The URL can be used to link to this page

Home My WebLink About04-27-15 W ANNUAL REPORT OF GUARDIAN OF THE ESTATE CzC> rn COURT OF COMMON PLEAS OF 7C CUMBERLAND COUNTY,PENNSYLVANIA ORPHANS' COURT DIVISION r- --j Q'i C5 I'D ,6ocgr- Estate of To 'LO-. han Incapacity d Perste' i- rn No. -:2-0 12--0 0&2,6 I. INTRODUCTION was appointed Plenary El Limited Guardian of the Estate by Decree of 0 Mq5 GQ-w, J., -0(`2 dated TO it 2 A. This is the Annual Report for the period from Un I to I�Atl- -zz I L4,_(the"Report Period"};or B. This is the Final Report for the period from to (the"Report D -0- 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 Decree of J., dated Form G-02 rev.10.13.06 Page I of 5 r, 4r Estate of --Dania An Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $ 0 B. State the value(s)of principal assets at the beginning of the Report Period. (Same as Inventory if first Report, n'� otherwise, ending balance from last Report.) $ �J C. What is the total amount of income earned during the Report Period? $ v r[d 14 D. What is the total amount of income and principal O spent for all purposes during the Report Period? $ E. What are the balances remaining at the end of the Report Period? 1. Principal $ 0 2. Income $ Z 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 ^^ ll during the Report Period? . . . . . . . . . . . . . . . . . . . . . .!. . . . . . El Yes 0 No If yes: a. Have all expenditures from the principal been for ) the sole benefit of the Incapacitated Person? . . . . . . . . ❑Yes ❑No Form G-02 rev.10.13.06 Page 2 of 5 A L Estate ofV ,An Incapacitated Person b. List purpose and amount of expenditures: $ $ $ c. Was Court approval received prior to expending the principal? . . . . . . . . . . . . . . . . . . . . . . . 0 Yes 0 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? . . . . . . . . . . . 0 Yes 0 No If yes: a. Was Court approval requested prior to receiving the additional principal? . . . . . . . . . . . . . . . . 0 Yes 0 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.): Total income received during Report Period: $ q 0 0.00 Form G-02 rev,10.13.06 Page 3 of 5 1 7 Estate of—�/ Y� I " ,An Incapacitated Person 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): pp � Iv 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.): PU ca.0 aVd) ym�i v rky""► oLdA pli .e umrn aril cA-bffyu i PW5 p -hWl �1r►m�n �'�-1,� 5upp0��' +rGt Y)�p r n 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 FV El Yes [I No El Yes F7 No Form G-02 rev.10.13.06 Page 4 of 5 10 Estate of -Dan n 11 Qj )4kg-t( ,An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Court Amount } Approval Obtained El Yes El No 0 Yes 0 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"penalties of 18 Pa S. §4904 relative to unsworn falsification to authorities. DateSi to of Guardian ofthe Estat �W n h - Name of Guardian of the Estate(type or print) Address City,State,Zip Telephone Form G-02 rev.10.13.06 Page 5 of 5 cry r � UJ ANNUAL REPORT OF ` -;w ,_:, GUARDIAN OF THE PERSON W ts� Cy :1 -: c,"' �_. LJ cr c� 0— CD v t'JCOURT OF COMMON PLEAS OF C C- CUMBERLAND COUNTY,PENNSYLVANIA ORPHANS' COURT DIVISION Estate of , an Incapacitated Person Nc1612— d� ' P 1. INTRODUCTION 6r Vt-r — 65Cty-) r was appointed Plenary ELimited Guardian of the Person by Decree of /] a, dated JO rt - i I-- A. This is the Annual Report for the period from aO-n2`0 14 to `7-)e-C- 31 , 2-O 1A4 (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: 2. The Guardianship was terminated by the Court by Decree of J.,dated For a Final Report,omit Sections II through Ill Form G-03 rev.10.13,06 Page I of 4 Estate of —Dotn{ / J , an Incapacitated Person II. PERSONAL DATA ,f Age of the Incapacitated Person: Date of Birth: z- III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: -p r n -r P z5� B. The Incapacitated Person's residence is: own home/apartment E]nursing home boarding home/personal care home Guardian's home/apartment hospital or medical facility . relative's home(name, relationship and address) other: C. The Incapacitated Person has been in the present residence since If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev.10.13.06 Page 2 of 4 Estate of i/ A �� 7 ' ` '� , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: 6U--2aVI �5]qC) r- ILI l+vrY) IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: (iO T. nd (2� T,7,D� B. Specify what, if any, social, medical,psychological and support services the Incapacitated Person is receiving: P\)1mo►i6Lo511 0,uottcAoy11 opilao nturolocj� V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: cI'Montinue be modified be terminated Form G-03 rev. 10.13.06 Page 3 of 4 Estate of - an Incapacitated Person The reasons for the foregoing opinion are: fc.f0rLW MCICf S. During the past year,the Guardian of the Person has visited the Incapacitated Person times with the average visit lasting hours, minutes. The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. 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 penalti of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. Dare Signature of ardiarlofthe Person Name of Guardian of the Person(type or print) `r q l ►rn .d Address pPM-S&U!Y Ply- -7� City,State,Zip 7l 7-3tI -gDW/ Telephone Form G-03. rev.10.13.06 Page 4 of 4 GUARDIAN'S INVENTORY COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of l�a'Yl t cwt -��1 CLt)`'f 1' �an Incapacitated Person ' El a Minor No. elI -�01Z 'bUG/Z (p 1. Real Estate: (Location, by whom occupied and rental Estimated Value: terms, if applicable) Sub-Total for Real Estate: 0.00 2. Personal Property: Estimated Value: r-n 70 Q n ;7 1 -:1 -n c) 3. Jointly Held Property: Estimated Value: (Set forth real and personal property owned by the Incapacitated Person JOINTLY with any other person(s). State whether held as tenants by the entireties;if not,whether the right of survivorship exists) Jointly Held Property 0 Iv� Form G-04 rev.10.13.06 Page I of 2 a i'1 i 2� r`� c� .. Incapacitated Person Estate of 1pa ' 0 a Minor 4. Anticipated Assets: Estimated Value: (Set forth property of any kind expected to be acquired hereafter,together with anticipated date of acquisition) Property Anticipated Date ofAcquisition N Sub-Total for Personal Estate. 0.00 (Attach additional sheets if necessary) TOTAL OF ITEMS 1,2,3, and 4: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.00 Commonwealth of Pennsylvania ss. County of _ says that the foregoing is a full, Guardian true and complete Inventory of the Estate of )a Y1 (t the aforesaid Incapacitated Person or Minor; and that all of the information set forth herein is true and correct to the best of the Guardian's knowledge and belief. I verify that the statements made in this ) Inventory are true and correct. I under- ) stand that false statements herein are -- made subject to the"penalties of ) _ 18 Pa.C.S. § 4904 relating to unsworn ) G than falsification to authorities. } Attorney for Guardian: Supreme Court I.D.No.: Address: Telephone: Form G-04 rev.10.13.06 Page 2 of 2