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ANNUAL REPORT OF .•" � � � � �
GUARDIAN OF THE ESTATE � � `� ''� ��
:�
COURT OF COMMON PLEAS OF
Cumberland COUN'�Y,�'ENNSY�,VANiA
ORPHANS' COURT DIVISION
Estate of Jay William Bedar� ,an Incapacitated Person
No. 21-12-1154
I. INTRODU�TION
Kelly Ann Landis was appointed
,
�Plenary �Lunited Guardian of the Estate by Decree of T�omas A. Placey .J.,
dated
� A. This is the Annual Report for the period from J��'Y 1 , 2013
to December 31 , 2013 �#1ie"Regort�'eriod");or
❑ B. This is the Finnl 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 dea.th:
Name of Personal Representative:
2. The t'ivardianship was�terminated by the Co�rt by�ecree of
J.,dated
Form G-02 rev 10.13.06 �A�S � Of 5
Estate of Jay William Bedard ,An Incapacitated Person
II. SUMMARY
�. State the value of the estate reported on the inventory $ 2,94�.23
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.) $ 2,942.23
C. Wl�at is the tota.l ainount of incorr�e earned during the
Report Period? $ 3,127.99
D. What is the total amount of income and principal
spent for all purposes during the Report Period? $ 11,378.18
E. What are the balances remaining at the end of the Report
Period?
1. Principal $ 2,942.23
2. Income $ 0.00
3. Total of Principal and Income $ 2,942.23
III, ADDITI()NAI.INFORMATION
(I,f'mvre space is needed,�lease attach additional puges.)
A. Principal
1. How is the principa.l balance listed abave currently
invested? (Please specify,e.g.,real estate,
certifica.tes of depos�t,resfiricted ba�k accounts,etc.):
A portion is personal belongings,the balance is in a restricted savings
account.
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? . . . . . . . . D Yes 0 No
Form G-02 rev.10.13.06 Page 2 of 5
Estate of Jay William Bedard ,An Incapacitated Person
b. List purpose and amount of expenditures:
$
$
. $
$
c. Was Court approval received prior to
expending the principal? . . . . . . . . . . . . . . . . . . . . . . . ❑Yes O No
3. Were additional principal assets received during the
Report Period which were not included in the
Inventory or a prior Report�led for the Estate? . . . . . . . . . . . ❑Yes �No
If yes:
a. Was Court approval requested prior to
receiving the additional principal? . . . . . . . . . . . . . . . . ❑Yes ❑No
b. Sta.te the sources and amounts of the
additional principal received:
$
$
$
$
$
B. Income
l. State sources and amaunts of income received
during the Report Period(e.g., Social Security,
pension,rents,etc.):
Social Security $ 7,128.Od
$
$
�
�
�
Totai income received during Report Period.: $ �,12g•�
F�c-oz rev.10.13.06 Page 3 of 5
�
Estate of Jav William Bedard .An Incapacita.ted Persan
2. How is income currently invested? (Please
specify,e.g.,restricted bank accounts, client
care account,etc.):
Not applicable
C. Ezpenses for Care and Maintenance
Specify wha.t expenditures were made from the principal and
income for the care and maintenance of the Incapacita.ted
Person(e.g.,clothing,nursing home,medicine, support,etc.):
Rent, food,utilities,insurance,personal maintena,nce,clothing,spending money.
D. Other Eapenditures
Specify what other expenditures were made duri.ng the Report
Period. (Do not include any items stated in response to
question C above.)
Vacation to North Carolina
E. Gusrdian's Commissions
List amounts of compensation paid as Guardian's commission
and state how amount was determined:
C���t
Amount Method o,f Determination Approval Obtained
0.00 (3 Yes ❑No
Q Yes �No
Form G-OZ rev.I0.13.06 Page 4 of 5
• •
Estate of Jay William Bedard ,An Incapacita.ted Persan
F. Counsel Fee
List amounts paid as counsel fee,and indicate whether Court approval was obtained.
Court
Amount Approval Obtained
0.00 ❑Yes ❑No
❑Yes ❑No
I verify that the foregoing information is correct to the best of my kuowledge,
information and belief;and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904
relative to unsworn falsification to authorities.
,
� .
January 10,2014
D�are sig►raru„e of ' of rhe ta�z
Kelly A. Landis
Nmne of Guardian of the Estate(type or print)
4231VIain Street
Address
York Springs PA 17372
City,State,Zip
717-528-7357
Telephone
Form G-02 rev.10.13.06 Page 5 of 5