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HomeMy WebLinkAbout11-19-12 (6) ~~:! C., i~.Y ~, -rl !^ `~" . r. < ANNUAL REPORT OF ~~ : , -„_; GUARDIAN OF THE ESTATE ,.. '' "' _ C-J( 17 41 r ~~~ M ._ ~ l -: AI (V l `- COURT OF COMMON PLEAS OF b ~ .- "~ti-, Cumberland County COUNTY, PENNSYLVA1vIA `'O ORPHANS' COURT DIVISION Estate of Inez H. Davis No. 21-07-0200 I. INTRODUCTION Gloria J. Banks ®Plenary ©Limited Guardian of the Estate by Decree of Oler dated Apri14, 2007 A. This is the Annual Report for the period from July 12 2010 to Julv 11 2011 (the "Report Period"); or B. This is the Final Report for the period from , J., 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 a.n Incapacitated Person was appointed Form G-02 rev- 10.73.06 Page 1 Of S 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, otherwise, ending balance from last Report.) C. What is 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? An Incapacitated Person $ 75.00 $ 555.46 $ 18,041.52 $ 17,906.21 E. What are the balances remaining at the end of the Report Period? 1. Principal $ 555.46 2. Income $ 135.31 3. Total of Principal and Income $ 690.77 III. ADDITIONAL INFORMATION (If more space is needed, please attach additdonal pages.) A. Principal 1. 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 Trust 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 1'or the sole benefit of the Incapacitated Person? ........ ^ Yes O No Form C-02 rev. 10.13.06 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? ........... 0 Yes ®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 $ 3,856.80 Pension $ 14,184.72 Total income received during Report Period: $ 18,041.52 Fo.m c-oz .e,. ~o. is.oe Page 3 of 5 Estate of Inez 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 Expenditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) An Incapacitated Person E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Amount Method of Determination Court Approval Obtained none Yes ~No Yes ONo Form c-nz rev. 10.!3.06 Page 4 of 5 Estate of Inez H. Davis An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Court Amount Approval Obtained None OYes ~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. Date Form G-01 rev./0.13.06 Signatwe ofGuar i of the Estate Gloria J. Banks Name oJGuardion of the Estate (type or print) 576 Catherine Street Address Harrisburg, PA 17112 Ciry. State, Zip 717 545-4816 TelepMne Page 5 of 5