HomeMy WebLinkAbout07-06-10 (2)ANN~JAL REPOI~.T OAF
GUARDIAN C}F THE FS''I'ATE
~' ~~~ I,~COURT OF G MMC7N PI.,EAS t7F
~~~~-~ COUNTY, PEISYLVt~I~tIA
UR.i'I~ANS' COURT DIVISION
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Estate of ~ ~.. ,,.~... , an Incapacitated Person
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I. INTROI~UCT~t~N
d ~ .
,.~ ~,.~,'a~.'_
~q Yt~lary ~ I.1TriIte~ ~'.1Li&~14~7
dated ~, ~ ~ Z.,~)~D
~,,,~j, _, was appointed
of the Estate by Decree of ~.,
A. Taus is the Annual Report far the periad from `J~,~i~„p,~, ~Z 2e~
to , .,,,,~.~~,,.. (the "Report Period"}; ar+
B. This is the Final It+epart for the period. from ,
to ,
for the fallowing; reason:
(the "Repast periad"), and is filled
I. The death of the Incapacitated Person. Date of deatlY;
Name of Personal Representative:
~. TIYe Gtjardianship was terminated by the Ca~irt by Decree of
,dated
F omt ~-U2 r~u. 7D. /3. fhf
Pale I of S
l.~
Estate of ~ - , An Incapacitated Person
II. SUMMARY
A. State the value ofthe estate reported on the Inventory
B. State the values} of principal assets at the beginning of
the Report Period. {Same as Inventory if" first Report,
otherwise, ending balance fror~n last Report,)
C. What is the total arrzount of income earned during the
Report. Period?
D. What is the total amount of income and principal.
spent for all purposes during the Report P'eriod`?
3 . What are the balances remaining at the end of the :Report
Period?
I. Principal
2. Income
3. Total oi' Principal and Income
~>~~. Al~iaa<T>iolvA>~, ><lvlj oR~T~aly
(If ma~.e .~;~ace is r~eecled, phase atlcrcFa r~~ditivrrcrl pagcs~.)
A. Principal
$ CJ~
.~? '~.2.0~ GC±-e ~ ~it1COn'PC~
'71nov u1 Y10.vp b t (zi'1 ~ l!?3.1
I ~.1~2~ ~ .`b~
~ I ~~., , ray
~2~<<10
Cos ~~ 51a ~ 1 le)
I . How is tl~e principal balance listed above currently
invested' (Please specify, e.~;., real. estate,
certificates of deposit, restricted bank accounts, etc.}:
l~e~ h`orXhovc~ ~r'V,~.~ CvS~~'a.Q ~ u-+. = ~ l~~c~. 13
nl~xlo~ ~2 ~+C~Q-rte" ~~) : ~ 15 5 ~ 7 7
2. Dave there been any expenditures from the principal
Burin tl~e Re ort Period? ............................ ~ Yes ~ No
~ P
If yes:
a. I-Iave all expenditures from the principal been for
the sole benefit of the Incapacitated Person? ........ D Yes ^ No
Fvrru G-07 reps tA.13.f3b Page ~ of ~
Estate of ~ A~i Incapacitated Person
b. List purpose and amount of expenditures:
c. Was Court approval received prior to
expending the principal? ..... . ......... . .. . .... d Yes d No
3. Were additional principal assets xeceived during the
Report Period which were not included in the
Inventory or a prier Report filed for the Estate? .... , . , .... ~ Yes No
If yes:
a. Was Court. approval requcstcd prior to
receiving the additional principal? ................ ~ Yes D No
h. Mate the sources and amounts of the
additional principal received::
B. Incnme
l . State sources and anYOUnts of income received.
during the Report Period {e.g., Social Securit3~,
ensign, rents, etc.):
~.~ ~'1S~ oYl ~~,, (.,P 2y~1, 4~
~>~~.~ ~ ~~ ~I
Total income received during Report Period: ~ ~ l ~ 25 ~ ~ g 5
~~,~ c-oa ~~,~. ru. ~3.ob Page 3 of 5
Estate of , An Incapacitated Person
2. Haw is income currently invested? {Please
specify, e.g,, restricted. bank accaunts~ client
care account, etc.}:
~~~~.~ ~c ~,~,~p
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 (~,~~., clothing, nursing l~otne, medicine, support, etc.):
~SoYI C~S2 ~ ~ `~ 35. ~ o
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.)
~~ ®q G~ ,~~- ~-~n ~ $l5, oz~
T : ~ ~ ~0 9
Svc pn.~p 3 -
,~t~t,0~.~c.~.~. ~-ee,~` ~ r2C~o
E. Guardian's Commissions
List amounts of compensation. paid as Guardian's con~nussiotl
and state how amount. was determined:
~motrnt Med~vr~r~,~l7etermrrrcrtan
~~lo o l~v )'Yl I~
Gcrrcrt
approval Ohtaaned
Yes No
Yes ~ No
~~„~, c~ct2 ~~~~. rn. r.~.a6 Page 4 of ~
Estate of An Incapacitated Person
~. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Amozrt~t
Court
Apt rival C~btanett
Q Yes Q Na
Yes ~ Na
I verify that the foregoing information is correct to the best of my knowledge,
'information and belief; and that this Verlficatlon is sub' t to the pe hies of 18 Pa.C.S. § 404
relative to unsworn fatsi'~cation to authorities.
Date Signature aj' rarrltan a~'ttu E'stme
1Vaere aJ`Guarrllan of tht Estate (t}yte ar ~rtnt)
NEIGiflb~Ylt~OVl) BEKVICES
134 SOUTH PRINCE STREET
P.O. BOX 1593
°LANCASTER, PA 17608-1593 Adcl+ra~~s
Ctt~; Slrxt~, Zr~s
~ (~ -3`~~. -217 S X~- 22.1
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Farrri t"r-ti2 rev. It~.13.06 ~~~e ~ 0~ ~