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Home My WebLink About06-10-13 (2) __ ___ _ _ _ . ne� _ COURT OF COMMON PLEAS CUMBERLAND COUNTY,PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: CAROLYN KIRK ,AN INCAPACITATED PERSON FILLE NO: 21-07-1121 ANNUAL REPORT OF THE GUARDIAN OF THE ESTATE 1. INTRODUCTION Pennsylvania Guardianship Association/Brian D. Brooks was appointed the Limited, X Plenary Guardian of the Estate by Decree of Orphan's Court . Judge Dated: 1/17/08 X (A) This is the Annual Report for the period from 1/17/09 to 1/17/10 _ (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 ,Judge, Dated 2. SUMMARY A. State the value of the estate reported on the inventory $ 3.130.51 r-.,;, B. State the value(s)of principle assets at the beginning of the Rep�t Period.�; � � rn (Same as the inventory if ttus is the first report, otherwise,balance��last re�►.ort)� a $— 12.88 n, � c, � v, :�s � z�► z m � r�y' �'' C. What is the total amount of income earned during the report pe�o� �' � "`' �`� $ 24,863.32 ° n o '�- ° C=7 c-� o -,-; � _. --� � � C �. zr '�.' ;..� D. What is the total amount of income and principle spent for all i�rodses d�ng�e� report period. �k'' y � -�, $24,721.56 ' E. What are the balances remaining at the end of the report period? 1. Principle $ 2. Income $ 3. Total principle and income $ 128.88 ��W _ _ .. ___ .._ _ . ._ _. ___ . _ .._ _ -- nAt7_ .. . THE ESTATE OF: CAROLYN KIRK 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 ' 2. Have there been any expenditures from principle during this report period? Yes X No If yes: a. Have all expenditures from principle been for the sole benefit of the Incapacita.ted 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 X 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. SOCIAL SECURITY 2. SERS PENSION Tota1 income received during report period: � 24,863.32 2. How is the income currently invested? (Specify) ' PAGA CUSTODIAL ACCOUNT _ _ ._ . . ._ _ . . �A.� _. _ THE ESTATE OF: CAROLYN KIRK C. Egpenses 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 ezpenditures (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 MONTHS(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. Date• / Bria . Brooks Pennsylvania Guardianship Association PO Boz 7295 Lancaster,PA 17604 717-299-4568 - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - �, _ _ __ _ . _ _ - _,��., . 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INTRODUCTION Pennsylvania Guardianship Association /Brian D. Brooks was appointed the Limited, X Plenary Guardian of the person by Decree of Or�han's Court , Jud�e. Dated: 1/17/08 X (A) This is the Annual Report for the period from 1 i 17109 to 1/17/10 _ (B) This the Final Report for the period from and is filed for the following reason: 1. The death of the incapacitated person, Date of Death 2. 'The guardianship was ternunated by the Court by Decree of .Judge. Dated For Final Report, omit sections II through IV. � * c ` rn!�� 2. PERSONAL DATA � .�.�° � �l�, Age of the incapacitated person 81 Date of Birth 1/26/28 � y � � ;�',h�ri; r s rTr o =�� ;+.w. � u' � °' !-. 3. LIVING ARRANGEMENTS ' � �', .,� c� Q � � .L�,;,y� A. Curr�nt address of the Incapacita.ted Person: c� __ - _�, �.� WEST SHORE HEALTH,770 poplar church rd. camp hill,pa 17011 `�' � -` �+'�' -�, —� w �?';� ;� a� B. The Incapacita.ted Person's residence is: _Ward's own home/apartment X Nursing Home _ Boazding Home!Personal Care Home , Guardians Home/Apartment _ Hospital or Medical Facility _ Relative's Home(name,relationship and address) C. T'he Incapacitated Person has lived here since: 2008 If the Incapacitated Person has moved since the last report, state the prior address and reason far move: '"�� .s� . , � . Estate of: CAROLYN KIRK D. Name and address of the Incapacitated Person's primary caze giver: WEST SHORE HEALTH NURSING HOME 4. MEDICAL INFORMATION A. T'he majar medical or mental problems of the Incapacitated Person are: DEMENTIA,HISTORY OF ORAL CANCER,AMBULATION DYSFUNCTION B. Specify what if any, social, medical,psychological and supportive services the Incapacitated Person is receiving: All social,psycbological, and medical services are being provided by staff and physicians ' at the facility. ' 5. GUARDIAN'S OPINION A. It is the opinion of the guardian that the guardianship should: X Continue Be modified Be terminated The reason for the foregoing opinion is: The need for guardianship continues. B. During the past year the Guardian of the Person has visited the Incapacitated Person ' 4 With an average visit time lasting 15-20 minutes . The report of a social service organization employed by the Guardian to oversee and coordina.te ! the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. ' I verify that the foregoing information is true and correct to the best of my knowledge, ' information and belief; and tbat this Verification is subject to the penalties in 18 PA. C.S.A. ' S/S 4904. Date: �v/ �/ nan D. Brooks Pennsylvania Guardianship Association PO Boz 7295 Lancaster,PA 17604 717-299-4568