HomeMy WebLinkAbout07-25-11~ i ~~','
~~ ` p ~ ~ GUARDIAN'S INVENTORY
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COURT OF COMMON PLEAS OF ~,!//IKXIf~c.CS~n.t~ COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
,--
~an Incapacitated Person
Estate of rb
f ~ a Minor
No.~y/ l ~~ / n __ _~
1. Real Estate: (Location, by whom occupied and rental
terms, if applicable)
Sub-Total for Real Estate:
3. Jointly Held Property:
(Set forth real and personal property owned by the Incapacitated Person JOINTLY with any
other person(s). State whether held as tenants by the entireties; ijnot, whether the right of
survivorship exists.)
Jointly Held Property
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Estimat-~ue: -~.
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0.00
Estimated Value:
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Estimated Value:
Form G-04 rev. 10.13.06 Page 1 of 2
f
~/° n ~,~- n Incapacitated Person
Estate of r~
a Minor
4. Anticipated Assets:
Estimated Value:
(Set forth property of any kind expected to be acquired hereafter, together with
anticipated date of acquisition.)
Property
oJAcquisition
~i~~
Sub-Total for Personal Estate:
(Attach additional sheets if necessary)
TOTAL OF ITEMS 1, 2, 3, and 4 : ............................ .
Anticipated Date
Commonwealth of Pennsylvania
o.oo
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County of .r'
Z~~ ~~~.~ C~c~ !~.~ C~T~~4=r ~n ~- ,says that the foregoing is a full,
Guardian ..-.
true and complete Inventory of the Estate of C~11~ -~- L-' V V' ~-r1'~-{ -1'~ ,
the aforesaid Incapacitated Person or Minor; and that all of the information set forth herein is
true and correct to the best of the Guardian's knowledge and belief.
I verify that the statements made in this )
Inventory are true and correct. I under- )
stand that false statements herein are )
made subject to the penalties of )
18 Pa.C.S. § 4904 relating to unsworn )
falsification to authorities. )
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Guardian
Attorney for Guardian: ~ ~ ~
Supreme Court I.D. No.: ~
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Address: ~) ,' ~ ~! f`c? C?" J"
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Telephone: ~ ~ ~]~,~ ~~-- ~ ~~ ~
Form G-04 rev. 10.13.06 Page 2 of 2
' Q MBfiFi~~nk
ACCOUNT'NO. ACCOUNT TYPE
9837362889 M&T CLASSIC CHECKING W/INTEREST
00 0 04346M NM 017
DOROTHY E WERNER
824 LISBURN RD APT 303
CAMP HILL PA 17011
INTEREST EARNED FOR STATEMENT PERIOD 0.09
INTEREST PAID YEAR TO DATE 0.37
55627
71("'(''(1TTT~T'T CTTMMZ~1?V
STATEMENT .PERIOD PAGE'
APR.07-MAY.06,2011 1 OF 1
NORLAND AVE OFFICE
BEGINNIN DEPOSITS & OTHER> CURRENT ENDING
BA CE OTHER: ADDITIONS CHECKS<PAID ' SUBTRACTIONS INTEREST.:PD BALANCE
NO. AMOUNT N0. AMOUNT NO. AMOUNT
` ~ 11,772.83 1 1,516.82 0 0.00 0 0.00 0.10 13,289.75
'~
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ACCOUNT ACTIVITY
POSTING
DATE
TRANSACTION DESCRIPTION::: DEPQSZTS,:INTEREST.
&:OTHER:ADDITIONS CHECKS &: OTHER
SUBTRACTIONS DAILY
>BALANC:E
04-07-11 BEGINNING BALANCE $11,772.83
05-02-11 US TREASURY 312 X:KCIV SERV 1,516.82 13,289.65
05-06-11 INTEREST PAYMENT 0.10 13,289.75
ENDING BALANCE $13,289.75
ANNUAL PERCENTAGE YIELD EARNED = 0.00 °s
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~~ ~
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The Managing Trustees HCR ManorCare
Resident Personal Trust Fund 5th floor
Resident Trust Statement 04/01/2011 Through 06/30/2011
07/07/2011 01:57 PM Page 1
Legal Rep resentative Resident # 2170
Werner, Dorothy E
Werner, Dorothy E
1700 MARKET STREET
CAMP HILChambe rsburg PA 170
Bank: Wachovia
Acct #: 20200001 04913
Admit: 3/14/2007 2:20:00 PM
Disch;
Beginning Balance
~ $0.00
---
Date Description Check# Withdrawals Deposits Balance Trans ID
04/01/2011 soc sec $281.00 $281.00 21163 j~
04/30/2011 Interest $0.03 $281.03 21363
04/30/2011 Service Charge $0.00 $281.03 21364
05/03/2011 soc sec $281.00 $562.03 21293
05/31/2011 PVT DEC 201.0 & J 2084 $86.00 $476.03 21429
05/31 /2011 Interest $0.04 $476.07 21477
05/31/2011 Service Charge $0.00 $476.07 21478
06/06/2011 SOC SEC $281.00 $757.07 21440
06/29!2011 JUNE B&B 2094 $46.00 $711.07 21562
Ending Balance ~ _ $711.07
~~,~
Resident Trust Fund Statement -This is not a bill
Wachovia 2020000104913