HomeMy WebLinkAbout12-31-13 (3) � .
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A►NNUAL REPORT OF � � � �
0
�GUARDIAN OF THE ESTATE � � � � �
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�. � � � � �
. COURT OF COMMON PLEAS OF �' c, a :� '�n�''' -n
G1.lnc��.es—�Cv��. COUNTY,PENNSYLVANI� � � `� -� �` .
ORPHANS' COURT DIVISION � � �. � �
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c� "�1
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Estate�f � � ���-�� ,an Incaracitated Person _ . .
No. C-1-I �"�Ci�-1�°s
i. INTRODUCTION �. �
����� ..� � '� ,was appointed
�len �Limited Guardian ofthe Estate by Decree of ,J.,
�'
dated I�-I17�/er�� �`5. ��3
�A. ' is the Annual Re ort for the eriod from �-� � , �3 . �
p p �
to 3 � , (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 Perso�nal Representative: . �
2. The Guardianship was terrninated by the Court by Decree of .
J.,dated
Form G-02 �.Io.13.06 Page 1 of 5
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Estate of (/��1•�5��. M.�GMa.�� 5��.. ,An Incapacitaxed Person
II. SUlVJ[MARY
A. Sta.te the value of the estate reported on the Inventory $ 5�bl� (.�
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.) $ 5 L�� t� -
C. Wha.t is the total amount of income earned during the � � . - �
Report Period? $ �-�4 . .
D. What is the total amount of income and principal . ,
spent for all purposes during the Report Period? $ 1`� :
E. What are the balances remaining at the end of the Report
Period? � �
1. Principal $
2. Income $
� 3. Tota.l of Principal and Income $ ��D� �,00 �
III. ADDITIONAL INFORMATION
. .(If:moFe space is needed,please attach additional pages.) . � - ,
. A. Principal �
1. How is the principal balance listed above currently
invested? (Please specify,e.g.,real estaxe,
certificates of deposit,restricted bank accounts, etc.): �
, /�1�°� .
2. Have there.been any expenditures from the principal
during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . �Yes �To �
If yes:
a. Ha.ve all expenditures from the principal been for
the sole benefit of the Incapacitated Person? . . . . . . . . ❑Yes ❑No �
Fornt G-02 rev.10.13.06 Page 2 of� �
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Estate of �-�,, 11R�ihc�.Q,d, � �e ,An Incapacita.ted Person
b. List purpose and amount of expenditures:
$ ��
1�i� � $
..,
$
$
� c: Was Court approval received prior to �
expending the principal? . . . . . . . . . . . . . . . . . . . . . . . ❑Yes G�'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 Esta.te? . . . . . . . . . . . �Yes �No
If yes:
a. Was Court approval requested prior to � �
receiving the additional principal? . . . . . . . . . . . . . . . . D Yes ❑No
b. Sta.te the sources and amounts of the
� additional principal received: �
�l�l�t $ ��
$
_ _�.___ ___ . ,. _ _ . _ _
$
. $
�
B.. �ncome . � �
1. State sources and amounts of income received � . �
during the Report Period(e.g., Social Security, � �
pension,rents,etc.):
$ ��
/Iti•���� t..,� G nr�,�.� s�� ! $ .
.. .. � �
�D
�
.D
Total income received during Report Period: $ �' o.00
Form G-oz rev.l0.13.06 Page 3 of 5
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Estate of An Incapacitated Person
� 2. How is income currently invested? {Please
. specify, e.g.,restricted bank accounts,.client
. care account, etc.):
.. �� . . . .
, C. E�penses for Care and,Maintenance : � . �
Specify what expenditures were made from the principal and � .
income for tlie care and maintena,nce of the Incapacitated . � ,
� . .Person(e.g:,clothing,nursing home,medicine, support, etc.): � . � � . �
. ��" . .
D. Other Ezpenditures . .. �
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 aniounts of compensation paid as Guardian's commission �
and state�how amount was determined: " _ �
. Court
Amount � � Metliod of Determination . Approval Obtained
,�� ,�Yes �No
�Yes Q No
Form G-02 rev.10.13.06 Page 4 of 5
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Estate of ,An Incapacitated Person ,
F. Counsel Fee �
� List amounts paid as coun.sel fee, and indicate whether Court approval was obtained. .
Court
Amount Approval Obtained
��.� � �Yes �No . . .
0 Yes �No
I.verify t11at the foregoing information is correct to the best of my knowledge; � �. .
� information and belief;and that this Verification is subject to the penalties of�1�8 Pa:C.S. ��4904
relative to unsworn falsification to authorities. � : .
y2-3r �3
Date Signature of Guardian of t tate
�f�Gr.�.J .5��
Name of Guardian of the Estate(type or print)
. . �Zv 1 G l�1—�.n---� 2z�
. Address
. . �G.t� l�s Lc . C�- 1�c�1.'�
. City,State,Zip
� � �� 'Z�� ► ► l I
Telephone
Form G-oz �.Io.13.06 Page 5 of 5