HomeMy WebLinkAbout03-15-12COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: ELI PETROVICH , AN INCAPACITATED PERSON
FILLE NO: 21-07-1027 '= o ~~ _,-;
' ~C7 ='= '_.~
ANNUAL REPORT OF THE GUARDIAN OF THE ESTATl~ ~ ~ ~-,
1. INTRODUCTION ~:~,. v `; -
Pennsylvania Guardianship Association /Brian D. Brooks was appointed the cy ~~ ~_
Limited, X Plenary Guardian of the Estate by Decree of
Orphan's Court Jude Dated: 12/20/08
X (A) This is the Annual Report for the period from 12/20/09 to 12/20/10
(B) This the Final Report for the period from to
and is filed for the following reason:
1. The death of the incapacitated person, Date of Death
2. The guardianship was terminated by the Court by Decree of
Jude Dated
2. SUMMARY
A. State the value of the estate reported on the inventory $ 18.387.70
B. State the value(s) of principle assets at the beginning of the Report Period.
(Same as the inventory if this is the first report, otherwise, balance from last report)
$ 692.18
C. What is the total amount of income earned during the report period?
$ 40,347.81
D. What is the total amount of income and principle spent for all purposes during the
report period.
$ 39,101.21
E. What are the balances remaining at the end of the report period?
1. Principle $
2. Income $
3. Total principle and income
$ 1,938.78
THE ESTATE OF: ELI PETROVICH
3. ADDITIONAL INFORMATION
(If more space is needed, please attach additional pages.)
A. Principle
1. How is the principle balance listed above currently invested? (Specify)
PAGA CUSTODIAL ACCOUNT /RESIDENT ACCOUNT AT FACILITY
2. Have there been any expenditures from principle during this report period?
Yes X No
If yes:
a. Have al all expenditures from principle been for the sole benefit of the
Incapacitated Person? Yes No
b. List the purpose and amount of expenditures:
SEE ATTACHED ALL TRANSACTION REPORT.
c. Was approval received prior to expending principle?
Yes No
3. Were additional principle assets received during this report period that were not
included in the inventory or any prior report filed for the estate?
Yes X No
If yes:
a. Was court approval requested prior to receiving additional principle?
Yes No
b. State the sources and amounts of additional principle received:
B. Income
1. State sources of income received during the report period:
1. VA PENSION
2. SOCIAL SECURITY
3. INTEREST
4. GIFT
Total income received during report period: $ 40,347.81
2. How is the income currently invested? (Specify)
PAGA CUSTODIAL ACCOUNT /RESIDENT ACCOUNT AT FACILITY
THE ESTATE OF: ELI PETROVICH
C. Expenses for Cage and Maintenance:
(Specify what expenditures were made from the principle and income for the care and
maintenance of the incapacitated person)
SEE ATTACHED ALL TRANSACTION REPORT
D. Other expenditures (Specify any other expenditures not previously reported)
E. Guardians Commissions
(List the amounts of compensation paid as guardian's commission and state how amount
was determined:)
Amount Method of Determination Court Approval Obtained
$1.200.00 12 (a~ 100 00 (Yesl No
F. Counsel Fee
(List amounts paid as counsel fee, and indicate whether Court approval was obtained.)
I verify that the foregoing information is true and correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A.
S/S 4904.
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Tian D. Brooks
Pennsylvania Guardianship Association
PO Box 7295
Date•
Lancaster, PA 17604
717-299-4568
CLAREMONT NT~'.SING & REHAB CTR
1000 CLAREMONT ROAD
CARLISLE, PA 1.7013
Pa Guardianship Asso
P.O. Box 7295
Lancaster, PA 17604
S A V I N G S S T A T E M E N T
Statement Number 424 Page 1
Date From 10/O1/10
to Thru 12/31/10
~• Eli Petrovich
Admission Date 08/11/06
----- Resident ID Nr 4813
1
`Y Ira~~ ----
~__ _ -------
---------
--------
Date
Refer
Ck Date Ck #
Fn Code
Description
_
D ---
_____
-------
Payee eposits Disbursed
Balance
10/15/10 41319 Balance Forward - ---- -----------
10/15/10 41301 AT 1'798.15
10/15/10 41337 G CABLE CABLE
ELEVISION 100.00 1,698.15
10/28/10 449257 G DISB OCT NET INC DUE- 7'00 1,691.15
10/28/10
473176 G
G DP
DP OCT VA
2,673.00 3,213.00 -1,521.85
11/08/10 41401 G DISB OCT SS
PA 685.00 1.151.15
11/08/10 41384 G CABLE GUARDIAN/FEE
CABLE
100
00 1,836.15
11/10/10
41417
G
DISB TELEVISION
NOV .
00
7 1, 736.15
11/15/10 391578 G Dp NET INC DUE
NOV SS .
3,213.00 1,729.15
-1
483
11/18/10
078138
G
DP
NOV VA
685.00 ,
.85
-798
85
12/13/10
12/16/10 41491 G DISB PA GUARDIAN/FEE 2'673.00 .
1,874.15
12/16/10 41513
1258 G DISB DEC NET INC DUE 100.00 1,774.15
12/28/10
DEC G
G DP GIFT FROM SAL MECH
50
00 3,213.00 -1,438.85
12/28/10 .
708294
G CABLE
DP CABLE TELEVISION
DEC VA .
7.00 _1,388.85
-1
39
7.2/30/10
12/31/
287354
G
DP
DEC SS
2.673.00 ,
.85
1 277
10 G
INTER INTEREST
Totals
685.00
NC TO RES 2.15
__ _ 1, 962:53
1, 798.15 10, 124.38 9, 960.00 - ^-~
1, 962.53
~QIV E-
,~ ~~,
(~-~
CLAREMONT NURSING & REHAB CTR
1000 CLAREMONT ROAD
CARLISLE, PA 17013
Pa Guardianship Asso
P.O. Box 7295
Lancaster, PA 17604
S A V I N G S S T A T E M E N T
Statement Number 425 Page 1
Date From 07/01/10
~""~ ~- ~ ate Thru 09/30/10
Eli Petrovich; /'
Admission Date 08/11/06
Resident ID Nr
-- 4813
T
y Tran -----
----
--------
Date Refer Fn Code Description
Ck Date Ck #
Payee Deposits . Disbursed Balance
07/03/10
620108
G
DP
Balance Forward ----6 ------ -
----- "----
07/03/10
399954
G
DP JUL SS
85.00 1, 669.63
07/12/10
41059
G
DISB JUL VA
L
2.673.00 2,354.63
5
027
63
07/14/10 41075 G DISB PA
GUARDIANSHIP/FEE
3, 213.00 ,
.
1, 814.63
08/03/10 186200 G DP AUG VA 100.00 1,714
-63
08/03/10 608090 G DP
G 2,673.00 .
4,387
63
08/11/10 41147 G DISB PA
GUARDIAN/FEE 685.00 .
5, 072.63
08/13/10
09/09/10 41157 G DISB AUG NET INC DUE 100.00 4,972.63
813967 G DP SEP VA 3.213.00 1,759
63
09/09/10 553390 G DP SEP SS 2,673.00 .
4,432
63
09/15/10 41210 G CABLE CABLE TELEVISION 685.00 .
5,117.63
09/15/10 41229 G DISB PA GUARDIAN/FEE 7'00 5.110.63
09/15/10 41249 G DISB SEP NET INC DUE 100.00 5,010.63
09/30/10 G INTER INTEREST INC TO RES 3,213.00 1,797.63
. 2
_ 1, 798.15
Totals. 1,669.63 10,074.52 9,946 00
1
, 798.15
-.---_.
i
CLAREMONT NURSING & REHAB CTR
1000 CLAREMONT ROAD S A V I N G S S T A T E M E N T
J,~RLISLE, PA 17013
-------
--------------
~~`-~ -.. _.___.. _-----~--~'" Statement Number 393 Page 1
Date From 04/01/10
ate Thru 06/30/10
~~~ ~ ~ $~k S Eli Petrovich
Pa Guardianship Asso `~
P. O. Box 7295
Lancaster, PA 17604
Admission Date 08/11/06
Resident ID Nr 4813
_-
Ty
Tran - ------------ -----
------
-----------
Date
Ck Date Refer
Ck # Fn Code Description Deposits Disbursed Balance
Payee
Balance Forward --- ------------ --1
04/03/10
472384
G
DP
APR SS ,534.10
04/03/10
487853
G
DP
APR VA 685.00
2,219.10
04/15/10 40839 G DISB PA GUARD/APR FEE 2,673.00 4,892.10
04/15/10 40843 G DISB APR NET INC DUE 100.00 4,792.10
05/03/10 128018 G DP ~y VA 3,213.00 1,579.10
05/03/10 520825 G DP ~y SS 2,673.00 4,252.10
05/15/10 40924 G DISB PA GUARDIAN/FEE 685.00 4,937.10
05/15/10 40940 G DISB MAY NET INC DUE 100.00 4,837.10
06/03/10 582003 G DP JUN SS 3.213.00 1,624.10
06/03/10 762093 G DP JUN VA 685.00 2,309.10
06/15/10 41008 G DISB PA GUARDIAN/FEE 2,673.00 4,982.10
06/15/10 41021 G DISB JUN NET INC DUE 100.00 4,882.10
06/30/10 G INTER INTEREST INC TO RES 3,213.00 1,669.10
.53 1,669.63
Totals 1,534.10 10,074.53 9,939.00 1,669.63
_,
CLAREMONT NURSING & REHAB CTR
1000 CLAREMONT ROAD
CARLISLE, PA 17013
Pa Guardianship Asso
P.O. Box 7295
Lancaster, PA 17604
S A V I N G S S T A T E M E N T
--------------------------------
Statement Number 395 Page 1
Date From Ol/Ol/10
Date Thru 03/31/10
.~
Eli Petrovich
Admission Date 08/11/06
- -----
-- Resident ID Nr 4813
-
Ty -------
Tran _ _ ----------------------
_ _ . ----------- ------------ ----------
Date Refer Fn Code Description Deposits Disbursed Balance
Ck Date
- - ---- Ck #
-------
---
------- Payee
--------------------
--
Balance Forward ----------- ------------ ----------
680.52
01/03/10 210381 G DP JAN SS 685.00 1,365.52
01/03/10 538053 G DP JAN VA 2,673.00 4,038.52
01/15/10 40561 G DISB PA GUARDIAN/FEE 100.00 3,938.52
01/15/10 40530 G DISB JAN NET INC DUE 2,973.60 964.92
02/03/10 G DP FEB SS 685.00 1,649.92
02/03/10 G DP FEB VA 2,673.00 4,322.92
02/15/10 40653 G DISB PAT GUARDIAN/FEE 100.00 4,222.92
02/15/10 40665 G DISB FEB NET INC DUE 2,973.60 1,249.32
03/10/10 4.0735 G DISB PA GUARDIANSHIP/FEE 100.00 1,149.32
03/10/10 840567 G DP MAR VA 2,673.00 3,822.32
03/10/10 401915 G DP MAR SS 685.00 4,507.32
03/15/10 40756 G DISB MAR NET INC DUE 2,973.60 1,533.72
03/31/10 G INTER INTEREST INC TO RES .38 1,534.10
Totals 680.52 10,074.38 9,220.80 1,534.10
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