HomeMy WebLinkAbout04-0550IN RE: ·IN THE COURT OF COMMON PLEAS OF
·OF CUMBERLAND COUNTY, PENNSYLVANIA
SAMUEL J. FAMA · ORPHANS' COURT DIVISION
An alleged incapacitated person ·
'NO.
TO SAMUEL J. FAMA
IMPORTANT NOTICE
CITATION WITH NOTICE
A petition has been filed with this Court to have you declared an Incapac'i-tated
Person· If the Court finds you to be an Incapacitated Person, your tights will be~ffected,
including you tight to manage money and property and to make decisions. A copy of the
petition which has been filed by Cumberland County Area Agency on Aging is att-ached.
You are hereby ordered to appear at an emergency hearing to be held on
dA4.t// ,2004at //,'~a.m_....z/p.m. in Courtroom No.~-~ onthe q,~4~lborof
the Cumberland County Courthouse, Carlisle, Pennsylvania and at a final heating to be
held ~zt/~,t ~_~ ,2004 at o~ J ad a.m./p.m, in Courtroom No. _~., on the
L/~ oor of the Cumberland County Courthouse, Carlisle, Pennsylvania to tell the
Court why it 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 heating, you have the fight to appear, to be represented by an attorney, and
to request a jury trial. 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 attomey's fees paid for you
1 ? 280a
if you cannot afford to pay them yourself. You also have the right to request that the
Court order that an independent evaluation be conducted 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 or 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 girl of your money or other property. If
the Court finds that you are partially incapacitated, your legal rights will also be plenary
as directed by the Court.
If you do not appear at the heating (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.
Clerk, Orphans'
IN RE: SAMUEL J FAMA
An alleged incapacitated person
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
· ORPHANS' COURT DIVISION
:
: NO. 21-2004-550
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 your right to
manage money and property and to make decisions. A copy of the petition which has been filed by the
Area Agency on Aging is attached.
You are hereby ordered to appear at a hearing to be held in Court Room No. 3, Cumberland
County Courthouse, Carlisle, Pennsylvania, on JUNE 11 ,2004, at 11:00 AM. 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 heating, you 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 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 Di~'isi-on ',~- ¢'"(.r~:~.~- ~
Cumberland County, Carlisle, PA ~[,)]~n, -~.
My Commission Expires 1 st Monday, ! ~[
January, 2006
IN RE: : IN THE COURT OF COMMON PLEAS OF
S~UEL J. F~A : O~HANS' COURT DWISION
~ alleged incapacitated person:
NOW, thi a of , 2004, in on ideration ofthe
foregoing petition ~d on motion of the Mea Agency on Aging, in and for Cumberland
Co~ty, Pe~sylvania, t~ou~ their Counsel, ~thony L. DeLuca, Esquire, it is
O~E~D ~D DEC~ED that a Citation be awarded, directed to Smuel J. Fama
~ to show cause why ~ emergency gu~dian of his person ~d estate should not be
appointed, ~d why he should not be adjudged an incapacitated person ~d a pe~anent
guardi~ of his person ~d estate should not be appointed.
The time and place ofhemng on the Petition for Appointment of ~ Emergency
Gu~dian of the Person and Estate of the alleged incapacitated person ~e fixed for
,2004 at //;~ ~.m., prevailing time in Courtroom O_
on the 4th Floor of the Cumberland County Cou~house, O~han's Cou~ Division,
Carlisle, Pe~sylv~ia.
The alleged incapacitated person shall be given notice of the hemng on
appointment of an emergency gu~dian of his person and estate by se~ing him personally
with the Citation ~d this Order of Cou~ and a copy of the foregoing Petition prior to the
time of such emergency he~ng.
The Court finds that the following additional notice to others of the hemng on
appoin~ent of an emergency guardian of the alleged incapacitated person is feasible
under the cimmst~ces ~d directs that sine be attempted to be made upon the
following person in the following manner: Mary Helen Fama by first class United
States mail.
The time and place of hearing on the Petition for Appointment of a Permanent
Guardian of the Person and Estate of the alleged incapacitated person are fixed for
J~ ,,~..3 ,2004, at ,,?,'t/~) a.m./p.m.,.~__prevailing time in Courtroom # ~
on the 4th Floor of the Cumberland County Courthouse, Orphan's Court Division,
Carlisle, Pennsylvania.
At least twenty (20) days written notice of the heating on appointment of a
permanent guardian of the person and estate shall be given to Samuel J. Fama, the
alleged incapacitated person, by serving him personally with the Citation and this Order
of Court and a copy of the foregoing Petition together with an explanation of the content
and terms of the Petition. Additionally, at least 20 days written notice of the Petition and
hearing on appointment of a permanent guardian shall also be given to: Mary Helen Fama
by first class United States mail.
~~/~~"~.'.. ' Y. hallbe appointed to represent Samuel J.
Fama, the alleged incapacitated person.
BY THE COURT,
IN THE COURT OF COMMON PLEAS OF
OF CUMBERLAND COUNTY, PENNSYLVANIA
SAMUEL J. FAMA ' ORPHANS' COURT DIVISION
An alleged incapacitated person·
· NO. 21_Oq_~S~b
PETITION FOR THE APPOINTMENT OF
EMERGENCY PLENARY GUARDIAN OF THE PERSON AND ESTATE
IN ACCORDANCE WITH 20 P.S. §5513 AND FOR PERMANENT PLENARY
GUARDIAN OF THE PERSON AND ESTATE
PURSUANT TO 20 P.S. §5511
AND NOW COMES THE PETITIONER, the Area Agency on Aging, in and for
Cumberland County, Pennsylvania, by its solicitor, Anthony L. DeLuca, Esquire, who
represents and avers as follows:
The Petitioner is the Area Agency on Aging, in and for Cumberland County,
Pennsylvania, with its office located at 16 West High Street, Carlisle, Cumberland
County, Pennsylvania.
o
The alleged incapacitated person is Samuel J. Fama, age 87, who currently resides
at 40 Susquehanna Avenue, Enola, Cumberland County, Pennsylvania and has resided
there for a period exceeding 1 year prior to the filing of this Petition.
The known relatives of the alleged incapacitated person are:
ao
Mary Helen Fama - Wife
40 Susquehanna Avenue
Enola, Pennsylvania
The Petitioner is not related to Samuel J. Fama
5.
The Petitioner's interest is that of a welfare agency concerned with his welfare
and is familiar With his case.
6.
Samuel J. Fama has, for at least three (3) months, been incapable of managing and
caring for himself and his financial affairs.
7.
Samuel J. Fama exhibits symptoms of mental incapacity, including but not limited
to dementia and paranoia.
8.
Samuel J. Fama's mental incapacity prevents him from managing and caring for
the affairs of his person and estate.
9
On or about March 8, 2004, the Petitioner received a referral for care management
for Samuel J. Fama and an authorized care manager visited with him and his wife.
10.
Since the first visit, Samuel J. Fama's condition has deteriorated as follows:
a. He wanders throughout Enola and surrounding areas but gets lost;
b. He has been returned home on at least four (4) occasions by East
Pennsboro Police;
c. He has no safety awareness and has stopped cars on Enola Road
asking for directions to his barber shop; and
d. His weight had been averaging 120 pounds
11.
Investigation by Petitioner's authorized representative indicates:
a. That Samuel J. Fama may be on the borderline of malnutrition and
anemia; and
b. That neighbors report yelling at the residence and they go to the house
to calm the situation down.
12.
On or about April 5, 2004, Samuel J. Fama had an angry outburst when a care
manager for Petitioner attempted to transport him to his physician. At that time, he
threatened to hit her with a crow bar and grabbed her ann but his wife intervened and he
did not hit either the care manager or his wife even though his fists were raised.
13.
Samuel J. Fama believes that people come into his home and are stealing things
from him
14.
Samuel J. Fama is unable to manage his finances based upon the following
observations by Petitioner's authorized representative:
a. Health insurance and real estate tax bills were marked "Save these
important" but they were not paid;
b. Stacks of papers with envelopes, some of which were dated back to
1999, lay in piles.
15.
On or about May 19, 2004, a psychological evaluation was conducted of Samuel
J. Fama and the opinion stated that due to the severity of Mr. Fama's cognitive deficits
and the potential risks this poses to his safety he requires 24 hour supervision.
16.
.On June 8, 2004, Samuel J. Fama's wife fled her home because she was afraid
that her husband was going to kill her and was found wandering by a citizen who
reported the matter to East Pennsboro Police.
17.
As a result of the June 8th incident, Petitioner's authorized representative found
emergency housing for the wife.
18.
On June 9, 2004, Samuel J. Fama was taken to Holy Spirit Hospital by
Petitioner's authorized representative because he cannot stay alone and has physical
problems.
19.
Holy Spirit Hospital admitted him for observation and he is scheduled to be
released at or before 5:00 P.M on Friday, June 11, 2004.
20.
Petitioner believes and, therefore, avers that Samuel J. Fama has substantial assets
and there is a financial planner assisting Mr. and Mrs. Fama.
21.
Petitioner asks that Pennsylvania Guardianship Association be appointed Plenary
Guardian of the Person and Estate on both an emergency and permanent basis.
22.
The proposed Guardian has no interest which is adverse to the interest of Samuel
J. Fama.
23.
Petitioner believes, and, therefore avers that Samuel J. Fama. does not already
have a Guardian.
24.
Petitioner asserts that Samuel J. Fama is incapacitated as defined in Chapter 55 of
the Probate Estates and Fiduciaries Code.
25.
Because of his impaired mental and physical condition, Samuel J. Fama lacks the
capacity to provide for his own personal care and maintenance.
26.
Because of his impaired mental and physical condition, Samuel J. Fama is unable
to manage his financial affairs, property and business and to make and communicate
responsible decisions relating thereto.
27.
A power of attorney would be a less restrictive alternative than Guardianship but
Samuel J. Fama currently does not have an attorney-in-fact and he lacks the capacity, at
present, to appoint one.
28.
To Petitioner's knowledge, no previous application has been made for the order
herein requested or for a similar order.
29.
No other Court has ever assumed jurisdiction in any proceeding to determine the
incapacity of Samuel J. Fama.
30.
Samuel J. Fama is due to be discharged from Holy Spirit Hospital at or before
5:00 P.M. on Friday, June 11, 2004 and, upon discharge from the hospital, Petitioner
believes, and, therefore, avers that Samuel J. Fama would be at imminent risk of serious
bodily harm because he has no place to go.
31.
The failure to appoint Pennsylvania Guardianship Association Petitioner as
Emergency Plenary Guardian of the Person and Estate of Samuel J. Fama and later as
Permanent Plenary Guardian of his Person and Estate will result in irreparable harm to
the person and estate of Samuel J. Fama.
32.
To eliminate the imminent risk of harm to Samuel J. Fama, Pennsylvania
Guardianship Association, if appointed as the proposed emergency and permanent
plenary guardian will seek to immediately place him in a personal care or other
appropriate facility.
WHEREFORE, the Petitioner respectfully requests that:
1. The Court appoint the Pennsylvania Guardianship Association as
emergency plenary guardian of the person and estate of Samuel J. Fama pending a final
heating on this Petition with such emergency guardian having full power to place Samuel
J. Fama into a personal care or other appropriate facility and such other powers and
restrictions the Court deems proper;
2. Pursuant to 20 Pa.C.S.A. {}5513 the Court find that the emergency
necessitating the filing of this Petition will continue beyond seventy-two (72) hours from
the date of any Emergency Order;
3. Pursuant to 20 Pa.C.S.A. §5513 the Court schedule a final hearing
on or within 23 days from the date of any Emergency Order; and
4. The Court appoint Pennsylvania Guardianship Association as Permanent
Plenary Guardian of the Person and Estate of Samuel J. Fama.
Respectfully Submitted,
~thony'D.~eLuca, Esquire
113 Front Street
P.O. Box 358
Boiling Springs, Pennsylvania 17007
(717) 258-6844
VERIFICATION
I hereby verify that the facts and information set forth in the foregoing Petition for
the appointment of Emergency Plenary Guardian of the Person and Estate in accordance
with 20 P.S. {}5513 and for Permanent Plenary Guardian of the Person and Estate
pursuant to 20 P.S. {}5511 of Samuel J. Fama are tree and correct to the best of my
knowledge, information, and beliefi I understand that any false statements contained
herein are subject to the penalties of 18 Pa. C.S. Section 4904, relating to unswom
falsification to authorities.
Dated:
Sandra D. Gurreri
CONSENT TO GUARDIANSHIp APPOINTMENT
I, Brian Brooks, President of Pennsylvania Guardianship Ass~iatioa, hereby ~cnz to
being ap~ted as Em~gency ~d Pe~nt Ple~' Ouar~ &thc P~on ~d
~ta~ ofS~l ~. F~a.
Date
EIr/ae Brooks--
Pennsylvania Guardianship Association
PA GUARDIANSHIP ASSOC.
P.O. BOX 7295
Lancaster, PA 17604.7295
· IN THE COURT OF COMMON PLEAS OF
· OF CUMBERLAND COUNTY, PENNSYLVANIA
SAMUEL J. FAMA ·
An alleged incapacitated person·
AND NOW, this
ORPHANS' COURT DIVISION
z.t-.oq-
PRELIMINARY DECREE
day of June, 2004~fler hearing, the Court finds that Samuel
J. Fama is an incapacitated person and that the Pennsylvania Guardianship Association
is hereby appointed Emergency Plenary Guardian of the Person and Estate of Samuel J.
Fama, pending a final hearing on this Petition, with such Emergency Plenary Guardian
having full power to place Samuel J. Fama into a personal care or other appropriate
facility. ~: ~'
: IN THE COURT OF COMMON PLEAS OF
: OF CUMBERLAND COUNTY, PENNSYLVANIA
SAMUEL J. FAMA : ORPHANS' COURT DIVISION
An alleged incapacitated person:
: NO. 21-04-550
AND NOW, this~5
ORDER
day of June, 2004, this matter having been called for a
hearing, the Court finds, upon clear and convincing evidence, that Samuel J. Fama is an
incapacitated person in that he suffers from a mental impairment that prevents him from
receiving and evaluating information effectively and prevents him from formulating and
communicating decisions to such a significant extent that he is unable to manage his
financial affairs or meet essential requirements for his physical health and safety on a
daily basis.
The Court appoints Pennsylvania Guardianship Association, as permanent plenary
guardian of the person and estate of Samuel J. Fama.
BY THE COURT
AUTHORI'FY TO PAY COURT APPOINTED COUNSEL 'i'C~J~li {'l ~ 2004
1. COURT 2 VOUCHER
[] District Justice G~Common P)eas [~ Appellate E] O,he, _ N° 8 8 4 0
4. AT ITY/STATE) 5. BUDGET CODE
J
9. PROCEEDINGS (Describe briefly) 11. PERSON REPRESENTED 12. CIVIL DOCKET NO
13 CRIMINAL DOCKET
0 PERSON REPRESENTED (Full Name) 8 ~ Pr ahoner Charged Wifh Violilion 14. APPEALS DOCKET NO
t6 NAME OFA~ORNEY/PAYEE AND
NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE
CLAIM FOR SERVICES OR EXPENSES
9. SERVICE HOURS DATES AMOUNTS CLAIMED
~ e Sentence Hearings
TOTAL HOURS = i , / X~ , .__
2~ I~MIZATION OF REIMBURSABLE EXPENSES AM% PER ITEM
Mileage $.25 ~r m~le x
Has compensation and/or reimbu~emenl for wo~ In this ~e previous~ ~en applied fop Q YES~0 = $ ( ~ I * ~'~
24.
PRIOR
, swear or aRirm the truth or co.e¢.e. ~ ~[~ ~?~ ~7~ ~ 25. N~ AMOUNT C~.MED
Copy I - Mail t, Pnistrator at completion of service ~'"~,./
In the Matter of the Person and Estate of Samuel J. Fama
Orphans' Court Division No. 21-04-550
Attachment
Hearing
Hearing
IN COURT
1.1 06/11/04
60 06/23/04
1.7 hours
Phone call from Office of Aging
Phone call from Office of Aging
Phone call from Agenc.', solicitor
Phone call from Office of Aging
Phone call to Office of Aging
Phone call to Bridges at Bent Creek
Phone call to guardian
Phone call to guardian
OUT OF COURT
10 06/17/04
.20 06/21/04
.10 (76/21/04
· 10 06/21/I)4
· 10 06/22/(74
10 (76/22/04
.20 06/22/04
· 10 06/23/04
1.00 honr _~
~w
1:\ THE COLRT OF COMMON PLEAS OF r COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RF::
~w)Uel ,j \Wm
an incapacitated person
GUARDIAN OF THE PERSON~ REPORT
(20 Pa.C.S. ~ 5521(c)J
No. -ill--6Y -ZiS 0,
For the period:J.une ;)31~O()'L, 20_ toJc.tf\l1 (J (~ 07~20_
I . I am the Limited <f~( circle one) Guardian of the Person of my ward,
named above. J
2. I was appointed Guardian by Order ofthe Court dated . lJJI..R.. ~I ~O \.{
19 _, which was IB(Circle one) modified by Court Order(s) dated
19 .
3. Is the incapacitated person still living? Yes ~circ1e one)
If no, answer the followin~: . /.,/ / ..--
a. Date of Death: ...:~ n I ~ 005 I b ICJ ~
b. Place of Death: "A,lLl\or CliU ("~ Co.--r\ i S\e.o.
c. Name of Administrator or Executor:
d Date Guardian of the Person filed the last annual report:
f1 { s t (l1\.eLJ ~
4. If the incapacitated person is still living, answer the following:
a. Date Guardian of the Person filed the last Annual Report:
b Date of birth of the incapacitated person:
c. Current address of the incapacitated person:
d. The incapacitated person's residence (type of placement) is:
Ward's own residence _ My home/apartment
_ Nursing Home Relative's home
____ Hospital/Medical Facility _ Boarding Home
J
~.
GunbdlaNl
. 1N THE COURT"OF COMMON PLEAS OF . . COUNTY , PENNSYLVANIA
ORPHANS' COURT DMSION
No. a.1-O~-~SO
IN RE:
Sa~u.d If ftiynQ..
an incapacitated person
R naY
GUARDIAN OF THE ESTATE ' REPORT
(20 Pa.C.S. ~ 5521(c))
Fortheperiod'~~;;'CD':L19_to~~ . ..
1. I am the Limitetl1J:!!n~~( circle one) Guardian of the Estate of my ward,
named above. I was}PR~ted Guar an by Order of the Court dated ~e. ~~ &t:d1
19-> which was/~(circle one) modified by Court Order(s) dated ,
19 .
- 2. Is the incapacitated person still living? Yes .(@irc1e one)
If no, answer the fOllO]W'; . ~ I "_
a. Date of Death: . r\~~ d~~~ . ~/r;/o~
b. Place of Death: _a n ~ ~__ \ s.1_ .
c. Name of Administrator or Executor:
d.
Date G~<!ian of the Estad fil\d the last annual report:
(~:r Of) OL\+
3. My initial Invento~ was filed on
estate value of$ ,{"It:. 54 ~. c.; S-:
The Inventory listed a total monthly income of $ ~ q;} 7, I ~
comprised of the following: 0
S~ M~AArr~ 97%.t/7J
p~~ '7'19,/8'
PLEASE ANSWER TIlE FOLLOWING QUESTIONS'
WHETHER THE INCAPACITATED PERSON
IS LIVING OR DECEASED
j J- /:+ 71t' r ' 19-, and listed a.total
)
At the beginning date of this reporting period. my initial balance on hand was
o
5. Dming this reporting period. the following reflects all sources of income
received by me for my ward (add additional pages if needed):
Date Received
4.
$
sur;;ofD~j J
Amount
1.
2.
3.
4.
5.
6.
TOTAL
6. During this reporting period. the following reflects all payments I have made for
my ward (add additional pages ifneeded):
1. ~ TO~aid~pavment
2.
3.
4.
5.
6.
Amount
TOTAL
7. The present principal assets of my ward are:
Description of Asset
1.
2.
3.
4.
5.
6.
Present Value
o
2
8. The present amount and sources of income for my ward are:
Sources of Income Amount of Income
(Indicate whether monthly,
quarterly or annually)
1.
2.
3.
4.
5.
6.
9. The regular monthly expenses of my ward that I pay are:
To Whom Paid Amount
1.
2.
3.
4.
5.
6.
10. I have~e ~circle one) petitioned the Court for permission to invade
principal to meet the needs of my ward.
(If applicable) The following expenses of my ward have been paid from principal:
To Whom Paid Purpose Amount
1.
2.
3.
4.
5.
6.
TOTAL
11. I have / have not ( circle one) paid ~yself compensation for services I rendered
as guardian.
The amount I paid myselftota1ed $ and was calculated at
the following rate: per week / monJh (circle one).
J
12. Crrcl. m. ""'F ond complete, if appli""'I..
a. There ill no e a need for extraordinary expenditures on behalf of
my ward in the next twelve ( ) months.
b. There will be a need for extraordinary expenditures on behalf of my
ward in the next twelve (12) months because:
13. Circle the correct response and complete, if appropriate.
a. My ward receives monthly social security benefits
directly.
b. I am the designated payee to receive my ward's social
security benefits.
c. The designated payee of my ward's social security benefits
IS
whose address is:
The payee is / is not (circle one) related to my ward as :
(insert relationship).
14. Please note any concerns about the incapacitated person's physical or mental
well being or the finances that the Court should know.
15. I~am not (circle one) the guardian of the incapacitated person's person. If
I am, my report IS attached.
4
I certify under the penalties of 18 Pa.C.S. ~ 4904 (relating to unsworn falsification to
authorities) that the information contained in this report is true and correct to the best of my
knowledge, information and belief.
J8;ctD Si~ tj;;;; ~Q' cr.l
Phone: (home) 11; ~qo; - '-/sl-07
(work) In 911~4S(pJ>
Name:
Address:
PA GUARDIANSHIP ASSOC.
P.O. BOX 7295
Lancaster, PA 17604.7295
5
ITEMIZED CATEGORY REPORT
1/ l' 0 Through 3/31' 5
PAGA_CUS-PAGA Custodial
3/ 2' 5
Page 2
Date
Num
Description
Memo
Category
Clr Amount
-------- ------ ------------------ ------------- ---------------- - ----------
11/ 3' 4 5388 MANORCARE CARLISLE SAM FAMA FAMA,SAM/COST OF X -5,155.00
11/ 3' 4 R5524 DEPOSIT FAMA,SAM/INTERES X 55.33
11/ 3' 4 R5525 DEPOSIT FAMA,SAM/REFUND X 95.26
11/ 4' 4 5399 QUANTUM IMAGING & SAM FAMA 0 FAMA,SAM/MEDICAL X -17.60
11/ 4' 4 5401 HOLLY SPIRIT HOSPI SAM J. FAMA FAMA,SAM/MEDICAL X -922.83
111 5' 4 5425 VOID:HOLLY SPIRIT MARY FAMA # FAMA,SAM/MEDICAL X 0.00
111 5' 4 R5593 DEPOSIT FAMA,SAM/STOCK S X 47.85
111 8' 4 5434 MS HERSHEY MED. CE SAM FAMA ACC FAMA,SAM/MEDICAL X -132.42
11/16' 4 5484 LANA L. HOOVER, LP SAM FAMA FAMA,SAM/PERSONA X -360.00
11/17' 4 5487 S BRIAN D. BROOKS POSTAGE FAMA,SAM/REIMBUR X -0.83
11/23' 4 5495 L.G.CONNOR REAL ES SAM FAMA FILE FAMA,SAM/FINACIA X -300.00
11/24' 4 ET SUPERSHOE SHOES FAMA,SAM/FINACIA X -49.88
11/29' 4 5498 LANA L. HOOVER, LP SAM FAMA FAMA,SAM/PERSONA X -1,676.25
11/30' 4 5503 HIGHMARK BLUE SHIE SAM J. FAMA 1 FAMA,SAM/INSURAN X -250.91
11/30' 4 5504 PENNSYLVANIA AMERI SAM FAMA 24- FAMA,SAM/UTILITI X -16.59
11/30' 4 5511 GUISTWITE FAMILY P SAM FAMA 346 FAMA,SAM/MEDICAL X -57.31
11/30' 4 5530 PPL UTILITIES SAM FAMA FAMA,SAM/UTILITI X -28.31
121 6' 4 5554 S PLATINUM PLUS FOR FAMA,SAM/PERSONA X -1,738.07
121 7' 4 R0063 DEPOSIT FAMA,SAM/REFUND X 132.42
12/17' 4 5607 S BRIAN D. BROOKS PARKING FAMA,SAM/REIMBUR X -1.50
12/17' 4 5607 S BRIAN D. BROOKS TOLL FAMA,SAM/REIMBUR X -1.25
12/20' 4 5649 NEIGHBORCARE PHARM #21-24141 SA FAMA,SAM/MEDICAL X -36.80
12/27' 4 5679 S REGISTER OF WILLS INVENTORY I S FAMA,SAM/COURT F X -10.00
12/27' 4 5679 S REGISTER OF WILLS INVENTORY I M FAMA,SAM/cOURT F X -10.00
12/27' 4 5679 S REGISTER OF WILLS BOND I MARY H FAMA,SAM/COURT F X -10.00
11 4' 5 R0105 DEPOSIT FAMA,sAM/SALE PR X 184.60
1/ 4' 5 R0106 DEPOSIT FAMA,SAM/SALE PR X 2,602.00
11 4' 5 R0107 DEPOSIT FAMA,SAM/INTERES X 29.10
11 4' 5 R0108 DEPOSIT PENSION FAMA,SAM/SALE PR X 325.00
1/10' 5 5707 MANORCARE CARLISLE SAM FAMA FAMA,SAM/COST OF X -15,917.27
1/10' 5 5714 EAST PENNSBORO TOW SAM FAMA FAMA,SAM/UTILITI X -115.00
1/10' 5 5731 PPL UTILITIES SAM FAMA FAMA,SAM/UTILITI X -30.09
1/10' 5 5744 VOID:KAPLAN'S CARE MARY FAMA FAMA,SAM/FINACIA X 0.00
1/10' 5 5754 HOME INSTEAD SENIO MARY FAMA (9 FAMA,sAM/MEDICAL X -56.85
1/10' 5 5755 PENNSYLVANIA AMERI SAM FAMA 24- FAMA,SAM/UTILITI X -16.59
1/13' 5 5775 LANA L. HOOVER, LP SAM & MARY FA FAMA,SAM/PERSONA X -720.00
1/13' 5 5776 NEIGHBORCARE PHARM #21-24141 SA FAMA,sAM/MEDICAL X -2,278.38
1/24' 5 5799 S PAGA GENERAL ACCOU FAMA,SAM/GUARDIA X -500.00
1/25' 5 5804 UGI SAM FAMA FAMA,SAM/UTILITI X -264.00
2/ 3' 5 5828 PPL UTILITIES SAM FAMA FAMA,SAM/UTILITI -14.52
21 7' 5 5887 VOID:MANORCARE CAR SAM FAMA FAMA,SAM/COST OF X 0.00
21 7' 5 5891 NEIGHBORCARE PHARM #21-24141 SA FAMA,SAM/MEDICAL -274.95
21 7' 5 5900 PENNSYLVANIA AMERI SAM FAMA 24- FAMA,SAM/UTILITI -33.40
2/24' 5 5971 PPL UTILITIES SAM FAMA FAMA,SAM/UTILITI -33.26
31 2' 5 ET DEPOSIT BANK TRANSl'ISR F'ID'Ur;SAI"r/HANK TIr 18. 57I. nT
~~::J':;::;:;'SAM M ~ O-<l 0/ :5/p-ll1j~9
t.; ~.<{ .t/u:.. MJ?f. -&- 11Tt'-1I &4 /11 fYUy 7evnvl'-<1 ~)
ITEMIZED CATEGORY REPORT
1/ I' 0 Through 3/31' 5
PAGA_CUS-PAGA CUstodial
3/ 2' 5
Date
6/28' 4
7/13' 4
7/26' 4
8/ 2' 4
8/ 2' 4
8/ 5' 4
8/ 5' 4
8/ 5' 4
8/ 5' 4
8/ 5' 4
8/ 5' 4
8/ 5' 4
8/ 5' 4
8/ 5' 4
8/ 6' 4
8/ 6' 4
8/10' 4
8/27' 4
8/28' 4
9/ 7' 4
9/ 7' 4
9/ 7' 4
9/ 7' 4
9/ 8' 4
9/ 8' 4
9/ 8' 4
9/ 8' 4
9/ 8' 4
9/ 8' 4
9/ 8' 4
9/ 8' 4
9/ 8' 4
9/ 8' 4
9/17' 4
9/23' 4
9/23' 4
9/23' 4
9/23' 4
9/23' 4
10/ l' 4
10/14' 4
10/18' 4
10/18' 4
10/21' 4
10/27' 4
11/ 3' 4
11/ 3' 4
Num
Description
INCOME/EXPENSE
INCOME
FAMA, SAM
Memo
4755
4790
4896
4935
4936
4943
4946
4955
4960
4961
4965
4966
4983
R6517
R6575
R6576
4996
5029
5035
5049
5074
5083
5088
5113
5117
5122
5126
5127
5128
5129
5129
5129
5141
5196
5216
5221
5222
5226
R5445
5258
5274
5308
5316
5338
5343
5358
5379
HIGHMARK BLUE SHIE SAM J. FAMA
S PLATINUM PLUS FOR
ELITE STAFFING SER
ROBC LIMITED PARTN
PLATINUM PLUS FOR
HIGHMARK BLUE SHIE
COMCAST
PPL UTILITIES
VERIZON
UGI
PENNSYLVANIA AMERI
EAST PENNSBORO TOW
RESTORECORE CETRAL
DEPOSIT
DEPOSIT
DEPOSIT
ROBC LIMITED PARTN
S PAGA GENERAL ACCOU
HALL SERVICES
LANA L. HOOVER. LP
LEHIGH VALLEY PHYS
PENNSYLVANIA AMERI
ALICIA D. STINE /
COLECTION CENTER I
PPL UTILITIES
VERIZON
VERIZON
TRAVELERS INDEMNIT
TRAVELERS INDEMNIT
S BRIAN D. BROOKS
S BRIAN D. BROOKS
S BRIAN D. BROOKS
DARLENE HALL FOR S
PPL UTILITIES
S PLATINUM PLUS FOR
PENNSYLVANIA AMERI SAM FAMA 24-
PPL UTILITIES SAM FAMA
ASSOCIATED CARDIOL SAM J. FAMA
DEPOSIT BANK TRANSFER
EASTERN ACCT. SYST FAMA/#1525378
LANA L. HOOVER, LP SAM FAMA
TRAVELERS INDEMNIT SAM FAMA ACC
EAST PENNSBORO TOW SAM FAMA
PENNSYLVANIA AMERI SAM FAMA 24-
S PAGA GENERAL ACCOU 10-11 M.H.FAM
MS HERSHEY MEDICAL SAM FAMA 468
MS HERSHEY MEDICAL SAM FAMA 122
SAM FAMA IN#
SAMUEL J. FAM
403647000030-
SAM J. FAMA
SAM J. FAMA
SAM FAMA
7177329771001
SAM FAMA
SAM FAMA 24-
SAM FAMA
SAM FAMA 40
BANK TRANSFER
SAM FAMA 015
6-9/04 INITIA
SAM FAMA
SAM FAMA
SAM FAMA
SAM FAMA
SAM FAMA
SAM FAMA
SAM FAMA
7177329771001
7177329771001
SAM FAMA ACC
SAM FAMA ACC
TOLL
KEYS
CERT.ORDER
SAM FAMA CLOT
SAM FAMA
/ PR
RP1
24-
09-
AG
Page 1
Category
Clr Amount
FAMA,SAM/INS~~ X
FAMA,SAM/PERSONA X
FAMA,SAM/FINACIA X
FAMA,SAM/COST OF X
FAMA,SAM/FINACIA X
FAMA,SAM/INSURAN X
FAMA,SAM/UTILITI X
FAMA,SAM/UTILITI X
FAMA,SAM/UTILITI X
FAMA,SAM/UTILITI X
FAMA,SAM/UTILITI X
FAMA,SAM/UTILITI X
FAMA,SAM/FINACIA X
FAMA, SAM/BANK TR X
FAMA,SAM/TRUST I X
FAMA,SAM/TRUST I X
FAMA, SAM/COST OF X
FAMA,SAM/GUARDIA X
FAMA,SAM/FINACIA X
FAMA,SAM/MEDICAL X
FAMA,SAM/MEDICAL X
FAMA, SAM/UTUITI X
FAMA,SAM/TAXES X
FAMA,SAM/TRANSPO X
FAMA,SAM/UTILITI X
FAMA,SAM/UTILITI X
FAMA,SAM/UTILITI X
FAMA,SAM/INSURAN X
FAMA,SAM/INSURAN X
FAMA,SAM/REIMBUR X
FAMA,SAM/REIMBUR X
FAMA,SAM/REIMBUR X
FAMA,SAM/PERSONA X
FAMA,SAM/UTILITI X
FAMA,SAM/PERSONA X
FAMA,SAM/UTILITI X
FAMA,SAM/UTILITI X
FAMA,SAM/MEDlCAL X
FAMA,SAM/BANK TR X
FAMA,SAM/FINACIA X
FAMA,SAM/PERSONA X
FAMA,SAM/INSURAN X
FAMA,SAM/UTILITI X
FAMA,SAM/UTILITI X
FAMA,SAM/GUARDIA X
FAMA,SAM/MEDICAL X
FAMA,SAM/MEDICAL X
-480.12
-190.77
-72.25
-7,557.23
-35.55
-960.24
-117.85
-252.43
-78.98
-326.40
-104.85
-201.60
-1,111.96
30,000.00
18.65
21. 86
-378.62
-1,500.00
-2,037.00
-292.50
-15.28
-17.55
-949.83
-500.00
-42.16
-4.47
-95.26
-80.00
-12.00
-0.85
-2.63
-3.50
-500.00
-42.16
-83.30
-16.71
-41. 57
-3.48
34.02
-117.85
-360.00
-407.00
-96.00
-16.59
-1,500.00
-132.42
-348.97
TOTAL INCOME
TOTAL INCOME 1 EX PENSE
ITEMIZED CATEGORY REPORT
11 l' 0 Through 3/31' 5
PAGA_CUS-PAGA Custodial
3/ 2' 5
Date
Num
Description
Memo
-------- ------ ------------------ ------------- ---------------- - ----------
----------
----------
Category
0.00
0.00
Page 3
Clr Amount