HomeMy WebLinkAbout02-18-10ANNUAL REPORT OF GUARDIAN OF THE PERSON
THE COURT OF COMMON PLEAS OF CUMBERLAND CO., PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of: ELI PETROVICH , an incapacitated person
FILE NO: 21-07-1027
I. INTRODUCTION
PENNSYLVANIA GUARDIANSHIP ASSOC. / BRIAN D. BROOKS, was
appointed Limited X Plenary Guardian of the Person by Decree of
ORPHAN'S COURT . Judge. Dated 12/20/07
X A. This is the Annual Report for the period from 12/20/08 to 12/20/09
B. This is the Final Report for the period from to
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
,Judge, Dated
For a Final Report, omit Sections II through IY.
II. PERSONAL DATA
Age of the Incapacitated Person 86 Date of Birth 7/29/23
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
CLAREMONT NURSING HOME 1000 CLAREMONT RD, CARLISLE~$A 17013
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B. The Incapacitated Person's residence is: ~
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relative's home (name, relationship and address)
C. The Incapacitated Person has been in the present residence since
2007
If the Incapacitated Person has moved within the past year, state prior residence
and reason for move:
L
Estate of ELI PETROVICH , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
CLAREMONT NURSING HOME
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as
follows: SEVERE DEMENTIA
B. Specify what if any ,social, medical, psychological and support services
the Incapacitated Person is receiving: ALL PSYCH AND SOCIAL
SERVICES PROVIDED BY STAFF AND PHYSICIANS AT THE FACILITY
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship
should
X Continue be modified be terminated
The reasons for the foregoing opinion are:
B. During the past year, the Guardian of the Person has visited the
Incapacitated Person 4 times with average visit lasting
Hours, 15-20 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 attoched to supplement this Report
I verify that the foregoing information correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties if 18 Pa.
C.S.A. S/S 49(14
Date• ~ 7~~ T /~~
Signature of the Guardian of the Person
Brian D. Brooks
Name of Guardian of the Person (type or print)
PENNSYLVANIA GUARDIANSHIP ASSOC.
PO BOX 7295
LANCASTER, PA 17604
Telephone 717-299-4568
ANNUAL REPORT OF GUARDIAN OF THE ESTATE
THE COURT OF COMMON PLEAS OF CUMBERLAND CO., PENNSYLVAN~
ORPHANS' COURT DIVISION.- ~
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Estate of: ELI PETROVICH , an incapacitated person ~:. ~n ~ C°`
FILE NO: Z1-07-1027 v; r;-~ -v
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I. INTRODUCTION ~~~' ;G..
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PENNSYLVANIA GUARDIANSHIP ASSOC. / BRIAN D, BROOKS, was
appointed Limited X Plenary Guardian of the Estate by Decree of
ORPHAN'S COURT ,dodge. Dated 12!10/07
X ~ A. This is the Anneal Report for the period from 12/20/08 to 12/20/09
_,,,_ B. This is the Final Report for the period from to
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
.lodge. Dated
lZ SIJIVIMARY
A. State the value of the estate reported on the Inventory $ 18387.70
B. State the value(s) of principle assets at the beginai~ of the Report Period.
(Same as inventory if this is first Report, otherwise, ending balance from last Repvrt.)
S 18,387.70
C. What is the total amount of income earned during ~e Report period?
$ 1,423.94
D. What h the total amount of income and principle spent for all purposes during
this Report period?
S 19,119.46
E. What are the balance remaining at the end of the Report period?
1. Principle $
2. Income $
3. Total of Principle and Income $ 692.18
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III. ADDITIONAL INFORMATION
(If store space is needed; please attach additional page)
A. Principle
1. How is the principle balance listed above currently invested? (Please
specify, e.g. real estate, certificates of deposit, restricted bank accounts, etc.):
PAGA CUSTODIAL ACCUNT
2. Have there been any expenditnres from principle daring this Report
period.? X ves no
If yes:
a. Have all expenditures from principle been for the sole benefit of the
Incapacitated Person? X ves no
b. List purpose and amount of expenditures:
SEE ATTACHED ALLTRANSACTION REPORT
C. Was Conrt of approval received prior to expending principal?
X ves no
3. Were additional principle assets received during the Report period
which were not included in the Inventory or a prior Report filed for the Estate?
ves X no
If yes:
B. Income
a. Was Conrt approval requested prior to receiving additional principle?
ves no
b. State the sources and amounts of the additional principle received:
1. State sources of income received daring the Report period
(e.g., Social Security, pensions, rents etc.):
1. SOCIAL SECURITY
Total income received daring Report period: $ 1,423.94
2. How is the income currently invested? (Please specify, e.g. restriMed
bank accounts, client care account, etc.):
PAGA CUSTODIAL
C. Expenses for Care and Maintenance
Specify what expenditares were made from the principle and income for the care and
maintenance of the Incapacitated Person (e.g., clothing, nursing home, medicine, support,
etc.): SEE ATTACHED ALL TRANSACTION REPORT
D. Other Expenditures
Specify what other expenditures were made daring 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
~ 2.650 7 (a7 250.00 9 (a, 100.00 (veal no
F. Counsel Fee
List amounts paid ss counsel fee, and indicate whether Court approval was obtained.
I verify that the foregoing information correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties if 18 Pa.
C.S.A. S/S 4904
Date: 7
Si re of the Guardian of the Person
Brian D. Brooks
Name of Guardian of the Person (type or print)
PENNSYLVANIA GUARDIANSHIP ASSOC.
PO BOX 7295
LANCASTER, PA 17604
Telephone 717-299-4568
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