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Home My WebLink About06-11-13 (2) _____ _ _ _- �II� A � � p <"' � 1'ri � � � � O � � = C"� Z tn Zs ANNUAL REPORT OF �' z rn '`-�' � �' GUARDIAN OF THE ESTATEQ �' � ~ a � � Q ° 3 � �' � c -�� . -�7-i �j p.,., � COURT OF COMMON PLEAS OF n cn cn o CUMBERLAND COUNTY, PENNSYLVANIA � -`�' ORPHANS' COURT DIVISION Estate of Susan J. Myers , an Incapacitated Person No. 21-10-0220 I. INTRODUCTION Patricia A.M. Havens , was appointed �Plenary ❑Limited Guardian of the Estate by Decree of J. Wesley Oler, Jr. � J � dated Apri126, 2010 0 A. This is the Annual Report for the period from Apri126 � 2012 to APri126 , 2013 (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 Form C-02 rev. 10.13.06 Page 1 of 5 ��, , '� �,�'� _ ___ 1�1� _ _ Estate of Susan J. Myers , An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ 65,000.00 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.) $ 68,776.00 C. What is the total amount of income earned during the Report Period? $ 28,476.00 D. What is the total amount of income and principal spent for all purposes during the Report Period? $ 25,857.00 E. What are the balances remaining at the end of the Report Period? l. Principal $ 70,297.00 2. Income $ 723.00 3. Total of Principal and Income $ 71,020.00 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.): Personal restricted checking account Personal checking account Insurance policies Automobile 2. Have there been any expenditures from the principal during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . �Yes m No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? . . . . . . . . ❑ Yes 0 No Form G-02 rev. 10.13.06 Page 2 of 5 _ _ _ __ �1� Estate of Susan J. Myers , An Incapacitated Person b. List purpose and amount of expenditures: $ $ $ $ ' 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? . . . . . . . . . . . ❑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 $ 13,151.00 Interest and Dividends $ 723.00 Jane C.Myers Trust $ 14,602.00 $ � � Total income received during Report Period: $ 28,476.00 Form G-02 rev. 10.13.06 Page 3 of 5 . �_ ____ �1� Estate of Susan J. Mvers , An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): Social Security Representative Payee Checking Account with PSECU-Restricted Susan Myers Guardian Checking Account with PSECU-Limited Guardian Account with M&T Bank-Limited 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.): See Attachment A - $19,361.00 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.) See Attachment A - $6,496.00 E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Court Amount Method of Determination Approval Obtained 0.00 �Yes �No �Yes �,,;No Form G-02 rev. 10.13.06 Page 4 of 5 _ _ _ _ _ _ _ _ . __ �� Cstate ot Susaii J. Vlye��s , �li�I�.ncapacitated Pecs�ri I+. Counsel Fee List a�nc�uiits paid as coi�cisel fee,and iudicate wlietlier Co«rt�a��p�•oval ��as c�bt�iiieci. C'oiu•I � �mount r�j��1t��al OUtcririecl ' 0.00 �]Yes 01�TC� ❑ Ves �l I�Tt� � I vei•ify lhat the �I'oi•egoiilg� information is correct to tlie b�st of iny kito�vlecige, infori�latio�i aiiti belief; ai�cl that tliis Verificatioi� is s�tb�ect to tlie penalties of]8 Fa,C,,S. � 4904 � relati��e to ��iils�vo��il f�lsification to authc�ri�ties. � � � �� _� -� ��. ��_ �� Dare !� Signcurtre ofGttardfan oftlre�slnta Patrici��1�.M. H.avens � �Y�ante nf Gunrdinri of/h2 F,slnlc(lype or prinl) ' 1235 Crestfielci Drive .9�t�rress Willian�sport, PA 177U 1 f.'try,3rnte,lrp (S7Q) 327-9079 (l�} re�ep�,a,te Forn,G-ll2 ien. lOJ3.06 ��e � 0�5 �� _ _ __ ��I+� ATTACH M E NT A Section III(A)(2)(b)-Expenditures Expenditures Utilities 5910 Food 5500 Ciothing 2400 Rx 420 Gas 2200 Cleaning 1050 Repairs 1100 Service 800 LT Carelnsurance 1536 Autolnsurance 860 ' Health Insurance 1763 Medical/Hospital Bills 1120 Car Payment(may-nov) 0 Part B Medicare 1198 Total Expenditures $ 25,857.00 Section III(C)-Care and Maintenance Expenditures Utilities 5910 Food 5500 Clothing 2400 Rx 420 Cleaning 1050 ' Health Insurence 1763 Medical/Hospital Bills 1120 Part B Medicare 1198 Total Expenditures 19,361.00 Section III(D)-Other Expenditures Expenditures Gas 2200 Repairs 1100 Service 800 LT Care Insurance 1536 , Auto Insurence 860 Car Payment(may-nov) 0 ' Totai Expenditures 6,496.00