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HomeMy WebLinkAbout09-07-10ANNUAL REPORT OF GUARDIAN OF THE ESTATE COURT QF COMMON PLEAS OF C ~M~~a~ d. COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ~t I Estate of , V ~ ~-o ~~ ~~ 0.,m ~~- . an Incapaai~ated Person No. ~ -- ~ o g '~' I. IIVTRODUCTiON Q.~Plenary ~ Limited Guardian of the Estate by Decree of ~ ~ d~ ~ r dated ~ 3l off. appointed J., A. This 's the Aunual Report for the period from Z.~~ to ~ ~ c^F- '~ ~ ?S~ 1 O (the "Rerrt •Per~od'~; r © B. This is the Final Report for the period from to (the "Report Period"), d is filed for the following reason: ~, ~' ' M ~ ~' 1. The death of the Incapacitated Person. Date of death: :~ w ~ cc Name of Personal Representative: :. ~ .. = .x ~ oc~, r-_, ~,~ u. i ~-- Q cn ~ 2 The Guardianship was terminated by the Court by Decree of ~, Ci ~ 4:i' <. ii _; ~_ : LL Lai cn V W ~~ J., dated I ~ ~J v 0 ~., Form G-02 rev. 10.13.06 Page 1 Of Jr Estate of ~ ~ C U ~ -~. ~t'-i \ 0~ .l) cC .C~ , An Incapacitated Person II. SUNIIVIARY A. State the value of thc 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 specrt 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 III. ADDITIONAL INFORMATION (If more space is r~ech'd, please attach additional pages.) A. Priecipal 0.~~ ~~`~ .~~ ~- 4~~~~ ~- t~I~~ 1. How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): 0.00 V 1116r-- 2. Have there been any expenditures from the principal durin the R rt Period? ............................ ~?'e ®No g ~ If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? ........~e~ D No F~ c-o~ ,n. lo.rs.o~ ip~ge 2 of 5 1_ __- -- - Estate of b. List purpose and amount of expendi An Incapacitated Person c. Was Court approval received prior to expending the principal? ....................... 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? ........... Q Yes ~ No If yes: a. Was Court approval requested prior to receiving the additional principal? ................ ©1Yes ^ No b. State the sources and amounts of the ~, additional principal received: '' B. Incoaae 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): ~- 0 Total income received during Report Period: Foyer G-02 m. 70.73.06 Page 3 of 5 I I_ _ Estate of 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): An IncapaCi~ated Person ~~ ~~ ~-~~~ lo~e~ Cc~~ ~~-~- U r ~ ~ C. Ezp fer Cue a~ hence ~, 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.): ~~~c~c• ` ~~ ~ ~ 6Lti~ D. Other Ezpeoditar~es Specify what other expenditures were made during the Report Period. (Uo not include any items stated in response to question C above.) ~ t1-~ E. Guardi~a's Coasie~sioas List amounts of compensation paid as Guardian's commission and state how amount was determined: Count Amount Method of I~termirration Aal Obtained ~pf~~~ ©Y~s [~No Forn- G-02 m 10.13.06 ~Y$s', QNo '~ Page 4 of 5 T ~_ ~_ Estate of ` `~ ~-~-->~0.V An Incapocita~ed Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was j obtained. Court Amount Approval ~dbtained ~ (~Q.... ~ Yes d 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 PaG.~s. § 4904 relative to unsworn falsification to authorities. _~~~ C7 zx~re S~g-wgo~e of Gwa-dton of rbe E~afe 1Vaare of GrKVdUrw ofrk &nw~e (type w p-b~ T ddcAreas ~'~u- sL~ ~ a 15 ~~.~.~ TikpAo~e Form G-02 rev. 10.13.06 IlPage 5 of 5 i - _~__ ._ I - L_-- -- ______._ _~7T _ ANNUAL REPORT OF GUARDIAN OF THE PERSON COURT OF COMMON FLEAS OF C~mb~~C h.~l COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ~ '' i i Estate of ~ ~ ,L ~~ .~ -~~ a y Q t: . an Incapacitate d Person i No. -b '~~ I. INTRODUG"1'ION c ~~;, t~1~R ~- yK~.J~1SE ~L-~'(~~~-~ .was ja II inted pip 1 1~! Plenary ~L' ited G ardian of the Person by Decree of ~ ~ ~l L. C- ~I~ . J., dated ~ r?~ ~, A. This is the Anneal Report for the period from `~e~`5-~ ` I Z~~ ~_ to ~,p (the "Report Period"); or' ', M © B. This is the Final Report for the period from ., rte. G? +1-: -- _ ' a, ~ (the "Report Period"), and ~s filed ~~ -~ ~ r ~_~ `a "" a the following reason: _ ~ ~ J ~ cL 1. The death of the Incapacitated Person. Date of death: ~_ s~~ ~ V w i _ ~..aw~ y ~(] ~ U 2. The Guardianship was terminated by thC Court by Decree of J., dated j For a Flital Report' ondt Sows II tArroaglr IV Form G03 rrr. 10.13.06 Page 1 Of 4 Estate of 1 V \ C 0 ~ •~ -~-~ ~ OIL) Ca C~ , an Incapaciti Person lQ. PERSONAL DATA Age of the Incapacitated Person: 2~ III. LIVING ARRANGEMENTS Date of Birth• ~•P~ '~ A. Current address of the Incapacitated Person: O j ~-~1~G'~S~O n ~~ rl ~~~ vec' n ~ P ~ \ 13~ B. The Incapacitated Person's residence is: ', own home /apartment 0 nursing. home ~!, I boarding home /personal care home ® Guardian's home /apartment ® hospital or medical facility ~' ~ relative's home (name, relationship and address) other: G~J P ~r~~'r~ C. The Incapacitated Person has been in the present residence since .h= ZL`~p ~ . If the Incapacitated Person has moved past Year, state prior residencc and reason(s) for move: Form G-03 rrv. 10.13.06 Plate 2 of 4 > of ~ ~ c o ~~ ~ ~ a ~ Gl ~ an Incapacitalt~d Person D. Name and address of the Incapacitated Person's primary caregiver: 1ti~\ mo` c- ~. 2tQ oo ~~ \a ~~ ~~ rv. 1VIEDICAL 1~iFORI1~IATION A. The major medical or mental problems of the Incapacitated Person are as fgl~ows: A` V \ ~ c7 \~~ ass t~~~ c~ ~ roc-1r2~\e-~ja~,Q ~~~Sa~~~S c~v~~j t~f-~ r\~cc\ B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: N\Cc~\~ iS \~~~DC ~, Ir'`1'~~ ~S. V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: ntinue ', ®be modified ®be terminated Fons G-03 rsv. IQ 13.06 1#age 3 Of 4 Estate of ~~~-e-- \~~~d .I~(~ C' ~ _, an Incapacitated Ptrson The reasons for the foregoing opinion are: ~.~, ~S ~ 0.b r ~. ~~~~ .~- ~~ ~ ~ he c-s~-~-~- .~.- c1,.e~~s bra c3-~che~ -s mac- h e ~ ~~ ~~C~ B. the ear, the Guardian of the Person has visited the Incapacitatd~ Person v, ~8 P~ Y ~b times with the average visit lasting S~ hours, _ ~ Minutes. The report of a social service organization employed by the Guardian to over se~e'II and coordinate the care of the Incapacitated Person for the period covered by this Report m~Cy be attached to supplement this Report. 1 verify that the foregoing information is correct to the best of my knowledge, information and beliefi and that this Verification is subject to the pcnakies of 18 Pa. C.SaA. § 4904 relative to unswom falsification to authorities. ofc afdu Pe.~ Nanrs of Garr ~tlbe Perao~ (type or prbx) Addntss ~, Slime. ~ Tekplwee Fa.~. c-o3 ~. ~o.ls.a~ ~8~ 4 of 4 Supplement to Annanl Report of Gnnrd»n of t>te Person Person: Nicole HIavac; Docket Nbr: 06-0608 Following are the details regarding visits to Niki during the August 1, 2009 to July 31, 2010 timeframe. P Number Visit Start End Durati on Notes 1 9/12109 9/13/10 22.25 Visit Niki, Visit Niki's Church, Puri clothes, raincoat and toiletries; shay.'.. and made ziti and some chicken so church overnight 2 11/25/09 11/29/09 93 Niki home for Thanks 'vin 3 12/23-09 12/27/09 88.5 Niki home for Christmas 4 4/2/10 4/4110 46 Niki home for Easter 5 4/17/10 4/17/10 4 Dinner with Niki after Prom Dress ~' b 4/18/10 4/18110 b Niki hosted RS P aad attended Service 7 4/29/10 4/29/10 2 Ice Cream with Niki after Prom Pick- 8 5/9/10 5/9/10 4 Mothers Da dinner w/Niki; A RS Service 8 b/10/10 6113/10 b0.5 Nik home for Kelse 's HS ' n 10 7/29/10 8/7/10 212 Mom and Niki -vacation to Lake visit her brother AZ to Total visits =10 Total hours = 360 Average Per Visit: 51 hrs and 36 minutes _~1.