HomeMy WebLinkAbout09-16-11 (2)
Y
IN RE
Date Received
'7 2011 TO: September 17, 2011
1
1)
2)
FROM:1une ward,
Co-Guardians of the dated lunetl7, 2011,
Limited X_ plenary Order of Court
ointed Co-(',uardiansCourt Order(s) dated
W e are the w e eW re apP odified by
named above. X~ Was not m e received by me
was
which ~ he following reflects all sources of inco
orting period, t
During this rep a es if needed) A=
for my Ward: (Add add~t~onal p g
f Income ~
90-Da In`'entor
Source o - ~~~
A~sQ DP`N.
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C ~ ~' o~ ~A ssP
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Sam- 4z~~ ` ward are:
is of my
. ~ ~~,
1.
3.
4.
h
3)
_~,
,7 _ ,_ .,
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,~,
T OF COMMON pLE ~ _ ~ _ •
IN TKE COUR UNTY~ PENNSYLVANIA -: ' ~,
CO
OF CUMBERL A D ~ COURT DIVISION _ -. f_ ~;
~-,
ORPK ~ _ ~ `,~ C,
FILE N4.21~1-514 OC
acitated person
ANDREW STERN an lncap
ge ort
The present principal asse
tion of Asset s
Descri ~+,.._ .~ ~~
1.
2.
3.
4.
5.
6.
~.
9.
TOTAL:
25 ,5
y ~~i ~ ~
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present V alue
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A
4) Check the correct response and complete, if a
ppropriate.
----`~' MY ward receives monthly social security benefi
--~--B• I am the designated a is directly.
--C• The desi p Yee to receives my ward's social security benefits.
grated payee o~y Ward's social security benefits is:
Whose address is ~
And/is not (circle one) relat d to rrm ~ W ~~
co - ~ ~ ~ Y and as (insert relationship:) ~~,
I CERTIFY under the
correct to the best ofm enalties ofperjury that the information contained in this r
Y knowledge, information and belief.
eport is true and
Na
me. Paula A. Stern
Address: 984 Mount Rock Road
Carlisle PA 17015
_~
C~
Signature
Name: John K. Stern
Address: 984 Mount Roc~ad
Carlisle PA 17015
Telephone No. 717 440-6163
(home)
717 245-9941 (work)
Date ~ ~ /6 -z-o ~
Telephone No. 717 440-6163
(home)
717 648-7899 (work)
_+
Send to: Register of Wills
Cumberland County Courhouse
One Courthouse Square
Carlisle, PA 17013
Date
2
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