HomeMy WebLinkAbout06-07-13 (2) � . Or�9inC�
ANNUAL REPORT OF _
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GUARDIAN OF THE ESTATE � � �" � �
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� COURT OF �OMMON PLEAS OF � �n � ^`'
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ORPHANS' COURT DNISION _ �_ �, �
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Estate of �1�k_fC�l.1-4� INIQ-(�.-� 1 , an Incapacitated Person
No. 'L I - 12. -�.,1 `��.P
I. INTRODUCTION
N�,lC��1�C�h(1('�(�� ��M1/1(�� , wasappointed
�Plenary 0 Limited Guardian of the Estate by Decree of , J�,
dated �� - �L( - Zl`��Z .
� A. This is the Annual Report for the period from L-� - � J " � L ,
to �-�� - I�i > (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
Fo.,,,r-nz .EV. �o-�s o6 Page 1 of 5
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Estate of_ l��l,k 1U. ,� � ,l;(^�,( -�� , A.n Incapacitated Person
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IL SUMMARY
A. State the value of the estate reported on the Im�entory $ J�"{ ' 1- - ]�
B. State the value(s) of principal assets at the beginning of
the Report Period. (Same as Inventory if first Report, � . �� _ c. i
otherwise, ending balance from last Report.) $ .`7�-� . '� � �• � 3
C. What is the total amount of income earned during the
Report Period? $ �: ��i 1 �'� �l/
D. What is the total amount of income and principal �` � �C.I � -2�
spent for all purposes during the Report Period? $ `�
E. What are the balances remaining at the end of the Report
Period?
1. Principal $ C CC�-a ' 3��
2. Income �$_(� �j�� .�2_ �
3. Total of Principal and Income $ J���`��'� J• �� ��
III. ADDITIONAL INFORMATION
(If more space is needed,please attach additional 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.):
'; :�C� c�ou 3�1 ;r l tr���� � cY��lk- }�����t , �� I I ��t�, rz;
�,ur Kna�-1�d� .�_ . i,�!e d���`i- I�;��u �a� � ��`��, t� �n���r�y�-a��%����.
C�.�.Y_�)�- 1� �L. �'I�I,�;�. � I i'OSt �-P � �� �i�Li�-k�,(��%;
�,,'l.E'���'tk?.{,�) .
2. Have there been any expenditures from the principal
duringthe Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes �No
If yes:
a. Have all expenditures from the principa] been for
the sole benefit of the Incapacitated Person? . . . . . . . . ❑ Yes ❑No
Form G-0Z rev. ]0.13.06 . Page 2 Of 5
i �"
Estate of_ ( ��/ l(�.�1 �,� d $ '�� {� � , An Incapacitated Person
b. List purpose and amount of expenditures:
$
$
$
$
c. Was Court approval received prior to
expendingthe 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 �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.):
-���-��'� �� $ ��i ����
C.1°l rl_Yl(1.�1 �Y�'(�1(�> $��'I(�� � (��L
f�i-��.��� � z r'��?
$
$
�
Total income received during Report Period: $ �� 1�E'_ : ����
ro.m c-oz .e,�. �o.is o6 Page 3 of 5
Estate of_ ��- �� �� � ����� ��-� � , An Incapacitated Person
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2. How is income currently invested? (Please
specify, e.g., restricYed bank accounfs, client
care account, etc.):
�`1���i(;l C,�ti� `��,��Y�
C. Expenses for Care and Maintenance
Specify what e�enditures were made from the principal and
income for the caze and maintenance of the Incapacitated
Person(e.g., clothing, nursing home, medicine, support, etc ):
����_h��l �i�� ��lT`��1.(_i -- ��-�i-l� >rt-� . ��? �''(_�.Y��i_`�1i'_�! `�l=��-�.I.Y1�1 --
;r1`a �� c�.!�,C'� � � � �t-I , �?c`.� � 1(.%(-orC� J
; ��1VC.Y�t�R1 ��il�t�l< - ,�, �`-' , CC
� °
�"�.�;���.a�����'� �� � - � � � �\'C��' �
. ���
1'';l CC'��J -_ � =��`"
X��l��.� �,JC i
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.)
E. Guardian's Commissions
List amounts of compensation paid as Guardian's commission
and state how amount was determined:
Court
Amount Method ofDete��mination Approval Obtained
�f> �1 �`�l)(1�1� ( a � f� .� ��'� _�Yes No
' �Yes ONo
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'�lG�����, ' ' , �
Estate of �� ��A � -� �L�,��T��- , A�n Incapacitated Person
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F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Court
.4mount Approval Obtained
�Yes Q No
�Yes 0 No
I verify that the foregoing information is conect to the best of my lrnowledge,
information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904
relative to unsworn falsification to authorities. 5= �'� �� f� ��
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(�,�.-„� _ .� r ,-
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Date � _ Signature ofCu dian afthe Estate
x�OD�y;�V►C1Y;$ Name of Guardian of fhe Estate(rype or printJ � .
NBI�PRINCE STREET . .
p,p,BOX 1593 .
LpNCAS7'ERpA »�&1593
Address
Clry.Slate,Zip .
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Telephone
Fa�mG-02 rev. IoJ3.06 PSgO 5 Of$