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HomeMy WebLinkAbout04-0781STEPHEN J. HOGG /c) S IL;\N¢)VER STREET SUITE 101 ('ARIISIE. P\ 17013 IN RE: WILLIAM C. WILSON ALLEGED INCAPACITATED PERSON : COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : ORPHAN COURT DIVISION : :NO.: PETITION FOR GUARDIANSHIP ~ The undersigned brings this Petition through his Attorney, Stephen J. Hogg, Esquire, seeking appointment for Guardianship of William C. Wilson alleging the following: 1. The Petitioner is Kenneth E. Wilson, brother of the alleged incapacitated person, residing at 429 Hogestown Road, Mechanicsburg, Pennsylvania. The Petitioner has no interest adverse to the alleged incapacitated person and seeks appointment of Guardianship to ensure the alleged incapacitated person's continued physical and mental health treatment. 2. The alleged incapacitated person is William C. Wilson born September 4, 1924 and whose last known address is Claremont Nursing Home. 3. The alleged incapacitated person is single and has no children. STEPHEN J. HOGG I~ S HANOVER STREET SUITE 101 ('~.RI ISLE. I'A 17013 10. The alleged incapacitated person is currently being treated by Dr. Ernest Josef, 1830 Good Hope Road, Enola, Pennsylvania 17025. The alleged incapacitated person has been diagnosed by Dr. Ernest Josef as having Alzheimers Disease. The Petitioner alleges that the alleged incapacitated person has shown his self to be unable to adequately care for his own needs and would likely not pursue any physical or mental health treatment as prescribed by Dr. Ernest Josef. The Petitioner requests that he be appointed Guardianship of the alleged incapacitated person to assure continued needed physical and mental health treatment and over the estate of the alleged incapacitated person to ensure that the alleged incapacitated person does not waste or squander his estate. The Petitioner alleges that he is the most qualified individual to be appointed Guardianship of the alleged incapacitated person having his best interests in mind. The Petitioner seeks appointment of Guardianship of the alleged incapacitated person only so long as the alleged incapacitated person is determined by his treating doctor, Dr Ernest Josef, to be unable to take care of his own needs. The Petitioner estimates that the gross value of the alleged incapacitated person's estate is $40,000.00. 11. Petitioner seeks appointment of guardianship of the alleged incapacitated person's estate and of his person. Respectfully Submitted, Date: S(ephen J. Hog~Jd~sj~ire Attorney for Pe~one~r STEPHEN J. HOGG 19S H:\NOYER STREt~T SUITE 101 CARLISI E, PA 17013 LAWOFFICES STEPHEN J. HOGG 19 S. HANOVER STREET- SUITE 101 CARLISLE, PENNSYLVANIA 17013 (717) 245-2698 · FAX (717) 245-0829 STEPtlEN J. HOGG IN RE: WILLIAM C. WILSON ALLEGED INCAPACITATED PERSON : COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : ORPHAN COURT DIVISION : :NO.: ~t~,';~- ,r ')~,~ ORDER AND NOW, it is Ordered and Decreed that a hearing be held on the ],.al~, dayof (t'~ (t-:/'~-/,~ L ,2004, at ,~ ). OL' ~, , /~1 . o'clock at the Cumberland County Courthouse, Carlisle, Cumberland County, Pennsylvania for the Petition for appointment of Guardianship in the above captioned matter and a citation issued to William C. Wilson to show cause why he should not be adjudged incapacitated and his brother, Kenneth E. Wilson, be appointed Guardianship. IN RE: William C Wilson Alleged incapacitated person : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : NO. 21-2004-781 IMPORTANT NOTICE CITATION WITIt NOTICE A petition has been filed with the Court to have you declared an Incapacitated Person. If the Court finds you to be an Incapacitated Person, your rights will be affected, including your tight to manage money and property and to make decisions. A copy of the petition which has been filed by St-~ohen J~_H_p_g~, Ese is attached. You are hereby ordered to appear at a heating to be held in Court Room No. 4, Cumberland County Courthouse, Carlisle, Pennsylvania, on October 1 ~ _, 200..~4, at 1__1:0_0 ~AM. to tell the Court why is should not find you to be an incapacitated Person and appoint a Guardian to act on your behalf. To be an incapacitated Person means that you are not able to receive and effectively evaluate information and communicate decisions and that you are unable to manage your money and/or other property, or to make necessary decisions about where you will live, what medical care you will get, or how your money will be spent. At the hearing, you have the right to appear, to be represented by an attorney, and to request a jury trial. If you do not have an attorney, you have the tight to request the Court to appoint an attorney to represent you and to have the attorney's fees paid for you if you cannot afford to pay them yourself. You also have the right to request that the Court order that an independent evaluation as to your alleged incapacity. If the Court decides that you are an Incapacitated person, the Court may appoint a Guardian for you, based on the nature of any condition or disability and your capacity to make and communicate decisions. The Guardian will be of your person and/or your money and other property and will have either limited of full powers to act for you. If the court finds you are totally incapacitated, your legal rights will be affected and you will not be able to make a contract or girl of your money to other property. If the court finds that you are partially incapacitated, your legal rights will also be limited as directed by the Court. If you do not appear at the hearing (either in person or by an attorney representing you) the court will still hold the hearing in your absence and may appoint the Guardian requested. Date:08_~-30-2004 By:,~ ~o~,~,~ z~Tg4 ~x~-~ga Cleric, OrPhans Court Divisiun ~ ~ [~(~}~ ~Cumberland County, Carlisle, pA7 My Commission Expires 1 st Monday, January, _2006 IN RE: WILLIAM C. WILSON an alleged incapacitated person IN THE COURT OF COMMON PI,EAS OF CUMBERLAND COLENTy, PENNSYLVANIA ORPHANs' COURT DIVISION 21-04-781 IN RE: PETITION FOR INCAPACITATION AND APPOINTMENT OF GUA~RDIAN ORDER AND NOW, this 2. '~' day of September, 2004, hearing on the above-captioned petition set fbr October 1,2004, is continued to Monday, November 8 ?004 at 9:30 a.m. in Courtroom Number 4, Cumberland C ' ounty Courthouse, Carlisle, PA. BY THE COURT, Stephen Hogg, Esquire For the Petitioner :rbn LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 10! CARLISLE, PA 17013 IN RE: WILLIAM C. WILSON ALLEGED INCAPACITATED PERSON : CO~JKi~O~'-~-15MMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : ORPHAN COURT DIVISION : .. ORDER AND NOW, this J'° day of ~', ~¢,, ~,~.,- , 2004, it is ordered and decreed that William C. Wilson is found to be incapacitated under Pa. Statute 20 Pa. C.S. §5501 et seq. Kenneth E. Wilson is appointed ~ of his Estate and of his Person. Glenda Farner Strasbaugh Register of Wills & Clerk of the Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esquire Solicitor OFFICES OF One Courthouse Square Carlisle, Pa. 17013 (717) 240-6345 FAX (717) 240-7797 ~egister of Wills anb ([lerk of toe ~rpoans' ([ourt <!tountp of <!tumbetlanb November 30, 2005 Kenneth E. Wilson 429 Hoggstown Road Mechanicsburg, P A 17050 IN RE: Estate of William C. Wilson, an incapacitated person File No. 21-04-0781 Dear Sir/Madam: It has come to my attention that you have not filed the guardian reports required by 20 Pa.C.S.A. S5521(c) in the above captioned guardianship. Enclosed you will find the suggested form(s). Please mail those reports, along with a check in the amount of $15, payable to the Clerk of Orphans' Court, to the following address within (30) days: Clerk of Orphans' Court One Courthouse Square Carlisle, P A 17013 If you have any questions, please contact your attorney. CC: Stephen Hogg, Esquire Respectfully, ~~~7f Clerk of the Orphans' Court Clerk of Orphans' Court of Cumberland County IN RE: \.....j \ L, \.. \. (\.~ C . W ~\...s.o~ Docket No. An Incapacitated Person :l-\. - 0'--\ -I 8' ( ANNUAL REPORT OF GUARDIAN OF THE PERSON I, t(E~HuB\~ ~< W ~Ls.~~ , was /were appointed plenary guardian(s) of the person of \i..)": L L'\: AWL c... ~) ~-L,~~ by Decree of the Honorable Judge \(!iih)~"") ~~ \.-\E<;..S., dated ~C~. tr, 'd...o C It . This is my annual report for the period from 'fI-.J 0-': , 'C'j J.. 0 0 4 +-...., i" ""l- S- ("T'-eR~portP . -,"\ LV ,....... C\J~ . - 0(:>. ,11 1. l;; enoCi ). 1. Present age of the incapacitated person: ~ ( Yrs. 2. Current address of the incapacitated person \ 00 <::) ~'-A:R..~Y"'o~ <<.<=> A ~ c.. A..'\Z. '-..'- SLE" (' (\ ~ \ \ C> \ ~ - 1S'"Cf oS 3. The incapacitated person's residence is: 0 own home/apartment ~ nursing home 0 boarding home/personal care home 0 guardian's home/apartment 0 hospital or medical facility 0 relative's home 0 other: 1....,- , -"'j r..) C::l (Na..-ne and relationship) (describe) 4. The incapacitated person has been in the present residence since 1\ e~. d...) ;l. c 0 '-I . If the incapacitated person has moved within the past year, state change and reason(s) for pt ... change: 5. Name and address of the incapacitated person's primary care giver: -1:... Lit\- Q E: ""'\. (:) ~ 7C" ~ '-.J ~ So'\..I\:) G,... <:EN-'CE:~ _la~ ~~ c...~~o(t..~rt\.~~ -R~,f\~ t-. 4\~l_~<..'-E. l ~ .~. \ ,'0 \~ - ~ 4" os- 6. The major medical or mental problems of the incapacitated person are as follows: ALl... l~ E L """ c~" - '\) E. YY\. ~ ~\ ~ t\, 7. Specify what, if any, social, medical, psychological and support services the incapacitated person IS receIvmg: ,"^--, ~ Jt't 'E........, aL , "S ~ E.E. ~ IE. \::::. 8. It is our opinion as guardian of the person that the guardianship should: (check one) ~ continue, 0 be modified, 0 be terminated. (Briefly explain your response) c....o "-J~\ ~\O~< S ~O\ -I~t><<<::)~:~ c;.. 9. During the past year, I have visited the incapacitated person , 4 times with the a"verage T,7isit lasting --h \~ <=> '-' v<-- (State number of hours/minutes, etc.) , The report of a social service organization employed by the guardian to oversee and coordinate the care of the incapacitated person for the period covered by this report may be attached to supplement this report. 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 Pa. C.S.A. 94904 relative to unsworn falsification to authorities. \-~-,,~ Date \.J...~ t - V~~) Signature of Guardian * FILING FEE $15 MUST ACCOMPANY THIS FILING. .., J . Clerk of Orphans' Court of Cumberland County IN RE: W ~ \....L \: V\W\ c.. ,~ \ \stJ~ Docket No. An Incapacitated Person ~\ -01.-{ -7 ~l ANNUAL REPORT OF GUARDIAN OF THE ESTATE I, \.( EN {u e'"t- \{ e I ~ ~ \....5:,; c. ~ , was /were appointed plenary guardian(s) of the estate of __ ~ ~ l.... '- ~ A~ ~ '- \A..) ~ \....s. or."::;) by Decree of the Honorable Judge "E"'3l-N A ..\~ated ~ov. '8', 'J..~o'4. This is my annual report for the period from ",",0 V'~I "lc:D"--{ to ~o\J, ~ i 1... c c S. , ("The Report Period"). I. ~,UMMf\RY A. Value of principal assets at the beginning of the Report Period? $ .s;34,~,,';L~ $ 44"14.00 , B. Total amount of income earned during the report period? Total amount of all expenditures made for care and maintenance of the C. incapacitated person during the Report Period? 1. From principal $ 9 l5:<:Do 2. From income $ 9? \4.'"'0 D. Total amount spent for all other purposes during the Report Period? $ -0- E. Total amounts remaining at the end of the Report Period? d. Principal $ 5ccl.("J.,. ~:!. Ll1come $ L{<oo. 00 c'-- .1;otalIncome and Principal $ 5Y~1 ,~-~ 1 ... ;,....) Rf.. .... -t II. ADDITIONAL INFORMATION A. Principal: 1. Total amount remaining at the end of the Report Period? $ 5L(0;-l/. I .~~ 2, How is principal currently invested? "-.)0 -r- ~ '('..)v E- S'"\e:~ 3, Have there been any expenditures from principal during the Report Period? t2'(Yes 0 No If you answered YES, was there Court approval for all expenditures from principal? 0 Y es ~o 4. Did you receive any principal assets during the report period which were not included on the inventory or a prior report filed for the estate? 0 Yes rRNo If you answered YES, did you receive Court approval prior to receiving addi tional principal? 0 Yes 0 No 5. State the sources and amounts of the additional principal you received: $ $ B. Income: 1. State sources and amounts of income received during the Report Period (i.e., social security, pension, rents, etc.): S..::. <:. ~ AL ~ E.C...; K ~ "t"( ~ V e::~~ (hv> 14 \) ~ ""'-l :~ 5\R ,,""\"~'O .~ $ J... -:L. ~ 0 . 00 , $ '7 I \ 9Y, 00 $ Total Income received during Report Period $ 9 ~ II..(. a 0 2. How is income currently invested? (Please specify, restricted bank accounts, client care account, etc.) .' ~ w o~ ~IN u ~<> ""t"E~ 3. Specify what payments were made for the care and maintenance of the incapacitated person (i.e., clothing, nursing home, medicine, support, etc.). w U R...S~l\10 C:".... \~=VY\ E. 4. Specify what other payments were made during the Report Period. NONE. 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 Pa. C.S.A. ~4904 relative to unsworn falsification to authorities. \ \- ~- o~ Date ..... \~~ ~. ~~),..../ Signature of Guardian * FILING FEE $15 MUST ACCOMPANY TIDS FILING. Clerk of Orphans' Court of Cumberland County rN RE: lAJ ~LL~ A-~ <: LA.. L ls'=>~ An Incapacitated Person Docket No. ':L \ - 0 L\ - I <f ( ANNUAL REPORT OF GUARDIAN OF THE ESTATE I, KEN~E~ E. ~~\....~o,'0 appointed plenary guardian(s) of the estate of W ~ \......."-~.~ (V',. , was /w;e I \ 'l So. ." ~ "- ~ ",- C \'-1 by Decree of the Honorable Judge \(.E.-..I~~A~ss.Dated Nc'-.l, 1( \~ocy, This is my annual report for the period from NO.J '6' ,,'adO'::; to <--.)c vc '8. ")..C<:::l4? ' ("The Report Period"). I. SUMMARY A. Value of principal assets at the beginning of the Report Period? $ 5~ ~f. 4)... $ '1 ~ o~.oo , B. Total amount of income earned during the report period? Total amount of all expenditures made for care and maintenance of the C. incapacitated person during the Report Period? 1. From principal $ 5''-1. SO 2. From income $ ---3 '"\ 7'1,oQ . D. Total amount spent for all other purposes during the Report Period? $ - 0_ E. Total amounts remaining at the end of the Report Period? 1. Principal $ Y.~~v.-l:t $ -D- 2. Income Total Income and Principal $ l\ ~<.oO" q 8 S : I Hd I - :.~ SuDZ s II. ADDITIONAL INFORMATION A. Principal: 1. Total amount remaining at the end of the Report Period? $ Y U (.,0. "1 q , 2. How is principal currently invested? ~\<- *,^-~es:t-- ~l.~~~ <:-AAE At.C-0;"':;'~ 3. Have there been any expenditures from principal during the Report Period? ~ Yes 0 No If you answered YES, was there Court approval for all expenditures from principal? 0 Y es ~ No 4. Did you receive any principal assets during the report period which were not included on the inventory or a prior report filed for the estate? 0 Y es ~ No If you answered YES, did you receive Court approval prior to receiving additional principal? 0 Yes 0 No 5. State the sources and amounts of the additional principal you received: ...- ' (' . :,-.fS) L. , ~L. .2c Q ..~...: '"t"-J \ l' " 'L~-::t-F.1 A.';'''''- "'" - c..:T~ ~ ~\ .~.'" - --- ,.... - . ,'. ~-.;::,~ 1 $ '}..- .... . f.oc:> $ ~,L J7/.uu B. Income: 1. State sources and amounts of income received during the Report Period (i.e., social security, pension, rents, etc.): S c;>c~A l S~<"'-'<<~"'\:'-( $ J..:~48.ac $ Il{~,oo , 'V ~E <<..(.\~)~ A \) ~ ~N';.. C:;;\(t(\"t'~o~ $ Total Income received during Report Period $ ("'.8' <J '~. 00 2. How is income currently invested? (Please specify, restricted bank accounts, client care account, etc.) -6A~\<- ~~E~ -C- '-",I~~,), c...A~e.E -A c.c.,o'-.) '^-)t- 3. Specify what payments were made for the care and maintenance of the incapacitated person (i.e., clothing, nursing home, medicine, support, etc.). N v 2... S '~ \'.-\ c.. \-\..0 'r'n E- 4. Specify what other payments were made during the Report Period. \'\J --::::;. l-...J e:.. 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 Pa. C.S.A. 94904 relative to unsworn falsification to authorities. l'D --?,O;-D ~ Date " \~ ;to L-- \.~ Signature of Guardian * FILING FEE $15 MUST ACCOMPANY THIS FILING. Clerk of Orphans' Court of Cumberland County N RE: L~.. J ~ Ll '\. -A ~ C \. W ; L So^-, : Docket No. ').. \ - " '-I - -, ~ ( An Incapacitated Person ANNUAL REPORT OF GUARDIAN OF THE PERSON I, \Z..~ Nt'Jet\{ e. L....) ~ \.. So ~ , was /wire appointed plenary guardian(s) of the person of \^-...l':\ L'i.A"" t.. v.....h'\...~~1\J by Decree of the Honorable Judge \(~,r~.......> {\. \~e<.~ dated ~O\.J. '8', d..<Slolt . This is my annual report for the period from No..... '8' ).,005"" to NO-...J a" .:10 C <&> , ("The Report Period"). , ' 1. Present age of the incapacitated person: & ~ Yrs. 2. Current address of the incapacitated person t <.1 (J .c c... ~A.R..e: X'Y\. o..:>t" (<o~"\) ~ A. <Z.\..:, S> \.e. ,) ~ (\. \ I 0 \~ - g ?os 3. The incapacitated person's residence is: 0 own home/apartment 't1t nursing home 0 boarding home/personal care home 0 guardian's home/apartment 0 hospital or medical facility 0 relative's home 0 other: r--.) t:..."'::,) c::.;,-:" CT\ Cd ,'J ~~ - .. U1 W (Name and relationship) (describe) 4. The incapacitated person has been in the present residence since _ \\f~. ':1..1 '1.oo~. If the incapacitated person has moved within the past year, state change and reason(s) for ~ change: 5. Name and address of the incapacitated person's primary care giver: C-. LA~(h=N' "-)U~,\.~~ ~E....N\t~ \ (:) D cO C:..~~EVY'\o;:;t" ~;O ~"> ~A(<..L\~'-E" f~. \,a\~-~~oS '- 6. The major medical or mental problems of the incapacitated person are as follows: ALL \-\C:'. '('1\t:e~ ~ \) e.ME.~-"C"~ 7. Specify what, if any, social, medical, psychological and support services the incapacitated person IS recelvmg: \.0 \-\.a'\~E>Jd..-,~\ ~ (\.)EE~S A~E. 8. It is our opinion as guardian of the person that the guardianship should: (check one) ~ continue, 0 be modified, 0 be terminated. (Briefly explain your response) \-\-~c:::, Co (\.....) '\::>\ -\:"\~ ,,j ~ S ~ .;\"1.. '(V-... e ~ 0 v'\ N ~ 9. During the past year, I have visited the incapacitated person I ~ average visit lasting times with the ~ \\t!... (State number of hours/minutes, etc.) The report of a social service organization employed by the guardian to oversee and coordinate the care of the incapacitated person for the period covered by this report may be attached to supplement this report. 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 Pa. C.S.A. 94904 relative to unsworn falsification to authorities. ) \o-~Q-o~ Date ~~~~~~ Signature of Guardian * FILING FEE $15 MUST ACCOMPANY THIS FILING. ANNUAL REPORT OF GUARDIAN OF THE PERSON COURT OF COMMON PLEAS OF (Uf'^0ERU,uu COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of w ~ '-.L ~ A."""" c.., ~ k. 1: L ~ b I\. ") , an Incapacitated Person No. '~\.-OL\-l~\ I. INTRODUCTION \ <- E N~ ~\\-\ ~. V-J ~ \... 5. C> r-..) . r--:t ~.O ~ b:J ~ ~ fT1 :r: (") <: ?2~Fn ---, Z:.o r;~^ (j\ oo~ ~ QC ~ ~ ~ ~ U1 , was appointe\:! ~nary 0 Limited Guardian of the Person by Decree of \c.'E:'-J ~~ f\ ~ \-\t. c; s , J., dated FR~ C'> C) ~:o (:::::::1 rn o C')O 'n -n -0:;; =0 :-.'" C) F= Ii] ('/'1..'3 -ll ~A. This is the Annual Report for the period from t'\...lo\"L R , J... oa~ to NO'-.J. ~ , ~OD '1 (the "Report Period"); or o B. This is the Final 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: 2. The Guardianship was terminated by the Court by Decree of J., dated For a Final Report, omit Sections II through IV. Form G.03 rev. /0./3.06 Page 1 of 4 , ~ Estate of L... ) ~ LL~ AI(\'\ C ~ ~ Ls.;,<::>N , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person: ~ ~ Date of Birth: S E (5\ "-\ \ \ q d.. ~ III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: l b 0 ~ <:... LA~~V\-\.oG\ R """po., ~ ~ A.R.L\cs.LE... f ~.. \'lb \~ - "8"X"cS - B. The Incapacitated Person's residence is: o own home I apartment ~sing home o boarding home I personal care home o Guardian's home I apartment o hospital or medical facility o relative's home (name, relationship and address) o other: C. The Incapacitated Person has been in the present residence since (-\f~. ":l.... d.... 00 l1 .. If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev. /0./3.06 Page 2 of 4 Estate of '-U ,'l l ~ AYV't. c'- (A..) : l s'"'" C\..J , an Incapacitated Person D. Name.and address of the Incapacitated Person's primary caregiver: C- L.. Clo.. ~ E tv' <::=...=;\ (\. .h.JJL <; \. vU G.. '*' ~ chAo. & ~ C- E.N-t- F<C \ t) D C;) C L-/\.~ ~ C:>r\.) l <<. C ~ ~ C-l\f<..L~'Sl.E...\f(\ ~ \IO\S - ~fos IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: f4. L "L ~ E.~H\ e..'L"> - ~ E. '(<'.lC.N '" ~ A.. B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: '"^-.J ~A-TE.\.\(:~ \-1,. ~ So <"- Jl::~~ "t> So (-\ e..~ V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: ~tinue o be modified o be terminated Form G-03 rev. /0./3.06 Page 3 of 4 Estate of W \. '-L~ R rn. c..... W ",' L S. ~r-.J , an Incapacitated Person The reasons for the foregoing opinion are: \-\ ~ s. 'T' c...- c:::.""",,- ~ \J '\ I. ~^-- ) \.. 'S. ~~ ~~ ~ (<..~ v~~) C... B. During the past year, the Guardian of the Person has visited the Incapacitated Person <:{ times with the average visit lasting hours, .~ D minutes. The report of a socia' service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. S 4904 relative to unsworn falsification to authorities. '~u'-J. \ S. d..... 0<:::::.7 ... \L~~.~~ Signature of Guardian of the Person Date \~ E.. '(\.J Ntt'T\ ~. \A)...' L So <:::> r() Name of Guardian of the Person (type or print) 4. 'd... q \.\ ~ G. e..s;.\C ~~ -i~. Address "Y"v\~ ~ "'~~~<:-S.BU~b l ~ \11.::.> D City, State, Zip ~l\) 137-7'8t1 Telep e FornI G-03 rev. 10.13.06 Page 4 of4 , an Incapacitated Pe~n ,("') = c: -' ~g t5 CO-O,....... __ CB:r: ?-': - i---~m ,.,.... ">-. ~ ::0 \J . 2: c/5 ?' 000 -0 00"" :x p~ ~ 1t <J1 , was appointeat \~\E ~ ~ , J., ANNUAL REPORT OF GUARDIAN OF THE ESTATE COURT OF COMMON PLEAS OF c..>J ("'-<3Ea..LA'C--~u COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of w ~ '- l. ~ f\ '^"'- c:.. . \A) ~' \.....- s;. "(;:;.r\..l No. ':1. \ - .:> '-\ - ,~ ( I. INTRODUCTION \ZE.~}lUet"\-\ E. 'vv~ '- <;. ~N ~enary 0 Limited Guardian of the Estate by Decree of \<. ~\. , ~ \A.j ~. dated ~D0.~. d...o~4 . ~. This is the Annual Report for the period from N\::>v.. R' , J.... <:> 0 ~ to t-J ChJ. (f , ~ .00 '7 (the "Report Period"); or o B. This is the Final 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 G-02 rev. 10.13.06 Page 1 of 5 -~ =!~ n:~\ ~~ (~) c:::> ;;'/~ :TI ::'-::,0 rn no :nCJ C)C") _'"I ':""'::f1 , . ::D c> en [7;Q :---~t';f:'" _ ~ Estate of ~ ~ '-'-~ f\M C. ~ \J0 ~ \...SON , An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ ~,:Lo~. y~ 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.) $ LU..Q <e.o, 1 q C. What is the total amount of income earned during the Report Period? $ "~ld". co D. What is the total amount of income and principal spent for all purposes during the Report Period? $ q 1<"5'(, 43'_ E. What are the balances remaining at the end of the Report Period? 1. Principal $ ~ I~ ., -,. q 0 2. Income $ l,1:l~.. S~ 3. Total of Principal and Income $ 51~~3, L(~ III. ADDITIONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principal 1. How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): ~ '-~ E.,\,,)\:" ~,,~~E. ~c c.=';'I'J~ - S~'-1 t~ i:..s. p...cc-o...:>~ ~ A~.} \<.. ~ \J....;::-c.\( ~"-\c~ ~ <:.c:..Qv-",;"""t'"" - (\.~c::c- "'C'X'..}u;;;;:, c:..~F"~ 2. Have there been any expenditures from the principal during the Report Period? ............................ ~es D No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? . . . . . . .. Cl1'es DNo Form G-02 rev. /0.13.06 Page 2 of 5 Estate of w ~ Ll. ~ f\ VV\. C. \..A.J': Lc;. ~nJ b. List purpose and amount of expenditures: c... \..... ci~'~~ ~ ~ A.l(Y' ~ ~ '-- ~.uc:..-=: SE R '" \c...1;:. , An Incapacitated Person $ $ $ $ '")4..Sl:::) ~ <.c:.. -:t. -:L c. Was Court approval received prior to expending the principal? ....................... 0 Yes ~ 3. Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? ........... 0 Yes ~ If yes: a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . .. 0 Yes 0 No b. State the sources and amounts of the additional principal received: B. Income 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): ~ ~ (;... ,P\l- s.E.c.'-J~<"\,, " f\ _ {> E 1\)<;" I. ~..u I Total income received during Report Period: Form G-02 rev. 10.13.06 $ $ $ $ $ $ $ $ $ $ $ 3~ ~d....~O (, ., 1<:0 00 $ t\. \ \ R'. c)c> . Page 3 of 5 Estate of l", 1;\ L~E'\V'Y\. c.. ~\.. Ls"C::>/l\.) - , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): ~ \.... ~ E.i'.J\" c.. Aa..E" ~ ~} ~ A. '--' ~ NG-c::...... A c.. CJ.::)u~ ~. ~i\.l\<... c.. ~<..<=c '<.......~( _ <.\c-c..~-.)r3\::" - ~ -.-C- ::I:.~\ vE-qF~ 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 (e.g., clothing, nursing home, medicine, support, etc.): .(\. \ '-.J ~ S. ~ ~ G:r ~e:.,^", E. 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.) ~ ~ "->E.. E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Amount Method of Determination Court Approval Obtained "-) 0 l\...) is DYes DNo DYes DNo Form G-02 rev. 10.13.06 Page 4 of 5 Estate of ~J ~ '- ~ '- A.~ C. \.......J .: \... <;.. C N , An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount Court Approval Obtained NC)"-lE.. DYes DNo DYes DNo 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 Pa.C.S. ~ 4904 relative to unsworn falsification to authorities. Na,,~ l~,\ -aoo"'7 , \.(~ ~ J:> _ l.J-} ~ (j /1___ j Signature of Guardian of the Estate Date \.( E:" (\:)\\.)ET ~ E-. Iv.-.) .- \... 5;. ~ l\.J Name of Guardian of the Estate (type or print) t.+ ~ Cf \-' \Q c;..€.ST~ V...)~ R~(\ ~ Address \'V\€c \:\.{\N~~S.~\."jR. Go. eA.. - \] D,$ ~ City. State. Zip , ~ \ c) l ~ I - -, 1) \ \ Telep ne Form G-02 rev. 10.13.06 Page 5 of 5 N O ANNUAL REPORT OF GUARDIAN OF THE ESTATE ~ c~ i - O ~~ n ~~ ~ , _- ._. - -~ ~ a; ~ ,. : . COURT OF COMMON PLEAS OF Z-y rn r(3 ~.~(L L~~tJ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of ~,~} ~ LL; ~ ~ ~ _ ~.1 ~: L s :~ n7 , an Incapacitated Person No. _~~- t5`l --7 I. INTRODUCTION ~~ L.Y,,o ,~; ~rt\-l E, . ~-J :1. S ~. ~ ,was appointed Plenary ®Limited Guardian of the Estate by Decree of ~~ :~ A . ~~, 55 , J., dated '`N ~ 'u, `til ~o~~ . ~A. This is the Annual Report for the period from >;V~~! .~, ~J~7 to tV cJ , ~, ~.~~$ (the "Report Period"); or B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: I . 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 G-02 rev. 10.13.06 Page 1 of 5 ~~ /J Estate of ~ : l,l, ~(~w. ~, lti.y ~ L~~ h7 , 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 during the Report Period? D. What is the total amount of income and principal spent for all purposes during the Report Period? $ ~? 2 a. • 1. ~ $ ~t;.F~~. UG E. What are the balances remaining at the end of the Report Period? 1. Principal $ (~, ~ ~'a.. •. l (o 2. Income $ !~ ~..~ °l y . k c 3. Total of Principal and Income $ ~~ ~ (Q, 9l~ 0.00 III. ADDITIONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principal 1. How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): L. `.. \ CYJ~ L ~t2~ (~ ~- Gac/ ~n.~ ,r ~ (tiv Z tU Chi I~t' C.L:~:r ~. ~ ~ iL z l~~\C.t,~v- ~ cc<xsn.,T -~ rv aZ" ~~v~~S~"~D 2. Have there been any expenditures from the principal during the Report Period? ............................ 'es ^ No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? ........ C9~Yes ^ No Form G-Ol rev. 10.13.06 Page 2 of 5 Estate of ~ ~ L ~- ~ f'~ rr ~... l>~9 i L Svr.1 , An Incapacitated Person b. List purpose and amount of expenditures: S 1~Lo~ .s $ l~ ~ , ~~ c. Was Court approval received prior to expending the principal? ....................... ^ Yes E~1o 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? ........... ~'es ^ No If yes: a. Was Court approval requested prior to receiving the additional principal? ................ ^ Yes ~o b. State the sources and amounts of the additional principal received: '?, ~~, o0 B. Income 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): S.~ c: r'~L Sc~:2~ ~~r 'V.~~ ~ cr3S:~r.~ ' Total income received during Report Period: $ ~._y ~~ . ~'~ $ 1 \ ~~~. 8~ o.oo Form G-02 rev. 10.13.06 Page 3 of 5 Estate of ~ ~ L. L- ~ r~~-. [ l-~.j . L S v~J , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted, bank accounts, client care account, etc.): a,~,,~t` ~, \-'~'~ C-~L ~ N Cam. ~ C C c:~ .r N~ '^ fv 3~-' ~r..i.~`c s~~c~ 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 (e.g., clothing, nursing home, medicine, support, etc.): IVu,f~S:tic~ ~nw~.E 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.) ~i ~vv ~.. E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Amount Method of Determination Court Approval Obtained '(~7 ~ rv ~ Yes ~ No Yes ~ No Form G-02 rev. !0./3.06 Page 4 of 5 Estate of L'~ ~ L L ~ ~ `K` ~- ~ ~ ~ ~--~~ `~ , An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount Court Approval Obtained ~ o „~ E, ~ Yes ~ 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 I8 Pa.C.S. § 4904 relative to unsworn falsification to authorities. 'lam ~ J ll~~~a~~ Date ~~ ~-~W.a..~ o ~ ~ ~ t/~'Kx=vim Signature of Guardian of-th}e Estate Name of Guardian of the Estate (type or print) ~ ~~ ~ a G +`c.~~v s.u ~y (2D . Address City, State, Zip ~1 I "t~ ~ 3 ~7 _ ~ g ~ ~ Telephone Form G-02 rev. !0.!3.06 Page 5 of 5 ANNUAL REPORT OF co 0 o ~ .~ _a GUARDIAN OF THE PERSON ~ ~' - ~ ` -~ n ~ l I " :~ . ." N ~ _ . ~.~ _ ? ~__.i COURT OF COMMON PLEAS OF ,, _l ~ ~ ~l ~ . ~ A COUNTY, PENNSYLVANIA ~-` :,;_a ORPHANS' COURT DIVISION w ~ Estate of ~ ~ L.L ~~,~.~ ~, L,~ ~ L ~ ~, ~ , an Incapacitated Person No. ~, 1- ©~-1 - 7 k 1 I. INTRODUCTION 1~'cy.~r~~-~ ~ ~ ~ f ~ L S c c~7 was appointed l~Plenary^Limited Guardian of the Person by Decree of ILL. ~~ ~~ , \y~~ J, dated 4L1=~.~ . ~~, 'a o~.~ ' ~A. This is the Annual Report for the period from 1.~ev ~ , ;,1.~r~~ to Nov g' '~~c$ (the "Report Pe;riod"); or ^ B. This is the Final 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: 2. The Guardianship was terminated by the Court by Decree of J., dated For a Firral Report, omit Sections II through ITS Form G-03 rev. 10.13.06 Page 1 of 4 Ci Estate of '~, L L ~ : H ,.~ ~ ,lam ~ L ~ `,,y , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person:~_ III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: Date of Birth:_ 5~:~, ~ t \ Q~~~{ O o a ~La~-,M1o~'C lf'`~~~ B. The Incapacitated Person's residence is: Q own home /apartment nursing home ® boarding home /personal care home 0 Guardian's home /apartment Q hospital or medical facility relative's home (name, relationship and address) mother: C. The Incapacitated Person has been in the present residence since _ (~t P(Z, :~, '~~y If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev. 10.13.06 Page 2 of 4 Estate of L~ ,; ~,~ ~ ,~,,n,~, C ~,..) ` L. S ory a~~ Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: C' L A v2 C ~. ~,,..srt '(V v b2.. S°. Y..s Gr ~ '~ < ~. ~ C3 t ~,wfiE~ ' O®p ~_Llai2~rn~rv'C Ra,A~ IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: 1a L, Z. 1-} ~ ~ w. ~R 5 -~ '~ E.rv~ `til ~ 1~ B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: w Nam ~~ Er°Z ~ , s ~vcEa s. ~~E V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: continue ~ be modified be terminated Form G-03 rev. 10. /3. D6 Page 3 of 4 s ~ i Estate of _ ~ ~ ~~; ,~ ,,,, ~ ~) ~ ~ S o ;,~ , a:n Incapacitated Person The reasons for the foregoing opinion are: '~-~ ~~ S ~ C~ rub ~ ~ 1, t' fJ '~ s N C3~ .~ 1'-'~ ~ ~,o V ~ ~N B. During the past year, the Guardian of the Person has visited the Incapacitated Person i ~ times with the average visit lasting hours, 3 o minutes. The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. 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 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. Date Form G-03 rev. 10.13.06 1~~,,,,,.w,~ ~a ~.~:~,.~..: Signature of Guardian of the Person Name of Guardian of the Person (type or print) '"1 a ~ y-~ O Ca'cS_~_ Ova rJ +~~ Address ~1/~ t-t ~ i G ~. (lj v to ~ . \ A - 1'1 v,50 City, State, Zip Telephor Page 4 of 4 ANNUAL REPORT OF GUARDIAN OF THE ESTATE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of WILLIAM C. WILSON No. 21-04-781 I. INTRODUCTION KENNETH E. WILSON Plenary ~ Limited dated NOV 8, 2004 Guardian of the Estate by Decree of KEVIN A. HESS was appointed I., 0 A. This is the Annual Report for the period from to (the "Report Period"); or B. This is the Final Report for the period from NOVEMBER 9 2008 to JANUARY 5 2009 (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: JANUARY 5, 2009 Name of Personal Representative: KENNETH E. WILSON 2. The Guardianship was terminated by the Court by Decree of Forme-02 rev. l0./_i.06 J., dated ~~ an Incap~e=~~ed Pers`O~n -v C ; x~ ~ J .'~ ~ 1 .~ ; 1 'T _ ` ;~'' ~ -, Page 1 of 5 ~~ Estate of WILLIAM C. WILSON , An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ 3,722.00 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.) $ 7,816.96 C. What is the total amount of income earned during the Report Period? $ 1,746.43 D. What is the total amount of income and principal spent for all purposes during the Report Period? $ 9,563.39 E. What are the balances remaining at the end of the Report Period? 1. Principal $ 0.00 2. Income $ 3. Total of Principal and Income $ 0.00 III. ADDITIONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principal 1. How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): Estate Account (non interest bearing) established on March 23, 2009 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? ........ ~ Yes ~ No FoYm c-oz Yw. ~o.i3.o6 Page 2 of 5 Estate of WILLIAM C. WILSON , An Incapacitated Person b. List purpose and amount of expenditures: Nursing Home Care $ 6,972.54 Funeral Expenses $ 2,590.85 c. Was Court approval received prior to expending the principal? ....................... Yes ~ 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? ........... ~ Yes ~ No If yes: a. Was Court approval requested prior to receiving the additional principal? ................ ^ Yes ^ 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.): Social Security VA Pension Claremont Client Care Account (Interest) $ 395.00 $ 1,348.00 $ 3.43 Total income received during Report Period: $ 1,746.43 Fo,,,, c-oz rw. X0.13.06 Page 3 of 5 Estate of WILLIAM C. WILSON , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): Non Interest Bearing Estate Account 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 (e.g., clothing, nursing home, medicine, support, etc.): All expenditures were for Nursing Home care and support. 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.) NONE E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Court Amount Method of Determination Approval Obtained 0.00 Yes ~ No Yes ~ No Form c-oz rev. ~0.~3.06 Page 4 of 5 Estate of WILLIAM C. WILSON An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount Court Approval Obtained 0.00 ~ yes ~ 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 Pa.C.S. § 4904 relative to unsworn falsification to authorities. Dale Signature of Guardian of the Estate KENNETH E. WILSON Name of Guardian of the Estate (type orprint) 429 Hogestown Road Address Mechanicsburg, Pennsylvania 17050 City, State, Zip (717)737-7811 Telephone Form c-oz rev. 10./3.06 Page 5 of 5 A~ r, i. 2009 9:40AM CLAREMONT BUSINESS 0 C ~~ ~~ pa ~ of3 p11L11 Ste' OL rG.~'11Gllt llitiu~ ~ 1 L77TV~ ~~ Pretirbus Module Map 9yStCt1 MAID rkw This Psge NEW MOdWE Map New Syltml Mep Workk~g Fac 1 Hap (1oa Home ... . _ Hismry _ '!::.:: - Clldc Hoe To Sao Wfors New TadcB Xfllor MOre,'Oi~ ~nll ~)'~QQpc •~'4.'tn~ 1~ 9eerert Retesh Print [`PAea~ Userki;sosQOS Billing & Paym Res#: 427b William C I#Idg; Floor: Wing: Sta Click the Refresh butt searcf, Ream 0 en Wil tion on t t In son : Ro o rel qui Endirn om; A oald t] rom d ~~ BiIF Date 1%adlity F f C Pay15r Typa DiJ61J7DD9 1 y y f+1A ~ R2 01/01/1009 i MA R/ Rl i~ 12/31/2001 1 MA l+lA RB 12/31/2005 2 MA M4'6 AtIC ~' 12/3132008 1 MA PP ANC C 12/dl/204a 1 MA RY Rx _, 11/3011008 I MA M0. 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Amgpnt SiOod QtYJ-ays PiVmen t Met 80ttr a97.44 1.00 7022s 195.12 ds/ -47.56 -1.00 97.56 -195.12 01/ 5397.76 31.00 Y347.76 0 11/ 5L70 1.00 6L70 0 12/ -96+10 -1.00 -96.40 0 12/ a97.40 1.00 897.40 D 11/ 5197.a0 30.00 5397.a0 0 li/0 20.00 1.00 20.00 0 1110 19.30 1.00 19.30 O 1;J0 41.70 1.00 51.70 D 11/ 61ao 1.00 61.7o D li/l 61.70 1.00 51.70 D 1113 6L70 1,Od 61.70 D li/ 61.74 1.00 61.70 D 11/ 61.70 1.00 6L74 O 11J2 61.7a Loo as.7o o u/D 73.85 Y.00 73.Bb 0 11/D -96.40 -1.00 -96.40 0 1113 4 0 0 4 D 0 0 0 897.40 5.00 697.40 0 11/0 5397.76 31.00 5397.75 0 10(0 -46.aD -1.00 -9a,44 D 101 897.40 2.00 697.40 0 10/0 s147.BO ~.oD 5197.ao D D9/o -96.40 -1.00 -96.4d 0 09/ 897.40 1.00 897.40 0 09/0 5'147.76 31.00 5397.75 0 08/0 -98.40 -1.00 -96.40 R OB/ 897.40 Lp0 897A0 0 08/01 5397.76 31.00 5397.75 0 07/ Ol A6.40 -1.00 -96.40 0 07/31 897.40 1.00 897.40 d 07101 s197.BO 30.0o s147.ao o D6/oi -98.40 -1.00 -96,40 11 06/30 897.40 1,00 897A0 0 06/01 5397.76 3L00 5397.7$ D OS/O1 -91.40 -3.00 •96.40 0 05/31 897.40 1.00 897.40 0 OSJOl 5197.90 30.D0 5197.60 D 04101, _. _CE~orgo Ise Gate Coda e1/2Da9 a 01/2004 0 O1/2noa 160 09/2008 4253$3 31/3003 44060 01/2008 0 1/200a 160 s/ZOda 9ocsa 6/2008 9065a0 os/200$ 935363 5/3001 925263 4/2doa 9zs253 22/2D08 975353 25lZOOa 913263 9/ZOOi 925263 7/200a 91s263 7lZOOa 9261D3 0/200a 90060 O 0 1/2001 0 i/700a 160 34/loos 90060 iJzaoa o :/moa 160 35/2008 90060 1/200a 0 111001 160 27Jao4a 90060 /2008 0 /200a 160 /2008 90060 JzDOfi D !Zoos 160 /zdda 9ao6D /200a D lZDDB 160 /~Da 9oo6a /aooa d 04/30/Z04$~ 1~MA ~MA ~RB ht•t„•J/1 ~~ t ~ eR ~ ~/~~~wPhlwt7)ata~ricif'heck.asnx?DH~na>7&NodeKev=PA9488r.~ey=42... 4/U2009 Ai~c~~ 1 ~ti~uuidsui4wi~ [*1'r'u,~~~ ~. 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";.~. ~.;.~.?~~9d~g~~2AMf [*P~LAR ~MONT BU 0 Fa f-' ~ 1 il/30J2006 11 2006 NOY06 PCA RESIDENTCA`Re ALLOW a General ~40AD ;J 1 10/:1J2006 10 2006 INTER IN7ERESTINCTfORES G General 0.48 ~~ 1 SOJ31/2006 10 2006 OCTO6 PCA WNTCARE RLLS G Genets! -40,80 O A r 1 09/3012006 9 2000 INTER INTFRESTINCTORES G 8enetAl 0.34 i 09130/Z006 9 2006 4EP06 PCA ~~~ CdRR Auow G General -40.00 ^ 1 08/31/2006 S 2006 INTER INTERESTING TO RE5 G General 0.36 ^ i 08/28J2A06 8 3006 IUN06 INCOME INCOME A07USTMEMT G General -625.00 [] 1 07/33/2006 7 340E INTER INTERESTINCTaRE3 G Genets) D.17 ^ 1 07/T0J204b 7 2006 aUN06 PGA RlSIDENTCJIRE a-LLaw G General -40.00 12 httn./1172.16.48.10lsosWeb/wfDataGridChcck.asvx?DBzi+~NodeKey=pA273&Key~=4276... 4/1/2009 ANNUAL REPORT OF GUARDIAN OF THE PERSON COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of WILLIAM C. WILSON , an Incapacitated Person . No. 21-04-781 N c~ ~ - z,. ~ , , I. INTRODUCTION ~.> ~ ~ - ~ °-:-= KENNETH E WILSON ''`'~`~ ~ . v~~pointe~ ~ , , •• Plenary Limited Guardian of the Person by Decree of KEVIN A. HESS ~ -, -; ~ ` dated NOV 8, 2004 J ' A. This is the Annual Report for the period from to (the "Report Period"); or B. This is the Final Report for the period from NOVEMBER 9 - 2008 to JANUARY 5 2009 (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: January 5, 2009 2. The Guardianship was terminated by the Court by Decree of For a Final Report, omit Sections II through IY. Form C-03 rev. 10.13.06 J., dated Page 1 of 4 Estate of WILLIAM C. WILSON II. PERSONAL DATA Age of the Incapacitated Person: 84 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: N/A B. The Incapacitated Person's residence is: an Incapacitated Person Date of Birth: September 4, 1924 own home / apartement nursing home boarding home /personal care home Guardian's home /apartment Q hospital or medical facility relative's home (name, relationship and address) other: C. The Incapacitated Person has been in the present residence since APRIL 2, 2004 If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev. io. ~ 3.06 Page 2 of 4 Estate of WILLIAM C. WILSON an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: CLAREMONT NURSING AND REHAB CENTER 1000 CLAREMONT ROAD CARLISLE, PA 17013 IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: ALZHEIMERS -DEMENTIA B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: WHATEVER HIS NEEDS WERE V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: continue be modified be terminated Form C-03 rev. /0.13.06 Page 3 of 4 Estate of WILLIAM C. WILSON an Incapacitated Person The reasons for the foregoing opinion are: WILLIAM C. WILSON PASSED AWAY ON JANUARY 5, 2009 B. During the past year, the Guardian of the Person has visited the Incapacitated Person 10 times with the average visit lasting hours, 30 minutes. The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. 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 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. ~~~:~ -a - ~o~ flat Sgnature ofCuardtan ofthe Person KENNETH E. WILSON Name of Guardian of the Person (type or print) 429 Hogestown Road Address Mechanicsburg, Pennsylvania 17050 City, State, Zip (717) 737-7811 Telephone Form G-03 rev. 10.13.06 Page 4 of 4