HomeMy WebLinkAbout08-28-14 (2) i
ANNUAL REPORT OF
GUARDIAN OF THE ESTATE
N
COURT OF COMMON PLEAS OF c � o
COUNTY, PENNSYLVANIA Tn z c-> G-3 U
ORPHANS' COURT DIVISION r o
! co o O °
F2au�1, i ST� dyd,''s/* i? 170 C? 0 Co -n � a
Estate of 1�:spa. l�drt7"c k2tipC an Incapacitated Pers§* r m
No.� fi
,
—Le53 o cn
I. INTRODUCTION ,9
r ty r e hd C ,was appointed
Plenary OLimited Guardian of the Estate by Decree of Il d . jEy we 'S'h F,4� 1J.,
dated x.44 kZ., R'QfD-
A. This is the Annual Report for the period from U—y
to 4� rte ,2e,. /y (the"Report Period"); or
0 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 Decrec of
J., dated
Form G-02 rm to,13.06 Page ] of 5
Estate of &4/4ia. —r✓elle SAaA0c An Incapacitated Person
II. SUMMARY
A. State the value of the estate reported on the Inventory $
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
Report Period? $
D. What is the total amount of income and principal
spent for all purposes during the Report Period? $
E. What are the balances remaining at the end of th eport
Period?
1. Principal $
2. Income $
3. Total of Principal and Income $ 0.00
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, 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 ETNo
If yes:
a. Have all expenditures from the principal been for
the sole benefit of the Incapacitated Person? . . . . . . . . 0 Yes U<O
Form G-02 rev. 10.13.06 Page.2 of 5
Estate of 836 �iiaNi x1 67— 6k/-���/P , >W1d An Incapacitated Person
b. List purpose and amount of expenditures:
$
c. Was Court approval received prior to
expending the principal? . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes tMo
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? . . . . . . . . . . . 0 Yes M-Wo
If yes:
a. Was Court approval requested prior to
receiving the additional principal? . . . . . . . . . . . . . . . . ❑ Yes
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.):
$ I
Total income received during Report Period: $ o.00
Form G-01 rev.10.13.06 Page 3 of 5
Estate of L� /n/1N /N l a�t��Pt ! 7��� An Incapacitated Person
2. How is income currently invested? (Please
specify, e.g., restricted bank accounts, client
care account, etc.):
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:
Court
Amount Method of Determination Approval Obtained
®Yes �M<O
0Yes 041
Form G-02 rev. 10.13.06 Page 4 of 5
Estate of 9-u 1;10m al 5T /tQR/1.6/e1 PA l7el3 An Incapacitated Person
F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Court
Amount Approval Obtained
_. es 0 No
®Yes ®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. �j//
Date Sioature of Guardian ofthe Estate
,`JfJM1X /- - c�-Ald/tl>2
Name of Guardian of the Estate(type o print -
B3�
Address
biz/s/� 9-od
City.Slate.zip
?i-7) as-6-97y0
Telepho
Form G-02 rev.10.13.06 Page 5 of 5