HomeMy WebLinkAbout03-15-12 (2)COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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IN RE: ELI PETROVICH , AN INCAPACITATED PERSCI!I!~ ~ ft{ '~
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FILLE NO: 21-07-1027 -
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ANNUAL REPORT OF THE GUARDIAN OF THE ESTATE =~ _
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1. INTRODUCTION a~r
Pennsylvania Guardianship Association /Brian D. Brooks was appointed the
Limited, X Plenary Guardian of the Estate by Decree of
han's Court Judi Dated: 12/20/08
X (A) This is the Annual Report for the period from 12/20/10 to 12/20/11
(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
Judge 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)
$ 1,938.78
C. What is the total amount of income earned during the report period?
$ 40,372.41
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
$ 2,236.99
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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. Ezpenses for Care 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 (Yes) 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.
. Brooks
Pennsylvania Guardianship Association
PO Box 7295
Date: ~3`
Lancaster, PA 17604
717-299-4568
CLAREMONT NURSING & REHAB CTR
1000 CLAREMONT ROAD
CARLISLE, PA 17013-8805
(717)243-2031
___ 01/18/2012
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' ,.-- ~, Trust Fund
ELI PETROVICH ~ +`~ 4813
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BRIAN BROOKS
PO Box 7295
LANCASTER, PA 17604 ''
--------------------------- 10/01/11 To 12/31/11
e ---------------------
----
Memo Withdrawal
---------------
--------------
-------
Deposits
--- _
--------------
Balance
10/01/11
Balance Forward
----------- _
-----------
2,266.14 2,266.14
10/03/11 OCT VA
10/03/11
OCT SS 2,673.00 4,939.14
10/15/11
OCT NET INC DUE
3
213
00 685.00 5,624.14
10/20/11 CABLE ,
. 2,411.14
10/20/11
PA GUARDIAN/FEE 8.00
100
00 2,403.14
10%31/11 interest for recon 10/31/2011 . 2.303.14
11/03/11
NOV SS 0.15 2,3v^^3.29
11/03/11
NOV VA 685.00 2,988.28
11/15/11
NOV NET INC DUE/42447
3
213
00 2,673.00 5,661.29
11/17/11 PA GUARDIAN FEE/42462 ,
.
100
00 2,448.29
11/18/11
CABLE/42474 . 2,348.29
11/18/11
CABLE/42474 16.00
2,332.29
11/30/11 interest for recon 11/30/2011 8'00 2.340.29
12/02/11
DEC SS 0.11 2,340.40
12/03/11
DEC VA/2758316 685.00 3,n25en0
12/06/11 PA GUARDIAN FEE/42516 100
00 2,673.00 5,698.40
12/15/11 CNRC DEC INC DUE/42527 .
3
213
00 5,598.40
12/22/11
CABLE/42555 ,
. 2,385.40
12/30/11
SAL POST 109 X-MAS/1340 8.00
2,377.40
12/31/11 interest for recon 12/31/2011 75.00 2,452..40
-------------- --------- 0.15 2, 452.55
----- -~
Ending Balance 2,452.55
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CLAREMONT NURSING & REHAB CTR
1000 CLr~REMONT ROAD. S A V I N G S S T A T E M E N T
CARLISLE, PA 17013 -'" "--""'--------------------
Statement Number 368 Page 1
Date From 07/01/11
~ Dat Thru 09/30/11
Eli Petrovich
Pa Guardianship Asso ~ L-
P.O. Box 7295
Lancaster, PA 17604
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 2,185.19
07/03/11 172748 G DP JUL VA 2,673.00 4,858.19
07/03/11 574055 G DP JUL SS 6S5.oo 5,543.19
07/06/11 CASH G WD Withdrawal/RAZOR 42.39 5,500.80
07/13/11 42081 G CABLE CABLE TELEVISION 8.00 5,492.80
07/13/11 42090 G DISB PA GUARDIAN/AUG FEE 100.00 5,392.80
07/19/11 42110 G DISB JUL NET INC DUE 3,213.00 2,17.9.80
08/03/11 727262 G DP AUG VA 2,673.00 4,852.80
08/03/11 983330 G DP AUG SS 685.00 5,537.80
08/09/11 42180 G DISB PA GUARDIAN FEE 100.00 5,437.80
08/09/11 42163 G CABLE CABLE TELEVISION 8.00 5,429.80
08/15/11 42205 G DISB AUG NET INC DUE 3,213.00 2,216.80
09/10/11 263906 G DP SEP VA 2,673.00 4,889.80
09/10/11 287007 G DP SEP SS 685.00 5,574.80
09/15/11 42258 G DISB SEP NET INC DUE 3,213.00 2,361.80
09/15/11 CASH G DP Deposits 12.00 2,373.80
09/20/11 42281 G .DISB. PA GUARDIANSHIP FEE 100.00 2,273.80
09/20/11 42266 G CABLE CABLE TELEVISION 8.00 2,265.80
09/30/11 G INTER INTEREST INC TO RES .34 2,266.14
Totals 2,185.19 10,086.34 10,005.39 2,266.14
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
Date From
ru
394 Page 1
04/01/11
06/30/11
~ ~
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 2,073.81
04/03/11 715271 G DP APR SS 685.00 2,758.81
04/03/11 171245 G DP APR VA 2,673.00 5,431.81
04/15/11 41850 G DISB PA GUARNSHIP/FEE 100.00 5,331.81
04/15/11 41838 G CABLE CABLE TELEVISION 8.00 5,323.81
04/15/11 41829 G DISB APR NET INC DUE 3,213.00 2,110.81
05/03/11 408027 G DP MAY SS 685.00 2,795.81
05/03/11 755857 G DP MAY VA 2,673.00 5,468.81
05/11/11 41920 G CABLE CABLE TELEVISION 8.00 5,460.81
05/11/11 41935 G DISB PA GUARDIANSHIP/FEE 100.00 5,360.81
05/15/11 41954 G DISB MAY NET INC DUE 3,213.00 2,147.81
06/03!11 041635 G DP JUN SS 685.00 2,832.81
06/03/11 319114 G DP JUN VA 2,673.00 5,505.81
06/08/11 41993 G CABLE CABLE TELEVISION 8.00 5,497.81
06/08/11 42003 G DISB PA GUARDIANSHIP/FEE 100.00 5,397.81
06/15/11 42027 G DISB JUN NET INC DUE 3,213.00 2,184.81
06/30/11 G INTER INTEREST INC TO RES
---------- .38
----------
---------- 2,185.19
----------
Totals 2,073.81 10,074.38 9,963.00 2,185.19
CLAREMONT NURSING & REHAB CTR
1000 CLAREi~lONT 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 402 Page
....]?ate From Ol/Ol/11
ate Thru 03/31/11
Eli Petrovich
C
Admission Date 08/11/06
Resident ID Nr 4813
1
-------- ------- ---
Ty -------
Tran ---------------------- ----------- ------------ ----------
Date Refer Fn Code Description Deposits Disbursed Balance
Ck Date
-------- Ck #
-------
---
------- Payee
----------------------
-----------
-
Balance Forward ----------- ----------
1,962.53
01/18/11 41574 G CABLE CABLE TELEVISION_ 8.00 1,954.53
01/18/11 41583 G DISB PA GUARDIAN FEE 100.00 1,854.53
01/27/11 159229 G DP JAN SS 685.00 2,539.53
01/28/11 335485 G DP JAN VA 2,673.00 5,212.53
01/31/11 41618 G DISB JAN NET INC DUE 3,213.00 1,999.53
02/03/11 123498 G DP FEB SS 685.00 2,684.53
02/03/11 955209 G DP FEB VA 2,673.00 5,357.53
02/15/11 41679 G DISB FEB NET INC DUE 3,213.00 2,144.53
02/15/11 41663 G DISB PA GUARDIAN FEE FEB 100.00 2,044.53
02/15/11 41648 G CABLE CABLE TELEVISION 8.00 2,036.53
03/03/11 931069 G DP MAR SS 685.00 2,721.53
03/03/11 568853 G DP MAR VA 2,673.00 5,394.53
03/15/11 41717 G DISB MAR NET INC DUE 3,213.00 2,181.53
03/18/11 41753 G DISB PA GUARDIANSHIP FEE 100.00 2,081.53
03/18/11 41730 G CABLE CABLE TELEVISION 8.00 2,073.53
03/31/11 G INTER INTEREST INC TO RES .28 2,073.81
Totals 1, 962.53 10, 074.28 9, 963.0 2, 0773. 81~'
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