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Home My WebLink About09-05-13 L f- `/ «'T� � L,til .... µ�i'tl � � � �—r�. _ �^'1 —... �..�., �.. `�� .��': �,�,vn � �� + .� �. ., � ..:� " " .. �.J.r'S��_. �` � .��gn� � �';` ' ' .._ ,_, .:., .. f�_ , ,� % * �-� �.,.7 ;<' � _ " ,. ��'�','�.�:i;�,<�i�� '�. � � �, a E��.'°��)� ' ' , w . -- r..� : , , i._r ,.. ..., COLTRT OF CO1��T��tO�PLEAS C?F � �' � CumrU�lar��1 C'()�_'LT�', PENI�SY1 VANI:1 O�Z�'HAi��' C(�UI�1'Dlv'I�tUN Estate of Nicole Hlavac , an Incapacitated Person No. 06-06(l$ I. 1tiTRODUCTtOiV' Dana and Rose Hlavac , was appointed �Plenary�Limited Guardian of the Person by Decree of J. Oler , J dated 8/31/2006 � A. This is the Annual Report for the period from September 1 2012 , to Au�ust 31 , 2013 (the `Report P�.riod"}; or � B. This is the Finai Report for the per:od fi•otn_ _ to , (the "Report Period"), and is filed for the follo«i,ig reason: 1. The death of the Incapacitated P�rson. Date o,deatli: � 2. The Guardiansl.iip was ternlinated by tl:e CouT�t by Decree�of 1., date�.f For a Finci!Report, t��rirt��tr,�its tI through 1�: r�r„z c-o3 r�ti�. ia r�.06 Pa�e 1 of 4 � 1 Estate of �icole Hla:ac , an Incapaeitated Person II. PL�?�O\:�T_. T}:�T:'� Age of the Incapacitated Person: 25 Date of Birth: 06/28/1988 III. LIVING ARRANGF.:�iENTS A. Current address of the Incapacitated Person: 314 Charleston Green Malvern, PA 19355 B. The Incapacitated Person's residence is: �own home/apartment �nursing home �boarding home/personal care home �Guardian's home/apartment �hospital or medical facility ❑relative's home (name, relationship and address) Dother: Group Home C. The Incapacitated Person has been in the present residence since September 3, 2012 �s . If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Moved from 905 Charleston Greene; Residents moved to a lar�er unit in t.le townhouse complex. � Form G-03 re��. 10.13.Oh p1�e 2 Of 4 Estate of Nicole Hla��ac , a:� (i�capaci�at��1 Person D. ��:�rm:� ��ind addresc ��the (nc��?cita*ec� Per�,�n'�� xr �v c�z��;�.�e,.. Melmark 2600 Waylana Rd I3erwvn. PA 19312 IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: Nicole 11as profound intellectual disabilities including: ADD/ADHD, CP, Autism and OCD due to a rare genetic defect. B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: In addition to su��i�ort ser��:ce�s throt�gh her group home pmvidc;r.Nicole is in a vocational program at 1Vlelmark. The program includes supports for Nicole's speech and behavioral needs. V. GUARDI:�:ti'S OPINIO'_v A. It is the opinion of the Guardian of the Person that the guardianship should: �continue �be modified �be ternlinated Foyrn G-D3 rev. 10.1.i.06 Page 3 of 4 Estate of Nicole Hlavac , an Incapacitated Person The reasons for the fore�oing opinion are: While Nicole is learning self care and job skills, she remains unable to care for herself and is dependent on others for her care and safety. B. During the past year,the Guardian of the Person has visited the Incapacitated Person � times with the average visit lasting 32 hours, 26 minutes. The report of a social service orgnrai�atior� errzployed vy the Guardian to oversee and coordirtate the care of the Incapacitated Per•son for the period covef•ed by this Report may be attached to supplerner�t tliis Repof•t. I verify that the foregoing information is correct to the best of my knowled�e, information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. � 4904 relative to unsworn falsification to authorities. 9/1/2013 '��)�� Date Sigrtalure ojGtrardiun of!he Per,son Rose Hlavac :1�'ume ajGuur•diun of lhe Person{rope or print) 42 Keswick Dr ,��ra,ess Mechanicsburg, PA 17050 Ciry,srure,zip 717-?58-�666 Telephone Forsri G-03 rev. 10.13.06 P1bC; 4 Of'� Supplement to Annual Report of Guardian of the Person Person: ?�'ic_�le Hl.a�°ac: L3oeket �[�r: 06-0608 Following are the details reg�rding v;sits to �iki during the Septeinber 1, 2012 to August 31, 20li timefratne. Trip Durati # Visit Start Visit End on Notes (Hrs) -- --- - —_ - _ _; __ _--- ___ __ __ _--- ----- ----_ —__ _ _ 1 9/30/2012 9/30i201"? 5.48 Joybells �;oncert, Shop and Duiiier 2 11/21/2012 11/25/2012 92.91 Thanksgiving 3 12/23/2012 12/26/2012 68.85 Christmas 4 3/18/2013 3/18/2013 4.64 Spring Break Visit 5 3/29/2013 3/31/2013 45.07 Easter 6 4/21/2013 4/21/2013 3.41 Joybells Concert and Dinner 7 6/29/2013 6/29/2013 6.57 Niki's Birthday Total visits= 7 Total hours=226.99 Average Per Visit: 32.43 hrs (32 hours 25.8 minutes) '. • -s , , .,.. :. � <_...� .. . ,�l _._ � ..� � ,. � ......� � , _ ....�,.5 C;:, i - �..,_f _. '. , . .� , :"��. '; ;_,�., : ;: �,"- >� � �7�' .:. _ ,.. , ��'t�.�� r�� 5_.) ' "x ;� ��•: �:S'�� `�, : � ; � ` _ ��; COURT OF COMMON PL�AS OF , � CunibPrland COUNTY, P�NNSYLVAN�'^_ u�� ' ��RP�-IA�' .>' (,t)l;iZ 1,DIVI`;IO;tiT Estate of Nicole Hlavac , an Incapacitated Person No. 06-0608 I. INTRODUCTION Dana and Rose Hlavac , was appointed m Plenary �Limited Guardian of the Estate by Decree of J. Oler J dated 08/31/2006 m A. This is the Annual Report for the period from September 1 � 2012 to Ati�us� 3�2013 _ ,_ _(tlle "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., datec' Form G-02 rev. 10.13.06 Page 1 of 5 � Estate of �`�icole ��lavac _ , Ali Incapa�itated Person II. S�"1�I�I�I?Y A. State the value of the estate reported on the Inventory $ 0.00 B. State the value(s) of arincipal assets at th�. beair:nina of the Report P�:r�iod. (Same as lm�entory if tir�t 1t�::p�rt, � otherwise, ending balance from last Report.) $ 736.46 C. What is the total amount of income earned during the Report Period? $ 9,418.53 D. What is the total amount of income and principal spent for all purposes during the Report Period? $ 8,795.06 E. What are the balances remaining at the end of the Report Period? l. Principal $ 2. Income `� 1,359.93 3. Total of Yrincipal and Income $ 1,359.93 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, �.g., real estate, certificates of deposit, restricted bank accounts, etc.): 2. Have there been any expenditures from the principal during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . �Yes �:vo If yes: a. Have all etinendi±�.�-es from the principal been f�r � the s��ie�bene�it or ihe Incapacita��e��Persori'? . . . . . . . . ��' �Yes �� Fornt G-02 rev. 10.13.06 Page 2 of 5 Estate of �icole �ilavac _ , An Incapacitated Person }). 1 Cl �Lii"'��iSf' `3?"1� �Yr`^';'lt '�f�°' ';1C�, ;�r�c,- � ---- _. See attached Cash Flow Statement for Detail:; $ � -- � _ c. Was Cou:-t approva' received prior to expendin�,the principal? . . . . . . . . . . . . . . . . . . . . . . . � Yes 0 No 3. Were additional principal assets received dur�ng the Report Period which were not included in the Invento:y or a prior Report filed for the Estate? . . . . . . . . . . . �Yes �IvTo If yes: a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . . . ❑ Yes ❑No b. State the sources and amot4n�s cf tl��e � additional principal received: $ $ $ $ $ B. Income 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, ete.): S S I $ 9,090.23 PA SSP _ $ 287.30 In+erest $ 16.00 Gifts $ 25.00 � ,, $ Total income received during Report Period: $ 9,418.53 Foim G-02 .ev. i o.�;.o� Page 3 of 5 Estate of Nicole Hlavac , An Incapacitated Person 2. How is ircom,� currently ir.�,�ested" �Please specify, �;.g., restricteci bank accoums, client care account, etc.): Pennsylvania State Emp',oyee's Credit Union(PSECU) 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 attached Cash Flow Statement Total Expenses=$9,418.53 ► D. Other Expenditures Specify what other expenditures were madf� during the Report Period. (Do not include any items stated in response to question C above.) None E. Guardian's Commissi�,�s List amounts of compensation paid as Guardian's commission and state how amount was determined: Court Amount Method of Determi��ation Approval Obtuined 1�,'�ne �Yes 0 No Q Yes ❑No Form G-02 rev. l0.13.06 Page 4 of 5 Estate of�!i�: � �I�_��iati�:.�_�_ , An Ir��pacitated Person F. C ;?= _! -,. Lis�an�lounts paid as cour::,el f�e, a�,J indicate whet3�er Coui�t approval w�as obtained. Court _q,-"��rrrt A,.,,�,,o�•�zl Ohtained 0.00 0 Yes �No �Yes 0 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 unsworn falsification to authorities. Ol Septe�:�ber 2013 '��—��-�-��y Date Sigrvat:�re of Guardian of the Estate Rose Hlavac Name of Guardran of the Estate(rype or printJ 42 Keswick Dr Address Mechanicsburg,PA 17050 Ciry,State,Zip 717-258-Sb66 Telephone Form G-OZ rev. 10.13.06 Page 5 of 5 .� , ---� ; � —., , —�-�--;—;---� M, � . . , . �0�.. w � � Mi H�? 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