Loading...
HomeMy WebLinkAbout06-22-10• Y ;~ Clerk of Orphans' Court of Cumberland County r-.~ r_~ ~? o ~ ` ) .--. iN RE: ~ ~ Y1 1 v ~ ~ ! ~ ~ Docket No. L ~ ~~ k~ ~ ~ ~ ~`~ - c~_--_ ~ - An Incapacitated "erson ~ ~ ~~ _z-, tv ;~~ -fc - _ ',=; ANNUAL REPORT OF GUARDIAN OF TAE ESTATES =~~ r ~.., ~, ~ ~ I, o~v~Uy~J'u'ih tth~ e v~ ~r ,was /were appointed plen y guar ian s} of the estate of ~ b ~v1 I v y ~ ~ ~ t Z ao by Decree of the Honorable .Tudge 6 ~ f,' Ir . /Dated J~n~ ~~. This is my annual report for the period from vh a to .Sly- O O , ("The Report Period"). I. SUMMARY A. Value of principal assets at the beginning of the Report Period? ~ B. Total amount of income earned during the report period?V h ~~/~~ ~ `~~~~`~ $ C% Total amount of all expenditures made for care and maintenance of the C. incapacitated person during the Report Period? 1. From principal ~ 2. From income $ 8~y. 0~ - D. Total amount spent for all other purposes during the Report Period? $ ~~ ~~ E. Total amounts remaining at the end of the Report Period? 1. Principal $ ?.Income $ C~ Total Income and Principal S V II. ADDITIONAL INFORMATION A. Principal: 1. Total amount remaining at the end of the Report Period? S 2. How is principal currently invested? 3. Have there been any expenditures from principal during the Report Period? ^ Yes~No If you answered YES, was there Court approval for all expenditures from principal? ^ Yes ,0'~io 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? ^ Yes ~o If you answered YES, did you receive Court approval prior to receiving ~~ additional principal? ^ Yes l~'No ~. State the sources and amounts of the additional principal you received: B. Income: 1. State sources and amounts of income received during the Report Period (i.e., social security, pension, rents, etc.): ~ ~_ ~,%- Total Income received during Report Period S 8~ ~, ~~,,~ 2. How is income currently invested? (Please specify, restricted bank accounts, client care account, etc.) 3. Specify what payments were made for the care and maintenance of the incapacitated person (i.e., clothing, nursing home, medicine, support, etc.). l` (~ ~ lei .~s 9 /' ~~~~~~/"///",3 ~3 9'~ 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. X4904 relative to unsworn falsification to authorities. r. (ll / // Date Signature of i * FILING FEE $IS MUST ACCOMPANY THIS FILING. Clerk of Orphans' Court of Cumberland County IN RE: ~~ G Y~Y~ N Y~ ~ ~ ~ Docket No. Z(~0(o ' QG y Y~ An Incapacitated Person ANNUAL REPORT OF GUARDIAN OF THE PERSON n 1' O~rt~f ~ ~ ~~` - ~ /' v~ ~ Y, was /were appointed plenary g and (s) of the person of ~ G hn NyE ~ ~ 1 by Decree of the Honorable Judge__ (~ ~ e r ,dated --~ ~ V1~ ~G ZUb ~O, This is my annual report for the period from J y:~.~ a~~U~ to _~v~,~ t3G, aUO , ("The Report Period"). 1. Present age of the incapacitated person: ~_Yrs. 2. Current address of the incapacitated person /~yr ~,+~~~ r ~s ~ ~~-, ~~, ~o~ ~C/fn yi ~.'~~, r~9 ~ ~7 D l/ ~ r-.~ ~, ~, - o ~ 3. The incapacitated person's residence is: _. ~, ' ~ _ -~- ,,, - - ~~r1 ra N - p own home/apartment ~- "~ > -~ -> ^ nursing home ~ •• ~ ~., `,,~, ,~ y. ,~- : , ^ boarding home/personal care home guardian's home/apartment p hospital or medical facility p relative's home (Name and relationship] p other: (describe) 4. The incapacitated person has been in the present residence since far,'/ ~ GSO~If the incapacitated person has moved within the past year, state change and reason(s) for ~-J ' change: 5. Name and address of the incapacitated person's primary caze giver: Sly- ~s -~ 2 6. The major medical or mental problems of the incapacitated person are as follows: ~P/- Specify what, if any, social, medical, psychological and support services the incapacitated 7. person is receiving: ~ / ~~ S ~r~~~' !~~ ~-~.~ UGC 8 It is our opinion as guardian of the person that the guardianship should: (check one) ~ontinue, ^ be modified, ^ be terminated. (Briefly explain your response) 9. During the past year, I have visited the incapacitated person times with the a-ver~age visit lasting ~J t Chi ~e / S Gu , ~ 1 1rc~ l ~-e ~- .-f t~ G- q~/ /~ o JC i ~/yi f~e (State number ofhours/minutes, etc.) ''--y 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 maybe 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. ~ /a Date -,, ~_ ignature of ian * FILING FEE $15 MUST ACCOMPANY THIS FILING.