HomeMy WebLinkAbout06-10-13 (3) __ _ . _ _
_ _ .��
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 Esta.te by Decree of '
Or�han's Court , Judge Dated: 1/17/08 '
X (A) This is the Annua.l Report for the period from 1/17/10 to 1/17/11 ''
_ (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 ,
.JudQe Dated '
2. SUMMARY '
A. State the value of the estate reported on the inventory $ 3.130.51
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 fro�last repo� '
$ 128.88 � o �,.> � �
� rn
r°rn -� � �' o '
C. What is the total amount of income earned during the report peri�ha r"- � "' �J '
$ 24,613.32 . � � � o °� '�'
� �
ot7a � ° � ,
D. What is the total amou.nt of income and principle spent for all p�es�'�duri�th� � '
report period. ' � ...c c; ',
$ 24,043.74 a r` �' '
'--s v, c�
rn � '
E. What are the balances remaining at the end of the report period? '
l. Principle $ ',
2. Income $
3. Tota1 principle and income $ 248.46 '
,rI�W
_ _ _ �a�
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? I
Yes X No II,
If yes:
a. Have 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 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: �24,613.32 ''�
�
2. How is the income cw�rently ipvested? (Specify) �!
PAGA CUSTODIAL ACCOUNT '
_ _ _
_ _ _ .��
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 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 Determinallon Court Approval Obtained '
$ 1.000.00 10 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•
an . Brooks
Pennsylvania Guardianship Association '
PO Boz 7295
Lancaster,PA 17604
717-299-4568 '
. _
_el��r
M �
� �
� �
t0 @
d
�� ,
(� CO I
� �
1� r � � '
O � N N
�
�
� � � �
0 � I
Q � '
N� �
LL L C
� � �
0 0 0, ',
� � Q 3
u� o ',
U � o � �
¢
a, N v ?
m �
a � � Q
U LL Y O '
Z F ,
a
� '
w
f- i
¢ ,
c�
Q
a
_
_
_ . �,
. _ ■��.
M N
� N
t` �
<O �
a
., oS�BSSo�S�SS�SBg$SS�oSo��
= o��o�ppp�o�opp�o�opa�MO�ppp�; �
� ON�O^Otf�O�AODC�(1?ON�NCI�C^DOO��COt�O�A�
� � � N�t� � � � � N1�I� �-N1�
� � � e- � e- e- a- �
a � � , ,
v ( �������������������oc�rr���
0 0 0 0 '
aQ aa aa aQ '
��i.z uv.z zuU. �Z
Ow� � Ow�� w00� Ow�
N_� H_� �� ��^
o ��� ��� ��� ���
� O� � O�� �O� O� �
�� � � �� � �
Y Y Y Y Y Y Y Y Y Y Y Y
��� ��� ��� ���
Y Y Y Y Y Y Y Y Y Y Y Y
� �J J J O J J J O O J J J �J J J O 1
� _����_�0��_����0 �0 0�_�
aoz���oz���oz�����oz���oz
cWi�c�naca.>ca.�vaiacaivvvia°c.aivv:=c�naca.�ca�c¢.�v�ia '
,� Y Y Y Y
O
Z z z
� � � �
�- J J J J
� O � � 0 0
y � C U U U V
�
•O � a V O J O J UO �U O� '
•� U u. u.a U tL -�U Iy Q-� �
� OO � a W W W W W Lll a W W W a W W LLJ
� H � � ��W OpW �pQW� ppW
U rn W ��� ��� W���W ���
� ° Z ww� ww0 ZwwOZ WWO
WF-F-»=F=F=»SF_-HW»2WF_I-»2F_-F_
N e�.- �fAfA'--�-��fnfn-�JNln(��J�lN�f�fAJJ�(nfn
' aoomm�oomm�ooamm�aoomm�oo
� Q W W J J W W W J J W W W Q J J W Q W W J J W W W
�ooc�c��ooc�c�3ooac�c��aooc�c��oo
�
�
z
C� N � W
� r�����r����c�u�'�t�C��ci��a��apti� y
M
t^O�N�C�OCn0��000��NNNNC������'�CD Z
1� hh�m1�h1�1�1�m�O1�1�1� �� W
�d'Q.'��c-�'a' �e-�Q.'Q�'r-�e-� r-Q'O.'�r- ��'p.' a
� �O�p���p���� �p�WO»�O� �W�� �
O O O O O O C O�p o O O O`O Q W�OO O`O O O O� �
Q � �������.�.� �OOOO��O��hl�l�f�f�`�a � �
V'�1n C C C CO 00 M Cq M�����a-M r-������C�
�a-- � ���.������.�� � ..
� � OOOOO� e- �e-��-�e-�f�t�f�f�Nf���Y O O '.
� �0��<- �-��a-- ��� a--e-�--� �e- �a-������� � Z
3 Y - -
� V Fa- IQ- l-a-
W O O O
¢
�
4
a
- - - i,__
.._. . . .. _ - __ .. . _ _. .. . _ .. ._. R�� __ .
M e-
� N
� �
fO a
� Or'e-Opp�-O�Or OrrOpp 00p O�p 00p e-p O O�--Op Opp
r. r O��-000�-OOD0��0�- �0000000�-0000�-OOSO�00000'.
� ��fJ c0�p�OOOM�A CDCMC'q00M�p Op Opp�pp cM0pp MCOp MCO�p�'�,
aDN�O�O�O��N��G�.-�O�O��AOOOOtOtpWCO00�O�COMO�O�00DCOOtO
O M �AN1�0) MNf�tO NhNNhO>N� h�M�Nh1� ��Nhh�.-N1��-1� � e- �
� i � � � � � � i � i
r l"' !� r T �"'T r �"' !' r r r r r
1 1 1 1 1 1 1 1
U I LL I.L.Y�Y�Y�LL�L Y�LL LL LL LL.LL LL LV Y�LL Y�LL IL LL LL LL Y�LL�LL Y�4.LL LL LL IL LL.4�LL 4.LL LL 4��L',
O� O � �p �� pll
¢a a a aQ aa a
U U U U �
� �� � � WO� w O OW Ow �y,�I
o r� r� r� � r� � �F-r� � F-� H�� F-onQ
t� 1� h r- 1� I� fn fn 1� (n fn 1� fn(n t� f/�fn�GD
� o 0o u� o o wOo w Oo Owo O�o��
v .tv aou� �r v �UV � U� U�� V��+'o�
� �� �� � � �� �� �I
YY YY YW Y Y YYY Y YY YYY YYY]C
��' ��' �Z �.' d' a'a'�' � ��' ���.' ����I
YY YY YJ Y Y YYY Y YY YYY p�YYYY'I
Z Z Z Z Z Z Z Q Z Z Z Z�Z Z Z Z Z 2 Z Z Z Z Z Z�Z Z Z�
>.} y.} }Z } }�} �} } �-} }}} �}.}}y .
J_! O J J O J� O J O J�J�.J J J O J J O J J J O(n J J J
0 0_��0���0������0��0�����0 Q ��Q�_���0��
�'Q'�Z�Q�'��Z���Z�OZ��Q�'��'.�Q'�ZQ.'Q.'O�OZI��Q'OZ��'�.'Q'�.'
QQ(�WQQ�'?(nWQWfAWQfnWQfAQQQ�Qf�WQQOfnWQQQfnW�QQQ4
c�c�cnac�c��v�ac�acnac�cnac�cnc�c�c� c�cnac�c��cnac�c�c�cnn.at�c�c.��
� j Y Y Y Y YII
I,
� o Q O O O O OI�
`' H �-' �-' d' Q: (l�
� � c Z 0 cJ U U U U
'� s a � �°—c~i o � � � ��� � � �� � ���d
O p� JQ JQ fA JQ JQ 0 _Q! 0 QJ V �JQ V O Q
� o V UJ� W�a �Y W W W WWaW WWQ WW W aWW WLW
+-� t � 20 =YJ �Z = = U' C�2--�U' C72J C�U' 2 -�C�C7=U"
(� ~ �ILLi �OC� �m W W O�W�� �W� ��W ��OWC3
W � � � ��� � �� ���
� � Y Q W W W���LY.I
-a n == oZZ m-. o o WwozW Woz ww� Zww�w
N � �UfAtA�J�fnfn�Ofnfn�fnfn�fA-�J�C�JfA(nJ��fnfnJ-��fAfnUJJfn=
�'ZOO�'OQOOW=00�00�0°om�"QmOOmHQOOm°ohOOQmmF-�II
� W�W W W Q Q W W O Q W W W W W W W J J W Q J W W J W Q W W J J W W W Q J J W UII
�aoo3�aoo��oo�oo�oc�c�3ac�ooc�3aooc�c��ooac�c��c�
� '
�
z
h a0��t� ON� ccpp��t00 rf��OD ��pt�N�hO0�CpC70��tOt�r��poopppM V'�t0
����N��O����NNN�`'�p�►���YON��OOCh�'`��"�NNN^��OOOC7
NN t0 COCDCO NONO�a-NNM��r-r01 W MMCq�� tntf�ln�G
�tp�n1��1�CYe-� ��-��-01�p0)�Q�O�OfOCC��ODCOCOr'�ODODCO�'� hhhh �
�e-Q_'d' r-��-�'�'e-��Q' �0.'d'��� ���a-��'Q.'�-�.�-���-���'Q'�-�r-�.�- I
� �� p�p��p�� C���C������ ���� W�O�W�� �'�,.
WWOOO� OOQOOrnO�o000QO�000�00000�CirnO�W�O OOOOQ� I
p ���a"�O��O�e�-�1(�������av c�w�oornwoocoo�c�. �avv��'
��a-a--��t��r�- �O�'��r-�e-����li
� � � � �N�������������������������
�cl. cl� c. c1. c�MC�c�MC�MVVVa�n�n�n��n�nu�mcccccflmr� tiraoa000wooaomaoaom
a
3 � V '
� V Z �
w Y
N
a
c�
a
a
_ _ _ _ .�� _ .
M �
� N
� �
� �
a
O�p�pr�OQ�pr-pe-p�-O�pe-p�-p�N N N
C O�O�O��Oc��0�0�-O�O�Oe-O�C1�M M Pf
3 ����������������f���W����� � �
O Nh.Nf�N1�hNN1�N1�N1�NhNhNf�N1�NI�tO t0 tp
a � a- � e-� �-- � � r- � r e- N N N
V I �'�..'Q.'����������'��Q'Q'�'��Q'�'Q.'� ..
O
� '
� Y
L
O Z Z Z Z Z Z Z Z Z Z Z Z
�� 'O^ O'^ O'A O'A O,^ O'^ O,^ O,^ O'^ 'O^ ,O^ O'^
� vJ�V/�vJ VJ��v/�v/�V!�v/�vJ�vJ�VJ�v/
� � 0 Z�Z 0 Z Z 0 0 Z 0 Z 0 Z�Z 0 Z�Z�Z�Z '
fnWfqWfAW WfnfpW(AWtAW(�WfnWfnWfAWfnW
� � cnacnav�aacncnacnacnacnacnacnacnacna ',
•L. �
rn =
� o
� L
U o '
� �
�
N � c
N � � '
� a '
•c
.� „
�
F-�����������������f-�f-���
cncntncncncncncncnc��ncnc��n�nv�cnc�cncnv�v�cncn
000000000000000000000000
aaaaaaaaaaaaaaaaaaaaaaaa '
000000000000000000000000 �
I W
� OONNMC'Mhh.00Qi . . �et��Af�hCCa0h1�a0CC Z
z �����������$������������ o"'.
x
m o000 0000°OOO� .-� W
�'r'r- �OOOOOOOOOOr-.- •--�"�rr-.-�--
'° �►aa�e-�e-��-��-e-�����(O<0� ���a W W
0 �.�,����.��.��MMCCe-�COODC9C7U � �
;�„����������„oo:�aa�.-
�NC�MM'd"�ll)1p(G(Oh1�C00D��� r�e-�e-e�-�� U �
� W Q X Z Z
(� _' V J J J
U Z � O O O
Y H F- F-
�
�
W '
F-
Q
U
Q
a
_ _ _ _
- _
_ _ _ _ __ _ _
.,��._
�
M �
� N
t` �
<O a
y O O O O O O O O O O O
C oO Opppp O G O G
3 p
� N ON O O O O O O O O O
� � � � � � � �
� � �
�
V I ��������
O '
�
d
�
�
O
�.
� � o0
� ��00000�
N co �nr���o�c��
� � vcoaorn��r-.-
_ �
.� L
0
� O
� �
U o
� �
n
N � O
•� � HF—l—HF—F—t—H
� UUUUUU(UJU
y.�. � QQQQQQQQ
� J J J J J J J J
LLL.LLCLL[LLL¢¢
W W W W W W W W
Z Z Z Z Z Z Z Z
WtLWWWWWW
U' C7C�C9C�C�C7C9
aU' aU' aU' aU' ¢U' U¢' U¢' aU' '
aaaaaaaa v�
I W
Z �N N N N N N N C.
K
W
� DO OOOO� GL �
�.--0�.--�—��— Q W W
Q Oa�D�O�MM�C)
�N�,o.-a�Y o 0
4�CUCO�e-�� r� U U ,
� W Q Y Z Z
� V J J J
.��. O Y � H �
�j Z Y O O O
a
�
w
F-
Q
�
Q
a
. _
_
.,��,_
�
r
COURT OF COMMON PLEAS CUMBERLAND COUNTY,PENNSYLVA1vIA
ORPHANS' COURT DIVISION
IN RE: CAROLYN KIRK ,AN INCAPACITATED PERSON
FILLE NO: 21-07-1121
ANNUAL REPORT OF THE GUARDIAN OF THE PERSON '
1. INTRODUCTION ',
Pennsylvania Guardianship Association /Brian D. Brooks was appointed the ',
Limited, X Plenary Guardian of the person by Decree of ',
Orphan's Court . Judge Dated: 1/17/08 '
X (A) This is the Annual Report for the period from 1/17/10 to 1/17/11 '
._ (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 terminated by the Court by Decree of
,Judg�e, Dated ',
For Final Report, omit sections II through IV. '
2. PERSONAL DATA �_,, '
Age of the incapacitated person 82 Date of Birth 1/26/28 � o w � �,'L'., '
m � � � a '
3. LIVING ARRANGEMENTS rn z c� z c� =� '
A. Current address of the Incapacitated Person: � z rn '`'' � � ,
GLC BLUE RIDGE 10 HOUSE AVE. CAMP HILL, PA 1 7 0 1 1 � "-' � � Q ,� '
c� �., ` -� � ._.,� '
c-s G -� � .� -,-i ,
B. The Incapacitated Person's residence is: ° �, � �; <-� '
_Wazd's own home/apartment -v � h, � o ,
_ Nursing Home �' rn `n ,
X Boarding Home/Personal Care Home ,
_ Guardians Home/Apartment ,
_ Hospital or Medical Facility ',
_ Relative's Home(name,relationship and address) '
C. The Incapacitated Person has lived here since: 2010 '
If the Incapacitated Person has moved since the last report, state the prior address and reason for '
move: '
MRS. KIRK'S PHYSICAL HEALTH IMPROVED TO THE PERSONAL CARE HOME
LEVEL OF CARE. '
�►;���)
_ _ _ �. -
.
Estate of: CAROLYN KIRK
D. Nazne and address of the Incapacitated Person's primary care giver:
GLC BLUE RIDGE PERSONAL CARE HOME
4. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacita.ted Person are:
DEMENTIA, HISTORY OF ORAL CANCER,AMBULATION DYSFUNCTION
B. Specify what if any, social,medical,psychological and supportive services the ,
Incapacita.ted Person is receiving:
All social,psychological, and medical services aze 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: T'he 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 organiza.tion employed by the Guardian to oversee and coordinate
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 that this Verification is subject to the penalties in 18 PA. C.S.A.
S/S 4904.
i ��
Date:
rian . Brooks
Pennsylvania Guardianship Association
PO Boa 7295
Lancaster,PA 17604 '
717-299-4568
_ _