HomeMy WebLinkAbout04-0831
INRE:
: IN THE COURT OF COMMON PLEAS OF
: OF CUMBERLAND COUNTY, PENNSYL VANIA
MARY H. FAMA, : ORPHANS' COURT DIVISION
An alleged incapacitated person:
: NO. ~ J - 0 Lj - 0 ~ 3 I
PETITION FOR THE APPOINTMENT OF
PERMANENT PLENARY
GUARDIANS OF THE PERSON AND ESTATE
PURSUANT TO 20 P.S. &5511
AND NOW COMES THE PETITIONER, the Area Agency on Aging, in and for
Cumberland County, Pennsylvania, by its solicitor, Anthony L. DeLui.<y~squire, who
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represents and avers as follows:
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The Petitioner is the Area Agency on Aging, in and for Cumberland County,
Pennsylvania, with its office located at 16 West High Street, Carlisle;~umbed~d
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County, Pennsylvania.
2.
The alleged incapacitated person is Mary H. Fama, age 84, who has been residing
at The Bridges at Bent Creek, 2300 Bent Creek Boulevard, Mechanicsburg, Cumberland
County, Pennsylvania since June 15, 2004 but previously resided at 40 Susquehanna
Avenue, Enola, Cumberland County, Pennsylvania and had resided there for a period
exceeding 1 year prior to the filing of this Petition.
3.
The known relatives of the alleged incapacitated person are:
a. Samuel J. Fama - Husband
Formerly, of 40 Susquehanna Avenue, Enola, Pennsylvania but
currently residing at ManorCare Health Services, 940 Walnut Bottom
Road, Carlisle, Cumberland County, Pennsylvania.
4.
The Petitioner is not related to Mary H. Fama.
5.
The Petitioner's interest is that of a welfare agency concerned with her welfare
and is familiar with her case.
6.
Mary H. Fama has, for at least three (3) months, been incapable of managing and
caring for herself and her financial affairs.
7.
Mary H. Fama exhibits symptoms of mental incapacity, including but not limited
to severe generalized deficits in both verbal and visual memory, attention and
concentration and in her ability to retain information after a delay.
8.
Mary H. Fama's mental incapacity prevents her from managing and caring for the
affairs of her person and estate.
9.
On or about March 8, 2004, the Petitioner received a referral for care management
for Samuel J. Fama, husband of Mary H. Fama, and an authorized care manager for
Petitioner, visited with him and Mary H. Fama.
10.
At the time of the visit on March 8, 2004, the Petitioner's authorized
representative noted the following:
a. That food was cooking on the stove but she was unable to state what she
was making other than to say it was something that she had in the
refrigerator and it looked like beef steak;
b. That Mrs. Fama could not find her pocket book to produce proof of her
age in order to complete a transportation application.
11.
Investigation by Petitioner's authorized representative indicates:
a. That her husband lost his driving license and she believed that a neighbor
reported her husband for drugs and that was the reason for him losing his
license;
b. That she received a notice to take a test to retain her privilege to drive and
she believed the same neighbor was lying about her too;
c. That she did not understand the reason for her husband losing his license
even though he had three (3) car accidents;
d. That Mrs. Fama was driving with her husband as a passenger when they
were involved in a car accident, causing his admission to Holy Spirit
Hospital; and
e. That she became more unkempt, her clothes were not washed, her hair was
greasy, her scalp yellow, and could not figure out how to operate the
washing machine.
12.
On or about March 8, 2004, Petitioner's authorized representative visited the
alleged incapacitated person and her husband at their residence and, although Mr. Fama
was agitated, she did not seem to be concerned or frightened.
13.
Subsequent visits to the residence reflected an apparent decline in their ability to
manage their home and
14.
Daily meals were later delivered to their home because Mrs. Fama stopped
cooking.
15.
When her husband began to wander out of the house, got lost, and was returned
by the Enola Police, Mrs. Fama did not comprehend the seriousness ofthe situation and
expressed her displeasure with the police officers when they told her she should not let
him out of the house. She would laugh and say he made it home.
16.
Mary H. Fama is unable to manage her finances based upon the following
observations by Petitioner's authorized representative:
a. Health insurance and real estate tax bills were past due and not paid.
She indicated that her husband pays them; and
b. When admitted to The Bridges at Bent Creek, she indicated that she
had $9,000.00 in her pocket book and, when examined, there was
more than $4,000.00 in her purse which was deposited into a bank
with the help of Petitioner's authorized representative.
17.
On or about May 19, 2004, a psychological evaluation was conducted of Mary H.
Fama and the opinion ofthe psychologist stated that she would be safest in an
environment that provides 24 hour supervision.
18.
On or about June 11,2004, Petitioner filed a Petition for the Appointment of
Emergency Plenary Guardians of the Person and Estate in accordance with 20 P.S. S5513
and for Permanent Plenary Guardian of the Person and Estate pursuant to 20 P.S. S5511
of Samuel J. Fama to No. 21-04-550 in the Court of Common Pleas, in and for
Cumberland County, Pennsylvania, Orphans' Court Division.
19.
A final Order, dated June 23, 2004, was entered by President Judge George E.
Hoffer finding, upon clear and convincing evidence, that Samuel J. Fama was an
Incapacitated Person and that Pennsylvania Guardianship Association be appointed
Permanent Plenary Guardian of his person and estate.
20.
On June 8, 2004, Samuel J. Fama's wife fled her home because she was afraid
that her husband was going to kill her and was found wandering by a citizen who
reported the matter to East Pennsboro Police.
21.
As a result ofthe June 8th incident, Petitioner's authorized representative found
emergency housing for the wife.
22.
Petitioner believes and, therefore, avers that Mary H. Fama has substantial assets
and there is a financial planner assisting Mr. and Mrs. Fama.
23.
Petitioner asks that Pennsylvania Guardianship Association be appointed Plenary
Guardian of the Person and Estate on a permanent basis.
24.
The proposed Guardian has no interest which is adverse to the interest of Mary H.
Fama.
25.
Petitioner believes, and, therefore avers that Mary H. Fama. does not already have
a Guardian.
26.
Petitioner asserts that Mary H. Fama is incapacitated as defined in Chapter 55 of
the Probate Estates and Fiduciaries Code.
27.
Because of her impaired mental and physical condition, Mary H. Fama lacks the
capacity to provide for her own personal care and maintenance.
28.
Because of her impaired mental and physical condition, Mary H. Fama is unable
to manage her financial affairs, property and business and to make and communicate
responsible decisions relating thereto.
29.
A power of attorney would be a less restrictive alternative than Guardianship but
Mary H. Fama currently does not have an attorney-in-fact and she lacks the capacity, at
present, to appoint one.
30.
To Petitioner's knowledge, no previous application has been made for the order
herein requested or for a similar order.
31.
No other Court has ever assumed jurisdiction in any proceeding to determine the
incapacity of Mary H. Fama.
32.
The failure to appoint Pennsylvania Guardianship Association Petitioner as
Permanent Plenary Guardian of her Person and Estate will result in irreparable harm to
the person and estate of Mary H. Fama .
WHEREFORE, the Petitioner respectfully requests that:
1. A Citation be issued directed to Mary H. Fama to show cause why
Permanent Plenary Guardians of her Person and Estate should not be appointed, and why
she should not be adjudged an incapacitated person and Permanent Plenary Guardians of
her Person and Estate should not be appointed; and
2. The Court appoint Pennsylvania Guardianship Association as Permanent
Plenary Guardians ofthe Person and Estate of Mary H. Fama and such other powers and
restrictions the Court deems proper.
Respectfully Submitted,
~~~
Anthony L. u~, squire
113 Front Street
P.O. Box 358
Boiling Springs, Pennsylvania 17007
(717) 258-6844
VERIFICATION
I hereby verify that the facts and information set forth in the foregoing Petition for
the appointment of Permanent Plenary Guardians ofthe Person and Estate pursuant to 20
P.S. S5511 ofMaryH. Fama are true and correct to the best of my knowledge,
information, and belief. I understand that any false statements contained herein are
subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to
authorities.
Dated:
C} - 10- (} L,
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Sandra D. Gurreri
INRE:
IN THE COURT OF COMMON PLEAS OF
OF CUMBERLAND COUNTY, PENNSYLVANIA
SEtlO 211114
o
MARY H. FAMA ORPHANS' COURT DIVISION
An alleged incapacitated person:
: NO. al-O'l-O&::31
PRELIMINARY DECREE
AND NOW, this Mday of ~~ ~ 1 ,2004, in consideration of the
foregoing Petition and on motion of the Area Agency on Aging, in and for Cumberland
County, Pennsylvania, through their Counsel, Anthony L. DeLuca, Esquire, it is
ORDERED AND DECREED that a Citation be awarded, directed to Mary H. Fama to
show cause why Permanent PlenalY Guardians of her Person and Estate should not be
appointed, and why she should not be adjudged an incapacitated person.
The Court finds that the following additional notice to others of the hearing on
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appointment of an emergency guardian of the alleged incapacitated ~n is ~asible;D "..
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under the circumstances and directs that same be attempted to be ma~ upon tfu:
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following person in the following manner: Samuel J. Fama, through Pennsyl-<:lmia
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Guardianship Association, by first class United States mail.
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The time and place of hearing on the Petition for Appointment ofPennallent
Plenary Guardians of the Person and Estate ofthe alleged incapacitated person are fixed
for ~~.;?t:, , 2004, at. ,;l! ~ a.m~prevailing time in Courtroom
#L on the 4th Floor of the Cumberland County Courthouse, Orphan's Court Division,
Carlisle, Pennsylvania.
At least twenty (20) days written notice of the hearing on appointment of a
Permanent Plenary Guardians of the Person and Estate shall be given to Mary H. Fama,
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the alleged incapacitated person, by serving her personally with the Citation and this
Order of Court and a copy of the foregoing Petition together with an explanation of the
content and terms ofthe Petition. Additionally, at least 20 days written notice of the
Petition and hearing on appointment of Permanent Plenary Guardians shall also be given
to: Samuel J. Fama, through his Guardian, Pennsylvania Guardianship Association, by
first class United States mail.
'-jJv~M"#j ~ Y1' shall be appointed to represent MaryH.
Fama, the alleged incapacitated person.
BY THE COURT,
1.
IN RE: MARY H FAMA
An alleged incapacitated person
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
: NO. 21-2004-0831
IMPORTANT NOTICE
CITATION WITH 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 right to
manage money and property and to make decisions. A copy of the petition which has been filed by Area
Agency on Aging is attached.
You are hereby ordered to appear at a hearing to be held in Court Room No.1, Cumberland
County Courthouse, Carlisle, Pennsylvania, on OCTOBER 26 , 2004, at 2:00 rM. 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 right 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 gift 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:09-16-2004
By:J1Q.M~" ~-'^ QA. ,~~\O~
Clerk, Orphans' Court Division ~~.
Cumberland County, Carlisle, PA
My Commission Expires I st Monday,
January, 2006
IN RE: MARY H. FAMA
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
An alleged incapacitated
person
NO. 21-2004-0831
IN RE: PETITION FOR APPOINTMENT OF PERMANENT PLENARY
GUARDIANS OF THE PERSON AND ESTATE
BEFORE OLER, J.
ORDER OF COURT
AND NOW, this 26th day of October, 2004, upon
consideration of the Petition for the Appointment of
Permanent Plenary Guardians of the Person and Estate
Pursuant to 20 P.S. Section 5511, and following a hearing at
which the allegedly incapacitated person, Mary H. Fama was
present and represented by her court-appointed counsel,
Michael Traxler, Esquire, and the Petitioner (the Area
Agency on Aging in and for Cumberland County, Pennsylvania)
was present through several representatives and was
represented by its counsel, Anthony L. DeLuca, Esquire, Mary
H. Fama is adjudicated an incapacitated person, and the
Pennsylvania Guardianship Association located in Lancaster,
Pennsylvania, is appointed plenary guardian of her person
and estate.
The guardian is directed to file reports in accordance
with the provisions of the Probate, Estates and Fiduciaries
Code applicable to such guardianships.
The guardian shall file a bond with respect to its
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duties hereunder in the amount of $500,000 with the Orphans'
Court of Cumberland County.
The guardian is directed to arrange for visits at least
once each week absent exigent circumstances between Ms. Fama
and her husband, Samuel, to maintain her residence at the
Bridges at Bent Creek pending further Order of Court, and to
consult with Ms. Fama with respect to any major decisions
regarding her wellbeing.
BY THE COURT,
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01.er, Jr., J.
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Wesley
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! Anthony L. DeLuca, Esqulre
7: 113 Front Street
oJ" ! Boiling Springs, Pa 17007
\ I Attorney for the Petitioner
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Michael Traxler, Esquire
36 S. Hanover Street
, Carlisle, Pa 17013
L Court-appointed Attorney
for Mary H. Fama
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IN RE: MARY H. FAMA
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
An alleged incapacitated
person
NO. 21-2004-0831
IN RE: PETITION FOR APPOINTMENT OF PERMANENT PLENARY
GUARDIANS OF THE PERSON AND ESTATE
BEFORE OLER, J.
OPINION and ORDER OF COURT
OLER, J., October 26, 2004.
At issue in the present case is whether Mary H. Fama
should be adjudicated an incapacitated person, and, if so,
who should be appointed plenary guardian of her person and
estate. A hearing was held on this matter on Tuesday,
October 26, 2004, before the undersigned judge.
Based upon the evidence presented at the hearing, the
following Findings of Fact, Discussion and Order of Court
are made and entered:
FINDINGS OF FACT
I. The allegedly incapacitated person is Mary H. Fama
(date of birth, October 19, 1919), a married woman who is
presently residing at an assisted living facility known as
the Bridges at Bent Creek, 2100 Bent Creek Boulevard,
Mechanicsburg, Cumberland County, Pennsylvania, 17055.
2. Petitioner is the Area Agency on Aging, County of
Cumberland, which has offices at 16 West High Street,
Carlisle, Cumberland County, Pennsylvania.
3. The allegedly incapacitated person, Mary H. Fama,
suffers from a condition diagnosed as a cognitive disorder
(not otherwise specified), possibly arising out of
Alzheimer's Disease; she has suffered from this condition
for a period of at least 5 months.
4. As a result of the aforesaid condition, Ms. Fama is
an individual whose ability to receive and evaluate
information effectively and communicate decisions is
impaired to such a significant extent that she is totally
unable to manage her financial resources and totally unable
to meet essential requirements for her physical health and
safety.
5. The prognosis with respect to her condition is
guarded at this time.
6. Based upon the aforesaid condition, the Court finds
it necessary to establish plenary guardianships with respect
to the estate and person of Ms. Fama.
7. In view of the absence of a more favorable
prognosis at this time, the duration of the guardianships
required must be said to be indefinite, pending further
Order of Court.
8. The Pennsylvania Guardianship Association with
offices located at 1253 Wabank Road, Lancaster, Pennsylvania
is an organization found to be qualified under the Probate,
Estates and Fiduciaries Code to serve as plenary guardian of
Ms. Fama's person and estate.
9. The foregoing Findings of Fact are made on the
basis of clear and convincing evidence.
DISCUSSION
The provisions respecting an adjudication of incapacity
are contained in 20 Pa. C.S. Section 5501 et seq.
Petitioner has substantially complied with these provisions,
and based upon the foregoing Findings of Fact the following
Order of Court will be entered:
ORDER OF COURT
AND NOW, this 26th day of October, 2004, upon
consideration of the Petition for the Appointment of
Permanent Plenary Guardians of the Person and Estate
Pursuant to 20 P.S. Section 5511, and following a hearing at
which the allegedly incapacitated person, Mary H. Fama was
present and represented by her court-appointed counsel,
Michael Traxler, Esquire, and the Petitioner (the Area
Agency on Aging in and for Cumberland County, Pennsylvania)
was present through several representatives and was
represented by its counsel, Anthony L. DeLuca, Esquire, Mary
H. Fama is adjudicated an incapacitated person, and the
Pennsylvania Guardianship Association located in Lancaster,
Pennsylvania, is appointed plenary guardian of her person
and estate.
The guardian is directed to file reports in accordance
with the provisions of the Probate, Estates and Fiduciaries
Code applicable to such guardianships.
The guardian shall file a bond with respect to its
duties hereunder in the amount of $500,000 with the Orphans'
Court of Cumberland County.
The guardian is directed to arrange for visits at least
once each week absent exigent circumstances between Ms. Fama
and her husband, Samuel, to maintain her residence at the
Bridges at Bent Creek pending further Order of Court, and to
consult with Ms. Fama with respect to any major decisions
regarding her well being.
BY THE COURT,
/s/ J. Wesley Oler, Jr.,
J. Wesley Oler, Jr., J.
Anthony L. DeLuca, Esquire
113 Front Street
Boiling Springs, Pa 17007
Attorney for the Petitioner
Michael Traxler, Esquire
36 S. Hanover Street
Carlisle, Pa 17013
Court-appointed Attorney for Mary H. Fama
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AUTHORITY TO PAY COURT APPOINTED COUNSEL
'1Jj: NOV 1 6 2004 1
1. COURT ~ommon 2. ~UCHER ~
o District Justice Pleas 0 Appellate o Other ~ 8034
3. FOR (D.J., C.P., APPELLATE) 4. AT (CITY/STATE) S'!Lu:hGET CODE
,_ J r:;}.'J1 /J- I ^" ..
6. IN THE CASE OF 7. CHARGE/OFFENSE (PURDON CITATION) 8. 0 PETTY OFFENSE
vs o FELONY 0 MISDEMEANOR
9. PROCEEDINGS (Describe briefly) .. 11. PERSON REPRESENTED 12. CIVIL DOCKET NO.
1 0 Defendant. Adult J-/- dOtJLf- Of3J
G.lACt reA I a Yl Ad CI +U ,.,., 2 0 Defendant. Juvenile
3 0 Appellant 13. CRIMINAL DOCKET NO
4 0 Appellee
5 0 Habeas Petitioner
6 0 Matenal Witness
~- 7 0 Parolee Charged With Violation
1 Q. PERSON REPRESENTED (Full Name) 8 0 Probationer Charged Wilh Violation 14. APPEALS DOCKET NO.
meU' " FQmCl 9 0 Other.
16. NAME OF ATTORNEY/PAYEE AND
Appl Dale MAILING ADDRESS
-YudQ~ 9tder Abo m + Ku.t\Alall)
3&i S HuY"\()ver Si.
Gtrll~le fA liOl3
NAME OF COMMON PLEAS JU GE ASSIGNED TO CASE
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17. TELEPHONE No. 18. SOCIAL SECURITY NO OR EIN NO
7/7- ;}yq - oCfOO ~r-/~7 7r?C/V
CLAIM,FOR SERVICES OR EXPENSES
19. SERVICE HOURS DATES AMOUNTS CLAIMED
a. ,,~aignment andlor Plea Multiply rate per hour limes total
b. 'Jli-eliminary Hearing hours to obtain "In Court" com.
pensation. Enter total below,
e. Motions and Requests
~ c1 Ba.1 Hearings \ nr D
a:
:J e. Sentence Hearings l \ "'IY\~
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u t. Trial .rX\/ ]W
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g. Revocation Hearings I rJ ( L\
h. Juvenile Hearings L- nV .......
i. Appeals Court )1(.... 19A. TOTAL IN COURT COMPo
~ Other (Specify on additional sheets) ~
~
TOTAL HOURS .. x;P PER HOUR =$
20. a Interviews and conferences Multiply rate per hour times total
b. Obtaining and reviewing records hours. Enter tolal "Out of Court"
u.~ compensation below.
Oa: e. Legal research and brief writing
~:J
:JO d. Investigative and other work (Specify on additional sheets) 20A. TOTAL OUT OF COURT
OU COMPo
tjl =$ JOI. S{)
TOTAL HOURS = X PER HOUR
21- ITEMIZATION OF REIMBURSABLE EXPENSES AMT. PER ITEM
Mileage $.25 per mile x
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I 21A. TOTAL ITEMIZED EXP.
~
0
-$
. -
22. CERTIFICATION OF ATTORNEY/PAYEE 23. GRAND TOTAL CLAIMED
Has compensation and/or reimbursement for work in this case previOUSly been applied for? DYES o NO =$ 3(j1.~O
If yes. were you paid? DYES o NO If yes, by whom were you paid? How much?
Has the person represented paid any money to you, or to your knowledge anyone else, In connection with the ma"er for 24. DEDUCT, PRIOR PYMTS.
which you were appointed to provide represent.~~io~~--'~ on additional sheets =$
I swear or affirm the truth or correctness l' Iv- 11//:1. /... t; 25. NET AMOUNT CLAIMED
of the above statements Slgnature~orney/Pey~,' I I Dale =$ 301. SO
26 A"PIlCJVl 01 . "'.J IJ/v"t/ ~ff/_ 27. AMT. APPROVED
. fOil Sognature of ruo V. I~, .1oo~ = $ ~ 0 (, SO
PAYMENT Judge . Dale:
C~py 1 . Mail t<~urt Administrator at completion of service
......
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Abom & Kutulakis
36 South Hanover Street
Carlisle, P A 17013
Ph: (717) 249-0900
Fax: (717) 249-3344
Fed. Tax ID Number 25-1877844
Pennsylvania Guardianship Association Inc.
PAGA
PO Box 7295. Lancaster. P A 17604-7295
(717)-299-4568 I (717)-940-7599
FAX# (717)-299-5540
December 27,2004
Court of Common Pleas of Cumberland County
One Courthouse Square
Carlisle, P A 17013
Attention:
Clerk ofthe Orphans' Court
Re:
Mary H. Fama
21-04-831
Greetings,
Enclosed is a copy of the Bond that Judge Oler ordered PA Guardianship to post in the above
referenced incapacitated person / guardianship order.
Please address any questions to Brian @ 717-299-4568
Thank You, Sincerely,
!l(t6.- D./5,4
Brian D, Brooks
President , P A Guardianship
RECORDED OFFICE OF
R'A"Y"".c '~r' 'I "I I "
ict]i~::, ; td tJt- )i~J~L...~~
PENNSYLVANIA NATIONAItoo~DJ:'C29 PM 12: 51
MUTUAL CASUALTY INSURANCE COMPANY l...
Harrisburg, Pennsylvania
CLERK OF
ORPHAN'S COURT
CUl~R.r.p! n'ln r'n Dt,
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In the Matter of the Estate of: MaryH Fama
KNOW ALL MEN BY THESE PRESENTS, that we,
guardian
of the Estate of
Pennsylvania Guardianship Association, Ioc.
Mary H Fama, an alleged incapcitated person
as
and Pennsylvania National Mutual Casualty Insurance Company, a Pennsylvania Corporation, of Harrisburg,
Pennsylv!lllia, as Surety, are held and firmly bound unto the
in the full and just sum of
Five Hundred Thousand
Court of Common Pleas of Cumberland County
DOLLARS,
($ 500.000.00 )
for the payment of which, well and truly to be made, we bind ourselves, our heirs, executors, ,
administrators, successors and assigns, jointly and severally, finnly by these presents.
Sealed with our seals, and dated this 19 day of November, 2004.
WHEREAS,
guardian
Pennsylvania Guardianship Association, Inc. , has been, or is about to be, appointed
of the estate of Mary H Fama, an alleged
incapacitated person
, by the
Common Please of Cumberland
Orphans Court Division of the
County.
Court of
NOW, THEREFORE, the condition of this obligation is such, that if the said Pennsylvan~.GuardiaDShip
Association, Ine.
shall well and truly discharge the duties of said trust according to law, then this obligation
is void, otherwise to remain in full force and effect.
0'1//1
Ci(1-~~
ill
Brian D Brooks, President
lVc~u''l f>- 6/~ ~4C:lt
. I
PENNSYLVANIA NATIONAL MUTUAL
CASUALTY INSURANCE COMPANY
By:
J
Form 78-168
Hartisburg, Pennsylvania I
POWER OF AITORNEY I
Know All Men By these Presents, That PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY, a I......
corporation of the Commonwealth of Pennsylvania, does hereby make, constitute and appoint
J. ANDREW GREINER, ALFRED L. STEELE, J ARNE FORNEY, 1. BRADFORD FORNEY, JOSHUA B. LEAMAN AND
JUSTIN D. LEAMAN, ALL OF LANCASTER, PENNSYLVANIA (EACH)
its true and lawful Attorney(s)-in-Fact to make, execute, seal and deliver for and on its behalf as surety as its act and deed: I".'
ANY AND ALL BONDS AND UNDERTAKINGS PROVIDED THE AMOUNT OF NO ONE BOND OR UNDERTAKING ...
EXCEEDS THE SUM OF FIVE HUNDRED THOUSAND DOLLARS ($500,000>-------------__________________________*_
ALL POWER AND AUTHORITY HEREBY CONFERRED SHALL HEREBY EXPIRE AND TERMINATE WITHOUT NOTI
AT MIDNIGHT OF THE 31 ST DAY OF OcrOBER 2005, AS RESPEcrS EXECUTION SUBSEQUENT THERETO. ::1
And the execution of such bonds in pursuance of these presents shall be as binding upon said Company as fully and amply, to all 1
intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the Company at its
office in Harrisburg Pennsylvania, in their own proper persons.,
This appointment is made by and under the authorization of a resolution adopted by the Board of Directors of the Company on J
October 24, 1973 at Harrisburg, Pennsylvania, which resolution is shown on the reverse side hereof and is now in full force and efti ..... t
In Witness Whereof: PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY has caused these I..
presents to be signed and its ~orporate seal to be affixed on OCTOBER I ], 2002
...,.,;;;U~ PENNSYL VANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPj''''
'11'''.~'''''~
r~('a2va\\1 ~~ ~:rli.r
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. Kenneth R. Shutts, Executive Vice-President, Secretary & General co1"el
ommonwealth of Pennsylvania, County of Dauphin - ss: ...
'n OCTOBER II, 2002, before me 'appeared Kenneth R. Shutts to me personally known, who being by me duly sworn, did say th I
~ resides in the Commonwealth of Pennsylvania, that he is Executive Vice-President, Secretary & General Counsel of 1
ENNSYL VANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY, That he is the individual described in and whl
{ecuted the preceding instrument, and that the seal affixed on said instrument is the corporate seal of said Company, and that said
:strument was signed and sealed on behalf of said Company by authority and direction of said Company, and the said office
:knowledged sa;d instrument to be the f,ee oot and de~ of sa;d Company. I
~~ l
\~~'~\J Q /' .'
~ NOIary PuhUe . '"'- t? "'" <.4 ~
:>mmonwealth of Pennsylvania, County of Dauphin - ss: Jacqueline ~~:,~tary Public I..".. ..
City Of Harrisburg, Dauphin County f
My Commission Expires Dec. 19,2005 --:J' J<'
Member, Pennsylvania Association of Notaries . .
Michael F. G....,. Vice Pn:sident, Surety & Fidel~ .fthe PENNSYLVANIA NATIONAL MUTUAL CASUALW MllR"NC ...
JMPANY, a corporation of the Commonwealth of Pennsylvania, do hereby certity that the above and foregoing is lit:r4e1.nd'com.'. '.'.
py of a Power of Attorney, executed by the said Company, which is still in full force and effect. 'I
Wi..... Whereof, I have hereunto set my hand and allixed the <0_ r / ~pan :::-_ \",. -
2'~~Fi _ I''':
IMPORTANT NOTICE: This border must be RED in color. If it is not ......
8-190 (Rev 05/02)
~
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RESOLUTION
adopted by the Board of Directors of
Pennsylvania National Mutual Casualty Insurance Company
on October 24, 1973
RESOLVED, that (1) the President, any Vice President, the Secretary, or
any Department Secretary shall have power to appoint, and to revoke the
appointments of, Attorneys-in-Fact or agents with power and authority as
defined or limited in their respective powers of attorney, and to execute
on behalf of the Company, and affix the Company's seal thereto, bonds,
undertakings, recognizances, contracts of indemnity and other written
obligations in the nature thereof or related thereto; and (2) any of such Of-
ficers of the Company may appoint and revoke the appointments of joint-
control custodians, agents for acceptance of process, and Attorneys-in-Fact
with authority to execute waivers and consents on behalf of the Company;
and (3) the signature of any such Officer or of any Assistant Secretary or
Department Assistant Secretary and the Company seal may be affIxed by
facsimile to any power of attorney or certification given for the execution
of any bond, undertaking, recognizance, contract of indemnity or other writ-
ten obligation in the nature thereof or related thereto, such signature and
seal when so used whether heretofore or hereafter, being hereby adopted
by the Company as the original signature of such Officer and the original
seal of the Company, to be valid and binding upon the Company with the
same force and effect as though manually affixed,
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYL VANIA
ORPHANS' COURT DIVISION
IN RE:
MARY HELEN FAMA
NO. 21-04-831
DATE OF APPOINTMENT
10/26/04
INVENTORY OF ASSETS
DATE: 12/27/04
DESCRIPTION
$ AMOUNT
SOCIAL SECURITY (MONTHL Y) 718.00
CUSTODIAL ACCOUNT @ P AGA 00.00
BANK / CHECKING ACCOUNT 11,603,65
NEW ENGLAND SECURITIES ACCOUNT 10/31/04 504,790.30
PENSION 00.00
TOTAL CASH ASSETS HELD FOR WARD (BY P AGA) 516,393.95
TOTAL MONTHLY INCOME 718.00
TOTAL MONTHLY COST OF CARE 4,000.00+
TOTAL MONTHLY GUARDIANSHIP FEE 250.00
Narrative:
PAGA was appointed guardian of the person and the estate on 10/26/04 .
P AGA has acquired or has documented all known assets for the ward, This wards Social Security
benefits are being direct deposited to a checking account at PNC Bank,
This ward jointly owns real estate at 40 Susquehanna Ave" Enola, PA., The property has an
appraised value of$75,000,OO, A petition for authorization to sell the property is forthcoming,
All bank accounts and securities are co-owned with Mrs, Fama's husband Sam Fama, Mr, Fama is
an incapacitated person, P A Guardianship was appointed his Guardian of the Person and Es~e
by the Cumberland County Court of Common Pleas, by order dated 6/23/04, ~o ~
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Pennsylvania Guardianship Association Inc.
PAGA
PO Box 7295, Lancaster, P A 17604
(717)-299-4568 I (717)-940-7599
FAX# (717)-299-5540
I certify under the penalties of 18 Pa. C.S. sls 4904 ( relating to unsworn
falsification to authorities) that the information contained in this report is true and
correct to the best of my knowledge, information and belief.
DATE: /(J/;J7/o ~
,
.f{IcL-fl J3/~
SIgnature
President
Position
IN RE:
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA ~
ORPHANS' COURT DIVISION 80 ~
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NO. 21-04-~SB ~
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SAM FAMA
DA TE OF APPOINTMENT
6/23/04
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INVENTORY OF ASSETS
DATE: 12/27/04
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DESCRIPTION
$ AMOUNT
SOCIAL SECURITY (MONTHL Y) 978.00
CUSTODIAL ACCOUNT @ P AGA 00,00
BANK / CHECKING ACCOUNT 11,603.65
NEW ENGLAND SECURITIES ACCOUNT 10/31/04 504,790.30
PENSION BETHLEHEM STEEL CORP, 449.18
TOTAL CASH ASSETS HELD FOR WARD (BY PAGA) 516,393.95
TOTAL MONTHLY INCOME 1,427.18
TOTAL MONTHLY COST OF CARE 5,000.00+
TOTAL MONTHLY GUARDIANSHIP FEE 250.00
Narrative:
PAGA was appointed guardian of the person and the estate on 6/23/04.
P AGA has acquired or has documented all known assets for the ward, This wards Social Security
and pension benefits are being direct deposited to a checking account at PNC Bank .
This ward jointly owns real estate at 40 Susquehanna Ave" Enola, PA., The property has an
appraised value of$75,000,OO, A petition for authorization to sell the property is forthcoming,
All bank accounts and securities are co-owned with Mr, Fama's wife Mary Helen Fama, Mrs.
Fama is an incapacitated person, PA Guardianship was appointed her Guardian of the Person and
Estate by the Cumberland County Court of Common Pleas by order dated 10/26/04.
~
Pennsylvania Guardianship Association Inc.
PAGA
PO Box 7295, Lancaster, PA 17604
(717)-299-4568 I (717)-940-7599
FAX# (717)-299-5540
I certify under the penalties of 18 Pa. C.S, s/s 4904 (relating to unsworn
falsification to authorities ) that the information contained in this report is true and
correct to the best of my knowledge, information and belief.
DATE: /:J/'d-7/0Y
Ilt~1]. is f~
gnature
President
Position
U A DEr. n ,., ,p
1. COURT ~mmon 2. ~UCHER ""
o District Justice Pleas 0 Appellate o Other ~ 8027
3. FOR (D.J., C.P., APPELLATE) 4. AT (CITY/STATE) 5)J;GET CODEt.
-k'1'U/)-I.lWM
6. IN THE CASE OF 7. CHARGE/OFFENSE (PURDON CITATION) 8. 0 PElTf OFFENSE
vs o FELONY 0 MISDEMEANOR
9. PROCEEDINGS (Describe briefly) .. 11.PER~REPRESENTED 12. CIVIL DOCKET NO.
I Delendant " Adull ;;1- dOOtf-O~3/
Ii1ca pClcrfoied 2 0 Delendanl . Juvenile
~\ leged 3 0 Appellanl 13. CRIMINAL DOCKET NO
4 0 Appellee
5 0 Habeas Pelilioner
6 0 Malertal WItness
7 0 Parolee Charged With Violation
10. PERSON REPRESENTED (Full Name) 8 0 Probalioner Charged With Violation 14. APPEALS DOCKET NO.
M ar'l +-\ FO~ 9 0 Other.
Appt Dale ~t.J 16. NAME OF ATTORNEY/PAYEE AND
MAILING ADDRESS
.(\)_ . _..... -.lJ Y. .4.-...... I
0. LVe.~ lev () le r Al1\J~.I..I.,.,.... _,_"' _____lJ
~r. 36 S Hanover St
NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE Carlisle, P A 17013
..q., J /XJ:;. ,;l
17. TELEPH~4E No. 18. SOCIAL SE~RITY NO OR~ NO
, J7" ~ q-()q<Jt) ;)5 -lCS I Ilf''f
CLAIM FOR SERVICES OR EXPENSES
19. SERVICE HOURS DATES AMOUNTS CLAIMED
a. Arraignment and/or Plea Multiply rate per hour times total
b. Preliminary Hearing \ hours 10 obtain "In Court" com.
pensatlon. Enler total below.
c. Malians and Requests A
~ d Bail Hearings II nV
0::
::I e. Sentence Hearings LY'
0
U t Trial , f'} II
~ I
g. Revocation Hearings i A II 1I1 ~ (") ~
'\ U7 ^' \ - =
h. Juvenile Hearings ~n =
c..-. ::n
L Appeals Court J/ fJJ ~~OTAL I,"OURr~.
~ Other (Specily on additional sheets) ';,;;::;;;I' v ";EO :D-
>=J r- =~ ;Jj
X~ER HOUR '--nI
'>~ I .'
TOTAL HOURS '" C-:j ~ 0"1
,,..-" "', ._'0
20. a Interviews and conlerences ?fiP"ft rateli!: hour ltIi-ieS'tQtal
b. Obtaining and reviewing records . ...J ~Is. Enl~r'l6tal "Out:Ol CQ~rt.
u..~ . .J ii pensatl~~low. ;_--'- M
00:: C. Legal research and briel writing
~::I ., ;. r. .___..
::10 d. Investigative and olher work (Specify on additional sheelS) 20A. TOTAWlUT OF CaililT
OU COMPo
TOTAL HOURS - X ~~ERHOUR =$ d7.oV
21- ITEMIZATION OF REIMBURSABLE EXPENSES AMT. PER ITEM
Mileaae $.25 per mile x
0::
W
:I: 21A. TOTAL ITEMIZED EXP.
~
0
-$
22. CERTIFICATION OF ATTORNEY/PAYEE 23. GRAND TOTAL CLAIMED
Has compensation and/or reimburaeme.nLlQI: rk in this case previoUSly been applied fat? DYES o NO =$ :J7,oiJ
If yes. were you paid? DYES ON If yes, bil whom _re you paid? How much?
Has the person represented paid any ney to YOl ... or to YOUi~ow'edge anyone else. In connection with the matter for 24. DEDUCT, PRIOR PYMTS.
which you were appointed to provide rep senl tJ?~ ~ . 0 ANO If yes, give details on a1~i1>~1 'fort ..$
I swear or affirm the truth or correctness 25. NET AMOUNT~ED
of the above statements '(I( v ~lgn811ml Of AttO / "j I I Date =$ ;:)).
TT
26.APp,mVlO\ . ~. / Jli/s ]( oft l).l :i6( t> l..I 27. AMT. APPROVED
FOil S.gnalure 01 21/, 00
PAYMENI Judge . Date: ..$
Copy I- Mail to Court Administrator at completion of service
A THORITY TO P Y COURT APPOINTED COUNSEL
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Abom & Kutulakis
36 South Hanover Street
Carlisle, P A 17013
Ph: (717) 249-0900
Fax: (717) 249-3344
Fed. Tax ID Number 25-1877844
December 2, 2004
Court Administrator
Cumberland County Courthouse
1 Courthouse Square
Carlisle, P A 17013
Attention: RE: Mary Fama
File #:
Inv #:
04-252
7939
DATE DESCRIPTION HOURS AMOUNT LAWYER
Nov-04-04 Review Order of Court dated 10/26/04 0.20 9.00 MTT
Review opinion and Order of Court dated 0.20 9.00 MTT
10/26/04
Draft letter to Mrs. Fama : C/O Karen Mackley 0.20 9.00 MTT
Totals 0.60 $27.00
Total Fee & Disbursements $27.00 ./
Previous Balance 301.50
Balance Now Due $328.50
Johnson. Duffie, Stewart & Weidner
By: David W. Deluce
I.D. No. 41687
301 Market Street
P. O. Box 109
lemoyne, Pennsylvania 17043.0109
(717) 761-4540
dwd@jdsw.com
Attomeys for Petitioner
IN RE: MARY H. FAMA
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21.2004-0831
CIVil ACTION - lAW
PETITION TO APPROVE THE SALE OF REAL ESTA TE
TO THE HONORABLE, THE JUDGES OF SAID COURT:
AND NOW, comes the Petitioner, Pennsylvania Guardianship Association, Inc.
by and through its attorneys, Johnson, Duffie, Stewart & Weidner and petitions this
Court and in support of this Petition avers as follows:
1. Petitioner, Pennsylvania Guardianship Association, Inc. located at P.O.
Box 7295, lancaster, Pennsylvania 17604 is the court appointed guardian of the person
and the estate Mary H. Fama by Order of Judge Oler entered on October 26, 2004.
Attached hereto as Exhibit "A" is a true and correct copy of said Order.
2. Mary H. Fama is an incapacitated person who resides at the Bridges of
Bent Creek Personal Care Home, 2100 Bent Creek Boulevard, Mechanicsburg, PA
pursuant to the October 26, 2004 Order of this Court.
~
3. Mary H. Fama suffers from a mild form of dementia that makes it
necessary, for her own safety, to have twenty.four (24) hour care in a secured
environment. She is not able to live independently and can not return to her home.
4. The incapacitated person and her husband, Sam J. Fama, are the title
owners to real property located at 40 Susquehanna Avenue, Enola, East Pennsboro
Township, Cumberland County, Pennsylvania having acquired the property by Deed
dated December 4, 1996 and recorded in the Cumberland County Recorder of Deeds
office in Record Book 150, Page 133. Attached hereto as Exhibit "B" is a true and
correct copy of said Deed.
5. Sam J. Fama, the incapacitated person's spouse, died on January 5, 2005
thus vesting sole ownership of the aforesaid real property in the name of the
incapacitated person.
6. The total value of the incapacitated person's assets, not including the real
estate, is approximately $450,000.00. In addition, she has monthly income of
approximately $1,777.18.
7. The approximate monthly costs for the incapacitated person to be
maintained in The Bridges of Bent Creek Personal Care Home, is $4,500.00.
8. Since the incapacitated person will not be able to return to the real estate
to reside, and no one else resides in the home, Petitioner authorized a public auction of
the real estate which occurred on May 21, 2005.
9. The aforesaid real estate (tax parcel 09-14-0832-262) has a current
assessed value of $88,250, and after applying the Cumberland County common level
ratio of 1.0, has an approximate market value of $88,250.00
10. Your Petitioner also had the property appraised by L. G. Connor Real
Estate Appraisers on November 16, 2004, and the appraisal report indicated the fair
market value was $75,000.00. Attached hereto as Exhibit "C" is a copy of said
appraisal.
11. An auction was conducted by an Auctioneer, Cindy Fenton, on May 21,
2005 which generated a sale price of $88,000.00.
12. Your Petitioner believes that a fair and equitable price of $88,000.00 has
been obtained for the real estate and respectfully requests this Court to approve the
sale.
13. Subsequent to the public auction, and consistent with the bid awarded by
the Auctioneer, your Petitioner and the successful bidder, Steven B. Worley entered into
a written Agreement for Sale of Real Estate in the amount of $88,000.00 with settlement
to occur on or within forty-five (45) days of the date of auction. Attached as Exhibit "D"
is a true copy of said Agreement.
WHEREFORE, your Petitioner requests this Court to enter an Order authorizing
the sale of the real estate at 40 Susquehanna Avenue, Enola, East Pennsboro
Township, Cumberland County, Pennsylvania to Steven B. Worley for $88,000.00
pursuant to the terms and conditions of the May 21, 2005 Agreement for Sale of Real
Estate.
Respectfully submitted,
UI 1<<, ks
I I
Date:
:251405
VERIFICA TlON
I, Brian D. Brooks, President, Pennsylvania Guardianship Association, Inc., verify
that the statements made in the foregoing Petition are true and correct to the best of my
knowledge, information and belief. I understand that false statements herein are made
subject to the penalties of 18 Pa.C.S. S4904 relating to unsworn falsification to
authorities.
'an D. Brooks, President
Pennsylvania Guardianship Association, Inc.
Dated:
6/; /tJ~
-'--.'
90 JCl\1d
--
",.......r'~
IN RE: MARY H. FAMA
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
An aLLeged incapacitated
person
NO. 21-2004-0831
\
IN RE: PETITION FOR APPOINTMENT OF PElWANEN'l' PLENARY
GUARDIANS OF THE PERSON AND ESTATE
BEFORE OLER, J.
c'
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ORDER OF COURT
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AND NOW, this 26th day of October, 2004, upon
consideration of the l?eti tion for the Appointment o~'
Permanent Plenary Guardians of the Person and Estate
Pursuant to 20 P.S. Section 5511, and following a hearing at
which the allegedly incapacitated person, Mary H. Fama was
present and represented by her court-appointed counsel,
Michael Traxler, Esquire, and the Petitioner (the Area
Agency on Aging in and for Cumberland County, Pennsylvania)
was present through several representatives and was
represented by its counsel, Anthony L. DeLuca, Esquire, Mary
H. Fama is adjudicated an incapacitated person, and the
Pennsylvania Guardianship Association located in Lancaster,
Pennsylvania, is appointed plenary guardian of her person
and estate.
The guardian ~s directed to file reports in accordance
with the provisions of the Probate, Estates and Fiduciaries
Code applicable to such guardianships.
The guardian shall file a bond with respect to its
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duties hereunder in Lne dInOunt of $500,000 ,.rith rhe Orphans'
Court of Cumberland County.
The guardian is directed to arrange for visits at least
once each week absent exigent circumstances between Ms. Fama
and her husband, Samuel, to maintain her residence at the
Bridges at Bent Creek pending further Order of Court, and to
cOnsult with Ms. Fama with respect to any major decisions
regarding her wellbeing.
BY THE COURT,
--
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Anthony L. DeLuca, Esquire
113 Front Street
Boiling Springs, Pa 17007
Attorney for the Petitioner
Michael Traxler, Esquire
36 S. Hanover Street
Carlisle, Pa 17013
Court-appointed Attorney for Mary H. Fama
:mae
A TRUE COpy FROM RECORD
In Testlmcnv ''Y';rer01 I het&ur'lto
set rrrv !-rfH-<i8.nd the seal
of salO COWl at Carlisle PA 4
piS n.day o( O. '20 0
P1/jiJt~ .-
Clerk 01 the Orp ans Court
CUrTI berland County
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~bi~ 1!lttbTAXPARCELNO
09-14-0832-262
MADE THE LT Pt day of .()?Z:E,41,6~
in the: year one thousand nine hundred ninety 9ix (1996)
BETWEEN
DAVID C. HILUARD and JOY M. HILLIARD, formerly mown as JOY M.
CASHNER, his wife, of Enola, Pennsylvania, Grantors,
AND
SAM J. FAMA and MARY HELEN FAMA, his wife, of Enola, Pennsylvania,
Grantees,
WITNESSETH, that in consideration of EIGHTY THOUSAND-------------------------------------u-----u-
_a__.~~_~~uu._n..~_..__________u_n__n______($gO,OOO761}J--------..----------------------.-------------~~--Dollur!j,
in hand paid, the receipt whereof is hereby acknowledged, the said grantors do hereby grant and
convey to the said grantees,
J
ALL THAT C~RTAIN lot or piece orland with th~ buildings and improvements thereon erected, sit-
uate in East Pennsboro Township, Cumberland County, Pennsylvania, bounded and described a::s
follows, to wit;
J
BEGINNING at a. point in !:ht:: ea.!)terly line of Sltsqltchanna Avenue at a distance of eight hundred
fifty~four and one hundred eighty~five one-thousandths (854.185) feet measured southwardly a-
long said line of Avenue from the southwesterly extremity of thl'l BJ:"C of a cu.rve, having a radiu:> of
ten (10) feet connecting the southerly line of Dauphin Street with the easterly line of said Susque-
hanna Avenue BIld extending thence South 84 degrees 50 minutes 30 seconds East, passing
through the ml.ddle of the pQrty w~11 between the house on this lot and the house On the adjoining
lot on the north, one hundred fifty (150) feet; thence South 5 degrees 9 minutes 30 seconds West,
50 feet; thence Nortb 84 degrees 50 minutes 30 seconds West, one hundred forty-nine and nine
hundred eleven one-thousandths (149.911) feet to the easterly Hne of Susquehanna Avenue, afore-
said, and thence northwardly along said line of Avenue a:9 follows, viz: First, curving toward the
right with a radius of three hundr(ld (300) fect, a distance of seven and two hundred nine lv-five
one-thousandths (7.295) feet; and Second, North 5 degrees 9 minutes 30 seconds East, fo~.ty-two
and seven llundI'ed five one-thousandths (42.705) feet to the Place of BEGINNING.
J BEING part of Eno1a as laid out on Plan recorded in the Cumberland County Recorder's Office in
Plan Book 1, Page 51,
J UNDER AND SUBJECT, HOWEVER, to the reserVations and restrictions therein conLained.
coo< 1.)0 "'f 1a3
nss~ rlTHSN~Ta~~n9 ~d
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And the said grantors do her~by Wanant SpelCially the property hereby conveyed,
IN wr/'NESS W.H:EREOF, said grantors ha.ve hereunto set their hands and scals the day
and year first above written.
"llnd,.6edtlllllllJJrllllutll
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DAVID C. HILLIARD
~;.'l;"''- ,<-\,Jl. "oj
JO HILLIARD
~'(''>'" C'J.d~
JO M,)::ASHNER
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eM t loA/:
stATE OF PENNSYLVA.NIA
couNTY OF COMBERL~ND
On this, the 41:.h day of December
,199...6.., before me, the undersign",d
offieer, personally appeared DAVID C. HILLIARD & JOY M, HILLIARD, f/k/a JOY M. CASHNER.
his wife.
known to me (or $atisfactorHy proven) to be the persons whose na.mes .arc subscribed to the within
instrumept, and aeknowh::dB;ed that they executed same for the purposes thc.ein contained.
IN WlT~~~ I hereunto set my hand and Of[l/)l seal /J '
~a~~j;';:";' tfkn<</ ..4 (;?,""",A~) IS~ALI
1':"~~i:tr.b-1~:'f Notary Public
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STATE ".~b~~"'"
COUNTlti;?.F~f~~
On this, the
day of
,199_. before me, the undersignecl
officer, personally appeared,
known to me (or satisfactorily proven) to be the persons whose names Are subscribed to the within
instrUmen.t, and acknowledged that they executed same for the purposes therein cOntained.
IN WIT~BB WHEREOT, I hereunto set my hand and official seal
ISML)
Notary Public
DOO' 150 PAct 135
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51:ZZ g0I21Z!ol!E0
I..G. Ccn'IJr Rell Es1IbI AoPrlmrl
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Adcten .(Q Su liWnna sttHt
Deed Book 00160 P 001
ASlnlor'I~" No. na.14..0B3'~
NA
M RESIDENTIAL APPRAISAL RL JRT "'No. 04-718
Eno4a state PA Zi C Il 17025
TIXV: ~5 .E fUll 11Bg.8Q
CLmnIOWner Fama Sam J. & Ma Helen
Foe _ PUD
or N EuI PennsbCIro iownstli
NA NA
PA Guardlanlhl AllOCIlltion e
Cltmtru A Leo Cert. R.,lldenllal
loclllon f.lrban S~ R1nI
IlIln", O0Yer75~ [8J'~75~ B...."25~
-,... 8/lapld [8JSIlIbIo Slow
_""'" ,_ [8J_. O""';;ng
__ _. [8JlnbtJ... 00'1,,_
IIl'nll ltlder3mos.
.... ................................ ~_....... .... IMt ......... ill.......
NeigtDomood boIIldIit5l1ld ~RcI: The nel hborhood bOund.ries ./'8 indIcated on the enclosed nei hborhood ma lnlhe addenda of
thlt: 11. Immediate ne hborhood Is residential
_1hIt_1he_'llycilhopropertiMlnthe"'i,hIJo_l"","nilylnlll1\lloyment01d_.llI1\Iloymentstolllllly."""~In"",,,o\oIn,l:
Scnools .ho in em nt ~8tion em:t houRs otwo.-.hl Ire all withIn 8 1 ~ mlrnm. drfvi time of the rub fQ
A. m.ain1enanoe ram. were ob&erved. Em ent atabll II ood due to the State Ca ltalln I bu e
Sl,l In New Cumbarland and me NtIvaJ $1,1 De enlcsbu . ea Incl'enes and MLS statistics sheM' a ood
derNI fort 8 anNI.
I..
n ~ In
PO Box 7 6 lanent. PA 176()4..7599
hi 159 Markel Street eam Hili P.... 17011
Pndomf,.nt PreMntill'llf1.U"
~ Wiil ~ o..l"'~ 75
[8J OWner 50 I lJJw "- 2-4_ 10
o r_ 300 120 .""'""" 10
181 ;....(~..) I'tod_" _..
80
tcIlIIA. 0.00
OWner Tenant VM:fIlt
'" HOA NA 0,
li 25420-<1101 00
NA
p,
lIndUM~
~Notlloly UlIloIy
Om""",
To;
__In1hr!OOjoot'""'....,~d(mudino..,""'1<i<1healm._""ol...I1l...l1<nI1ci"""'r1f_:d__,ond_"ti""
-1UCh a& dataOl'l ~prapd8lfor _lnltllll.i.Jbu.I.......d, dncripIioo lithe pni'v*oce of 18IelI.x:I1il1lncing COIICIlllilXll, Illt:.):
Cou . nd MLS shIti,tlcJ ,how rice. to be stable. The MLS shows that the leal marketln time ror the area 1$ s..6 months.
Mort fund. are readi avalhlble h eo ntl 81 loan, bein 6.00% to 6.06'H. Interest t'ix.,d 30 .r 961M. mo 8 If with u to three
'ms $II1JeI"l.... nat 1,1' d 10 offer sales orflnancln concesaians but seller a.alstance hs occumn .
PNj..._llGo '" PIIOt(" 'A'r.obIe) -- 101he _opor,lJd1dtr In ""*"" the H"", Ownero' A$saOalloo (HOAI? V.. No
_Iota........"............."'... _""'lotantmbotci...."'...1n1llt0Jb[ec1_
Descri OOllIlaclitles.
DIrnen5lon$ 42.705'x:CUrve7. '14 'x1eO' T~' ADOVe-8t. l'l1delll .mcll
SII! I'ea O. t7 acre Del' tax recorda Com8Ilot No SIze Avera e for area
Spmfic ttri1g c1w1fteM1on and descrIpIIon CG . CommeR:Iel Genelll ShIp! somewhat rectan uler
Zoo/ng"""'''' OLoP [8JLoP,.~,r""..(G-_"'1 001,,- ONo"""" _ "" uat.
Prasent 110 Vinr A e Street
0lrlIlf OI't-IItth,............,b,. Typs PttJIic f'Iiv!II Lm$caplng T ICIIf r
street Mleedam [8] ~ Ilrtnway Slltace Stone
_gultw eoncme ~ _..."""'" Standltd Utll'
_ C_ 0 FEMAs.,ecl~Rood_Ar.. ov.. [8JNo
S1Jtet Ughts "".Quate 181 0 FE.. lo.. C Mep Dale 4115"
S None FEMA 42035911
_ (_IdYne_, ._..."ts. """~ .._. ~~, .....IkG~ .-Ioga nonoonIOIIr/ng!lOng use, ""): stand.rd
easements for eIeotri tele etc. There .re no knowTl Qr a arent advern easements encroachments or cond 'gn. thal would
've im ct on lhe v"ue ofttle su 'eeI ,SU ec:t l'ell~ use rtldatn existin :loni . SuIToundJn use. al'e limarl
tBfiAL ~ BTB\IlI\ DESCRJP110N FOUNDATlON BASEMENT !NSIJL.AnON
No. of lHIs One FotnIllIion SlaM Slab No Are. Sq. Fl 64& Roof ~ 0
No. of sturIlls edel'Ior Wilts Aluminum CmrI SpIce 0 "Rri1hld 0'Ml Ceiling 181
T)'pe (Det.IAtt.) Atlac:hed RooI'SlJface ha Shm I. 8tMmeI'It Ful CeIlIng Joists Walls ~ I2J
","Q/lISllltl IOmI ......,_, Alumi SUr4>~ No W'" st _ _ 0
Exitting/Proposed Exllt1n WlndtIWTyfle Wood DbleHn ~I Nonenot.a Roor Concrete Nons _ 0
AlItI (Yrs.) 84 ara Stomv'Smn V.. SetIItment Due To e ~e E'*Y No UnIoJown !Zl
25 rs ell No on Nc)ne noted
KItdlen Bedrooms # Baths L
x
....
718
646
120
3
lbove econtalns'
Matel'ial/COndilioo
Oa VI Av
o aUlAv
Wood Ra
8IlhROlI' VI A
5alhWailscoI: Abe JuliA
~ Wood/Av
7R
HEATING
r",
...
:3 Bedrooms'
KITCl-fNEQUIP.
1424
,;
v
FHA
01.
Av
-
R"'le/O'lm>
~-
""""""'"
None FWHood
None Micr'aWele
NA W
AVeni e for ......
....,.lIS
A"~"'lsl#_ 0
Pallo 0
0"" 0
PoIoh Front [8;)
m. 0
Pool 0
"'" G
eM STOOAlI:::
Nanlt 0
G....
"".""
-
Buit-ln
"""'"
#"...
000UIf.l
.....
Oll1M
2....
2 ..,.
Ad_.......tspeoilli""'1YtllldInt_,""',):
ConclJtion Dfh irnplC....,....IlS. ~ (Q$lCII,~, iI1d nlIm8), repairl needed, qllllHy 01 oonstruclIon, remodellng/addiIionlI, etc.: l'tIe home fa
in avo e eondltion. Thert were no a l'ent functlonallnad 1,1 . anstru(:tton uaU 11 leal rt Brva. The estimated
efflJtUve tis below the ICbJII. . due to maIntenance condition land com arison to com 81in nIl borhoods. Ph slcal de ciation is
attributed to .rtd defelTed mIIlrrtemmC4t. Unit oIhefWlse mentioned tl'ttte w.te no si nl1l tlems ob that uire See
Mverse lllWirortTlllfCill CtWldhklnl (such as. butllll:lnitedlD, hamIoos wastes, tGld:c sWstn:es, m.l pte5eIllln Ihl! ~IIJll"l:hemera, 1Il1hl1ite, (Jintlll
Immedl. >AcInI!y of the 5I1Iject ~.: Ttl. Is of an a Where lead balled alnl m be resent. The market doell not "211. .
ro e but Ihe enent .houfd be advised of It's osslble exIltence. It I, 'Isumed that It II not resent. If tn. entnt has 8 e Addendum
FmldleMacForm11I6i93 FAGE1Of2 fmeMiIllFtml1004l1/93
Fu'm 00 -"ltITAI. toJ WIf1IO'fft' appmaI softwD by ala modt, inc. -1.SOO.Jtl...t.MOOE
10 39\;;1d
oss~ dIHSN~Ia~\;;In9 ~d
0togg6GU 1L
L~:0~ g00~J~~/g0
--.
leQIIDosalptioo
~
.......
....
1\1-
""""'Tract
M.._
...-
OtOoot...
aonuw.- f Cln
L_
SOl (Sqlllf1l ""l
_perS<pAweFoal
l>>cllloo
...
""""""
T...1loomJ
Bodrooms
-
Awnlm
O..ot_sod.....
flW _01.'"
~,
SUMMARY OF SALIENT FEATURES
40 SUequehlnn8 Avenue
Deed Book 00150, P.geOO133
Enota
Cumberland
PA
17025
2542Q..01D1,OO
$ NA
NA
NA
P,A. Gu.-rd~hlp AsaocbltJon. Inc..
1.424
S
A""'Qe
84 ye....
Average
7
.
C1.ment A Leo. Cart. Residentlal AIlprIIl..r
November 18, 2004
$ 715,000
F\wm SSD --nJTAl. fllr wnIowt"lII>PIWMl SlJftw.-e by a Ia mode, R. -1-800-AlAMOOE
~0 39'1td
OSS'lt dIHSN'l;fla~'l;fn9 'ltd
0PSSG6ZLlL
Lz:ez S00Z/Zl/50
L APPIlAllAL II. lIRT R. 04-718
_"'Co9t_I_........~""_.ollo_.
.....foatt>ll_..."'HllD,VA...-..._.-...
BCllI'IOmIellflal"PfOPII1r); Cost wi!
re . in'" ~ mllte of value If the buildi ..
reuon.b new and the I reflect the h hf,tt and
bUt u.. or the 'end when Items of leal
must be edmaied *' It('$ of em '-
Invotved v.tIlch Is 10. The Colt WIllS not
utIIt2ed due to the
UII f, .. IIIIIDEI'
EST1MATEDSlTEVAUJE ........... .................. . ..... I
ESTlW TED REPRODUCTION CQSf..fIEW..{F \MfROVEMENTS:
Dweling 1..424 Cq.R.eS -$
.... Sq. It @$
2 "
A1umlnumfA
So< ..
"
7 ~
10124
Full tMInment
U
"
F_
"
2__
-
None
--
-s
... ..........-.
. .........-$
........-
.--.e NO. 1
S35 Wool PoI1y"",
"
'"
..
2
'"
1c.-~lId
Pon:hlOoek
--
--.....
"~#' '~\.,." .-. ~
_ '" ,.,., J,... _ ~ c ~ .J", I~:r; t',;"
, .
.
+-
7.000
65." rt>
MUI,__
COuItIlouH It_
+-
Con_
None
5/13104 [)OM;
AV
F..81m
O.O&Ilcte
A ._
IA
VI Av
104 1iI~
""
ConvenIIooaI
C<lst.
7/1411)4 28 OOM :
A
Foe 0
O.08AC:ft
'" ......
2 Av
Aluminum/A:
'04 ora
I
-3 000
+3 000
-2,500 7: 3 :
.3 80D 1 344
Full bllsement
Unf;rf
'"
FH/\/NonO
A"~ .,
+2000 Off strHI
.500 Pote1VCov Deck
Non.
NonolNono
8 : 3 : 1.5
o 11Q
FuU bdement
Unftn'-hed
"
FHAICA
'"
"'3000 2 car deUlched
.500 PonWPatio
Non.
F~Il,..
~1,500
+3 SOO
-2000
.500
,!lOQ
4800
1000
75100
_",SIl..c.n".tooo(lncludlng1ho1lb",_,~,,1ho...g/jlo!tlood."".): Aft.,olllo
00 reDid. c~en W8nt eonald. he . .v.llable, uacment. wer1I made to reflect ~""" ~. between 1M com
1"0 rtje. and the . ,l"ne UIt nt. thlll W8rs mede rened the ietl ac::tlClOl of and seiter In the tn lece. All
co lei were c:onlldertd. a . sa"., la In 'mmllculate- condition Vt1th new kitchen roof' dfJW and Interlor
alnun . Sale:... had some w1ndowa covered d ta In need of CQtrMtlc u 1It!. Addendum
lllIUCT CC>>.tPAFWlE I<<). t COMPAIWl.E NO. 2-
S8D,0D0 None None None
12/....., NA NA NA
Crthae Records COt.IIthou.. ~ Courthou.. Recorda Courthouse Records
~. afq ct.mrrtagmmentgf.. opOon. <<lstIna of ~~W1d ..,.sof Q pt\or sales of Ujectlrlll ~'" wtIt*l OM)''' at.. dibl ofillppniiAl;
Prt .,.. of the com . 0CCUfrIId mo~ than on. r a ,The .ub II cu not u nor listed in the 0
rnarMt. S hu .~ In the aat three .ra. BRed on IllIIftet data IU sold above Indlcatlo 1118.
~'ALUErYlIALB__ . .............. . .......................m.......... $ 75DOD
INlIQ\ 'llLUErY _ D GnmR<lnl D
lli.lpIlIOWls_ ...,,' UjoclIDllo.....,_."""'cIIllno..__lstldbelow UjoclID_porJl..&_.
tordIoos of ~ No warra of UlII Alia I 0 I lied. No IJabir illlAUmed for the IInJctural ndIor mKhlnlcal .wments of
Ill.."
AM F1econc11ta11orr. Due to lack of rental d8ta the Income
ven to the Sale. IOn h .. , nIfI the
"'"
Oole._...o.a
Source,IorIJlorSllM
~NM.E NO. 3
wa.
don. of
-
..
was
.andnotutj. .Greet_
HII8r1i In the market.
~ptq:lOSIc.-1J'is ~ II tv IIIImIIlIllemnll VIM allhlIl1III ~lhIIjtllllW}IcI mitis... bINd oolhliDM llUIdIIonsMd twClf1ilalan. tm:ingIfi
"'1II'li!IJ1 condl1lc:m, WId I1'lII1IItYltul'lMrftonlhll: iIl'lI stDd In the 8ltICI1od frtddie Mac Foon43WFNMA turn 1004B(R1villlid June 1993 I.
I (WE) mllATl THI MlAKa'VAW!. AlDE~ OFlME REAL PAOPImTHATI$ llfE SUBJECTOFltftS REPORT, MOF November 16 2004
fW*"ISTIIlDAttOFm:.~, ~AlI'ORl)T08E S 75000
-, _IlDIlVAI'l'RAlISl(lllll.'If'_
- -.. [J~d n""Nol
NII1'lIl Clement A !.eo, Cel"tln.d Rnld8ntlaJ,AbDl'lllsel NamI Npect ~
DoIsR__ No_"9.20D4
_~# RL.(ID1780:-L _PA
. -
Fr8ddIe h rum 70 &'IS PAGE 2 OF 2 Fni. Mae Foon 1004 &-93
fom1 UA2 - 'TOTAL kif WIndowI" appqISIIIOftwn by a fa I'tlodt, ifIC. -1-800-ALAMODE
E13 39ltd
OSSlt dIHSNltla~ltn9 ~d
13t:>99GGlLIL
Ll:Bl 913Bll(;l/913
~
,~
m.......~'J'18
November 19, 2004
L. G. Connor Real ElIIate Appralsers. Ltd.
2159 Market Street
Camp HiD, PA 17011
PA Guardianship AssoclaIion, Inc.
A1TN: Brian O. Bmoks
PO Box 7295
Lancaster, PA 17804-7599
RE: 40 Susquehanna Avenue, Enola. PA 17025
Dear Mr. Bmoks:
Pul'BUant \0 your request. I have prepared a Comp/etll Apprai..l,
Summary Report for the property captioned In the "Summary of Salient
Feetures" which follows.
The accompanying report is based on a aile inspection of
improvements, investigation of the subjacl nalghborllood area of influence,
and review of sales, cost and Income data for similar properties.
This appraisal has baan made with parllcular attention paid \0 \he
applicable value Influencing economiC conditions and has baan proceaaed
In llOCOrdenca with nlllionBlIy recognized appreiael guldeNnaa.
The value conclusions stated herein are as of the dale as atated in
the body of the eppraiul and contingent upon the certificallons and nmiting
conditions attached,
P_ do not he_e \0 contact me or any of my atalI n we can be
of addlllonal service to you.
RespedfuUy.
~h
Clement A. Leo
Pennsyivania Slate Certified Residential Apprai_
km1 OCVR - -rotAL IlI'Wlndows. ~ $ClflWn by IlI.mode, Inc. -1-<<1O-ALAMOOE
1:>13 39\;l'd
OSS\;l' dIHSN\;l'Ia~\;l'n9 \;lid
0t>!;i!;i65U 1L
LG:0G 500llll/~Q
,
-----
"c",.".' ;",'c.'!!!"'" ,_
'T1:" ." :""':~,-:,'.!:", "r.>li "ia,'\i:'t~'
,'.r -'/':~':,':~'-:""~'::';'-!::"""'f""..-, ;'.
APPRAISAL OF REAL PROPERTY
LOCATED AT:
.c.o Susquehannl A.....nu.
east Penn.boto Township, Cumber1.nd County
Enol_, PA 1702!S
<r;;rg'fl~
FOR:
PA Gu.m~fUIhip AuociaUon. Inc.
PO Box 12815, L.ancuter, PA 17804-7599
AS OF:
November 16, 2004
BT:
CI~nlALeo
PA CerOfted RQidenttII App~lHr
L G. CONNOR REAL ESTATE APPRAI8I:RSLTD
2159 Mlr1tet StreM,
Camp HUI, PA 17011
LG.CIXl1OfRealEsblhlA.ppralstl1
firm GA2 - 'TOTAl for WIndows' 8f)pf1jsal saftwR by a la mode, inc. - t.8QO..ALAMODE
513 39Vd
OS5V dIHSNVla~~n9 Vd
13t>SS66~L 1L
L~:0l 5813z/zz/5l3
AGREEMENT FOR SALE OF REAL ESTA TE
THIS AGREEMENT made this '2. ~ ~ay of May, 2005, by and between the PENNSYLVANIA
GUARDIANSHIP ASSOCIATION, INC., P.O. Box 7295, Lancaster, Pennsylvania 17604, Plenary Guardian
of the Estate of Mary H. Fama by Order of Court dated October 26, 2004 (hereafter "Seller") and
~VU\ B. \.UHI~t; &koifLRFJa.cL) f-V\J) It;{ fA- l"J02$"""
(hereafter "Buyer");
WITNESSETH
1. Sale and Purchase. Seller agrees to sell and convey and Buyer agrees to purchase all that
certain tract of real estate municipally known as 40 Susquehanna Avenue, Enola (East Pennsboro Township),
Cumberland County, Pennsylvania, upon the terms and conditions hereafter set forth.
2. Real Estate. The Real Estate is more particularly described on Exhibit "A" ("Real Estate")
attached hereto.
3. Purchase Price. The purchase price is
($~<bl00D I O~ payable as follows:
A. Down Pavment The sum of Ten Thousand ($10,000.00) Dollars shall be paid
by Buyer to Seller at or before the signing of this Agreement Said down payment is non-
refundable.
/'~oo
R Balance. The balance of >eV - 'ii
($~ Dollars shall be paid by Buyer 0 Seller at settlement in the form of a
cashier's, certified or title insurance company check.
4. Default. In case of a default by the Buyer in the performance of this Agreement, the Seller's
sole remedy shall be the retention of the down payment as liquidated damages.
5. Court Aooroval. The sale of the aforesaid real estate by the Seller, a court-appointed Plenary
Guardian of the Estate of Mary H. Fama, is contingent upon the approval of the Orphans' Court of Cumberland
County. Seller shall petition the Orphans' Court of Cumberland County for approval of this Agreement, and
obtain authorization to execute a Deed and other documents necessary to convey title to Buyer at settlement
6. Settlement. Settlement shall be held on or before forty five (45) days from the date of this
Agreement, at such time and place as the parties shall mutually agree. Said date of settlement may be
extended an additional thirty (30) days unilaterally by Seller in the event more time is needed to obtain court
approval of the sale by the Guardian as referenced in Paragraph 5 above.
7. Possession. Possession shall be given at settlement
8. Real estate Transfer Taxes. Real estate transfer taxes will be shared equally by the Buyer
and Seller at settlement
9. Prorations. All real estate taxes levied on the Real Estate shall be prorated as of the date of
settlement, the County and Borough taxes being prorated on a calendar year basis and the school district
taxes being prorated on a July 1 fiscal year basis.
10. Municipal Charaes. Municipal charges for sewer rental, trash service and/or water service by
the municipality shall be prorated as of the date of settlement
11. Title. At settlement, the Real Estate shall be conveyed by special warranty deed free and clear
of all liens and encumbrances, subject to all easements and conditions of record, any de facto easements, and
any other existing conditions apparent from physical inspection of the premises, such title to be good and
marketable or such as will be insured by any responsible title insurance company at its regular rates in the full
amount of the purchase price.
12. Risk of Loss. Risk of loss by fire or other casualty shall remain in the Seller until final
settlement In case of fire or other casualty prior to settlement, Buyer shall have the option of rescinding the
Agreement or of settling and obtaining an assignment of the insurance proceeds.
13. Notices. All notices required by this Agreement shall be sufficient if delivered by certified mail,
postage prepaid, return receipt requested, or personally delivered to one of the parties to this Agreement as
follows:
A. To the Seller addressed as follows: Pennsylvania Guardianship Association, Inc.
P.O. Box 7295
Lancaster, PA 17604
With a copy to:
David W. DeLuce, Esquire
Johnson, Duffie, Stewart & Weidner
P.O. Box 109
Lemoyne, PA 17043-0109
B.
To the Buyer addressed as follows:
~~~
14. Conditions. Buyer agrees to purchase the Real Estate and improvements in their present
condition "as is" and Seller makes no warranty, representation or inducement to the Buyer with respect to the
condition of the improvements.
15. Lead Paint.
A Lead Paint Warnino Statement. Every purchaser of any interest in residential
real property on which a residential dwelling was built prior to 1978 is notified that such
property may present exposure to lead from lead-based paint that may place young children at
risk of developing lead poisoning. Lead poisoning in young children may produce permanent
neurological damage, including leaming disabilities, reduced intelligence quotient, behavioral
problems, and impaired memory. Lead poisoning also poses a particular risk to pregnant
women. The Seller of any interest in residential real property is required to provide the Buyer
with any information on lead-based paint hazards from risk assessments or inspections in the
Seller's possession and notify the Buyer of any known lead-based paint hazards. A risk
assessment or inspection for possible lead-based paint hazards is recommended prior to
purchase.
B. Seller's Disclosure.
(1) Presence of lead-based paint and/or lead-based paint hazards
(check (a) or (b) below):
(2)
below):
a. Known lead-based paint and/or lead-based
hazards are present in the housing (explain).
b. X Seller has no knowledge of lead-based paint
and/or lead-based paint hazards in the housing.
Records and reports available to the Seller (check (a) and (b)
a. Seller has provided the purchaser with all
available records and reports pertaining to lead-based
paint and/or lead-based paint hazards in the housing (list
documents below).
b. X Seller has no reports or records pertaining to
lead-based paint and/or lead-based paint hazards in the
housing.
C. Buver's Acknowledament. (initial)
above.
(1)
Buyer has received copies of all information listed
(2)
Buyer has received the pamphlet Protect Your Family
from Lead in Your Home.
(3)
Buyer has (check (a) or (b) below):
X
a. received a 10-day opportunity or mutually agreed upon period)
to conduct a risk assessment or inspection for the presence of lead-
based paint and/or lead-based paint hazards; or
b. X waived the opportunity to conduct a risk assessment or
inspection for the presence of lead-based paint and/or lead-based paint
hazards.
16. Time of the Essence. The time for settlement and for performance of the obligations in this
Agreement is hereby agreed to be of the essence of this Agreement
17. Whole Aareement. This Agreement contains the whole agreement between the parties, and
there are no other terms, obligations, covenants, representations, statements or conditions, oral or otherwise,
of any kind whatsoever, and this agreement may not be altered, amended or modified other than in writing
executed by the parties hereto.
IN WITNESS WHEREOF, with intent to be legally bound hereby, the parties have hereunto set their
hands and seals the day and year first above written.
WITNESS:
:249713/3-9
BUYER:
/:f"-~..
EXHIBIT "A"
ALL THAT CERTAIN lot or piece of land with the buildings and improvements thereon erected, situate in East
Pennsboro Township, Cumberland County, Pennsylvania, bounded and described as follows, to wit:
BEGINNING at a point in the easterly line of Susquehanna Avenue at a distance of eight hundred fifty-four and
one hundred eighty-five one-thousandths (854.185) feet measured southwardly along said line of Avenue from
the southwesterly extremity of the arc of a curve, having a radius of ten (10) feet connecting the southerly line
of Dauphin Street with the easterly line of said Susquehanna Avenue and extending thence South 84 degrees
50 minutes 30 seconds East, passing through the middle of the party wall between the house on this lot and
the house on the adjoining lot on the north, one hundred fifty (150) feet; thence South 5 degrees 9 minutes 30
seconds West, 50 feet; thence North 84 degrees 50 minutes 30 seconds West, one hundred forty-nine and
nine hundred eleven one-thousandths (149.911) feet to the easterly line of Susquehanna Avenue, aforesaid,
and thence northwardly along said line of Avenue as follows, viz: First, curving toward the right with a radius of
three hundred (300) feet, a distance of seven and two hundred ninety-five one-thousandths (7.295) feet; and
Second, North 5 degrees 9 minutes 30 seconds East, forty-two and seven hundred five one-thousandths
(42.705) feet to the Place of BEGINNING.
BEING part of Enola as laid out on Plan recorded in the Cumberland County Recorder's Office in Plan Book 1,
Page 51.
UNDER AND SUBJECT, HOWEVER, to the reservations and restrictions therein contained.
IU~I~\ Ii. \)1 IIII
1::lll ".:n:, \\. \! ]\\\1; I
l I~I)\ \X\ 11 :\i'" '!',;
1'\]: 1(, \i'li;"
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OF COUNSEL
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JOHNSON
DUFFIE
\\'ltIT):j!';;; 1':\1' :'\'1' II;)
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June 6, 2005
Register of Wills Office
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
Re: In Re: Mary H. Fama
No. 21-2004-0831
Dear Sir or Madam:
Enclosed herewith for filing, please find an original and two (2) copies of a Petition to
Approve the Sale of Real Estate in regard to the above matter. Please forward the same to Judge
Oler for approval. After the Order has been issued, please return both clocked-in copies to the
undersigned in the envelope provided. Also enclosed is a check in the amount of $15.00 for the cost
of filing.
Thank you for your attention to this matter. If you have any questions, please do not hesitate
to contact me.
Very truly yours,
~NSON, DUFF.
\ ~dW.D
iT" & WEIDNER
DWD:kkm:240226
Enclosure
cc: Pennsylvania Guardianship Association
)01 \r.\J:Jd'"l~lr;J'Tl )ll), I.;()\ Illq IJ\)()\\I.. Pt'},\\\I,\,\\I.\ \i(i~\ \I\\\ll
\r\\\\IIJS\\'(()\J 71;;hl1)li! 1\\;i;7hl,()li \1 \IL\"'/lJS\\((i\1
JOHNSON. DUFFIE, STEWART & WEIDNER, PC
RECEIVED JUN 0 8 .-:Y'
IN RE: MARY H. FAMA
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-2004-0831
~--
(,-)
CIVIL ACTION - LAW
Lf'")
i;IN RE: PETITION TO APPROVE SALE OF REAL ESTATE
lL
0, ,0
-~
DECREE
AND NO~ this ---11..l:L- day of June, 2005, upon consideration of the Petition
of Pennsylvania Guardianship Association, Inc., the court appointed plenary guardian of
the estate of Mary H. Fama a/k/a Mary Helen Fama, the proposed sale of real property
to Steven B. Worley for $88,000.00 according to the May 21, 2005 Agreement for Sale
of Real Estate is hereby authorized and upon receipt of the full purchase price, the court
appointed plenary guardian of the Estate is authorized to make, execute and deliver a
Deed conveying all interest of Mary H. Fama a/k/a Mary Helen Fama to Steven B.
Worley for the premises at 40 Susquehanna Avenue, Enola, East Pennsboro Township,
Cumberland County, Pennsylvania.
The purchase money shall be accounted for by the plenary guardian of the
Estate in the annual accounting filed with this Court.
BY THE COURT:
~tJ
~\
C)\J
(,
J. Wesley Oler, ., J.
lo/, ~ OS
rY\ 1\-\ lJ2:l) coP 'I TO
. ~ j)A1Ilb DI::l1tCJ~-.t..s G..
VII\- LlSPS
Vi:
vi;
Marjorie A Wevodau
First Deputy
One Courthouse Square
Carlisle, Pa 17013
'3iell0a r81Y1er Slr2.sbau~Ji-1
Re9Jste~. of \MiI)s &.
Clerk of the Orphans' Court
(717) 240-6345
FAX (717) 240-7797
Kirk S Sohonage, EsqUire
Solicitor
OFFICES OF
Register of Wins anti <!Clerk of tl)e <!E)rpf)ans' QCourt
([ountp of <Cultlucrlan/)
December 1, 2005
P A Guardianship Assn. Inc.
PO Box 7295
Lancaster P A 17604
TN RE: Estate of Mary H. Fama, an incapacitated person
File No. 21-04-831
Dear Sir/Madam:
It has come to my attention that you have not filed the guardian reports required
by 20 Pa.C.S.A. ~5521(c) in the above captioned guardianship. Enclosed you will find
the suggested fonn(s).
Please mail those repmis, along with a check for the filing fee which is $15 for
eacb report filed, payable to the Clerk of Orphans' Court to the following address within
(30) days:
Clerk of Orphans' Court
One Courthouse Square
Carlisle, PA ] 70] 3
If you have any questions, please contact your attorney.
Respectfully,
Glenda Farner Strasbaugh
Cierk of the Orphans' Comi
cc: Anthony L. Deluca, Esquire
Clerk of Orphans' Court of Cumberland County
IN RE: at()..V-~ H, Fo.-rY1 0....
An Incapacitated Person
Docket No. ') (-0 'I - '6 ~ I
I,
ANNUAL REPORT OF GUARDIAN OF THE PERSON
~ ( i "- ~ 'r,. [<" cro Ie- "; @Jwere appointed
..-
14. r-O-mc....... by Decree of the
/()/~c,IOq . This is my annual report for
to /oh-,/o)
111()-~~
, dated
plenary guardian(s) of the person of
Honorable Judge (3L e y
the penod from lobe, Iot:-(
, ("The Report Period").
1.
Present age of the incapacitated person:
25 ~ Yrs.
2. Current address of the incapacitated person
/J.c b-u-~ ~ ~ ~
a !tJO ~ CnLU~ ~_
~~/Plt 170s7
3. The incapacitated person's residence is:
M (j
own home/apartment
1___ ~
Cc-
G- (ji_c ':=U!Irsing home
, i
,_OJ X3 (boarding home/personal care home
[-i_
[ e-
(j (~;~ardian's home/apartment
()
(j hospital or medical facility
o
relative's home
(Name and relationship)
(j
other:
(describe)
~
The incapacitated person has been in the present residence since :Jet; r
. If
the incapacitated person has moved within the past year, state change and reason(s) for
~
V
change:
5, Name and address of the incapacitated person's primary care giver:
S{'UV4~ ~ ~
r-
~.~~
_~O ~ ~O((>) C~~ I{JJ ) pfJ /7() I /
6. The major medical or mental problems of the incapacitated person are as follows:
~
7.
Specify what, if any, social, medical, psychological and support services the incapacitated
. . .
person IS receIvmg:
8.
~~;YCJ/-llJoJ7~-J ~@)~} ~~
~ J &~ ~ /~ q.-,~4//I-~-
..,.~) Pkr~+~k.J4R/7A~~A~~1 Iy ~.~
It is our opinion as guardian of the person that the guardianship should: ( check one)
~ontinue, 0 be modified, 0 be terminated. (Briefly explain your response)
9. During the past year, I have visited the incapacitated person J (, times with the
average visit lasting
30~~ ,) ~tu./U
(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. S4904 relative to
unsworn falsification to authorities.
/J-/716~
Date
i:!v:- b-/)/4
19nature of Guardian
* FILING FEE $15 MUST ACCOMPANY TillS FILING.
Clerk of Orphans' Court of Cumberland County
IN RE: ~tLV'~ It. FO.- WIG--
An Incapacitated Person
Docket No. 'J... / - () 'I - <l -=? I
.
ANNUAL REPORT OF GUARDIAN OF THE ESTATE
t(i~ t. Brot>l<.s d'
PA Guardianship
P.O. Box 7295
l-anoooor. PA 17604 7296
Jf tJ.-v-~ H. /4,Y1c.-
. Dated 10 /~ /0'-1 . This is my annual
/ 0 /~u, /0 5- , ("The Report Period").
~ere
I,
appointed plenary guardian(s) of the estate of
by Decree of the Honorable Judge oL-er
report for the period from /0 /}.Glp r to
I, SUMMARY
A. Value of principal assets at the beginning of the Report Period?
$ Sl~/39J, 95
5 ~
$) 7/~.~ ~
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
$IO~O!J~. If.3
$ 9>) 71vJJ()
$ 'f) 7cr)'. 70
2. From income
D. Total amount spent for all other purposes during the Report Period?
E. Total amounts remaining at the end of the Report Period?
Total Income and Principal
$ If '19. 5;JO./o
I
$'H-
$ r Lf'1; {;){).jU
1. Principal
.2. LTlcome
II I
('.\ "'Q
\ u ... \'"
t r"
\) \ ,'-
'0--
II. ADDITIONAL INFORMATION
A. Principal:
1. Total amolmt remaining at the end of the Report Period?
$ L/!j~ SJO. /()
2. How is principal currently invested?
Ntu-<J L1~ Silh~JrJTnJ- VOj/>'-~ ,u.fJ/I@rJ
~/{)-~&/- <it000
3. Have there been any expenditures from principal during the Report
Period?
~s 0 No
If you answered YES, was there Court approval for all expenditures
from principal?
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?
OYes~
OYes~
If you answered YES, did you receive Court approval prior to receiving
additional principal?
OYesONo
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,):
~~ 1 ~9-<'H_-'~ b~~05 $ 7;}'1, .@
\ \. , /( ~ r $ 7/ S'. dO
~~tL) O1t ~-fkL:l:o I'lf~ 'i?S.'6c, ~
Total Income received during Report Period $
2, How is income currently invested? (Please specify, restricted bank accounts, client care
account, etc.)
3. Specify what payments were made for the care and maintenance ofthe incapacitated
person (i.e" clothing, nursing home, medicine, support, etc.).
~DQ~
4. Specify what other payments were made during the Report Period,
,-C::;QJ2- a-~ve/
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, 34904 relative to
unsworn falsification to authorities.
PA Guardianship
P,O, Box 7295
lancaster, PA 17604-7295
~D.i4
ature of Guardian
13/5/05'
Date
* FILING FEE $15 MUST ACCOMPANY TIDS FILING.
ITEMIZED CATEGORY REPORT
1/ I' o Through 10/31' 5
PAGA_CUS-PAGA Custodial Page 1
12/ 6' 5
Date Num Description Memo Category Clr Amount
INCOME/EXPENSE ~#Jw~~
INCOME
FAMA,MARY If
2/10' 5 R0185 DEPOSIT BANK TRANSFER FAMA,MARY/BANK X 50,000,00
2/10' 5 R0186 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 65,78
2/10' 5 R0187 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 24,93
3/14' 5 R5898 DEPOSIT PENSION FAMA,MARY/PENSI X 753,68
3/14' 5 R5899 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 16,55
3/14' 5 R5900 DEPOSIT BANK TRANSFER FAMA,MARY/BANK X 50,000,00
4/ 4' 5 R5965 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 15,85
5/ 9' 5 R0650 DEPOSIT INTEREST FAMA,MARY/INTER X 118,95
5/ 9' 5 R0656 DEPOSIT INTEREST FAMA,MARY/INTER X 6.60
6/ I' 5 R0705 DEPOSIT ~ P~G.- B.P-k. BANK TRANSFER FAMA,MARY/BANK X 15,000.00
6/ I' 5 R0708 DEPOSIT INTEREST R FAMA,MARY/INTER X 395,85
6/ 3' 5 R0751 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 27,51
7/ 6' 5 R0419 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 6,41
7/ 6' 5 R0420 DEPOSIT ~01- REAL R~TATE S FAMA,MARY/REAL X 77,528,27
7/ 6' 5 R0421 DEPOSIT INTEREST FAMA,MARY/INTER X 235,30
7/25' 5 R0486 DEPOSIT INTEREST FAMA,MARY/INTER X 200,41
7/25' 5 R0487 DEPOSIT INTEREST FAMA,MARY/INTER X 465,73
7/25' 5 R0488 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 15,14
8/ 8' 5 R0519 DEPOSIT INSURANCE FAMA,MARY/REFUN X 314,00
8/ 8' 5 R0520 DEPOSIT SSDI FAMA,MARY/SSDI X 728,00
8/22' 5 R0568 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 6,29
8/22' 5 R0569 DEPOSIT INTEREST FAMA,MARY/INTER X 530,88
8/22' 5 R0570 DEPOSIT PENSION FAMA,MARY/PENSI X 87,50
8/22' 5 R0571 DEPOSIT INTEREST FAMA,MARY/INTER X 436.80
9/13' 5 R7007 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 10.61
9/13' 5 R7008 DEPOSIT PENSION FAMA,MARY/PENSI X 87,50
9/13' 5 R7009 DEPOSIT INTEREST FAMA,MARY/INTER X 199,23
9/13' 5 R7010 DEPOSIT SSDI FAMA,MARY/SSDI X 728.00
10/ 6' 5 R7078 DEPOSIT PENSION FAMA,MARY/PENSI X 85.86
10/ 6' 5 R7079 DEPOSIT SSDI FAMA,MARY/SSDI X 728,00
10/ 6' 5 R7080 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 36.31
TOTAL FAMA,MARY 198,855,94
TOTAL INCOME 198,855,94
--------~._.----~~~
C 198,855.:-")
QJi ~~ C1 ffl Uu-~~~ &l-J4J
Clu~
TOTAL INCOME/EXPENSE
ITEMIZED CATEGORY REPORT
1/ l' 0 Through 10/31' 5
PAGA_CUS-PAGA Custodial
12/ 6' 5
Date Num Description Memo
10/ 4' 5 7194 METRO MED SERVICES MARY H, FAMA
10/ 4' 5 7195 HIGHMARK BLUE SHIE MARY H, FAMA
10/ 6' 5 R7078 DEPOSIT PENSION
10/ 6' 5 R7079 DEPOSIT SSDI
10/ 6' 5 R7080 DEPOSIT DIVIDEND
10/11' 5 7223 HAMPDEN CLEANERS MARY FAMA
10/11' 5 7224 LINKS 2 CARE MARY H. FAMA
10/11' 5 7245 LANA L. HOOVER, LP MARY HELEN FA
10/11' 5 7248 S PLATINUM PLUS FOR
10/21' 5 7284 ROBC LIMITED PARTN MARY HELEN FA
10/21' 5 7307 LANA L. HOOVER, LP MARY HELEN FA
10/21' 5 7319 LINKS 2 CARE MARY H, FAMA
TOTAL FAMA,MARY
TOTAL INCOME
TOTAL INCOME/EXPENSE
Category
FAMA,MARY/TRANSP X
FAMA,MARY/INSURA X
FAMA,MARY/PENSIO X
FAMA,MARY/SSDI X
FAMA,MARY/DIVIDE X
FAMA,MARY/FINACI X
FAMA,MARY/MEDICA X
FAMA,MARY/PERSON X
FAMA,MARY/FINACI X
FAMA,MARY/COST 0 X
FAMA,MARY/PERSON X
FAMA,MARY/MEDICA X
Page 4
Clr Amount
-58,75
-244.40
85.86
728,00
36.31
-320,90
-1,686,50
-450,00
-689,90
-4,540.32
-360,00
-1,909,50
24,334,81
24,334,81
~ ~~
~~~~!
/O/31(O)~
{luf '&~ CU C1
(l /7 (J .-r-
.&G~
~~
\ I
PAGA_CUS-PAGA Custodial
12/ 6' 5
ITEMIZED CATEGORY REPORT
1/ l' 0 Through 10/31' 5
Date
6/28' 5
7/ 6' 5
7/ 6' 5
7/ 6' 5
7/ 6' 5
7/12' 5
7/13' 5
7/13' 5
7/13' 5
7/21' 5
7/22' 5
7/22' 5
7/25' 5
7/25' 5
7/25' 5
7/27' 5
7/27' 5
7/29' 5
8/ 8' 5
8/ 8' 5
8/ 9' 5
8/ 9' 5
8/18' 5
8/22' 5
8/22' 5
8/22' 5
8/22' 5
8/22' 5
8/22' 5
8/22' 5
8/22' 5
8/22' 5
8/23' 5
8/24' 5
8/26' 5
8/29' 5
9/ 6' 5
9/ 8' 5
9/13' 5
9/13' 5
9/13' 5
9/13' 5
9/13' 5
9/13' 5
9/14' 5
9/19' 5
9/19' 5
9/22' 5
9/27' 5
10/ 4' 5
10/ 4' 5
10/ 4' 5
Num
6620
R0419
R0420
R0421
6649 S
6698
6704
6712
6730
6772 S
6776
6777
R0486
R0487
R0488
6817 S
6829 S
6836 S
R0519
R0520
6880
6911
6949
6976
6978
6980
6983
6984 S
R0568
R0569
R0570
R0571
6992
7001
7014
7021 S
7047
7075
R7007
R7008
R7009
R7010
7098
7100
7110 S
7118
7119
7130
7158
7179
7184
7193
Description
Memo
LANA L, HOOVER, LP
DEPOSIT
DEPOSIT
DEPOSIT
PLATINUM PLUS FOR
HAMPDEN CLEANERS MARY FAMA
HIGHMARK BLUE SHIE MARY H, FAMA
LANA L. HOOVER, LP MARY HELEN FA
HALL SERVICES MARY H, FAMA
PAGA GENERAL ACCOU 5-8/05
ALERT PHARMACY SER MARY FAMA FA
ROBC LIMITED PARTN MARY HELEN FA
DEPOSIT INTEREST
DEPOSIT INTEREST
DEPOSIT DIVIDEND
LANA L. HOOVER, LP
PLATINUM PLUS FOR
PLATINUM PLUS FOR
DEPOSIT INSURANCE
DEPOSIT SSDI
PENNSYLVANIA AMERI SAM FAMA 24-
LANA L, HOOVER, LP MARY HELEN FA
LINKS 2 CARE MARY H, FAMA
ROBC LIMITED PARTN MARY HELEN FA
LINKS 2 CARE MARY H, FAMA
HAMPDEN CLEANERS MARY FAMA
CINDY FENTON / AUC MARY FAMA 40
BRIAN D, BROOKS POSTAGE
DEPOSIT DIVIDEND
DEPOSIT INTEREST
DEPOSIT PENSION
DEPOSIT INTEREST
LANA L. HOOVER, LP MARY HELEN FA
ALERT PHARMACY SER MARY FAMA FA
LINKS 2 CARE MARY H. FAMA
PLATINUM PLUS FOR
LINKS 2 CARE MARY H, FAMA
LANA L, HOOVER, LP MARY HELEN FA
DEPOSIT DIVIDEND
DEPOSIT PENSION
DEPOSIT INTEREST
DEPOSIT SSDI
HAMPDEN CLEANERS MARY FAMA
LINKS 2 CARE MARY H. FAMA
PAGA GENERAL ACCOU 9-10
LINKS 2 CARE MARY H, FAMA
QUANTUM IMAGING & SAM FAMA 055
LANA L. HOOVER, LP MARY HELEN FA
HALL SERVICES MARY H. FAMA
ROBC LIMITED PARTN MARY HELEN FA
LINKS 2 CARE MARY H, FAMA
LINKS 2 CARE MARY H, FAMA
MARY HELEN
DIVIDEND
REAL ESTATE
INTEREST
Category
FA FAMA,MARY/PERSON X
FAMA,MARY/DIVIDE X
S FAMA,MARY/REAL E X
FAMA,MARY/INTERE X
FAMA,MARY/FINACI X
FAMA,MARY/FINACI X
FAMA,MARY/INSURA X
FAMA,MARY/PERSON X
FAMA,MARY/FINACI X
FAMA,MARY/GUARDI X
FAMA,MARY/MEDICA X
FAMA,MARY/COST 0 X
FAMA,MARY/INTERE X
FAMA,MARY/INTERE X
FAMA,MARY/DIVIDE X
FAMA,MARY/PERSON X
FAMA,MARY/FINACI X
FAMA,MARY/FINACI X
FAMA,MARY/REFUND X
FAMA,MARY/SSDI X
FAMA,MARY/UTILIT X
FAMA,MARY/PERSON X
FAMA,MARY/MEDICA X
FAMA,MARY/COST 0 X
FAMA,MARY/MEDICA X
FAMA,MARY/FINACI X
FAMA,MARY/FINACI X
FAMA,MARY/REIMBU X
FAMA,MARY/DIVIDE X
FAMA,MARY/INTERE X
FAMA,MARY/PENSIO X
FAMA,MARY/INTERE X
FAMA,MARY/PERSON X
FAMA,MARY/MEDICA X
FAMA,MARY/MEDICA X
FAMA,MARY/FINACI X
FAMA,MARY/MEDICA X
FAMA,MARY/PERSON X
FAMA,MARY/DIVIDE X
FAMA,MARY/PENSIO X
FAMA,MARY/INTERE X
FAMA,MARY/SSDI X
FAMA,MARY/FINACI X
FAMA,MARY/MEDICA X
FAMA,MARY/GUARDI X
FAMA,MARY/MEDICA X
FAMA,MARY/MEDICA X
FAMA,MARY/PERSON X
FAMA,MARY/FINACI X
FAMA,MARY/COST 0 X
FAMA,MARY/MEDICA X
FAMA,MARY/MEDICA X
Page 3
Clr Amount
-450.00
6.41
77,528.27
235,30
-1,052.36
-287.15
-244,40
-540,00
-4,532,60
-1,000,00
-395,91
-4,494.67
200.41
465,73
15,14
-630,00
-292,54
-312,28
314,00
728,00
-9,65
-450.00
-335,50
-9,074,06
-1,708,00
-278.87
-220,00
-0,60
6,29
530,88
87.50
436.80
-495,00
-853,51
-1,599,00
- 851. 84
-1,705.00
-495,00
10,61
87,50
199,23
728,00
-379,42
-1,647,00
-500,00
-1,874,00
-471,00
-585.00
-3,383,96
-119,54
-1,431,00
-1,522,00
pAGA_CUS-PAGA Custodial
12/ 6' 5
ITEMIZED CATEGORY REPORT
1/ l' 0 Through 10/31' 5
Date
6/28' 4
7/29' 4
9/ 7' 4
9/17' 4
9/23' 4
10/14' 4
10/25' 4
11/ 3' 4
11/ 3' 4
11/ 3' 4
11/24' 4
11/29' 4
11/30' 4
11/30' 4
12/ 8' 4
12/17' 4
12/20' 4
12/20' 4
12/20' 4
12/21' 4
12/23' 4
1/10' 5
1/10' 5
1/10' 5
1/10' 5
1/13' 5
1/13' 5
1/21' 5
1/24' 5
1/28' 5
1/28' 5
2/ 2' 5
2/ 7' 5
2/ 7' 5
2/ 7' 5
2/ 7' 5
2/ 7' 5
2/ 7' 5
2/ 7' 5
2/10' 5
2/10' 5
2/10' 5
2/19' 5
2/24' 5
2/24' 5
2/24' 5
2/24' 5
Num
Description
Category
Memo
INCOME/EXPENSE
INCOME
FAMA, MARY
4756
4922
5087
5210
5220
5266 S
5340
5356
5357
5373
ET
5499
5502
5547
5567
5624
5639
5642
5648
5667
5671
5704
5729
5733
5734
5771
5777
5796
5799 S
5809
5810
5815
5873
5876
5878
5883
5894
5909
5910 S
R0185
R0186
R0187
5946
5979
5982
5994
5996
HIGHMARK BLUE SHIE MARY H.FAMA 1 FAMA,MARY/INSURA X
ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X
ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X
DARLENE HALL FOR M CLOTHING FAMA,MARY/PERSON X
ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X
PLATINUM PLUS FOR FAMA,MARY/PERSON X
DARLENE HALL FOR M FURNITURE / A FAMA,MARY/PERSON X
ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X
ALERT RX SERVICES M.H, FAMA FA FAMA,MARY/MEDICA X
HOLLY SPIRIT HOSPI MARY FAMA FAMA,MARY/MEDICA X
BOSCOV'S MARY ROOM DEC FAMA,MARY/FINACI X
LANA L. HOOVER, LP MARY FAMA / FAMA,MARY/PERSON X
HIGHMARK BLUE SHIE MARY H, FAMA FAMA,MARY/INSURA X
LANA L. HOOVER, LP SAM & MARY FA FAMA,MARY/PERSON X
HOME INSTEAD SENIO MARY FAMA (9 FAMA,MARY/MEDICA X
ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X
SUSQUEHANNA INTERN MARY H. FAMA FAMA,MARY/MEDICA X
LANA L, HOOVER, LP SAM & MARY FA FAMA,MARY/PERSON X
ALICIA D, STINE TR FAMA SAM & MA FAMA,MARY/TAXES X
HALL SERVICES SAM & MARY FA FAMA,MARY/FINACI X
BCF INSURANCE BOND / MARY H FAMA,MARY/BOND X
SUSQUEHANNA INTERN MARY H. FAMA FAMA,MARY/MEDICA X
ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X
ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDICA X
LANA L, HOOVER, LP SAM & MARY FA FAMA,MARY/PERSON X
KAPLAN'S CAREFUL C MARY FAMA FAMA,MARY/FINACI X
CUMBERLAND CO, TAX SAM & MARY FA FAMA,MARY/TAXES X
BRAD WINTERSTEEN C MARY FAMA 40 FAMA,MARY/FINACI X
PAGA GENERAL ACCOU INIITIAL 10/0 FAMA,MARY/GUARDI X
BRAD WINTERSTEEN C MARY FAMA 40 FAMA,MARY/FINACI X
BRAD WINTERSTEEN C MARY FAMA 40 FAMA,MARY/FINACI X
BRAD WINTERSTEEN C MARY FAMA 40 FAMA,MARY/FINACI X
LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X
CINDY FENTON / AUC MARY FAMA 40 FAMA,MARY/FINACI X
ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDICA X
WASTE MANAGEMENT 611-0125906-0 FAMA,MARY/FINACI X
LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X
HIGHMARK BLUE SHIE MARY H, FAMA FAMA,MARY/INSURA X
BRIAN D, BROOKS POSTAGE FAMA,MARY/REIMBU X
DEPOSIT BANK TRANSFER FAMA,MARY/BANK T X
DEPOSIT DIVIDEND FAMA,MARY/DIVIDE X
DEPOSIT DIVIDEND FAMA,MARY/DIVIDE X
BRAD WINTERSTEEN C MARY FAMA 40 FAMA,MARY/FINACI X
ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X
LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X
HIGHMARK BLUE SHIE MARY H, FAMA FAMA,MARY/INSURA X
ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDICA X
a1J~~~
Page 1
Clr Amount
-480,12
-6,812,00
-2,410,00
-1,000.00
-2,410,00
-1,273,66
-5,000.00
-2,454,50
-78,56
-86.69
-82,66
-225,00
-250.91
-730,00
-60.60
-4,939,96
-10.10
-720.00
-264.05
-4,125,60
-1,610,00
-9.87
-10,566.41
-108,68
-720,00
-19,35
-1,085,03
-1,375.00
-1,750,00
-110.00
-100,001-1,300,00
-562,50
-1,420.00
-38,20
-96,49
-450,00
-244,40
-0,83
50,000.00
65,78
24,93
-1,600,00
-3,948,50
-472,50
-244.40
-38,20
PAGA_CUS-PAGA Custodial
12/ 6' 5
ITEMIZED CATEGORY REPORT
1/ l' 0 Through 10/31' 5
Date
2/24' 5
3/ 2' 5
3/14' 5
3/14' 5
3/14' 5
3/14' 5
3/14' 5
3/14' 5
3/14' 5
3/16' 5
3/16' 5
3/16' 5
3/16' 5
3/22' 5
3/22' 5
3/22' 5
3/30' 5
3/30' 5
3/30' 5
3/30' 5
4/ l' 5
4/ l' 5
4/ 2' 5
4/ 2' 5
4/ 4' 5
4/ 8' 5
4/ 8' 5
4/ 8' 5
4/18' 5
5/ 2' 5
5/ 2' 5
5/ 2' 5
5/ 5' 5
5/ 9' 5
5/ 9' 5
5/17' 5
5/17' 5
5/17' 5
5/17' 5
5/18' 5
5/23' 5
5/23' 5
5/31' 5
6/ l' 5
6/ l' 5
6/ 3' 5
6/13' 5
6/14' 5
6/14' 5
6/14' 5
6/14' 5
6/14' 5
Num
5999 S
ET
6020
6021
6024
6056
R5898
R5899
R5900
6077
6086
6097
6098
6108
6114
6119
6130 S
6131
6132
6142
6147
6158 S
6161
6162 S
R5965
6189
6200
6202
6262
6277 S
6287
6288 S
6306 S
R0650
R0656
6376
6379
6387
6391
6396 S
6408
6409
6442 S
R0705
R0708
R0751
6463
6472
6474
6534
6539
6546
PLATINUM PLUS FOR
SAM FAMA TRANSFER TO C
CAPITAL FLOORING M.FAMA 40 SU
DARLENE HALL FOR M TABLE / TV /
PENN CREDIT CORPOR MARY FAMA
UGI MARY H. FAMA
DEPOSIT PENSION
DEPOSIT DIVIDEND
DEPOSIT BANK TRANSFER
GUISTWITE FAMILY P SAM FAMA 346
LANA L, HOOVER, LP MARY HELEN FA
NEW ENGLAND FINANC MARY H. FAMA
RICHARDSON FUNERAL SAM J, FAMA
ROBC LIMITED PARTN MARY HELEN FA
LEHIGH VALLEY PHYS MARY FAMA RP
LANA L, HOOVER, LP MARY HELEN FA
BRIAN D. BROOKS POSTAGE
CAPITAL FLOORING M,FAMA 40 SU
ALICIA D, STINE TR MARY FAMA 40
ALERT PHARMACY SER MARY FAMA FA
UGI MARY H, FAMA
PAGA GENERAL ACCOU 3-4
CINDY FAMA SAM & MARY FA
PLATINUM PLUS FOR
DEPOSIT
LANA L. HOOVER, LP
UGI
BRAD WINTERSTEEN C
LANA L, HOOVER, LP
HALL SERVICES
LANA L, HOOVER, LP
CLERK OF THE ORPHA
PLATINUM PLUS FOR
DEPOSIT
DEPOSIT
ROBC LIMITED PARTN
UGI
LANA L. HOOVER, LP
HIGHMARK BLUE SHIE
HALL SERVICES
PENNSYLVANIA AMERI
ROBC LIMITED PARTN
PLATINUM PLUS FOR
DEPOSIT
DEPOSIT
DEPOSIT
FOREMOST
HAMPDEN CLEANERS
LANA L, HOOVER, LP
LANA L, HOOVER, LP
UGI
ALERT PHARMACY SER
Description
Memo
DIVIDEND
MARY HELEN FA
MARY H, FAMA
MARY FAMA 40
MARY HELEN FA
138 HRS / 662
MARY HELEN FA
INTEREST
INTEREST
MARY HELEN FA
MARY H. FAMA
MARY HELEN FA
MARY H, FAMA
PETTY CASH RE
SAM FAMA 24-
MARY HELEN FA
BANK TRANSFER
INTEREST R
DIVIDEND
40 SUSQUEHANN
MARY FAMA
MARY HELEN FA
MARY HELEN FA
MARY H. FAMA
MARY FAMA FA
Category
FAMA,MARY/PERSON X
FAMA,MARY/BANK T X
FAMA,MARY/FINACI X
FAMA,MARY/PERSON X
FAMA,MARY/FINACI X
FAMA,MARY/UTILIT X
FAMA,MARY/PENSIO X
FAMA,MARY/DIVIDE X
FAMA,MARY/BANK T X
FAMA,MARY/MEDICA X
FAMA,MARY/PERSON X
FAMA,MARY/INSURA X
FAMA,MARY/FUNERA X
FAMA,MARY/COST 0 X
FAMA,MARY/MEDICA X
FAMA,MARY/PERSON X
FAMA,MARY/REIMBU X
FAMA,MARY/FINACI X
FAMA,MARY/TAXES X
FAMA,MARY/MEDICA X
FAMA,MARY/UTILIT X
FAMA,MARY/GUARDI X
FAMA,MARY/REIMBU X
FAMA,MARY/FINACI X
FAMA,MARY/DIVIDE X
FAMA,MARY/PERSON X
FAMA,MARY/UTILIT X
FAMA,MARY/FINACI X
FAMA,MARY/PERSON X
FAMA,MARY/FINACI X
FAMA,MARY/PERSON X
FAMA,MARY/COURT X
FAMA,MARY/FINACI X
FAMA,MARY/INTERE X
FAMA,MARY/INTERE X
FAMA,MARY/COST 0 X
FAMA,MARY/UTILIT X
FAMA,MARY/PERSON X
FAMA,MARY/INSURA X
FAMA,MARY/FINACI X
FAMA,MARY/UTILIT X
FAMA,MARY/COST 0 X
FAMA,MARY/FINACI X
FAMA,MARY/BANK T X
FAMA,MARY/INTERE X
FAMA,MARY/DIVIDE X
FAMA,MARY/INSURA X
FAMA,MARY/FINACI X
FAMA,MARY/PERSON X
FAMA,MARY/PERSON X
FAMA,MARY/UTILIT X
FAMA,MARY/MEDICA X
- (jjj~~-Jj
Page 2
Clr Amount
-2,229,36
-18,571.70
-1,000,00
-2,000.00
-28,50
-190.77
753,68
16,55
50,000.00
-56,97
-450,00
-14,69
-1,082.70
-4,450,00
-1,218,18
-450,00
-1. 63
-855,15
-4,90
-38.20
-164.56
-500.00
-1,000,00
-543.49
15.85
-450,00
-95,00
-225,00
-450,00
-3,661. 84
-450,00
-30,00
-765.34
118.95
6,60
-4,425.61
-108,33
-720,00
-244.40
-110.47
-31. 43
-8,899,15
-1,231,78
15,000,00
395,85
27.51
-380,00
-79,60
-540,00
-787,50
-5,96
-213,02
Interest Chec~ D {, Acco~n'lt Statement
PNC Bank
-
~'."".-r'
-:~< ~~
For the P\':: 10/22l::~Y"21/2005
SAM J FAMA
MARY HElEN FAMA
C/O PAGA
PO BOX 7295
LANCASTER PA 17604-7295
Interest Checking Account .......ry
Account number: 50-0377-5509
....nce
Inter_t Sumnaary
Beginning
balance
6,093..30
)
Checks and other
deductions
2.00
Deposits and
other additions
.52
Average monthly
balance
6,093.25
Annual Percentage
Yield Earned (APYE)
0.107.
Number of days
In Interest period
:n
Average collected
balance for APYE
6,093.25
activity Detail
Dep.... and 011I. AddiIh.n.
Date Amount Description
11/21 .52 Interest Payment
011I. DecIaction.
Date Amount Description
1l/21___,__._,~Q9 C:w~('UedQ1eck BetumF'e~
Daily Balance Detail
Date Balance
10/22 6,093,30
Date
11/21
Balance
6,091.82
p'
Ending
balance
6,091.82
Charges
and fees
2.00
Interest Earned
this period
,52
~
o PNCBANl<
Primary account number: 50-0377-5509
Page 1 ot 1
Number ot enclosures: 0
Q For 24-hour banking, and transaction or
interest rate information, sign-on to
11" Account lin~ by Web on pncbank.com.
For customer service call1-888-PNC-BANK
between the hours ot 6 AM and Midnight ET.
Para servicio en espat'iol, 1-866-HOLA-PNC
Motring? Please contact us at 1-888-PNC-BANK
I:i!5I Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
a. Visit us at pncbank.com
I)
TOO terminal: 1-800-531-1648
For hearing impaired clients only
Sam J Fama
Mary Helen Fama
Please see the Activity Detail section for
additional information,
As of 11/21, a total of $18.73 in interest was
earned this year.
There was 1 Deposit or Other Addition
totaling $.52.
There was 1 Other Deduction totaling
$2.00.
FORM953R,0405
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PAGA_CUS-PAGA Custodial
12/ 6' 5
CASH FLOW REPORT
1/ l' 0 Through 10/31' 5
Category Description
Page 1
INFLOWS
FAMA,MARY
24,334.81
TOTAL INFLOWS
24,334,81
f~
pAGA_CUS-PAGA Custodial
12/ 6' 5
ITEMIZED CATEGORY REPORT
1/ l' 0 Through 10/31' 5
Page 1
Date
Num
Description
Memo
Category
Clr Amount
INCOME/EXPENSE
INCOME
FAMA,MARY
11/ 3' 4 5357 ALERT RX SERVICES M,H. FAMA FA FAMA,MARY/MEDICA X -78.56
11/ 3' 4 5373 HOLLY SPIRIT HOSPI MARY FAMA FAMA,MARY/MEDICA X -86,69
12/ 8' 4 5567 HOME INSTEAD SENIO MARY FAMA (9 FAMA,MARY/MEDICA X -60,60
12/20' 4 5639 SUSQUEHANNA INTERN MARY H. FAMA FAMA,MARY/MEDICA X -10,10
1/10' 5 5704 SUSQUEHANNA INTERN MARY H, FAMA FAMA,MARY/MEDICA X -9.87
1/10' 5 5733 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDICA X -108,68
2/ 7' 5 5878 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDICA X -38,20
2/24' 5 5996 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDICA X -38,20
3/16' 5 6077 GUISTWITE FAMILY P SAM FAMA 346 FAMA,MARY/MEDICA X -56,97
3/22' 5 6114 LEHIGH VALLEY PHYS MARY FAMA RP FAMA,MARY/MEDICA X -1,218.18
3/30' 5 6142 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDICA X -38.20
6/14' 5 6546 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDICA X -213,02
7/22' 5 6776 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDICA X -395,91
8/18' 5 6949 LINKS 2 CARE MARY H, FAMA FAMA,MARY/MEDICA X -335,50
8/22' 5 6978 LINKS 2 CARE MARY H, FAMA FAMA,MARY/MEDICA X -1,708.00
8/24' 5 7001 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDICA X -853.51
8/26' 5 7014 LINKS 2 CARE MARY H, FAMA FAMA,MARY/MEDICA X -1,599,00
9/ 6' 5 7047 LINKS 2 CARE MARY H, FAMA FAMA,MARY/MEDICA X -1,705,00
9/13' 5 7100 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDICA X -1,647,00
9/19' 5 7118 LINKS 2 CARE MARY H, FAMA FAMA,MARY/MEDICA X -1,874,00
9/19' 5 7119 QUANTUM I MAG ING & SAM FAMA 055 FAMA,MARY/MEDICA X -471. 00
10/ 4' 5 7184 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDICA X -1,431.00
10/ 4' 5 7193 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDICA X -1,522,00
10/11' 5 7224 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDICA X -1,686.50
10/21' 5 7319 LINKS 2 CARE MARY H, FAMA FAMA,MARY/MEDICA X -1,909,50
TOTAL FAMA,MARY -19,095.19
TOTAL INCOME -19,095.19
TOTAL INCOME/EXPENSE -19,095,19
ITEMIZED CATEGORY REPORT
1/ l' o Through 10/31' 5
PAGA_CUS-PAGA Custodial Page 1
12/ 6' 5
Date Num Description Memo Category Clr Amount
INCOME/EXPENSE
INCOME
FAMA,MARY
9/17' 4 5210 DARLENE HALL FOR M CLOTHING FAMA,MARY/PERSON X -1,000.00
10/14' 4 5266 S PLATINUM PLUS FOR FAMA,MARY/PERSON X -1,273,66
10/25' 4 5340 DARLENE HALL FOR M FURNITURE / A FAMA,MARY/PERSON X -5,000,00
11/29' 4 5499 LANA L. HOOVER, LP MARY FAMA / FAMA,MARY/PERSON X -225,00
11/30' 4 5547 LANA L. HOOVER, LP SAM & MARY FA FAMA,MARY/PERSON X -730,00
12/20' 4 5642 LANA L, HOOVER, LP SAM & MARY FA FAMA,MARY/PERSON X -720,00
1/10' 5 5734 LANA L, HOOVER, LP SAM & MARY FA FAMA,MARY/PERSON X -720.00
2/ 7' 5 5873 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -562,50
2/ 7' 5 5894 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -450,00
2/24' 5 5982 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -472,50
2/24' 5 5999 S PLATINUM PLUS FOR FAMA,MARY/PERSON X -2,229.36
3/14' 5 6021 DARLENE HALL FOR M TABLE / TV / FAMA,MARY/PERSON X -2,000,00
3/16' 5 6086 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -450.00
3/22' 5 6119 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -450.00
4/ 8' 5 6189 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -450,00
4/18' 5 6262 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -450,00
5/ 2' 5 6287 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -450.00
5/17' 5 6387 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -720,00
6/14' 5 6474 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -540.00
6/14' 5 6534 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -787,50
6/28' 5 6620 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -450,00
7/13' 5 6712 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -540.00
7/27' 5 6817 S LANA L, HOOVER, LP FAMA,MARY/PERSON X -630.00
8/ 9' 5 6911 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -450,00
8/23' 5 6992 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -495.00
9/ 8' 5 7075 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -495,00
9/22' 5 7130 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -585,00
10/11' 5 7245 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -450,00
10/21' 5 7307 LANA L, HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X -360,00
TOTAL FAMA,MARY -24,135,52
TOTAL INCOME -24,135.52
TOTAL INCOME/EXPENSE -24,135.52
f
~
ITEMIZED CATEGORY REPORT
1/ l' o Through 10/31' 5
PAGA_CUS-PAGA Custodial Page 1
12/ 6' 5
Date Num Description Memo Category Clr Amount
INCOME/EXPENSE
INCOME
FAMA,MARY
7/29' 4 4922 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -6,812,00
9/ 7' 4 5087 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -2,410.00
9/23' 4 5220 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -2,410,00
11/ 3' 4 5356 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -2,454,50
12/17' 4 5624 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -4,939.96
1/10' 5 5729 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -10,566.41
2/24' 5 5979 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -3,948.50
3/22' 5 6108 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -4,450,00
5/17' 5 6376 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -4,425,61
5/23' 5 6409 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -8,899,15
7/22' 5 6777 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -4,494,67
8/22' 5 6976 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -9,074.06
10/ 4' 5 7179 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -119.54
10/21' 5 7284 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST 0 X -4,540,32
TOTAL FAMA,MARY -69,544,72
TOTAL INCOME -69,544,72
TOTAL INCOME/EXPENSE -69,544,72
.
PAGA_CUS-PAGA Custodial
12/ 6' 5
Date
ITEMIZED CATEGORY REPORT
1/ l' 0 Through 10/31' 5
Num
Description
Memo
INCOME/EXPENSE
INCOME
FAMA,MARY
1/24'
4/ l'
7/21'
9/14'
5 5799 S PAGA GENERAL ACCOU INIITIAL 10/0
5 6158 S PAGA GENERAL ACCOU 3-4
5 6772 S PAGA GENERAL ACCOU 5-8/05
5 7110 S PAGA GENERAL ACCOU 9-10
TOTAL FAMA,MARY
TOTAL INCOME
TOTAL INCOME/EXPENSE
------
y~
Category
FAMA,MARY/GUARDIA X
FAMA,MARY/GUARDIA X
FAMA,MARY/GUARDIA X
FAMA,MARY/GUARDIA X
Page 1
Clr Amount
-1,750,00
-500,00
-1,000,00
-500.00
-3,750,00
-3,750,00
-3,750,00
ITEMIZED CATEGORY REPORT
10/ l' 4 Through 10/31' 5
PAGA_CUS - PAGA Custodial Page 1
12/ 6' 5
Date Num Description Memo Category Clr Amount
INCOME/EXPENSE
INCOME
FAMA, MARY
11/24' 4 ET BOSCOV'S MARY ROOM DEC FAMA,MARY/FINACI X -82,66
12/21' 4 5667 HALL SERVICES SAM & MARY FA FAMA,MARY/FINACI X -4,125,60
1/13' 5 5771 KAPLAN'S CAREFUL C MARY FAMA FAMA,MARY/FINACI X -19,35
1/21' 5 5796 BRAD WINTERSTEEN C MARY FAMA 40 FAMA,MARY/FINACI X -1,375.00
1/28' 5 5809 BRAD WINTERSTEEN C MARY FAMA 40 FAMA,MARY/FINACI X -110,00
1/28' 5 5810 BRAD WINTERSTEEN C MARY FAMA 40 FAMA,MARY/FINACI X -100,00
2/ 2' 5 5815 BRAD WINTERSTEEN C MARY FAMA 40 FAMA,MARY/FINACI X -1,300,00
2/ 7' 5 5876 CINDY FENTON / AUC MARY FAMA 40 FAMA,MARY/FINACI X -1,420,00
2/ 7' 5 5883 WASTE MANAGEMENT 611-0125906-0 FAMA,MARY/FINACI X -96.49
2/19' 5 5946 BRAD WINTERSTEEN C MARY FAMA 40 FAMA,MARY/FINACI X -1,600.00
3/14' 5 6020 CAPITAL FLOORING M.FAMA 40 SU FAMA,MARY/FINACI X -1,000,00
3/14' 5 6024 PENN CREDIT CORPOR MARY FAMA FAMA,MARY/FINACI X -28,50
3/30' 5 6131 CAPITAL FLOORING M,FAMA 40 SU FAMA,MARY/FINACI X -855,15
4/ 2' 5 6162 S PLATINUM PLUS FOR FAMA,MARY/FINACI X -543,49
4/ 8' 5 6202 BRAD WINTERSTEEN C MARY FAMA 40 FAMA,MARY/FINACI X -225.00
5/ 2' 5 6277 S HALL SERVICES 138 HRS / 662 FAMA,MARY/FINACI X -3,661.84
. 5/ 5' 5 6306 S PLATINUM PLUS FOR FAMA,MARY/FINACI X -765.34
5/18' 5 6396 S HALL SERVICES PETTY CASH RE FAMA,MARY/FINACI X -110,47
5/31' 5 6442 S PLATINUM PLUS FOR FAMA,MARY/FINACI X -1,231,78
6/14' 5 6472 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINACI X -79.60
7/ 6' 5 6649 S PLATINUM PLUS FOR FAMA,MARY/FINACI X -1,052,36
7/12' 5 6698 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINACI X -287,15
7/13' 5 6730 HALL SERVICES MARY H. FAMA FAMA,MARY/FINACI X -4,532,60
7/27' 5 6829 S PLATINUM PLUS FOR FAMA,MARY/FINACI X -292.54
7/29' 5 6836 S PLATINUM PLUS FOR FAMA,MARY/FINACI X -312,28
8/22' 5 6980 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINACI X -278,87
8/22' 5 6983 CINDY FENTON / AUC MARY FAMA 40 FAMA,MARY/FINACI X -220.00
8/29' 5 7021 S PLATINUM PLUS FOR FAMA,MARY/FINACI X -851.84
9/13' 5 7098 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINACI X -379.42
9/27' 5 7158 HALL SERVICES MARY H. FAMA FAMA,MARY/FINACI X -3,383,96
10/ 4' 5 7194 METRO MED SERVICES MARY H. FAMA FAMA,MARY/FINACI X -58,75
10/11' 5 7223 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINACI X -320.90
10/11' 5 7248 S PLATINUM PLUS FOR FAMA,MARY/FINACI X -689,90
TOTAL FAMA,MARY -31,390,84
TOTAL INCOME -31,390.84
TOTAL INCOME/EXPENSE -31,390,84
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND CO., PENNSYL VANIA
ORPHANS' COURT DIVISION
INRE: FAMA,MARY
, an incapacitated person
FILE NO 21-2004-0831
GUARDIAN OF PERSON ANNUAL REPORT
[20 Pa. C.S.A. 5521 (c)]
FROM 10/26/06
TO
10/26/06
1.1 am the Limited X Plenary Guardian of the Person of my ward, named
- --
above.
2. I was appointed Guardian by Order of the Court dated
was X was not modified by Court Order(s) dated
()
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10/26/04, which~ C)
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3. Is the incapacitated person still living?
If no, answer the following:
YES
~-~
(a) Date of Death?
(b) Place of Death?
(c) Name of Administrator or Executor?
(d) Date Guardian of the Person filed the last Annual Report?
4. If the incapacitated person is still living, answer the following questions:
(a) Date Guardian of the Person filed the last Annual Report? 10/26/05
(b) Current address of the incapacitated person
THE BRIDGES OF BENT CREEK, 2100 BENT CREEK BLVD.
MECHANICHSGURG, P A 17057
(c) Current age _87_Date of birth of incapacitated person 10/19/19
(d) The incapacitated person's residence is:
Ward's own residence
Nursing Home
Hospital or Medical Facility
_My home/apartment
_Relative's Home
_X Personal Care
( e) The incapacitated person has been living there since 2004
If moved within the past year, state from where and the reason for the change
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(t) I rated hislber living arrangement as:
_X_ Excellent Average
Explain:
Below Average
(g) I believe he/she is:
_X _content with the living situation
unhappy with the living situation
unaware of the living situation
5. Physical health
(a) Current physical condition ofthe incapacitated person is:
Excellent Good Fair Poor X
(b) Hislber major physical health problems are as follows:
AMBULATION PROBLEMS, HX HIP FRACTURES Xl, RECURRING UTI
(c)During the past year, hislber physical condition has:
remained about the same.
improved. Explain
_X _worsened. Explain
(d) During the past year, he/she received the following medical treatment
(include check-ups and dental work):
Date
MONTHL Y
PERIODIC
4/3/06
4/06
6/14/06
9/06
Ailment Type of treatment Doctor's name
ONGOING CARE AT FACILITY DR. E. BINDER
PODIATRY DPM E. ROSBOSCHIL
HIPFRACTURE SURGERY DR. W. POLACHECK
HIP FRACTURE AFTER CARE HOLLY SPIRIT HOSP.
DECLINE HOSP. CARE HOLLY SPIRIT HOSP.
HIPFRACTURE SURGERY DR. W. POLACHECK
6. Mental Health
(a) The incapacitated person's condition is
Excellent Good _X _Poor
(b) Hislber major mental health problems are as follows:
DEMENTIA
(c) During the past year, hislher mental condition has:
X remained about the same.
Improved. Explain
Worsened. Explain
(d) During the past year, treatment or evaluation by a psychiatrist,
psychologist or social worker was _X_ was not provided. Such
mental health services are briefly described as:
7. Social Activities / Services
(a) Hislher current social condition is:
excellent good _X_fair poor
(b) During the past year, hislher social condition has:
X remained about the same.
improved. Explain.
worsened Explain
(c) During the past year he/she has participated in the following activities:
X recreational
- -
educational
X social
occupational
no activities available
he/she refuses to participate in any activities
8. Visitation
(a) During the last year, I visited him/her as follows
BI-WEEKL Y OR AS NEEDED
(b) The average amount of time I spent on each visit was
30 MINUTES - SEVERAL HOURS
(c) The last time I visited was on 10/23/06 Date
9. During the last year I have performed the following activities on behalf the
incapacitated person:
ALL MEDICAL AND FINANCIAL DECISIONS
10. I believe he/she has the following unmet needs:_ NONE
11. The guardianship _X_ Should
modification because:
should not be continued without
12. Please note any concerns about the Incapacitated person's physical or mental
well being or the finances that the Court should know.
13. I _X_ am am not guardian of the incapacitated person's estate. If yes,
my report is attached.
I certify under the penalties of perjury that the information contained in this report
is true and correct to the best of my knowledge, information and belief.
Date:
IO&7/trtf
.
&~&~
19nature of the Guardian of the Person
Name: BRIAN D. BROOKS
TELE#:
717-299-4568
PENNSYL VANIA GUARDIANSHIP ASSOC. INC.
PO BOX 7295
LANCASTER, PA 17604
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DMSION
IN RE: F AMA, MARY H. , an incapacitated person
FILE NO. 21-2004-0831
GUARDIAN OF THE ESTATE ANNUAL REPORT
[20 Pa.C.S.A.5521 (c)]
FROM
10/26/05
TO
10/26/06
1) I am the _ Limited _X_Plenary Guardian of the Estate of my ward, named above.
I was appointed Guardian by Order of the Court dated _10/26/04
_was _X_ was not modified by Court Order (s) dated
, which
2) Is the incapacitated person still living?
YES
If no, answer the following:
(a) Date of Death
(b) Place of Death
(c) Name of Adminstrator/trix or Executor/trix
(d) Date Guardian of the Person filed the last Annual Report
PLEASE ANSWER THE FOLLOWING QUESTIONS WHETHER THE
INCAPACITATED PERSON IS LIVING OR DECEASED.
3) My initial Inventory was filed on _12/27/04_ and listed a total estate value of.
$ 516,393.95
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The Inventory listed a total monthly income of$_718.00_comprised ofthe following:
SOCIAL SECURITY
4) At the beginning date of this report period, my initial balance on hand was
$ 449,520.10
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5) During this reporting period, the following reflects all sources of income (other than
Social security) received by me for my ward: (Add additional pages of needed)
Date Received
Source of Income
Amount
1. SEE ATTACHED ALL DEPOSIT REPORT
2.
3.
4.
5.
6.
TOTAL
6) During this reporting period, the following reflects all payments I have made for my
ward: (Add additional pages if needed)
Date
To Whom Paid
Reason for Payment Amount
1. SEE ALL TRANSACTION REPORT
2.
3.
4.
5.
6.
TOTAL
..-
(7) The present principal assets of my ward are:
Description of Asset
Present Value
1.
PAGA CUSTODIAL ACCOUNT
11,881.13
2.
PERSHING SECURITIES CO.
267,122.16
3.
4.
5.
6.
TOTAL
$ 279,003.29
8) The present amount and sources of income for my ward are:
Source of Income
Amount of Income
(Indicate whether (monthly),
Quarterly, annually)
1.
SOCIAL SECURITY
739.00
2.
PENSION
85.86
3.
4.
5.
6.
9) The regular monthly expenses of my ward which I pay are:
To Whom Paid
Amount
1. SEE ATTACHED ALL TRANSACTION REPORT
2.
PA GUARDIANSHIP FEE
250.00
3.
ROBC LP, THE BRIDGES PERSONAL CARE
4,000.00 APPROX..
4.
(10) I have/ (have not) (circle one) petitioned the Court for permission to invade principal
to meet the needs of my ward.
(If applicable) The following expenses of my ward have been paid from principal:
To Whom Paid
Purpose
Amount
1.
2.
3.
4.
5.
6.
11) I (have) /have not (circle one) paid myself compensation for services I rendered as
guardian.
The amount I Paid myselftotaled $ 2,750.00
Calculated at the following rate: $ 250.00
and was
per week/(month) (circle one).
12) Check the correct response and complete, if appropriate.
_x _There will be no need for extraordinary expenditures on behalf of my ward in
the next (12) months.
There will be a need for extraordinary expenditures on behalf of my ward in
the next (12) months because:
13) Check the correct response and complete, if appropriate.
A. My ward receives monthly social security benefits directly.
_x _B. I am the designated payee to receive my ward's social security benefits.
C. The designated payee of my ward's social security benefits is
".
14) Please note any concerns about the incapacitated person's physical or mental well
being or the finances that the Court should know.
15) I_X_ am _ am not guardian of the incapacitated person's person. If yes,
report is attached.
I certify under the penalties of perjury that the information contained in this report is
true and correct to the best of my knowledge, information and belief.
,. /..- r:/}
J V--- -
IGATURE
DATE 1t7b-"7~h
Name: BRIAN D. BROOKS
Telephone No. 717-299-4568
PENNSYLVANIA GUARDIANSHIP ASSOe. INe.
PO BOX 7295
LANCASTER, PA 17604
CASH FLOW REPORT
1/ l' 0 Through 10/31' 5
~GA_CUS-PAGA Custodial
}/27' 6
Page 1
Category Description
1/ l' 0-
10/31' 5
INFLOWS
FAMA, MARY
TOTAL INFLOWS
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10/3//':; S~
/
PAGA_CUS-PAGA CUstodial
10/27' 6
ITEMIZED CATEGORY REPORT
11/ l' 5 Through 10/31' 6
Date Num Description
INCOME/EXPENSE
INCOME
FAMA, MARY
11/17' 5 R9202 DEPOSIT
11/17' 5 R9203 DEPOSIT
11/21' 5 R9213 DEPOSIT
11/21' 5 R9214 DEPOSIT
11/21' 5 R9215 DEPOSIT
11/21' 5 R9232 DEPOSIT
12/ 8' 5 R9269 DEPOSIT
12/ 8' 5 R9270 DEPOSIT
12/ 8' 5 R9271 DEPOSIT
1/ 6' 6 R9345 DEPOSIT
1/ 6' 6 R9346 DEPOSIT
1/ 6' 6 R9347 DEPOSIT
1/ 6' 6 R9348 DEPOSIT
2/ 7' 6 R7729 DEPOSIT
2/ 7' 6 R7730 DEPOSIT
2/ 7' 6 R7731 DEPOSIT
3/ 8' 6 R7622 DEPOSIT
3/ 8' 6 R7623 DEPOSIT
3/ 8' 6 R7624 DEPOSIT
3/ 8' 6 R7625 DEPOSIT
4/10' 6 R8015 DEPOSIT
4/10' 6 R8016 DEPOSIT
4/10' 6 R8017 DEPOSIT
5/10' 6 R8115 DEPOSIT
5/10' 6 R8116 DEPOSIT
5/10' 6 R8117 DEPOSIT
5/10' 6 R8118 DEPOSIT
6/ 8' 6 R8205 DEPOSIT
6/ 8' 6 R8206 DEPOSIT
6/ 8' 6 R8207 DEPOSIT
7/ 6' 6 R7515 DEPOSIT
7/ 6' 6 R7516 DEPOSIT
7/ 6' 6 R7517 DEPOSIT
8/ 9' 6 R7577 DEPOSIT
8/ 9' 6 R7578 DEPOSIT
8/ 9' 6 R7579 DEPOSIT
8/ 9' 6 R7580 DEPOSIT
9/ 8' 6 R7465 DEPOSIT
9/ 8' 6 R7466 DEPOSIT
9/ 81 6 R7467 DEPOSIT
10/11' 6 R9669 DEPOSIT
10/11' 6 R9670 DEPOSIT
10/11' 6 R9671 DEPOSIT
10/20' 6 R9743 DEPOSIT
TOTAL FAMA,MARY
Memo
AUCTION
AUCTION
SSDI
REFUND
PENSION
PENSION
DIVIDEND
PENSION
SSDI
PENSION
SSDI
DIVIDEND
DIVIDEND
SSDI
PENSION
DIVIDEND
BANK ACCT CLO
PENSION
DIVIDEND
SSDI
SSDI
PENSION
DIVIDEND
DIVIDEND
PENSION
SSDI
BANK TRANSFER
PENSION
DIVIDEND
SSDI
SSDI
PENSION
DIVIDEND
PENSION
INSURANCE
DIVIDEND
SSDI
SSDI
DIVIDEND
PENSION
PENSION
SSDI
DIVIDEND
BANK TRANSFER
Category
FAMA,MARY/SALE X
FAMA,MARY/SALE X
FAMA,MARY/SSDI X
FAMA,MARY/REFUN X
FAMA,MARY/PENSI X
FAMA,MARY/PENSI X
FAMA,MARY/DIVID X
FAMA,MARY/PENSI X
FAMA,MARY/SSDI X
FAMA,MARY/PENSI X
FAMA,MARY/SSDI X
FAMA,MARY/DIVID X
FAMA,MARY/DIVID X
FAMA,MARY/SSDI X
FAMA,MARY/PENSI X
FAMA,MARY/DIVID X
FAMA,MARY/CLOSE X
FAMA,MARY/PENSI X
FAMA,MARY/DIVID X
FAMA,MARY/SSDI X
FAMA,MARY/SSDI X
FAMA,MARY/PENSI X
FAMA,MARY/DIVID X
FAMA,MARY/DIVID X
FAMA,MARY/PENSI X
FAMA,MARY/SSDI X
FAMA,MARY/BANK X
FAMA,MARY/PENSI X
FAMA,MARY/DIVID X
FAMA,MARY/SSDI X
FAMA,MARY/SSDI X
FAMA,MARY/PENSI X
FAMA,MARY/DIVID X
FAMA,MARY/PENSI X
FAMA,MARY/INSUR X
FAMA,MARY/DIVID X
FAMA,MARY/SSDI X
FAMA,MARY/SSDI X
FAMA,MARY/DIVID X
FAMA,MARY/PENSI X
FAMA,MARY/PENSI
FAMA,MARY/SSDI
FAMA,MARY/DIVID
FAMA, MARY/BANK
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Page 1
Clr Amount
227.00
162.50
728.00
17.60
5.95
85.86
18.71
85.86
728.00
85.86
750.00
9.51
29.64
750,00
85,86
34.99
6,087.27
85.86
9.07
750.00
750.00
85.86
11.14
37.86
85.86
750.00
100,000.00
85.86
4.87
750.00
729.80
85.86
11,62
85.86
24,627.63
4.86
739.90
739.90
4.91
85.86
85.86
739.90
5.09
75,000.00
216,246.04
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BRIAN D BROOKS GUARDIAN
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LANCASTER PA 17604-7295
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Check Number:
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Account Number:
Amount Paid:
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72145068
10/161:!006
783-554397-1
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Issuing Bank Acct:
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DATE
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AMOUNT
10/16/06 AS PER YOUR REQUEST
NET AMOUNT
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"~~c.:~
II-DO? 2 .... 501;8"-
.: I. 2 2 20...?? I.': ...? 5111; 1.8111;011-
ITEMIZED CATEGORY REPORT
11/ l' 5 Through 10/31' 6
PAGA_CUS-PAGA Custodial Page 5
10/27' 6
Date Num Description Memo Category Clr Amount
9/25' 6 9106 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDIC X -135.81
9/26' 6 9109 S HALL SERVICES 8/06 FAMA,MARY/FINAC X -2,130.24
9/26' 6 9109 S HALL SERVICES 7/06 FAMA,MARY/FINAC X -1,972.56
9/27' 6 9114 VOID:METRO MED SER MARY H. FAMA FAMA,MARY/TRANS X 0.00
10/ 3' 6 9134 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC -2,442.26
10/ 3' 6 9135 ALICIA STONEROAD MARY H. FAMA FAMA,MARY/FINAC -752.00
10/ 3' 6 9158 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO -540.00
10/ 4' 6 9166 S PLATINUM PLUS FOR STORAGE UNIT FAMA,MARY/FINAC -26.00
10/ 4' 6 9194 S PLATINUM PLUS FOR PERSONAL NEED FAMA,MARY/FINAC -401.95
10/ 9' 6 9181 ROSA LUCIDON MARY FAMA FAMA,MARY/COST -774.75
10/ 9' 6 9191 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC -1,852.92
10/ 9' 6 9193 S VOID: PLATINUM PLUS PERSONAL NEED FAMA,MARY/FINAC X 0.00
10/11' 6 R9669 DEPOSIT PENSION FAMA,MARY/PENSI 85.86
10/11' 6 R9670 DEPOSIT SSDI FAMA,MARY/SSDI 739.90
10/11' 6 R9671 DEPOSIT DIVIDEND FAMA,MARY/DIVID 5.09
10/17' 6 9244 ALICIA STONEROAD MARY H. FAMA FAMA,MARY/FINAC -826.00
10/17' 6 9245 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINAC -246.99
10/17' 6 9252 YOUNGS MEDICAL EQU MARY.H.FAMA FAMA,MARY/MEDIC -108.20
10/17' 6 9257 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC -2,153.33
10/20' 6 9263 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST -3,804.11
10/20' 6 9266 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO -450.00
10/20' 6 9267 ROSA LUCIDON MARY FAMA FAMA,MARY/COST -693.75
10/20' 6 9273 S HALL SERVICES SOCIAL SERVIC FAMA,MARY/FINAC -2,665.44
10/20' 6 R9743 DEPOSIT BANK TRANSFER FAMA, MARY/BANK 75,000.00
10/25' 6 9302 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC -2,678.70
10/25' 6 9303 BCF INSURANCE BOND / MARY H FAMA,MARY/BOND -1,610.00
10/26' 6 9307 AMERICAN HOME MEDI MARY FAMA CH FAMA,MARY/MEDIC -32.07
TOTAL FAMA,MARY If
TOTAL INCOME
TOTAL INCOME/EXPENSE
on
P !+6-!1
/I/r (06 -
cud.
/0/3/ (t:JG
,.. ITEMIZED CATEGORY REPORT
11/ l' 5 Through 10/31' 6
PAGA_CUS-PAGA Custodial Page 4
10/27' 6
Date Num Description Memo Category Clr Amount
7/11' 6 8714 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -2,868.84
7/14' 6 8744 HALL SERVICES MARY H. FAMA FAMA,MARY/FINAC X -660.00
7/19' 6 8755 S PLATINUM PLUS FOR PERSONAL NEED FAMA,MARY/FINAC X -657.41
7/19' 6 8764 S LINKS 2 CARE COST OF CARE FAMA,MARY/MEDIC X -1,022.56
7/19' 6 8764 S LINKS 2 CARE COST OF CARE FAMA,MARY/MEDIC X -1,745.82
7/31' 6 8782 ROSA LUClDON MARY FAMA FAMA,MARY/COST X -193.13
7/31' 6 8784 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST X -3,807.61
7/31' 6 8785 BETTY REINER MARY FAMA FAMA,MARY/COST X -272.00
8/ l' 6 8800 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -810.00
8/ l' 6 8802 ROSA LUClDON MARY FAMA 7/ FAMA,MARY/COST X -120.00
8/ l' 6 8803 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINAC X -123.74
8/ l' 6 8814 ALICIA STONEROAD MARY H. FAMA FAMA,MARY/FINAC X -581.00
8/ l' 6 8815 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -2,319.76
8/ l' 6 8817 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDIC X -204.42
8/ l' 6 8819 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -2,405.40
8/ 7' 6 8838 HALL SERVICES MARY FAMA FAMA,MARY/FINAC X -1,710.00
8/ 7' 6 8841 MANORCARE CARLISLE MARION DEIBER FAMA,MARY/COST X -3,689.00
8/ 7' 6 8842 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -2,631.38
8/ 9' 6 R7577 DEPOSIT PENSION FAMA,MARY/PENSI X 85.86
8/ 9' 6 R7578 DEPOSIT INSURANCE FAMA,MARY/INSUR X 24,627.63
8/ 9' 6 R7579 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 4.86
8/ 9' 6 R7580 DEPOSIT SSDI FAMA,MARY/SSDI X 739.90
8/11' 6 8867 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -750.00
8/17' 6 8896 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -2,099.63
8/17' 6 8897 S METRO MED SERVICES 06-26319 FAMA,MARY/TRANS X -73,60
8/17' 6 8897 S METRO MED SERVICES 06-33617 FAMA, MARY/TRANS X -112.10
8/17' 6 8897 S METRO MED SERVICES 06-33630 FAMA,MARY/TRANS X -113.45
8/17' 6 8898 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -579,38
8/17' 6 8903 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINAC X -390.96
8/21' 6 8913 S PLATINUM PLUS FOR PERSONAL NEED FAMA,MARY/FINAC X -472.59
8/23' 6 8935 HALL SERVICES MARY FAMA FAMA,MARY/FINAC X " -858.72
8/28' 6 8945 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -2,462.70
8/28' 6 8946 ALICIA STONEROAD MARY H. FAMA FAMA,MARY/FINAC X -854.00
8/29' 6 8972 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST X ',-3,861.08
8/29' 6 8975 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -870.00
8/29' 6 8977 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDIC X -66.21
8/29' 6 8980 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -2,841.00
9/ l' 6 9094 LINKS 2 CARE MARY H, FAMA FAMA,MARY/MEDIC X -2,517.15
9/ 6' 6 8993 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -2,275.79
9/ 6' 6 9003 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -540.00
9/ 8' 6 R7465 DEPOSIT SSDI FAMA,MARY/SSDI X 739.90
9/ 8' 6 R7466 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 4.91
9/ 8' 6 R7467 DEPOSIT PENSION FAMA,MARY/PENSI X 85.86
9/11' 6 9013 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -3,154.81
9/11' 6 9015 ROSA LUCIDON MARY FAMA FAMA,MARY/COST X -221.25
9/13' 6 9051 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINAC X -370.74
9/13' 6 9053 HIGHMARK BLUE SHIE MARY H. FAMA FAMA,MARY/INSUR X -244.40
9/14' 6 9058 S PAGA GENERAL ACCOU 7-9/06 FAMA,MARY/GUARD X -750.00
9/19' 6 9075 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -450,00
9/20' 6 9084 ROSA LUCIDON MARY FAMA FAMA,MARY/COST X -363.75
9/20' 6 9086 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -2,890.13
9/21' 6 9089 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST X -4,210.49
a11 ~--0
PAGA_CUS-PAGA Custodial
10/27' 6
ITEMIZED CATEGORY REPORT
11/ l' 5 Through 10/31' 6
Date
4/26' 6
4/26' 6
4/28' 6
4/28' 6
5/ 3' 6
5/ 3' 6
5/10' 6
5/10' 6
5/10' 6
5/10' 6
5/15' 6
5/15' 6
5/15' 6
5/15' 6
5/16' 6
5/16' 6
5/16' 6
5/17' 6
5/18' 6
6/ l' 6
6/ 2' 6
6/ 5' 6
6/ 5' 6
6/ 5' 6
6/ 5' 6
6/ 5' 6
6/ 5' 6
6/ 6' 6
6/ 8' 6
6/ 8' 6
6/ 8' 6
6/ 9' 6
6/14' 6
6/14' 6
6/14' 6
6/14' 6
6/16' 6
6/20' 6
6/22' 6
6/22' 6
6/22' 6
6/26' 6
6/26' 6
6/26' 6
6/27' 6
7/ 6' 6
7/ 6' 6
7/ 6' 6
7/ 6' 6
7/11' 6
7/11' 6
7/11' 6
Num
8261
8269
8276
8277
8301
8304
R8115
R8116
R8117
R8118
8348
8388
8393
8394
8401
8402
8406 S
8414
8424
8453
8455 S
8470
8477
8481
8483
8485
8499
8515
R8205
R8206
R8207
8534 S
8547
8548
8549
8552
8582
8590
8596
8597
8600
8607 S
8607 S
8623
8631
R7515
R7516
R7517
8667
8677
8705
8709
Description
Memo
LANA L. HOOVER, LP MARY HELEN FA
LINKS 2 CARE MARY H. FAMA
ROBC LIMITED PARTN MARY HELEN FA
HAMPDEN CLEANERS MARY FAMA
LINKS 2 CARE MARY H. FAMA
LANA L. HOOVER, LP MARY HELEN FA
DEPOSIT DIVIDEND
DEPOSIT PENSION
DEPOSIT SSDI
DEPOSIT BANK TRANSFER
LINKS 2 CARE MARY H. FAMA
MET-LIFE MARY FAMA PO
LINKS 2 CARE MARY H. FAMA
HIGHMARK BLUE SHIE MARY H. FAMA
LANA L. HOOVER, LP MARY HELEN FA
HAMPDEN CLEANERS MARY FAMA
PLATINUM PLUS FOR PERSONAL ITEM
HALL SERVICES MARY H. FAMA
LINKS 2 CARE MARY H. FAMA
REGISTER OF WILLS MARY H. FAMA
PAGA GENERAL ACCOU 5-6
LANA L. HOOVER, LP MARY HELEN FA
LINKS 2 CARE MARY H. FAMA
ROBC LIMITED PARTN MARY HELEN FA
VOID:ROBC LIMITED MARY HELEN FA
SUSQUEHANNA INTERN MARY H. FAMA
CHESAPEAK REHAB MARY FAMA ELE
LINKS 2 CARE MARY H. FAMA
DEPOSIT PENSION
DEPOSIT DIVIDEND
DEPOSIT SSDI
PLATINUM PLUS FOR PERSONAL NEED
HAMPDEN CLEANERS MARY FAMA
LINKS 2 CARE MARY H. FAMA
LINKS 2 CARE MARY H. FAMA
MANORCARE CARLISLE MARY FAMA
LANA L. HOOVER, LP MARY HELEN FA
LINKS 2 CARE MARY H. FAMA
REGISTER OF WILLS MARY FAMA
ROBC LIMITED PARTN MARY HELEN FA
ALICIA STONEROAD MARY H. FAMA
LINKS 2 CARE IN# 208528
LINKS 2 CARE IN# 208427
YOUNGS MEDICAL EQU MARY.H.FAMA
LANA L. HOOVER, LP MARY HELEN FA
DEPOSIT SSDI
DEPOSIT PENSION
DEPOSIT DIVIDEND
ALICIA STONEROAD MARY H. FAMA
LINKS 2 CARE MARY H. FAMA
LANA L. HOOVER, LP MARY HELEN FA
HIGHMARK BLUE SHIE MARY H. FAMA
"
Page 3
Category
Clr Amount
FAMA,MARY/PERSO X
FAMA,MARY/MEDIC X
FAMA,MARY/COST X
FAMA,MARY/FINAC X
FAMA,MARY/MEDIC X
FAMA,MARY/PERSO X
FAMA,MARY/DIVID X
FAMA,MARY/PENSI X
FAMA,MARY/SSDI X
FAMA,MARY/BANK X
FAMA,MARY/MEDIC X
FAMA,MARY/INSUR X
FAMA,MARY/MEDIC X
FAMA,MARY/INSUR X
FAMA,MARY/PERSO X
FAMA,MARY/FINAC X
FAMA,MARY/FINAC X
FAMA,MARY/FINAC X
FAMA,MARY/MEDIC X
FAMA,MARY/COURT X
FAMA,MARY/GUARD X
FAMA,MARY/PERSO X
FAMA,MARY/MEDIC X
FAMA,MARY/COST X
FAMA,MARY/COST X
FAMA,MARY/MEDIC X
FAMA,MARY/MEDIC
FAMA,MARY/MEDIC X
FAMA,MARY/PENSI X
FAMA,MARY/DIVID X
FAMA,MARY/SSDI X
FAMA,MARY/FINAC X
FAMA,MARY/FINAC X
FAMA,MARY/MEDIC X
FAMA,MARY/MEDIC X
FAMA,MARY/COST X
FAMA,MARY/PERSO X
FAMA,MARY/MEDIC X
FAMA,MARY/COURT X
FAMA,MARY/COST X
FAMA,MARY/FINAC X
FAMA,MARY/MEDIC X
FAMA,MARY/MEDIC X
FAMA,MARY/MEDIC X
FAMA,MARY/PERSO X
FAMA,MARY/SSDI X
FAMA,MARY/PENSI X
FAMA,MARY/DIVID X
FAMA,MARY/FINAC X
FAMA,MARY/MEDIC X
FAMA,MARY/PERSO X
FAMA,MARY/INSUR X
d
-450.00
-1,868.00
-4,628.04
-475.14
-1,317,60
-450.00
37.86
85.86
750,00
100,000.00
-1,536.00
-18.66
-1,536.00
-977.60
-360.00
-435.43
-380.79
-694.80
-1,167.60
-5.00
-500.00
-405.00
-1,560.79
-2,325.00
0.00
-60.29
-900.00
-1,536,90
85.864.87
750.00
-667.07
-248.06
-1,350.23
-386.14
-39.00
-615.00
-2,796.39
-25.00
-3,802.11
-581.00
-1,612.88
-893.70
-2,025.00
-660.00
729.80
85.86
11.62
-376,00
-2,090.33
-860.00
-244,40
". ITEMIZED CATEGORY REPORT
11/ l' 5 Through 10/31' 6
PAGA_CUS-PAGA Custodial Page 2
10/27' 6
Date Num Description Memo Category Clr Amount
1/24' 6 7794 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,748.00
1/31' 6 7822 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,575.50
2/ 7' 6 R7729 DEPOSIT SSDI FAMA,MARY/SSDI X 750.00
2/ 7' 6 R7730 DEPOSIT PENSION FAMA,MARY/PENSI X 85.86
2/ 7' 6 R7731 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 34.99
2/ 9' 6 7852 S PLATINUM PLUS FOR CLOTHING FAMA,MARY/FINAC X -774.57
2/ 9' 6 7862 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -180.00
2/ 9' 6 7871 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,664.00
2/10' 6 7884 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,752.00
2/10' 6 7887 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINAC X -204.03
2/10' 6 7898 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDIC X -298.80
2/10' 6 7905 BCF INSURANCE BOND / MARY H FAMA,MARY/BOND X -848.00
2/22' 6 7926 METRO MED SERVICES MARY H. FAMA FAMA,MARY/TRANS X -99.95
2/22' 6 7931 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,136.00
2/22' 6 7939 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -360.00
2/22' 6 7943 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST X -4,679.57
2/24' 6 7963 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDIC X -632.55
2/27' 6 7970 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,664.00
2/28' 6 7973 S PLATINUM PLUS FOR PERSONAL NEED FAMA,MARY/FINAC X -65.21
3/ 8' 6 R7622 DEPOSIT BANK ACCT CLO FAMA,MARY/CLOSE X 6,087.27
3/ 8' 6 R7623 DEPOSIT PENSION FAMA,MARY/PENSI X 85.86
3/ 8' 6 R7624 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 9.07
3/ 8' 6 R7625 DEPOSIT SSDI FAMA,MARY/SSDI X 750.00
3/ 9' 6 8014 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,400.00
3/10' 6 8034 SUSQUEHANNA INTERN MARY H. FAMA FAMA,MARY/MEDIC X -14.97
3/10' 6 8042 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -615.00
3/10' 6 8046 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,478.50
3/10' 6 8047 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINAC X -474.36
3/13' 6 8054 MET-LIFE M.H. FAMA FAMA,MARY/INSUR X -18.66
3/15' 6 8064 METRO MED SERVICES MARY H. FAMA FAMA,MARY/TRANS X -131.00
3/17' 6 8101 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,540.00
3/17' 6 ET MARY FAMA TRANSFER SAM FAMA, MARY/BANK X 127.24
3/21' 6 8105 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -405.00
3/24' 6 8092 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST X -4,698.34
3/27' 6 8093 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDIC X -258.91
3/28' 6 8121 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,862.00
3/30' 6 8136 HALL SERVICES MARY FAMA FAMA,MARY/FINAC X -6,077.52
4/ 3' 6 8138 S PLATINUM PLUS FOR CLOTHING FAMA,MARY/FINAC X -956.45
4/ 5' 6 8161 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,536.00
4/ 5' 6 8168 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -360.00
4/10' 6 R8015 DEPOSIT SSDI FAMA,MARY/SSDI X 750,00
4/10' 6 R8016 DEPOSIT PENSION FAMA,MARY/PENSI X 85.86
4/10' 6 R8017 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 11.14
4/11' 6 8198 S PAGA GENERAL ACCOU 2-4/06 FAMA,MARY/GUARD X -750.00
4/18' 6 8218 REGISTER OF WILLS MARY FAMA FAMA,MARY/COURT X -5.00
4/26' 6 8229 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDIC X -168.46
4/26' 6 8234 RICHARDSON FUNERAL IDA ROBERTS FAMA,MARY/FUNER X -5,733.00
4/26' 6 8237 VOID:HAMPDEN CLEAN MARY FAMA FAMA,MARY/FINAC X 0.00
4/26' 6 8238 HAMPDEN CLEANERS MARION DIEBER FAMA,MARY/FINAC X -32.13
4/26' 6 8239 VOID:ROBC LIMITED MARY FAMA FAMA,MARY/COST X 0.00
4/26' 6 8240 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,672.13
4/26' 6 8254 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,627.24
aU
:
# ITEMIZED CATEGORY REPORT
11/ l' 5 Through 10/31' 6
PAGA_CUS-PAGA Custodial Page 1
10/27' 6
Date Num Description Memo Category Clr Amount
INCOME/EXPENSE
INCOME
FAMA, MARY
11/ l' 5 7340 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,488.00
11/ l' 5 7343 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -450.00
11/ 2' 5 7356 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,468.00
11/ 8' 5 7389 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -2,100.00
11/14' 5 7416 S PLATINUM PLUS FOR FAMA,MARY/FINAC X -1,497.03
11/17' 5 R9202 DEPOSIT AUCTION FAMA,MARY/SALE X 227.00
11/17' 5 R9203 DEPOSIT AUCTION FAMA,MARY/SALE X 162.50
11/21' 5 R9213 DEPOSIT SSDI FAMA,MARY/SSDI X 728.00
11/21' 5 R9214 DEPOSIT REFUND FAMA,MARY/REFUN X 17.60
11/21' 5 R9215 DEPOSIT PENSION FAMA,MARY/PENSI X 5.95
11/21' 5 R9232 DEPOSIT PENSION FAMA,MARY/PENSI X 85.86
11/28' 5 7446 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDIC X -565.18
11/28' 5 7448 BCF INSURANCE BOND / MARY H FAMA,MARY/BOND X -1,610.00
11/29' 5 7454 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST X -4,704.94
11/29' 5 7455 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,668.00
11/29' 5 7462 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -450.00
11/29' 5 7466 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,873.63
11/29' 5 7477 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINAC X -469.72
12/ 2' 5 7504 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,766.50
12/ 8' 5 R9269 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 18.71
12/ 8' 5 R9270 DEPOSIT PENSION FAMA,MARY/PENSI X 85.86
12/ 8' 5 R9271 DEPOSIT SSDI FAMA,MARY/SSDI X 728.00
12/ 8' 5 7516 REGISTER OF WILLS MARY H. FAMA FAMA,MARY/COURT X -30.00
12/14' 5 7534 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,840.00
12/14' 5 7542 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINAC X -410.19
12/14' 5 7549 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -360.00
12/14' 5 7585 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -500.00
12/14' 5 7593 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,740.50
12/16' 5 7612 S PLATINUM PLUS FOR FAMA,MARY/FINAC X -643.22
1/ 3' 6 7638 HALL SERVICES MARY FAMA FAMA,MARY/FINAC X -4,022.14
1/ 6' 6 R9345 DEPOSIT PENSION FAMA,MARY/PENSI X 85.86
1/ 6' 6 R9346 DEPOSIT SSDI FAMA,MARY/SSDI X 750.00
1/ 6' 6 R9347 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 9,51
1/ 6' 6 R9348 DEPOSIT DIVIDEND FAMA,MARY/DIVID X 29.64
1/ 9' 6 7687 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,636.00
1/ 9' 6 7700 ALERT PHARMACY SER MARY FAMA FA FAMA,MARY/MEDIC X -339.31
1/ 9' 6 7703 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -360.00
1/ 9' 6 7713 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST X -4,704.94
1/ 9' 6 7722 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,510.00
1/ 9' 6 7729 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,479.25
1/10' 6 7737 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,896.50
1/10' 6 7740 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -360.00
1/10' 6 7752 HAMPDEN CLEANERS MARY FAMA FAMA,MARY/FINAC X -346.97
1/11' 6 7753 S PAGA GENERAL ACCOU 11-1/06 FAMA,MARY/GUARD X -750.00
1/18' 6 7775 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDIC X -1,815.00
1/24' 6 7786 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSO X -360.00
1/24' 6 7789 ROBC LIMITED PARTN MARY HELEN FA FAMA,MARY/COST X -4,741.06
ad ~
.
ITEMIZED CP~TEGORY REPORT
11/ :L'5 Through lO/3lt G
"'-.............,.l;.~ '-...00 l.:.'ri\...:1n '.....:u.oL0ula-L
.., ..." 1",..- e ..-
.tUlLO' !.')
Date
n..-...l"""I..-.....-..;,.....~..:_........
.J.-i-......Jo.;I__...L ...l..l/L..LV.l.i
1'r'u.m
i.1eI(tO
Category
INcor.m/EXPENSE
INCOME
.FP.Jv1A , Iv'gi....R Y
1/11' 6 7753 S PAGA GENE~4L ACCOU 11-1/06
4/11' 6 8198 S PAGA GENERAL ACCOU 2-4/06
6/ 2' 6 8455 S PAGA GENERAL ACCOU 5-6
9/14' 6 9058 S PAGA GENERAL ACCOU 7-9/06
FA-MA, MARY/GUP-...EDIl\ X
FA1".1A, i"'J.ARY / GUARD IA X
FAMA,MARY/GUARDIA X
FAMA,MARY/GUARDIA X
TOTAL FAMA,MARY
TOTAL INCOME
TOTAL INCOME/EXPENSE
QY1
~/J
II~
~ --/1 /r7J
~ d-~ (./ - UL/
~
Page 1
(:1 r Amount
-750..00
-750.00
-500,00
-750.00
-2,750.00
-2,750.00
-2,750.00
.,
..
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CASH FLOW REPORT
1/ I' 0 Through 10/31' 6
PAGA_CUS-PAGA Custodial
10/26' 6
Page 1
Category Description
1/ I' 0-
10/31' 6
INFLOWS
FAMA, MARY
~\
/ I
~1.881.~j
TOTAL INFLOWS
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Pennsylvania Guardianship Association Inc.
PAGA
December 13,2006
PO Box 7295. Lancaster. P A 17604-7295
(717)-299-4568 / (717)-940-7599
FAX# (717)-299-5540
Cumberland Co, Courthouse
One Courthouse Square
Carlisle, P A 17013
Attn: Register of Wills
Re:
Mary Fama
21-2004-0831
an incapacitated person
Greetings,
P A Guardianship is the court appointed guardian for Mary Fama.
Please send me 2 certified copies of the court order appointing P A Guardianship from 10/26/04,
Thank You, Sincerely,
&v.-0-,1,~
Bnan D, Brooks
President, P A Guardianship
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COMM ONWEAL TH OF PENNSYL VANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2806~ .
HARRISBURG. PA 17128-0601
REV-1162 EX(11.96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
CHllENSKI ROGER E
315 NORTH MOUNTAIN ROAD
NEWVillE, PA 17241
-------- fold
ESTATE INFORMATION: SSN: 206-64-4675
FILE NUMBER: 2105-0098
DECEDENT NAME: CHllENSKI MICHAEL J
DA TE OF PAYMENT: 1 2/14/2006
POSTMARK DATE: 12/14/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 12/18/2004
NO. CD 007561
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,413.90
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$3,413.90
REMARKS: ROGER CHllENSKI
CHECK# 3176
SEAL
INITIALS: WZ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
J
Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A Wevodau
First Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
RIG-IARD L WEBBERJR ESQ.
126 EAST KING ST
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
1198
12/14/2006
a-IILENSKI. Wa-IAEL T.
21-2005-0098
Bill To:
wz
SHIPPENSBURG, P A 17257
Qty
1
Fee Description
Additional Probate
Fee Total
190.00 $190.00
Total:
$190.00
Checks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.
REV-1500 EX + (6'00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REY-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I OFFICiAL USE ONLY
I FILE NUMBER
, II 05 0098
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
~ 1. Original Return 0 2. Supplemental Return
D 4. Limited Estate n
D 6. Decedent Died Testate (Attach LJ
copy of Will)
IJ(l 9. Litigation Proceeds Received D 10 Spousal Poverty Credit (date of death between D 11.Election to tax under Sec. 9113(A)(Attach SchO)
I ~ . 12-31-91 and 1-1-95)
THIS SECTlC)),HJ10S'UIE CO""PLETED:lAL.li. CORRESPONDENCE' AND CONFIDENTIAL TAX INF~r.1AtlbN SAOU'LD. BE DIRECTEQ TO;11h:l;;l;iJ1tt11;;y;<1$i
I NAME COMPLETE MAILING ADDRESS
Richard L. Webber, Jr.
4a. Future Interest Compromise (date of dea,h after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy oITrust)
! DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
I- I Chilenski, Michael J.
z
W ! DATE OF DEATH (MM-DD-YEAR) i DATE OF BIRTH (MM-DD-YEAR)
o
~ 12-18-2004 ! 09-27-1981
~ I (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
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FIRM NAME (If applicable)
Weigle & Associates, P.C.
TELEPHONE NUMBER
717-532-7388
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) D Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
206-64-4675
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death prior to 12-13-82)
D
o
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
126 East King Street
Shippensburg, PA 17257
o
,....,
=
=
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n'-"1
(1 ) None
(2) None
(3) None
(4) None
(5) 96,291.46
(6) 1,500.00
(7) None
(9) 21,845.00
(10) 81.93
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(8)
97,791.46
(11 )
21,926.93
75,864.53
0.00
(12)
(13)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
75,864.53
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
20.0
0.00
3,413.90
0.00
0.00
3,413.90
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
>> Sr::S\JRI!'tQA!IlSWeA'ALL Q"UEiS:TloNSON R.EVI5RSE SII:lE,l\ND RECHeCK MATH -<:<:
Copyright 2002 form software only The Lackner Group, Inc.
15.Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
z or transfers under Sec. 9116(a)(1.2)
0 (16)
i= 16. Amount of Line 14 taxable at lineal rate 75,864.53 x ,045
;:5
~
D.. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
~
0
u 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18)
>< x
;:5 19. Tax Due
(19)
Form REV-1500 EX (Rev, 6-00:
l'
Decedent's Complete Address:
STREET ADDRESS
315 North Mountain Road
CITY Newville
STATE PA
ZIP 17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
3,413.90
0,00
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE. (5B)
3,413.90
3,413.90
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;......u..................................................................... 0 [!J
b. retain the right to designate who shall use the property transferred or its income;................................ 0 [!J
c. retain a reversionary interest: or............................._............................................................................. 0 [!J
d. receive the promise for life of either payments, benefits or care?........................................................... 0 [!J
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.... ....... ................. ............... ........... .... ..m... .... ................... .n......... ............ 0 [!J
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 [!J
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.........................................................................................,-.................... 0 [!J
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief. it is true. correct and
complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE R FILING RETURN ADDRESS
Roge il i '\
315 North Mountain Road
Newville, PA 17241
DATE
{( / d(
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, DATE
(2
ADDRESS
315 North Mountain Road
Newville, PA 17241
ADDRESS
126 East King Street
Shippensburg, PA 17257
/)/r:;/~ (
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P .S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 99116 (a) (1.1) (ii)]. The statutedoes not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty.one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P .S. 99116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S.
991161.2)[72P.S.99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (a) (1.3)]. A sibling is
defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
f
Rev-15G8 EX+ (6'98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Chilenski, Michael J.
FILE NUMBER
21-05-0098
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 F&M Trust Checking Account 33-86201 1.084.43
2 F&M Trust Savings Account #3150026369 2.689.72
3 F&M Trust Savings Account #3150026369 - Accrued Interest 17.31
4 Proceeds from settlement on survival action filed to Docket #2005-00098 of the 90.000.00
Court of Common Pleas of Cumberland County, PA and as per Order of Court dated
June 14, 2005
5 Progressive - Funeral coverage payment - Auto Insurance 2.500.00
TOTAL (Also enter on Line 5, Recapitulation)
96.291.46
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleE (Rev. 6-98)
,
Rev-1509 EX+ (6-98)
*'
SCHEDULE F
JOINTL Y~OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Chilenski, Michael J.
FILE NUMBER
21-05-0098
ESTATE OF
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Carol L. Chilenski
ADDRESS
RELATIONSHIP TO DECEDENT
Mother
313 North Mountain Road
Newville, PA 17241
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
LETTER DATE
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INT-EREST
JOINTL V-HELD REAL ESTATE.
1 1996 Dodge Truck Motor Vehicle VIN 1.500.00 50.000% 750.00
#2B7HB11X3TK173562
2 1996 VW Motor Vehicle VIN 1.500.00 50.000% 750.00
#~EE83A8TE108089
TOTAL (Also enter on Line 6, Recapitulation) 1.500.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
REV-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Chilenski, Michael J.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-05-0098
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 3,400.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Weigle & Associates, P.C. 18,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 445.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 21,845.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleH (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Chilenski, Michael J.
FILE NUMBER
21-05-0098
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Egger Funeral Home
3.360.00
2
Egger Funeral Home
40.00
Subtotal
3.400.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Chilenski, Michael J.
IFILE NUMBER
21-05-0098
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Commonwealth of Pennsylvania - accident report request fee
8.00
2
Cumberland County Register of Wills - Probate Fee and Short Certificates
47.00
3
Cumberland County Register of Wills - Additional Probate Fee
190.00
4
Cumberland County Register of Wills - Short Certificate
4.00
5
Cumberland Law Journal - Legal Advertising costs
75.00
6
F&M Trust - Researching Fee
15.00
7
Sollenbergers Messenger Service - Transfer of decedent's vehicle
36.50
8
The Valley Times-Star - Legal Advertising Costs
69.50
Subtotal
445.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Chilenski, Michael J.
FILE NUMBER
21-05-0098
ESTATE OF
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 West Shore EMS - Emergency Medical Services
VALUE AT DATE
OF DEATH
81.93
TOTAL (Also enter on Line 10, Recapitulation)
81.93
(If more space is needed, additional pages of the same size)
Copyright (e) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV-1513 EX+ (9-00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
Chilenski, Michael J.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
aistributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trusteelsl
FILE NUMBER
21-05-0098
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
I.
Carol L Chilenski
313 North Mountain Road
Newville, PA 17241
Mother
One-Half
38,682.27
Roger E. Chilenski
313 North Mountain Road
Newville, PA 17241
Father
One-Half
37,182.27
Total 75,864.54
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 ScheduleJ (Rev. 6-98)
..
TRUST
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May 24, 2005
Weigle & Associates, P .C.
Attorneys-at-Law
1 26 East King Street
Shippensburg, PA 17257-1397
RE: Michael J. Chilenski
Mr. Webber:
In reference to the above customer, our records show the enclosed information to be
accurate as of December 18, 2004. Our researching fee for the information we have
provided is $ 15.00. Please send your remittance to the following address:
Farmers and Merchants Trust Company
A TIN Karen Davis
20 South Main Street
Chambersburg, PA 17201-0819
.'
If I may be of any further assistance, please contact me.
Sincerely,
~...~
Karen E. Davis
Deposit Operations Manager
717-264-6116 888-264-6116 P.O. Box 6010 Chambersburg, PA
FIN A N P. I A l SOL U TI 0 N S... FRO M
17201-6010
RE: Michael J. Chilenski
DATE OF DEATH December 18, 2004
ACCOUNT INFORMATION
x
CHECKING
SAFE DEPOSIT
SAVINGS ____CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED 10/02/2000
ACCOUNT NUMBER 33-86201
ACCOUNT BALANCE AT DATE OF DEATH
ACCRUED INTEREST
TOTAL ACCOUNT BALANCE
NAME(S) ON ACCOUNT
REGISTRATION OF ACCOUNT
DATE CLOSED
04/04/05
$ 1,084.43
$ 0.00
$ 1, 084 . 43
Michael J. Chilenski
Individual
---------------------------------------------------------------
ACCOUNT INFORMATION
CHECKING
SAFE DEPOSIT
_X___ Installment Loan
DATE OPENED 09/19/2003
ACCOUNT NUMBER 3150026369
ACCOUNT BALANCE AT DATE OF DEATH $ 2,689.72
ACCRUED INTEREST $ 17.31
TOTAL ACCOUNT BALANCE $ 2,707.03
NAME(S) ON ACCOUNT Michael J Chilenski or Carol L Chilenski
REGISTRATION OF ACCOUNT Co-borrowers
____SAVINGS ___CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE CLOSED
03/08/05
"
IN RE: ESTATE OF MICHAEL J. CHILENSKl,
Deceased
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS COURT DIVISION
NO. 2005-00098
PA NO 21-05-0098
ORDER OF COURT
RECEIVED JUN 13Z0~5
~
AND NOW, this /1 TH day of June, 2005, in consideration of the attached Petition, the
proposed settlement of $360,000.00 for the Wrongful Death Action and $90,000.00 for the
Survival Action is approved, and the following distribution is directed:
TOTAL
$144,000.00
$144,000.00
$ 72,000.00
$ 90,000.00
$450,000.00
Roger E. Chilenski
Carol L. Chilenski
Estate of Michael J. Chilenski
Weigle & Associates, P.C.
It is further ordered that Roger E. Chilenski and Carol L. Chilenski, Co-Administrators of
the Estate of Michael J. Chilenski, are authorized to execute releases in favor of Chad M.
Hutchinson, Nationwide Mutual Insurance Company, and Progressive Northern Insurance.
~.s{ }~cLqa~~. (/;;. a)(LLJ{LLl
V 'I d' (j.
.J.
Richard L. Webber, Jr.
Attorney for Petitioners
91 .iI
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WEIGLE & ASSOCIATES P
. .c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
--.,.,..... ..,,~-,~.-"., -,
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IN RE: ESTATE OF MICHAEL J. CHILENSKI,
Deceased
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS COURT DIVISION
NO. 2005-00098
PA NO 21-05-0098
ORDER
AND NOW, this day of ,2005, upon consideration
of the attached Petition for Approval of Compromise of Wrongful Death and Survival Actions
and proposed Order, a hearing is scheduled for ' 2005, at
o'clock M., in Courtroom Number of the Cumberland County
Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania 17013.
J.
WEIGLE & ASSOCIATES. P.c. _ ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
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INRE:
ESTATE OF MICHAEL J. CffiLENSKI,
Deceased
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS COURT DIVISION
NO. 2005-00098
PA NO 21-05-0098
PETITION FOR APPROVAL OF
COMPROMISE OF WRONGFUL DEATH
AND SURVIVAL ACTIONS
TO THE HONORABLE, THE JUDGES OF SAID COURT:
1. The Petitioners are Roger E. Chilenski and Carol L. Chilenski, husband and wife, residing
at 315 North Mountain Road, Newville, Upper Frankford Township, Cumberland County,
Pennsylvania 17241.
2. On January 31, 2005, Letters of Administration were issued by the Register of Wills of
Cumberland County and the Petitioners were appointed as Co-Administrators of the Estate
of Michael J. Chilenski, deceased.
3. Michael J. Chilenski was the son of the Petitioners. He was born September 27, 1981,
resided with the Petitioners, and was 23 years of age at the time of his death.
4. On December 18,2004, at approximately 12:45 a.m., Michael J. Chilenski was a passenger
in a 2001 Mercury Cougar owned and operated by Chad M. Hutchinson, which collided
with a tree in the Borough of Newville.
5. Michael J. Chilenski died instantly as a result of the injuries he received in the collision.
6. Michael J. Chilenski died irttestate, was never married, and had no children.
7. Michael J. Chilenski was survived by the Petitioners, and a brother, Nicholas p, Chilenski,
and a half brother, Stephen M. Chilenski.
8. At the time of the accident, Chad H. Hutchinson was insured by Nationwide Mutual
Insurance Company, with a policy limit of $100,000.00.
9. Progressive Northern Insurance issued two automobile policies to Roger E. and Carol L.
Chilenski, which provide a total of $350,000.00 in policy limits in underinsured motorist
benefits, with respect to Michael J. Chilenski.
WEIGLE & ASSOCIATES, p,c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
...
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1 O. Both carriers have offered their policy limits totaling $450,000.00, and the Petitioners are
willing to settle the claims against Chad M. Hutchinson for this amount.
11. The Petitioners propose allocating $360,000.00 to the Wrongful Death Action and
$90,000.00 for the Survival Action.
12. Petitioners executed a written fee agreement dated January 28, 2005 with Weigle &-
Associates, P,c" which provides for a contingent fee of 20% of the amount recovered if
settlement is obtained prior to filing suit. Legal fees for assistance in estate administration
are included in the 20% arrangement.
13. The Petitioners request that distribution be made as follows:
Roger E. Chilenski
Carol L. Chilenski
Estate of Michael J. Chilenski
Weigle & Associates, P.C.
$144,000.00
$144,000.00
$ 72,000.00
$ 90.000.00
TOTAL
$450,000.00
14. The resolution of this matter and the proposed allocation have been reviewed and approved
by the Pennsylvania Department of Revenue.
WHEREFORE, the Petitioners request Your Honorable Court to approve the settlement
and distribution as set forth above, and to authorize the Petitioners to execute releases in favor of
Chad M. Hutchinson and the insurance carriers involved.
WEIGLE & ASSOCIATES, P.C.
By:
~J /L,~
Richard L. Webber, Jr., Esquire
Attorney for Petitioners
Attorney ID #49634
126 East King Street
Shippensburg, P A 17257
717-532-7388
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Date: r~~.- c:;--, l) C;-
WEIGLE & ASSOCIATES. P.c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
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VERIFICATION
I verify that the statements made in the foregoing document are true and correct to the best
of my knowledge, information, and belief. I understand that false statements herein made are
subject to the provisions of 18 Pa. C.S.A.g 4904 relating to unsworn falsification to authorities.
~ / Gl /'"
Date: 6~
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Date: uS
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CvwL ct Cj2jvrvLk.J
Carol L. Chilenski
WEIGLE & ASSOCIATES, P.c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
. "
PROGRESSIVE
February 22, 2005
FEB 2 4 2005
5165 Campus Drive, Suite 100
Plymouth Meeting, PA 19462-1135
Telephone.' 610567-3660
800937-3352
Facsimile' 610 397-0840
progressive. con;
Richard Webber
126 East King Street
Shippensburg, P A 17257
RE:
OUR INSURED:
OUR CLAIM #:
DATE OF LOSS:
YOUR CLIENT:
Roger Chilenski
045053730
12/18/05
Michael Chilenski
Medical Claim Information
Dear: Attorney Webber
This letter is to confirm the status of your client's medical claim. The ambulance bill that
was submitted has been paid. Additionally, this policy carried $2,500.00 in funeral
benefits which was paid directly to the funeral home.
Enclosed is a copy of your client's medical payment log. If there are any outstanding bills
not shown on the payment log, please contact me.
Pro~ssiye North~
i
\/1' / ( - _.~
", Ill!L, ; -
Rachel Addre'ss ..'
Medical Claims Representative
(610) 567-3709
Rachel_ Address@progressive.com
enclosure
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WEIGLE & ASSOCIATES, P.C.
Attorneys-at-Law
126 EAST KING STREET
SHIPPENSBURG, PENNSYLVANIA 17257-1397
JERRY A. WEIGLE
Associates
JOSEPH P. RUANE
RICHARD L. WEBBER, JR.
Of Counsel
THOMAS L. BRIGHT
TELEPHONE (717) 532-7388 or (717) 776-4295
FAX (717) 532-5289
weigleassociates@earthlink.net
January 28,2005
Mr. and Mrs. Roger E. Chilenski
Co-Administrators ofthe Estate of
Michael James Chilenskj
315 North Mountain Road
Newville, PA '17241
Re: Automobile Accident on 12/18/04,
Involving Michael James Chilenski
Our File #10139
Dear Mr. and Mrs. Chilenski:
This letter will confirm our recent discussion in which we agreed, at your request, to represent
you in the above-referenced matter.
We have agreed to provide our services on a contingent fee basis. This means that we will
undertake your representation to perform the services described below and, in return, you will
pay this firm a percentage of the amount of money received as an award or settlement, if any.
Our services may include a review of applicable statutes, research of case law, interview and
taking statements of witnesses, the taking of depositions, retaining the services of experts where
necessary and consultations with them, planning and preparation of appearances, negotiations
'.'lith insurance adjusters and opposing counsel, con-espondence ,md meetings and teiephone
conversations with you.
You hereby grant to us full power to make any inquiries, to negotiate or settle, bring, conduct,
prosecute, sue or compromise any action or suit with your concun-ence, and, if authorized, to
exercise such rights and endorse any papers, checks, or orders on your behalf in connection
therewith.
No settlement shall be made, nor shall any Defendant be released, without your prior approval.
Our fee will be twenty percent (20%) of the amount recovered if "settlement" is obtained prior to
filing suit. Our fee will be twenty-five percent (25%) of the amount recovered if "settlement"is
obtained after filing suit but prior to trial. Our fee will be thirty-three percent (33%) of he
amount recovered via a trial or arbitration hearing.
.
Mr. and Mrs. Roger E. Chilenski
January 28, 2005
Page 2
I will not charge any additional fees for estate administration procedures.
Regardless of whether there is a recovery in your case, and irrespective of whether a fee is paid
to this firm, out-of-pocket expenses directly attributable to your case are required to be paid by
you. These may include expenses for such things as investigative reports, medical reports, court
costs, depositions, witness fees, use and appearance of experts and possible exhibits used in trial.
Should you withdraw the case from our firm, you agree to pay to us a sum of twenty percent
(20%) of any type of outstanding offer made prior to the effective time of withdrawal, as stated
below, plus any expenses incurred. If there is no outstanding offer, it is agreed that thIS firm
shall be entitled to a sum equal to the number of hours spent on behalf of the case, times the
hourly rate of One Hundred Thirty-five Dollars ($135.00) plus any costs and expenses incurred.
While it is impossible to guarantee any results in your behalf, we can assure you that your case
will be handled in a diligent and expeditious manner.
If you have questions concerning this, please contact me at your earliest convenience. In the
event that this letter represents our understanding, please execute the enclosed copy where
indicated and return it to this office for our files, keeping the original for your records.
Very truly yours,
WEIGLE & ASSOCIATES, P.C.
'~'I i ,,/}
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Richard L. Webber, Jr., Esquire
Enclosure
RL VI/pit
ACCEPTED this
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~5 day of
,2005.
ACCEPTED this ~ )
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day of
,2005.
R \ R E. CHILENSKI
Co-Administrator of the Estate of
Michael James Chilenski
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CAROL L. CHILENSKI
Co-Administrator ofthe Estate of
Michael James Chilenski
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: FAMA, MARY H. , an incapacitated person FILE N0.21-20040831
GUARDIAN OF THE ESTATE FINAL REPORT
[20 Pa.C.S.A.5521(c)]
FROM 10/26/07 TO 8/08/08
1) I am the _ Limited _X Plenary Guardian of the Estate of my ward, named above.
I was appointed Guardian by Order of the Court dated _10/26/04 ,which
_was _X_ was not modified by Court Order (s) dated
2) Is the incapacitated person still living? NO
If no, answer the following: 0
~,
(a) Date of Death 8/08/08 ~A
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(b) Place of Death
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MANORCARE CARLISLE, 940 WALNUT BOTTOM RD
CARLISLE
PA 1
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(c) Name of Adminstrator/trig or Ezecutor/trig NONE a 'i a, c
= 1
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,
(d) Date Guardian of the Person filed the last Annual Report 10/26/07 ~
N
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PLEASE ANSWER THE FOLLOWING QUESTIONS WHETHER THE
INCAPACITATED PERSON IS LIVING OR DECEASED.
3) My initial Inventory was filed on _12/27/04 and listed a total estate value of
.
$ 516,393.95
The Inventory listed a total monthly income of $ 718.00 comprised of the following:
SOCIAL SECURITY
4) At the beginning date of this report period, my iuitial balance on hand was
$ 67,704.34
5) During this reporting period, the following reflects all sources of income (other than
Social security) received by me for my ward: (Add additional pages of needed)
Date Received Source of Income Amount
1. SEE ATTACHED ALL DEPOSTT REPORT
6) Daring this reporting period, the following reflects all payments I have made for my
ward: (Add additional pages if needed)
Date To Whom Paid Reason for Payment Amours
1. SEE ALL TRANSACTION REPORT
(7) The present principal assets of my ward are:
Description of Asset Present Value
1. PAGA CUSTODIAL ACCOUNT -2771.59
TOTAL $ -2771.39
8) The present amount and sources of income for my ward sre:
Source of Income Amount of Income
(Indicate whether (monthly),
Quarterly, annually)
1. SOCIAL SECURITY 758.20
2. PENSION 85 86
9) The regular monthly expenses of my ward which I pay are:
To Whom Paid Amount
1. SEE ATTACHED ALL TRANSACTION REPORT
2. PA GUARDIANSHIP FEE 250.00
3. MANORCARE CARLISLE 8,000.00 APPROX.
(10) I have/ have not (circle one) petitioned the Court for permission to invade principal
to meet the needs of my ward.
(If applicable) The following expenses of my ward have been paid from principal:
To Whom Paid
Purim
Amount
11) I (have) /have not (circle one) paid myself compensation for services I rendered as
guardian.
The amount I Paid myself totaled $ 1500.00 and was
Calculated at the follo}vipg rate: $ 250.00 per weeWtmonth) (circle one).
12) Check the correct response and complete, if appropriate.
_X _There will be no need for extraordinary expenditures on behalf of my ward ip
the nett (12) months.
There will be a need for extraordinary expenditures on behalf of my ward in
the neat (12) months because:
13) Check the correct response and complete, if appropriate.
A. My ward receives monthly social security benefits directly.
_X _B. I am the designated payee to receive my ward's social security benefits.
C. The designated payee of my ward's social security benefits is
14) Please note any concerns about the incapacitated persou's physical or mental well
being or the finances that the Court should know.
15) I_X_ am _ am not guardian of the incapacitated person's person. If yes,
report is attached.
I certify under the penalties of perjury that the information contained in this report is
true and correct to the best of my knowledge, information and belief.
~~
GATURE
Name: BRIAN D. BROOKS
DATE ~/~cp/C7g
Telephone No. 717-299-4568
PENNSYLVANIA GUARDIANSHIP ASSOC. INC.
PO BOX 7295
LANCASTER, PA 17604
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1N THE COURT OF COMMON PLEAS OF
CUMBERLAND CO., PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: FAMA, MARY , an incapacitated person FILE NO 21-2004-0831
GUARDIAN OF PERSON FINAL REPORT
[20 Pa. C.5.A. 5521(c)]
FROM 10/26/07 TO 8/08/08
1.I am the_ Limited _X_ Plenary Guardian of the Person of my ward, named above.
2. I was appointed Guardian by Order of the Court dated 10/26/04, whi~
was X was not mod~ed by Court Order(s) dated ~~~ a
3. Is the incapacitated person still living? NO ~~m ao
If no, answer the following: ~ U~ ~_ ^~
,.~,Ss
(a) Date of Death? 8!08/08 °~ ~ s
N
(b) Place of Death? 4i
MANORCARE CARLISLE, 940 WALNUT BOTTOM RD, CARLISLE, PA 17015
(c) Name of Administrator or Executor? NONE
(d) Date Guardian of the Person filed the last Annual Report? 10/26/07
4. If the incapacitated person is still living, answer the following questions:
(a) Date Guardian of the Person filed the last Annual Report? 10/26/06
(b) Current address of the incapacitated person
MANORCARE CARLISLE, 940 WALNUT BOTTOM RD, CARLISLE, PA 17015
(c) Current age _88_Date of birth of incapacitated person 10/19/19
(d) The incapacitated person's residence is:
Ward's own residence My home/apartment
_X Nursing Home Relative's Home
Hospital or Medical Facility _ Personal Care
(e) The incapacitated person has been living there since 2006
If moved within the past year, state from where and the reason for the change
i _
-n 1
< ; ~:-~
~~ fi
(f) I rated his/her living arrangement as:
Excellent Average Below Average
Explain•
(g) I believe he/she is:
_ _content with the living aitaation
anhappy with the living situation
unaware of the living situation
5. Physical health
(a) Current physical condition of the incapacitated person is:
Excellent Good Fair poor
(b) His/her major physical health problems are as follows:
(c)During the past year, his/her physical condition has:
remained about the same.
improved. Explain
_X worsened. Explain DEATH
(d) During the past year, he/she received the following medical treatment
(include check-ups and dental work):
Date Ailment Type of treatment Doctor's name
MONTHLY ONGOING CARE AT FACILITY DR I{. GUISTWITE
PERIODIC PODIATRY DPM R MARQUES
10/19/07 HOSPICE HEARTLAND HOSPICE
6. Mental Health
(a) The incapacitated person's condition is
Excellent Good poor
(b) His/her major mental health problems are as follows:
SEVERE END STAGE DEMENTIA
(c) Daring the past year, his/her mental rnndition has:
_ remained about the same.
Improved. Explain
_X Worsened. Explain DECLINE
(d) During the past year, treatment or evaluation by a psychiatrist, psychologist
or social worker was X was not provided.
7. Social Activities / Services
(a) His/her current social rnndition is:
ezcellent good fair -poor
(b) During the past year, his/her social condition has:
_ remained about the same.
improved. Eaphtin.
worsened Explain DEATH
(c) During the past year he/she has participated in the following activities:
X -recreational
educational
X social
occupational
no activities available
he/she refuses to participate in any activities
S. Visitation
(a) During the last year, I visited him/her as follows
PRIVATE DUTY CARE BY PAGA STAFF MEMBER 4 HRS PER WEEK
(b) The average amount of time I spent on each visit was 2HRS 2XWEEKLY
(c) The last time I visited was on 8!08/118 Date
9. During the last year I have performed the following activities on behalf the
incapacitated person:
ALL MEDICAL AND FINANCIAL DECISIONS
10. I believe helshe has the following unmet needs:- NONE
11. The guardianship Should _X shoald not be continued without
modification because: DEATH
12. Please note any concerns about the Incapacitated person's physical or mental
well being or the finances that the Court should know.
13. I _X_ am am not guardian of the incapacitated person's estate. If yes,
my report is attached.
I certify under the penalties of perjury that the information contained in this report
is true and correct to the best of my lmowledge, information and belief.
l
Date: ~ ~~~ %~ - ,~, ~:~
Signature of the Guardian o the Person
Nsme: BRIAN D. BROOKS TELE#: 717-299-4568
PENNSYLVANIA GUARDIANSIIIP ASSOC. INC.
PO BOX 7295
LANCASTER, PA 17604
IN Re: Mary H. Fama :IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVA~NTA,
(The Estate of) ORPHANS' COURT DIVISION
NO. 21-2004-0831
IN RE: PETITION FOR THE RELEASE OF FIDUCIARY BOND
ORDERING JUDGE: J. OLER
1. BY COURT ORDER DATED OCTOBER 26, 2004 THIS COURT APPOINTED
PENNSYLVANIA GUARDIANSHIP ASSOCIATION AS THE PLENARY
GUARDIAN OF THE PERSON AND ESTATE OF MARY H. FAMA.
2. IN THAT ORDER THE GUARDIAN WAS DIRECTED TO FILE A BOND WITH THE
COURT IN THE AMOUNT OF $500,000.00. THE GUARDIAN COMPLIED AND
PRESENTED THE BOND TO THIS COURT.
3. MARY H. FAMA PASSED AWAY AUGUST 08, 2008. A FINAL REPORT OF THE
PERSON AND ESTATE WAS FILED BY THE GUARDIAN AND WAS CLOCKED
IN AT THE REGISTER OF WILLS CUMBERLAND CO. MARCH 03, 2009
4. WE HAVE NOT BEEN ABLE TO HAVE 'THE BONDING COMPANY RELEASE
THE BOND WITHOUT A COURT ORDER STATING IT IS NO LONGER
REQUIRED.
5. AT THE TIME OF DEATH MARY H. FAMA HAD NO ASSETS OF ANY KIND IN
HER ESTATE. NO ESTATE WAS OPENED OR WILL PROBATED.
WHEREFORE, PETITIONER PRAYS THAT AN ORDER BE GIVEN RELEASING THE
PENNSYLVANIA GUARDIANSHIP ASSOCIATION OF ANY FURTHER BONDING
REQUIREMENT IN THIS MAT'T'ER.
RESPECTFULLY SUBMITTED,
N
n ~ ,.,
~, ,:_;
~_ ~~ c_:
F ;~} ~ ~ J
B D. BROOKS -~~' ~ ~' ~~~
PENNSYLVANIA GUARDIANSHIP ASSOCIATION ~ ~~ , ~ ~ c-~
:ta ~5. ; f ~ 1 ~. _ _ ~ i _1
117 S. W. END AVE. / PO BOX 7295 ~.- ~ ~~f~ ~~~ ~ - ~ - ;~ - ;.
LANCASTER, PA 17604 ` ~' ~~-' ~~' ^~' ~ -~
(717) 299-4568 ~=' ~-, ~ ~ .~
• •
E
IN RE: MARY H. FAMA IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
An alleged incapacitated ORPHANS' COURT DIVISION
person N0. 21-2004-0831
IN RE: PETITION FOR APPOINTMENT OF PERMANENT PLENARY
GUARDIANS OF THE PERSON AND ESTATE
BEFORE OLER, J.
ORDER OF COURT
AND NOW, this 26th day of October, 2004, upon
consideration of the Petition for the Appointment of~
Permanent Plenary Guardians of the Person and Estate
Pursuant to 20 P.S. Section 5511, and following a hearing at
which the allegedly incapacitated person, Mary H. Fama was
present and represented by her court-appointed counsel,
Michael Traxler, Esquire, and the Petitioner (the Area
Agency on Aging in and for Cumberland County, Pennsylvania}
was present through several representatives and was
represented by its counsel, Anthony L. DeLuca, Esquire, Mary
H. Fama is adjudicated an incapacitated person, and the
Pennsylvania Guardianship Association located in Lancaster,
Pennsylvania, is appointed plenary guardian of her person
and estate.
The guardian is directed to file reports in accordance
with the provisions of the Probate, Estates and Fiduciaries
Code applicable to such guardianships.
The guardian shall file a bond with respect to its
~. ~ a~tU~ Ct7PY ~PC)M RECORD
In Testimony wherof, I hereunto
set my hand and the seal
of said Court at Carlisle, PA
This~day o ~~- 20~~
//,
Clerk of.the Orphans Court
t;i~mherland County
l
• •
d~~ties hereunder in the amcunt of $500,000 with the Orphans'
Court of Cumberland County.
The guardian is directed to arrange for visits at least
once each week absent exigent circumstances between Ms. Fama
and r~er husband, Samuel, to maintain her residence at the
Bridges at Bent Creek pending further Order of Court, and to
consult with Ms. Fama with respect to any major decisions
regarding her wellbeing.
BY THE COURT,
_~
.i ._- i~Ar,thony L. DeLuca, Esquire
r..~ 113 Front Street
.~,~ i Boiling Springs, Pa 17007
~- `'~ j Attorney for the Petitioner
~ . J \~ ~
~:.~ ~ Michael Traxler, Esquire
~. :~-~ 36 S . Hanover Street
~~ ~; Carlisle, Pa 17013
'..~; ~ Court-appointed Attorney for Mary H. Fama
,___. s ~ .
:mae
s'~°.
PEr~NSYLV NA~oNAL
Mv~rvai~ cASVAi.~ nvsv~lvCE COMPANY
Han~isburg, Pennsylvania
In the Matter of the Estate of Mary H Fama
KNOW ALL MEN BY THESE PRESENTS, that we, Pennsytvanis Guardianship Association, Inc. ,
as gesrdisn of the Estate of Mary H Fame, an alleged incapcitated person ,
and Pennsylvania National Mutual Casualty Insurance Company, a Pennsylvania Corporation, of Harrisburg,
Pennsylvania, as Surety, aze held and firmly bound unto the Coen of Common Peas of Cumberland County ,
in the full and just sum of Five Hundred Thoes~nd
DOLLARS,
($ 500,000.00) for the payment of which, well and truly to be made, we bind ourselves, ow heirs, executors, ,
administrators, successors and assigns, jointly and severally, firmly by these presents.
Sealed with our seals, and dated this 19 day of November. 2004.
WHEREAS, Pennsylvania Guardianship Association, Inc. ,has been, or is about to be, appointed
guardian of the estate of Mary H Fame, an alleged
incapacitated person
by the Orphans Coen Division of the Court of
Common. Please of Cumberland
County.
NOW, THEREFORE, the condition of this obligation is such, that if the said Pennsylvania Guardianship
Assa-cistion, Inc.
shall well and truly discharge the duties of said trust according to law, then this obligation
is void, otherwise to remain in full force and effect.
Brian D Brooks, President
~ i,~~
PENNSYLVANIA NATIONAL MUTUAL
CASUALTY~~INSURANCE COMPANY
BY~ . ~~~..Ldw.+ ~ ____ - _. _.
Form 78-168
J A dr w- Greiner, Attorney-Irn~~ct - ~ -, _ -
Y {'1VN5YLVANIA 1VA'1'1t1*~~L MUTUAL C;ASUAL'1'Y 1N~)KA1VC,' +' (;UMYANY
Harrisburg, Pennsylvania
POWER OF ATTORNEY
Know All Men By these Presents, That PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY, a
corporation of the Commonwealth of Pennsylvania, does hereby make, constitute and appoint
J. ANDREW GREINER, ALFRED L. STEELE, J ARNE FORNEY, J. BRADFORD FORNEY, JOSHUA B. LEAMAN AND
JUSTIN D. LEAMAN, ALL OF LANCASTER, PENNSYLVANIA (EACH)
its true and lawful Attorneys}in-Fact to make, execute, seal and deliver for and on its behalf as surety as its act and deed:
ANY AND ALL BONDS AND UNDERTAKINGS PROVIDED THE AMOUNT OF NO ONE BOND OR UNDERTAKING
EXCEEDS THE SUM OF FIVE HUNDRED THOUSAND DOLLARS 0500,000)--------- --~_~~_
ALL POWER AND AUTHORITY HEREBY CONFERRED SHALL HEREBY EXPIRE AND TERMINATE WITHOUT NOTI
AT MIDNIGHT OF THE 31 ~ DAY OF OCTOBER 2005, AS RESPECTS EXECUTION SUBSEQUENT THERETO.
And the execution of such bonds in pursuance of these presents shall be as binding upon said Company as fully and amply, to ali
intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the Company at its
office in Harrisburg Pennsylvania, in their own proper persons.
This appointment is made by and under the authorization of a resolution adopted by the Board of Directors of the Company on
October 24, 1973 at Harrisburg, Pennsylvania, which resolution is shown on the reverse side hereof and is now in full force and
In Witness Whereof: PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY has caused these
presents to be signed and its corporate seal to be affixed on OCTOBER 11, 2002
• ~y~'r~~
f`~"~
~R9tt !~
t i~ ~
Kenneth R. Shuns, Executive Vice-President, Secretary & General
' commonwealth of Pennsylvania, County of Dauphin - ss:
Jn OCTOBER 11, 2002, before me appeared Kenneth R. Shuns to me personaily known, who being by me duly sworn, did say ~
ie resides in the Commonwealth of Pennsylvania, that he is Executive Vice-President, Secretary & General Counsel of
'ENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY, That he is the individual described in and v
;xecuted the preceding instrument, and that the seal affixed on said instrument is the corporate seal of said Company, and that said
nstrument was signed and sealed on behalf of said Company by authority and direction of said Company, and the said office
tcknowledged said instrument to be the free act and deed of said Company.
~~~~
~~•~ ~ . ~a
~.
Notary Public
;ommonwealth of Pennsylvania, County of Dauphin - ss: Notarial Seal
lacqudine A. Ellis, Notary Public " ~ ~ " `
City Of Harrisburg, Dauphin Cowtty
My Commission Expires Dec. 19, 2005 . - _ 1j~- ~~
Member, Pamsylvania Association ofNotanes -- -'~
Michael F. Greer, Vice President, Surety & Fidelity of the PENNSYLVANIA NATIONAL MUTUAL CASUAL.~1~t~r~JRA~fCI
;OMPANY, a corporation of the Commonwealth of Pennsylvania, do hereby certify that the above and foregoing is a ""true end corre:
opy of a Power of Attorney, executed by the said Company, which is still in full force and effect. - . - . -
n Witness Whereof, I have hereunto set my hand and affixed the corporate said Cor~pan - ~~,. !rt ~~o~ __ ~~.
!" ! v
PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMP.
~~~-~
IMPORTANT NOTICE: This border must be RED in color. If it is not D, this is not a certii"ied copy. ~h e us at Area Code 717-255-6870. -
78-1.90 (Rev 05/02) / -
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Dan Monvi lle ._ _ _. ~_. _ _ _ ._ _ __ ._..__ ._ __, _ _ _. _ _. ~. __ .~ __ ,_ r. _ ___ _.. _ _ ._ ~._ .._.~.._.....__.._ __. _ _ _ ._ .__ ._ w. .
From: fan Monvi~ie
Sent; Tuesday, October 13, 20C91C:19 Ate
To: 'Gierka(Gctu'~102~IebcnC~r org`
Cc: J. Andrew Greiner
Subjeck: PENNSYLVANIA Gt)ARD~ANSHIP ASStJGIAT;ON INC - GU,~RCIAN 0~ MARY H FAMA - 8onc#~ S8~1312860
ImportancQ: 4N~h
Attachments :0490 .pdf
Tracking: Rec'p'ie~ Del~ytry
'ClerkofCcu; r~ ]OZtale~rnty,org`
J. A~drety Grei~~ Delivered: LOjl3;1ZQ09 iC:19 AM
PEhNSY~VANIA GJARC~ANSHfR
ASSOCIATION INC
GUARDIAN OF AtA~Y H FAl11A
2~3 WABANK RD
LANCASTER PA 178G3
Please provide a release for the subject band at your earliest conwenienc$_
Thank you,
D,:n Monviile %ISR
Aecourt Ma~aQe~
3Cf Grouo
2~ 0' C3re8on Pace. Suite 3rJ0
Lancaster. PA 17601-4604
'hcne ;71 ~; SE~J-773D
~cx ('17j 56f~-83E9
a:-mail: Ca~m~~bciD~oup.net
Y~~.h~J.f3~CFGROUP.NET
INSURANCE & BEI~FITS
IN Re: Mary H. Fama :IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA,
(The Estate ofj ORPHANS' COURT DIVISION
NO. 21-2004-0831
IN RE: PETITION FOR THE RELEASE OF FIDUCIARY BOND
ORDERING JUDGE: ~ S \ r ud e
ORDER OF COURT
AND NOW, this ~ ~L r `~ .2009 upon consideration of the PETITION
FOR THE RELEASE OF FIDUCIARY BOND.
IT IS ORDERED THAT PENNSYLVANIA GUARDIANSHIP ASSOCIATION /
BRIAN D. BROOKS IS RELEASED FROM THEIR REQUIREMENT TO CARRY
ANY BOND IN THIS MATTER.
BY THE COURT,
1
8~ ~~ Wd L- 3~0 6~I~
~~"~~~~j
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
In Re: MARY H. FAMA CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-04-0831
CERTIFICATE OF SERVICE OF ORDER
ORDER DATE: 12/04/09
JUDGE'S INITIALS: JWO
TIME STAMP DATE: 12/07/09
IN RE: ORDER OF COURT
SERVICE TO: PA GUARDIANSHIP SERVICES-BRIAN D BROOKS
METHOD OF MAILING:
® USPS
^ RRR
^ HAND DELIVERED
^ OTHER
MAILED: 12/08/09
ENVELOPES PROVIDED BY:
® PETITIONER
^ JUDGE
^ CLERK OF ORPHANS COURT
SERVICE TO:
METHOD OF MAILING:
^ USPS
^ RRR
^ HAND DELIVERED
^ OTHER
MAILED:
ENVELOPES PROVIDED BY:
^ PETITIONER
^ JUDGE
^ CLERK OF ORPHANS COURT
Depu
Clerk Orphans' Court
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DMSION
,...",
(") g
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FILE NO. 2l-2~1 ~
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IN RE: FAMA, MARY R
, an incapacitated person
GUARDIAN OF THE ESTATE ANNUAL REPORT
(20 Pa.C.S.A.5S21 (c))
FROM
10/26/06
TO
10/26/07
1) I am the _ Limited _X_ Plenary Guardian Qf the Estate of my ward, named above.
I was appointed Guardian by Order of the Court dated _10/26/84
_was _X_ was not modified by Court Order (s) dated
. which
2) Is the incapacitated person still living?
YES
If no, answer the foUowing:
(a) Date of Death
(b) Place of Death
(c) Name of Adminstrator/trix or Executor/trix
(d) Date Guardian of the Person filecl the last Annual Report
PLEASE ANSWER THE FOLLOWING QUESTIONS WHETHER THE
INCAPACITATED PERSON IS LIVING OR DECEASED.
3) My initial Inventory was filed on _12/27/04_ and listed a total estate value of.
S 516,393.95
The Inventory listed a total monthly income of S _718.00 _comprised of the foUowing:
SOCIAL SECURITY
4) At the beginning date of this report period, my initial balance on hand was
S 279,003.79
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5) During this reporting period, the foUowing reOeets all sources of income (other than
Social security) reeeived by me for my ward: (Add additional pages of needed)
Date Received
Source of Income
Amount
1. SEE AITACBED ALL DEPOSIT REPORT
6) During this reporting period, the foUowing reOects aU payments I have made for my
ward: (Add additional pages if needed)
Date
To Whom Paid
Reason for Pavment Amount
1. SEE ALL TRANSACTION REPORT
TOTAL
(7) The present principal assets of my ward are:
DescriDtion of Asset
Present Value
1.
2.
PAGA CUSTODIAL ACCOUNT
PERSHING SECURITIES CO.
16,598.65
48,105.69
TOTAL
$
64,704.34
8) The present amount and sources of income for my ward are:
Source of Income
Amount of Income
(Indicate whether (monthly),
Quarterly, annually)
1.
2.
SOCIAL SECURITY
PENSION
758.20
85.86
9) The regular monthly expenses of my ward which I pay are:
To Whom Paid
Amount
1.
2.
3.
SEE AITACHED ALL TRANSACTION REPORT
PA GUARDIANSHIP FEE
MANORCARE CARLISLE
250.00
8,000.00 APPROX.
(10) I have! (have not) (circle one) petitioned the Court for permission to invade principal
to meet the needs of my ward.
(If appliable) The foUowing expenses of my ward have been paid from Drincioal:
To Whom Paid
PUrDOSe
Amount
1.
11) I (have) /have not (circle one) paid myself compensation for services I rendered as
guardian.
The amount I Paid myself totaled $ 3,250.00
Calculated at the foDowing rate: $ 250.00
and was
per week!(month) (circle one).
12) Check the correct response and complete, if appropriate.
_X _There wiD be no need for extraordinary expenditures on behalf of my ward in
the next (U) months.
There wiD be a need for extraordinary expenditures on behalf of my ward in
the next (12) months because:
13) Check the correct response and complete, if appropriate.
A. My ward receives monthly social security benefits directly.
_X _B. I am the designated payee to receive my ward's social security benefits.
C. The designated payee of my ward's social security benefits is
14) Please note any concerns about the incapacitated penon's physical or mental weD
being or the finances that the Court should know.
15) I_X_ am _ am not guardian of the incapacitated penon's penon. Hyes,
report is attached.
I certify under the penalties of perjury that the information contained in this report is
true and correct to the best of my knowledge, information and belief.
&~jl(~
S ATURE
DATE #~/0,?
Name: B~D.BROOKS
Telephone No. 717-299-4568
PENNSYLVANIA GUARDIANSHIP ASSOC. INC.
PO BOX 7295
LANCASTER, PA 17604
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ITEMIZED CATEGORY REPORT
11/ I' 6 Through 10)31' 7
PAGJLCUS-PAGA CUstodial
11/16' 7
Page 1
Date
Num
Pescription
Category
Clr Au\OUIlt
Memo
INCOME/EXPENSE
INCOME
FAMA, MARY
11/ 7' 6 R9764 DEPOSIT
11/ 7' 6 R9765 DEPOSIT
11/ 7' 6 R9766 DEPOSIT
12/ 6' 6 R9475 DBPOSIT
12/ 6' 6 R9476 DEPOSIT
12/ 6' 6 R9477 DEPOSIT
1/11' 7 R9582 DEPOSIT
1/11' 7 R9583 DEPOSIT
1/11' 7 R9584 DEPOSIT
1/11' 7 R9585 DEPOSIT
1/11' 7 R9586 DEPOSIT
2/12' 7 R1585 DEPOSIT
2/12' 7 R1586 DEPOSIT
2/12' 7 R1587 DEPOSIT
3/12' 7 R1697 DEPOSIT
3/12' 7 R1698 DEPOSIT
3/12' 7 R1699 DEPOSIT
4/12' 7 R1812 DEPOSIT
4/12' 7 R1813 DEPOSIT
4/12' 7 R1814 DEPOSIT
5/14' 7 R1943 DEPOSIT
5/14' 7 R1944 DEPOSIT
5/14' 7 R1945 DEPOSIT
5/14' 7 R1946 DEPOSIT
5/14' 7 R1947 DEPOSIT
6/14' 7 R2086 DEPOSIT
6/14' 7 R2087 DEPOSIT
6/14' 7 R2088 DEPOSIT
6/14' 7 R2089 DEPOSIT
6/14' 7 R7262 DEPOSIT
7/11' 7 R7310 DEPOSIT
7/11' 7 R7311 DEPOSIT
7/11' 7 R7312 DEPOSIT
8/ 8' 7 R6653 DEPOSIT
8/ 8' 7 R6654 DEPOSIT
8/ 8' 7 R6655 DEPOSIT
9/ 7' 7 R6770 DEPOSIT
9/ 7' 7 R6771 DEPOSIT
9/ 7' 7 R6772 OEPOSIT
SSDI
PENSION
INTEREST
SSDI
PENSION
DIVIDEND
DIVIDEND
REFUND
PENSION
INTEREST
SSDI
SSDI
INTBRBST
PENSION
SSDI
INTEREST
PENSION
PENSION
SSDI
INTEREST
DIVIDEND
SSDI
INSURANCE
PENSION
DISBURSEMENT
SSDI
INTEREST
REFUND
CLOSE ACCT
PENSION
. SSDI
PENSION
INTEREST
SSDI
PENSION
INTEREST
PENSION
INTEREST
SSDI
FAMA,MARY/SSDI X
FAMA,MARY/PENSI X
FAMA,MARY/INTER X
FAMA,MARY/SSDI X
FAMA, MARY/PENSI X
FAMA,MARY/DIVID X
FAMA,MARY/DIVID X
FAMA, MARY/REFUN X
FAMA,MARY/PENSI X
FAMA, MARY/INTER X
FAMA,MARY/SSDI X
FAMA,MARY/SSDI X
FAMA,MARY/INTER X
FAMA, MARY/PENS I X
FAMA,MARY/SSDI X
FAMA,MARY/INTBRX
FAMA,MARY/PENSI X
FAMA,MARY/PENSI X
FAMA,MARY/SSDI X
FAMA, MARY/INTER X
FAMA,MARY/DIVID X
FAMA,MARY/SSDI X
FAMA,MARY/INSUR X
FAMA,MARY/PENSI X
FAMA,MARY/DIVID X
FAMA,MARY/SSDI X
FAMA, MARY/INTER X
FAMA,MARY/REFUN X
FAMA, MARY X
FAMA,MARY/PENSI X
FAMA,MARY/SSDI X
FAMA, MARY /PENSI X
FAMA,MARY/INTER X
FAMA,MARY/SSDI X
FAMA, MARY/PENS I X
FAMA,MARY/INTER X
FAMA,MARY/PBNSI
FAMA,MARY/INTBR
FAMA,MARY/SSDI
TOTAL FAMA, MARY
TOTAL INCOME
TOTAL INCOME/EXPENSE
f /16A au;f.
-r /vto~ 9/t)'
()2f ~ tb
739.90
85.86
4.81
739.90
85.86
4.77
36.10
250.00
85.86
4.84
758.20
758.20
11.35
85.86
758.20
22.35
85.86
85.86
758 -40
.fi~
4.'
75&._.
3,551.16
85.86
150,000.00
758.20
4.43
65.29
4,623.88
85.86
758.20
85.86
4.57
758.20
85.86
4.28
85.86
4.38
758.20
167,855.04
167,855.04
167,855.04
PAGAC07-PAGATEMP
11/16' 7
Date
10/15' 7
10/15' 7
10/15' 7
10/15' 7
10/15' 7
Num
I
ITEMIZED CATEGORY REPORT
1/ l' 0 Through 10/31' 7
Description
INCOME/EXPENSE
INCOME
FAMA, MARY
R8710
R8711
R8712
R8713
R8714
DEPOSIT
DEPOSIT
DEPOSIT
DEPOSIT
DEPOSIT
TOTAL INCOME
TOTAL FAMA,MARY
TOTAL INCOME/EXPENSE
Memo
SSDI
BANK TRANSFER
DIVIDEND
PENSION
BANK TRANSFER
Category
FAMA,MARY/SSDI X
FAMA,MARY/BANK T X
FAMA,MARY/DIVIDE X
FAMA,MARY/PENSIO X
FAMA,MARY/BANK T X
-f
Page 1
Clr Amount
758.20
49,000.00
10.94
85.86
26,000.00
75,855.00
75,855.00
75,855.00
I~ 7 I 3)6./)'{
--,ij ;;-f5/ 7/tJ. t) r
7iV~ /'
PAGA_CUS-PAGA CUstodial
11/16' 7
ITEMIZED CATEGORY REPORT
11/ l' 6 Through 10/31' 7
Date
Num
Description
Memo
Category
INCOME/EXPENSE
INCOME
FAMA,MARY
12/ l' 6 9525 S PAGA GENERAL ACCOU 10-12/06
1/25' 7 9849 S PAGA GENERAL ACCOO 1-2
5/ 8' 7 10495S PAGA GENERAL ACCOO 3-5/07
8/ 2' 7 11072S PAGA GENERAL ACCO06-8/07
FAMA, MARY /GOARDIA X
FAMA,MARY/GOARDIA X
FAMA,MARY/GOARDIA X
FAMA,MARY/GOARDIA X
TOTAL FAMA,MARY
TOTAL INCOME
TOTAL INCOME/EXPENSE
oJJ} ~~ f~
f~ q/o 7
Page 1
Clr Amount
-750.00
-500.00
-750.00
-750.00
-2,750.00
-2,750.00
-2,750.00
PAGAC07-PAGATBMP
11/16' 7
ITEMIZED CATEGORY REPORT
1/ l' 0 Through 10/31' 7
Date
Num
Description
Memo
INCOME/EXPENSE
INCOME
FAMA, MARY
9/20' 7 11407S PAGA GENERAL ACCT 9-10/07
TOTAL FAMA, MARY
TOTAL INCOME
Category
Page 1
Clr Amount
FAMA,MARY/GDN FE X -500.00
-500.00
TOTAL INCOME/EXPENSE
pll GA
9 -r / 0 /0 7
~
-500.00
-500.00
?-, 7?O. trO
~r:J~o.tJQ
1~t
~
ITEMIZED CATEGORY REPORT
1/ l' 0 Through 10/31' 7
PAGAC07-PAGATEMP Page 1
11/16' 7
Date Num Description Memo Category Clr Amount
INCOME/EXPENSB
INCOME
FAMA, MARY
8/21' 7 11217 ALICIAL STONBROAD MARY FAMA FAMA,MARY/COST 0 X -1,128.00
8/28' 7 11244 ROSA LUClOON FAMA,MARY/COST 0 X -2,371.50
8/28' 7 11248 IDA ANDERSON FAMA,MARY/COST 0 X -420.00
9/ 6' 7 11278S LANA HOOVER FAMA,MARY/COST 0 X -360.00
9/ 6' 7 11288 ROSA LUClOON FAMA,MARY/COST 0 X -1,003.00
9/ 6' 7 11293 ALICIAL STONBROAD MARY FAMA FAMA,MARY/COST 0 X -1,060.50
9/10' 7 BEGINNING BALANCE FAMA,MARY/BBGINN X -19,252.67
9/14' 7 11325 ALICIAL STONBROAD MARY FAMA FAMA,MARY/COST 0 X -1,029.50
9/14' 7 11347 HEARTLAND PHARMACY MARY FAMA FAMA, MARY/MEDICA X -477.33
9/14' 7 11357 HIGHMARK BLUE SHIB MARY H. FAMA FAMA,MARY/INSURA X -244.40
9/14' 7 11385 MANORCARB CARLISLE MARY FAMA FAMA,MARY/COST 0 X -8,188.17
9/14' 7 11386 MANORCARB CARLISLE MARY FAMA R FAMA,MARY/PERSON X -500.00
9/14' 7 11389 ROSA LUClOON MARY FAMA FAMA,MARY/COST 0 X -1,122.00
9/20' 7 11407S PAGA GENERAL ACCT 9-10/07 FAMA,MARY/GDN FE X -500.00
9/26' 7 11448 IDA ANDERSON MARY FAMA FAMA,MARY/COST 0 X -420.00
9/26' 7 11452 HAMPDEN CLBANBRS MARY FAMA FAMA,MARY/FINACI X -329.42
9/26' 7 11453S WACHOVIA BANK STORAGB UNIT FAMA,MARY/FINACI X -30.74
9/27' 7 11456 ROSA LUClDON MARY FAMA FAMA,MARY/COST 0 X -1,428.00
9/27' 7 1.1458S LANA HOOVER PRIVATE DUTY FAMA,MARY/COST 0 X -360.00
9/27' 7 1.1.459 ROSA LUCIDON .MARY FAMA FAMA,MARY/COST 0 X -1,360.00
9/27' 7 11482S LANA HOOVER PRIVATE DUTY FAMA,MARY/COST 0 X -360.00
10/ 3' 7 1.1506 TAMMY STODDARD MARY FAMA FAMA,MARY/COST 0 X -294.00
10/ 8' 7 1.1522 TAMMY STODDARD MARY FAMA FAMA,MARY/COST 0 X -504.00
10/ 8' 7 1.1524 ROSA LUClOON MARY F.AMA F.AMA,MARY/COST 0 X -399.50
10/11' 7 11.547 HEARTLAND PHARMACY MARY FAMA FAMA,MARY/MBDlCA X -344.15
10/1.1' 7 1.1.569 HAMPDEN CLBANBRS MARY FAMA FAMA,MARY/FINACI X -333.20
10/11' 7 11588 ALICIAL STONBROAD MARY FAMA FAMA,MARY/COST 0 X -1,1.13.00
1.0/11' 7 1.1595 MANORCARB CARLISLE MARY FAMA F.AMA,MARY/COST 0 X -7,960.30
10/15' 7 11.632 TAMMY STODDARD MARY FAMA FAMA,MARY/COST 0 X -462.00
10/151 7 R8710 DEPOSIT SSDI FAMA,MARY/SSDI X 758.20
10/1.5' 7 R8711 DBPOSIT BANK TRANSFER FAMA,MARY/BANK T X 49,000.00
10/15' 7 R87i2 DBPOSIT DIVIDEND FAMA,MARY/DIVIDB X 10.94
10/15' 7 R871.3 DBPOSIT PENSION FAMA,MARY/PENSIO X 85.86
10/15' 7 R8714 DBPOSIT BANK TRANSFER FAMA,MARY/BANK T X 26,000.00
10/16' 7 11639S LANA HOOVER PRIVATE DUTY FAMA,MARY/COST 0 X -360.00
1.0/16' 7 11648 ALICIAL STONBROAD MARY FAMA FAMA,MARY/COST 0 X -1.,022.00
10/16' 7 1.1655 JODIB LOMISON MARY FAMA FAMA, MARY/MEDICA X -238.00
10/17' 7 1.1662S BRIAN D.BROOKS FAMA,MARY/TOLL X -0.75
1.0/19' 7 11668S WACHOVIA BANK STORAGB UNIT FAMA, MARY/FlNACr X -30.74
10/23' 7 11710 TAMMY STODDARD MARY FAMA FAMA,MARY/COST 0 X -497.00
10/251 7 11735 ALICIAL STONBROAD MARY FAMA FAMA,MARY/COST 0 -910.50
10/25' 7 11741 IDA ANDERSON MARY FAMA FAMA,MARY/COST 0 -385.00
10/29' 7 11745 TAMMY STODDARD MARY FAMA FAMA,MARY/COST 0 -448.00
10/29' 7 11749 BCF GROUP MARY FAMA SB3 FAMA, MARY/BOND -1,610.00
10/30' 7 11753S LANA HOOVER PRIVATE DUTY FAMA,MARY/COST 0 -360.00
10/30' 7 11753S LANA HOOVER PERSONAL NEED FAMA,MARY/PERSON -38.98
()Jj ~ /116-11
ITEMIZED CATEGORY REPORT
4/ l' 7 Through 8/31' 7
PAGA.-CUS-PAGA CUstodial
11/16' 7
Date Num
Description
Category
Memo
7/29 11035 ROSA LUCIOON MARY FAMA FAMA,MARY X
7/29 11036S LANA L. HOOVER, LPN PRIVATE NURSB FAMA,MARY/PBRSON X
7/29 11050 ALICIA STONBROAD MARY H. FAMA N FAMA, MARY/FlNACI X
8/ 2 11072S PAGA GENERAL ACCOUN 6-8/07 FAMA,MARY/GUARDI X
8/ 7 11095S LANA L. HOOVER, LPN PRIVATE:NURSB FAMA,MARY/PBRSON X
8/ 7 11097 MANORCARB CARLISLE MARY FAMA FAMA,MARY X
8/ 7 11108 ROSA LUClOON MARY FAMA FAMA,MARY X
8/ 8 R6653 DBPOSIT SSDI FAMA,MARY/SSDI X
8/ 8 R6654 DEPOSIT PENSION FAMA,MARY/PENSIO X
8/ 8 R6655 DBPOSIT INTEREST FAMA,MARY/INTBRB X
8/13 11129S WACHOVIA VISA PERSONAL NEEDS FAMA, MARY/PERSON X
8/13 11130S WACHOVIA VISA STORAGB UNIT FAMA,MARY/PERSON X
8/14 11148 HEARTLAND PHARMACY MARY FAMA 105 FAMA,MARY/MEDlCA X
8/14 11152 ROSA LUCIOON MARY FAMA FAMA,MARY X
8/14 11170S HAMPDEN CLBANBRS FAMA,MARY/FlNACI X
8/21 11215S LANA L. HOOVER, LPN PRIVATE NURSB FAMA,MARY/PERSON X
8,'1~ .l~J..&., Jd..lCa a..~.~..;3lllB IIARY H. 1___ ft J."~, --....,.1'111Jl~81
A /7 A. ......, A A ~ R.Q8JIl. l!li8l!lIJVft PMth, IVIilY
8/89 !U.!44.! Avmc l:itJL.1.00.R JfM~,ruuu
""'Ii I/lii- ikillIiU.i. 1M 'M.Bft881~ - PfII<<l' 1'M11'. iWIIl' . MNlV,'i'BBelf
. ..
TOTAL FAMA,MARY
TOTAL INCOME
TOTAL INCOME/EXPENSE
tnt~~
ail
Page 3
Clr Amount
-981.75
-1,200.00
-1,158.00
-750.00
-1,060.00
-8,011.51
-1,024.25
758.20
85.86
4.28
-30.74
-30.74
-654.32
-841..50
-327.49
-1,200.00
1.1"1r iQ
1.~Jg.gO
811 IiQ
li9.88
~
.i1
-
ITEMIZED CATEGORY REPORT
4/ l' 7 Through 8/31' 7
PAGlLCUS-PAGA Custodial
11/16' 7
Date Hum
Description
Memo
Category
Clr Amount
5/15 10568S LANA L. HOOVER, LPN PRIVATE NURSE FANA,MARY/PBRSON X
5/21 10578 IDA ANDBR,SON MARY FANA FAMA,MARY/MBDlCA X
5/21 10582 ALICIA STONBROAD MARY H.FANA N FANA,MARY/FlNACI X
5/24 10594 ALICIA STONBROAD MARY H.FAMA N FAMA,MARY/FlNACI X
6/ 1 10615S HALL SERVICES SOCIAL SERVICE FANA,MARY/FlNACI X
6/ 5 10626S LANA L. HOOVER, LPN PRIVATE NURSE FANA,MARY/PERSON X
6/ 5 10632 LINKS 2 CARE MARY H. FANA FANA,MARY/MBDlCA X
6/ 5 10638S ROSA LUClOON FANA,MARY X
6/ 5 10638S ROSA LUClOON FANA,MARY X
6/ 5 10649 LINKS 2 CARE MARY H. FANA FAMA,MARY/MEDlCA X
6/ 7 10658 ALICIA STONBROAD MARY H.FAMA N FAMA,MARY/FINACI X
6/ 8 10677 HAMPDEN CLBANBRS MARY FANA PANA,MARY/FlNACI X
6/ 8 10686 MANORCARE CARLISLE MARY FANA FAMA,MARY X
6/ 8 10693 LINKS 2 CARE MARY H. FANA FANA,MARY/MEDlCA X
6/ 8 10703 NATIONAL RECOVERY A MARY FANA 132 FAMA,MARY/TRANSP X
6/11 10711 LINKS 2 CARE MARY H. FANA FAMA,MARY/MEDlCA X
6/1+ 10713 ROSA LUClDON MARY FAMA FANA,MARY X
6/11 10714 HEARTLAND PHARMACY MARY FAMA 10 FANA, MARY/MEDICA X
6/13 10720 ROSA LUCIOON MARY FANA FANA,MARY X
6/13 10730 GUIS'lWlTE FAMILY PR MARY H. FANA PANA,MARY/MEDICA X
6/14 R2086 DBPOSIT SSDI FANA,MARY/SSDI X
6/14 R2087 DEPOSIT INTBRBST FAMA,MARY/INTBRB X
6/14 R2088 DEPOSIT REFUND FANA,MARY/REFUND X
6/14 R2089 DBPOSIT CLOSB ACCT FANA,MARY X
6/14 R7262 DEPOSIT PENSION FAMA,MARY/PBNSIO X
6/17 10747 LINKS 2 CARE MARY H. FANA FANA,MARY/MBDlCA X
6/17 10750 ROSA LUClOON MARY FANA FANA,MARY X
6/17 107588 LANA L. HOOVBR, LPN PRIVATE NURSB FANA,MARY/PERSON X
6/25 10782 LINKS 2 CARE MARY H. FANA FAMA,MARY/MBDlCA X
6/25 10799S LANA L. HOOVER, LPN PRIVATE N'pRSB FAMA,MARY/PBRSON X
6/28 10817S HALL SERVICES FANA,MARY/PROFBS X
6/28 10817S HALL SERVICES FANA, MARY/PROPES X
7/ 9 10830S BRIAN D. BROOKS POSTAGB FAMA,MARY X
7/10 10850 MANORCARE CARLISLE MARY FANA FANA,MARY X
7/10 10854 ROSA LUClOON MARY FANA FANA,MARY X
7/10 10858 IDA ANDBRSON MARY FANA FAMA,MARY/MBDlCA X
7/10 10868S ROSA LUClDON FANA,MARY X
7/10 10868S ROSA LUClOON FAMA,MARY X
7/10 10870 LINKS 2 CARE MARY H. FAHA FAHA,MARY/MBDlCA X
7/10 10871 ALICIA STONBROAD MARY H.FAHA N FAMA,MARY/FINACI X
7/10 10881S LANA L. HOOVER, LPN PRIVATE NURSB FAMA,MARY/PER80N X
7/11 R7310 DBPOSIT SSDI FAMA,MARY/SSDI X
7/11 R7311 DEPOSIT PENSION FANA,MARY/PENSIO X
7/11 R7312 DEPOSIT INTEREST FANA,MARY/INTERB X
7/16 10904 HAMPDEN CLBANBRS MARY PANA FANA, MARY/PlNACI X
7/16 10911 HIGHMARK BLUE SHIBL MARY H. FANA FANA,MARY/INSURA X
7/16 10942 HEARTLAND PHARMACY MARY FANA 10 FANA, MARY/MEDICA X
7/16 10943 IDA ANDERSON MARY PANA FANA,MARY/MEDlCA X
7/16 10957 LINKS 2 CARE MARY H. FANA FANA,MARY/MEDlCAX
7/16 10960S LANA L. HOOVER, LPN PRIVATE NURSE FANA,MARY/PBRSON X
7/18 10968 ROSA LUClOON MARY FANA FAMA,MARY X
7/29 11015 ROSA LUClOON MARY FANA FAMA,MARY X
Page 2
"'360.00
-420.00
-932.00
-888.00
-1,624.36
-500.00
-423.90
-973.25
-926.50
-537.98
-1,068.00
-389.81
-7,473.51
-451.13
-255.47
-396.64
-722.50
-65.47
-850.00
-131.00
758.20
4.43
65.29
4,623.88
85.86
-57.04
-952.00
-360.00
-140.40
-472.50
-537.40
-367.60
-0.63
-7,960.30
-1,292.00
-700.00
-1,088.00
-824.50
-140.40
-1,085.00
-990.00
758.20
85.86
4.57
-268.99
-244.40
-237.85
-210.00
-140.40
-675.00
-1,224.00
-1,343.00
PAGA.-CUS-PAGA CUstodial
11/16' 7
ITEMIZED CATEGORY REPORT
4/ l' 7 Through 8/31' 7
Date Num.
Description
Memo
Category
INCOME/EXPENSB
INCOME
FAMA, MARY
4/ 3 102568 PLATINUM PLUS POR B PERSONAL NEEDS PAMA,MARY/PINACI X
4/ 4 10258S HALL SERVICES SOCIAL SERVICE PAMA, MARY/PIDCI X
4/11 10286 LINKS 2 CARE MARY H. PAMA FAMA,MARY/MEDICA X
4/11 10290 MANORCARE CARLISLE MARY PAMA PAMA, MARY X
4/11 10298 ALICIA STONBROAD MARY H.PAMA N FAMA,MARY/FINACI X
4/11 10299 ROSA LUCIDON MARY FAMA FAMA,MARY X
4/11 10301S LANA L. HOOVER, LPN PRIVATE NURSB PAMA,MARY/PBRSON X
4/11 10325 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDlCA X
4/12 R1812 DBPOSIT PENSION FAMA,MARY/PENSIO X
4/12 R1813 DBPOSIT SSDI FAMA,MARY/SSDI X
4/12 R1814 DBPOSIT INTEREST FAMA,MARY/INTERE X
4/12 10328S PLATINUM PLUS FOR B FAMA,MARY/FlNACI X
4/22 10352 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDlCA X
4/22 10356S LANA L. HOOVER, LPN PRIVATE NURSB PAMA,MARY/PERSON X
4/22 10357 LINKS 2 CARE MARY H. FAMA PAMA,MARY/MEDICJ\. X
4/22 10362 ROSA LUClDON MARY PAMA PAMA,MARY X
4/22 10363 HAMPDEN CLEANERS MARY FAMA FAMA, MARY/FlNACI X
4/22 10376 ROSA LUClDON MARY FAMA FAMA,MARY X
5/ 1 10398 ROSA LUCIDON MARY FAMA FAMA,MARY X
5/ 1 10402 ALICIA STONBROAD MARY H.PAMA N FAMA,MARY/FlNACI X
5/ 1 10441 PINNACLB HEALTH BMB MARY H.FAMA FAMA,MARY/MEDlCA X
5/ 1 10442 QUANTUM IMAGING & T MARY H.PAMA PAMA,MARY/MEDlCA X
5/ 1 10443 HOLY SPIRIT HOSPITA MARY H.PAMA FAMA,MARY/MBDlCA X
5/ 1 10444 UROLOGY OF CENT. PA MARY H. FAMA FAMA,MARY/MBDlCA X
5/ 1 10445 HEARTLAND PHARMACY MARY FAMA 105 FAMA,MARY/MBDlCA X
5/ 1 10446 NATIONAL RECOVERY A MARY FAMA FAMA,MARY/MBDICA X
5/ 1 10450 LINKS 2 CARE MARY H. PAMA FAMA,MARY/MEDlCA X
5/ 1 10452S LANA L. HOOVER, LPN PRIVATE NURSB FAMA,MARY/PBRSON X
5/ 2 10465 HEARTLAND PHARMACY MARY PAMA 10 PAMA,MARY/MBDICA X
5/ 3 10466S HALL SERVICES PAMA,MARY/PlNACI X
5/ 8 10475 ROSA LUClDON MARY PAMA PAMA,MARY X
5/ 8 10476 HOSPITAL TELEPHONE MARY PAMA FAMA,MARY/PlNACI X
5/ 8 10477 HOLY SPIRIT HOSPITA MARY H.PAMA PAMA,MARY/MBDlCA X
5/ 8 10478 AMERICAN HOME MEDIC MARY PAMA CHB PAMA,MARY/MBDlCA X
5/ 8 10495S PAGA GENERAL ACCOUN' 3-5/07 PAMA,MARY/GUARDI X
5/10 10500 HIGHMAR.K BLUE SHIBL MARY H. FAMA FAMA,MARY/INSURA X
5/10 10516 IDA ANDERSON MARY PAMA PAMA,MARY/MBDlCA X
5/10 10530 MANORCARE CARLISLE MARY PAMA FAMA,MARY X
5/10 10540 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
5/14 R1943 DEPOSIT DIVIDEND PAMA,MARY/DIVIDB X
5/14 R1944 DBPOSIT SSDI FAMA,MARY/SSDI X
5/14 R1945 DBPOSIT INSURANCE FAMA,MARY/INSURA X
5/14 R1946 DEPOSIT PENSION PAMA,MARY/PENSIO X
5/14 R1947 DBPOSIT DISBURSEMENT FAMA,MARY/DIVIDB X
5/14 10551S PLATINUM PLUS FOR B PERSONAL NEEDS FAMA,MARY/PlNACI X
5/15 10553 LINKS 2 CARE MARY H. FAMA PAMA,MARY/MBDlCA X
5/15 10563 HAMPDEN CLEANERS MARY FAMA PAMA,MARY/FlNACI X
Page 1
Clr Amount
-360.00
-1,334.40
-564.30
-7,857.00
-1,068.00
-1,530.00
-360.00
-564.30
85.86
758.20
4.34
-67.24
-544.32
-360.00
-573.08
-850.00
-324.21
-833.00
-8a.OO
-1,0110.00
-60.60
-14.92
-112.00
-65'.29
-51.34
-727.77
-599.40
-405.00
-871.29
-1,345.20
-850.00
-76.00
-112.00
-238.68
-750.00
-244.40
,..350.00
-7,854.30
-564.30
4.43
758.20
3,557.16
85.86
150,000.00
-1,259.85
-564.30
-298.38
ITEMIZED CATEGORY REPORT
11/ 11 6 Through 3/311 7
PAGA_COS-PAGA CUstodial
11/16' 7
Date Hum
3/191 7 10177
3/191 7 10181
3/20' 7 10195
3/201 7 10198
3/20' 7 10200
3/26' 7 10138
3/27' 7 10144
3/28' 7 10236
3/28' 7 10237
3/291 7 10239
Description
Memo
Category
LINKS 2 CARE MARY H. FJ\MA FAMA,MARY/MEDlCA x
MET-LIFE MARY FAMA PO FAMA,MARY/INSURA X
HAMPDEN CLBANBRS MARY PAMA FAMA,MARY/FlNACI X
LANA L. HOOVER, LP MARY HELEN FA FAMA, MARY /PBRSON X
LANA L.' HOOVER, LP MARY HELEN FA FAMA,MARY/PBRSON X
ROSA LUClDON MARY FAMA PAMA,MARY X
MARY FAMA C/O MANO MARY FAMA FAMA,MARY/PBRSON X
LINKS 2 CARE MARY H. FAMA FAMA,MARY/MEDICA X
ALICIA STONBROAD MARY H.PANA PAMA,MARY/PlNACI X
IDA ANDERSON MARY PAMA PAMA, MARY/MEDICA X
TOTAL INCOME
TOTAL FAMA,MARY
TOTAL INCOME/EXPENSB
w
Page 3
Clr Amount
-843.08
-23.30
-338.63
-360.00
-350.00
-1,768.00
-200.00
-404.40
-940.00
-420.00
AJ
v
"
,~
ITEMIZED CATEGORY REPORT
11/ l' 6 Through 3/31' 7
PAGA_CUS-PAGA Custodial
11/16' 7
Date
1/ 8'
1/ 8'
1/ 8'
1/ 9'
1/ 9'
1/11'
1/11'
1/11'
1/11'
1/11'
1/22'
1/23'
1/23'
1/23'
1/23'
1/23'
1/24'
1/25'
1/29'
1/30'
1/31'
2/ 5'
2/ 8'
2/12'
2/12'
2/12'
2/19'
2/19'
2/19'
2/19'
2/19'
2/19'
2/20'
2/20'
2/20'
2/23'
2/28'
2/28'
2/28'
2/28'
2/28'
3/ 6'
3/ 6'
3/ 8'
3/12'
3/12'
3/12'
3/12'
3/12'
3/12'
3/19'
3/19'
Page 2
Num
Description
Memo
Category
Clr Amount
7 9730 MANORCARB CARLISLE MARY FAMA FAMA,MARY X
7 9737 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
7 9739 ROSA LUClOON MARY FAMA FAMA,MARY X
7 9756 ROSA LUClDON' MARY FAMA FAMA,MARY X
7 9761 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PBRSON X
7 R9582 DBPOSIT D!VIDEND FAMA,MARY/DIVIDB X
7 R9583 DBPOSIT REFUND FAMA,MARY/REFUND X
7 R9584 DBPOSIT PENSION FAMA,MARY/PENSIO X
7 R9585 DBPOSIT INTBRBST FAMA, MARY/INTBRB X
7 R9586 DBPOSIT SSDI PAMA,MARY/SSDI X
7 9811 ROSA LUClDON' MARY FAMA FAMA,MARY X
7 9822. ROSA LUClDON MARY FAMA FAMA,MARY X
7 9823 HAMPDEN CLBANBRS MARY FAMA FAMA,MARY/FINACI X
7 9826 HIGBMARK BLUE SHIB MARY H. FAMA FAMA,MARY/INSURA X
7 9830 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
7 9837 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
7 9840 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X
7 9849 S PAGA GENERAL ACCOU 1-2 FAMA,MARY/GUARDI X
7 9854 ROSA LUCIDON MARY FAMA FAMA,MARY X
7 9851 S PLATINUM PLUS FOR PERSONAL NEED FAMA,MARY/FlNACI X
7 9884 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
7 9919 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
7 9926 S PLATINUM PLUS FOR PERSONAL NEED FAMA,MARY/FlNACI X
7 R1585 DBPOSIT SSDI FAMA,MARY/SSDI X
7 R1586 DBPOSIT INTBRBST FAMA,MARY/INTBRB X
7 R1587 DBPOSIT PENSION FAMA,MARY/PENSIO X
7 9941 S ROSA LUClOON FAMA,MARY X
7 9941 S ROSA LUCIDON FAMA,MARY X
7 9942 ALICIA STONBROAD MARY H.FAMA FAMA,MARY/FlNACI X
7 9944 MANORCARE CARLISLE MARY FAMA FAMA, MARY X
7 9965 LANA L. HOOVER, LP MARY H8LBN FA FAMA,MARY/PBRSON X
7 9971 IDA ANDERSON MARY FAMA FAMA,MARY X
7 9976 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
7 9992 HAMPDEN CLBANBRS MARY FAMA FAMA, MARY /FlNACI X
7 9993 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
7 10010S HALL SERVICES SOCIAL SBRVIC FANA,MARY/FINACI X
7 10027 IDA ANDERSON MARY FAMA FAMA, MARY/MEDICA X
7 10028 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
7 10029 ROSA LUClOON MARY FAMA FAMA,MARY X
7 10033 ROSA LUCIOON MARY FAMA FAMA,MARY X
7 10040 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PBRSON X
7 10059 ALICIA STONBROAD MARY H.FAMA FAMA,MARY/FINACI X
7 10060 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
7 10091 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PBRSON X
7 R1697 DBPOSIT SSDI FAMA,MARY/SSDI X
7 R1698 DBPOSIT INTEREST FAMA,MARY/INTBRB X
7 R1699 DBPOSIT PENSION FAMA,MARY/PBNSIO X
7 10112 HIGBMARK BLUE SHIB MARY H. FAMA FAMA,MARY/INSURA X
7 10115 ROSA LUClOON MARY FAMA FAMA,MARY X
7 10125 MANORCARE CARLISLE MARY FAMA FAMA, MARY X
7 10159S PLATINUM PLUS FOR FAMA,MARY/FINACI X
7 10168 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
aD
-19,800.20
-1,391.07
-1,326.00
-612.00
-675.00
36.10
250.00
85.86
4.84
758.20
-794.00
-488.00
-258.35
-244.40
-1,274.55
-402.00
-835.00
-500.00
-510.00
-269.80
-1,178.33
-902.18
-220.00
758.20
11.35
85.86
-680.00
-425.00
-786.00
-7,783.00
-360.00
-420.00
-1,012.21
-280.06
-856.09
-1,405.20
-420.00
-631.77
-544.00
-646.00
-360.00
-902.00
-941.82
-535.00
758.20
22.35
85.86
-244.40
-1,309.00
-8,118.00
-61.48
-564.30
PAGA_CUS-PAGA CUstodial
11/16' 7
ITEMIZED CATEGORY REPORT
11/ l' 6 Through 3/31' 7
Page 1
Date
Num
Description
Memo
Category . Clr Amount
INCOMB/~PENSB
INCOME
FAMA,MARY
11/ l' 6 9323 S PLATINUM PLUS FOR PERSONAL NEED FAMA,MARY/FlNACI X
11/ l' 6 9323 S PLATINUM .PLUS FOR PERSONAL NEED FAMA,MARY/FIDCI X
11/ 3' 6 9327 ALICIA STONBROAD MARY H.FAMA FAMA,MARY/FlNACI X
11/ 3' 6 9333 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X
11/ 3' 6 9337 METRO MBD SERVICES MARY H. FAMA FAMA,MAR.Y/TRANSP X
11/ 3' 6 9340 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
11/ 6' 6 9352 S BRIAN D. BROOKS POSTAGB FAMA, MARY/POSTAG X
11/ 6' 6 9354 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
11/ 7' 6 R9764 DBPOSIT SSDI FAMA,MARY/SSDI X
11/ 7' 6 R9765 DBPOSIT PENSION FAMA,MARY/PBNSIO X
11/ 7' 6 R9766 DBPOSIT INTEREST FAMA,MARY/~ X
11/10' 6 9395 DARLENE HALL FOR M MOVING BXPBNS FAMA, MARY/PERSON X
11/14' 6 9410 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDICA X
11/14' 6 9414 HAMPDEN CLBANBRS MARY FAMAFAMA,MARY/FlNACI X
11/14' 6 9415 ROSA LUCIDON MARY FAMA FAMA,MARY X
11/14' 6 9417 HIGHMARK BLUE SHIB MARY H. FAMA FAMA,MARY/INSURA X
11/20' 6 9461 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
11/21' 6 9471 LANA L. HOOVER, LP MARY HELEN FA FAMA,MARY/PERSON X
11/21' 6 9485 IDA ANDERSON MARY FAMA FAMA,MARY X
11/27' 6 9489 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
11/29' 6 9504 ROSA LUCIDON MARYFAMA FAMA,MARY X
11/29' 6 9508 LANA L. HOOVER, LP MARY HBLBN FA FAMA.,MARY/PERSON X
11/30' 6 9514 ALICIA STONBROAD MARY H.FAMA FAMA,MARY/FINACI X
12/ l' 6 9525 S PAGA GENERAL ACCOU 10-12/06 FAMA,MARY/GUARDI X
12/ 5' 6 9548 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
12/ 6' 6 R9475 DBPOSIT SSDI FAMA,MARY/SSDI X
12/ 6' 6 R9476 DBPOSIT PENSION FAMA,MARY/PBNSIO X
12/ 61 6 R9477 DBPOSIT DIVIDEND FAMA,MARY/DIVIDB X
12/ 6' 6 9567 S PLATINUM PLUS FOR PERSONAL NEED FAMA,MARY/FIDCI X
12/11' 6 9579 ROSA LUClOON MARY FAMA FAMA,MARY X
12/12' 6 9588 S HALL SERVICES FAMA,MARY/FlNACI X
12/12' 6 9602 LANA L. HOOVER, LP MARY HBLBN FA FAMA,MARY/PERSON X
12/12' 6 9611 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
12/12' 6 9627 HAMPDEN CLBANBRS MARY FAMA FAMA,MARY/FlNACI X
12/131 6 9633 REGISTER OF WILLS MARY FAMA FAMA,MARY X
12/15' 6 9643 ROSA LUClOON MARY FAMA FAMA,MARY X
12/18' 6 9646 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
1/ 3' 7 9681 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
1/ 3' 7 9690 S ROSA LUClOON 12/06 FAMA,MARY X
1/ 3' 7 9690 S ROSA LUClOON 12/31/06 FAMA,MARY X
1/ 3' 7 9696 IDA ANDBRSON MARY FAMA FAMA, MARY X
1/ 3' 7 9698 LINKS 2 CARE MARY H. FAMA FAMA,MARY/MBDlCA X
1/ 3' 7 9703 ALICIA STONBROAD MARY H.FAMA FAMA,MARY/FlNACI X
1/ 3' 7 9706 LANA L. HOOVER, LP MARY HELEN FA FAMA, MARY/PERSON X
1/ 41 7 9716 LANA L. HOOVER, LP MARY HELEN FA FAMA, MARY/PERSON X
1/ 5' 7 9727 S HALL SERVICES SOCIAL SERVIC FAMA.,MARY/FINACI X
1/ 5' 7 9728 S HALL SERVICES SOCIAL SERVIC FAMA,MARY/FlNACI X
rdf
-279.07
-53.00
-833.80
-450.00
-126.95
-2,332.96
-1.35
-2,848.51
739.90
85.86
4.81
-750.00
-2,449.21
-282.40
-765.00
-244.40
-2,103.51
-630.00
-262.50
-1,970.33
-788.3ft
-450.00
-783.38
-750.00
-1,513.20
739.90
85.86
4.77
-549.73
-833.00
-1,579.20
-630.00
-1,867.20
-349.04
-10.00
-408.00
-2,085.65
-868.80
-918.00
-204.00
-385.00
-2,555.35
-752.00
-360.00
-280.00 -
-896.40
-1.,696.80
.
PAGAC07-PAGATEMP
11/16' 7
CASH FLOW REPORT
1/ l' 0 Through 10/31' 7
Category Description
1/ l' 0-
10/31' 7
INFLOWS
FAMA, MARY
TOTAL INFLOWS
/116--11
Page 1
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND CO., PENNSYLVANIA
ORPHANS' COURT DMSION
INRE: FAMA,MARY
I"'.)
(") g
co"'"
-- :z
FILE NO 21-~1 ~
;> :z;: ::0 _
".7(1)7' .......
I,:J () 0 -0
C)O." :x
Oc:
o :0
:0-1
)>
, an incapacitated penon
GUARDIAN OF PERSON ANNUAL REPORT
[20 Pa. C.S.A. 5521 (c))
FROM
10/26/06
TO
10/26/07
1.1 am the_ Limited _X_ Plenary Guardian of the Penon OfDlY ward, named above.
2. I was appointed Guardian by Order of the Court dated 10/26/04, which
_was X was not modified by Court Order(s) dated
3. Is the incapacitated penon still living? YES
If no, answer the foRowing:
(a) Date of Death?
(b) Place of Death?
(c) Name of Administrator or Executor?
(d) Date Guardian of the Person filed the last Annual Report?
4. If the incapacitated penon is still living, answer the foRowing questions:
(a) Date Guardian of the Penon filed the last Annual Report? 10/26/06
(b) Current address of the incapacitated person
MANORCARE CARLISLE, 940 WALNUT BOTTOM RD, CARLISLE, PA 17015
(c) Current age _88_Date of birth ofincapaeitated person 10/19119
(d) The incapacitated penon's residence is:
Ward's own residence
_X _Nursing Home
Hospital or Medical Facility
_My home/apartment
Relative's Home
-----
Personal Care
(e) The incapacitated person has been living there since 2006
If moved within the past year, state from where and the reason for the change
MOVE TO SKILLED NURSING DUE TO DECLINE
-
..
_,_,,~_~ p;.2
fi'-'; c:i
<;;)Q
,,"} _or)
:-.-":\ <::;:J
r-nrn
:::no
ClO
-n ."
~~
,~ ".. ("-..
"r)
o
\D
Co
.
(I) I rated hislher living arrangement as:
_X_ Excellent Average
Explain:
Below Average
(g) I believe he/she is:
_X _content with the living situation
unhappy with the living situation
unaware of the living situation
s. Physical health
(a) Current physical condition of the incapacitated penon is:
_Excellent Good Fair Poor _X_
(b) Hislher major physical health problems are as follows:
AMBULA TION PROBLEMS, HX mp FRACTURES X2, RECURRING UTI
(c)During the past year, hislher physical condition has:
remained about the same.
improved. Explain
_X _wonened. Explain DECLINE
(d) During the past year, he/she received the following medical treatment
(include check-ups and dental work):
Date Ailment Type of treatment Doctor's name
MONTHLY ONGOING CARE AT FACILITY DR. K. GUlSTWlTE
PERIODIC PODIATRY DPMR.MARQUES
10/19/07 HOSPICE HEARTLAND HOSPICE
6. Mental Health
(a) The incapacitated penon's condition is
Excellent _Good _X_Poor
(b) Hislher major mental health problems are as foUows:
SEVERE END STAGE DEMENTIA
(c) During the past year, hislher mental condition has:
_ _remained about the same.
Improved. Explain
_X_ Wonened. Explain DECLINE
(d) During the past year, treatment or evaluation by a psychiatrist, psychologist
or social worker was _X_ was not provided.
7. Social Activities I Services
(a) Hislher current social condition is:
exceUent good _X_ fair pOOr
(b) During the past year, hislher social condition has:
_X remained about the same.
improved. Explain.
wonened Explain
(c) During the past year he/she has participated in the foUowing activities:
_X _recreational
educational
_X social
occupational
no activities available
he/she refuses to participate in any activities
8. Visitation
(a) During the last year, I visited himlher as foUows
PAGA HAS PRIVATE DUTY STAFFING IN WITH THIS WARD 12 HOURS
PER DAY
(b) The average amount of ~e I spent on each visit was
DAILY 12 HOURS
(c) The last time I visited was on 10/26107 Date
9. During the last year I have performed the foUowing activities on behalf the
incapacitated penon:
ALL MEDICAL AND FINANCIAL DECISIONS
10. I believe he/she has the foUowing unmet needs:_ NONE
11. The guardianship _X_ Should should not be continued without
modification because:
12. Please note any concerns about the Incapacitated penon's physical or mental
weD being or the fmances that the Court should know.
13. I _X_ am am not guardian of the incapacitated penon's estate. lIyes,
my report is attached.
I certify under the penalties of perjury that the information contained in this report
is true and correct to the best of my knowledge, information and belief.
Date: II It ')- M /
, ,
Name: BRIAN D. BROOKS
TELE#:
717-299-4568
PENNSYL VANIA GUARDIANSHIP ASSOC. INC.
PO BOX 7295
LANCASTER, PA 17604