HomeMy WebLinkAbout02-09-15 ANNUAL REPORT OF ��
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Estate of Gladys Shughart , an Incapacitated Person
No. 21-2013-1249
I. INTRODUCTION
Neighborhood Services , was appointed
�Plenary �Limited Guardian of the Estate by Decree of placey � J ,
dated March 31, 2014
� A. This is the Annual Report for the period from April 1 � 2014
to Decenber 31 , 2014 (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 Personal Representative:
2. The Guardianship was tenninated by the Court by Decree of
J., dated
Form G-02 r�e��.]0.13.06 Page 1 of 5 �
\
Estate of Gladys Shughart , An Incapacitated Person
II. SITMMARY
A. State the value of the estate reported on the Inventory $ 2,78432
B. State the value(s) of principal assets at the be�inning of
the Report Period. (Same as Inventory if first Report,
otherwise, ending balance from last Report.) � 2,784.32
C. What is the total amount of income earned during fhe
Report Period? $ 4,302.55
D. What is the total amount of income and principal
spent for all purposes durin�the Report Period? $ 5,760.04
E. What are the balances remaining at the end of the Report
Period?
l. Principal $ 1,484.83
2. Income $ 250.00
3. Total of Principal and Income $ 1,734.83
III. ADDITIONAL INFORMATION
(If more space is needed,plea.se attach additioraal page.s.)
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.):
Custodial Account
Coin Value
2. Have there been any expenditures from the principal
diiring 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
Form G-02 re��. 10.13.06 Page 2 of 5
Estate of Gladys Shughart , An Incapacitated Person
b. List purpose and amount of expenditures:
Housing � 1,035.16
Past Due insurance premium � 422.33
$
$
c. Was Court approval received prior to
expending the principal? . . . . . . . . . . . . . . . . . . . . . . . �Yes �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 Estate? . . . . . . . . . . . �Yes �No
If yes:
a. Was Court approval requested prior to
receiving the additional principal? . . . . . . . . . . . . . . . . 0 Yes �No
b. State the sources and amounts of the
additional principal received:
Coins $ 408.00
$
$
$
$
B. Income
1. State sources and amounts of income received
during the Report Period (e.g., Social Security,
pension,rents, etc.):
Prudential Annuity $ 900.00
OPM Pension $ 3,384.90
AXA CD lnterest $ 17.65
$
$
$
Total income received during Report Period: $ 4,302.55
Fam�G-02 rer. 1013.OG Page 3 of 5
Estate of Gladvs Shu�hart , An Incapacitated Person
2. How is income currently invested? (Please
specify, e.g., restricted bank accounts, client
care account, etc.):
Resident Fund
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.):
Housing, Court Filing Fee, Guardian Fee, Insurance, Personal Spending
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.)
None
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
1,100.00 Welfare Rate �Yes �No
�Yes �No
Fnrm G-02 rei•.10.13.06 Page 4 of 5
Estate of Gladys Shughart , An Incapacitated Person
F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
C�urt
Amount Approval Obtained
�Yes 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 siibject to the penalties of 18 Pa.C.S. § 4904
relative to unsworn falsification to authorities.
2/3/15
Dale �gnatru•e o ar�li n the ta
Neighborhood Se ces
:tiame qf Guar•dian qJ the Esln�e(h-pe or prini/
PO Box 1593
aaa,��.s
Lancaster, PA 17608
Citt�,State,Zrp
717-392-2175
Telephor�e
Form G-02 rei•.10.13.06 Page 5 of 5