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ANNUAL REPORT OF � v r� �; �,;;; CY�
GUARDIAN OF THE ESTATE �. u: ,.�, �' ��
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COURT OF COMMON PLEAS OF " = � `='
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�a,�M(� c;- )a.n c� COUNTY, PENNSYLVAI�(��sA �
ORPHANS' COURT DIV[SION
Estate of �- o r� i e.- R 0.�/ �/1�I f`�'"� P r _, an Incapacitated Person
No. at - v7 - 09-37
L INTRODUCTION �
�(ar en c e, il, 1/�/i�'n� e�^ �n�1 (��-�y � Vv��tvn cr, was appointed
Q�Plenary 0 Limited Guardian of the Estate by Decree of ��warc:� C. Gu i dv �.,
dated /V avcrn be.r )3_.�Do7
�A. This is the Annual Report for the period from .�a� �ar � _, �
ol
to D z-��m��r" �� , �U�3 (the "Report eriod"); or
� B. This is the Final Report for the period from �
to , (the "Report Period"), and is filed
for the following reason:
L 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
Page 1 of 5
FormG-02 rev.10.13.06
�
Estate of L ��� � � °C-`� W � t� e r , An Incapacitated Person
II. SUMMARY
A. State the value of the estate reported on the [nventory $ 0� G�O
B. State the value(s) of principal assets at the beginning of
the Report Period. (Same as Inventory if first Report, $ �, 0 �
otherwise, endinb balance from last Report.)
C. What is the totai amount of income earned during the $
Report Period?
D. What is the total amount of income and principal
spent for all purposes durinb the Report Period? �
E. What are the balances remaining at the end of the Report
Period?
l. Principal � �` � �
2. [ncome $ a � d�
� 0.00
3. Total of Principal and Income
III. ADDITIONAL INFORMATION
(If more space is needed,please attach additional pages.)
A. Principal
l. 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . �Yes �No
If yes:
a. Have all expenditures from the principal been for
the sole benefit of the Incapacitated Person? . . . . . . . . ❑ Yes ❑No
Page 2 of 5
Form G-02 rev.10.13.06
Estate of L�n i�- � Q ����� �m �r , /�n �ncapacitated Person
b. List purpose and amount of e�penditures:
C (� U SS x�nc, �
$
$
�
c. Was Court approval received prior to
eYpending the principal? . . . � . . . . . . . .. . . . . . . . . � . . � Yes �'�10
3. Were additional principal assets received durin� the
Report Period which were not included in the �,.�
Inventory or a prior Report tiled for the Estate? . . a . . . . � . . • � Yes � No
I f yes:
a. Was (:�urt 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.): `
-Soci0.1 Secu�i`t7` $ 7-� 36 , oD
S, s. S $ 6 Y 9.�, � o
$
�
$
�
Total income received during Report Period: $ 1`I a 31. �D �
Page 3 of 5
Fornt G-02 rev.l0.l3.06
[?state of L �h� �- � `� � � t� e� , An Incapacitated Person
2. How is income currently invested? (Please
specify, e.g., restricted bank accounts, client
care account, etc.): tc� , T.h � �� (r S'o u rc e
� �� � ot' inve5 , S, -�,
�]'J�e i n c c�m C Y � � s
soc_�a� Scc�.cri � �� +
� -� � n ��rti e r s �z�r w 4 r ct e�'�- a
h ej�� -f-�ts , u/i�f"ti l /
a �� a.n�c v u h�S
� (� � S S jn r. -TO� /�� � efS o n c�.l G at�- N a m ��
C. Expenses for Care and Maintenance
Specify what eYpenditures were made from the principal and
income for the care and maintenance of the Incapacitated
Person (e.g., clothing, nursing home, medicine, support, etc.): �
� ��� U SS. ,.�it c,
e.. ��I'e c-f� U
/� �( j n c ��Y„ � i 5 S f" `'� r �'/� 7�_° 6 �
'�/� l'71��1aIa— !`�i � S/t ���r-_nsb �-crR � a �
/ /
��t,��i`e�� �d �� C a�e- a't
� � e�-s v^��i f� e_ e�f'
���ryCr,
L CJl1��e-
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:
Court
Amount Method of Determination Approval Obtained
J%n� �e ue sfie�- or re c�%v��-- �Yes �10
�Yes �No
Page 4 of 5
Form G-02 rev.10.13.06
Estate of L �n � e- R d- � �� tm e r , An Incapacitated Person
F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Court
Amount Approval Ohtained
�( �� � _ �Yes �No
�Yes �No
I verify that the foregoing information is correct to the best of my knowled�e,
information and belief; and that this ueritication is subject to the penalties of 18 Pa.C.S. § 4904
relative to unsworn falsification to authorities. l'�,tyc,��,c�. �- �,�%�-�`-'
�J
/ - 3 1 - 013 ,�
Signature of G rdian o e Gstate
Date
C(a�enc� I/ (/��� n�' ee-
(� e f� ,�. vH e r
Nume of Guard un of lhe Estate(type or print)
3�y /�l o v a— D►'�i v e.-
�l ddress
�j!'eenc�s�t�e- �� /���.SJ
Ciry,Smte,Zip
�/� s�7 G � 3 7
Te[ephone
�ell 7/� 97�7 �� l3
Page 5 of 5
Form G-02 rev.10.I3.06