HomeMy WebLinkAbout09-03-14 N
���V]l�Ii�AL R�PORT OT� � �, � rn ;
GIJI�RDIA�1 O� TH� P�R�ON � � � ° � �
r` �' '�"� G, � ;
''. cra :�',
.... . ,, , pt'3
:�� .-� � ""O '�,7 —�7
. � _? � � �= C�
���RT�����0�������� � .a
C'umb�land �Oi�'TY,PE�V[Nf�7�LV/�V7i �1 � =� ►-' � m
_.., .� r-
ORPH��VI��C'OLDRT DI�'I�ION , E-' �n -°
�
�e of�icole Hla�ac an In�iltatted Per�an
�60. �g
L I�'TRODIpCTI01�
Dana and Ra�Hlawac �����
�Pl��ted Guardian of lthe Per�on by I�cree of J_Ol�r �J.a
dated 8,/"31l2006
� �ll. Thi�i�tthe Aanaal Report for t�e period frvm ���l 2A13
�All��t 3l , 2014 (th�"R�t period'"�A or*
❑ B_ This i�the F'mal Report fo�td�period frvm
tto (1�"Report Period�,and is flcd
for t�e follo�ing rea.�:
1_ The dearb of td�e I�citated Person. Datte of dearh:
2_ T��uardiam�lrip��ed by the C'ourt by D�r�e of
J.s dared
l�'or a F"n�o/Rep�owal`�s II t�lrsorrgh li!
��,,.�yr ,,,�- e�.l�.� Pa�e 1 of�
�of �icole Hla� an Incapa�ill�+ed P�an
II. P�',R,SOAI'iAL DATA
d��e of 1�he v��aCilt�d Person:�4 Date of BirII�_ ��`1988
IIL L1�PI�1'iG�IRR�IAI'iG�A�ATi"I'�
� Ctiurent addr�of the Incapaci�Per�on:
314 C�arle�ton Green
Aelal�emT PA 19355
B_ Tl�Incapacitalted Pe�onrs re�idenc�i�_
�o�en hame/'�
�nu�ing h�
�boarding home�per�onal c�home
�Guardian'�hom�A ap�ent
�hosPi�al a�r medical fa�bty
�r+�lai�e's home�name�relarion�hip a�d addr�)
��
c�x�
C. The inca�itated Pe�on l�as been m tlhe�1t residence since �=2�12
. If 13te Incap�itated Pe�on l�m,�wed�sithm id�e
Pa�t year,sttate pri�r+e�idence and��)far mo�e:
����r �.p.:.aa p.�..� Pa�e 2 of 4
�te of�icole Hla��ac ,an I���ci�ri�d P�
D_ �ame and ad�of t�e Inc�apacital`ed Per�a�Fs primary�er.
Melmark
2600�ayland Rd
Bernr�na PA 19312
I� IlMI�DIC'a�lL,IIlV'iF'ORAoI�I'TT01'V'i
d�_ The major medical or me.ntal pnobl�of ffie Incap�cil�alted Per�ar�e as follo�s:
Alficole has�found i�Decltual di�abilil�es inclnding�D�'�DHDr(:'P,�i�i�u
and OC'D due to a rac+�genetic defect.
B_ �pecifj�whaltr if aular social,medic�p�cholo�ical and�pp�t�ices td�
In�apacitated Peraon i�receiwing:
In a�i�io�1to�uppo�lt�ices throngh�r group ho�e p��iderD�lficole i�m a
�ocational progcam a1t�4lelmazk. 1'Le�gram includ�s sup�t�for�icole"s�h
and beha�ioral ne0ds_
�. GUARDIa+IAIi'�OPI�V'iIO�Y
A It is the opinion of the Guazdian of the Per�n t�hat lthe guardiau�hip�ha�uld:
�crontmue
Dbe moaifie�d
❑be ter�mm�t�d
��.� ,�:.B�r�.� Pa�e 3 of 4
�Ite of flVficole Hla�aac .an I�ilrated Pet�on.
The r�a�ons fot ffie foregom�op�mon are:
�i�7e AAicole is l�arnio��If caze and job�kill�she r�umable to car+�for
her$elf a�d is dep��ent an di�r far her care and safelt�.
B- Daring�e Past Yeazr 1�Guardian of tfie Per�on has�si�d 1�he Incapacitated Per�on
6 �witih the a�erage�risilt la�aing 37 �r 12 �
The report o�a,socwl sen�ice orga�ation emPloped b�w'tlee G'var�to ower�see ar�d
caorafi�ate tJ�e care of the h�cap�ociiul`ed Peraan far the periad cou+ened b�thi�Repvst ma�h�e
at'tached to,s�pplement thxs.Repvrt.
I�e.rify iChat tthe fc�going mfazma�on is cameclt 1to th�be�lt of m�lmo�wl�dgeS
mfoimatian and belie�and tdrat this�deri6calhion is snbgect to the penallhres of 18 P�C_�� �4904
relal�e to uos�o�n f�lsific�rion ito a�ilie�.
9,�1/2013
�.....
� �s.�,�.�,;��
Rose Hla�ac
���������
42 Ke�s�ick Dr
�
Meclranic�biug„PA 17050
��;.��
71"D 258-5666
��
��.� .,�:aa.l.�.� Pag�4 of 4
Supplement to Annua!Report of Guardian of t6e Person
Person: Nicole Hlavac; Docket Nbr: 06-0608
Foliowing are the details regazding visits to Niki during the September l, 2013 to August
31,2014 timeframe.
T�p Durati
# Visit Start Visit End on Notes
rs
1 11/28/2013 12/1/2013 78.75 Thanks ivin
2 12/23/2Q13 12/28l2013 117.5 Christmas
3 3/8/2014 3/8/2014 1.5 Luach
4 4/20/2014 4/20/2104 6.5 Easter
5 7/4/2014 7/4/2014 S.5 Niki's Birtlzda
6 8/24/2014 8I24/2014 10.5 Visit with Niki and sister
Total visits=6
Total haurs=223.25
Average Per Visit: 37.21 hrs(37 ho�ars 12 minutes)
�
C � � rn
� � � � �
ANNUAL REPORT OF � -� � �., �
GUARDIAN OF THE ESTATE �' � � �,,, � n
� �
�� . ;:
� a
�� :�, � --o �, -�,
COURT OP COMMON PLEAS OF `^' � �' � � �
�:::, c_ c�
Cumberland COLINTY,PENNSYLVANIA � � ~' �-'�- m ,
ORPHANS' COURT DIVISION := , ,� �' �°
Estate of Nicole Hlavac ,an Incapacitated Person
No. 06-06U9
I. INTRUDUCTION
Dana and Rose Hlavac ,was appointed
�Plenary ❑Limited Guardian of the Estate by Decree of J. Oler �J.�
dated 8�31/2006
� A. This is the Annual Report for the period from September 1 � 2013
to Au�ust,�1 .�014 (the"Report Period");or
� B. This is the Final Report far the period from
to (the"Report Period"),and is filed
for the following reasan:
1. The death of the Incapa�itated Person. Date of death:
Name of Personal Representative:
2. The Guardianship was terminated by the Court by Decree of
J.,dated _ _ ______ �
�o.�,c-oz ►�.�o.is.o6 Page 1 of 5
Estate of Nicole Hlavac An Incapacitated Persan
II. SiJMMARY
A. State the value of the estate reported on the Invenfory $ 0.00
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.) $ 1,359.93
C. What is the total amount of incorne earned during the
Report Period? $ 8,801.03
D. What is the total amount of income and principal
spent for all purposes during the Report Period? $ 9,204.77
E. What are the balances remaining at the end of the Report
Period?
l. P'rincipal $
2. Income $ 956.19
3. Total of Principal and Income $ 956.19
III. ADDITIONAL INFORMATION
(If more space is needed,please attach additional pages.)
A. Principat
1. How is the principal balance listed above currently
invested? (Please specify,e.g.,real estate,
certificates of deposit,restricted bank accounts,etc.):
Pennsylvania State Employee's Credit Union(PSECU)-Checking and
Savings
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
Farm G-02 rev.10.13.06 Page 2 of 5
Estate of Nicale Hlavac .An Incapacitated Person
b. List purpc>se and amount of expenditures:
$ .
See attached Cash Flow Statement for Details $
$
$
c. Was Court approval received prior to
expending the principal? . . . . . . . . . . . . . . . . . . . . . . . �Yes �No
3. Were additianal principal assets received during the
Report Period which were not included in the
Inventory or a prior Report filed foF the Estate? . . : . . . . . . . . �Y�es �No
If yes: _
a. Was Court�pproval rEquested prior'to
receiving the additional principal? . . . . . . . . . . .. . . . . CI Yes 0 No
b. State the sources and amounts�f the
additianal principal received:
$
$
�
$
$
B. Incom�
l. State sources and amounts of income received
during the Report Period{e.g., S�cial Security,
pension,rents, etc.}:
SSI � 8,520.00
PA SSP $ 265.20
Interest . _ $ ' 0.83
PSECU Relationship Reward $ 15.00
$
_ $
Total income received during Repork Period: � g,soi.o3
Form G-OZ.rev.10.13.06 Page 3 of 5
Estate of Nicole Hlavac An Incapacita.ted Person
2. How is income currentIy invested? (Please
specify,e.g.,restricted bank accaunts,client
care account,etc.):
Pennsylvania State Emptoyee's Credit Union(PSECtn
G 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=$9,204.77
D. Other F.xpenditures
Specify what other expenditures were made dnring the Report
Period. (Da not include any items stated in response to
question C above.)
None
E. Guardian's Commissions
List amounts of compensation paid as Guardian's commission
and state how amount was determined:
Court
Amount Methvd of Determination Appr�oval Obtained
None �J Yes �No
�Yes �No
F�,G-oz ��.�o.rs.o� Page 4 of 5
Estate of Nicvle Hlavac .An lncapacitated Person
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 kn�wledge,
information and belief;and that this Verific�tion is subject to the penalties of 18 Pa.C.S. §49Q4
relative to unsworn falsification to authorities.
O1 Se�tember 2014
�¢ egnatnre ofGnardian oftireEstare
Rose Hlavac
Nanee ofGkardian of the B.#tde(type or prira)
42 Keswick Dr
Aaaress
Mechanicsburg,PA 17050
c�r�,sr�.�n
717-258-5666
r�rep��
Fo�n G-02 rev.I0.13.06 Page 5 of 5
a�
�
r �
� �
W 0 �
3 � � � �
M CO N
�� � N i�A
m O � � � tA M
+�+ � N 0 O O +�
� � H3 M tp 00 •-' M
WW � � l�3 d� d�?
00 �
� O
� p m O N Om0 O C
�o O u7 C tti C
O�Q � = � N � � �
� � � �
� z
� -�
� � 3
00 �
A �
c "
a � � N � a �
ax " � � � � ` o
� �, d � _ � `°
� �. U c
� a G � � =o •�, � .Q �s
A � a n � � 2c ca
d' '" v�i � V rn �° � c� r°n � -��-p' o
� z fI� Q � fl� � 7 � N p� � N (A
�'-' �na � at� C� c� � a � � >
� �
8 a c � � c,
M
G m W e�i
r% V m � �
C C r' �
� O
' � r
t/1 m N
N
O� G� M W W Cfm �
m C v � 'E N C v O
Q a� N � a O � �
� m � Z � V m a�p