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HomeMy WebLinkAbout11-19-12 (2) ~ ~„ y -~' o r~, -' ~ ~; ANNUAL REPORT OF ~, ~ ° `' `'' ;=1 ;_ GUARDIAN OF THE ESTATE ~ tD , _ ~~' ~` -a ,~ COURT OF COMMON PLEAS OF ~~, ::; N =lJ r ~T~ Cumberland County y ti~~ COUNTY, PENNSYLVANIA ~^' ORPHANS' COURT DIVISION Estate of Inez H. Davis No. 21-07-0200 I. INTRODUCTION Gloria J. Banks .an Incapacitated Person was appointed ®Plenary ©Limited Guardian ofthe Estate by Decree of Oler dated Apri14, 2007 ~-' J'' m A. This is the Annual Report for the period from July 12 2008 to Julv 11 2009 (the "Report Period"); or B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death; Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J., dated Form G-02 reu. /0./3D6 Page 1 of 5 Estate of Inez H. Davis II. SUMMARY A. State the value of the estate reported on the Inventory B. State the value(s) of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, otheruvise, ending balance from last Report.) C. Whatis the total amount of income earned during the Report Period? D. What is the total amount of income and principal spent for all purposes during the Report Period? E. What are the balances remaining at the end of the Report Period? Principal Income $ 118.84 $ 135.00 An Incapacitated Person ~ 75.00 $ 118.84 $ 17,837.70 $ 17,702.70 253.84 3. Total of Principal and Income III. ADDITIONAL INFORMATION (If more space fs needed, please attach additional pages.) A. Principal l . How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): Principal is maintained in an interest-bearing Resident 7['rust Account at Golden Living Center, the nursing home in which the Incapacitated Person receives care. 2. Have there been any expenditures from the principal during the Report Period? ............................ ©Yes ®No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? ........ ^Yes ^ No Form G-02 rev. 70.!3.06 Page 2 of 5 Estate of Inez H. Davis b. List purpose and amount of expenditures: An Incapacitated Person c. Was Court approval received prior to expending the principal? ....................... ^ Yes ^ No 3. Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? .......... . ~ Yes m No If yes: a• Was Court approval requested prior to receiving the additional principal? ................ ^ Yes ^ No b. State the sources and amounts of the additional principal received: B. Income 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): Social Security Pension ~~ 3,754.38 $ 14,083.32 Total income received during Report Period: $_ 17,837.70 Form G-01 rerz /0.73.06 Page 3 of 5 Estate of Inez H. Davis An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): Income is maintained in an interest-bearing Resident Trust Account at Golden Living Center, the nursing home in which the Incapacitated Person receives care. C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person (e.g., clothing, nursing home, medicine, support, etc.): The Incapacitated Person is a Medical Assistance recipient at a long-term care facility. Her income, with the exception of $45 per month personal needs allowance, is applied to the cost of her nursing facility care. The personal needs allowance is applied to the cost of personal care needs such as clothing and hair care. D. Other>~xpenditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Amount Court Method of Determination Approval Obtained none Q Yes ~ No Yes ~ No Form G-02 rev. /0.13.06 Page 4 of 5 Estate of Inez H. Davis F. Counsel Fee An Incapacitated Person List amounts paid as counsel fee, and indicate whether Court approval was obtained. Amount None Court Approval Obtained Yes ~ No Yes ~ No I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. ~l~t/, / f ~o/~ Dale ,¢ Signanrre ofGnardi of (he Es(a(e Gloria J. Banks Name ofGvardion oj(he Fs(orc (type or print) 576 Catherine Street Address Harrisburg, PA 1711:? cry, sra(e, zip 717 545-4816 Telephone Farm c-oz rev. 70.13.06 Page 5 of 5