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HomeMy WebLinkAbout01-05-11 (2)F.~. ~ ~; . ~ ~, ~ n ~'7 ANNUAL REPORT OF GUARDIAN OF THE ESTATE ~ _ ~ f~ `r ~~~ _ COURT OF COMMON PLEAS OF ..~ --. ,. ~ = ^~'+ C U t~ 13F7Lc.. ~ ND COUN'T'Y, PENNSYLVANIA '' ~ `'' ~ ORPHANS' COURT DIVISION Estate of t v i • ~ t uC an Incapacitated Person No. Z~-0_(~-(IU7 I. INTRO~D-;U~CTION !~J OYId~' ~- ~ . ~~Vl C ~ appointed ©Plenary Limited Guardian of the Estate by Decree of _ ~ . J., dated A. This is the Annnal Report for the period from ©~ d ~ - .~ ~ ~ to l :~- ' 3 t - . 7~C1_ 1.O_ (the "Report Period" ); or ® B. This is the Flnal Report for the period from '- to (the "Report Period"),.and! is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J., dated Form G02 rsv.10.13.06 __.T - T ~_~,_ __ ____ ____ _ ... Estate of ~ • ~ ~ An Incapacitated Person II. SUMMARY A. State the value of the 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 duringthe -~ Report Period? $ ~ ~' D. What is the total amount of income and principal ~_ spent for all purposes during the Report Period? $ _ E. What are the balances remaining ax the end of the Report Period? 1. Principal CS~D ~-~ $ ~~ ~ O 2. Income $ -~ 3. Total of Principal and Income $ ~t ~ ~ D 0.00 III. ADDTITONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principal 1. How is the principal balance listed above currently - ~ ~ CJ . l~ invested? (PIease specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): 2: Have there been any expenditures from the principal during the Report Period? ............................ ©Yes' ~ No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? ........ ^ Y'es ^ No Foy c-o~ .N. ~o.~s.o6 ~a~e 2 of 5 _ r-r . Estate of C'l'1~1~e_..._...... ~....._ ~ ~ tU ~. C~ - .._ An~Tricapac~tafed Person . ` .. b. List pu ose and amount of expenditures: c ~ $~o oo0•DO $_ c. Was Court approval received prior to expending the principal? ....................... ~''~es ^ 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? ........... ~ ~l'es ~No If yes: a. Was Court approval requested prior to .receiving the additional principal? ................ O Ixes ^ No b. State the sources and amounts of the additional principal received: B. Income 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents etc.): a,~r~r. l Total income received during Report Period: Form G-02 m.10.13.06 $ ~~ $r t~~3~i6~.vo . $ I~ T OD ~_ $ a ~ , g~-~ .~o ~'a~e 3 of 5 r ~ _,. W _ _ ~ ,_,- . ...- . _ _ _. Estate of C~ 1+1 ~~ ~~ ~ ~ ' An IricapaGitated Iverson 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): G. Ezpenses for Care and Maintenance Specify what expenditures were made irom the principal and income for the care and maintenance of the Incapacitated Person (e.g., clothing, nursing home, medicine, support, etc.): ~ e c~.,~f1 ~ - 6G ~ , 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.) Non ~ E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: . Court Amount Method ofDetermination ;4pproval CI$tained ~ `~ '~ ®Yes ' ~ No Q Yes ~ No Fom G-o~ ,,,~,:: ~o.~s.o6 Paige 4 of 5 A . .. Estate of ~ ' _ (~ An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount Court Appro~all G~btained b Yl.~ _ 0 Yes ~' No © Yes ', ~'No I verify that the forcgoing information is correct to the best of my knowledge, information and belief and that this Verification is subject to the penalties of 18 P~.C.3. § 4904 relative to unsworn falsification to authorities.. ~s sly of cfrJx rsucre 1 oV1~ ~ ' ~! L~-~t~c... Nmu ~Grrmdtar of rbs Bswu (ryps orP-'~ r ~~ ~~ ~~~~~ Avg ~1 Addresr e vin o v~ , ~~ ~ 7 ~ ~F3 ~,~~ _ 1 73 ~-.- 0 2- 3 Telephons C'at', ~-2237 >~5 Iw Ea~ia Dr., `,F~, p' ~ ~~~ Form G-02 rev. !0.!3.06 Pale 5 of 5 _i