not find you to be an incapacitated Person and appoint a Guardian to act on your behalf. To be an incapacitated Person means that you are not able to receive and effectively evaluate information and communicate decisions and that you are unable to manage your money and/or other property, or to make necessary decisions about where you will live, what medical care you will get, or how your money will be spent. At the hearing, you have the right to appear, to be represented by an attorney, and to request a jury ttial. If you do not have an attorney, you have the tight to request the Court to appoint an attorney to represent you and to have the attorney's fees paid for you if you cannot afford to pay them yourself. You also have the tight to request that the Court order that an independent evaluation as to your alleged incapacity. If the Court decides that you are an Incapacitated person, the Court may appoint a Guardian for you, based on the nature of any condition or disability and your capacity to make and communicate decisions. The Guardian will be of your person and/or your money and other property and will have either limited of full powers to act for you. If the court finds you are totally incapacitated, your legal rights will be affected and you will not be able to make a contract or gift of your money to other property. If the court finds that you are partially incapacitated, your legal rights will also be limited as directed by the Court. If you do not appear at the hearing (either in person or by an attorney representing you) the court will still hold the heating in your absence and may appoint the Guardian requested. Clerk, Orphans' Court E~ivision ~, Cumberland County, Carlisle, PA pt4 My Commission Expires 1 st Monday, January, 2006 Marjorie A. Wevodau First Deputy One Courthouse Square Carlisle, Pa. 17013 Glenda Famer Strasbaugh Register of Wills & Clerk of the Orphans' Court Kirk S. Soh on age, Esquire Solicitor (717) 240-6345 FAX (717) 240-7797 OFFICES OF l\egi.ster of Wills anti (!Clerk of tbe <!&rpbans' (!Court <!Countp of <!Cumberlanl:J December 1, 2005 Deborah Cornter 299 W oodsedge Place Langhorne, P A 19047 IN RE: Estate of Brooke Lynn Sariano, an incapacitated person File No. 21-04-0066 Dear Sir/Madam: It has come to my attention that you have not filed the guardian reports required by 20 Pa.C.S.A. 95521(c) in the above captioned guardianship. Enclosed you will find the suggested formes). Please mail those reports, along with a check for the filing fee which is $15 for each report filed, payable to the Clerk of Orphans' Court, to the following address within (30) days: Clerk of Orphans' Court One Courthouse Square Carlisle, P A 17013 If you have any questions, please contact your attorney. Respectfully, . 0#.1 (4' ~.~ ~ !f /'/, '7'- .' f .' .J", .,'.. ',. .", Ie. ". /.'2: .J;_~4&.':1:":;':,- l".?a'~,::.~:.../ ,~. . ~ .... ~. -, Glenda Farner Strasbaugh /.' Clerk of the Orphans' Court CC: Debra Denison Cantor, Esquire . ..: ,,-..,. r INRE: bvook.e, ~v\(,L/hO An Incapacitated Person Docket No. ~ (.,"J{) '1- 000 t" f., ANNUAL REPORT OF GUARDIAN OF THE ESTATE I,~y~ 4 COl'"n-t ev ,was/were ap!"ointed plenary guardian(s) of the estate of ~ rtJ ~e... S~V"'i~n D by Decree of the Honorable Judge GtiLt'il{) . Dated '5/.J. J...//) t/ . This is my annual report for the period from 0 f to 0 S' , ("The Report Period"). T. SUMMARY A. Value of principal assets at the beginning of the Report Period? $ C) B. Total amount of income earned during the report period? $ 1:<'iiv c,," Total amount of all expenditures made for care and maintenance ofthe C. incapacitated person during the Report Period? 1. From principal $ () 2. From income $ '/ :2 '1(., eo oJ D. Total amOlmt spent for all other purposes during the Report Period? $ () E. Total amounts remaining at the end of the Report Period? 1. Principal $ (~) 2. Income $ 0 Total Income and Principal $ 0 " (' I-J .,' I , r-, I !, . i I ;..' 1_ Z ~';. I~'v ~\~, .'" - II. ADDITIONAL INFORMATION A. Principal: 1. Total amount remaining at the end of the Report Period? $ c) 2. How is principal currently invested? /v / 4- , 3. Have there been any expenditures from principal during the Report Period? 0 Yes ~ No If you answered YES, was there Court approval for all expenditures from principal? 0 Yes 0 No 4':"Did you receive any principal assets during the report period which were not included on the inventory or a prior report filed for the estate? 0 Y es ~ No If you answered YES, did you receive Court approval prior to receiving additional principal? 0 Yes 0 No 5. State the sources and amounts of the additional principal you received: ;V'/A $ $ B. Income: 1. State sources and amounts of income received during ihe Report Period (i.e., social security, pension, rents, etc.): Skta.i:z. d 7, Y IJ ~)11 0 VJ I-A $ J, '9 YI $ ? .2, cf $ $ 7~7~ )~ei?..vt'~ 5Sf 5"'"'/CJ &1';) <<'{.. /Vi 0/) II; , Total Income received during Report Period 2. How is income currently invested? (Please specify, restricted bank accounts, client care account, etc.) .-" ... # 710 /J1C:Vu(::< S ?v'e In lI'e s1t'd' 3, Specify what payments were made for the care and maintenance of the incapacitated person (Le., clothing, nursing !lome, medicine, support, etc.). ~4r- l1",?o 11-1-17 .L/:J7 redi- .L/y- ,j/"'.c'/:;?C))1,;'-/:' / k friF .y ~y"/ :2 '-- ? 6- 7 Jl~1 4/1 /)~' 4. Specify what other payments were made during the Report Period. F7'~ t)elJ+~_(? clC~_t7(}i i i !e.) i-4-j)1t? j (ri) ve~r!cI /;;0-1 /.t1 Stcrd.tYk:~ v ;},Q I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this verification is subject to the penalties of 18 Pa. C.S.A. 84904 relative to unsworn falsification to authorities. J::<- :< c?-O~- Date ,'il. I' / /~ d ---;:-- .y;;u./'-f-?et-~ ;::<1. i C MA{,.~ /~ ilgnature of Guardian * FILING FEE $15 MUST ACCOMPANY TIDS FILING. ~ ." ......, Clerk of Orphans' Court of Cumberland County INRE: ~roo/(e ~V;CVhO An Incapacitated Person Docket No :2- 0 iJ'I- tJOtJ &; ~ I, ANNUAL REPORT OF GUARDIAN OF THE PERSON ~oY0-'~ It. Cv"V\t.ev f)yO 0 r~ SV\.-Yl'{\.,1I0 , dated 3/ ~ 1/ bt.{ cJ5 , was /were appointed plenary guardian(s) of the person of Honorable Judge G tA-1 dD by Decree of the . This is my annual report for the period from OL/ to ("The Ro""'''rt D iod") _ , \. _ ~VFV-"" .1. er..l _ 6 1. Present age of the incapacitated person: g~ Yrs. 1.. Lurrent address of the incapacitated person '.3 1 [) /;:;k L +.J Y} Sf ve-e-t ~:j/O Ice-) I(}- I I 7o;? 5 3. The incapacitated person's residence is: D own home/apartment D nursing home , boarding home/personal care home D guardian's home/apartment D hospital or medical facility D relative's home D other: ,.., -.---j ,.-, ~, . " ...---. (.,.) (Name and relationship) (describe) 4. The incapacitated person has been in the present residence since j ~ - g; -),CO 3 . If the incapacitated person has moved within the past year, state change and reason(s) for ~ ,0 '. .,.. ,,", change: 5. Name and address of the incapacitated person's primary care giver: Lt, (!.. . P. () + C e{// WcV-t PeL. _-9_iS LI-vldlL l~h ~__ ___ t~~ +lvll) Pel. /70 II 6. The major medical or mental problems of the incapacitated person are as follows: SeV Q y .~/ fY6-h LA.. nd V Q-h-/wLl~- on ( ~12,?- 7. Specify what, if any, social, medical, psychological and support services the incapacitated person IS recelvmg: 8. {i-; {oD ke. need s yC',S fc/~1.f-lccf ~ '&u-ffovt /11 QyJe r -1-0 y e C If:: 1I}.e s S l ~ 0. n Cc.. 0 rt k ' .t' ~ I ( ~ I n { ~ Iw Il~ L 0 1111,)<-",,- ~{ n i ~ ~ 0 -Gl v rt-'\ -f. \ Clj~J .-/-v {Lfl s. f w-bA tlu (\ ) It is our opinion as guardian of the person that the guardianship should: (check one) Jji continue, 0 be modified, 0 be terminated. (Briefly explain your response) 9. During the past year, I have visited the incapacitated person 6 - / 0 times with the a"'v'"erage 'visit lasting 1-.:( hovvs (State number of hours/minutes, etc) "" .---', .. The rep011 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 to the penalties of 18 Pa. C.S.A. 94904 relative to unsworn falsification to authorities. ./J / .-) cj>(/S Date Fd?ld It, (~/~~ SIgnature of Guardian * FILING FEE $15 MUST ACCOMPANY THIS FILING. One Courthouse Square Carlisle, PA 17013 Marjorie A. Wevodau First Deputy Glenda Farner Strasbaugh Register of Wills & Clerk of the Orphans' Court Kirk S. Sohonage, Esquire Solicitor Wanda S. Zeigler Second Deputy OFFICES OF (717) 240-6345 FAX (717) 240-7797 1-888-697-0371 x 6345 l\egister of Wins anb QClerk of tbe ~rpbans' QCourt (!Count!, of (!Cumberlanb October 8, 2007 Deborah Cornter 299 W oodsedge Place Langhorne P A 19047 IN RE: Estate of Brooke Lynn Sariano, an incapacitated person File No. 21-04-0066 Dear Sir/Madam: It has come to my attention that you have not filed the guardian repOlis required by 20 Pa.C.S.A. S5521(c) in the above captioned guardianship. Enclosed you will find the suggested formes). Please mail those reports, along with a check for the filing fee which is $15 payable to the Clerk of Orphans' Court, to the following address within (30) days: Clerk of Orphans' Court One Courthouse Square Carlisle, P A 17013 If you have any questions, please contact your attorney. Respectfull y, UMh. Xw~ JtfiAt~(1- , . ./ ; Glenda Farner Strasbaugh Clerk of the Orphans' Court CC: Debra Denison Cantor, Esquire . Clerk of Orphans' Court of Cumberland County IN RE: /!J YOO Ke- L1fJ n ~YI~n0 Docket No. An Incapacitated Person 21- tlt./ - 60fpc:' ANNUAL REPORT OF GUARDIAN OF THE ESTATE I, b e..-b 0 v~t, A. (! ov-rrt e V' , was /were , appointed plenary guardian(s) ofthe estate, of 6 YDok e.. LJ YI Yl sa..r~a.hD by Decree of the Honorable Judge G-u.., I do. Dated.)1(J..Y-c.j, ;<::1'1 ;lCDVThis is my annual report for the period from /--~Jr-CJt.R to /1.-4/-~~ , ("The Report Period"). I. SUMMARY A. Value of principal assets at the beginning of the Report Period? $ 0 $ 7$ 6 (J B. Total amount of income earned during the report period? Total amount of all expenditures made for care and maintenance of the C. incapacitated person during the Report Period? 1. From principal $ 6 $ ,5 Ao 2. From income D. Total amount spent for all other purposes during the Report Period? $ D E. Total amounts remaining at the end of the Report Period? 1. Principal $ C> Total Income and Princip'~ '.,\\J '),~\dbO -'.......... ~ ~: ':- ..J $ {) D 2. Income $ :.... J II. ADDITIONAL INFORMATION A. Principal: 1. Total amount remaining at the end ofthe Report Period? $ o 2. How is principal currently invested? ~ 3. Have there been any expenditures from plincipal during the Report Period? 0 Yes l'fNo If you answered YES, was there Court approval for all expenditures from principal? 0 Yes 0 No 4. Did you receive any principal assets during the report period which were not included on the inventory or a prior report filed for the estate? 0 Yes ttNo If you answered YES, did you receive Court approval prior to receiving additional principal? 0 Yes D No 5. State the sources and amounts ofthe additional principal you received: ~/A- $ $ B. Income: 1. State sources and amounts of income received during the Report Period (i.e., social security, pension, rents, etc.): SSI SSP (Po ~ J() L- d-. 7 )( 1:)- $ 7Aa6 $ 3 ;<L.j- $ Total Income received during Report Period $ '75' &'0 2. How is income currently invested? (Please specify, restricted bank accounts, client care account, etc.) (!u vren-L J h (!OVYl e (10 lie v':> a 1/ /111 /hj e xfen Se Sr' yent, ~dJ ~/61-1-1f'~1 jetJJ.oJ{'tt'vLJ ,oQ1/50V1Cl/;~Jj reL-VCtA--h 1~/VtlC.J'DV\ 0 u-h,,~s 3. Specify what payments were made for the care and maintenance ofthe incapacitated person (i.e., clothing, nursing home, medicine, support, etc.). y-evJ- deJl&J. 1/ /l e 1I.):::70h 5 Q--x7 gqy Z,2~ aJ~t phlt VWl~~ &1 Swi M P~t1~J 50 PM/SC}}7a-! )femS / do-.J-.h,':j 337 4. Specify what other payments were made during the Report Period. I verify that the foregoing information is correct to the best of my knowledge, 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. /tJ .;'/3-01 Date oJJ~d.~ Signature of Guardian * FILING FEE $15 MUST ACCOMPANY THIS FILING. Clerk of Orphans' Court of Cumberland County INRE: b voo& L~ h Y\ S4.vi4.Y1 0 An Incapacitated PeMn Docket No. ~ I-at.{ -(jb~ ANNUAL REPORT OF GUARDIAN OF THE PERSON D-ebor~ h A .6.r V1. -b€t/ ~ voo k...e.. L~ h n S~V'"'l~b by Decree of the , dated MIA. vc--h ;2.l) ~his is my annual report for to /2 - 3> ] - 0 Go , ("The Report Period"). , was /were appointed I, plenary guardian(s) of the person of Honorable Judge h--o.... i ck the period from / - DI-ore 1. Present age of the incapacitated person: .3 7 Yrs. 2. Current address of the incapacitated person J'-/o Fu../-bon 5-tveei ~V)O 10-) fa..... 170")..5"'" r-.."1 c~ L.:.~ ; ( ......: I..() :-"oJI 3. The incapacitated person's residence is: 0 own home/apartment 0 nursing home 0 boarding home/personal care home 0 guardian's home/apartment 0 hospital or medical facility 0 relative's home 0 other: ~vrJ l..A.-F )-J-o """ e.. 1'.) o~\ (Name and relationship) 4. (describe) The incapacitated person has been in the present residence since .:l 0 0 1- . If the incapacitated person has moved within the past year, state change and reason(s) for J change: IV //1 I 5. Name and address of the incapacitated person's primary care giver: LA (!, f 0'; C -0n f-v~ ( PtA. . q ^ \ II ~d~ l<JJYJ~ ~YYLp 1-fJ{ I f~ · /10 II 6. The major medical or mental problems of the incapacitated person are as follows: 5e';eve. /IYO~U.h d lI'efc>-vdc\.--hoYl 31""2 ( 2- 7. Specify what, if any, social, medical, psychological and support services the incapacitated person IS reCeIVIng: u ~ p ~ 0Yl-bvttj Pit.. / ;t/-IwnvAIVt'S [J"'S-t ~ Pv~Y1t1f1 8. It is our opinion as guardian of the person that the guardianship should: (check one) ~ continue, 0 be modified, 0 be terminated. (Briefly explain your response) 9. During the past year, I have visited the incapacitated person )2- -I ~ times with the average visit lasting I +0 (p hovr~, (State number of hours 1m in utes, etc.) 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 to the penalties of 18 Pa. C.S.A. 94904 relative to unsworn falsification to authorities. I ()-- /3 -01 Date cxQ~G !J,~ Signature of Guardian * FILING FEE $15 MUST ACCOMPANY THIS FILING. ANNUAL REPORT OF GUARDIAN OF THE ESTATE /. CUUKl UF CUMMUN PLEAS Ur &L4Jt;/-2?..vltt I)d COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of I3r/lt/fe. 5~z y la-flO No. ~/ - 0'(--0'1#& , an Incapacitated Person INTRODUCTI01..6a..-a-A dV/J-t:. ey ~Plenary OLimited Guardian ofthe Estate by Decree of dated )l )fo;~(h ,);). , ;/O,Y/ , I. C::-?U d) Q :----,0 '; -:.?~ . ---t '" = L~ = ~ "''"tJ ;;0 :J) m , ~~poi!'led ....jS :: :-I:~ ---1 ~ 1., N ~ m A. This is the Annual Report for the period from ,JdJ-1 ~: d t r:, , ,,o<'"! C!/ . 7 to ./)a.'!/2..-1n ~ -:3/ , ~oo 7 (the "Report Period"); or o B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: 1. 1 he oeatn or tne lncapacItateo rerson. vate or oeatn: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J " dated Estate of .6 NltllU.-Lfj h /1 -ScY/dft10 , An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ o !:S. ~tate me vaIUe~S) 01 prmClpal assets at me oegmmng or the Report Period. (Same as Inventory if first Report, otherwise, ending balance from last Report.) $ 0 Co W hat IS tne total amount or meome earneo ourmg the .7 j'tJ /f i'tJ Report Period? $ u. w nat IS me total amount 01 Income ana prInCipal 7)'tJ~ }'tJ spent for all purposes during the Report Period? $ E. What are the balances remaining at the end of the Report Period? 1. Pnnclpal :I> C> 2. Income $ C> 3. Total of Principal and Income $ 0 0.00 111. AJJJJHIUNAL 1NJ:lUKNlAHUN (If more space is needed, please attach additional pages.) A. Principal I. HOW IS the pnnclpal oaIanee l1stea aoove currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): 2. Have there been any expenditures from the principal during the Report Period? ............................ 0 Yes &l No 11 yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? . . . . . . .. 0 Yes 0 No Form G-02 rev. 10./3.06 Page 2 of 5 Estate of /; yO[) f:b St-rla/~l 0 b. List purpose and amount ot expenditures: IJJIt , , An Incapacitated Person $ :!> $ $ c. Was Court approval received prior to expending the principal? ....................... 0 Yes 0 No .;. were aoomonal pnncIpal assets receIveo ounng me Report Period which were not included in the Inventory or a prior Report filed for the Estate? ........... 0 Y esS No 1I yes: a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . .. 0 Yes 0 No o. ~tate me sources ana amounts or me additional principal received: ~/A B. Income 1. ~tate sources ana amounts or mcome recelvea during the Report Period (e.g., Social Security, penSIOn, rents, etc.): S's.:r SSP Total income received during Report Period: Form G-02 rev. 10.13.06 :I> $ :I> $ $ $ :I> ?/f 7/"',00 $ :!> ,g~8, lU) $ $ $ '7J'o~ 0.00 Page 3 of 5 Estate of I3r(J,? ~ 11 /J/7 ,C;;~/;(~?t> , An Incapacitated Person L. HOW IS mcome currently mvestea.t ~rlease specify, e.g., restricted bank accounts, client care account, etc.): . 4J, ....6/~ //Jt!'C'l.171c. (UJ/G!Y5 dt / }J///ztl ax~l~f' {.4-2:1'/' J /4471 / kc~ alb/j~) de:~~c!~r~ //;p:r~~_ j2e-+-SCJ/7?...e /k//?f/ )/cEc!'d.-C;IO/ l t:L4d rC"'c. ve~t!J;'J~ (J Ph I(j'" L. Expenses lor Lare ana IVlamtenance Specify what expenditures were made from the principal and mcome tor tne care ana mamtenance ot tne mcapacnatea Person (e.g., clothing, nursing home, medicine, support, etc.): ).-C" n-t & J 59 - F"'f:Jcj,r2:t/; -k/,?~ t./?,I/;;ry 39~ fl~f/6 ?J;aYlll. /t/I-- )/dt!dio rp. . J1...< $- - ?JU c:-P~y s' ~-i/s;+ ~3- U. utner Expenanures Specify what other expenditures were made during the Report Penoo. ~uo not mcJuOe any Items stateo m response to question C above.) ~A E. lJuardlan's Lommlsslons List amounts of compensation paid as Guardian's commission and state how amount was determined: Amount Method of Determination )/111 Form G-02 rev. 10.13.06 Court Approval Obtained DYes DNo , DYes DNo Page 4 of 5 Estate of bv{)&J~ 1y11Y/ ~ntW10 , An Incapacitated Person 1'. Lounset.. ee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount court Approval Obtained DYes DNo DYes DNo 1 venty mat me roregomg mrormation IS correct to me oest or my KnOWleoge, information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. ~ 4904 relative to unsworn falsification to authorities. ~Yi I j~, :JOO,? Date . I .~~ /! ~( Signatufpd/l1uordian of the Estate ~/;or~J7 J4.t1vntf'r Name of Guardian of the Estate (type or print) ;Irq tut>tJdS f dev.-. 1/t:tC!L Address U ~ hOT 11 -eo A, J9tJf// City, State, Zip " d If) - p~() - ;))4.:1-- Telephone Form G-02 rev. lO.13.06 Page 5 of 5 , an Incapacitated P~n o g ~=~ ~ ) .,.J -u ,:J ,{~ ::v . . ANNUAL REPORT OF GUARDIAN OF THE PERSON ,7 COURT OF COMMON PLEAS OF e U In 68r fa.; d L,UU1'l1 l, rtl'll'l~ l L V Al'HA ORPHANS' COURT DIVISION Estate of (jrZh) J:.e- 1-1f nr1 5~ruLnD J No. ...;fl- 0 ~-tJOt/~") I. INTRODUCTION ^' i /i : .{)'e.l)~ ~ n C~/Yj ;{ c ;/ ~ Plenary OLimited Guardian of the Person by Decree of dated ~ /.~ ..:< /,; if , I &-f.v/(j..., _D J> Ol -0 -lc ,'-' N .c:- , was appointed ., , ~ A. This is the Annual Report for the period from / - C:11 - 0 7 , /.A - d/ -07 . to , (the "Report Period"); or o B. This is the Final Report for the period from , J., 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 J., dated For a Final Report, omit Sections II through W. Form G-03 rev. /0.13.06 Page 1 of 4 c) Estate of , an Incapacitated Person II. PERSONAL DATA Age ofthe Incapacitated Person: 27 Date of Birth: /-/1- 70 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: g ~O )?fj frin { nt;j {{ ;Jet. J c-' ,.Jt:v cc: t' 171).J, s- B. The Incapacitated Person's residence is: o own home / apartment o nursing home o boarding home / personal care home o Guardian's home / apartment o hospital or medical facility o relative's home (name, relationship and address) ~other: gV{}I.A-f /--kytJ e....., C. The Incapacitated Person has been in the present residence since c2CJ 0 ,/ . 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 h r{)(I~ ,~YI'a1'}() , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: IL e p tJI.: (~A'/ l rit.L' A t yA 5' L1/) Lit L~U7C (!tlrYfFIA/J/ ~... /70// IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: ~i/eYe/';rt1IVt<-.,^j retclrc/~{j, ) ~3/21 2- !S. :specIty what, It any, SOCIal, meaIcal, PSYChologIcal ana suppon servIces me Incapacitated Person is receiving: LL- (! r' (' enl-vd. .4..//); le--prM It;e '5 iU tJ j "J,,:/ ?r'?.J ,,*,.. I) V. GUARDIAN'S OPINION A. It is the opinion of the Guardian ofthe Person that the guardianship should: [gcontinue D be modified D be terminated Form G-03 rev. 10.13.06 Page 3 of 4 Estate of )J) VOl) l(lL SW/ti.4'1() , an Incapacitated Person The reasons for the foregoing opinion are: Illl d. b t.blz, I? 1 tjic.- ()f'(" '<j ("/i )-k / ;;> r S"- II. B. During the past year, the Guardian of the Person has visited the Incapacitated Person ./ J J-.... I') times with the average visit lasting 1- ti9 hours, minutes. 1 he report oJ a social service organizatIOn employed by the uuaralOn 10 oversee ana coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. 1 verIty that the toregomg mtormatlon 1S correct to the best ot my knOWledge, 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. j! ..I. . '<Lf!~ d' t:i~V)~:Li,z: ./Signature of Guardian of the Person '1 "/ , i~ I~ .;;;l0Ci? Date / be b.;)vd.. h ;.j. fl, VI} l-ev'- Name of Guardian of the Person (type or print) ;2c?Ct !/IdrJe/S f2~ lL fJ/Cl_(/L Address / h. }'L jCA/u 7' ~ ,)Vne "t-t- . /V7/ City, State, Zip < j dl<~- -6'6 () -~~9l. Telephone Form G-03 rev. 10.13.06 Page 4 of 4 ANNUAL REPORT OF `?~ r., ~ =~- ,,~ ; -, ~ GUARDIAN OF THE PERSON -J ,'=_ ~ r -~ `-=' c 1 j ~ ~ i _ __; ~ ~~ Y~ r. ~~ ~>-- ~ - 7 `~ ~ ~ J r ~ j ~ i J~ ~ COURT OF COMMON PLEAS OF ~, ~ r'v ~h~laj~ covlvTY, PENNSYLVANIA a ~ ~~, ORPHANS' COURT DIVISION ~. Estate of ~ v00 I. INTRODUCTION S~!Gc,r~C~ an Incapacitated Person _11P~Dr'~ ~Cl r~L~-Cr was appointed .Plenary ^Limited Guardian of the Person by Decree of lt`U ic~o J., dated ~ d A. This the Anneal Report for the period from-~CchLi ~u o/ o?Oc~ to ~~? ~,,1~ 3/ ~ (the "Report Penod"), or B. This is the Finat 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 J., dated For a Final Report omit Sections ll through IY. Fom, G-o3 .,ev 10.!3.06 Page 1 of 4 Estate of v II. PERSONAL DATA Age of the Incapacitated Person: 3 1 an Incapacitated Person Date of Birth: ~ ~/. 7d III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: 3~0 ~u/.~vn ~ /C~T ~~b /et~ P~ ~ ~ 70.~~ 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: l~YD" 1_ ho~6 C. The Incapacitated Person has been in the present residence since 00 . 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 ~l b~ ~ ~! ` D an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: ~~.~ Li~~a Lam. ~m~ ~ll~~~ ~~°t~ IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: s'eve~ ~~-o~ovnd /~e>~va~a~ica~, 3l~'.,Z B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: J~ V. GUARDL~l~T'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. 10.13.Ob Page 3 of 4 Estate of _lUl-7J0 ~P JGC// Gc,N O an Incapacitated Person The reasons for the foregoing opinion are: ~t~~chl~ ~a ~ta~ ~ec~sians ~~ h~-se/~ B. During the past year, the Guardian of the Person has visited the Incapacitated Person i ~ times with the average visit lasting ' ~' hours, `""' 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 informarion is correct to the best of my laiowledge, 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. nee ffy'°~10 y' ofGm ofthe Perswe ~~~ ra-~ ~- _ ~orn~e ~ Name ofGumdlari nJ'dre Person (hPe ~P-~--~) 00 ~s ~ 1~~e ~-~~l~r.~c . ~iL. t9c~~{> c=~:~~ Telephone Form G-03 m+. 10.13.06 Page 4 of 4 c7 N - ~ ~. ., ,~ ~ _ 3 ~ ~ _ _ ANNUAL REPORT OF ?1 ~ _. __~;,~ . _. -- __ GUARDIAN OF THE ESTATE ='„ ` ~ _ -~ ` _ ~_ ~ .._ _ _'=+ ° COURT OF COMMON PLEAS OF > rv ~ ~~V n~ h~2.v~ I/-Y-~I COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of ~ ro o lL e ~ ~~ ~c. h p , an Incapacitated Person No. ~~ - D ~ - fJL~~ I. INTRODUCTION `~ ~~~ ~' ~Yn -~ Pry ,was appointed ®Plenary ^ Limited Guardian of the Estate by Decree of CT UJ dv , J,, dated ~,~ ~a - (,5 y A. This is the Annual Report for the period from Ju ~ yd-r~c~ f ~UU a' to ~ ~m ~~~_, v0 (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-02 rev. 10.13.06 Page 1 of 5 S~ Estate of ~ f OD ~~ ~ (.~n~ SGZ ~'/~ 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 $_ C~ $ ~ L~ $ ~97~- ~° $ ~9~~'~° E. What are the balances remaining at the end of the Report Period? 1. Principal $ 0 2. Income $_ ~ 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 accounts, etc.): 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-O2 rev. 10.13.06 Page 2 of 5 Estate of ,~Ji'DD ~Le ~-v~d~ w An Incapacitated Person b. List purpose and amount of expenditures: ~' c. Was Court approval received prior to expending the principal? ....................... ^ Yes ^ No 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.): SJ~ ~~P Total income received during Report Period: Form G-02 rev. 10.13.06 $ 7~ y5~ $.~~ 8f86 $ ,~97 goo Page 3 of 5 Estate of ~YD©,C! Ski-'ice d An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): -4// ~r~ c~,~ ~ c-~ v~-~-s - Ji ~ihy ~~~s~~~ r~:~ ~ ~~~, L~~O 7~i~~ f~ t~~ z~ c~u `-e ~ ~~cz~m~ ~~ ~~~flna-~~~~r~ % l~lc:-c~7d;'1 ~~ rPC~re~~ar~a.~ ~~/%I~S~ C. Ezpenses 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.): ~j~ r ~ ~ J ~~~/ ~~ ~~ ~ 7 y f SD.~ 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.) ,, // /V~ E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Court Amount Method of Determination Approval Obtained ^ Yes ^ No Yes ^ No Form G-01 rev. 10.]3.06 Page 4 of 5 Estate of ~~ydL~G[i ~G~Y/~h 0 An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount Court Approval Obtained ^ Yes ^ No ^ Yes ^ 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 the penalties of 1 S Pa.C.S. § 4904 relative to unsworn falsification to authorities. Date ~:~"` ` Sigrwture of (neardimr of the Estate Name of Gucsdtan of the Estate (type or print) X99 t:UDU ms's ~ ~ ,f~/a ~ P Address ~ ~, /- ~ ' L City, State, Zi Telephone Fo-m c-o2 rev. 10.13.06 Page 5 of 5 ANNUAL REPORT OF GUARDIAN OF THE PERSON COURT OF COMMON PLEAS OF ~"-~~/y~ ~ ~//,~~~ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of I. INTRODUCTION Y7 r! ~ ~i~~y)O ~~ No. o` l __ Q` f --~ C.~` ra ~ ~r:~ ~ F;;;. ~ , ~ 4 i ~ J ~ ~ ~ i'l Q ~ ' ..~ su - t ~ _ ~ N an Incapacitated Person was appointed ~-Plenary OLimited Guardian of the Person by Decree of ~r~i~~ , J., dated ~ ~~ ~ /u ~ f [,~ A. This is the Annual Report for the period from ~c ~~ Lr-Ctw c ~ o1c~~X~ to ~ ~~C-a-ri ~ - ~ ~ .~yc~_ (the "Report eriod"); 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 IY. J., dated For~nr c,-o3 rw. lo.r3.o~ Page 1 of 4 .Estate of dl rY~%~ ~~~ ~~ ~~~~-~~~' , an Incapacitated Person IL PERSONAL DATA Age of the Incapacitated Person: ~~ III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: B. The Incapacitated Person's residence is: Date of Birth: / - ~ / ~ 7~ own home /apartment 0 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 ,--~~c=~~~ If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: For,n c-o3 rev. ~o. X3.06 Page 2 of 4 Estate of Yy~ ~~ ~~ Y~i a r~ ~~ , 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 ~ti ~~s-C 1~~, y ~y~~ ~~~. A. It is the opinion of the Guardian of the Person that the guardianship should: continue be modified be terminated Firm c-o3 Yev. ~o.is.oh Page 3 of 4 ~ Q Estate of ~~d ~~ ~~C V ~ t~ ~'~ ~ , 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 J °~-"~~~ times with the average visit lasting / _ ~ hours, 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 to the penalties of I8 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. ._~ '~~- of U Date // I r r ~ ~ ~ ~'2 yr, ,~~L rgnature of Guardian of the Person n Name of Guardian of t~he/Person/(type or print) W ~C1~-r .~ ~'C 1~T~. ~J ~ z ~ C Address ~J City, State, Zip ~ Telephone Form G-n3 rev. ~0.13.0~ Page 4 of 4 N_ } ANNUAL REPORT OF ~ O t -T GUARDIAN OF THE ESTATE ~ =~ , ~ ~ V`l z~ COURT OF COMMON PLEAS OF ~~ ~` Z N _'-~' ~ U rr, ~ ~~~ ~~ r~~ _ COUNTY, PENNSYLVANIA y-a, ~.,~ " ORPHANS' COURT DIVISION A~~ Estate of ~ rUo ~~- ~~Y i ct. vl ~ , an Incapacitated Person No. ~ ~ - n ~ - U Urn ~> I. INTRODUCTION i ~~,~-c~-~ ~ ~,v"v1 ~~~ ,was appointed Plenary ~ Limited Guardian of the Estate by Decree of ~ U i ~~~ ~ , J., dated ~~~~ ~`c:~~' A. This i the Annual Report for the period from ~~/~, ~~ / ~~~~3~' to ~~- _ ~ J _ , c~~D J (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 Fir,,, c-oz rev. ~o.i,i.o6 Page 1 of 5 Estate of .~~ i'C~D ~~ ~ ~'n ~ ~~f~`f~-t7~r , 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? $ ~i 55Z" s s ~ $ ~yi~~¢~ E. What are the balances remaining at the end of the Report Period? 1. Principal $ ~' 2. Income $ ~- 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 accounts, etc.): 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? ........ 0 Yes ^ No Foy c-oz ,-~. ro.~3.o6 Page 2 of 5 Estate of ~-~p~ ~~, ~~ r ~~,~ ~~ , An Incapacitated Person b. List purpose and amount of expenditures: ~ ' $ , c. Was Court approval received prior to expending the principal? ....................... D 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.): 5 ~~ 5~P Total income received during Report Period: Form G-02 rev. 10.13.06 Page 3 Of S Estate of ~ rQD ~(~ ~r 1.x,4-~~ ~ , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): / ~, / r / ~ ~ ECG?' ~'/~ 1~7~<+/, `~' Fe-7 ~-F L~~_~, .~ ~'l~Ic:t v'G17 ~iC'`' ~ ~~~~~'1~~ /~ ~,Y~''1~ ~/-~~~ti ~/ C'!~i Cam. < 7 `~/ t~~~ i"°~c.~~7 ~'i-~,~. i ` J Uhl ~~~ S 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.): !'~- h 1 ~_ T V ~ ~7~~ 5 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: Amount Court Method of Determination Approval Obtained ,/~~~ ~ Yes Q No Yes ~No Form c-oz rev. io.~3.n6 Page 4 of 5 r , ANNUAL REPORT OF GUARDIAN OF THE PERSON COURT OF COMMON PLEAS OF Cumber (~.hoJ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ~ r., ~dy O ~J C.., ~.` ~Tl ~:.. 7 ~~~ ..~. ~ i c+Y C ~j . ~"L. ~ f!~ C^~ f ~~ ~~l T . -- ~ r7C7~ ,., ~" _ . ' : -- _,, ~ ~ ~, iT, ~~ ~,, ~ Estate of d roo ICS Lynn S0.r -a,-, o an Incapacitated Person NO. ~~-~y-DU(e(e I. INTRODUCTION ~e'4'o'r°`~h ~rn~r was appointed '~ Plenary ^Limited Guardian of the Person by Decree of G- U i ~ o ,i., anted ~-,~~-oy ~ A. This is the Annual Report for the period from ~ C~Yi ~a.ry / , o?U / b to ~~ o~Yrti ~r 3 l ~ O /~) (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: 2. The Guardianship was terminated by the Court by Decree of For a Final Report, omit Sections II through IV Form G-03 rev. 10.13.06 Page 1 of 4 ~~ J., dated :, Estate of ~YD!) ~ S cir~av, n an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person:~_ III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: 3ya r=~l~~ 5~ ~nola.~ {~A-~J7D~ B. The Incapacitated Person's residence is: ^ own home /apartment Date of Birth: ~ - ~ ~ " 7p ^ nursing home ^ boarding home /personal care home ^ Guardian's home /apartment ^ hospital or medical facility ^ relative's home (name, relationship and address) ®.other: [~ rv ~ p h o w..~ C. The Incapacitated Person has been in the present residence since Z UU ~ If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev. 10.!3.06 Page 2 of 4 ~ ~ Estate of d r6v~~2 ~6~.,r~a.v+o , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: u e,p a-F L~~,~-~ ~ ~sy ~ J~;,.a 9 2~ L~ nda l_a,r~. IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: S~v~r~-~~uhd re~a,,rdo-f,o-v~ 318•Z B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: u. ~P ~.~- +~a.-~. Pa/,4 I ~..-na~t ~e~ ti/~ s~ Day P rn~ --~.r--- , 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. 10.13.06 Page 3 of 4 Estate of t~rva ~~ ~a ~tc~,r~ , an Incapacitated Person The reasons for the foregoing opinion are: Glnab I~ -4~ rnalCa.. ct,eus! ov~s -~,r I'ler~e..l~. B. During the past year, the Guardian of the Person has visited the Incapacitated Person lp- 12times with the average visit lasting I- ~o hours, 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 to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. ~ ~~~ Dare CYry, ware, zp FornrG-03 m.10.(3.06 ~.~/,~ ~G slgnanXve of (nmdian ojrhe Person U~onx.l~ .d-~. ~.v,rtt~er Name ojGaardlan of the Person (type or print) ag9 woo d S ~. ~'1 ~. ~~ ~~ l~.o -ry-~. ~a.. I~t v~fir a ~ 5 -8la.o -~.~ gz. Telephorre Page 4 of 4 ... ANNUAL REPORT OF c-~ ~=' GUARDIAN OF THE ESTATE r- ~ m W ;-~t-t rr~, COURT OF COMMON PLEAS OF ~'c~c~ ~ `- ~ : ` ~~ ~.am b~er Ian COUNTY, PENNSYLVANIA o~-t, ~'` ;-=~ " ORPHANS' COURT DIVISION D-'' ~ _ .n p ~r Estate of ~ -rvo ~ So~,r~ay,~ , an Incapacitated Person. I. INTRODUCTION ~n1 ~a ru-~ ~.~o ~n`~~/ .was appointed Plenary ^ Limited Guardian of the Estate by Decree of (1- / ~ d o , J_, dated 3 ,aa-Oi{ ^ A. This i the Aunual Report for the period from-~T coo // to w--- ~~- 3/ . ~ e~ !/ (the "Report Penod"); 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 Form G-02 rev. I0. /3.06 J., dated Page I of 5 Estate of ~ -'~ ~~-e- ~"r 10i-'^`o , 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? E. What are the balances remaining at the end of the Report Period? 1. Principal $ d 2. Income $ O 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.): O 5,,~ ssP $ X08$ a7D • 50 $ 5358. 0.00 2. Have there been any expenditures from the principal during the Report Period? ............................ Q 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. !0.13.06 Page 2 of 5 Estate of F~ rOO ~ .J~-~r-a-h O , An Incapacitated Person b. List purpose and amount of expenditures: 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.): ssx 5sP Total income received during Report Period: $ ~~1 ~ $ ago $ 835 moo Form G-02 rev. I D. /3.06 Page 3 of 5 Estate of ~ roo ~ ~0.v~a.yta , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): ,4/l in~orre Go~~/s ltviny ~x~~s. 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.): rG/1~ /~00~ ~ e~,on~- ~-~ems c~-b I~ 1,~..vi+~St VQ-Le_7F~.or~ 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.) N~f} E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Amount Method of Determination Court Approval Obtained ~~~} ^ Yes ^ No Yes ^ No Farts c-oz rev. 10.13.06 Page 4 of 5 Estate of U rno IU2- S~-Q-~ o _ , An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount Court Approval Obtained ^ Yes ^ No ^ Yes ^ 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 the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. b/ Date ~~'~-'t-s-1L (~- signanve ajcuardian ajthe Estate ~ bora•h ~ • ~ ~~ Name ojcuordian ojthe Estote (type or print) 299' ltlvac~-g ~-,e~ ~~e- addess city, suue. ~p 2t s-~c,o-aa.9~- Te/ephone Form G-02 rev. 10.!3.06 Page 5 of 5 r-~~ h.~+• ANNUAL REPORT OF ~ ~ ^-> ;-~ ~ rn GUARDIAN OF THE PERSON ~ ~ ~' `~~] ~ ~ s~' ~~ r ~~ l~ ~~ ~ w.{m Hm ~ ~ ~ ~ .~ COURT OF COMMON PLEAS OF ~ ~=° ` ~ .. }-- x ~ ~~ p . wY / ~ PENNSYLV -~j~111~ f~~ e1 COUNTY T AJA~ ~ ~- j ~~ ~~ , , ~ , , ~ ORPHANS' COURT DIVISION ~''~' ~ Estate of ~ ~~~ ~- ~ C~ ~/>i~ S ~'/ ~ . ~~~ , an Incapac itated rcrson I. INTRODUCTION Plenary Limited Guardian of the Person by Decree of Lsf~icw dated d~ - ~?~? -Q J., A. This is the Annual Report for the period from ./~`/~L;C,,t y~ / , ~~/~ to ~~p ~~ ~~~~~ _:~ j (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: 2. The Guardianship was terminated by the Court by Decree of For a Final Report, omit Sections II through IV. Form G-03 rev. 10.13.06 J., dated was appointed Page 1 of 4 ti~~ Estate of ~ ~c~~~~- ~~ r ~ C , ~ ' , an Inca acitated Person p IL PERSONAL DATA Age of the Incapacitated Person: ~ ~ III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: ~~~~ /~~_~ ~ ~ iJ~.~ ~ 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 Date of Birth: /~~-1 ~ --~1~ relative's home (name, relationship and address) mother: VL~u /~'l.~~~~ C. The Incapacitated Person has been in the present residence since c~~C.~ 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 ~'i'~O ~ ~~ `-J~z. •~~ CU an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: ~ /'~ l y~y- ~-i ~>~~ ~~ ~~ IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: ~. r/~' f'~ ,~i ~~~ c~r~~,~ /~~-~e~rc/~..~~r~ ,3~~~,~ 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: continue be modified be terminated Form G-03 rev. 10.13.06 Page 3 Of 4 Estate of _ v~,~ ~lir-il~.. ~ , , an Incapacitated Person The reasons for the foregoing opinion are: /I ~ 6~~ "T~ %3 7~ ~ - ~ C r S ~ r~:~1~ rte' / ~J ~ l~ S.~' - ~~ ~ l B. During the past year, the Guardian of the Person has visited the Incapacitated Person ~ ~- ~ times with the average visit lasting / - ~ hours, 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 to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. ~ Date %~ ,~ ~-~~ ~ '-'~-1 L f ,__l,.cS'ig ature of Guardian of the Person '~' G/~-% `~7 /`7' • C_~. c?~ ~~/ J~ CO'Y' Name of Guardian of the Person (type or print) ~- Address City, State, Zip Telephone Form c-03 rev. 10.13.06 Page 4 of 4 rti~ C::.'." C ^~> ~ ~~ ~~ ~ ANNUAL REPORT OF "'ii ~ ~ r ~,_ J t--, ~,~ ~ ~ ~~b-; GUARDIAN OF THE ESTATE ~~ ~ -~ ~ C°... ~a e` "~ ,_„~~ .~.. ...~.k .. ,,.~ ~,....., ~~ei 1.,, ... ~' - ~~ l h° `._ T . ... t ~~u, + H~ ~ ~~ COURT OF COMMON PLEAS OF ~- G'am' ~ ~'/~ ~x_~ COUNTY, PENNSYLVANIA c: ~ - ~~" ~~~ ORPHANS' COURT DIVISION Estate of ,~~f~>f/~ -~~'/C/1~ , an Incapacitated Person I. INTRODUCTION ,., ~G r~~-~? Cy.~/~ fir' ,was appointed Plenary Limited Guardian of the Estate by Decree of ~ G~/ ~~~ , J., dated "~~'.:;1,~~-l~~ A. This is the Annual Report for the period from ~ e.~-1~~~~~r ~ ~'c~r to _ ~ ~%,~? n ~ .~~ c=~ i-~ ,~ r ~C~/( (the "Report eriod"); o~ 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 FoYm c-o2 Yep. 10.13.06 Page 1 of 5 J-, 1 Estate of r'C~~' ~ ^ ~~i ~-C~,~ ~C~ , 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.} $ -" SSA' C. What is the total amount of income earned during the ~~ Report Period? $ ~'(.~' ~?~' a~~~g ;,z ~ D. What is the total amount of income and principal spent for all purposes during the Report Period? $ ~:~ ~.~..~ ~ E. What are the balances remaining at the end of the Report Period? 1. Principal $ ~`? 2. Income $ ~~ 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 accounts, etc.): 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 F~Ym c-oz Yev. 10.13.0 Page 2 of 5 Estate of Y~i;~l~~ ~~ ~'lG- ~- ~' , An Incapacitated Person b. List purpose and amount of expenditures: . f $ 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: ~ 1~. $ B. Income 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): $ $ $ Total income received during Report Period: $ ~~',3 ~ Form G-oz rev.10.13.06 Page 3 of 5 Estate of ~'-~c~~~~ -fit ~tG< y~t~ , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): :' f~ l~ 1Cc~~ t~ (''c~;J~'v'~S ~ ~L~1 t~ ~~ ~~ X~~ j~~ y 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.): i~~' ~ t~"'~l C ~t~r C l ~-~~ 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: Amount Method of Determination . ~'/~ Court Approval Obtained Yes No Yes ~ No Form c-oa rw.10.13.06 Page 4 of 5 Estate ofY~'a ~~.. ~ ~'~~''1f nc , An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount Court Approval Obtained Yes ~ No Yes ~ 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 the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. ~d Date Signature of Guardian of the Estate r;. / f'~ ~~ p s Name of Guardian of the Estate (type or print) Address L~'( ~ ,~Z U~'i? ~' ~ , ~' y~ City, State, Zip ~ 5! - ~l>C~ ° ~ 2 ~Z Ti~lephone Form G-02 rev. 10.13.06 Page 5 of 5 L-`:± N � G�.J '"^""'� fTi � Q !� ['T"1 �..� � � - "� C? rn -;'- c� � �� =% �� r"_ rv r;,� r,.� ANNUAL REPORT OF � =" � �-� =� �-:� �. � _._ GUARDIAN OF THE ESTATE �� ry �-.; � �� °s c'� c� - . =� ��,� r> <::_ ..: �- � c.� : r�i ' ,� i _ COURT OF COMMON PLEAS OF :� �� "' r i vr�C�-r•[r�� coulv�,PENNSYLVANIA ORPHANS' COURT DIVISION Estate of �1`'�'L�i�� Y'1 A.►�t. , an Incapacitated Person D�G� No. ��'-��`� I. INTRODUCTION >1 �C�,i�r,�. �� .��;'r��f� ,was appointed �Plenary ❑Limited Guardian of the Estate by Decree of .-�t c�v ,J•, dated j`2-� "� � ❑ A. This is the Annual Report for the period from �� ' ' ,� to em -e�✓ �j , 2v l�2- (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-02 rev. 10.I3.06 Page 1 of 5 Estate of �YDb�� v t�-Y` � ,An Incapacitated Person II. SiTMMARY A. State the value of the estate reported on the Inventory $ � B. Sta.te 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 j� ��'� Report Period? $ �3 7C,�°''' ��,2° D. What is the total amount of income and principal spent for all purposes during the Report Period? $ ��y�°Z'O E. What are the balances remaining at the end of the Report Period? 1. Principal $ v 2. Income $ � 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 accounts, etc.): 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? . . . . . . . . 0 Yes ❑No Fo�c-oz rev.10.13.06 Page 2 of 5 Estate of �Op�(� �ri d.n o , An Incapacitated Person b. List purpose and amount of expenditures: $ . � � $ $ c. Was Court approval received prior to , /(/'/� expending the principal? . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ��o 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: $ $ /i'� $ $ $ B. Income 1. State sources and amounts of income received during the Report Period(e.g., Social Security, pension,rents, etc.): $ Cv' S._i.- $ �.-3"��o �S P $ ��l�5" , Lo $ � $ Total income received during Report Period: $ S��v`i�/ ''"�o.00 Form G-01 rev.10.13.06 Page 3 of 5 Estate of iJ'�� L'' �a Y�G�°�d , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g.,restricted bank accounts, client care account, etc.): - ��lG�/�� S �3�!'Tc� U� �i l�/r?G� �i�'�G'��e S, J 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.): ��'✓?� GL�IC� � .�%z� ��l�� -� � �l�s ��. 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: Court Amount Method of Determination Approval Obtained /�� ❑Yes 0 No ❑Yes ❑No Form G-Ol rev.10.13.06 Page 4 of 5 �' ��Y1C�a , An Incapacitated Person Estate of 1 d�l� F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Court Amount Approval Obtained ❑Yes ❑No � ❑Yes ❑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 the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. `�'�»��..�!�� . ,�b�� C�� Date � Signature of Guardian of the Estate �1�b�v r�u�� • �,—r��j' Name of Guardiart of the Estate(type or print) Z��' Gvav�/s ��Q� ��a�.�-e_ Address �� ,��.-�� -• /9C�f7 Ciry,State,Zip ��/�-�'lp� -s�.a-9� Telephone Form G-02 rev.10.13.06 Page 5 of 5 :r=' -,� C? u; �' rr1 � � — � � ANNUAL REPORT OF � �i �= <.� ° rn �; c�� ...� c� � 7,, r rv �-,s �°�-� GUARDIAN OF THE PERSON �- -� � � =J �=' ?�; cr� � �„ ��:: �� --� -�-; ..,, c� ,-� � _w�d �_7 <-> ', �.. ,-, (..M+ �., C;'� COURT OF COMMON PLEAS OF - "' �� "y i� ..' '-7 if y i� �✓�'►�b�✓/k►-�e� COiJNTY, PENNSYLVANI�' � � ORPHANS' COURT DIVISION Estate of Qro olG� LW r,n ��c✓it► n o , an Incapacitated Person No. aI `Q�—DC� G I. INTRODUCTION �.e�o ra..,�� ✓n•°��v ,was appointed '�Plenary�Limited Guardian of the Person by Decree of [s'd 1 �D , J., dated 3- LZ �-O �1 � A. This is the Annual Report for the period from �ar-r+u F r K / , ��/.z�= to �c��+�b�►' '3!� , ��/�- (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: 2. The Guardianship was terminated by the Court by Decree of J., dated For a Final Report, omit Sections II through IV. Form G-03 rev.10./3.06 Page 1 of 4 Estate of D �`C}(?�Cc ��✓1 dl�►c, , an Incapacitated Person II. PER50NAL DATA Age of the Incapacitated Person:� Date of Birth: f ��` �� T� III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: 3�/'o ,��l,P��-� S-�r�.c� �►�c� la , I�a . l7�zs' 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�YDt�� I v r�R � C. The Incapacitated Person has been in the present residence since ?-CC�� . If the Incapacitated Person has rnoved within the past year, state prior residence and reason(s) for move: Form G-03 rev.10.13.06 Page 2 of 4 . 1 Estate of �l��`t.-�- ��a✓l��<<� , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: �� '� ��`t�� cx-?' �t.1�1 M t��V�l�r�1 M t4. � '�� p�1 c�,� �. e4�tt' ,1��.�.� t�`{� � ��,� � �`^`��, f! L IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: �' d!!wt� ,��1��-cs�,� ��-�r�r`�i� �t a n �� .�_� B. Specify what,if any, social,medicai,psychological and support services the Incapacitated Person is receiving: 1 �.t� d-� �€t��f�� ;y��E'r,°f��.�r� ��r��.� � �� -��a � ; 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.10.13.06 Page 3 of 4 . .. Estate of ��' ��.�� , an Incapacitated Person The reasons for the foregoing opinion are: C,.(1t Li�j �t `��t� A''�� !. �t�°C l`i I�C%'T 1 �j-�t1w'� I+�'r'�,!�-�. � YI t� �.+�� vl�:� �, �tc �� '� C;� �1� k � �.`��'� ��`�'��'� �� B. During the past year, the Guardian of the Person has visited the Incapacitated Person �Q -I�_times with the average visit lasting —�JT hours, 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 to the penalties of 18 Pa. C.S.A. § 4904 relative to unswom falsification to authorities. ' � � J°�tr' A?� ("�l;:,l+��C.,�,:r`~ "-�` `` �t tL�C t D Q�e Si g nature of Guardian of the Person �', ' ; !' ` f � �� <' i.;�Gr"t+ j� ,r*-* ( t'r'1� � � Name of Gttardian of the Person(rype or print) ��P '?. �•.,r`�! �lj�t $ �f.°� t�t° Address � - d.� f��'.A ��) [��r�� f�:C� �F(,� ! 3 F�,� ( f� l City,State,Zip _ �� ,,...T ��i% ° ��_�.� Telephone Form G-03 rev.10.13.06 Page 4 of 4 f � ANNUAL REPORT OF GUARDIAN OF THE ESTATE n COURT OF COMMON PLEAS OF a -�'`,; C> CUMBERLAND COUNTY,PENNSYLVANIA ORPHANS'COURT DIVISION z r-r7 `+ 7 CIO 'd rT7 Estate of 8100/Z4-1- �ca v-1c�r,n ,an Incapacitated Person No. ,-/- 0q- 6&4 co <D 03 L INTRODUCTION /} �liy reL�1 &Y-r Ler ,was appointed .'$Plenary 0 Limited Guardian of the Estate by Decree of U I Do dated A. This is the Annual Report for the period from -x-11 aG to p e+'1 1 b C�. -:?/ , c�2 OJ (the"Report Period");or 13 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 corm G-02 rev.10.13.06 Page 1 of 5 " V Estate of U�✓DD K c! Sa t'IL� 11 v ,An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ Q 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 Ski l S Report Period? $ g2 S�. O —2(a5�.2- D. D. What is the total amount of income and principal spent for all purposes during the Report Period? $ E. What are the balances remaining at the end of the Report Period? 1. Principal $ 2. Income $ D 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 accounts,etc.): 2. Have there been any expenditures from the principal during the Report Period? ............................ 0 Yes C9 No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? ........ 0 Yes ❑No Form C-02 rev.10.13.06 Page 2 of 5 Estate of B r-oc)V,-- bayt c no An Incapacitated Person b. List purpose and amount of expenditures: c. Was Court approval received prior to expending the principal? ..............NIA.... ❑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? ........... 0 Yes JN 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.): $ Y66a •G' SP $ Total income received during Report Period: $ 8 -7e Awe Form c-02 10.13.06 Page 3 of 5 . Y Estate of 4"006. An Incapacitated Person 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.,clothing,nursing home,medicine,support,etc.): r4— Gt,,47 d / oe-,J 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: Court Amount Method of Determination Approval Obtained Nei+ rlYes 0No DYes E]No Form G-02 mv.10.13.06 Page 4 of 5 Estate of b,-00/4. Sa""10 r)a ,An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee,and indicate whether Court approval was obtained. Court Amount Approval Obtained ,All/4 0 Yes M No Yes El 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 the penalties of 18 Pa.C.S.§4904 relative to unsworn falsification to authorities. Date Signature ojGuaaidian of the Estate /y Name ojGuardian of the Estate(type or print) Address City,State,Zip 2-15-Y& Telephone Form G-02 rev.10.13.06 Page 5 of 5 a - ANNUAL REPORT OF GUARDIAN OF THE PERSON COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA ORPHANS'COURT DIVISION c� o rz, r'7 :zj Estate of roo r) ��Y�l�n U ,an Incapacitated Person �`„4 r, rJ �' C.0 1 r1 7 ~r- 60 q co '*7 L INTRODUCTION t / I),CboY4 A ��r►1 ted ,was appointed 10 Plenary OLimited Guardian of the Person by Decree of GU J6 dated '3—a a—ag CK A. This is the Annual Report for the period from to bee eM /fit Y 31 , 52.0 (the"Report Period');or 0 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 J.,dated For a Final Report,omit Sections H through IV. Fonn G-03 rev.10.13.06 Page I of 4 1 Estate of ro O�� ✓ i Ct V U ,an Incapacitated Person H. PERSONAL DATA Age of the Incapacitated Person: Date of Birth: III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: 3yo Fal-1.0n S-L,reet 17O Z- B. The Incapacitated Person's residence is: Q own home/apartment Q nursing home H$(boarding home/personal care home (,J:k-0�p '�► - Guardian's home/apartment rl hospital or medical facility r relative's home(name,relationship and address) Oother: C. The Incapacitated Person has been in the present residence since DU . If the Incapacitated Person has moved within the past year,state prior residence and reason(s)for move: Form c,03 rev.10.13.06 Page 2 of 4 Estate of VJ 1-0 o Y, e—4q 0 ,an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: CC»-� gas Lri, L- d-4-n-1 �X, 170// IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: Sea--f-e- Prc-our►d re-&rd-4foy, 9/8"2 B. Specify what,if any,social,medical,psychological and support services the Incapacitated Person is receiving: CGP cF Cent✓a� P�.�,�1-��►-�� -ices iAl�s�- .icy �rr�gr�;� V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: continue Q be modified 0 be terminated Form C-03 rev.10.13.06 Page 3 of 4 Estate of UrGb e U an Incapacitated Person The reasons for the foregoing opinion are: LiOadk dPG ISIpVv5-ro'r B. During the past year,the Guardian of the Person has visited the Incapacitated Person /0—/2- times with the average visit lasting /—4(--� hours, 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 to the penalties of 18 Pa.C.S.A.§4904 relative to unsworn falsification to authorities. Date Signature of Guardian ofthe Person )x- Name A C e��h � Name of Guardian ofthe Person(type orprint) 2!e-71 wedcl S fA-� l ace- Address City,State,zip z 15-Y&O -az q y Telephone Form G-03 rev.10.13.06 Page 4 of 4