HomeMy WebLinkAbout09-10-13 C•)
ANNUAL REPORT OF
GUARDIAN OF. THE ESTATE � �.r CD> Cn ;z C
V n C -71 ;
C� C -n
COURT OF COMMON PLEAS OF
COUNTY,PENNSYLVANIA= r--
ORPHANS' COURT DIVISION v� A cr
Estate of an Incapacitated Person
No. ;?H2 - L/C4Z
L . INTRODUCTION
was appointed
Plenary.❑Limited Guardian of the Estate by Decree of J
dated L - 12_ lZ 2 .
XA. This is the Annual Report for the period from
to �o - (� (the "Report Period';or
❑ B. This is the Final Report for the period from
to (the"Report Period".), and is filed
for the following zeesom
The death of the Incapacitated Person. Date of death:
Name of Personal Representative: -
2. The Guardianship was terminated by the Court by Decree of
I.,dated .
Page 1 of 5
Form G.OT rev.10.13.06
Estate of Gad �C-CR 4 )'S An Incapacitated Person
H. SUMMARY n G p�
A. State the value of the estate reported on the Inventory $ O
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)
C. What is the total amount of income earned during the DG `
Report Period? $ o
D. What is the total amount of income and principal �{
spent for all purposes during the Report Period? $ ` ( )l p
E. What are the balances remsining at the end of the Report
Period?
1. Principal $
2. Income
3. Total of Principal and Income
III. ADDITIONAL INFORMATION
((f 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,):
2. Have there been any expenditures from the principal '
during the Report Period? . . . . . . . . :. . ... . . . . . . . .. . . QYes ao
If yes:
a. have all expenditures from the principal been for
the sole benefit of the Incapacitated Person? . . . .. . . . Yes No
'Fam G-07 r".10.13a6 Page 2 of 5
Estate of G>��� -a bad s 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 1:1 No
If yes:
a Was Court approval requested prior to
receiving the additional principal?'. . . . . . . . . . . . . . . . E]Yes E]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,
Gopension,rents,etc.): 00
C.'a f nl $ 7b
Tby)c inn $ .g .02
rn+��r $ •
12-
$
$
Total income received during Report Period: $ 91) �'-3- Ll
F�G-02 rn.10.13.06 Page 3 of 5 .
Estate of (�e)tU C(-- 0 rfj A 1S An Incapacitated Person
2, How is income currently invested? (Please
specify, e.g.,restricted bank accounts, client
care account, etc.):
Cvs�oC acc�- � Net hl �� C5
OLc LfZ2. 7Q
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,):
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:
Com t
gAmount Method of Determination' Approval Obtained
es [:]No.es []hTo
Form G-07 rev.70.15a6 _ .. . .Page 4.6f 5
Estate of - 1 An Incapacitated Person
F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Court
Amount Approval Obtained
,Dyes ONo .
Dyes ❑No
I verify that the foregoing information is correct to the best of my knowledge, .
information and belief; and that this Verification is subject to the penalties of 18.Pa.C.S. § 4904
relative to unworn falsification to authorities.
Date Sigwame of Guardian c#"dw L•rtate
Name qV Gware i=ofthe F•Iate(6Te or prtn#
. . NEIGHBORHOOD SEXVICES
134 SOUTH PRINCE STREET
P.O.BOX 1593
LANCASTER,PA 17608-1593 A&SM
Ciry,State,Zip ..
-W - Mz -z7--7s
Telephone'
'Farm G-aa M.10.13-01f Page 5 of 5