HomeMy WebLinkAbout06-10-13 (4) . _
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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 1/17/11 to 1/17/12
_ (B) This the Final Report for the period from to � � � �
rn
and is filed for the following reason: � °� � G? o
1. The death of the incapacitated person, Date of Death m = � � �' �
2. The guardianship was terminated by the Court by Decre�b � a �''' ��`
:.� �
.Jud�e Dated � �'�-' x c �
n � � � �
2. SUMMARY � C � =` �
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A. State the value of the estate reported on the inventory 3 13(�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 from last report)
$ 248.46
C. What is the total amount of income earned during the report period?
$24,658.32
D. What is the total amount of income and principle spent for all purposes during the
report period.
$24,280.01
E. What are the balances rema.ining at the end of the report period?
1. Principle $
2. Income $
3. Total principle and income $ 626.77
���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?
Yes X No
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. Sta.te 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: $ 24,658.32
2. How is the income currently invested? (Specify)
PAGA CUSTODIAL ACCOUNT
.
_ ���r -
THE ESTATE OF: CAROLYN KIRK
C. Expenses 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
$ 1,000.00 10 MONTHS n, 100.00 (Yesl No
F. Counsel Fee
(List amounts paid as counsel fee, and indicate whether Court approval was obtained.)
I verify that the foregoing informallon 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: �.5 �
Brian .Brooks
Pennsylvania Guardianship Associafion
PO Boz 7295
Lancaster,PA 17604
717-299-4568
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COURT OF COMMON PLEAS CUMBERLAND COUNTY,PENNSYLVAIVIA
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 1/17/11 to 1/17/12
_ (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. T'he guardianship was terminated by the Court by Decree of
Jud�e Dated
For Final Report,omit sections II through IV.
2. PERSONAL DATA
Age of the incapacitated person 83 Date of Birth 1/26/28
c� �
3. LIVING ARR.ANGEMENTS � o `�`' m � ''' '
cz� ..�� � c� � ,
A. Current address of the Incapacitated Person: �„ _ �.,� z �� �
GLC BLL1E RIDGE 10 HOUSE AVE. CAMP HILL, PA 17011 � n �" f-.� --! �
A � CFt � ;'t�� {;-T
� (1� �7 :+�.;s :_w
B. The Incapacitated Person's residence is: �' c> �, -� .� `�
_Ward's own home/apartment � � ^� � - `�°�
Nursing Home " ;:� -�= � ;�,'
� � i�..�� ..
X Boarding Home/Personal Caze Home � Q� � ,.a�
_ 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 IlVIPROVED TO THE PERSONAL CARE HOME
LEVEL OF CARE.
��'�
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,, .
Estate of: CAROLYN KIRK
D. Name and address of the Incapacita.ted Person's primary care giver:
GLC BLUE RIDGE PERSONAL CARE HOME
4. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are:
DEMENTIA, HISTORY OF ORAL CANCER, AMBULATION DYSFUNCTION
B. Specify wha.t if any, social, medical,psychological and supportive services the
Incapacitated Person is receiving:
All social,psychological,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: 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 organization employed by the Guardian to oversee and coordinate
the caze of the Incapacitated Person for the period covered by this Report may be attached to
supplement this Report. '
I verify that t6e foregoing information is true and correct to the best of my knowledge,
informafion and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A.
S/S 4904.
,-�
Date: ��J/��
rian . Brooks
Pennsylvania Guardianship Association
PO Bog 7295
Lancaster,PA 17604
717-299-4568