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HomeMy WebLinkAbout06-27-11or~g~~~- h3 -.~~.. ~. ~ ~INNUAL REPORT QF ~ a N GUARDIAN OF THE ESTATE ~ ~~ ~, COURT OF CO ON PLEAS OF a -a ~~~.~~,~y~~ COUNTY, PENNSYLVAMA ~4 ORPHANS' COURT DIVTSTON Estate of , an Incapacitated Person o. ~ D-~6 4'1'1 ~`? ~ac~ c.- C~"! fY"1 .~~ ~~ C'l ~7 ~ .~ "Tl ~y t ~~ ~ L INTRQDUCI'°CON r w~ appoir~ Plenary ~ Limited `an of the Estate hY Decree of 7., dated ~p-~2-~~ © A. This is the Annual Report far the period from -/ to (the "Report Preriod"); or ~ B. This is the Final Rapart for the period from ~ ~ 3 ! r to 5 - ~ 1 - ~ I ,,,., (the "Report Period"), and is filed. for the following ream: 1. The death of dre Incapacitated Perm. Date of death: ~- ~~- ~~ Name of Personal Represeatati~er 2. The Guardianship was terminated by the Court h5' Decresr of J., dated FwaeQ-Q2 m. 10.13.A6 Page 1 of S s~ >:~te of ~ An Incapacitated ~ II. SUMMARY A. Staff the value of the estate reported. en the Im+entcny B. State the value(s) of principal assets at the beginning of the Report Period. (Same as Inventory if fnrst Report, otherwise, endixag balance from last Rspart.) G. What is tho total amount of income earned during the Report Period? D. What is the total amount of income and principal spent for all purposes daring the ~ Period? & 82~~a s ! ~ ~(..~-I.13 x.15~~(, 35_ R. What are tht balances remaining at the +md of the Report Period? 1. Princi~l 2. Income S 3. Total. of Principal and Income ~.~ l O ~? g III. ADDITIONAL INFORMATION (Tf»nare space is needed please attach additfarttrt pages.} A. Priuclpal I . Haw is the principal. balance listed above currontly inveated7 {Please specify, e.g, real estate, certificates of deposit, restricted bank. accounts, etc.): NSL C~st~~c~..Q i~-cc~,~ . ~ 2(~SS ~ ~ 2. Have there been any expenditures from the principal during the Report Period? ...... . ..................... ®Yes No If yes: a. Have all expenndituaes from the principal been far the ale benefit of file Incapacitated Person? ........ O Yes O No Fa,. c-or m:1013OG Page 2 of 5 Lstace of ~ An Incapacitated Person. b. List purpose and amount of expra~clitures: S c. Was Court approval received prior to expending the principal? .................... . .. ^ Yes (7 Na 3. Were additional principal assets received during the Report Period which were net included in the ,,,,/ Inventory or a prior Report filed for the FSState7 ........... ®Yes R+ca iva If yea: a. Was Court approval requested prior to receiving the additional principal? ................ d Yes D Ida b. Slate the sources and. amours of the additional principal received: S B. Ineome I . State sources and a~t~a~mts of income received during the Report Period (e.g., Social Secsaity, pension, rents, etc.): ~,tn51 D(~ ~ ~ 7~~ ~t=~ ~, ~ . 4°1 S. Do ~a~~d~~ ~~~.r C~ ~ ti S 3 Total income received during Report Period.: S 1 Z ~ ~~ • ~ 3 F~.c-as .~ ra:raaa Page 3 of S Estate of r Ann Incapacitated Person 2. How is inca~me cun~ealtly invested? (Please specify, e.g., resdricted bank accounts, client care acxaunt, etc.): ~1 ~ C~S~-cow ~c~. C. Expanses for Care and MAintenanee Specify What expenditures werc made from the principal. and incos~ far the and maintenance of the incapacitated Person (e.g., clothing, nursing ,medicine, support, etc.): ~~ UlS i~ (~~ = ~13 i 3~`~ l ~'L~.du ~ _ ~ z.so D. Other F.XpendltRresl Specify What abler expenditures Were lllade during the Report. Period. (Do not include any items stag in response do ~ c1 question. C above.) o~ C~ r.~~~5 _ o~ ~9a~ = X200. . ~'//ao, 1 . lanes ~- ~ ~ t'.e-P - ~ - ~~,Gb E. Guardian's Commissions List amounts of comper>sation }mid as t3uardian's aammissian ami state haw amount was determined: Amount Metlevd of'Deternrfnatfan Court Anprovat Obtained ^Yas QNo Faai a-0? rex IQ 13.06 Page ~ ~ 5 Estate of _„_ An Inca~citated Person F. Coawel F~ List ~ paid as cotmsel f~, azr`i indicate whether Cant approval was obtained. Anwrnra Court ~ Yes ~ No ®Yes ®No I verify that the foregoing iaforc~tion is correct to the best of my knowlyd8c, informs#ian amd belieF acrd that this Verification is subject to the penalties of 18 Pa.C.S. § 4~4 relative ~ v~vvorn falsification bcs atrtharities. ~~°~ ~,~~ ~c~" ..~~- (c~ - I l Nl-e~~a,P~~c~c~ ~v c S ~ ~,~1~ rye gltlro ~~ smm (~ arprt~ ,~nvca s't ro. Box ism „epCAB'rEll, PA 17p61l~Ci ~ ~4~~ "(l7 -3~ 2 -2.17 S 7Cf-, ZZ rerepke-+e FarraG=D2 ,tee. Id13.06 ~a~'C 5 Of ~