HomeMy WebLinkAbout04-23-15 1P
ANNUAL REPORT OF
GUARDIAN OF THE ESTATE
UJ __j
COURT OF COMMON PLEAS OF
COUNTY,PENNSYLVANIA
U_
ORPHANS' COURT DIVISION
co
a=
Uj gstaaof Q of i-Col. RaLe_ an Incapacitated Person
CC
No.
I. INTRODUCTION
was appointed
Plenary OLimited Guardian of the Estate by Decree of i ;>X1 J.,
dated
A. This 'I he Annual Report I for the period from Jwrle toIline, 7 �OIZ (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 1,7-lapacitated Person. Date of death:
Name of Personal Representative: —
2. The Guardianship was terminated by the Court by Decree of
J., dated
Form G-02 rev.10.!3.06 Page I of 5
Estate of L06AI'e_ - JPVO_jn� -,An Incapacitated Person
11. 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.) At
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 the Report
Period?
1. Principal $
2. Income $
3. Total of Principal and Income 0.00
Ill. 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? . . . . . . . . . . . . . . . . . . . . . .I. . . . . . Yes BUNO
If yes:
a. Have all expenditures from the principal been for
the sole benefit of the Incapacitated Person? . . . . . . . . C3 Yes �No
Form G-02 rev.10,13.06 Page 2 of 5
Estate 4L; t VW An Incapacitated Nison
b. List purpose and arnount of expenditures:
c. Was Court approval received prior to
expending the principal? . . . . . . . . . . . . . . . . . . . . . . . F-1 Yes Ll 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? . . . . . . . . . . . El Yes ;Iwo
If yes:
a. Was Court approval requested prior to
receiving the additional principal? . . . . . . . . . . . . . ... . Ll Yes Q No
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.):
Sb S'ecurkl 7. 6o
Total income received during Report Period: -30'�Z4#00
Form G-02 rev.10.13.06 Page 3 of 5
r
Estate of_ �L�I'e � yrr��b�n(A , An Incapacitated Person
2. How is income currently invested? (Please
specify, e.g., restricted bank accounts, client
care account, etc.): ^
�'��-l-(,�rl lore
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.):
R65 n board - '706a 00/M-b .
iz,1�4-16YL c6
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.)
D�P%AS c�� +- 3f x dcs/vkn q�,
k' -L U- -Sa� '7l
E. Guard'SC Commissions
List amounts of compensation paid as Guardian's commission
and state how amount was determined:
Court
Amount Method of Determination Approval Obtained
Q Yes KNo
E]Yes )&o
Form G-02 rev.10.13.06 Page 4 of 5
s
Estate of hod-/e � - �t I �-ICi -An Incapacitat4person
F. Counsel Fee
List amounts paid as counsel fee,and indicate whether Court approval was obtained.
Court
Amount Approval Obtained
j0o �t?nGPfr -- Q Yes Q No
Yes ONo
I veriPy-that ffie 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.
Date r�gnwureqf/� ��G:,ra�rdiarr f 14e Estate' f
Name of Guardian of the Estate(type or print)
Address
Cil °s l� P,4 U60
City,State,Zip
L/ozt Z 7-/
Telephone
Fora:G-02 rev.10.13.06 Page 5 of 5